AC 4353 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1929. 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, Barrlster-at-Law. LONDON: VAIL & CO., 170, FARRINGDON ROAD. 1930 Metropolitan Borough of St. Marylebane. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1929. 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. 1930 Vail and Co., Printers, Farringdon Road, E.C. 1. Public Health Department, Town Hall, Marylebone Road, N.W.1. 2nd May, 1930. 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 for the year 1929. It is again an "ordinary" report, and differs from that known as a "Survey" report, in that it mainly contains a record of events without going into detail. The next report, that for 1930, will be of the "survey" type. Speaking generally, 1929, from the health point of view, may be regarded as satisfactory, The severe and prolonged frost in the early part of the year imposed a great strain upon young children and the aged among the inhabitants, which is reflected in the heavy death rate from pneumonia and other respiratory diseases and the rather high infantile mortality rate (77 per 1,000 births). None of the infectious diseases occurred in an epidemic degree and having regard to the prevalence of the disease elsewhere, the Borough was particularly fortunate in escaping with only three cases of smallpox. The receipt of the approval of the Minister of Health to the Carlisle Street Housing Scheme marks a further stage in the progress towards a clearance of an area in which the housing conditions are extremely unsatisfactory. Under the chairmanship of Mr. Councillor P. O'Connell and later of Councillor Dr. Fuller, the Public Health Committee, as ever, took the keenest interest in the work done and never failed to give real encouragement and support. For this help and all the kindness and consideration shewn I desire to express sincere appreciation and thanks, and to the members of the staff whose industry and loyalty were unfailing, I offer my thanks also. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER. Medical Officer of Health. PUBLIC HEALTH COMMITTEE. (Which is also the Committee appointed for the purposes of the Maternity and Child Welfare Act, 1918). 1929. His Worship the Mayor (Councillor S. G. Joseph, J.P.) ALDERMEN. G. B. Brooks J. Fettes, J.P. A. C. Rickatson. COUNCILLORS. Mrs. V. A. L. Freeman. H. Jones. Dr. C. A. Fuller. Capt. J. T. O'Brien, J.P. S. H. Haynes. P. O.'Connell (Chairman). Mrs. C. Q. Henriques. G. B. Ramsay. Lt.-Col. R. Q. Henriques. Mrs. E. M. Shirley. Dr. E. Jacobs. Mrs. A. West-Russell. CONTENTS. page Natural and Social Conditions of the Borough. Population 7 Sanitary Circumstances 7 Water Supply 7 Drainage 7 Combined Drainage 8 Sewer Emanations 8 Closet Accommodation 8 Public Sanitary Conveniences 8 Scavenging 9 Removal of House Refuse 9 Removal of Offensive Refuse 9 Sanitary circumstances of the Borough 9 Staff 9 Nuisances 10 Inspections 11 Nuisances—Legal Proceedings 12 Rat Repression 12 Pigeons 13 Fouling of Footways by Dogs 13 Smoke Nuisances 61 Premises and Occupations controlled by By-laws and Regulations 14 Business Premises 14 Cow Sheds 14 Milk Premises 14 Slaughterhouses 14 Offensive Trades 14 Ice Cream Premises 15 Butter, Margarine, etc., Premises 15 Bakehouses 15 Fried Fish Vendors and Fish Curers 15 Food Stalls 15 Factories and Workshops 15 Inspections 16 Defects found 16 Home Work 17 Registered Workshops 18 Other matters 18 Rag Flock 18 Premises used for Hutan Habitation 18 Houses let in lodgings 18 Common Lodging Houses 19 Underground Rooms 19 Premises that are not but should be Registered 19 Food— Milk Supply 19 Milk Analysis 19 Legal proceedings for adulteration 20 Bacteriological examination of Milk 20 Dairies, Cowsheds and Milkshops Orders 20 The Milk (Special Designations) Order 20 Milk (Mothers and Children) Order, 1918 20 Food Inspections 20 Food, Unsound, Condemned 21 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 Rates 26 Sub-District Births and Deaths 26 Deaths in relation to Age 27 Deaths among the Aged 27 Causes of and ages at death 27 Infantile Mortality 27-28 „ ,, Causes 29 Maternal Mortality 31 Deaths in relation to Disease 31 Diarrhoeal Diseases 31 Infectious (Communicable) Diseases 31 Phthisis and other Tuberculous Diseases 31 Respiratory Diseases 32 Cancer and Malignant Disease 32 Accident, Suicide and Manslaughter 33 Prevalence of and Control over Infectious Diseases 33 Isolation of Cases 33 Discharge Notices 34 Diphtheria and Membranous Croup 34 Schick Testing and Diphtheria Immunization 34 Scarlet Fever 35 Enteric Fever 35 Cerebro-Spinal Fever 35 Encephalitis Lethalgica 36 Polio-Myelitis 36 Erysipelas 36 Puerperal Fever 36 Puerperal Pyrexia 36 Measles and German Measles 36 Whooping Cough 36 Glanders and Anthrax 36 Smallpox 36 Infectious Diseases in Schools 37 Ophthalmia Neonatorum 38 Influenza 38 Pneumonia 38 Tuberculosis 88 Treatment 38 Public Health (Prevention of Tuberculosis) Regulations, 1925 38 Notifications 39, 50 Prevention of 41 Care Committee 41 Open Air School 41 Work and Dispensaries 42, 44 Deaths 49 Bacteriological Diagnosis of 43 Non-Pulmonary Tuberculosis 43 Disinfection 51 Cleansing of Persons 52 Bacteriological Examinations 53 Maternity and Child Welfare 53 Health Visitors 54 Centres 55 Ante-Natal Work 55 Dental Clinic 55-56 Massage Clinics 55 Schick Testing, etc., Clinics 55 Hospital Treatment 55 Maternity Cases 55 Infant Consultations—Work at 56 Day Nurseries 56 Home Helps 57 Sanitary Administration— Staff 9,57 Report of Mortuary Keeper 57 Housing 58 Statistics 59 Sanitary Inspection (Summary) 60 Ministry of Health, Tables I—III 63-67 Vaccination Returns 68 7 THE YEAR 1929. POPULATION. The population of the Borough when the Census was taken on June 19th, 1921, was found to be 104,173, made up of 63,166 females and 41,007 males, thr 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 1929 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 1928. 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. 1928 104,000 24,915 26,638 32,371 20,076 1929 102,400 24,532 26,228 81,873 19,767 SANITARY CIRCUMSTANCES. Water. Complaints as to water supply, either as regards quantity or quality, were few. As a matter of historical interest it is perhaps worth noting that during the month of February, owing to the very severe frost, stand-pipes were brought into use by the Metropolitan Water Board. 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 tight premises. The reason for discontinuing the supply was in each case the non-payment of rate. During ihe year, 47 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.—Ten certificates were granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. The number in 1928 was twenty-one. On 4 occasions intimation notices were served, calling for the provision of a supply of water to the upper storeys of tenement houses, as required by Section 78 of the London County Council (General Powers) Act, 1907. The supply was provided after receipt of the intimation notice in three cases. In one case the supply was provided after the issue of a statutory notice. Drainage. The total number of drain inspections made during the year was 4,925, as against 5,433 in 1928. The total number of plans deposited was 449 in respect of 547 premises, the number in 1928 being 428 and 545 respectively. 8 Plans relating to new buildings numbered 82, the number deposited in 1928 being 138. In the case of old buildings, the number of plans received was 367, as against 290 in 1928. On one occasion a report was submitted with regard to a case discovered by the inspector, 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 this case, the fine and costs imposed amounting to £6 3s. Od. Combined Drainage.—Orders as to combined drainage were issued by the Council in respect of 29 premises. The number in 1928 was 35. Sewer Emanations.—At intervals during the year, but especially in the early summer months, a number of complaints were received with regard to nuisance from smells issuing from sewer ventilators in the roadway. In the main the complaints came from residents in the neighbourhood of Avenue Road and St. John's Wood Road and had reference to smells escaping from the part of the sewerage system ("deep sewers") for which the County Council is responsible. For this reason the complaints in each instance were forwarded to the appropriate officer of the L.C.C. As this did not produce any marked effect representations were made direct to the County Council by the Public Health Committee of the Council and later a deputation from the Committee, introduced by Mr. Alderman Sanger, L.C.C., consisting of Mr. Councillor Hugh Jones, a former Chairman of the Public Health Committee, and the Medical Officer of Health, was received by the Main Drainage Committee of the County Council. Eventually, as a result of these various steps, a large number of sewer ventilating openings on the roadway were closed. Whether this or the coming of the colder weather was the cause of the cessation of the complaints will not be known until the summer of 1930 arrives. 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, 1930, and the amount of increase or decrease as compared with the previous year. 1930 1929 Increase Decrease £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus —Men's Department 892 10 7 912 10 8 — 20 0 1 „ Women's „ 1,532 6 11 1,424 5 7 108 1 4 — Gt. Portland Street—Men's „ 241 16 10 259 9 2 — 17 12 4 „ Women's „ 246 9 5 265 2 11 — 18 13 6 Marylebone Road—Men's „ 329 11 8 295 10 9 34 0 11 — „ Women's „ 378 7 10 372 1 10 6 6 0 — Foley Street—Men only „ 165 7 6 149 19 2 15 8 4 — St. John's Wood Road—Men only 111 6 4 110 8 1 0 18 3 — Barrett Street—Men only „ 259 8 3 231 10 6 27 17 9 — Salisbury Street— Men's Department 84 11 4 76 6 2 8 5 2 ‡ „ Women's „ 118 10 2 111 12 2 6 18 0 - £4,360 6 10 4,208 17 0 207 15 9 56 5 11 *One free urinette provided. ‡ Two free urinettes provided. 9 During the year, following receipt of a numbtr of complaints as to the absence of public sanitary convenience in the neighbourhood of St. John's Wood Road Station, the Public Health Committee decided that in the interests of the public health such provision was necessary and recommended the Council accordingly. In the view of the Public Health Committee there was necessity for a convenience for women as well as men, these to be constructed underground, but no definite decision had been arrived at by the Council upon the matter before the year closed. Removal and Disposal of House Refuse. Throughout the year the arrangements in connection with scavenging emained 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 the year ended 31st March, 1930, it may be mentioned, was 44,061 tons, as compared with 41,999 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 226 premises. During the year the inspectors made 3,156 visits. The majority of these were made by Inspectors Hill and Lumley, who give part time to this work. For neglect of the provisions with regard to the covering of dustbins, etc., placed on the footway for collection from the kerb, 177 notices were served. Remedies in each case were carried out, legal proceedings not being necessary in any instance. Removal of Offensive Refuse.—Owing to the number of hotels, boarding houses, restaurants, and large private establishments in the borough, considerable quantities of food refuse (hog wash) are collected by pig-feeders daily, and close watch is necessary in order to ensure that the requirements of the bye-laws relating to removal of offensive refuse, as to hours of removal, provision of proper receptacles, etc., are complied with. During the year a number of warnings with regard to these matters were issued and in three instances prosecutions instituted, which resulted in the imposition of fines amounting with costs to £8 14s. 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. 10 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. Hale (d, e). W. H. Draper (a, b, c). Miss E. D. Mann (d, e, f, 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 F. A. Baker (b). *Drainage Inspectors. Miss S. Kenion (d, e, f, g). F. C. Cook (b, c). † 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. P. H. Hill (a, b, c). G. W. Matthews. C. D. Turbayne. R. G. Turner. *Women Sanitary Inspectors and *Maternity and Child Welfare and Health Visitors. Tuberculosis Clerk. Miss D. Chabot (b, d, e). Miss J. Jones. Miss C. E. Durant (b, d, g). Miss N. C. Stokes, R.R.C. Mortuary Keeper. (b, d, e, f, g). Mrs. H. Spears. 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. ‡ Resigned on appointment to the staff of the Division of Public Health, London School of Hygiene and Tropical Medicine. The post of District Inspector vacated by Inspector Cook, who succeeded Inspector Clay as Drainage Inspector, was still vacant at the end of the year. 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 2,608, as against 2,175 in 1928. 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, 142 statutory notices were issued, as against 140 in 1928. 11 Of these notices, 95 related to ordinary nuisances (dirt, dampness, etc.), 17 to verminous rooms, 3 to drains, 1 to water supply in tenement houses, 19 to insufficient dust bins, three to insufficient w.c. accommodation, 1 to underground rooms, and 3 to houses let in lodgings. The 17 notices respecting verminous rooms were served under powers contained in the London County Council (General Powers) Act, 1922, and referred to 35 rooms. In 2,470 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 one instance there was failure to carry out works after receipt of statutory notice and legal proceedings were instituted. Details of this case 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:— Districts. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Houses damp, dirty or dilapidated remedied 175 85 314 209 121 57 961 Doors, windows, floors, ceilings sash cords, etc., repaired 218 68 273 79 36 34 708 Overcrowding abated - - - 2 3 - 5 Illegal occupation of underground rooms dealt with - - 5 7 7 - 19 Water closet defects remedied 149 60 132 166 134 82 723 Water closets erected - - - 9 9 6 24 Urinal defects remedied - - 3 - 2 - 5 Soilpipes and ventilating shafts repaired or renewed - 3 4 2 3 - 12 Yard defects remedied 102 42 75 120 42 30 411 Waste pipe defects remedied 23 8 15 24 16 14 100 Water cistern defects remedied 7 5 23 5 4 3 47 Rubbish, manure, etc., accumulations removed 8 2 31 37 15 12 105 Dung or dust receptacles repaired or renewed 43 14 45 37 12 9 160 Drains relaid or amended 40 5 18 30 38 13 144 Drains cleared 8 11 11 15 9 8 57 Rainwater pipes repaired or renewed 17 3 31 .20 10 9 90 Water supply to houses reinstated - - - 6 - 2 8 Roofs and gutters repaired 113 48 78 63 22 19 343 Area defects remedied 6 2 8 88 16 17 137 Wash-house defects remedied 101 41 103 113 22 14 394 Animal nuisances abated 2 - 15 6 3 - 26 Basement defects remedied 48 - 15 18 16 1 98 Stables cleansed or repaired - - - - - - - Water supply laid on to upper storeys of house - - 3 1 - - 4 Miscellaneous nuisances abated 197 86 63 117 46 31 540 Verminous rooms cleansed 54 45 111 134 16 14 404 Workshops dirty, overcrowded, unventilated or defective, remedied - 4 — 13 5 15 37 12 Proceedings in Connection with Nuisances. The number of summonses issued in respect of nuisances during the year was one. Particulars with regard to the case is given below. Premises. Offence. (Proceedings taken under the Public Health (London) Act 1891, etc.) Result. 2, Hardington Street Failure to comply with a statutory notice to execute certain sanitary requirements. Closing order made. Rat Repression. The number of complaints received during the year, viz., 50, was lower by 4 than the 1928 figure. The investigation of these complaints necessitated the inspection of 62 premises, 22 of which were used for business purposes (4 of these for the preparation or storage of food), the remaining 40 being private or tenement houses. In 4 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 4th to the 9th November, 1929, 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. The accompanying report submitted to the Public Health Committee in connection therewith contains a certain amount of information that may be found interesting. "Rat Week this year was, at the suggestion of the Ministry of Agriculture, held in the Borough during the week commencing Monday, November 4th, and the special steps which have been found to meet the needs of the district in other years in relation to this campaign were taken on this occasion. Rats and mice, as the Ministry point out, are responsible for an immense loss (said to fall little short of £10,000,000) to the country each year both directly, in the destruction of foodstuffs and materials, and indirectly as the agents and carriers of disease germs, and it is only by systematic action on the part of all occupiers of lands and premises and by the local authorities vested with powers under the Rats and Mice (Destruction) Act, 1919, that any marked improvement in the position can be looked for. In St. Marylebone, though there has been no slackening of effort to deal with the problem, I think it may safely be said that improvement sufficient to be called " marked " is taking place. Complaints of nuisance from rats are fewer in number than formerly, and from careful observations made by Inspector Draper, who has the matter specially in hand, and by other members of the staff of the Department over a period of some years, it appears that the majority of the people in the Borough—from the large railway and commercial concerns to the individual householder—as a result of the publicity given to the matter and the persistent propaganda of the Council, are fully alive to the nuisance and possible danger from rats and mice, and to their responsibility for getting rid of the vermin. As an instance of the success attending continuous efforts to deal with rat infestation, mention may be made of a communication received from the Civil Engineer of the Group comprising the Metropolitan District Railway Company, 13 the London Electric Railway Company, the City and South London Railway Company and the Central London Railway Company, reporting- on the results achieved in this connection. This clearly indicates that by the use of every known method of rat destruction, including traps, poisons and gas, the numbers have been reduced to negligible proportions, only some sixty rats having been caught over the whole system. This improved condition is confirmed by Inspector Draper so far as St. Marylebone is concerned. Equally satisfactory returns were received from the power stations, railwav stations (above ground), siding's, warehouses, and in respect of the various open spaces in the Borough. In addition, co-operation with neighbouring boroughs in connection with increased baiting of the sewers was again secured during Rat Week. Special posters were displayed and leaflets distributed throughout the Borough, and prominence was given to the subject in the daily and local press. Circulars were also sent to occupiers of food premises, to property owners and agents, and to the large business houses and institutions in the Borough drawing attention to the duties imposed by statue in connection with rat destruction and, at the same time, offering to assist them in every way possible with technical advice as to the best means to be adopted in any particular circumstances for ridding property of the pests." Pigeons.—Considerable effort was made during the year to cope with the nuisance caused by these birds, of which frequent complaints were received from various sources from time to time. Taking advantage of the powers granted by Sec. 52 of the L.C.C. (General Powers) Act, 1927, the Council after much discussion and trouble entered into an agreement with Mr. T. Anthony, of 33, Lascotts Road, Wood Green, who specialises in work of this kind. Partly as a result of his endeavours and those of Inspector Draper, who in addition to acting as Rat Officer undertook this work, as well by means of netting and other measures, a certain amount of reduction in the numbers of the birds in the neighbourhood of the Parish Church and the Town Hall particularly was brought about. The amount expended upon the work done, which included the fixing of spikes in certain positions on the eastern flank of the Town Hall was £27 7s. lOd. Fouling of Footways by Dogs. In enforcing the provisions of the bye-law relating to this matter great assistance was obtained from the police. There were two prosecutions during the year on reports from police officers, the defendants being fined 10/- and 5/respectively. Though complaints of nuisance from this cause still continue to be made, it would appear to be justifiable to claim that as a result of the operation of the byelaws there has been a certain amount of improvement. In this connection it is probable that some effect has been produced by the posters in use in the Borough. These in addition to drawing attention to the existence of the bye-law indicate the need for the co-operation of the public with the Council in order to secure the abolition of the nuisance. FOULING OF FOOTWAYS BY DOGS. Nuisance and danger to health are caused by the excreta of dogs. In order to protect the public the Borough Council have made the following 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 its excrement upon the public footway. PENALTY:—Forty Shillings for each offence. In the general interest YOU are asked to assist in securing enforcement of the Bye-law. 14 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 Number Number of of On Abbed ReOn inspec- prose- register moved register tions notices 1929 cutions, at end in at end 1929 1929 of 1928 1929 of 1929 A. Business Premises Milk premises 107 - - 107 350 12 — *Cowsheds *1 — — — 19 — Slaughterhouses 1 — — 1 75 — — Offensive trade premises 3 — — 3 60 — — Ice cream premises 70 — 2 68 130 8 — Butter and Margarine Manufacturers and Dealers 16 — — 16 30 — — Bakehouses 54 — — 54 112 6 — Fried Fish Shops 24 — — 24 65 4 — Fish Curers 5 — — 5 58 2 — B. Habitations Houses let in lodgings 1,055 — — 1.055 9 054 1,265 — Common lodging houses 5 — — 5 — — — * Closed September, 1929. A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 107. In 1914 there were 237 on the register. Cow Sheds.—The only cow shed remaining in the borough at the end of 1928, that situated at 42a, Clipstone Street, and licensed for 10 cows, was closed in September, 1929. As has been explained in previous reports there were certain reasons which appeared to justify the continuance of this shed, but it is without regret that its final disappearance, as indeed the disappearance of all cow sheds from the borough is recorded. Slaughter Houses.—At the moment the only slaughter house in the Borough is that at 32a, Union Street, W.1, which is held by Mr. E. J. Barclay, of 70, Great Titchfield Street, W.1. No conditions are attached to the licence and the amount of slaughtering now done is comparatively small : during the year only 58 sheep, 12 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 this slaughter house, 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 hoiling, and in the remaining one that of poultry slaughtering. The Food Inspector made 60 visits, but no cause for complaint was found. 15 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 in the trade has greatly diminished. The actual number of premises included in the register at the end of the year was 68, as compared with 70 in 1928. Regular inspections were made throughout 1929, and in 8 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 tnd of 1929 the number of bakehouses on the register was 54. Of the 54, 49 are underground bakehouses. In all, 112 visits were paid and 6 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. All food stalls are inspected daily by officers of the Public Health Department, a special feature being made of inspections 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 3,386; 351 by the women and 3,035 by the men inspectors. The complaints received numbered 23. 16 The following report which the Medical Officer of Health is required to make to the Secretary of State for the Home Department in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901, gives, in addition to other information, the total number of defects found and of notices served. 1.—INSPECTION. Premises Inspections Slumber of Written Noiices Prosecu tions (1) (2) (8) (4) Factories 92 12 - (Including Factory Laundries) Workshops 1,079 84 - (Including Workshop Laundries) Workplaces 2,214 60 - (Other than Outworkers' Premises included in Part 3 of this Report) Total 3,386 156 - 2—DEFECTS FOUND. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts— Want of cleanliness 58 58 - - Want of ventilation 7 7 - - Overcrowding 2 2 - - Want of drainage of floors — — — — Other nuisances 54 54 — — insufficient 13 13 — — Sanitary unsuitable or accommodation defective not separate for sexes 61 61 - - 10 10 - - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 8 8 - - Other offences — - - - (Excluding offences relating to outwork whieh are included in .Part 3 of this Report) Total 213 213 - - 3.—HOME WORK. OUTWORKERS LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110 NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S 110) Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 65 157 953 ... ... ... 10 ... ... ... ... ... ... ... ... Total 65 157 953 ... ... ... 10 ... ... ... ... ... ... ... ... 18 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year (1) Number (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 3,338 Coffee Shops, &c. 325 Bakehouses 54 Total number of workshops on Register 3.717 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) 1 Action taken in matters Notified by H.M. Inspector referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Reports (of action taken) Workshop Act (s. 5). sent to H.M. Inspector 23 23 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 District 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. 19 During the year the arrangements for compiling a new register were continued and in connection with this and for purposes of supervision, some 9,054 visits were paid to the 1,055 houses on the old list. The number of intimation notices served was 1,265, relating to cleansing and other defects. Except in 3 cases, where statutory notices were issued, all of these notices were complied with without the necessity for further proceedings arising. Common Lodging Houses.—The following table contains all the necessary particulars with regard to the licensed premises of this class in the borough. Situation, etc., of Licensed Common Lodging Houses. Address. Registered Owner. Registered number of Occupants. 54, Bell Street Eliza Crew 55 men 2, Burne Street and Lisson Street W. Bramwell Booth 499 men 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 remedy. Underground Rooms.—As close supervision as possible was kept over rooms of this class, and whenever necessity compelled, notices to discontinue occupation were served. The total number dealt with in this way was 19. 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 1929 there were 326, this number including : Restaurant, dining- room and coffee shop kitchens, 194; tea-rooms and pastry-cooks, 83; hotel kitchens, 21 ; fried fish shops, 24; and fish-curers, 5. In addition, there was a number of shops in which meat, ham, sausages, etc., were cooked and sold only over the counter. On more than one occasion the Borough Council, at the suggestion of the Public Health Committee, have directed the attention of the Ministry of Health and the London County Council to the necessity for legislation requiring registration of food premises of this class. Up to the present no step in this direction has been taken by either of the authorities mentioned. The routine practice of visiting a number of restaurants, etc., each week was continued by the Food Inspector, and any matters discovered dealt with at once. In 1029 the total number of inspections was 810, the number of notices served being 24. 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 292. On examination by the Public Analyst 4 (1.4 per cent.) were found to be adulterated. In 1928 the percentage was .62. 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 proceedings were instituted in one case only. 20 A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 86 were obtained on delivery at Marylebone Station of the London & North-Eastern Railway. All proved to be genuine. The quarterly returns as to milk samples are tabulated below:— Quarter of the Year. No. of Samples Taken. No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. Fines and Costs. 1st 57. - - - £ s. d. 2nd 90 2 2.2 -— - 3rd 62 2 3.2 1 530 4th 83 *- - - - Total for year 292 4 1'4 1 5 3 0 Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 9 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, 50 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, Milkshops, etc.—Frequent inspections of 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. The Milk (Special Designations) Order, 1923.—Under this Order 35 applications were received from 11 dealers in the borough for licence to sell milk as "Certified " Milk, or Grade "A" Tuberculin Tested Milk or " Pasteurised " Milk. 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 10 in respect of "Certified" Milk, 8 for Grade "A" Tuberculin Tested Milk, and 17 "Pasteurised" Milk. In accordance with the instructions of the Ministry 50 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 1929 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1930, was £244 4s. 6d. as against £253 2s. 9d. up to 31st March, 1929. The actual number of cases dealt with was 205, and the number of orders issued 862. 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 Simth received the assistance of other members of the staff having the necessary qualifications and experience. 21 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 Meat- Year 1929. Beef 56 lbs. Mutton 38 „ Pork 28 ,, Bacon 10 cwt. Fish— Wet—Skate 27 stone Codlings 10 boxes Herrings 1 box Dry—Kippers 13 boxes Haddocks 5 ,, Shell—Winkles 1 bag Crabs ½ barrel Fruit— Bananas 15 baskets Pears ½ ton Miscellaneous—(Tinned Goods, etc.). Gruyere Cheese 12½ boxes Cheddar Cheese 76 lbs. Corned Beef 181 tins Sausages 29 Tongues 79 Mushrooms 7 Brawn 205 Ham Roll 12 Chicken Roll 81 Pork Roll 41 Roast Pork and Stuffing 18 Hams 33 Beef and Tongue 84 Herrings 13 Veal 37 Salmon 3 Strawberries 4 Cream 418 Grape Fruit 42 Milk 6 C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,102. Of this number 15 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 1.3 per cent., the figure for 1928 being 0.27 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 proceedings were instituted. In a second in which a vendor was prosecuted for selling as butter a substance containing 51.3 per cent, of margarine a fine of 10/- was imposed with costs amounting to £1 11s. 6d. 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, 1929. The number of samples taken under the Sale of Food and Drugs Acts and submitted to analysis, was 1,102, a decrease as compared with the samples for 1928, the number for that year being 1,109. A complete list is as follows : ANALYSES No. Article Number Examined Number Adulterated, etc. Formal Informal Private Total Formal Informal Private Total 1 Bacon - 3 - 3 2 Baking Powder — 2 — 2 3 Barley — 6 — 6 4 Brandy — 2 — 2 5 Butter 34 125 — 159 1 1 6 Cheese — 48 — 48 7 „ Cream — 10 — 10 8 Cherries, Glace — 3 — 3 9 Chicory — 1 — 1 10 Chocolate, Cream — 1 — 1 11 Cocoa — 8 — 8 12 Coffee — 44 — 44 13 Coffee and Chicory Essence — 3 — 3 14 Corned Beef — 1 — 1 15 Cream 21 — - 21 16 „ Banana — 1 — 1 17 „ Tinned — 3 — 3 18 Currants — 7 — 7 19 Desiccated Cocoanut — 3 — 3 20 Egg and Substitute Powder — 1 — 1 21 Flour — 6 — 6 22 „ Corn — 2 — 2 23 „ Self-Raising — 4 — 4 24 „ Whole-Meal 1 — — 1 25 Fruit, Dried — 2 — 26 „ Glace — 2 — 2 27 „ Mixed — 1 — 1 28 Golden Syrup — 1 — 1 29 Grape Fruit, Tinned — 4 — 4 30 Ground Ginger — 7 — 7 31 Honey 1 13 — 14 1 1 32 Jams — 30 — 30 33 Jelly, Black Currant — 1 — 1 34 „ Red — 1 — 1 35 Lard — 55 — 55 36 Lemonade Powder — 7 — 7 37 Liquorice Powder — 2 — 2 38 Margarine — 15 — 15 39 Marmalade — 15 — 15 40 Milk 247 45 — 292 1 3 4 41 „ Condensed — 46 — 46 42 Mincemeat — o — 2 43 Mustard — 12 — 12 44 Oil, Cod Liver — 2 — 2 45 „ Olive — 4 — 4 46 Ointment, Boric — 17 — 17 47 „ Carbolic — 1 — 1 48 „ Sulphur — 6 — H 49 Zinc — 3 — 3 Carried forward ... 304 578 — 882 3 3 - 6 23 ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total Brought forward 304 578 882 3 3 - 6 50 Paste, Fish — 6 - 6 51 „ Meat — 6 - 6 52 „ Tooth — 1 1 53 Peas, Tinned — 1 1 54 Peel, Candied — 7 - 7 55 Pepper — 11 - 11 56 Pickles — 5 - 5 57 Puff Pastry — 2 - 2 58 Raisins — 13 - 13 59 Rice — 8 - 8 60 Roll and Butter 1 3 - 4 31 Salt — — 1 1 62 Sauce — 3 - 3 63 Sausages, Beef — 13 - 13 64 „ Pork — 11 - 11 65 Sherbert — 3 - 3 66 Seidlitz Powders — 3 - 3 67 Spice — 3 - 3 68 „ Mixed — 3 - 3 69 Sponge Cakes — 4 - 4 70 Sugar 1 24 - 25 2 7 9 71 Sultanas — 24 - 24 72 Sweets — 14 - 14 73 Tea — 36 - 36 74 Tomato Ketchup — 1 - 1 75 Whiskey 1 — - 1 76 Wine, Orange — 1 - 1 77 „ Orange and Quinine — 10 - 10 Totals 307 794 1 1102 5 10 - 15 24 Adulterated Samples, etc. Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 352 Milk Informal 10.0 per cent- deficient in milk fat. 390 Milk Informal 13-3 per cent, deficient in milk fat. 651 Milk Formal 33.3 per cent.deficient in milk fat and contained 44.85 per cent, of added water. Fined £2 0s. and £3 3s. costs- 701 Honey Formal Was a mixture of honey and invert sugar. Vendor cautioned. 702 Sugar Informal Contained 2.1 grains of tin per lb. 743 Butter Formal The mixed fats contained 51.3 per cent, of margarine fats. Fined 10s. and £1 11 6d. costs, 766 Milk Informal 6.7 per cent, deficient in milk fat. 825 Demerara Sugar Formal Contained 1.0 grains of tin per lb. Information communicated to the Ministry of Health. 893 Demerara Sugar Informal Contained 1.1 grains of tin per lb. 895 Demerara Sugar Informal Contained 0.7 grains of tin per lb. 901 Demerara Sugar Informal Contained 0.9 grains of tin per lb. 908 Demerara Sugar Informal Contained 1.1 graii.s of tin per lb. 939 Demerara Sugar Informal Contained 0.8 grains of tin per lb. 945 Demerara Sugar Informal Contained 0.8 grains of tin per lb. 952 Demerara Sugar Informal Contained 1.1 grains of tin per lb. The sum paid in respect ol each analysis was 12s. 6d. per sample. The Public Analyst (Mr. J. F. F. Rowland) comments, as follows, with regard to various of the articles examined :— Milk.—292 samples were examined during the year. Of these 4 were adulterated, which is 1.37 per cent. The figure for 1928 was only 0.625 per cent. Apart from the adulterated samples the average composition of the other milks was as follows :— Year. Sp: Gr: Total Solids. Fat. Solids not Fat. 1928 1031.3 12.29 8.60 8.69 1929 1031.4 12.34 3.62 8.72 The composition is but slightly different from that of the previous two years, but what little change there is, is to the good, as the figures for both fat and total solids have gone up. Creams.—For the past three years the figures for loose and tinned creams have been given and compared. So far this comparison has revealed a steady lowering of the fat content of both kinds of cream. This year, however, the figures indicate a better average quality, the actual results obtained being-:— Loose Creams. Year. Fat. 1926 54.7 1927 51.4 1928 42.33 1929 47.39 Tinned Creams Year. Fat. 1926 28.87 1927 25.6 1928 28.73 1929 29.92 25 The figures for 1929 are, to some extent, reassuring as it seems as if for a moment a halt has been called to the progressive deterioration in quality of the loose creams. As for the tinned creams there has been a distinct recovery from the low figure of 1927. One would like to ieel that the St. Marylebone reports for that and the subsequent year had something to do with the improvement in the quality. At any rate the fact remains that the quality of both the loose and tinned creams shows a definite improvement. Metals in foods (tinned or otherwise).—In ordinary tinned foods it is the exception to find one that has not become to some extent contaminated with the metal of the container. So long as this is small in amount and that lead or other recognised poison is absent no action is generally taken. On the other hand this year has revealed the somewhat disturbing fact that certain makes of household sugar contain well marked quantities of tin. Now that attention has been drawn to its presence, it is to be hoped that steps will be taken to do away with the use of tin chloride in the manufacture of certain classes of sugar. The presence of small amounts of preservative has been prohibited in milk, cream, butter, etc., yet other foods, e.g., sugars, tinned goods and cheese wrapped in tin foil may contain appreciable amounts of metal without any legal penalty being incurred. Various chemicals and drugs of the British Phamacopoeia have limiting values for the contaminating bodies most likely to be found in them. But these drugs whose purity is so properly and carefully protected are only taken in medicinal doses while foods taken in large quantities have no limitations set to such metallic impurities as are so often found. In this country where tinned meats and fruits are so largely used and where the supervision of the health of the public rightly holds first place it would seem most desirable that some move should be made to prevent the members of the community becoming sedimentary metallic deposits of ores. Honey.—-One sample of Honey was a mixture of honey and invert sugar. Butter.—It is a rare thing to find a butter adulterated in these days yet of the samples examined one contained half its weight of margarine. In no instance was any preservative or added colouring matter found. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1929 was 1,233*, being 84 less than in 1928. Of the children born, 643 were boys and 590 girls. The birth rate per 1,000 of the population was 11.9, as against 12.6 in 1928. The rates in the several registration sub-districts of the borough were :— All Souls, 9.4; St. Mary, 9.7; Christ Church, 15.8, St. John, 12.3. Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,769; Live births, 3,578; Still births, 191. 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. * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 207 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone :— Legitimate Males 84 ,, Females 81 Illegitimate Males 23 ,, Females 19 26 The main sources of the notifications are set out below. The figures, it may be noted, refer to notifications and not to births. No. Per cent. From parents 20 0.6 „ doctors 151 4.0 „ midwives 532 14.1 „ other persons 264 7.0 „ hospitals, etc 2,802 74.3 3,769 Of the total births notified, 191 referred to still-births (120 males and 71 females): 2,233 took place at Queen Charlotte's Hospital; 267 at Middlesex Hospital; 183 at St. Marylebone Home; and 967 were born at home. Of those notified as having occurred in St. Marylebone, 2,139 belonged to other Boroughs. Of the 191 still-births only 37 (23 males and 14 females) were to St. Marylebone mothers. DEATHS AND DEATH RATES. The number of deaths registered in 1929 was 1,455. 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 corercted death-rate* per thousand for the year was 13.24. In the previous year, the rate was 11.14, and the number of deaths 1,238. The following short table shows the death rates in the several registration sub-districts in 1929 and compares them with those of the preceding 5 years :— 1924 1925 1928 1927 1928 1929 All Souls 9.7 9.2 9.6 9.7 9.9 13.3 St. Mary 15.6 12.5 13.6 14.2 12 0 13.8 Christ Church 14.4 12.9 18.6 12.6 13.4 15.8 St. John 14.6 12.5 14.3 11.9 12.8 13.8 The Borough 13.6 11.0 11.9 11.8 11.1 13.2 District births and deaths for the year ended 31st December, 1929, are given in the following table. A further table giving the vital statistics of separate localities for 1929 and the ten preceding years will be found amongst the Ministry of Health Tables on page 64. Population estimated to Births. Deaths. Sub-District. middle of 1929. Males. Females. Total. Males. Females. Total. All Souls 24,532 118 115 233 151 176 327 St. Mary 26,228 127 127 254 177 185 362 Christ Church 31,873 260 243 503 258 251 504 St. John 19,767 138 105 243 124 138 262 The Borough 102,400 643 590 1,233 705 750 1,455 *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 anl vigorous adults; a population made up of a large number of males ana 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 1929 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 The following- table shows the number of deaths that took place amongst infants under 1 year and adults of 65 years and upwards in each of the four quarters of 1929. 1929. JanuaryMarch AprilJune JulySeplembei OctoberDecember Total Infants under ] year 34 26 14 21 95 Persons of 65 years and upwards 283 133 79 149 644 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 whicn death took place, is given in Table III of the Ministry of Health series at page 67. This same table gives the number of deaths from various specified causes which occurred in institutions, in hospitals, nursing homes, etc. In each of the groups all deaths, whether of residents or non-residents, are included, which accounts for the fact that the total comes up to 928. 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 1929 was 95, and the number of births in that year 1,233. The infantile mortality rate is therefore 77, which is lower by 2 points than the rate for 1928 (79). The lowest rate on record for the Borough is 59, which was reached in 1927. The course which the rate has taken is graphically shown in the chart on page 30. The means adopted in the Borough with a view to bringing about a reduction in infantile mortality and generally improving the life and health chances of infants and children are described in a separate section of this report—Maternity and Child Welfare. This part being merely statistical, it is not proposed at this point to do more than give some sort of analysis of the figures relating to deaths amongst infants. Causes.—A Table (Ministry of Health Table I.) will be found on page 29, 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 1929, 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 59 less than three months. The figures for 1928 were 35 and 53. 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 25 deaths, eight less than in the year 1928. Diarrhœa 28 and enteritis (7 and 8) accounted for 17 in 1928, and for 16 in 1929. Respiratory diseases, the third of the main causes, took 20 in 1928, and in 1929, 18. The commoner infectious diseases together led to 9 deaths amongst infants. Four deaths were stated to be due to over-laying, 1 to tuberculosis, 3 to convulsions, and 14 to pneumona. 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 43 deaths amongst infants. In 1928 the figure was 46. In the following table information supplementary to that in the large table is given with regard to deaths in the various sub-districts. 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 11 - - - 5 1 1 3 21 St. Mary 6 — - — 5 5 3 — 19 Christ Church 8 3 1 — 12 10 4 5 43 St. John 8 1 - 2 2 2 2 — 12 Totals 28 4 1 2 24 18 10 8 95 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 S Months 3 and under 6 Month? 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-Fox - - - - - - - - - - - - - - - 2 Chicken-Pox - - - — — — — — 1 1 — — 1 — 1 Measles - - - - - - - - 1 1 1 - — — 1 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Diphtheria and Croup — — — — — — — 1 — 1 — — 1 — 1 6 Whooping Cough — - - — — 1 2 1 2 6 — — 6 — 6 7 Diarrhœa - - - - - 2 1 1 — 4 — — 3 1 4 8 Enteritis - - - - - 7 4 1 — 12 3 3 4 2 12 9 Tuberculous Meningitis - - - - - - - - - - - - - - - 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - 1 1 - 1 - - 1 12 Congenital Malformation 3 - - - 3 1 - - - 4 1 1 2 - 4 13 Premature Birth 8 2 1 1 12 - - — 1 13 6 - 3 4 13 14 Atrophy, Debility and Marasmus 1 1 - - 2 4 2 - - 8 1 3 3 1 8 15 Atelectasis 8 — — — 8 — — — — 8 2 3 3 — 8 16 Injury at Birth - - - - - - - - - - - - - - - 17 Erysipelas - - - - - - - - - - - - - - - 18 Syphilis — — — — — — .— — — — — — — — — 19 Rickets — — — — — — — — — — — — — — — 20 Meningitis (not Tuberculous) - - - - - - - - - - - - - - - 21 Convulsions 1 — — 1 2 — 1 — — 3 — 2 - 1 3 22 Gastritis — — — — - — — — — - — — — — — 23 Laryngitis — — — — — — — — — — — — — — — 24 Bronchitis 1 — — — 1 — 2 1 — 4 — 1 3 — 4 25 Pneumonia (all forms) 2 — — — 2 4 3 3 2 14 4 1 8 1 14 26 Suffocation, Overlying — 1 — — 1 1 2 — — 4 1 — 3 — 4 27 Other Causes 4 — - — 4 4 1 1 1 11 2 4 3 2 11 Totals 28 4 1 2 35 24 18 10 8 95 21 19 43 12 95 29 M. F. Nett Births Legitimate, 553 518 in the Year Illegitimate, 90 72 Total 643 590 1,233 M. F. Nett Deaths Legitimate Infants 44 29 in the Year Illegitimate Infants, 12 10 Total 56 39 95 M. F. Nett Stillbirths Legitimate Infants, 20 10 in the Year Illegitimate Infants, 3 4 Total 23 14 37 30 INFANTILE MORTALITY FIGURES. •– •– •– • Number of deaths of children under one year of age. •---•---•---• Rate per 1,000 registered births. 31 MATERNAL MORTALITY. The number of women who died from conditions arising during or consequent upon child birth was 5, and the maternal mortality rate 4 per 1,000 as against 7 per 1,000 in the previous year. The main facts with regard to the cases are In two cases the women died undelivered, in one the child was macerated, and in another death occurred 11 days after the normal confinement of a stillborn child. One of the women died of pneumonia, an inquest being held when it was fpund that there had been a miscarriage. All the deaths occurred in hospital; the ages of the patients being 22, 22, 26, 29 and 35 respectively. Two were married and 3 were single. DEATHS IN RELATION TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table III. of the Ministry of Health series on page 65. This Table also shows the distribution of deaths according to causes in the various registration sub-districts. The following notes with regard to certain of the causes which contributed most largely to the death rate, may be of interest. DIARRHŒAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 22, equal to 0.21 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur among infants, and in 1929, as a matter of fact, all those who died, with the exception of 6, were less than 1 year of age. In 1928 the deaths from diarrhoeal diseases numbered 22 also, all the victims being under one year of age, with the exception of 5. 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 59 deaths), the diseases contributing to the total of 52 deaths were— diphtheria, 2; scarlet fever, 1; whooping cough, 23; measles, 4; 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 98, which is higher by 6 than the figure 92 for 1928. The great bulk of the 98 deaths, viz., 89, was due to phthisis. Of the total number of deaths registered (1,155), the percentage due to phthisis was 6.0 as against 7.0 in 1928. The age periods at which the deaths occurred were 1—2, 1 (1.1 per cent.); 2—5, 1 (1.1 per cent.); 5—15, 3 (3.4 per cent.); 15—25, 20 (22.5 per cent.); 25—45, 21 (23.6 per cent.); 45—65, 36 (40.4 per cent.); 65—75, 4 (4.5 per cent.); 75 and upwards, 3 (3.4 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. 32 Deaths from Phthisis and other Tuberculous Diseases. Year No. of Deaths Population Rate per 1,000 of Population 1919 116 97,953 1.18 1920 122 101,856 1.19 1921 117 105,200 1.11 19s2 127 105,200 1.20 1923 115 105,400 1.09 1924 121 105,300 1.14 1925 93 106,100 .81 1926 109 105,800 .95 1927 94 103.500 .90 1928 92 104,000 .82 1929 98 102,400 .89 RESPIRATORY DISEASES. As a result of the very severe winter the number of deaths, 264, due to bronchitis, pneumonia, and other diseases of the organs of respiration was exceptionally large, higher in fact by 105 than the figure (159) for 1928. The death rate was 2.40 per 1,000. In 1928 the rate was 1.43. The greatest number of deaths occurred in the first quarter of the year. The number of death certified to be due to bronchitis was 88, as against 46 in 1928. Of this number 54 were amongst persons aged 65 and upwards, and 23 amongst those of the age group 45—65. The deaths attributed to pneumonia numbered 154, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 30 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified was 92. Of the patients 28 were aged 25—45, the other age periods contributing smaller numbers. Further particulars with regard to distribution of the cases, both in relation to age and residence will be found in the table on page 66. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 197, and the death rate 1.7 per 1,000 of the population. In 1928 the total was 151, and the death rate 1.3 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 - - 1 8 22 35 18 85 Females - - 1 1 17 29 34 30 112 Totals 1 - 1 2 25 51 69 48 197 33 Cancer.—Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 3 1 4 Throat, Neck, Gullet 19 6 25 Stomach 5 12 17 Intestines 23 23 46 Liver 7 7 14 Breast — 21 21 Uterus and Generative Organs — 26 26 Various 28 16 44 Totals 85 112 197 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. Onel 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 1929 numbered 66. 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 66. The total number of notifications coming to hand was 773, which is lower by 2 than the figure (775) for 1928. The diseases in respect of which fairly large numbers of notifications were received were scarlet fever (237), diphtheria (180), pneumonia (92), tuberculosis (173), and erysipelas (40). The notification rate (proportion to population of notified cases of infectious diseases) in 1929 was 7.5 per 1,000, as against 7.4 in 1928. 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 3 or loOO per cent, of the cases notified. Diphtheria 177 „ 98.3 ,, „ „ Erysipelas 14 „ 35.0 „ „ „ Scarlet Fever 233 „ 98.3 „ „ „ Enteric and Paratyphoid Fever 9 „ 81.8 „ „ Encephalitis Lethargica 2 „ 66.6 „ „ „ Tuberculosis 71 ,, 41.0 „ ,, „ Pneumonia 26 ,, 28.2 „ „ „ Puerperal Fever 8 ,, 75.0 „ ,, „ Puerperal Pyrexia 14 ,, 73.0 ,, ,, 34 The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £55 4s. Od., equal to 10s. 9d. per 1,000 of the population. The cost and rate per 1,000 for each of the past 10 years are shown in following table:— Year Amounts paid to Medical Practitioners Cost per 1,000 of Population £ s. d. £ s. d. 1920 88 2 6 0 17 3 1921 82 1 0 0 15 7 1922 89 5 9 0 16 11 1923 40 7 6 0 7 8 1924 49 14 0 0 9 5 1925 48 4 0 0 9 1 1926 49 1 6 0 9 8 1927 51 14 0 0 10 0 1928 56 16 0 0 10 11 1929 55 4 0 0 10 9 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 483, and referred to 985 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 180, the number in 1928 being 177. Of the cases 2 died, and the case mortality rate was 1.1 per cent. The number of cases per thousand of the population was 1.8. The cases were more or less evenly distributed, as usual, throughout the borough, and only in a few instances was it possible to determine accurately the source of infection. In 5 cases the source appeared to be a member of the family previously infected; in 4 cases infection was counted to have been acquired in school, and in 23 cases in an institution. The number Of swabs from doubtful cases submitted for bacteriological examination was 2,408. A positive result was returned in 121 instances. Of the registration districts Christ Church which since in it there are more children than in the others, in general contributes the largest number of cases, in 1929 took third place with 46 cases. All Souls, largely on account of an outbreak in the Royal National Orthopaedic Hospital, Great Portland Street .heads the list with 56 cases and is followed by St. Mary with 50. In St. John the number was 25. As usual, the age groups 1—5 and 5—15 were those most affected, 48 of the cases falling into the former and 80 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., 24. These were all remedied after service of notices. The Schick Testing and Diphtheria Immunization Clinic opened at the beginning of 1928, continued to operate at the Lissonia Centre throughout the year, the work being in the hands of Dr. Margaret Emslie. In the main the children dealt with were those attending the Welfare Centre. In addition, however, advantage was taken of the occurence of a number of cases of diphtheria amongst the children attending the Convent in Wigmore Street, to test and immunize several of those who had been in contact. 35 The following table and summary give details of the work of the Clinic during the year. Children under 5. Children over 5. Adults. Total. Total number on books 58 100 3 161 Inoculated without Schick Test 10 — - 10 Tested—Positive 34 43 3 80 Negative 10 53 - 63 Not reported 5 3 - 8 Injections—1st 49 73 2 124 2nd 41 43 2 86 3rd 37 39 2 78 Retested 70 20 2 92 Injections—4th 1 4 2 7 5th - 2 1 3 6th - 1 - 1 Completely immunized 54 17 2 73 311 298 16 625 SUMMARY. Total number on books 161 Number of children under 5 58 Number of children over 5 100 Number of adults 3 Number of Sessions 47 Number of attendances 625 Average weekly attendance 13 Scarlet Fever. The number of casts was higher than in 1928, 237 cases as against 223, the increase in the main being due to an outbreak numbering some 50 cases in the Hospital of St. John and St. Elizabeth. The source of the infection appeared to be an unrecognised case amongst the patients admitted, and an interesting feature that so very many of the members of the staff were attacked. The highest number of cases reported in any one week was 35. The total deaths from scarlet fever numbered 1, and the number of deaths per cent, of the cases was 0.42. The districts to suffer most were Christ Church and St. John. In the former there were 62 cases and in the latter 79. In St. Mary there were 48 and in Al! Souls 44. ; As usual the majority of patients were children of school age, the age group, 5—15, giving 86 of the total. Of the remainder, 53 were aged between 1 and 5 years, and 98 over 15 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 22 instances that a definite connection could be made out. Defects in sanitation to the number of 16 were discovered in the premises visited. All these were want of cleanliness, etc. The nuisances were remedied after the service of notices in each case. Enteric Fever and Paratyphoid Fever. The Enteric Fever notifications received numbered 5. There were no deaths. Of Paratyphoid Fever there were 6 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. Three cases of this disease were notified during the year. 36 Encephalitis Lethargica. There were three cases of this disease notified. All 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. R.E 39 F. 20-2-29 Died 16-2-1929. 2. E.A 63 F. 11-4-29 Died 16-4-1929. 3. E.S.D 45 F. 28-8-29 Recovered 28-2-30. Polio-Myelitis. There were two cases of this disease notified. Erysipelas. The notifications of erysipelas numbered 40. Puerperal Fever. The number of cases of this disease notified was 4, the figure for 1928 being 3. Puerperal Pyrexia. There were 19 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 1928 was 32. Measles and German Measles. Since the disease is not now notifiable it is impossible to say exactly the number of cases that occurred, but as only 364 were reported by school teachers, compared with 1,424 in 1928, it is safe to conclude that 1929 may be counted as one of the non-epidemic years. There were only 4 deaths. The course adopted in relation to the cases was the same as in previous years so far as visitation and nursing were concerned. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1929 the number of deaths registered as due to whooping cough was 23; thirteen more than in 1928. Nurses were sent in to 5 cases, and 61 visits were paid. Glanders and Anthrax. No cases were notified. Small Pox. The number of cases of this disease notified was 3. There were no deaths. In 1928 there were 30 cases, all from the St. Marylebone Home. In all three instances the infection had been acquired outside the Borough, one on board the s.s. Tuscania. The outbreak on this vessel was noteworthy partly on account of the virulence of the infection and partly because it was largely responsible for the setting up by the French Government of a quarantine barrier against Cross-Channel traffic. Fortunately neither from the Tuscania case nor from any of the others was there any spread of infection. For this presumably the 37 close supervision exercised over contacts and the fact that without exception all immediately associated with the patients availed themselves of the protection afforded by vaccination, were mainly responsible. Although the Borough was practically free from actual cases, the presence of the infection in the Metropolis involved the department and various members of the staff in a very great deal of additional work. Much time was devoted to the visitation of contacts residing or employed in the Borough who had been in contact with cases elsewhere; in arranging for vaccination and re-vaccination, etc. In this connection most valuable assistance was rendered from the Public Vaccinator, Dr. Greenwood, whose death in November was a source of very real regret. Appointed Public Vaccinator in 1889, during the years he held the office his relations with the Public Health Department and its staff were always most friendly. As a practitioner he was of high skill; he was kindly and thoughtful and had the confidence and affection of every one of the many under his care. On all matters relating to vaccination he was a recognized authority and he was widely and frequently consulted. All his skill and knowledge were always freely at the disposal of the Public Health Department during times of anxiety in relation to small pox. Not only because of this but because of the affection in which he was held his loss is keenlv felt and regretted. 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 1929. SCHOOLS Scarlet Fever Diphtheria Whoopirg Cough Chickenpox Measles All other Diseases All Souls, Foley Street 18 6 9 17 10 2 Barrett Street — — — — 2 - Barrow Hill Road 2 31 51 41 6 17 Bell Street 9 7 36 36 43 64 Blandford Square 1 — — 4 1 — Capland Street 22 9 21 30 82 39 Catholic, Richmond Street — — — — 1 - Christ Church, Lisson Grove 1 7 1 4 2 12 Convent, Little Union Place — 8 - 3 - - Christ Church Cosway Street 11 15 34 51 12 104 Emmanuel, Aberdeen Place 5 — 9 - 3 50 Emmanuel, North Street 9 — — 12 8 - Gateforth Street 5 5 13 3 12 38 Hampden Gurney, Upper Berkeley Street 5 5 5 52 20 35 Homer Row, Catholic 1 8 9 11 34 32 Jewish, Hanway Street — — - - - - Portland, Little Titchfield Street — - - - - - Polytechnic, Regent Street 8 — — 6 — 2 Queen's College, Harley Street — — — - — — St. Andrew's. Wells Street — — - - - St. Francis, Upper William Street — — — — — — St. James's, Marylebone Lane 3 3 3 1 1 4 St. Luke's Nutford Place 14 2 2 10 29 6 St. Mark's, Violet Hill 17 15 12 23 11 107 St. Marylebone, High Street 31 18 45 105 15 21 St. Marylebone Grammar, Marylebone Road 1 — — 12 1 3 St. Mary's, Crawford Street 8 8 6 27 5 20 St. Paul's, East Street — — — — - - St. Paul's, Broadley Terrace 7 — 8 32 6 12 St. Thomas', Orchard Street 9 2 18 54 7 33 St. Vincent, Wigmore Street 6 4 — — 9 2 Upper Marylebone Street 25 28 28 42 20 92 Schools out of Borough 30 14 12 35 33 18 Totals 248 205 322 601 364 713 38 Ophthalmia Neonatorum. The following table gives information with regard to 3 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 3 2 1 3 — — — Nurses were sent in 1 case and 13 visits were paid. INFLUENZA. This disease showed no epidemic tendencies during the year. The deaths certified as due to Influenza numbered 59, as against 13 in 1928. Nurses were sent in to 21 cases and 273 visits were paid. PNEUMONIA. Figures with regard to notification will be found on page 66, and information as to methods of prevention, etc., adopted in relation to this disease will be found in previous reports. As already noted, because of the severity of the weather, particularly during the earlier months of the year, the number of deaths was very high, totalling no fewer than 154. The services of the nurses were requisitioned in 34 casts, and 779 visits were paid. TUBERCULOSIS. In all 173 notifications were received, 147 relating to pulmonary tuberculosis, the remainder (26) to cases in which structures other than the lungs were affected. The table given on page 39 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 1928 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 98 2.The number of cases unnotified or notified at death 29 3.The number of cases notified within a month of death 13 4.The number of cases notified within three months of death 5 5.The number of cases notified within six months of death 6 Treatment of Tuberculosis.—Of the cases notified 199 received some form of institutional treatment, and during the year every effort was made to obtain admission to sanatoria of cases deemed suitable for such treatment. Of the total new cases notified 90 were insured persons; of these 51 were admitted to sanatorium or hospital treatment, and 25 to St. Marylebone Hospital. Non-insured persons numbered 83, of whom 39 (13 being children) received sanatorium treatment and 11 (5 being children) were admitted to St. Marylebone Hospital. Nurses were sent in to 10 cases and 365 visits were paid. Public Health (Prevention of Tuberculosis) Regulations, 1925.—In no case was it necessary for action to be taken under these regulations. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 30th December, 1928, to the 28th December, 1929. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Notifications on Form A. Notifications on Form B. Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. No. of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Primary Notifications. Under 5 5 to 10 10 to 15 Toial Primary Notifications. Pulmonary Males — — 2 2 6 7 17 16 13 9 1 73 81 — — — — — 28 57 „ Females — — — 3 10 19 20 11 5 3 3 74 82 — — — — 1 19 49 Non-Pulmonary Males — — 2 — 1 8 6 1 - - — 13 13 — 1 — 1 1 2 12 „ Females 2 2 1 1 - 2 2 1 1 - - 12 13 - - - - - 1 7 Totals 2 2 5 6 17 31 45 29 19 12 4 172 189 - 1 - 1 2 50 125 39 375 Males PULMONARY PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. Number of cases of Tuberculosis remaining- on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough of St. Marylebone, on the 31st December, 1929. 277 Females 652 Total 115 Males NON-PULMONARY 95 Females 210 Total 862 Total Cases 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 30rh december, 1928, to the 28th december, 1929, otherwise than by Formal Notification under the Public Health (Tuberculosis) Regulations, 1912, or by notification in pursuance of 5 (b) of the Local Government (Emergency Provisions) Act, 1916. 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 Cases Pulmonary, Males — — — — — - 1 2 3 6 3 15 „ Females — 1 — — 8 1 — — 2 3 1 11 Non-Pulmonary Males — 2 — 1 — 1 1 — — 1 — 6 „ Females — 1 1 — 1 — — — — — — 3 Totals — 4 1 1 4 2 2 2 5 10 4 35 40 No. of Cases. Source of Information. Pulmonary. Non-Pulmonary. Death Returns—from local Registrars 5 — transferable deaths from Registrar General 9 5 Posthumous notifications 3 3 "Transfers" from other areas (other than transferable deaths) 5 1 Forms C and D (in respect of cases not previously known to the M.O.H.) 4 — Other Sources if any (specify) — — 41 Prevention of Tuberculosis.—As is in general the case the Dispensary continued to prove most valuable, the members of the staff rendering excellent service in relation to prevention work. Particulars with regard to patients dealt with during the year are shown in a table at page 44, while the following short table summarises the information as to visits paid by Dr. Saner and the staff of the Dispensary :— No. of visits by Tuberculosis Officer New, 52 Old, 88 No. of cases at Dispensary New, 414 Old, 1,406 No. of attendances at Dispensary 2,665 No. of visits by Miss Baker First visits, 189 Re-visits, 1,434 No. of visits by Miss Kenion First visits, 29 Re-vxsits, 1,124 No. of Committee Meetings attended 22 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 P.O'Connell and Councillor G.B. Ramsay. In addition to the Council's representatives this Committee includes Sir Francis Morris (Chairman, representing St. Marylebone Board of Guardians), Miss Broadbent (Invalid Children's Aid Association and St. Marylebone Guardians), Dr. Sykes, Divisional Medical Officer, Miss Whitmore, District Organiser, Children's Cart Committee (London County Council), Miss Bowen (Local War Pensions Committee), Miss Higgin (Portland Town Association), Mrs. Hawthorne (Margaret Street Hospital), Miss Price (Middlesex Hospital),Miss O. Lazarus (Central Jewish Synagogue), Miss Wetherall, Senior Almoner (St. Mary's Hospital), Mrs. Somerville Hastings (The Working Classes), and Miss Bennett (Paddington and St. Marylebone District Nursing Association). The Open Air School in Regent's Park, which was established in 1911, continued its useful work during 1929, which, unfortunately, as is noted in the report of Dr. Saner, proved to be the last year of its existence. A pioneer of schools of this class, the school, primitive as it was, did work of sterling value, and the resolution of thanks to the Committee and which with the entry on the Minutes, is set out below, was well-earned :— " Tuberculosis Dispensary—Open Air School, Regent's Park. We have received the following Report from the Medical Officer of Health in regard to (i) the closing of the Open Air School, which, for many years, has been maintained in Regent's Park, in association with the Tuberculosis Dispensary, and (ii) the excellent work which has been performed by the Commttee responsible for the Organsation, and Mrs. Fitzgerald, the Teacher employed for these purposes, namely :— I have to report that at a recent meeting of the Open Air School Committee it was decided to close the School at the end of this year. The reasons for taking this step are partly the increasing difficulty in obtaining funds for carrying on the work, and partly because its real objective has been attained, namely, the encouragement of the open air school idea in the case of children found to be suffering from tuberculosis in the early stages or who have for one reason or another, because they were contacts with cases of tuberculosis or presented signs of the disease, indicated that unless great care were taken they might be attacked by the disease. The number of open air schools provided by the London County Council has been greatly increased, and there is now full opportunity for the admission of suitable children to such schools. The work done by the Open Air School in Regent's Park, not only in a pioneer sense, but also on behalf of individual children has been of the greatest vclue. Many who might quite readily have succumbed to the infection have 42 been put on the way to lead a perfectly normal, healthful and useful life, and many who, because of periods of ili-health, might have failed to benefit from the education provided in the ordinary schools have been enabled to have the advantage of a course of instruction in no sense inferior to that available in such schools. The Open Air School was established in June, 1911, at the time when the Tuberculosis Dispensary was conducted on a voluntary basis, and ever since that date has gone on day by day in the extremely primitive accommodation originally selected, namely, one of the bandstands in Regent's Park. After the Dispensary was taken over by the Borough Council the School continued to run, and though the Borough Council was precluded from rendering any financial aid they placed the services of Dr. Saner, the Tuberculosis Officer, at the disposal of the Special Committee who carried on the affairs of the School. As Medical Officer to the School for many years, Dr. Saner has performed a valuable service which has been greatly appreciated. The Council, as responsible for the working of the tuberculosis scheme in the Borough, is under a deep debt of gratitude to the Open Air School Committee for the work it has done. The activities of the Dispensary, particularly so far as regards preventive work amongst children, have been supplemented to a very large extent by the Open Air School Committee and the establishment for which they made themselves responsible. So far as the administrative work is concerned, Miss Broadbent, who has been associated with the School since its inception, is particularly deserving of gratitude; and on the executive side most praiseworthy if not, indeed, wonderful work has been done by the teacher Mrs. Fitzgerald. We RECOMMEND- That the Council do place on record their appreciation of the services rendered by Miss M. E. Broadbent, Mrs. Fitzgerald, and the Members of the Committee responsible for the establishment and maintenance of the Open Air School in Regent's Park for tuberculous children." The number of children on the roll for 1929 was 22—14 boys and 8 girls—and the attendances numbered 4,994. Dr. Saner, who has been Medical Officer of the School since he took office at the Dispensary, continued to act throughout the year. The following extracts from a report by the Tuberculosis Officer (Dr. Saner) contain reference to a number of points that may be of interest:— "Tuberculosis Dispensary.—Statistics for the year 1929, are set out in the tables and need no comment except to say that it is the wish of the Ministry of Health that all patients who have received public treatment, whether they have attended the Dispensary or not, should be placed on the Dispensary Register. This has been done. The Care Committee has met fortnightly during the year and has had under discussion 308 cases. Of these 156 were in connection with treatment through the London County Council to whom 191 reports on the progress of patients (post sanatorium treatment) have been forwarded, 8 children have been away through the Invalid Children's Aid Association, and other children through the London County Council included in the 156. The Open Air School in Regent's Park closed its doors at the end of the year, having been in existence since 1911. During the whole of that time it was supported entirely by voluntary contributions. It is greatly to be regretted that this very useful work has ended but there is no doubt that in a large sense a pioneer it showed the way to many other like establishments not only in this country but abroad and in the Colonies. A word of praise is due to the teacher, Mrs. Fitzgerald, who has during a long period achieved some excellent, even wonderful, 43 results, not only as regards education but as regards health and the method of keeping healthy. The children have taken their correct places at the ordinary elementary schools to which they have returned and in some cases even have shown themselves qualified to enter a higher standard. This is due to the individual attention lavished on them by Mrs. Fitzgerald. To obtain suitable work for the disabled man and woman on leaving Sanatorium is and not improbably always will be a difficult problem. Perhaps more so for the man than the woman. An open air job is always recommended but the number of these is limited even if such occupations as motor driving and delivery vans, insurance agent, painting, gardening, gardening in cemeteries, park keeping, road sweeping, porter outside stores or mansion flats, are included. All of these are more or less suitable but to some extent must be made to fit the man. For instance, motor driving if the starting of the heavy vehicle could be done by an able man; paintirig without high ladder work; a delivery van provided only small parcels are dealt with. Park keeping and cemetery keeping are quite suitable. Gardening too is suitable, perhaps one of the most, as it is in this kind of work in which they are instructed in Sanatoria. Gardening work in a cemetery if the digging of deep graves is excluded, does not entail any arduous work and it seems a pity that most of these jobs, even by borough councils, are given to the able bodied. House to house visiting as an insurance agent either seeking new clients or collecting premia, becomes vry tiring after a day's tramping. Road sweeping too is a dirty job and not therefore particularly suitable. The porter at the door of shops or mansion flats is fairly suitable but .the lifting of heavy packages should be avoided. As regards the clerical worker, he should if possible return to his work especially if the office is a well-ventilated one. The difficulty here, however, is that his fellow workers are unwilling to work anywhere near him and do not realize that the careful consumptive is a danger to no one. It still seems fatal for anyone to expectorate into a blue flask, but no notice is taken of the man who spits on the floor or pavement. The housing of the consumptive and his family is perhaps more of a difficult proposition even than obtaining work, and it seems as if the only solution is colonization, a suggestion put forward with some diffidence having in mind views recently expressed as to the imminence of the danger of transforming this country into an island of prisons, hospitals and lunatic asylums." Bacteriological Diagnosis of Consumption. — The number of specimens of expectoration sent by medical men for bacteriological examinati&n, from cases in which there was some doubt as to the diagnosis, was 749, as against 653 in 1928. Of these, 93 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—26 as against 22 in 1928—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 50. 44 TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1929. DIAGNOSIS. pulmonary. non-pulmonary. TOTAL. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts) :— (a) Definitely tuberculous 41 51 3 1 14 7 4 2 58 58 7 3 (6) Doubtfully tuberculous - - - - - - - - 41 62 21 21 (c) Non-tuberculous - - - - - - - - 13 18 12 5 b.—Contacts examined during the year:— (a) Definitely tuberculous — 1 1 1 — 1 — — — 2 1 1 (&) Doubtfully tuberculous - - - - - - - - 8 5 13 18 (c) Non-tuberculous - - - - - - - - 7 11 12 13 C.—Cases written off the Dispensary Register as (a) Cured 5 5 3 8 — — — 3 5 5 3 11 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 57 96 66 63 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 145 139 28 15 25 13 25 22 170 152 53 37 (6) Diagnosis not completed — — — — — — — — 11 13 32 32 1.Number of persons on Dispensary Register on January 1st, 1929 436 2.Number of patients transferred from other areas and of "lost sight of" cases returned 218 3.Number of patients transferred to other areas and cases " lost sight of " 173 4.Died during the year 85 5.Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 19 6.Number of attendances at the Dispensary (including Contacts) 2,665 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 (а)"Light" treatment 33 (б)Other special forms of treatment 76 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 11 (b) Otherwise 130 11.Number of other visits by Tuberculosis Officer to Homes 129 12.Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,739 13. Number of (a)Specimens of sputum, &c., examined 266 (b) X-ray examinations made, in connection with Dispensary work 18 14.Number of Insured Persons on Dispensary Register on the 31st December 155 15.Number of Insured Persons under Domiciliary Treatment on the 31st December 144 16.Number of reports received during the year in respect of Insured Persons :— (a) Form G-P. 17 — (b) Form G.P. 36 4 Two female adults who were crossed off as cured, re-attended and were found healthy. (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 1929, 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 Previous to 1926 1926 1927 1928 1929 Class T. B. minus. Class T. B. plus Class T. B. minus. Class T. B. plus. 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 3. Total (Class T.B. plus). Group 1. Group 2 Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plusi. Group 1. Group 2. Group 3- Total (Class T. B. plus). Alive. Discharged as cured Adults M. 5 - - - - - - - - - - - - - - - - - - - - - - - - F. 9 - - - - - - - - - - - - - - - - - - - - - - - - Chil- dren M. 3 - - - - - - - - - - - - - - - - - - - - - - - - F. 8 - - - - - - - - - - - - - - - - - - - - - - - - Disease arrested Adults M. 4 1 - - 1 - - - - - - - - - - - - - - - - - - - - F. 2 1 - - 1 - - - - - - - - - - - - - - - - - - - - Children M. - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - Disease not arrested Adults M. 8 15 7 5 27 5 5 2 1 8 1 8 4 5 17 9 6 6 5 17 11 21 10 1 32 F. 16 10 3 4 17 4 2 1 2 5 5 7 7 2 16 8 10 5 2 17 18 14 9 2 25 Children M. 12 - - - - - - - - - 3 - - - - 1 - - - - 6 1 - - 1 F. 7 - - - - - - - - - - - - - 1 4 - - - - - - - - - Condition not ascertained during the year - - - - - 2 - - - - 5 2 1 - 3 1 1 - - 1 - - - - — Lost Sight of or otherwise removed from dispensary Register 58 47 7 1 55 16 10 4 2 16 13 6 3 1 10 12 10 3 - 13 5 3 2 - 5 Dead Adults M. 1 4 6 23 33 - - 5 21 26 2 - 1 14 15 - - - 12 12 — — — 4 4 F. 1 2 3 10 15 — - - 9 9 3 — 1 10 11 — — 1 11 12 - — — 6 6 Children M. - - - - - - - - - - - - - - - - - - - - - - - - - F. 1 - - - - - - - - - - - - - - - - - 1 1 — - - 2 2 Totals 135 80 26 43 149 33 17 12 35 64 33 24 17 32 73 35 27 15 31 73 40 39 21 15 75 45 (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 1929, 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 Previous to 1926 1926 1927 1928 1929 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. 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. 1 - 1 2 4 - - - - - - - - - - - - - - - - - - - - Disease arrested Adults M. 2 - 1 - 3 1 - - 1 2 - 1 - - 1 1 - - - 1 1 - — — 1 F. 1 - - 2 3 - - - - - - - - - - - - - - - - - - - - Children M. 2 1 — 1 4 — — — 1 1 - - — 1 2 - - - — — — — — — — F. 2 — — 2 4 — — - 3 3 - - - - - 1 - - 1 2 - - - - - Disease not arrested Adults M. 1 - - - 1 — — - — - 1 - - - 1 1 - - - 1 9 - 3 2 14 F. 1 — — — 1 — — 1 — 1 1 - - - 1 - - — - - 2 1 1 3 7 Children M. 7 - — 2 9 2 — — — 2 — — — — — 1 1 — 2 4 1 — — 2 3 F. 2 — — 3 5 1 — - — 1 1 1 - 1 3 1 - - 1 2 1 - - 1 2 Transferred to Pulmonary - — - - - - - - - - - - - - - - - - - - - - - - - Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - Lost Sight of or otherwise removed from dispensary Register 15 - 5 5 25 1 1 - - 2 2 - - 1 3 1 - - 2 3 - - 1 1 2 Dead Adults M. 2 1 - - 3 - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - Children M. - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - 1 1 - - - - - - - - - - - - - - - Totals 36 2 7 17 62 5 1 1 6 13 6 2 — 3 11 6 1 - 6 13 14 1 5 9 29 46 Statement of-Work carried out in connection with the Dispensary Treatment of Tuberculosis during the period 1st January, 1929, to the 31st December, 1929, 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, 1929, to the 31st December, 1929, at or in connection with the Dispensary and were:— Number of Persons diagnosed to be suffering from Tuberculosis who were treated or supervised at or in connection with the Dispensary during the period from 1st January, 1929 to 31st December, 1929. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1929. Number of Persons referred for diagnosis or treatment tothe Hospital with which the Dispensary is affiliated during the period 1st January, 1929, to 31st December, 1929. Diagnosed as suffering from Tuberculosis. Diagnosed as not suffering from Tuberculosis. Undiagnosed and j 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 W'ednes., 9.30—5 Thursday,9.30—9 130 91 189 165 245 141 148 155 345 10 10 Friday, 9.30—5 Saturday, 9.30-—1 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:— 47 48 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. 1. Name of Hospital to which Special Cases are reterred from the Dispensary for diagnosis or treatment Middlesex Hospital. 2. Is any provision for the home nursing of Tuberculous Patients made in connection with the Dispensary ? If so Yes. Application can be made to the District Nursing Association. (1)State the general nature of the arrangement (1) Note sent to Matron from Dispensary. (2)What qualifications are the Nurses required to possess ? (2)Fully trained. (3)Do they carry out other work ? If so, what ? (3)Yes, District Nursing. (4)Are their services available for Insured and Uninsured Patients ? (4)Yes. (5)If so (a) by what procedure are their services secured for individual patients ? (5)(a) As above. (b)Under whose instructions do they perform the actual duties of nursing in an individual case ? (b)Matron of Nursing Association and Tuberculosis Officer. 3. If no provision of nursing is made in connection with the Dispensary is any such provision contemplated ? If so, give particulars ? 4. State number of Shelters provided by the Council or by the Dispensary Authorities up to 31st December. 1929, for lending out to Patients for use at their own homes None. Deaths front 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- 1929 the total number certified as due to this cause was 89, 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 1925-1929. 49 Deaths from Phthisis. Five years—1925-1929. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1929 102,400 89 20 31 28 10 The distribution of the 89 deaths was as follows:—In Poor Law Institutions, 38; general and other hospitals, 24; and at home, 27. Of those who died 38 were insured (24 males and 14 females) and 51 uninsured (24 males and 27 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 89, the notified cases of pulmonary tuberculosis totalled 147. 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 - - - 2 1-5 1 2 3 - 1 1 1 5-10 2 - 2 3 - - - 1 10-15 2 3 1 1 - 1 2 - 15-20 6 13 1 1 - 4 - - 20-25 7 20 4 2 3 10 1 - 25-35 18 20 7 2 4 7 - - 35-45 18 11 1 1 8 3 - - 45-55 16 7 - 1 12 6 - - 55 -65 15 6 1 - 15 7 1 - 65 and upwards 4 4 - - 6 2 - - Totals 88 85 19 16 48 41 5 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. CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 28TH DECEMBER, 1929. Localization of Disease. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. At all Ages. At ages—years. All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals Cases Isolated at Home Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Lungs 147 — — 7 42 64 30 4 35 45 44 23 147 12 25 13 10 60 87 Glands 10 — 1 5 1 3 — — 3 2 2 3 10 — 1 — 1 2 8 Knee 2 — — — — 2 — — 1 — 1 — 2 — — 1 — 1 1 Spine 3 — — — 1 2 — — — 1 — 2 3 — — — 1 1 2 Hip 2 — — — 1 1 — — — 1 — 1 2 —' 1 — — 1 1 Colon 1 — — — 1 — — — — — — 1 1 — — — 1 1 — Kidney 1 — — — — — 1 — — — — 1 1 — — — 1 1 — Lupus 1 — — — 1 — — — 1 — — — 1 — — — — — 1 Miliary 2 — — — — — — — 1 1 — 2 — 1 — — 1 1 Peritoneum 1 — 1 — — — — — — — 1 — 1 — — 1 — 1 — Skin 1 — — — 1 — — — — 1 — — 1 — — — — — 1 Epididymis 1 — — — — 1 — — — 1 — — 1 — 1 — — 1 — Meninges 1 — — — — 1 — — — 1 — — 1 — 1 — — 1 — Totals 173 2 2 12 48 74 31 4 40 53 49 31 173 12 30 15 14 71 102 173 50 51 DISINFECTION. The work done in this connection during 1929 is shown in the following tables. The methods employed during the greater part of the time were substantially the same as in previous years; articles suitable for treatment by steam were dealt with in the Washington-Lyons Disinfector, while for rooms either formalin or sulphur vapour was generally employed. The number and nature of the articles disinfected are shown hereunder Compulsorily Notifiable Diseases. Phthisis Measles. Vermin. Other causes. Total. Beds 156 9 — 6 4 175 Mattresses 539 27 13 12 86 677 Bolsters 239 11 3 5 32 290 Pillows 1,250 64 15 17 310 1,656 Sheets 630 24 9 10 6 679 Blankets 1,229 25 15 17 13 1,299 Sundries 4,789 433 20 144 29 5,415 Totals 8,832 593 75 211 480 10,191 In 1928 the number of articles disinfected was 10,358. The number of journeys made by the disinfecting vans during the year ended December. 1929, was:— January 82 August 75 February 65 September 59 March 98 October 73 April 78 November 83 May 74 December 75 June 67 891 July 72 The number of journeys made during 1928 was 962. 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 146 7 3 — — 156 February 58 10 2 — — 70 March 169 8 11 — — 188 April 38 7 28 — — 73 May 64 6 46 — — 116 June 36 5 10 — — 51 July 60 3 4 — 9 76 August 59 8 — — 6 73 September 21 6 — — — 27 October 42 5 — — 13 60 November 68 11 — — 10 89 December 126 8 8 — 7 149 Totals 887 84 112 — 45 1,128 52 The number of rooms disinfected in 1928 was 1,010. 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 187. 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 1929, and annually since 1919:— 1929 ADULTS CHILDREN Males Females Total Males Females Total January 242 58 300 39 99 138 February 183 35 218 22 75 97 March 210 47 257 46 207 253 April 212 60 272 40 188 228 May 233 67 300 70 187 257 June 211 59 270 52 164 216 July 235 85 320 81 262 343 August 192 61 253 22 60 82 September 222 105 327 66 150 216 October 252 90 342 50 231 281 November 231 90 321 71 183 254 December 239 61 300 47 84 131 Totals 2,662 818 3,480 606 1,890 2,496 Cleansing Station Attendances, 1919-1929. 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 1929 2,662 818 3,480 606 1,890 2,496 The total attendances since the Baths were opened in 1898 number 253,323 (adults, 181,595; children, 71,728). 53 BACTERIOLOGICAL EXAMINATIONS. The following table shows the number of specimens examined for purposes o 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 5 40 45 Diphtheria 121 2,297 2,408 Phthisis 93 756 749 Totals 219 2,983 3,202 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 £1,000 in 1929 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 1929. 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 of the year, is also held at Salisbury Street. Here in addition there is a Lighi Clinic which is open on two days per week, and a massage clinic. 54 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, 1.30 ,, Toddlers (2—5 years). Friday, 1.30 „ Infant Consultation. *30, Marylebone Lane, W, 1— Monday, 4.30 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, 10.30 a.m. Infant Consultation. Queen Charlotte's Hospital, 12, Harcourt Street, W. 1— Daily, 9.30 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 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 1929 the health visitors made 8,831 visits. Children are visited up to school age. 55 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. One of the Health Visitors acts as superintendent. 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 hospital, 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, Marylebone Lane, and Queen Charlotte's Hospital. 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 1929 was 2,683; the total births numbering 3,769. The midwives residing in the borough registered as intending to practice in the administrative County of London, number 26. Two conduct maternity homes which are registered by the London County Council. By arrangement with the Paddington and Marylebone Nursing Association which took effect at the beginning of December, all women in the borough attended by externs of St. Mary's Hospital, are provided with nursing attention by the Association. Up till the end of the year two cases had been dealt with under the arrangement, the services of the nurses being greatly appreciated by the patients. Work done during 1929.—The following table gives some idea of the work done at the various centres during the year. Full details of the method adopted in relation to the granting of orders for milk and food under the Maternity and Child Welfare Act, 1918, will be found in previous reports, and need not again be discussed. The total number of orders issued is shown in the table. 56 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDING 31ST DECEMBER, 1929. CENTRE. No. 24 Hill Road. 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 98 147 51 99 94 143 90 Toddlers — 49 — — — 52 90 Maternity 45 51 306 — 44 93 — Massage — 83 109 — 124 — — Light — 86 — — 56 — — No. of attenda n c e s of mothers at clinic:— Ante-natal 21 191 12,228 — 24 3,290 — Post-natal 92 425 14 — — 30 — No. of attendances of babies 1,748 4,526 1,724 1,793 1,805 4,980 191 No. of attendances of children over 2 years 671 1,138 477 532 269 1,544 1,089 No. of attendances at light Clinic — 1,824 — — 819 — — No. of attendances at massage Clinic — 1,068 331 — 223 — — No. of orders issued for milk, etc. 72 399 68 65 76 109 — No. of home visits 1,468 2,813 325 1,015 529 3,021 — No. of new cases:— Infants 68 227 59 48 85 304 92 Toddlers 6 27 — — 9 12 128 Ante-natal 7 39 3,677 — 15 514 — Post-natal 30 53 13 — 1 10 — Massage — 79 13 — 8 — — Light — 62 — — 18 — Day Nurseries—Attendances during the year. The Crossley, Barrow Hill Road 6,458 The Portman, Exeter Street 7,657 Dental Clinic, 12 Salisbury Street. Attendances during the year : Mothers, 959 ; Children 101. Advice and treatment given in 684 cases—extractions under gas, 376. 57 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 1929 was one, and the total amount expended during the financial year to 31st March, 1930, was £2 5s. Od. SANITARY ADMINISTRATION. Under this, which is made a separate heading by the Ministry of Health, the Medical Officer of Health is required to make reference to a number of matters, e.g., staff, hospital accommodation and some others, most of which will be found dealt with elsewhere. (1) Staff: Work of sanitary inspectors and other officers engaged in sanitary work. This matter, so far as the inspectors are concerned, is fully discussed in an early part of the report. The report of the Mortuary Keeper (Mrs. Spears) is as follows:— Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1929, 1929. Males. Females. Total. For burial only. For inquests. Total. No. of P.M 's held. No. of courts held. No. of Infectious cases. January 15 8 23 19 4 23 9 2 - February 18 18 36 29 7 36 15 5 1 March 17 19 36 27 9 36 11 6 - April 14 15 29 21 8 29 9 6 - May 12 12 24 20 4 24 5 2 - June 7 11 18 14 4 18 4 3 - July 13 6 19 14 5 19 4 4 - August 9 7 16 9 7 16 5 4 - September 7 11 18 6 12 18 8 9 - October . 8 13 21 13 8 21 9 6 1 November 9 10 19 18 1 19 7 1 - December 11 15 26 23 3 26 7 1 1 Totals 140 145 285 213 72 285 88 49 3 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. Nursing homes in the Borough number 55, but with these registration under the Nursing Homes (Registration) Act, 1927, being in the hands of the London County Council, the Borough Council, whose officers could very easily and efficiently carry out the duties involved, have no concern whatever. (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. 58 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)) flats Nil houses 18 (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) 2,362 (2) Number of dwelling-houses (included under sub.head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925— Houses 589 Tenements in blocks 273 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 1,687 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) 1,583 3. Action under statutory powers: (a) Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (b) Proceedings under Public Health Acts (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied (statutory notices) 104 (2) Number of dwelling-houses in which defects were remedied after services of formal notices— (a) By owners 104 (b) By Local Authority in default of owners Nil 59 (c) Proceedings under Sections 11,14 and 15 of the Housing Act, 1925; (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (8) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil 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 on the report made by him the Minister of Health, in granting approval, which he did during the year, made certain minor alterations in the scheme. The year closed without any active steps in the direction of carrying out the Scheme having been taken, though the lay-out has been prepared and the majority of the negotiations, it is understood, have been completed. GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921). 104,173 (1929) 102,400 estimated. Number of inhabited houses (1921), 18,507. Number of families or separate occupiers (1921). 27,214. Rateable value. £2,793,745. Sum represented by a penny rate. £11,520. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimate 1,071 533 518 Birth Rate, 11.9 Illegitimate 162 90 72 Deaths, 1,455. Death Rate, 13.2. Number of women dying in, or in consequence of, childbirth—from sepsis, 2; other causes, 3. Deaths of Infants under 1 year of age per 1,000 births:— Legitimate 68. Illegitimate 136. Total 77. Deaths from Measles (all ages), 4, Deaths from Whooping Cough (all ages), 23. Deaths from Diarrhoea (under 2 years of age) 16. 60 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 107 Cowhouses 1 Slaughterhouses 1 Offensive Trades 3 Ice Cream Premises 68 Bakehouses 54 Restaurant, Dining Room and Coffee Shop Kitchens 194 Hotel Kitchens 21 Pastrycooks and Tea Rooms 83 Fried Fish Shops 24 Fish Curers 5 Houses Let in Lodgings 1,055 Workshops and Workplaces 3,717 Total 5,333 Smoke Nuisances. Number of Observations 441 Number of Nuisances and Complaints 9 Number of Intimation Notices Number of Summonses Nil served nill 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 (a) On account of complaints Medical Officer or other or illness (P.H. Act)2,862 person Nil (b) House-to-house (Housing Consolidated RegulaNumber of Houses included in tions, 1925) 589 such representations Nil Tenements in blocks273 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 1,583 (2) Statutory 104 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, 1891 1,687 Total Number of Houses in the Number of Houses repaired borough 19,545 under Section 3 of Housing Act, 1925— Number of Houses occupied by (a) By Owners Nil the Working Classes8,558 (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 ing Classes- Number of Prosecutions Nil (a) Erected during year 18 flats (b) In course of erpr.tion 12 flats 61 Mortuary. Number of bodies received 285 Number of Infectious bodies received 3 Disinfection. Number of rooms disinfected 1,128 Number of articles disinfected 10,191 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 2,662 818 606 1,890 5,976 Bakehouses. Number on Register at end of 1929 54 Number above ground 5 Number underground 49 Number of Inspections 112 Number of Notices 6 Number of Prosecutions Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1929 826 Number of Inspections 810 Number of Notices 24 Number of Prosecutions Nil House to House Inspections. Number of Inspections Houses 589 Tenements 278 Number of Notices issued Intimations 345 Statutory Notices 30 Number of Prosecutions 1 House Refuse. Number of Inspections 3,156 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 226 Number of Notices issued. Intimations 177 Number of Statutory Notices 19 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 4 Number of Statutory Notices served 1 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 5 Number Remedied 5 Number of Prosecutions Nil 62 Underground Rooms. Number dealt with 19 Number of Notices served under P. H. (L.) Act, 1891 19 Number of Notices served under the Housing Act, 1925 Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms cleansed after infectious disease 1,128 Number of rooms cleansed from vermin 404 Number of Statutory Notices served 17 Number of Prosecutions Nil Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of Persons accommodated during the year 9 63 MINISTRY OF HEALTH AND OTHER TABLES. table I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1929 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births, No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1911 117,844 4,130 2,375 20.2 1,578 14.2 600 840 261 109.8 1,818 16.3 1912 116,155 4,111 2,246 19.3 1,652 15.0 769 752 209 93.0 1,635 14.8 1913 114,532 3,804 2,146 18.6 1,629 14.9 755 753 195 90.0 1,627 14.9 1914 112,892 3,847 2,128 18.7 1,631 15.1 813 787 210 98.6 1,605 14.9 1915 100,260 3,647 1,852 16.2 1,741 17.2 817 773 178 96.1 1,697 17.8 1916 98,573 3,936 1,814 16.8 1,681 16.9 855 720 188 103.6 1,583 16.0 1917 92,796 3,065 1,506 14.5 1,647 17.6 853 752 182 120.9 1,580 17.0 1918 98,526 3,340 1,375 12.4 1,852 18.7 898 879 152 110.5 1,835 18.5 1919 97,953 3,625 1.492 14.6 1,724 17.3 864 708 147 98.5 1,568 15.9 1920 101,856 4,287 2,217 21.5 1,638 160 939 600 145 65.6 1,299 12.7 1921 105,200 3,393 1,939 18.4 1,625 15.4 877 607 128 66.0 1,355 12.8 1922 105,200 3,588 1,679 15.9 1,638 15.5 905 718 115 68.0 1,451 13.7 1923 105,400 3,601 1,668 15.8 1,468 13.9 827 594 111 66.0 1,235 11.7 1924 105,300 3,432 1,531 14.5 1,686 15.9 936 688 123 78.0 1,436 13.6 1925 106,100 3,418 1,496 14.1 1,472 13.8 873 658 94 63.0 1,257 11.0 1926 105,800 3,220 1,359 12.7 1,325 12.4 748 740 111 81.6 1,356 11.9 1927 103,500 3,521 1,374 13.2 1,375 13.2 781 621 81 59.0 1,262 11.3 1928 104,000 3,662 1,317 12.6 1,335 12.8 787 690 105 79.0 1,238 11.1 1929 102,400 3,526 1,233 11.9 1,465 14.3 821 804 93 77.0 1,455 13.24 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. 64 TABLE I (a). Vital Statistics of Separate Localities in 1929 and the Ten Previous Years. Names of Localities The Whole Borough All Souls St. Mary Christ Church St. John Year Population estitaated to middle of each year Births registered Deaths at all Ages Deaths untler 1 year Population estimatec to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages | Deaths under 1 year Population estimated to middle of each year Births registered : Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 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 21 32,445 720 455 55 17,862 384 287 23 1922 1.05,200 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 32,806 643 430 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 16 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 1928 104,000 1,317 1,238 105 24,915 232 248 21 26,638 285 299 17 32,371 533 434 46 20,076 313 257 21 Averages of Years 1919 to 1928 104,030 1,607 1,345 116 25,209 302 256 20 27,155 342 367 22 32,294 651 451 53 19,371 310 270 19 1929 102,400 1,233 1,455 95 24,532 233 327 21 26,228 254 362 19 31,873 503 504 43 19,767 243 262 12 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. 65 TABLE 11. Notifiable Diseases During the Year 1929. 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 3 — —- 1 — — 1 — 3 — — — — — — — — — Diphtheria 180 9 48 80 30 12 1 — 177 2 1 — 1 — — — — — Erysipelas 40 — — 1 3 14 12 10 14 — — — — — — — — — Scarlet Fever. 237 — 53 86 65 28 5 233 — — — — — — — — — Enteric Fever (including Paratyphoid) . 11 — — — 5 4 2 9 — — — — — — — — Cerebro Spinal Fever 3 — — 2 1 — — — 1 — — — — — — — — — Puerperal Fever 4 — — — 1 3 — — 3 1 — — — — 1 — — — Puerperal Pyrexia . 19 — — — 7 12 — — 14 1 — — — — — 1 — — Tuberculosis, Pulmonary . 147 — — 7 42 64 30 4 60 89 — 1 1 3 20 21 36 7 Tuberculosis, Non-Pulmonary . 26 2 2 5 6 10 1 — 11 9 1 1 2 2 1 1 1 — Acute Poliomyelitis 2 — 1 1 — — — — — — — — — — — — — — Ophthalmia Neonatorum . 8 3 — — — — — — 1 — — — — — — — — — Encephalitis Lethargica . 3 — — — — 1 2 — 2 3 — — — 1 2 — Pneumonia 92 2 11 16 6 28 18 11 26 20 1 1 1 — 3 5 5 4 Malaria . 2 — — — — 2 — — — — — — — — — — — — Dysentery 1 — — — — 1 — — 1 — — — — — — — — — Totals 773 16 115 199 166 180 72 25 554 125 3 3 5 5 25 29 44 11 66 TABLE II. (A). Cases of Infectious Disease Notified during the 52 weeks ending 28th December, 1929. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality.* Cases isolatec at home. At all ages. At Ages—years. 65 and upwards All Souls. St. Mary. Christ Church St. John. Total;. All' Souls. St. Mary. Christ Church Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 St. John. Totals. Smallpox 3 — — 1 — 1 — — — 2 1 — 3 — 2 1 — 3 — Cholera — — — — — — — — — — — — — — — — — — — Diphtheria, including Membranous Croup 180 9 48 80 30 12 1 — 57 51 47 25 180 56 50 46 25 177 3 Erysipelas 40 — — 1 3 14 12 10 7 16 12 5 40 3 7 2 2 14 26 Scarlet Fever 237 — 53 86 65 28 5 — 44 49 62 82 237 44 48 62 79 233 4 Typhus Fever Enteric Fever 5 — — — 2 3 — — 2 1 2 5 1 1 2 4 1 Paratyphoid Fever 6 — — — 3 ] 2 — 1 2 1 2 6 1 2 1 1 5 1 Relapsing Fever — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — Puerperal Fever 4 — — — 1 3 — — 2 — 1 1 4 1 1 1 3 1 Puerperal Pyrexia. 19 — — — 7 13 — — 4 4 9 2 19 2 3 8 1 14 5 Plague —• — — — — — — — — — — — — — — — — — Glanders — — — — — — — — — — — — — — — — — — — Farcy — — — — — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — — Cerebro-Spinal Fever 3 — — 2 1 — — — — 1 1 1 3 — — — 1 1 2 Tuberculosis— Pulmonary 147 — — 7 42 64 30 4 34 46 44 23 147 11 27 12 10 60 87 Non-Pulmonary 26 2 2 5 6 10 1 — 5 8 5 8 26 — 5 2 4 11 15 Acute Poliomyelitis 2 — 1 1 — — — — — 1 1 — 2 — — — — — 2 Polio-Encephalitis — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 3 3 — — — — — — 1 2 — — 3 — 1 — — 1 2 Encephalitis Lethargica 8 — — — — 1 2 — 3 — — — 3 2 — — — 2 1 Pneumonia 92 2 11 16 6 28 18 11 24 9 49 10 92 6 4 12 4 26 66 Malaria . 2 — — — — 2 — — 1 — 1 — 2 — — — — — 2 Dysentery 1 — — — — 1 — — — — 1 — 1 — — — — — 1 Totals 773 16 115 199 166 180 72 25 185 192 237 159 773 127 150 149 128 554 219 Cases of mistaken diagnosis are not excluded from the above table. 773 TABLE III.—Causes of, and Ages at Death during the year ending 28th December, 1929. No. CAUSES OF DEATH. Net deaths at the sunjoined ages of " Residents " whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church. St. John. Total All Ages. Under 1 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under65 05 and under 75. 75 and upwards 1 Enteric Fever - - - - - - - - - - 2 - - - - - 2 Small Pox . - - - - - - - - - - - - - - - - 3 Measles 4 1 2 1 - - - - - - - - 1 3 - 4 4 Scarlet Fever 1 - - - - - - 1 - - - 1 - - - 1 5 Whooping Cough 23 6 12 4 1 - - - - - - 2 2 17 2 23 6 Diphtheria . 2 1 - 1 - - - - - - - - 1 11 - 2 7 Influenza . 59 - 2 1 1 1 6 15 14 19 16 17 9 22 11 59 8 Encephalitis Lethargica . 1 - - - - - 1 - - - - 1 - - - 1 9 Meningococal Meningitis . 3 - - - 1 1 1 - - - 3 1 2 - - 3 10 Tuberculosis of Respiratory System . 89 - 1 1 8 20 21 86 4 3 5 20 31 28 10 89 11 Other Tuberculous diseases 9 1 1 2 2 1 1 1 - - 11 3 1 3 2 9 12 Cancer, Malignant Diseases 197 - - 1 - - 9 102 55 30 227 52 38 73 34 197 13 Rheumatic Fever 3 - - - 1 - 1 1 - - 2 - 1 2 - 3 14 Diabetes 7 - - - - - 1 3 3 - 4 2 1 3 1 7 15 Cerebral Haemorrhage, etc. 38 - - - - - 1 10 14 13 18 5 15 12 6 88 16 Heart Disease . 297 - - - 2 3 14 88 88 107 99 69 73 95 60 297 17 Arterio-sclerosis 51 - 1 14 19 17 17 12 15 12 12 51 18 Bronchitis 88 4 - - - — 7 23 24 30 35 12 25 37 14 88 19 Pneumonia (all forms) 154 14 16 4 2 - 16 42 33 27 88 38 46 57 13 154 20 Other Respiratory Diseases 22 - - - 1 - 4 7 6 4 11 5 45 5 7 22 21 Ulcer of Stomach or Duodenum 20 - - - - 1 3 11 4 1 22 4 4 9 3 20 22 Diarrhoea, etc. . 22 16 - - - - 3 1 1 1 9 5 5 8 4 22 23 Appendicitis 5 - - - - 1 2 1 - 1 12 1 2 1 1 5 24 Cirrhosis of Liver 14 - - - - - 3 6 4 1 6 2 5 3 4 14 25 Acute and Chronic Nephritis 38 - - - - 3 4 12 7 12 19 3 12 14 9 88 26 Puerperal Sepsis 2 - - - - 1 1 - - - 1 - - 2 - 2 27 Other accidents and diseases of Pregnancy and Parturition . 3 - - - - - 3 - - - 22 1 - 2 - 8 28 Congenital Debility and Malformation, including Premature Birth 33 33 - - - - - - - - 101 9 5 14 5 33 29 Suicide 17 - - - - - 5 9 3 - 11 3 5 6 8 17 30 Other Deaths from Violence 49 4 - 1 4 7 8 8 5 12 34 7 16 19 7 49 31 Other defined Diseases 204 15 2 1 7 5 29 63 34 48 158 52 42 56 54 204 32 Causes ill-defined or unknown - 1 - - - - - - - - - - - - - - Totals 1455 95 36 17 25 44 145 449 318 326 928 327 362 504 262 1455 67 68 VACCINATION RETURNS. Return for 1928. Return made to the Board of Guardians and Ministry of Health on the 8th February, 1930, 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, 1928, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District Number of Births returned in the " Birth List Sheets " as registered from 1st January to 31st Dec., 1928 Number of these Births duly entered by 31st January, 1930, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1930, remained unentered in the " Vaccination Register ' on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1930, neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book " (columns 8, 9 and 10 of this Return) Number of Certificates of Successful Primary Vaccination of children under 14 years received during the calendar year 1929 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 1929 Col. I. Success fully Vaccinated Col. II. Col. IV. Col. V. Dead, Un vaccinated Postpone ment by Medical Certificate Removal to Districts,the Vaccination Officer of which has been duly apprised Removal to Places unknown or which cannot be reached ; and Cases not having been found Insuscep tible of Vaccination Had SmallPox Number in respect of whom Certificates of Conscientious Objection have been received 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 568 333 — — 104 28 11 14 19 59 2,303 447 2. St. Mary 2,498 1,807 3 — 235 99 14 291 23 26 3. All Souls 595 347 7 — 80 29 13 87 10 22 Total 3,661 2,487 10 419 156 38 392 52 107 2,303 447 Dated 8th February, 1930. (Signed) GEORGE H. BASSETT, Vaccination Officer.