WES 48 City of Westminster REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938 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.G.2. III CONTENTS. pagb Committees vi Introduction ix Statistics and Social Conditions 6 Births 7,22 Deaths 9, 22 Causes of, compiled by Medical Officer of Health 12 „ „ „ „ Registrar General 9 Common Lodging-Houses 22 Distribution of, in Wards 17 Infantile Mortality 17, 22 Stillbirths 11 Population 6 Staff of the Public Health Department 1 Statistics, General and Vital 6 Prevalence of, and Control over, Infectious Diseases 23 Bacteriological Laboratory 32 Cerebro-spinal Fever 31 Chicken-pox 31 Diarrhoea and Enteritis 30 Diphtheria 28 Anti-toxin 29 Schick Test and Immunization Treatment 28 Enteric Fever 29, 97 German Measles 29 Influenza 29 Measles 29 Mumps 31 Notifications 23, 26 Ophthalmia Neonatorum 31,57 Puerperal Fever 31 Puerperal Pyrexia 31 Scarlet Fever 28 Tuberculosis 32 Cases on Register 38 Deaths 33, 37, 38 Dispensary—Annual Report 39 Returns (Ministry of Health) 42 Notifications—primary 32 Tables 33 Vaccination 23 Whooping Cough 30 (8677) a 2 iv page General Provision of Health Services 44 Adoption of Children Act, 1926 59 Ambulance facilities 44 Ante-natal services 50 „ cases 50 „ clinics 51 „ visiting 50 Barlow's Gift Charity 60 Child Life Protection 59 Clinics and Treatment Centres 44 Convalescent Treatment 52 Cookery classes 59 Day Nursery 62 Dental Clinic—Annual Report 61 Dental Treatment 61 Health Visiting 58 Home Helps 61 Hospitals 45 Infant Clinics 54 Institutional Provision for Mothers and Children 51 Insulin Treatment 61 Laboratory facilities 44 Lectures and Demonstrations 62 Maternal Mortality 52 Maternity and Child Welfare Centres 44 ,, ,, „ Services 46 Maternity Beds 51 Midwifery Service 48 Midwifery—Consultant services 49 Midwives Act, 1936 48 Midwives—Medical Assistance 49 Minor Ailment Clinics 47 Mothercraft Classes 58 Milk—Supply to Necessitous Mothers and Infants 60 Nursing in the Home 44, 56 Nutrition 59 Toddlers' Clinics 54 Unmarried Mothers—Homes for 60 Sanitary Circumstances 63 Aliens—Medical inspection 67 Atmospheric Pollution 87 Cleansing of Persons 77 Common Lodging Houses 74 Coroner's Court and Mortuary 80 Disinfection 77, 79 Disinfestation 78 Drainage and Sewerage 64 Factories and Workplaces 71 Factories Act, 1937 74 Fumigation of Furnitures 78 Infirm and Diseased Person—Removal to Institutions 76 New Sanitary Construction 65 Nuisances—General 69 „ —Noise 76 Outworkers 74 Pigeons 76 V page Sanitary Circumstances—(contd.) Public Cleansing 65 Public Sanitary Conveniences 67 Public Swimming Pools, etc 64 Rag and Bone Dealers 75 Rag Flock Acts 75 Rat Repression 75 Refuse Collection and Disposal 66 Rent Restriction Acts 86 Sanitary Inspection 68 Schools 75 Shops Act 1934 70 Smoke Abatement Tenement Houses 70,75 Town and Country Planning Act, 1932 65 Water Supply 63,70 Housing 80 Basement dwellings 83, 103 Clearance Areas 99 Housing Schemes—New Estates 82 Overcrowding 80, 85 Rehousing Operations 83 Statistics required by Ministry of Health 84 Unfit Habitations—Closing Orders 81 „ ,, —Demolition Orders 81 „ „ —Reconditioning 81 Inspection and Supervision of Food, etc. 88 Agricultural Produce (Grading and Marking) Act, 1928 90 Artificial Cream Act, 1929 90 Bakehouses 96 Condensed Milk Regulations, 1923-1927 93 Dairymen and Dairy premises—registration 92 Dried Milk Regulations, 1923-1927 93 Food—certification for export 88 Food and Drugs (Adulteration) Act, 1928 92 Samples, results of analysis, action taken, etc. 94 Food, Unsound 96 Food Poisoning 97 Fried Fish Shops 96 Ice-cream premises 88 Ice-cream—Bacteriological Examination 89 Meat Regulations, 1924 96 Merchandise Marks Act, 1926 90 Milk Act, 1934 93 Milk Bars 91 Milk—Bacteriological Examination 91 Milk and Dairies Amendment Act, 1922 90 Milk and Dairies (Consolidation) Act, 1915—tubercle in milk 90 Milk and Dairies Order, 1926 91 Milk Samples 92 Milk (Special Designations) Order, 1936 90 Milk—-Supply to Schools 93 Pharmacy and Poisons Act, 1933 97 Preserved Meat, etc., premises 89 Preservatives in Food Regulations, 1925-1927 93 Restaurants 96 Schools—Supply of Milk 93 Street Trading 95 (8677) a 3 VI Public Health and Maternity and Child Welfare Committee. Mayor: Councillor 6. F. Jerdein, J.P. Deputy Mayor: Councillor Sir Harry Vanderpant, 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 H. H. Sparks. Vice-Chairman: Councillor Capt. H. Norman Edwards. Members: Alderman Capt. J. F. C. Bennett, D.L., C.C. „ Capt. J. C. Dalton, D.L., J.P. (deceased 18th December, 1938). f Councillor Lady Doris Blacker. „ Norman Bower. ,, George 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. „ A. Sargeant. ,, A. Sciver, B.Sc., F.I.C. „ Mrs. Francis Storrs. „ The Hon. Mrs. Vickers, J.P. G. H. Wilson-Fox. 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. Vickers, J.P. † Chairman of Standing Sub-Committee. (The Public Health Standing Sub-Committee consists of all members of the Main Committee.) VII Maternity and Child Welfare Sub-Committee—continued. Co-opted, Members : A. C. H. Bell, F.R.C.S., M.C.O.G. (Westminster Hospital). Mrs. J. C. Dalton (deceased 21st December, 1938). Mrs. Crawford Munro (City of Westminster Health Society). Dr. Redmond Roche. Sub-Committee re Children under School Age. Co-opted Members representing the City of Westminster Health Society: Members of the Council: Councillor Mrs. Alderson Home. „ The Hon. Mrs. Vickers, J. P. Councillor Mrs. F. M. Odone (Chairman). The Countess of Iddesleigh. Miss Margaret Horn. Mrs. Crawford Munro. Committee Clerk: F. J. Burbridge. IX Annual Report on the Health and Sanitary Condition of the City of Westminster. 1938. Mr. Mayor, My Lords, Ladies and Gentlemen, I beg to submit my Annual Report on the health and sanitary conditions of the City during 1938. The report is drawn up in accordance with Circular 1728 of the Minister of Health who directs the form in which such reports are to be made and specifies any particular matters on which he desires information. This report has been prepared during a period in which the Public Health Department has been busily engaged in carrying out its particular duties relating to Civil Defence. In spite of these difficult circumstances every effort has been made to maintain the efficiency of the health services of the City. Vital Statistics. A slight increase in the births has been maintained giving a rate of 8.3 as compared with 8.2 in 1937. The Registrar General in his estimate of population has indicated an increase of 100 persons resident in the City. There are fewer deaths, 1,300 as compared with 1,432 in 1937, the rates being 10.4 and 11.5. A fortunate feature is the fall in still-births, 29, lower by 12 than last year. More welcome still is the lowest infant death rate since 1923, namely 54.9 while the figure for London as a whole is 57. As a cause of death among infants, however, prematurity still predominates more than ever. Infectious Disease. There were no serious outbreaks. Diphtheria caused more cases but scarlet fever many fewer and 1938 being a "measles" year the cases reached the high figure of 819—the highest since 1928. The incidence of enteric fever was about the usual average of one per month. There was a marked reduction in the death-rate from tuberculosis and fewer cases were notified. There were no deaths from scarlet fever but one from diphtheria, one from enteric fever and four from measles. Five deaths from influenza was the lowest figure during the past five years. Maternity and Child Welfare. These services continue to be of increasing benefit to the women and children of Westminster. A new feature introduced during the year was a scheme for the physical education of the children at the Welfare Centres. Classes under a teacher qualified in physical culture are held weekly and already considerable improvement is reported in the general condition and muscular tone of the children taking part. Maternity Beds. The vastly improved accommodation in the new Westminster Hospital provides not only additional beds for Westminster mothers but a standard of comfort and medical attention unsurpassed in the country. X Maternal Mortality. Another unfortunate year, but less so than 1937. Of the seven fatalities, six were the result of attempts to procure abortion. General Sanitation. Attention is drawn to water supplies from deep wells throughout the City and to the possibilities of shortage from this source in the future owing to increasing number of borings. Plans of drainage work in buildings have decreased, no doubt due to a natural hesitation to expend capital in constructional work in these times of uncertainty. Civil Defence (Air Raid Precautions). The Medical Officer of Health is responsible for First Aid services, preliminary training of Air Raid Wardens, war time mortuary services and advice as to protection of food from contamination. In writing of this subject in last year's report I mentioned that it had to some extent disturbed the ordinary work. During 1938 this became greatly accentuated. I cannot speak too highly of the splendid efforts made by members of the staff of the Department in this exceedingly difficult task. Long hours of work and sacrifice of personal and private interests have been associated with the shaping of an enterprise which in urgency and importance must take precedence in these ominous times. Staff Matters. In a year when experienced assistance was so greatly needed, the absence of Mr. Francis Haigh and Mr. John Dee through illness was a severe handicap. They were two of the most capable and conscientious Sanitary Inspectors in the Council's service. In both cases it seemed that the strain of present day conditions contributed to the breakdown in their health which, it is hoped, they will fully recover in quiet retirement. Mr. Haigh had 39 years' service and Mr. Dee 26. Mr. H. R. Hardy, Sanitary Inspector, having given of his best during a period of 44 years in the Local Government Service retired in good health on pension. Miss G. Thomson, Health Visitor since 1934, resigned her appointment on account of ill-health. Mr. John Sanderson, Senior Sanitary Inspector, due to retire in June, 1938, was invited by the Council to remain in office until 1939, chiefly because of the additional duties created by Air Raid Precautions. Dr. E. A. Hardy, Part-time Assistant Medical Officer, was appointed to wholetime duty in July, thus enabling Dr. Ian Thomson, my deputy, to devote more time to Air Raid Precautions. In conclusion I should like to offer my grateful thanks to the Chairman, ViceChairman, and members of the Committees whom it is my privilege to serve for their kindly consideration at all times. I have the honour to be, Your obedient servant, ANDREW J. SHINNIE. July, 1939. 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. Assistant Medical Officer of Health and Assistant Medical Inspector (Aliens Order, 1920): E. A. Hardy M.D., B.S., M.R.C.P., D.P.H. (Appointed 24th January, 1938.) Infant Welfare Medical Officers: *A. D. C. Bell M.A., D.M., 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 Inspector under Aliens Order, 1920: *D. G. Ferriman D.M., M.R.C.P. Westminster Hospital Laboratories: *R. J. V. Pulvertaft, M.D., F.R.C.P. Bacteriologist to the Hospital. (8677) 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, Tachbrook 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., B.C.S.(Ed.). *F. J. Gordon (Anaesthetist) ... B.A., M.R.C.S., L.R.C.P. Public Analysts: *F. W. Edwards F.I.O. *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. (Retired 31st March, 1939.) Chief Clerk and Vaccination Officer: W. D. Sambrook. Sanitary Inspectors: J. W. Baxter S. G. Bennett C. F. Brockett S. J. Cassidy (Sampling Officer) W. J. Davies (Sampling Officer) C. J. Dee W. L. French F. J. Haigh H. R. Hardy T. H. Jackson H. D. Luke C. Ratcliff F. E, siddle W. G. J. Sutton (Sampling Officer)iss C. Hughesdon S.I.E.B., Meat and Food Cert. (Appointed 28th March, 1938.) S.I.E.B., Meat and Food Cert. (Seconded whole time to A.R.P.) S.I.E.B., Meat and Food Cert. S.I.E.B., Meat and Food Cert. S.I.E.B., Meat and Food Cert. S.I.E.B., R.S.I., Meat and Food Cert. (Retired 31st July, 1938.) S.I.E.B., R.S.I., Meat and Food Cert. S.I.E.B. (Retired 31sf December, 1938.) R.S.I., M.I. San. Eng. (Retired 30th September, 1938.) S.I.E.B. S.I.E.B., Meat and Food Cert. S.I.E.B., Meat and Food Cert. (Seconded whole time to A.R.P.) S.I.E.B., Meat Cert., R.S.I. S.I.E.B., Meat and Food Cert. 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) : A. J. Allison J. R. Baily A. V. Benjafield M. J. Flynn C. T. Peacock S.I.E.B. S.I.E.B., Meat and Food Cert. S.I.E.B. (Appointed 2nd May, 1938.) S.I.E.B. (Appointed lst March, 1938.) S.I.E.B. (12th May, 1938 to 23rd July, 1938.) Health Visitors: Miss J. G. Alexander (Superintendent). Miss D. H. M. Walding (Superintendent). Miss M. M. Scott (Superintendent). Miss P. L. Luff Miss E. M. Craigie Miss G. C. H. Thomson Miss F. A. K. Arnold (temporary) Miss M. W. Smith Miss G. M. Saddler (temporary) Mrs. M. W. Walton (temporary) Health Visitor's Certificate, Certified Midwife, State Registered Nurse. Board of Education Health Visitor's Diploma, S.I.E.B., National Health Society's Diploma, Nursing. Health Visitor's Certificate, Certified Midwife, Board of Education Health Visitor's Diploma, S.I.E.B. Board of Education Health Visitor's Diploma, Certified Midwife, S.I.E.B. Health Visitor's Certificate, Certified Midwife, State Registered Nurse, Mothercraft Training Certificate, Ophthalmic Nursing Certificate. Health Visitor's Certificate, Certified Midwife, State Registered Nurse. (Resigned 31st December, 1938.) Health Visitor's Certificate, Certified Midwife, State Registered Nurse, S.I.E.B., R.S.I. Health Visitor's Certificate, Certified Midwife. (Appointed 4th April, 1938.) Health Visitor's Certificate, Certified Midwife, Stats Registered Nurse. (Appointed 9th May, 1938.) Health Visitor's Certificate. (28th July, 1938 to 16th September, 1938.) Nutrition and Dietetics: *Mrs. B. M. Latey 1st Class Diploma in Domestic Science. Mothercraft: *miss F. willats. Physical Culture for Children: Miss D. S. Webber Dip. C.C.P.E., A.T.R.G.D., etc. (8677) a 2 4 Clerical Staff: A. J. Manhood, 1st Division Clerk. W. F. Lake, 1st Division Clerk. (Assistant Vaccination Officer.) A. E. Hobbs, 1st Division Clerk. F. E. Norwood, S.I.E.B., 2nd Division Clerk. W. Jenkins, 3rd Division Clerk. W. F. C. King, 3rd Division Clerk. S. F. Hammond, Junior Clerk. Miss E. M. Armstrong. Miss M. McFarlane (Tuberculosis Dispensary). Temporary Clerks. J. W. Anderson. E. Jones. A. G. Bates. (Appointed 3rd March, W. H. Smith. (Appointed 1st March, 1938.) 1938.) H. J. Bright. Miss R. M. Turner (Maternity and Child J. M. Burbridge, S.I.E.B. Welfare). Coroner's Court and Mortuary: Superintendent. A. R. Ford (late Chief Petty Officer, R.N.). A. W. Nicholls First Mortuary Assistant. F. Nunn Second Mortuary Assistant. (Appointed 15th April, 1938.) *A. F. Knott Part-time Mortuary Assistant. (Appointed 16th August, 1938.) Miss E. S. Dunford Nurse Attendant. (State Registered Nurse) Disinfecting Staff: S. C. West, Foreman Disinfector. J. Atkins, Disinfector. N. Heathcote, Disinfector and Rat Officer. A. B. Holland, Disiniector. J. Shillingford, Disinfector. J. R. Doyle, Motor Driver. W. T. Brady, Disinfector (temporary). Assistants in the Department: A. T. Steward, Assistant to Sanitary Inspectors. J. Hooper, Messenger. (Appointed 1st March, 1938.) 5 Caretakers, Attendants, etc. Disinfecting Station—Mrs. Nicholls. Maternity and Child Welfare Centres— Ebury Bridge—Mrs. Whittlesea. Bessborough Street—Mr. & Mrs. W. Happy, Resident Caretakers. C. H. Deakin, Assistant Caretaker. (Appointed 3rd October, 1938.) Mrs. Pinnock, Cleaner. Marshall Street—Mrs. Ratcliffe, *Mrs. Marriage. Tuberculosis Dispensary—Mrs. Crowley. Coroner's Court—Miss Hamilton, *Mrs. Cattermole. The following are the staff of the City of Westminster Health Society, a voluntary organisation carrying out Maternity and Child Welfare services in a part of the City on behalf of the City Council. Medical Officers Director of Remedial Exercises Superintendent and Health Visitor Assistant Health Visitor Assistant Health Visitor and Midwife Midwife Organiser of Special Toddlers' Nursery Superintendent of Mothercraft Work Cookery Teacher Sister-in-Charge of Special Infants' Nursery and Babies' Club Secretary Clerk The Hon. Mrs. Olivier Richards, M.D., M.R.C.P. Mrs. Muriel Radford, M.B., B.S., D.P.H. Miss Elizabeth Gourlay, M.D. Mrs. A. Kellgren Cyriax, L.R.C.P. and S. Edin. Miss H. Callaghan, Pinal Certificate and Medal at Princess Christian Training College, Manchester, H. V. Cert., Royal Sanitary Institute. Mrs. W. M. Bailey, S.R.N., S.C.M., M.T.S. Miss E. M. Reed, Certified Midwife, H. V. Cert., Royal Sanitary Instituto. Miss G. Cross, Cert. Midwife. Miss A. Fiennes, Norland Cert. Mrs. V. Steffens, Professionally trained teacher of Needlecraft. Mrs. J. Gloag. Miss E. Heath, S.R.N., Cert. Midwife, Mothercraft Training Society. Miss A. Fiennes. Mrs. Swanton. 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, J une. 1938 (Registrar General's Estimate)—124,400. Number of Inhabited Houses (Census 1931)—22,536. Rateable value—£11,038,700 (March, 1939). Sum represented by a penny rate— £43,240 (Estimate). Extracts from Vital Statistics for the Year. Live Births— Total. Males. Females. Legitimate 900 463 437 Illegitimate 138 71 67 1,038 534 504 Birth-rate per 1,000 of the estimated resident population—8-3. Stillbirths—29. Rate per 1,000 total (live and still) births—27.1. Deaths—1,300. Death-rate per 1,000 of the estimated resident population—Crude rate 10.4. Adjusted rate 10.7. Deaths from puerperal causes:— Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis 5 4.6 Other puerperal causes 2 1.8 Total 7 6.5 Death-rate of infants under one year of age:— All infants per 1,000 live births 54.9 Legitimate infants per 1.000 legitimate live births 45.5 Illegitimate infants per 1,000 illegitimate live births 115.9 Deaths from measles (all ages) 4 „ whooping cough (all ages) — „ diarrhœa (under 2 years of age) 11 ,, cancer 222 7 Births. The births registered in Westminster during 1938 (52 weeks) numbered 1,427, but of these the homes of 888 were in other districts, and have therefore to be deducted from the total. There were, however, 499 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,038, which is 17 more than the corresponding figure for 1937. The Birth Rate for the City was 8.3, for London 13.4 and for England and Wales 15.1. The comparative net totals of the registered births for the last three years are:— Table I.—Legitimate and Illegitimate Births. 1936. 1937. 1938. Legitimate. Legitimate. Legitimate. Males 460 449 463 Females 470 434 437 Illegitimate. Illegitimate. Illegitimate. Mules 76 80 71 Females 57 58 68 1,063 1,021 1,038 Table II.—Registered and Notified Births. Births Registered Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total Alive. Stillborn. 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 1,7.32 1,045 1,016 29 1924 1,447 344 521 1,624 1,250 1,214 36 1925 1,519 481 497 1,535 1,435 1,385 50 1926 1,535 500 571 1,606 1,402 1,355 47 1927 1,375 552 (20) 576 1,399 1,205 1,169 36 1928 1,471 643 (23) 542 1,370 1,404 1,362 42 1929 1,677 758 (7) 538 1,357 1,532 1,474 58 1930 1,689 859 (16) 538 1,368 1,653 1,597 56 1931 1,640 942 (21) 513 1,211 1,589 1,536 53 1932 1,608 954 (12) 498 1,152 1,594 1,538 56 1933 1,610 977 (15) 466 1,099 1,615 1,559 56 1934 1,609 969 (3) 526 1,166 1,567 1,516 51 1935 1,527 944 (7) 459 1,042 1,537 1,488 49 1936 1,563 970 (3) 470 1,063 1,551 1,499 52 1937 1,460 952 513 1,021 1,488 1,448 40 1938 1,427 888 499 1,038 1,450 1,397 53 The numbers in brackets are registrations under the Legitimacy Act, and cannot be classified as births. 8 As shown in Table II, 1,450 notifications of births were received by the department in 1938 as compared with 1,488 in 1937. Of the total notifications, 243 were sent by midwives. The following table shows the number of male and female children born since 1922, and those who did not survive the first year of life, with the number of the surviving children at the end of the first year of life:— Table III.—Male and Female Births. Number Born. Number of Deaths under 1 year Number remaining at end of year. Boys. Girls. Boys. Girls. Boys. Giria. 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 1938 534 504 33 24 501 480 The number of boys born again exceeded that of girls, but 33 boys and 24 girls failed to survive the first year of life. 9 Deaths. The following tables are supplied by the Registrar General at the request of the Ministry of Health :— Table IV.—Causes of Death at different Periods of Life in the Metropolitan Borough of Westminster, 1938. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35 45— 55— 65— 75— All Causes M. 699 34 6 2 4 18 26 40 89 151 171 152 F. 607 26 1 1 6 18 17 36 70 86 144 203 1. Typhoid and paratyphoid fevers M. 1 - - - - - 1 - - - - - F. - - - - - - - - - - - - 2. Measles M. 3 - 3 - - - - - - - - - F. 1 — 1 - - - - - - - - - 3. Scarlet fever M. - - - - - - - - - - - - F. - - - - - - - - - - - - 4. Whooping-cough M. - - - - - - - - - - - - F. - - - - - - - - - - - — 5. Diphtheria M. 1 - - - 1 - - - - - - - F. - - - - - - - - - - - - 6. Influenza M. 4 - - - - - - 1 - 1 1 1 F. 6 - - - - - - - - 2 3 1 7. Encephalitis lethargica M. - - - - - - - - - - - - F. 2 - - - - - - 1 - - 1 — 8. Cerebro-spinal fever M. 1 - - - - 1 - - - - - - F. 1 - - - 1 - - - - - - - 9. Tuberculosis of respiratory system M. 41 - - - - 6 6 9 12 8 - - F. 19 — — — — 7 2 6 1 — 3 — 10. Other tuberculous diseases M. 4 - - - - 2 1 1 - - F. 5 — — — — 1 2 — — 1 — 1 11. Syphilis M 7 1 1 ?, 2 1 F. 1 - - - - - - 1 - - - - 12. General paralysis of the insane, tabes dorsalis M. 8 — — — — — — — 5 3 — — F. - - - - - - - - - - - - 13. Cancer, malignant disease M. 112 - - - - - 1 fi 15 31 46 13 F. 116 - - - - - 1 6 26 27 31 25 14. Diabetes M. 12 - - - - - 1 1 3 2 4 1 F. 12 - - - - - - 1 2 4 5 15. Cerebral hæmorrhage, etc. M 16 - - - - - - - 1 4 4 7 F. 23 — — — — — — 1 2 5 5 10 16. Heart disease M. 183 - - - - 2 1 9 14 38 59 60 F. 169 — — — 2 1 2 3 8 19 48 86 17. Aneurysm M. 6 - - - - - - 2 1 1 2 - F. 4 — — — — — 1 1 1 1 - 10 Table IV—continued. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45- 55— 65— 75— 18. Other circulatory diseases M. 50 - - - - - - - 3 15 11 21 F 41 - - - - - - - 3 4 13 21 19. Bronchitis M> 17 - - - - - - 1 5 1 4 6 F. 10 - - - - - - 1 3 6 20. Pneumonia (all M. 36 3 2 - - 2 1 3 9 6 4 6 forms) F. 34 3 - — — 1 - 3 3 5 / 5 14 21. Other respiratory diseases M 9 1 - - - - - - - 5 9 1 F. 4 - - - — 1 — — 1 1 1 22. Peptic ulcer M 21. - - - - - - 4 7 6 3 1 F. 7 - - - - - - - 1 3 - 3 23. Diarrhoea, etc M. 8 6 - - - - - - - 1 - 1 F. 7 4 1 - - - - - - 1 — 1 24. Appendicitis M. 9 - - - 2 - 1 1 2 2, 1 - F. 4 — — — — 1 1 2 — 25. Cirrhosis of liver M. 5 - - - - - - - 3 - - 2 F. 3 - — — — — - 1 1 — 1 26. Other diseases of liver, etc. M. 4 - - - - - - - - 2 2 - F. 3 - - - - - - 1 - - 2 - 27. Other digestive diseases M. 11 - - - - - 2 - - 3 5 1 F. 20 - - - - - 2 1 6 3 4 4 28. Acute and chronic nephritis M. 9 - - - - - 1 - 1 1 6 F. 13 - - - - - 2 -— 5 2 3 1 29. Puerperal sepsis F. 6 — — — — — 3 3 —- -— — — 30. Other puerperal causes F. - - - - - - - - - - - - 31. Congenital debility, premature birth, malformation, etc. M. 21 20 - - 1 - - - - - - - F. 13 13 - - - - - - - - - - 32. Senility M. 2 - - - - - - - - - - 2 F. 9 - - - - - - - - - - 9 33. Suicide M. 17 - - - - - 5 2 6 4 - - F. 10 - -—- — — 1 3 1 3 1 1 — 34. Other violence M. 30 3 - 1 - 2 2 4 3 0 7 2 F. 21 4 — — — — 2 1 1 3 3 7 35. Other defined diseases M. 51 1 1 1 - 2 3 2 3 7 11 20 F. 41 1 - - 2 3 1 4 6 4 7 13 36. Causes ill-defined, or unknown M - - - - - - - - - - - - F. 2 - - - - - - - - - 2 -— 11 Table V.—Still-births. Notification and Registration. Fifty-three still-born children were notified during the year. Allocated to Westminster. Total Legitimate and Illegitimate Males 14 Females 15 Illegitimate Males 2 Females 3 Table VI.—Infectious Diseases. The following shows the number of cases of certain infectious diseases in the area during the 52 weeks ended 31st December, 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. — 159 192 11 21 6 37 24 (The case rates of these diseases for England and Wales per 1,000 living are respectively as follows:—Scarlet fever, 2.41; diphtheria, 1.58; enteric fever, 0.03; and erysipelas, 0.40.) 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, 14 cases of diphtheria, scarlet fever and dysentery were discharged from hospital owing to incorrect diagnosis during 1938. 12 MALES. Table VII.—Gauges of, and Ages at, Death during the year 1938. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosrenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St.. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent. Garden. Strand. Homeless. Smallpox - - - - - - - - - - - - - - - - - - - - - - - - Measles 4 1 3 - - - - - - - - - - - - - - - - - - - - - Scarlet fever - - - - - - - - - - - - - - - - - - - - - - - - Influenza 3 - 1 1 1 - - - 1 - - - 1 - 1 - - - - - Whooping-cough - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria, Memb. croup 1 - - - - - - - - - - - - - - - - - - - - - - - Cerebrospinal meningitis .. 1 - - - - - 1 - - 1 - - - - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever 1 — - - - - - - - - - - - - - - - - - - - - - - Diarrhœa, enteritis 7 5 — — — — - — 2 — 9 2 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Other sentic diseases 3 - - - - - - - 3 1 - - 1 - - - - - 1 - - - - - Syphilis, &c. 4 ' — - — — 1 - 3 - - - 1 - 1 - 1 - — — — 1 — - Diabetes 11 —- - -— — — 2 5 4 — 1 1 2 2 1 2 - 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis of lungs 43 — — — — 7 15 21 — — 6 — 2 10 3 12 3 — - — 2 1 3 1 Other forms of tuberculosis 3 — — — — 2 1 — - — — — - 1 — 1 - - - — 1 Malignant growths 112 — — — — — 8 47 57 1 11 7 9 28 5 26 4 1 6 1 1 6 4 2 Congenital debility, malformation, and premature birth 16 16 - - - - - - - - - - 2 2 1 5 1 1 - - - 2 - 2 Old age 4 — — — — — - - 4 1 1 - - 1 - - 1 - - - - - - - Meningitis and convulsions 1 1 - - - - - - - - - - - - - - - - 1 - - - - 13 Loc. ataxia and general paralysis 4 - - - - - - 3 1 - - - - 1 - - 2 - - - - - 1 - Other diseases of nervous system 5 - - - - - - 2 3 - - 1 1 2 - 1 - - - - - - - - Valvular diseases of heart 4 - - - - - 2 — 2 - — — — — - 3 - - - — — 1 — Other circulatory diseases 220 - — — 1 1 12 68 138 3 26 10 13 61 11 47 9 5 8 5 6 3 15 8 Bronchitis 29 - — — — — — 11 18 — 2 — 1 9 1 9 2 - 2 — — 2 1 Broncho-pneumonia 35 5 2 — — — — 7 21 — — 1 4 10 1 12 2 — - — — ] 1 3 Pneumonia, other forms 21 — — — — 3 2 10 6 _ 2 — 4 4 1 5 1 - - 1 1 2 — Other respiratory diseases 9 — — — — — — 6 3 — 1 — — 2 1 1 - — - — 1 2 — 1 Alcoholism 6 — — — — 1 2 2 1 - 2 - - 3 - 1 - - - - - - - — Cirrhosis of liver 5 - - - — - - 2 3 - 1 - 1 2 - - - - - - - 1 - - Appendicitis and typhlitis 9 - — — 2 2 4 1 - 1 — 1 2 1 2 - - - - 1 1 - — Other digeslive diseases Bright's disease, &c. 32 1 — — — 5 15 11 - 2 1 3 16 1 6 1 - 1 1 — - — 16 - - - - - 1 5 10 - 2 2 1 2 3 - 1 2 1 1 1 Cystitis, &c. 29 - - - - - 1 5 23 1 1 1 2 10 3 5 1 - - 1 3 1 - Deaths by accident or negligence 30 4 - 1 - 2 6 8 9 1 - 2 - 10 7 - 1 3 1 - - 1 4 Deaths by suicide and murder 17 - - - - 2 7 8 - - 2 - 3 ft 1 1 1 - 1 1 - - - 1 Other defined diseases 11 1 1 - 1 2 4 2 1 1 1 4 - - 1 _ 9, 1 Diseases, ill defined or unknown - - - - - - - - - - - - - - - - - - - - - - - - All causes 697 33 6 2 4 20 71 237 324 9 63 30 52 184 32 151 32 9 22 15 15 23 34 26 t—' FEMALES. Table VII {continued).—Causes of, and. Ages at, Death during the year 1938, Causes or Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - -. - - - - - - - - - - - - - - - - - - Scarlet fever - - - - - - - - - - - - - - - - - - - - - - - - Influenza 2 - - - - - - - 2 - - - - 1 - 1 - - - - - - - - Whooping-cough - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria, Memb. croup - - - - - - - - - - - - - - - - - - - - - - - - Cerebro spinal meningitis 2 - - - - - - - - - - - - - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever - - - - - - - - - - - - - - - - - - - - - - - - Diarrhœa, enteritis 6 5 1 - - - - - - - - - - 3 1 - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - - - - - - - - - Puerperal fever — — - - - -_ - - - - - - - - - - - - - - - - - - Other septic diseases 1 - - - - - - - - - - - - - - - - - - - - - - - Syphilis, &c. - - - - - - - - - - - - - - - - - - - - - - - - Diabetes 10 - - - - - 1 6 3 - 1 - - 3 - - - - - - - - - - Rheumatic fever 1 - - - - - 1- - - - 1 - - - - - - - - - - - - Tuberculosis of lungs 19 - - - - 6 8 1 4 - - - 2 6 2 5 2 - - - - - - - Other forms of tuberculosis 5 - - - 1 2 - 1 1 - - 1 - 1 - 2 - - - - - - - - Malignant growths 110 - - - - - 7 49 54 2 15 3 8 38 6 27 3 - - - - - - - Congenital debility, - - - - - - - - - - - - - - - - - - - - - - - - formation, and premature birth 13 13 - - - - - - - - 1 - 1 5 1 3 1 - - - - 1 - - Old age - - - - - - - 7 — — 1 1 2 1 1 1 - - - - - - - Meningitis and convulsion - - - - - - - - - - - - - - - - - - - - - - - - 15 Loc. ataxia and general paralysis - - - - - - - - - - - - - - - - - - - - - - - - Other diseases of nervous system 13 - - - - - 3 3 7 — 3 — — 4 2 3 1 — — — 1 — 1 — — Valvular diseases of heart 6 - - - - - 1 — 0 — 2 — — z — — — — — — — Other circulatory diseases 218 — — — 3 3 4 45 163 1 17 10 11 68 18 54 13 2 3 8 4 7 — Bronchitis 28 — — — — 2 3 23 — — — 2 8 9 4 10 — — 1 1 — 2 — — Broncho-pneumonia 39 2 9 28 — 4 5 2 — 16 1 — — —- — 2 — — Pneumonia, other forms 12 — — — — 1 2 4 5 1 — — — 4 — 5 — — — 1 1 — — — Other respiratory diseases 3 - - - - - 1 — 2 — — — 1 1 — — — — — — 1 1 — — Alcoholism 3 — — — — — 1 1 1 1 1 1 1 Cirrhosis of liver 3 — — — — — 1 2 — — — — 1 — —. — — — — — — — Appendicitis and typhlitis 4 — — — — 1 — 1 2 — 2 — — 1 1 — — — — — — — — — Other digestive diseases 23 — — — 1 — 2 10 10 — 1 — — 4 3 10 — 1 1 1 — 2 — — Bright"s disease, &c. 23 — — — — 1 1 10 11 1 b — 2 10 — 3 1 — — — 1 — — — Cystitis, &c. 5 — — — — — — 1 4 — 1 2 — 1 — — — — — — — 1 — Accidents and diseases of parturition 7 - - - - - - - - - - - - - - - - - - - - - - - Deaths by accident or negligence 20 3 - - - — 2 4 11 1 4 2 2 4 2 2 — — — — — 1 — 2 Deaths by suicide and murder 10 - - - - 1 4 4 1 - 1 - — 3 1 2 — — 1 1 1 — — — Other defined diseases 10 1 — — 1 1 2 2 3 — 1 — — 7 — 1 1 — — — — — — — Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — All causes 603 24 1 1 6 17 50 157 347 7 61 24 33 191 43 150 26 6 9 17 9 22 1 4 16 Registered deaths numbered 1,383 in the City during 1938. Aiter deducting 829 deaths of non-citizens in public institutions, etc., in the City, and adding those of 746 citizens who died in other districts, the corrected total is 1,300 as compared with 1,432 in 1937, and is equivalent to an annual crude rate of 10.4 per 1,000 persons compared with 11.5 last year. The London death-rate for 1938 was 11.4 and for England and Wales, 11.6. Table VIII. Deaths Distributed amongst Age Groups. This table shows the total deaths distributed among age periods:— 1938. 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. 33 6 2 4 20 71 237 324 697 F. 24 1 1 6 17 50 157 347 603 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 1030 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 1938 57 7 3 10 37 121 394 671 1,300 The causes of death are set out in Table VII. There was an increase among males of deaths from alcoholism and diseases of the respiratory system. 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:— 17 Table IX.—Deaths According to Wards. 1934. 1935. 1936. 1937. 1938. Death rate for ward per 1,000 population m. F. Total M. F. Total M. F. Total m. F. Total m. f. Total Conduit - 3 3 8 4 12 4 6 10 6 11 17 9 7 16 7.6 Grosvenor 64 61 125 61 57 118 60 53 113 66 61 127 63 61 124 9.3 Hamelt 12 24 36 14 30 44 23 28 51 28 27 55 30 24 54 8.3 K. st. George 60 61 121 45 70 115 42 55 97 66 59 125 52 33 85 7.4 Victoria 224 235 459 226 240 466 209 276 485 234 235 469 184 191 375 10.1 St. Margaret 43 40 83 39 34 73 49 42 91 46 45 91 32 43 75 8.6 St. John 183 144 327 190 147 337 184 137 321 142 144 286 151 150 301 13.0 St. Anne Great 27 34 61 24 31 55 19 31 50 28 23 51 32 26 58 10.7 Marlborough 12 19 31 11 7 18 8 9 17 3 6 9 9 6 15 4.5 Pall Mall 22 10 32 21 5 26 23 11 34 16 8 24 22 9 31 10.7 Regent 16 25 41 21 19 40 18 28 46 15 24 39 15 17 32 7.9 Charing Cross 17 5 22 19 6 25 20 12 32 13 8 21 15 9 24 7.4 Govent Garden 24 31 55 24 23 47 24 31 55 28 33 61 23 22 45 6.7 Strand 32 3 35 28 5 33 42 4 46 35 1 36 34 1 35 17.0 Homeless 20 15 35 16 11 27 20 9 29 12 9 21 26 4 30 - Infantile Mortality.—The corrected death-rate of infants for Westminster was 54.9 per 1,000 births. The mortality among legitimate infants was 45.5 per 1,000; that of illegitimate 115.9. The infant mortality rate for London was 57. The number of infants dying under 1 year was 57, a decrease of 3 on the figure of last year. The chief contributory causes of death were want of attention at birth, congenital defects, prematurity, bronchopneumonia, and affections of the stomach and bowels. Table X shows the deaths as they occurred during the four quarters of the last four years:— Table X.—Infantile Mortality. Total 1935. Total 1936. Total 1937. Total 1938. 1st Quarter 26 22 17 16 2nd „ 18 17 14 11 3rd „ 14 19 13 16 4th „ 17 12 16 14 75 70 60 57 Table XI shows the births and deaths of infants, legitimate and illegitimate, since 1911 onwards, with the corresponding infantile mortality rates for Westminster and for London. (8677) B 18 Table XI.—Infantile Mortality since 1911. Legitimate. Illegitimate. Total Bate, Westminster. Total Rate, London. Year. Births. Deaths. Death-rate per 1,000 Births. Births. Deaths. Death-rate per 1,000 Births. 1911 2,195 210 95 166 25 198 103 129 1912 2,194 168 76 155 33 174 83 91 1913 2,057 184 89 176 27 164 95 105 1914 1,995 147 73 162 29 148 79 104 1915 1,798 141 78 181 24 225 92 112 1916 1,632 110 68 178 41 230 83.4 89 1917 1,348 112 83 196 41 239 103.6 104 1918 1,234 112 86.6 225 48 155 100 108 1919 1,383 99 71.5 217 36 188 87.5 85 1920 2,047 123 60 219 41 200 73.6 76 1921 1,729 117 67.7 190 44 194 80.2 80 1022 1,703 84 49.3 199 37 100 54.6 74 1023 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 1031 1,063 74 69.6 148 29 114.8 75.1 65 1932 1,020 50 49.0 132 17 196.9 65.9 66 1933 970 54 55.6 129 26 162.7 68 59 1934 1,015 56 55.1 151 21 139 66 67 1935 913 54 59.1 129 21 162.7 72 58 1936 930 56 60 133 14 105.2 65.8 66 1937 883 43 48.6 138 17 123.1 58.7 60 1938 900 41 45.5 138 16 115.9 54.9 57 Table XII shows the causes of death of children who died under one year of age. Figures under the same grouped causes are given from 1931 onwards, showing the proportion per 1,000 births applicable under each heading:— Table XII.—Infantile Mortality—Causes. — 1931. 1932 1933. 1934. 1935. 1936. 1937. 1938. Influenza — — 27 — — 0.94 — — Measles — 0.86 — 0.85 — 0.94 — 0.96 Whooping Cough 0.82 0.86 1.8 — 1.9 — 0.97 — Bronchitis and pneumonia 22.3 12.1 10.9 12.0 12.4 4.7 8.8 6.7 Stomach and bowel diseases 13.2 8.6 9.0 15.4 11.5 11.2 12.7 10.5 Syphilis 1.6 1.7 3.6 1.71 — — 0.97 — Congenital malformations, debility, etc. 6.6 1.8 2.57 8.6 15.9 5.8 2.8 Prematurity 22.3 19.9 16.3 20.5 20.1 15.0 19.5 25.0 Tuberculosis — 0.86 — — — — — — Murder — 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 6.7 Cerebro-spinal Meningitis 0.82 0.86 0.9 - 1.9 - - - Erysipelas — 0.86 0.9 0.85 — — — — Other causes 1.6 3.4 1.8 6.85 4.7 5.6 6.8 1.9 19 Table XIII shows net deaths from various causes at several age periods during the first year of life in the City of Westminster:— Table XIII.—Infant Mortality.—Causes at various ages. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 months. Total Deaths under 1 Year. Bronchitis and Pneumonia (all forms) - - - - - 3 3 1 - 7 Premature birth 19 3 — — 22 1 — — — 23 Other causes — — — — — — 1 — 1 2 Stomach and bowel - - - - - 4 5 1 1 11 Accidents and negligence 7 - - - 7 - - - - 7 Congenital Defects 4 — — 2 6 — — — — 6 Measles — — — — — — — — 1 1 30 3 - 2 35 8 9 2 3 57 The causes of death of the Illegitimate were:—br. pneumonia 1, prematurity 3, stomach and bowel diseases 4, congenital defects 2, and accidents and negligence 6. Table XIV. Infant Mortality.—Net Deaths from stated causes at various ages under One Year of Age in Pimlico A rea (Victoria, Kniglitsbridge St. George and Hamlet Wards). causes of death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Measles - - - - - - - - 1 1 Bronchitis and Pneumonia (all forms) - - - - - - 1 1 - 2 Stomach and bowel — — — — — 2 4 1 - 7 Premature birth 8 — — — 8 — - — - 8 Accidents 1 — — — 1 - - - - 1 Congenital defects 2 — — — 2 - - - - 2 Other causes — — — — — — — — 1 1 Totals 11 — — — 11 2 5 2 2 22 (8677) b 2 20 Table XV. Infant Mortality.—Net Deaths from stated causes at various ages under One Year of Age in St. John and St. Margaret Wards. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Congenital defects 1 - - 1 2 - - - - 2 Stomach complaints — — — — — 1 1 — 1 3 Premature birth 7 — - — 7 — — — — 7 Other causes — — — — — — 1 — — 1 Bronchitis and monia - - - - - 2 1 - - 3 Totals 8 — — 1 9 3 3 — 1 16 Table XVI. Infant Mortality. Net 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 6 - - - 6 1 - - - 7 Stomach complaints — — - — — 1 — — — 1 Congenital defects — — — 1 1 — — — — 1 Pneumonia — — — — — — 1 - - 1 Totals 6 — — 1 7 2 1 — — 10 21 Table XVII.—Infant Mortality and Births in Wards. The following table shows the allocation of the net births and infant deaths among the various wards in the City, together with the infantile mortality rate for the ward. Wards. Population, 1931 Census. Total Births, 1938. Legitimate. Illegitimate. Total Infant Deaths, 1938. Legitimate. Illegitimate. 1938—Infant death rate per 1,000 births Legitimate. Illegitimate. Total Rate. Conduit 2,086 6 3 3 - - - - - - Grosvenor 13,318 44 37 7 2 1 1 27.0 142.8 45.4 Pall Mall 2,872 8 7 1 - - - - - - Regent 4,047 25 18 7 - - - - - - Gt.Marlborough 3,331 11 9 2 2 1 1 111.1 500 181.8 St. Anne 5,405 41 28 13 3 2 1 71.4 76.9 73.1 Covent Garden 6,655 46 43 3 3 3 - 69.7 - 65.2 Charing Cross 3,210 7 6 1 - - - - - - Strand 2,052 2 2 - - - - - - - Victoria 36,955 430 371 59 17 15 2 40-4 33-9 39-5 K. St. George 11,445 87 75 12 4 3 1 40.0 83.3 45.9 Hamlet 6,461 29 27 2 1 1 - 37.0 - 34.4 St. Margaret 8,671 47 46 1 3 2 1 43.4 1000 63.8 St. John 23,071 244 228 16 13 13 - 57.0 - 53.2 Homeless, etc. - 11 - 11 9 - 9 - 818.1 818.1 Total 129,579 1,038 900 138 57 41 16 45.5 115.9 54.9 22 The following table is inserted by courtesy of the Medical Officer of Health for Poplar, by whom the figures were compiled. Table XVIII.—Birth and Death Rates in Metropolitan Boroughs for 1938. 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 137,400 13.74 11.33 11.21 66 Kensington 174,100 12.8 11.7 10.9 78 Hammersmith 125,100 15.5 11.3 11.6 61 Fulham 137,700 14.2 11.6 11.7 51 Chelsea 56,050 10.2 13.5 11.5 80 City of Westminster 124,400 8.3 10.4 10.7 54.9 North Districts— St. Marylebone 90,680 8.84 11.12 11.0 60 Hampstead 90,480 11.7 11.4 10.7 57 St. Pancras 179,400 13.5 11.5 11.7 64 Islington 292,300 15.32 11.90 12.02 65 Stoke Newington 50,480 13.8 11.0 10.5 43.2 Hackney 205,200 13.4 10.7 11.2 56.46 Central Districts— Holborn 34,350 7.28 10.51 11.25 84 Finsbury 56,960 13.0 12.9 14.1 73 City of London 8,780 6.6 10.7 11.8 51.8 East Districts— Shoreditch 80,360 14.7 11.4 12.5 64 Bethnal Green 92,910 14.2 11.3 12.8 59.3 Stepney 200,500 13.06 11.05 12.92 60.7 Poplar 134,400 14.9 11.4 12.7 60 South Districts— Southwark 145,300 14.0 12.5 13.4 57 Bermondsey 97,420 14.8 11.0 12.54 45 Lambeth 272,800 14.09 11.9 11.7 51 Battersea 141,700 14.92 11.82 11.70 53.45 Wandsworth 340,100 11.92 11.17 10.38 46 Camberwell 222,400 13.97 12.27 12.27 61 Deptford 95,460 14.4 11.8 ? 54 Greenwich 95,770 13.64 10.89 11.1 42 Lewisham 229,000 13.9 10.49 10.5 47 Woolwich 150,900 13.6 10.4 11.0 50 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 among the latter class of people tend to increase the death-rates of the wards in which those lodging houses are situated; 57 deaths of persons giving addresses in common lodging houses occurred in 1938. They were mostly in institutions. 23 Table XIX.—Deaths in Common Lodging Houses. Deaths. Ward. Bruce House (L.C.C.) 27 Strand 33, Great Peter Street 2 St. John. 7, St. Ann's Street (Salvation Army) 16 16, Strutton Ground 7 Church Army Home, Greencoat Place 5 57 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 1934-1938. Details respecting the notifications of infectious disease received are set out in the following pages. Table XX.—Notifications of Infectious Disease. 1934 1935 1936 1937 1938 Smallpox - - - - - Diphtheria 153 111 82 133 204 Erysipelas 63 44 35 42 43 Scarlet fever 375 194 198 258 164 Enteric fever 6 11 12 16 11 Continued fever 1 — — — — Puerperal fever 5 9 1 3 5 Puerperal pyrexia 13 17 13 26 22 Cercbro-spinal meningitis 4 3 4 12 10 Encephalitis lethargica — — — — — Poliomyelitis 5 2 — 2 4 Ophthalmia, neonatorum 4 1 11 9 7 Measles 807 195 590 136 819 German measles 39 10 27 51 52 Pneumonia 48 35 22 28 24 Malaria 1 15 2 3 3 Dysentery 3 15 14 32 34 Ohickenpox 146 194 162 164 184 Mumps 105 272 102 99 45 Whooping-cough 95 134 141 127 137 Vaccination.—The Vaccination Officer reports that the following number of persons were vaccinated by the Public Vaccinators during the year:— Primary 58 Secondary 149 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. Table XXI. Vaccination Return foe the Year ended 31st December, 1937. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1937. Number of these Births duly entered by 31st January, 1939, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1939, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st Jan., 1939, 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 1938. Number of Statutory Declarations of Conscientious Objection actual-\ ly received by the Vaccination Officer, irrespective of the dates of birth of the children to which they relate, during the calendar year 1938. 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. 1,450 767 2 — 283 50 3 185 156 4 1,085 252 24 Table XXII. Summary of Monthly Returns for the Year ended 31st December, 1938. 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. 1,461 1,085 21 252 5 89 253 25 Table XXIII. 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, 1938. Name of Public Vaccinator and District. Numbers of successful primary vaccinations of persons Number of successful re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under 1 year of age. 1 year and upwards. Total. Dr. J. Forbes (Mayfair, Strand, St. James and St. Anne) 44 8 52 12 Dr. J. Gorsky (Westminster, St. Margaret and St. John) 170 10 180 22 Dr. T. Bromley (Belgrave and Knightsbridge) 176 10 186 10 Totals 390 28 418 44 Table XXIV.—Cases of Infectious Disease Notified. Notifiable Diseases. At all Ages. Cases Notified. Cases removed to Hospital. Treated at Home. At all Ages. Deaths. At Ages—Years. At Ages—Years. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera (C). Plague (R) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria 187 5 4 10 18 18 69 13 19 24 5 2 — 187 — 1 — — — — — 1 — — — — — — Erysipelas 37 — - — - 2 1 1 - 10 2 12 9 36 1 1 - - - - - - - - - - - 1 Scarlet fever 156 2 3 8 10 8 36 8 27 48 5 1 — 155 1 - - - - - - - - - - - - - Typhus fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever 11 — — — — 1 — — 1 4 4 1 — 10 1 1 - - - - - - - - 1 - - - Relapsing fever (R) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal fever 5 - - - - - - - - 4 1 - - 5 - - — — — — — — - - — — — — Cerebro-spinal meningitis 9 — 1 — 1 — — — 1 6 — — — 9 — 3 — — 1 — — — — 1 1 — — — Poliomyelitis 3 — — — 1 — 1 — 1 - — — — 2 1 - - - - - - - - - - - - - Encephalitis lethargica - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - - Ophthalmia neonatorum 7 7 - - - - - - - - - - - 4 3 - - - - - - - - - - - - Pneumonia 24 — 2 — 1 1 2 1 2 6 3 6 — 20 4 33 - - - - - - - 3 1 4 14 11 Malaria 3 — — — — — — — — — 3 — — 2 1 - - - - - - - - - - - - - Dysentery 33 4 4 9 3 1 5 — — 3 1 2 1 33 - - - - - - - - - - - - - - Puerperal pyrexia 22 — — — — — — — 2 17 3 - - 21 1 - - - - - - - - - - - - - Totals 497 18 14 27 34 31 114 23 53 122 27 24 10 484 13 40 — — 1 — — 1 — 4 3 5 14 12 26 Correction has been made for errors in notification or reviiion of diagnosis in 14 eaaas. Diphtheria 8, Scarlet Fever 3, Dysentery 3. Cases not notified Scarlet fever, 8. Dysentery 1. Diphtheria, 17. Poliomyelitis 1. Erysipelas 6. Table XXV.—Infectious Diseases, Distributed according to Ward. Notifiable Diseases. Condult. 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 2 7 9 40 23 75 2 2 16 2 1 4 - 7 14 Erysipelas 1 5 2 16 2 7 1 2 — — 1 1 — — 5 Scarlet fever — 5 7 51 26 37 6 1 3 1 1 8 — 5 13 Typhus fever — — — — — — — — — — — — — — — Enteric fever 1 2 2 1 — 2 — - 2 — — 1 — — — Relapsing fever (R) - - - - - - - - - - - - - - - Puerperal fever — — 1 2 — 1 — — 1 — — — — — — Cerebro-spinal meningitis 1 2 2 1 - - - - - - - - - 1 3 Poliomyelitis — 2 1 - - - - - - - - - - - 1 Encephalitis lethargica - - - - - - - - - - - - - - - Ophthalmia neonatorum — — 1 1 — 4 — — 1 — — — — — — Pneumonia — 2 2 5 1 9 1 — 1 — — 1 — — 2 Malaria — — — — 1 — — — 1 — — — — — 1 Dysentery — — — 6 1 12 1 — 2 — 1 — — 1 10 Puerperal pyrexia — — 2 8 — 4 — — — 1 — 2 — 2 3 Membranous Croup - - - - - - - - - - - - - - - Totals 5 25 29 131 54 151 11 5 27 4 4 17 — 16 52 27 28 Scarlet Fever.—One hundred and sixty-four cases of this disease occurred in 1938, a decrease of 94 on the figures of 1937. No death occurred. The case rate of this disease per 1,000 of the population was 1.3 for the City, and for England and Wales 2.41. The death-rate for London was 0.01 per 1,000, and for England and Wales 0.01. Diphtheria.—Two hundred and four cases of this disease occurred, showing an increase of 71 on the figures of 1937. The case rate of this disease for Westminster was 1.63 per 1,000 living, and for England and Wales 1.58. One death occurred. The death-rate for England and Wales was 0.07, for London 0.05, and for Westminster 0.008. Report on Schick Testing and Immunisation Treatment against Diphtheria, 1938. 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 223 new cases were dealt with, as compared with 254 and 245 in 1937 and 1936 respectively. New cases attended the Centres as follows:— Ebury Bridge 67 Bessborough Street 34 Marshall Street 55 Westminster Health Society 67 223 Treatment was continued on the lines indicated in previous reports, using toxoid antitoxin mixture for immunisation. 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. The following table shows the age groups of those treated and the results of such preliminary tests as were performed:— Table XXVI. Ages. Preliminary Schick Test. No Test. Total. Positive. Negative. Under 5 years 1 1 159 161 5 to 10 years 4 3 43 50 Over 10 years 4 4 4 12 Totals 9 8 206 223 29 The one child under 5 years, whose preliminary test was negative, had had previous immunisation elsewhere. None of those over 5 years had had immunisation treatment. 139 cases who had previously been treated were re-tested during the year and all were found negative. Antitoxin, for use in cases of diphtheria, is provided free of charge for medical practitioners attending patients residing in the City. The supply is available on application at the Public Health Department, and at the Coroner's Court in Horseferry Road. Enteric Fever.—There were 11 cases of typhoid and paratyphoid which came to the knowledge of the department during 1938. Of these, 7 were notified as paratyphoid and 4 as typhoid. The case rate for England and Wales was 0.03 and for Westminster 0.08. One death occurred. County of London (Measles and Whooping Cough) Regulations 1938. These Regulations, which came into force on 1st October, 1938, made notifiable the first case occurring in a house within a period of two months. All medical practitioners practising in the City were informed of these regulations by circular letter. Measles.—The following table shows the number of cases notified by head teachers of schools, hospitals and private practitioners during the last five years:— Table XXVII.—Measles—Cases Notified. 1934. 1935. 1936. 1937. 1938. 807 195 590 136 819 The death-rate for England and Wales per 1,000 population was 0.04. Two hundred and eighty-one cases were removed to hospital, 169 being between the ages of 1 and 5. Four deaths occurred, giving a death rate of 0.03. German Measles.—Fifty-two cases were notified. Influenza.—The deaths certified from this cause during the last five years are as follows:— 30 Table XXVIII.—Deaths from Influenza 1934. 1935. 1936. 1937. 1938. Males 12 5 7 15 3 Females 6 10 7 17 2 18 15 14 32 5 The death-rate in 1938 for Westminster was 0.04 per 1,000; for London 0.06, and for England and Wales 0.ll. Last year the corresponding rates were 0.25 for Westminster, 0.38 for London, and 0.45 for England and Wales. Influenza by itself is not notifiable under existing regulations but only when complicated by pneumonia, therefore no reasonable deductions can be made by comparing the notification rate of influenzal pneumonia with the death-rate from influenza. Diarrhœa and Enteritis.—The total deaths were 13—7 males and 6 females—10 being under 1 year. The infant death-rate from this cause in Westminster was 10.5. Table XXIX. Deaths from Diarrhoea and Enteritis. - Under 1 year. Other ages. Total. 1934 16 3 19 1935 10 2 12 1936 12 3 15 1937 13 3 16 1938 10 3 13 Whooping Cough.—137 cases were notified during the year, 31 cases were moved to hospital, 24 being between the ages of 1 and 5. No death occurred. The death rate for London was 0.03, and for England and Wales 0.03. The deaths from whooping cough during the last five years are thus set out:— Table XXX.—Deaths from Whooping Cough. Under 1 year. At other ages. Total. 1934 - 9 9 1935 2 — 2 1936 — 3 3 1937 1 3 4 1938 - - - 31 Cerebro-spinal Fever.—10 cases of this disease occurred. Seven of these cases were between the ages of 19 and 30. Three deaths occurred Chicken Pox.—184 cases occurred, 57 being moved to hospital. Mumps.—45 cases were recorded, 21 cases being moved to hospital. Puerperal Fever.—5 cases were notified and removed to hospital. The following table shows the number of births for the last five years, together with the number of cases of puerperal fever and deaths:— Table XXXI.—Puerperal Fever. Year. No. of births. No. of cases. Deaths. Death rate per 1000 births 1934 1,166 5 - - 1935 1,042 9 1 0.9 1936 1,063 1 — — 1937 1,021 3 — — 1938 1,038 5 - - Puerperal Pyrexia.—22 cases occurred, 21 being removed to hospital. Ophthalmia Neonatorum.—7 cases occurred in 1938. In addition to these notified cases, 4 cases of slight inflammation of the eyes came to the knowledge of the department. Facilities are afforded for the treatment of this disease by the London County Council at St. Margaret's Hospital, Kentish Town, N.W. Mothers are also admitted, and, if necessary, receive treatment. The following details in tabular form are required by the Ministry of Health of the cases notified in 1938:— Table XXXII.—Ophthalmia Neonatorum. Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Left district. Total. Treated. At home. In hospital. 7 3 4 3 — — — 4 32 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 791 Sputa for investigation of tuberculosis 341 Expenditure on the first was £134 6s. 7d., and on the second £47 12s. 5d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1938, 188 new cases of pulmonary tuberculosis came to the knowledge of the department, including 7 cases who had moved into the City and 9 non-notified deaths. Non-pulmonary forms of tuberculosis gave 41 cases—4 of these being non-notified deaths and 6 transfers from other districts. Table XXXIII.—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 2 — 2 1 — — - — 5 „ 10 „ 1 3 3 4 — — - 1 10 „ 15 „ — 1 1 — — - - — 15 „ 20 8 8 3 4 1 2 2 1 20 „ 25 11 21 4 2 5 5 — 1 25 ,, 35 ,, 21 21 4 5 6 2 1 — 3o ,, 4o ,, 21 13 2 2 9 6 — — 45 ,, 55 ,, 24 4 1 1 14 1 — — 55 „ 65 „ 19 3 — 1 8 — — 1 65 and upwards 3 3 — 1 — 3 — 1 Totals 111 77 20 21 43 19 3 5 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. 33 The total cases for 1938 show a decrease of 22 on those of 1937. Out of the total cases primarily notified in 1938, 28 died, and the following table shows the period between notification and death of these cases:— Table XXXIV.—Tuberculosis—Period between Notification and Death. Weeks. Months. 1—2 2—3 3—4 1—2 2—3 3—4 4—5 5—6 6—7 7—8 8—9 9—10 10—11 11—12 7 4 1 1 7 4 — — 1 1 2 — — — Table XXXV.—Tuberculosis Deaths. 1934 1935 1936 1937 1938 New cases notified 266 201 188 228 203 Number included in above who died during the year 38 20 24 31 28 (14.28%) (9.9%) (12.7%) (13.6%) (13.7%) Total Tuberculous Deaths 99 67 90 94 70 Death Rates per 100,000 79.8 53.8 72.5 75.6 56.2 (8677) Table XXXVI. Tuberculosis.—Notifications received during the period from 1st January, 1938, to 31st December, 1938. Age periods. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified. 0 to l. 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 2 — — 8 11 20 19 20 17 3 101 105 Females — — 2 1 6 21 21 12 4 3 1 71 79 Non-pulmonary— Males — 2 3 1 2 2 2 2 — — - 14 15 Females — 1 2 — 3 2 5 2 1 — 1 17 18 Total 1 5 7 2 19 36 48 35 25 20 5 203 217 34 (8677) Table XXXVII. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1038. Age Periods. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total. Pulmonary— Males — — 1 — — — 1 2 4 2 — 10 Females — — 1 - 2 - - 1 - — 2 6 Non-pulmonary— Males - - - - 1 2 2 - 1 - - 6 Females — — 2 — 1 — — — — 1 — 4 Total — — 4 — 4 2 3 3 5 3 2 26 o 2 35 Table XXXVIII. Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions. 1938. 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 1938. Pulmonary— Male 1ll - 6 4 42 4 30 1 1 2 1 2 1 10 5 2 78 Females 77 1 5 7 26 7 17 3 1 - 2 2 4 - 2 - 42 Non-pulmonary— Males 20 - - 3 6 1 7 - - - - - — 1 1 1 11 Females 21 — 2 3 8 - 4 — — 2 — — 1 - 1 - 7 229 1 13 17 82 12 58 4 2 4 3 4 6 11 9 3 138 36 37 Table XXXIX. Tuberculosis Notifications. The figures for a series of years are shown below:— Pulmonary. Non-Pulmonary. Total of all forms. General Population. Resident in Common Lodging Houses and Homeless. Total. Males. Females. Males. Females. Males. Females. Total. 1918 293 225 40 4 562 50 55 105 667 1919 197 122 30 4 353 35 23 58 411 1920 143 133 29 4 309 29 29 58 367 1921 118 114 37 2 271 19 22 41 312 1922 119 110 42 2 273 24 30 54 327 1923 111 114 42 1 268 24 32 56 324 1924 140 122 33 1 296 27 24 51 347 1925 108 92 27 1 228 23 31 54 282 1926 117 90 29 4 240 18 30 48 288 1927 103 67 24 1 195 21 29 50 245 1928 97 61 27 2 187 22 27 49 236 1929 106 105 42 6 259 14 28 42 301 1930 104 69 16 1 190 24 33 57 247 1931 108 86 17 1 212 20 23 43 255 1932 136 84 28 - 248 26 36 62 310 1933 106 75 24 - 205 19 22 41 246 1934 130 94 27 - 251 31 23 54 305 1935 93 62 29 — 184 27 18 45 229 1930 98 72 28 1 199 15 10 25 224 1937 110 80 16 — 206 23 22 45 251 1938 89 76 22 1 188 20 21 41 229 Non-notified Deaths.—The number of unnotified deaths during the year was 13; the corresponding percentage proportions are 18.0 ner cent. (1937) and 18.5 per cent. (1938). Enquiries were made, but in no instance did there appear to be neglect to notify a case on the part of a medical practitioner. 9 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 1938. 38 Table XL.—Tuberculosis—Cases on the Register. Pulmonary. non-Pulmonary. Males. Females. Males. Females. Number of cases on register at beginning of year 1938 819 392 162 192 Notified for the first time during year 111 77 20 21 930 469 182 213 Removed from the register on account of death or removal etc., from Westminster 64 43 6 6 866 426 176 207 Of the 119 cases removed from the register during the year 1938, 68 were on account of death, 48 persons suffering from tuberculosis moved from the City and notification was withdrawn in 3 cases. The total number of cases of tuberculosis on the Register at the end of 1938 was 1,675 (as compared with 1,565 at the end of the year 1937), of which 1,292 were pulmonary cases, consisting of 866 males and 426 females. Deaths from Tuberculosis.—The total number of deaths from tuberculosis for 1938 (all forms) was 70—males 46, females 24. This gives a death-rate for this disease of 0.56 per 1,000. The following table shows deaths per 100,000 population since 1924. Table XLI. Westminster—Deaths from Tuberculosis per 100,000 population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1924 annual 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 71 101 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 1938 62 49.8 8 6.4 70 56.1 39 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, 1938. The work of the Dispensary has been carried on throughout the year on the established lines. New patients numbering 374 were seen during the year, of whom 154 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 XLII. - 1936. 1937. 1938. Medical Practitioners 136 121 1ll Health Visitors 171 189 170 St. Stephen's Hospital 115 65 59 Ministry of Pensions 0 0 0 School Medical Officer 18 12 14 Voluntary Hospital 7 9 8 Friends, Charitable Organisations, &c. 9 9 12 456 405 374 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. 40 The following table gives certain details of the work of the Dispensary during 1938 and the four preceding years:— Table XLIII. - 1934. 1935. 1936. 1937. 1938. New patients attending 462 425 456 405 374 Old patients attending 473 472 494 497 480 New contacts examined 109 108 127 114 133 Individual attendances 935 897 950 902 854 Total attendances 2,615 2,454 2,393 2,141 2,045 Written reports to Medical Practitioners and Public Authorities 1,066 1,064 1,108 1,171 1,195 Home Visits 67 73 109 95 101 Consultations with Medical Practitioners 153 145 131 113 101 Visits by Health Visitors to Dispensary Cases 3,526 3,335 2,885 2,915 2,727 Sputum Examinations 193 171 187 162 172 X-Ray Examinations 60 78 100 123 164 Patients have been recommended for institutional treatment from the Dispensary as follows:— Table XLIV. Hospitals. Sanatoria. Insured Males 5 50 Insured Females 6 28 Uninsured Males 2 7 Uninsured Females 3 16 Boys 3 6 Girls 1 3 20 110 This Table does not include patients sent direct to St. Stephen's Hospital. Many of these are transferred to a Sanatorium later. In addition, 64 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. 41 School children requiring dental treatment were referred to the School dentist. Six adult patients were referred to the Council's Dental Clinic, six extractions were carried out and four of the patients were fitted with dentures. Twenty-nine patients received Artificial Pneumothorax treatment at Brompton Hospital and elsewhere and had in all 428 refills. One case of Lupus received special Light treatment at a cost to the Council of £11 12s. 6d. 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. Fifty-six patients received this extra diet allowance at a total cost to the Council of £378 7s. 10d. 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 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. 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 an annual income to the Handicraft Class, the amount for 1938 being £18 12s. 8d. Without this help it would be difficult to carry on this useful work. Table XLV. TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. (A) Return showing the Work of the Dispensary during the Year 1938. 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 79 78 3 6 12 20 10 4 91 98 13 10 212 *(b) Diagnosis not completed — — — — — — — — — 2 — — 2 (c) Non-tuberculous — — — — — — — — 17 47 12 15 91 B.—Contacts examined during the year:— (a) Definitely tuberculous — 2 1 — — — 2 1 — 2 3 1 6 *(b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 10 38 39 40 127 C.—Cases written off the Dispensary Register as— (a) Recovered — — — — — — — — — — — — — (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 31 89 55 58 233 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 209 169 24 22 31 43 44 42 240 212 68 64 584 (6) Diagnosis not completed - - - - - - - - - 2 - - 2 * i.e., remaining undiagnosed on 31st December. 42 Table XLV—continued. TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL—continued. (A) Return showing the Work of the Dispensary during the Year 1938—continued. 1. Number of cases on Dispensary Register on 1st January 686 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 101 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 14 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,727 3. Number of cases transferred to other areas, pases not desiring further assistance under the scheme, and cases "lost sight of" 272 10. Number of— (a) Specimens of sputum, etc., examined 172 4. Cases written off during the year as Dead (all causes) 47 (6) X-ray examinations made in connection with Dispensary work 164 5. Number of attendances at the Dispensary (including Contacts) 2,045 6. Number of Insured Persons under Domiciliary Treatment on 31st December 201 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above Nil 7. Number of consultations with medical practitioners— 12. Number of "T.B. plus" cases on Dispensary Register on 31st December 200 (a) Personal 101 (6) Other 280 43 (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 44 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. The work is now done at the new hospital laboratories which are situated in the recently opened Westminster Hospital Medical School building in Horseferry Road, S.W.1, to which specimens are sent direct by medical practitioners. 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 T. McLachlan, Esq., F.I.C., one of the two 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 1938 amounted to £193 2s. 2d., representing some 2,808 visits as compared with 2,874 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. 45 Hospitals. Municipal.—Particulars of the various hospitals in the City have been fully outlined in previous reports. One municipal hospital is situated in the City, viz.:—that in Sheffield Street, controlled by the London County Council, which has 82 beds, 30 for parturient venereal cases and 52 for ordinary cases suffering from venereal disease. Voluntary.—There are 12 voluntary hospitals and two military hospitals in the City. The City Council has made agreements with certain voluntary hospitals, 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. (v) The services of consultants, pathologists &c., in cases of puerperal fever and pyrexia. (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. 46 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. Id) Services of an obstetric consultant in case of difficulty. (e) In the event of illness after confinement the services of an obstetric consultant, pathologists, nursing and treatment in hospital. (f) Confinement as in-patient in hospital. (g) Provision of home help during the mother's period of ability. (h) Convalescent treatment if necessary before and after finement. (i) Instruction in mothercraft, i.e.:— (1) Classes for making garments. (2) Classes for cookery, food values, and marketing. (3) A variety of health lectures. (j) Dental treatment, and supply of dentures. (k) Extra nourishment. (2) Care of the mother after confinement and the infant:— (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. 47 (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. (i) Physical Improvement Classes for children from 2 to 5 years. 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. The physical culture classes are an innovation which has proved popular with the mothers who usually attend to see their children carrying out the exercises. Even the youngest children enjoy acting in unison with the others through the enthusiastic leadership of the instructress. Exercises which are carried out in play, copying the instructress, are designed to improve muscular tone and co-ordination and are specially for the round shouldered or flatfooted child, and also the thin or over fat child with undeveloped muscles. Other children are also admitted where there is room in the classes for them. Treatment of Minor Ailments in Children of Pre-School Age.—The City Council in 1936 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 also made provision for the treatment 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 had 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 arrangements were made with the Infants Hospital, Vincent Square, for this purpose. 48 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. Midwifery Service. Since 1938 the London County Council, under the Midwives Act, 1936, has been the authority for providing domiciliary services throughout the whole of London. The voluntary bodies who were, until the coming into force of the new Midwives Act, carrying out district midwifery in Westminster under the City Council's scheme entered into agreements with the London County Council for a similar purpose. The latter, in permitting the City Council's midwifery scheme to operate as before, has acted generously and most considerately, while retaining its rights as the paramount authority under the statute. There has been, therefore, no change or break in the continuity of these services. The figures below indicate the work of the district midwives of Westminster Hospital and of the Westminster Health Society acting for the London County Council through the City Council's original scheme. Table XLVI.—Westminster Hospital. Midwifery Visits. 1935. 1936. 1937. 1938. Number of— Pre-natal visits 34 29 20 26 Lying-in visits 961 897 1,663 1,832 Subsequent visits 18 26 23 32 Total number of visits 1,013 952 1,706 1,890 Number of confinements attended 74 71 100 107 49 Table XLVII. Attendances by midwives at ante-natal and other clinics:— 1935. 1936. 1937. 1938. Ebury Bridge 50 51 51 50 Bessborough Street 49 50 49 51 Marshall Street — — 8 23 Total 99 101 108 124 Table XLVIII.—Westminster Health Society, Midwifery and Nursing Visits 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:— St. Margaret and St. John Number of— Wards, 1938. Pre-natal visits 296 Lying-in visits 1,347 Subsequent visits 103 Total number of visits 1,746 Number of cases attended 58 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 8161, Ext. 35) can have such skilled assistance, which is also available to all midwives practising in Westminster who may require it. These services were utilized on nine separate occasions during the year. (8677) D 50 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 net number of births registered during the year was 1,038, the number of expectant mothers dealt with at the centres was 852; that is to say, some 82 per cent, of the total cases, as compared with the percentage of 83 • 6 for the previous year. Cases were brought to the notice of the centres from the following sources:— Table XLIX.—Ante-natal Cases. City Council's Centres. Westminster Health Society. Source of Information. Ebury Bridge. Bessborough Street. Marshall Street. Marsham Street. Totals. Elizabeth Garrett Anderson Hospital 1 — 1 — 2 Brompton Hospital 1 — — — 1 Paddington Hospital — — 1 — 1 Queen Charlotte's Hospital — 1 — — 1 Hammersmith Hospital — 1 — — 1 General Lying-in 6 13 3 20 42 St. George's 31 19 2 13 65 Westminster 17 21 4 14 56 St. Thomas' 2 1 1 — 4 Charing Cross 2 5 34 — 41 Middlesex — 1 19 — 20 Royal Free Hospital — 1 1 — 2 St. Stephen's 26 28 3 15 72 University College 3 1 12 — 16 St. Mary Abbot's Hospital 7 17 3 — 27 Found by Health Visitors 33 30 24 24 111 Reported to Centre voluntarily 134 140 23 83 380 St. Mary's Hospital — 1 — — 1 Other Hospitals — — — 9 9 Totals 263 280 131 178 852 Ante-natal Visiting.—To the 852 expectant mothers who became known to the centres, 792 primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,366. 51 The attendances by mothers at the clinics are detailed below:— Table L.—Ante-natal Clinics. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Ebury Bridge 52 168 534 702 197 Bessborough Street 49 166 432 598 192 Marshall Street 24 38 90 128 45 Westminster Health Society. 22 71 296 367 110 These clinics are held at the following times:— Ebury Bridge Wednesday, 10 a.m. to 12 noon. Bessborough Street Thursday, 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. 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. 349 women belonging to the City were delivered in these hospitals. * Situated in Chelsea. (8677) D 2 52 The following table shows the number of confinements in the hospitals mentioned:— Table LI.—Confinements in Hospitals. Charing Cross Hospital: 373, of which 50 were Westminster cases. St. George's Hospital: 299, of which 53 were Westminster cases. Westminster Hospital: 259, of which 109 were Westminster cases. Sheffield St. Hospital: 170, of which 23 were Westminster cases. St. Stephen's Hospital: 114 (Westminster cases only). Convalescent Treatment.—The Council has during the year contributed towards the cost of the convalescent treatment of 36 Westminster patients at convalescent homes, and 21 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 £107 14s. 5d. Maternal Mortality.—The number of maternal deaths in Westminster during the year ended December, 1938, was 7, which gives a maternal mortality rate of 6.5 per thousand (live and still) births, as compared with the rate for the whole country of 3.08 per thousand (live and still) births. Notes on Cases of Maternal Mortality in 1938. 1. M.D. (married). Died of peritonitis following abortion. No evidence of effort to secure ante-natal attention. 2. G.K. (married). Died of septicaemia following septic abortion. Pregnancy was concealed and there was no evidence of effort to secure ante-natal attention. 3. E.O.R. (married). Died of shock due to injection of fluid into the uterus. No evidence of effort to secure ante-natal attention. 4. V.G.W. (single). Died of narcotic poisoning following an abortion. No evidence of effort to secure ante-natal attention. 5. M.G.W. (single). Died of septicæmia following a miscarriage which was produced by injection of corrosive fluid into the uterus. 6. A.E. (single). Died of pulmonary embolism following labour at the 38th week. The foetus was macerated and foul smelling. Post partum 53 uterine sepsis followed and caused the thrombosis of neighbouring veins, which resulted in fatal embolism. The patient was admitted to hospital in labour as an emergency case. There was no evidence of effort to secure ante-natal attention and in hospital the patient admitted attempts to produce abortion. She was in hospital for a short period at the 30th week on account of uterine sepsis and discharged herself against advice. 7. M.J.F. (married). Died from paralysis of the bowel and toxæmia due to puerperal sepsis following difficult labour. Under hospital supervision throughout pregnancy. These notes give a brief summary of the full enquiry that has been made into each of these unfortunate cases. The maternal mortality rate of 6.5 per thousand is a very high one and should therefore be carefully considered, especially from the point of view of finding out if there were any circumstances which indicate failure in the provision of suitable pre-natal or midwifery care. In the first six cases there was undoubtedly intentional failure on the part of the patient to take advantage of the available services, because the pregnancy was unwanted. The list clearly indicates the terrible dangers of attempts to get rid of an unwanted pregnancy by unskilled persons. The last case is in a totally different category. The patient took full advantage of the ante-natal care and skilled attention in confinement, which are readily available to every mother in Westminster. She was admitted to hospital at the onset of labour and later showed a condition of feebleness of contraction of the uterine muscle, known as "uterine inertia," which sometimes, though rarely, occurs in first pregnancies. As a result, this factor, associated with a very slight degree of disproportion between the size of the mother's pelvis and the baby's head, which had been noted at ante-natal examinations, though it was insufficient in degree to indicate Caesarian section or some such operative procedure, made forceps delivery and a minor operation for enlarging the diameter of the birth canal necessary. Puerperal infection followed the delivery of a dead child, which was found at post-mortem to have certain congenital abnormalities which would have rendered its life precarious even if it had lived. The origin of the infection was almost certainly from the intestinal tract of the mother and not from the instruments or the persons attending the patient. These persons are regularly examined 54 at the hospital to make sure that they shall not carry infection. After a long illness in hospital, in which everything that could be possibly done to save the life of the patient was tried without success, the patient died. An occasional death of this kind, unfortunately, appears to be inevitable, even with the very best services, while the others cannot be prevented by any provision of services. These abortion cases reveal with alarming directness the desperate efforts of some poor women to free themselves from pregnancy. There may be many instances where such attempts are successful; but there are no means of assessing the number. Only the unfortunate few whose fate brings them to the light of public inquest can be numbered. They should not be included under the term "Maternal Mortality" for they bear no relationship to childbed. Infant Clinics.—These are held at the following centres at the times mentioned:— Council's Centres— Ebury Bridge—2p.m. Wednesday. 2p.m. Friday. Bessborough Street—2p.m. Tuesday and 2p.m. Thursday. Marshall Street—2p.m. Wednesday. Westminster Health Society— Marsham Street—2p.m. Tuesday. 2p.m. Friday. Toddlers' Clinic—1st Tuesday each month at 10a.m. 2nd Tuesday each month at 2p.m. Clinics are also held at the Infants' Hospital, Vincent Square and Charing Cross Hospital. Table LII. Attendances at Infant Consultations, 1938. 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 101 235 85 2,551 1,299 2,786 1,384 4,170 Bessborough Street 100 175 48 2,210 1,536 2,385 1,584 3,969 Marshall Street 51 87 20 835 1,037 922 1,057 1,979 Marsham Street 98 167 51 1,874 1,326 2,041 1,377 3,418 The average attendances per session were— 1938. 1937. 1936. 1935. 1934. 1933. Ebury Bridge 41.2 46.1 44.6 42.9 46.9 50.2 Bessborough Street 39.6 43.4 53.4 51.5 55.7 54.5 Marshall Street 38.8 41.3 44.4 46.8 44.3 48.0 Marsham Street 34.8 39.4 44.3 45.3 38.1 37.6 The number of individual children medically inspected were— Ebury Bridge 801 Marshall Street 267 Bessborough Street 544 121, Marsham Street 522 55 56 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 by the three nursing associations:— Table LIII.—Home Nursing. Chelsea, Pimlico and Belgravia. Westminster Nursing Committee. Metropolitan Nursing Association. Number of Patients. Number of Visits. Number of Patients. Number of Visits. Number of Patients. Number of Visits. Affection of the eyes 8 223 7 67 2 15 Complications of maternity 22 192 10 123 1 31 Pneumonia 12 222 4 54 7 100 Bronchitis 2 13 2 16 1 71 Tuberculosis 8 139 4 141 — — Measles 15 145 9 143 4 29 Septic conditions 1 26 — — — — Phimosis 1 9 — — — — Worms 4 26 1 5 3 8 Boils 1 6 — — — — Impetigo 7 69 4 51 2 27 Chicken-pox 2 15 — — — — Constipation 7 18 1 2 1 2 Vomiting 1 2 — — — — Affection of ears 12 195 4 70 5 101 Circumcision 10 75 10 89 8 76 Burns 2 16 1 11 — — Adenitis — — — — 1 22 Tonsillectomy — — 5 27 3 9 Vaginitis — — — — 1 13 Bathing — — — — 1 3 Ulcerated mouth — — 1 65 — — Erythema — — 1 46 — — 115 1,391 64 910 40 507 57 Ophthalmia neonatorum.—Seven cases were notified during the year. There were also 4 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 17 cases, 305 visits being paid. Ophthalmia neonatorum has been notifiable since 1911. The percentage of cases, both mild and purulent (notifiable) in relation to births from the year 1929 is as follows:— Table LIV.—Ophthalmia Neonatorum and Inflammation of the Eyes. Cases. Rate per 100 births for both classes of cases. 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 1938 11 1.05 Table LV.—Death Rates from Syphilis under 1 Year of Age Per 1,000 Births. 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 1931 1.6 1938 - 58 Health Visiting.—The following table shows the number of visits paid in connection with the four centres:— Table LVI.—Health Visiting. 1938 Ebury Bridge. Bessborough Street. Marshall Street. Marsham Street. Total. Pre-natal— First visits 260 230 131 171 792 Other visits 365 418 188 395 1,366 Children under 1 year of age— First visits 289 275 146 198 908 Other visits 991 733 673 973 3,370 Children over 1 and under 5 years— Visits 2,759 1,976 1,905 2,106 8,746 Death enquiries, still-births, &c. 27 20 16 13 76 Infectious diseases 499 370 214 289 1,372 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 62. Table LVII.—Mothercraft Classes. 1938. Ebury Bridge. Bessboro' Street. Marshall Street. Marsham Street. Total. Number of classes 64 46 43 89 242 Total attendances 2,050 1,220 615 2,946 6,831 Average attendances 32.0 26.5 14.3 33.1 28.2 Number of expectant mothers 104 67 43 46 260 Number of attendances by expectant mothers 720 287 197 751 1.955 Number of other mothers 149 122 25 86 382 Number of attendances by other mothers 1,330 933 418 2,195 4,876 Attendances of children in nurseries during classes 1,306 967 501 3,085 5,859 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Ebury Bridge was 2,607; at Bessborough Street, 832; at Marshall Street, 420; and at Marsham Street, 1,489. 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. 59 Child Life Protection.—Public Health (London) Act, 1936, Part XIII. At the end of the year the register contained the names of 12 foster mothers who were then in possession of foster children. Each had one child only. 7 new registrations were made. No death occurred amongst foster children during the year. Notices numbering 109 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 1937, under the provisions of Section 271 (2) of the Act, in respect of the Nursery established at Dolphin Square, Grosvenor Road, which has accommodation for some 40 children. During the year visits to foster children were carried out as follows:— Table LVIII.—Foster Children. District. SouthWest. Southern. Northern. Visits by Child Life Protection Visitors to:— Foster Children under 5— First visits 19 16 9 Subsequent visits 20 18 — Foster Children 5 to 9— First visits 8 — 6 Subsequent visits 37 18 1 Adoption of Children Act, 1926.—The Medical Officer of Health was appointed guardian ad litem by the County Court in 2 cases where application had been made to the Court by residents in the City for adoption orders for infants, under the above Act. The order was made in both instances. In carrying out this duty the Medical Officer has to satisfy the Court as to the suitability of the proposed adoptors and that the interests of the infant will be safeguarded. 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 during the year. A limited 60 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. 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 1938 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. 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 61 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 4,936 pounds were distributed during the year. The amount expended by the Council for fresh milk as extra nourishment for mothers and infants was £872 2s. 2d. Home Helps.—Provision was made in ten cases for the services of home helps at a cost of £16 13s. 9d. 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 £26 9s. 3d. Treatment of Rheumatism.—The City Council, with the approval of the Minister of Health, made a grant of £105 to the St. John Clinic and Institute of Physical Medicine, Ranelagh Road, towards the cost of treatment of poor inhabitants of Westminster suffering from rheumatism. 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 £11 3s. 6d. in small sums according to their means. The Council contributed sums totalling £61 5s. 6d. towards the cost of dentures (£4 per set), which were supplied in 51 cases. Dental Clinic (held in the premises of the Western Dispensary). Mr. Stewart Tait, Dental Surgeon, in submitting the following statistics of work carried out at the dental clinic points out the general increase since last year; in fact the highest figures since 1930. An additional weekly session was instituted during the year to meet the in creasing demand for treatment. 62 Table LIX.—Dental Treatment. New Cases. Reappoint ments. Extractions. Fillings. Other Operations. Anæsthetics. Patients Supplied with Dentures. Local. General. 1937 237 950 843 260 370 6 193 32 1938 242 1,009 1,043 146 399 9 209 51 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:— Demonstration of exercises for expectant mothers. Dental Care. Special demonstration of food for Babies and Toddlers. Invalid Cookery. Infectious Diseases. "How to keep young." "Keep well: keep fit." Care of the hands and feet. Health and modern housecraft. "Woman the Health Maker." Care of the skin and hair. Bathing baby. "Safety First." First Aid. Air Raid Precautions. City of Westminster Day Nursery (Voluntary).— The total attendances at the Nursery were 16,545 by 183 individual children in the following age groups:— (a) Under one year—46. (b) Over one year and under three years—55. (c) Over three years and under five years—82. (d) Resident children—24. The average daily attendance during the year was 54. 63 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.—All premises in Westminster, with the exception of those provided with deep wells, take their water supply from the Metropolitan Water Board. In a number of cases, the supply is obtained from both sources. Two deep wells were sunk during 1938, both at Rex House, 2/12, Regent Street, W.l. During the year extensive enquiries were made and it was found that there is a total of 150 deep wells in the City; 51 of them are now out of use owing to the failure of the supply, while 99 are still actively functioning. Some were sunk 70 to 80 years ago. As more wells have been sunk the level of the subterranean water has become lower, so that wells now have to be bored to much greater depths; consequently the deeper wells in some cases have deprived the more shallow ones of supplies of water. Many of the large blocks of business premises and flats draw their supplies from more than one boring. The 99 wells now in use serve 65 properties. As mentioned in the report of the Medical Officer of Health for 1937, reports on the chemical analysis and bacteriological examination of samples of water from deep wells are being collected. Of 56 certificates received only one has shown an unsatisfactory result. This sample showed a high bacterial count and indicated the presence of B. Coli; as a result of this the water has since been chlorinated. It was suggested by the water engineers concerned that the contamination might be due to leakage downwards from a disused well in the same street within about 100 yards. This disused well, which had been out of use since 1920, consisted of a brick shaft about 10 feet in diameter and some 150 feet deep, below which was a boring to approximately 350 feet in all from the surface. It contained water about 150 feet from the surface, and a sample submitted to the City Council's Bacteriologist showed that it 64 contained B. Coli in 10cc. and other evidence of gross contamination. It is therefore possible that this well had contaminated the first mentioned, and to prevent possible surface contamination of the disused well the large upper part of the shaft was filled with concrete. The use of another well not far away has been abandoned as the water was found to contain a high percentage of salts and was inorganically impure. The depth of the older wells, most of which are out of use, varies from 250 feet to 400 feet. Those now in use vary from 450 feet to 700 feet deep, though a few of the deeper wells do not even now give adequate supplies and some have been abandoned. 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 1938 were:— Buckingham Palace Road: 114,129 men; 60,018 women. Great Smith Street: 128,471 men; 47,797 women. Marshall Street: 163,647 men; 88,451 women. The numbers relating to users of the public laundries were:— Buckingham Palace Road, 18,881; Great Smith Street, 17,137; Marshall Street, 6,317. 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 were made of the water in the pools during the year with satisfactory results. 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. Drainage and Sewerage.—During the year 743 plans of drainage and other sanitary works relating to existing and new buildings were examined and approved by the Public Health Committee. 65 Many small alterations such as the diversion of pipes, replacement of fittings, &c., not involving the deposit of plans were dealt with by the Department during the year. 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 1938, some 250 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, etc. Acts, are embodied in appropriate cases in the reports of the Sub-Committee. New Sanitary Construction.—Of 743 plans submitted relating to drainage and other sanitary works, 49 represented sanitary provisions in entirely new buildings. The corresponding figures since 1934 are as follows:— Table LX.—Drainage and other Sanitary Works. 1934. 1935. 1936. 1937. 1938. Plans 935 1,080 1,087 990 743 Plans of work in new buildings included in above 102 94 102 113 49 Combined drainage orders were made in 10 cases. Infringements of the by-laws were reported by the sanitary inspectors in 18 instances in respect of failure to give notice of intention to construct, or to deposit plans. Appropriate action was taken in each case. Closet Accommodation.—The water carriage system is in existence throughout the City. Public Cleansing.—This is carried out by a special Department of the City Council with a staff of about 600 men under the control of 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 report:- (8677) E 66 "Refuse Collection.—There is a daily collection of refuse throughout the greater part of the City, the quantities of refuse collected and barged away, or otherwise dealt with during the year ended 31st March, 1939, being as follows :— tons. House refuse 88,768 Trade refuse 4,612 Street refuse 10,811 Gully detritus 990 Clinker 5,870 Total 111,051 The figures for house and trade refuse show a reduction of 2,655 tons on last year which is mainly due to the change in character of refuse which tends to decrease in weight but increase in volume. The clinker is collected from large premises in the City and disposed of by a contractor. Transport.—The 4-year programme for the modernization of transport adopted by the Council in 1933 has been completed, and at the 31st March, 1939, 42 motive units of the mechanical horse type were in commission. These motive units are used with trailers carrying bodies of special design for refuse collection, street washing gully cleansing, general transport work, &c. Twenty of the motive units are petrol driven and twenty-two electrically operated. The latter are quiet in operation and therefore are of special utility during the night and early morning when the greater part of the refuse collection and cleansing work is done. Container System, of Refuse Storage and Collection.—The use of refuse containers (covered receptacles on wheels with a capacity of 1¼ cubic yards) continues to increase, and they are installed in 139 premises (chiefly hotels, restaurants, large blocks of buildings and institute buildings) throughout the City. The use of containers enables refuse to be stored in a sanitary manner pending collection which may be done at any time during the 24 hours, an empty container being left when a full one is taken. Refuse Receptacles.—A house to house inspection of refuse receptacles in use throughout the City is maintained and, where the receptacle does not comply with the London County Council byelaws, the occupier is asked to supply a new one. Occupiers of premises are also urged not to put their dustbins out overnight where this is unnecessary and not to leave them out over the week-end or public holidays. Where receptacles require replacement the occupiers are recommended to provide dustbins complying with British Standard Specification No. 792 for mild steel dustbins. Refuse Disposal.—The erection of the Central Cleansing and Transport Depot at Gatlifi Road was completed during the year and the Depot came into full operation at the end of November. It contains a garage for all the Council's vehicles, work and repair shops, salt store, general stores for the major part of the Council's requirements, administrative offices, canteen, drying and locker rooms and shower baths for the 260 employees working in and from the Depot. The building has been erected round the refuse disposal plant which is now totally enclosed so 67 that the whole of the City's refuse is conveyed into barges in Grosvenor Dock with a minimum of noise and dust. In accordance with the conditions of contract, the refuse is conveyed in steel barges with wooden hatches completely covered with tarpaulins to the Contractor's dump at Pitsea, Essex, where it is deposited in accordance with the recommendations of the Ministry of Health, 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 it is also visited periodically by the Committee. Civil Defence Duties.—The employees of the Department have been trained in decontamination work and special decontamination facilities are being provided at the Central Depot and two other Depots." Signed. H. ARDERN. Public Sanitary Conveniences.—These are under the control of the City Engineer. There are 42 public conveniences in the City, 23 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, except those at Rochester Row and Victoria Embankment by Westminster Bridge. In addition, there are 27 public urinals for men Medical Inspection of Aliens. The Medical Inspection of Aliens arriving at Victoria Station by the through sleeping car service from Paris, 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, or owing to delay in arrival of the boats, passengers were inspected at Dover instead of at Victoria. A total of 9,934 passengers from 358 boats were dealt with during the year by the assistant medical inspectors appointed by the Council for this purpose. The following are particulars of the inspections and examinations made during the year :— (8677) E 2 68 Table LXI.—Medical Inspection of Aliens. [###Classification of Aliens arriving at Victoria Station. Total. Medically Inspected. Medically Examined. Temporary Residents. Visitors 4,144 4,127 67 Business Visitors 3,800 3,785 3 Diplomatic 496 494 — Seamen — — — Contract Seamen 2 2 — Permanent Residents. Returning Residents 684 681 — Ministry of Labour Permits. Males 106 106 3 Females 71 71 9 Children 4 4 — Immigrants. Males 218 215 — Females 133 132 2 Children 33 33 — In Transit 285 284 — Total 9,976 9,434 84 Rejected for all causes — — — Transmigrants — — — Grand Total 9,976 9,934 84 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, duties connected with housing and infectious disease, factories, 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. 69 Table LXII.—District Sanitary Inspection. Inspection of premises :— Water-Closets— Dwelling-houses- Insufficiently ventilated or lighted 283 Primary Inspections— (a) On complaint 947 Directly approached from rooms 53 (b) Infectious disease 1,122 (c) Special Housing Inspections 1,126 Accommodation insufficient 64 Water Supply— (d) Housing Regulations, 1925 1,427 Insufficient or unsatisfactory 29 Cisterns dirty and uncovered 33 (e) Housing applications 285 Absence of—in parts of tenement houses 62 (f) Housing Act, 1936 (overcrowding) 340 Dustbins- (g) Other reasons 3,282 Absence of 32 Total 8,529 Insufficient 39 Defective 53 Re-inspections 10,828 Animals kept so as to be a nuisance 3 Other Premises— Other nuisances 454 Primary inspections— Dangerous structures noted 12 (a) On complaint 522 Overcrowding 71 (b) Other reasons 7,507 Sanitary works supervised :— Total 8,029 Drains (including soil, waste, rainwater pipes, etc.)— Re-inspections 5,796 Constructed 6,782 Altered, repaired, etc 1,291 Total number of inspections for all purposes 33,182 Intercepting traps fixed 62 Petrol interceptors provided 33 Tested by smoke 525 Sanitary Works- ,, chemical 390 Total Inspections— ,, water 1,242 (a) Under notice 2,176 „ air 622 (b) Voluntary works 11,561 W ater-closets— Nuisances, etc.:— Constructed 1,814 Defective or dirty conditions Repaired and reconditioned 596 of internal structure 1,242 Urinals— Verminous conditions 221 Constructed 216 Damp conditions 565 Repaired and reconditioned 42 Inadequate under-floor ventilation 216 Waste Fittings fixed— Defective drainage, water- Baths 1,362 closets, etc. 496 Bidets 85 „ roofs 152 Lavatory basins 2,927 ,, paving of areas, etc. 28 Sinks, etc. 2,237 Nuisances.—Intimation notices were served in 894 instances, the number of premises concerned being 862. Statutory notices authorised by the sanitary authority numbered 26 and related to 26 premises An owner was prosecuted under the byelaws of the London County Council for failing to maintain water-closets in a proper state of repair The necessary work having been completed before the hearing of the case, the summons was withdrawn on payment of £2 2s. costs. 70 The following are the comparative figures since 1934 :— Table LXIII.—Nuisances. 1934 1935. 1936. 1937. 1938. Intimation Notices 2,060 1,776 1,471 1,080 894 Statutory Notices 66 89 73 67 26 Legal Proceedings 3 3 5 1 1 Water Supply.—The Metropolitan Water Board sent 17 notices of withdrawal of water supply to premises. Fifteen were in respect of failure of the occupiers to pay the water rate, and the remaining two for non-compliance with the Regulations of the Metropolitan Water Board. 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 62 water supplies (additional) were provided in these working-class tenement houses. Shops Act, 1934.—During the year, 1,052 shops were inspected, and 1,242 inspections were made. A total of 46 notices was served requiring the provision of:— Notices. Suitable and sufficient means of ventilation 18 Means to maintain a reasonable temperature 12 Suitable and sufficient sanitary conveniences 6 Remedying other defects 10 Total ... 46 An occupier was prosecuted for failing to comply with the provisions of the Act relating to ventilation of a shop. The summons was withdrawn on payment of £1 Is. costs, the work having been completed before the hearing of the case. 71 Factories 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 1938, the number of inspections made, and the results of such inspections :— Table LXIV.—Factories. Premises Registered. Trad 33. Total Number. Tailors, shirt makers, hat and cap makers 1,418 Dressmakers, milliners, embroiderers, costumiers, lingerie makers, children's outfit makers, feather workers, corset makers, furriers, etc 1,466 Leather workers, boot and shoe makers, harness makers, etc 76 Woodworkers, upholsterers, carvers, gilders, etc 91 Tobacco manufacturers 8 Wig makers and hair workers 47 Printers, bookbinders, lithographers, stationers, relief stampers, etc. 60 Jewellers, silversmiths, diamond cutters and polishers, engravers, etc 54 Metal workers 47 Miscellaneous 38 Florists 27 Laundries 17 Bakehouses 53 Photosraphers 66 Cinema film workplaces 19 Total 3,487 The use of 350 factories was discontinued, and 163 additions were made to the register during the year. Table LXV.—Factories and Workplaces. Inspection for Purposes of Provisions as to Health. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (with mechanical power) 245 1 — Factories (without mechanical power) 2,247 184 — Other premises under the Act, but not including outworkers' premises 3,415 218 — Total 5 ,907 403 — 72 Table LXVI.—Factories and Workplaces. Defects found. Particulars. Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to h.m. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 191 191 — — Inadequate ventilation 26 26 Overcrowding 7 7 Ineffective drainage of floors Other nuisances 77 77 — — Sanitary conveniences— Insufficient 13 13 Unsuitable or defective 113 113 — — Not separate for sexes 22 22 — — Other offences — - (Excluding offences relating to Home Work and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, reenacted in Factories Act, 1937.) Total 449 449 — — Table LXVII.—Factories and Workplaces. Other Matters. Class. Number. Visits to Outworkers' premises olher than factories 177 Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factories Act 92 Matters referred by H.M. Inspectors 47 Workrooms measured 185 Visits of Enquiry re Employment of Women 92 „ „ Outworkers 110 Underground bakehouses in use at the end of the year 33 A copy of a table relating to outworkers required by the Home Office under the Factories Act, 1937, and giving information under the headings of Sections 110 and 111 is appended. 73 Table LXVIII.—Factories and Workplaces. Outworkers. Outworkers' Lists, Section 110. Outwork in unwholesome premises, Section 111. Trade. Lists received from employers. Addresses of Outworkers. Notices served on occupiers as to keeping or sending of lists. Prosecutions. Instances. Notices served. Prosecutions. Failing to keep or permit inspection of lists. Failing to send lists. Sending twice in the year. Sending once in the year. Outworkers. Outworkers. Received from other Councils. Sent to other Councils. Lists. Contractors. Workmen. Lists. Contractors. 1 i Workmen. Wearing apparel 903 1,982 7,047 22 43 30 329 5,007 156 — — — — — Linens, etc. 5 22 25 — — — 4 99 — — — — — —— Furriers 9 40 10 — — — 16 54 — — — — Miscellaneous 7 58 30 — — — 31 36 — — — — — — Total 924 2,102 7,112 22 43 30 380 5,196 156 — — — — — 74 Outworkers.—A total of 946 lists was received during the year. Notices in respect of failure to send lists were sent to 156 firms. No legal proceedings were necessary. The lists contained 9,287 names and addresses, of which 5,196 were in other districts, 4,493 being within the Metropolitan area and 690 in the London Suburban districts. The number of individual outworkers in the City at the close of the year was 1,561, of whom 1,483 were registered as occupying factories. The number of premises in which outwork was being carried on was 649. Factories Act, 1937.—This Act, of which details were given in last year's report, came into force in July, 1938. 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 (private owner) 201 — Bruce House, Kemble Street (London County Council) 716 — 33, Creat Peter Street (Church Army) 80 — 7, St. Ann's Street (Salvation Army) 565 — 28-30, Greencoat Place (Church Army) — 184 The City Council renewed all licences for a period of one year from 1st July, 1938. 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, 158 inspections were made, 52 being between the hours of 6 p.m. and 9 a.m. A satisfactory standard has been maintained during the year in four of the houses. In the fifth, owing to inadequate staff, a satisfactory standard of cleanliness was not obtained, and the washing and lighting facilities were inadequate. These conditions were improved following representations to the owner, and electric lighting was substituted for gas. The owner provided a small canteen for the use of the lodgers. This house is in a somewhat lower grade than the other common lodging houses, but serves a useful purpose as it provides accommodation for the type of lodger who does not expect, nor can he afford, the amenities of the others. 75 Houses Let in Tenements.—The sanitary inspectors paid 3,811 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 337 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. 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 used there only in making up material for mattresses, &c. 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. 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 :— Millbank School. Royal College of Music, Prince Consort Road. Warwick Junior School, Ranelagh Road. Rat Repression.—During the year 136 complaints were received and investigated; 274 premises were visited and 352 inspections 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. 76 For the purpose of investigating complaints in premises the City Engineer's staff examined the sewer connections of some 101 premises; 22 were found to be defective and notices requiring repair or renewal were served upon the persons responsible. During "Eat Week," 10,480 baits were laid in the sewers and 1,375 at the Council's depots, etc. The number of dead rats discovered or killed was 196. The laying of baits in the sewers is carried out at regular intervals throughout the year as a matter of routine. Noise Nuisances.—Complaints were made in respect of 23 noise nuisances during the year, and these were adequately dealt with by informal action. They related to the noise of machinery, wireless sets, electric drills in streets, &c. One complaint was of noise from a pin-table saloon and another from an all-night cafe. Fire alarm bells on two large adjoining buildings caused considerable annoyance to residents in the neighbourhood by ringing almost every day at about 2 a.m. The cause of this baffled investigation at first, until it transpired that the ringing of the bells coincided with the flushing of the street by the Highways Department. The operation of the hydrants had caused the bells to ring, the alarm systems being connected with " sprinkler " extinguishing systems. Certain minor adjustments in the sprinkler systems were all that was necessary to abate the nuisance. Nuisance from Pigeons.—During the year, 23 complaints of nuisance from pigeons were received and investigated. Complaints were more numerous than in previous years, and it appeared that the pigeon population had considerably increased, particularly in Trafalgar Square. In consequence, the Council's contractors were instructed to intensify their activities and by the end of the year some 1,400 pigeons had been caught, this being double the number obtained last year. Public Health (London) Act, 1936, Section 224.—Removal of Aged, Infirm or Physically Incapacitated Persons to Suitable Institutions. Twenty-three 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. 77 An order was obtained for her removal, and she was admitted to an institution. 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.—This treatment is carried out at the Council's Disinfecting Station. Individuals, numbering 329 men, 81 women, and 20 children (under school age), were cleansed, making 668 attendances. and 11,388 articles of clothing, bedding, &c., were disinfected. Visits to premises numbered 111. Cleansing of School Children.—Under an agreement with the London County Council, school children from the boroughs of Battersea, Chelsea, Fulham, Kensington, Lambeth and Wandsworth attended for treatment at the disinfecting station. Among Westminster school children 392 cases of head lice, 2 of body lice, and 60 of scabies were treated. In all cases the clothing was disinfected, together with the bedding from their homes, amounting in all to 1,770 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows : 74 for head lice and 20 for scabies. Articles of clothing disinfected numbered 570. The total number of attendances of school children for baths at the disinfecting station was 1,120. Notices from the London County Council in respect of verminous children numbered 48 and 60 visits of inspection were paid to the families concerned. The following table shows the number of individuals who received treatment:— 78 Table LXIX.—Cleansing of Persons. 1938. Head lice. Body lice. Scabies. Total. Children (including those under 467 3 98 568 school age). Adults 2 255 153 410 469 258 251 978 Eradication of bed bugs.—The Ministry of Health in Circular 1728 asks 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 15 and of other houses 221. 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 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 the most 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. 79 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 1938. During the year the furniture and effects of 192 families were dealt with by the contractor. Of this number, 126 were removed to the City Council's dwellings, 39 to dwellings of the Chelsea Borough Council, and 4 to the Tachbrook Estate of the Westminster Housing Trust. Twentythree cases were dealt with at the request of the Grosvenor Estate, the families concerned being rehoused in other dwellings belonging to the Estate. Articles of bedding, clothing, etc., totalling 6,522, 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 6 occasions during the year, for periods varying from one day to three weeks. 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 in co-operation with the Sanitary Inspector in charge of disinfestation (Mr. W. L. French) gives such advice and help as appear to be necessary in dealing with vermin. Talks by Mr. French, on the subject of vermin in the home, are given from time to time to mothers attending the Maternity and Child Welfare Centres. Table LXX.—General Disinfection of Premises, Articles, etc. 1934. 1935. 1936. 1937. 1938. Rooms 1,058 674 837 663 599 Articles disinfected 22,174 22,759 25,643 26,951 28,069 Articles washed 3,450 3,800 3,400 3,450 3,500 Articles destroyed 300 281 565 312 105 Books disinfected * 132 421 114 206 25 Vehicles ,, 15 38 41 53 60 Offices and business premises 6 11 17 5 8 • Library books, 19; private books, 6. 80 Coroner's Court and Mortuary. There were 199 bodies removed to the mortuary during the year by order of the Coroner or to await burial. Inquests were held in 127 cases but not in 68, while 4 bodies were received to await burial. Post-mortem examinations were made in 177 instances. The following is a list of the causes of death of the cases brought to the mortuary:— Drowning 7 Street accidents 16 Other accidents 26 Murder 1 Suicide 36 Natural causes 63 Misadventure 24 Other miscellaneous causes 26 HOUSING. Overcrowding. In 71 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. Alleviation of overcrowding was effected iu the following instances :— Rehoused by the Westminster City Council 15 Rehoused by the London County Council 35 Rehoused by Housing Trusts, Societies, Private tions, &c. 9 Families who obtained other or additional accommodation in privately-owned dwelling houses or where some members of the family left the household 115 Total 174 81 Closure of Parts of Buildings. Closing Orders to the number of 190 were made prohibiting the use of parts of buildings for human habitation, and in seven 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, 196 related to basements and 1 to a part of a house other than a basement, comprising in all 542 rooms. In 77 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 273 basements. In addition to the basements which have been the subject of formal procedure, 158 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 was 431 (1,163 rooms). An unsuccessful appeal was made to the County Court against a decision of the Council not to allow three basement rooms, the subject of a Closing Order to be relet for human habitation. Since the procedure relating to basements was begun, 1,318 have been dealt with up to the end of 1938. The total of Closing Orders made is 696 ; undertakings 36. Reconditioning for occupation has been completed or was in hand in 698 basements, including those done voluntarily. Demolition Orders. One house was made the subject of a Demolition Order. The Housing Committee and its Standing Sub-Committee, besides meeting on 18 occasions, held 5 special meetings for the purpose of interviewing persons interested in the premises under consideration for closure or demolition ; 1,536 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 262 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 118 For reconditioning basements prior to or apart from any formal action by the City Council 139 For reconditioning whole houses 5 (8677) F 82 Reconditioning works were carried out in 218 basements during the year, whilst in 166 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 31 basements for purposes other than that of human habitation. Provision of New Houses for the Working Classes. Rehousing Operations.—During the year 67 families were rehoused by the City Council and 96 by the London County Council, making a total of 163 families removed from unsatisfactory dwellings. The estates on which these families were accommodated are as follows :— Westminster City Council Estates. Admiral House 1 Ebury Bridge 9 Ebury Bridge Extension 4 Grosvenor Housing Scheme 12 Marshall Street Dwellings 2 10/11, Monck Street 1 Regency Street Dwellings 36 St. James' Dwellings 1 Walden House 1 — 67 London County Council Estates Battersea Bridge Buildings 1 Becontree 4 Bellingham 1 Clapham Park 2 Comber 1 Downham 6 Duke's Court and York Street 3 East Hill, Wandsworth 2 Hanwell 1 Herbrand Street 1 Kennington Park 5 83 London County Council Estates—continued. Lilford Road 2 Millbank 36 Mottingham 1 Newburn Street 2 Norbury 1 North Avenue 1 Oaklands 1 Old Oak 1 Roehampton 3 St. Helier (including Morden) 3 Shelton Street 1 Springfield 1 Stamford Hill 2 Stockwell 2 Streatham Hill 1 Totterdown 1 Vauxliall Gardens 3 Wandsworth Road 1 Watling 2 Wormholt 4 — 96 Total 163 84 Table LXXI. 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) 8,529 (b) Number of inspections made for the purpose 19,357 (2)—(a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,427 (b) Number of inspections made for the purpose 3,974 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 274† (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 609* 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 152 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 *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. 85 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 527 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 527 (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 suance of Demolition Orders 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 197 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 94 4. Housing Act, 1936. Part IV.—Overcrowding. (а)—(i) Number of dwellings overcrowded at end of year 519 (ii) Number of families dwelling therein 519 (iii) Number of persons dwelling therein 2,448 (b) Number of new cases of overcrowding reported during the year 71 (c)—(i) Number of cases of overcrowding relieved during the year 174 (ii) Number of persons concerned in such cases 925 (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— 86 Rent Restriction Acts, 1920-38.—During the year 14 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. 210 applications were received for registration under section 4 (2) of the Act of 1938. The number of "dwelling-houses" included in those applications totalled 1,076. The number of dwelling-houses on the register at the end of the year was 8,994. Certificates of registration or non-registration, which local authorities are required to issue on payment of a fee of Is., were issued in 193 cases, 189 being in respect of registered houses and 4 non-registered. There were no cancellations of registration by the County Court. 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 LXXII.—Smoke Abatement—Results of Observations and Action Taken. - 1934. 1935. 1936. 1937. 1938. Complaints received 58 47 78 36 35 Observations taken 875 830 728 522 545 Notices issued— Preliminary 5 22 19 24 15 Statutory — — 2 2 2 Legal Proceedings - - - — — There were no prosecutions in respect of smoke nuisances during 1938. 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. CHART “A." ATMOSPHERIC POLLUTION, AUTOMATIC AIR FILTER. Readings taken at City Hall, Charing Cross Road. 1938 shown thus Average for the 6 years 1932-37 Average degrees of suspended impurities estimated for the year 1938, compared with the average for the years 1932-1937, showing the variations at each hour in the 24 hours. The means are calculated on this graph to show in convenient form the sum of pollution throughout the whole year interpreted in terms of a single period of 24 hours. To face page 87, DEGREES OF POLLUTION. (1 degree = 0.54 lb. of dirt per million cubic yards of air.) 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. Weight of SO2 Visibility Rainfall—Trace (Tr) = under 0.1 mm. To face page 87. 87 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. A description of the apparatus and methods employed for the collection of this data was given in the report for the year 1937. Deposited Impurities. (1) 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. Table LXXIII.—Atmospheric Pollution—Analyses of Deposited Impurities. 1938. Figures in English Tons per Square Mile. Horseferry Road, S.W.1. Farm Street, W.1. Total Solids. Sulphur SO3. Daily Average. Total Solids. Sulphur. sO3. Daily Average. January 40.48 4.26 1.36 29.36 3.17 0.95 February 40.37 3.15 1.44 36.08 2.24 1.28 March 38.60 2.60 1.24 35.02 2.01 1.13 April 26.39 1.60 0.88 17.91 1.39 5.09 May 32.67 2.03 1.05 27.76 1.80 0.89 June 18.97 0.82 0.60 14.94 0.91 0.49 July 21.84 0.99 0.70 17.99 0.59 0.58 August 26.46 1.90 0.85 15.97 1.60 0.51 September 27.01 1.34 0.90 19.02 1.67 0.63 October 34.33 4.28 1.18 19.96 2.44 0.64 November 31.32 3.26 1.04 25.00 3.09 0.83 December 37.38 330 1.26 28.41 3.86 0.92 (2) The quantitative estimation of suspended impurities in the air is carried out by means of the automatic air filter. Chart "A" shows the amount of suspended impurities for an average day of 1938, together with a similar curve for the years 1932 to 1937. (3) Estimation of sulphur gas (as sulphur dioxide). Chart "B" indicates graphically the amount of sulphur gas correlated with visibility, wind direction and rainfall during 1938. (4) The measurement of sulphur activity is obtained by the lead peroxide method, which was described in the Report for 1937. Three of the cylinders are installed in the City, and the results obtained during the year are shown in the following table:— 88 Table LXXIV.—Atmospheric Pollution—Measurement of Sulphur Activity. Table LXXIV.—Atmospheric Pollution—Measurement of Sulphur Activity. Month. City Hall, W.C.2. Farm Street, w.1. Horseferry Road, S.W.1. January 4.02 4.03 3.57 February 3.68 4.22 4.12 March 3.50 2.88 3.07 April 2.337 3.01 2.377 May 1.965 2.390 2.039 June 1.562 1.398 1.659 July 1.656 1.539 1.523 August 1.650 1.606 1.468 September 1.737 2.133 1.837 October 2.549 1.800 2.445 November 4.02 4.137 3.497 December 4.576 4.539 4.910 These figures show the amount of sulphur tri-oxide, in milligrammes formed on a piece of fabric 100 square centimetres in area, per day, due to the active sulphurous impurities in the atmosphere. INSPECTION AND SUPERVISION OF FOOD. The inspection of food and of premises where foodstuffs are stored or sold receives constant attention. One thousand eight hundred and twenty-three samples of various foods and drugs were purchased for analysis, while 2,546 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 131 were served in respect of various defects. All were complied with, no legal proceedings being necessary. Certification of food for export.—Ten certificates were issued in respect of the export of articles of food to Switzerland. 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, 1938, there were 146 premises on the register for the sale or storage of ice cream, of which 28 were also registered for the manufacture of this commodity. Twenty-one premises were added to the register, and 140 inspections were made during the year. Two notices requiring remedy of defects were served and were complied with. 89 During the year 29 samples of ice-cream were obtained for bacteriological examination and the results are tabulated below. Table LXXV.—Ice-Cream. Bacteriological Examinations. No. of Sample. No. of Colonies per c.c. B. Coli per c.c. Positive. Negative. S.1 180,000 + 0.001 - 8.2 16,000 — - 0.1 S.4 40,000 + 0.01 - 0.001 S.5 6,000 — - 0.1 S.6 640,000 — - 0.1 S.7 8,000 — - 0.1 S.8 21,000 — - 0.1 S.9 70,000 — - 0.1 S.10 15,000 + 0.1 - 0.01 S.11 10,400 - - 0.1 S.12 4,000 — - 0.1 S.13 12,000 — - 0.1 S.14 240,000 + 0.01 - 0.001 S.15 12,000 — - 0.1 S.I6 26,000 - - 0.1 n.l 32,000 — - 0.1 N.2 14,000 — - 0.1 N.3 70,000 + 0.1 - 0.01 N.4 86,000 + 0.1 - 0.01 N.5 108,000 + 0.01 - 0.001 n.6 12,000 - - 0.1 N.7 176,000 + 0.1 - 0.01 n.8 4,000 - - 0.1 N.9 1,280,000 + 0.001 - n.10 144,000 + 0.001 -: n.11 17,400 — - 0.1 N.I2 1,300.000 + 0.001 — N.13 1,040,000 + 0.001 — N.14 106,000 — 0.1 The attention of the vendors was directed to the results where counts of over 200,000 colonies per c.c. were obtained, or where B. Coli was found to be present in 0.001 c.c. Samples taken subsequently in these cases indicated a general improvement. Preserved meat, etc., premises. One hundred and eighteen premises were on the register for the manufacture of pressed, pickled, potted or preserved meat, fish or other foods. Five new registrations were made during the year. Eightynine inspections were made. The premises generally were satisfactory and well conducted. (8677) f3 90 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. 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. The duties under these Acts are carried out by the food inspectors in the course of their inspection of food premises and stalls. They made 250 observations during the year but no infringements were detected. Artificial Cream Act, 1929. There are two premises in the City registered under the provisions of this Act and four visits of inspection were paid to them. A considerable amount of artificial cream is made in bakehouses for use in confectionery, and in restaurants for consumption on the premises, but such premises are exempt from registration. Milk and Dairies (Consolidation) Act, 1915. Tubercle bacillus in milk.—Six samples of milk were taken during the year for bacteriological examination, and all gave negative results. The milk was taken from shops in the ordinary course of delivery from purveyor to customer. Milk and Dairies Amendment Act, 1922. Milk (Special Designations) Orders, 1936 and 1938. The following licences were issued by the Council during the year:— Dealer's Supplementary licences. licences. Tuberculin tested 21 5 Accredited 4 — Pasteurized milk 34 7 Pasteurization of milk is not undertaken at any premises in the City. 91 Bacteriological Examination or Milk. Eighteen samples of undesignated milk were taken for bacteriological examination and the following results were reported. Table LXXVI.—Milk. Bacteriological Examinations. No. of Sample. Colonies per c.c. B. Coli per c.c. Positive. Negative. S.1 70,000 - - 0.1 S.2 54,000 — - 0.1 S.3 28,000 — - 0.1 S.4 16,000 — - 0.1 S.6 46,000 — - 0.1 S.7 180,000 — - 0.1 S.8 20,000 + 0.01 - 0.001 S.9 60,000 + 0.01 - 0.001 S.10 48,000 — - 0.1 S.11 104,000 + 0.001 — S.12 324,000 + 0.001 - S.13 31,800 + 0.1 - 0.01 N.32 14,000 - - 0.1 N.33 22,000 + 0.1 - 0.01 N.34 74,000 + 0.01 - 0.001 N.35 32,000 + 0.1 - 0.01 N.36 160,000 - - 0.1 N.37 21,000 + 0.1 - 0.01 Where counts of 200,000 colonies per c.c. were obtained or B. coli was found to be present in 0.001 c.c., special investigations were made as to methods of storage, handling, etc. As a result of measures adopted further samples taken showed definite improvement. Milk Bars.—The number of milk bars established in the City is now 22. 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 included in the tables relating to milk and ice cream samples. Milk and Dairies Order, 1926. Proceedings were instituted under Article 31 of the above order against a milk roundsman for bottling milk in the street. The defendant was fined £3. 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:— 92 Table LXXVII.—Registration of Dairymen and Dairies. Premises. Persons. Registered to 31st December, 1937 169 229 Registered during year 1938 9 17 Removed from register (ceased or transferred business) 12 5 Registered to 31st December, 1938 166 241 The inspectors paid 299 visits to milk shops and dairies during the year, Eleven notices were served in respect of minor defects which were duly rectified. Food and Drugs (Adulteration) Act, 1928. Analysis of milk samples.—Of the total of 896 samples of milk taken during the year, 78 were taken on Sundays. The action taken in regard to adulterated samples of milk is shown below:— Table LXVIII. Adulterated Samples of Milk. Sample No. Extent of Adulteration. Action taken and result thereof. N.99 Was 17 per cent. deficient in fat Summary proceedings. A penalty of £2 was imposed together with £2 2s. costs. N.109 Contained 1.3 per cent. of added water and was 0.7 per cent. deficient in fat. Vendor cautioned. N.119 Contained 3 per cent. of added water Vendor cautioned. N.219 Contained 1.8 per cent. of added water. Vendor cautioned. N.767 Contained 3.9 per cent. of added water. Vendor cautioned. N.768 Contained 3.9 per cent. of added water. Vendor cautioned. S.69 Was 14 per cent. deficient in fat Summary proceedings. Summons dismissed under Probation of Offenders Act on payment of £5 5s. costs. S.301 Was 6 per cent. deficient in fat and 1.53 per cent. deficient in nonfatty solids. Summary proceedings. A penalty of £2 was imposed. S.607 Was 16 per cent. deficient in fat Summary proceedings. Summons dismissed under Probation of Offenders Act on payment of £3 3s. costs. S.782 Was 31 per cent. deficient in fat Summary proceedings. Summons dismissed under Probation of Offenders Act on payment of £1 10s. costs. S.860 Was 10 per cent. deficient in fat Summary proceedings. Summons dismissed under Probation of Offenders Act on payment of 2s. costs. The Milk Act, 1934. Milk Marketing Board's Scheme for the Supply of Milk to Schools. By arrangement with the London County Council samples of milk delivered to schools in the City under this scheme were taken in course of delivery to such schools for the purpose of chemical analysis and bacteriological examination. Thirty-six samples for bacteriological examination were obtained. Three samples showed counts of over 200,000 colonies per c.c. The facts were brought to the notice of the vendors and the appropriate authorities. In each case further samples were taken and proved satisfactory. Samples taken at the same time for chemical analysis were found to be genuine. Public Health (Condensed Milk) Regulations, 1923 and 1927. Fifty-two samples were taken and found to be genuine and properly labelled. Public Health (Dried Milk) Regulations, 1923 and 1927. One sample was taken and found to be genuine and properly labelled. 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. Eleven infringements of these regulations were found as a result of analysis of samples, details of which are set out in tbe following pages, 93 94 Table LXXIX. Samples purchased under the Food and Drugs (Adulteration) Act, 1928, showing results of Analysis and subsequent Proceedings for year 1938. Number. Article of Food or Drug. Number of samples purchased. Genuine. Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ s. d. £ s. d. 1 Almonds 1 1 — — — - - 2 Brandy 4 4 — — — — — — 3 Bread 1 — 1 — — — - — 4 Butter 140 140 — — — - - — 5 Cereals 28 28 — — — - - — 6 Cheese 24 24 — — — - - — 7 Cocoa 8 8 — — — - - — 8 Coffee 5 5 — — — - - - 9 Confectionery 19 19 — — — - - — 10 Condiments & Spices 7 7 - — — - - - 11 Cordials 34 34 — — - — - — 12 Creams 81 81 — — — — - — 13 Drugs 37 37 — — — — — — 14 Fish Paste 32 32 — — — — — — 15 Fish (preserved) 31 24 7 7 1 6 1 0 0 34 6 0 16 Fruit (preserved) 36 35 1 — — — — — 17 Gin 10 10 — — — — — — 18 Ice Cream 28 28 — — — - - — 19 Jams & Preserves 24 24 — — — — - — 20 Lard 10 10 — — — — - — 21 Margarine 16 16 — — — — — — 22 Meat Paste 20 20 — — — — — — 23 Meat (preserved) 30 30 — — — — — — 24 Milk 896 885 11 8 2 6 4 0 0 12 2 0 25 Milk (condensed) 52 52 — — — — — — 26 Milk (dried) 1 1 — — — — — — 27 Oils 12 12 - - — — — — 28 Pickles & Sauces 33 33 - — — — — — 29 Rum 5 5 - — — — — — 30 Sausages 60 60 - — — — — — 31 Soups (tinned) 7 7 - — — - — — 32 Sugar 2 2 - — — — — — 33 Tea 21 21 - — — — — — 34 Vegetables(pr's'rv'd) 21 18 3 — — — — — 35 Vinegar 36 35 1 — — — — — 36 Whisky 33 33 — — — — — — 37 Wines 18 18 - - - - - - 1,823 1,799 24 15 3 12 5 0 0 46 8 0 Bread.—A loaf of bread purchased at a shop in the City was submitted to the Department, and on analysis was found to contain some ferrous substance. The matter was taken up with the baker, and the presence of the foreign matter was found to be due to the use of a defective container. 95 Cheese.—Twenty-four samples were obtained, the majority being of the foil wrapped type. A carton of foil wrapped cheese was submitted to the department which on macroscopic examination appeared to contain crystals of glass. The vendors were interviewed, and on the nature of the complaint being disclosed to them, the remainder of the stock was immediately withdrawn from sale. A sample from this consignment was submitted to the analyst when the "glass" was found to be crystals of lactose. Preserved Fruits.—Thirty-six samples of tinned, crystallized, dried, and fresh fruits were purchased for analysis. One sample of fresh green plums was reported as adulterated inasmuch as it contained 250 parts per million of sulphur in the form of a dusting powder on the fruit. A sample of greengages was found to show traces of arsenic to the extent of l/500th gr. per lb. Nine samples of grapes were purchased, 4 of which contained minute amounts of arsenic varying from l/800th gr. to l/200th gr. per lb. Preserved Vegetables.—Twenty-one samples of tinned vegetables and vegetable products were purchased. Three samples of tomato puree were found to be adulterated since they contained copper in amounts varying from 35 to 110 parts per million. The vendors were cautioned in each case. Preserved Fish.—Thirty-one samples of tinned, salted &c., fish were purchased. Seven samples of tinned anchovies were reported to contain a preservative, viz., a benzoic acid substance. Summary proceedings were instituted. Vinegar.—Of the 36 samples of vinegar examined 1 sample of wine vinegar was found to be deficient in acetic acid. The deficiency was due to selling the soured wine before the acetification of the alcohol was completed. The vendor's attention was drawn to this deficiency. 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. 96 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 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 1938 was 129. The inspectors paid 85 visits to these premises, including stalls. Six notices were served in respect of minor defects and were complied with. Restaurants.—The register of restaurants includes 1,478 premises. During the year 1,236 inspections were made, particular attention being paid to kitchens, pantries, messroom arrangements for staff, systems for washing up, and general sanitary arrangements. Defects requiring notices were found in 92 instances, and in each case the work was satisfactorily carried out. Bakehouses.—At the end of 1938 there were 53 bakehouses in use in the City, of which 33 were underground. One hundred and fifty-six 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 38 instances. Fried Fish Shops.—There are 18 fried fish shops in the City to which the food inspectors paid 14 visits. It was necessary to send two notices for cleansing. Table LXXX.—Unsound Food. Article. Tons cwts. qrs. lbs. Article. Tons. cwts. qrs. lbs. Almonds (green) 1 1 0 Mandarines 9 0 0 Apples 339 19 1 0 Melons 2 7 3 0 Artichokes 7 3 0 Nectarines 5 1 7 Aubergines 4 3 0 Onions 6 6 0 0 Avocado Pears 5 3 0 Oranges 49 0 0 0 Beans 11 1 7 Peaches 3 0 Bitter Oranges i 13 0 0 Pears 4 3 3 0 Capsicums 1 0 0 Peas 3 13 0 a Carrots 5 3 14 Pineapples ... 3 18 0 20 Cherries 1 4 Potatoes 3 19 0 0 Chestnuts 1 0 0 0 Radishes .... 2 0 Dates 1 1 0 Spinach 3 15 2 0 Endive 8 1 0 Sprouts 14 0 0 Grapes 2 18 2 0 Strawberries 1 0 0 Grapefruit ... 21 8 0 0 Turnips 3 14 Grenadillas 1 0 Fish 1 0 Horseradish 4 0 0 Lobster 1 9 Lemons 8 0 0 Meat 6 Lettuce 3 1 0 0 97 A consignment of some 50,000 cases of imported apples affected with "brown heart," which had been unloaded at the London Docks, were released to premises in Westminster on condition that they were sorted prior to sale to the general public. About 50 per cent. of the consignment was condemned as unfit for human consumption. Some 14,000 cases of apples were destroyed and the remainder were either re-exported or disposed of for purposes other than human food. Food Poisoning.—No case was notified by medical practitioners in the City, but five cases brought to notice by Medical Officers of other districts or directly by the persons affected were investigated. All were in respect of meals taken at restaurants in Westminster. No definite information could be obtained as to the actual cause of the illness of the persons concerned, and there was no evidence that other persons had been affected. In one instance, conditions in the restaurant premises were not altogether satisfactory and notice was served upon the occupier. Oysters—Typhoid Fever.—During the latter months of 1938 a number of letters from various medical officers of health were received with reference to the possibility of typhoid fever in their districts being caused by oysters bought in Westminster. Oysters from all the main sources of supply were obtained and bacteriologically examined, while full enquiries were made. No evidence sufficient to indicate that oysters were the source of infection was 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 218 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 simdriesmen. Thirteen names were removed from the register and 10 were added during the year. Two samples were examined during the year, one a hair dye and the other a sanitary fluid; both were found to be satisfactory.