library\<S\ APR 1967 )§ ^JlSr AC4353 Amthais STMAEY 35 Metropalitan Borough of St.Marglebanae. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1930. 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. 1931 64890 Metropalitan Borough of St.Marglebanae. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1930. 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. 1931 VAIL & Co. Printers, London, E.C.I Public Health Department, Town Hall, Marylebone Road, N.W.l. 6th May, 1931. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, I have the honour as Medical Officer of Health to submit my annual report on the Health of the Borough of St. Marylebone during the year 1930. Like the report for 1925, it is a "Survey Report," and something more than a record only. In making it I have followed the lines laid down by the Ministry of Health and have been able to compare the results obtained in the year under discussion with those for 1925 and the intervening years. From such comparison it is plain that there has been progress in most directions and considerable improvement,s in many respects. The facts and figures set out in the report support these views and afford justification for offering congratulation to the Council and particularly to the members of the Public Health Committee most intimately concerned in the work. To the Committee I offer also my thanks for the many kindnesses and real consideration they have shown me at all times, and the assistance they have given me. The various occupants of the Chair since 1925, Councillor Hugh Jones, 1925-6; Alderman G. B. Brooks, 1926-7 and 1927-8; Councillor P. O'Connell, 1928-9; and Councillor Dr. C. A. Fuller, 1929-1930, and under them the members of the Committee have taken the sincerest interest in the work and have been ready always to give consideration to any suggestion likely to lead to the betterment of health conditions and to offer advice, guidance and encouragement as occasion required. The staff of the department as always worked steadily and well. They were unfailing in their loyalty and devotion to duty. 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). 1930. His Worship the Mayor (Councillor S. G. Joseph, J.P.) ALDERMEN. G. B. Brooks J. Fettes, J.P. A. C. Rickatson, J.P. COUNCILLORS. Mrs. V. A. L. Freeman. Dr. C. A. Fuller (Chairman). S. H. Haynes. Mrs. C. Q. Henriques. Lt.-Col. R. Q. Henriques. Dr. E. Jacobs. H. Jones. Capt. J. T. O'Brien, J.P P. O.'Connell G. B. Ramsay. Mrs. E. M. Shirley. Mrs. A. West-Russell. CONTENTS. page Natural and Social Conditions of the Borough. Population 7 Sanitary Circumstances 7 Water Supply 7 Drainage 8 Combined Drainage Sewer Emanations 9 Closet Accommodation Public Sanitary Conveniences Scavenging 10 Removal of House Refuse 11 The Crown Estate 12 Removal of Offensive Refuse 12 Sanitary circumstances of the Borough 12 Staff 12 Nuisances 13 Inspections 14 Nuisances—Legal Proceedings 14 Smoke Nuisances 14 Rat Repression 15 Pigeons 16 Fouling of Footways by Dogs 16 Premises and Occupations controlled by By-laws and Regulations 17 Business Premises 17 Milk Premises 17 Cow Sheds . 17 Slaughterhouses 17 Offensive Trades. 18 Ice Cream Premises 18 Butter. Margarine, etc., Premises 18 Bakehouses 18 Fried Fish Vendors and Fish Curers 18 Factories and Workshops. 18 Inspections 19 Defects found 19 Home Work 20 Registered Workshops 21 Other matters 21 Rag Flock 21 Premises used for Human Habitation 21 Houses let in lodgings 21 Common Lodging Houses 22 Underground Rooms 22 Premises that are not but should be Registered 22 Food Stalls 23 Food— Milk Supply 24 Milk Analysis. 24 Legal proceedings for adulteration 24 Bacteriological examination of Milk 24 Dairies, Milkshops, etc. 25 The Milk (Special Designations) Order 25 Milk (Mothers and Children) Scheme 25 Foods other than Milk. 25 Food Inspections 26 Food, Unsound, Condemned 26 Food and Drugs Adulteration Act, 1928 27 Reports of Public Analyst .. 27-30 Statistical— Births 31 Birth Registration 31 Birth Notifications 31 Deaths and Death Rates 31 Sub-District Births and Deaths 32 Deaths in relation to Age 33 page Causes of and ages at death. 33-79 Infantile Mortality 33 ,, ,, Causes 34 Maternal Mortality 37 Deaths in relation to Disease 37,79 Diarrhoeal Diseases 37 Infectious (Communicable) Diseases 37 Phthisis and other Tuberculous Diseases 38 Respiratory Diseases 38 Cancer and Malignant Diseas 38 Accident, Suicide and Manslaughter 39 Prevalence of and Control over Infectious Diseases 40 Isolation of Cases 40 Discharge Notices 41 Diphtheria and Membranous Croup 41 Schick Testing and Diphtheria Immunization 41 Scarlet Fever 42 Enteric Fever 42 Cerebro-Spinal Fever 43 Encephalitis Lethargica 43 Polio-Myelitis. 43 Polio-Encephalitis 43 Erysipelas 43 Puerperal Fever 43 Puerperal Pyrexia 43 Measles and German Measles. 43 Whooping Cough . 43 Glanders and Anthrax. 43 Smallpox 43 Vaccination 44 Infectious Diseases in Schools. 44 Ophthalmia Neonatorum 45 Influenza 46 Pneumonia 46 Tuberculosis 46 Treatment 46 Public Health (Prevention of Tuberculosis) Regulations, 1925 46 Notifications 47-48, 55 Prevention of. 49 Care Committee 49 Open Air School 49 Eacteriological Diagnosis of. 50 Work and Dispensaries 51 Non-Pulmonary Tuberculosis 50 Deaths 54 Disinfection 56 Cleansing of Persons 57 Bacteriological Examinations 58 Maternity and Child Welfare 58 Health Visitors 61 Centres 61-62 Ante-Natal Work. 62 Dental Clinic 62-63 Massage Clinics 62 Schick Testing, etc., Clinics 62 Hospital Treatment 62 Maternity Cases 62 Infant Consultations—Work at 63 Day Nurseries 63 Home Helps 64 Sanitary Administration— Staff.12,64 Report of Mortuary Keeper 64 Housing 65-72 Statistics 72 Sanitary Inspection (Summary) . 73 Ministry of Health, Tables I—III 76-80 Vaccination Returns. 81 7 INTRODUCTORY. Population.—In the Annual Report for 1925 which, like that for this year, was a "Survey Report," under this head references were made to the difficulties associated with the making of estimates as to numbers of inhabitants in the years between the censuses. The difficulties in this connection increase as the period since the taking of the census lengthens and are particularly marked in areas in which the resident population is a decreasing one. The year 1930 in the case of St. Marylebone could not be surpassed for difficutly so tar as population is concerned, and the population figure being so very important in relation to the bulk of the rates to be quoted in the following pages, it is well to note that the number of inhabitants is estimated only, and that the number is not absolutely reliable. According to the Registrar the population at the middle of 1930 for calculation purposes is to be taken as 102,400. This is the same as the figure estimated for the middle of 1929, and is entirely arbitrary. Being so, it is perhaps not particularly useful for comparison with other figures shown in the following table. These, however, being of the various wards, are interesting from other points of view and are well worth showing. Year. The Borough. All Souls. St. Mary. Christ Church. St. John.  1925 106,100 25,425 27,172 83,024 20,479 1926 105,800 25,353 27,095 32,931 20,421 1927 103,500 24,794 26,509 32,218 19,979 1928 104,000 24,915 26,638 32,371 20,076 1929 102,400 24,532 26,228 31,873 19,767 1930 102,400 24,532 26,228 31,873 19.767 SANITARY CIRCUMSTANCES. Under this heading the Ministry of Health calls for a report with regard to such matters as Water, Drainage and Sewerage, Closet Accommodation, Scavenging, Sanitary Inspection, Premises and Occupations controlled by By-laws or Regulations, Schools, &c. In respect of some of these matters, on account of the circumstances and arrangements existing in London Boroughs, there is little to be said, and much of the information is obtainable only from other departments of the Council or from other bodies. In order, however, to comply with the requirements of the Ministry, and to assist in obtaining uniformity in reports, each of the more important matters is dealt with as fully as possible. Water. As usual, and naturally, of course, having regard to the excellence of the provision made by the Metropolitan Water Board, complaints as to water supply, either as regards quantity or quality, were few. All were dealt with, and a remedy found. Water Supply cut off.—In accordance with the requirements of the Public Health (London) Act, 1891, Section 49 (1), the Metropolitan Water Board reported that the water had been cut off in four premises. This is the lowest number for a considerable period. The reason for discontinuing the supply was in each case the non-payment of rate. In the event of the premises being a tenement house, action was taken immediately on receipt of the Board's notice, in order to secure that the tenants should suffer no hardship as a result of being deprived of water. 8 Cisterns.—The bulk of the houses in the Borough, in accordance with the requirements of the Water Board, are provided with a cistern, and though in a considerable percentage water for drinking purposes is drawn from the main, there are still many in which supplies for all purposes are obtained from the cistern. In many cases this leaves much to be desired, both as regards situation and accessibility, and despite the fact that a by-law of the Council requires that the apparatus shall be emptied and cleansed every six months, it cannot be doubted but that in many houses no such step is taken. During the year 29 notices were served in regard to defects in and necessity for cleansing cisterns. The fact that the number is falling year by year (in 1930, 29, against 102 in 1925), suggests, however, that improvements are occurring in this connection. Water Supply in Dwelling Houses.—The certificates granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises numbered ten. As showing the progress made in building it may be noted that in each of the years since 1925, when five certificates were granted, the numbers issued have been in 1926, 7 ; in 1927, 19; in 1928, 21 ; in 1929, 10. That these certificates have value from the health point of view may be accepted, though there is the risk, as has been found elsewhere, that they may be regarded as certificates of completion and suitability for habitation of the premises and may be held as such. In 9 instances intimation notices were served, calling for the provision of a supply of water to the upper storeys of tenement houses, as required by Section 78 of the London County Council (General Powers) Act, 1907. The supply was provided after receipt of the intimation notice in all cases. The number of tenement houses in the Borough without a supply of water on one or more of the upper floors, in addition to that in the lower part of the premises, is steadily diminishing. In 1925 the number of notices served was 23. Drainage. There have been few changes in regard to work in this connection during the last five years. Duties in connection with drainage in the portion of the Borough north of Marylebone Road, which were allotted to Inspector Cook in 1929 have been in his hands ever since, duties in the southern half being performed by Inspector Gorniot, and later by Inspector Draper. Engaged exclusively in drainage work, these officers between them in 1930 made 5,394 inspections. The total number of plans deposited was 380 in respect of 4(il premises, as against 499 and 547 respectively in 1929 and in 1925 460. The number relating to new buildings was 41. The number deposited in 1929 was 82 and in 1925, 74. In the case of old buildings, the number of plans received was 339. In 1929 the total number was 367 and in 1925, 386. In the bulk of the cases the arrangements shown were in accordance with th'.: by-laws and the work was allowed to proceed under the preliminary approval of the Medical Officer of Health. In cases in which there was departure from the requirements a special report was made to the Public Health Committee, who rarely refused approval if satisfied that compliance was impossible and that there was no possibility of nuisance or injury to health arising. In the majority of cases the departure referred to closet accommodation and affected particularly conveniinces proposed to be constructed in basements. Now that the new by-laws (1930) of the London County Council with regard to sanitary conveniences are in operation the number of such cases will diminish, provision having been made for accepting as compliance a number of arrangements which were definitely outside the provisions of the earlier by-laws. Combined Drainage.—Orders under seal as to combined drainage were issued n respect of 46 premises. The number in 1925 was 63. 9 Server Emanations.—At intervals during 1929 and to an extent also in other years, 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 Healtii 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 Count)- Council. Eventually, as a result of these various steps, a large number of sewer ventilating openings on the roadway were closed. Following this, complaints largely ceased, and in 1920 were not renewed. Closet Accommodation. In the table at page 14, summarizing the work carried out by the district inspectors, figures indicating the number of defects in water closets remedied and of water closets erected are set out. In most instances the closets erected were with a view to providing additional accommodation in tenement houses, shops, or workshops or in order to afford suitable separate accommodation for women in places where both sexes were or were about to be employed. Though there may be here and there a small lock-up shop in which it is necessary for the individuals engaged on the premises to make use of a convenience in some other part of the building, or more rarely in an adjoining building, there are no premises in the Borough totally without sanitary conveniences of this type. The only class of closet is, of course, the water closet. One of the great difficulties experienced from time to time is in regard to finding a suitable place for a convenience and a position in which there will be complete compliance with the requirements of the regulations in respect of waterclosets. This is particularly the case in relation to closets in basements and in the more over-crowded business and shopping portions of the Borough. All plans showing proposals to construct water-closets are most carefully scrutinized and only if it is impossible to find a completely suitable position, and there appears to be no possible risk of nuisance or injury to health, is permission granted to construct the convenience in a situation where there is not compliance. As already noted, the 1930 by-laws have considerably modified the requirements so far as situation is concerned. Particularly by allowing of the introduction of closets in bathrooms entered directly from rooms used exclusively as sleeping or dressing-rooms they have met a demand that has been increasing for some time and that caused considerable administrative difficulties. Public Sanitary Conveniences.—The usual supervision w as exercised over the public conveniences during the year, Inspector. Hill, the outdoor superintendent, visiting those provided for the use of males; the women inspectors, especially Miss Baker, supervising those provided for females. Reports and comparative statements as to receipts for use of the underground conveniences were regularly submitted to and considered by the Public Health Committee. Of the conveniences the most recently provided are those at Salisbury Street, which were opened in March, 1925. At intervals during the last few years a demand for accommodation in the neighbourhood of St. John's Wood Road Station and Lord's Cricket Ground has been raised and has been accentuated by the action of the Metropolitan Railway Company in limiting the user of conveniences at the station to passengers only. Several most careful inquiries have been made with a view to discovering a suitable site but up to the present without success. The matter remains under consideration. 10 The following is a statement showing the total receipts at each of the conveniences for the year ended March, 1931, and the amount of increase or decrease as compared with the previous year. 1931 1930 Increase Decrease £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus —Men's Department 865 7 4 892 10 7 — 27 3 3 1 „ Women's „ 1,642 11 5 1,532 6 11 110 4 6 — Gt. Portland Street—Men's „ 233 5 7 241 16 10 — 8 11 3 ., Women's „ 245 13 3 246 9 5 — 0 16 2 Marylebone Road—Men's „ „ Women's „ 313 0 2 329 11 8 — 16 11 6 360 7 0 378 7 10 — 18 0 10 Foley Street—Men only „ 145 7 1 165 7 6 — 20 0 5 St. John's Wood Road—Men only 108 4 10 111 6 4 — 3 1 6 Barrett Street—Men only „ 247 11 9 259 8 3 — 11 16 6 Salisbury Street— 14 Men's Department 74 16 10 84 11 4 — 9 6 J „ Women's „ 111 19 5 118 10 2 6 10 9 £4,348 4 8 4,360 6 10 110 4 6 122 6 8 One free urinette provided. ‡Two free urinettes provided. SCAVENGING. Refuse Collectiun.—The collection of house refuse in the Borough is under the jurisdiction of the Highways Committee of the Council and under the control of the Borough Engineer, Mr. James Gair, to whom I am indebted for the information given here. The system of collection is continually under revision and changes are made from time to time with a view of more efficient working. Until recently there still existed a number of premises from which refuse was collected only once weekly. Re-arrangements have been made whereby all premises in the Borough now receive at least a twice weekly collection and this alone necessitated some 23,100 additional calls being made in the course of a year. In addition, over a great portion of the Borough a daily collection is made, and in certain streets in which refuse collecting vehicles are prohibited by the Ministry of Transport during certain hours, collection is carried out from the kerb within the hours prescribed. This naturally entails a greater concentration of collecting vehicles in certain parts of the Borough and still further increases the number of calls made per annum. Considerable increase continues in the number of large premises, such as blocks of flats, hotels, etc., where the " container " system of collection is in operation. This method provides for the provision of special containers, which are purchased by the owners of properties. Collection is made daily with the exception of Sundays, Christmas Days, Good Fridays and Bank Holidays. The containers are removed bodily from the premises and conveyed to the Council's Wharf, where they are emptied and cleansed and disinfected before being returned to the premises. This method, obviously more hygienic, is also quicker and less noisy in working and far more satisfactory than refuse bin collection. Refuse Disposal.—With regard to disposal, the whole of the refuse collected in the Borough is taken to the Council's Wharf at Paddington and there discharged into a collecting pit. From this it is taken by means of an electric crane into a screen having a graded mesh which separates the large and small material. The larger material passes along a picking belt and from this is extracted all saleable material, such as waste paper, rags, bones, scrap metal, etc., the latter finding a ready sale. The fine ashes and breeze obtained by screening is, during the winter months, disposed of to brickmakers and others, so that practically none of this material is dumped on to the Shoot. The residue from the picking belt is conveyed to a Woodall-Duckham refuse destructor, which is mechanically fed, and clinkered. It had been the intention of the Committee to extend this system but pending a definite decision as to the steps to be taken to regularise or consolidate the collection of refuse in London as a whole on the lines of the Dawes' report or otherwise, further action has been postponed. The system now obtaining for disposal of refuse at the Council's Wharf practically eliminates the need for the conveyance of crude refuse to the Council's Shoot at Northolt, where, in any case, all material which is dumped is carefully covered and so dealt with as to conform to the Ministry of Health's regulations for controlled tipping. 11 Street Sweepings.—Street sweepings are collected by means of special vans and conveyed to the Council's Wharf. Here the greater part is passed through a pulveriser and is disposed of to market gardeners, etc., for use as a fertiliser, the remainder being conveyed to the Council's Shoot and used for covering the surface of the dump. Recently the method of collection has been revised and it has been decided to adopt exclusively motor vehicles and to improve the type of orderly barrow used in the streets. Each barrow carries two galvanized refuse bins into which the sweepings are placed by the man in charge of the barrow. Periodical calls are made during the day at prearranged collecting spots and the contents of the bins are loaded into vans and conveyed to the Wharf as shown above. When the fleet of motor vehicles is complete, it is the intention entirely to dispense with horse-drawn traffic and the contents of the barrows will then be emptied direct from the barrows into the collecting vehicles, all of which are specially constructed and are fitted with covers to prevent the blowing of refuse over the public streets. The cleansing of the Borough is being gradually extended on the best system so that in the near future the whole will be dealt with by this system rather than by sweeping gangs. The result will be that each thoroughfare will receive closer and more constant attention. Generally.—New plant is being installed at the Council's Shoot at Northolt to deal with refuse unloaded there, and the whole question of collection, disposal and dumping is constantly under supervision with a view of avoiding nuisance. Every precaution is taken to ensure that the whole service is carried out in a satisfactory and efficient manner and in such a way as will give as little annoyance as possible when dealing with objectionable material of this nature. Offals of various descriptions such as green offal, fish offal, refuse from petrol interceptors at garages, etc., are collected by the Council, a charge being made for this service as well as for the removal of other trade refuse. The effect of this has been to improve the general cleanliness of the Borough. Fish offal is disposed of to Contractors and green offal is treated in the same way as street sweepings. Statistical.—The following figures will give some idea of the tonnages dealt with and the revenues obtained from the sale of salvage. House Refuse collected during the year ending 31st March, 1931 45,123 tons. Street Sweepings collected during the year ending 31st March, 1931 8,409½ tons. Of the 45,123 tons of refuse collected, 12,939 tons were disposed of in the form of salvage, 11,2044 tons were burnt in the furnaces to provide steam and power for driving the plant, and 20,979½ tons were deposited on the Shoot in the form of treated refuse. With regard to street sweepings, 2,679½ tons were disposed of to market gardeners, etc., the remainder (5,730 tons) being sent to the Shoot for covering purposes. So far as revenue is concerned, the value of the material salved and sold is :— Fine Ashes £1,975 16 9 Breeze 719 17 6 Waste Paper 793 7 6 Scrap Metal 621 15 10 Rags, Bones, etc. 353 15 3 £4,464 12 0 In addition, a sum of approximately £1,600 was received for the removal of Trade Refuse, Green and Fish Offal and for the cleansing of petrol interceptors. Removal of House Refuse. So far as the arrangements existing in houses, business premises, etc., are concerned, it may be noted that the movable, covered metal dustbin is most commonly found. New metal dust receptacles were provided to 238 premises. During the year the inspectors made 2,933 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, 50 notices were served. 12 Remedies in each case were carried out, legal proceedings not being necessary in any instance. The Cruwn Estate.—All that has been said above applies only to that part of the Borough—the bulk, of course—for which the Council is responsible. In the part constituting the "Crown Estate," which comprises a large number of properties encircling Regent's Park and includes certain premises in Marylebone Road and Park Road, the responsibility for collection, removal and disposal of the refuse is still in the hands of the Crown authorities. From the appearance particularly of the vehicles in use, the opinion one has formed is that the arrangements in operation at the moment are still those which might have been devised half a century or more ago. No attempt has been made to bring the methods into line with those which the Borough Council, through the Highways Committee, is endeavouring to perfect in the health interests, of the inhabitants. The hope is still entertained, however, that before the time for making another survey report arrives, some arrangement whereby improvements may be obtained will have been made. Removal of Offensive Refuse.—Owing to the number of hotels, boarding houses, restaurants, and large private establishments in the borough, considerable quantities of food refuse (hog wash) are collected by pig-feeders daily, and close watch is necessary in order to ensure that the requirements of the bye-laws relating to removal of offensive refuse, as to hours of removal, provision of proper receptacles, etc., are complied with. During the year a number of warnings with regard to these matters were issued. SANITARY INSPECTION OF THE DISTRICT. Staff.—During the year there were on the staff of the Public Health Department, in addition to the medical officer of health, an assistant medical officer of health, who acts also as public vaccinator (Dr. H. Allen Bulman), a tuberculosis officer and assistant medical officer of health for tuberculosis purposes (Dr. J. Donaldson Saner), two drainage inspectors, one outdoor superintendent, one meat and food inspector, one house-to-house inspector, six district inspectors, seven women sanitary inspectors and health visitors (one engaged exclusively in tuberculosis work), one chief and five assistant clerks and an office youth, with, in addition, at the Tuberculosis Dispensary, a sister and a clerk dispenser, and at the Salisbury Street Welfare Centre 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. Assistant Medical Officer of Health : H. Allen Bulman, M.R.C.S. (Enir.), L.R.C.P. (Lond.), D.P.H. Assistant Medical Officer of Health for Tuberculosis Purposes : *J. Donaldson Saner, M.B., C.M. (Edinl), D.P.H. Public Analyst (Part time) : J. F. F. Rowland, B.A., A.I.C. Bacteriologist (Part time) : A. G. R. Foulerton, O.B.E., F.R.C.S., L.R.C.P., D.P.H. Public Vaccitiator (after 1st April, 1930) : Dr. H. Allen Bulman. Vaccination Officer (after 1st April, 1930) : G. H. Bassett. *District Sanitary Inspectors. *Food Inspector. T. A. Cartledge, M.S.M. (a, b, d). G. Smith (Senior Sanitary **H. E. P. Corline ('b, d). Inspector) (a, b, d). T. W. Forbes (b, d). . E. Lumley (a, b). Outdoor Superintendent. **H. E. Scoble (c, d). P. H. Hill (a, b, d). E. E. Willis, M.M. (a, b, d). clerks A. S. Wilson (a, b, d) H. E. Curtis (Chief). *Drainage Inspectors. James. F. C. Cook (b, d). W. J. Howe. W. H. Draper (a, b, d). G. W. Matthews. ttT. Gorniot (late Senior Sani- C. D. Turbayne. tary Inspector) (a) R. G. Turner. 13 Disinfectors. . *Maternity and Child Welfare and J. C. Kendall. Tuberculosis Clerk. J. Overton. Miss J. Jones. * Women Sanitary Inspectors and Health Maternity Child Welfare Clerk— Visitors. Dispenser. Miss D. Chabot (b, e, f) Miss C. E. Durant (b, e, h). † Miss C.M. Courtney. Miss N. C. Stokes, R.R.C. (b, e, f, g, h). Cleansing of Persons—Baths & Shelter. * Health Visitors. Miss L .Killin (Matron). Miss C. Hale (e, f). Miss E. D. Mann (e, f, g, h). Mortuary Keeper. Miss K. Stewart (e). Mrs H S.pears. *Tuberculosis Visitors */Tuberculosis Dispensary. Miss F. A. Baker (b). Miss S. Kenion (e, f, g, h). E.D.Marston (Caretaker). *Tuberculosis Clerk—Dispenser. Messenger. Miss M. T. Challis. J. Eatwell. *Officers to whose salary contribution is made under the Public Health Acts or by Exchequer grants. a Royal Sanitary Institute Certificate. b Certificate Sanitary Inspectors' Examination Board (London). c Certificate of the Sanitary Inspectors' Examination Joint Board. d Meat and other Foods Certificate. e Health Visitors Diploma. f Central Midwives Board Certificate. Certificate of State Registration for Nurses. h Three or Four Years' Hospital General Training Certificate. ** Appointed May, 1930. t Appointed March, 1930. ft Resigned July, 1930. NUISANCES. In the following summary some idea of the amount of work done in relation to nuisances is given. For details of other works carried out by the inspectors, reference must be made to the sections dealing with housing, food, infectious diseases, etc. In regard to nuisances, the first point to note is that the total number of complaints received was 2,335, as against 2,608 in 1029, and 3,470 in 1925. The majority of these complaints were made by the inspectors themselves, though a certain number came from other members of the Council's staff, from voluntary workers of the St. Marylebone Health Society, members of the Children's Care Committee, neighbours and others. In respect of nuisances, 79 statutory notices were issued, the figure being 142 in 1929 and 370 in 1925. Of these notices, 53 related to ordinary nuisances (dirt, dampness, etc.), 9 to verminous rooms, 5 to drains, 1 to insufficient w.c. accommodation, 10 to insufficient dustbins, and 1 to underground rooms. The 9 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1922, and referred to 16 rooms. The number of notices in 1929 was 17, and in 1925, 36. In 2,256 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 1 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 ponnection with Nuisances." The total inspections made in 1930 by each inspector, and the number of 14 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 154 146 382 182 83 49 996 Doors, windows, floors, ceilings sash cords, etc., repaired 173 99 245 73 24 31 645 Overcrowding abated 2 4 6 30 Illegal occupation of underground rooms dealt with – 1 3 18 6 2 Water closet defects remedied 80 64 140 180 72 51 587 Water closets erected 7 4 46 57 Urinal defects remedied – 1 8 2 2 13 Soilpipes and ventilating shafts repaired or renewed – – – – – – – Yard defects remedied 61 33 50 132 33 13 322 Waste pipe defects remedied 20 6 18 11 13 9 77 Water cistern defects remedied 9 8 4 8 21 29 143 Rubbish, manure, etc., accumulations removed 9 11 57 23 22 Dung or dust receptacles repaired or renewed 19 11 35 23 9 9 106 Drains relaid or amended 14 5 8 20 16 17 80 Drains cleared 5 1 22 2 8 2 40 Rainwater pipes repaired or renewed 18 10 20 13 11 6 78 Water supply to houses instated 4 11 2 2 19 Roofs and gutters repaired 82 75 75 37 18 14 301 Area defects remedied 5 17 31 7 6 66 Wash-house defects remedied. 65 1 72 78 19 7 242 Animal nuisances abated 8 9 12 3 1 33 Basement defects remedied 37 1 2 17 12 3 72 Stables cleansed or repaired – 1 2 3 Water supply laid on to upper storeys of house – – 3 3 – 3 9 Miscellaneous nuisances abated 220 73 37 72 34 25 461 Verminous rooms cleansed 35 35 150 112 29 30 391 Workshops dirty, overcrowded, unventilated or defective, remedied 1 5 3 35 22 44 110 Legal Proceedings in Connection with Nuisances. The only summons issued during the year had reference to a failure to comply with a statutory notice and is detailed below :— Premises. Offence. (Proceedings taken under the Public Health (London) Act 1891, etc.) Result. Castle Public House, Shouldham Street. Failure to comply with a statutory notice to execute certain sanitary requirements. Closing order made and accepted by Owner. Costs £3 3 0. Smoke Nuisances.—Since the date of the last Survey report the Public Health (Smoke Abatement) Act, 1926, has come into operation. Amongst the changes it has introduced may be noted the abolition of the distinction between black and any 15 other coloured smoke so far as nuisance is concerned ; an extension of the definition of smoke to include grit and the recognition of smoke in quantity as a source of nuisance. So far as procedure is concerned the system of inspection of chimneys in the Borough with a view to discovering and as far as possible dealing with such as were found to be a source of nuisance which was established several years ago was continued. A special report is submitted at each meeting of the Public Health Committee setting out the number of observations made and nuisances discovered and instructions taken as to procedure to be followed. During the year 1930 six complaints were received and dealt with. The number of nuisances reported to the Committee was six, and in each case the attention of the offender was drawn to the matter. In no case was it necessary to institute proceedings in court. Rat Repression. Though activity in this connection continues unabated, the number of complaints received varies little year by year. In 1925, for example, the total was 67, and in 1930 it reached 60. The investigation of these complaints necessitated the inspection of 64 premises, 25 of which were used for business purposes (7 of these for the preparation or storage of food), the remaining 37 being private or tenement houses. In 5 of the cases investigated the infestation was directly attributable to defects in the drainage system and disappeared immediately these were remedied. In every instance all advice and assistance was given to the owner or occupier by Inspectors Draper and Willis, who acted as Rat Officers, and secured excellent results from the methods advocated. A Rat Week was held during the year from the 3rd to the 8th November, 1930, 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 following one of the Rat Weeks held in the Borough 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 ran 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 the officer, 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 Chief Engineer of the Group comprising the Metropolitan District Railway Company, the London Electric Railway Company, the City and South London Railway 16 pany and the Central London Railway Company, reporting on the results achieved in this connection. This clearly indicates that by the use of various methods 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 the inspector so far as St. Marylebone is concerned. Equally satisfactory returns were received from the power stations, railway stations (above ground), sidings, 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 statute in connection with rat destruction and, at the same time, offering to assist 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. In relation to the nuisance caused by these birds, the Borough Council was not given what may be called an official position until after the coming into operation of Sec. 52 of the L.C.C. (General Powers) Act, 1927. In this section the Council was empowered to seize and destroy, sell, or otherwise dispose of, or cause to be seized, etc., house doves or pigeons in excessive numbers, if they believe them to be without an owner. Under these powers an agreement was made with a firm specializing in work of this kind. The results obtained were not satisfactory and after a time the agreement lapsed. Some attempt at netting the birds frequenting the Town Hall was made and a certain number were caught, and by fixing spikes in certain positions on the eastern flank it was hoped that the pigeons would be prevented from nesting in this position. The cost of this work was £27 7s. 10d. and some amount of effect has been produced. Occasional complaints are received from churches and other institutions, and as much assistance as possible is given by the inspector in charge of this work to reduce the nuisance. Fouling of Footways by Dogs. About the middle of the year 1928 a bye-law dealing with the matter of the fouling of footways by dogs came into operation, and leaflets notifying the fact were widely distributed and exposed on lamp-posts and elsewhere. Prior to this date efforts were made, by means of notices and leaflets, to induce dog owners to realize the seriousness of the nuisance caused and to take steps to obviate it. These no doubt produced a certain amount of effect, but it was because it was felt that something more stringent was needed that the bye-law referred to was passed. In enforcing the provisions of the bye-law great assistance has always been obtained from the police. In 1930, the only prosecution undertaken was on the report of a police officer. In this case the defendant, who pleaded guilty, was fined 5/-. Including this case the total number of prosecutions since the bye-law came into operation is 4, the amount of fines imposed being £1 10s. Od. 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. 17 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. PREMISES AND OCCUPATIONS CONTROLLED BY BY-LAWS AND REGULATIONS. The following list sets out the majority of the premises and occupations of the class referred to in the heading to this part of the report, and contains a certain amount of information with regard to registration, inspection, etc. Underground rooms and underground sleeping rooms, though controlled, the former under the Public Health (London) Act, 1891, and the latter under special regulations under the Housing Acts, are not registered. Number of premises Number of inspections 1930 Number of notices 1930 Number of prosecutions, 1930 On register at end of 1929 Added in 1930 Removed in 1930 On register at end of 1930 A. Business Premises Milk premises 107 11 5 113 326 6 — Slaughterhouses 1 — — 1 50 — — Offensive trade premises 3 — 1 2 56 — — Ice cream premises 68 4 — 72 120 7 — Butter and Margarine — facturers and Dealers 16 — — 16 32 — — Bakehouses 54 — — 54 114 8 — Fried Fish Shops 24 — — 24 60 2 — Fish Curers 5 — — 5 76 1 — B. Habitations Houses let in lodgings 1,055 — — 1,055 7,481 789 — Common lodging houses 4 — — 4 — — — A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 113. This is 6 more than in 1929, 11 having been added and 5 removed; in 1925 there were 148 on the register. Cow Sheds.—In the Survey Report of 1925, commenting upon the fact that there still remained one cow shed in the Borough, at 42a, Clipstone Street, licensed for 10 cows, opportunity was taken to discuss the reasons responsible for the recognition by cowkeepers and others of the unsuitability of this part of the metropolis for the purposes of their trade. It was noted that as recently as 1919 the number of cows licensed to be kept was 105, though, in fact, only 16 were kept. In 1925 the only licence in existence covered 10 cows. These were kept on premises the lease of which eventually expired in 1929, when the last of the cow sheds disappeared and cowkeeping in St. Marylebone ceased, presumably, for ever. Slaughter Houses.—At the moment the only slaughter house in the Borough 18 is that at 32a, Union Street, W.l, which is held by Mr. E. J. Barclay, of 70, Great Titchfield Street, W.l. In 1925 the number licensed was three. No conditions are attached to the licence and the amount of slaughtering now done is comparatively small : during the year only 20 sheep and 6 lambs 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.—At the end of 1930 there were two premises only within the Borough upon which trades classed as offensive were carried on, the business in each case being that of tripe boiling. The Food Inspector made 56 visits, but no cause of complaint was found. Ice Cream Premises.—In 1925 these numbered 118, but since the coming into operation of the provisions of sec. 29 of the L.C.C. (General Powers) Act, 1928, requiring the registration of such places, the number of persons in the trade has greatly diminished. The actual number of premises included in the register at the end of 1930 was 72, 2 more than in 1929. Regular inspections were made throughout 1930, and in 7 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 " Food and Drugs (Adulteration) Act, 1928." At the end of the year there were on the registers 13 dealers in margarine, 1 wholesale dealer in butter and milk-blended butter and 2 butter manufacturers. All the registered premises were frequently visited. Bakehouses.—At the end of 1930 the number of bakehouses on the register was 54, 49 being underground bakehouses. In 1925 the bakehouses numbered GG, of which 60 were underground, so that there is happening in regard to these latter what is taking place in respect of other premises unsatisfactory from the point of view of hygiene, a gradual disappearance, the result of constant pressure by the authorities and of recognition of their unsuitability by the people themselves. The provisions with regard to registration are contained in the Factory and Workshop Act, 1901, and so far as underground premises are concerned, only premises used prior to the passing of the Act were eligible for registration, which was to be completed before 1904. All the underground bakehouses now in use were registered at this time. Premises underground are rarely satisfactory, but as there was no time limit fixed and the Act contains no requirement as to application for renewal, all that can be done is to exercise a close supervision in order to see that the places are kept in as good condition as possible. In 1929, 112 visits were paid and 6 notices with regard to defects were served. In 1930, 114 visits were paid to these and 8 notices with regard to defects were served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, etc., of the inside walls and other parts of the bakehouses were issued. It was not necessary to institute proceedings to enforce compliance with any notice. Fried Fish Vendors and Fish Curers.—The number of premises in the Borough used by vendors of fried fish is 24 and by fish curers 5. Notices calling for periodical lime-washing, etc., of such premises as required by the by-laws of the London County Council, made under Section 9 of the London County Council (General Powers) Act, 1908, were issued, and regular visits of inspection made and action taken where necessary to have any defects noted remedied. Factories and Workshops. Though factories are comparatively few in the Borough, the number of workshops, many of them domestic workshops, is considerable, and work in relation to them bulks very large amongst the duties of the district inspectors, more especially those in charge of districts on the south of Marylebone Road. The staple industry 19 is, of course, dressmaking, millinery and tailoring in all its branches, but in a number of places other trades, some of them distinctly curious, are carried on. The total number of visits to factories, workshops and workplaces during the year was 3,780, 389 by the women and 3,391 by the men inspectors. The complaints received numbered 120. The following report which the Medical Officer of Health is required to make to the. Secretary of State for the Home Department in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901, gives, in addition to other information, the total number of defects found and of notices served. 1.—INSPECTION. Number of Premises Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories (Including Factory Laundries) 227 19 – Workshops (Including Workshop Laundries) 1,274 72 – Workolaces (Other than Outworkers' Premises included in Part 3 of this Report) 2,279 61 – Total 3,780 152 – 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 79 79 — — Want of ventilation.. 4 4 — — Overcrowding 8 8 — — Want of drainage of floors 3 3 — — Other nuisances 56 56 – Sanitary accommodation insufficient 6 6 — — unsuitable or defective 33 33 – – not separate for sexes 13 13 — — Offences under the Factory and Workshop Act- Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 8 8 – – Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) – – – – Total. 210 210 — — 20 3.—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109,110 NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S 110) Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers. Outworkers. Lists. Contrac tors. Workmen. Lists. Contrac tors. Workmen. (1) (2, (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 67 183 992 ... ... ... 14 ... ... ... ... ... ... ... ... Total 67 183 992 ... ... ... ... ... ... ... ... ... ... ... ... 21 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year Number (1) (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 3,338 Coffee Shops, &c. 331 Bakehouses 54 Total number of workshops on Register 3.723 5.—OTHER MATTERS. Class Number (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 120 Reports (of action taken) sent to H.M. Inspector. 120 Other — Underground Bakehouses (s.101):- Certicates gramted durig the yers — In use at the end of the yers 49 RAG FLOCK ACTS, 1911 AND 1928. There are no premises within the district where rag flock is manufactured, used in the making; of mattresses, &c., 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 (j 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. 22 Under these a new register is being formed, and during the year in connection with this and for purposes of supervision, some 7,481 visits were paid to the 1,055 houses on the old list. The number of intimation notices served was 789, relating to cleansing and other defects. Except in 31 cases, where statutory notices were issued, all of these notices were complied with without the necessity for further proceedings arising. In all tenement buildings the provision of lighting arrangements in staircases called for by Sec. 61 of the L.C.C. (General Powers) Act, 1927, has now been made and appears to be working satisfactorily. Common Lodging Houses.—Though the licence in the case of these houses is actually granted or renewed yearly by the London County Council, the grant or renewal is made subject to the approval of the Borough Council who are provided with a list of applications received prior to the day fixed for consideration. The following table contains all the necessary particulars with regard to the licensed premises of this class in the Borough. On account of the war and the reduction in the number of lodgers, one or two of the lodging houses were shut down and will not again be used in this way. Of those still on the list special reference may be made to " Portman House " in which accommodation is provided for women only. Houses for women are badly needed, but very difficult to find; houses so well arranged and conducted as " Portman House " are rare indeed. Situation, etc., of Licensed Common Lodging Houses, Address. Registered Owner. Registered number of Occupants. 54, Bell Street Eliza Crew 52 men 2, Burne Street and Lisson Street Edward J. Higgins 499 men 29, Circus Street Catherine Wren 86 men " Portman House " (late Shaftesbury Institute), Harrow and Daventry Streets, Lisson Grove Ellen Homewood 102 women Total 637 men 102 women 739 A number of visits were paid to all the houses from time to time by officers of the department and the attention of the person in charge or the London County Council directed to any matter calling for remedy. Underground rooms.—In the report of 1925 it was stated with regard to these rooms that : " Despite all efforts quite a number that had been closed and disused for some years were once more found to be occupied. In these cases practically all that could be done was to warn both the person who had let and the person who had taken the rooms and to ensure that the rooms should be put into as good condition as possible. Fortunately, only the best of the rooms were re-let and many that were, or on account of neglect had become, unsuitable remain empty." Since 1925 conditions have not changed, and despite the greatest care and watchfulness rooms of this kind are occupied. In 1930 thirty cases in which the occupation was definitely illegal were dealt with. C.—PREMISES THAT ARE NOT BUT SHOULD BE REGISTERED. For a variety of reasons the number of premises in the Borough in which meals are provided or food is sold already cooked or is prepared for sale is very large. At the end of 1930 there were 331, this number including : restaurant, dining room and coffee shop kitchens, 19C ; tea-rooms and pastry-cooks, 87; hotel kitchens, 21; 23 fried fish shops, 24; and fish-curers, 5. In addition, there were a number of shop in which meat, ham, sausages, &c., were cooked and sold only over the counter. None of these premises is, or is required to be, registered, and apart from fish-curing and fish-frying premises, which are required to be in compliance with certain requirements contained in by-laws of the London County Council, none of them is subject to any very special provisions. Any individual, in short, may take any sort of premises, and proceed to cook and prepare food for sale; no notice to the local authority is required, and unless complaint is received, or infection or suspicious illness occurs, or the premises are visited by an inspector, the fact that they are so used may never be discovered. That this is so appears to be at least unsatisfactory. On account of changed conditions the amount of home cooking done is steadily diminishing, and more and more the cook-shop, the restaurant, and the cooked-food shop are being resorted to. In the poorer quarters of the Borough the extent to which the fried fish shop, for example, is depended upon may be judged from the number of children making purchases during the school dinner hour, and the number of adult and child customers in the evenings. In the evenings, too, the busiest shops in the main thoroughfares are those where cooked foods are retailed over the counter. Legislation, which did not foresee these changes, contains no provision for dealing properly with the premises, and the Legislature has made no attempt to obtain control over them. Such places as the law, as it now stands, requires to be registered or licensed are mainly those in which uncooked food is dealt with, e.g., slaughter-houses, cowsheds, milk shops, etc. Having regard to the changes, the law should be extended in order to provide for registration of the cooked-food premises also. Before establishing a restaurant or eating rooms of any description, a cook-shop or a cooked-food shop, it shoulc be necessary for application for registration to be made to the local authority, and registration should not be granted until the premises had been inspected and passed as suitable. All this has been said many times before, and in the meantime, for departmental and inspection purposes, a register is kept at the Public Health Office, and particulars with regard to new premises are added as they are found. As a matter of routine, a number of restaurants, etc., are visited each week by the Food Inspector, and any matters discovered at these inspections are dealt with at once. In 1930, the total number of inspections was 745, the number of notices served being 18. If and when registration is made compulsory, the work of supervision and control will be greatly simplified, though it is just possible that at first, at least, it might entail an increase in work. The matter is, however, of sufficient importance from the public health point of view to warrant it. Just as from this point of view also, the suggestion that there should be registration of lestaurants and cooked-food shops, even of all food shops, is warranted. Food Stalls.—Since 1925 there has been a certain amount of change in relation to these, because as a result of the coming into operation of by-laws with regard to registration of street traders under the L.C.C. (General Powers) Act, 1927, they have been affected in common with other stalls. The registration, however, is not in the hands of the Public Health Committee, and the conditions affecting grant or refusal are not exclusively hygienic. The Committee actually responsible is the Highways Committee, who co-operate in the closest possible manner with the Public Health Committee and make every effort to limit the numbers to whom registration is granted. In spite of this, the number of registered stalls from which food is sold in the market streets, particularly Great Titchfield Street, Church Street, Bell Street, Blandford Street, etc., is 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 24 of the Public Health Department, a special feature being made of inspections over each week-end. Stalls from which meat is retailed though they must comply with certain requirements laid down in the Public Health (Meat) Regulations, 1925, are not registered. FOOD. A.—Milk Supply. Analysis of milk.—It has always been one of the chief aims of the Council to ensure that the quality of the milk supplied in the Borough shall be maintained, and during the year much of the time of the department and the food inspector was devoted to this matter. The total number of samples taken either formally and in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, or informally as "test" samples was 266. On examination by the Public Analyst 3 (1.1 per cent.) were found to be adulterated. In 1929 the percentage was 1.4, in 1928 and 1927 .62 and 2.9, respectively. Further reference to the question of milk examinations is made in the report of the Public Analyst which will be found elsewhere. Within recent years methods of distribution have very greatly improved. Very much more milk than formerly is delivered in bottle, the quantity sold loose —from churns, etc.—being, it would seem, iess and, on the whole, definitely cleaner. To judge from the number of firms licensed to deal in various grades of graded milk, and the sampling done on behalf of the Ministry of Health, considerable quantities also must be sold in the Borough. Of the non-graded variety it is probable that the greater part is pasteurised, a circumstance which may be regarded as definitely in the interest of the consumer. As in former years, as soon as the analyst's report was obtained, vendors whose samples were found to be up to standard were informed that it would be unnecessary for them to retain the portion of milk left with them. When the samples were found to be slightly below the standard, a special report was made to the Public Health Committee. Of the sampling done, a certain amount was carried out on Saturday nights and Sunday mornings, but the practice of forwarding milk by rail to Marylebone Station having ceased in favour of road transport or delivery to King's Cross Station, railway sampling in course of delivery is not now possible. *Dismissed, under First Offenders Act. 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. 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 82 — — — £ s. d. — 2nd 62 2 32 — — 3rd 60 1 16 1 3 3 0 (Costs) 4th 62 – – – – Total for year 266 3 1.1 1 3 3 0 25 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, 38 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., under the Milk and Dairies Order, 1926, were being complied with. In no case was it necessary to take action. The Milk (Special Designations) Order, 1923.—Under this Order 47 applications were received from 12 dealers in the Borough for licences to sell milk as " Certified " Milk, 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 11 in respect of "Certified" Milk, 12 for Grade "A" Tuberculin Tested Milk, 21 "Pasteurised" Milk, 1 Grade "A," 1 Grade " A "Bottlers, and 1 Pasteurising Licence. In accordance with the instructions of the Ministry 38 samples were taken during the year and submitted to the Council's Bacteriologist, Dr. A. J. R. Foulerton. Copies of the reports were duly forwarded to the Ministry. Milk (Mothers and Children) Scheme.—Since 1925, there has been practically no change in the methods adopted in relation to the supply of milk to mothers and children. Up to 31st March, 1931, the amount expended was £314 7s. lid., as against £357 5s. 9d. in the year ended 31st March, 1926. The actual number of cases dealt with was 234, and the number of orders issued 1,116, which were larger figures than those for 1925, when the cases numbered 220 and the orders 1,051. The number of instances in which the supply was granted absolutely free, having regard to the total number of cases and circumstances generally, is comparatively small. The amount contributed in individual cases varies considerably, but from the very beginning what the amount should be has always been very carefully assessed, the size of the family and the family earnings and circumstances being taken into consideration. In every case formal application is required to be made by the individual whether recommended by the Medical Officer of a consultation or seeking assistance personally. Following receipt of the application, enquiries are made by the Health Visitors and on their report and the information provided in the application, assessment is made by the Medical Officer of Health. The period for which the grant is made varies, but is usually four weeks, and at the end of this period the case is again considered and alterations made in the amount ordered, and the contribution charged if necessary. The system, it may be said, has worked with absolute smoothness and has done a very great deal of good. Here and there an individual not quite deserving may have received assistance, but on the whole the efforts of the officers to make a just assessment have been helped rather than hindered. FOODS OTHER THAN MILK. Though there have been certain changes and advances in connection with legislation since 1925, The Food and Drugs (Adulteration) Act, 1928, for example, having replaced the cumbersome collection of Sale of Food and Drugs Acts, administrative procedure has altered little, if at all. 26 The main duties in relation to food protection generally in 1930, as for some years past, have been carried out by Inspector Smith, who made inspections of premises in which food is sold, stored or prepared, and acted as Sampling Officer under the Food and Drugs (Adulteration) Act, 1928. The Public Health (Meat) Regulations, 1925, which had only come into operation in the year of the last Survey Report gave rise here, as elsewhere, to a certain amount of difficulty. In course of time this was overcome and in the main the provisions relating to shops and to stalls and slaughtering of animals work with absolute smoothness, the butchers endeavouring to comply as completely as possible w ith the requirements. On the whole it may be claimed that as a result of the operation of the regulations there has been real improvement so far as exposure of meat is concerned, and that in the matter of protection from contamination conditions are very much better than they were when the regulations came into operation. Food Inspection.—The work of food inspection receives year by year adequate attention. During 1930, as formerly, the special Saturday night and Sunday inspections in market streets, etc., were made, and in carrying them out Inspector Smith received the assistance of other members of the staff having the necessary qualifications and experience. On a great many occasions the inspector was called by vendors to examine articles of food under Section 47 (8) of the Public Health (London) Act, 1891, and to accept surrender of such as were unsound or unwholesome or unfit for food. Amongst the articles dealt with in this way were :— Unsound and Diseased Food Condemned and Destroyed During the Year 1930. M eat— Beef 80 lbs. Mutton 28 ,, Pork 12 ,, Bacon 16 cwt. 13 lbs. 1 Ox Liver. Fish- Wet—Skate 59 stone Dog 5 ,, Roe 1 box Fruit— Peaches 7 boxes Plums 60 lbs. Cherries 90 ,, Red Currants 25 ,, Greengages 25 ,, Lemons 1 case Raspberries 2 baskets Vegetables— Mushrooms 5 baskets 27 Miscellaneous— Brawn 66 tins Corned Beef 383 „ Sausages 82 „ Tongues 61 „ Beef and Tongue 14 „ Veal 5 „ Pressed Beef 13 „ Pork 7 „ Hams and Gammons 41 „ Chicken and Ham Roll. 33 Pork Roll 21 Ham Roll 22 Chicken Roll 15 Chicken and Ham Paste 11 tins Kipper Snacks 10 „ Herrings 54 „ Oats 3 packets Barley Kernels 1 packet Grape Fruit 11 tins Pineapple 28 „ Cream 349 „ Cheese 1 cwt. 1 qr Food Premises.—The points of importance in relation to food premises generally, i.e., slaughterhouses, bakehouses, etc., have already been defined, and here it is unnecessary to say more than that during the year these places were kept under regular supervision. Numerous visits were paid and inspections both of the premises and contents carried out. C.—FOOD AND DRUGS (ADULTERATION) ACT, 1928. The total number of samples taken under this Act in 1930 was 1,103, the figure for 1925 being 1,040. Of this number 14 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 1.2 per cent., which is higher than that for 1925, when it was 0.86, a similar percentage to that for 1929. The method adopted in connection with the taking of samples and described in former reports, it has not been found necessary to alter. The majority were " formal " samples, and in carrying out the sampling, the officer was almost invariably assisted by an agent. The bulk of the samples taken were of milk and dairy produce. Reference has already been made to the case in which a prosecution was instituted. The following Tables and Report from the Public Analyst, Mr. J. F. F. Rowland, give full information with regard to samples submitted to and examined by him :— 28 ANNUAL REPORT OF THE PUBLIC ANALYST, 1930. The number of samples taken under the Food and Drugs (Adulteration) Act and submitted for analysis, was 1,103 : an increase as compared with the samples for 1929, the number for that year being 1,040. A complete list is as follows :— ANALYSES No. Article Number Examined Number Adulterated, etc. Formal Informal Private Total Formal Informal Private Total 1 Arrowroot – 3 _ 3 2 Black Treacle – 6 – 6 6 6 3 Brandy – 1 – 1 4 Butter 23 140 1 164 1 1 5 „ and Roll – 5 – 5 6 Cheese – 40 – 40 7 „ Creain – 2 – 2 8 Chewing Gum – 1 – 1 9 Cocoa – 17 – 17 10 Coffee – 71 – 71 11 Cream 24 – – 24 12 „ Bun – 1 – 1 13 „ Eclair – 1 – 1 14 „ Tinued – 8 – 8 15 Currants – 11 – 11 16 Distilled Water – 2 – 2 17 Dripping – 12 – 12 18 Eggs – 1 – 1 19 Egg Powder – 2 – 2 20 Flour – 1 – 1 21 „ Self-Raising – 3 3 22 Glace Cherries – 3 – 3 23 Glucose – 3 – 3 24 Honey – 8 – 8 25 Jam – 35 – 35 26 Laid – 83 – 83 27 Lemonade Powder – 15 – 15 28 Margarine – 8 – 8 29 Marmalade – 17 17 30 Milk 222 44 – 266 3 3 31 „ Condensed – 20 – 20 32 Mincemeat – 2 2 33 Mustard – 23 – 23 34 „ Pickles 3 – 3 35 Oatmeal .. – 3 – 3 36 Ointment, Boric – 23 – 23 37 „ Sulphur – 6 – 6 38 „ Zinc – 9 – 9 39 Olive Oil – 6 – 6 40 Paste, Fish – 13 – 13 41 „ Meat – 9 – 9 42 Peas, Tinned – 4 – 4 43 Pepper – 7 – 7 44 Pickles – 2 – 2 45 Phosphoric Quinine – 1 – 1 46 Prunes – 2 – 2 * 47 Raisins – 3 – 3 48 Rice – 4 – 4 49 Rum – 5 – 5 3 3 Carried forward 269 689 1 959 3 9 1 13 ■29 ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total Brought forward... 269 689 1 - i CD959 3 9 I 13 50 Sage 1 — 2,'ii'l 51 Salmon—Tinned 4 — 4 52 Sausages, Beef 3 — 3 53 „ Breakfast . . 3 — 3 54 „ Pork 2 — 2 Ho Scotch Whisky 1 — 1 56 Sugar 30 — ^.30 57 „ Demerara 1 — 1 1 1 58 „ Granulated 6 — 6 59 Sultanas 26 — 26 60 Sweets 7 — 7 61 Tartaric Acid 3 — 3 62 Tea 54 — 54 63 Vinegar ... 1 2 — 3 Totals 270 832 1 1103 3 10 1 14 Adulterated Samples, etc. Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 162 Black Treacle... Informal Contains 0.8 grains of tin per lb. 167 Black Treacle... Informal Contains 1.1 grains of tin per lb. 168 Black Treacle... Informal Contains 0.9 grains of tin per lb. 180 Black Treacle... Informal Contains 1.2 grains of tin per lb. 189 Black Treacle... Informal Contains 1.1 grains of tin per lb. 192 Black Treacle... Informal Contains 1.2 grains of tin per lb. 177 Rum ... Informal Contains 0.3 grains of tin per pint. 178 Rum Informal Contains0.2 grains of tin per pint. 179 Rum ... Informal Contains 0.5 grains of tin per pint. 484 Milk Formal 6.7 per cent, deficient in milk fat. 487 Milk Formal 3.3 per cent, deficient in milk fat. 749 Milk Formal 10.0 per cent, deficient in milk fat. Dismissed under First Offenders Act. Costs £3 3s. Od. 796 Demerara Sugar Informal 1.4 grains of tin per lb. 1068 Butter Private 80 per cent, of the fat of, this sample was not butter fat. The sum paid in respect of each analysis was 12s. 6d. per sample. 30 The Public Analyst (Mr. J. F. F. Rowland) comments, as follows, with regard to various articles examined :— Milk.—Of the 266 samples examined during the year 3 were adulterated. This represents 1.13 per cent, as compared with 1.37 per cent, for 1929 and 0.625 per cent, for 928. Omitting adulterated samples the average composition or the other milks taken during the year was as follows :— Year. Sp: Gr: Total Solids. Fat. Solids not Fat. 1925 1031.3 12.27 3.58 8.69 1929 1031.4 12.34 3.62 8.72 1930 1031.0 12.20 3.59 8.61 The figures for 1925 and 1929 are given for the purpose of comparison. The composition it will be noted varies but slightly from that of 1929 but the variation, slight as it is, is of an adverse nature. Creams.—Once again the figures for loose and tinned creams are given and compared with those of previous years. As will be seen from an inspection of the results obtained the year 1929 saw a distinct improvement in the quality of both loose and tinned creams. This year (1930) the fat content of the loose creams examined is even more satisfactory than that of 1929, while the tinned creams have maintained their recovery fairly well from the low record touched in 1927. Loose Creams. Tinned Creams. Year. Fat. Year. Fat. 1926 54.7 1926 28.87 1927 51.4 1927 25.6 1928 42.33 1928 28.73 1929 47.39 1929 29.92 1930 49.63 1930 29.46 Metals in Foods.—During the year 1929 tin was found in certain makes of household sugars. In 1930 the investigation was carried a step further and tin was discovered in 6 samples of black treacle and in the only Demerara sugar taken, the amounts ranging from 0.8 to 1.4 grains per pound. As six was the total number of samples of treacle taken a hasty deduction might lead to the conclusion that every sample of black treacle contains tin. On the number examined this would be a too rash conclusion ; but that treacle which is a by-product of the sugar industry, should be liable to contamination by tin because tin compounds are used in the manufacture of certain classes of sugar, makes it all the more urgent and important that the use of tin should be prohibited in the manufacture of sugar. Another by-product of the sugar industry is Rum and in the 3 samples of rum taken tin was present in amounts which ranged from 0.26 to 0.5 grains per pint. In accordance with the instructions of the Public Health Committee the attention of the Ministry of Health was directed particularly to these findings of the Public Analyst in the examinations of Sugar, Black Treacle, etc. Butter.—One sample of butter was adulterated, 80 per cent, of its fat being fat other than butter fat. Cream Bun and Craem Eclair.—The "creams" of these two confectionery products contained no butter fat. 31 STATISTICAL. BIRTHS. Registration.—The number of births registered during 1930 was 1,247,* being 14 more than in 1929, and 249 less than in 1925. Of the children born, (538 were boys and 009 girls. The birth rate per 1,000 of the population was 12.1, as against 11.9 in 1929 and 14.1 in 1925. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1930, with those of each of the years since 1925 :— 1925 1926 1927 1928 1929 1930 All Souls 10.4 9.0 9.0 9.7 9.4 10.1 St. Mary 12.8 10.1 10.6 10.7 9.7 10.4 Christ Church 17.9 18.0 19.1 16.4 15.8 14.1 St. John's 141 12.6 12.6 13.2 12.3 18.8 The Borough 14.1 12.7 13. 2 12.6 11.9 12.1 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,5.30; live births, 3,325; still births, 205. The total notifications in 1925 was 3,699. The provisions of the Act are now very generally known, and the necessity for notifying is not less well recognised than that for registration. Failures to notify within 36 hours of birth, as required, were comparatively few. In such cases as there was failure, a perfectly reasonable explanation was forthcoming, and it was not considered necessary to take proceedings against any of the parties. The main sources of the notifications are set out below. The figures, it may be noted, refer to notifications and not to births. In some cases duplicate notifications, from different sources, were received with regard to the same birth. No. Per cent. From parents 21 0.6 ,, doctors 146 4.1 „ mid wives 523 14.8 „ other persons 269 7.6 „ hospitals, etc. 2,571 72.9 3,530 100.0 Of the total births notified, 205 referred to still-births (118 males and 87 females) : 2,130 took place at Queen Charlotte's Hospital; 85 at Middlesex Hospital ; 205 at the St. Marylebone Home ; and 959 were born at home. Of those notified as having occurred in St. Marylebone, 1,875 belong to other Boroughs. Of the 205 still-births only 43 (21 males and 22 females) were to St. Marylebone mothers. DEATHS AND DEATH RATES. The number of deaths registered in 1930 was 1,171. 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. * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 297 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 121 „ Females 104 Illegitimate Males 31 ,, Females ,, 41 32 The corrected death-rate* per thousand for the year was 10.6. In the previous year, the rate was 13.2 and the number of deaths 1,455. In 1925, when the last summary report was submitted, the deaths numbered 1,257, and the corrected death-rate was 11.0. The following short table shows the death-rates in the several registration sub-districts in 1930, and compares them with those of the years onward from 1925 :— 1925 1928 1927 1928 1929 1930 All Souls 9.2 9.6 9.7 9.9 13.3 10. 2 St. Mary 12.5 13.6 14.2 12.0 13.8 11.5 Christ Church 12.9 13.6 12.6 13.4 15.8 11.8 St. John 12.5 14.3 119 128 13.8 12.1 The Borough 110 11.9 11.3 11.1 13.2 10.6 District births and deaths for the year ended 2nd January, 1931, are given in the following table. A further table giving the vital statistics of separate localities for 1930, and the ten preceding years, will be found amongst the Ministry of Health Tables on page 77. Sub-District. Population estimated to middle of 1929. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 24,532 128 121 249 116 134 250 St. Mary 26,228 140 133 273 159 143 302 Christ Church 31,873 242 210 452 203 176 379 St. John 19,767 128 145 273 110 130 210 The Borough 102,400 638 609 1.247 588 583 1,171 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 1930. For purposes of comparison the table for 1925 is reproduced from the report for that year. It is interesting to note that the figures relating to both infants and the elderly have fallen definitely. The distribution of the deaths is the same in each of the two years, the heaviest incidence in both old and young falling in the first and last quarter. 1930. J anuaryMarch AprilJune JulySeplember OctoberDecember Total Infants under 1 year 25 20 16 16 77 Persons of 65 years and upwards 159 116 122 130 526 *By a " corrected death rate " is meant one which has been treated in such a way, raised or lowered in a certain ratio, as to be comparable with the death rates similarly treated of other districts. That " correction " is necessary is due to the fact that differences in death rates in various areas are not entirely dependent upon the sanitary conditions existing in these areas, but also on the constitution (age and sex) of the population. A population consisting of aged persons would show more deaths than one consisting entirely of young and vigorous adults; a population made up of a large number of males and a small number of females has more deaths and a higher death rate than one in which the females outnumber the males. The death rates of such populations are not comparable the one with the other nor with those of populations differently constituted. To overcome this difficulty the Registrar General issues a " factor for correction " for each district which represents the number of times which the actual death rate of each must be raised in order to permit of its examination side by side with the rates of other districts. The " factor for correction '' in the case of St. Marylebone in 1930 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. 33 1925. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 27 20 17 30 94 Persons of 65 years and upwards 162 119 94 171 546 DEATHS IN RELATION TO AGE. The percentage relation of each group to the total number of deaths in 1930 is shown below :— Under 1 year 6.6 per cent. 1 and „ 2 years 2.1 „ 2 „ „ 5 1.5 „ 5 „ „ 15 20 „ 15 „ „ 25 „ 32 „ 25 „ „ 45 11.3 „ 45 „ „ 65 „ 28.3 „ 65 ,, upwards 45.0 „ Of the total, 144 at death were aged between 65 and 70; 249 between 70 and 80 ; 120 between 80 and 90 ; and 13 between 90 and 100. The age distribution of the deaths that occurred in 1930 is shown in the following table, which gives also, for the purpose of comparison, the figures for each age group since 1925. Age Periods Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 ard under 25 years 25 and under 45 years 45 and under 65 years 65 and upward At all Ages 1925 94 25 19 25 42 149 357 546 1,257 1926 111 33 26 31 45 156 405 549 1,356 1927 81 27 22 18 37 138 391 548 1,292 1928 105 37 17 21 34 123 367 534 1,238 1929 95 36 17 25 44 145 449 642 1,456 1930 77 25 17 24 38 133 331 526 1,171 Causes of and ages at Death.—General information with regard to the deaths which occurred in the Borough during the year, mainly as to causes and the ages at which death took place, is given in Table 111. of the Ministry of Health series at page 79. 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 946. Fulier 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. 34 The number of babies under one year who died in St. Marylebone in 1930 was 77, and the number of births in that year 1,247. The infantile mortality rate is therefore 62. This, which is second to the lowest rate ever recorded (59 in 1927), is a slight improvement on 1925, when the rate was 63, and a great improvement on 1919, when the figure was 98.5. The course which the rate has taken is graphically shown in the chart on page 36, which indicates clearly that the only really serious interruption to the decline was in 1917. The means adopted in the Borough with a view to bringing about a reduction and generally improving the life and health chances of infants and children are described in a separate section of the report—Maternity and Child Welfare. This part being merely statistical, it is not proposed at this point to do more than give some sort of analysis of the figures relating to deaths amongst infants. Causes.—A Table (Ministry of Health, Table I.) will be found on page 85, in which, in addition to the causes of death, are shown the distribution of the deaths according to age and locality. So far as age and causation are concerned, conditions vary little year by year. In 1930, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 29 were less than one month old when they died and 40 less than three months. The figures for 1929 were 35 and 59, for 1925 31 and 45, respectively. The outstanding causes of death and the proportions traceable to them were those usually noted. Prematurity (numbers 12, 13 and 14 in the table), which, as usual heads the list, caused 25 in 1929 and 26 in 1930. Diarrhoea and enteritis (7 and 8) accounted for 16 in 1929 and for 14 in 1930. Respiratory diseases, the third of the main causes, took 18 in 1929 and in 1930, 14. Amongst the other causes of death, those which call for mention are the commoner infectious diseases, which together led to 2 deaths among infants, the particular disease being diphtheria. Two deaths were stated to be due to overlaying, 1 to meningitis and 6 to measles. In the following table information supplementary to that in the large table is given with regard to deaths in various sub-districts. Christ Church, which always contributes most largely to the infantile as to most of the other mortality rates, being the most thickly populated area and that in which there is most poverty, most overcrowding and most neglect of ordinary precautions, is again at the head of the list with 27 deaths amongst infants. In 1929 the figure was 43, and in 1925, 56. Sub-District. Under 1 week. 1 and under 2 weeks. 2 and under 3 weeks. 3 and under 4 weeks. 4 weeks and under 3 months. 3 and under 6 months. 6 and under 9 months. 9 and under 12 months. Totals. All Souls 6 (3) -(-) - (1) -(-) 1 (-) 7 (2) 1 (31 1 (1) 16(10) St. Mary 7 (4) - (1) - (1) i (-) 4 (2) 3 (5) 2 (4) 3 (2) 20(19) Christ Church 4 (13) - (4) - (1) -(-) 5 (11) 6 (14) 9 (8) 3 (5) 27(56) St. John 9 (2) 1 (1) -(-) i (-) 1 (1) - (1) 1 (3) 1 (1) 14 (9) Totals 26(22) 1 (6) - (3) 3 (-) 11 (14) 16 (22) 13(18) 8 (9) 77(94) The figures in brackets are for the year 1925. 35 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year of age, and in Sub-Districts. No. CAUSE OF DEATH Under 1 Week 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 1 Month 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year All Souls St. Mary Christ Church St. John Total 1| Small-Fox – – _ _ – – – – – – – – - 2 Chicken-Pox - - - - - - - - - - - - - - si Measles - - - - - 1 2 3 6 1 1 3 1 - 4 Scarlet Fever - - - - - - - - - 6 Diphtheria and Croup - _ 1 1 2 1 1 - 2 e Whooping Cough - - - - - - - - - - - - 71 Diarrhoea - - - - - 2 - - 1 3 1 2 - 3 8 > Enteritis - - - - - 4 3 3 1 11 3 - 8 - 11 9( Tuberculous Meuingitip - - - - - - - - - - - - - - 10j Abdominal Tuberculosis - - - - - - - - - - - - - nl Other Tuberculous Diseases - - - - - - - - - - - - - 12 Congenital Malformation 4 - 4 - 1 1 - 6 1 1 1 3 - 13 Premature Birth 11 - - 1 12 1 1 - - 14 3 7 1 1 3 14 14 Atrophy, Debility and Marasmus 2 2 1 3 6 2 3 6 15 Atelectasis - - - - - - - - - - - - - - - 16 Injury at Birth - - - 17 Erysipelas - - - 18 Syphilis - — — — — — — - - 19 Rickets - — — — — — — - - - 20 Meningitis (not - - - - Tuberculous) 1 - — — 1 — — — 1 1 - 1 21 Convulsions - - — — — — — — - - 22 Gastritis - - - - 23 Laryngitis - - - - - - - - - - - - 24 Bronchitis - 1 1 - 2 i 1 - 2 12 2 25 Pneumonia (all forms) 1 - - 1 2 2 3 3 2 12 2 3 - 2 26 Suffocation, Overlying 1 - - - 1 - 1 - - 2 1 - 1 27 Other Causes 6 1 7 - 2 3 - 12 3 2 3 4 12 Totals . 26 1 - 2 29 11 16 13 8 77 16 20 27 14 77 M. F M. F. M. F. Nett Births . Legltlmate, 556 521 Nett Deaths . Legltlmate Infants' 37 26 Nett Stillbirths Legitimate Infaats' 19 20 1D the Year Illegitimate, 82 88 111 tberie,u Illegitimate Infants, 11 3 m.the Year [illegitimate Infants. 2 2 Total 638 609 Total 48 29 Total 21 22 1,247 77 48 36 INFANTILE MORTALITY FIGURES. Number of deaths of children under one year of age. Rate per 1,000 registered births. 37 MATERNAL MORTALITY. In previous summary reports, apart from indicating' the number of deaths due to puerperal fever, no special reference was made to mortality due to conditions arising or consequent upon child-birth. During the last few years, however, increasing attention has been directed to this subject, mainly because the mortality has remained consistently high, and very full and careful investigations have been carried out by a departmental committee of the Ministry of Health. Amongst other matters inquired into by this body has been the particular causes leading to death, and in the last two or three years in this annual report as full information as possible has been given in this connection. The numbers naturally and fortunately are, of course, small, and from a statistical point of view really not particularly helpful. When an analysis comes to be made, the amount of help given indeed is practically nil, either in the direction of indicating the preventive measures that might be taken, or providing any explanation of how it arises that amongst the Metropolitan Boroughs, St. Marylebone occupies a rather high position. In 1930, for example, the number of deaths was 7, the Maternal mortality rate being 5 per 1,000 births. In 1929, the deaths numbered 5, and the rate was 4 per 1,000. Of the 7 cases it was possible to obtain full information with regard to 6, and the main facts with regard to these are : In 2, inquests were held, and death was found to be due to septicaemia following abortion ; in 2 others the primary cause of death was pneumonia; while 1 died of pulmonary embolism and 1 of eclampsia. All the deaths occurred in hospital, two of the patients being 26 years of age, one 32, one 33, one 35, and one 37. Two of the six were single women. In only one case did the baby survive. 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 79. 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. DIARRHOEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 18, equal to 0.16 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1930 this was the case also, no fewer than 14 of the 18 being children under 1 year of age. In 1929, the deaths from diarrhoea diseases numbered 22, and of this number 16 were babies. In 1930, therefore, there was a slight decrease in the total over 1929, the decrease over 1925, when the total was 25, the figure for children under 1 year of age being 22, being slightly more marked. Having regard to the general course followed by these diseases and the mortality traceable to them, this is not remarkable. Steadily year by year these diseases are ceasing to be the very real menace they were formerly, and the summer and early autumn months, which were looked forward to with dread as far as babies were concerned, are nowadays not regarded as greatly different from any others. The reasons for the change, in addition to work done in relation to public health and health education, are chiefly impiovements in the food supply, milk particularly. INFECTIOUS (COMMUNICABLE) DISEASES. The number of deaths due to each of the diseases included in this group is referred to when dealing specifically with the disease under the heading " Prevalence of and Control over Infectious Diseases." It is interesting to note here, however, that excluding influenza, which caused 8 deaths, and including diarrhoea (18 deaths) the total number registered as due to them was 70. The figure for 1925 was only 56, but in that year there was not, as in 1930, a measles epidemic which alone contributed 35 deaths to the total. 38 The diseases contributing most largely to the total were diphtheria, 12 ; whooping cough, 2 ; scarlet fever, 1 ; enteric fever, 1 ; encephalitis lethargica, 1 ; and measles, 35. 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 84, a figure smaller by 14 than that for 1929. Than the figure for 1925 it is smaller by 9. The great bulk of the 84 deaths, viz., 75, was due to phthisis. The number in 1929 was 89, and in 1925, 93. Of the total number of deaths registered (1,171), the percentage due to phthisis was 6.4, as against 6.0 in 1929, and 6.3 in 1925. The age periods at which the deaths occurred were: 5—15, 2 (2.6 per cent.); 15—25, 13 (17.4 per cent.); 25—45, 26 (34.6 per cent.); 45—65, 22 (29.4 per cent.); 65 and over, 12 (16.0 per cent.). The subject of phthisis is further discussed in connection with the notification and prevention of tuberculosis. The following table gives the figures for each of the years from 1925. It may be noted that though there have been occasional rises the tendency has all the time been downwards. The reasons for this will be discussed later. Deaths from Phthisis and other Tuberculous Diseases. Year No. of Deaths Population Rale per 1,000 of Population 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 1930 84 102,400 .76 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 133. This is lower by 131 tl;an the figure (264) for 1929, and only about one-third of the figure (320) for 1925. The death-rate was 1.2 per 1,000. In 1929 the rate was 2.4. In 1925 there were 320 deaths, and the rate was 2.8. The number of deaths certified to be due to bronchitis was 41, as against 88 in 1929, the year of the severe frost. Of this number 30 were amongst persons aged 65 and upwards, and 7 amongst those of the group 45—65. The deaths traceable to pneumonia numbered 80, and, as in the case of bronchitis, the later age groups contributed the greatest numbers, though 16 of the deaths occurred amongst children under 2 years of age. Notification of pneumonia, which was introduced in March, 1919, has been in full operation since that date. The number of notifications received in 1930 was 42. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in the table on page 80. Visits were paid to each of the notified cases, and any assistance possible in the way of removal to hospital or nursing (under the Council's arrangement with the Paddington and Marylebone Nursing Association) offered. As a matter of interest it may be noted that requests for disinfection after recovery or death from pneumonia, which about 1925 were fairly common, practically are never now received. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 170 and the death-rate 1.5 per 1,000 39 of the population. These figures are higher than those for 1925, when the deaths numbered 161 and the rate was 1.4 per 1,000. In 1929 the figures were higher, the total being 197 and the death-rate 1.7 per 1,000 of the population. Information with regard to the situation of the disease and the age at which death occurred is given in the following tables :— Cancer : Ages at Death. Ages Under 10 1 10 and under 20 20 and under 30 30 and 40 and under 40 under 50 50 and under 60 60 and under 70 70 and upwards Totals Males 1 (1) 2 (3) 1 (-) 6 (6) 19 (10) 21 (23) 20 (20) 70 (63) Females - (-) 1 (-) 2 (2) 10 (10) 27 (27) 28 (35) 32 (24) 100 (98) Totals — 1 (1) 3 (3) 3 (2) 16 (16) 46 (37) 49 (58) 52 (44) 170(161) Cancer-situation of the disease. Parts of the body affected. Males. Females. s. Face, Tongue, Jaw 6 (6) 1 (-) 7 (6) Threat, Neck, Gullet 14 (10) 7 (5) 21 (15) Stomach 13 (6) 11 (14) 24 (20) Intestines 11 (17) 21 (27) 32 (44) Liver 4 (3) 10 (5) 14 (8) Breast (-) 11 (17) 11 (17) Uterus and Generative Organs (-) 24 (26) 24 (26) Various 22 (21) 15 (4) 37 (25) Totals 70 (63) 100 (98) 170 (161) Note. The figures in brackets are those for 1925. The fact, commonly accepted, that the number of deaths certified as due to cancer is showing a definite tendency to increase receives confirmation from these figures. No reason, generally acceptable, to account for this has as yet been put forward, nor has any theory to account for the occurrence of the disease, to which the medical profession as a whole can subscribe, been submitted. One point upon which there is general agreement, however, is with regard to the importance, advisability and advantage of early treatment. Of the accuracy of the advice now so widely given that there should never be any delay in seeking an authoritative opinion in any case of doubt and in securing treatment there can be no question. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1930 numbered 60. Of these 19 were due to suicide. The figures lor 1925 were 50 and 11 respectively. Deaths of babies certified as resulting from suffocation (overlaying) numbered 2. 40 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. A table showing, with regard to the infections, the total number of notifications received, the age distribution and the number of cases notified from each of the four registration districts will be found on page 80. The following table shows the number of cases of infectious disease notified during the past six years :— 1925 1926 1927 1928 1929 1930 Smallpox — 2 — 30 3 6 Diphtheria 132 193 160 177 180 271 Erysipelas 36 41 36 67 40 61 Scarlet Fever 168 121 178 223 237 226 Enteric Fever 14 9 5 13 5 9 Paratyphoid Fever 3 2 12 10 6 6 Continued Fevei — — — 1 — — Puerperal Fever 6 12 1 3 4 8 Puerperal Pyrexia — 9 35 32 19 25 Cerebro-spinal Meningitis 2 2 2 — 3 4 Tuberculosis (Pulmonary) 187 151 155 139 147 141 Tuberculosis (Non-Pulmonary) 36 30 35 22 26 20 Acute Poliomyelitis 2 1 3 — 2 2 Polio-Encephalitis 1 — — — — Ophthalmia Neonatorum 8 7 12 7 3 16 Encephalitis Lethargica 2 3 3 3 3 2 Pneumonia 69 86 45 44 92 42 Malaria 1 3 3 1 2 1 Dysentery 1 2 1 2 1 — Trench Fever 1 — — — — — Totals 669 674 686 775 773 840 The total number of notifications coming to hand was 840. The bulk of the notifications related to diphtheria and scarlet fever, which contributed 271 and 226 respectively to the total. Other diseases in respect of which considerable numbers of notifications were received were tuberculosis (161), erysipelas (61), and pneumonia (42). In 1029 the number of cases notified was 773. The notification rate (proportion to population of notified cases of infectious diseases) in 1930 was 8.2 per 1,000, as against 7.5 in 1929. The figures for 1925 were, total notifications, 669; notification rate 6.3 per 1,000. Isolation of Cases.—As the following table shows, the number of cases removed was as high as usual In no case was compulsion necessary in order to ensure removal to hospital :— Diphtheria 268 or 99.0 per cent. of the cases notified. Erysipelas 39 „ 550 „ „ „ Scarlet Fever 221 „ 98.0 „ ,, „ Enteric and Paratyphoid Fever 12 „ 80.0 „ „ „ Puerperal Fever 7 „ 87.0 „ „ „ Puerperal Pyrexia 20 „ 80.0 „ „ „ Tuberculosis 63 „ 390 „ „ „ Pneumonia 14 „ 33.0 „ „ „ Encephalitis Lethargica 2 „ 100.0 „ „ „ Smallpox 6 „ 100.0 „ ‚ „ 41 The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was -£('>1 13s. Od., equal to 12s. per 1,000 of the population. I he cost and rate per 1,000 lor each ol the past years since 192.) are shown in the following table :— Year Amounts paid to Medical Practitioners Cost per 1,000 of Population £ s. d. £ s. d. 1925 48 4 0 0 9 1 1926 4 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 1930 61 18 0 0 12 0 Discharge Notices.—The number of certificates received from the hospital authorities regarding the return of patients sent to hospital with infectious diseases was 350, and referred to 465 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 271, the number in 1929) being 180. Of the cases 12 died, and the case mortality rate was 6.6 per cent. The number of cases per thousand of the population was 1.7. The cases were more or less evenly distributed, as usual, throughout the borough, and only in a few instances was it possible to determine accurately the source of infection. In 9 cases the source appeared to be a member of the family previously infected ; in 5 cases infection was counted to have been acquired in school, and in 16 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 3,189. The bulk of these were from institutions, St. Charles, and the Royal National Orthopaedic Hospitals, from which many of the cases were notified, and were taken from ward contacts. Fortunately nearly all proved negative, a positive result actually being returned in 213 instances only. Of the registration districts, that contributing the largest number of cases, naturally, since in respect of child population it is the largest, was Christ Church, with 97. In All Souls the number was 71, in St. Mary 58, and in St. John 45. As usual, the age groups 1—5 and 5—15 were those most affected, 103 of the cases falling into the former and 99 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., 31. 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, and later of Dr. H. A. Bulman. In the main the children dealt with were those attending the Welfare Centres. 42 The following table and summary give details of the work of the clinic during the year. Children under 5. Children over 5. Adults. Tota. Inoculated without Schick Test 63 4 – 67 Tested—Positive 15 11 46 72 Negative – 3 42 45 Not reported 5 1 — 6 Injections—1st 15 12 45 72 2nd 77 14 41 132 3rd 61 12 39 112 4th 1 8 28 32 5th — — 25 25 Completely immunized 39 35 15 89 Retested 48 42 16 10 Not reported 7 1 1 9 Additional injections 2 6 — 8 SUMMARY. Number of Sessions 66 Total Number of New Cases 190 „ „ under 5 83 „ „ over 5 19 „ „ Adults 88 Number of attendances 856 Average attendance per session 13 Scarlet Fever. The notifications of this disease numbered 226. That there is a liability for scarlet fever to show epidemic tendencies at intervals of five years, more or less, is well known. In St. Marylebone the last year in which there was marked prevalence was 1921 when the cases numbered 478. The highest number of cases reported in any one week it may be noted was 14. The total deaths from scarlet fever numbered 1, and the number of deaths per cent, of the cases was 34. The districts to suffer most from this disease were Christ Church and St. Mary. In the former there were 100 cases and in the latter 49. In All Souls there were 43 and in St. John 34. As usual, the majority of the patients were children of school age, the age group, 5—15, giving over one-half (117) of the total. Of the remainder 51 were aged between 1 and 5 years, and 55 over 15 years of age. The source of infection was believed to be a previous case in the same family in 17 cases and in 9 cases in an institution. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 23 instances that a definite connection could be made out. Defects in sanitation to the number of 18 were discovered. All these were want of cleanliness, etc. The nuisances were remedied after the service of notice in each case. Enteric Fever and Paratyphoid Fever. The notifications of Enteric Fever numbered 9. There was one death. Of Paratyphoid Fever there were 6 cases. All the patients recovered. In none of the cases was any information obtainable indicating the source of infection within the Borough. The majority indeed appeared to have been infected abroad or outside the Metropolis. 43 Cerebro-Spinal Fever. Four cases of this disease were notified during the year. Encephalitis Lethakgica. There w ere 2 cases of this disease notified. Polio-Encephalitis. No cases of this disease were notified. Polio-Myelitis. There was 2 cases of this disease notified during- the year. Erysipelas. The notifications of erysipelas numbered 61, and there were no deaths. Most of the cases were notified from the St. Charles Hospital and the General Hospitals, and 39 patients were treated in one or other of these institutions. Puerperal Fever and Puerperal Pyrexia. The number of cases of this disease notified, viz., 8, was above the average of the last few jears. Four of the patients died. Particulars of these cases are given under the heading Maternal Mortality. In each case a visit was paid by one of the Health Visitors and the premises were disinfected. The Puerperal Pyrexia cases notified during the year numbered 25 ; 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 1920 was 19. Measles and German Measles. Though these conditions are not now notifiable, 1,251 cases were reported : 98 voluntarily by doctors and parents and 1,153 by school teachers. There were 35 deaths. The course adopted in relation to the notified cases was the same as in the previous year. Practically every case was visited by the Health Visitors, particular attention being given to such as occurred in tenement houses. Under an agreement entered into between the Council and the Paddington and Marylebone Nursing Association, the services of a Nurse were obtained in cases in which the attack was severe. The nurses made 49 visits to 9 cases. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1930 the number of deaths registered as due to whooping cough was 2. In 1929 the number was 23, and in 1925, 21. Glanders and Anthrax. No cases were notified during the year. Small Pox. In spite of the fact that there has been a fairly considerable prevalence of small pox of the milder variety throughout the metropolis, more or less each year since the date of the last Survey Report in 1925, the Borough has remained remarkably free. The only year, indeed, in which a notable number of cases 44 occurred was 1928, when an outbreak of 30 cases, all in the St. Marylebone Home, gave rise to considerable anxiety, but fortunately was kept within the bounds of the institution. Full details with regard to the cases were printed in the report of 1928 and need not be repeated. The same may be said of the 3 cases notified in 1929. In 1930, the number of notifications received was 6, although the cases actually proved to be small pox numbered only 5. In each instance the infection was of the mild type and all the patients recovered. Active steps to guard against spread of infection were taken, including the vaccination or revaccination of contacts and were uniformly successful. The most interesting cases and those that gave rise to the greatest amount of work were two that occurred in the staff of a large store in the Borough. Recognizing their importance the management facilitated in every way possible the carrying out of preventive measures, and largely as a result no further spread of infection occurred. Inspection of the staff led to the discovery of the origin of infection in two cases, sisters who, having been lately out of sorts for a day or two, regarded their complaint as influenza and did not seek medical advice. These cases as well as the following up of individuals residing or employed in the Borough who had been in contact with patients elsewhere, gave rise to a great amount of work. In this, Dr. Bulman, both during the time he was acting as temporary Public Vaccinator and after his appointment as Assistant Medical Officer of Health and Public Vaccinator, rendered valuable assistance. Appointment to this position, which is the only one of the kind in the Kingdom, was made in July, 1930. At the same time the appointments of Dr. P. K. Byrne as Public Vaccinator to St. Marylebone Home, and of Dr. L. Phillips as Public Vaccinator to Queen Charlotte's Hospital were confirmed ; Dr. R. L. Bell being appointed as Deputy Public Vaccinator. Vaccination.—On the subject of vaccination generally, this opportunity may be taken to note that since the coming into operation of the Local Government Act, 1929, and the transference to the Borough Council of the functions of the Board of Guardians in relation to vaccination, matters have moved with great smoothness. Largely this is due to the fact that the whole staff concerned, including the Vaccination Officer and the Public Vaccinator, are whole-time officers of the Council and are attached to the Public Health Department. This alone, it is felt, has had an influence in creating confidence in the procedure and those connected with it. From the beginning an attempt has been made to stress less the legal than the protective and preventive aspects of the procedure. This, it is believed, has had good results, the number of refusals showing a marked tendency to fall. By explaining by letter and at visits the reasons for recommending vaccination, it is felt that great progress is likely to be made and that the results as shown by statistics will steadily improve. The usual table has been prepared by the Vaccination Officer and will be found on page 81, while the following statement gives some information with regard to the work done and the results obtained by Dr. Bulman in the 9 months he has been acting as Public Vaccinator. Number of visits paid 1,539 Number of vaccinations— Primary 492 Re-vaccinations 632 1,124 Number of successful vaccinations 1,120 N umber of unsuccessful vaccinations 4 Number of refusals 5 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 1930. During the year in certain of the schools, one or more classrooms were closed on account of measles. 45 During; the year in certain of the schools, one or more classrooms were closed on account of measles. SCHOOLS Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 2 13 5 13 90 - Barrett Street 1 — — 3 — 1 Barrow Hill Road 9 38 4 53 122 48 Bell Street 30 19 21 21 76 20 Blandford Square 1 2 — — 15 — Capland Street 20 13 14 15 83 64 Catholic, Richmond Street — — — — — Christ Church, Lisson Grove 22 9 1 19 15 2 Convent, Little Union Place — — — 6 15 — Council School Grove Road 45 33 3 61 57 39 Emmanuel, Aberdeen Place 5 17 1 24 50 23 Emmanuel, North Street — — — - 29 — Gateforth Street 7 17 4 21 62 10 Hampden Gurney, Upper Berkeley Street 25 — 5 12 32 15 Homer Row, Catholic 3 7 1 1 26 4 Jewish, Hanway Street — — — — 2 1 Portland, Little Titchfield Street — — — — — — Polytechnic, Regent Street — — — 2 1 — Queen's College, Harley Street - - - - - — St. Andrew's, Wells Street - - - - - - St. Francis, Upper William Street - - - - - - St. James's, Marylebone Lane 1 2 — 3 4 1 St. Luke's Nutford Place 3 5 — — — 4 St. Mark's, Violet Hill 23 11 — 5 59 2 St. Marylebone, High Street 40 46 8 15 65 35 St. Marylebone Grammar, Marylebone Road — 2 — — 6 1 St. Mary's, Crawford Street 3 13 1 22 75 13 St. Paul's, East Street — — — — — — St. Paul's, Broadley Terrace 26 — 8 22 1 4 St. Thomas', Orchard Street — 15 — 5 16 6 St. Vincent, Wigmore Street 2 3 — — 18 2 Upper Marylebone Street 18 8 — 11 201 4 Schools out of Borough 18 9 3 11 33 5 Totals 304 282 79 345 1,153 304 Ophthalmia Neonatorum. This disease—inflammation of the eyes in newly-born children— made notifiable by order of the London County Council in 1911, continued to be so during the whole of 1930. The total number of cases notified was 16, as against 3 in 1929, and 8 in 1925. Visits were paid to all notified cases by the Health Visitors, and in 3 cases arrangements were made for one of the nurses of the Paddington and Marylebone Nursing Association to attend and apply treatment. In this connection 64 visits were made. In bad cases removal to hospital is carried out, special arrangements having been provided at St. Margaret's Hospital for receiving and dealing with children suffering from this condition. The following table gives information with regard to the cases notified. Notified Cases Treated Vision Unimpaired Vision Impaired Total Blindness Deaths At Home At Hospital 16 7 9 16 — — — 46 INFLUENZA. This disease showed no epidemic tendencies during the year. The deaths certified as due to Influenza numbered 8, as against 59 in 1929. PNEUMONIA. Figures with regard to notification and information as to methods of prevention, etc., adopted in relation to this disease will be found on pages 38 and 80. The services of the nurses were requisitioned in 28 cases and 154 visits were paid. TUBERCULOSIS. In all 161 notifications were received, 141 relating to pulmonary tuberculosis, the remainder (20) to cases in which structures other than the lungs were affected. The table given on page 47 contains the information required by the Ministry of Health with regard to notifications. Notifications on Form B relate to school children. The number, it will be noted, was 1, the same as in 1929. 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 84 2. The number of cases unnotified or notified at death 27 3. The number of cases notified within a month of death 14 4. The number of cases notified within three months of death 6 5. The number of cases notified within six months of death . 6 Treatment of Tuberculosis.—Of the cases notified 160 received some form of institutional treatment, and during the year every effort was made to obtain admission to sanatoria of cases deemed suitable for such treatment. Of the total new cases notified 101 were insured persons; of those 50 were admitted to sanatorium or hospital treatment, and 28 to St. Charles' Hospital. Non-insured persons numbered 64, of whom 21 (7 being children) received sanatorium treatment and 9 (5 being children) were admitted to St. Charles' Hospital. Nurses were sent in to 7 cases and 201 visits were paid. Public Health (Prevention of Tuberculosis) Regulations, 1925.—In no case was it necessary for action to be taken under these regulations, which empower the Council to call upon a person suffering from tuberculosis engaged in the milk trade to discontinue such employment. 47 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 29th December, 1929, to the 27th December, 1980. METROPOLITAN BOROUGH OF ST. MARYLEBON'E. 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 66 and upwards. Total Primary Notifications Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males - - - 1 6 2 22 11 19 10 5 76 88 - - - - - 14 42 „ Females Non-Pulmonary — — 2 1 7 13 20 9 4 2 7 65 77 — — — — 1 12 41 Males — 1 3 2 — 1 3 — — — — 10 11 - — — — — 1 10 „ Females - 1 - 1 3 3 1 - - - - 9 9 - 1 - 1 1 1 12 Totals - 2 5 5 16 19 46 20 23 12 12 100 185 — 1 — 1 2 28 105 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. 342 Males PULMONARY 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, 1930. 240 Females 582 Total 89 Males NON-PULMONARY 72 Females 161 Total 743 Total Cases PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Supplemental return of new Cases of tuberculosis coming to the knowledge of the Medical Officer of Health or Chief (Administrative) Tuberculosis Officer during The period from The 29th december, 1929, to THE 27th december, 1930, otherwise than by Formal Notification under the Public Health (Tuberculosis) Regulations, 1912, or by notification in pursuance of sec. 5 (b) or the Local * ment (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 Total Cases Pulmonary, Males — — - — - 1 6 1 1 3 5 17 „ Females — — — 1 1 1 3 1 — 1 — 8 Non-Pulmonary Males — — 1 1 1 — — — 1 — — 4 „ Females — 1 1 — 2 — — — — — _ 4 Totals — 1 2 2 4 2 9 2 2 4 5 33 48 No. of Cases. Source of Information. Pulmonary. Non-Pulmonary. Death Returns—from local Registrars 4 3 transferable deaths from Registrar General 9 2 Posthumous notifications 5 3 "Transfers " from other areas (other than transferable deaths) 4 — Forms C and D (in respect of cases not previously known to the M.O.H.) 3 — Other Sources if any (specify) — — 49 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 preventive work. Particulars with regard to patients dealt with during the year are shown in a table at Pages 51-53, 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, 78 No. of cases at Dispensary New, 333 Old, 1,173 No. of attendances at Dispensary 2,224 No. of visits by Miss Baker First visits, 147 Re-visits, 1,422 No. of visits by Miss Kenion First visits, 55 Re-visits, 918 No. of Committee Meetings attended 23 The Tuberculosis Care Committee continued to meet fortnightly throughout the year, Dr. Saner, Miss Baker and Miss Kenion attending and assisting in every way possible. The representatives of the Council on this Committee were: Councillor Dr. C. A. Fuller and Councillor G. B. Ramsay. In addition to the Council's representatives this Committee includes Sir Francis Morris (Chairman), Miss Broadbent (Invalid Children's Aid Association), Dr. Lewis, Divisional Medical Officer, Miss Marriott, District Organiser, Children's Care 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), Miss Bennett (Paddington and St. Marylebone District Nursing Association), Miss McWilliams (Charity Organisation Society), and Mr. H. F. Lesser (London Insurance Committee). The Open Air School, which was in full operation in 1925, unfortunately had to close down in 1929. As noted in the report for that year the necessity for this step was greatly regretted, but less perhaps than might otherwise have been the case since the L.C.C. having made provision, any children for whom education in the open air is desirable can now be dealt with, as they certainly could not have been during the greater part of the time since the school was established as a pioneer in 1911. The following extract from a report by the Tuberculosis Officer (Dr. Saner) contains reference to a number of points that may be of interest:— "The statistics for the year are set out in the tables and need no comment. During the year 95 patients have been sent for treatment under the London County Council's scheme and 76 patients have been discharged either home for return to work, or to St. Charles' Hospital, these latter being cases who have unfortunately not responded to treatment. Children have been sent away through the Invalid Children's Aid Association, and some contacts of open cases have been boarded out under the London County Council's Contact Scheme. "Seventy yearly progress reports on the condition of patients who have received treatment have been forwarded to the London County Council. "Two hundred and twenty re-examinations over and above those of new cases have been carried out during the year. "The X-ray department of the Middlesex Hospital has been used frequently in cases of doubtful diagnosis with the best results, and some very early cases have been found and sent for treatment. "Brompton Hospital, as heretofore, have carried out the 'refills 'for artificial Pneumothorax on those patients who have received this form of treatment at sanatorium. 50 "The Care Committee has met fortnightly throughout the year, except during August, and has discussed, assessed, received reports of and arranged for ' After Care' in the 291 cases brought before them. Patients have been referred to the Charity Organisation Society and Portland Town Association for convalescence, work and help. Some have been referred to the Public Assistance Committee. The United Services Fund has been in requisition for the Ex-Service men and their families. "Contact children of open cases living at home have been reported to the School Medical Service for extra supervision at school. "The closing of Regent's Park Voluntary Open Air School has made a gap in the interests of the Dispensary, but it is satisfactory to know that the majority of children have done well and kept well, including those who were transferred to the Kensal House School, Harrow Road. "It is gratifying that the General Practitioner has made use of the Dispensary as a consultative centre in a number of cases." Bacteriological Diagnosis of Consumption.—The number of specimens of expectoration sent by medical men for bacteriological examination, from cases in which there was some doubt as to the diagnosis, was 776, as against 749 in 1929. Of these, 145 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—20, as against 26 in 1929—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 55. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1980. 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 ye9r (excluding contacts):— (a) Definitely tuberculous 42 26 2 2 2 6 3 3 44 32 5 5 (b) Doubtfully tuberculous - - - - - - - - 46 46 11 13 (c) Non-tuberculous - - - - - - - - 16 10 4 3 B.—Contacts examined during the year:— (a) Definitely tuberculous — 3 — 1 1 — — — 1 3 - 1 (b) Doubtfully tuberculous - - - - - - - - 2 6 18 11 (c) Non-tuherculous - — - _ - - - — 8 10 8 15 C.—Cases written off the Dispensary Register as (a) Cured 2 — — - - — — — 2 — — — (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 74 71 34 40 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 167 114 31 22 24 22 28 23 191 166 59 45 (b) Diagnosis not completed - - - - - - - - 10 10 39 30 1. Number of persons on Dispensary Register on January 1st, 1930 500 2 Number of patients transferred from other areas and of " lost sight of " cases returned 20 3. Number of patients transferred to other areas and cases "lost sight of " 34 4. Died during the year 33 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) 2,224 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 — (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 12 (b) Otherwise 112 11. Number of other visits by Tuberculosis Officer to Homes 118 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,557 13. Number of (a) Specimens of sputum, &c., examined 218 (b) X-ray examinations made, in connection with Dispensary work 28 14. Number of Insured Persons on Dispensary Register on the 31st December 212 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 172 16. Number of reports received during the year in respect of Insured Persons (a) Form G.P. 17 2 (b) Form G.P. 36 1 Two girls and three women who had been crossed off as cured, re-attended and were found to be healthy. 51 TUBERCULOSIS SCHEME. 52 (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 1930, 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 1930 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. 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. plus). Group 1. Group 2. Group 3. Total (Class T. B. plus). Group 1. Group 2. Group 3. Total (Class T. B. plus). Alive. Discharged as cured Adults M. 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 9 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children M. 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 8 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Disease arrested Adults M. 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 8 3 - - 3 - - - - - - - - - - - - - - - - - - - - - - - - - Children M. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Disease not arrested « Adults M. 10 12 6 6 24 4 5 1 2 8 1 5 3 4 12 7 4 6 - 10 - 12 9 3 24 9 14 9 3 26 F. 6 4 3 4 11 2 1 - - 1 4 2 4 2 8 3 7 5 1 13 12 7 7 1 15 11 9 2 4 15 Children M. 9 - - - - - - - - - 2 - - - - 1 - - - - 6 1 - - 1 2 - - - - F. 7 - - - - - - - - - - 1 - - 1 3 - - - - - - - - - 7 - - - - Condition not ascertained during the year 7 3 1 - 4 .— 1 - - 1 1 3 2 - 5 - 1 - - 1 - 2 - - 2 - - - - - Lost Sight of or otherwise removed from dispensary Register 58 47 7 2 56 24 11 5 3 19 22 12 4 1 17 22 - 3 1 17 15 | 15 3 - 18 5 1 2 - 3 Dead Adults M. 1 4 6 24 34 — - 5 21 26 2 — 1 17 18 — - 1 16 17 1 1 - 6 7 — — - 5 5 F. 1 2 3 11 16 - - — 10 10 3 — 1 11 12 - - 1 15 16 1 - — 10 10 1 - - 2 2 Children M. - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - F. 1 - - - - - - - - - - - - - - - - - 1 1 - - - 2 2 - - - - - Totals 137 77 26 47 150 34 18 11 36 65 35 23 15 35 73 36 25 16 34 75 40 38 19 22 79 34 24 13 14 51 53 (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 1930, 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 1930 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. 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. 1 - 1 — 2 1 - - 1 2 - 1 - — 1 - - - — - 1 - - — 1 - - - - - F. 1 — — 2 3 - - - - - - - - - - - - - - - - - - - - - - - - - Children M. 2 1 — 2 5 - - — 1 1 1 - - - - - - - - - - - - - - - - - - - F. 1 - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - Disease not arrested Adults M. 1 — - — 1 - - - — — 1 — - — 1 1 - - — 1 6 - 2 — 8 - - - 2 2 F. 2 — — — 2 — — — — — — — — — — - — — — — 2 1 1 3 7 3 2 2 1 8 Children M. 3 — — 1 4 2 — — — 2 — — — — — 1 1 — 2 4 1 — — 2 3 2 — — 1 3 F. 1 — — 2 3 1 - — — 1 1 1 - 1 3 1 - - 1 2 1 - — 1 2 - - - 2 2 Transferred to Pulmonary - - — - - - - - - - - - - - - - - - - - - - - - - - — - - - Condition not ascertained during the Year 5 - - - - - - - - - - - — - - - - - - 1 - - - - - - - - - - Lost Sight of or otherwise removed from Dispensary Register 17 3 2 6 28 1 1 1 - 3 3 - - 1 4 1 - - 2 3 1 - 2 1 4 - - - 1 1 Dead Adults M. 2 1 - - 3 - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children M. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - 1 1 - - - - - - - - - - - - - - - 1 - - - 1 Totals 37 5 4 17 63 5 1 1 6; 13 6 2 — 3 11 6 1 — 6 13 14 1 5 9 29 6 2 2 7 17 54 Deaths from Phthisis.—Some reference has already been made to the matter of deaths from tuberculosis and at this point it is proposed only to deal with the figures relating- to tuberculosis of the lung's (consumption or phthisis). During 1930 the total number certified as due to this cause was 75, the deathrate being 0.7 per 1,000. In 1925 the deaths numbered 80, the death rate being the same as in 1930. The distribution of the deaths according to registration districts is shown in the accompanying table, which gives also the figures for each of the 6 years 1925—1930. Deaths from Phthisis. 1925—1930. 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 1930 102,400 75 17 23 23 12 The distribution of the 75 deaths was as follows:—In Poor Law Institutions, 35; in general and other hospitals, 17; and at home, 23. Of those who died 37 were insured (26 males and 11 females), and 38 uninsured (15 males and 23 females). In addition there were 4 children. As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 75, the notified cases of pulmonary tuberculosis totalled 141. The following table prepared at the request of the Ministry of Health contains information with regard to age and sex distribution that may be found interesting. Age Periods *NEW CASES ALL DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 - - - - - - - - 1—5 — — 1 2 — — — — 5—10 — 2 4 1 — — 1 1 10—15 1 2 3 1 1 1 — — 15—20 6 8 1 5 1 5 1 2 20—25 3 14 1 3 4 5 1 — 25—35 28 23 3 1 8 5 — — 35—45 12 10 — — 5 6 — 1 45—55 20 4 1 — 7 3 2 — 55 -65 13 3 — — 6 4 — — 65 and upwards 10 7 — — 9 5 Totals 93 73 14 13 41 34 5 4 *Including all cases known otherwise than by notification. The following table, giving information as to localisation of the disease, brings out no fact to which attention has not already been directed. 55 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 27TH DECEMBER, 1980. 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 141 — — 4 28 62 35 12 22 52 49 18 141 9 17 23 4 53 88 Glands 6 - — 4 2 — — - — 3 3 — 6 — — 1 — 1 5 Knee 2 — 1 — — 1 — — 1 — 1 — 2 1 — — — 1 1 Spine 3 - - — 2 1 — — 1 — 2 — 3 1 — — — 1 2 Peritoneum 2 - — — 1 1 — — 1 — — 1 2 1 — — 1 2 — Epididymis 1 — - 1 - - — 1 — - - 1 1 — — — 1 — Hip 4 — 1 2 — 1 — — 2 2 - - 4 1 1 — — 2 2 Rib 1 — — 1 — — — — — 1 — — 1 — 1 — 1 — Abdomen 1 - - — - — - - — — 1 — 1 — — 1 — 1 — Totals 161 — 2 11 35 66 35 12 28 58 56 19 161 14 19 25 5 63 98 161 56 DISINFECTION. The work done in this connection during 1930 is shown in the following tables. The methods employed during the greater part of the time were substantially the same as in previous years, articles suitable for treatment by steam were dealt with in the Washington-Lyons Disinfector, while for rooms either formalin or sulphur was generally employed. The number and nature of the articles disinfected are shown hereunder:— Compulsorily Notifiable Diseases. Phthisis Measles. Vermin. Other causes. Total. Beds 205 6 1 10 1 223 Mattresses 648 17 13 14 106 798 Bolsters 330 13 1 10 52 406 Pillows 1,314 36 12 29 356 1,747 Sheets 683 22 2 39 13 759 Blankets 1,263 26 21 58 12 1,380 Sundries 9,686 165 130 1145 44 11,170 Totals 14,129 285 180 1805 584 16,483 In 1929 the number of articles disinfected was 10,191. The number of journeys made by the disinfecting vans during the year ended December, 1930, was:— January 102 August 84 February 95 September 78 March 108 October 100 April 101 November 89 May 103 December 82 June 101 July 89 1,132 The number of journeys made during 1929 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 116 2 8 - 14 140 February 79 6 17 — 5 107 March 112 11 13 — 18 154 April 92 6 33 — 12 143 May 49 12 21 — 7 89 June 75 4 8 — 14 101 July 67 3 6 — 7 83 August 34 1 1 — 11 47 Ssptember 52 2 — — 9 63 October 67 3 6 — 7 83 November 49 5 — — 11 65 December 66 3 3 - 7 79 Totals 858 58 116 — 122 1,154 57 The number of rooms disinfected in 1929 was 1,128. At the request of the Public Libraries Committee, whose rule requires that on the occurrence of a case of infectious disease in any house in which there is a library book, information must be given to the librarian, arrangements were made to receive and disinfect the volumes. The number dealt with during the year was 254. 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 1930 and annually since 1919:— 1930 ADULTS CHILDREN Males Females Total Males Females Total January 268 62 330 38 164 202 February 213 67 280 55 266 321 March 251 71 322 94 214 308 April 231 69 300 38 100 138 May 226 74 300 74 166 240 June 192 48 240 113 234 347 July 244 65 309 67 271 338 August 156 60 216 12 33 45 September 218 93 311 122 251 381 October 245 55 300 190 295 485 November 210 61 271 143 231 374 December 237 56 293 46 110 156 Totals 2,691 781 3,472 992 2,343 3,335 Cleansing Station Attendances, 1919-1930. 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 1930 2,691 781 3,472 992 2,343 3,335 The total attendances since the Baths were opened in 1898 number 260,130 (adults 185 067; children, 75,063). 58 It will be noted that there is a considerable increase in the number of school children cleansed during 1930, and this is accounted for by the increased activity of the School Nurses. Of the number, 3,314 children were sent from schools in the Borough, but not all of them were resident here. The cost of cleansing these children was borne by the London County Council, who paid the Borough Council the sum of £287 4s. for this service. BACTERIOLOGICAL EXAMINATIONS. The following table shows the number ot specimens examined for purposes of diagnosis, and indicates also the diseases in relation to which the examinations were made. The work, as formerly, was carried out by Dr. Foulerton. 1930. Positive. Negative. Total. Typhoid feve 1 52 53 Diphtheria 213 2,976 3,189 Phthisis 145 631 776 Totals 359 3,659 4,018 MATERNITY AND CHILD WELFARE. In its construction, the Maternity and Child Welfare Scheme has undergone no change since 1925, and still 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 Societv. where unmarried mothers particularly are provided for, both before and after the birth of their child. The following summaries, the second of which (Form M.C.W. 96 revised) is prepared at the request of the Ministry, give a number of details with regard to the arrangements under the scheme and afford some indication of the work done during 1930, and of the extensions that have taken place since 1925. It will be noted that at the end of the year there were available eight 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, 59 etc., Clinic, which was opened in 1928, is also held at Salisbury Street. Here in addition there is a Light Clinic and a massage clinic which were established in 1927, and are open on two days per week. The following statements contain so much information with regard to the scheme and the work done that they will probably be found useful. Both are required to be made by the Ministry of Health, the first to show the arrangements made for maternity and child welfare by the Council and by Voluntary Associations providing maternity and child welfare services in respect of which the Council pay contributions under Section 101 of the Local Government Act, 1929, or otherwise; and the second to give particulars of the work done during the year 1930. 1. Statement Showing Arrangements Made for Maternity and Child Welfare. 1. Population of the area served by the Council, 102,400. 2. Number of births notified in that area during the year under the tion of Births Act, 1907: (a) Live births, 3,325; (b) Still births, 205; (c) Total, 3,530*; (d) By midwives, 523; (e) By doctors and parents, 167. 3. Health Visiting. (i) Number of officers employed for health visiting at the end of the year: (a) by the Council, 6; (b) by Voluntary Associations, 2. (ii) If any of the Health Visitors are engaged on other work during part of their time, state the equivalent of whole-time services devoted by the whole staff to health visiting:—(a) in the case of Health Visitors employed by the Council, 5; (b) in the case of Health Visitors employed by Voluntary Associations, 1. (iii) Number of visits paid during the year by all Health Visitors:—(a) To expectant mothers, first visits, 365; total visits, 491. (b) To children under 1 year of age, first visits, 1,082; total visits, 5,159. (c) To children between the ages of 1 and 5 years, total visits, 3,402. 4. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council, nil. (b) Number of Centres provided and maintained by Voluntary Associations, 7. (c) Total number of attendances at all Centres during the year: (i) By children under 2 years of age, 19,009; (ii) By children between the ages of 2 and 5 years, 8,789. (d) Average attendance of children per session at all Centres during the year, 20. (e) Total number of children who attended at the Centres for the first time during the year: (i) Children under 1 year of age, 966; (ii) Children between the ages of 1 and 5 years, 210. (f) Percentage of total notified births represented by the number in (e) (i), 66.6 (corrected number of births notified, 1,450). 5. Ante-natal clinics (whether held at Infant Welfare Centres or at other premises):— (a) Number of Clinics provided and maintained by the Council, nil. (b) Number of Clinics provided and maintained by Voluntary Associations, 5. (c) Total number of attendances by expectant mothers at all Clinics during the year, 18,547.* (d) Average attendance of expectant mothers per session at all Clinics during the year, 36.* (e) Total number of expectant mothers who attended at the Clinics during the year, 4,464.* (f) Percentage of total notified births represented by the number in (e) 126.* *These figures refer to all births notified in the Borough, including Queen Charlotte's Hospital and Middlesex Hospital, and not to residents only. 60 6, 7, 8, 9. * * * * * 10. Day Nurseries. (a) Number of day nurseries: (i) provided by the Council, nil; (ii) provided by Voluntary Associations, 3. (b) Number of places for children under 5 years of age in the nurseries: (i) provided by the Council, nil; (ii) provided by Voluntary Associations, 105. (c) Total number of attendances of children at these nurseries during the year: (i) whole day, 10,633; (ii) half-day, 2,271. 11. Infectious Diseases. Disease. Number of cases notified during the year. 1930. Number of cases visited by officers of the Council Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals. (1) Ophthalmia Neonatorum 16 8 3 9 (2) Pemphigus Neonatorum — — — - (3) Puerperal Fever 8 7 — 7 (4) Puerperal Pyrexia 25 8 — 20 (5) Measles and German Measles (in children under 5 years of age) 910 9 — (6) Whooping Cough (in children under 5 years of age) Not Notifiable 80 — — (7) Epidemic Diarrhœa (in children under 5 years of age) 4 — — (8) Poliomyelitis (in children under 5 years of age) 1 1 — 1 12. Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever: (i) by the Council, nil; (ii) by Voluntary Associations, one whole-time and one quarter-time. (b) Total number of cases attended during the year by these nurses, 54. 13. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 16. (b) Number (i) employed by the Council, nil; (ii) subsidised by the Council, nil; (iii) employed by Voluntary Associations, nil. (c) Number of cases attended by midwives during the year: (i) as mid- wives, 523 (see 2(d)); (ii) as maternity nurses, no information. (d) Number of cases during the year in which the Council paid or contributed to the fee of a midwife, nil. 14. Maternal deaths. (a) Number of women who died in, or in consequence of, childbirth in the area served by the Council for maternity and child welfare during the year (i) from sepsis, 4; (ii) from other causes, 3. (b) Number of these cases which died: (i) at home, nil; (ii) in tions, 7. 61 INFANT WELFARE CENTRES, MATERNITY CLINICS, DAY NURSERIES AND DIPHTHERIA IMMUNIZATION CLINIC. 30, Marylebone Lane, W, 1— Tuesday, 10.30 a.m. Infant Consultation. Thursday, 2 p.m „ „ „ 2 „ Maternity Clinic. Middlesex Hospital, Mortimer Street, W. 1— Monday and 9 a.m. Maternity Clinic. Thursday. Monday, 1.30 p.m. Infant Consultation. Wednesday, 2 ,, ,, ,, Thursday, 1.30 „ Toddlers (2—5 years). Friday, 2 „ Infant Consultation, "West Marylebone, held temporarily at Western General Dispensary, Cosway Street, N.W. 1— Tuesday, 1 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 a.m. Maternity Clinic. Wednesday, 2 p.m. Infant Consultation. *14, Salisbury Street, Lisson Grove, N.W.8— Monday, 2 p.m. Infant Consultation. Tuesday, 10 a.m. Light Clinic. Do. 10 „ Massage Clinic. Do. 2 p.m. Infant Consultation. Wednesday, 2 „ Maternity Clinic. Thursday, 1.30 „ Toddlers (2—5 years). Do. 1,30 ,, Diphtheria Immunization Clinic. Do. 2 ,, Needlework Class. Friday, 10 a.m Light Clinic. Do. 10 ,, Massage Clinic. Do. 2 p.m Infant Consultation. *Mansergh Woodall Club, 24, Hill Road, N.W. 8— Tuesday, 2 p.m. Infant Consultation. Western General Dispensary, Cosway Street, N.W. 1— Monday, 2 p.m. Infant Consultation, Thursday, 10 a.m. „ „ Church Army Dispensary, 12, Little Harcourt Street, W. 1— Tuesday, 2.15 p.m. Infant Consultation. *12, Salisbury Street, Lisson Grove, N.W. 8— Wednesday, 2.30 p.m. Dental 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. A health visitor appointed by the Health Society is responsible mainly for work amongst pre-school children. Three of the women give whole time to health visiting, and three are part-time health visitors, holding appointments also as sanitary inspectors. The Borough for the purposes of health visiting is divided into five districts, and in 1930 the health visitors made 11,545 visits. Children are visited up to school age. 62 Centres.—There are in all eight 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. One of the Health Visitors acts as Superintendent, 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.—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, as the figures given elsewhere show, 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, having regard to the large amount of accommodation available 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 1930 was 2,420; the total births numbering 3,530. The midwives residing in the borough registered as intending to practise in the administrative County of London, number 16. Two conduct maternity homes which were registered by the London County Council. By an 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. During the year 23 cases were dealt with under the arrangement, and 368 visits were paid, the services of the nurses being greatly appreciated by the patients. Work done during 1930.—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 under the Maternity and Child Welfare Act, 1918, are given elsewhere. The total number of orders issued is shown in the table. 63 II. STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDING 31 st DECEMBER, 1930. 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 96 148 52 99 92 151 92 Toddlers — 50 — — — 51 92 Maternity 32 51 307 - 28 101 — Massage — 92 81 — 115 — — Light - 79 - - 79 - - No. of attendances of mothers at clinic:— Ante-natal 18 208 14,634 — 34 3,653 — Post-natal 21 379 14 — — 157 — No. of attendan c e s of babies 2,003 4,635 1,556 1,755 1,812 6,127 323 No. of a n c e s of children over 2 years 600 1,138 586 543 307 1,688 990 No. of attendances at light Clinic - 2,038 - - 127 - - No. of attendances at massage Clinic - 1,044 374 - 152 - - No. of orders issued for milk, etc. 101 462 28 81 73 206 - No. of home visits 2,172 2,555 247 828 499 2,679 - No. of new cases:— Infants 107 219 64 60 87 339 90 Toddlers 12 33 5 39 3 17 101 Ante-natal 11 29 3,832 — 10 582 — Post-natal 13 58 16 — — 149 — Massage — 45 9 — 3 — — Light — 67 - — 16 — — Day Nurseries—Attendances during the year. The Crossley, Barrow Hill Road 5,660 The Portman, Exeter Street 7,244 Dental Clinic, 12 Salisbury Street. Attendances during the year: Mothers, 909; Children 102. Advice and treatment given in 689 cases—extractions under gas, 322, 64 Home Helps.—Provision for rendering assistance in carrying out the work of the home to expectant, nursing or ailing mothers was available throughout the year. The women employed are found by and are well known to the health visitors. The number of cases in which there is willingness to take advantage of the assistance is trivial, the women preferring apparently to make their own arrangements for securing assistance. Actually home helps were employed in 1930 in 4 cases, the total amount expended during the financial year to 31st March, 1931, being £3 17s. 6d. SANITARY ADMINISTRATION. Under this, which is made a separate heading by the Ministry of Health, the Medical Officer of Health is required to make reference to a number of matters, e.g., staff, hospital accommodation and some others, most of which will be found dealt with elsewhere. (1) Staff: Work of sanitary inspectors and other officers engaged in sanitary work. This matter, so far as the inspectors are concerned, is fully discussed in an early part of the report. The report of the Mortuary Keeper (Mrs. Spears) is as follows:— Report of Mortuary Keeper. Number of bodies deposited from 1st January to 3lst December, 1930. 1930. Males. Females. Total. For burial only. For inquests. Total. No. of P.M 's held. No. of courts held. No. of Infectious cases. January 12 9 21 15 6 21 7 5 - February 11 15 26 16 10 26 6 6 - March 7 12 19 15 4 19 9 5 - April 13 11 24 19 5 24 6 4 - May 21 16 37 21 16 37 10 8 2 June 10 5 15 14 1 15 6 — — July 9 7 16 8 8 16 6 5 — August 10 11 21 16 5 21 6 3 — September 7 11 18 12 6 18 7 5 — October 6 2 8 6 2 8 3 1 — November 5 6 11 10 1 11 4 — December 10 14 24 22 2 24 3 — — Totals 121 119 240 174 66 240 73 42 2 The fact that there are caretakers (a man and his wife) at the Tuberculosis Dispensary has already been noted. In addition to looking after the premises they also render great assistance in connection with the conduct of the clinics, taking notes, helping in the weighing of the patients, etc. (2) Hospital accommodation.—This being a matter with which the Borough Councils in London have no direct concern, it is not considered necessary to make special reference to it. 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 65 number of provisions under which a considerable amount of work is done, e.g., those relating' to places where food is dealt with. Reference is made to these elsewhere. HOUSING. (a) Statistics. 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, were 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). (i) By the Local Authority Nil. (ii) By other Local Authorities Nil. (iii) By other bodies and persons 2 Blocks comprising 15 flats. (b) With State assistance under the Housing Acts: (i) By the Local Authority— (a) For the purpose of Part II. of the Act of 1925. (b) For the purpose of Part III. of the Act of 1925. Nil. (c) For other purposes. (ii) By other bodies or persons 2 Blocks comprising 15 flats. 1. Inspection of dwelling-houses during the year: (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and the number of inspections made 2,257 (2) Number of dwelling-houses (included under sub-head (i) above) which were insptcted and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made— Houses 467 Tenements in blocks 528 (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 1,570 2. Remedy of defects during the year 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) 1,521 66 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) 49 (2) Number of dwelling-houses in which defects were remedied after services of formal notices— (a) By owners 49 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11,14 and 15 of the Housing Act, 1925 (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil 4. Number of houses owned by the Local Authority distinguishing those built in the last two years under— (1) Part III. of the Housing Act, 1925 Nil (2) Part II. of the Housing Act, 1925 Nil (3) Other powers— Erected in 1902 52 flats Housing Act, 1919 112 flats Housing Act, 1924 18 flats (b) Housing Conditions. 1. General Observations as to Housing Conditions.—The prevalent type of house in the part of the Borough occupied by the working classes is of the tenement class, the standard in general being low. The general tendency throughout the Borough indeed is and for some time has been to make the single family house into a dwelling place for more than one family, and whenever the time has come for getting rid of a house if the site has not been required for commercial purposes entirely to erect in its stead a block of flats or tenements. Beginning in the Working-class portions this tendency has spread to the other parts, and since the 67 date of the last Survey report the appearance of large parts of the Borough has been completely altered as a result of this process. Possibly in the working-class parts of the district, the areas which have been described in earlier reports as the "tenement house areas"—in Lisson Grove, in the east-end behind Tottenham Court Road and Oxford Street—the progress has been slower. Even there, however, private individuals as well as otlicial bodies have been at work, have acquired blocks and groups of tenement houses of a poor type, have demolished them in such a way as to cause as little hardship as possible to the occupiers, who in the main have been unable or unwilling to leave the neighbourhood, and have erected blocks of dwellings in their stead. The numbers of such dwellings at the moment is not large, but if it is recognised that it has all, or mostly, been done in the interval between the last Survey report in 1925 and in the face of great difficulties, the chief of which is the finding of alternative accommodation, it is something of an achievement. The blocks mostly in mind are those provided by the Council on the Fisherton Street site, which comprise 130 tenements, and those erected by the St. Marvlebone Housing Association in Salisbury Street and Exeter Street, containing 45 tenements. In both these instances it is only, or mainly, of course, persons formerly residing on the sites who have been accommodated, so that they cannot be regarded as having contributed to the solution of the housing problem in the Borough. What has been done, however, has been to reduce the number of dwellings, defective in greater or less degree and mostly overcrowded. Very little more than this will in fact result from any housing activities in the Borough. Even the Carlisle Street Improvement Scheme, which at the end of 1930 was beginning to take shape to the extent that demolitions were beginning in North Street and Richmond Street, will do no more than this, and it, like any other scheme of improvement by the Borough or County Council, will only be possible to carry out rf accommodation can be secured for the dishoused outside the Borough. Because the number of tenement houses demolished for these various schemes is so small, there has been comparatively little effect on overcrowding, which is the chief nuisance, apart from verminous conditions, general dirtiness and minor states of disrepair arising largely because the premises are to an extent worn out and have been misused and abused. The list on page 14, which sets out the nuisances detected by each of the inspectors, gives some idea of the nature of the defects existing. Even in the worst areas indeed many of the houses call for treatment only because they are old, though numbers of course are and have been for some time badly treated and many, if in different surroundings, would be still quite fit for habitation. To some extent what has been said already covers the query as to sufficiency of supply of houses at this point, but otherwise I cannot do better than repeat what I wrote in the last survey report, when I pointed out that the Borough shared in the general shortage of houses in London. I indicated also that there had for many years been a shortage, that this had been met by dividing the existing houses in certain districts into two or more tenements, and that though this may have given more dwellings it had led to considerable overcrowding in various parts, not only of houses, but of space. Attempting to put this into figures, I stated that in the tenement house districts the number of tenements containing at least one more person than the standard of two per room was 1,894. That there has been any measurable progress in the direction of meeting the shortage I do not believe. Conceivably there may be more dwellings, since the proportion of houses subdivided to accommodate two or more families has increased, more and more individuals finding it impossible, for one reason or another, to retain a whole house for their separate occupation, but at the same time there has been an increase in the numbers requiring separate dwellings. To meet neither of these increases has anything been done locally. The provision made by the London County Council may have helped, but could only have done so in a very minor degree. So far as the Borough Council is concerned, their activities in connection with the housing scheme on the Fisherton Street, since it involved clearance must have made matters worse. The only conclusion possible is, and this is borne out by experience, that accommodation has been found by further subdivision of existing houses. That this has objections from points of view other than the sanitary is well recognised. 68 So far as the sanitary aspect is concerned, subdivision means that most of the conveniences—water-closets, etc.—have to be used in common and suffer not only as a result of overuse, but from mis-use and neglect. The houses themselves are also to a large extent misused by the tenants and are neglected by the landlords or owners, though this is perhaps less the case now than formerly, many leases in the Lisson Grove area particularly having reverted to the freeholders, who try as far as possible to see that the best is done with a view to keeping the premises in a reasonably fit state of repair. The intention of subdivision being to reduce overcrowding, its effect, in reality is to increase it, since though it may mean that the number of individuals per room is lessened, the number of rooms occupied continuously and used for all purposes is greatly increased. This point was very definitely proved during the course of an enquiry carried out recently in one of the most notoriously overcrowded parts parts of the Borough. Here it was shown that though practically every house was small and housed three, four or more families, the average number of persons per room was less than 1.7. Such a figure is very comforting until individual cases and the conditions as to overcrowding in particular families come to be investigated. From the census figures also comfort may be drawn. The table below is taken from the report on the census of 1921 and shows the number of families occupying 1, 2, 3 and 4 rooms and the population in private families:— Number of Rooms. 1 2 3 4 Total private families 5,776 7,480 4,548 3,126 Population in do. 9,367 22,921 16,504 12,153 Rooms occupied 5,772 14,859 13,629 12,504 The actual number of persons represented in the table is 60,945, rather more than half of the total population (105,200) at the time of the enumeration. In respect of measures taken or contemplated to meet the shortage nothing can be said that was not said in 1925. The situation, so far as the Borough itself is concerned, is still very difficult. Within the boundaries there is no space upon which to erect houses to accommodate the working classes. Before houses can be erected, houses will have to be demolished, and there is probably no site in the Borough which, if once cleared, even if entirely used for housing purposes, could provide accommodation for a number of persons appreciably larger than that dishoused. It is this largely that complicates the housing problem in St. Marylebone, and makes the task of the Council and its Housing Committee so difficult. 2. Sufficiency of supply of houses. (a) Extent of shortage, if any, of houses available at reasonable rents, and the measures taken or contemplated to meet any shortage. (b) Information as to any important changes in population during the period under review or anticipated in the future. (c) Any special difficulties in the way of providing suitable sites for new houses. 3. Overcrowding. (a) Extent. (b) Causes. The information called for under these heads is more or less given above. So far as regards inability to pay the rents of available houses is concerned, it cannot be doubted that this operates as a cause in a number of cases. Over and over again this is given as a reason for not accepting a family as tenants on County Council estates. At the same time, however, it must be stated that one is astonished at the number of instances in which there is overcrowding in spite of 69 the fact that the earnings of the various members of the family are considerable. Such cases as these do not, of course, constitute a problem at all, but there is an obvious necessity for finding accommodation for families who overcrowd only because they cannot afford to do anything else. Having regard to the cost of housing in St. Marylebone it does not appear to be the kind of place in which such families can be housed, though in the meantime they are one of the chief difficulties in the way of housing progress in the Borough. Action taken.—Marked as overcrowding was in a number of cases, those in which it was possible to take action without inflicting serious hardship upon the individuals were few. A certain number, of course, were accepted as tenants by the L.C.C., and in a few by means of re-arrangements the worst features associated with the overcrowding were modified. That any marked effect was produced cannot be claimed. 4. Fitness of houses. (a) Difficulties found in action under the Public Health Acts or under Section 3 of the Housing Act, 1925.—None experienced. (b) Special measures taken or suggested, e.g., in relation to particular types of insanitary property or in regard to arrangements for the gradual carrying out of programmes of repair.—See page 71. (c) Extent to which houses have not an adequate internal water supply, distinguishing those houses supplied by— (a) private, and (b) common supplies.—None. (d) Extent to which houses have no water closet or other adequate sanitary accommodation within their own curtilage, distinguishing those having— (a) Private. (b) Common accommodation.—None. The procedure adopted in connection with defects is described elsewhere. The hope is that in the areas in which the most defective and unsatisfactory property exists schemes of clearance and improvement will be carried out under the Housing Act, 1930. The steps taken in the direction of securing this are described below. 5. Unhealthy areas. Extent to which areas of the district are unhealthy, with information as to complaints received or representations made, and action taken, in regard to any of these areas. Carlisle Street Improvement Scheme.—Considerable progress has been made in connection with the carrying out by the London County Council of the Carlisle Street Improvement Scheme, and it is hoped that actual building operations will be commenced in the near future. During the year, the Borough Council had submitted to them a plan of the preliminary lay-out of the scheme, from which it was noted that the scheme provides for the erection of seven blocks of dwellings comprising in all about 300 tenements containing some 920 rooms with accommodation (on the basis of two persons per room) for 1,840 persons compared with the minimum of 1,800 persons for whom accommodation must be provided within the area in order to comply with the scheme as approved by the Minister of Health. In order to assist the County Council in dealing with the clearance of the portion of the area upon which it was proposed to commence building operations, the Borough Council acceded to the request of the County Council to be allowed to nominate applicants for any vacant housing accommodation in the Borough Council's dwellings, in consideration of the County Council accepting as their tenants persons nominated by the Borough Council, the exchange being dealt with on a room for room basis. The form of quinquennial statement sent by the Council to the L.C.C. in accordance with a request for information under the Housing Act, 1930, reproduced below, relates to the areas of the Borough which appear to be most urgently in need of attention. 70 6. Bye-laws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc. No comments in addition to those already made in dealing with houses let in lodging's elsewhere in this report need be made. There are no tents, vans, sheds, etc., within the Borough. 7. General observations on housing matters not already covered, and on any difficulties experienced in housing administration and the measures taken to meet them. In what has gone before in this section and other parts of this report, the ground appears to have been fairly well covered. Many difficulties in relation to housing administration arise because of intrinsic peculiarities of the Borough and must be dealt with as they are encountered. HOUSING ACT, 1930 (Sec. 25) (2). Form of Quinquennial Statement. NOTE.—In this table no account is taken of housing accommodation provided by the Council otherwise than under the Act of 1924 or of re-housing accommodation provided for purposes other than those of the Act of 1930. If work of this kind is anticipated a brief note of its extent should be appended. Name of Local Authority Borough of St. Marylebone. Population (estimated figure for middle of 1929) 102,400 Number of inhabited houses (according to rate books) 19,447 (a). Estimated production of houses by the local authority during the next five years Nil. (b). Estimated production of new houses of working class type by private enterprise during the next five years:— (i) with subsidy under the Act of 1924 (ii) under arrangement made under Section 29 of the Act of 1930 See NOTE 1. (iii) otherwise (c). Estimated number of new houses to be allocated by the local authority during the next five years to the purposes of the Housing Act, 1930 (i.e., the purposes mentioned in (e) and (f) (d).Estimated number of new houses to be allocated by the sec NOTE 2. local authority during the next five years to the purposes of the Act of 1924 (i.e., new housing) Total (e). Estimated number of houses to be demolished during the next five years:— (i) in clearance areas 207 (ii) in improvement areas (a) for opening the area (b) as unfit houses — See NOTE 3. (iii) individual houses outside clearance and improvement areas Total 207 (f). Estimated number of persons to be displaced during the next five years:— (i) by any of the processes mentioned in (e) 1,797 (ii) to abate overcrowding in improvement areas See NOTE 3. Total 1,797 71 (g). Estimated number of houses to be repaired under Part II Nil. Any repairs of the Housing Act, 1930, during the next five years etc., will be done under the Public Health (London) Act, 1891. NOTE.—If the annual rate of production, clearance, etc., is not estimated to be approximately constant a note giving an estimate for each year of the period should be appended. • Note 1. The St. Marylebone Housing Association are carrying out a further slum clearance scheme in the Lisson Grove area, involving the displacement of 306 persons and rehousing provision for 350 persons of the working classes. The scheme, which has attracted subsidy under the 1924 Act, comprises: Four blocks, containing 47 self-contained flats and 13 single room tenements. So far, 3 blocks comprising 39 flats have been completed, leaving 1 block and 13 single-room tenements which, it is hoped, will be completed during the next year. Note 2. Items B, C and D. So far as regards the production and provision of new houses, it is impossible to make an entry on the form for the reason that reliance for new housing accommodation, so far as this Borough is concerned, must be placed entirely upon the London County Council. As is well known, building sites are limited—if not, indeed, absent—within the Borough, and up to the present it is to the County Council that the Borough Council has looked for housing accommodation for persons dishoused in connection with slum clearance, etc. Any housing provision to be made on the Carlisle Street Area will almost certainly be required for persons dishoused, and no part will be available for use for decanting purposes. With regard to production of new housing accommodation of working class type by private enterprise—see Note 1. Note 3. Items E and F. The figures given with regard to demolition during the next five years have reference entirely to areas in Ward 3 (Lisson Grove). As the Housing Committee know, there are a number of blocks which it is certain should be made the subject, of clearance or improvement schemes, which having regard to the size, are appropriate for dealing with as County Schemes, though, of course, the Borough Council might contribute specially to the cost. For the purposes of the return, however, it is only such areas as appear to call urgently for treatment within the next five years that have been included. The details of such areas are as follows:— (1) Princess Street Area. Bounded by North Street (rear of); Hatton Street; Princess Street; Carlisle Street; St. Matthew's Church; Cranmore Place; Hardington Street; Church Street (rear of); Edgware Road (rear of); and including North Place, Hatton Place, Milners Mews, Hardington Place, Hardington Street (part of), Hatton Street (part of), Princess Street (part of), and Carlisle Street (several houses). Number of houses 93 Estimated Population 807 (2) Harrow Street Area. Bounded by Bendall Street (rear of); Union Street; Hereford Street; and Lisson Street; and including Harrow Street (part of), Hereford Street (part of), Union Street (part of), and Lisson Street (part of). Number of houses 46 Estimated population 516 72 (3) Providence Place Area. Bounded by Lisson Street (rear of); Burnc Street (rear of); Bell Street (rear of); and the Salvation Army Shelter; and including Providence Place and Sun Cottages. Number of houses 34 Estimated population 149 (4) Wilcove Place Area. Bounded by Earl Street (rear of); Exeter Street (rear of); Ashmill Street; and including Wilcove Place, Salisbury Street (several houses) and Ashmill Street (several houses). Number of houses 34 Estimated population 325 Other blocks in this area, though in some respects only slightly better than those included in the blocks referred to, can, in my opinion, be allowed to remain till, at any rate, the time of making the next return, presumably five years hence. It will be noted that there is no reference whatever to any blocks in the St. John's Wood area. As a matter of fact, my own inspections of this area are not quite completed, but from what inspections I have made, and from my study of the reports of the Inspectors.it seems to me that the Housing Committee and the Council would be perfectly justified in refraining from the taking of action in connection with clearance or improvement until at any rate the end of the first quinquennium. The generality of the houses are kept in a fairly good state of repair, so far as the interior is concerned certainly, and little or no difficulty is experienced in having any notices served under the Public Health Act or other Acts complied with by the owners. GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including- water). Population (1921). 104,173 (1930) 102,400 estimated. Number of inhabited houses (1921), 18,507. Number of inhabited houses (end of 1930) according to Rate Books, 19,566 Number of families or separate occupiers (1921). 27,214. Rateable value. £3,116,627. Sum represented by a penny rate. £12,480. Extracts from Vital Statistics of the Year. Births- Total M. F. Legitimate 1,077 556 521 Illegitimate 170 82 88 Birth Rate, 12.1 Still Births, 43. Rate per 1,000 total births, 3.4. Deaths, 1,171. Death Rate, 10.6. Percentage of total deaths occurring in public institutions, 41.0. Number of women dying in, or in consequence of, childbirth—from sepsis, 4, other causes, 3. Deaths of Infants under 1 year of age per 1,000 live births:— Legitimate 58. Illegitimate 82. Total 62. Deaths from Measles (all ages), 35 Deaths from Whooping Cough (all ages), 2. Deaths from Diarrhœa (under 2 years of age), 14. 73 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 113 Slaughterhouses 1 Oifensive Trades 2 Ice Cream Premises 68 Bakehouses 54 Restaurant, Dining Room and Coffee Shop Kitchens 196 Hotel Kitchens 21 Pastrycooks and Tea Rooms 87 Fried Fish Shops 24 Fish Curers 5 Houses Let in Lodgings 1,055 Workshops and Workplaces 3,669 Total 5,295 Smoke Nuisances. Number of Observations 297 Number of Nuisances and Complaints 6 Number of Intimation Notices Number of Summonses Nil served 6 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— (a) On account of complaints or illness (P.H. Act) 2,257 (b) House-to-house (Housing Consolidated Regulations, 1925) 467 Tenements in blocks 528 Number of Notices served— (a) Under P.H. Act:— (1) Intimation 1,570 (2) Statutory 49 (b) Under Housing Act Nil Number of Houses repaired or nuisances remedied under P.H. Act, 1891 1,521 Number of Houses repaired under Section 3 of Housing Act, 1925— (a) By Owners Nil (b) By Local Authority in default of Owners Nil Number of Houses closed on Notice by Owner that they could not be made fit Nil Number of Houses for theWorking Classes— (a) Erected during year 21 flats (b) In course of crwtion 12 flats Number of Representations by Medical Officer or other person Nil Number of Houses included in such representations Nil Number of Closing Orders made Nil Number of Closing Orders determined (i.e., Houses made fit) Nil Number of Demolition Orders Nil Number of Houses demolished— (a) In pursuance of Orders 41 (b) Voluntarily 10 Total Number of Houses in the borough 19,566 Number of Houses occupied by the Working Classes 8,579 Number of Houses registered under the new Bye-laws as to Houses Let in Lodgings Nil Number of Inspections made of such Houses Nil Number of Prosecutions Nil 74 Mortuary. Number of bodies received 240 Number of Infectious bodies received 2 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 2,691 781 992 2,343 6,807 Bakehouses. Number on Register at end of 1930 54 Number above ground 5 Number underground 49 Number of Inspections 114 Number of Notices 8 Number of Prosecutions Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1930 331 Number of Inspections 745 Number of Notices 18 Number of Prosecutions Nil House to.House Inspections. Number of Inspections Houses 467 Tenements 528 Number of Notices issued Intimations 418 Statutory Notices 41 Number of Prosecutions Nil House Refuse. Number of Inspections 2,933 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 238 Number of Notices issued. Intimations 193 Number of Statutory Notices 10 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 9 Number of Statutory Notices served Nil Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 6 Number Remedied 6 Number of Prosecutions Nill 75 Underground Rooms. Number dealt with 30 Number of Notices served under P. H. (L.) Act, 1891 ) 30 Number of Notices served under the Housing Act, 1925 Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms cleansed after infectious disease 1,032 Number of rooms cleansed from vermin 391 Number of articles 16,483 Number of Statutory Notices served 9 Number of Prosecutions Nil Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of Persons accommodated during the year 16 Drainage. Number of inspections made 5,394 Number of drainage plans deposited 380 Number relating to new buildings 41 „ „ old buildings 339 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops and Cowsheds 386 Number of Inspections 859 Sanitary Officers. Number of Sanitary Inspectors (Whole-time) Male 8 Female Nil „ „ „ (Part-time) Male 3 Female 3 „ Health Visitors Whole-time 3 Part-time 3 Tuberculosis Visitors Whole-time 1 Part-time 1 76 MINISTRY OF HEALTH AND OTHER TABLES. table i. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1930 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. 3 Nett. of Non. residents registered in the District. 8 of Residents not registered in the District. 9 Under 1 year of Age. At all Ages. No. 4 Rate, 5 No. 6 Rate. 7 No. 10 Rate per 1.000 Nett Births. 11 No. 12 Rate 13 1919 97 953 3,625 1.492 14.6 1,724 17.3 864 708 147 98.5 1,568 15.9 1920 101,856 4,287 2,217 21.5 1,638 16.0 939 600 145 65.6 1,299 12.7 1921 105,200 3,393 1,939 18.4 1,625 15.4 877 607 128 66.0 1,355 12.8 1922 105,200 3,588 1,679 15.9 1,638 15.5 905 718 115 68.0 1,451 13.7 1923 105,400 3,601 1,668 15.8 1,468 13.9 827 594 111 66.0 1,235 11.7 1924 105,300 3,432 1,531 14.5 1,686 15.9 936 688 123 78.0 1,436 13.6 1925 106,100 3,418 1,496 14.1 1,472 13.8 873 658 94 63.0 1,257 11.0 1926 105,800 3,220 1,359 12.7 1,325 12.4 748 740 111 81.6 1,356 11.9 1927 103,500 3,521 1,374 13.2 1,375 13.2 781 621 81 59.0 1,262 11.3 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 13.2 1930 102,400 3,162 1,247 12.1 1,373 13.3 831 618 77 62.0 1,171 10.6 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. 77 TABLE I (a). Vital Statistics of Separate Localities in 1930 and the Ten Previous Years. Names of Localities The Whole Borough All Souls St. Mary Christ Church St. John Year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population esiimatec 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. 6. c. d. a. b. c. d. a. b. C. d. a. b. c. d. a. b. c. d. 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 105,200 1,679 1,451 115 25,202 318 286 18 26,948 405 415 21 32,747 673 459 50 20,308 283 291 26 1923 105,400 1,668 1,235 111 25,258 323 226 14 26,992 340 333 18 32,806 643 410 52 20,344 362 266 27 1924 105,300 1,531 1,436 123 25,233 280 245 22 26,967 336 422 30 32,775 629 472 55 20,825 286 297 16 J 925 106.100 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 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 Averages of Years 1920 to 1929 104,475 1,581 1,334 110 25,224 293 257 19 27,104 341 362 21 32,460 642 446 51 19,685 305 268 18 1930 102,400 1,247 1,171 77 24,532 249 250 16 26,228 273 302 20 31,873 452 379 27 19,767 273 240 14 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 78 TABLE II. Notifiable Diseases During the Year 1930. 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 6 - - - 2 1 2 1 6 - - - - - - - - - Diphtheria 271 13 103 99 33 22 1 — 268 12 2 1 4 5 — — — — Erysipelas 61 2 2 2 6 20 16 13 39 - - - - - - - - - Scarlet Fever 226 3 51 117 29 23 3 — 221 1 — — 1 — — — — — Enteric Fever 9 — — 3 4 1 1 — 8 1 — — — — 1 - - — Paratyphoid Fever 6 - 1 1 1 2 1 — 4 — — — — — - — — — Puerperal Fever 8 - — — 5 3 — — 7 4 — — - — - 4 — — Puerperal Pyrexia 25 - — — 8 16 1 — 20 - - - - - - - - - Cerebro Spinal Fever 4 1 2 1 — — - — 3 — — — — — — — — Tuberculosis, Pulmonary 141 - - 4 28 62 35 12 53 75 - - - 2 13 26 22 12 Tuberculosis, Non-Pulmonary 20 — 2 7 7 4 — — 10 9 — 1 — 2 4 1 - 1 Acute Poliomyelitis 2 - 1 1 - - - - - - - - - - - - - - Ophthalmia Neonatorum 16 16 - - - - - - - - - - - - - - - - Encephalitis Lethargica 2 —- - — 1 — 1 — 2 1 - — — — - — 1 — Pneumonia 42 2 3 2 8 11 15 1 14 10 1 1 — — - 2 4 2 Malaria 1 - - - - - - - - - - - - - - - - - Totals 840 37 165 237 132 166 76 27 666 113 3 3 5 9 18 33 27 15 79 TABLE III.—Causes of, and Ages at Death during the year ending 31st December, 1930. No. CAUSES OF DEATH, Net deaths at the subjoined ages ot ''Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church. St. John. Total. All Ages. Under 1 1 1 and under 2. 2 and under 5 5 and under 15. 15 and under25. 25 and under 45. 45 and under65 65 and under 75. 75 and upwards. 1 Enteric Fever 1 - - - - - - - - - - 1 - - - 1 2 Small Pox - - - - - - - - - - - - - - - - 3 Measles 35 6 15 10 3 1 - - - - - 4 8 19 4 35 4 Scarlet Fever 1 - - 1 - - - - - - - - 1 - - 1 5 Whooping Cough 2 - 2 - - - - - - - - - 1 1 - 2 6 Diphtheria 12 2 1 4 5 - - - - - 1 2 2 5 3 12 7 Influenza 8 - - - - - 1 2 3 2 4 1 1 4 2 8 8 Encephalitis Lethargica 1 - - - - - - 1 - - - - - 1 - 1 9 Meningococal Meningitis 2 1 - 1 - - - - - - 2 - - 1 1 2 10 Tuberculosis of Respiratory System 75 - - - 2 13 26 22 12 - 7 17 23 23 12 75 11 Other Tuberculous diseases 9 - 1 - 2 4 1 - 1 - 16 2 3 3 1 9 12 Cancer, Malignant Disease 170 - - - - 2 11 79 42 36 243 37 40 57 36 170 13 Rheumatic Fever 1 - - - - 1 - - - - - - 1 - - 1 14 Diabetes 17 - - - - - 3 6 7 1 7 3 6 7 1 17 15 Cerebral Hæmorrhage, etc. 51 - - - - - - 14 17 20 23 12 11 11 17 51 16 Heart Disease 238 - - - 2 3 16 57 78 82 99 46 67 69 56 238 17 Arterio-sclerosis 34 - - - - - - 4 18 12 16 7 9 11 7 34 18 Bronchitis 41 2 - - - - 2 7 8 22 29 4 11 16 10 41 19 Pneumonia (all forms) 80 12 4 - 2 1 9 34 8 10 70 12 26 32 10 80 20 Other Respiratory Diseases 12 - - - - - - 6 3 3 7 5 1 4 2 12 21 Ulcer of Stomach or Duodenum 9 - - - - - 1 3 4 1 31 4 2 2 1 9 22 Diarrhoea, etc. 18 14 - - - - 1 1 - 2 2 4 2 10 2 18 23 Appendicitis 8 - - - - 2 2 2 2 - 26 5 2 1 - 8 24 Cirrhosis of Liver 7 - - - - - 2 2 2 1 7 1 1 3 2 7 25 Acute and Chronic Nephritis 55 - - - - 1 5 19 20 10 28 14 10 18 13 55 26 Puerperal Sepsis 4 - - - - - 4 - - - 3 1 2 1 - 4 27 Other accidents and diseases of Pregnancy and Parturition 3 - - - - - 3 - - - 14 1 1 1 - 3 28 Congenital Debility and Malformation, including Premature Birth 26 26 - - - - - - - - 64 7 9 3 7 26 29 Suicide 19 - - - - - 8 6 5 - 7 6 4 6 3 19 30 Other Deaths from Violence 41 2 1 1 4 3 6 9 5 10 48 10 7 14 10 41 31 Other defined Diseases 191 12 1 - 4 6 32 57 33 46 192 44 51 56 40 191 32 Causes ill-defined or unknown - - - - - - - - - - - - - - - - Totals 1171 77 25 17 24 38 133 331 268 258 946 250 302 379 240 1171 80 TABLE II. (a). Cases of Infectious Disease Notified during the 53 weeks ending 3rd January, 1931. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home. At all ages. At Ages—years. All Souls. St. Mary. Christ Church St. John. Totals. All Souls, St. Mary. Christ Church St. John. Totals. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Smallpox 6 - - - 2 1 2 1 2 2 2 - 6 2 2 2 - 6 - Cliolera . - - - - - - - - - - - - - - - - - - - Diphtheria, including Membranous Croup 271 13 103 99 33 22 1 - 71 58 97 45 271 71 58 95 44 268 3 Erysipelas 61 2 2 2 6 20 16 13 12 17 23 9 61 6 15 12 6 39 22 Scarlet Fever.- 226 3 51 117 29 23 3 - 43 49 100 34 226 41 50 98 32 221 5 Typhus Fever Enteric Fever 9 — — 3 4 ] 1 — 1 3 5 — 9 1 2 5 — 8 1 Paratyphoid Fever 6 — 1 1 1 2 1 — 2 3 1 — 6 1 2 1 — 4 2 Relapsing Fever Continued Fever - - - - - - - - - - - - - - - - - - - Puerperal Fever 8 — — — 5 3 — — 3 — 2 3 8 3 — 2 2 7 1 Puerperal Pyrexia. 25 — — — 8 16 1 — 4 6 8 7 25 2 5 8 5 20 5 Plague — — — — — — — — — — — — — — — — — — — Glanders - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever 4 1 2 1 - - - - 1 1 1 1 4 - 1 1 1 3 1 Tuberculosis— Pulmonary 141 - - 4 28 62 35 12 22 52 49 18 141 9 17 23 4 53 88 Non-Pulmonary 20 — 2 7 7 4 — — 6 6 7 1 20 5 2 2 1 10 10 Acute Poliomyelitis 2 — 1 1 — — — — 2 — — — 2 1 — — - 1 1 Polio-Encephalitis - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 16 16 - - - - - - 3 7 4 2 16 1 5 2 1 9 , 7 Encephalitis Lethargica 2 - - - 1 - 1 - 1 1 - - 2 1 1 - - 2 - Pneumonia 42 2 3 2 8 11 15 1 7 6 22 7 42 1 1 7 5 14 28 Malaria 1 - - — — 1 — — — 1 — — 1 — 1 — 1 — Dysentery - - - - - - - - - - - - - - - - - - - Totals 840 37 165 237 132 166 76 27 180 212 321 127 840 145 162 258 101 666 174 Cases of mistaken diagnosis are not excluded from the above table. 840 81 VACCINATION RETURNS. Return for 1929, Return made to the Borough Council and Ministry of Health on the 9th February, 1931, by Mr. George H. Bassett, Vaccination Officer of the Borough of St. Marylebone, respecting the Vaccination of Children whose Births were registered in St. Marylebone, from 1st January to 31st December, 1929, 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., 1929 Number of these Births duly entered by 31st January, 1931, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1931, remained unentered in the "Vaccination Register'' on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1931. 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 1930 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irres pective of the dates of birth of the children to which they relate during the calendai year 1930 Col. I. Success fully Vaccinated Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received Col. V. Dead, Unvaccinated Postpone ment by Medical 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 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 509 256 5 — 114 26 8 12 19 69 2. St. Mary 2,417 1,633 2 - 271 122 15 320 30 24 2,373 402 3. All Souls 611 362 7 — 79 33 8 103 5 14 Total 3,537 2,251 14 — 464 181 31 435 54 107 2,373 402 Dated 9th February, 1931. (Signed) GEORGE H. BASSETT, Vaccination Officer.