AC 4353 Metropolitan Borogh of St Marglebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1926. 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. 1 9 2 7. Metropolitan Borongh of St. Marglebone , REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1926. Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.RCP. (Ed.) Of the Middle Temple, Barrister-at-Law. LONDON: VAIL & CO., 170, FARRINGDON ROAD. 1 92 7, Vail & Co., Printers. 170, Farringdon Road, E.C. Public Health Department, Town Hall, Marylebone Road, N.W.1. 22nd April, 1927 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 1926. In accordance with the instructions of the Ministry of Health I have gone less into detail than was the case in the report for 1925, which was what is called a " Survey" repirt. Though considered worthy only a mere " chronicle " report, 1926 was exceedingly important and saw a number of events of great interest and the initiation of one, viz., the representation of the Carlisle Street area and the passing of the Council's resolution with regard thereto, that will undoubtedly be fraught with great and beneficial consequences to the health of a large section of the population of the Borough. In the body of the report this matter is touched upon as are also a number of others to which reference need not be made here. Amongst events that may be noted is the visit that was paid at the beginning of the year by a number of foreign medical officers of health under the auspices oE the League of Nations. The group, which included representatives from Canada, from Panama, from France and Austria and Greece, was attached to the Public Health Department, and remained in the Borough for several days studying the methods adopted and viewing the various activities of the Council in relation to Public Health particularly. The delegates were greatly impressed by what they saw and expressed great appreciation of the opportunities for study offered to them. Not least did they appreciate the splendid hospitality of the Mayor (Mr. Councillor Tonkin) and the cordial welcome extended by him and by members of the Council. It is a source of great gratification to me that the Borough should have been chosen as one of those to be visited and that the Council so very readily and generously afforded facilities for the making of the observations by the visitors. In this, naturally, the Public Health Committee were most prominent and I desire to express to them my thanks for this and generally for the help and kindness they continue to show me. Under Mr. Hugh Jones and later Mr. Alderman Brooks as Chairmen, the Committee 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. To the staff of the department I must also express sincere thanks for the help they have given and the loyalty and devotion they have shown to their work and to myself. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER, Medical Officer of Health, CONTENTS. PAGE PAGE Natural and Social Conditions Sub-District Births and Deaths 29 of the Borough. Deaths in relation to Age 29 Population 7 Deaths among the Aged 29 Sanitary Circumstances 7 Causes of and ages at death 29 Water Supply 7 Infantile Mortality 30 Drainage 7 Causes 31 Combined Drainage 8 Deaths in relation to Disease 33 Closet Accommodation 8 Diarrhceal Diseases 33 Public Sanitary Conveniences 8 Infectious (Communicable) Scavenging 8 Diseases 33 Removal of House Refuse 8 Phthisis and other Tuberculous Removal of Offensive Refuse 8 Diseases 33 Sanitary circumstances of the Borough 9 Respiratory Diseases gtag- , _ , _ 9 Cancer and Malignant Disease 34 Nuisances 10 Alcoholism 35 Inspections 11 Accident, Suicide and Man- Nuisances—Legal Proceedings 11 slaughter 35 Rat Repression 11 Prevalence of and Control over In- Smoke Nuisances 60 fectious Diseases 35 Premises and Occupations controlled Isolation of Cases 35 by By-laws and Regulations 12 Discharge Notices 36 Business Premises 12 Diphtheria and Membranous Cow Sheds 12 Croup 36 Milk Premises 12 Scarlet Fever 36 Slaughterhouses 12 Enteric Fever 37 Offensive Trades 13 Cerebro-Spiual Fever 37 Ice Cream Premises 13 Encephalitis Lethaigica 37 Butter, Margarine, etc., Premises 13 Polio-Encephalitis 37 Bakehouses 13 Polio-Myelitis 37 Fried Fish Vendors and Fish Erysipelas 37 Curers 13 Puerperal Fever 37 Factories and Workshops 13 Measles and German Measles 37 Inspections 14 Whooping Cough 38 Defects found 14 Glanders and Anthrax 38 Home Work 15 Smallpox 38 Registered Workshops 16 Infectious Diseases in Schools 39 Premises used for Human Habitation 16 Ophthalmia Neonatorum 39 Premises used for Human Habitation 6 Influenza 40 Houses let in lodgings 16 Pneumonia 40 Common Lodging Houses 17 Tuberculosis Treatment 40 Underground Rooms 17 Notifications 41-51 Premises that are not but should be Prevention of 43 Registered 17 Care Committee 43 Food Stalls 18 Work and Dispensaries 45 Food Pulmonary Deaths 49 Milk Supply 18 Bacteriological Diagnosis of 44 Milk Analysis 18 Disinfection 52 Legal proceedings for adul- Cleansing of Persons Act, 1897 53 teration 18 Bacteriological Examinations 54 Bacteriological examination of Milk 19 Maternity and Child Welfare 54 Health Visitors 54 Dairies, Cowsheds and Milkshops Orders 19 Centres 55 Milk and Cream Regulations 19 Ante-Natal Work 55 The Milk (Special Designation) 19 Dental Clinic 56 The Milk (Speaal Designation) Order 20 Massage Clinics 55 Hospital Treatment 55) Milk (Mothers and Children) 20 Maternity Cases 55 Order, 1918 20 Infant Consultations—Work at 56 Bacteriological examination of Day Nurseries 53 Milk 20 20 Home Helps 56 Food Inspections 20 Food, Unsound, Condemned 20 Sanitary Administration— Sale of Food and Drugs Acts 21 Staff 9,57 Reports of Public Analyst during Report of Mortuary Keeper 57 year 22-26 Housing 57 Statistical General Housing Conditions 58 Births 28 Statistics 59 Births Registration 28 Sanitary Inspection (Summary) 60 Births Notifications 28 Ministry of Health, Tables I-1II 63-67 Deaths and Death Rates 28 Vaccination Returns 68 7 THE YEAR 1926. POPULATION. The population of the Borough when the Census was taken on June 19th, 1921, was found to be 104,173, made up of 63,166 females and 41,007 males, the former thus exceeding the latter by 22,159. 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 1926 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 1925. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. 1925 106,100 25,425 27,172 33,024 20,479 1926 105,800 25,353 27,095 32,931 20,421 SANITARY CIRCUMSTANCES. Water. Complaints as to water supply, either as regards quantity or quality, were few. 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 six premises. The reasons for discontinuing the supply were : Nonpayment of rate, five; defective pipes, one. During the year 122 notices in regard to defects in and necessity for cleansing and repairing of water cisterns were served and were complied with. Water Supply in Dwelling Houses.—Seven certificates were granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. The number in 1925 was five. In 18 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, 1907. The supply w£l provided after receipt of the intimation notice in 16 cases. In two cases the supply was provided after the issue of a statutory notice. Drainage. The total number of drain inspections made during the year was 5,896, as against 5,917 in 1925. The total number of plans deposited was 530, the number in 1925 being 460 Plans relating to new buildings numbered 85, the number deposited in 1925 being 74. In the case of old buildings, the number of plans received was 445, as against 386 in 1925. On three occasions reports were submitted with regard to cases discovered by the inspectors, in which drainage or sanitary work was being carried out without permission from the Council and without deposit of plans, or not in compliance with requirements. Proceedings in court were taken in one case, the costs imposed amounting to £2 2s. 8 Combined. Drainage.—Orders as to combined drainage were issued by the Council in respect of 28 premises. The number in 1925 was 63. Closet Accommodation. In the table at page 11, 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. 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, 1927, and the amount of increase or decrease as compared with the previous year. 1927 1926 Decrease Increase £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus—Men's Department 211 11 5 252 5 10 40 14 5 — ‡ „ Women's „ 343 11 10 379 1 9 35 12 11 — Gt. Portland Street—Men's „ 61 15 11 61 8 4 — 0 7 7 ., Women's „ 58 1 2 61 15 5 3 14 3 — Marylebone Road—Men's „ 54 3 3 52 13 2 — 1 10 1 „ Women's „ 53 7 10 50 10 6 — 2 37 4 Foley Street—Men only „ 35 3 4 39 2 11 3 19 7 — St. John's Wood Road—Men only 29 8 5 27 18 2 — 0 10 3 Barrett Street—Men only „ 56 12 10 59 16 4 3 3 6 — Salisbury Street— Men's Department 16 16 4 16 14 11 0 1 5 ‡„ Women's „ 21 3 9 21 12 7 0 8 10 - * One free urinette provided. ‡ Two free urinettes provided. Removal and Disposal of House Refuse. Throughout the year the arrangements in connection with scavenging remained in the hands of the Highways Committee and under the control of the Borough Engineer, Mr. James Gair. The considerable improvements recently made in the plant are fully described in my report for 1925 and it is unnecessary to repeat the information there given. The total amount of refuse collected for the year ended 31st March, 1927, it may be mentioned, was 41,887 tons, as compared with 42,889 tons in the previous year. 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 531 premises. During the year the inspectors made 4,949 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, 62 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 9 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, and in three cases in which there was serious neglect it was necessary to institute proceedings. The fines and costs imposed amounted to £18 7s. Od. 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. A. A. 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.j, 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). †Miss K. Stewart (d). 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. (/). *Drainage Inspectors. Tuberculosis Clerk—-Dispenser. H. H. Clay (a, b, c). *Miss M.T. Challis. T. Gorniot (Senior Sanitary Inspector) (a). Clerks. Chief Clerk : H. E. Curtis. *Food Inspector. A.H. James. G. Smith (a, b, c). W.J.Howe. *Outdoor Superintendent. G. W . Matthews. R. C. Thorpe. P. H. Hill (a, b, c). D. C. Mead. 10 *W omen 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) tt Miss N. C. Stokes, R.R.C. Mortuary Keeper. (b, d, e, f, g). Mrs. H. Spea-s. 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 Cestificate. b Certificate Sanitary Inspectors' Examination Board (London). c Meat and other Foods Certificate. d Health Visitors Diploma. e Central Midwives Board Certificate. f Certificate ot State Registration for Nurses. g Three or Four Years' Hospital General Training Certificate. t Temporary. †† Resigned October, 1926. 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 3,114, as against 3,470 in 1925. The majority of these complaints were made by the inspectors themselves, though a certain number came from other members of the Council's staff, from voluntary health workers, etc. In respect of nuisances, 182 statutory notices were issued, as against 370 in 1925. Of these notices, 138 related to ordinary nuisances (dirt, dampness, etc.), 17 to verminous rooms, 11 to drains, 2 to water supply in tenement houses, and 14 to insufficient dust bins. The 17 notices respecting verminous rooms were served under powers contained in the London County Council (General Powers) Act, 1922, and referred to 20 rooms. In 2,932 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 no instance was there failure to carry out works after receipt of statutory notice. 11 The total inspections made by each inspector, and the number of nuisances of various kinds detected and remedied, are set out in the following table:— Districts. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Houses damp, dirty or dilapidated remedied 279 200 532 330 146 107 1,594 Doors, windows, floors, ceilings sash cords, etc., repaired 281 241 715 103 155 60 1,555 Overcrowding abated — — 3 3 — — 6 Illegal occupation of underground rooms dealt with - - 3 4 4 1 12 Water closet defects remedied 205 162 335 107 127 90 1,026 Water closets erected — - — 2 6 22 30 Urinal defects remedied 1 - 1 2 — 4 8 Soilpipes and ventilating shafts repaired or renewed 6 3 4 - 27 1 41 Yard defects remedied 131 115 141 182 83 49 701 Waste pipe defects remedied 49 26 46 14 23 14 172 Water cistern defects remedied 27 11 27 21 23 13 122 Rubbish, manure, etc., accumulations removed 14 5 66 36 25 21 167 Dung or dust receptacles repaired or renewed 42 20 42 59 15 11 189 Drains relaid or amended 32 7 20 11 29 25 124 Drains cleared 9 28 11 3 14 — 65 Rainwater pipes repaired or renewed 21 14 42 19 13 8 117 Water supply to houses reinstated 2 - 6 4 2 14 Roofs and gutters repaired 132 108 127 85 22 37 511 Area defects remedied 37 — 37 121 68 22 285 Wash-house defects remedied 124 119 257 119 55 34 708 Animal nuisances abated 1 2 34 9 4 — 50 Basement defects remedied 9 — 8 12 33 4 66 Stables cleansed or repaired 6 — 10 — — - 16 Water supply laid on to upper storeys of house 5 2 3 4 3 1 18 Miscellaneous nuisances abated 527 195 12 150 32 13 929 Verminous rooms cleansed 30 185 263 189 60 28 705 Workshops dirty, overcrowded, unventilated or defective, remedied 12 2 1 18 9 44 86 Legal Notices in Connection with Nuisances. No summonses were issued in respect of nuisances during the year. Rat Repression. The number of complaints received during the year, viz., 48, was lower by 19 than the 1925 figure. The investigation of these complaints necessitated the inspection of 54 premises, 23 of which were used for business purposes (6 of these for the preparation or storage of food), the remaining 31 being private or tenement houses. In 7 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. 12 A Rat Week was held during the year from the 1st to the 8th November, 1926, and attracted a considerable amount of attention to the subject. Great assistance was obtained from the Borough Engineer 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, 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 1926 Number °f notices 1926 Number of prosecutions. 1926 On register at end of 192f Added in 1926 [ Removed in 1926 On register at end of 1926 A. Business Premises Milk premises 144 5 22 127 340 20 — Cowsheds 1 — — 1 21 — — Slaughterhouses 3 — 2 1 96 — — Offensive trade premises 2 — 1 3 70 — — Ice cream premises 118 - — 118 200 12 — Butter and Margarine Manufacturers and Dealers 16 .— 16 16 __ — Bakehouses 67 — 13 54 145 12 — Fried Fish Shops 22 2 1 23 70 5 — Fish Curers 5 — — 5 54 — — B. Habitations Houses let in lodgings 1,079 — 7 1.070 10 920 1,736 — Common lodging houses 5 — — 5 — — — Underground rooms not gistered — — — — — — Underground sleeping rooms A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 127. This is 17 less than in 1925,5 having been added and 22 removed; in 1914 there were 237 on the register. Cow Sheds.—The only cow shed remaining in the borough is situated at 42a, Clipstone Street, and is licensed for 10 cows. During the year regular and frequent visits of inspection were made and attention directed at the time to any matters that seemed to require it. The need for serving notices did not arise. Slaughter Houses.—At the beginning of the year the number of licensed premises of this class was three, but in October the L.C.C., which is the licensing 13 authority in the case of slaughter houses, refused renewal of licence in respect of two premises situated, one at 50, Henry Street and the other at 134, High Street, both in St. John's Wood, on the ground that no slaughtering had been done for a period of over 18 months. At the moment the only slaughter house in the Borough is that at 32a, Union Street, W. 1, which is held by Mr. E. J. Barclay, of 70, Great Titchfield Street, W.l. No conditions are attached to the licence and the. amount of slaughtering now done is comparatively small. Humane killers, in accordance with the requirements of the L.C.C. by-laws, are being used in every case, and apparently with complete success. Offensive Trades.—There are only three premises within the borough upon which trades classed as offensive are carried on. The business in two cases is that of tripe boiling, and in the remaining one that of poultry slaughtering. The Food Inspector made 70 visits, but no cause for complaint was found. Ice Cream Premises.—The number of such premises in the Borough on the Register is 118. Regular inspections were made throughout 1926, 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 1926 the number of bakehouses on the register was 54, 13 underground bakehouses having been removed. Of the 54, 49 are underground bakehouses. In all, 145 visits were paid and 12 notices 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 23 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. 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 dressmaking, millinery and tailoring in all its branches. The total number of visits to factories, workshops and workplaces during the year was 3,478; 56 by the women and 3,42'2 by the men inspectors. The complaints received numbered 72. 14 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 Inspection. Written Notice. Prosecutions (1) (2) (3) (4) Factories (Including Factory Laundries) 154 18 — Workshops (Including Workshop Laundries) 1048 95 - Workplaces (Other than Outworkers' Premises included in Part 3 of this Report) 2276 74 - Total 3478 187 - 2.-DEFECTS FOUND. Particulars Numb r 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 75 75 — — Want of ventilation 2 2 — — Overcrowding 8 8 — — Want of drainage of floors 1 1 — — Other nuisances 54 54 — — Sanitary accommodation insufficient 11 11 — — unsuitable or defective 55 55 — — not separate for sexes 9 9 — — 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) 12 12 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 227 227 — — 15 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 Employes Notices served on Occ piers as to keeping or sending lists. Pro ecmions. 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) 15) (6) (7) (8) (9) (10) (11) (12) (13) (14) 115) (16) Wearing Apparel— (1) Making, etc. 65 249 815 ... ... ... 34 ... ... •• ... ... ... ... ... Total 65 249 815 ... ... ... 34 ... ... ... ... ... ... ... ... 16 * In 31 instances intimation notices have been served, but the works necessary for the remedy of the defects are not yet complete. B.—PREMISES USED FOR HUMAN HABITATION. The only premises used for human habitation in respect of which there is 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 and Housing Acts 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, all houses suitable for the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to sanitation, cleanliness, cleansing, etc, 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year Number (1) (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 3,310 Coffee Shops, &c. 296 Bakehouses 67 Total number of workshops on Register 3,573 5.—OTHER MATTERS. Class Number (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 10 Action taken in matters 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 72 Reports (of action taken) L sent to H.M. Inspector *41 Other — Underground Bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 49 17 During the year under review, the list of registered houses covered 1,070 premises, and in all, 10.920 visits were paid to these. The number of notices served was 1,730, relating to cleansing and other defects. All of these were complied with without the necessity for further proceedings arising. Common Lodging Houses.—The following table contains all the necessary particulars with regard to the licensed premises of this class in the borough. 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 Streets, Lisson Grove Frederick Gerard van de Linde 102 women Total 654 men 109 women 768 That these beds are fully used may be taken as certain, a census made by the L.C.C. on the nights of November 5th and 6th, and referred to in a report recently issued by Dr. Kay Menzies, the County Medical Officer of Health, revealing that of the 654 beds for men no fewer than 050 were occupied, and of the 109 for women 106. 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. Underground Rooms.—As close supervision as possible was kept over rooms of this class, and whenever necessity compelled notices to discontinue occupation were served. The total number dealt with in this way was 6. 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 prepared for sale is very large. At the end of 1926 there were 296, this number including: Restaurant, dining room and coffee shop kitchens, 190; tea-rooms and pastry-cooks, 58; hotel kitchens, 20 ; fried fish shops, 23; and fish-curers 5. In addition, there were a number of shops in which meat, ham, sausages, etc., were cooked and sold only over the counter. On more than one occasion the Borough Council, at the suggestion of the Public Health Committee, have directed the attention of the Ministry of Health and the London County Council to the necessity for legislation requiring registration of food premises of this class. Up to the present no step in this direction has been taken by either of the authorities mentioned. The routine practice of visiting a number of restaurants, etc., each week was continued by the Food Inspector, and any matters discovered dealt with at once. In 1926 the total number of inspections was 1,092, the number of notices served being 21. 18 Food Stalls.—Of these there are considerable numbers in the market streets, particularly Great Titchfield Street, Bell Street, Church Street, Blandford Street, etc. Definite arrangements are made for the keeping of such as are used for the sale of food under close observation. Throughout 1926 visits were paid to all the market streets every day, a special feature being made of Saturday night and Sunday morning inspections. FOOD. A. Milk Supply. Analysis of Milk.—The total number of samples taken either formally and in accordance with the provisions of the Sale of Food and Drugs Acts, or informally as "test" samples, was 233. On examination by the Public Analyst 2 (0.8 per cent.) were found to be adulterated. In 1925 the percentage was 1.5. Further reference to the question of milk examinations is made in the report of the Public Analyst, which will be found elsewhere. Proceedings.—During the year also proceedings were instituted in 2 cases, the defendant in each instance being the occupier of a general shop and selling sterilised milk in bottle. The number of premises in the Borough on which such milk is sold is fortunately not large, the demand being small, and the Council after consideration of all the circumstances decided that registration should be withheld on the ground that if granted the sale of unbottled milk could not be prevented. Having regard to the possibility that though in general the sterilised milk was sold in the bottle as received, the vendor might open the receptacle and retail a portion of the contents, warnings were issued and samples were taken from time to time. In the two cases here referred to the vendors were detected in the act of selling the article other than in the unopened bottle, and in accordance with the instructions of the Public Health Committee were prosecuted for selling milk without being registered. Having regard to the fact that the defendants were in a small way of business, the magistrate decided to deal with the cases under the Probation of Offenders Act and, the defendants having undertaken to discontinue the sale of milk, imposed no fine but called upon them to pay each £2 2s. costs. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 67 were obtained on delivery at Marylebone Station of the London & North-Eastern Railway. Of the 67, two proved to be adulterated, and proceedings were instituted and fines and costs amounting to ,£40 and £5 5s. respectively imposed. 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. 1st 65 — — — £ s. d. 2nd 60 — — — — 3rd 59 2 3.4 2 45 5 0 4th 49 — — — — Total for year 233 2 0.8 2 45 5 0 19 Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 8 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, 66 of certified milk were taken and submitted to Dr. Foulerton for examination. The reports were almost invariably satisfactory and, in accordance with the usual arrangement, were forwarded to the Ministry of Health. Dairies, Cowsheds and Milkshops.—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., 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. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 & 1917. Report for the year ended 31st December, 1926. 1.—Milk: and Cream not sold as Preserved Cream. (a) Number of samples (6) Number in which a examined for the pre- preservative was resence of a preservative. ported to be present, and percentage of preservative found in each sample. Milk 233 Nil. Cream 12 Nil. Nature of preservative in each case in column (b), and action taken under the regulations in regard to it. Nil. 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 18 (ii.) Statements incorrect Nil Total 18 (iii.) Percentage of preservative found in each sample Average .0729% Boric Acid per lb. Lowest .051% Highest .097% Percentage stated on statutory label. Not exceeding 0.4%. 20 (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent 18 (ii.) Below 35 per cent Nil Total 18 (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 plied with, and action taken Nil 3.—Thickening substances.—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 39 applications were received from 8 dealers in the borough for licence to sell milk as Certified Milk, or Grade " A " Tuberculin Tested Milk or " Pasteurised " Milk. In addition 1 licence was granted to bottle and sell Grade " A " (Tuberculin Tested) milk, another to " Pasteurise " and sell " Pasteurised " 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, 11 for Grade " A " Tuberculin Tested Milk, and 13 " Pasteurised " Milk. In accordance with the instructions of the Ministry 66 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 1926 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1927, was £387 0s. Od., as against £357 5s. 9d. up to 31st March, 1926. The actual number of cases dealt with was 223, and the number of orders issued 1,110- B.—FOODS OTHER THAN MILK. 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. The articles dealt with in this way are set out below. Unsound and Diseased Food Condemned and Destroyed During the Year 1926. Meat— Beef 108 lbs. Mutton 78 lbs. Bacon 31 cwts. Poultry— 22 Ducks 3 Turkeys 21 Fish— Wet—Skate 64 stone Plaice 5 boxes Herrings 1 box Roe 5 boxes Cat Fish 2 boxes Cod 3 boxes Fillets 10 boxes Dry—Kippers 18 boxes Haddocks 1 box Lemon Soles 1 box Mackerel 1 box Shell Fish— Mussels 1 sack Whelks 2 sacks Fruit— Bananas ¾ crate Pineapples (Tinned) 4 cases Apricots (Tinned) 2 cases Apples 2 barrels Pears 3 baskets Strawberries 6 baskets Miscellaneous— Cream 271 tins Roquefort Cheeses 24 C —SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,103. 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 0 8 per cent., which is the same as the figure for 1925. 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 cases (2) in which prosecutions were 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:— 22 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. FIRST QUARTER ENDING 31st MARCH, 1926. 65 milk Food Inspector, St. Marylebone Borough Council Genuine. 12/6 per sample. 8 were test samples. No sample contained either preservative or colouring matter. 8 cheese Do. Do. All were test samples. 7 Gorgonzola cheese Do. Do. Do. 6 cream cheese Do. Do. Do. 9 cream Do. Do. No. Fat. Preservatives. 45 54.0% Preserved .057% boric acid 130 53 7% Nil. 134 56.25% Nil. 137 500% Nil. Devonshire. 160 56 7% .065% boric acid.Preserved. 162 58 0% Preserved. 066% boric acid. 210 52 6% Preserved. .097 „ 247 525% Preserved. .065% 267 560% Preserved. .069% All divided. 59 butter Do. Genuine. 32 were test samples. Of the 59 samples examined only two were free from preservatives. All the others contained boric acid ranging from 0.1% to 0.35%. 10 condensed milk Do. Do. All were test samples. 6 lard Do. Do. Do. 44 apples Do. Do. 42 were test, 1 divided and 1 private. 3 tea Do. Do. All were test samples. 3 jam Do. Do. 8 marmalade Do. Do. 21 coffee Do. Do. 4 mustard Do. Do. 1 lobster paste Do. Do. 3 chicken and ham paste Do. Do. 1 salmon and anchovy paste Do. Do. 1 salmon and shrimp Do. Do. 1 turkey and tongue Do. Do. 3 lemon curd Do. Do. 1 fruit drop Do. Do. 1 tinned, peas Do. Do. Divided. 2 camphorated oil Do. Do. All were test samples. 3 sulphur ointment Do. Do. Do. 1 nut milk chocolate Private Sample. So deteriorated as to be unfit for consumption. 1 raisin wine Food Inspector, Adulterated with 2 grains of Sulphur dioxide per pint. This was a test sample 1 orange wine Do. do. 0.5 do. Do. 1 ginger wine Do. do. 1.0 do. DO, Total number of Samples analysed during the Quarter 274 Number of Samples adulterated 3 and 1 unfit for cons umption. 23 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 ot 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 tbe Analysis. vations. SECOND QUA RTER ENDING 30TH JUNE, 1920. 60 milk Food Inspector, St. Marylebone Borough Council Genuine 12/6 per sample. 4 were test samples. No sample contained either preservative or added colouring matter. 56 butter Do. Do. 41 were test samples. Of the 56 samples examined all contained boric acid as a preservative. The amounts ranged from 01% to 035%. 6 cream Do. Do. No. Fat. Preservatives. 426 59 0% 0.051% boric acid Preserved. 428 58 6% 0.070% „ 497 565 % 0.064%„ 502 52 0% 0.085%„ 519 47 8% 0.091%„ 480 48.0% Nil. Not Preserved. Test. 1 was a test sample. 2 cream tinned Do. Genuine. 488 26.5% Nil. Not Preserved. 491 29.7% Nil. Not Preserved. These were test samples 17 condensed milk Do. Genuine. All were test samples. 7 cream cheese Do. Do. 21 cheese Do. Do. 5 lemon curd Do. Do. 1 sugar Do. Do. 2 demerara sugar Do. Do. 7 margarine Do. Do. 12 coffee Do. Do. 7 marmalade Do. Do. 11 jam Do. Do. 2 flour Do. Do. 2 self raising flour Do. Do. 7 tea Do. Do. 7 mustard Do. Do. 3 pepper Do. Do. 18 lard Do. Do. 3 lemonade pdrs. Do. Do. 1 chicken and ham paste Do. Do. 1 chicken and tongue paste Do. Do. 1 salmon and shrimp paste Do. Do. 1 salmon and anchovy paste Do. Do 1 lobster paste Do. Do. 2 camphorated oil Do. Do. 3 boracic ointment Do. Do. 3 sulphur ointment Do. Do. Samples analysed during the Quaiter 269 Samples adulterated Nil. 24  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, 1926 57 milk Food Inspector, St. Marylebone Borough Council. Genuine 12/6 per sample. 9 were test samples. Of the 59 samples analysed none was found to contain preservative or added colouring matter. 2 milk Do. Adulterated. Fined £20 0s. Od. ,, £20 and £5 5s. costs. No. 768 11.48% of added water. No. 772 17.2% of added water. 48 butter Do. Genuine 43 were test samples. All the samples contained boric acid as a preservative, the amounts ranging from 0.15% to 0.37%, i.e., 10.5 to 25.9 grains per lb. 3 tinned cream Do. Do. See cream below.* 9 condensed milk Do. Do. All were test samples. 6 margarine Do. Do. 31 cheese Do. Do. 4 cream cheese Do. Do. 8 lard Do. Do. 1 evaporated milk Do. Do. 10 marmalade Do. Do. 5 lemon cheese Do. Do. 21 jam Do. Do. 4 tea Do. Do. 24 coffee Do. Do. 2 honey Do. Do. 8 meat paste Do. Do. 5 fish paste Do. Do. 6 mustard Do. Do. 8 pepper Do. Do. 4 zinc ointment Do. Do. 4 bicarbonate of soda Do. Do. 5 apples Do. Do. 1 whiskey Do. Do. 3 whiskey Do. Adulterated. 2 were test samples. No. 816 (Test) 36.83 degrees under proof. No. 817 (Test) 35.68 do. No. 819 35.02 do. 9 cream Do. Genuine No. Fat. Preservative. 545 56.0% 0.064% boric acid Preserved. 559 52.4% 0.092% do. do. 563 48.0% Nil. 565 56.7% 0.064% boric acid Preserved 567 49.6% Nil. 573 52.0% 0.068% boric acid Preserved 561 27.0% Nil, Tinned. *This was a test sample 673 28.0% Nil. do. Do. 693 31.0% Nil. do. Do. 747 58.6% 0.092% boric acid Preserved. 751 60.0% 0.066% do. do. 779 59.0% 0.089% do. do. Total number of Samples analysed during the Quarter 288 Number of Samples adulterated 5 25  Articles submitted lor Analysis. State whether the amp e 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.  FOURTH QUARTER ENDING 31ST DECEMBER, 1926. 49 milk Food Inspector, St. Marylebone Borough Council. Genuine. 12/6 per sample 12 were test samples. Of the 49 samples taken, no sample contained preservative or added colouring matter. 49 butter Do. Do. Of the 49 samples examined, 4 were free from any kind of preservative. All the others contained boric acid in amounts which ranged from 0.18% to 0.42%. 45 were test samples. 1 cream (tinned) Do. Do. No. Fat. Preservative. 872 29.0% Nil. This was a test sample 21 condensed milk Do. Genuine. All were test samples. 7 cream cheese Do. Do. 24 cheese Do. Do. 8 honey Do. Do. 12 lard Do. Do. 2 cocoa Do. Do. 20 jam Do. Do. 4 coffee Do. Do. 6 tea Do. Do. 7 marmalade Do. Do. 1 compound mustard Do. Do. 4 mustard Do. Do. 6 margarine Do. Do. 3 meat paste Do. Do. 3 fish paste Do. Do. 1 Scotch whisky Do. Do. 22 sponge cakes Do. Do. 1 orange wine Do. Do. 1 raisin wine Do. Do. 4 tomato ketchup Do. Do. 2 spaghetti Do. Do 2 beans Do. Do. 2 pickled onions Do. Do. 1 mustard pickles Do. Do. 2 ginger wine Do. Do. 3 boracic ointment Do. Do. 1 Mercurial ointment Do. Do. 1 mincemeat Do. Do. 2 Iced cake Private Sample. Do. Total number of Samples analysed during the Quarter 272 Number of Samples adulterated Nil 26 annual report of the public analyst, 1926. The number of samples taken under the Sale of Food and Drugs Acts and submitted to analysis, was 1,103; an increase as compared with the samples for 1925. the number for that year being 1,040. A complete list is as follows : No. Article. Genuine. Adulterated. Unfit for Consumption. Total. 1 Apples 49 49 2 Beans 2 — — 2 3 Bicarbonate of Soda 0 4 — — 4 4 Boracic Ointment 6 — — 6 5 Butter 212 — — 212 6 Camphorated Oil 4 — — 4 7 Cheese 84 — — 84 8 Chicken and Ham Paste 4 — — 4 9 Chicken and Tongue Paste 1 — — 1 10 Cocoa 2 — — 2 11 Coffee 61 — — 61 12 Compound Mustard 1 — — 1 13 Condensed Milk 57 — — 57 14 Cream 25 — — 25 15 Cream Cheese 24 — — 24 16 Cream Tinned 5 — — 5 17 Demerara Sugar 2 — — 2 18 Evaporated Milk 1 — — 1 19 Fish Paste 8 — — 8 20 Flour 2 — — 2 21 Fruit Drops 1 — — 1 22 Ginger Wine 2 1 — 3 23 Gorgonzola Cheese 7 — — 7 24 Honey 10 — — 10 25 Iced Cake 2 — — 2 26 Jam 55 — — 55 27 Lard 44 — — 44 28 Lemon Cheese 5 — — 5 29 Lemon Curd 8 — — 8 30 Lemonade Powders 8 — — 3 31 Lobster Paste 2 — — 2 32 Margarine 19 — — 19 33 Marmalade 32 — — 32 34 Meat Paste 11 — — 11 35 Mercurial Ointment 1 — — 1 36 Milk 231 2 — 233 37 Mincemeat 1 — — 1 38 Mustard 21 — — 21 39 Mustard Pickles 1 — — 1 40 Nut Milk Chocolate 1 1 41 Orange Wine 1 1 — 2 42 Pepper 11 — — 11 43 Pickled Onions 2 — — 2 44 Baisin Wine 1 1 — 2 45 Salmon and Anchovy Paste 2 — — 2 46 Salmon and Shrimp Paste 2 — — 2 47 Self Haisiug Flour 2 — — 2 48 Spaghetti 2 — — 2 49 SpongeCakes 22 — — 22 50 Sugar 1 — — 1 51 Sulphur Ointment 6 — — 6 55 Tea 20 — — 20 56 Tinned Peas 1 — — 1 57 Tomato Ketchup 4 - — 4 58 Turkey and Tongue Paste 1 — — 1 59 Whisky 2 8 - 5 60 Zinc Ointment 4 — — 4 1,094 8 1 1,103 27 Milk.—233 samples were examined during the year, and of these only two were adulterated. This is equivalent to 0.86%, and is the lowest percentage which has been recorded, so far, in the Borough. It is a result that may be received with the greatest satisfaction seeing what an important article of diet milk is for young and old alike. Nor is this satisfaction diminished when we observe that the average composition of the milks taken was as follows : Year Sp. Gr. Total Solids Fat Solids not Fat 1926 1031.6 12.60 3.67 8.93 1925 1031.3 12.27 3.58 8.69 Shewing a small but all round improvement in both Fat and Solids not Fat. Butter.—A second year has passed without any sample being adulterated. As in the case of milk, this absence of adulteration in such a universal article of diet is most satisfactory. Margarine.—No sample was adulterated, or exceeded in any instance the standards laid down. Cream.—What constitutes a " cream " has yet to be decided, so at present a most unsatisfactory state of affairs is developing rapidly. More and more samples of tinned cream are being put upon the market, and all of such samples which have been examined during 1926 have contained such a low percentage of fat as to justify their being termed enriched milks rather than cream. A definite standard should be fixed, and any thing sold as cream, either loose or in tins, should conform to standard. Devonshire Cream contains about 65% of fat, and it should not be impossible for the Public to be sure of obtaining an article containing at least 55% of milk fat. The creams examined during 1926 shewed the following composition : Ordinary Cream, 54.7 per cent, of fat (average) Tinned Cream, 28.87 per cent, of fat (average) i.e., Tinned Cream contains only about half the amount of fat of ordinary cream. Apples.—As all the samples examined were found to be free from arsenic, it is probable that any risk of arsenical poisoning from this source has been reduced to a minimum. At no time was the danger in any way proportionate to the excitement prevailing at the time, nevertheless it is reassuring to realize that the apple's reputation of being able to keep the doctor away has not been either permanently or seriously undermined. Nut Milk Chocolate.—One sample was examined. This, owing to deterioration and to the development of rancidity, was certified as being unfit for consumption. Raisin Wine, Orange Wine, Ginger Wine.—One sample of each was examined, and each contained sulphur dioxide as preservative; the amounts ranged from 0.5 to 2 grains per pint. Whiskey.—Out of 5 samples taken 3 were found to be slightly below the legal standard. Tinned Goods.—All these were examined for the presence of metals, but nothing in excess of the usual amounts was found. Iced Cake.—Two Iced Cakes were suspected of causing illness to the persons who had partaken of them. These cakes were examined very carefully for the presence of metals or of other harmful ingredients. The only undesirable substance found to be present was boric acid. This substance was present not only in each cake but also in the icing on each cake. It is unusual for any person to eat say a pound of butter at one meal, but by no means exceptional for a pound of cake to be consumed. By this means quite a considerable amount of boric acid may be ingested at one time and so this substance may under those conditions have contributed to the trouble complained of. 28 STATISTICAL. BIRTHS. Registration.—The number of births registered during 1926 was 1,359,* being 172 less than in 1925. Of the children born, 685 were boys and 674 girls. The birth rate per 1,000 of the population was 12.77, as against 14.1 in 1925. The rates in the several registration sub-districts and the borough were:— All Souls, 9.0; St. Mary, 10.1; Christ Church, 18.0; St. John, 12.6. Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,448; Live births, 3,282; Still births, 166. Failure 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. No. Per cent. From parents 39 1.1 „ doctors 212 6.1 „ midwives 616 17.9 „ other persons 168 4.9 „ hospitals, etc. 2,418 70.0 3,448 Of the total births notified, 166 referred to still-births (96 males and 70 females) : 1,881 took place at Queen Charlotte's Hospital, 351 at Middlesex Hospital; 56 at St. Marylebone Home; and 1,035 were born at home. Of those notified as having occurred in St. Marylebone, 1,877 belonged to other Boroughs. DEATHS AND DEATH RATES. The number of. deaths registered in 1926 was 1,356. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, 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. The corrected death-rate† per thousand for the year was 11.93. In the previous year, the rate was 11.0, and the number of deaths 1,257. * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 209 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 90 ,, Females 74 Illegitimate Males 15 ,, Females 30 † Bya " corrected death rate " is meapt one which has been treated in such a way, raised or lowered in a certain ratio, as to be comparable with the death rates similarly treated of other districts. That " correction " is necessary is due to the fact that differences in death rates in various areas are not entirely dependent upon the sanitary conditions existing in these areas, but also on the constitution (age and sex) of the population. A population consisting of aged persons would show more deaths than one consisting entirely of young and vigorous adults; a population made up of a large number of males and a small number of females has more deaths and a higher death rate than one in which the females outnumber the males. The death rates of such populations are not comparable the one with the other nor with those of populations differently constituted. To overcome this difficulty the Registrar General issues a "factor for correction " for each district which represents the number of times which the actual death rate of each must be raised in order to permit of its examination side by side with the rates of other districts. The " factor for correction " in the case of St. Marylebone in 1926 is 0.944, and the corrected death rate is obtained by multiplying with this figure the number of deaths per 1,000, calculated from the total deaths and the population estimated to the middle of the year. 29 The following short table shows the death rates in the several registration sub.districts in 1926, and compares them with those of the preceding 5 years :— 1921 1922 1923 1924 1925 1928 All Souls 10.2 11.3 8.9 9.7 9.2 9.6 St. Marys 120 15.4 12.3 15.6 12.5 13.6 Christ Church 14.0 14.0 12.5 14.4 12.9 13.6 St. John 16.0 14.8 13.0 14.6 12.5 14.3 The Borough 12.8 13.7 11.7 13.6 11.0 11.9 A further table giving the vital statistics of separate localities for 1926 and the ten preceding years will be found amongst the Ministry of Health Tables on page 64. Sub-District. Population estimated to middle of 1926. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 25,353 119 111 230 132 112 244 St. Mary 27,095 149 127 876 164 205 369 Christ Church 32,931 294 300 594 248 202 450 St. John 20,421 123 186 259 131 162 293 The Borough 105,800 685 674 1359 675 681 1,356 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 1926. 1926. January. March April. June July. September October. December Total Infants under 1 year 37 34 18 22 111 Persons of 65 years and upwards 164 136 93 156 549 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 67. 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 845. 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. District births and deaths for the year ended 31st December, 1926, are given in the following table 30 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 1926 was 111, and the number of births in that year 1,359. The infantile mortality rate is therefore 81, which is somewhat above that for 1925 (78 per 1,000). The course which the rate has taken is graphically shown in the chart on page 32, which indicates clearly that in spite of occasional variations 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 in infantile mortality and generally improving the life and health chances of infants and children are described in a separate section of this 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 31, in which, in addition to the causes of death, is 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 1926, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 38 were less than one month old when they died, and 55 less than three months. The figures for 1925 were 31 and 45. 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 31 deaths, four more than in the year 1925. Diarrhoea and enteritis (7 and 8) accounted for 22 in 1925, and for 16 in 1926. Respiratory diseases, the third of the main causes, took 18 in 1925, and in 1926 17. The commoner infectious diseases together led to 7 deaths amongst infants, the particular disease being in each case measles. Two deaths were stated to be due to overlaying, 2 to tuberculosis, 5 to convulsions, 3 to meningitis, and 15 to pneumonia. 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 53 deaths amongst infants. In 1925 the figure was 56. 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 4 1 - - 1 4 4 3 17 St. Mary 7 — — — 8 9 8 3 25 Christ Church 11 4 2 — 11 7 8 10 53 St. John 7 1 1 — 2 3 1 1 16 Totals 29 6 3 — 17 23 16 17 111 31 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 — — — — — 1 — 2 3 6 1 2 3 — ' 6 4 Scarlet Fever — — — — — — — — — — — - — - — 5 Diphtheria and Croup — — — — — — — 1 — 1 — — 1 — 1 6 Whooping Cough — — — — — — —— — 4 4 1 — 3 4 7 Diarrhoea — — — — — 1 — — — 1 — — 1 — 1 8 ' Enteritis — 1 — — 1 5 6 8 — 15 3 4 8 — 15 9( Tuberculous Meningitis — — — — — — — 1 — 1 — — 1 — 1 10 Abdominal Tuberculosis — — — — — — — — — — — — — — — 11 Other Tuberculous Diseases — — — — — — 1 1 — 1 — 1 12 Congenital Malformation 1 — 1 _ 2 — 2 — — 4 1 3 — 4 13 Premature Birth 15 1 — — 16 3 1 1 — 21 3 3 10 5 21 14 Atrophy, Debility and Marasmus — — — — _ 1 4 1 6 2 2 2 6 15 Atelectasis 1 2 1 — 4 — — — — 4 — 1 1 2 4 16 Injury at Birth 2 — — — 2 — — — — 2 — 1 — 1 2 17 Erysipelas — — — — — — — — — — — — — — — 18 Syphilis — — — — — l — — 1 2 — — 2 —— 2 19 Rickets — — — — — — — — — — — — — — — 20 Meningitis (not Tuberculous) _ 1 _ — 1 — —— 1 1 3 — 1 2 3 21 Convulsions 1 1 — — 2 1 2 — — 5 1 1 3 — 5 22 Gastritis — — — — — — — — — — — — — — — 23 Laryngitis — — — — — — — — — — — — — — — 24 Bronchitis — — 1 — 1 — — 1 — 2 — — 2 — 2 25 Pneumonia (all forms) — — — — — 3 4 5 3 15 4 4 4 3 15 26 Suffocation, Overlying 2 — — — 2 — — — — 2 1 — 1 — 2 27 Other Causes 7 — — — 7 1 3 — 5 16 3 4 6 3 16 Totals 29 6 8 — 38 17 23 16 17 111 17 25 53 16 111 Legitimate, 1,227 Legitimate Infants, 95 Nett Births in the Year Nett Deaths in the Year Illegitimate, 132 Illegitimate Infants, 16 Total 1,359 Total Ill 32 33 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 67. 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. DIARRHCEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 16, equal to 0.14 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur among infants, and in 1926, as a matter of fact, all those who died, with the exception of 1, were less than 1 year of age. In 1925 the deaths from diarrhoeal diseases numbered 25, all the victims being under one year of age with the exception of 3. In 1926, therefore, there was a decrease in the total, 15 being under 1 year of age. 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 diseases under the heading " Prevalence of and Control over Infectious Diseases." Excluding influenza (which caused 14 deaths), the diseases contributing to the total of 68 deaths were— diphtheria, 9; scarlet fever, 1 ; whooping cough, 11; measles, 30 ; erysipelas 1 ; and, as already noted, diarrhoea, 16. 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 109, which is higher by 16 than the figure 93 for 1925. The great bulk of the 109 deaths, viz., 94, was due to phthisis. Of the total number of deaths registered (1,356), the percentage due to phthisis was 6.9, as against 6.3 in 1925. The age periods at which the deaths occurred were: 5 15, 2 (2.1 per cent.); 15—25, 10 (10.6 per cent.); 25—45, 29 (30.9 per cent.); 45—65, 40 (42.6 per cent.); 65 and over, 13 (13.8 per cent.). The subject of phthisis is further discussed in connection with the notification and prevention of tuberculosis. The following table gives the mortality figures for each of the years from 1919. It will be noted that though there have been occasional rises the tendency has all the time been downwards. The reason for this will be discussed later. TABLE VIII. Deaths from Phthisis and other Tuberculous Diseases. Year No. of Deaths Population Kale per 1,000 of Population 1919 116 97,953 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 121 105,300 1.14 1925 93 106,100 .81 1926 109 105,800 .95 34 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 306. This is lower by 14 than the figure (320) for 1023. The death rate was 2.6 per 1,000. In 1925 the rate was 2.8, The number of deaths certified to be due to bronchitis was 160, as against 168 in 1925. Of this number 107 were amongst persons aged 65 and upwards, and 42 amongst those of the age group 45—65. The deaths attributed to pneumonia numbered 135, and as in the case of bronchitis the later-age groups contributed the greatest numbers, though 2."> of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified was 86. Of the patients 13 were aged 1—5, the other age periods contributing smaller numbers. Further particulars with regard to distribution of the cases, both in relation to age and residence will be found in the table on page 67. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 170, and the death rate 1.49 per 1,000 of the population. In 1925 the figures were lower, the total being 161 and the death rate 1.41 per 1,000 of the population. Information with regard to the age at which death occurred and situation of the disease, is given in the following tables :— Cancer : Ages at Death. Ages Under 10 10 and under 20 20 and under 30 30and under 40 40and under50 50and under60 60and under 70 and upward? Totals- Males 2 12 17 21 26 78 Females - 1 2 4 14 16 27 28 92 Totals — 1 2 6 26 33 48 54 170 Cancer.—Situation of the Disease. Parts of the body affected. Males, Females. Totals. Face, Tongue, Jaw 5 - 5 Throat, Neck, Gullet 13 6 19 Stomach 12 12 24 Intestines 26 13 39 Liver 2 5 7 Breast — 19 19 Uterus and Generative Organs — 23 23 Various 20 14 34 Totals 78 92 170 The fact that the number of deaths certified as due to cancer is showing a definite tendency to increase is common knowledge, and has been referred to more than once in these reports. No reason, generally acceptable, to account for this has as yet been put forward, nor has any theory to account for the occurrence of the disease, to which the medical profession as a whole can subscribe, been submitted. 35 ALCOHOLISM. One death was certified during the year as due to alcoholism. Year after year the number so certified has been quite small, and in 1923 there were three deaths. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 15 deaths, nearly treble the number in the previous year. The deaths from conditions sometimes due to the irritation produced in various organs by chronic alcoholism, e.g., nephritis (inflammation of the kidneys) and Bright's disease of the kidneys, numbered 44, as against 42 for the year 1925. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1926 numbered 72. Of these 13 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 66. The total number of notifications coming to hand was 674, which is higher by 5 than the figure (669) for 1925. The bulk of the notifications related to tuberculosis, which contributed 181 to the total. Other diseases in respect of which fairly large numbers of notifications were received were scarlet fever (121), diphtheria (193), and pneumonia (86). The notification rate (proportion to population of notified cases of infectious diseases) in 1926 was 6.2 per 1,000, as against 6.3 in 1925. Isolation of Cases.—As the following table shows, the number of cases removed was as high as usual:— Diphtheria 184 or 95.3 per cent, of the cases notified. Erysipelas 18 „ 44.0 „ ,, „ Scarlet Fever 117 „ 96.7 „ „ „ Enteric and Paratyphoid Fever 9 „ 81.8 „ „ „ Encephalitis Lethargica 1 „ 33.3 „ „ „ Tuberculosis 66 ,, 36 5 „ ,, „ Pneumonia 31 „ 86.0 „ „ ,, Puerperal Fever 12 ,, 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 £49 Is. 6d., equal to 9s. 3d. per 1,000 of the population. The cost and rate per 1,000 for each of the past 10 years are shown in the following table :— Year Amounts paid to Medical Practitioners Cost per 1,000 of Population £ s. d. £ s. d. 1917 163 8 0 1 15 2 1918 86 9 6 0 17 6 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 1926 49 1 6 0 9 8 36 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 315, and referred to 397 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. The number of cases notified was 193, the number in 1925 being 132. Of the cases 9 died, and the case mortality rate was 4.6 per cent. The number of cases per thousand of the population was 1.8. The cases were more or less evenly distributed, as usual, throughout the borough, and only in a few instances was it possible to determine accurately the source of infection. In 8 cases the source appeared to be a member of the family previously infected ; in 4 cases infection was counted to have been acquired in school, and in 7 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 2,075. A positive result was returned in 149 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 98. In All Souls the number was 32, in St. Mary 43, and in St. John 20. As usual, the age groups 1—5 and 5—15 were those most affected, 100 of the cases falling into the former and 60 into the latter group. One application for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, was received. The nuisances detected during the course of investigating the notified cases were : Dirty Premises, etc., 29. These were all remedied after service of notices. Scarlet Fever. There was no epidemic prevalence of this disease during the year; the number of cases being 121, as against 168 in 1925. The highest number of cases reported in any one week was 7. The total deaths from scarlet fever numbered 1, and the number of deaths per cent, of the cases was 0.82. The districts to suffer most from this disease were Christ Church and All Souls. In the former there were 59 cases and in the latter 25. In St. Mary there were 21 and in St. John 16. As usual, the majority of patients were children of school age, the age group, 5—15, giving 58 of the total. Of the remainder 33 were aged between 1 and 5 years, and 28 over 15 years of age. 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. 37 following table contains information as to result in each case :— Name. Age. Sex. Date Notified. Subsequent progress, i.e., whether recovery complete or partial. 1. C.A.J. 58 M. 8-4-26 Died 23-4-26. 2. L.R. 33 F. 7-7-26 Recovered. 3. R.D. 20 M. 18-9-26 Not recovered. Still in hospital undergoing treatment Defects in sanitation to the number of 41 were discovered in the premises visited. All these were want of cleanliness, etc. The nuisances were remedied after the service of notices in each case. Enteric Fever and Paratyphoid Fever. The Enteric Fever notifications received numbered 9. There were no deaths. Of Paratyphoid Fever there were 2 cases. .Both the patients recovered. Cerebro-Spinal Fever. There were two cases of this disease notified during the year. Encephalitis Lethargica. There were 3 cases of this disease notified. One of the patients died. For the reason that the disease frequently runs a slow and long course and the sequels are often of a serious and distressing nature, arrangements were made.for following up and keeping the patients under observation, Polio-Myelitis. There was one case of this disease during the year. Erysipelas. The notifications of erysipelas numbered 41, and there was one death. Puerperal Fever. The number of cases of this disease notified, viz., 12, was much above the average. Four of the patients died. A nurse was sent in to one case, and paid 15 visits. Puerperal Pyrexia. This disease was made compulsory notifiable on 1st October, 1926. The number of cases notified to the end of the year was 9, 3 of the patients being women whose home address was outside the Borough. Measles and German Measles. These conditions are not now notifiable. 1,050 cases were, however, reported, 66 voluntarily by doctors and parents and 984 by school teachers. 38 There were 30 deaths. The course adopted in relation to the cases was the same as in previous years. Nurses were sent in to 4 cases, and 23 visits were paid. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1926 the number of deaths registered as due to whooping cough was 11. In 1925 the number was 21. Glanders and Anthrax. No cases were notified. Small Pox. Two cases were notified at the beginning of October, one a woman, age 32, employed as a chamber-maid in a hotel in the Borough, and the other a boy, age 14½, acting as page boy in the same establishment. Both patients were infected from the same source, viz., a guest in the hotel, who, apparently infected in Paris, occupied a room for over a week while in an infectious condition. On account of the fact that the condition was not diagnosed as small pox the patient was not isolated at all, members of the hotel staff entering the room, which he occupied with his wife, in connection with their duties, and visitors being freely received. On more than one occasion also the patient left his room to attend a place of worship and transact business. That he was actually suffering from small pox was not recognised until after he had left the hotel ana the Borough, and his wile had developed this disease in a form so severe as to cause her death. As soon as these facts were ascertained careful enquiries and full investigations were carried out at the hotel, and resulted in the discovery of early signs of infection in the chamber-maid and the page boy and the arousing of suspicions with regard to a char-woman whose home was in Lambeth. The first two patients were removed to hospital at once, as was also the char-woman, though some difficulty was found in tracing her. Probably because all three were isolated before they were definitely infectious and because all persons who had been at all in contact with them or the original patient were successfully vaccinated, no further cases developed. In carrying out the vaccinations, and maintaining close supervision over the contacts in the hotel during the period of incubation, the greatest assistance was obtained from the physician to the hotel (Dr. Gordon Hume) and Dr. Greenwood, the Public Vaccinator. The two cases notified in St. Marylebone both recovered ; the char-woman, who developed a severe attack, died after a few days. As regards vaccination, it may be mentioned that the chamber-maid, who was 32, had not been vaccinated since infancy, and the page boy not at all. As a result of the wide publicity given to the outbreak in the press, and of a communication addressed to all medical practitioners in the Borough advising them of the occurrence of the cases, a considerable stimulus was given to vaccination, and large numbers of persons, private and in institutions, were either vaccinated or re-vaccinated. 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 39 Ophthalmia Neonatorum. This disease—inflammation of the eyes in newly-horn children—made notifiable by order of the London County Council in 1911, continued to be so during the whole of 1926, new regulations with regard to it coming into operation on 1st October of that year. The following table gives information with regard to the 7 cases notified. Notified Cases Treated Vision Unimpaired Vision Impaired Total Blindness Deaths At Home At Hospital 7 4 3 *6 — — — Nurses were sent in to 2 cases and 16 visits were paid. * One of the patients still in hospital under treatment. during 1926. 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 ther Diseases All Souls, Foley Street 4 3 37 46 1 Barrett Street — — — — — — Barrow Hill Road 2 9 13 9 101 9 Bell Street 8 21 2 44 102 63 Blandford Square — 2 — — 5 1 Capland Street 12 25 3 20 79 20 Catholic, Richmond Street — 1 — 4 21 — Christ Church, Lisson Grove 8 40 — 45 107 66 Convent, Little Union Place — 1 — 3 1 — Council School, Grove Road 2 — — — 1 — Emmanuel, Aberdeen Place — — — 9 — 3 Emmanuel, North Street 9 7 1 3 36 1 Gateforth Street 22 23 1 17 49 16 Hampden Gurney, Upper Berkeley Street 5 6 8 9 9 3 Homer Row, Catholic 1 11 10 34 12 6 Jewish, Hanway Street — — — — — — Portland, Little Titchfield Street — — — — — — Polytechnic, Regent Street — — — 1 3 — Queen's College, Harley Street — — — — — — St. Andrew's. Wells Street — — — — — — St. Francis, Upper William Street — — — — — — St. James's, Marylebone Lane — — — — — — St. Luke's Nutford Place 1 — — 1 31 34 St. Mark's, Violet Hill 6 3 — 25 59 3 St. Mark's, Marylebone Road — — — 1 12 1 St. Marylebone, High Street 7 6 9 29 138 54 St. Marylebone Grammar, Marylebone Road — 1 — 2 2 1 St. Mary's, Crawford Street 8 9 18 4 41 78 St. Paul's, East Street 7 — — — — — St. Paul's, Broadley Terrace — 17 — 25 13 49 St. Thomas', Orchard Street — 1 2 2 22 5 St. Vincent, Wigmore Street — — — — 1 1 Upper Marylebone Street 35 21 — 28 78 29 Schools out of Borough 8 18 13 44 15 20 Totals 145 225 80 396 984 464 40 INFLUENZA. This disease showed no epidemic tendencies during the year. The deaths certified as due to Influenza numbered 14, as against 17 in 1925. PNEUMONIA. Figures with regard to notification will be found on page 66, and information as to methods of prevention, etc., adopted in relation, to this disease will be found as previous reports. The services of the nurses were requisitioned in 27 cases, and 403 visits were paid. TUBERCULOSIS. In all 181 notifications were received, 151 relating to pulmonary tuberculosis, the remainder (30) to cases in which structures other than the lungs were affected. The table given on page 41 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 1, as against 13 in 1925. From time to time reference is made to the difficulty associated with ti.i 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 109 2. The number of cases unnotified or notified at death 34 3. The number of cases notified within a month of death 22 4. The number of cases notified within three months of death 12 5. The number of cases notified within six months of death 4 Treatment of Tuberculosis.—Of the cases notified 193 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 90 were insured persons; of these 48 were admitted to sanatorium or hospital treatment, and 18 to St. Marylebone Hospital. Non-insured persons numbered 91, of whom 22 (15 being children) received sanatorium treatment and 17 were admitted to the St. Marylebone Hospital. Nurses were sent in to 12 cases and 370 visits were paid. 41 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 3rd January, 1926, to the 1st January, 1927. 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 13. Poor Law Institu tions. 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 65 55 to 65 65 and upwards. Total Primary Notifications Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males — — 1 2 6 3 14 20 30 13 7 96 122 — — — — — 48 70 „ Females — — — 4 9 3 17 11 5 3 3 55 69 — — — — — 18 36 Non-Pulmonary Males — 2 3 4 2 — — 3 2 — 1 17 18 -- ' — 1 1 2 — 13 „ Females — 4 2 1 2 1 2 — — — — 12 13 — — — — — — 6 Totals — 6 6 11 19 7 33 34 37 16 11 180 222 — — 1 1 2 68 125 42 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Suppple mental return of N ew cases coming to the knowledge of the medical Officer of Health otherwise than by Notification on Form A and B during the period 3rd January, 1926, to the 1st January, 1927. 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 1 1 5 2 3 14 „ Females — — — — — 1 1 3 3 — 1 9 Non-Pulmonary Males 1 1 4 — — — — 1 — — — 7 „ Females 1 — 1 — — 2 1 2 1 1 — 9 2 1 6 — — 4 3 7 9 3 4 39 43 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 48, while the following short table summarises the information as to visits paid by members of the staff :— No. of visits by Tuberculosis Officer New, 77 Old, 167 No. of cases at Dispensary New, 293 Old, 1,496 No. of attendances at Dispensary 3,316 No. of visits by Miss Baker First visit, 174 Re-visits, 1,312 No. of visits by Miss Bartleet First visit, 85 Re-visits, 816 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 representatives of the Council on this Committee were : Councillor Hugh Jones, Councillor Dr. C. A. Fuller, and Councillor Miss J. M. A. Hamilton. 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 21—14 boys and 7 girls—and the attendance numbered 7,707. 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 extracts from a report by the Tuberculosis Officer (Dr. Saner) contain reference to a number of points that may be of interest :— " In the last report mention was made of the arrangement with the Middlesex Hospital for the carrying out of X-ray examinations in doubtful cases. Advantage has been taken of this, and some early cases have been sent for sanatorium treatment with gratifying results. " Light treatment also referred to as a possibility is now an accomplished fact, and some patients are undergoing treatment for glands and general debility. So far the results have been promising, but it is too early to give a definite statement as to the ultimate effect. " During the year 104 patients have received sanatorium treatment or treatment in one of the advanced hospitals. Of these twelve died during the year. Twenty-eight are working, and thirty not working. Seven are fit for work but do not seem inclined to begin. Seven have left the district. Others are out of work only because they cannot find suitable employment. " Wherever possible each patient has been recommended to return to his or her original work because suitable out-of-door occupation is so difficult to find, and is as a rule found to be more strenuous than the original. A very real difficulty arises in connection with those patients who are infective and whose ordinary work was in connection with food. " To provide for Ex-Service men with a pension, a firewood factory has been opened under the Red Cross and L.C.C., but the fact that a pension is necessary tor admission bars those unfortunate Ex-Service men who applied too late or whose disease did not show itself sufficiently early to be accepted as due to service. It is these men who, unfit for ordinary work, could have done with the wages paid in such a place to help the income of the wife who undertakes something in the way of " daily cleaning." "The Work of the Care Committee.—The Care Committee meets once a fortnight to consider cases who need ordinary convalescent treatment, or other help. The Committee consists of representatives from the Borough Council and the following bodies or Hospitals : The Public Health Department, the London County Council, the Board of Guardians, the United Services Fund, the Charity Organisation Society, Portland Town Association (St. John's Wood Branch of the Charity Organisation Society), The Invalid Children's Aid Association, the Jewish Board of Guardians, Paddington and St. Marylebone District Nursing Association, London Insurance Committee, the Working Classes, St. Mary's, St. Margaret's 44 and Middlesex Hospitals. Several cases, in fact nearly every case dealt with, comes before the Committee more than once; first, when forms have been sent for sanatorium treatment, and secondly for acceptance or refusal by L.C.C., and on return from treatment. If the patient is the bread-winner, the family or the wife may need some help while he is away. According as he is Ex-Service or civilian the appropriate representative is asked to deal with the circumstances. During this year 38 patients or their families have been brought to the notice of the United Services Fund representative, who has helped financially, with clothing or by getting the children away either for convalescent treatment or having them looked after permanently. This figure of 38 does not, of course, refer to other years, and it is probable that more than double this number are on the United Services Fund's books, and are being helped in some way from the funds. A great amount of individual work and visiting is entailed for the representative of the fund. " When patients need a few weeks' convalescence, work, or a little financial help in some way, they are referred to the Charity Organisation Society, which takes the matter in hand. Children requiring more than a few weeks' convalescence are referred to the Invalid Children's Aid Association or the Board of Guardians. It is very difficult to apportion to each the exact number dealt with because of the unavoidable overlapping. During the year the Committee, in co-operation with the Charity Organisation Society, have been the means of returning a whole family to Switzerland, for which, as can be imagined, much detail had to be arranged. Some families are not easy to deal with, and the more that is done for them the more they expect, few attempting to help themselves, preferring to blame the Dispensary or the Committee if anything goes wrong. As an example may be quoted the case of a family in which, in spite of treatment and every possible assistance, one of the children died. The other members were examined, the eldest girl submitted to X-ray examination, the boys admitted to the Open-Air School, one of them after sanatorium treatment. The eldest girl found to be suffering was given sanatorium treatment and returned fit and well and able to do housework. This, however, she was not allowed to do by her parents, who kept her at home. She steadily lost weight, until after much persuasion the girl herself took a situation as maid. With the regular work, meals, sleep, etc., she began to gain weight, to feel and look ever so much better. But again the mother wanted her at home, so she left work, and now treatment has to be started all over a second time. The same sort of thing occurred in a surgical case, for whom every possible form of treatment was provided, at the close of which he was given an instrument to wear constantly for a time. The parents, however, did not trouble to see that it was worn, and when enquiries were made it was found that the apparatus was so badly broken that extensive repairs or an entirely new instrument was needed. It is cases of the above description that give the Hon. Secretary such a vast amount of trouble and double her work, which is further increased since most patients who are granted treatment by the London County Council have to be assessed for payment, and this means visiting the homes in order to obtain details of the approximate income of the family. A proper idea of the work carried out by the Care Committee it is difficult to give, and to say that apart from those who come before the Committee from former years, over 100 cases have been dealt with during 19'26, can convey very little. Very safely, however, it may be claimed that the Care Committee is a live factoi in this scheme." 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 730, as against 689 in 1925. Of these, 108 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—30, as against 36 in 1925—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. 45 Particulars as to the parts affected by the disease will be found in the table on page 51. TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1926. diagnosis. pulmonary. non-pulmonary. total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts) :— (a) Definitely tuberculous 37 26 2 1 1 1 1 1 38 27 3 2 (b) Doubtfully tuberculous — — — — — — — — 29 19 18 7 (c) Non-tuberculous — — — — — — — — 20 16 8 7 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 2 2 1 — — — 2 1 2 2 3 (b) Doubtfully tuberculous — — — — — — — — 4 5 14 11 (c) Non-tuberculous — — — — — — — — 4 12 14 15 C.—Cases written off the Dispensary Register as (a) Cured 3 8 — — — — — — 3 8 — — (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 68 84 66 47 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 106 65 23 19 2 1 5 7 108 66 28 26 (b) Diagnosis not completed — — — — — — — — 11 16 45 34 1. Number of persons on Dispensary Register on January 1st 371 2. Number of patients transferred from other areas and of " lost sight of " cases returned 12 3. Number of patients transferred to other areas and cases " lost sight of " 25 4. Died during the year 29 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 17 6. Number of attendances at the Dispensary (including Contacts) 3,316 7. Number of attendances of non-pulmonary cases at Orthopaedic Out- stations for treatment or supervision — 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) " Light" treatment 62 (b) Other special forms of treatment — 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary — 10. Number of consultations with medical practitioners :— (a) At Homes of Applicants 33 (b) Otherwise 90 11. Number of other visits by Tuberculosis Officer to Homes 212 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,242 46 13. Number of (a) Specimens of sputum, &c., examined 230 (b) X-ray examinations made in connection with Dispensary work 28 14. Number of Insured persons on Dispensary Register on the 31st December 131 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 96 16. Number of reports received during the year in respect of Insured Persons: (а) Form G.P. 17 8 (б) Form G.P. 36 6 (a) Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1926, arranged according to the years in which the patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. 1926. Class T. B. minus. Class T. B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Alive. Discharged as cured. Adults. M. - - - - - F. - - - - - Children. M. — — — — - F. — — — — — Disease arrested. Adults. M. — — — — — F. — — — — — Children. M. - - - - - F. — — — — — Disease not arrested. Adults. M. 8 7 5 6 18 F. 8 7 5 2 14 Children. M. 5 — — — — F. 2 — — — — Condition not ascertained during the Year. Lost Sight of or otherwise removed from Dispensary Register. 1 1 2 1 4 Dead. Adults. M. — — — 11 11 F. — — — 3 3 Children. M. - - - — - F. — — — - — Totals 24 15 12 23 50 47 (b) Non-Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1926, arranged according to the years in which the Patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time o£ ttie last record made during the year to which the Return relates. 1926. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. -Alive. Discharged as cured. Adults. M. - - - - - F. Children. M. F. Disease arrested. Adults. M. - - - - - F. - - - - - Children. M. - - - — — F. - - - - - Disease not arrested. Adults. M. — 1 — — 1 F. 1 — — — 1 Children. M. — — — 1 1 F. 1 — — 2 3 Transferred to Pulmonary - - - - - Condition not ascertained during the Year. - - - - - Lost Sight of or otherwise removed from Dispensary Register. - - - - - Dead. Adults. M. — — — — — F. - - - - - Children. M. - - - - - F. - - - - - Totals 2 1 — 3 6 Statement of Work carried out in connection with the Dispensary Treatment of Tuberculosis during the period 1st January, L926, to the 31st December, 1926, and Sundry Particulars in connection with the Scheme of Treatment. 48 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:— 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 Government Board. Days and Hours w hen the Dispensary is open. Number of Persons including Contacts who were examined for the first time during the period from the 1st January, 1926, to the 31st December, 1926, 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, 19 26 to 31st December, 1926. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1926. Number ot Persons referred for diagnosis or treatment tothe Hospital with which the Dispensary is affiliated during the period 1st January, 1926, to 31st December, 1926. 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—8 Wednes., 9.30—5 Thursday ,9.30—9 Friday, 9.30—5 Saturday, 9.30—1 78 96 107 94 187 137 133 131 203 14 9 49 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. 1. Name of Hospital to which Special Cases are referred from the Dispensary for diagmosis or treatment 2. Is any provision for the home nursing of Tuberculous Patients made in connection with the Dispensary ? If so (1) State the general nature of the arrangement (2) What qualifications are the Nurses required to possess ? (3) Do they carry out other work ? If so, what ? (4) Are their services available for sured and Uninsured Patients ? (5) If so (a) by what procedure are their services secured for individual patients ? (6) Under whose instructions do they perform the actual duties of nursing in an individual case ? 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, 1926, for lending out to Patients for use at their own homes Middlesex Hospital. Royal Free Hospital for light treatment. Yes. Application can be made to the District Nursing Association. (1) Note sent to Matron from Dispensary. (2) Fully trained. (3) Yes, District Nursing. (4) Yes. (5) (a) As above. (b) Matron of Nursing Association and Tuberculosis Officer. 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 1926 the total number certified as due to this cause was 94, the deathrate being 0.8 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 5 years 1922-1926. 50 Deaths from Phthisis. Five years—1922-1926. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 1922 105,200 98 15 27 42 14 1923 105,400 94 19 25 33 17 1921 105,300 98 18 32 35 13 1925 106,100 80 15 30 25 10 1926 105,800 94 12 25 40 17 The distribution of the 94 deaths was as follows:—In Poor Law Institutions, 41; general and other hospitals, 31; and at home, 22. Of those who died 49 were insured (42 males and 7 females), and 41 uninsured (21 males and 20 females). In addition there were 4 children. As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 94, the notified cases of pulmonary tuberculosis totalled 151. 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 S Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. #] 0—1 - - - - - - - - 1—5 — — 2 4 — — — 1 5—10 1 — 3 2 — — — — 10—15 2 4 5 1 — 1 — — 15—20 6 9 2 2 — 1 — — 20—25 3 3 — 1 — — — — 25—35 14 17 — 2 2 2 — , — 35—45 20 11 3 — 3 4 — 1 45—55 30 5 2 — 9 2 — — 55 -65 13 3 — — 4 — — — 65 and upwards 7 3 1 - 3 3 ~ — Totals 96 55 18 12 21 13 — 2 The information as to the localisation of the disease, given in the following table brings out no fact to which attention has not already been directed. CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 1ST JANUARY, 1927. Localization of Disease. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. At all Ages. At ages—year?. All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Total Cases Isolated at Home Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Lungs 151 — — 7 21 62 51 10 24 51 50 26 151 6 19 22 4 51 100 Fallopian Tubes 1 - - - 1 - - - 1 - - - 1 1 - - - 1 - Glands 12 - o 7 1 1 1 — 4 2 5 1 12 1 1 2 — 4 8 Spine 4 - 1 1 1 1 — — — 1 3 — 4 — — 1 — 1 8 Peritoneum 3 - — 1 1 I — — 1 1 1 — 8 1 1 — — 2 1 Hip 1 - — 1 — — — — — — 1 — 1 — — 1 — 1 — Lupus of Face 1 - — — — 1 — — — 1 — — 1 — 1 — — 1 — Adenoids 1 - 1 — — — — — 1 — — — 1 — — — — — 1 Knee 2 - — — 1 1 — — — 2 — — 2 — 2 — — 2 — Abdomen 1 - - 1 - - - - - 1 - - 1 - - - - - 1 Epididymitis 1 - — — — — — 1 — 1 — — 1 — 1 — — 1 — Kidney 1 - - - - - 1 - - 1 - - 1 - - - - - 1 Leg 1 - 1 - - - - - - - - 1 1 — — — 1 1 — Meninges 1 - 1 — — — — - — — — 1 1 — - — 1 1 — Totals 181 — 6 18 26 67 53 11 81 61 60 29 181 9 25 26 6 66 115 181 51 52 DISINFECTION. The work done in this connection during 1926 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 vapour was generally employed. The number and nature of the articles disinfected are shown hereunder:— Compulsorily Notifiable Diseases. P this . Measles. Vermin. Other causes. Total. Beds 160 5 1 2 168 Mattresses 622 26 10 6 58 722 Bolsters 207 16 5 3 19 250 Pillows 1,292 69 18 10 212 1,601 Sheets 395 14 12 9 3 433 Blankets 986 21 23 3 25 1,058 Sundries 2,641 102 229 47 17 8,036 Totals 6,303 253 298 80 334 7,268 In 1925 the number of articles disinfected was 9,233. The number of journeys made by the disinfecting vans during the year ended December, 1926, was 7:- January 46 August 64 February 44 September 62 March 50 October 78 April 46 November 52 May 46 December 51 *June 70 660 July 51 The number of journeys made during 1925 was 567. *The old horse-drawn vans were replaced by motor vehicles at the beginning of this month. 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 83 6 17 1 107 February 39 7 31 — — 77 March 30 8 26 1 2 67 April 57 2 20 — — 79 May 47 8 26 — — 81 June 63 3 20 2 — 88 July 33 19 — 2 — 54 August 38 5 1 9 — 53 September 37 6 — 2 — 45 October 58 15 — — — 73 November 53 2 — — — 55 December 39 2 1 - - 42 Totals 577 83 142 17 2 821 53 The number of rooms disinfected in 1925 was 750. At the request of the Public Libraries Commutes, whose rules require 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 195. 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 1926 and annually since 1910:— 1926 ADULTS CHILDREN Males Females Total Males Females Total January 230 70 300 20 164 184 February 235 73 308 67 203 270 March 270 82 352 28 266 294 April 226 54 280 11 128 139 May 213 52 265 36 210 246 June 256 92 348 32 290 322 July 173 37 210 45 245 290 August 225 63 288 3 36 39 September 250 80 330 77 383 460 October 230 100 330 60 154 214 November 255 85 297 54 243 297 December 240 60 300 18 200 218 Totals 2,803 848 3,651 451 2,522 2,973 Cleansing Station Attendances, 1910 1926. 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 2,613 1926 2,803 848 3,651 451 2,522 2,973 The total attendances since the Baths were opened in 1898 number 230,250 (adults, 171,046; children, 64,204). 54 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. Fouierton, at University College. 1926. Positive. Negative. Total. Typhoid fever 8 20 28 Diphtheria 149 1,926 2,075 Phthisis 108 622 730 Totals 265 2,568 2,833 MATERNITY AND CHILD WELFARE. As is well known, the Maternity and Child Welfare Scheme now in existence 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 maternity 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 Queen Charlotte's Hospital and Middlesex Hospital, which 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. At the Western General Dispensary the special clinic for children under Dr. Bernard Myers does most useful work. 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 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. 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 1926. 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, open on four days, for two of which the Health Society is responsible. By arrangement with the London County Council the dental clinic is used also by school children, and in conjunction with this there is also a minor ailment treatment centre for school children. Health Visitors.—There are six health visitors. 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. The borough for the purpose of health visiting is divided into five districts, and in 1926 the health visitors made 7,136 visits; children are visited up to school age. 55 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 cooperate, one of them acting as superintendent.—(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, and in addition one or moie of the health visitors assist at the various consultations. Children attend up to school age.—(3) Ogle Mews, Ogle Street, W.1. lntant consultations are held weekly uuder medical supervision. The Council's health visitors attend.—(4) 24, Hill Road. Infant consultations under medical supervision were held weekly. The health visitors co operate, and a nurse is employed three days a week by the Health Society for the purpose of visiting.—(5) Western Centre. Temporarily held at Western General Dispensary, Cosway Street. Infant consultations under medical supervision are held weekly. There are also classes for needlework. One of the health visitors is specially attached to this centre and acts as superintendent. In addition to these centres, consultations are held weekly at Queen Charlotte's Hosptial, at Middlesex Hospital, at the Church Army Dispensary, and at the Western General Dispensary. One of the Council's health visitors attends at each, and Middlesex Hospital has also a paid health visitor in attendance. All the consultations are open to other than St. Marylebone babies, who, however, constitute the bulk of those attending. At the 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. 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. 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 lor ante-natal and complicated maternity cases. By arrangement cases calling lor special examination or treatment are referred by the doctors at the centres to Middlesex Hospital. The fact that a special centre has been established at the Western General Dispensary has already been mentioned. 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 1926 was 2,288, the total births numbering 3,448. 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 1926.—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 in previous reports, and need not again be discussed. The total number of orders issued is shown in the table. 56 statement showing work at infant consultations and ante-natal clinic centres during the 52 weeks ending 31st december, 1926. 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 Ilospl- The Westn. Genl. Dispy. The Church Army Dispy. No. of consultations held . 72 253 357 97 90 47 155 89 51 (203 children 50 maternity) (306 antenatal 61 infants) No. of attendances of mothers at ante-natal clinic . 142 - 32 - - - 134 532 10,557 No. of attendances of babies . 1,706 4,144 1,825 1,999 1,216 844 2,666 494 1,022 No. of attendances of children over 2 years 172 1,319 376 539 135 309 1,662 1,232 328 No. of orders issued for milk, etc. 48 412 76 167 63 45 71 - 2 No. of home visits . 1,323 3,370 641 995 563 670 1,789 — 535 No. of new cases 137 337 4,317 99 67 49 253 269 111 Day Nurseries—Attendances during the year. The Crossley Day Nursery, Barrow Hill Road 6,012 The Portman Day Nursery, Exeter Street 8,308 Dental Clinic, 12 Salisbury Street. Attendances during the year: Mothers, 1,095; children, 108. Advice and treatment given in 871 cases—extractions under gas, 332. Home Helps.— Arrangements for providing assistance in carrying out the work of the home to expectant, nursing or ailing mothers continued in operation throughout the year. The women employed were found by and were well known to the health visitors, who also noted the cases in which assistance was required. The number of cases in which home helps were employed in 1926 was 3, and the total amount expended during the financial year to 31st March, 1927, was £2 7s. 57 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:— Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1926. 1926. Males. Females. Total. For burial only. For inquests. Total. No. of P.M.'s held. No. of courts held. No. of Infectious cases. January . 10 3 13 5 8 13 6 6 - February 8 1 9 3 6 9 4 4 — March 5 12 17 4 13 17 7 7 — April 10 10 20 12 8 20 6 5 — May 6 13 19 9 10 19 6 5 — June 11 7 18 8 10 18 3 4 — July 9 13 22 7 15 22 11 7 — August 10 7 17 9 8 17 4 5 — September 7 6 13 7 6 13 4 2 — October 8 3 11 2 9 11 5 5 — November 11 3 14 3 11 14 7 6 — December 6 11 17 7 10 17 7 3 - Totals 101 89 190 76 114 190 69 59 — 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 the 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. HOUSING. From the formal return given below, which is that required to be made by the Ministry, it will be noted that amongst the new houses erected there are, "as part of a municipal housing scheme, 20 flats." This indicates the completion of the tilth of seven blocks of flats planned to be erected upon the site presented by the late Lord Portman to the Council for the purpose of housing the working 58 classes, and known as The Fisherton Street Site. The first block, the completion of which was considerably delayed by strikes and other labour difficulties, was formally opened by the then Mayor (Mr. Alderman Brooks) on 7th November, 1924, and very shortly afterwards the second also was completed and occupied. The accommodation provided in each of the flats consists of a living room, scullery, bathroom, and W.C., and three bedrooms. There is a plentiful supply of hot water to each, and there is in addition a laundry with washing and drying rooms for the use of the tenants in common. The blocks are well situated as regards light and air, and both gas and electricity are available for cooking, lighting, etc. As this scheme is rather in the nature of a slum clearance the provision made in the various blocks will help hardly at all towards a reduction of the housing shortage, most of the families taking up occupation of the flats being such as have been dishoused in order to permit the scheme to proceed. Even when the scheme is completed, it is doubtful if any but previous residents on the site will be accommodated. At the end of the year progress was being made in connection with arrangements for the erection of the remaining two of the seven blocks. The information asked for by the Ministry with regard to housing is contained in the following statement. The Increase of Rent and Mortgage Interest (Restrictions) Act, 1920, so far as regards the provisions of Section 2(2), and the Rent and Mortgage Interest Restrictions Act, 1923, Section 18(1) relating to certificates as to suitability for occupation of houses, was comparatively little taken advantage of during the year. Actually, only 1 application was received, and a certificate in this case was granted. During the year (in October) a representation was made to the Council under Section 35 of the Housing Act, 1925, relating to an area known as the Carlisle Street area. The total number of premises covered by the representation is 533, and the approximate population 5,000. The area occupied by the represented premises measures approximately 16 acres. The representation was taken into consideration by the Council at a meeting held on 28th October, 1926, when in accordance with Section 35 a resolution was passed to the effect that the area is an unhealthy area and that an improvement scheme ought to be made in respect of the area. Apart from negotiations with the Ministry and the London County Council, little progress had been made by the end of the year. Number of new houses erected during the year: (a) Total (b) As part of a municipal housing scheme 10 houses and 289 flats. 20 flats. 1. Unfit dwelling-houses : Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,977 (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 1,071 Tenements in blocks 255 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 2,063 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 officers (intimation only) 1,936 59 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— (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) 157 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 157 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11, 11 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. (1926). 105,800 (estimated). Number of inhabited houses (1921), 18,507. Number of families or separate occupiers (1921). 27,214. Rateable value. £2,746,543. Sum represented by a penny rate. £10,700. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimate 1,227 630 597 Illegitimate 132 53 79 Birth Rate 12.9 Deaths, 1,356. Death Rate, 11.9. Number of women dying in, or in consequence of, childbirth—from sepsis, 4; other causes, 8. 60 Deaths of Infants under 1 year of age per 1,000 births:— Legitimate 77. Illegitimate 121. Total 8l. Deaths from Measles (all ages), 30. Deaths from Whooping Cough (all ages), 11. Deaths from Diarrhoea (under 2 years of age), 16. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 127 Cowhouses 1 Slaughterhouses 1 Offensive Trades 3 Ice Cream Premises 118 Bakehouses 54 Restaurant, Dining Room and Coffee Shop Kitchens 190 Hotel Kitchens 20 Pastrycooks and Tea Rooms 58 Fried Fish Shops 23 Fish Curers 5 Houses Let in Lodgings 1,070 Workshops and Workplaces 3,573 Total 5,243 Smoke Nuisances. Number of Observations 453 Number of Nuisances and Complaints 4 Number of Notices 4 Number of Summonses Nil Housing of the Working Classes. Number of Houses inspected— (a) On account of complaints or illness (P.H. Act) 2,977 (b) House-to-house (Housing Consolidated Regulations, 1925) 1,071 Tenements in blocks ... 255 Number of Notices served— (a) Under P.H. Act (1) Intimation 1,060 (2) Statutory 157 (b) Under Housing Act Nil Number of Houses repaired or nuisances remedied under P.H. Act 2,063 Number of Houses repaired under Section 3 of Housing Act— (a) By Owners Nil (b) By Local Authority in default of Owners ... Nil Number of Houses closed on Notice by Owner that they could not be made fit Nil Number of Houses for the Working Classes— (a) Erected during year 20 (b) In course of erection 46 Number of Representations by Medical Officer or other person Number of Houses included in such representations 533 Number of Closing Orders made Nil Number of Closing Orders determined (i.e., Houses made fit) Nil Number of Demolition Orders Nil Number of Houses demolished— (a) In pursuance of Orders... Nil (b) Voluntarily Nil Total Number of Houses in the borough 19,341 Number of Houses occupied by the Working Classes 8,232 Number of Houses registered under the new Bye-laws as to Houses Let in Lodgings Nil Number of Inspections made of such Houses Nil Number of Prosecutions Nil 61 Mortuary. Number of bodies received 190 Number of Infectious bodies received Nil Disinfection. Number of rooms disinfected 821 Number of articles disinfected 7,268 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total Number of persons cleansed 2,803 848 451 2,522 6,624 Bakehouses. Number on Register at end of 1926 54 Number above ground 5 Number underground 49 Number of Inspections 145 Number of Notices 12 Number of Prosecutions Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1926 296 Number of Inspections 1,092 Number of Notices 21 Number of Prosecutions Nil House to House Inspections. Number of Inspections Houses 1,071 Tenements 255 Number of Notices issued Intimations 1,060 Statutory Notices 92 Number of Prosecutions Nil House Refuse. Number of Inspections 4,949 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 473 Number of Notices issued. Intimations 531 Number of Statutory Notices 44 Number of Prosecutions Nil 62 Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 81 Number of Statutory Notices served 2 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 6 Number Remedied 6 Number of Prosecutions Nil Underground Rooms. Number dealt with 12 Number of Notices served under P. H. (L.) Act, 1891 12 Number of Notices served under the Housing Act, 1925 Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms cleansed 705 Number of Statutory Notices served 17 Number of Prosecutions Nil Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 10 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 5,896 Number of drainage plans deposited 580 Number relating to new buildings 85 „ ,, old buildings 445 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops, and Cowsheds 388 Number of Inspections 1,562 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 ,, ,, ,, (Part-time) Male 3 Female 3 ,, Health Visitors Whole-time 3 Part-time 3 Tuberculosis Visitors Whole-time 1 Part-time 1 63 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1926 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths. Ne[t Deaths belonging to , the District. Nett. of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Under 1 year or Age. At all Ages. Uncorrected No. 3 No. 4 Rate. 5 No. 6 Rate. 7 No. 10 Rate per 1,000 Nett Births. 11 No. 12 Rate 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 1,588 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 17.3 804 708 147 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 14.1 1,472 13.8 873 658 94 63.0 1,257 11.0 1926 105,800 3,220 1,359 12.7 1,325 12.4 748 740 111 81.6 1,356 11.9 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. TABLE I (a). Vital Statistics of Separate Localities in 1926 and the Ten Previous Years. Names of Localities Year The Whole Boroogh All Souls St. Mary Christ Church* St. John* 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 P opulation estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Populaton estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year a. b. C. d. a. b. 0. d. a. b. C. d. a. b. C. d. a. b. c. A 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 28 1922 105,200 1,679 1,451 115 25,202 318 286 18 26,943 405 415 21 32,747 673 459 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 3925 106,100 1,496 1,257 94 25,425 265 234 10 27,172 348 339 19 33,024 593 426 56 20,479 390 258 9 Averages of Years 1616 to 1925 101,690 1,671 1,460 138 24,919 337 280 24 27,042 344 387 30 31,413 667 512 63 18,246 323 280 21 1926 105,800 1,359 1,356 111 25,353 230 244 17 27,095 276 369 25 32,931 594 450 53 20,421 259 293 16 64 *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 TABLE II. Notifiable Diseases During the Year 1926. Disease. Cases Notified. Deaths Certified. 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 Smallpox 2 — — 1 — 1 — — 2 — — . — — — — — — — Diphtheria 193 12 88 60 18 15 2 — 184 9 1 1 5 2 — — — — Erysipelas 41 1 — 4 8 12 10 6 18 1 — - - - - - 1 - Scarlet Fever 121 2 33 58 18 6 4 — 117 1 — — — 1 — — — Encephalitis Lethargica 3 - - - 1 1 1 - 1 1 - - - - - - 1 - Dysentery 2 — — — 2 — — — — — — — — — — — Enteric Fever (including Paratyphoid) . 11 - 1 2 4 - 4 - 9 - - - - - - - - - Puerperal Pyrexia . 9 — — — 4 5 — — 8 — — — — — ' — — — — Puerperal Fever 12 — — - 2 10 - — 12 4 — — — — 1 3 — — Malaria . 3 - — 1 - 2 - - 2 — — — — — — — — — Cerebro Spinal Fever 2 2 - - - - - - - - - - - - - - - - Tuberculosis, Pulmonary . 151 - - 7 21 62 51 10 51 94 - - - 2 10 29 40 13 Tuberculosis, Non-Pulmonary 30 — 6 11 5 5 2 1 15 15 2 1 1 4 2 2 2 1 Pneumonia 86 5 8 6 12 23 26 6 31 10 2 — — — — 3 3 2 Ophthalmia Neonatorum 7 7 - - - - - - 3 - - - - - - - - - Poliomyelitis 1 — — 1 — - - - - - - - - - - - - - Totals 674 29 136 151 91 144 100 23 455 135 5 2 6 9 13 37 47 16 65 TABLE II. (A). Cases of Infectious Disease Notified during the 52 weeks ending 1st January, 1927. Notifiable Disease. Cases noti6ed 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 s, 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 66 65 and upwards Smallpox 2 - - 1 - 1 - - 2 - - - 2 2 - - - 2 - Cholera - - - - - - - - - - - - - - - - - - - Diptheria,including Membranous Croup 193 12 88 60 16 15 2 - 32 43 98 20 193 29 40 97 18 184 9 Erysipelas 41 1 — 4 8 12 10 6 7 8 21 5 41 5 6 5 2 18 23 Scarlet Fever 121 2 33 58 18 6 4 — 25 21 59 16 121 24 20 59 14 117 4 Typhus Fever — - — — — — .— — — — — — — — — — — — — Enteric Fever 9 - 1 2 2 4 — 2 1 5 1 9 2 1 4 — 7 2 Paratyphoid Fever 2 - — — 2 — — — — 1 1 — 2 — 1 1 — 2 — Relapsing Fever - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - Puerperal Fever 12 - — — 2 10 — 2 3 5 2 12 2 3 5 2 12 — Puerperal Pyrexia. 9 - — — 4 5 — — — 6 2 1 9 — 5 2 1 8 1 Plague . - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever . 2 2 - - - - - - - 1 1 - 2 - 1 1 - 2 - Tuberculosis— Pulmonary 151 — — 7 21 62 51 10 24 51 50 23 151 6 19 22 4 51 100 Non-Pulmonary 30 — 6 11 5 5 2 1 7 10 10 3 30 3 6 4 2 15 15 Acute Poliomyelitis 1 — — 1 — — — — — 1 — — 1 — — — — — 1 Polio-Encephalitis — - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 7 7 - - - - - - - 3 3 1 7 - 1 1 1 3 4 Encephalitis Lethargicu 8 - - - 1 1 1 - 1 2 - - 3 - 1 - - 1 2 Pneumonia 86 5 8 6 12 23 26 6 11 14 43 18 86 5 4 15 7 31 55 Malaria 3 - — 1 — 2 — — — 1 — 2 3 - 1 — 1 2 1 Dvsentery 2 - 2 - - 1 1 2 - - - - — 2 Trench Fever - - - - - - - - - - - - - - - - - - - Totals 674 29 136 151 91 144 100 23 114 166 298 96 674 78 109 216 52 455 219 674 66 TABLE III.—Causes of, and Ages at Death during the year ending 1st January, 1927. No. CAUSES OF DEATH. Net deaths at ttie subjoined ages ot " 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 unaer 5. 5 and under 15, 15 and under 25. 25 ana under 45. 45 and under65 05 and upwards. 1 Enteric Fever - - - - - - - - - 1 - - - - - 2 Small Pox - - - - - - - - - — — — — — 3 Measles 30 6 14 8 1 1 — — — 1 3 4 17 6 30 4 Scarlet Fever 1 — — — 1 — — — — — 1 — — 1 5 Whooping Cough 11 4 3 3 1 — — — — — 2 — 5 4 11 6 Diphtheria and Croup 9 1 1 5 2 — — — — — — 1 6 2 9 7 Influenza 14 - - - - - 2 6 6 5 6 3 3 2 14 8 Erysipelas 1 — — — — — — 1 — — — 1 — — 1 9 Phthisis (Pulmonary Tuberculosis) 94 - - - 2 10 29 40 13 12 12 25 40 17 94 10 Tuberculous Meningitis 8 1 1 1 3 1 — — 1 3 2 1 2 3 8 11 Other Tuberculous diseases 7 1 — — 1 1 2 2 — 6 1 2 1 3 7 12 Cancer 170 — — — — 1 21 79 78 242 33 47 49 41 170 13 Rheumatic Fever 2 — — — 1 1 — — — — — — 1 1 2 14 Meningitis 8 3 — — 1 1 1 2 — 6 1 1 4 2 8 15 Organic Heart Disease 137 — — — 2 2 6 42 85 56 24 45 37 31 137 16 Bronchitis 160 2 — 1 1 — 7 42 107 18 25 55 55 25 160 17 Pneumonia (all forms) 135 15 10 5 3 5 15 43 39 44 25 36 48 26 135 18 Other diseases of Respiratory Organs 11 1 - - - - 4 1 5 2 8 3 4 1 11 19 Diarrhoea and Enteritis (under 2years) 16 15 1 11 3 4 9 - 16 20 Appendicitis and Typhlitis 7 — — — 3 — 3 1 — 12 3 1 2 1 7 21 Cirrhosis of Liver 15 — — — 1 — 1 8 5 7 6 3 2 4 15 21a Alcoholism 1 - - - - - - 1 — 2 — — 1 — 1 22 Nephritis and Bright's Disease 44 — — — 1 2 5 17 19 21 14 9 12 9 44 23 Puerperal Fever 4 — — — — 1 3 — — 3 — 1 2 1 4 24 Other accidents and diseases of Pregnancy and Parturition 8 - - - - 1 6 1 - 6 1 3 3 1 8 25 Congenital Debility and Malformatyion, including premature Birth 41 41 - - - - - - - 70 3 8 19 11 41 26 Violent Deaths, excluding Suicide 59 3 - 1 4 7 7 19 18 31 11 21 21 6 59 27 Suicides 13 — — — — — 7 5 1 6 2 6 2 3 13 28 Other defined Causes 350 18 3 2 3 11 37 104 172 280 61 89 105 95 350 29 Diseases ill-defined or unknown - - - - - - - - - - - - - - - Totals 1356 111 33 26 31 45 156 405 549 845 244 369 450 293 1356 67 VACCINATION RETURNS. Return for 1925. Return made to the Board or Guardians and Ministry of Health on the. 9th February, 1927, 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, 1925, 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., 1925 Number of these Births duly entered by 31st January, 1927, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which od 31st January, 1927, remained unentered in the "Vaccination Register ' on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1927, neither duly entered in the "Vaccination Register" (columns 3, 4. 5, 6 and 7 of this Return) nor tempcrarily 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 1926 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1926 Col. II. Col. IV. Col. V Dead, Unvaccinated 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 be reached; and Cases not having been found Col. I. Success fully Vaccinated Insus ceptible of Vaccination Had SmallPox Number in respect of whom Certificates of Conscientious Objection ha\e been received 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 657 407 1 — 118 36 10 13 28 44 2,346 371 2. St. Mary 2,184 1,496 12 — 223 99 14 313 13 14 3. All Souls 577 385 2 - 72 21 13 72 5 7 Total 3,418 2,288 15 - 413 156 37 398 46 65 2,346 371 68 Dated 9th February, 1927- (Signed) GEORGE H. BASSETT, Vaccination Officer.