WES 57 AC 4344 Health Citv of Westminster. REPORT op the MEDICAL OFFICER OF HEALTH FOR THE YEAH 1947 ANDREW J. 8HINNIE, M.D., D.P.H. (Lond.) Medical Officer of Health and Administrative Tuberculosis Officer LONDON: HARRISON AND SONS, LTD. PRINTERS TO HIS MAJESTY THE KING, ST. MARTIN'S LANE, W.C.2. 3 CONTENTS. Page Ante-and Post-Natal Clinics 16 Atmospheric Pollution 26 Bacteriological Examinations 12 Births 10 Botulism 20 Catering Establishments 24 Child Life Protection17 Convalescent Treatment for Mothers and Children 16 Coroner's Court and Mortuary 27 Dairymen and Dairies, Registration of 25 Day Nurseries15 Deaths, Causes of 10, 11 Dental Treatment 18 Diabetic Patients 20 Diphtheria Immunization 18 Disinfection 26 Domestic and Home Help Service 19 Dwelling Houses 23 Factories 24 Food, Inspection and Supervision of 24 Food Poisoning 20 Health Visitors, Visits by 16 Home Nursing 19 House to House Inspection 21 Ice Cream 25 Illegitimate Children 17 Infant Clinics 16 Infantile Mortality 10, 11 Infectious Diseases 12 Insulin Treatment 20 International Certificates of Vaccination and Inoculation 21 Introduction 5-9 Legal Proceedings 26 (9063) a 2 4 Page Mass Miniature Radiography 14 Maternity Beds 14 Maternity and Child Welfare 15 Medical Inspection of Aliens 21 Mobile Meal Service 19 Mothercraft Classes 16 Noise Nuisance 26 Notices 23 Pharmacy and Poisons Act 25 Population 10 Premature Infants 16 Preserved Meat Premises 25 Premises 23 Private Deep Wells 22 Rats 25 Rheumatism Clinic 21 Sanitary Circumstances 21 Schick Testing 19 Sheets for Expectant Mothers 18 Slaughter of Animals Act, 1937 20 Statistics and Social Conditions 10 Tuberculosis 13 Tuberculosis Dispensary 13 Tuberculosis Maintenance Allowances 14 Vaccination 12 Water 22 Welfare Foods 18 Workplaces, Shops, etc. 25 5 To the Right Worshipful the Mayor, Aldermen and Councillors of the City of Westminster. My Lord, Ladies and Gentlemen, I beg to submit my report on the public health and sanitary conditions of the City for the year 1947. The scope of this report is prescribed by the Minister of Health who requests that it should again be in abbreviated form (Circular 13/47) as has been the practice ever since the outbreak of war in 1939. This is the last report which I shall make dealing with a complete year of the operations of those services which were transferred from the Council to other authorities under Part III of the National Health Service Act, 1946. They ceased to be the responsibility of the City Council on 5th July, 1948. In the period of 48 years since the City Council was formed there have been two Medical Officers of Health, the late Ur. F. J. Allan and myself, each having served as Medical Officer of Health for a period of approximately 24 years. When Dr. Allan was appointed in 1901 these personal health services did not exist. It was largely due to him that between 1902 and 1904 Maternity and Child Welfare, Care of Consumptives, and other personal health services came into being in Westminster. This was probably earlier than in most parts of the country. It was a period when the spirit of voluntary service was strong and there was no lack of willing helpers with experience of social problems. They had the time to spare and the means to contribute to the material side of the movement for in those early days voluntary bodies could not look for Government grants. All this voluntary service was organised in a body established as the Westminster Health Society. The Society now in its 45th year still actively maintains its maternity and child welfare service in one area of the City. It was first in the field in Westminster, many years before the City Council was legally empowered to promote such services, and has survived to see the City Council itself deprived of those powers granted only some thirty-odd years ago. Under the National Health Service Act of 1946 all the staff responsible for maternity and child welfare, tuberculosis dispensary and other services and the buildings in which they work were automatically transferred to the London County Council and the Regional Hospital Board on 5th July of this year. I have already in a small booklet issued by the Council earlier this year made somewhat full reference to the origin and rise of the personal health services in Westminster and shall do no more than mention that I am proud to have been associated in the development of these services in the founding of which my predecessor, Dr. Allan, played so considerable a part in the early years of the century. 6 Matters which the Minister does not wish to be excluded from this report are tuberculosis (including the allowance scheme), progress of diphtheria immunization, poliomyelitis and the care of premature infants and illegitimate children. All these receive due comment but venereal disease mentioned also by the Minister is not within the purview of the City Council. The population, according to the Registrar General's estimate, rose from90,110in 1946 to 103,440 in 1947. This estimated increase of 13,000 persons is confirmed by the data in the possession of the Local Food Executive Officer. It is a very substantial increase, the equivalent of a country town and cannot be due solely to a return of residents to their former homes. It must largely reflect the prodigious efforts made in providing additional housing by requisitioning houses, adapting them into multiple dwellings and by the restoration of severely damaged properties. Overcrowding still exists but in no more aggravated degree than before the war but it is true to say that houses, particularly those let in single furnished rooms are occupied more fully; for example, rooms formerly let to individuals often now contain married couples. The birth rate at 15-4 per 1,000 living at all ages is slightly higher and contrasts with a rate of 8-2 in 1937, the last year of freedom from rumours of war and, dare one say it, peace and plenty. Now in an era of controls, scarcities, tightened belts, and uncertainties as to the economic future, the number of babies born has almost doubled. This surely is not the reaction of a downcast people but rather of a virile and confident race. Motherhood for the moment is all in the fashion. Before the war it was rather demode. Young married people in that decade thought that to have children was old fashioned and unintelligent. But it must be remembered that after the 1914-18 war there was a similar rise in the birth rate ; in Westminster it went up to 16-1 in 1920 but did not remain at that high level falling to 10-5 in 1930. The death rate at 11-0 per 1,000 compares with 11-3 in 1946. If it had not been for the severe wintry conditions in the first three months of 1947 the death rate might have been still lower because of the ameliorating influences of the exceptionally warm summer of 1947, so fine that it almost echoed the golden summers of 1911 and 1921. The very old and the very young tend to wither and die in very cold winters. Diseases of the heart and blood vessels again accounted for more than a third of all deaths ; malignant disease less than one-fifth, while, •tuberculosis which in 1920 caused 157 deaths, in 1947 caused 73 deaths As regards infectious disease, there was an outbreak of Poliomyelitis and Polio-Encephalitis which appeared in July and continued until December. The total cases in England and Wales notified was 9,262 ; in London, 1,058, and in Westminster 21. None of the Westminster cases died but there were 49 deaths in London and 708 in England and Wales. Sixteen cases of Diphtheria were notified in Westminster com- 7 tared with 48 in 1946 but whereas none of the 48 died in 1946, one of the 16 died in 1947. This was the case of a child of 4 years of age who unfortunately had not been immunized against diphtheria. It is computed that 86 per cent, of all children in Westminster between the ages of 1 to 5 years who have attended the Welfare Clinics have been immunized against diphtheria. The incidence of other infectious disease as shown by notifications was low in comparison with 1946, the most pronounced reductions were those relating to Scarlet Fever, Measles and Scabies. A case of Anthrax in a docker unloading hides from a ship from the Far East was diagnosed in the Out-patient Department of Westminster Hospital. He was transferred to St. Stephen's Hospital where, thanks to efficient treatment he made an uneventful recovery. Five cases clinically diagnosed as suffering from Botulism occurred in the autumn. One of the sufferers died soon after admission to hospital. The other three had persistent neurological vmptoms for some time after recovery from the acute phase. None of the patients lived in Westminster and tribute is paid to Dr. Bradley and Dr. Gale of the Ministry of Health who pursued careful investigations in the districts where the patients lived or were in hospital. Investigations were at the same time conducted by the staff of the Central Laboratory at Colindale in collaboration with my department, but no conclusive evidence was established as to the source of infection. The expansion of the Maternity and Child Welfare Service to meet the needs arising from the greatly increased birth rate continued from last year. The staff of health visitors had increased to 14 and the activities of the Welfare Centres continued to expand. The close association with Westminster Hospital whereby the complete care of the mother before, during and after confinement is in the hands of the obstetricians of the hospital has continued to gain increasing confidence from the women of Westminster, and has been of very great benefit to them. In 1947 293 home confinements were conducted by the hospital mid wives. Infant mortality at 33 per 1,000 was the lowest ever recorded in Westminster. A very satisfactory feature was the increase in legitimate births from 1,143 in 1946 to 1,427 in 1947, and the decrease in illegitimate births from 218 in 1946 to 167 in 1947 ; and the death rate in the latter had fallen from 91-7 to 65-9. The care of illegitimate children and of those prematurely born has again received particular attention. The care of illegitimate children must necessarily be bound up with child life protection for it is almost always the illegitimate baby who needs pecial care and protection. The City Council considered that this problem should receive the individual attention of a child protection officer and she has been at work for two years. Her work brings her in ' lose contact with the staff of the Moral Welfare Associations and their co-ordinated efforts have been rewarded with considerable success in many baffling problems. (9063) a 3 8 With regard to the care of premature infants, of 141 born during the year, 16 died, of whom 14 were born and died in hospital. The services of a consulting pediatrician are available for any medical practitioner attending premature infants at home but his services were not called during the year. There was an increase in the notified cases of Tuberculosis and in the deaths, but as the population was markedly greater the mortality rates for this disease had in fact fallen. Details relating to Mass Radiography and Allowances are given later in this Report. At the request of the Ministry of Health arrangements for the medical inspection of aliens was resumed in December, 1947. This is a procedure usually carried out at sea and airports. In this instance the train ferry service from Paris, through Dunkirk to Dover, enables passengers to sleep undisturbed by customs enquiries until they are deposited on the platform at Victoria. The duties of inspection are carried out as before the war with the assistance of part-time medical officers. Features of special importance in the work of the Sanitary Inspectors were the inspection of food premises and the resumption of house to house inspections under the Inspection of District Regulations, 1936. The additional Inspector appointed for the purpose of the supervision of catering establishments and other food premises took up his duties on 1st March, 1947. Now that there are two inspectors devoting the whole of their time to the work, much of the war-time arrears are being overtaken and satisfactory progress is being made in maintaining good standards in restaurants and other food premises. The Inspectors were relieved of duties relating to the search for empty properties for housing purposes on 1st November, 1947, and were thus enabled to resume the routine inspection of houses fallen into abeyance during and for some time after the war. In April 5 Inspectors were allocated to this work. The task has proved particularly heavy and progress necessarily slow, as obviously much deterioration had taken place in the years of war and repairs by reason of various restrictions and shortages could not readily be put in hand. The campaign to clear premises from rats actively continues. Special surveys were made of the Covent Garden area, mostly business premises and of dwellings in the Victoria Ward. In business premises recovery of expenses from the owner is made when rats are found and cleared. In dwelling houses the cost falls on the local authority aided by grant from the Ministry of Food. At the time of writing some 130 members of the Department havf been transferred to London County Council and to the Regional Hospital Board. All the transactions relating to the transfer of staff and premises have naturally caused some measure of interference in the smooth running of the Department and explains why this Report is somewhat delayed in 9 appearing. These two Authorities are fortunate in receiving into their employment such a highly experienced, efficient and loyal band of workers—and those who remain in the service of the City Council deserve a tribute no less warm or sincere. I should like to place on record my appreciation of the consideration and active co-operation given by the Chairman of the Public Health and Maternity and Child Welfare Committee, the Committee itself, other Members of the Council and my colleagues, the other Chief Officers. ANDREW J. SHINNIE, Medical Officer of Health. September, 1948. (9063) A4 10 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,502.7 Population (Registrar General's Estimate 1947) 103,440 Number of Inhabited Houses (Census, 1931) 22,536 Rateable Value, March, 1948 £10,108,800 Births. Live Births— Total. Males. Females. Legitimate 1,427 750 677 Illegitimate 167 84 83 1,594 834 760 Births notified—1,411. Birth rate per 1,000 of the estimated resident population 15.4 (Rate for London, 22.7 ; for England and Wales, 20.5) Number of stillbirths 41 Rate of stillbirths per 1,000 (live and still) births 25.1 Deaths. Net deaths (males 581, females 554) 1,135 Death.rate per 1,000 of the est imated resident population (Rate for London, 12.8 ; for England and Wales, 12.0) 11.0 Deaths from puerperal causes 1 Rate per 1,000 total (live and still) births 0.61 Deaths of infants under 1 year (males 24, females 29) 53 Death.rate of infants under 1 year— All infants per 1,000 live births 33.2 Legitimate infants per 1,000 legitimate live births 29.4 Illegitimate infants per 1,000 illegitimate live births 65.9 Rate for London for infants under 1 year 37 Deaths from measles (all ages) Nil ,, whooping cough Nil „ diarrhoea and enteritis 10 ,, cancer 204 11 Infant Mortality. Causes of Death. Total. Legitimate. Illegitimate. Diarrhoea and Enteritis 8 5 3 Congenital malformation, prematurity and other neo-natal causes 22 20 2 Want of attention 4 — 4 Broncho-pneumonia 13 12 1 Accident 2 2 — Other causes 4 3 1 53 42 11 Causes of Death (at all Ages). Males. Females. Totals. Influenza 1 1 2 Meningitis and Convulsions 1 3 4 Diarrhoea 8 2 10 Septic Diesases 4 2 6 Syphilis 1 — 1 Diabetes 1 6 7 Tuberculosis of the Lungs 57 13 70 Non-pulmonary Tuberculosis 3 — 3 Malignant Growths 94 110 204 Congenital Debility 11 13 24 Malformation, Prematurity, etc. Old Age 13 36 49 Locomotor Ataxia and General Paralysis 4 — 4 Diseases of Nervous System — 1 1 Circulatory Diseases 199 200 399 Bronchitis 34 26 60 Broncho-pneumonia 52 40 92 Pneumonia 6 13 19 Other Respiratory Diseases 1 2 3 Alcoholism 1 — 1 Appendicitis 2 2 4 Digestive Diseases 25 21 46 Bright's Disease, Nephritis, etc. 20 22 42 Cystitis 6 — 6 Accidents and Negligence 17 27 44 Suicide and Murder 14 7 21 Other Violent Causes — — Other Defined Diseases 1 2 3 Puerperal Causes other than Sepsis — 1 1 Diphtheria — 1 1 Cirrhosis 4 2 6 Enteric Fever 1 1 2 581 554 1,135 12 Among the causes of death, those of the heart and blood vessels hold highest place ; a long way behind comes malignant disease. There was one maternal death during the year. Infectious Diseases. Notifications. Removed to Hospital. Deaths. Polio-Encephalitis 2 1 — Encephalitis Lethargica — — — Polio-Myelitis 19 15 — Diphtheria 16 16 1 Erysipelas 11 4 — Scarlet Fever 57 37 — Enteric Fever 1 1 2 Paratyphoid 2 — — Puerperal Fever — — — Puerperal Pyrexia 9 4 — Cerebro-Spinal Meningitis 5 5 — Ophthalmia Neonatorum 5 5 — Measles 178 69 — Pneumonia 5 — 19 Dysentery 7 7 — Whooping Cough 86 25 — Malaria — — — Scabies 148 — — Food Poisoning 2 1 — Anthrax 1 1 — Corrected Diagnosis—Nil. Non-notifiable diseases—removed to hospital:— German Measles 3 Chickenpox 16 Mumps 4 Gastro Enteritis 20 Vaccination. Number of certificates of successful primary vaccination of children under 14 years of age received during 1947 ... 1,820 Number of persons vaccinated by the Public Vaccinators for the City— Primary 724 Secondary 33 Bacteriological Examinations. Diphtheria—negative 187, positive 6. Tuberculosis—negative 130, positive 60. 13 Tuberculosis. New Cases and Deaths. Age Periods. New Cases. Deaths. Non- Pulmonary. Pulmonary. Pulmonary NonPulrmnary. M. F. M. F. M. F. M. F. Under 1 year 3 1 2 — — — 1 — 1 to 5 years 3 2 3 2 — — — — 5 to 10 ,, — 4 2 3 — — — — 10 to 15 „ — ' 5 2 — — — — 15 to 20 ,, 6 6 1 — 1 — — — 20 to 25 „ 21 23 2 2 2 2 r — 25 to 35 ,, 33 29 5 2 3 2 •— — 35 to 45 „ 20 14 1 2 10 4 l — 45 to 55 „ 21 6 — 3 18 2 — — 55 to 65 „ 23 4 1 — 13 — — — 65 and upwards 18 3 1 — 10 3 — — 148 97 20 14 57 13 3 — New Cases. Pulmonary—245 new cases, including 23 transfers and 16 non-notified deaths. Non-Pulmonary—34 new cases, including 3 transfers and 2 nonnotified deaths. (1946—Pulmonary, 152 new cases ; Non-Pulmonary, 9 new cases.) Deaths from Tuberculosis. Pulmonary—70 (57 males, 13 females). Non-Pulmonary—3 (3 males, 0 females). Work of the Tuberculosis Dispensary, 1947. The work has been continued on the lines indicated in previous reports. The difficulty of obtaining beds in hospitals and sanatoria still continues, and adds many complications to the work of the Dispensary. A patient may have to wait many months for a vacancy, and this delay in the application of treatment is a constant source of anxiety. Where home conditions permit, the patient is encouraged to rest in bed at home, as a preliminary to treatment in an institution. This can be aided by arranging visits by a District Nurse and a Home Help, and by the provision of extra diet, the boarding out of children, etc. But even in the best circumstances, the delay is detrimental to the patient. During the year 559 new cases attended, 258 male and 301 female. These included 167 examined as contacts. Total attendances numbered 2,333. 14 1§3 of the new patients were found to be suffering from pulmonary tuberculosis, though not all in an active stage of the disease. 26 suffered from other forms of tuberculosis. 49 were recommended for sanatorium treatment and 95 for admission to hospital. 1,089 reports were made to public authorities and 295 to medical practitioners. During the year 1,151 X-ray films were taken and 190 specimens submitted for bacteriological examination. Tuberculosis—Maintenance Alio wances. The Ministry of Health treatment allowances continued to be of value to patients who fall into the categories eligible and the following applications were dealt with during the year : - Applications received 68 Applications granted 61 Allowances stopped during the year for following reasons— (a) Returned to work 24 (6) Refused treatment 3 (c) Died 5 (d) Left district 5 (e) End of period 2 (/) In Institutions and receiving National Health Insurance 7 (g) In receipt of. Army pension 12 An average of 54 patients are drawing allowances at any given time. Mass Miniatwe Radiography. During the year arrangements were made with the London County Council for a visit of their Miniature Radiography Unit to the City. The Unit subsequently operated at one of the City Council's Depots from 28th November, 1947, to 14th March, 1948, and arrangements were made for some 17,000 persons employed in the City and residents to be examined during that period. Similar arrangements were also made for the London County Council Miniature Radiography Mobile Unit to visit the premises of large firms in the Citv employing over 300 employees. During the year some 5,064 persons working and resident in the City were examined either at these Units, or attended the Units whilst operating in other London Boroughs. Of these 50 were referred for further examination. Maternity Beds for Westminster Mothers. The arrangements made by the City Council for the reservation of maternity beds for Westminster mothers at Westminster Hospital, Charing Cross Hospital, St. George's Hospital and the General Lying-in Hospital at York Road continued to work smoothly. These beds were available for Westminster mothers who for various reasons were unable to have their confinements in their own homes. 15 This hospital accommodation was in addition to the maternity beds also available to Westminster mothers which were provided by the London County Council at Westminster Hospital, at its own hospitals and in evacuation maternity homes in the country. The number of Westminster babies born in these and other hospitals during 1947 numbered 1,102, as compared with 309 born at home. Day Nurseries. Day Nurseries provided by the City Council continued to operate at the undermentioned premises throughout the year 1, Bessborough Street, S. 11.1, with accommodation for 70 children, 0 to 5 years of age. 37-39, BloomfieW Terrace, S. 11.1, with accommodation for 59 children 0 to 5 years of age. A third Day Nursery was under construction on a bombed site in Regency Street, S.W.I, but the completion of this Nursery has been delayed owing to difficulties experienced in obtaining supplies and labour. The Nursery when completed will have accommodation for 60 children of 0 to 5 years of age. Great difficulty has also been encountered during the year in securing trained staff for the nurseries and the number of children admitted to the nurseries has had to be restricted from time to time on account of insufficient staff. The following numbers show the average number of children accommodated daily in the nurseries during the year :— Bessborough Street Day Nursery 50 Bloomfield Terrace Day Nursery 46 The City of Westminster Health Society, a voluntary organisation performing maternity and child welfare services in the St. Margaret and St. John Wards also conducted a part-time Day Nursery for 30 children at 121, Marsham Street. The City Council made a grant of £840 towards the cost of the Nursery for the financial year 1947-48. Maternity and Child Welfare. There are four specially designed maternity and child welfare centres in the City, three built by the City Council and one by the City of Westminster Health Society. They are situated as follows :— 1, Bessborough Street, S.W.I ; 1, Ebury Bridge Road, S.W.I. ; Marshall Street, W.l. ; and The Health Society Centre at 121, Marsham Street, S.W.I. In addition Infant Clinics are held once a week in hired accommodation at:— The German Church, 19, Montpelier Place, S.W.I ; and The London Medical Mission, Short's Gardens, Endell Street, W.C.2. 16 Visits by Health Visitors. To expectant mothers 3,438 To children under 1 6,122 To children between 1 and 5 4,894 Ante- and Post-Natal Clinics. Number of clinics held weekly 7 A.N. P.N. Number of women attending 2,521 249 Weekly clinics are also held at Westminster Hospital, Charing Cross Hospital, St. George's Hospital and the General Lying-in Hospital, Lambeth, for mothers who have made arrangements for their confinements in these hospitals. Infant Clinics. Number of clinics held weekly 10 Attendances 4,712 Mothercraft Classes. Number of mothercraft instruction classes held weekly 6 The increasing demand on the Maternity and Chief Welfare services was only to be expected from a marked increase in the birth rate. Convalescent Treatment for Mothers and Children. The City Council as a Welfare Authority is empowered to provide convalescent treatment for expectant and nursing mothers and children under 5 years of age. This work has for some years been undertaken by the St. Henry Convalescent Fund. Mothers and children requiring convalescence are recommended by the Maternity and Child Welfare Centres to the Fund who arrange the convalescence and pay the expenses, recovering from the family such reasonable contributions as they can afford to pay, the City Council making a contribution towards the balance of cost. During the year some 43 cases were sent away for convalescence in this way, the City Council contributing fill 5s. towards the cost. Care of Premature Infants. The Ministry of Health issued a Circular in March, 1944, on the subject of the care of premature infants and the problem of neo-natal mortality. The Minister suggested that a weight at birth of 5£ lbs. or less should be recorded on the notification of births cards. This was put into operation in the City. The City Council in accordance with the Minister's recommendation also appointed a psedatrician whose services are available for consultant visits in the home where premature infants are being nurtured. His services were not called upon during the year. Other recommendations of the Minister have been observed. Of the 141 premature births notified in Westminster, 16 were born at home and 125 in hospital. Of these 8 failed to survive the first 24 hours 17 of life, and another 8 died before reaching the age of one month. These 16 children died in hospital. (These figures do not include infants born to Westminster mothers outside the City. The Ministry of Health require these to be returned by the local authority in whose area the birth took place.) Care of Illegitimate Children. The voluntary organisations who have for so many years dealt with this problem in the City have continued to do so, and have worked in close association with the Council's Health Visitors and Child Protection Visitor. The City Council in co-operation with the other London Borough Councils, makes an annual contribution based on rateable value, to these voluntary organisations, the Council's contribution for 1947 being £972. The Council has a Scheme of Guaranteed Payments to Foster Mothers who are prepared to undertake the care and maintenance of illegitimate children in the City. Under the Scheme, the Council pays the foster mother 21s. per week in respect of each child maintained, and recovers reasonable contributions from the mother. The latter is also required to provide clothing for her child and pay for any necessary doctor's fees for attendance on the child. Although no suitable foster mothers have been found willing to undertake service under this Scheme during the year, some 18 illegitimate children were being cared for at one time or another during the year by foster mothers in the City under arrangements made direct between the natural mother and the foster parent, and where the weekly payment ranged from 30s. to £3 per week. A number of illegitimate children are also cared for in the City Council's Day Nurseries, enabling the natural mother to go out to work during the day to earn sufficient to keep herself and her child, in the great majority of cases this being the mother's only source of income. This arrangement has the advantage of the mother having the child in her care at night and at week ends, thus maintaining her interest and affection for the child. Child Life Protection. The Council is responsible for the supervision of children under nine years of age whose care and maintenance is undertaken for reward by persons other than their natural parents. This work is carried out by a' whole-time Child Protection Visitor who pays regular visits to the homes where the foster children reside. The Child Protection Visitor has also carried out a systematic search for suitable foster mothers in the City willing to undertake, the care of illegitimate children under the Council's guaranteed Payment Scheme. Number of foster mothers at the end of the year 16 Number of foster mothers who relinquished the care of children during the year 16 Number of children in the care of foster mothers at the end of the year 16 Number of children in the care of foster mothers during the year 21 Number of children returned to their natural parents in Westminster from foster mothers in other areas 116 18 Supply of Sheets for Expectant Mothers. By arrangement with the Ministry of Health and the Board of Trade Priority Dockets for utility sheets, on production of a medical certificate, are issued to expectant mothers who are to be confined in their own homes. These are being issued through the Maternity and Child Welfare Centres and 198 dockets and 576 coupon equivalent certificates were issued to expectant mothers in 1947 as compared with 759 for the previous year. Supply of Welfare Foods. By arrangement with the Ministry of Food, national dried milk, fruit juices, vitamin tablets and cod liver oil have been distributed to expectant mothers and children at the Maternity and Child Welfare Centres in the City. The City Council as a Welfare Authority have for many years supplied food accessories in the way of dried milk, cod liver oil, etc., to necessitous mothers and children, and have continued to do so under the direction of the Clinic doctors. Dental Treatment -Clinic Reports. Re- Other New Cases. appointments. Extractions. Fillings. operations. A no'sthetics. Local. General. 1946 178 526 311 250 394 33 71 1947 226 819 617 343 547 51 130 Diphtheria Immunization Treatment and Schick Testing. The following are particulars of children under five years of age who have been immunized against diphtheria in the City. Number of Children who had completed a full course of Immunization at any time up to 31s£ December, 1947. Age at 31.12.47, i.e., born in year Under 1. 1 2 3 4 1947, 1946. 1945. 1944. 1943. Number immunized 58 525 439 655 568 Estimated mid-year population 1947 of children 0 to 5 years of age — 3,910 — — — Children immunized in 1947— Under five years of age 919 School children over five years of age immunized by City Council's Medical Staff 67 986 19 Children Schick tested in 1947— , Negative 219 Positive 4 223 There was one death from diphtheria during the year. Adequate facilities exist for immunization at the Maternity and Child Welfare Centres in the City which is carried out by the Council's Medical Staff. Home Nursing. The City Council has an arrangement with three District Nursing Associations for the nursing in the homes of children under five years of age suffering from various ailments and for certain conditions in adults. The City Council pay the Associations 2s. 6d. per visit for this service. During the year the District Nurses made 1,704 nursing visits under these arrangements. Domestic and Home Help Service. The Domestic Help Service inaugurated in 1945 was continued throughout the year. The object of the scheme is to provide help in the home for sick and infirm who are in need of such assistance and unable themselves to obtain it. A scale is in force for the assessment of contributions by the persons assisted based on their income and outgoings. The Government reimburse the cost of this service. During the year some 193 persons were assisted under the scheme. In 91 cases they were aged persons and unable to attend to their household duties on account of such infirmity as paralysis, rheumatism, arthritis, etc. These received regular assistance each week. The remaining 102 cases were not aged persons but suffered from such disabilities as blindness, heart trouble, tuberculosis, limb injuries and temporary illnesses. In addition to the above, assistance was also given in the home under the Council's maternity and child welfare scheme during the confinement of the mother or where the mother was otherwise incapacitated and where there were young children in the home. Some 192 households were assisted in this way during the year. Mobile Meal Service. The Westminster Division of the British Red Cross Society were able, in December, 1946, to start a meals delivery service for aged people who are unable themselves to get hot meals. The meals are purchased by the British Red Cross Society from a Londoners' Meals Service Centre, at a special price of 8d. per meal for aged people and delivered in a mobile van to their homes. The cost of the meal is recovered by the British Red Cross Society from the recipients. The names and addresses of the aged people requiring the delivery of hot meals are submitted to the Society by the Medical Officer of Health weekly. 20 Some 120 hot dimmers per week were being delivered by the Society to aged people in the City under this arrangement at the end of the year, and the Society were hopeful of expanding the service. Insulin Treatment and Diabetic Patients. During part of the year the Council provided, free of charge, insulin treatment for one diabetic patient in the City at a cost of £4 17s. 3d. Botulism. In June information was received that two men who had partaken of a meal on 5th June in a restaurant in the City had been removed to hospital suffering from suspected Botulism. One of the patients who was aged 55 died in hospital, the other recovered. The Ministry of Health were notified and an inquiry into the circumstances was immediately put in hand. Evidence of a third person who had partaken of a meal on the same date at the same restaurant came to light, and after discussions with the owners of the restaurant information was forthcoming resulting in the tracing of two further patients. These three later cases, all women, ultimately recovered. None of the patients were resident within the City although they were employed at premises within the area. . Medical Officers of the Ministry of Health and Central Public Health Laboratories collaborated in the investigation, and Officers and Staff of the firm concerned gave every assistance. Samples of food and utensils used were examined but no conclusive evidence was obtained pointing to any particular food as being the cause of the outbreak. Food Poisoning. Three cases of food poisoning occurred in May amongst members of two families living in different areas of the City. The source of the trouble was traced to a liver galantine manufactured in the provinces which had been consumed by the patients. The makers of this product were informed and information was received that similar cases were occurring in various parts of the country where the patients were alleged to have consumed a similar product, and steps were immediately taken by the manufacturers to recall stocks of this particular product which had been distributed by them. There were no fatalities in the two Westminster families. Slaughter of Animals Act, 1937. During the year the Council granted licences to 21 persons to act as slaughtermen under the provisions of the above-mentioned Act. All the applicants for licences were undergoing training under the auspices of the Royal Society for the Prevention of Cruelty to Animals. This training included the humane slaughtering of animals, and the licences were granted to enable the applicants to act in this latter capacity. 21 Rheumatism Clinic. , The Order of St. John Clinic for Rheumatism and other diseases which had been operating in Ranelagh Road for many years for the treatment of rheumatic complaints was closed during the year. The City Council have for some years made an annual grant of £100 to the Clinic for their work in the treatment of the poorer inhabitants of the district. Medical Inspection of Aliens. At the request of the Minister of Health, the City Council made arrangements to resume the medical inspection of aliens arriving at Victoria Station by through sleeping car service from Paris, which arrangement had ceased on the outbreak of war. The actual inspection is carried out by medical staff from Westminster Hospital under the supervision of the Medical Officer of Health, and includes attendance daily at Victoria Station by medical inspectors to inspect aliens arriving by this service, and carry out medical examination where necessary. The service recommenced on the 15th December, 1947. The Government reimburse the Council the cost of the service. International Certificates of Vaccination and Inoculation. Arrangements were made during the year with the British Overseas Airways Corporation for the authentication by the Medical Officer of Health of International Certificates of Vaccination and Inoculation completed by the Corporation's medical stafE or by medical practitioners practising in Westminster. These certicates are required by passengers proceeding abroad. Sanitary Circumstances. House to House Inspection. With a view to expediting the repair of defective premises in the City, house to house inspection was resumed on a modified scale at the end of August. Progress was necessarily slow owing to the difficulty of releasing a sufficient number of sanitary inspectors to carry out the work because of their heavy duties in other directions. Towards the end of the year it was found possible to relieve additional sanitary inspectors of duties in connection with the inspection of empty properties for requisitioning purposes for housing the homeless. The routine house to house inspection, however, must still progress slowly and steadily because, as the survey advances, more and more reinspections become necessary to ensure that the work required by Intimation Notices is completed satisfactorily. Intimation Notices have been served under the Public Health (London) Act, 1936, but when circumstances permit consideration will be given to the application of the wider powers offered by the Housing Act. The general or widespread operation of these powers is at present not practicable in view of the difficulty of rehousing the families concerned, although since the end of the war one demolition order in regard to a whole house, and numbers of closing orders regarding unfit parts of houses, have already been made. 22 Water. The quality and quantity of the water supplied by the Metropolitan Water Board is satisfactory. Six complaints were received from premises where the drinking water was drawn from intervening storage tanks but in all cases it was found the tanks had become dirty by oversight of the persons responsible. 21,536 inhabited houses with an estimated population of 101,940 receive water supply from public water mains direct to the houses. All the dwelling houses in the area, apart from those blocks of flats supplied from deep wells, derive their piped supplies from the Metropolitan Water Board and are provided with internal water taps. Private Deep Wells. At the request of the Ministry of Health a survey was made of the sources of underground water on similar lines to that made in 1939. In 1939 when the last survey was carried out, 150 deep wells existed in the City area. Of the 96 wells still actively used, 86 have been found to provide a suitable and satisfactory supply of water for drinking purposes. The remainder can be classified in the manner following :— 1 well is used for cooling purposes in connection with a brewery. 1 well is used for supplying boilers at an hotel. 1 well is used as a standby in case of fire at an hotel. 6 wells are used for domestic purposes but a continuous chlorinating plant is installed. One well where high bacterial counts are being obtained is at present being investigated. The machinery of the well is being overhauled and sterilised. If, after completion of this work, satisfactory results are not obtained, a continuous chlorinating plant will be installed. It should be reported that in addition to the total number of wells in existence in 1939 in the City area, one new well has been bored for use at Government premises. Requests were sent to the owners or agents of buildings supplied by deep wells for bacteriological and chemical tests to be made, and the results to be submitted to the Medical Officer of Health. In most cases it was possible to furnish such reports without delay. In some instances owners who had not had recent tests made were requested to have samples of water from the wells tested and the reports submitted. These have now been received. During the survey it was found that in 7 cases where wells are now definitely out of use, inadequate measures had been made to deal with the well tops. In these cases the owners have been requested to ensure effective sealing to prevent seepage into the shaft which might affect and possibly contaminate similar wells in adjoining premises. The upper level of the chalk subsoil under the City of Westminster is between 175 feet and 230 feet below ground level and the wells within 23 the City area range in depth from 200 feet to 700 feet, water being obtained from an average level of 150 feet to 250 feet. Over a period of years there has been a gradual decline in the water level in the chalk subsoil under London, and it is interesting to note from data supplied by the Geological Survey that the water level in wells in Trafalgar Square completed in 1844 was 68 feet below ground level. By 1911 this level had fallen to 195 feet below ground level, and in the years since that date these wells were abandoned owing to drying-up. One explanation of this falling in level is the increasing number of wells which have been sunk within the period concerned, and by the increased demand made upon this form of supply. Dwelling Houses. Inspections for undermentioned reasons :— Complaint 3,392 Housing applications 828 Infectious disease 337 Routine 351 Housing Act and Regulations, etc 717 Requisitioned houses 207 Sanitary work in progress 3,711 Application for Building Licences 1,218 Empty properties (re requisitioning) 2,131 Total 12,892 Other Premises. Inspection for undermentioned reasons :— Complaint 1,429 Sanitary work in progress 3,609 Application for Building Licences 374 Factories, workshops, catering establishments, food premises, etc 6,999 Total 12,411 Notices. Dwellings. Intimation Notices 1,620 Statutory Orders 152 Food Premises. Catering establishments 515 Food shops 190 Factories, etc. Power 68 Non-power 124 Workplaces, shops, etc. 104 As will be noted on page 26 only in 33 instances had orders of the Court to be made to enforce compliance. 24 Catering Establishnents. Inspection. Hotels, Restaurants, Clubs, etc. 1,684 Cafes, Tea Shops 1,484 Public Houses 417 Canteens, etc 733 Notices served 515 Factories. Power Factories. Inspections ... 775 Notices served for defects ... 68 Defects found ... 76 Non-Power Factories. Inspections ... 1,980 Notices served for defects ... 124 Defects found ... 224 Analysis of Defects. Want of cleanliness 65 Want of ventilation 8 Want of ventilation of gas stoves 4 Overcrowding 4 Temperature 2 Sanitary Accommodation. Insufficient 1 Unsuitable 25 Defective 14 Not separate for sexes 9 Other defects 75 Failure to affix abstracts 17 Outworkers, Premises. Inspections ... 187 Number of outworkers ... 3,200 (includes workers living in areas outside the City) Insj>ection and Supervision of Food. Inspection. Bakehouses 57 Dairies and Milkshops 362 Fried Fish Shops 62 Ice Cream Premises, Stalls, etc. 355 Butchers, Shops and Stalls 322 Confectioners 114 Fishmongers and Poulterers 206 Preserved Food Premises 9 Greengrocers, etc. 209 Provision Shops 614 Samples purchased for analysis 1,800 Adulterated samples 58 Notices served 190 25 Workplaces, Shops, etc. (other than Food). Number of inspections 1,985 Notices served for defects 104 Defects 137 Ice Cream . Premises on Register at 31st December, 1947 109 Number of samples obtained for bacteriological examination or Methylene Blue Test 89 Satisfactory 52 Indifferent 16 Unsatisfactory 21 Number of inspections made 265 The Ice Cream (Heat Treatment) Regulations, 1947, came into operation on the 1st May, 1947. The Regulations broadly require that, subject to certain qualifications, the ingredients of ice cream shall be heat treated after being mixed and that the mixture shall then be cooled until the freezing process is begun. Ice cream must not be sold unless it has been kept at a temperature of 28° F. Although the Regulations do not impose a bacteriological standard of cleanliness for ice cream the Minister draws attention to a form of methylene blue test and suggests certain provisional grades into which the results of these tests should be placed. Registration of Dairymen and Dairies. On Register at 31st December, 1947 78 Premises. 163 Persons. New Dairies or Dairymen registered during the year - 8 Number of inspections made ... 362 Pharmacy and Poisons Act. Number of samples obtained 13 Number of sellers of Part II poisons 173 Preserved Meat, etc., Premises. Number of premises on Register at 31st December, 1947 90 Rats. Number of complaints 1,109 Number of visits 19,212 Number of rodents destroyed 10,237 Black rats 4,157 Brown rats 2,392 Mice 3,688 Amount recovered for disinfestation work executed by the Council's ratcatchers in cases of default by owners or occupiers £236 3s, 26 In addition to the normal rat repression work following complaints, etc., 2 surveys were carried out during the year. A survey of Pimlico, started in September, 1946, was completed by July, 1947, and covered all the dwelling houses in that area. On completion of the work in Pimlico the survey was extended to the northern part of the City, and will be completed by the end of March, 1948. In addition to this comprehensive survey of dwelling houses a special survey was undertaken at the instigation of the Ministry of Food in the Covent Garden area. This survey, started in November, 1946, was completed in June, 1947. Atmospheric Pollution. Complaints 31 Observations recorded 531 Nuisances reported 5 Notices served 6 The recording and measuring of atmospheric pollution has been continued throughout the year. Instruments for this purpose were set up at three sites in the City. The records continue to show some increase in pollution, this being most marked in the southern part of the City. Noise Nuisances. Complaints 15 Number of inspections 27 Disinfection. Includes Poliomyelitis Precautions. Rooms 676 53 Articles 96,538 69,129 Articles destroyed 944 — Articles washed 8,909 — Vehicles 131 121 Books 400 14 Leqal Proceedings. Food. Catering Establishments. Dwelling Houses (Nuisances). Total. Proceedings instituted 13 7 11 33 Convictions 12 6 5* 23 Cases adjourned 1 — 1 2 Cases dismissed — 1 2† 3 Cases withdrawn on completion of work — — 3 3 Fines £430 5s. Orf. £170 0s. 0d. £12 0s. Od. £612 5s. Od. Costs £65 7s. 6d. £50 3s. 0d. £22 19s. 0d. £138 9s. 6d. * Work completed before hearing. † Includes one offence under Drainage Byelaws. 27 Coroner's Court and Mortuary. Found drowned 7 Suicide by drowning 2 Suicide by other means 27 Murder — Natural causes 306 Miscellaneous 11 Accidents. Drowning 1 Street 18 Domestic 13 Others 17