AC.4345 STMARY 30 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1925. Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B Sc., M.R.C.P. (Ed. ) Of the Middle Temple, Barrister-at-Law. LONDON: VAIL & CO., 170, FARRINGDON ROAD. 1926. Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1925. Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. LONDON : VAIL & CO., 170, FARRINGDON ROAD. 1926. VAIL & CO., Printers, 170, Farringdon Road, London, E.C. 1 Public Health Department, Town Hall, Marylebone Road, N.W.1. 25th June, 1926. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, I have the honour, as Medical Officer of Health, to submit my Annual Report on the Health of the Borough of St. Marylebone during the year 1925. Like the report for 1919 it is a "Survey Report" and is on similar lines to those followed when reporting with regard to that year. Being the second of the series of such reports, in making it an opportunity has been taken of comparing figures as to various matters in the two periods. For the reason that in 1919 conditions were still very abnormal after the war, comparisons are not easy or quite fair. It is interesting to note, however, that the improvement, as judged from such figures as those of infantile mortality, is very marked, 1925 giving a rate of 63.0 per 1,000 births as against 98.5 for 1919. I desire to thank the Public Health Committee for the help and kindness they continue to show me. Under Mr. Hugh Jones, the chairman, they have displayed the greatest interest in the work and are always ready to give consideration to any suggestion likely to lead to the betterment of health conditions within the Borough, and to offer to me guidance and encouragement as occasion requires. The staff of the department have never flagged, either in their interest in the work or their loyalty or their devotion to duty. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER, Medical Officer of Health. CONTENTS. Page Natural and Social Conditions of the Borough. Population 7 Sanitary Circumstances 7 Water Supply 8 Drainage 8 Combined Drainage 9 Closet Accommodation 9 Public Sanitary Conveniences 9 Scavenging 10 Removal of House Refuse 11 Removal of Offensive Refuse 11 Sanitary circumstances of the Borough Staff 12 Nuisances 13 Inspections 14 Nuisances Legal Proceedings 15 Rat Repression 15 Smoke Nuisances 15 Premises and Occupations controlled by By-laws and Regulations 16 Business Premises 16 Cow Sheds 16 Milk Premises 16 Slaughterhouses 17 Offensive Trades 17 Ice Cream Premises 17 Butter, Margarine, etc., Premises 18 Bakehouses 18 Fried Fish Vendors and Fish Curers 18 Factories and Workshops 18 Inspections 19 Defects found 19 Home Work 20 Registered Workshops 21 Premises used for Human Habitation Houses let in lodgings 22 Common Lodging Houses 22 Underground Rooms 23 Premises that are not but should be Registered 23 Food Stalls 24 Schools 25 Food 25 Milk Supply 25 Milk Analysis 25 Legal proceedings for adulteration 26 Bacteriological examination of Milk 26 Dairies, Cowsheds and Milkshops Orders 26 Milk and Cream Regulations 26 The Milk Special Designation Order 27 Milk (Mothers and Children) Order, 1918 27 Bacteriological examination of Milk 27 Food Inspections 28 Food, Unsound, Condemned 28 Public Health Meat Regulations, 1925 29 Sale of Food and Drugs Acts 29 Reports of Public Analyst during year 30-35 Statistical 36 Births 36 Births Registration 36 Births Notifications 36 Page Deaths and Death Rates 36 Sub-District Births and Deaths 37 Deaths in relation to Age 38 Deaths among the Aged 38 Causes of and ages at death 38 Infantile Mortality 38 ,, ,, Causes 39-40 Deaths in relation to Disease 42 Diarrhœal Diseases 42 Infectious (Communicable) Diseases 42 Phthi is and other Tuberculous Diseases 42 Respiratory Diseases 43 Cancer and Malignant Disease 43, 44 Alcoholism 44 Accident, Suicide and Manslaughter 45 Prevalence of and Control over Infectious Diseases 45 Isolation of Cases 46 Discharge Notices 46 Diphtheria and Membranous Croup 46 Scarlet Fever 47 Enteric Fever 47 Cerebro-Spinal Fever 47 Encephalitis Lethargica 47 Polio Encephalitis 48 Polio-Myelitis 48 Erysipelas 48 Puerperal Fever 48 Measles and German Measles 48 Whooping Cough 48 Glanders and Anthrax 48 Smallpox 48 Infectious Diseases in Schools 49 Ophthalmia Neonatorum 49 Pneumonia 50 Tuberculosis 60,51,52 Notifications 51-60 Prevention of 53 Work and Dispensaries 55-58 Pulmonary Deaths 59 Bacteriological Diagnosis of 63 Disinfection 61 Cleansing of Persons Act, 1897 62 Bacteriological Examinations 63 Maternity and Child Welfare 63 Health Visitors 64 Centres 64 Ante-Natal Work 65 Dental Clinic 65 Massage Clinics 65 Hospital Treatment 65 Maternity Cases 65 Infant Consultations—Work at 66 Day Nurseries 66 Home Helps 66 Sanitary Administration— Staff 12, 67 Report of Mortuary Keeper 67 Housing— General Housing Conditions 68 Overcrowding 69 Fitness of Houses 69 Unhealthy Areas 69 Statistics 71-72 Sanitary Inspection (Summary) 73-76 Ministry of Health, Tables I—III 77-81 Vaccinations Returns 82 FISHERTON STREET SITE—THE OLD AND THE NEW. Shewing some of the Blocks of Flats provided by the Borough Council and, in the centre, the type of dwellings they replace. 7 INTRODUCTORY, Population.— In the Annual Report for 1919 which, like that for this year, was a "Survey Report," under this head references were made to the difficulties associated with the making of estimates as to numbers of inhabitants in the years between the censuses. In 1919 the population was estimated at 97,953, a figure which it was stated was probably considerably out. Since these words were written events have occurred that have shown this view to be correct, the population of the Borough when the Census was taken on June 19th, 1921, proving to be 104,173, made up of 63,166 females and 41,007 males, the former thus exceeding the latter by 22,159. Even if, as the estimates show, the population is actually increasing by approximately 1,000 a year it is likely to be some time before it will reach the 1911 level, and this is because the changes that have been occurring in the character of the Borough are not only certain to continue but to become more marked. The previous Census, taken in 1911, enumerated the population at 118,211, so that during the period of ten years there was a decrease of 14,038. The population estimated to the middle of 1925 by the Registrar-General is shown below, and is that used in calculating the various rates, etc., given in this report. For information the estimated population of each of the wards is also set out, and for comparison the figures for the six previous years. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. 1919 97,953 24,381 26,731 30,210 16,631 1920 101,856 25,352 27,796 31,414 17,294 1921 105,200 26,184 28,709 32,445 17,862 1922 105,200 25,202 26,943 32,747 20,308 1923 105,400 25,258 26,992 32,806 20,344 1924 105,300 25,233 26,967 32,775 20,325 1925 106,100 25,425 27,172 33,024 20,479 SANITARY CIRCUMSTANCES. Under this heading the Ministry of Health calls for a report with regard to such matters as Water, Drainage and Sewerage, Closet Accommodation, Scavenging, Sanitary Inspection, Premises and Occupations controlled by By-laws cr Regulations, Schools, &c. In respect of some of these matters, on account of the circumstances and arrangements existing in London Boroughs, there is little to be said, and much of the information is obtainable only from other departments of the Council or from other bodies. In order, however, to comply with the requirements ot the Ministry, and to assist in obtaining uniformity in repqrts, each of the more important matters is dealt with as fully as possible. 8 Water. As usual, complaints as to water supply, either as regards quantity or quality, were few. All were dealt with, and a remedy found. Water Supply cut off.— In accordance with the requirements of the Public Health (London) Act, 1891, Section 49 (1), the Metropolitan Water Board reported that the water had been cut off in three premises. This is the lowest number for a considerable period. The reasons for discontinuing the supply were: nonpayment of rate, one; defective pipes, two. In the event of the premises being a tenement house, action was taken immediately on receipt of the Board's notice, in order to secure that the tenants should suffer no Hardship as a result of being deprived of water. Cisterns.—The bulk of the houses in the Borough, in accordance with the requirement of the Water Board, are provided with a cistern, and though in a considerable percentage water for drinking purposes is drawn from the main, there are still many in which supplies for all purposes are obtained from the cistern. In many cases this leaves much to be desired, both as regards situation and accessibility, and despite the fact that a by-law of the Council requires that the apparatus shall be emptied and cleansed every six months, it connot be doubted but that in a majority of houses no such step is taken. During the year 102 notices in regard to defects in and necessity for cleansing cisterns were; served and were complied with. Water Supply in Dwelling Homes.—The certificates granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises numbered five. As showing the progress made in building it may be noted that in each of the years since 1919, when two certificates were granted, the numbers issued have been in 1920, 1; in 1921, 6; in 1922, 9; in 1923, 5; and in 1924, 13. In 23 instances intimation notices were served, calling for the provision of a supply of water to the upper storeys of tenement houses, as required by Section 78 of the London County Council (General Powers) Act, 1897. The supply was provided after receipt of the intimation notice in 15 cases. In the remaining 8 it was found necessary to report the facts specifically to the Public Health Committee, and obtain instructions for the issue of a statutory notice and the taking of all necessary proceedings for its enforcement. Following receipt of this notice the work was done, and no further action had to be taken. The number of tenement houses in the Borough without a supply of water on one or more of the upper floors, in addition to that in the lower part of the premises, is steadily diminishing. In 1919 the number of notices served was 60. Drainage. There have been few changes in regard to work in this connection during the last five years. Duties in connection with drainage in the portion of the Borough north of Marylebone Road, which were allotted to Inspector Clay in 1920, have been in his hands ever since, duties in the southern half being performed by Inspector Gorniot. Both of these officers are engaged exclusively in drainage work, and between them in 1925 made 5,917 inspections. In 1919, which was, of course, exceptional, inasmuch as the arrears of the war years were then being overtaken, the number was 7,554. The total number of plans deposited was 460, as against 536 in 1924 and in 1919, 278. The number relating to new buildings was 74. The number deposited in 1924 was 86 and in 1919, 16. In the case of old buildings, the number of plans received was 386. In 1924 the total number was 450 and in 1919, 262. 9 In the bulk of the cases the arrangements shown were in accordance with the by-laws and the work was allowed to proceed under the preliminary approval of the Medical Officer of Health. In cases in which there was departure from the requirements a special report was made to the Public Health Committee, who rarely refused approval if satisfied that compliance was impossible and that there was no possibility of nuisance or injury to health arising. In the majority of cases the departure referred to closet accommodation and affected particularly conveniences proposed to be constructed in basements. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 63 premises. The number in 1919 was 37. Closet Accommodation. In the table at page 14, summarizing the work carried out by the district inspectors, figures indicating the number of defects in water closets remedied and of water closets erected are set out. In most instances the closets erected were with a view to providing additional accommodation in tenements, houses, shops or workshops or in order to afford suitable separate accommodation for women in places where both sexes were or were about to be employed. Though there may be here and there a small lock-up shop in which it is necessary for the individuals engaged on the premises to make use of a convenience in some other part of the building, or more rarely in an adjoining building, there are no premises in the Borough totally without sanitary conveniences of this type. The only class of closet is, of course, the water closet. One of the great difficulties experienced from time to time is in regard to finding a suitable place for a convenience and a position in which there will be complete compliance with the requirements of the regulations in respect of waterclosets. This is particularly the case as regards closets in basements and in the more over-crowded business and shopping portions of the Borough. All plans showing proposals to construct water-closets are most carefully scrutinized and only if it is impossible to find a completely suitable position, and there appears to be no possible risk of nuisance or injury to health, is permission granted to construct the convenience in a situation where there is not compliance. Public Sanitary Conveniences.— The usual supervision was exercised over the public conveniences during the year, Inspector Hill, the outdoor superintendent, visiting those provided for the males: the women inspectors, especially Miss Baker, supervising those provided for females. Reports and comparative statements as to receipts for use of the underground conveniences were regularly submitted to and considered by the Public Health Committee. The following is a statement showing the total receipts at each of the conveniences for the year ended March, 1926, and the amount of increase or decrease as compared with the previous year. 1926 1925 Increase Decrease £ s. d. £ s d. £ s. d. £ s. d. Oxford Circus—Men's Department 1,066 13 5 1,004 10 3 62 2 - „ Women's ., 1,555 6 2 1,257 11 6 297 14 8 - Gt. Portland Street—Men's ,, 282 9 7 292 9 10 - 10 0 3 ., Women's „ 282 14 10 283 16 10 - 1 2 0 Marylebone Road—Men's ,, 254 16 9 334 0 0 - 79 3 3 „ Women's „ 244 3 8 333 0 11 - 88 17 3 Foley Street—Men only „ 171 17 3 161 14 11 10 2 4 - St. John's Wood Road—Men only 121 10 7 120 6 2 1 4 5 - Barrett Street—Men only „ 260 4 5 237 18 9 22 5 8 - † Salisbury Street— Men's Department 65 3 7 2 12 3 62 11 4 - †‡ ,, Women's „ 84 14 10 3 10 3 81 4 7 - * One free urinette provided. † Opened 10th March, 1925. ‡ Two free urinettes provided. 10 SCAVENGING. In 1917 the Council decided that the responsible duty of collecting and disposing of the house refuse should be carried out by direct labour, and a special committee, known as the Highways Committee, was created to deal with this and other matters. Prior to the formation of this Committee the whole of the work had been carried out by contract. The arrangements have been in the hands of the Highways Committee and under the control of the Highways Engineer, Mr. James Gair, who has had charge of this work ever since the decision to discontinue the carrying out by contract of this most important public health duty was reached. Both as regards collection and disposal, the arrangements have worked very smoothly from the beginning, and each year has shown improvement on its predecessor. Owing to labour and other difficulties it has not, unfortunately, been possible to depart from the old practice of carrying out removal once a week only, except in the case of the main business thoroughfares, large institutions, blocks of flats, etc., where a daily collection is made or, in special cases, where the refuse is collected twice or oftener as conditions warrant. As matters improve, however, it is definitely the intention of the Council to institute a system under which more frequent collection will be made and, in the meantime, the whole of the dusting districts are being revised with a view to regularising and increasing the efficiency of the collection in order to obviate the existing state of affairs so that there will not be a weekly collection, twice weekly, three times weekly, and perhaps a daily collection in the same street. The whole of the work is carried out by means of motor-vehicles, and although an efficient dust cover has not been forthcoming the Highways Committee have this matter under special consideration, and it is hoped that an efficient cover will, in time, be available for the whole of the Council's vehicles. As regards disposal, the whole of the refuse is taken to the Council's Wharf and there discharged into a collecting pit. From this it is taken, by means of an electric crane, into a large screen where it is divided into three constituents, viz.: Fine ashes (i.e., material below ½ in. size); breeze (i.e., material not exceeding 2 in.); the surplus or debris that comes over the end of the screen. During the winter months—i.e., from October to March—practically the whole of the fine ashes and breeze is disposed of to brickmakers, the fine ashes being mixed with the clay and the breeze being used as material for burning the bricks. Approximately, from 33 per cent. to 40 per cent. of the total annual tonnage collected is disposed of in this way. With regard to the debris, on its way to the furnaces material for which a sale can be obtained is extracted, and at the present time consists of waste paper, scrap metals, tins, rags and bones—from 1,500 to 2,000 tons being disposed of annually. The debris is then burnt by means of furnaces under a "Babcock" boiler which is used to raise steam for driving the plant. Any material that is in excess of what can be burnt and is absolutely useless is conveyed by boat to the Council's shoot at Northolt. The following table shows the remarkable increase that has taken place since this work was taken over by the Council, and it would appear that as the efficiency 11 of the service increases this also entails a corresponding increase in the tonnage to be removed. The yearly collections to date are as under :— Year ending 31st March, 1918 26,886 tons. Do. do. 1919 27,735 „ Do. do. 1920 35,602 „ Do. do. 1921 35,744 „ Do. do. 1922 37,088 ,, Do. do. 1923 39,559 „ Do. do. 1924 40,173 „ Do. do. 1925 41,908 „ Do. do. 1926 42,899 ,, At the same time it must be borne in mind that the present-day householder has little or no means, either as regards furnaces or labour, to get rid of the refuse collected in either houses or flats, so that the dust-bin becomes the only means of disposal so far as the householder is concerned, and in any case the ordinary household grate cannot be used as an efficient incinerator. The collection and disposal of the road sweepings has also been undertaken by the Council since 1920, and the following table shows that the tonnage collected per annum has remained practically at a standstill despite the enormous improvement that has taken and is taking place as regards permanent carriageway paving throughout the Borough. The yearly tonnage of road sweepings and slop collected in the Borough is as under:— Year ending 31st March, 1921 10,506 tons. Do. do. 1922 9,440 „ Do. do. 1923 9,759 ,, Do. do. 1924 10,138 ,, Do. do. 1925 9,238 ,, Do. do. 1926 9,927 „ The greater part of the street sweepings are passed through a pulveriser and sold as a fertiliser, the lemainder being conveyed to the Council's shoot and used for covering the surface of the dump. Removal of House Refuse. So far as the arrangements existing in houses, business premises, etc., are concerned, it may be noted that the movable, covered metal dustbin is most commonly found. New metal dust receptacles were provided to 413 premises. During the year the inspectors made 5,250 visits. The majority of these were made by Inspectors Hill and Lumley, who give part time to this work. For neglect of the provisions with regard to the covering of dustbins, etc., placed on the footway for collection from the kerb, 87 notices were served. Remedies in each case were carried out, legal proceedings not being necessary in any instance. Removal of Offensive Refuse. -Owing to the number of hotels, boarding houses, restaurants, and large private establishments in the borough, considerable quantities of food refuse (hog wash) are collected by pig-feeders daily, and close watch is necessary in order to ensure that the requirements of the bye-laws relating to removal of offensive refuse, as to hours of removal, provision of proper receptacles, etc., are complied with. During the year a number of warnings with regard to these matters were issued. 12 SANITARY INSPECTION OF THE DISTRICT. Staff. —During the year there were on the staff of the Public Health Department, in addition to the medical officer of health, a deputy medical officer of health (Dr. W. W. Jameson and later Dr. Turner), a tuberculosis officer and assistant medical officer of health for tuberculosis purposes (Dr. J. Donaldson Saner), two drainage inspectors, one outdoor superintendent, one meat and food inspector, one house-to-house inspector, six district inspectors, seven women sanitary inspectors and health visitors (one engaged exclusively in tuberculosis work), one chief and five assistant clerks and an office youth, with, in addition, at the Tuberculosis Dispensary, a sister and a clerk dispenser. The following list gives information with regard to qualifications, etc., of each of these officers as required by the Ministry of Health :— Medical Officer of Health and Administrative Medical Officer Tuberculosis, and Maternity and Child Welfare: Charles Porter, M.D., B.Sc., M.R.C.P. (Edin.), of the Middle Temple, Barrister-at-law. Deputy Medical Officer of Health (Part time): Adam A. Turner, M.C., M.B., Ch.B. (Aberd.), D.P.H. (Medical Officer of Health, Finchley). Assistant Medical Officer of Health for Tuberculosis Purposes : *J. Donaldson Saner, M.B., C.M. (Edin.), D.P.H. R.C.P.S. (Edin. & Glas.). Public Analyst (Part time) : J. F. F. Rowland, B.A., A.I.C. Bacteriologist (Part time) : A. G. R. Foulerton, O.B.E., F.R.C.S., L.R.C.P., D.P.H. *District Sanitary Inspectors. *Health Visitors. T. A. Cartledge (a, b, c). Miss C. E. Durant (b, d, g). F. C. Cook (b, c). Miss C. Hale (d, e). W. H. Draper (a, b, c). Miss E. D. Mann (d, e, g). E. Lumley (a, b). T. W. Forbes (b, c). *Tuberculosis Visitors. E. E. Willis (a, b, c). Miss F. A. Baker (b). A. S. Wilson (a, b, c). Miss F. A. Bartleet, R.R.C. (f). Tuberculosis Clerk—Dispenser. *Drainage Inspectors. *Miss M. T. Chaillis. H. H. Clay (a, b, c). T. Gorniot (Senior Sanitary Clerks Inspector) (a). Chief Clerk: H.E. Curtis. *Food Inspector. A. H. James. G. Smith (a, b, c). W. J. Howe. G. W, Matthews. *Outdoor Superintendent. R.C. Thorpe P. H. Hill (a, b, c). D. C. Mead. *Women Sanitary Inspectors and Maternity and Child Welfare and Health Visitors. Tuberculosis Clerk. Miss H. Dean (b, d, e). *Miss J. Jones. Miss A. Meses (a, b). Miss N. C. Stokes, R.R.C. Mortuary Keeper. (b, d, e, f, g). Mrs. H. Spears. 13 Cleansing of Persons Baths & Shelter Disinfectors. Matron : Miss L. Kilgallin. J. C. Kendall J. Overton. Tuberculosis Dispensary. Messenger. *Caretaker: E. D. Marston. J. Eatwell. * Officers to whose salary contribution is made under the Public Health Acts or by Exchequer grants. a Royal Sanitary Institute Certificate b Certificate Sanitary Inspectors' Examination Board (London) c Meat and other Foods Certificate. d Health Visitors Diploma. e Central Midwives Board Certificate. f Certificate of State Registration for Nurses. g Three or Four Years' Hospital General Training Certificate. NUISANCES. In the following summary some idea of the amount of work done in relation to nuisances is given. For details of other works carried out by the inspectors, reference must be made to the sections dealing with housing, food, infectious diseases, etc. In regard to nuisances, the first point to note is that the total number of complaints received was 3,470, as against 3,804 in 1924 and 1,588 in 1919. The majority of these complaints were made by the inspectors themselves, the number from outside being 356. These came from voluntary workers of the St. Marylebone Health Society, members of the Children's Care Committee, neighbours and others. In respect of nuisances, 370 statutory notices were issued, as against 199 in 1924 and 380 in 1919. Of these notices, 271 related to ordinary nuisances (dirt, dampness, etc.) 36 to verminous rooms, 15 to drains, and 3 to insufficient w.c. accommodation. The remaining 8 were served on owners to provide a proper and sufficient supply of water to the upper storeys of tenement houses, under the London County Council (General Powers) Act of 1907. The number of such notices in 1924 was 6, and in 1919, 12. The 36 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1922, and referred to 77 rooms. The number of notices in 1924 was 28, and in 1919, 66. In 3,100 cases the nuisances were abated by the persons responsible for their removal after receipt of a preliminary (intimation) notice advising them of the existence of the defect. In 3 instances there was failure to carry out works after receipt of statutory notice and legal proceedings were instituted. Details of these cases will be found under the heading "Legal Proceedings in connection with Nuisances." 14 The total inspections made by each inspector, and the number of nuisances of various kinds detected and remedied, are set forth in the following table :— Districts. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Total Inspections 3,388 2,643 3,548 3,693 3,137 3,665 20,074 Houses damp, dirty or dilapidated remedied 319 255 327 322 236 130 1,589 Doors, windows, floors, ceilings sash cords, etc., repaired 417 287 370 154 162 98 1,488 Overcrowding abated - - 2 - - 2 4 Illegal occupation of underground rooms dealt with - - 2 2 - 2 6 Water closet defects remedied 230 205 283 254 127 128 1,227 Water closets erected 2 - 2 19 5 26 54 Urinal defects remedied - - 1 1 - - 2 Soilpipe and ventilating shaft repaired or renewed 5 - 19 2 1 1 28 Yard defects remedied 163 122 114 168 102 59 728 Waste pipe defects remedied 49 20 55 43 14 9 190 Water cistern defects remedied 22 4 21 23 24 8 102 Rubbish, manure, etc., accumulations removed 5 4 46 46 25 17 143 Dung or dust receptacles repaired or renewed 67 46 89 108 41 15 366 Drains relaid or amended 31 9 26 33 26 22 147 Drains cleared 19 52 5 16 9 8 109 Rainwater pipes repaired or renewed 35 61 35 28 23 9 191 Water supply to houses reinstated - - 1 1 - - 2 Roofs and gutters repaired 165 134 137 103 88 78 705 Area defects remedied 12 - 8 112 10 16 150 Wash-house defects remedied 192 122 258 128 58 75 833 Animal nuisances abated 3 - 5 13 2 - 23 Basement defects remedied 1 - 7 22 19 12 61 Stables cleansed or repaired 4 - - - - - 4 Water supply laid on to upper storeys of house 12 - 4 6 1 - 23 Miscellaneous nuisance abated 558 248 208 134 56 50 1,254 Verminous rooms cleaned 109 155 122 193 84 80 734 Workshops dirty, overcrowded, unventilated or defective, remedied - 3 3 10 18 15 49 15 Legal Notices in Connection with Nuisances. The number of summonses issued during the year was three. Particulars with regard to each of the cases ate given below and it should be noted that in each instance, though there were contraventions of provisions contained in other acts and by-laws, the Public Health (London) Act, 1891, is the only enactment mentioned in the list. Premises. Offence. Proceedings taken under the Public Health (London) Act, 1891, &c. Result. 61, Lisson Street Failure to comply with a statutory notice to execute certain sanitary requirements. Closing Order granted with £5 5s. 0d. costs. 22, Abercorn Place Do. Order made to abate nuisance within three weeks. £1 1s. 0d. costs. 9, Belgrave Road Do. Fined £5 and £6 costs. The work was subsequently completed. Order to abate nuisance in two weeks. Further summons issued when defendant failed to appear. He was arrested and committed to one month's imprisonment for default. Black Smoke Nuisances.— The system of inspection of chimneys in the Borough with a view to discovering and as far as possible dealing with such as were found to be a source of nuisance which was established several years ago was continued ; a special report being submitted to the Public Health Committee at each meeting setting out the number of observations made and nuisances discovered. During the year two complaints were received and dealt with. The number of nuisances reported to the Committee was two and in each case the attention of the offender was drawn to the matter. In no case was it necessary to institute proceedings in court. Rat Repression. This is a matter to which during recent years considerable attention has been given and every effort has been made to bring about a reduction in the number of rats and mice, and to operate the provisions of the Rats and Mice (Destruction) Act, 1919. With a view to assisting owners and occupiers of premises one of the inspectors (Draper) was appointed Rat Officer to deal with this in addition to his ordinary work as a district inspector, and has betrayed the greatest keenness and rendered very great assistance is this connection. Special leaflets and posters are widely circulated throughout the Borough, all complaints and all cases of infestation are fully investigated and advice offered as to the procedure most suitable for adoption. The number of complaints received during the year, viz., 67, was lower by 18 than the 1924 figure. The investigation of these complaints necessitated the inspection of 79 premises, 15 of which were used for business purposes (5 of these for the preparation or storage of food), the remaining 52 being private or tenement houses. In 22 of the cases investigated the infestation was directly attributable to defects in the drainage system and disappeared immediately these were remedied. In every instance all advice and assistance was given to the owner or occupier by Inspector Draper, who continued to act as Rat Officer, and to obtain excellent results from the methods advocated. 16 A Rat Week of the series was held during the year from the 2nd to the 7th November, 1925, and attracted a considerable amount of attention to the subject. Great assistance was obtained from the Borough Surveyor and his staff, and also from a number of large firms in the Borough. The result, it is safe to state, was a considerable reduction in the rat population of the sewers and other places affected by these vermin. PREMISES AND OCCUPATIONS CONTROLLED BY BY-LAWS AND REGULATIONS. The following list sets out the majority of the premises and occupations of the class referred to in the heading to this part of the report, and contains a certain amount of information with regard to registration, inspection, etc. Underground rooms and underground sleeping rooms, though controlled, the former under the Public Health (London) Act, 1891, and the latter under special regulations made by the Council in 1910, are not registered. Number of places Number of inspections 1925 Number of notices 1925 Number of prosecutions, 1925 On register at end of 1924 Added in 1925 Removed in 1925 On register at end of 1925 A. Business Premises Milk premises 143 5 4 148 360 5 - Cowsheds 2 - 1 1 20 - - Slaughterhouses 3 - - 3 51 - - Offensive trade premises 2 - - 2 63 - - Ice cream premises 120 6 8 118 210 12 - Butter and Margarine Manufacturers and Dealers 16 - - 16 41 - - Bakehouses 67 - 1 66 136 6 - Fried Fish Shops 22 1 2 21 90 3 - Fish Curers 5 - - 5 53 1 1 B. Habitations Houses let in lodgings 1,115 - - 1,079 13,564 2,462 - Common lodging houses 5 - - 5 - - - A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 148. This is 5 more than in 1924, 9 having been added and 4 removed; in 1919 there were 183 on the register. Cow Sheds.—The only cowshed remaining in the Borough is situated at 42a, Clipstone Street and is licensed for 10 cows. In 1919 the number of cows licensed to be kept in the Borough was 105, though, in fact, only 16 were kept. During the year regular and frequent visits of inspection were made to the premises and attention directed at the time to any matters that seemed to require it. The need for serving notices did not arise. The reduction in the numbers of cows kept in sheds began during the war, several of the cowkeepers having found it impossible, or at least impracticable, to face the increase in the cost of cows, the difficulty in obtaining fodder and 17 labour and the increased cost of both. Following the war these conditions continued to operate and steadily the numbers have gone down until now, as indicated above, only one remains, the reason for its continued existence being largely to meet a demand for milk straight from the cow by members of the Jewish faith, many of whom reside in the neighbourhood. That it was fortunate that the conditions compelled discontinuance of the other sheds cannot be denied. In a Borough such as St. Marylebone there are few situations which can be regarded as anything like suitable for cowsheds. Though it may be admitted that the cow in the town shed is as a rule much cleaner, much better groomed, probably much better looked after than many of her sisters in the country, it cannot be regarded as fair or just to her that she should be shut up continuously for so long as she will give a satisfactory quantity of milk, in a place that, if just sufficiently ventilated and lighted, is no more than sufficiently so and in which no more space is given her than will permit of her standing up and lying down. Even if she does provide for the people a milk that is rather fresher than that generally provided in a town, from her point of view, as well as from the point of view of the individuals in the neighbourhood of the shed who have to bear with the nuisance that must from time to time, at least, arise, the justification must appear inadequate. The system in regard to registration of cowsheds in the Borough is the same as that throughout London. The London County Council is the licensing authority and the Borough Council have the right to object to the renewal of licence before the court at which this is considered. In the absence of any objection on the part of the Borough Council the London County Council apparently grant renewal automatically. Slaughter Houses.—In a general way much of what was said with regard to cowsheds applies in the case of slaughter houses. Very steadily, not only has the number of licensed premises diminished, but also the number of premises actually used even though licensed. The amount of slaughtering done in the premises licensed and used for slaughtering has also been greatly reduced. The total number licensed is shown in the list below in which is indicated the situation and the conditions, if any, under which licence was granted. Premises. Conditions. 50, Henry Street, St. John's Wood Small cattle only. 134, High Street, St. John's Wood On the clear and distinct understanding that the room over the slaughter house is not used as a living room. 32a, Union Street, Middlesex Hospital Nil. All these places were regularly and frequently visited during the year. In no case was objection raised to the renewal of licence after receipt of notice from the County Council that application for renewal had been made. Four notices were received from butchers with regard to slaughtering under the Public Health (Meat) Regulations, 1924, and humane-killers in accordance with the requirements of the L.C.C. bye-laws are being used in every case, and apparently with complete success. Offensive Trades.—There are only two premises within the Borough upon which trades classed as offensive are carried on. The business in each case is that of tripe boiling. The Food Inspector made 63 visits, but no cause of complaint was found. Ice Cream Premises.—The number of such premises in the Borough on the Register is 118. As indicating the growing popularity of this article it may be noted that in 1919 the number registered was 96. 18 Regular inspections were made throughout 1925, and in 12 cases notices were served in respect of uncleanly conditions. Butter, Margarine, etc., Premises.— Information with regard to the sampling of these substances will be found under the heading, "Sale of Food and Drugs Acts." At the end of the year there were on the registers 13 dealers in margarine, 1 wholesale dealer in butter and milk-blended butter and 2 butter manufacturers. All the registered premises were frequently visited. Bakehouses.— At the end of 1925 the number of bakehouses on the register was 66, 60 being underground bakehouses. In 1919 the bakehouses numbered 75 of which 65 were underground, so that there is happening in regard to these latter what is taking place in respect of other premises unsatisfactory from the point of view of hygiene, a gradual disappearance, the result of constant pressure by the authorities and of recognition of their unsuitability by the people themselves. The provisions with regard to registration are contained in the Factory and Workshop Act, 1901, and so far as underground premises are concerned, only premises used prior to the passing of the Act were eligible for registration, which was to be completed before 1904. All the underground bakehouses now in use were registered at this time. Premises underground are rarely satisfactory, but as there was no time limit fixed and the Act contains no requirement as to application for renewal, all that can be done is to exercise as close supervision in order to see that the places are kept in as good condition as possible. In 1924, 156 visits were paid and 10 notices with regard to defects were served. In 1925", 136 visits were paid to these and 6 notices with regard to defects were served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, etc., of the inside walls and other parts of the bakehouses were issued. It was not necessary to institute proceedings to enforce compliance with any notice. Fried Fish Vendors and Fish Curers.—The number of premises in the borough used by vendors of fried fish is 21 and by fish curers 5. Notices calling for periodical lime-washing, etc., of such premises as required by the By-laws of the London County Council, made under Section 9 of the London County Council (General Powers) Act, 1908, were issued, and regular visits of inspection made and action taken where necessary to have any defects noted remedied. In one case in which the business of fish curer had been established without the consent of the Council proceedings were instituted during the year, but were adjourned on the defendant giving an undertaking not to carry On the trade of fish curer on the premises. Factories and Workshops. Though factories are comparatively few in the Borough, the number of workshops, many of them domestic workshops, is considerable, and work in relation to them bulks very large amongst the duties of the district inspectors, more especially those in charge of districts on the south of Marylebone Road. The staple industry is, of course, dressmaking, millinery and tailoring in all its branches, but in a number of places other trades, some of them distinctly curious, are carried on. The total number of visits to factories, workshops and workplaces during the year was 3,189, 535 by the women and 2,654 by the men inspectors. The complaints received numbered 38. 19 The following report which the Medical Officer of Health is required to make to the Secretary of State for the Home Department in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901, gives, in addition to other information, the total number of defects found and of notices served. 1.—INSPECTION. Premises Number of Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories 115 18 - (Including Factory Laundries) Workshops 1450 66 - (Including "Workshop Laundries) Workplaces 1624 60 - (Other than Outworkers' Premises included in Part 3 of this Report) Total 3189 144 - 2.—DEFECTS FOUND. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts— Want of cleanliness 37 37 - - Want of ventilation 10 10 - - Overcrowding 2 2 - - Want of drainage of floors - - - - Other nuisances 57 57 - - Sanitary accommodation insufficient 10 10 - - unsuitable or defective 40 40 - - not separate for sexes 24 24 - - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 6 6 - - Other offences - - - - (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 186 186 - - 20 3.—HOME WORK. OUTWORKERS' LISTS. SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109,110 NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S 110) Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2, (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 69 186 810 ... ... ... 36 ... ... " * * ... ... ... ... ... Total 69 186 810 ... ... ... 36 ... ... ... ... ... ... ... ... 21 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year (1) Number (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 3,278 Coffee Shops, &c. 278 Bakehouses 66 Total number of workshops on Register 3,622 5.—OTHER MATTERS. Class (1) Number (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 57 Action taken in maters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 30 Reports (of action taken) sent to N.M. Inspector 30 Other — Underground Bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 60 22 B.—PREMISES USED FOR HUMAN HABITATION. The only premises used for human habitation in respect of which there ever has been a system of registration are what are called "Houses let in Lodgings" and "Common Lodging Houses." Rooms underground if used as sleeping rooms or for human habitation apart from rooms on the upper floors, though they are not definitely registered, are required to comply with certain requirements contained in the Public Health Act and special regulations. They are referred to here for this reason. Houses Let in Lodgings.—Included under this head are all ordinary tenement houses in which the rooms or floors are let out separately. To some extent as a result of housing shortage a very large proportion of the houses in the Borough are of course so let, and under by-laws made by the London County Council under "The Housing, Town Planning, etc., Act, 1919," the number placed on the register will be greatly increased since no provision whatever has been made for exemption. During the year under review the only list of registered houses in existence was that under the old by-laws and covered 1,079 houses. In all 13,564 visits were paid to these and 2,462 notices relating to cleansing and other defects were served, all of which were complied with without the necessity for further proceedings arising. Common Lodging House.—Though the licence in the case of these houses is actually granted or renewed yearly by the London County Council, the grant or renewal is made subject to the approval of the Borough Council who are provided with a list of applications received prior to the day fixed for consideration. The following table contains all the necessary particulars with regard to the licensed premises of this class in the Borough. On account of the war and the reduction in the number of lodgers, one or two of the lodging houses were shut down and will not again be used in this way. Of those still on the list special reference may be made to "Portman House" in which accommodation is provided for women only. Houses for women are badly needed, but very difficult to find; houses so well arranged and conducted as "Portman House" are rare indeed. Situation, etc., of Licensed Common Lodging Houses. Address. Registered Owner. Registered number of Occupants. 54, Bell Street Eliza Crew 55 men 2, Burne Street and Lisson Street W. Bramwell Booth 499 men 6, Charlotte Place Emma Lawson 7 women 29, Circus Street William H. G. Richardson 100 men "Portland House" (late Shaftesbury Institute), Harrow and Union Street, Lisson Grove Frederick Gerard van de Linde 102 women Total 654 men 109 women 763 A number of visits were paid to all the houses from time to time by officers of the department and the attention of the person in charge or the London County Council directed to any matter calling for remedy. 23 Underground rooms.— In the report of 1919 it was stated with regard to these rooms that: "Despite all efforts quite a number that had been closed and disused for some years were once more found to be occupied. In these cases practically all that could be done was to warn both the person who had let and the person who had taken the rooms and to ensure that the rooms should be put into as good condition as possible. Fortunately, only the best of the rooms were re-let and many that were, or on account of neglect had become, unsuitable remain empty." Since 1919 conditions have not changed, and despite the greatest care and watchfulness rooms of this kind are occupied. In 1926 6 cases in which the occupation was definitely illegal were dealt with. C.—PREMISES THAT ARE NOT BUT SHOULD BE REGISTERED. For a variety of reasons the number of premises in the Borough in which meals are provided or food is sold ready cooked or is prepare 1 for sale is very large. At the end of 1925 there were 276, this number including: restaurant, dining room and coffee shop kitchens, 180; tea-rooms and pastry-cooks, 50; hotel kitchens, 20; fried fish shops, 21; and fish-curers, 5. In addition, there were a number of shops in which meat, ham, sausages, &c., were cooked and sold only over the counter. None of these premises is, or is required to be, registered, and apart from fish-curing and fish-frying premises, which are required to be in compliance with certain requirements contained in by-laws of the London County Council, none of them is subject to any very special provisions. Any individual, in short, may take any sort of premises, and proceed to cook and prepare food for sale; no notice to the local authority is required, and unless compliant is received, or infection or suspicious illness occurs, or the premises are visited by an inspector, the fact that they are so used may never be discovered. That this is so appears to be at least unsatisfactory. On account of changed conditions the amount of home cooking done is steadily diminishing, and more and more the cook-shop, the restaurant, and the cooked-food shop are being resorted to. In the poorer quarters of the Borough the extent to which the friedfish shop, for example, is depended upon may be judged from the number of children making purchases during the school dinner hour, and the number of adult and child customers in the evenings. In the evenings, too, the busiest shops in the main thoroughfares are those where cooked foods are retailed over the counter. Legislation, which did not foresee these changes, contains no provision for dealing properly with the premises, and the Legislature has made no attempt to obtain control over them. Such places as the law, as it now stands, requires to be registered or licensed are mainly those in which uncooked food is dealt with, e.g., slaughter-houses, cowsheds, milk shops, etc. Having regard to the changes, the law should be extended in order to provide for registration of the cooked-food premises also. Before establishing a restaurant or eating rooms of any description, a cook-shop or a cooked-food shop, it should be necessary for application for registration to be made to the local authority, and registration should not be granted until the premises had been inspected and passed as suitable. All this has been said many times before, and in the meantime, for departmental and inspection purposes, a register is kept at the Public Health Office, and particulars with regard to new premises are added as they are found. As a matter of routine, a number of restaurants, etc., are visited each week by the Food Inspector, and any matters discovered at these inspections are dealt with at once. In 1925 the total number of inspections was 1,072, the number of notices served being 23. If and when registration is made compulsory, the work of supervision and control will be greatly simplified, though it is just possible 24 that at first, at least, it might entail an increase in work. The matter is, however, of sufficient importance from the public health point of view to warrant it. Just as from this point of view also, the suggestion that there should be registration of restaurants and cooked-food shops, even of all food shops, is warranted. Food Stalls.—Another class of food premises to which reference may conveniently be made at this point are the food stalls. Of these there are considerable numbers in the market streets, particularly Great Titchfield Street, Bell Street, Church Street, Blandford Street, etc. Up to the present the only class of food stall that has received any attention at all from the Legislature is that from which meat is purveyed. To this certain requirements in the Public Health (Meat) Regulations, 1925, apply, requiring, amongst other matters, that there shall be a covering over the top, back and sides, and that provision shall be made for preventing contamination by flies, etc. As a result of these regulations a certain amount of improvement has taken place, the stallholders, following receipt of a notice setting out the provisions with which they must comply, providing covering of some sort in the positions indicated. With a view to securing a reduction in the amount of litter in the market streets and mainly produced by these and other stallholders the Council have arranged for regular and frequent cleansing each day, and have called upon the stallholders and shopkeepers to bear.part of the cost. The amount payable is from Is. to 3s. per week, according to the number of days the stall is in position. In general it is claimed that improvement has resulted from the introduction of the system. SCHOOLS. The Medical Officer of Health of a Borough in the Metropolis is not school medical officer. The work in connection with both schools and school children is entirely in the hands of the London County Council and their officers, the local medical officer of health having little or nothing to do with it. In no part of the kingdom, indeed, is the divorce between the general public health work and school medical work so complete as in the Metropolis, and since it is impossible to find any justification for it on public health grounds, certainly, and probably also on economic grounds, it is difficult to see why either the central government authorities or the local authorities have for so long acquiesced in the arrangement For the reason that the question of re-organisation of public health in London is under consideration and this as well as Other anomalies are, or will soon be, under discussion, it is not proposed to take it up here. It may be stated, however, that because of the existence of the two authorities there is frequently duplication of work, a quite unnecessary and excessive amount of interchange of correspondence and from time to time cross-purposes. All of which is contrary to the best interests of the public health locally and particularly to those of the children. In regard to the infectious diseases, as they affect the school child, that there should be two staffs—the local and the County Council—engaged, appears to be unnecessary and generally leads merely to the expenditure of a great deal of energy as a result of each endeavouring to keep the other informed as to the state of affairs. That, so far as the general health of the school children, as determined by medical inspection, is concerned, only one authority, and that not the local authority but the County Council, possesses full information, is a serious matter. In regard to conditions found at the medical inspections, the local medical officer of health receives no direct information; as a matter of fact, if he desires to learn where inspections are to be made, he must ask to be informed or find out from 25 the Weekly Gazette of the County Council. Again, if he wishes to know what the results were, he must ask or endeavour to glean the information from the pages of reports issued by the County Council long afterwards. These are, clearly, serious objections, and it is sincerely to be hoped that when re-organization takes place, school medical work will be put in the hands of the local health authority, the Borough Council. A certain amount of information with regard to infectious diseases in the schools will be found in the section dealing with these diseases. FOOD. A. Milk Supply. Only a very small part of the milk consumed in the district Is produced within the Borough and reference is made elsewhere to the cowsheds still occupied. The bulk of the supply is derived from outside, the distribution being in the hands of a lew large firms, most of whom belong to a large combine. Despite the operations of this body, a considerable part of the population is served from a number of fairly large dairy shops, and in the poorer districts certain general shops continue to retail milk along with other articles of food. Writing in 1919 it was stated that: "Having regard to the amount of consideration that is now being given to the milk question generally, it seems probable that there will in time be improvements in this as in other connections," and there is little doubt but that anticipation has proved correct. Analysis of milk.—It has always been one of the chief aims of the Council to ensure that the quality of the milk supplied in the Borough shall be maintained, and during the year much of the time of the department and the food inspector was devoted to this matter. The total number of samples taken either formally and in accordance with the provisions of the Sale of Food and Drugs Act, or informally as "test" samples was 259. On examination by the Public Analyst 4 (1.5 per cent.) were found to be adulterated. In 1924 the percentage was 2.2, in 1923 and 19522 2.1 and 3.3, respectively. Further reference to the question of milk examinations is made in the report of the Public Analyst which will be found elsewhere. Since 1919 methods of distribution have very greatly improved. Very much more milk than formerly is delivered in bottle, the quantity sold loose—from churns, etc.—being, it would seem, less and, on the whole, definitely cleaner. Since 1919 also the system of grading has been introduced, and to judge from the number of firms licensed to deal in milk of various grades and the sampling done on behalf of the Ministry of Health considerable quantities must be sold in the Borough. As in former years, as soon as the analyst's report was obtained, vendors whose samples were found to be up to standard were informed that it would be unnecessary for them to retain the portion of milk left with them. When the samples were found to be slightly below the standard, a special report was made to the Public Health Committee. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 64 were obtained on delivery at Marylebone Station of the London & North-Eastern Railway and 3 on arrival at Baker Street Station of the Metropolitan Railway. Of the 64 one proved to be adulterated, and proceedings were instituted and costs amounting to £5 5s. were imposed. 26 The quarterly returns as to milk samples are tabulated below :— Quarter of the Year. No. of Samples Taken. No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. Fines and Costs. £ s. d. 1st 73 - - - - 2nd 86 2 2.3 - - 3rd 70 1 1.4 1 5 5 0 4th 30 1 3.3 - - Total for year 259 4 1.5 1 5 5 0 Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 5 samples were taken and submitted to Dr. Foulerton, the Council's Bacteriologist, for examination. In each case in which a result not entirely satisfactory was obtained communications were sent to the Local Authority of the district in which the milk was produced in order that an investigation might be carried out locally. On all occasions the greatest willingness to co-operate was shown by the officers of these authorities, and it is safe to claim that definite improvements have followed the taking of action on these lines. In addition to these samples, 70 of "Certified" milk were taken and submitted to Dr. Foulerton for examination. The reports were, in accordance with the usual arrangement, forwarded to the Ministry of Health, but with regard to them it may be stated, generally, that the results were satisfactory. Of 4 Grade A Tuberculin Tested samples all were in compliance with the standard. Of 66 samples of Certified milk, 14 failed in one way or another to comply, 5, in addition to containing over the standard number of bacteria, showing the presence of Bacillus Coli. The remaining 9, though complying with the bacterial standard, showed Bacillus Coli to be present. Dairies, Cowsheds and Milkshops Orders.—Frequent inspections of cowsheds and milk premises were made with the object of discovering whether or not the requirements of the regulations as to cleanliness, etc., under these orders, were being complied with. In no case was it necessary to take action. Milk and Cream Regulations.—The following is a copy of the return required by the Ministry of Health with regard to proceedings under the Public Health (Milk and Cream) Regulations. These regulations absolutely forbid the addition of preservatives to milk, and so far as can be gathered from the reports of the Public Analyst, the prohibition is loyally obeyed. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 & 1917. Report for the year ended 31st December, 1925. 1.—Milk ; and Cream not sold as Preserved Cream. (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present, and persentage of preservative found in each sample. Milk 259 Nil Cream 7 Nil Nature of preservative in each case in column (b), and action taken under the regulations in regard to it. Nil. 27 2.—Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correct statements made 17 (ii.) Statements incorrect Nil Total 17 (iii.) Percentage of preservative found in each sample Average .0651% Boric Acid per lb. Lowest .0464% Highest .097% Persentage stated on statutory label. Not exceeding 0.4%. (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent 17 (ii.) Below 35 per cent Nil Total 17 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed Nil (d) Particulars of each case in which the Regulations have not been complied with, and action taken Nil 3.—Thickening instances.—Any evidence of their addition to cream or to preserved cream. Action taken where found.— None. 4.—Observations, if any.— Nil. The Milk Special Designations Order, 1923.—Under this Order 41 applications were received from 9 dealers in the Borough for licences to sell milk as "Certified" Milk or Grade "A" Tuberculin Tested Milk. As the milk in each case was obtained from a producer licensed under the Order and the premises of the applicants were found to be satisfactory, licences were granted in each case, the numbers being 15 in respect of Certified Milk and 12 for Grade "A" Tuberculin Tested Milk. In addition to these, one licence has been granted in respect of pasteurised milk, the Holding Plant provided and the methods generally having been considered satisfactory. In accordance with the instructions of the Ministry 70 samples were taken during the year and submitted to the Council's Bacteriologist, Dr. A. J. R. Foulerton. Copies of the reports were duly forwarded to the Ministry. Milk (Mothers and Children) Orders.—During 1925 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1926, was £357 5s. 9d., as against £304 19s. 9d. up to 31st March, 1925. The actual number of cases dealt with was 220, and the number of orders issued 1,051. The number of instances in which the supply was granted absolutely free, having regard to the total number of cases and circumstances generally, is comparatively small. The amount contributed in individual cases varies considerably, but from the very beginning what the amount should be has always been very carefully assessed, the size of the family and the family earnings and circumstances being taken into consideration. In every case formal application is required to be made by the individual whether recommended by the Medical Officer of a consultation or seeking assistance personally. Following receipt of the application enquiries are made by the Health Visitors and on their report and the information provided in the application, assessment is made by the Medical Officer of Health. 28 The period for which the grant is made varies, but is usually two weeks, and at the end of this period the case is again considered and alterations made in the amount ordered, and the contribution charged if necessary. The system, it may be said, has worked with absolute smoothness and has done a very great deal of good. Here and there an individual not quite deserving may have received assistance, but on the whole the efforts of the officers to make a first assessment have been helped rather than hindered. FOODS OTHER THAN MILK. The main duties in relation to food protection generally were carried out by Inspector Smith, who made inspections of premises in which food is sold, stored or prepared, and acted as inspector under the Sale of Food and Drugs Acts. Food Inspection.—There was no change in the method of carrying out the work of food inspection during year. The special Saturday night and Sunday inspections in market streets, etc., were continued, and in carrying them out Inspector Smith received the assistance of other members of the staff having the necessary qualifications and experience. On a great many occasions the inspector was called by vendors to examine articles of food under Section 47 (8) of the Public Health (London) Act, 1891, and to accept surrender of such as were unsound or unwholesome or unfit for food Amongst the articles dealt with in this way were Unsound and Diseased Food Condemned and Destroyed During the Year 1925. Meat— Beef 186 lbs. Mutton 85 lbs. Pork (Tuberculosis) 2 heads and 1 fore end Bacon 11¾ cwt. Fish— Wet —Salmon 5 fish Ireland Dabs 1 box Haddocks 4 boxes Plaice 1 box Skate 4 boxes Codlings 1 box Herrings 5 boxes Eels 1 draft Dry—Kippers 5 boxes Fillet 1 box Fruit— Bananas 2 stalks Tomatoes 26 boxes Apples 3 barrels Strawberries 4 baskets Pears 4 baskets Vegetables— Cabbages 1 sack Miscellaneous— Cream 228 tins Dressed Crab 500 tins 29 Food, Premises.— The points of importance in relation to food premises generally, i.e., slaughterhouses, bakehouses, etc., have already been defined, and here it is unnecessary to say more than that during the year these places were kept under regular supervision. Numerous visits were paid and inspections both of the premises and contents carried out. Public Health (Meat) Regulations, 1925.—Some reference has already been made to these regulations, but here it may be stated that in connection with their enforcement a very considerable amount of work was done during the year. Prior to the coming into operation of the regulations a communication was sent to all butchers and other engaged in the sale of meat and other articles, e.g., bacon, falling within the definition of meat. Suggestions were also offered as to the methods to be adopted with a view to insuring compliance both in the case of shops and of stalls. In a number of instances shopkeepers abandoned the practice of exposing meat on window ledges and stalls outside their shops and provided, in addition, glass fronts. In others, there was compliance to the extent of abandoning outside stalls and only exposing the meat on the window ledge inside the open window. In the market streets, on account of the existence of meat stalls in the roadway, great difficulty was experienced with the shopkeepers, and up to the present in the majority of instances the only provision made has been in the form of canvas screens over the top and sides of the outside stalls. In one case in which even this arrangement was improperly carried out proceedings were instituted, and the defendant was called upon to pay a fine of £10 with £8 8s. costs in addition. In the case of stalls the screening of the top, back and sides provided has been in the form of tarpaulin. In one instance, despite repeated warnings, proceedings for failure to carry out screening properly became necessary, and the magistrate, after making a personal inspection with the Medical Officer of Health, imposed a fine of £10 with costs amounting to £10 10s. The fact that the requirement of the regulations as to notification of intention to slaughter had been complied with has already been noted. C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,040. Of this number 9 were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of .86 per cent., which is lower than that for 1924, when it was 1.4. The method adopted in connection with the taking of samples was similar to that followed in previous years and described in former reports. The majority were "formal" samples, and in carrying out the sampling, the inspector was almost invariably assisted by an agent. The bulk of the samples taken were of milk and dairy produce. Reference has already been made to the case in which a prosecution was instituted. The following Tables and Report from the Public Analyst, Mr. J. F. F. Rowland, give full information with regard to samples submitted to and examined by him :— 30 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and, if so, the name of such Authority. Result of Anal sis ; showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. The sum paid 1in respect of the Analysis. Observations. FIRST QUARTER ENDING 31st MARCH, 1925. 73 milk Food Inspector, St. Marylebone Borough Council Genuine. 12/6 per sample. 12 were test samples. All the samples were free from preservatives and contained no colouring matter. 6 condensed milk Do. Do. All were test samples. 52 butter Do. Do. 44 were test samples. All the samples contained boric acid as a preservative in amounts ranging from 6 5 to 23.1 grains per lb. 4 margarine Do. Do. All were test samples. * 27 cheese Do. Do. 26 coffee Do. Do. 2 cocoa Do. Do. 6 pepper Do. Do. 5 mustard Do. Do. 1 mustard mixture Do. Do. 6 tea Do. Do. 3 China tea Do. Do. 7 jam Do. Do. 5 marmalade Do. Do. 2 granulated sugar Do. Do. 3 demarara sugar Do. Do. 4 whiskey Do. Do. 2 rice Do. Do. 2 cornflour Do. Do. 2 custard powder Do. Do. 3 borax Do. Do. 9 boracic ointment Do. Do. 3 zinc ointment Do. Do. 3 compound liquorice powder Do. Do. 8 cream Do. Do. One was a test sample. No. Fat. Preservatives. 102 45.75% 4.5 grains boric acid per lb. Preserved. Private Sample. 132 Weighed ¼ oz. No preservatives present. 158 47"6% 4.0 grains boric acid per lb. Preserved. 168 48.0% 6.8 grains boric acid per lb. Preserved. 170 50.0% No preservatives present. 184 48.7% 6 45 grains boric acid per lb. Preserved. 208 54.2% 4.50 grains boric acid per lb. Preserved. 212 50.0% 4.9 grains boric acid per lb. Preserved. Total number of Samples analysed during the Quarter 264 Number of Samples adulterated Nil 31 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and if so, the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration The sum paid in respect of the Analysis Observations. SECOND QUARTER ENDING 30TH JUNE, 1925. 84 milk Food Inspector, St. Marylebone Borough Council. Genuine 12/6 per sample. 10 were test samples. All the samples were free from preservative and contained no colouring matter. 1 milk Do. Adulterated. No. 428 10% deficient in milk fat. No. 428—divided sample. First offence. No fine imposed. £5 5s costs. 1 milk Private Sample. Adulterated. No. 319 13.3% deficient in milk fat. No. 319. 46 butter Food Inspector, St. Marylebone Borough Council. Genuine 45 were test samples. All the samples contained boric acid in amounts which ranged from 7.0 grains up to 23.2 grams per lb. 23 margar Do. Do. All were test samples. 13 cheese Do. Do. All divided. 6 cream Do. Do. No. Fat. Preservatives. 361 49.7% Nil 363 50.2% 4 5 grains boric acid per lb. Preserved. 399 50.0% 4.75 grains boric acid per lb. Preserved. 402 48.7% 3.90 grains boric acid per lb. Preserved. 510 52.7% 3.25 grains boric acid per lb. Preserved. 514 50.0% 4 0 grains boric acid per lb. Preserved. 6 rice Do. Genuine. All were test samples. 4 sago Do. Do. 5 cocoa Do. Do. 5 custard powder Do. Do. 4 ground rice Do. Do. 5 mustard Do. Do. 18 coffee Do. Do. 6 marmalade Do. Do. 10 jam Do. Do. 5 honey Do. Do. 1 sweets Do. Do. 1 bread Do. Do. 1 cocoa & milk Do. Do. 2 lemon chees Do. Do. 1 lemon curd Do. Do. 9 condensed milk Do. Do. 2 olive oil Do. Do. 2 cod liver oil Do. Do. 1 bottled plums Do. Do. 2 bottled gooseberries Do. Do. 1 bottled sausages Do. Do. 2 pickles Do. Do. 2 pickled onions Do. Do. 3 malt vinegar Do. Do. 3 fairy cakes Do. Do. 5 sponge cakes Do. Do. 6 lemonade pdrs. Do. Do. 1 lemonade Do. Do. 4 soda water Do. Do. 2 scotch whiskey Do. Do. Total number of Samples analysed during the Quarter 293 Number of Samples adulterated 2 32 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and. if so, the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis Observations. THIRD QUARTER ENDING 30TH SEPTEMBER, 1925 68 milk Food Inspector, St. Marylebone Borough Council. Genuine 12/6 per sample. 8 were test samples. No sample contained preservative or added colouring matter. 1 milk Do. Adulterated. No. 613—divided sample. No. 613 contained 10%added water. 1 milk Do. Genuine This was a test sample. 35 butter Do. Do. 25 were test samples. All the samples contained boric acid as preservative, the amounts varying between 0.1% and 0.38% 15 cheese Do. Do. All were test samples. 7 condensed milk Do. Do. 1 lard Do. Do. 14 coffee Do. Do. 12 tea Do. Do. 12 marmalade Do. Do. 4 jam Do. Do. 1 cocoa and milk Do. Do. powder 9 lemon cheese Do. Do. 2 chocolate Do. Do. 1 chocolate Do. Do. nuggets 1 brick ice cream Do. Do. 1 brick ice cream Do. Adulterated. No. 641 contained 0.057% boric acid per lb.—4 0 grains 1 fruit drops Do. Genuine 3 granulated sugar Do. Do. 2 lemonade Do. Do. 3 pickles Do. Do. 3 tartaric acid Do. Do. 1 mixed drops Do. Do. 2 mustard Do. Do. 2 mustard mixture Do. Do. 2 cod liver oil Do. Do. 12 whiskey Do. Do. 4 whiskey Do. Adulterated No. 738 Scotch Whiskey. Sample was 41.62 degrees under proof. This was a test sample. No. 760 Whiskey. Sample was 42.34 degrees under proof. This was a test sample. No. 785 Scotch Whiskey. Sample was 36.12 degrees under proof. Divided sample. Vendor cautioned. No. 786 Scotch Whiskey. Sample was 36.23 degrees under proof. Divided sample. Vendor cautioned. 9 cream Do. Genuine No. Fat. Preservative. 575 53.0% 0 05 grains boric acid per lb. Preserved. 579 50.0% 0 057 grains boric acid per lb. Preserved. 608 56.0% 0 05 grains boric acid per lb. Preserved. This was a test sample. 33 Articles submitted for Analyst*. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration The sum paid in respect of the Analysis. Observations. cream (contd.) Food Inspector, St. Marylebone Borough Council. 612 49.7% Nil. 620 52.0% Nil. 622 56.5% 0.0476 grains boric acid per lb. Preserved. 624 52.7% Nil. 628 56.0% Nil. This was a test sample. 717 56.0% 0.0907 grains boric acid per lb. Preserved. Total number of Samples analysed during the Quarter 229 Number of Samples adulterated 6 FOURTH QUARTER ENDING 31ST DECEMBER, 1925. 29 milk Food Inspector, St. Marylebone Borough Council. Genuine. 12/6 per sample 7 were test samples. No sample contained preservative or colouring matter. 1 milk Private Sample. Adulterated. No. 805 13.3% deficient in fat and contained 27.53% of added water. 1 cream Food Inspector, St. Marylebone Borough Council. Genuine. Divided. No. Fat. Preservative. 915 57.6% contained 0.07% boric acid Preserved. 67 butter Do. Genuine. 61 were test samples. All the samples examined contained boric acid in amounts ranging from 014% to 0.37% 4 roll and butter Do. Do. All were test samples. 7 condensed milk Do. Do. 6 margarine Do. Do. 7 lard Do. Do. 27 cheese Do. Do. 4 olive oil Do. Do. 3 honey Do. Do. 15 jam Do. Do. 10 marmalade Do. Do. 4 Pepper Do. Do. 7 mustard Do. Do. 42 coffee Do. Do. 4 tea Do. Do. 1 sauce O.K. Do. Do. 5 tartaric acid Do. Do. 4 bicarbonate of soda Do. Do. 3 boracic ointment Do. Do. 3 zinc ointment Do. Do. Total number of Samples analysed during the Quarter 254 Number of Samples adulterated 1 34 ANNUAL REPORT OF THE PUBLIC ANALYST, 1925. The number of samples taken under the Sale of Food and Drugs Acts and submitted for analysis, was 1,040: a decrease as compared with the samples for 1924, the number for that year being 1,106. A complete list is as follows:— No. Article. Genuine. Adulterated. Total. 1 Bicarbonate of Soda 4 - 4 2 Boracic Ointment 12 - 12 8 Borax 3 - 3 4 Bottled Gooseberries 2 - 2 5 Bottled Plums 1 - 1 6 Bottled Sausages 1 - 1 7 Bread 1 - 1 8 Brick Ice Cream 1 1 2 9 Butter 200 - 200 10 Cheese 82 - 82 11 China Tea 3 - 3 12 Chocolate 2 - 2 13 Chocolate Nuggets 1 - 1 14 Cocoa 7 - 7 15 Cocoa and Milk 2 - 2 16 Cod Liver Oil 4 - 4 17 Coffee 100 - 100 18 Compound Liquorice Powder 3 - 6 19 Condensed Milk 29 - 29 20 Cornflower 2 - 2 21 Cream 24 - 24 22 Custard Powder 7 - 7 23 Demarara Sugar 3 - 3 24 Fairy Cakes 3 - 3 25 Fruit Drops 1 - 1 26 Granulated Sugar 5 - 5 27 Ground Rice 4 - 4 28 Honey 8 - 8 29 Jam 36 - 36 30 Lard 8 - 8 31 Lemonade 3 - 3 32 Lemon Cheese 11 - 11 33 Lemon Curd 1 - 1 34 Lemonade Powders 6 - 6 35 Malt Vinegar 3 - 3 36 Margarine 33 - 33 37 Milk 255 4 259 38 Marmalade 33 - 33 39 Mixed Drops 1 - 1 40 Mustard 19 - 19 41 Mustard Mixture 3 - 3 42 Olive Oil 6 - 6 43 Pepper 10 - 10 44 Pickles 5 - 5 45 Pickle Onions 2 - 2 46 Rice 8 - 8 47 Rolls and Butter 4 - 4 48 Sago 4 - 4 49 Sauce (O.K.) 1 - 1 50 Scotch Whisky 2 - 2 51 Sponge Cakes 5 - 5 52 Soda Water 4 - 4 53 Sweets 1 - 1 54 Tartaric Acid 8 - 8 55 Tea 22 - 22 56 Whisky 16 4 20 57 Zinc Ointment 6 - 6 1,031 9 1,040 35 Milk. —Of the 259 samples taken and examined during the year four were adulterated. This represents 1.54 per cent. of the total, a figure much lower than any obtained during recent years. In 1922 the percentage was 3.36, in 1923 2.18 per cent. and 2.56 per cent. for 1924. The worst instance of adulteration was one which was 13.3 per cent. deficient in fat and which contained 27.53 per cent. of added water. This was a private sample. Coming now to the average composition of the milks taken during the year we find the figures to be as follow:— Year Sp. Gr. Total Solids Fat Solids not Fat 1925 1031.3 12.27 3.58 8.69 1924 1031.33 12.42 3.70 8.72 The figures for 1924 are given for comparative purposes, and from the comparison we must conclude that little variation in quality has taken place during the year, though what variation there is is in a retrograde direction. Butter.—200 samples were analyzed during the year and none was found to be adulterated. This represents a great improvement on the previous year when out of 215 taken 2.33 per cent, were adulterated. Margarine.—In the manufacture of this food under modern conditions so much use is made of cheap and varied vegetable products that there is little incentive to any form of adulteration other than excess of water or excess of preservative. Of the 33 samples examined during the year none was adulterated, and none contained excess of either of the substances mentioned. Cream.—24 samples were taken and all were found genuine, and none contained other preservative than, or an amount in excess of, what was allowed on the label. Sugar.—3 samples of Demarara sugar and 5 of granulated were examined, but no sample was contaminated with tin, as was one of the samples taken during 1924. It is to be hoped that this indicates that the steps taken by the Ministry of Health as a result of the previous report may be so effective as to prevent any such contaminated sugar being again on sale. Brick Ice Cream.—One of the two samples examined contained Boric Acid (0.057 per cent.). Sponge Cakes.—5 samples were examined and it is satisfactory to note that none contained boric acid as a constituent of any of the ingredients used in the manufacture. Tea.—In view of the grave and disquieting statements which have been made in what should be authorative quarters, it is very satisfactory to find that none of the 25 samples examined contained any form of adulteration whatsoever. Rolls and Butter.—4 samples were taken—none was adulterated. Whisky.—Of the 20 samples analyzed 4 were adulterated, this represents no less than 20 per cent, of the whole number taken—a very considerable proportion. Other Samples.—All the other samples examined were genuine and call for no special comment. 36 STATISTICAL. BIRTHS. Registration.— The number of births registered during 1925 was 1,496*, being 4 more than in 1919 and 35 less than in 1924. Of the children born, 775 were boys and 721 girls. The birth rate per 1,000 of the population was 14.1, as against 14.5 in 1924. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1925, with those of each of the years since 1919:— 1919. ]920. 1921. 1922 1923. 1924. 1925. All Souls 120 17.3 14.3 14.2 12.8 11.1 10.4 St. Mary 10.5 15.8 15.5 11.8 12.7 12.4 12.8 Christ Church 22.6 29.6 22.1 20.5 19.6 19.1 17.9 St. John's 12.5 22.9 22.0 13.9 17.8 14.0 14.1 The Borough 14.6 21.5 18.4 15.9 15.8 14.5 14.1 Notifications.— The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,699. The provisions of the Act are now very generally known, and the necessity for notifying is not less well recognised than that for registration. Failures to notify within 36 hours of birth, as required, were comparatively few. In such cases as there was failure, a perfectly reasonable explanation was forthcoming, and it was not considered necessary to take proceedings against any of the parties. The main sources of the notifications are set out below. The figures, it may be noted, refer to notifications and not to births. In some cases duplicate notifications, from different sources, were received with regard to the same birth. No. Per cent. From parents 41 1.4 „ doctors 238 6.3 „ midwives 725 20.3 „ other persons 195 6.0 „ hospitals, etc. 2,505 66.0 3,699 Of the total births notified, 175 referred to still-births (86 males and 89 females): 1,962 took place at Queen Charlotte's Hospital; 391 at Middlesex Hospital; 47 at the St. Marylebone Home; and 1,194 were born at home. Of those notified as having occurred in St. Marylebone, 1,997 belong to other Boroughs. DEATHS AND DEATH RATE. The number of deaths registered in 1925 was 1,257. This figure is inclusive of person; who, though normally resident in the Borough, died in institutions outs, de, but, exclusive of persons, who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 225 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone :— Legitimate Males 91 ,, Females 73 Illegitimate Males 31 ,, Females 30 37 The corrected death-rate* per thousand for the year was 11.0. In the previous year, the rate was 13.6 and the number of deaths 1,436. In 1923 the rate was 11.7 per 1,000 and in 1922, 13.7. In 1919, when the last summary report was submitted, the deaths numbered 1,568 and the corrected death-rate was 15.9. The following short table shows the death-rates in the several registration sub-districts in 1925 and compares them with those of the years onward from 1919:— 1919 1920 1921 1922 1923 1924 1925 All Souls 12.9 9.9 10.2 11.8 8.9 9.7 9.2 St. Marys 15.3 13.2 12.0 15.4 12.3 15.6 12.5 Christ Church 18.5 14.2 14.0 14.0 12.5 14.4 12.9 St. John 17.0 13.6 16.0 14.3 18.0 14.6 12.5 The Borough 15.9 12.7 12.8 13.7 11.7 13.6 11.0 District births and deaths for the year ended 2nd January, 1925, are given in the following table. A further table giving the vital statistics of separate localities for 1925 and the ten preceding years, will be found amongst the Ministry of Health Tables on page 78. Sub-District. Population estimated to middle of 1925. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 25,425 145 120 265 110 124 234 St. Mary 27,172 174 174 348 151 188 389 Christ Church 33,024 318 275 593 213 213 426 St. John 20,479 138 152 290 111 147 258 The Borough 106,100 775 721 1,496 585 672 1,257 The following table shows the number of deaths that took place amongst infants under 1 year and adults of 65 years and upwards in each of the four quarters of 1925. For purposes of comparison the table for 1919 is reproduced from the report for that year. It is interesting to note that the figures relating to both infants and the elderly have fallen considerably. The distribution of the deaths is the same in each of the two years, the heaviest incidence in both ok and young falling in the first and last quarter. 1925 January March AprilJune JulySeptember OctoberDecember Total Infants under 1 year 27 20 17 30 94 Persons of 65 years and upwards 162 119 94 171 546 1919 JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 46 32 29 40 147 Persons of 65 years and upwards 227 128 90 158 603 * A definition of the term "corrected death-rate" will be found on page 9 of the Report for 1912. 38 DEATHS IN RELATION TO AGE. The age distribution of the deaths that occurred in 1925 is shown in the following table, which gives also, for the purpose of comparison, the figures for each age group since 1919. Age Periods Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards At all Ages 1919 147 34 39 35 42 227 441 603 1,568 1920 145 25 21 33 49 145 383 498 1,299 1921 123 22 26 28 44 167 450 490 1,355 1922 115 49 49 38 39 193 422 546 1,451 1923 111 26 16 26 50 142 363 501 1,235 1924 123 51 44 25 54 152 438 549 1,436 1925 94 25 19 25 42 149 357 546 1,257 The percentage relation of each group to the total number of deaths in 1925 is shown below:— Under 1 year 7.4 per cent. 1 and „ 2 years 2.0 „ 2 „ ,, 5 „ 1.5 ,, 5 ,, ,, 15 „ 2.0 ,, 15 „ „ 25 „ 3.3 ,, 25 „ „ 45 „ 11.8 „ 45 „ „ 65 „ 28.5 ,, 65 „ upwards 43.5 ,, Of the total, 145 at death were aged between 65 and 70; 257 between 70 and 80; 126 between 80 and 90, and 17 between 90 and 100. Over 100—one resident, a spinster, died at the advanced age of 104. Causes— 1919 1920 1921 1922 1923 1924 1925 Bronchitis and other respiratory diseases 165 137 140 152 113 157 169 Nephritis and Bright's disease 12 13 15 16 11 9 18 Cancer 63 64 66 77 67 76 74 Tuberculosis 14 4 9 6 8 9 8 Influenza 28 9 3 19 12 22 7 Violent deaths 13 15 14 9 16 12 12 Causes of and ages at Death.— General information with regard to the deaths which occurred in the Borough during the year, mainly as to causes and the ages at which death took place, is given in Table III of the Ministry of Health series at page 81. This same table gives the number of deaths from various specified causes which occurred in institutions, in hospitals, nursing homes, etc. In each of the groups all deaths, whether of residents or non-residents, are included, which accounts for the fact that the total comes up to 1,472. Fuller information than is possible in the table is given in the following pages, in which also the figures relating both to causes of death and the ages at which these causes were operative are analysed. INFANTILE MORTALITY. The infantile mortality rate of any district is the number of deaths of infants under one year of age per 1,000 of the births which occurred in the same year. The number of babies under one year who died in St. Marylebone in 1925 was 94, and the number of births in that year 1,496. The infantile mortality rate is therefore 63. This is an improvement on 1919 when the rate was 98.5, and a great improvement on 1917 when the figure was 120.9, and the highest since 1905, at 39 or about which time infantile mortality preventive work was seriously undertaken. In the report for 1919 commenting upon the rate (98.5) registered in that year it was described as "more or less of a return to the pre-war level, and though it is always unsafe to prophesy with regard to the behaviour of death rates, it is not too much to say that it is unlikely there will be further occasion for declaring a rate anything like so high as that for 1917." The progress that has taken place since then and the fact that in 1925 not only was the rate (63), but also the number of deaths, actually the lowest on record would appear to suggest that it might not be unsafe to repeat the prophecy. The course which the rate has taken is graphically shown in the chart on page 41, which indicates clearly that the only really serious interruption to the decline was in 1917. The means adopted in the Borough with a view to bringing about a reduction and generally improving the life and health chances of infants and children are described in a separate section of the report—Maternity and Child Welfare. This part being merely statistical, it is not proposed at this point to do more than give some sort of analysis of the figures relating to deaths amongst infants. Causes.— A Table (Ministry of Health, Table I) will be found on page 40, in which, in addition to the causes of health, are shown the distribution of the deaths according to age and locality. So far as age and causation are concerned, conditions vary little year by year. In 1925, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 31 were less than one month old when they died and 45 less than three months. The figures for 1924 were 47 and 69, for 1919, 60 and 90, respectively. The outstanding causes of death and the proportions traceable to them were those usually noted. Prematurity (numbers 12, 13 and 14 in the table), which as usual heads the list, caused 43 in 1924 and 27 in 1925. Diarrhoea and enteritis (7 and 8) accounted for 18 in 1924 and for 22 in 1925. Respiratory diseases, the third of the main causes, took 31 in 1924 and in 1925, 18. Amongst the other causes of death, those which call for mention are the commoner infectious diseases, which together led to 1 death among infants the particular disease being diphtheria. Two deaths were stated to be due to overlaying, 3 to convulsions, 1 to meningitis, and 8 to whooping cough. In the following table information supplementary to that in the large table is given with regard to deaths in the various sub-districts. Christ Church, which always contributes most largely to the infantile as to most of the other mortality rates, being the most thickly populated area and that in which there is most poverty, most overcrowding and most neglect of ordinary precautions, is again at the head of the list with 56 deaths amongst infants. In1 924 the figure was 55 and in 1919, 63. Sub-District. Under 1 week. 1 and under 2 weeks. 2 and under 3 weeks. 3 and under 4 weeks. 4 weeks and under 3 months. 3 and under 6 months. 6 and under 9 months. 9 and under 12 months. Totals. All Souls 3 - 1 - - 2 3 1 10 St. Mary 4 1 1 - 2 5 4 2 19 Christ Church 18 4 1 - 11 14 8 5 56 St. John 2 1 - - 1 1 3 1 9 Totals 22 6 3 - 14 22 18 9 94 40 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year of age, and in Sub-Districts. No. CAUSE OF DEATH Under 1 Week 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 1 Month 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year All Souls St. Mary Christ Church St. John Total 1 Small-Pox - - - - - - - - - - - - - - - 2 Chicken-Pox - - - - - - - - - - - - - - - 3 Measles - - - - - - - - - - - - - - - 4 Scarlet Fever - - - - - - - - - - - - - - - 5 Diphtheria and Croup - - - - - - - - 1 1 - - 1 - 1 6 Whooping Cough - - - - - 2 2 2 2 8 - 1 6 1 8 7 Diarrhœa - - - - - - 1 - - 1 - 1 - - 1 8 Enteritis - 3 - - 3 4 7 5 2 21 2 4 14 1 21 9 Tuberculous Meningitis - - - - - - - - - - - - - - - 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation - - 1 - 1 - 1 - - 2 - 1 - 1 2 13 Premature Birth 14 2 - - 16 - 2 - - 18 2 1 13 2 18 14 Atrophy, Debility and Marasmus - - - - - 3 2 2 - 7 2 3 2 - 7 15 Atelectasis 3 - - - 3 - - - - 3 - 1 2 - 3 16 Injury at Birth - - - - - - - - - - - - - - - 17 Erysipelas - - - - - - - - - - - - - - - 18 Syphilis - - - - - - - - - - - - - - - 19 Rickets - - - - - - - - - - - - - - - 20 Meningitis (not Tuberculous) - - - - - - 1 - - 1 - - 1 - 1 21 Convulsions - 1 1 - 2 - - 1 - 3 1 2 - - 3 22 Gastritis - - - - - - - - - - - - - - - 23 Laryngitis - - - - - - - - - - - - - - - 24 Bronchitis - - - - - 1 - 1 1 3 - - 2 1 3 25 Pneumonia (all forms) 1 - - - 1 2 4 5 3 15 - 3 10 2 15 26 Suffocation, Overlying - - - - - - 1 1 - 2 - - 2 - 2 27 Other Causes 4 - 1 - 5 2 1 1 - 9 3 2 3 1 9 Totals 22 6 3 - 31 14 22 18 9 94 10 19 56 9 94 Legitimate, 1,844 Nett Births in the Year I Illegitimate, 152 Total 1,496 Legitimate Infants, 82 Nett Deaths in the Year Illegitimate Infants, 12 Total 94 41 INFANTILE MORTALITY FIGURES. 42 DEATHS IN RELATION. TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table III. of the Ministry of Health series on page 81. This Table also shows the distribution of deaths according to causes in the various registration sub-districts. The following notes with regard to certain of the causes which contributed most largely to the death rate, may be of interest. DIARRHŒAL DISEASES. The total number of deaths registered as due to diarrhœa and enteritis (inflammation of the bowels), was 25, equal to 0.23 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1925 this was the case also, no fewer than 22 of the 25 beingchildren under 1 year of age. In 1924 the deaths from diarrhœal diseases numbered 18, and of this number 15 were babies. In 1925, therefore, there was an increase in the total over 1924, but a slight decrease over 1919 when the total was 29, the figure for children under 1 year of age being 23. Deaths from diarrhœal diseases always vary most markedly with the weather conditions, being higher when the summer is warm and dry, lower when it is cold and wet. They vary also with the sanitary condition of the district and the amount of welfare work done on behalf of the babies. The year 1925, from the point of view of weather, was not what might be called a " diarrhœa year," and doubtless this accounts for part of the fall. Much was also due to welfare work; and even to sanitary work some credit must be given. Taking all things into consideration, indeed, it may be taken as reflecting credit on all parties concerned, the mothers of the babies and health workers alike, that the death figure was no higher than 25. Particularly in relation to diarrhœa amongst children, a very great deal of educational work is done at the centres of the Health Society and in the homes by health visitors and inspectors, and during the year there was the usual wide distribution of special leaflets on diarrhoea, flies in relation to disease, etc. INFECTIOUS (COMMUNICABLE) DISEASES. The number of deaths due to each of the diseases included in this group is referred to when dealing specifically with the disease under the heading " Prevalence of and Control over Infectious Diseases." It is interesting to note here, however, that excluding influenza, which alone caused 17 deaths, and including diarrhoea (25 deaths) the total number registered as due to them was 56. This is a comparatively low figure, lower certainly than that of 1919 when it reached 69. The diseases contributing most largely to the total were diphtheria, 5 ; whooping cough, 21; scarlet fever, 2; enteric fever, 2 ; erysipelas, 1. Phthisis and Other Tuberculous Diseases. The total deaths due to the diseases dealt with under this heading, viz., phthisis (pulmonary tuberculosis or consumption of the lungs), tuberculous meningitis, general tuberculosis, tabes mesenterica, and all conditions due to the germ of consumption, numbered 93, a figure smaller by 28 than that for 1924. Than the figure for 1919 it is smaller by 17, when the 116 returned for that year was claimed to be the smallest number ever registered in the Borough. 43 The great bulk of the 93 deaths, viz., 80, was due to phthisis. The number in 1924 was 121. Of the total number of deaths registered (1,257), the percentage due to phthisis was 6.3, as against 6.1 in 1924 and 9.1 in 1919. The age periods at which the deaths occurred were: 5—15, 2 (2.5 per cent.); 15—25, 13 (16.2 per cent.); 25—45, 32 (40.2 per cent.) ; 45—65, 25 (31.1 per cent.); 65 and over. 8 (10.0 per cent.). Below the age of five years, 5 deaths were certified as having occurred from this disease. The subject of phthisis is further discussed in connection with the notification and prevention of tuberculosis. The following table gives the figures for each of the years from 1919. It may be noted that though there have been occasional rises the tendency has all the time been downwards. The reasons for this will be discussed later. TABLE VIII. Deaths from Phthisis and other Tuberculous Diseases. Year No. of Deaths Population Rate per 1,000 of Population 1919 116 97,958 1.18 1920 122 101,856 1.19 1921 117 105,200 1.11 1922 127 105,200 1.20 1923 115 105,400 1.09 1924 121 105,800 1.14 1925 93 106,100 .81 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 320. This is lower by 46 than the figure (366) for 1924. The death-rate was 2.8 per 1,000. In 1924 the rate was 3.4. In 1919 there were 362 deaths, and the rate was 3.6. The number of deaths certified to be due to bronchitis was 168, as against 184 in 1924. Of this number 116 were amongst persons aged 65 and upwards, and 42 amongst those of the group 45—65. The deaths traceable to pneumonia numbered 133, and, as in the case of bronchitis, the later age groups contributed the greatest numbers, though 25 of the deaths occurred amongst children under 2 years of age. Notification of pneumonia, which was introduced in March, 1919, has been in full operation since that date. The number of notifications received in 1925 was 69. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in the table on page 80. Visits were paid to each of the notified cases, and any assistance possible in the way of removal to hospital or nursing (under the Council's arrangement with the Paddington and Marylebone Nursing Association) offered. After recovery, or if death unfortunately occurred, as soon as convenient thereafter, disinfection, if desired, was carried out. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 161 and the death-rate 1.41 per 1,000 of the population. These figures are slightly less than those for 1919 when the deaths numbered 161 and the rate was 1.68 per 1,000. In 1924 the figures were higher, the total being 186 and the death-rate 1.76 per 1,000 of the population. 44 Information with regard to the situation of the disease and the age at which death occurred is given in the following tables:— Cancer : Ages at Death. Ages Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals Males - 1 3 - 6 10 23 20 63 Females - - - 2 10 27 35 24 98 Totals - 1 3 2 16 37 58 44 161 Cancer.—Situation of the Disease. Parts of the body affected. Males, Females. Totals. Face, Tongue, Jaw 6 - 6 Throat, Neck, Gullet 10 5 15 Stomach 6 14 20 Intestines 17 27 44 Liver 3 5 8 Breast - 17 17 Uterus and Generative Organs - 26 26 Various 21 4 25 Totals 63 98 161 The following table, which was included tor the first time in the Report for 1912, is repeated, as it lends further support to the view then expressed that cancer was in no sense a class disease, since if those who died at home or in nursing homes are taken to represent the rich or well-to-do, and those who died in hospitals or the infirmary the less favourably circumstanced, the one group suffered equally with the other. At Home In Nursing Homes In Hospitals In Infirmary (Marylebone Hospital) In Asylums Totals Males 16 7 19 21 - 63 Females 40 5 30 23 - 98 Totals 56 12 49 44 161 ALCOHOLISM. Three deaths were certified during- the year as due to alcoholism. Cirrhosis of the liver, a condition in most cases probably resulting- from abuse of alcohol, was held to be accountable for 6 deaths. In 1919 the deaths from this cause numbered 6, and from alcoholism nil. 45 The deaths from nephritis (inflammation of the kidneys) and Bright's disease of the kidneys, sometimes regarded as the result of irritation of the organs produced by chronic alcoholism, numbered 42. The number in 1924 was 31, and in 1919, 39. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1925 numbered 50. Of these 11 were due to suicide. Deaths of babies certified as resulting from suffocation (overlaying) numbered 2. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. A table showing, with regard to the infections, the total number of notifications received, the age distribution and the number of cases notified from each of the four registration districts, will be found on page 80. The following table shows the number of cases of infectious disease notified during the past seven years :— 1919 1920 1921 1922 1923 1924 1925 Diphtheria 154 119 239 268 127 122 132 Erysipelas 60 68 46 52 47 50 36 Scarlet Fever 197 435 478 339 126 185 168 Typhus Fever - - - 1 - - - Enteric Fever 4 29 6 8 11 7 14 Paratyphoid Fever - 2 7 4 5 10 3 Puerperal Fever 6 6 4 2 1 13 6 Cerebro-spinal Meningitis 1 2 5 - - 1 2 Tuberculosis (Pulmonary) 224 202 234 170 190 178 187 Tuberculosis (Non-Pulmonary) 37 44 37 24 34 46 36 Acute Poliomyelitis 5 2 2 1 3 - 2 Polio-Encephalitis - - - - - - 1 Ophthalmia Neonatorum 22 46 34 22 16 7 8 Encephalitis Lethargica - 5 5 .3 - 18 2 Pneumonia 121 71 55 113 51 68 69 Malaria 44 18 3 1 1 - 1 Dysentery - 2 2 - 2 1 1 Trench Fever - - - - - - 1 Totals 875 1,051 1,157 1,008 614 706 669 The total number of notifications coming to hand was 669. The bulk of the notifications related to tuberculosis, which contributed 223 to the total. Other diseases in respect of which fairly large numbers of notifications were received were scarlet fever (168), diphtheria (132), and pneumonia (69). In 1924 the number of cases notified was 706. The notification rate (proportion to population of notified cases of infectious diseases) in 1925 was 6.3 per 1,000, as against 6.6 in 1924. The figures for 1919 were, total notifications (including 920 of measles and German measles at that time notifiable), 1,795; notification rate 18.9 per 1,000. 46 Isolation of Cases.—As the following table shows, the number of cases removed was as high as usual:— Diphtheria 128 or 96.9 per cent. of the cases notified. Erysipelas 15 „ 41.6 „ „ Scarlet Fever 162 „ 96.4 „ „ Enteric & Paratyphoid Fever 12 „ 70.5 „ ,, „ Puerperal Fever 5 „ 83.3 „ „ ,, Tuberculosis 55 „ 20.1 „ „ „ Pneumonia 21 „ 30.4 ,, ,. „ Encephalitis Lethargica 2 „ 100.0 ,, „ The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £48 4s., equal to 9s. 1d. per 1,000 of the population. The cost and rate per 1,000 for each of the past years since 1919 are shown in the following table :— Year Amounts paid to Medical Practitioners Cost per 1,000 of Population £ s. d. £ s. d. 1919 98 11 0 1 0 1 1920 88 2 6 0 17 3 1921 82 1 0 0 15 7 1922 89 5 9 0 16 11 1923 40 7 6 0 7 8 1924 49 14 0 0 9 5 1925 48 4 0 0 9 1 Discharge Notices.-—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 271 and referred to 326 cases. Visits were paid to these cases by the District Inspectors, and advice given as to date of the return of children to school and the advisability of obtaining treatment for and isolation of any suffering from any sequel of a disease. Diphtheria and Membranous Croup. Diphtheria was rather more prevalent in 1925 than in 1924—132 cases, as against 122 in the previous year. Of the cases 5 died, and the case mortality rate was 3.7 per cent. The number of cases per 1,000 of the population was 1.2. Throughout the whole year nothing in the way of grouping of the cases suggested that there was anything like an outbreak of the disease. The cases, indeed, were more or less evenly distributed and only in a few instances was it possible to determine accurately the source of infection. In 4 is proved to be in the home of the patient, and in 5 cases was derived from a member of the family previously infected. Two patients were believed to have obtained infection in school, and in 17 cases in an institution. The number of swabs from doubtful cases (contacts) submitted for bacteriological examination was 1,041. A positive result was returned in 61 instances. Of the registration districts, that contributing the largest number of cases, naturally, since in respect of child population it is the largest, was Christ Church, with 55. In All Souls the number was 32, in St. Mary, 23, and in St. John, 22. 47 As usual, the age groups 1—5 and 5—15 were those most affected, 50 of the cases falling into the former and 39 in the latter group. Six applications for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, were received. The nuisances detected during the course of investigating the notified cases were : Dirty Premises, etc., 15. These were all remedied after service of notices. Scarlet Fever. The notifications of this disease numbered 168. That there is a tendency for scarlet fever to show epidemic tendencies at intervals of five years, more or less, is well known. In St. Marylebone the last year in which there was marked prevalence was 1921 when the cases numbered 478. The figure for 1925 is the lowest since then, the fall having been steady year by year. The highest number of cases reported in any one week it may be noted was 7. The total deaths from scarlet fever numbered 2, and the number of deaths per cent. of the cases was 1.2. The districts to suffer most from this disease were Christ Church and All Souls. In the former there were 55 cases and in the latter 46. In St. Mary there were 29 and in St. John 38. As usual, the majority of the patients were children of school age, the age group, 5—15, giving over one-half (87) of the total. Of the remainder 47 were aged between 1 and 5 years, and 33 over 15 years of age. The source of infection was believed to be a previous case in the same family in 22 cases and in 6 cases in an institution. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 8 instances that a definite connection could be made out. Defects in sanitation to the number of 24 were discovered. All these were want of cleanliness, etc. The nuisances were remedied after the service of notice in each case. Enteric Fever and Paratyphoid Fever. The notifications of Enteric Fever numbered 14. There were two deaths. Of Paratyphoid Fever there were 3 cases. All the patients recovered. From the grouping of the cases it appeared probable that the source of infection was a common one. In spite of all efforts, however, the origin remained undiscovered. Cerebro-Spinal Fever. Two cases of this disease were notified during the year. Encephalitis Lethargica. There were 2 cases of this disease notified. Both the patients died. 48 Polio-Encephalitis. Only 1 case of this disease was notified during the year. Having regard to the sequels to this disease arrangements have been made for keeping all those who have been infected under supervision for some time and for co-operating with the London County Council in obtaining treatment for those who are affected by any nervous condition which necessitates the provision of accommodation in hospital. Polio-Myelitis. There was 2 cases of this disease notified during the year. Erysipelas. The notifications of erysipelas numbered 36, and there was 1 death. Most of the cases were notified from the St. Marylebone Hospital and the General Hospitals, and 15 patients were treated in one or other of these institutions. Puerperal Fever. The number of cases of this disease notified, viz., 6, was above the average of the last few years. None of the patients died. In each case a visit was paid by one of the Health Visitors and the premises were disinfected. Measles and German Measles. Though these conditions are not now notifiable, 322 cases were reported : 35 voluntarily by doctors and parents and 287 by school teachers. There were no deaths. The course adopted in relation to the notified cases was the same as in the previous year. Practically every case was visited by the Health Visitors, particular attention being given to such as occurred in tenement houses. Under an agreement entered into between the Council and the Paddington and Marylebone Nursing Association, the services of a Nurse were obtained in cases in which the attack was severe. The nurses made 65 visits to 6 cases. The amount paid by the Council for services in connection with measles and other cases in which nursing is considered necessary is £112 10s. per annum. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1925 the number of deaths registered as due to whooping cough was 21. In 1924 the number was 3 and in 1919, 2. The arrangements with regard to nursing are similar to those in the case of measles. Glanders and Anthrax. No cases were notified during the year. Small Pox. No cases were notified. 49 Infectious Diseases in Schools. The accompanying table shows the number of cases of measles, whooping cough, chicken-pox and the notifiable infectious diseases reported from Schools during 1925. During the year in certain of the schools, one or more classrooms were closed on account of measles. SCHOOLS Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 19 10 9 12 33 12 Barrett Street - - - - 1 - Barrow Hill Road 26 20 23 16 22 20 Bell Street 18 22 40 78 34 18 Blandford Square 2 1 - - - - Capland Street 8 12 16 7 1 5 Catholic, Richmond Street - - - - - - Christ Church, Lisson Grove 35 15 23 25 9 13 Convent, Little Union Place - 1 - - - - Council School, Grove Road - - - - 1 - Emmanuel, Aberdeen Place - 5 8 8 - 11 Emmanuel, North Street 5 - - - 1 - Gateforth Street 6 15 2 24 - 8 Hampden Gurney, Upper Berkeley Street - - - 4 88 5 Homer Row, Catholic - 1 6 5 5 40 Jewish, Hanway Street - 1 Portland, Little Titchfield Street - - - - - Polytechnic, Regent Street 1 2 - - - - Queen's College, Harley Street - - - - 1 - St. Andrew's, Wells Street - - - - - - St. Francis, Upper William Street - - - - - - St. James's, Marylebone Lane - - - - - - St. Luke's Nutford Place 12 - 8 1 - 4 St. Mark's, Violet Hill 12 4 16 8 5 15 St. Mark's, Marylebone Road 3 - 7 2 2 1 St. Marylebone, High Street 14 27 32 118 30 31 St. Marylebone Grammar, Marylebone Road 2 - - 2 - - St. Mary's, Crawford Street - - - - - - St. Paul's, East Street 5 7 - 5 3 6 St. Paul's, Broadley Terrace 5 3 11 10 9 10 St. Thomas', Orchard Street - 3 3 1 6 1 St. Vincent, Wigmore Street - - - - 2 - Upper Marylebone Street 60 33 21 69 18 54 Schools out of Borough 7 13 45 20 16 9 Totals 240 194 270 415 287 259 Ophthalmia Neonatorum. This disease—inflammation of the eyes in newly-born children—made notifiable by order of the London County Council in 1911, continued to be so during the whole of 1925. The total number of cases notified was 8, as against 7 in 1924 and 22 in 1919. Visits were paid to all notified cases by the Health Visitors, and in 3 cases arrangements were made for one of the nurses of the Paddington and Marylebone Nursing Association to attend and apply treatment, and in this connection 75 visits were made. In bad cases removal to hospital is carried out, special arrangements having been provided at St. Margaret's Hospital for receiving and dealing with children suffering from this condition. 50 The following table gives information with regard to the cases notified. Notified Cases Treated Vision Unimpaired Vision Impaired Total Blindness Deaths At Home At Hospital *8 8 5 5 - - - * Three of the cases left the district and could not be traced. PNEUMONIA. Figures with regard to notification and information as to methods of prevention, etc., adopted in relation to this disease will be found on pages 43 and 80. The services of the nurses were requisitioned in 69 cases and 1,671 visits were paid. TUBERCULOSIS. In all 223 notifications were received, 187 relating to pulmonary tuberculosis, the remainder (36) to cases in which structures other than the lungs were affected. The table given on page 51 contains the information required by the Ministry of Health with regard to notifications. Notifications on Form B relate to school children. The number, it will be noted, was 13, as against 17 in 1924. From time to time reference is made to the difficulty associated with the obtaining of notifications sufficiently early, and the following figures are introduced because they are interesting in this connection. They relate, as will be seen, to cases in which death had taken place before the fact that the individual was suffering from the disease had been brought to the notice of the Medical Officer of Health, as required by the regulations :— 1. Total number of deaths from tuberculosis in the Borough 93 2. The number of cases unnotified or notified at death 24 3. The number of cases notified within a month of death 16 4. The number of cases notified within three months of death 7 5. The number of cases notified within six months of death 5 Treatment of Tuberculosis.—Of the cases notified 186 received some form of institutional treatment, and during the year every effort was made to obtain admission to sanatoria of cases deemed suitable for such treatment. Of the total new cases notified 101 were insured persons; of those 46 were admitted to sanatorium or hospital treatment, and 15 to St. Marylebone Hospital. Non-insured persons numbered 122, of whom 33 (16 being children) received sanatorium treatment and 12 were admitted to the St. Marylebone Hospital. Nurses were sent in to 34 cases and 272 visits were paid. 51 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 4th January, 1925, to the 2nd January, 1926. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Notifications on Form A. Notifications on Form B, Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. No. of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria, 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 upwards. Total Primary Notifications. Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males - - 2 3 7 14 21 22 20 13 10 112 130 - 2 2 4 6 52 63 „ Females - - 1 2 7 18 24 6 6 9 1 69 92 - 1 1 2 2 12 42 Non-Pulmonary Males - 2 4 1 1 2 2 2 - - - 14 15 1 1 2 4 4 3 13 „ Females 1 5 1 1 1 1 3 2 - - - 15 15 - 1 2 3 3 - 8 Totals 1 7 8 7 16 30 50 32 26 22 11 210 252 1 5 7 13 15 67 126 52 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. supplemental return of new cases coming to the knowledge of the medical Officer of Health otherwise than by Notification on Form A and B during the period 4th January, 1925, to the 2nd January, 1926. METROPOLITAN BOROUGH OF ST. MARYLEBONE. 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 upwards Total Cases Pulmonary, Males - - - - 1 1 3 3 1 4 2 15 „ Females - - - - 1 1 3 2 - 1 1 9 Non-Pulmonary Males - 2 1 - - 2 2 - - - - 4 „ Females - - - 1 1 - - - - 1 - 5 - 2 1 1 3 4 8 5 1 6 3 33 53 Prevention of Tuberculosis.—In connection with preventive work in respect of tuberculosis, the Dispensary, which has now been part of the borough tuberculosis scheme since April, 1921, continued to prove most valuable, the members of the staff rendering excellent service. Particulars with regard to patients dealt with during the year are shown in a table at page 55, while the following short table, summarises the information as to visits paid by members of the staff :— No. of visits by Tuberculosis Officer New, 59 Old, 150 No. of cases at Dispensary New, 360 Old, 1,701 No. of attendances at Dispensary 3,772 No. of visits by Miss Baker First visit, 201 Re-visits, 1,652 No. of visits by Miss Bartleet First visit, 177 Re-visits, 881 No. of Committee Meetings attended 23 The Tuberculosis Care Committee continued to meet fortnightly throughout the year, Dr. Saner, Miss Baker and Sister Bartleet attending and assisting in every way possible. The Open Air School in Regent's Park, which was established in 1911, continued its useful work during the year. The number of children on the roll was 24—12 boys and 12 girls—and the attendances numbered 8,742. Dr. Saner, who has been Medical Officer of the School since he took office at the Dispensary, continued to act in this capacity. The following note by Dr. Saner, Assistant Medical Officer of Health for Tuberculosis Purposes, contains certain historical and other information that will be found interesting :— " The chief change in the Dispensary's history is the fact that five years ago it ceased to function as a voluntary institution and became a municipal one. 1 his with advantage, inasmuch as it was put on a sound financial basis, and it became an integral part of the great London County Council scheme for the prevention and treatment of Tuberculosis. " In 1920, owing to the Metropolitan Railway Company requiring the premises then occupied, the Dispensary was moved from 15, Allsop Place, to 111, Marylebone Road, a much more prominent position. Alterations had to be carried out to adapt the building to requirements, but even with these there is much to be desired owing to the age of the house. " Whether the more prominent position of the Dispensary is an advantage to its activities is a moot point since, owing to statements as to the infectivity of the diseases, there is a tendency among the people to avoid being seen entering the doors of an institution whose special duty it is to deal with the complaint, until they are so far advanced as to necessitate cessation from work. One is led to believe, therefore, that a back or side entrance to the Dispensary would lead to a greater number attending for examination to make sure that the cough and malaise they are suffering from is only an ordinary catarrhal condition. Thus perhaps many more early cases would be dealt with and to greater advantage than the majority now undergoing treatment. " The Dispensary still remains, as part of the whole scheme in fighting Tuberculosis, a consultation, observation centre and clearing house. It is an institution to which any individual may come for advice free. The way in which people find their way to the Dispensary is either that they have seen the plate on the gate, that they are sent by their medical practitioner, or by the School Medical Officer, by another patient, or by other agencies. " The Care Committee instituted in the voluntary days still continues, and is now a recognised body, consisting of members representing various societies 54 in connection with philanthropic work, viz. : The Invalid Children's Aid Association, Charity Organisation Society and Portland Town Association, branch of the former, The Board of Guardians, The United Services (especially for the Ex-Service men and their families), members of the Borough Council and Public Health Department, The District Nursing Association, Jewish Board of Guardians, School Care Committee, and the London County Council. " The Committee meets regularly every fortnight in order to deal with cases brought up for their consideration as to the best means to be followed for the benefit of the family afflicted, also to assess payment according to means, each case being dealt with on its merits. During the last year the Committee has dealt with 249 cases. " During the five years, after much work and delving into past history, it has been found that 349 individuals have received Sanatorium treatment, some of whom have been away more than once. Out of this 349, 128 are now working, 73 not working but getting about, 42 transferred to other districts, 2 could not be traced and 104 have died. Out of the larger figures 29.8 per cent, deaths and 36.6 per cent. working. One ventures to predict that during the next quinquenium the percentage of those working will be increased, and the deaths reduced, chiefly because the methods for early diagnosis are so much better. The Dispensary is affiliated to the Middlesex Hospital, and advantage is being taken of the X-Ray Department in doubtful cases. The X-Ray examination being a great help in confirming or disputing the clinical evidence gained by percussion and auscultation. Examination of sputum is carried out at the Dispensary. A positive sputum decides the issue, but a negative one frequently leaves a doubt even after three or four specimens have been examined. The Dental and Throat Department of Middlesex Hospital are made use of—the first for the cleaning of the mouth prior to the patient going away, the second for the examination of doubtful throats. Surgical cases are also referred to the Hospital. " The Dispensary is open daily from 9.30 a.m. to 5 p.m., except Saturdays, 9.30 to 1; an evening clinic being held each Thursday for those patients who are working and cannot attend at any other time. " The Open Air School, run entirely on voluntary subscriptions, attached to the Dispensary still carries on and, although the numbers are not so large as formerly, about 26 children daily meet at the Bandstand in Regent's Park for lessons, fresh air, and exercise. These children bring with them sufficient food for the middle day and have their bigger meal when they get home in the evening. The midday dinner has always been a stumbling block to the parents, and it is often on account of this they refuse to allow their children to attend the school. Various eating-houses have been approached with the idea of having a good " Hot Pot " sent up to the Bandstand for the children, but no shop would do it under sixpence a head per diem. The parents mostly refuse to pay this and the project had to be dropped. It makes one wonder what the child's dinner really does cost the parents if 2/6 for five days is too much. However, with the existing arrangement they do very well and gain weight. It says a great deal for the children and their teacher that they go to the bandstand in almost any weather. " A scheme for the boarding-out of children while mother or father is undergoing treatment at a Sanatorium has met with a certain amount of success, but it is frequently the case that parents do not wish them to be removed, and on this account the scheme has not been so successful here as it has been in France, where it is more or less forcibly carried out, inasmuch as there they take the children away from the consumptive home and place them in the country. " The latest adjunct to treatment is the ultra-violet rays, and arrangements are being made with certain hospitals for the carrying out of the process in suitable cases. Up to date one is unable to give any idea of its efficiency as regards Pulmonary Tuberculosis. 55 " For 1925 the Dispensary figures show a slight increase over those for 1924 : 360 new cases have been examined and 632 old cases re-examined. These latter include definite cases and those who are suspects or under observation. " The visiting of patients in their home is done by the Sister at the Dispensary and the Tuberculosis Visitor. " The Tuberculosis Officer has been appointed Visiting Physician to the St. Marylebone Hospital, where treatment can be carried out if the patient will consent to remain long enough. There is, however, a strong tendency for the patient to go home directly he feels better. " The advantage of this appointment is that it links together the Institutions dealing with Tuberculosis." Bacteriological Diagnosis of Consumption.—The number of specimens of expectoration sent by medical men for bacteriological examination, from cases in which there was some doubt as to the diagnosis, was 689, as against 655 in 1924. Of these, 123 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—36, as against 46 in 1924—in the case of this form of tuberculosis came from institutions where the patients were undergoing treatment. Visits were paid to the homes and, where necessary, advice with regard to the obtaining- of treatment was offered. Particulars as to the parts affected by the disease will be found in the table on page 60. Return as to work carried out in connection with the St. Marylebone Tuberculosis Dirpensary for the year 1925. (The return relates only to persons residing in the area which is served by the Dispensary under the scheme of the Council.) Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary. Non. Pulmonary. (a) All persons (including " Contacts ") M. 4 119 123 49 2 61 3 8 Adults F. 6 112 118 33 3 56 6 20 Children M. 15 71 86 4 3 47 14 18 under 15 F. 13 58 71 2 5 37 9 18 Total 38 360 398 88 13 201 32 64 (b) " Contacts " (included in la) ). M. 15 15 3 - 11 1 - Adults F. 3 24 27 4 - 15 1 7 Children M. 7 38 45 1 - 35 3 6 under 15 F. 3 32 35 1 - 24 3 7 (c) Insured persons in (a) ). (included M. 2 79 81 28 2 43 2 6 F. 2 57 59 18 2 26 1 12 56 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 253 2. Total number of attendances of patients of Insured 1,092 at the Dispensary during the year ( Uninsured 2,680 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 86 4. Number of cases in which the period of observation at the Dispensary exceeded two months 23 5. Number of insured patients under domiciliary treatment on December 31st * 86 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 10 7. Number of persons referred to affiliated hospital for consultation 17 8. Number of consultations with medical prac- Insured 5 titioners at the homes of patients Uninsured 10 9. Number of other visits paid by Tuberculosis Officer to the homes of patients 194 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 1,378 11. Number of specimens of sputum examined in connection with the work of the Dispensary 350 . * All insured persons in the dispensary area who are actually receiving domiciliary treatment from Insurance practitioners are included. 57 The following table, which has been prepared for the Ministry of Health and the London County Council, shows the work carried out at the Dispensary:— Statement of Work carried out in connection with the Dispensary Treatment of Tuberculosis during the period 1st January, 1925, to the 31st December, 1925, and Sundry Particulars in connection with the Scheme of Treatment. I.-PARTICULARS OF WORK CARRIED OUT IN CONNECTION WITH THE DISPENSARY. [Name of Dispensary Name of Dispensary Medical Officer. Date of Approval of Appointment by Local Govern ment Board. Days and Hours when the Dispensary is open. Number of Persons including Contacts who were examined lor the first time during the period from the 1st January, 1925, to the 31st December, 1925, at or in connection with the Dispensary and were :— Number of Persons diagnosed to be suffering from Tuberculosis who were treated or supervised at or in connection with the Dispensary during the period from 1st January, 1925 to 31st December, 1925. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1925. Number of Persons referred for diagnosis or treatment tothe Hospital with which the Difpensary is affiliated during the period 1st January, 1925. to 31st December, 1925. Diagnosed as suffering from Tuberculosis. Diagnosed as not suffering from Tuberculosis. Undiagnosed and remaining under observation. Total Number Examined. Insured Uninsured Insured Uninsured Insured Uninsured Insured Uninsured St. Marylebone Tuberculosis Dispensary James Donaldson Saner, M.B., C.M., D.P.H. 1st April. 1916. Monday, 9.30—5 Tuesday, 9.30—5 101 173 86 136 224 159 133 190 270 12 5 Wednes., 9.30—5 Thursday ,9.30—9 Friday, 9.30—5 Saturday, 9.30—1 58 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. 1. Name of Hospital to which Special Cases are referred from the Dispensary for diagnosis or treatment Middlesex Hospital. 2. Is any provision for the home nursing of Tuberculous Patients made in connection with the Dispensary ? If so Yes. Application can be made to the District Nursing Association. (1) State the general nature of the arrangement (1) Note sent to Matron from Dispensary. (2) What qualifications are the Nurses required to possess ? (2) Fully trained. (3) Do they carry'out other work? If so, what ? (3) Yes, District Nursing. (4) Are their services available for Insured and Uninsured Patients? (4) Yes. (5) If so (a) by what procedure are their services secured for individual patients ? (5) (a) As above. (6) Under whose instructions do they perform the actual duties of nursing in an individual case ? (6) Matron of Nursing Association and Tuberculosis Officer. 3. If no provision of nursing is made in connection with the Dispensary is any such provision contemplated ? If so, give particulars ? 4. State number of Shelters provided by the Council or by the Dispensary Authorities up to 31st December, 1925, for lending out to Patients for use at their own homes None. Deaths from Phthisis.—Some reference has already been made to the matter of deaths from tuberculosis and at this point it is proposed only to deal with the figures relating to tuberculosis of the lungs (consumption or phthisis). During 1925 the total number certified as due to this cause was 80, the deathrate being 0.7 per 1,000. The distribution of the deaths according to registration districts is shown in the accompanying table, which gives also the figures for each of the 7 years 1919—1925. 59 Deaths from Phthisis. Seven years—1919-1925. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 1919 97,953 104 12 27 53 12 1920 101,856 94 14 28 38 14 1921 105,200 102 24 24 40 14 1922 105,200 98 15 27 42 14 1923 105,400 94 19 25 33 17 1924 105,300 98 18 32 35 13 1925 106,100 80 15 30 25 10 The distribution of the 80 deaths was as follows :—In Poor Law Institutions, 28; general and other hospitals, 21; and at home, 31. Of those who died 50 were insured (34 males and 16 females), and 35 uninsured (17 males and 18 females). In addition there were 8 children. As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 80, the notified cases of pulmonary tuberculosis totalled 187. The following table prepared at the request of the Ministry of Health contains information with regard to age and sex distribution that may be found interesting. Age Periods NEW CASES DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 - - - 1 - - - - 1—5 - - 3 5 - - - 3 5—10 4 2 5 2 - - - - 10—15 5 3 3 3 - - - - 15—20 7 7 1 1 1 - - - 20—25 14 13 2 1 1 2 - - 25—35 21 24 2 3 4 4 - - 35—45 22 6 2 2 4 1 - - 45—55 20 6 - - 5 1 - 55 -65 13 9 - - 5 1 - - 65 and upwards 10 1 - - 2 - - - Totals 116 71 18 18 22 9 - 8 The following table, giving information as to the localisation of the disease, brings out no fact to which attention has not already been directed. 60 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 2nd JANUARY, 1926. Localization of Disease. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. At ages—years. At all Ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals Cases Isolated at Home Lungs 187 - - 14 41 73 48 11 41 59 60 27 187 9 17 11 5 42 145 Testicle 1 - - - 1 - - - - - - 1 1 - - - - - 1 Spine 6 - - 1 - 5 - - 1 3 1 1 6 - 1 - - 1 5 Meninges 4 - 3 - - 1 - - - 1 3 - 4 - 1 1 - 2 2 Peritoneum 1 - - - - 1 - - - - 1 - 1 - - - - - 1 Knee 3 - - 2 1 - - - - 1 1 1 3 - 1 - - 1 2 Thumb 1 1 - - - - - - - - 1 - 1 - - - - - 1 Glands 16 - 4 8 3 1 - - 3 5 6 2 16 - 2 3 1 6 10 Metacarpus 1 - 1 - - - - - 1 - - 1 - 1 - - 1 - Finger 1 - - 1 - - - - - - - 1 1 - - 1 1 - Hip 2 - - 1 - 1 - - 1 - 1 - 2 - - 1 - 1 1 Totals 223 1 8 27 46 82 48 11 46 70 74 33 223 9 23 16 7 55 168 223 61 DISINFECTION. The work done in this connection during- 1925 is shown in the following tables. The methods employed during the greater part of the time were substantially the same as in previous years, articles suitable for treatment by steam were dealt with in the Washington-Lyons Disinfector, while for rooms either formalin or sulphur was generally employed. The number and nature of the articles disinfected are shown hereunder :— Compulsorily Notifiable Diseases. Phthisis Measles. Vermin. Other causes. Total. Beds 194 15 - 1 - 210 Mattresses 433 31 - 8 81 553 Bolsters 208 22 - 4 22 256 Pillows 821 64 - 8 262 1,155 Sheets 445 21 - 8 2 476 Blankets 976 73 - 10 36 1,095 Sundries 4,655 466 - 280 87 5,488 Totals 7,732 692 - 319 490 9,233 In 1924 the number of articles disinfected was 14,885. The number of journeys made by the disinfecting vans during the year ended December, 1925, was :— January 49 August 46 February 44 September 48 March 48 October 48 April 46 November 46 May 47 December 48 June 47 July 50 567 The number of journeys made during 1924 was 578. The number of rooms disinfected and the reasons for carrying out disinfection are stated below :— Reasons for Disinfection. Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other causes Total. January 49 15 2 - 1 67 February 47 2 2 - 1 52 March 53 7 4 - - 64 April 78 7 16 - - 101 May 35 8 14 - - 57 June 45 10 3 - - 58 July 37 11 1 - - 49 August 63 4 1 - - 68 September 33 1 1 - - 35 October 48 4 2 - - 54 November 63 5 2 - - 70 December 42 8 25 - - 75 Totals 593 82 73 - 2 750 62 The number of rooms disinfected in 1924 was 875. At the request of the Public Libraries Committee, whose rule requires that on the occurrence of a case of infectious disease in any house in which there is a library book, information must be given to the librarian, arrangements were made to receive and disinfect the volumes. The number dealt with during the year was 144. The arrangements referred to in previous reports for placing a spraying apparatus and a supply of " Fluid D " at the disposal of owners and occupiers of premises infested with vermin continued in operation. The sprayers were in great demand and satisfactory results were obtained. CLEANSING OF PERSONS ACT, 1897. The following table shows the number of Adults and School Children using the Baths provided under the above-mentioned Act each month during the year 1925 and annually since 1910 :— 1925 ADULTS CHILDREN Males Females Total Males Females Total January 287 91 378 10 192 202 February 258 74 332 15 234 249 March 280 86 366 16 234 250 April 246 69 315 10 114 124 May 246 74 320 12 253 265 June 200 80 280 18 234 252 July 279 98 377 36 260 296 August 235 80 315 4 57 61 September 238 92 330 21 205 226 October 245 108 353 12 195 207 November 223 77 300 28 210 238 December 232 80 312 14 129 143 Totals 2,969 1,009 3,978 196 2,317 2,513 Cleansing Station Attendances, 1910-1925. Year. ADULTS CHILDREN Males Females Total Males Females Total 1910 6,433 2,051 8,484 513 859 1,372 1911 6,510 2,575 9,085 504 463 967 1912 5,818 2,384 8,202 740 1,138 1,878 1913 5,797 2,208 8,005 771 1,305 2,076 1914 5,555 2,379 7,934 623 1,243 1,866 1915 3,323 1,672 4,995 589 1,091 1,680 1916 1,919 1,158 3,077 905 1,288 2,193 1917 1,947 967 2,914 1,376 1,699 3,075 1918 2,031 1,085 3,116 1,249 1,474 2,723 1919 2,082 1,063 3,145 981 2,132 3,113 1920 2,669 893 3,562 1,059 2,802 3,861 1921 3,486 1,287 4,773 715 2,802 3,517 1922 2,936 1,063 3,999 429 2,876 3,305 1923 2,907 993 3,900 305 2,528 2,833 1924 3,306 1,081 4,387 373 2,543 2,916 1925 2,969 1,009 3,978 196 2,317 2,513 The total attendances since the Baths were opened in 1898 number 228,626 (adults, 167,395 ; children, 61,231). 63 BACTERIOLOGICAL EXAMINATIONS. The following table shows the number of specimens examined for purposes of diagnosis, and indicates also the diseases in relation to which the examinations were made. The work, as formerly, was carried out by Dr. Foulerton, at University College. 1925. Positive. Negative. Total. Typhoid fever 13 31 44 Diphtheria 61 980 1,041 Phthisis 123 566 689 Totals 197 1,577 1,774 MATERNITY AND CHILD WELFARE. Under this head the Ministry of Health asks that in the case of Metropolitan Boroughs information should be provided with regard to (a) the incidence of puerperal fever, ophthalmia neonatorum, and other infectious diseases, and (b) general arrangements for attending to the health of expectant and nursing mothers and children under five years of age. Inasmuch as the information asked for with regard to the infectious diseases has already been given under the heading relating to the prevention and control of these diseases, it is unnecessary to refer to them again here. It is proposed, therefore, at this point to deal only with the question of arrangements for attending to the health of expectant and nursing mothers and children, and to give a short description of the scheme in operation in the Borough. Although it was not then known as a " Maternity and Child Welfare Scheme," works in this connection were inaugurated in 1906, and in the discussions that arise from time to time as to which was the first district to begin infant welfare work, the name of St. Marylebone is always mentioned as at least being among the earliest. The composition of the scheme now in existence has been very frequently described in annual reports. As is well known, it contains voluntary and official elements. Of the voluntary elements, to the nature of which reference is made later, those for which the St. Marylebone Health Society is responsible bulk largest, and the Council and the inhabitants of the Borough are greatly indebted to this body and those who work for it for what they have done and what they are doing in relation to maternal and child welfare. Apart from the Health Society, however, there are other bodies that assist, and that are more or less definitely linked up to the main scheme, the connecting link being the Public Health Department of the Council. Amongst these bodies may be mentioned the Church Army, the Western General Dispensary, Queen Charlotte's Hospital and Middlesex Hospital. The two latter, in addition to providing lying-in accommodation, arrange for attention to be given to out-door patients as well, and conduct ante-natal clinics and infant consultations. Less definitely part of the scheme, but still doing very valuable work and helping whenever possible, are St. Agatha's Home, The Home of the Little Company of 64 Mary, and The Home of the St. Marylebone Female Protection Society, where unmarried mothers particularly are provided for, both before and after the birth of their child. A special feature is made at St. Agatha's of keeping the mother and child together for at least three to six months after the birth, and of endeavouring to arrange that they shall be together after leaving the home. On several occasions places on the domestic staff of one or other of the institutions day nurseries, for example—within the scheme, have been found for mothers from the home. The following summaries give a number of details with regard to the arrangements under the scheme and of the extent of the work done during 1925. It will be noted that at the end of the year there were available nine centres where attention was given to infant and child welfare, and if those at the hospitals are included four ante-natal clinics. At some of the centres consultations are held every day, sometimes twice a day. In addition to the ordinary infant and young child (" toddlers ") consultations, there is a dental clinic for mothers and young children on four days, for two of which the Health Society is responsible. Massage clinics are held weekly at several of the centres. By arrangement with the London County Council the dental clinic is used also by school children, and in conjunction with this there is now also a minor ailment treatment centre for school children. Up to the present no provision has been made for the administration of light treatment, though by arrangement with Welbeck Street Dispensary cases were sent there, and also to two private practitioners who kindly afford facilities and the use of their private installations in selected cases free of charge. The summary given here is convenient as showing the elements in the scheme. Health Visitors.—There are six health visitors. One acts exclusively as tuberculosis health visitor; two give whole time to health visiting and work, one at the centre in Salisbury Street, the other at Cosway Street. Three are part-time health visitors, holding appointments also as sanitary inspectors. Voluntary workers of the St. Marylebone Health Society also do visiting in co-operation with the work of the Council. The Borough for the purpose of health visiting is divided into five districts, and in 1925 the health visitors made 6,535 visits to 2,052 infants. In addition large numbers of visits were paid by the voluntaryvisitors attached to the schools for mothers. Children are visited up to school age. Centres.—There are in all nine centres, all " voluntary," at which consultations are held. Five of these are under the Health Society, viz. :—(1) North Marylebone School of Mothercraft, Salisbury Street. Has an ante- and post-natal consultation under medical supervision. The dental clinic and minor ailment treatment centre are in the same building. The Council's health visitors co-operate, one of them acting as Superintendent. The nurse in charge of the dental clinic assists at the ante-natal clinics. (2) South Marylebone School of Mothercraft', St. Marylebone General Dispensary, 77, Welbeck Street, and 30, Marylebone Lane. An ante-natal clinic is held once weekly, and an infant consultation twice weekly, both under medical supervision. There is a superintendent and a part-time assistant, both of whom are nurses. Children attend up to school age, and the Council's health visitors co-operate. The light installation here is available for cases attending at other centres. (3) Ogle Mews, Ogle Street, W.1. Infant consultations are held weekly under medical supervision. The Council's health visitors attend. There are also classes weekly in cookery, needlework and hygiene. (4) 24, Hill Road. Infant consultations under medical supervision are held weekly. The health visitors co-operate and one of the nurses of the Barrow Hill Road day nursery gives part time to health visiting. (5) By arrangement with the Committee of the Western General Dispensary, Cosway Street, a temporary centre has been installed in the building. Infant consultations under medical supervision are held weekly. There are also classes for nursing, etc. One of the health visitors is specially attached to this centre and acts as superintendent. 65 In addition to these centres consultations are held weekly at Queen Charlotte's Hospital and at Middlesex Hospital. Each is presided over by a member of the Hospital Medical Staff. One of the Council's health visitors attends at each and Middlesex Hospital has also a paid health visitor in attendance. Both consultations are open to other than St. Marylebone babies, who, however, constitute the bulk of those attending. At both hospitals there is an ante-natal clinic particularly for hospital patients. Ante-Natal Work as indicated. There are two voluntary Ante-Natal Clinics. Visiting is undertaken by the Council's health visitors, and in the case of the clinic in Salisbury Street by a nurse who gives part time also to the dental clinic. There is a system of co-operation with the Middlesex and Queen Charlotte's Hospitals. Dental Clinic.—This was originally established for the treatment of women and children of pre-school age. By arrangement with the London County Council, school children are also dealt with. Massage Clinics are held weekly at Salisbury Street and Ogle Mews, and at the Western General Dispensary there is a special clinic for children, which is available for all the centres. Hospital Treatment.—Children's cases are referred from the centres to the dispensaries and hospitals in the Borough, and the Queen Charlotte's and Middlesex Hospitals are available for ante-natal and complicated maternity cases. Under a special arrangement cases calling for special examination or treatment are referred by the doctors at the centres to Middlesex Hospital and the Western General Dispensary. Maternity Cases.—The Council have not established a Maternity Home or Hospital, but there is accommodation within the Borough at Queen Charlotte's Hospital, Middlesex Hospital, and in the Labour Wards at the St. Marylebone Home, Marylebone Road. The number of births notified from these institutions during 1925 was 2,400, the total births numbering 3,699. The midwives living and practising in the Borough number 4. Two conduct maternity homes which are registered by the London County Council. Work done during 1925.—The following table gives some idea of the work done at the various centres during the year. Full details of the method adopted in relation to the granting of orders for milk and food under the Maternity and Child Welfare Act, 1918, will be found elsewhere. The total number of orders issued is shown in the table. 66 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDING 31ST DECEMBER, 1925. CENTRE. No. 24 Hill Road. No. 14 Salisbury Street. Queen Charlotte's Hospl. Cosway Street. No. 30 Marylebone Lane. No. 8 Ogle Mews. The Middlesex Hospl- The Westn. Genl. Dispy. The Church Array Dispy. No. of consultations held 82 251 353 94 91 50 151 86 51 (201 children 50 mater- nity) (300 antenatal 50 in- fants) No. of attendances of mothers at ante-natal clinic . 498 11,700 - 56 - - - 144 No. of attendances of babies . 1,477 4,123 1,820 1,792 1,329 1,245 2,982 374 858 No. of attendances of children over 2 years 128 1,079 271 382 121 448 1,054 1,383 177 No. of orders issued for milk, etc. 70 356 80 117 67 89 109 5 10 No. of home visits . 828 3,775 649 1,111 434 902 1,429 2 323 No. of new cases 84 361 4,563 104 77 46 243 290 71 Day Nurseries—Attendances during the year. The Crossley Day Nursery, Barrow Hill Road 6,104 Portman Day Nursery, Exeter Street 8,651 Dental Clinic, 12, Salisbury Street. Attendances during the year : Mothers, 1,019 ; children, 106. Advice and treatment given in 783 cases—extractions under gas 342. Home Helps.—A system of providing assistance in carrying out the work of the home to expectant, nursing or ailing mothers was in operation throughout the year. The women employed were found by the health visitors, who also noted the cases in which assistance was required. Both the women and the cases were submitted for approval to the Medical Officer of Health. The system has worked exceedingly well and the assistance rendered has been greatly appreciated by those who received it. When the scheme was first adopted it was intended to engage one or more women who had received or who would be given special training and instruction at one of the centres, but at the time of starting it was practically impossible to find women considered suitable. It was decided, therefore, for a time at least to employ women experienced merely in ordinary house work, and this arrangement proving highly satisfactory, has been continued. The chief work in 67 connection with which assistance is required is the more or less rough work of the house and the washing, and it is essential to find women willing to undertake these. Several women both willing and capable have been found and more or less of a band of "Home Helps" has been formed. In some cases they are only required for half a day, a few days a week, in others for a whole day and every day. All of them have taken the greatest interest in the work and have willingly carried out all instructions. The system adopted is on the lines described in connection with milk orders under the Milk (Mothers and Children) Order, and the scheme being a contributory one the contribution, if any, to be made by the mother towards the payment of the home help is estimated in much the same way. The number of cases in which home helps were employed in 1925 was 2. The total amount expended during the financial year to 31st March, 1926, was £4 12s. 6d. SANITARY ADMINISTRATION. Under this, which is made a separate heading by the Ministry of Health, the. Medical Officer of Health is required to make reference to a number of matters, e.g., staff, hospital accommodation and some others, most of which will be found dealt with elsewhere. (1) Staff: Work of sanitary inspectors and other officers engaged in sanitary work. This matter, so far as the inspectors are concerned, is fully discussed in an early part of the report. The report of the Mortuary Keeper (Mrs. Spears) is as follows:— Number of bodies deposited from 1st January to 31st December, 1925. 1925. Males. Females. Total. For burial only. For inquests. Total. No. of P.M 's held. No. of courts held. No. of Infectious cases. January 8 11 19 8 11 19 9 6 - February 8 9 17 14 3 17 2 3 - March 6 8 14 9 5 14 5 3 - April 5 9 14 8 6 14 4 3 - May 6 5 11 5 6 11 3 4 - June 9 5 14 4 10 14 7 4 - July 1 4 5 4 1 5 1 1 - August 7 7 14 9 5 14 3 8 - September 6 4 9 5 4 9 4 3 - October 7 6 13 6 7 13 6 2 - November 9 8 17 5 12 17 3 7 - December 7 16 23 14 9 23 6 7 - Totals 78 92 170 91 79 170 53 46 - The fact that there are caretakers (a man and his wife) at the Tuberculosis Dispensary has already been noted. In addition to looking after the premises they also render great assistance in connection with conduct of the clinics, taking notes, helping in the weighing of the patients, etc. (2) Hospital accommodation.—This being a matter with which the Borough Councils in London have no direct concern, it is not considered necessary to make special reference to it. (3) Local Acts, special local orders and their administration.—There are no Acts or Orders applicable in the Borough which do not apply to other parts of London. The London County Council (General Powers) Acts contain a number of provisions under which a considerable amount of work is done, e.g., those relating to places where food is dealt with. Reference is made to these elsewhere. 68 HOUSING. In the earlier part of this report some reference was made to the subject of housing in the Borough, and in this portion all that is attempted is to provide the particulars asked for by the Ministry of Health in the memorandum as to the contents of reports of medical officers of health. I.—General Housing Conditions. (1) Number of houses, including divided houses and flats, 18,274. Number of houses for the working classes : If each tenement or part of a house let as a separate dwelling be reckoned as a separate dwelling house, there are probably about 8,131. New houses for the working classes erected during the year or in course of erection. 180 Flats. (2) Population (estimated), 106,100. This is almost certainly an underestimate and the actual figure is probably nearer 120,000. Important changes during the year or anticipated in the future. None. (3) (a) Extent of shortage or excess of houses, and (b) Measures taken or contemplated to meet any shortage. Writing in 1919,. in the last Survey Report, I showed that the very marked shortage of houses in London was shared by St. Marylebone. I indicated also that there had for many years been a shortage, that this had been met by dividing the existing houses in certain districts into two or more tenements, and that though this may have given more dwellings it had led to considerable overcrowding in various parts not only of houses, but of space. Attempting to put this into figures, I stated that in the tenement house districts the number of tenements containing at least one more person than the standard of two per room was 1,894. That there has been any measurable progress in the direction of meeting the shortage I do not believe. Conceivably there may be more dwellings, since the proportion of houses subdivided to accommodate two or more families has increased, more and more individuals finding it impossible, for one reason or another, to retain a whole house for their separate occupation, but at the same time there has been an increase in population from 97,953 in 1919 to 106,100 (both estimates). More important still, there has been an increase in the numbers requiring separate dwellings. To meet neither of these increases has anything been done locally. The provision made by the London County Council may have helped, but could only have done so in a very minor degree. So far as the Borough Council is concerned, their activities in connection with the housing scheme on the Fisherton Street, referred to later, since it involved clearance must have made matters worse. The only conclusion possible is, and this is borne out by experience, that accommodation has been found by further subdivision of existing houses. That this has objections from points of view other than the sanitary is well recognised. So far as the sanitary aspect is concerned, subdivision means that most of the conveniences—water-closets, etc.—have to be used in common and suffer not only as a result of over use, but from mis-use and neglect. The houses themselves are also to a large extent misused by the tenants and are neglected by the landlords or owners, though this is perhaps less the case now than formerly, many leases in the Lisson Grove area particularly having reverted to the freeholders, who try as far as possible to see that the best is done with a view to keeping the premises in a reasonably fit state of repair. The intention of subdivision being to reduce overcrowding, its effect, in reality is to increase it, since though it may mean that the number of individuals per room is lessened, the number of rooms occupied continuously and used for all purposes is greatly increased. This point was very definitely proved during the course of an enquiry carried out during the year in one of the most notoriously overcrowded parts of the Borough. Here it was shown that though practically 69 every house was small and housed three, four or more families, the average number of persons per room was less than 1.7. Such a figure is very comforting until individual cases and the conditions as to overcrowding in particular families come to be investigated. From the census figures also comfort may be drawn. The table below is taken from the report on the census of 1921 and shows the number of families occupying 1, 2, 3 and 4 rooms and the population in private families :— Number of Rooms. 1 2 3 4 Total private families 5,776 7,430 4 543 3,126 Population in do, 9,367 22,921 16,504 12 153 Rooms occupied 5,772 14,859 13 629 12.504 The actual number of persons represented in the table is 60,945, rather more than half of the total population (105,200) at the time of the enumeration. In respect of measures taken or contemplated to meet the shortage nothing can be said that was not said in 1919. The situation, so far as the Borough itself is concerned, is still very difficult. Within the boundaries there is no space upon which to erect houses to accommodate the working classes. Before houses can be erected, houses will have to be demolished, and there is probably no site in the Borough which, if once cleared, even if entirely used for housing purposes, could provide accommodation for a number of persons appreciably larger than that dishoused. It is this largely that complicates the housing problem in St. Marylebone, and makes the task of the Council and its Housing Committee so difficult. II.—Overcrowding. (1) Extent. (2) Causes. (3) Measures taken or contemplated to deal with overcrowding. The information called for under these heads is more or less given above. (4) Principal cases of overcrowding dealt with during the year and action taken. Though the general overcrowding was marked, for various reasons, the number of cases dealt with was comparatively small. The notices served numbered 4, and for the reason that more or less of a remedy was found in each case, no proceedings were instituted. III.—Fitness of Houses. (1) (a) General standard of housing in the district, and (b) General character of the defects found to exist in unfit houses. (2) Action taken as regards unfit houses under (a) the Public Health Acts, (b) the Housing Acts. (3) Difficulties in remedying unfitness, special measures taken and any suggestions in the matter. (4) Conditions, so far as they affect housing, as regards water supply, closet accommodation and refuse disposal, together with measures taken during the year in these matters. All the information asked for here is given elsewhere in this report or will be found in the table of detailed statistics appended to this section. IV.—Unhealthy Areas. (1) Action taken as regards areas represented before the beginning of the year under Part I. or Part II. of the Housing Act, 1890. None. (2) Particulars of, and action taken, as regards areas represented during the year. None. (3) Information as to complaints made during the year that areas were unhealthy and action taken. None received. 71 V.—By-laws relating to Houses, Houses Let In Lodgings, and to Tents, Vans, Sheds, etc. (1) As to working of existing By-laws. (See p. 22.) (2) As to need for new By-laws or revision of existing By-laws. The London County Council is now the authority for making- By-laws with regard to tenement houses. The new By-laws had not come into operation before the end of the year. VI.—General and Miscellaneous. Under this head there may be noted the fact that during the year further progress was made in connection with the Council's housing scheme on the Fisherton Street site. At the end of the year, including the 32 flats completed during 1925, there were 82 flats in occupation, and of the total 3 blocks had been erected, one was in course of erection and 3 still remained to be built. ' HOUSING STATISTICS FOR THE YEAR 1925. The information asked for by the Ministry with regard to housing is contained in the following statement. Under the Increase of Rent and Mortgage Interest (Restriction) Act, 1920, so far as regards the provisions of Section 2 (2), relating to certificates as to suitability for occupation of houses, 5 applications were received, and a certificate in each case was granted. Number of new houses erected during the year : 13 houses and a) Total| 180 flats (b) With State assistance under the Housing Acts : (1) by the local authority 32 flats. (2) by other bodies or persons 104 houses and flats. 1. Unfit dwelling-houses: Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,167 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925— Houses 952 Tenements in block 421 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (The house in this case (61, Lisson Street) was one which had been dealt with by the District Surveyor as a dangerous structure. The occupants continued in residence in spite of the fact that the front had been removed until a closing order was made by the magistrate.) (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 2,322 2. Remedy for defects without service of formal notices : Number of defective dwelling-houses rendered fit in consequence of informal action by the local authority or their officer (intimation only) 2,021 72 3. Action under statutory powers : (a) Proceedings under Section 3 of the Housing Act, 1925 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (b) Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied (statutory notices) 301 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 301 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil GENERAL STATISTICS. Area (acres), 1,427.8 (exclusive of water); 1,473 (including water). Population (1921), 104,173; (1925), 106,100 (estimated). Number of inhabited houses (1921), 18,507. Number of families or separate occupiers (1921), 27,214. Rateable value, £2,712,500. Sum represented by a penny rate, £11,302 1s. 8d. Extracts from Vital Statistics of the Year. Births— Total. M. F. Legitimate 1,344 698 641 Birth Rate, 14.1 Illegitimate 152 77 75 Deaths, 1,257. Death Rate, 11.0. 73 Number of women dying in, or in consequence of, childbirth—from sepsis, Nil; other causes, 8. Death rates of Infants under 1 year of age per 1,000 registered births :— Legitimate, 61 per 1,000; Illegitimate, 78 per 1,000; Total, 63 per 1,000. Deaths from Measles (all ages), Nil. Deaths from Whooping Cough (all ages), 21. Deaths from Diarrhœa (under 2 years of age), 25. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision :— Milk Premises 148 Cowhouses 1 Slaughterhouses 3 Offensive Trades 2 Ice Cream Premises 118 Bakehouses 66 Restaurant, Dining Room and Coffee Shop Kitchens 180 Hotel Kitchens 20 Pastrycooks and Tea Rooms 50 Fried Fish Shops 21 Fish Curers 5 Houses Let in Lodgings 1,079 Workshops and Workplaces 3,278 Total 4,971 Smoke Nuisances. Number of Observations 693 Number of Nuisances and Complaints 2 Number of Notices 2 Number of Summonses Nil Housing of the Working Classes. Number of houses inspected 973 Number of Houses for the Working Classes— Tenements in Blocks 504 (a) Erected during year 32 flats Number of Representations by (b) In course of erection 20 flats Householders Nil Number of closing Orders Nil Number of Representations by Number of Houses included in Medical Officer Nil such Closing Orders Nil Number of Houses included in Number of Closing Orders such Representations Nil determined Nil Number of Houses demolished— Number of Houses remedied (a) In pursuance of Orders Nil without Closing Orders Nil (b) Voluntarily Nil Number of Domolition Orders Nil Number of Houses repaired by Local Authority Nil Number of Houses repaired under Section 3 of the Hous- ing Act, 1925 Number House closed on Notice by Onwer that they could not be made fit Nil Total Number of Houses in the Number of Houses occupied by Borough 16,294 the Working Classes 8,131 74 Mortuary. Number of bodies received 170 Number of Infectious bodies received Nil Disinfection. Number of rooms disinfected 750 Number of articles disinfected 9,233 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total Number of persons cleansed 2,969 1,099 196 2,317 6,491 Bakehouses. Number on Register at end of 1925 66 Number above ground 6 Number underground 60 Number of Inspections 136 Number of Notices 6 Number of Prosecutions Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1925 276 Number of Inspections 1,072 Number of Notices 23 Number of Prosecutions 1 House to House Inspections. Number of Inspections Houses 952 Tenements 421 Number of Notices issued Intimations 1,180 Statutory Notices 190 Number of Prosecutions 1 House Refuse. Number of Inspections 5,250 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 447 Number of Notices issued. Intimations 418 Number of Statutory Notices 37 Number of Prosecutions Nil 75 Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 23 Number of Statutory Notices served 8 Number of Prosecutions 1 Overcrowding. Number of Dwelling Rooms overcrowded 4 Number Remedied 4 Number of Prosecutions Nil Underground Rooms. Number dealt with 6 Number of Notices served under P. H. (L.) Act, 1891 6 Number of Notices served under H. T. P., &c., Act, 1909 Number of Prosecutions Nil Verminous Rooms. London County Council (General Powers) Act, 1922, Section 9 (1). Number of rooms cleansed 784 Number of Statutory Notices served 36 Number of Prosecutions.1 Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 13 Inland Revenue Act. Number of houses for which applications were received Nil Number of tenements comprised therein Nil Number of tenements for which certificates were granted Nil ,, ,, ,, ,, refused Nil ,, ,, ,, ,, deferred Nil Drainage. Number of inspections made 5,917 Number of drainage plans deposited 460 Number relating to new buildings 74 „ „ old buildings 386 76 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops, and Cowsheds 366 Number of Inspections 1,254 Ophthalmia Neonatorum Regulations. Number of Notifications received during the year from certified midwives Nil Sanitary Officers. Number of Sanitary Inspectors (Whole-time) Male 8 Female Nil „ M ,, (Part-time) Male 3 Female 3 ,, Health Visitors Whole-time 3 Part-time 3 ,, Tuberculosis Visitors Whole-time 1 Part-time 1 77 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1925 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Non. residents registered in the District. of Residents not registered in the District. Under 1 year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1911 117,844 4,130 2,375 20.2 1,578 14.2 600 840 261 109.8 1,818 16.3 1912 116,155 4,111 2,246 19.3 1,652 15.0 769 752 209 93.0 1,635 14.8 1913 114,532 3,804 2,146 18'6 1,629 14.9 755 753 195 90.0 1,627 14.9 1914 112,892 3,847 2,128 18.7 1,631 15.1 813 787 210 98.6 1,605 14.9 1915 100,260 3,647 1,852 16.2 1,741 17.2 817 773 178 96.1 1,697 17.8 1916 98,573 3,936 1,814 16.8 1,681 16.9 855 720 188 103.6 1,583 16.0 1917 92,796 3,065 1,506 14.5 1,647 17.6 853 752 182 120.9 1,580 17.0 1918 98,526 3,340 1,375 12.4 1,852 18.7 893 879 152 110.5 1,835 18.5 1919 97 953 3,625 1.492 14.6 1,724 17.3 864 708 147 98.5 1,568 15.9 1920 101,856 4,287 2,217 21.5 1,638 16.0 939 600 145 65.6 1,299 12.7 1921 105,200 3,393 1,939 18.4 1,625 15.4 877 607 128 66.0 1,355 12.8 1922 105,200 3,588 1,679 15.9 1,638 15.5 905 718 115 68.0 1,451 13.7 1923 105,400 3,601 1,668 15.8 1,468 13.9 827 594 111 66.0 1,235 11.7 1924 105,300 3,432 1,531 14.5 1,686 15.9 936 688 123 78.0 1,436 13.6 1925 106,100 3,418 1,496 141 1,472 13.8 873 658 94 63.0 1,257 11.0 Total population at all ages at Census of 1921, 104,173. Area of district in acres (exclusive of area covered by water), 1427.8 acres. „ „ (including area covered by water), 1473 acres. 78 TABLE I (a). Vital Statistics of Separate Localities in 1925 and the Ten Previous Years. Names of Localities The Whole Borough All Souls St. Mary Christ Church St. John Year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year a. b. c. d. a. b. c. d. a. b. C. d. a. b. C. d. a. b. c. d. 1915 100,260 1,852 1,697 178 25,002 367 341 21 27,342 337 422 35 30,901 801 639 94 17,015 347 295 28 1916* 98,573 1,814 1,588 188 24,540 392 337 32 26,892 353 400 40 30,403 755 574 88 16,738 314 277 28 1917 92,796 1,506 1,580 182 23,089 332 275 28 25,334 248 416 41 28,621 618 614 87 15,752 308 275 26 1918 98,526 1,375 1,835 152 24,528 311 366 30 26,880 257 429 45 30,391 522 708 58 16,727 285 332 19 1919 97,953 1,492 1,568 147 24,381 311 316 27 26,731 272 408 34 30,210 584 560 63 16,631 325 284 23 1920 101,856 2.217 1.299 145 25,352 450 252 28 27,796 439 366 27 31,414 933 446 71 17,294 395 235 19 1921 105,200 1,939 1,355 128 26,184 390 268 29 28,709 445 345 27 32,445 720 455 55 17,862 384 287 23 1922 105,200 1,679 1,451 115 25,202 318 286 18 26,943 405 415 21 82,747 673 459 50 20,308 283 291 26 1923 105,400 1,668 1,235 111 25,258 323 226 14 26.992 340 333 18 32,806 643 410 52 20,344 362 266 27 1924 105,300 1,531 1,436 123 25,233 280 245 22 26,967 336 422 30 32,775 629 472 55 20,325 286 297 6 Averages of Years 1915 to 1924 ) 101,106 1,707 1,504 146 24,876 347 291 24 27,058 343 395 31 31,271 687 533 67 17,899 328 283 22 1925 106,100 1,496 1,257 94 25,425 265 234 10 27.172 348 339 19 33,024 593 426 56 20,479 290 258 9 *The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sub-District on the 1st April 1916, but for the purposes of District comparison over previous years the figures have been allocated to the old Sub-Districts 79 TABLE II. Notifiable Diseases During the Year 1925. Cases Notified. Deaths Certified. Disease. At all Ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards. Total No. of Cases Admitted to Hospital. Total deaths Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Diphtheria 132 2 50 39 21 16 4 - 128 6 - 1 8 1 - - - Erysipelas 36 1 1 1 8 11 11 8 15 1 - - - - - - - 1 Scarlet Fever. 168 1 47 87 19 12 2 - 162 2 - - 1 1 - - - - Enteric Fever (including Paratyphoid) . 17 - - 1 4 12 - - 12 2 - - - - - 1 1 - Puerperal Fever 6 - - - 8 3 - - 5 - - - - - - - - - Encephalitis Lethargica 2 - - - 1 - 1 - 2 2 - - - - 1 - 1 - Ophthalmia Neonatorum 8 8 - - - - - - 5 - - - - - - - - - Pneumonia 69 1 9 4 11 24 16 4 21 9 - - - - - 1 6 2 Dysentery 1 - 1 - - - - - - - - - - - - - - - Cerebro Spinal Fever 2 1 1 - - - - - 2 - - - - - - - - - Acute Poliomyelitis 2 - 1 1 - - - - 1 - - - - - - - - - Polio-Encephalitis 1 - - - - - - - - - - - - - - - - - Trench Fever 1 - - - - - - - - - - - - - - - - - Malaria 1 - - - - 1 - - - - - - - - - - - - Tuberculosis, Pulmonary 187 - - 14 41 73 48 11 42 31 - - - - 4 13 12 2 Tuberculosis, Non-Pulmonary 36 1 8 13 5 9 - - 13 3 - - 3 - - - - - Totals 669 15 118 161 108 162 82 23 410 55 - 1 7 2 5 15 20 5 08 TABLE II. (a). Cases of Infectious Disease Notified during the 52 weeks ending 2nd January, 1926. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home. At all ages. At Ages—years. All Souls. St. Mary. Christ Church St. John. Totals. All Souls. St. Mary. Christ Church St. John. Totals. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Smallpox - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - Diphtheria, ing Membranous Croup 132 2 50 39 21 16 4 - 32 23 55 22 132 32 20 54 22 128 4 Erysipelas 36 1 1 1 3 11 11 8 8 10 11 7 36 3 4 6 2 15 21 Scarlet Fever 168 1 47 87 19 12 2 - 46 29 55 38 168 45 29 53 35 162 6 Typhus Fever - - - - - - - - - - - - - - - - - - - Enteric Fever 14 - - 1 4 9 - - 5 8 - 1 14 5 4 - 1 10 4 Paratyphoid Fever 3 - - - - 3 - - 1 1 1 - 3 1 - 1 - 2 1 Relapsing Fever - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - -- - Puerperal Fever 6 - - - 3 3 - - 3 2 1 - 6 3 2 - - 5 1 Plague - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever 2 1 1 - - - - - - - - - 2 - - 2 - 2 - Tuberculosis— Pulmonary 187 - - 14 41 73 48 11 41 59 60 27 187 9 17 11 5 42 145 Non-Pulmonary 36 1 8 13 5 9 - - 5 11 14 6 36 - 6 5 2 13 23 Acute Poliomyelitis 2 - 1 1 - - - - - 1 - 1 2 - 1 - - 1 1 Polio-Encephalitis 1 - - 1 - - - - - - - 1 1 - - - 1 1 - Ophthalmia Neonatorum 8 8 - - - - - - 1 - 5 2 8 1 - 3 1 5 3 Encephalitis Lethargica 2 - - - 1 - 1 - 1 1 - - 2 1 1 - - 2 - Pneumonia 69 1 9 4 11 24 16 4 6 17 32 14 69 1 6 12 2 21 48 Malaria 1 - - - - 1 - - - - 1 - 1 - - - - - 1 Dysentery 1 - 1 - - - - - - - 1 - 1 - - 1 - 1 - Trench Fever 1 - - - - - - - - - - - - - - - - - 1 Totals 669 15 118 161 108 162 82 23 149 162 239 119 669 101 90 148 71 410 260 669 81 TABLE III.— Causes of, and Ages at Death during the year ending 3rd January, 1926. No. CAUSES OF DEATH. Net deaths at the subjoined ages of " Residents " whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls St Mary. Christ Church. St John. Total. 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 under65 65 and upwards. 1 Enteric Fever 2 - - - - - 1 - - - - - 2 - 2 2 Small Pox - - - - - - - - - - - - - - - 3 Measles - - - - - - - - - - - - - - - 4 Scarlet Fever 2 - - 1 1 - - - - - - 1 - 1 2 5 Whooping Cough 21 9 8 4 - - - - - - 2 2 13 4 21 6 Diphtheria and Croup 5 - 1 3 1 - - - - - - 2 3 - 5 7 Influenza 17 - - - - 1 2 7 7 4 3 3 4 7 17 8 9 Erysipelas Phthisis (Pulmonary 1 - - - - - - - 1 3 - 1 - - 1 culosis) 80 - - - 2 13 32 25 8 8 15 30 25 10 80 9a Tuberculosis of the Respiratory System (Lungs, Pleura and Throat - - - - - - - - - 2 - - - - - 10 Tuberculous Meningitis 7 - 1 4 1 - 1 - - 10 2 1 4 - 7 11 Other Tuberculous diseases 6 - - - 1 1 2 2 - 5 1 2 - 3 6 12 Cancer 161 - - - - 2 11 74 74 337 35 40 46 40 161 13 Rheumatic Fever 2 - - - - 1 - 1 - 3 - 1 - 1 2 14 Meningitis 6 1 - - 4 -- - 1 - 4 2 1 2 1 6 15 Organic Heart Disease 114 - - - 3 4 4 38 65 86 31 29 25 29 114 16 Bronchitis 168 3 - 1 - - 6 42 116 22 30 46 62 30 168 17 Pneumonia (all forms) 133 15 10 3 3 4 23 31 44 56 11 36 62 24 133 18 Other diseases of Respiratory 19 Organs Diarrhœa and Enteritis (under 19 2 - - - 1 1 6 9 4 2 6 7 4 19 2 years) 25 22 3 - - - - - - 1 2 6 15 2 25 20 Appendicitis and Typhlitis 8 - - - 1 1 - 5 1 23 3 4 - 1 8 21 Cirrhosis of Liver 6 - - - - - 1 3 2 9 1 1 1 3 6 21a Alcoholism 3 - - - - - 1 2 - - - 2 1 - 3 22 Nephritis aud Bright's Disease 42 - - - - 1 7 16 18 15 8 13 12 9 42 23 Puerperal Fever - - - - - - - - - 2 - - - - - 24 Other accidents and diseases of Pregnancy and Parturition 8 - - -- - 2 5 1 - 16 2 2 3 1 8 25 Congenital Debility and Malformation, including mature Birth 32 32 - - - - - - - 42 5 7 17 3 32 26 Violent Deaths, excluding Suicide 39 3 1 1 3 5 6 8 12 33 11 8 12 8 39 27 Suicides 11 - - - - - 2 7 2 6 1 4 6 - 11 28 Other defined Causes 339 7 1 2 5 6 44 87 187 282 67 91 104 77 339 Totals 1257 94 25 19 25 42 149 357 546 973 234 339 426 258 1257 VACCINATION RETURNS. Return for 1924, Return made to the Board or Guardians and Ministry of Health on the 9th February, 1926, by Mr. George H. Bassett, Vaccination Officer of the St. Marylebone Parish, respecting the Vaccination of Children whose Births were registered in St. Marylebone, from 1st January to 31st December, 1924, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District Number of Births returned in the " Birth List Sheets " as registered from 1st January to 31st Dec., 1924 Number of these Births duly entered by 31st January, 1926, in Columns I, 11, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1926, remained unentered in the " Vaccination Register ' on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1926, neither duly entered in the " Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book " (columns 8, 9 and 10 of this Return) Number of Certificates of Successful Primary Vaccination at ALL AGES received during the calendar year 1925 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth ot the children to which they relate during the calendar year 1925 Col. II. Col. IV. Postpone ment by Medical Certifi. cate Removal to Districts,the Vaccination Officer of which has been duly apprised Removal to Places unknown or which cannot bs reached ; and Cases not having been found Col. I. Success fully Vaccinated Insuscep tible o I Vaccination Had SmallPox IN umber in respect of whom Certificates oi Conscientious Objection have been received Col. V Dead, Un vaccinated 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 695 423 7 - 108 34 27 16 35 45 2. St. Mary 2,1133 1,561 6 - 153 110 14 270 25 14 2,363 410 3. All Souls 583 405 - - 55 10 14 77 15 7 Total 3,431 2,389 13 - 316 154 55 363 75 66 2,363 410 Dated 9th February, 1926. (Signed) GEORGE H. BASSETT, Vaccination Officer. 82 ■ ? — - ■ ■ " —•> - . " . , ■ - v - ~. \ . , "C - r" ' •• - • - *vj - '