Metropolitan Borough of St. Marylebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1927. 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. 1928 Metropolitan Borough of St. Marylebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1927. 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. 1928 Vail and Co., Printers, Farringdon Road, E.C. 1. Public Health Department, Town Hall, Marylebone Road, N.W.1. 27th April, 1928 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 1927. Being a "Chronicle" as distinct from a "Survey" report I have not gone greatly into detail with regard to any particular matter but have contented myself, as it is suggested I should in a report of this type, with simply recording the chief occurrences during the period under review. In general, the year may be regarded as one in which progress was a feature. In relation to housing there certainly was progress, proceedings in relation to the Carlisle Street area in particular, having advanced very appreciably, consequent upon the success of the negotiations which resulted in an adoption of the Council's Scheme by the London County Council. In other directions also there has been progress, and it is gratifying to note that the Infant mortality Rate for the first time on record has fallen below 60 per 1,000 births and that practically without exception the various other diseases and death rates are also low. On these results I desire to congratulate the Council and more particularly perhaps the Public Health Committee who have shown a real and serious interest in the work necessary to obtain them. I welcome the opportunity this report offers of expressing ray appreciation of the kindness and consideration shown to me and the help given by the Committee and the Chairman, Mr. Alderman G. B. Brooks. The Staff of the department have worked as usual admirably and are deserving of sincere thanks and praise. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant CHARLES PORTER, Medical Officer of Health, PUBLIC HEALTH COMMITTEE. Which is also the Committee appointed for the purposes of the Maternity and Child Welfare Act, 1918). 1927. His Worship the Mayor (Councillor P. R. Clark, J.P.) ALDERMEN. G. B. Brooks (Chairman) Sir Henry F. New. J. Fettes, J.P. A. C. Rickatson. COUNCILLORS. Mrs. V. A. L. Freeman. Capt. J. T. O'Brien, J.P. Dr. C. A. Fuller. P. O’Connell. Miss J. M. A. Hamilton. Capt. R. W. Phillips. Mrs. C. Q. Henriques. G. B. Ramsay. H. Jones. Mrs. A. F. Sanger. C. E. Morier, M.A., L.L.B. CONTENTS. page Natural and Social Conditions of the Borough. Population 7 Sanitary Circumstances 7 Water Supply 7 Drainage 7 Combined Drainage 8 Closet Accommodation 8 Public Sanitary Conveniences 8 Scavenging 8 Removal of House Refuse 8 Removal of Offensive Refuse 9 Sanitary circumstances of the Borough 9 Staff 9 Nuisances 10 Inspections 11 Nuisances—Legal Proceedings 11 Rat Repression 12 Smoke Nuisances 59 Premises and Occupations controlled by By-laws and Regulations 12 Business Premises 13 Cow Sheds 13 Milk Premises 13 Slaughterhouses 13 Offensive Trades 13 Ice Cream Premises 13 Butter, Margarine, etc., Premises 13 Bakehouses 13 Fried Fish Vendors and Fish Curers 13 Factories and Workshops 13 Inspections 14 Defects found 14 HomeWork 15 Registered Workshops 16 Premises used for Human Habitation 16 Houses let in lodgings 16 Common Lodging Houses 17 Underground Rooms 17 Premises that are not but should be Registered 17 Food Stalls 17 Food— Milk Supply 18 Milk Analysis. 18 Legal proceedings for adulteration 18 Bacteriological examination of Milk 18 Dairies, Cowsheds and Milkshops Orders 18 Milk and Cream Regulations 19 The Milk (Special Designations) Order 19 Milk (Mothers and Children) Order, 1918 20 Food Inspections 20 Food, Unsound, Condemned 20 Sale of Food and Drugs Acts 21 Reports of Public Analyst during year 22-24 Statistical— Births 25 Birth Registration 25 Birth Notifications 25 Deaths and Death Rates 25 Sub-District Birtht and Deaths 26 page Deaths in relation to Age 26 Deaths among the Aged 26 Causes of and ages at death 26 Infantile Mortality 27-29 ,, ,, Causes 27 Maternal Mortality 30 Deaths in relation to Disease 30 Diarrhoeal Diseases 30 Infectious (Communicable) Diseases 30 Phthisis and other Tuberculous Diseases 30 Respiratory Diseases 31 Cancer and Malignant Disease 31 Alcoholism 32 Accident, Suicide and Manslaughter 32 Prevalence of and Control over Infectious Diseases 32 Isolation of Cases 33 Discharge Notices 33 Diphtheria and Membranous Croup 33 Scarlet Fever 34 Enteric Fever 34 Cerebro-Spinal Fever 34 Encephalitis Lethargica 34 Polio-Myelitis 35 Erysipelas 35 Puerperal Fever 35 Measles and German Measles 35 Whooping Cough 35 Glanders and Anthrax 35 Smallpox 35 Infectious Diseases in Schools 36 Ophthalmia Neonatorum 36 Influenza 37 Pneumonia 37 Tuberculosis 37 Treatment 37 Notifications 38-47 Prevention of 40 Care Committee 40 Work and Dispensaries 41 Pulmonary Deaths 45,46 Bacteriological Diagnosis of 40 Disinfection 48 Cleansing of Persons Act, 1897 49 Bacteriological Examinations 50 Maternity and Child Welfare 50 Health Visitors 51 Centres 51 Ante-Natal Work 52 Dental Clinic 52 Massage Clinics 52 Hospital Treatment 52 Maternity Cases 52 Infant Consultations—Work at. 53 Day Nurseries 53 Home Helps 54 Light Treatment 54 Sanitary Administration— Staff 9,55 Report of Mortuary Keeper 56 Housing 56 Statistics 58 Sanitary Inspection (Summary) 59 Ministry of Health, Tables I—III 61-65 Vaccination Returns 66 7 THE YEAR 1927. 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 1927 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 1926. That the population is, in fact, falling at the rate indicated by these figures is something more than doubtful. As has been explained on more than one occasion the difficulty of obtaining accurate information in intercensal periods is insuperable and the method of calculation of and the figure obtained by the Registrar-General must be accepted for the purpose of determining rates at least. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. 1926 105,800 25,353 27,095 32,931 20,421 1927 103,500 24,794 26,509 82,218 19,979 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 four premises. The reason for discontinuing the supply was in each case the non-payment of rate. During the year 88 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.—Nineteen certificates were granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. The number in 1926 was seven. In 13 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 was provided after receipt of the intimation notice in 11 cases. In one case the supply was provided after the issue of a statutory notice, and one after proceedings had been taken. Drainage. The total number of drain inspections made during the year was 5,439, as against 5,896 in 1926. The total number of plans deposited was 492 the number in 1926 being 530. Plans relating to new buildings numbered 68, the number deposited in 1926 being 85. In the case of old buildings, the number of plans received was 429 as against 445 in 1926. 8 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 fines and cost imposed amounting to £4 2s. Od. Combined Drainage.—Orders as to combined drainage were issued by the Council in respect of 26 premises. The number in 1926 was 28. 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, 1928, and the amount of increase or decrease as compared with the previous year. 1927 1928 Increase Decrease £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus—Men's Department 911 19 10 921 16 10 9 17 0 — ‡ „ Women's „ 1,433 14 11 1,484 17 3 51 2 4 — Gt. Portland Street—Men's „ 268 14 8 255 15 9 — 12 18 11 * ” Women's „ 281 18 4 266 2 3 — 15 16 1 Marylebone Road—Men's „ 240 9 6 244 18 1 4 8 7 — * „ Women's „ 237 2 7 236 7 9 — 0 14 10 Foley Street—Men only „ 152 6 4 147 13 3 — 4 13 1 St. John's Wood Road—Men only 123 6 3 111 10 1 — 11 16 2 Barrett Street—Men only „ 239 11 0 242 14 2 3 3 2 — Salisbury Street— Men's Department 68 8 7 70 6 1 1 17 6 — ‡ „ Women's „ 96 3 4 105 19 1 9 15 9 - £4,053 15 4 4,088 0 7 80 4 4 45 19 1 *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, 1928, it may be mentioned, was 45,021 tons, as compared with 41,887 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 149 premises. 9 During the year the inspectors made 5,018 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, 31 notices were served. Remedies in each case were carried out, legal proceedings not being necessary in any instance. Removal of Offensive Refuse.—Owing to the number of hotels, boarding houses, restaurants, and large private establishments in the borough, considerable quantities of food refuse (hog wash) are collected by pig-feeders daily, and close watch is necessary in order to ensure that the requirements of the bye-laws relating to removal of offensive refuse, as to hours of removal, provision of proper receptacles, etc., are complied with. During the year a number of warnings with regard to these matters were issued. 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: *Charl Porter, M.D., B.Sc., M.R.C.P. (Edin.), of the Middle Temple, Barrister-at-law. Deputy Medical Officer of Health (Part time) : Adam A. Turner, M.C., M.B., Ch.B. (Aberd.), D.P.H. (Medical Officer of Health, Finchley). Assistant Medical Officer of Health for Tuberculosis Purposes: *J. Donaldson Saner, M.B., C.M. (Edin.), D.P.H. 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. T. A. Cartledge (a, b, c). F. C. Cook (b, c). W. H. Draper (a, b, c). E. Lumley (a, b). T. W. Forbes (b, c). E. E. Willis (a, b, c). A. S. Wilson (a, b, c). *Health Visitors. Miss C. E. Durant (b, d, g). Miss C. Hale (d, e). Miss E. D. Mann (d, e, g). h Miss K. Stewart (d). *Tuberculosis Visitors. Miss F. A. Baker (b). i Miss F. A. Bartleet, R.R.C. (/). j Miss S. Kenion (e, d, g). Tuberculosis Clerk—Dispenser. *Miss M. T. Challis. *Drainage Inspectors. H. H. Clay (a, b, c). T. Gorniot (Senior Sanitary Inspector) (a). 10 *Food Inspector. G. Smith (a, b, c). *Outdoor Superintendent. P. H. Hill (a, b, c). *Women Sanitary Inspectors and Health Visitors. k Miss D. Chabot(b, d, e, g). I Miss H. Dean (b, d, e). Miss N. C. Stokes, R.R.C. (b, d, e, f, g). Cleansing of Persons Baths & Shelter Matron: Miss L. Kilgallin. Tuberculosis Dispensary. *Caretaker: E. D. Marston. Clerks. Chief Clerk: H. E. Curtis. A. H. James. W. J. Howe. G. W. Matthews. C. D. Turbayne. G. C. Ewins. Maternity and Child Welfare and Tuberculosis Clerk. *Miss J. Jones. Mortuary Keeper. Mrs. H. Spears. Disinfectors. J. C. Kendall. J. Overton. Messenger. J. Eatwell. *Officers to whose salary contribution is made under the Public Health Acts or by Exchequer grants. a Royal Sanitary Institute Certificate. b Certificate Sanitary Inspectors' Examination Board (London). c Meat and other Foods Certificate. d Health Visitors Diploma. e Central Midwives Board Certificate. f Certificate ot State Registration for Nurses. g Three or Four Years' Hospital General Training Certificate h Appointed February, 1927. i Resigned September, 1927. j Appointed September, 1927. k Appointed July, 1927. l Resigned August, 1927. 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. The total number of complaints of nuisance received was 2,179, as against 3,114 in 1926. 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, 144 statutory notices were issued, as against 182 in 1926. Of these notices, 102 related to ordinary nuisances (dirt, dampness, etc.), 23 to verminous rooms, 2 to drains, 2 to water supply in tenement houses, 14 to insufficient dust bins and one to insufficient W.C. accommodation. The 23 notices respecting verminous rooms were served under powers contained in the London County Council (General Powers) Act, 1922, and referred to 37 rooms. In 2,035 cases the nuisances were abated by the persons responsible for their removal after receipt of a preliminary (intimation) notice advising them of the existence of the defect. In 3 instances there was failure to carry out works after receipt of statutory notice and legal proceedings were instituted. Details of these cases will be found under the heading "Legal Pioceedings in connection with nuisances." 11 The total inspections made by each inspector, and the number of nuisanaes of various kinds detected and remedied, are set out in the following table:- No. 1 No. 2 Districts. No. 6 Borough No. 3 No. 4 No. 5 Houses damp, dirty or dilapidated remedied 210 173 264 259 74 76 1,056 Doors, windows, floors, ceilings sash cords, etc., repaired 250 191 182 72 46 58 799 Overcrowding abated — — — — — — — Illegal occupation of underground rooms dealt with - - - 5 2 1 8 Water closet defects remedied 168 123 129 163 65 78 726 Water closets erected 2 1 1 - 2 11 17 Urinal defects remedied - - - - - 1 1 Soilpipes and ventilating shafts repaired or renewed - 2 2 25 29 Yard defects remedied 101 74 62 117 51 29 434 Waste pipe defects remedied 32 15 10 7 6 10 80 Water cistern defects remedied 17 26 19 8 18 — 88 Rubbish, manure, etc., lations removed 9 4 34 30 10 6 93 Dung or dust receptacles repaired or renewed 36 22 31 51 5 4 149 Drains relaid or amended 31 10 15 8 21 15 100 Drains cleared 1 21 7 10 10 4 53 Rainwater pipes repaired or renewed 21 11 20 8 9 10 19- Water supply to houses reinstated 1 1 - 3 - - 5 Roofs and gutters repaired 117 118 89 73 16 50 463 Area defects remedied 2 - 2 95 45 19 163 Wash-house defects remedied 126 78 100 85 22 17 428 Animal nuisances abated 3 - 18 2 4 1 28 Basement defects remedied 32 1 9 21 17 — 80 Stables cleansed or re 4 - - 3 — — 7 Water supply laid on to upper storeys of house 3 - - 8 1 1 13 Miscellaneous nuisances abated 380 160 42 214 22 35 853 Verminous rooms cleansed 65 83 133 105 31 31 448 Workshops dirty, overcrowded, unventilated or defective, remedied 4 2 19 10 3 42 80 Proceedings in Connection with Nuisances. The number of summonses issued in respect of nuisances during the year was three. Particulars with regard to each of the cases are given below and it should be noted that in each instance, though there were contraventions of provisions contained in other acts and by-laws, the Public Health (London) Act, 1891, is the only enactment mentioned in the list. Premises. 55, Bell Street. 55a, Bell Street. 55b, Bell Street. Offence. (Proceedings taken under the Public Health (London) Act 1891, etc.) Failure to comply with a statutory notice to execute certain sanitary requirements. Do. Do. Result. Order made to abate nuisances within 21 days. Fined £3 10s. Od. and £7 7s. Od. casts. Was committed to Holloway Prison 24.1.28 for 13 days imprisonment, in default of fines and costs. She served 3 days, and then paid £9 0s. lOd. 12 Rat Repression. The number of complaints received during- the year, viz., 60, was higher by 12 than the 1926 figure. The investigation of these complaints necessitated the inspection of 65 premises, 29 of which were used for business purposes (8 of these for the preparation or storage of food), the remaining 36 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. A Rat Week was held during the year from the 31st October to the 5th November, 1927, 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 in a convenient way the majority of the premises and occupations of the class referred to in the heading to this part of the report, and contains a certain amount of information with regard to registration, inspection, etc. Underground rooms and underground sleeping rooms, though controlled, the former under the Public Health (London) Act, 1891, and the latter under special regulations made by the Council in 1910, are not registered. Number of premises Number of inspections 1927 Number of notices 1927 Number of prosecutions, 1927 On register at end of 1926 Added in 1927 Removed in 1927 On register at end of 1927 A. Business Premises Milk premises 127 8 26 109 340 40 — Cowsheds 1 — — 1 26 — — Slaughterhouses 1 — — 1 84 — — Offensive trade premises 3 — — 3 66 — — Ice cream premises 118 — — 118 192 10 — Butter and Margarine facturers and Dealers 16 — — 16 16 — — Bakehouses 54 — — 54 136 16 — Fried Fish Shops 23 1 — 24 67 7 — Fish Curers 5 — — 5 64 — — B. Habitations Houses let in lodgings 1,070 — 15 1,055 10.833 1,311 — Common lodging houses 5 — — 5 1 - — Underground rooms not registered — — — — - — Underground sleeping rooms... 13 A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 109. This is 18 less than in 1926, 8 having been added and 26 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. The reasons underlying its existence and continuance have previously been given. 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 moment the only slaughter house in the Borough is that at 32a, Union Street, W.l, which is held by Mr. E. J. Barclay, of 70, Great Titchfield Street, W. 1. 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 66 visits, but no cause for complaint was found. Ice Cream Premises.—The number of such premises in the Borough on the Register is 121. Regular inspections were made throughout 1927, and in 10 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 1927 the number of bakehouses on the register was 54- Of the 54, 49 are underground bakehouses. In all, 136 visits were paid and 16 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 24 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 14 especially those in charge of districts on the south of Marylebone Road. The staplel industry is dressmaking, millinery and tailoring in all its branches. The total number of visits to factories, workshops and workplaces during the year was 2,610; 111 by the women and 2,499 by the men inspectors. The complaints received numbered 61. 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 (1) Number of Inspections (2) Written Notices (3) Prosecutions (4) Factories 93 5 (Including Factory Laundries) Workshops 929 94 (Including Workshop Laundries) Workplace 1588 60 (Other than Outworkers' Premises included in Part 3 of this Report) Total 2610 159 2,—DEFECTS FOUND. Particulars (1) Number of Defects Number of Prosecutions (5) Found (2) Remedied (3) Referred to H.M Inspector (4) Nuisances under the Public Health Acts— Want of cleanliness 66 66 — — Want of ventilation 10 10 — — Overcrowding 4 4 — — Want of drainage of floors 3 3 — — Other nuisances 36 36 — — Sanitary accommodation insufficient 7 7 — — unsuitable or defective 46 46 — not separate for sexes 15 15 — — 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) 16 16 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 203 203 — — 3.—HOME WORK. NATURE OF WORK. (1) OUTWORKERS LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109,110 Lists received from Employers. Notices served on Occupiers as to keeping or sending lists Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S 110) Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 64 213 954 ... ... ... 20 ... ... ... ... ... ... ... ... Total 64 213 954 ... ... ... 20 ... ... ... ... ... ... ... ... 15 16 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year (1) Number (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 3,329 Coffee Shops, &c. 310 Bakehouses 54 Total number of workshops on Register 3,683 5.—OTHER MATTERS. Class (1) Number (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 9 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 61 Reports (of action taken) sent to H.M. Inspector ... 61 Other 1 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 49 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 Public Health (London) Act, 1891, and Section 6 of the Housing Act, 1925, 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. During the year under review, arrangements were made for compiling a new register and in connection with this and for purposes of supervision, some 10,833 visits were paid to the 1,055 houses on the old list. The number of notices served was 1,311, relating to cleansing and other defects. All of these were complied with without the necessity for further proceedings arising. 17 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. Kegistered number of Occupants. 54, Bell Street Eliza Crew 55 men 2, Burne Street and Lisson Street W. Bramwell Booth 499 men 29, Circus Street William H. G. Richardson 100 men " Portland House " (late Shaftesbury Institute), Harrow and Union Streets, Lisson Grove Ellen Homewood 102 women 654 men 102 women Total ... 756 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 8. 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 fot sale is very large. At the end of 1927 there were 310, this number including : Restaurant, dining room and coffee shop kitchens, 194; tea-rooms and pastry-cooks, 68 ; hotel kitchens, 20; fried fish shops, 24; and fish-curers, 5. In addition, there was 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 1927 the total number of inspections was 947, the number of notices served being 25. Food Stalls —Of these there are considerable numbers in the market streets, particularly Great Titchfield Street, Bell Street, Church Street, Blandford Street, etc., though it is hoped that, as a result of the operation of the by-laws relating to registration of street traders, made by the Council under the London County Council (General Powers) Act, 1927, Sec. 36, there will be a diminution in the amount of food-selling from stalls in the open street. Prior to coming into operation of these new provisions a great amount of inspection of stalls and of premises used for food storage was done and a number of improvements obtained. Definite arrangements are made for the keeping of all stalls used for the sale of food under close observation. Throughout 1927 visits were paid to all the market streets every day, a special feature being made of Saturday night and Sunday morning-inspections. 18 A.—FOOD: 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 273. On examination by the Public Analyst 8 (2.9 per cent.) were found to be adulterated. In 1926 the percentage was 0.8. Further reference to the question of milk examinations is made in the report of the Public Analyst, which will be found elsewhere. As will be seen from the table setting out the quarterly returns the number of cases in which proceedings were instituted was 7. Six of the summonses were in respect of samples taken from one individual, a farmer, whose milk had been found on several occasions to be below standard. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 74 were obtained on delivery at Marylebone Station of the London & North-Eastern Railway. Of the 74, six proved to be adulterated, and proceedings were instituted and fines and costs amounting to £18 and £7 7s. 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. and Costs. 1st 81 — — — £ s. d. 2nd 52 2 3'8 1 3 1 0 3rd 79 — — — - 4th 61 6 98 6 25 7 0 Total for year 273 8 29 7 28 8 0 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, 53 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, Ik no case was it necessary to take action. 19 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, 1927. 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 ... ... 273 Nil. Cream ... ... 12 Nil. Nature of preservative in each case in column (6), 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 15 (ji.) Statements incorrect Nil Total 15 (iii.) Percentage of preservative found in each sample Average .105% Boric Acid per lb. Lowest .013% Highest .19% Percentage stated on statutory label. Not exceeding 0.4%. (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent 15 (ii.) Below 35 per cent Nil Total 15 (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 32 applications were received from 11 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 20 Tested) milk. As the milk in each case was obtained from a producer licensed under the Order and the premises of the applicants were found to be satisfactory, licences were granted in each case, the numbers being 9 in respect of "Certified" Milk, 7 for Grade "A" Tuberculin Tested Milk, and 16 "Pasteurised" Milk. In accordance with the instructions of the Ministry 53 samples were taken during the year and submitted to the Council's Bacteriologist, Dr. A. G. R. Foulerton. Copies of the reports were duly forwarded to the Ministry. Milk (Mothers and Children) Orders.—During 1927 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1928, was £348 12s. lid., as against £387 0s. Od. up to 31st March, 1927. The actual number of cases dealt with was 218, and the number of orders issued 1,086. B.—FOODS OTHER THAN MILK. Food Inspection.—'There was no change in the method of carrying out the work of food inspection during the 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 1927. Meat— Beef Mutton Pork Bacon. Fish— Wet—Whiiing Skate Roe Lemon Soles Cod Halibut Plaice Dry—Haddocks Fillets Codlings Kippers Salmon Shell—Winkles Lobsters 17 lbs. 36 lbs. 1 Pig's Head (Tuberculous). 22 cwts. 8 stone. 86£ „ 28 „ 8 „ 5 „ 4 „ 6 „ 19 stone 10 boxes 15 „ 1 box Half 2 bags 1 box 21 Fruit— Pears 16 boxes Bananas 16 halves Grapes 8¾ lbs. Oranges ¾case Miscellaneous— (Tinned Goods, etc.) Hams 17 Ox Tongues 8 Lunch Tongues 16 Spiced Beef 81 Beef & Tongue 22 Pork & Stuffing 36 Chicken and Ham Roll 11 Beef Corned 31 Meat Paste 23 Crab 55 Herrings 10 Cream 59 Condensed Milk 76 Grape Fruit 6 C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,070. Of this number 10 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 0.9 per cent., the figure for 1926 being 0.8 per cent. 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 (7) 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 ANNUAL REPORT OF THE PUBLIC ANALYST, 1927. The number of samples taken under the Sale of Food and Drugs Acts and submitted to analysis, was 1,070; a decrease as compared with the samples for 1926, the number for that year being 1,103. Of these 1,070 samples nearly 1 out of every 100 was an adulterated sample, the exact percentage being 0.934. A complete list is as follows : ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total 1 Apples 1 5 — 6 1 1 — 2 2 Apple Cyder — 3 - 3 3 Beef Sausages 1 24 - 25 4 Bicarbonate of Soda — 5 - 5 5 Black Currant Wine — 1 - 1 6 Blackberry Jelly — 1 - 1 7 Boracic Ointment — 4 - 4 8 Butter 52 91 - 143 9 Candied Peel — 2 - 2 10 Cheese — 60 - 60 11 Cherry Cyder — 1 - 1 12 Chicory — 6 - 6 13 Cocoa — 10 - 10 14 Coffee — 60 - 60 15 Coffee and Chicory Essence — 4 - 4 16 Coffee Essence — 3 - 3 17 Condensed Milk — 62 - 62 18 Cream 25 2 - 27 19 Cream Cheese — 6 - 6 20 Cream, Tinned — 4 - 4 21 Currants — 5 - 5 22 Custard Powder — 2 - 2 23 Demerara Sugar — 2 - 2 24 Dried Fruit — 6 - 6 25 Fish Pasta — 9 - 9 26 Flour — 1 - 1 27 Gelatine — 1 - 1 28 Ginger Beer — 2 - 2 29 Glace Cherries — 8 - 8 30 Glace Fruit 1 3 - 4 31 Granulated Sugar — 8 - 8 32 Grape Fruit — 4 - 4 33 Honey — 6 - 6 34 Jam — 31 - 31 35 Lard — 50 - 50 36 Lemonade — 1 - 1 37 Lemon Cheese — 3 - 3 38 Lemonade Powder — 5 - 5 39 Manna Loaf — 1 - 1 40 Margarine — 41 - 41 41 Marmalade — 16 - 16 42 Meat Paste — 10 - 10 43 Milk 223 50 - 273 7 1 - 8 44 Mincemeat — 2 - 2 45 Mixed Fruit — 1 - 1 46 Mustard — 5 - 5 47 Mustard Compound — 1 - 1 48 Olive Oil — 1 - 1 Carried forward 303 629 932 8 2 10 23 ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total Brought forward 303 629 - 932 8 2 - 10 49 Peas — 2 — 2 50 Pickles — 3 — 3 51 Pork Sausages 1 23 — 24 52 Raisins — 22 — 22 53 Raisin Wine — 1 — 1 54 Roll and Butter — 3 — 3 55 Self-Raising Flour — 6 — 6 56 Scotch Whiskey — 4 — 4 57 Soft Moist Sugar — 1 — 1 58 Sugar — 6 — 6 59 Sultanas — 12 — 12 60 Tea — 30 — 30 61 Tinned Cherries — 1 — 1 62 „ Fruit Salad — 1 — 1 63 „ Grape Fruit — 2 — 2 64 „ Loganberries — 1 — 1 65 „ Peas — 9 — 9 66 „ Pine Apple — 1 — 1 67 „ Raspberries — 1 — 1 68 „ Strawberries — 1 — 1 69 „ Tomatoes — 2 1 3 70 Tomato Ketchup — 1 — 1 71 Vegetable Lard — 1 — 1 72 Yellow Crystal Sugar — 2 — 2 304 765 1 1070 8 2 — 10 Adulterated Samples, etc. Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 289 Apples Informal 0.5 parts AS2 O3 per 1,000,000 Nil 308 Apples (Russet) Formal 0.1 do. Nil 379 Milk do. 6.7 percent. deficient in milk fat Fined £2 0s. 0d. and £1 1s. 0d. costs. 449 do. Informal 3.3 per cent. do. Nil 802 do. Formal 6.7 per cent. deficient in fat and also contained 31.8 per cent. of added water Fined £3 3s. 0d. on reach summons and £1 7s. 0d. costs. 803 do. do. 6.7 percent. deficient in fat and also contained 12.7 per cent. of added water 809 do. do. 6.7 percent. deficient in fat and also contained 17.4 per cent. of added water 810 do. do. Contained 16.0 per cent. of added water 812 do. do. Contained 13.4 percent. of added water 813 do. do. Contained 4.47 per cent. of added water The sum paid in respect of each analysis was 12s. 6d. per sample. 24 The Public Analyst (Mr. J.F.F. Rowland) comments, as follows, with regard to various of the articles examined:— "Milk.—273 samples were examined during the twelve months ending December 31st, 1927, as compared with 233 taken during 1926. Of these 273 samples 8 were adulterated. This gives 2.93 as the percentage of adulterated samples, a figure considerably in excess of the corresponding figure for 1926 (0.86%). Leaving out the adulterated samples the average composition of the milks taken was as follows:— Year. Sp: Gr: Total Solids. Fat. Solids not Fat. 1927 1031.3 12.29 3.59 8.70 1926 1031.6 12.60 3.67 8.93 "From a comparison with the figures obtained for 1926 we see that the average composition of the milks has fallen off, giving a slightly lower value for each of the main constituents. "The cold, wet and inclement weather experienced during the year can in all probability be held responsible for the poorer quality of the milk obtained. "Butter.—Once more all samples proved free from adulteration. Under the new regulations no preservative must be added so that butter and milk are alike to be free from Borax or other preservative. This is most satisfactory considering the part they play in the diet of old and young alike. "Cream.—Last year attention was drawn to the unsatisfactory nature of the tinned creams sold and to the fact that no standard is laid down for cream in any of the forms in which it is sold. To-day the situation is the same as then and further experience only confirms what was said at the time, viz.: that the cream sold in tins is of such poor quality that they are better termed 'enriched milks ' than cream. "The loose creams examined during 1926 had an average fat value of 54.7%, whereas the figures for 1927 is 51.4%. "The tinned creams also are even poorer than in 1926. The respective figures being 28.87% of fat for 1926 and 25.6% for 1927. It is a peculiar coincidence that the percentage fall is practically the same (3.3 and 3.2%) for both the ordinary and for the tinned variety. "When quantity, quality and price are taken into consideration the cost of the tinned cream is almost exactly half as much again as for ordinary cream; this, too, for an article of uncertain age. "Apples.—Of the six samples of apples taken two were contaminated with arsenic. This gives the somewhat alarming figure of 33.3% adulterated. However, when we remember that in 1926 no fewer than 49 samples were examined and not one was found to be contaminated, we may take it that the actual percentage of contaminated samples is very small and further that the amount of contamination when it does Occur is nearly always quite trifling. "Peas.—Two cases of food poisoning caused suspicion to fall on some peas that had been partaken of by the victims. The peas were examined most carefully but no sign of any harmful ingredient was found. "Tinned Tomatoes.—One sample of tinned tomatoes was brought specially for examination for preservative. It contained 5.5 parts of Sulphur dioxide per million." 25 STATISTICAL BIRTHS. Registration.—The number of births registered during 1927 was 1,374,* being 15 more than in 1926. Of the children born, 697 were boys and 677 girls. The birth rate per 1,000 of the population was 13.2, as against 12.77 in 1926. The rates in the several registration sub-districts and the borough were:— All Souls, 9.0; St. Mary, 10.6; Christ Church, 19.1 ; St. John, 12.6. Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,800; Live births, 3,620; Still births, 180. Failures to notify within 36 hours of birth, as required, were comparatively few. In such cases as there was failure, a perfectly reasonable explanation was forthcoming, and it was not considered necessary to take proceedings against any of the parties. The main sources of the notifications are set out below. The figures, it maybe noted, refer to notifications and not to births. No. Per cent. From parents 29 0.8 „ doctors 194 5.1 „ midwives 584 15.4 „ other persons 198 5.2 „ hospitals, etc. 2,795 73.5 3,800 Of the total births notified, 180 referred to still-births (112 males and 68 females): 2,155 took place at Queen Charlotte's Hospital; 346 at Middlesex Hospital; 155 at St. Marylebone Home; and 1,005 were born at home. Of those notified as having occurred in St. Marylebone, 2,098 belonged to other Boroughs. DEATHS AND DEATH RATES. The number of deaths registered in 1927 was 1,262. 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 11.35. In the previous year, the rate was 11.93, and the number of deaths 1,356. *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 212 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:- Legitimate Males 92 „ Females 75 Illegitimate Males 23 „ Females 22 †By a "corrected death rate" is meant 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 1927 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 oi the year. 26 The following short table shows the death rates in the several registration sub-districts in 1927, and compares them with those of the preceding 5 years:— 1922 1923 1924 1925 1926 1927 All Souls 11.3 8.9 9.7 9.2 9.6 9.7 St. Mary. 15.4 12.3 15.6 12.5 13.6 14.2 Christ Church 14.0 12.5 14.4 12.9 13.6 12.6 St. John 14.3 13.0 14.6 12.5 14.3 11.9 The Borough 13.7 11.7 13.6 11.0 11.9 11.3 District births and deaths for the year ended 31st December, 1927, are given in the following table. A further table giving the vital statistics of separate localities for 1927 and the ten preceding years will be found amongst the Ministry of Health Tables on page 62. Sub-District. Population estimated to middle of 1927. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 24,794 115 110 225 118 123 241 St. Mary 26,509 140 142 282 178 199 377 Christ Church 32,218 317 298 615 207 199 406 St. John 19,979 125 127 252 114 124 238 The Borough 103,500 697 677 1,374 617 645 1,262 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 1927. 1927. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 22 18 15 26 81 Persons of 65 years and upwards 215 112 92 129 548 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 65. 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 862. 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. 27 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 1927 was 81, and the number of births in that year 1,374. The infantile mortality rate is therefore 59, which is definitely the lowest ever recorded. It is lower by 22 points than the rate for 1926 (81), and 4 points below the figure for 1925 (63.0), the next lowest rate on record for the Borough. The course which the rate has taken is graphically shown in the chart on page 29, 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 28, 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 1927, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 31 were less than one month old when they died, and 37 less than three months. The figures for 1926 were 38 and 55. 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 30 deaths, one less than in the year 1926. Diarrhoea and enteritis (7 and 8) accounted for 16 in 1926, and for 12 in 1927. Respiratory diseases, the third of the main causes, took 17 in 1926, and in 1927, 14. The commoner infectious diseases together led to 4 deaths amongst infants, the particular disease being in each case measles. One death was stated to be due to overlaying, 2 to tuberculosis, 1 to meningitis, and 11 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 37 deaths amongst infants. In 1926 the figure was 53. Sub-District. Under 1 Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under 4 Weeks. 4 and under 3 Weeks. 3 and under 9 months. 9 and under 12 months. Totals. All Souls 6 — — — — 3 5 — 14 St. Mary 4 1 — — — 8 4 — 17 Christ Church 6 4 — 2 5 5 8 7 37 St. John 4 2 2 — 1 2 2 — 13 Totals 20 7 2 2 6 18 19 7 81 28 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 1 — 1 3 — — 3 — 3 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Diphtheria and Croup — — — — — — — 1 — 1 — — 1 — 1 6 Whooping Cough — — — — — 1 2 4 — 7 1 2 3 1 7 7 Diarrhœa — — — — — — - 1 1 2 — 1 1 — 2 8 Enteritis — — — — — 1 4 3 2 10 1 4 4 1 10 9 Tuberculous Meningitis — — — — — 1 — 1 2 — 1 1 — 2 10 Abdominal Tuberculosis — — — — — — — — — — — — — 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation 1 1 1 - 3 1 - 1 - 5 - 1 2 2 5 13 Premature Birth 12 4 1 — 17 — 1 1 — 19 4 4 5 6 19 14 Atrophy, Debility and Marasmus 1 - - 1 2 - 3 1 - 6 1 1 4 - 6 15 Atelectasis — — - — — — — — — — — — — — - 16 Injury at Birth 1 — — — 1 — — — — 1 — — 1 — 1 17 Erysipelas - — — — - — — — — — — - — — — 18 Syphilis — — - — — — — — — — — — — — — 19 Rickets - - - - - - - - - - - - - - - 20 Meningitis (not Tuberculous) - - - 1 1 - - - - 1 - - 1 - 1 21 Convulsions — — — — - — — — — — — — — — - 22 Gastritis - - - - - - - - - - - - - - - 23 Laryngitis — — — — — — — — — — - - - - - 24 Bronchitis — 1 — — 1 — 2 — — 3 1 1 1 - 3 25 Pneumonia (all forms) 1 - — — 1 2 2 4 2 11 2 1 6 2 11 26 Suffocation, Overlying 1 — — — 1 — — — — 1 1 — — — 1 27 Other Causes 3 1 — — 4 — 2 3 — 9 3 1 4 1 9 Totals 20 7 2 2 31 6 18 19 7 81 14 17 37 13 81 Legitimate, 1,202 Legitimate Infants, 64 Nett Births in the Year Nett Deaths in the Year Illegitimate, 172 Illegitimate Infants, 17 Total 1,874 Total 81 INFANTILE MORTALITY FIGURES. Number of deaths of children under one year of age Rate per 1,000 registered births. 30 MATERNAL MORTALITY. The number of women who died from conditions arising during or consequent upon child birth was 3 and the maternal mortality rate 2 per 1,000 as against 4 per 1,000 for the country as a whole. Of the deaths all occurred on the same day as the birth of the child. In one case the confinement took place at home, one at a nursing home, and one at a hospital. The causes of death were (1) Embolism (puerperal); (2) Double pyelitis and cystitis 6 years, fatty heart and kidneys 4 years or more and heart failure following Cæsarean Section 2 hours; and (3) Eclampsia (puerperal) 29 hours. All were attended by a medical practitioner. The ages of the patients were 23, 29 and 41 respectively and all were married. In two cases the children survived, the other being stillborn. 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 65. This Table also shows the distribution of deaths according to causes in the various registration sub-districts. The following notes with regard to certain of the causes which contributed most largely to the death rate, may be of interest. DIARRHŒAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 15, equal to 0.13 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur among infants, and in 1927, as a matter of fact, all whose who died, with the exception of 3, were less than 1 year of age. In 1926 the deaths from diarrhæal diseases numbered 16, all the victims being under one year of age with the exception of 1. In 1927, therefore, there was a decrease in the total, 12 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 42 deaths), the diseases contributing to the total of 48 deaths were— diphtheria, 12; scarlet fever, 1; whooping cough, 11; measles, 9; and, as already noted, diarrhœa, 15. 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 94 which is lower by 15 than the figure 109 for 1926. The great bulk of the 94 deaths, viz., 76, was due to phthisis. Of the total number of deaths registered (1,262), the percentage due to phthisis was 6.0 as against 6.9 in 1926. The age periods at which the deaths occurred were: 15—25, 13 (17.0 percent.); 25—45, 24 (31.5 per cent.); 45—65, 28 (37.0 per cent.); 65—75, 9 (12.0 per cent.); 75 and over, 2 (2.5 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. 31 TABLE VIII. Deaths from Phthisis and other Tuberculous Diseases. Year No. of Deaths Population Rate 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 1927 94 103,500 .90 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 211. This is lower by 95 than the figure (306) for 1926. The death rate was 1.89 per 1,000. In 1926 the rate was 2.6. The number of deaths certified to be due to bronchitis was 86, as against 160 in 1926. Of this number 60 were amongst persons aged 65 and upwards, and 19 amongst those of the age group 45—65. The deaths attributed to pneumonia numbered 105, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 17 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified was 45. Of the patients 20 were aged 25—45, the other aged 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 65. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 149, and the death rate 1.4 per 1,000 of the population. These figures are lower than those for 1926, when the total was 170 and the death rate 1.51 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 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals Males - - 1 2 2 20 29 13 67 Females 2 - - 8 12 21 18 26 87 Totals 2 - 1 10 14 41 47 39 154 32 Cancer.—Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 10 2 12 Throat, Neck, Gullet 18 3 21 Stomach 59 9 18 Intestines 16 23 39 Liver 3 4 7 Breast — 18 18 Uterus and Generative Organs — 12 12 Various 11 16 27 Totals 67 87 154 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. One point upon which there is general agreement, however, is with regard to the importance, advisability and advantage of early treatment. Of the accuracy of the, advice now so widely given that there should never be any delay in seeking an authoritative opinion in any case of doubt and in securing treatment there can be no question. ALCOHOLISM. There were no deaths certified as due to alcoholism, though cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was given as the cause in 12 cases. This is less than the figure for 1926, when 15 deaths were ascribed to this cause. The deaths from conditions sometimes due to the irritation produced in various organs by chronic alcoholism, e.g., nephritis (inflammation of the kidneys) numbered 43, as against 44 for the year 1926. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1927 numbered 48. Of these 15 were due to suicide. Deaths of babies, certified as resulting from suffocation (overlaying) numbered 1. 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 64. The total number of notifications coming to hand was 686, which is higher by 12 than the figure (674) for 1926. The bulk of the notifications related to tuberculosis, which contributed 190 to the total. Other diseases in respect of which fairly large numbers of notifications were received were scarlet fever 178), diphtheria (160), and pneumonia (45). The notification rate (proportion to population of notified cases of infectious diseases) in 1927 was 6.6 per 1,000, as against 6.2 in 1926. 33 Isolation of Cases.—As the following table shows, the number of cases removed was as high as usual. In no case was compulsion necessary in order to ensure removal to hospital:— Diphtheria 158 or 99.0 per cent. of the cases notified. Erysipelas 23 „ 64.0 „ „ „ Scarlet Fever 170 „ 95.5 „ „ „ Enteric and Paratyphoid Fever 16 „ 94.1 „ „ „ Encephalitis Lethargica 2 „ 66.6 „ „ „ Tuberculosis 81 „ 42.6 „ „ „ Pneumonia 6 „ 15.4 „ „ „ Puerperal Fever 1 „ 100.0 „ „ „ Puerperal Pyrexia 31 „ 88.6 „ „ „ The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £51 14s. 0d., equal to 10s. 0d. 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. 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 3 1927 51 14 0 0 10 0 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 323, and referred to 401 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 160, the number in 1926 being 193. Of the cases 12 died, and the case mortality rate was 7.5 per cent. The number of cases per thousand of the population was 1.5. 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 10 cases the source appeared to be a member of the family previously infected; in 5 cases infection was counted to have been acquired in school, and in 9 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 1,710. A positive result was returned in 50 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 76. In All Souls the number was 14, in St. Mary 46, and in St. John 24. As usual, the age groups 1—5 and 5—15 were those most affected, 56 of the cases falling into the former and 73 into the latter group. 34 No applications for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, were received. The nuisances detected during the course of investigating the notified cases were : Dirty Premises, etc., 31. These were all remedied after service of notices. Schick Test and Diphtheria Immunization.—Towards the end of the year by agreement with the Marylebone Health Society, arrangements were made for the establishment of a Schick Testing and Diphtheria Immunization Clinic at the Infant Welfare Centre in Salisbury Street ("Lissonia Centre") to be open one day per week and available primarily for the infants and children attending the Centre and for any mothers who might desire to take advantage of the provision. Dr. Mabel Brodie was appointed by the Council to carry out the work on 4th November, 1927, and between that date and the end of the year was engaged in making preparations for the opening of the clinic at the beginning of the New Year. Numbers of meetings were held at the Centre and a great deal of propaganda work through talks and by means of posters and leaflets done. The results up to date have been satisfactory and have justified the action of the Council, but fuller information will be available by the end of the present year and be given and discussed in the next annual report. Scarlet Fever. There was no epidemic prevalence of this disease during the year; the number of cases being 178, as against 121 in 1926. The highest number of cases reported in any one week was 9. The total deaths from scarlet fever numbered 1, and the number of deaths per cent, of the cases was 0.56. The districts to suffer most from this disease were Christ Church and St. Mary. In the former there were 82 cases and in the latter 43. In All Souls there were 34 and in St. John 19. As usual the majority of patients were children of school age, the age group, 5—15, giving 95 of the total. Of the remainder 54 were' aged between 1 and 5 years, and 29 over 15 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 7 instances that a definite connection could be made out. Defects in sanitation to the number of 39 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 5. There were 2 deaths. Of Paratyphoid Fever there were 12 cases. All the patients recovered. Cerebro-Spinal Fever. There were two cases of this disease notified during the year. Encephalitis Lethargica. There were three 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. The following table contains information as to result in each case:— 35 Name. Age. Sex. Date Notified. Subsequent progress, i.e., whether recovery complete or partial. 1. E.S. 35 F. 31-1-27 Recovered. 2. E.C. 6 M. 2-6-27 Died 29-5-27. 3. M.O.D. 30 F. 28-11-27 Removed from district. Now a patient in the West Park Mental Hospital. Polio-Myelitis. There were three cases of this disease during the year. Erysipelas. The notifications of eyrsipelas numbered 36. Puerperal Fever. The number of cases of this disease notified, viz., 1, was much below the figure (12) for the preceding year. Puerperal Pyrexia. There were 35 cases notified as suffering from puerperal pyrexia during the year; most of the notifications received came from institutions where, of course, the precautions taken would naturally result in the detection of any signs indicating the occurrence of pyrexia (fever) in the early stages of the lying-in period. No application was made for the services of a consultant or any other of the services the Council is empowered to provide under the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations. Measles and German Measles. These conditions are not now notifiable. 40 cases were, however, reported voluntarily by doctors and parents and 33 by school teachers. There were 9 deaths. The course adopted in relation to the cases was the same as in previous years. Nurses were sent in to 1 case, and 6 visits were paid. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1927 the number of deaths registered as due to whooping cough was 11, the same as in 1926. Glanders and Anthrax. No cases were notified. Small Pox. No cases were notified. On a number of occasions information was received from other districts with regard to residents who had been in more or less direct contact with cases elsewhere. Such persons were kept under observation for a suitable period and if necessary vaccinated by the Public Vaccinator. In no case was vaccination carried out by the Medical Officer of Health. 36 Infectious Diseases in Schools. The accompanying table shows the number of cases of measles, whooping cough, chicken-pox and the notifiable infectious diseases reported from Schools during 1927. During the year in certain of the schools, one or more classrooms were closed on account of measles. SCHOOLS Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 3 4 8 5 7 1 Barrett Street — — — — — 13 Barrow Hill Road 11 9 5 109 — 24 Bell Street 25 16 30 13 2 — Blandford Square 1 1 — — — — Capland Street 12 14 7 9 2 41 Catholic, Richmond Street — — — — — — Christ Church, Lisson Grove 18 36 17 50 2 55 Convent, Little Union Place — — — 1 — — Council School, Grove Road 26 — — — — — Emmanuel, Aberdeen Place 1 1 1 21 2 — Emmanuel, North Street 1 10 — 12 — 5 Gateforth Street 5 14 1 10 2 6 Hampden Gurney, Upper Berkeley Street — 15 13 2 5 Homer Row, Catholic 8 13 — 8 — 39 Jewish, Hanway Street — — — — — — Portland, Little Titchfield Street — 2 — — — — Polytechnic, Regent Street 1 — — — — — Queen's College, Harley Street — — — — — — St. Andrew's. Wells Street - - - - - - St. Francis, Upper William Street - - - - - - St. James's, Marylebone Lane — 3 1 — — — St. Luke's Nutford Place — 4 6 — — 2 St. Mark's, Violet Hill 20 61 18 7 — 14 St. Mark's, Marylebone Road — — — — — — St. Marylebone, High Street 11 18 23 48 — 44 St. Marylebone Grammar, Marylebone Road — 2 — 5 1 — St. Mary's, Crawford Street 37 18 3 7 6 6 St. Paul's, East Street — — — — — — St. Paul's. Broadley Terrace 36 7 6 16 5 42 St. Thomas', Orchard Street 8 12 18 17 — 4 St. Vincent, Wigmore Street — — — — — — Upper Marylebone Street 11 8 19 60 1 19 Schools out of Borough 16 20 8 10 3 9 Totals 251 288 184 410 33 329 Ophthalmia Neonatorum. The following table gives information with regard to 12 cases of this disease —inflammation of the eyes in newly-born children—notified during the year:- Notified Cases Treated Vision Unimpaired Vision Impaired Total Blindness Deaths At Home At Hospital 12 8 4 *10 — - — Nurses were sent in to 6 cases and 217 visits were paid. * Two of the patients left the District. 37 INFLUENZA. This disease showed no epidemic tendencies during the year. The deaths certified as due to Influenza numbered 42, as against 14 in 1926. PNEUMONIA. Figures with regard to notification will be found on page 64, and information as to methods of prevention, etc., adopted in relation to this disease will be found in previous reports. The services of the nurses were requisitioned in 27 cases, and 439 visits were paid. TUBERCULOSIS. In all 190 notifications were received, 155 relating to pulmonary tuberculosis, the remainder (35) to cases in which structures other than the lungs were alfected. The table given on page 38 contains the information required by the Ministry of Health with regard to notifications. Notifications on Form B relate to school children. Of these as in 1926 only 1 was received. From time to time reference is made to the difficulty associated with the obtaining of notifications sufficiently early, and the following figures are introduced because they are interesting in this connection. They relate, as ,will be seen, to cases in which death had taken place before the fact that the individual was suffering from the disease had been brought to the notice of the Medical Officer of Health, as required by the regulations:— 1. Total number of deaths from tuberculosis in the Borough 94 2. The number of cases unnotified or notified at death 35 3. The number of cases notified within a month of death 12 4. The number of cases notified within three months of death 10 5. The number of cases notified within six months of death 7 Treatment of Tuberculosis.—Of the cases notified 208 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 114 were insured persons; of these 41 were admitted to sanatorium or hospital treatment, and 31 to St. Marylebone Hospital. Non-insured persons numbered 76, of whom 34 (10 being children) received sanatorium treatment and 11 were admitted to the St. Marylebone Hospital. Nurses were sent in to 9 cases and 148 visits were paid. 38 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 2nd January, 1927, to the 31st December, 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 B. Poor Law 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 55 55 to 65 65 and upwards. Total Primary Notifications Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males — — 1 2 2 10 17 18 23 11 5 89 110 - - 1 1 1 63 45 „ Females - - 1 1 14 12 17 11 6 3 - 65 76 - - - - - 13 33 Non-Pulmonary Males 1 4 1 2 2 2 4 3 — 1 — 20 21 - — — — — — 15 „ Females - 2 2 3 2 1 3 - - 2 - 15 16 - - - - - 2 8 Totals 1 6 5 8 20 25 41 32 29 17 5 189 213 — — 1 1 1 78 101 39 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. supplemental return of New cases of tuberculosis coming to the knowledge of the Medical Officer of Health or Chief (Administrative) Tuberculosis Officer during the period from the 2nd january, 1927, to the 31st december, 1927 otherwise than by notification on form A or form b under the public health (Tuberculosis) Regulations, 1912. 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 3 3 4 2 13 „ Females — - — — 1 1 3 — 4 — 2 11 Non-Pulmonary Males — 3 1 — - — — — - — 1 5 „ Females 1 3 2 — 1 1 1 1 - 1 2 13 Totals 1 6 3 — 2 2 5 4 7 5 7 42 Source of Information. No. of Cases. Pulmonary. Non-Pulmonary. Death Returns 17 8 "Inward" Transfers 2 5 Other Sources, viz.: after death 5 5 325 Males PULMONARY PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. Number of cases of Tuberculosis remaining on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough of St. Marylebone:— 246 Females 598 Total 98 Males NON-PULMONARY 87 Females 185 Total 783 Total Cases 40 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 41, while the following short table summarises the information as to visits paid by members of the staff:— No. of visits by Tuberculosis Officer New, 67 Old, 128 No. of cases at Dispensary New, 407 Old, 1,616 No. of attendances at Dispensary 3,449 No. of visits by Miss Baker First visits, 170 Re-visits, 1,177 No. of visits by Miss Bartleet First visits, 90 Re-visits, 572 No. of visits by Miss Kenion First visits, 6 Re-visits, 298 No. of Committee Meetings attended 23 The Tuberculosis Care Committee continued to meet fortnightly throughout the year, Dr. Saner, Miss Baker and Sister Bartleet (later Miss Kenion) 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 28—19 boys and 9 girls—and the attendances numbered 7,285. 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:— "The figures for the year show an increase in the number of new cases examined at the Dispensary, details of such examinations are set forth in the tables. A figure which does not so appear is one indicating the number of examinations carried out in the case of other than new patients. Such examinations numbered 500. It is pleasing to find that more people are presenting themselves either on their Own initiative or on advice of their doctor or on recommendation of another patient who has already attended. This gives the Dispensary a greater opportunity of weeding out the really sick from the healthy and of bringing those in need under treatment at an earlier stage of the disease. Special attention is being paid to "contacts," i.e., those persons who have been in contact with an infectious case. "The X-Ray department of the Middlesex Hospital is proving most useful for verifying a doubtful case, and although it may involve expenditure it is money well spent. In all 25 patients have been radiographed during the year with the best results. "The Sunlight Department of the same hospital has been taken advantage of in a few cases of debilitated children in what is usually known as the "pretubercular stage.'' The results here have been fairly satisfactory but improvement has not been so rapid as was expected and wished. The efficacy of the treatment is still under discussion and perhaps it is too early to form a definite opinion. "During the year the Care Committee have had 222 cases brought before them, 90 of which have been sent to or returned after sanatorium treatment. Eleven children have been away through the Invalid Children's Aid Association and the Charity Organisation Society. Twenty-eight of the Ex-Service men and their families have been added to Miss BOwen's already long list." 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 712, as against 730 in 1926. Of these, 105 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis—The great bulk of the total notifications—35 as against 30 in 1926—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. 41 Particulars as to the parts affected by the disease will be found in the table on page 47. TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1927. 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 38 35 2 2 1 1 2 2 39 36 4 4 (b) Doubtfully tuberculous — — — — - — — — 38 38 26 26 (c) Non-tuberculous - - - - - - - - 16 19 11 5 B.—Contacts examined during the year:— (a) Definitely tuberculous — 4 - - - - - - - 4 - - (b) Doubtfully tuberculous — — — — - — — — 4 16 26 32 (c) Non-tuberculous - - - - - - - - 9 19 19 16 C.—Cases written off the Dispensary Register as (a) Cured — 1 — 2 - — - — — 1 — 2 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 65 87 86 74 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 120 93 26 17 7 3 8 11 127 96 34 28 (b) Diagnosis not completed - - - - - - - - 9 17 38 37 1. Number of persons on Dispensary Register on January 1st 334 2. Number of patients transferred from other areas and of "lost sight of" cases returned 14 3. Number of patients transferred to other areas and cases " lost sight of " 24 4. Died during the year 30 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 38 6. Number of attendances at the Dispensary (including Contacts) 3,449 7. Number of attendances of non-pulmonary cases at Orthopaedic stations for treatment or supervisipn — 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light" treatment 188 (b) Other special forms of treatment 4 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 15 (b) Otherwise 101 11. Number of other visits by Tuberculosis Officer to Homes 170 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,325 13. Number of (a) Specimens of sputum, &c., examined 240 (b) X-ray examinations made, in connection with Dispensary work 35 42 14. Number of Insured Persons on Dispensary Register on the 3lst December 144 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 108 16. Number of reports received during the year in respect of Insured Persons:— (а) Form G.P. 17 2 (b) Form G.P. 36 1 (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 1927, 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. 1927- Class T.B. minus. Class T.B. plus. Class T.B. Minus. Class T.B. Plus. Group 1. Group 2. Group 8. Total (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. 7 6 5 3 14 3 15 12 2 29 F. 8 6 2 3 11 20 13 5 2 20 Children. M. 5 - — - - 2 - - - - F. 2 — — — — 2 — — — — Condition not ascertained during the Year. - - - - - - - - - - Lost Sight of or otherwise removed from Dispensary Register. 1 2 2 1 5 1 1 — — 1 Dead. Adults. M. 1 — — 15 15 — — — 7 7 F. — — — 5 5 — — — 3 3 Children. M. - - - - - - - - - - F. — — - - - - - - - - Totals 24 14 9 27 50 28 29 17 14 60 43 (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 1927, 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 of the last record made during the year to which the Return relates. 1926. 1927. Bones and Joints. Abdominal. Other Organs. Peripheral Glauds. Total. 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 — 1 — — 1 F. — — — — — 1 — — — 1 Children. M. — — — 1 1 1 — — 1 2 F. 1 — — 2 3 1 — — 1 2 Transferred to Pulmonary - - - - - - - - - - Condition not ascertained during the Year. - - - - - - - - - - Lost Sight of or otherwise removed from Dispensary Register. 1 — — - 1 — — — — — Dead. Adults. M. - - - - - - - - - - F. - - - - - - - - - - Children. M. - - - - - - - - - - F. - - - - - - - - - - Totals 2 1 — 3 6 3 1 — 2 6 44 The following table, which has been prepared for the Ministry of Health and the London County Council, shows the work carried out at the Dispensary: Statement of Work carried out in connection with the Dispensary Treatment of Tuberculosis during the period 1st January, 1927, to the 31st December, 1927, and Sundry Particulars in connection with the Scheme of Treatment. I.-Particulars of work carried out in connection with the dispensary. Name of Dispensary. Name of Dispensary Medical Officer. Date of Approval of Appointment by Local Government Board. Days and Hours when the Dispensary is open. Number of Persons including Contacts who were examined for the first time during the period from the 1st January, 1927, to the 31st December, 1927, 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, 192 7 to 31st December, 1927. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1927. Number of Persons referred for diagnosis or treatment tothe Hospital with which the Dispensary is affiliated during the period 1st January, 1927. to 31st December, 1927. 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 87 114 206 125 282 143 115 144 242 17 23 Tuesday, 9.30—5 Wednes., 9.30—5 Thursday ,9.30—9 Friday, 9.30—5 Saturday, 9.30—1 45 II.—Sundry particulars in connection with the scheme of treatment. 1. Name of Hospital to which Special Cases are referred from the Dispensary for diagnosis or treatment Middlesex Hospital. 2. Is any provision for the home nursing of Tuberculous Patients made in connection with the Dispensary ? If so Yes. Application can be made to the District Nursing Association. (1) State the general nature of the arrangement (1) Note sent to Matron from Dispensary. (2) What qualifications are the Nurses required to possess ? (2) Fully trained. (3) Do they carry out other work ? If so, what ? (3) Yes, District Nursing. (4) Are their services available for Insured and Uninsured Patients ? (4) Yes. (5) If so (a) by what procedure are their services secured for individual patients ? (5) (a) As above. (b) Under whose instructions do they perform the actual duties of nursing in an individual case ? (b Matron of Nursing Association and Tuberculosis Officer. 3. If no provision of nursing is made in connection with the Dispensary is any such provision contemplated ? If so, give particulars ? - 4. State number of Shelters provided by the Council or by the Dispensary Authorities up to 31st December, 1927, for lending out to Patients for use at their own homes None. Deaths from Phthisis.—Some reference has already been made to the matter of deaths from tuberculosis and at this point it is proposed only to deal with the figures relating to tuberculosis of the lungs (consumption or Dhthisis). During 1927 the total number certified as due to this cause was 76, the deathrate being 0.7 per 1,000. The distribution of the deaths according to registration districts is shown in the accompanying table, which gives also the: figures for each of the 5 years 1923-1927. 46 Deaths from Phthisis. Five years—1923-1927. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1927 103,500 76 20 21 25 10 The distribution of the 76 deaths was as follows:- In Poor Law Institutions, 30; general and other hospitals, 21; and at home, 25. Of those who died 40 were insured (31 males and 9 females), and 37 uninsured (20 males and 17 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 76, the notified cases of pulmonary tuberculosis totalled 155. 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 ALL DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 - - 1 1 - - 1 1 1—5 — — 7 5 — — 2 5 5—10 1 1 2 4 — — — 1 10—15 2 1 2 3 — — 1 — 15—20 2 15 2 3 1 3 — — 20—25 10 13 2 2 4 6 1 — 25—35 18 20 4 4 2 4 — — 35—45 21 11 3 1 15 4 — 1 45—55 26 10 — — 14 2 — 1 55 -65 15 3 1 3 7 3 — 1 65 and upwards 7 2 1 2 7 4 1 2 Totals 102 76 25 28 50 26 6 12 *Including all cases known otherwise than by notification. 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. 47 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 31st DECEMBER, 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—years. All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals 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 155 — — 6 38 63 43 5 30 51 54 20 155 13 23 18 6 60 95 Glands 5 - 1 2 1 - 1 - 1 - 4 - 5 - - 1 - 1 4 Peritoneum 2 - - — 1 1 — — — — 2 — 2 - — 2 - 2 — Hip 6 - 2 1 — 3 — — 1 2 3 — 6 - 1 3 - 4 2 Meninges 4 1 2 1 — — — — — — 3 1 4 - — 2 1 3 1 Kuee 2 - — — 1 1 — — — 1 1 — 2 - 1 — - 1 1 Spine 5 - — — 2 3 — — 3 — — 2 5 - — — 2 2 3 Pelvic Bones 1 - — 1 — — — — — 1 — — 1 - 1 — - 1 - Rib 2 - 1 — — — 1 — — 2 — — 2 - 2 — - 2 — Abdomen 1 - - 1 - - - - - 1 - - 1 - - - - - 1 Instep 1 - - 1 - - - - - - 1 — 1 - — 1 - 1 — Elbow 1 - — — — — 1 — — 1 — — 1 - — — - - 1 Renal Tract 1 - — — — 1 — — — — — 1 1 - — - 1 1 - Axilla 1 - — — 1 — — — — 1 — — 1 - 1 — - 1 - Lupus of Hard Palate 1 - - 1 — — — — 1 — — — 1 1 — — - 1 - Ankle 1 - - - 1 - - - - 1 — — 1 - 1 — - 1 - Larynx 1 - - - - 1 - - - - 1 - 1 - - - - - - Totals 190 1 6 14 45 73 46 5 36 61 69 24 190 14 30 27 10 81 09 190 48 DISINFECTION. The work done in this connection during 1927 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. Phthisis Measles. Vermin. Other causes. Total. Beds 130 11 - 8 13 162 Mattresses 455 23 5 17 103 603 Bolsters 216 16 1 11 87 331 Pillows 9,821 77 11 25 303 1,398 Sheets 501 15 9 3 13 541 Blankets 1,153 37 6 116 53 1,365 Sundries 4,521 349 19 89 43 5,021 Totals 7,958 528 51 269 615 9,421 In 1926 the number of articles disinfected was 7,268. The number of journeys made by the disinfecting vans during the year ended December, 1927, was:— January 66 August 72 February 65 September 63 March 76 October 73 April 78 November 78 May 79 December 87 June 75 July 54 861 The number of journeys made during 1926 was 660. 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 41 5 5 1 52 February 45 5 5 — — 55 March 56 2 4 — — 62 April 42 3 3 3 — 51 May 61 4 — 1 — 66 June 44 8 — — — 52 July 47 12 5 1 - 65 August 94 12 3 — — 109 September 41 3 1 — — 45 October 54 2 — — — 56 November 55 3 — — — 58 December 34 8 42 Totals 614 67 26 6 — 713 49 The number of rooms disinfected in 1926 was 821. At the request of the Public Libraries Committee, 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 153. 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 1927, and annually since 1910:— 1927 ADULTS CHILDREN Males Females Total Males Females Total January 224 53 277 42 184 226 February 217 53 270 39 206 245 March 248 92 340 79 309 388 April 216 80 296 20 147 167 May 237 91 328 32 296 328 June 221 79 300 85 181 266 July 243 72 315 60 175 235 August 244 90 334 5 44 49 September 223 94 317 31 223 254 October 168 57 225 55 166 221 November 137 43 180 42 175 217 December 200 53 253 41 87 128 Totals 2,578 857 3,435 531 2,193 2,724 Cleansing Station Attendances, 1910-1927. Year. ADULTS CHILDREN Males Females Total Males Females Total 1910 6,433 2,051 8,484 513 859 1,372 1911 6,510 2,575 9,085 504 463 967 1912 5,818 2,384 8,202 740 1,138 1,878 1913 5,797 2,208 8,005 771 1,305 2,076 1914 5,555 2,379 7,934 623 1,243 1,866 1915 3,323 1,672 4,995 589 1,091 1,680 1916 1,919 1,158 3,077 905 1,288 2,193 1917 1,947 967 2,914 1,376 1,699 3,075 1918 2,031 1,085 3,116 1,249 1,474 2,723 1919 2,082 1,063 3,145 981 2,132 3,113 1920 2,669 893 3,562 1,059 2,802 3,861 1921 3,486 1,287 4,773 715 2,802 3.517 1922 2,936 1,063 3,999 429 2,876 3,305 1923 2,907 993 3,900 305 2,528 2,833 1924 3,306 1,081 4,387 373 2,543 2,916 1925 2,969 1,009 3,978 196 2,317 2,513 1926 2,803 848 3,651 451 2,522 2,973 1927 2,578 857 3,435 531 2,193 2,724 The total attendances since the Baths were opened in 1898 number 241,409 (adults, 174,481 ; children, 66,928). 50 BACTERIOLOGICAL EXAMINATIONS. The following table shows the number of specimens examined for purposes of diagnosis, and indicates also the diseases in relation to which the examinations were made. The work, as formerly, was carried out by Dr. Foulerton, at University College. 1927. Positive. Negative. Total. Typhoid fever 2 34 36 Diphtheria 50 1,660 2,710 Phthisis 2 34 36 Totals 54 1,728 1,782 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 1927. 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, as is shown in the accompanying time-table, 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. The Schick Testing, etc., Clinic, though not in operation until the close of the year is also held at Salisbury Street. Here also there is a light clinic which is open on two days per week. 51 INFANT WELFARE CENTRES, MATERNITY CLINICS AND DAY NURSERIES. *30, Marylebone Lane— Monday, 4.80 p.m Maternity Clinic. Tuesday, 10.30 a.m Infant Consultation. Thursday, 2 p.m, „ ,, Middlesex Hospital— Monday, 1.30 p.m Infant Consultation. Wednesday, 2 „ „ „ Friday, 10.30 a.m. „ „ Thursday, 1.30 p.m. Toddlers (2—5). *Cosway Street— Tuesday, 1.30 p.m. Infant Consultation. Friday, 10.30 a.m ,, „ Thursday, 2 p.m Needlework Class. Queen Charlotte's Hospital— Daily, 9.30 a.m Maternity Clinic. Wednesday, 2 p.m Infant Consultation. *14, Salisbury Street— Monday, 2 p.m. Infant Consultation. Tuesday, 2 „ „ „ Wednesday, 2 „ Maternity Clinic. Do. Massage Clinic. Thursday, 1.30 „ Toddlers (2—5). Friday, 2 „ Infant Consultation. Friday, 2.30 ,, Massage Clinic. Wednesday, 10 a.m. Light Clinic. Friday, 10 ,, do. Thursday, 2 p.m. Needlework Class. *Mansergh Woodall Club, 24, Hill Road— Wednesday, 2 p.m Infant Consultation. Do, Maternity Clinic. Western General Dispensary, Cosway Street— Monday, 2 p.m Infant Consultation. Thursday 10 a.m „ „ Church Army Dispensary, Bryanston Street— Tuesday, 2,15 p.m Infant Consultation. *12, Salisbury Street— Tuesday, 4 p.m Dental Clinic. *Day Nurseries— *The Crossley, Barrow Hill Road. *The Portman, Exeter Street. * Provided by the St. Marylebone Health Society 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 1927 the health visitors made 11,090 visits; children are visited up to school age. 52 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 more of the health visitors assist at the various consultations. Children attend up to school age.—(3) 24, Hill Road. Infant consultations under medical supervision are 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.—(4) 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. On account of the demolition of the premises the consultations formerly held at Ogle Mews, Ogle Street, W.l, were discontinued at the middle of the year, accommodation being found for those attending at Middlesex Hospital. In addition to these centres, consultations are held weekly at Queen Charlotte's Hospital, 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 hospital there are ante-natal clinics 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. Schick Testing, etc., Clinics —As already indicated arrangements for Holding clinics of this kind are made at Salisbury Street. The clinic was not in operation until after the close of the year. Hospital Treatment.—Children's cases are referred from the centres to the dispensaries and hospitals in the borough, and the Queen Charlotte's and Middlesex Hospitals are available for ante-natal and complicated maternity cases. By arrangement cases calling for special examination or treatment are referred by the doct&rs 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 1927 was 2.656, the total births numbering 3,800. The midwives living and practising in the borough number 4. Two conduct maternity homes which are registered by the L&ndon County Council. Work done during 1927.—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. 53 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDING 31ST DECEMBER, 1927. CENTRE. No. 24 Hill Road. No. 14 Salisbury Street. Queen Charlotte's Hospl. Cosway Street. No. 30 Marylebone Lane. No. 8 Ogle Mews. The Middlesex Hospl- The Westn. Genl. Dispy. The Church Army Dispy. No. of consultations held:— Infants 92 149 51 98 90 20 166 90 51 Toddlers 70 51 — - — — 35 — 51 Maternity 43 48 307 — 40 —. 72 — 46 Massage — 95 65 - - - - - — Light — 93 - - - - - - - No. of attendances of mothers at clinic:— Ante-natal 57 162 11,525 — 12 — 2,656 — 92 Post-natal 71 387 8 — - - - — 915 No. of attendances of babies 1,915 4,139 2,165 1,965 1,433 360 4,604 434 772 No. of attendances of children over 2 years 384 1,229 471 440 239 217 1,300 919 388 No. of attendances at light Clinic - 2,377 - - - - - - - No. of orders issued for milk, etc. 76 488 68 136 100 23 96 - - No. of home visits 2,123 2,749 408 835 701 386 2,009 — 820 No. of new cases:— Infants 105 195 80 63 97 13 309 231 117 Toddlers 21 20 1 — 6 — 29 - 93 Ante-natal 10 41 3,282 — 9 — 426 - 30 Post-natal 28 36 7 — — — — - 102 Massage — 37 42 — — — — - — Light - 123 - - - - - - - Day Nurseries—Attendances during the year. *Closed at end of May. The Crossley Day Nursery, Barrow Hill Road 6,611 The Portman Day Nursery, Exeter Street 7,360 54 Dental Clinic, 12 Salisbury Street. Attendances during the year: Mothers, 947; Children 113. Advice and treatment given in 692 cases—extractions under gas, 368. 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 1927 was 3, and the total amount expended during the financial year to 31st March, 1928, was £6 5s. Light Treatment is provided to children and mothers at Salisbury Street on two days each week. From the following report by Dr. A. S. Craggs, the officerin-charge, it will be gathered that the results obtained in an appreciable percentage of the cases are regarded as extremely satisfactory. The apparatus used, it should be stated, was presented to the clinic by Frank Keevil, Esq., a member of a very large firm in the Borough. ARTIFICIAL SUNLIGHT CLINIC. Attendances for 1927-8. Individual Cases treated 115 Total Attendances 2,718 Average Attendance at each Session 26 The Actino-Therapeutic Section of the Marylebone Health Society was opened in February, 1927, and the following is a Report of its work during the year 1927-8. The Lamp used is a Sunrae Carbon Arc Lamp, and the dosage has been from three to fifteen minutes at a distance of three feet. We have found that the babies can take much larger doses than their mothers. Two treatments per week were given, and the courses varied from twelve to forty-eight treatments. Mothers.—-Only fifteen mothers have received treatment, but it is interesting to note that even mothers who merely sit and hold their babies while under treatment are heard constantly declaring in the waiting room that they feel benefit from such exposures. The majority of the fifteen mothers were suffering from those dreadful diseases—tiredness, depression, and utter hopelessness—and after three to four treatments the staff was amazed at their altered outlook on life and general physical uplifting. We very much hope that during the ensuing year the doctors of the centres will send us more mothers, as we feel that more advantage might be taken of the Clinic's possibilities in this direction. Children —The conditions we have treated may be divided roughly into three categories. Firstly, a considerable number of children suffering from anaemia, lack of appetite, sleeplessness and irritability, many of them either under weight or with a weight record that is extremely irregular. It was found in the latter case that treatment made little difference—the weight was still variable: the child who was very much under weight gained regularly, and in most cases the gain was in correct proportion to the age. Appetite, almost without exception, improved to a very noticeable extent; sleeplessness vanished and the irritable child became almost invariably contented. One case might be quoted here of a child — a girl of four — who was "wicked," disobedient, irritable, and full of fight. We took her for treatment partly because her brother and sister were having it, and she could not be left at home. To our amazement she became a model of propriety! Her case is one which we have been able to follow up, and we are pleased to say that this state has been maintained: long may it last! We had to tell her mother to keep it a secret as wq feared an influx of small patients suffering from " wickedness." 55 Secondly, a large group of throat and lung cases. The treatment of chronic septic tonsils has been disappointing, and those cases of repeated bronchitis accompanying such tonsils have shown little improvement, though as a rule the mother has said that the attacks are milder. Apart from this, the reports from the clinic doctors on their bronchitic patients have been good. The asthma cases do surprisingly well. The child who is constantly catching cold has been greatly benefited, as also the type of child that catches cold with every tooth it cuts. Thirdly, a group comprising various conditions. Thei general good effect on the debility following such illnesses as measles, whooping-cough, etc., is very marked and shows itself rapidly. The improvement in the rickety child is quite definite, but the treatment must be prolonged. The results in cases of impetigo are so very satisfactory that it is to be hoped that every one will be sent up to the Sunlight Clinic, as comparatively few doses are usually sufficient, even in severe cases. In one case of severe chilblains of the toes, treatment gave a cure, but the patient has' only just finished his course, so whether it is permanent remains to be proved. Enlarged cervical glands due to septic tonsils have not responded to treatment, but one case of a discharging tuberculous gland of long standing completely healed up after six doses. Two cases of nocturnal enuresis showed some improvement; others were unaffected. We have one case of diabetes recommended to us by Dr. Cameron of Guy's Hospital, which, from his report, is making good progress. Another interesting case is one of a child whose teeth had developed no enamel and whose blood showed a calcium deficiency. It is too early yet to say whether we are doing any good. What of the subsequent history of these patients? We have endeavoured to see them every six weeks for a space of six months after finishing their treatments, in order to judge whether progress is maintained. We have thus been able to follow up forty-two cases, and we have to report that of these nine were sent back for further treatment, at the end of six weeks: three after four months : ten are very well up to date: twenty have reached the end of six months and have maintained their good condition. Many who were ordered back for further treatment picked up again very quickly. Our X-ray examinations and reports have been disappointing, but we hope to get better results in the future. I should like to say a word in conclusion in praise of the untiring energy of the Superintendent, Miss Hale, and the generous enthusiasm of Miss Lang and other voluntary workers, which has contributed so much to the efficient working of the Clinic. 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:— 56 Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1927. 1927. Males. Females. Total. For burial only. For inquests. Total. No. of P.M.'s held. No. of courts held. No. of Infectious cases. January 13 20 33 16 17 33 15 8 - February 9 7 16 7 9 16 9 6 — March 10 9 19 8 11 19 9 5 — April 13 6 19 9 10 19 7 7 — May 9 8 17 13 4 17 5 4 — June 7 8 15 8 7 15 5 4 — July 4 2 6 5 1 6 1 1 — August 7 7 14 8 6 14 7 3 — September 8 6 14 3 11 14 6 7 1 October 5 8 13 10 3 13 5 4 — November 13 17 30 21 9 30 9 6 - December 14 10 24 16 8 24 10 6 1 Totals 112 108 220 124 96 220 88 61 2 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, 40 flats." This indicates the completion of the 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 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. The total number of families housed is 130, the majority being persons who were dishoused when the site was cleared. That this would be so was anticipated as it was also anticipated that the scheme itself would help very little towards a reduction of the housing shortage in the borough as a whole. As a matter of fact, so far as this is concerned, the chief reliance is still and will continue to be upon the London County Council, who during the year found accommodation for 192 families living in the borough under overcrowded conditions. 57 In the matter of housing, what is now looked forward to, is the effect that will be produced if and when the Carlisle Street area is dealt with. During 1927 a certain amount of progress was made in connection with this, as a result of negotiations between the Borough Council and the London County Council; the latter body expressed willingness to undertake responsibility for the area and more or less proceedings had to be recommenced. On the 28th November, 1927, a fresh representation was made to the London County Council under Section 35 of the Housing Act, 1925. The area referred to in the representation extends to 8.05 acres and affects 2,832 persons. Having received the representation the County Council passed the necessary resolutions and by the end of the year most of the necessary investigations had been made and steps taken preparatory to the holding of a local enquiry in the early part of 1928. The decision as to this had not been received from the Ministry of Health when the year closed but it was confidently expected and was, in fact, given soon after the New Year opened. 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 fbr occupation of houses, was not taken advantage of during the year, no application being received. Number of new houses erected during the year : (a) Total (including numlers given separately under (b) 10 houses and 268 flats. (b) With State assistance under the Housing Acts : (i) By the Local Authority 40 flats (ii) By other bodies or persons Nil 1. Inspection of dwelling-houses during the year : (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,478 (2) Number of dwelling-houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925— Houses 731 Tenements in blocks 253 (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 1,982 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) 1,869 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 58 (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) 95 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 95 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11,14 and 15 of the Housing Act, 1925 : (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (8) 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. (1927. 103,500 estimated). Number of inhabited houses (1921), 18,507. Number of families or separate occupiers (1921). 27,214. Rateable value. £2,768,805. Sum represented by a penny rate. £'11,050. Extracts from Vital Statistics of the Year. Births— Total M. F. Birth Rate, 13.2 Legitimate 1,202 619 583 Illegimate 172 78 94 Deaths, 1,262 Death Rate, 11.3. Number of women dying in, or in consequence of, childbirth—from sepsis, 1; other causes, 2. Deaths of Infants under 1 year of age per 1,000 births:— Legitimate 53. Illegitimate 99. Total 59. Deaths from Measles (all ages), 9. Deaths from Whooping Cough (all ages), 11. Deaths from Diarrhœa (under 2 years of age) 13. 59 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 109 Cowhouses 1 Slaughterhouses 1 Offensive Trades 3 Ice Cream Premises 121 Bakehouses 54 Restaurant, Dining Room and Coffee Shop Kitchens 194 Hotel Kitchens 20 Pastrycooks and Tea Rooms 68 Fried Fish Shops 24 Fish Curers 5 Houses Let in Lodgings 1,055 Workshops and Workplaces 3,688 Total 5,838 Smoke Nuisances. Number of Observations 246 Number of Nuisances and Complaints 7 Number of Notices 7 Number of Summonses Nil Housing of the Working Classes. Number of Houses inspected— Number of Representations by (a) On account of complaints Medical Officer or other or illness (P.H. Act) 2,478 person One (b) House-to-house (Housing Consolidated Regula- Number of Houses included in tions, 1925) 731 such representations 310 Tenements in blocks 253 Number of Closing Orders made Nil Number of Notices served— (a) Under P.H. ActNumber of Closing Orders determined (i.e, Houses made fit) (1) Intimation 1,869 (2) Statutory 95 Number of Demolition Orders Nil (b) Under Housing Act Nil Number of Houses repaired or Number of Houses demolished- nuisances remedied under P.H. pursuance of Orders Nil Act 1,982 (b) Voluntarily Nil Number of Houses repaired Total Number of Houses in the under Section 3 of Housing borough 19,287 Act (a) By Owners Nil Number of Houses occupied (b) By Local Authority in the Worklng Classes 8,226 default of Owners Nil Number of Houses registered Number of Houses closed on under the new Bye-laws as to Notice by Owner that they Houses Let in Lodgings Nil could not be made fit Nil Number of Inspections made of Number of Houses for theWork- such Houses Nil ing Classes— Number of Prosecutions Nil (a) Erected during year 40 flats (b) In course of erection Nil Mortuary. Number of bodies received 220 Number of Infectious bodies received 2 Disinfection. Number of rooms disinfected 713 Number of articles disinfected 9,421 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total Number of persons cleansed 2,578 857 531 2,198 6,169 60 Bakehouses. Number on Register at end of 54 Number above ground g Number underground 49 Number of Inspections 13(5 Number of Notices 16 Number of Prosecutions Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1927 810 Number of Inspections 947 Number of Notices 25 Number of Prosecutions Nil House to House Inspections. Number of Inspections Houses 731 Tenements 253 Number of Notices issued Intimations 437 Statutory Notices 35 Number of Prosecutions Nil House Refuse. Number of Inspections 5,018 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 149 Number of Notices issued. Intimations 180 Number of Statutory Notices 14 Number of Prosecutions 8 Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water has been provided to Upper Storeys 13 Number of Statutory Notices served 2 Number of Prosecutions 1 Overcrowding. Number of Dwelling Rooms overcrowded 192 Families were found Number Remedied accommodation on the Number of Prosecutions Nil L.C.C. Estates. Underground Rooms. Number dealt with 8 Number of Notices served under P. H. (L.) Act, 1891 ) 8 Number of Notices served under the Housing Act, 1925 Number of Prosecutions 1 Cleansing and Disinfection. Number of rooms cleansed 448 Number of Statutory Notices served 23 Number of Prosecutions 1 Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of Persons accommodated during the year 7 Drainage. Number of inspections made 5,439 Number of drainage plans deposited 492 Number relating to new buildings 68 „ „ old buildings 429 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops and Cowsheds 397 Number of Inspections 1,336 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 61 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1927 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Birhs Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. receted No. Nett of Non. residents registered in the District. of Residents not registerec in the District. Under 1 year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1911 117,844 4,130 2,375 20.2 1,578 14.2 600 840 261 109.8 1,818 16.3 1912 116,155 4,111 2,246 19.3 1.652 15.0 769 752 209 93.0 1,635 14.8 1913 114,532 3,804 2,146 18.6 1,629 14.9 755 753 195 90.0 1,627 14.9 1914 112,892 3,847 2,128 18.7 1,631 15.1 813 787 210 98.6 1,605 14.9 1915 100,260 3,647 1,852 16.2 1,741 17.2 817 773 178 96.1 1,697 17.8 1916 98,573 3,936 1,814 16.8 1,681 16.9 855 720 188 103.6 1,588 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 18.7 898 879 152 110.5 1,835 18.5 1919 97,953 3,625 1,492 14.6 1,724 17.3 864 708 147 98.5 1,568 15.9 1920 101,856 4,287 2,217 21.5 1,638 16.0 939 600 145 65.6 1,299 12.7 1921 105,200 3,393 1,939 18.4 1,625 15.4 877 607 128 66.0 1,355 12.8 1922 105,200 3,588 1,679 15.9 1,638 15.5 905 718 115 68.0 1,451 13.7 1923 105,400 3,601 1,668 15.8 1,468 13.9 827 594 111 66.0 1,235 11.7 1924 105,300 3,432 1,531 14.5 1,686 15.9 936 688 123 78.0 1,436 13.6 1925 106,100 3,418 1,496 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 1927 103,500 3,521 1.374 13.2 1,375 13.2 781 621 81 59.0 1,262 11.3 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. 62 TABLE I (a). Vital Statistics of Separate Localities in 1927 and the Ten Previous Years. Names of Localities The Whole Borough All Souls St. Mary Christ Church St. John Year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimatec 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 Populaton estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year a. b. c. d. a. b. c. d. a. b. C. d. a. b. c. d. a. b. C. d. 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 24,628 311 366 30 26,880 257 429 45 30,391 522 708 58 16,727 285 332 19 1919 97,953 1,492 1,568 147 24,381 311 316 27 26,731 272 408 34 30,210 584 560 63 16,631 325 284 23 1920 101,856 2,217 1,299 145 25,352 450 252 28 27,796 439 366 27 31,414 933 446 71 17,294 395 235 19 1921 105,200 1,939 1,355 128 26,184 390 268 29 28,709 445 345 27 32,445 720 455 55 17,862 384 287 23 1922 105,200 1,679 1,451 115 25,202 318 286 18 26,943 405 415 21 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 1925 106,100 1,496 1,257 94 25,425 265 234 10 27,172 348 339 19 33,024 593 426 56 20,479 290 258 9 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 Averages of Years 1617 to 1926 102,413 1,626 1,437 130 25,000 321 271 22 27,061 336 384 28 31,736 650 500 60 18,614 317 281 19 1927 103,500 1,374 1,262 81 24,794 225 241 14 26,509 282 377 17 32,218 615 406 37 19,979 252 238 13 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 63 TABLE II. Notifiable Diseases During the Year 1927. 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 6 to 15 15 to 25 25 to 45 45 to 65 65 and wards Diphtheria 160 8 56 73 9 14 — — 158 12 1 2 7 2 — — — — Erysipelas 36 1 — 4 3 8 13 7 23 - - - - - - - - - Scarlet Fever. 178 — 54 95 16 12 1 — 170 1 - — 1 — — — - - Enteric Fever (ineluding Paratyphoid) 17 - - 4 6 4 3 - 16 2 - - - — 2 - - — Puerperal Fever 1 — — — — 1 - — 1 1 — — — — — 1 - - Puerperal Pyrexia 35 — — - 15 20 - - 31 - - - - - - - - - Cerebrospinal Fever 2 — 2 — - - - - 2 - - - - - - - - - Tuberculosis, Pulmonary . 155 - - 6 38 63 43 5 60 76 - — - — 13 24 28 11 Tuberculosis, Non-Pulmonary 35 1 6 8 7 10 3 — 21 18 2 1 5 2 2 2 2 2 Acute Poliomyelitis 3 — 2 - - 1 - - 3 - - - - - - - - - Ophthalmia Neonatorum 12 12 — — — - - - 4 — — — — — — — - Encephalitis Lethargica . 3 — - 1 — 2 — — 2 2 — - — — — 2 — Pneumonia 45 2 4 3 6 20 9 1 6 12 1 — — 1 2 3 2 3 Malaria 3 — — — — 3 — — 3 — — — - - - - - - Dysentery 1 — - — — 1 — — 1 — — — — — — — - - Totals 686 24 124 194 100 159 72 13 501 124 4 3 13 5 19 32 32 16 64 TABLE II. (A). Cases of Infectious Disease Notified during the 52 weeks ending 31st December, 1927. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolatec at home. At all ages. At Ages—years. All Souls. St. Mary. Christ Church St. John. Totals. All Souls, St. Mary. Christ Church. St. John. Totals. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Smallpox - - - - - - - - - - - - - - - - - - - Cholera - — - - - - - - - - - - - - - - - - - Diphtheria, including Membranous Croup 160 8 56 73 9 14 - - 14 46 76 24 160 14 46 74 24 158 2 36 1 — 4 3 8 13 7 10 13 8 5 36 7 9 4 3 23 13 Scarlet Fever. 178 — 54 95 16 12 1 — 34 43 82 19 178 34 42 79 15 170 8 - - - — — — — — — — — — - - - - - - - Enteric Fever 5 — — — 1 1 3 - 2 2 1 - 5 1 2 1 - 4 1 Paratyphoid Fever 12 — — 4 5 3 - — 5 1 5 1 12 5 1 5 1 12 - Relapsing Fever — — — — — — — - — - - - - - - - - - - Continued Fever — — — — — — — - - - - - - - - - - - - Puerperal Fever 1 — — — — 1 — - 1 - - - 1 1 - - - 1 - Puerperal Pyrexia. 35 — — — 15 20 — — 5 10 6 14 35 4 9 5 13 31 4 - — — — — — — — — - — — — — - - - - - Glanders - — — — — - - - - - - - - - - - - - - Farcy - — — — — - - - - - - - - - - - - - - Anthrax - — — — — - - - - - - - - - - - - - - Cerebrospinal Fever 2 - 2 — - - - - - 1 - 1 2 - 1 - 1 2 - Tuberculosis- Pulmonary 155 — — 6 38 63 43 5 30 51 54 20 155 13 23 18 6 60 95 Non-Pulmonary 35 1 6 8 7 10 3 — 6 10 15 4 35 1 7 9 4 21 14 Acute Poliomyelitis 3 — 2 — — 1 - - - 1 - 2 3 - 1 - 2 3 - Polio-Encephalitis — — — — - - - - - - - - - - - - - - - Ophthalmia Neonatorum 12 12 - - - - - - 3 3 6 - 12 1 1 2 - 4 8 Encephalitis Lethargica 3 — — 1 - 2 - - - 1 2 - 3 - - 2 - 2 1 Pneumonia 45 2 4 3 6 20 9 1 6 7 21 11 45 2 1 1 2 6 39 Malaria 3 - - - - 3 - - - - 3 - 3 - - 3 - 3 - Dysentery 1 — — - - 1 - - - - - 1 1 - - - 1 1 — Trench Fever - — — — — - - - - - - - - - - - - - - Totals 686 24 124 194 100 159 72 13 116 189 279 102 686 83 143 203 72 501 185 Cases of mistaken diagnosis are not excluded from the above table 686 65 TABLE III.—Causes of, and Ages at Death during the year ending 31st December, 1927. No. CAUSES OF DEATH. Net deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church, St. John. Total. All Ages. Under 1 1 and under 2 2 and under 5. 5 and under15 15 and under 25. 25 and under 45. 45 and under65 05 and under 75. 75 and upwards 1 Enteric Fever 2 - - - - 2 — — — — — — 2 — — 2 2 Small Pox — — — — — — — — — — - — — — - - 3 Measles 9 3 5 — 1 - - - - - - 1 2 6 - 9 4 Scarlet Fever 1 - — 1 — — — — — — — — — 1 - 1 5 Whooping Cough 11 7 3 1 - - - - - - — 1 4 5 1 11 6 Diphtheria 12 1 2 7 2 — — — — - — 1 2 7 2 12 7 Influenza 42 1 1 — — — 7 11 11 11 4 11 8 16 7 42 8 Encephalitis Lethargica 2 — — — — — 2 — — — 1 — 1 1 — 2 9 Meningococal Meningitis 2 — 1 1 — — — — - - 1 - 1 1 - 2 10 Tuberculosis of Respiratory System 76 - - - — 13 24 28 9 2 10 20 21 25 10 76 11 Other Tuberculous diseases 18 2 1 5 2 2 2 2 1 1 10 4 3 8 3 18 12 Cancer, Malignant Diseases 154 — — 2 — 1 15 71 43 22 245 36 47 39 32 154 13 Rheumatic Fever 1 — — — — — 1 — — — — — 1 — — 1 14 Diabetes 21 - - - - - — 11 4 6 6 4 5 6 6 21 15 Cerebral Hæemorrhage, etc- 53 — — — — 1 1 23 13 15 25 14 17 11 11 53 16 Heart Disease 182 — — 1 — 3 12 57 51 58 101 35 55 59 33 182 17 Arterio-sclerosis 71 - - - - - — 9 31 31 6 17 21 18 15 71 18 Bronchitis 86 3 — — — — 4 19 25 35 12 8 27 43 8 86 19 Pneumonia (all forms) 105 11 6 3 2 3 15 28 18 19 76 16 37 31 21 105 20 Other Respiratory Diseases 20 1 2 — — 1 2 9 2 3 7 2 6 7 5 20 21 Ulcer of Stomach or Duodenum 14 — — — — — 5 8 — 1 10 4 4 2 4 14 22 Diarrhoea, etc 15 12 1 — 1 — — 1 — — 2 2 6 5 2 15 23 Appendicitis 9 — — — 2 1 4 1 — 1 16 1 4 3 1 9 24 Cirrhosis of Liver 12 — — — — — 1 9 2 4 2 4 2 4 12 25 Acute and Chronic Nephritis 43 — — — — — 5 17 12 9 27 9 11 13 10 43 26 Puerperal Sepsis 1 - - - - - - - - - 4 — 1 - - 1 27 Other accidents and diseases of Pregnancy and Parturition 2 — — — — 1 1 — — — 19 — 1 1 — 2 28 Congenital Debility and Malformation, including Premature Birth 32 30 - - 1 - 1 - - - 49 5 6 12 9 32 29 Suicide 15 — — — — — 7 7 1 — 6 2 6 5 2 15 30 Other Deaths from Violence 33 1 2 — 1 3 3 8 7 8 28 4 11 12 6 33 31 Other defined Diseases 218 9 3 1 6 6 25 72 42 54 193 42 63 67 46 218 32 Causes ill-defined or unknown - - - - - - - - - - - - - - - - Totals 1262 81 27 22 18 37 138 391 272 276 862 241 377 406 238 1262 66 vaccination returns. Return for 1926. Return made to the Board of Guardians and Ministry of Health on the 9th February, 1928, 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, 1926, 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., 1926 Number of these Births duly entered by 31st January, 1928, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1926, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1928, neither duly entered in the "Vaccination Register" (columns 3, 4. 5. 6 and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9 and 10 of this Return) Number of Certificates of Successful Primary Vaccination at ALL AGES received during the calendar year 1927 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth ol the children to which they relate during the calendar year 1927 Col. I. Success fully Vaccinated Col. II. Col. IV, Number in respect of whom Certificates of Conscientious Objection have been received 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 Insuscep tible of Vaccination Had SmallPox 1 2 3 4 5 6 7 8 9 10 11 13 1. North Marylebone 635 373 5 — 124 31 15 12 37 38 2,393 410 2. St. Mary 1,992 1,471 — — 177 92 15 215 7 15 8. All Sonls 596 360 6 — 87 24 7 91 5 16 Total 3,223 2,204 11 — 388 147 37 318 49 69 2,393 410 Dated 9th February, 1928. (Signed) GEORGE H. BASSETT, Vaccination Officer. v * - =\ •*••• - " v V