AC 4353 STMARY 33 Metropolitan Borough of St. Marglebonte. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1928. 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. 1929 Metropolitan Borough of St. Marglebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1928. 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. 19 2 9 Vail and Co., Printers, Farringdon Road, E.C. 1. Public Health Department, Town Hall, Mahylebone Road, N.W.I. 3rd May, 1929, 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 1928. It is like the last, an "ordinary" report, and less detailed than the "Survey" reports, the last of which was submitted in 1925. The year 1928 was interesting for several reasons, particularly, perhaps, because it saw housing on the Carlisle Street area advanced beyond the local enquiry stage and on account of the occurrence of a small though sharp outbreak of smallpox in the St. Marylebone Home and Hospital. Apart from measles, which was more or less epidemic throughout London, disease was not more prevalent than in other years, and in general the healthiness of the borough, as judged from statistics, was satisfactory. For a variety of reasons, some of which are given, the year was a heavy one. Throughout, the Public Health Committee, under the chairmanship of Mr. Alderman Brooks and later Mr, Councillor P. O'Connell, gave real support and encouragement and showed every kindness and consideration. For this I desire to express ray sincere appreciation and thanks, as I do also to the members of the staff whose industry and loyalty were unfailing. 1 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 oj the Maternity and Child Welfare Act, 1918). 1928. His Worship the Mayor (Councillor R. Stiles Allen, 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 9 Removal of Offensive Refuse 0 Sanitary circumstances of the Borough 9 Staff 9 Nuisances 10 Inspections 11 Nuisances—Legal Proceedings 11 Rat Repression 12 Fouling of Footways by Dogs 12 Smoke Nuisances 61 Premises and Occupations controlled by By-laws and Regulations 13 Business Premises13 Cow Sheds 13 Milk Premises 13 Slaughterhouses 13 Offensive Trades 13 Ice Cream Premises 14 Butter, Margarine, etc., Premises 14 Bakehouses 14 Fried Fish Vendors and Fish Curers 14 Food Stalls 14 Factories and Workshops 14 Inspections 15 Defects found 15 HomeWork 16 Registered Workshops 17 Other matters 17 Rag Flock 17 Premises used for Human Habitation 17 Houses let in lodgings 17 Common Lodging Houses 18 Underground Rooms 18 Lighting of Staircases in Tenement Buildings 18 Premises that are not but should be Registered 18 Food— Milk Supply 19 Milk Analysis 19 Legal proceedings for adulteration 19 Bacteriological examination of Milk 19 Dairies, Cowsheds and Milkshops Orders 19 The Milk (Special Designations) Order 20 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 22-25 Statistical— Births 25 Birth Registration 25 Birth Notifications 25 Deaths and Death Kates 26 Sub-District Births 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 ,, ,, Causes 28 Maternal Mortality 30 Deaths in relation to Disease 30 Diarrhœal Diseases 30 Infectious (Communicable) Diseases 30 Phthisis and other Tuberculous Diseases 30 Respiratory Diseases 31 Cancer and Malignant Disease 31 Accident, Suicide ana Manslaughter 32 Prevalence of and Control over Infectious Diseases 32 Isolation of Cases 32 Discharge Notices 33 Diphtheria and Membranous Croup 33 Schick Testing and Diphtheria Immunization 33 Scarlet Fever 34 Enteric Fever 34 Cerebro-Spinal Fever 34 Encephalitis Lethaigica 35 Polio-Myelitis 35 Erysipelas 35 Puerperal Fever 35 Puerperal Pyrexia 35 Measles and German Measles 35 Whooping Cough 35 Glanders and Anthrax 35 Smallpox 36 Infectious Diseases in Schools 39 Ophthalmia Neonatorum 39 Influenza 40 Pneumonia 40 Tuberculosis 40 Treatment 40 Public Health (Prevention of Tuberculosis) Regulations, 1925 40 Notifications 38-41 Prevention of 43 Care Committee 43 Work and Dispensaries 43 Deaths 50 Bacteriological Diagnosis of 44 Disinfection 52 Cleansing of Persons 53 Bacteriological Examinations 54 Maternity and Child Welfare 54 Health Visitors 55 Centres 55, 56 Ante-Natal Work 56 Dental Clinic 56, 57 Massage Clinics 56 Schick Testing, etc., Clinics 56 Hospital Treatment 56 Maternity Cases 56 Infant Consultations—Work at 57 Day Nurseries 57 Home Helps 58 Light Treatment 58 Sanitary Administration— Staff 9, 58 Report of Mortuary Keeper 58 Housing 59 Statistics 60 Sanitary Inspection (Summary) 61 Ministry of Health, Tables I—III 64-68 Vaccination Returns 69 7 THE YEAR 1928 POPULATION. The population of the Borough when the Census was taken on June 19th, 1021, 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 1928 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 1927. 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. 1927 103,500 24,794 26,509 32,218 19,979 1928 104,000 24,915 26,638 32,371 20,076 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 46 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.—Twenty-one certificates were granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. The number in 1927 was nineteen. In two instances the application had reference to supplies derived from borings within the curtilage of the piemises, viz.: Abbey Lodge, Park Road, and the new flats, Baker Street Station. The certificates will only be granted after the approval of the Metropolitan Water Board has been obtained and a satisfactory report upon the water after analysis has been submitted. On 3 occasions intimation notices weret 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 one case. In two cases the supply was provided after the issue of a statutory notice. Drainage. The total number of drain inspections made during the year was 5,433, as against 5,439 in 1927. The total number of plans deposited was 428 in respect of 545 premises, the number in 1927 being 492. 8 Plans relating to new buildings numbered 138, the number deposited in 1927 being 68. In the case of old buildings, the number of plans received was 290, as against 429 in 1927. On five 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 three cases, the fines and costs imposed amounting to £16 10s. Od. Combined Drainage.—Orders as to combined drainage were issued by the Council in respect of 35 premises. The number in 1927 was 26. 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 males; the women inspectors 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, 1929, and the amount of increase or decrease as compared with the previous year. 1929 1928 Increase Decrease £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus —Men's Department 912 10 3 921 16 10 - 9 6 2 „ Women's „ 1,424 5 7 1,484 17 3 - 60 11 8 Gt Portland Street—Men's „ 259 9 2 255 15 9 3 13 5 - „ Women's „ 265 2 11 205 17 3 - 0 14 4 Marylebone lioad—Meu's „ „ Women's „ 295 10 9 244 18 1 50 12 8 - 379 1 10 236 10 3 135 11 7 - Foley Street—Men only „ 149 19 2 147 10 9 2 8 5 - St. John's Wood Road—Men only 110 8 1 111 10 1 - 1 2 0 Barrett Street—Men only „ 231 10 6 242 14 2 - 11 3 8 Salisbury Street— Men's Department 76 6 2 70 6 1 6 0 1 - 1 „ Women's „ 111 12 2 105 19 1 5 13 1 - £4,208 17 0 4,087 15 » 203 19 3 82 17 10 *One free urinette provided. ‡ Two free urinettes provided. Removal and Disposal of House Refuse. Throughout the year the arrangements in connection with scavenging remained in the hands of the Highways Committee and under the control of the Borough Engineer, Mr. James Gair. The disposal plant and methods fully described in my report for 1925 have undergone certain changes during recent times and further alterations are in progress or contemplated. It is proposed to give a full description of the system in the next "Survey" report when it is anticipated it will be nearing completion. The total amount of refuse collected for 9 the year ended 31st March, 1929, it may be mentioned, was 41,999 tons, as compared with 45,021 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 250 premises. During the year the inspectors made 3,275 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 cm the footway for collection from the kerb, 46 notices were served. Remedies in cach 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 partly in tuberculosis work), one chief and five assistant clerks and an office youth, with, in addition, at the Tuberculosis Dispensary, a sister and a clerk dispenser. The following list gives information with regard to qualifications, etc., of each of these officers as required by the Ministry of Health :— Medical Officer of Health and Administrative Medical Officer—Tuberculosis, and Maternity and Child Welfare: *Charles Porter, M.D., B.Sc., M.R.C.P. (Edin.), of the Middle Temple, Barrister-at-law. Deputy Medical Officer of Health (Part time) : Adam A. Turner, M.C., M.B., Ch.B. (Aberd.), D.P.H. (Medical Officer of Health, Finchley). Assistant Medical Officer of Health for Tuberculosis Purposes : *J. Donaldson Saner, M.B., C.M. (Edin.), D.P.H. Public Analyst (Part time) : J. F. F. Rowland, B.A., A.I.C. Bacteriologist (Part time) : A. G. R. Foulerton, O.B.E., F.R.C.S., L.R.C.P., D.P.H. *District Sanitary Inspectors. *Health Visitors. T. A. Cartledge, M.S.M. (a, b, c). Miss C. E. Durant (b, d, g). F. C. Cook (b, c). Miss C. Hale (d, e). W. H. Draper (a, b, c). Miss E. D. Mann (d, e, g). E. Lumley (a, b). Miss K. Stewart (d). T. W. Forbes (b, c). E. E. Willis, M.M., (a, b, c). *Tuberculosis Visitors. A. S. Wilson (a, b, c). Miss p A Baker (by Miss S. Kenion (e, dt g). 10 *Drainage Inspectors. H. H. Clay (a, b, c). T. Gorniot (Senior Sanitary *Tuberculosis Clerk—Dispenser. Inspector) (a). Miss M. T. Challis. *Food Inspector. Clerks. G. Smith (a, b, c). Chief Clerk : H. E. Curtis. A. H. James. *Outdoor Superintendent. W. J. Howe. G. W. Matthews. P. H, Hill (a, b, c). c D Turbayne. A. F. Trickey.. *Women Sanitary Inspectors and *Maternity and Child Welfare and Health Visitors. Tuberculosis Clerk. Miss D. Chabot (b, d. e, g). Miss J. Jones. Miss N. C. Stokes, R.R.C. Mortuary Keeper. (b, d, e, f, g). ^ H Spearg Cleansing of Persons Baths & Shelter. Disinfectors. Matron : Miss L. Kilgallin. J. C. Kendall. J. Overton. *Tuberculosis Dispensary. Messenger. Caretaker: E. D. Marston. J. Eatwell. * Officers to whose salary contribution is made under the Public Health Acts or by Exchequer grants. a Royal Sanitary Institute Certificate. b Certificate Sanitary Inspectors' Examination Board (London). c Meat and other Foods Certificate. d Health Visitors Diploma. e Central Midwives Board Certificate. f Certificate ot State Registration for Nurses. g Three or Four Years' Hospital General Training Certificate Nuisances.—In the following summary some idea of the amount of work done in relation to nuisances is given. For details of other works carried out by the inspectors, reference must be made to the sections dealing with housing, food, infectious diseases, etc. The total number of complaints of nuisance received was 2,175, as against 2,179 in 1927. 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, 140 statutory notices were issued, as against 144 in 1927. Of these notices, 99 related to ordinary nuisances (dirt, dampness, etc.), 23 to verminous rooms, 2 to drains, 2 to water supply in tenement houses, 13 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 40 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 4 instances there was failure to carry out works after receipt of statutory notice and legal proceedings were instituted. Details of these cases will be found under the heading "Legal Proceedings in connection with nuisances." The total inspections made by each inspector, and the number of nuisances of various kinds detected and remedied, are set out in the following table :— 11 Districts. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Houses damp, dirty or dilapidated remedied 184 170 274 280 136 49 1,093 Doors, windows, floors, ceilings sash cords, etc., repaired 196 136 254 65 44 39 734 Overcrowding abated - - - 1 1 2 4 Illegal occupation of underground rooms dealt with - - 8 1 4 - 13 Water closet defects remedied 119 132 136 188 145 75 795 Water closets erected 3 - - 23 1 16 43 Urinal defects remedied - - 4 1 - - 5 Soilpipes and ventilating shafts repaired or renewed 1 6 1 2 9 19 Yard defects remedied 90 84 53 128 53 12 420 Waste pipe defects remedied ... 11 16 14 12 9 2 64 Water cistern defects remedied 13 11 6 11 5 - . 46 Rubbish, manure, etc., accumulations removed 8 4 33 22 15 12 94 Dung or dust receptacles repaired or renewed 20 28 34 39 5 12 138 Drains relaid or amended 13 9 11 21 23 5 82 Drains cleared 3 23 7 5 15 2 55 Rainwater pipes repaired or renewed 16 7 12 14 29 7 85 Water supply to houses reinstated - - 14 4 - - 18 Roofs and gutters repaired 75 96 84 74 36 12 377 Area defects remedied 10 2 4 113 44 13 186 Wash-house defects remedied 102 82 80 72 76 5 417 Animal nuisances abated 2 1 23 7 1 1 35 Basement defects remedied 13 - 92 17 5 1 128 Stables cleansed or repaired ... 1 - 1 1 - - 3 Water supply laid on to upper storeys of house 1 - 1 1 - - 3 Miscellaneous nuisances abated 311 172 143 36 12 674 Verminous rooms cleansed 45 110 131 132 16 12 446 Workshops dirty, overcrowded, unventilated or defective, remedied — - - 4 3 38 45 Proceedings in Connection with Nuisances. The number of summonses issued in respect of nuisances during the year was four. 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. Offence. (Proceedings taken under the Public Health (London) Act 1891, etc.) Result. 73, Carlisle Street. Failure to comply with a statutory notice to execute certain sanitary requirements. Order made for work to be executed. Fined £2 and £2 2s. costs. 75, Do. Do. Do. 77, Do. Do. Order made for work to be executed, £1 1s. costs- 81, Do. Do. Do. 12 Rat Repression. The number of complaints received during the year, viz., 54, was lower by 6 than the 1927 figure. The investigation of these complaints necessitated the inspection of 54 premises, 24 of which were used for business purposes (5 of these for the preparation or storage of food), the remaining 30 being private or tenement houses. In 5 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 5th to the 10th November, 1928, 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. Fouling of Footways by Dogs. About the middle of the year a bye-law dealing with the matter of the fouling of footways by dogs came into operation, and leaflets in the following form were widely distributed and exposed on lamp-posts and elsewhere :— BOROUGH OF St. MARYLEBONE. FOULING OF FOOTWAYS BY DOGS. Attention is drawn to the provisions of the following Byelaw recently made by the St. Marylebone Borough Council, under which it is now a statutory offence punishable by a penalty not exceeding FORTY SHILLINGS for any person being in charge of a dog, to allow Or permit such dog to foul any public footway in the Borough, contrary to the terms of such Bye-law. The Council will be glad to receive the co-operation of residents in securing the enforcement of this Bye-law. Bye-Law. No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit excrement upon the public footway. Any person offending against this Bye-law shall be liable to a penalty not exceeding forty shillings. By Order, CHARLES PORTER, Medical Officer of Health. Town Hall, St. Marylebone, June, 1928. In enforcing the provisions of the bye-law great assistance was obtained from the police. There was one prosecution during the year on a report from a police constable, the defendant being fined 10/- and costs amounting to 10/6. 13 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 1928 N umber of notices 1928 Number of prosecutions, 1928 On register at end of 1927 Added in 1928 Removed in 1928 On register at end of 1928 A. Business Premises Milk premises 109 7 9 107 360 25 - Cowsheds 1 - - 1 27 - - Slaughterhouses 1 - - 1 87 - - Offensive trade premises 3 - - 3 70 - - Ice cream premises 118 - - 70 146 6 - Butter and Margarine facturers and Dealers 16 - - 16 26 - - Bakehouses 54 - - 54 126 10 - Fried Fish Shops 24 - - 24 70 6 - Fish Curers 5 - - 5 57 1 - B. Habitations Houses let in lodgings 1,055 - - 1,055 9.895 1,371 - Common lodging houses 5 - - 5 - - - A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 107. This is 2 less than in 1927, 7 having been added and 9 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 in previous reports 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 : during the year only 53 sheep, 9 lambs, and 1 bullock were dealt with. 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, afid in the remaining one that of poultry slaughtering'. 14 The Food Inspector made 70 visits, but no cause for complaint was found. Ice Cream Premises.—Following the coming into operation of the provisions of sec. 29 of the L.C.C. (General Powers) Act, 1928, requiring the registration of premises of this description, the number of persons irr the trade has greatly diminished. The actual number of premises included in the register at the end of the year was 70, as compared with 121 in 1927. Regular inspections were made throughout 1928, and in 6 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 1928 the number of bakehouses on the register was 54- Of the 54, 49 are underground bakehouses. In all, 126 visits were paid and 10 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. Regular visits of inspection were made and action taken where necessary to have any defects noted remedied. Food Stalls.—In spite of the efforts of the Highways Committee, which is responsible for the administration of the bye-laws relating to registration of street traders, the number of registered stalls from which food is sold in the market streets, particularly Great Titchfield Street, Church Street, Bell Street, Blandford Street, &c., is still regrettably large. Wherever possible, the Committee refuse to allot space for stalls from which food is to be sold, and in each case full enquiries are made and investigations of storage accommodation carried out. Where improvements are required and are possible, these are called for. If the conditions are unsatisfactory and irremediable, this is made a ground for refusal of registration. In one case during the year, in which a stallholder was found to be storing vegetables in a stable, proceedings were instituted and resulted in the defendant being fined £1 Is. with costs amounting to £2 2s. All food stalls are inspected daily by officers of the Public Health Department, a special feature being made of inspection over each week-end. Factories and Workshops. Though factories are comparatively few in the Borough, the number of workshops, many of them domestic workshops, is considerable, and work in relation to them bulks very large amongst the duties of the district inspectors, more especially those in charge of districts on the south of Marylebone Road. The staple industry is dressmaking, millinery and tailoring in all its branches. The total number of visits to factories, workshops and workplaces during the year was 2,946; 208 by the women and 2,738 by the men inspectors. The complaints received numbered 53. 15 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. Number of Premises Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories 73 10 - (Including Factory Laundries) Workshops 980 126 - (Including Workshop Laundries) Workplaces 1,893 31 - (Other than Outworkers' Premises included in Part 3 of this Report) Total 2,946 167 - 2.—DEFECTS FOUND. Number of Defects Number of Prosecutions Particulars Found Remedied Referred to H.M. tor (1) (2) (3) (4) (5) Nuisances under the Public Health Acts— Want of cleanliness 37 37 - - Want of ventilation 2 2 - - Overcrowding 6 6 - - Want cf drainage of floors 2 2 - - Other nuisances 31 31 - - Sanitary accommodation insufficient 3 3 - - unsuitable or defective 60 60 - - not separate for sexes 13 13 - - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (88. 97 to 100) 12 12 - - Other offences - - - - (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 166 166 - - 16 3.—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109,110 nature OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists Prosecutions. Instances. Notices served. Prosecutions. Instance. 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. Outworkers. Outworkers. Lists. Contrac tors. Workmen. Lists. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 65 198 987 ... ... ... 15 ... ... ... ... ... .. ... ... Total 65 198 987 ... ... ... 15 ... ... ... ... ... ... ... ... 17 5.—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. 318 Bakehouses 54 Total number of workshops on Register 3,701 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) 4 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 48 Reports (of action taken) sent to H.M. Inspector 48 Other Underground Bakehouses (s. 101):- Certificates granted during the year - In use at the end of the year 49 RAG FLOCK ACTS, 1911 AND 1928. There are no premises within the fristrict where rag flock is manufactured, used or sold. 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. 18 During the year under review, arrangements were made for compiling a new register and in connection with this and for purposes of supervision, some 9,875 visits were paid to the 1,055 houses on the old list. The number of notices served was 1,371, relating to cleansing and other defects. All of these were complied with without the necessity for further proceedings arising. Lighting of Staircases of Tenement Buildings.—In anticipation of the coming into operation of Sec. 61 of the L.C.C. (General Powers) Act, 1927, in respect of this matter, a complete survey was made into the conditions as regards lighting of staircases in such buildings, in the early part of the year, and reports as to the findings were submitted to and considered by the Public Health Committee. In most instances the existing arrangements were found to be satisfactory, and all that was necessary was to direct the attention of owners to the requirement as to the maintaining of artificial lighting from one hour after sunset until 11 p.m. In 28 cases in which there was either inadequate or no provision, notice was served, and at the end of the year the works called for in each instance had been completed or were well forward. Common ,Lodging Houses.—The following table contains all the necessary particulars with regard to the licensed premises of this class in the borough. Situation, etc., of Licensed Common Lodging Houses. Address. Registered Owner. Registered number of Occupants. 54, Bell Street Eliza Crew 55 men 2, Burne Street and Lisson Street W. Bramwell Booth 499 men 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 Countv Council directed to any matter calling for femedy. 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 13. 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 1928 there were 318, this number including: Restaurant, dining room and coffee shop kitchens, 194; tea-rooms and pastry-cooks, 76; 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. 19 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 1928 the total number of inspections was 816, the number of notices served being 21. 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 320. On examination by the Public Analyst 2 (.62 per cent.) were found to be adulterated. In 1927 the percentage was 2.9. 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 2. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 87 were obtained on delivery at Marylebone Station of the London & North-Fastern Railway. Of the 87, 2 proved to be adulterated, and proceedings were instituted and costs amounting to £3 3s. Od. 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. Costs. £ s. d. 1st 103 - - - - 2nd 72 2 2.8 2 3 3 0 3rd 81 - - - - 4th 64 - - - - Total for year 320 2 62 2 3 3 0 Bacteriological Examination of Milk.-With a view to testing the purity of milk from the bacteriological point of view, 12 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, 56 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.-Frequerit inspections of cowsheds and milk premises were made with the object of discovering whether or not the requirements of the regulations as to cleanliness, etc., were being complied with. In no case was it necessary to take action. Two prosecutions instituted against individuals charged with bottling milk in the street contrary to the provisions of the Milk and Dairies Order, 1926, resulted in the defendants being discharged under the First Offenders' Act on the payment of costs amounting to £3 3s. 20 The Milk (Special Designations) Order, 1923.-Under this Order 32 applications were received from 9 dealers in the borough for licence to sell milk as "Certified" Milk, or Grade "A" Tuberculin Tested Milk or "Pasteurised" Milk. As the milk in each case was obtained from a producer licensed under the Order and the premises of the applicants were found to be satisfactory, licences were granted as appropriate, the numbers being 9 ini respect of "Certified" Milk, 5 for Grade "A" Tuberculin Tested Milk, and 18 "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 to Mothers and Children.-During 1928 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1929, was £253 2s. 9d. as against £348 12s. l1d. up to 31st March, 1928. The actual number of cases dealt with was 188, and the number of orders issued 828. 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 week-end inspections in market streets, etc., were continued, and in carrying them out Inspector Simtli 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 1928. Meat- Beef 38 lbs. Mutton 54 lbs. Pork 1 Carcase (Tuberculous). „ 2 Heads „ „ 2 Plucks „ Bacon 6 cwt. Poultry- Geese 11 Fowls 2 Turkey 1 Fish- Wet-Cod 6 stone Skate 6 „ Roe 8 „ Herrings 1 box Dry-Haddocks 16 stone Shell-Crabs 1 barrel Mussels 1 bag Fruit- Cherries 2 baskets Pears 26 „ Grapes ... 4 boxes Tomatoes 40 lbs. 21 Miscellaneous- (Tinned Goods, etc.) Hams 18 Ox Tongues 92 Lunch Tongues 86 Spiced Beef 66 Beef and Tongue 74 Pork and Stuffing 42 Chicken and Ham Rolls 77 Corned Beef 31 Crab 1 Herrings 6 Cream 327 Condensed Milk 38 Grape Fruit 25 Potted Meat (Paste) 62 Brawn 24 Pork and Beans 3 Jellied Veal 5 Spiced Beel and Tongue 114 Chicken and Ham 39 Ham and Tongue 36 C.-SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,109. Of this number 3 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 0.27 per cent., the figure for 1927 being 0.9 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 (2) in which prosecutions were instituted. The following Tables and Report from the Public Analyst, Mr. J. F. F. Rowland, give full information with regard to samples submitted to and examined by him:- 22 ANNUAL REPORT OF THE PUBLIC ANALYST, 1928. The number of samples taken under the Sale of Food and Drugs Acts and submitted to analysis, was 1,109, an increase as compared with the samples for 1927, the number for that year being 1,070. A complete list is as follows: ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total 1 Apples - 3 - 3 2 Butter 26 132 - 158 3 Cheese - 53 - 53 4 „ Cream - 3 - 3 5 „ Lemon - 1 - 1 6 Chicory - 2 - 2 7 Chocolate, Milk - 3 - 3 8 Cocoa - 9 - 9 9 Coffee - 26 - 26 10 Coffee and Chicory Essence - 2 - 2 11 Cornflower - 4 - 4 12 Cream 33 1 - 34 13 „ Tinned - 3 - 3 14 Currants - 6 - 6 15 Custard Powder - 1 - 1 16 Cyder - 2 - 2 17 Flour, Self-raising - 5 - 5 18 Fruit, Dried - 4 - 4 19 „ Mixed - 2 - a 20 Gelatine - 3 - 3 21 Ginger Beer - 1 - 1 22 Golden Syrup - 1 - 1 23 Grape Fruit, Tinned - 1 - 1 24 Honey - 12 - 12 25 Jam - 45 - 45 26 Lard - 25 - 25 27 Lemon Curd - 2 - 2 28 Lemonade Powder - 8 - 8 29 Liquorice Powder - 1 - 1 30 Margarine - 46 - 46 31 Marmalade - 22 - 22 32 Milk 268 52 - 320 2 2 38 „ Condensed - 50 - 50 34 „ Dried - 2 - 2 35 Mince, Beef - 3 - 3 36 „ Meat - 3 - 3 37 Mustard - 14 - 14 38 „ Compound - 1 - 1 39 Oil, Camphorated - 2 - 2 40 „ Olive - 7 - 7 41 Ointment, Boric - 10 - 10 42 „ Mercuric - 1 - 1 43 „ Sulphur - 9 - 9 44 „ Zinc - 8 - 8 45 Onions, Pickled - 1 - 1 46 Paste, Fish - 10 - 10 47 „ Meat - 12 - 12 48 „ Sardine and Tomato - 1 - 1 Carried forward 327 615 942 2 2 23 ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total Brought forward. 327 615 - 942 2 2 49 Pearl Barley . - 3 - 3 50 Peas, Tinned - 3 - 3 51 Peel, Candied - 8 - 8 52 Pepper - 18 - 18 58 Pickles - 1 - 1 54 Prunes - 2 - 2 55 Quinine, Ammoniated Tincture of 1 - 1 56 Raisins - 14 - 14 57 Salad Dressing - 1 - 1 58 Sardines - 1 - 1 59 Sausages, Beef - 12 - 12 60 „ Pork - 12 - 12 61 Soda, Bicarbonate of - 1 - 1 62 Sponge Cakes - 6 - 6 63 Sultanas - 22 - 22 64 Sugar - 29 - 29 65 „ Granulated - 7 - 7 66 Sweets - 4 - 4 67 Tea - 16 - 16 68 Whiskey - 3 - 3 1 1 69 Wine, Blackcurrant - 1 - 1 70 „ Ginger - 1 - 1 71 „ Orange - 1 - 1 327 782 - 1109 2 1 3 Adulterated Samples, etc. Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 336 Milk Formal 13.3 per cent. deficient in milk fat. Defendant discharged under First Offenders Act. No fine imposed. On the first summons £2 2s. costs and on the second £1 1s costs. Both were station samples taken on delivery at Marylebone Station, London and North Eastern Railway. 338 Milk Formal 3.3 per cent. deficient in milk fat. 1109 Whiskey Informal 47.2° under proof, and contained 81.2 per cent. of 35° under proof whiskey and 18'8 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.—Of the 320 samples examined during the year 2 only were adulterated. This gives a percentage of only 0.625 as compared with the figure 2.93% for 1927. Leaving out the adulterated samples the average composition of the remaining 318 was as follows:- Year. Sp:Gr: Total Solids. Fat. Solids not Fat. 1927 1031.3 12.29 8.59 8.70 1928 1031.3 12.29 3.60 8.69 The average composition value has changed so little as to be negligible, and we may say that, except for the few samples found adulterated, the composition of nearly 600 samples has remained constant. Creams.—For the past two years attention has been drawn to the very considerable differences in quality which existed between the ordinary loose cream on the market and of that supplied in tins. After the passage of another year the position is still worse. The average amount of fat present in the loose creams taken in 1926 was 54.7; in 1927 the figure was 51.4%, while now in 1928 the value has fallen to 42.33%. An average drop of over 12% in two years. The figures for the tinned creams for the same years are:—In 1926, 28.87%; 1927, 25.6%; 1928, 28.73%. That is, having accustomed the public to some extent to be satisfied with a thin poor cream from tins, it seems as if an attempt were now being made fairly rapidly to reduce the quality of the loose creams so that no comment on the large discrepancy of quality will soon be possible, for both kinds may then be equally bad. Apples.—Three samples were examined during the year but no trace of arsenic was found to be present. This amount of evidence is, of course, too small to base any general conclusion upon, but so far as it goes it is satisfactory, and to that extent strengthens the steadily growing scientific opinion that little as the general danger of poisoning from apples ever, was, it is practically nil at the present time. Butter.—The new regulations for butter and milk are being stringently observed in this borough by all vendors of milk and butter from whom samples have been taken. Out of 158 samples of butter, all conformed to legal requirements as to standard of purity, and in not one was any preservative of any kind found. Lemon Cheese.—The one sample taken during the year contained starch. The main constituents of lemon cheese are:—sugar, butter, eggs and lemon. However, it has become a practice with manufacturers to add starch and even sometimes glucose to the other materials. As no legal standard has been laid down for lemon cheese, this product in common with so many other articles of diet which stand in the .same highly unsatisfactory position, is likely to suffer in quality more as the years pass and the thin end of the wedge of extraneous and cheaper ingredients is allowed to be more firmly inserted. It is often difficult to decide upon standard values for a marketed commodity, which are fair to all concerned. This is the case even with things in their natural state. How often has the minimum of 3.0% of milk fat in milk been called in question and an " appeal to the cow " made? If this is the state with a natural 25 product, how much more so must it be with a manufactured one? And once manufacturing processes are introduced, the statement so often made is that the addition of some entirely foreign and extraneous body helps the manufacturing process. Gradually this introduction of some foreign substance is accepted as part of the manufacturing process and a new factor and a fresh complication have arisen in the fixing of a standard which is acceptable and fair to manufacturers and public alike. Difficult as the problem is at present, each year adds to the difficulty and the earlier it is attacked and settled the better it will be for the public. Whiskey.—Out of three Informal samples examined, one was found to be adulterated. It was 47.2° U.P. and therefore contained only 81.2% of 35° U.P. whiskey with 18.8% added water. In conclusion it is very satisfactory to note that so few cases of adulteration occurred during the year, there being only 3 adulterated samples out of 1,109 taken, and to know that the steps taken to prevent adulterated products being sold are so effective. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1928 was 1,317*, being 57 more than in 1927. Of the children born, 669 were boys and 648 girls. The birth rate per 1,000 of the population was 12.6, as against 13.2 in 1927. The rates in tile several registration sub-districts of the borough were:— All Souls, 9.7; St. Mary, 10.7; Christ Church, 16.4; St. John, 13.2. Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,875; Live births, 3,667, Still births, 208. 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 33 0.9 ,, doctors 177 4.6 „ midwives 590 15.2 „ other persons 195 5.0 „ hospitals, etc. 2,880 71.3 3,875 Of the total births notified, 208 referred to still-births („4 males and 94 females) : 2,306 took place at Queen Charlotte's Hospital; 294 at Middlesex Hospital; 183 at St. Marylebone Home; and 995 were born at home. Of those notified as having occurred in St. Marylebone, 2,193 belonged to other Boroughs. Of the 208 still-births only 38 (15 males and 23 females) were to St. Marylebone mothers. . * This figure is exclusive of birth occurring in the Borough to persons usually non-resident therein, but includes 107 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:- Legitimate Males 60 ,, Females 70 Illegitimate Males 21 ,, Females 16 26 DEATHS AND DEATH RATES. The number of deaths registered in 1928 was 1,238. 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 „.14. In the previous year, the rate was „.35, and the number of deaths 1,262. The following short table shows the death rates in the several registration sub-districts in 1928. and compares them with those of the preceding: 5 years:- 1923 1924 1925 1928 1927 1928 All Souls 8.9 9.7 9.2 9.6 9.7 9.9 St. Mary 12.3 15.6 12.5 13.6 14.2 12.0 Christ Church 12.5 14.4 12.9 13.6 12.6 13.4 St. John 13.0 „.6 12.5 14.3 „.9 12.8 The Borough „.7 13.6 „.0 „.9 „.8 „.1 District births and deaths for the year ended 31st December, 1928, are given in the following table. A further table giving the vital statistics of separate A further table giving the vital statistics of seprate localities for 1928, and the ten preceding years will be found amongst the Ministry of Health Tables on page 65. Sub-District. Population estimated to middle of 1928. Males. Births. Females. Total. Males. Deaths. Females. Total. All Souls 24,915 121 1ll 232 125 123 248 St. Mary 26,638 139 146 285 159 140 299 Christ Church 32.371 274 259 533 227 207 434 St. John 20,076 135 132 267 „7 140 257 The Borough 104,000 669 648 1,317 628 610 1,238 The following tame snows the number 91 deaths mat took place amongst infants under 1 year and adults of 65 years and upwards in each of the four quarters of 1928. 1928. JanuaryMarch AprilJune July- Seplember OctoberDecember Total Infants under 1 year 40 33 „ 21 105 Persons of 65 years and upwards 172 136 80 146 534 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 plnce, is given in Table III of the Ministry of Health series at page 68. 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 868. *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 1928 is 0 944, and the corrected death rate is obtained by multiplying with this figure the number of deaths per 1,000, calculated from the total deaths and the population estimated to the middle of the year. 27 Fuller information than is possible in the table is given in the following pages, in which also the figures relating both to causes of death and the ages at which these causes were operative are analysed. INFANTILE MORTALITY. The infantile mortality rate of any district is the number of deaths of infants under one year of age per 1,000 of the births which occurred in the same year. The number of babies under one year who died in St. Marylebone in 1928 was 105, and the number of births in that year 1,317. The infantile mortality rate is therefore 79, which is higher by 20 points than the rate for 1927 (59), and 2 points below the figure for 1926 (81). The rate for 1927 (59) was the lowest on record for the Borough. The course which the rate has taken is graphically shown in the chart on page 29. 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 no more than give some sort of analysis of the figures relating to deaths amongst infants. Causes.—A Table (Ministry of Health Table 1.) 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 1928, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 35 were less than one month old when they died, and 53 less than three months. The figures for 1927 were 31 and 37. 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 33 deaths, three more than in the year 1927. Diarrhoea and enteritis (7 and 8) accounted for 12 in 1927, and for 17 in 1928. Respiratory diseases, the third of the main causes, took 14 in 1927, and in 1928, 20. The commoner infectious diseases together led to 21 deaths amongst infants, measles being responsible for 14 of these as it was responsible also for the general increase in the infantile mortality rate. One death was stated to be due to overlaying, 1 to tuberculosis, 2 to meningitis, and 17 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 46 deaths amongst infants. In 1927 the figure was 37. Sub-District. Under 1 week. 1 and under 2 weeks. '2 and under 3 weeks. 3 and under 4 weeks. 4 weeks and under 3 months. 3 and under 6 months. 6 and under 9 months. 9 and under 12 months. Totals. All Souls 1 1 2 1 5 4 5 2 21 St. Mary 2 4 - 2 3 2 4 - 17 Christ Church 9 3 - - 7 7 8 12 46 St. John 9 - 1 - 3 3 1 4 21 Totals 21 8 3 3 18 16 18 18 105 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 2 5 6 14 - 2 9 3 14 4 Scarlet Fever - - - - - - 1 - - 1 - - 1 - 1 5 Diphtheria and Croup - - - - - - 1 - 2 3 - - 2 1 3 6 Whooping Cough - - - - - 1 - 1 1 3 1 1 1 - 3 7 Diarrhœa - - - - - 1 1 - 1 3 - - 2 1 3 8 Enteritis - 1 - - 1 2 6 3 2 14 4 2 5 3 14 9 Tuberculous Meningitis - - - - - - - - - - - - - - - 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - „ Other Tuberculous Diseases - - - - - - 1 - - 1 1 - - - 1 12 Congenital Malformation 2 2 - 1 5 2 - - - 7 1 3 1 2 7 13 Premature Birth 14 4 2 - 20 1 - - - 21 3 3 10 5 21 14 Atrophy, Debility and Marasmus 1 - - - 1 4 - - - 5 1 - 2 2 5 15 Atelectasis 1 - - - 1 - - - - 1 - - - 1 1 16 Injury at Birth 2 - - - 2 - - - - 2 - 1 1 - 2 17 Erysipelas - - - - - - - - - - - - - - - 18 Syphilis - - - - - - - - - - - - - - - 19 Rickets - - - - - - - - - - 1 1 — - 2 20 Meningitis (not Tuberculous) - - - - - - - 2 - 2 - - 1 - 1 21 Convulsions - - - - - - - 1 - 1 1 - - - 1 22 Gastritis - - - - - - 1 - - 1 - - - - - 23 Laryngitis - - - - - - - - - - - - - - - 24 Bronchitis - 1 1 - 2 1 - - - 8 - 1 1 1 3 25 Pneumonia (all forms) - - - 2 2 4 8 5 3 17 7 3 7 - 17 26 Suffocation, Overlying 1 - - - 1 - - - - 1 - - - 1 1 27 Other Causes - - - - - 1 - 1 3 5 1 - 3 1 5 Totals 21 8 8 3 35 18 16 18 18 105 21 17 46 21 105 Legitimate, 1,170 Legitimate Infants, 89 Nett Births in tho Year Nett Deaths in the Year Illegitimate, 147 Illegitimate Infants, 16 Total 1,317 Total 105 29 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 9 and the maternal mortality rate 7 per 1,000 as against 3 per 1,000 in the previous year. Of the deaths 3 occurred on the same day as the birth of the child. In 3 cases the confinement took place at home, the remainder being at a hospital. One of the babies was stillborn: in one case, in which the death was due to eclampsia, the woman being in the 30th week of pregnancy, the child was undelivered, and in the remainder the baby survived the mother. In all except two cases the death appeared to be due directly to conditions arising out of the pregnancy or childbirth. In one of the exceptions the patient was suffering from paratyphoid fever, and in the other the causes of death shown on the certificate were " heart failure; bronchitis and asthma." Four of the women were attended by a medical practitioner, the remainder being under the care of a midwife. The ages of the patients were 41, 23, 37, 22, 31, 23, 22, 17 and 46 respectively and all but two were married. 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 68. This Table also shows the distribution of deaths according to causes in the various registration sub-districts. The lollowing notes with regard to certain of the causes which contribrtted most largely to the death rate, may be of interest. DIARRHCEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 22, equal to 0.19 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur among infants, and in 1928, as a matter of fact, all those who died, with the exception of 5, were less than 1 year of age. In 1927 the deaths from diarrhœal diseases numbered 15, all the victims being under one year of age, with the exception of 3. In 1928, therefore, there was an increase in the total, 17 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 13 deaths), the diseases contributing to the total of 83 deaths were— diphtheria, 12; scarlet fever, 2; whooping cough, 10; measles, 37; and as already noted, diarrhoea, 22. 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 92, which is lower by 2 than the figure 94 for 1927. The great bulk of the 92 deaths, viz., 86 was due to phthisis. Of the total number of deaths registered (1,238), the percentage due to phthisis was 7.0 as against 6.0 in 1927. The age periods at which the deaths occurred were: 5—15, 1 (1.0 per cent.); 15—25, 18 (21.0 per cent.); 25—45, 32 (37.2 per cent.); 45—65, 31 (36.1 per cent.); 65—75, 4 (4.7 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 Deaths from Phthisis and other Tuberculous Diseases. Year No. of Deaths Population Rate per 1,000 of Population 1919 „6 97,953 1.18 1920 122 101.856 1.19 1921 „7 105,200 1.„ 1922 127 105,200 1.20 1923 „5 105,400 1.09 1924 121 105,300 1.14 1925 93 106,100 .81 1926 109 105,800 .95 1927 94 103.500 .90 1928 92 104,000 .82 RESPIRATORY DISEASES. The number of deaths clue to bronchitis, pneumonia, and other diseases of the organs of respiration was 159. This is lower by 52 than the figure (2„) for 1927. The death rate was 1.43 per 1,000. In 1927 the rate was 1.89. The number of deaths certified to be due to 1bronchitis was 46, as against 86 in 1927. Of this number 32 were amongst persons aged 65 and upwards, and 10 amongst those of the age group 45—65. The deaths attributed to pneumonia numbered 86, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 26 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified was 44. Of the patients 18 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 67. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 151, and the death rate 1.3 per' 1,000 of the population. In 1927 the total was 149 and the death rate 1.2 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 4 4 „ 36 15 71 Females - - - 4 13 22 23 18 .80 Totals - - 1 8 17 33 59 33 151 32 Cancer.—Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 5 1 6 Throat, Neck, Gullet 9 4 13 Stomach 17 17 34 Intestines 13 10 23 Liver 2 7 19 Breast - 15 15 Uterus and Generative Organs - 18 18 Various 25 8 33 Totals 71 80 151 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. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1928 numbered 62. Of these 17 were due to suicide. 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 67. The total number of notifications coming to hand was 775, which is higher by 89 than the figure (686) for 1927. The diseases in respect of which fairly large numbers of notifications were received were scarlet fever (223), diphtheria (177), tuberculosis (161), and erysipelas (67). The notification rate (proportion to population of notified cases of infectious diseases) in 1928 was 7.4 per 1,000, as against 6.6 in 1927. 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:- Smallpox 30 or 100.0 per cent. of the cases notified. Diphtheria 176 „ 99.4 „ „ „ Erysipelas 30 „ 44.8 „ ,, ,, Scarlet Fever 217 „ 97.2 „ „ „ Enteric and Paratyphoid Fever 12 „ 52.1 „ „ „ Encephalitis Lethargica 2 „ 66.6 „ „ „ Tuberculosis 59 „ 36.6 „ ,, „ Pneumonia „ ,, 25.0 „ „ „ Puerperal Fever 2 „ 66.6 „ „ Puerperal Pyrexia 25 „ 78.1 „ „ „ 33 The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £56 16s. Od., equal to 10s. l1d. 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. 1919 98 „ 0 1 0 1 1920 88 2 6 0 17 3 1921 82 1 0 0 15 7 1922 89 5 9 0 16 „ 1923 40 7 6 0 7 8 1924 49 14 0 0 9 5 1925 48 4 0 0 9 l 1926 49 1 6 0 9 3 1927 51 14 0 0 10 0 1928 56 16 0 0 10 „ Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 456, and referred to 931 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 177, the number in 1927 being 160. Of the cases 12 died, and the case mortality rate was 6.7 percent. The number of cases per thousand of the population was 1.7. 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 6 cases the source appeared to be a member of the family previously infected; in 2 cases infection was counted to have been acquired ia school, and in 21 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 1,633. A positive result was returned in 68 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 72. In All Souls the number was 43, in St. Mary 42, and in St. John 20. As usual, the age groups 1—5 and 5—15 were those most affected, 69 of the cases falling into the former and 66 into the latter group. 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., 18. These were all remedied after service of notices. Schick Test and Diphtheria Immunization.—By agreement with the Marylebone Health Society a Schick Testing and Diphtheria Immunization Clinic was opened at the Infant Welfare Centre in Salisbury Street ("Lissonia Centre") at the beginning of the year. At the outset the proposal was that clinics should be held on one day per week and be 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 1928. 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. 34 THE FOLLOWING TABLE AND SUMMARY GIVES DETAILS OF THE WORK OF THE CLINIC DURING THE YEAR 1928. Children under 5. Children over 5. Adults Total. Total number on books 161 70 10 241 Inoculated without Schick Test 160 40 - 200 Tested—Positive - 20 6 26 Negative 1 10 3 14 Not reported - - 1 1 Inoculated but not retested - 19 1 20 Inoculations incomplete 18 4 4 26 Inoculations completed but not retested 66 - - 66 Retested—Positive 1 3 1 5 Negative 59 29 - 88 Not reported - 5 - 5 Receiving additional inoculations 1 3 1 5 Retested—Positive - - - - Negative 1 - - 1 Not retested - 3 1 4 Completely immunized 60 29 - 89 528 235 28 791 SUMMARY. Total number on books 241 Number of children under 5 161 Number of children over 5 70 Number of adults 10 Number of Sessions 51 Total number of attendances 886 Average weekly attendance 17 Scarlet Fever. Though the number of cases was higher than in 1927, 223 cases as against 178, there was no epidemic prevalence of this disease during the year. The highest number of cases reported in any one week was 12. The total deaths from scarlet fever numbered 2, and the number of deaths per cent. of the cases was 0.88. The districts to suffer most were Christ Church and All Souls. In the former there were 92 cases and in the latter 52. In St. Mary there were 49 and in St. John 30. As usual the majority of patients were children of school age, the age group, 5—15, giving 126 of the total. Of the remainder 2 were under 1 year of age, 55 were aged between 1 and 5 years, and 40 over 15 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 27 instances that a definite connection could be made out. Defects in sanitation to the number of 24 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 23. There were 2 deaths. Of Paratyphoid Fever there were 10 cases. In no case was it possible to trace with any degree of accuracy the exact source of infection, which in a majority of instances appeared to have been acquired outside the metropolis. All the patients recovered. Cerebro-Spinal Fever. No cases of this disease were notified during the year. 35 Encephalitis Lethargica. There were three cases of this disease notified. Two 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:- Name. Age. Sex. Date Notified. Subsequent progress, i.e., whether recovery complete or partial. 1. D.F.C. 34 F. 25-2-28 Died 20-2-1928. 2. E.M. 7 F. 1-8-28 Died 12-8-1928. Tubercular Meningitis. 3. B.L. 5 M. 10-9-28 Recovered. Polio-Myelitis. No cases were notified. Erysipelas. The notifications of erysipelas numbered 67. Puerperal Fever. The number of cases of this disease notified was 3. In 1927 there was 1 case only. Puerperal Pyrexia. There were 32 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 facilities the Council is empowered to provide under the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations. The number notified in 1927 was 35. Measles and German Measles. Measles was more or less epidemic throughout the metropolis, and in this the Borough shared to a considerable extent. Since the disease is not now notifiable it is impossible to say exactly the number of cases that occurred, but no fewer than 1,424 were reported by school teachers. The number reported in 1927 was 40. There were 37 deaths. The course adopted in relation to the cases was the same as in previous years. Nurses were sent in to 26 cases, and 446 visits were paid. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1928 the number of deaths registered as due to whooping cough was 10, one less than in 1927. Glanders and Anthrax. No cases were notified. 36 Small Pox. An outbreak of this disease amongst the inmates of the institutions of the St. Marylebone Guardians led to the detection and notification of 30 cases. The following extracts from a special report to the Public Health Committee give the main particulars with regard to the occurrence and the steps taken to deal with it. All the cases were of the so-called " western type " of the disease, and there were no deaths. "The first case was seen on the night of Sunday, June 3rd, 1928, and since that date 28 cases have been detected in the Home. In addition, and part of the outbreak, there have been two detected by me at the St. Marylebone Hospital, and one in a patient who, having been in the Home since May 18th, took his discharge on the 30th May and spent the period between that date and 8th June, when he was recognised to be suffering at Wandsworth, sleeping out at Epsom and elsewhere. The source of his infection was probably the same as that of the cases occurring at the Home between the 3rd June and 13th June, as well as of the two cases at the Hospital. "In spite of the fullest and most careful investigations this source has not been found, though it was probably an individual (almost certainly a male inmate since only one of the cases has come from the women's side) who spent some time in the Home and had either taken his discharge before the search began or had lost all signs of infection. "The case of June 3rd when seen had been in an infective condition for at least 5 days though the man had made no complaint with regard either to his general condition or to the rash. Until the afternoon of the day of his detection, he had been mixing freely not only with the inmates of the room he occupied but with others. This absence of or extreme mildness of symptoms of onset has been a curious feature of the outbreak and practically none of the patients has complained at all and several might have escaped notice entirely had not regular nightly inspections been carried out. Indeed the whole outbreak is probably due to the fact that the original case or cases were so mildly attacked they either did not find it necessary to report or were able to conceal the fact they were sick. " In spite of the fact that the case of June 3rd had this start of at least 5 days of the precautions possible to be taken, in all it gave rise to only two others. These in their turn, like all those that were detected after the first case, became possible sources, but because of the precautions the chances in their favour grew steadily less. This has in fact been shown in what has happened since the campaign initiated since the occurrence of the outbreak and more particularly in the later stages, each one of the patients notified having been individuals who had not been re-vaccinated sufficiently early or had refused or evaded re-vaccination. The patient detected on the 15th successfully avoided vaccination until June 10th, the day before the onset of symptoms. In two other cases, one detected on the 26th, and the other on the 27th, there had been complete evasion. "Prior to the appearance of the two last mentioned it had been proposed to remove restrictions in respect of admissions and discharges completely on Monday July 2nd. As a result of their occurrence it has been felt that certain limitations must be imposed in spite of the difficulties that may be expected from a section of the inmates who contend, rightly, that unless with their consent it is impossible to refuse to allow them to take their discharge. After consultation with officers of the Ministry of Health the course to be adopted is as follows: that on July 2nd and thereafter all inmates who have been successfully vaccinated or re-vaccinated within 16 days of the date of application shall be allowed to take discharge; that unless they agree to vaccination, unvaccinated inmates shall be refused discharge until restrictions are raised completely; that no person shall be admitted unless they satisfy the medical officer that they have been successfully vaccinated or 37 re-vaccinated recently or agree to be vaccinated on admission. With such restrictions the work of the Home should proceed more or less normally and in my own view and that of the officers of the Ministry of Health without risk of spread of infection.* "Up to the present the quarantine imposed has been strictly enforced and the instructions that 1 issued on June 3rd that until further orders there were to be neither admissions nor discharges were unhesitatingly accepted by the Board and most loyally obeyed by everybody. "The main object of the quarantine was to limit the outbreak to the Home itself and in this so far as can be seen it has been entirely successful. Numbers of cases of doubt have been seen amongst the general population and with one exception it was possible in all not only to exclude smallpox but also any connection with the cases in the Home. "Apart from quarantine the chief action taken was in the direction of securing vaccination and routine inspection of each of the inmates. For the reason that the first case—that of June 3rd—had been infectious for 5 days before detection it was considered essential to vaccinate at once all those more immediately in contact. To this end the assistance of Dr. Greenwood, the Public Vaccinator, was obtained and a supply of Government Lymph secured. As several persons had been transferred to the Hospital during the infective period a warning was issued and arrangements were made for their segregation and vaccination. It is largely because of this no doubt that spread of infection did not occur in that Institution. "On the following and succeeding days the campaign of vaccination continued and within a comparatively short time the reports received indicated that all the inmates with the exception of between 20 and 30, and all workers whether resident or non-resident were done. Employees of contractors bringing in supplies, dustmen, etc., unless recently vaccinated were required also to be protected in this way. "As it was felt that there might be a risk of the infection spreading beyond the Institution notices recommending vaccination generally were posted and Dr. Greenwood, who considered it advisable to open an extra station in Lisson Grove, has vaccinated and re-vaccinated considerable numbers of persons. "The actual vaccinations in the Home were done mainly by Dr. Greenwood and Dr. Byrne, the Visiting Medical Officer. "Both of these officers also most readily agreed to my suggestion that nightly inspections were necessary and did not spare themselves in carrying out a most trying and difficult task." The following table, summarized from the returns made to the Ministry of Health, give particulars with regard to each of the patients. None, it will be noted, had been re-vaccinated since infancy, and in many, the evidence that vaccination had in fact been performed at this time was extremely scanty. *No further cases in fact did occur and the limitation of the infection to the institutions was complete throughout. 38 SMALLPOX. Consecutive No. Age. Sex. Date of Vaccinal Condition at time of Infection. Notification. Onset. Bash. Removal to Hospital. Successful Primary. Successful re-vaccination. Unvaccinated. Doubtful. 1 69 M 4/6/28 28/5/28 30/5/28 3/6/28 Infancy - - - 2 61 M 5/6/28 31/5/28 2/6/28 5/6/28 „ - - - 3 67 M „ „ „ „ „ - - - 4 65 M „ „ „ „ „ - - - 5 64 M „ „ „ „ „ - - - 6 58 M " „ „ „ „ 5/6/28 - - 7 57 M 6/6/23 4/6/28 6/6/28 6/6/28 „ 4/6/28 - - 8 65 M „ „ 5/6/28 „ „ 5/6/28 - - * 9 53 M „ 29/5/28 5/6/28 - 4/6/28 - - *10 70 M „ „ „ „ Infancy 4/6/28 - - „ 26 M 7/6/28 7/6/28 7/6/28 7/6/28 „ 5/6/28 - - 12 69 M 8/6/28 4/6/28 8/6/28 8/6/28 „ - - - 18 61 M „ 5/6/28 „ „ „ 3/6/28 - - 14 75 M „ „ „ „ „ - - - 15 33 F „ „ „ „ - - Yes - 16 67 M 10/6/28 7/6/28 9/6/28 9/6/28 Infancy 4/6/28 - - 17 66 M „ 5/6/28 7/6/28 „ „ 4/6/28 - - 18 69 M „ 7/6/28 9/6/28 „ „ 6/6/28 - - 19 64 M „ 7/6/28 „ „ - - Yes - 20 57 M „ 6/6/28 8/6/28 „ Infancy - - - 21 69 M „ 8/6/28 10/6/28 10/6/28 „ 5/6/28 - - 22 67 M „ „ „ „ „ 5/6/28 - - 23 68 M „ „ „ „ „ 4/6/28 - - 24 67 M „ „ „ „ „ 10/6/28 - - 25 76 M „/6/28 9/6/28 „/6/28 „/6/28 - - Yes - 26 68 M 13/6/28 12/6/28 13/6/28 13/6/28 Infancy 3/6/28 - - 27 72 M 14/6/28 12/6/28 13/6/28 14/6/28 „ - - - 28 78 M J 5/6/28 „/6/28 13/6/28 15/6/28 10/6/28 - - - 29 70 M 26/6/28 23/6/28 25/6/28 26/6/28 Infancy - - - 30 70 M 27/6/28 24/6/28 26/6/28 27/6/28 „ - - - * Removed from St. Maryleboue Hospital which is situated in Kensington. 39 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 1928. 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 7 29 - 45 50 28 Barrett Street - - - - - - Barrow Hill Road 4 20 4 14 167 4 Bell Street 16 33 28 17 159 26 Blandford Square 5 2 - 4 19 8 Capland Street 47 40 26 11 118 32 Catholic, Richmond Street 2 - - 1 13 - Christ Church, Lisson Grove 17 31 32 17 254 64 Convent, Little Union Place - 3 - - 6 - Council School, Grove Road 27 4 - - - - Emmanuel, Aberdeen Place 14 16 10 - 122 4 Emmanuel, North Street 5 - - 13 - 3 Gateforth Street 5 24 20 2 63 10 Hampden Gurney Upper Berkeley Street 17 3 6 23 36 5 Homer Bow, Catholic 5 4 - 6 30 1 Jewish, Hanway Street - - - - - - Portland, Little Titchfield Street - - - - - - Polytechnic, Regent Street 6 1 - 2 4 1 Queen's College, Harley Street - - - - - - St. Andrew's, Wells Street - - - - - - St. Francis, Upper William Street - - - - - - St. James's, Marylebone Lane 1 4 - - 3 - St. Luke's Nutford Place 2 12 - 8 28 - St. Mark's, Violet Hill 25 78 1 47 28 7 St. Mark's, Marylebone Road - - - - - - St. Marylebone, High Street 25 26 5 26 105 7 St. Marylebone Grammar, Marylebone Boad 5 4 - 2 3 - St. Mary's, Crawford Street 22 11 9 32 34 2 St. Paul's, East Street - - - - - - St. Paul's, Broadley Terrace 14 10 13 34 70 6 St. Thomas', Orchard Street 15 9 4 2 44 15 St. Vincent, Wigmore Street 2 1 - 1 - 1 Upper Marylebone Street 20 14 13 34 40 22 Schools out of Borough 7 12 6 12 28 6 Totals 315 391 177 353 1,424 252 Ophthalmia Neonatorum. The following table gives information with regard to 7 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 7 2 5 7 - - - Nurses were sent in to 2 cases and 74 visits were paid. 40 INFLUENZA. This disease showed no epidemic tendencies during the year. Th'e deaths certified as due to Influenza numbered 13, as against 42 in 1927. PNEUMONIA. Figures with regard to notification will be found on page 67, 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 12 cases, and 236 visits were paid. TUBERCULOSIS. In all 161 notifications were received, 139 relating to pulmonary tuberculosis, the remainder (22) to cases in which structures other than the lungs were affected. The table given on page 41 contains the information required by the Ministry of Health with regard to notifications. Notifications on Form B relate to school children. Of these as in 1927 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 92 2. The number of cases unnotified or notified at death 14 3. The number of cases notified within a month of death 14 4. The number of cases notified within three months of death 10 5. The number of cases notified within six months of death 3 Treatment of Tuberculosis.—Of the cases notified 192 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 92 were insured persons; of these 44 were admitted to sanatorium or hospital treatment, and 24 to St. Marylebone Hospital. Non-insured persons numbered 69, of whom 34 (11 being children) received sanatorium treatment and 15 (4 being children) were admitted to St. Marylebone Hospital. Nurses were sent in to 15 cases and 263 visits were paid. Public Health (Prevention of Tuberculosis) Regulations, 1925.—In no case was it necessary for action to be taken under these regulations. 41 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1928, to the 29th December, 1928. 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 Institu tions. Sanatoria Age Periods. 0 to 1 1 to 5 5 to 10 10 to 16 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 8 6 8 16 15 15 8 8 75 8.7 - - - - 81 45 „ Females - - 1 2 9 13 19 11 7 1 1 64 7.7 - - - - 1 17 41 Non-Pulmonary Males 1 - 8 5 - 2 - 2 1 - - 14 1.6 - - - - - - 10 „ Females - - 8 1 - 2 1 1 - - - 8 8 - - - - - - 9 Totals 1 - 8 11 15 25 86 29 28 9 4 161 188 - - - - 1 48 105 42 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. suppplemental 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 1ST january, 1928, to THE 29TH december, 1928, 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 - - - - - 2 2 4 1 1 1 11 „ Females - - - - 1 1 4 2 2 - - 10 Non-Pulmonary Males 1 - - - - - 1 1 2 - - 5 „ Females - - 1 - - - 1 - - - - 2 Totals 1 - 1 - 1 3 8 7 5 1 1 28 No. of Cases. Source of Information. Pulmonary. Non-Pulmonary. Death Returns 6 4 " Inward" Transfers 13 1 Other Sources, viz.: after death 2 2 356 Males PULMONARY PUBLIC HEAL 1 H (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:- 267 Females 623 Total 106 Males NON-PULMONARY 91 Females 197 Total 820 Total Cases 43 Prevention of Tuberculosis.—In connection with preventive work in respect of tuberculosis, the Dispensary, which has now been part of the borough tuberculosis scheme since April, 1921, continued to prove most valuable, the members of the staff rendering excellent service. Particulars with regard to patients dealt with during the year are shown in a table at page 45, while the following short table summarises the information as to visits paid by members of the staff:— No. of visits by Tuberculosis Officer New, 50 Old, 98 No. of cases at Dispensary New, 416 Old, 1,490 No. of attendances at Dispensary 3,253 No. of visits by Miss Baker First visits, 140 Re-visits, 1,380 No. of visits by Miss Kenion First visits, 39 Re-visits, 1,232 No. of Committee Meetings attended 23 The Tuberculosis Care Committee continued to meet fortnightly throughout the year, Dr. Saner, Miss Baker and 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 23—14 boys and 9 girls—and the attendances numbered 5,917. 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 number of new cases and the attendances at the Dispensary are set forth in the Tables. The fine summer reduced the number of attendances in the Autumn, as the majority of winter coughs became dormant during the hot dry weather, but with the advent of the damp foggy months helped by the Influenza epidemic the number of patients increased rapidly. The Influenza is leaving behind a very irritating kind of cough which takes some time to get rid of. Fortunately among the Tubercular patients the breakdowns have been few, but it is early to be optimistic. During the year 400 patients were re-examined for various reasons, e.g., for progress reports for the London County Council, for War Pensions, and for re-diagnosis in case of those who were regarded as suspected cases at the first attendance. "The X-ray department of the Middlesex Hospital has been used in about 30 instances to confirm or otherwise the findings of the stethescope. In this way several early cases have been recognised and sent for treatment. "Several small children suffering from tubercular glands in the neck and others who for no apparent reason did not seem to be fit and getting on, were placed under Sunlight Treatment at the hospital. In most of these general improvement has taken place, not so much in the way of putting on weight as in the development of a more healthy appearance with increased mental activity or in a diminution in the size of the glands. "The Dental arrangements are satisfactory and have been the means of obtaining new dentures for those patients in need of such. The Middlesex Hospital carry out extractions and new dentures are supplied through the National Health Insurance, the Charity Organisation, the National Association for Prevention of Tuberculosis and the Saturday Hospital Fund. 44 "Although 'Housing' is not an affair of the Dispensary, it is gratifying to learn that some of the patients, especially those in whom the disease is either quiescent or arrested, have been moved into surroundings more suitable to their needs on the recommendation of the Tuberculosis Officer. The difficulty still appears to be with the large family, where the parents are not in a position to pay a higher rent in addition to the increased travelling expenses. "The Open Air School supported by voluntary contribution still parries on its good work in Regent's Park. The attendances of the children during the year have been well up to the average. It is satisfactory to learn that a child returning to ordinary elementary school takes its place in its proper standard and sometimes even one higher. This must be gratifying to the teacher, Mrs. Fitzgerald, who spares no effort to bring about such good results. "The Care Committee has met regularly once a fortnight during the year except the holiday month, and 270 cases were brought to their notice, discussed and dealt with. Of these, 118 were either recommended to the London County Council for treatment or were returned home after treatment which had commenced in 1927. The Ex-Service men in need of financial help or clothing have been referred to Miss Bowen, the United Services Fund representative of the district. "In October the Tuberculosis Officer attended the Conference arranged by the National Association for the Prevention of Tuberculosis, a report of which was tendered to the Council." 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 653, as against 712 in 1927. Of these, 117 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—22 as against 35 in 1927—in the case of this form of tuberculosis came from institutions where the patients were undergoing treatment. Visits were paid to the homes and, where necessary, advice with regard to the obtaining of treatment was offered. Particulars as to the parts affected by the disease will be found in the table on page 51. 45 TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1928. DIAGNOSIS. PULMONARY. NON PULMONARY. TOTAL. Adult*. 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 35 41 1 5 1 - 2 3 36 41 3 8 (b) Doubtfully tuberculous - - - - - - - - 31 45 38 29 (c) Non-tuberculous - - - - - - - - 16 15 8 5 B.—Contacts examined during the year:— (a) Definitely tuberculous 6 3 1 1 - - - - 6 3 1 1 (b) Doubtfully tuberculous - - - - - - - - 6 10 22 17 (c) Non-tuberculous - - - - - - - - 15 16 16 21 C.—Cases written off the Dispensary Register as (a) Cured - - - - - - - - - - - - (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) 72 95 80 70 - - - - 72 95 80 70 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 140 120 26 21 10 5 11 14 150 125 37 35 (b) Diagnosis not completed - - - - - - - - 3 8 41 37 1. Number of persons on Dispensary Register on January 1st, 1928 386 2. Number o£ patients transferred from other areas and of " lost sight of" cases returned 30 3. Number of patients transferred to other areas and cases " lost sight of " 37 4. Died during the year 35 5. Number of observation cases under A (b) and B (6) above in which period of observation exceeded 2 months 22 6. Number of attendances at the Dispensary (including Contacts) 3,253 7. Number of attendances of non-pulmonary cases at Orthopaedic Out- stations for treatment or supervision - 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) " Light " treatment 20 (b) Other special forms of treatment 27 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 6 (b) Otherwise 105 11. Number of other visits by Tuberculosis Officer to Homes 142 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,840 13. Number of (a) Specimens of sputum, &c., examined 185 (b) X-ray examinations made, in connection with Dispensary work 34 46 14. Number of Insured Persona on Dispensary Register on the 31st December 151 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 126 16. Number of reports received during the year in respect of Insured Persons:— (а) Form G.P. 17 1 (b) Form G.P. 36 2 (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 1928, 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. 1928. Class T. B. minus. Class T. B. plus. Class T. B. minus. Class T. B. Plus. Class T- B. minus. Class T. B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 8. Total (Class T.B. plus). Group 1. Group 2 Group 8. 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. 4 5 3 2 10 2 9 6 5 20 11 13 6 4 23 F. 6 4 1 2 7 10 7 9 2 18 10 12 7 4 23 Children. m. 4 - - - - 2 - - - - 1 - - - - F. 2 - - - - 1 1 - - 1 4 - - 1 1 Condition not ascertained during the Year. - - - - - - - - - - - - - - - Lost Sight of or otherwise removed from Dispensary Register. 7 4 4 1 9 6 4 2 1 7 5 6 - - 6 Dead. Adults. m. 1 - - 18 18 1 1 2 10 13 - - - 5 5 F. - - - 6 6 - - 1 6 7 - - - 4 4 Children. M. - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - Totals 24 13 8 29 50 22 22 20 24 66 31 31 13 18 62 47 (b) Non-Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1928, 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. 1928. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. 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 1 - - - 1 F. - - - - - 1 - - - 1 - - - - - Children. M. - - - 1 1 1 - - 1 2 - - - 2 2 F. 1 - - 2 3 1 - - 1 2 2 - - - 2 Transferred to Pulmonary - - - - - - - - - - - - - - - Condition not ascertained during the year. - - - - - - - - - - - - - - - Lost Sight of or otherwise removed from Dispensary Register. 1 - - - 1 - - - - - - - - 1 1 Dead. Adults. M. - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - Children. M. - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - Totals 2 1 - 3 6 3 1 - 2 6 3 - - 3 6 48 The following table, which has been prepared for the Ministry of Health and the London County Council, shows the work carried out at the Dispensary:— Statement of Work carried out in connection with the Dispensary Treatment of Tuberculosis during the period 1st January, 1928, to the 31st December, 1928, 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, 1928, to the 31st December, 1928, 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 froml january, 192 8 to 31st December, 1928. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1928. Number of Persons referred for diagnosis or treatment tothe Hospital with which the Dispensary is affiliated during the period 1st January, 1928, to 31st December, 1928. Diagnosed as suffering from Tuberculosis. Diagnosed as not suffering from Tuberculosis. Undiagnosed and remaining under observation. Total Number Examined. Insured Uninsured Insured Uninsured Insured Uninsured Insured Uninsured St. Marylebone Tuberculosis Dispensary James Donaldson Saner, M.B., C.M., D.P.H. 1st April. 1916. Monday, 9.30—5 Tuesday, 9.30—5 Wednes., 9.30—5 Thursday ,9.30—9 99 11'2 198 108 301 139 141 151 285 16 25 Friday, 9.30—5 Saturday, 9.30—1 49 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. 1. Name of Hospital to which Special Cases are referred from the Dispensary for 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 pf 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, 1928, for lending out to Patients for use at their own homes None. Deaths from Phthisis.—Some reference has already been made to the matter of deaths from tuberculosis and at this point it is proposed only to deal with the figures relating to tuberculosis of the lungs (consumption or phthisis'). During 1928 the total number certified as due to this cause was 86, 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 1924-1928. 50 Deaths from Phthisis. Five years—1924-1928. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1928 104,000 86 10 28 36 12 The distributionof the 86 deaths was as follows:—In Poor Law Institutions, 36; general and other hospitals, 25; and at home, 25. Of those who died 58 were insured (42 males and 16 females), and 28 uninsured (12 males and 16 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 86, the notified cases of pulmonary tuberculosis totalled 139. 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 2 - — 1 — 1—5 - - — - — — — — 5—10 1 1 8 4 — — — 1 10—15 3 2 5 1 — - — 1 15—20 6 10 — — 3 5 — - 20—25 10 14 2 2 2 8 — - 25—35 18 23 1 2 8 6 — 1 35—45 19 13 3 1 14 5 1 - 45—55 16 9 3 — 18 4 2 1 55 -65 9 1 — 5 2 — — 65 and upwards 4 1 — — 4 - - - Totals 86 74 19 10 54 30 4 4 *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. 51 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 29th DECEMBER, 1928. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. 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 Localization of Disease. At all Ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Lungs 139 - - 7 36 61 31 4 29 43 46 21 139 13 14 14 8 49 90 Glands 7 - - 5 - 2 - - 2 1 4 — 7 1 1 1 — 3 4 Spine 2 - - 1 — 1 — — — — — 2 2 — - — 1 1 1 Epididymis 1 - - - 1 — — — — — — 1 1 - - - - - 1 Peritoneum 4 - - 3 1 — — — 1 — 2 1 4 1 - — 1 - 2 Miliary 1 1 - - - — — — 1 — — — 1 1 - — — 1 — Abscess 1 - - - 1 — — — — — 1 — 1 — - — — — 1 Bladder 1 - - — 1 — — — — — 1 — 1 — - 1 — 1 — Calf 1 - - 1 — — — — — — 1 — 1 — - — — — 1 Kidney 1 - - — — 1 — — — — 1 — 1 — 1 — 1 — Scapula 1 - - 1 — — — — — — 1 — 1 — - — — — 1 1 - - 1 - - — - - - - 1 1 - - - - - 1 Ankle 1 - - - - - 1 - - - - 1 1 - - - 1 1 Totals 161 1 — 19 40 65 32 4 33 44 57 27 161 16 15 17 11 59 102 161 52 DISINFECTION. The work done in this connection during 1928 is shown in the following tables. The methods employed during the greater part of the time were substantially the same as in previous vears; 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 :— Corapulsorily Notifiable Diseases. Phthisis Measles. Vermin. Other causes. Total. Beds 304 4 - 1 4 313 Mattresses 445 18 7 14 92 576 Bolsters 324 18 7 4 81 434 Pillows 1,991 48 10 12 351 2,412 Sheets 610 10 2 17 1 640 Blankets 962 9 13 31 8 1,023 Sundries 4,763 50 32 38 77 4,960 Totals 9,399 157 71 117 614 10,358 In 1927 the number of articles disinfected was 9,421. The number of journeys made by the disinfecting vans during the year ended December, 1928, was:— January 88 August 78 February 75 September 88 March 76 October 86 April 62 November 84 May 80 December 61 June 109 - July 75 962 The number of journeys made during 1927 was 861. 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 39 8 16 - - 63 February 56 10 24 1 — 91 March 37 12 71 - — 120 April 45 3 24 - — 72 May 40 3 42 - — 85 June 156 — 7 - — 163 July 54 3 4 - — 61 August 51 3 1 1 — 56 September 60 3 1 - — 64 October 90 9 — - — 99 November 60 8 7 - — 75 December 57 1 3 - — 61 Totals 745 63 200 2 — 1,010 58 The number of rooms disinfected in 1927 was 713. 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 206. 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 1928, and annually since 1919:— 1928 ADULTS CHILDREN Males Females Total Males Females Total January 238 74 312 27 102 129 February 212 58 270 37 162 199 March 231 63 294 64 167 231 April 204 66 270 17 123 140 May 240 90 330 36 170 206 June 244 56 300 80 167 247 July 270 68 338 88 258 346 August 260 84 344 2 32 34 September 209 57 266 30 176 206 October 252 60 312 54 200 254 November 235 93 328 54 133 187 December 208 62 270 31 94 125 Totals 2,803 831 3,634 520 1,784 2,304 Cleansing Station Attendances, 1919-1928. Year. ADULTS CHILDREN Males Females Total Males Females Total 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 1928 2,803 831 3,634 520 1,784 2,304 The total attendances since the Baths were opened in 1898 number 247,347 (adults, 178,115 : children, 69,232). 54 BACTERIOLOGICAL EXAMINATIONS. The following table shows the number of specimens examined for purposes of diagnosis, and indicates also the diseases in relation to which the examinations were made. The work, as formerly, was carried out by Dr. Foulerton. 1928. Positive. Negative. Total. Typhoid fever 4 32 36 Diphtheria 68 1,565 1,633 Phthisis 117 536 653 Totals 189 2,133 2,322 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. The Council, who made a grant of £600 in 1928 to the Society, 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 1928. 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, which was opened at the beginning ol the year, is also held at Salisbury Street. Here in addition there is a Light Clinic which is open on two days per week, and a massage clinic. 55 INFANT WELFARE CENTRES, MATERNITY CLINICS, DAY NURSERIES AND DIPHTHERIA IMMUNIZATION CLINIC. Middlesex Hospital, Mortimer Street, W. 1— Monday, 1.30 p.m. Infant Consultation. Wednesday, 2 ,, ,, „ Thursday, 1.80 ,, Toddlers (2—5 years). Friday, 1,80 „ Infant Consultation, *80, Marylebone Lane, W, 1— Monday, 4.80 p.m. Maternity Clinic. Tuesday, 10.30 a.m. Infant Consultation. Thursday, 2 p.m. „ ,, *West Marylebone, held temporarily at Western General Dispensary, Cosway Street, N.W. 1— Tuesday, 1.30 p.m. Infant Consultation. Thursday, 2 „ Needlework Class. Friday, 10.80 a.m. Infant Consultation. Queen Charlotte's Hospital, 12, Harcourt Street, W. 1— Daily, 9.80 a.m. Maternity Clinic. Wednesday, 2 p.m. Infant Consultation. Church Army Dispensary, Little Harcourt Street, W. 1— Tuesday, 2,15 p.m. Infant Consultation, Western General Dispensary, Cosway Street, N.W. 1— Monday, 2 p.m. Infant Consultation, Thursday, 10 a.m. „ ,, *14, Salisbury Street, Lisson Grove, N.W.8—- Monday, 2 p.m. Infant Consultation. Tuesday, 10 a.m. Artificial Light Clinic. Do. 2 p,m, Infant Consultation. Wednesday, 2 „ Maternity Clinic. Do. 2 ,, Massage Clinic. Thursday, 1.30 „ Toddlers (2—5 years). Do. 1,30 ,, Diphtheria Immunization Clinic. Do. 2 ,, Needlework Class. Friday, 10 a.m. Artificial Light Clinic. Do. 2 p.m. Infant Consultation. Do. 2.30 „ Massage Clinic. *12, Salisbury Street, Lisson Grove, N,W. 8— Tuesday, 4 p.m. Dental Clinic. *Mansergh Woodall Club, 24, Hill Road, N.W.8— Tuesday, 2 p.m. Infant Consultation. Do, 2 ,, Maternity Clinic. *Day Nurseries or Creches— *The Crossley Day Nursery, Barrow Hill Road, N.W. 8. *The Portman Day Nursery, Exeter Street, Lisson Grove, N.W. 8. * Provided by the St. Marylebone Health Society. Health Visitors.—There are six health visitors. Three 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 1928 the health visitors made 12,852 visits; children are visited up to school age. 56 Centres.—There are in all seven centres, all "voluntary," at which consultations are held. Four 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, 30, Marylebone Lane. An antenatal 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. 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 Queen Charlotte.'s Hospital, and Middlesex Hospital, which has a paid health visitor in addition. All the consultations are open to other than St. Marylebone babies, who, however, constitute the bulk of those attending. At the hospit 11, as at Queen Charlotte's, there are ante-natal clinics particularly for hospital patients. Ante-Natal Work as indicated. There are three 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 Marylebone Lane. Schick Testing, etc., Clinics —As already indicated arrangements for holding clinics of this kind are made at Salisbury Street. The clinic was held weekly throughout the year and was largely used. 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 doctors at the centres to Middlesex Hospital. The fact that a special centre has been established at the Western General Dispensary has already been mentioned. Maternity Cases.—The Council have not established a Maternity Home or Hospital, but there is accommodation within the borough at Queen Charlotte's Hospital, Middlesex Hospital, and in the Labour Wards at the St. Marylebone Home, Marylebone Road. The number of births notified from these institutions during 1928 was 2,783, the total births numbering 3,875. The midwives living and practising in the borough number 13. Two conduct maternity homes which are registered by the London County Council. Work done during 1928.—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. 57 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THIi 52 WEEKS ENDING 31ST DECEMBER, 1928. CENTRE. No. 24 Hill Koad. No 14 Salisbury Street. Queen Charlotte's Hospl. Cosway Street. No. 30 Marylebone Lane The Middlesex Hospl. The Westn. Genl. Dispy. No. of consultations held:— Infants 96 151 51 100 94 152 91 Toddlers 96 51 — — — 52 65 Maternity 48 48 305 — 36 99 — Massage — 87 88 — 112 — — Light — 102 — - - - - No. of attendances of mothers at clinic:— Ante-natal 39 208 13,028 — 31 2,685 — Post-natal 214 418 10 - — - — No. of attendances of babies 2,387 4,355 2,131 1,984 1,452 5,602 212 No. of attendances of children over 2 years 673 1,208 355 444 379 1,310 1,208 No. of attendances at light Clinic 2,663 - - - - - No. of orders issued for milk, etc 84 369 43 95 81 107 1 No. of home visits 2,185 2,928 452 1,071 652 2,633 - No. of new cases :— Infants 110 207 89 64 81 328 109 Toddlers 20 34 1 - 9 12 136 Ante-natal 8 34 3,454 — 18 416 Post-natal 62 55 11 - - - - Massage - 33 14 — 38 - - Light - 92 - - - - - Day Nurseries—Attendances during the year. The Crossley, Barrow Hill Koad 4,857 The Portman, Exeter Street 7,116 Dental Clinic, 12 Salisbury Street. Attendances during the year: Mothers, 830; Children 111. Advice and treatment given in 635 cases—extractions under gas, 306. 58 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 1928 was 3, and the total amount expended during the financial year to 31st March, 1929 was £3 Is. 6d. Light Treatment is provided to children and mothers at Salisbury Street on two days each week. The attendances during the year numbered 2663, the results obtained in an appreciable percentage of the cases being 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. SANITARY ADIMINISTRATION. Under this, which is made a separate heading by the Ministry of Health, the Medical Officer of Health is required to make reference to a number of matters, e.g., staff, hospital accommodation and some others, most of which will be found dealt with elsewhere. (1) Staff: Work of sanitary inspectors and other officers engaged in sanitary work. This matter, so far as the inspectors are concerned, is fully discussed in an early part of the report. The report of the Mortuary Keeper (Mrs. Spears) is as follows:— Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1928. 1928. Males. Females. Total. For burial only. For inquests. Total. No. of P.Ms held. No. of courts held. No. of Infectious cases. January 14 19 33 8 25 33 11 7 - February 8 6 14 4 10 14 5 3 — March 14 8 22 1 21 22 10 1 — April 13 8 21 8 13 21 6 5 — May 9 6 15 5 10 15 3 4 — June 11 9 20 6 14 20 8 3 — July 10 10 20 8 12 20 7 5 — August . 10 4 14 6 8 14 4 4 — September 6 10 16 6 10 16 8 3 — October . 8 9 17 4 13 17 12 5 1 November 13 14 27 13 14 27 9 5 — December 11 19 30 5 25 30 11 3 — Totals 127 122 2451 74 175 249 94 48 1 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. 59 HOUSING. The information asked for by the Ministry with regard to housing is contained in the following statement. The Increase of Rent and Mortgage Interest (Restrictions) Act, 1920, so far as regards the provisions of Section 2 (2), and the Rent and Mortgage Interest Restrictions Act, 1923, Section 18 (1) relating to certificates as to suitability for occupation of houses, was not taken advantage of during the year, no application being received. Number of new houses erected during the year : (a) Total (including numbers given separately under (b).) 160 houses and 12 flats. (b) With State assistance under the Housing Acts: (i) By the Local Authority Nil (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) ... ... 2,575 (2) Number of dwelling-houses (included under sub.head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925— Houses 578 Tenements in blocks 57 (8) Number of dwelling-houses fovnd 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 ... 1,939 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) 1,845 3. Action under statutory powers: (a) Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners Nil (b) By Local Authority in default of owners Nil (8) 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) 94 (2) Number of dwelling-houses in which defects were remedied after services of formal notices— (a) By owners 94 (b) By Local Authority in default of owners Nil 60 (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) N umber 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 Carlisle Street Area.—As indicated in the report for 1927, the London County Council accepted responsibility for this area, and having received the formal representation made by me under Sec. 35 of. the Housing Act, 1925, passed the necessary resolutions and arranged for the taking of all steps preparatory for the local enquiry. This was eventually held in July, 1928, and occupied two days, evidence being given in support of the representation and generally with regard to the area by Dr. Middleton Hewat, one of the assistant medical officers of the London County Council, and myself. Subsequently the Inspector of the Ministry of Health, who held the inquiry, himself carried out an investigation, presumably for the purpose of his report to the Minister of Health. When the year ended the decision of the Minister had not been received. The Carlisle Street area, as noted in previous reports, is the largest ever represented in the Metropolis and extends to 7 acres, affecting 340 premises and 2,832 persons. GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921). 104,173. (1928) 101,000 estimated. Number of inhabited houses (1921), 18,507. Number of families or separate occupiers (1921). 27,214. Rateable value. £2,850,966. Sum represented by a penny rate. £11,879. Extracts from Vital Statistics of the Year. Births- Total M. F. Legitimate 1,170 595 575 Illegitimate 147 74 73 Blrth Rate, 12 6 Deaths, 1,238. Death Rate, 11.14. Number of women dying in, or in consequence of, childbirth—from sepsis, 4. other causes> 5. Deaths of Infants under 1 year of age per 1,000 births:— Legitimate 76. Illegitimate 109. Total 79. Deaths from Measles (all ages), 37, Deaths from Whooping Cough (all ages), 10. Deaths from Diarrhœa (under 2 years of age) 18. 61 GENERAL SUMMARY. The following: is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 170 Cowhouses 1 Slaughterhouses 1 Offensive Trades 3 Ice Cream Premises 70 Bakehouses 54 Restaurant, Dining Room and Coffee Shop Kitchens 194 Hotel Kitchens 20 Pastrycooks and Tea Rooms 76 Fried Fish Shops 24 Fish Curers 5 Houses Let in Lodgings 1,055 Workshops and Workplaces 3,701 Total 5,311 Smoke Nuisances. Number of Observations 483 Number of Nuisances and Complaints Number of Intimation Notices Number of Summonses Nil served Nil Number of Convictions Nil Number of Statutory Notices Amount of Penalty and Costs served Nil imposed in each case Nil * Housing of the Working Classes. Number of Houses inspected— Number of Representations by fa) On account of complaints Medical Officer or other or illness (P.H. Act) 2,575 person Nil (b) House-to-house (Housing Consolidated Regula- Number of Houses included in tions, 1925) 578 such representations Nil Tenements in blocks 345 Number of Closing Orders made Nil Number of Notices served Number of Closing Orders deter- (a) Under P.H. Act: mined (i.e., Houses made fit) Nil (1) Intimation 1,845 (2) Statutory 94 Number of Demolition Orders Nil (b) Under Housing Act Nil Number of Houses demolished— Number of Houses repaired or (a) In pursuance of Orders Nil nuisances remedied under P.H. Voluntarily Nil Act 1,939 Total Number of Houses in the Number of Houses repaired borough 19,447 under Section 3 of Housing Act, 1925— Number of Houses occupied by (a) By Owners Nil the Working Classes 8,540 (b) By Local Authority in default of Owners Nil Number of Houses registered under the new Bye-laws as to Number of Houses closed on Houses Let in Lodgings Nil Notice by Owner that they could not be made fit Nil Number of Inspections made of such Houses Nil Number of Houses for theWork- ing Classes- Number of Prosecutions Nil (a) Erected during year 12 flats (b) In course of erection 12 flats 62 Mortuary. Number of bodies received 249 Number of Infectious bodies received 1 Disinfection. Number of rooms disinfected 1,010 Number of articles disinfected 10,858 Cleansing of Persons Act, 1897. Adults. Children. Males, Females. Males. Females. Total. Number of persons cleansed 2,808 831 520 1,784 5,988 Bakehouses. Number on Register at end of 1928 54 Number above ground 5 Number underground 49 Number of Inspections 126 Number of Notices 10 Number of Prosecutions Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1928 818 Number of Inspections 816 Number of Notices 21 Number of Prosecutions Nil House to House Inspections. Number of Inspections Houses 578 Tenements 845 Number of Notices issued Intimations 459 Statutory Notices 34 Number of Prosecutions 4 House Refuse. Number of Inspections 8,275 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 250 Number of Notices issued. Intimations 200 Number of Statutory Notices 13 Number of Prosecutions Nil Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water has been provided to Upper Storeys Number of Statutory Notices served 2 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 4 Number Remedied 4 Number of Prosecutions Nil 63 Underground Rooms. Number dealt with Number of Notices served under P. H. (L.) Act, 1891 13 Number of Notices served under the Housing Act, 1925 Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms cleansed after infectious disease 1,008 Number of rooms cleansed from vermin 446 Number of Statutory Notices served 23 Number of Prosecutions Nil Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of Persons accommodated during the year 8 Drainage. Number of inspections made 5,433 Number of drainage plans deposited 428 Number relating to new buildings 138 „ „ old buildings 290 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops and Cowsheds 392 Number of Inspections 1,248 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 64 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1928 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncor-. rected No. Nett. of Non. residents registeret in the District. of Resi. dents not registered in the District. Under 1 year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1911 117,844 4,130 2,375 20'2 1,578 14.2 600 840 261 109.8 1,818 16.3 1912 116,155 4,111 2,246 193 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 8,065 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 1,724 173 864 708 147 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 1,686 159 936 688 123 78.0 1,436 13.6 1925 106,100 3,418 1,496 141 1,472 13.8 873 658 94 63.0 1,257 11.0 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 1928 104,000 3,662 1,317 12.6 1,335 12.8 787 690 105 79.0 1,238 11.1 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. 65 TABLE I (a). Vital Statistics of Separate Localities in 1928 and the Ten Previous Years. Names of Localities The Whole Borough All Sodls St. Mary Christ Church St. John Year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths atall 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. 1918 98,526 1,875 1,835 152 24,528 311 366 30 26,880 257 429 45 30,391 522 708 58 16,727 285 332 19 1919 97,953 1,492 1,568 147 24,381 311 316 27 26,731 272 408 34 30,210 584 560 63 16,631 325 284 23 1920 101,856 2.217 1.299 145 25,352 450 252 28 27,796 439 366 27 31,414 933 446 71 17,294 395 235 19 1921 105,200 1,939 1,355 128 26,184 390 268 29 28,709 445 345 27 32,445 720 455 55 17,862 384 287 23 1922 105,200 1,679 1,451 115 25,202 318 286 18 26,943 405 415 21 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 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 Averages of Years 1918 to 1927 103,483 1,613 1,405 120 25,171 310 267 20 27,179 340 380 26 32,096 650 479 55 19,037 313 279 19 1928 104,000 1,317 1,238 105 24,915 232 248 21 26,638 285 299 17 32,371 533 434 46 20,076 267 257 21 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. 66 TABLE II. Notifiable Diseases During the Year 1928. Cases Notified. Deaths Certified. Disease. At all Ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards. Total No. of Cases Admitted to Hospital. Total deaths Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Smallpox 30 - - - — 2 8 20 30 - - - - - - - - - Diphtheria 177 15 69 66 18 9 — — 176 12 3 3 1 5 — — — — Erysipelas 67 1 1 5 8 15 24 13 30 — - - - - - - — — Scarlet Fever. 223 2 55 126 22 15 2 1 217 2 1 — 1 — — - - - Enteric Fever (including Baratyr phoid). 23 — — 3 7 11 2 — 12 2 - - - - - 1 1 - Continued Fever . 1 — — — 1 — — — 1 - — — — - — — — — Puerperal Fever 3 -\ - - 2 1 - — 2 4 - — — — 3 1 — — Puerperal Pyrexia . 32 - - - 14 18 — - 25 - - - - - - - - - Tuberculosis, Pulmonary . 139 - - 7. 36. 61. 31. 4. 49 86 - - - 1 18 32 31 4 Tuberculosis, Non-Pulmonary . 22 1 — 12 4 4 1 — 10 6 1 - — 1 — 2 2 - Polio Encephalitis . 1 1 - - - — — - 1 — — — — - — — - — Ophthalmia Neonatorum . 7 7 - - - - - - - - - - - - - - - - Encephalitis Lethargica . 3 - - 2 — 1 - — 2 - — — — - - - - - Pneumonia 44 1 6 5 7 18 3 4 11 15 1 - 1 - 1 3 4 5 Malaria . 11 — — - - 1 - - - - - - - - - - - - Dysentery 2 — 1 - - - 1 - 1 - - - - - - - - - Totals 775 28 132 226 119 156 72 42 572 127 6 3 8 7 22 89 38 9 67 TABLE II. (a). Cases of Infectious Disease Notified during the 52 weeks ending 29th December, 1928. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home. Notifiable Disease. At Ages—years. All Souls. St. Mary. Christ Church St. John. Totals. All Souls. St Mary Christ Church St. John. Totals. At all ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Smallpox 30 - - - - 2 8 20 - 30 - - 30 - 30 - - 30 - Cholera . - - - - - - - - - - - - - - - - - - - Diphtheria, including Membranous Croup . 177 15 69 66 18 9 - - 43 42 72 20 177 43 42 72 19 176 1 Erysipelas 67 1 1 5 8 15 24 13 12 13 35 7 67 6 9 12 3 30 37 Scarlet Fever. 223 2 55 126 22 15 2 1 52 49 92 30 228 49 48 91 39 217 6 Typhus Fever — — — — — — — — — — — — — — — — — — — Enteric Fever 13 — 1 4 7 1 — 6 3 1 3 13 1 1 1 2 5 8 Paratyphoid Fever 10 - — 2 8 4 1 — 1 3 2 4 10 1 1 2 3 7 3 Relapsing Fever — - — — — — — — — - — — — — — — — — — Continued Fever . 1 - - - 1 - — — — - — 1 1 - - 1 1 - Puerperal Fever 3 - - - 2 1 - - 1 1 — 1 3 - 1 - 1 2 1 Puerperal Pyrexia. 32 - - — 14 18 — — 7 8 10 7 32 4 5 9 7 25 7 Plague . - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever . - - - - - - - - - - - - - - - - - - - Tuberculosis— Pulmonary 139 - - 7 36 61 31 4 29 43 46 21 139 13 14 14 8 49 90 Non-Pulmonary 22 1 - 12 4 4 1 - 4 1 11 6 22 3 1 3 3 10 12 Acute Poliomyelitis - - - - - - - - - — — — — — — - - - - Polio-Encephalitis 1 1 - - - - — — — — 1 — 1 — — 1 — 1 — Ophthalmia Neonatorum 7 7 - - 1 - - - - 2 3 2 7 - 2 1 2 5 2 Encephalitis Lethargica 3 - - 2 - 1 - - - 1 2 - 3 - - 2 - 2 1 Pneumonia 44 1 6 5 7 18 3 4 8 7. 14 15 44. 1 2. 3 5 11 33 Malaria . 1 — — — - 1 — - - — 1 — 1 — — — — 1 Dysentery 2 - 1 - - - 1 - - - 2 - 2 - - 1 - 1 1 Totals 775 28 132 226 119 156 72 42 163 203 292 117 775 121 156 212 83 572 203 Cases of mistaken diagnosis are not excluded from the above table. 775 68 TABLE III.— Causes of, and Ages at Death during the year ending 29th December, 1928. 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. No. CAUSES OF DEATH. All Ages. Under 1 1 and under 2. 2 and under 5. 5 and under 15 15 and under 25. 25 and under 45 45 and under 65. 65 and under 75. 75 and upwards 1 Enteric Fever 2 - - - - - 1 1 - - 2 - 1 1 - 2 2 Small Pox - — - - - - - - - - - - - - - - 8 Measles 37 14 17 4 2 — — — — — 8 2 7 22 6 37 4 Scarlet Fever . 2 1 — 1 — — — — — — — — 1 1 — 2 5 Whooping Cough 10 3 5 2 — — — — — — — 2 — 8 — 10 6 Diphtheria 12 8 3 1 5 — — — — — — 1 8 6 2 12 7 Influenza 18 — — 1 2 — 2 2 2 4 5 8 4 8 3 18 8 Encephalitis Lethargica . - - - - - - - - - - 1 - - - - - 9 Meningococal Meningitis. 1 1 - - - - - - - - 2 - - 1 - 1 10 Tuberculosis of Eespiratory System 86 - - - 1 18 32 81 4 - 14 10 28 36 12 86 11 Other Tuberculous diseases 6 1 — - 1 — 2 2 — - 6 2 1 1 2 6 12 Cancer, Malignant Diseases 151 - - - - - 15 72 46 18 220 27 29 65 80 151 13 Rheumatic Fever — — — - — — — — — — — - — — — — 14 Diabetes . 10 - - - - - - 5 4 1 7 8 2 2 3 10 15 Cerebral Hæmorrhage, etc. 50 - - - - - - 17 15 18 22 10 18 12 15 50 16 Heart Disease 232 — — - 2 2 7 75 78 68 78 50 61 78 43 282 17 Arterio-sclerosis 87 — — - - - 1 12 34 40 11 28 21 22 21 87 18 Bronchitis 46 8 - - - - 1 10 5 27 34 7 14 15 10 46 19 Pneumonia (all forms) 86 17 9 7 — — 7 26 12 8 77 22 14 88 12 86 20 Other Respiratory Diseases 27 — — — — — 4 10 9 4 12 6 5 10 6 27 21 Ulcer of Stomach or Duodenum 10 - - - - - 4 4 2 — 18 1 5 2 2 10 22 Diarrhoea, etc. 22 17 1 — — — - 2 2 — 6 4 3 10 5 22 23 Appendicitis. 6 - - - 1 1 1 3 - - 18 - 2 1 8 6 24 Cirrhosis of Liver 18 - - - - - 3 5 5 — 8 2 4 5 2 18 25 Acute and Chronic Nephritis . 38 - - - - - 2 17 13 1 27 6 7 14 6 83 26 Puerperal Sepsis 4 — — — — 3 1 - - - 2 - 1 2 1 4 27 Other accidents and diseases of Pregnancy and Parturition . 5 - - - - 2 3 - - - 26 1 2 1 1 5 28 Congenital Debility and Malformation, including Premature Birth 33 33 - - - - - - - - 68 6 6 12 9 33 29 Suicide 17 — — — — 1 2 9 4 1 12 4 5 2 6 17 30 Other Deaths from Violence 45 2 1 1 2 4 11 8 10 6 34 12 10 18 10 45 31 Other defined Diseases 192 10 1 - 5 3 24 56 37 66 174 44 50 51 47 192 32 Causes ill-defined or unknown - - - - - - - - - - - - - - - - Totals 1238 105 37 17 21 34 123 367 282 252 868 248 299 434 257 1238 69 VACCINATION RETURNS. Return for 1927. Return made to the Board or Guardians and Ministry of Health on the 9th February, 1929, 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, 1927, inclusive. Registration Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st Dec., 1927 Number of these Births duly entered by 31st January, 1929, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1929, remained unentered in the "Vaccination Register' on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1929, 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 o( Certificates of Successful Primary Vaccination of children under 14 years received during the calendar year 1928 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1928 Sub-Districts comprised in the Vaccination Officer's District Col. I. Success fully Vaccinated Col. II. Col. IV. Postpone ment by Medical Certifi. cate Removal to Districts,the Vaccination Oflicer 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 Small- Pox Number in respect of whom Certificates of Conscientious Objection have been received Col. V. Dead, Unvaccinated 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Mnrylebone 586 330 2 — 110 27 18 14 26 59 2. St. Mary 2,317 1,656 5 — 220 94 10 279 23 31 2,718 420 8. All Souls 620 349 2 — 107 24 6 104 16 12 Total 3,523 2,334 9 — 437 145 34 397 65 102 2,718 420 Dated 9th February, 1929. (Signed) GEORGE H. BASSETT, Vaccination Officer.