4C 4353 STMARY 36 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1931. Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P.(Ed) Of the Middle Temple, Barrlster-at-Law. LONDON: VAIL & CO. 170, FARRINGDON ROAD. Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1931. 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-l.aw. LONDON: VAIL & CO., 170, FARRINGDON ROAD, PRINTED BY VAIL AND CO., LONDON, E C.I Public Health Department, Town Hall, Marylebone Road, N.W.1. 6th May, 1932. 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 1931. In accordance with the instructions of the Ministry of Health it is mainly a recor 1 of the happenings of the year and contains less of detail than did its predecessor of 1930, which was of course a "Survey Report." In carrying out the work to which reference is made and the various duties entrusted to me, I received as always every kindness and the fullest possible help and support from the Public Health Committee and the Chairman, Dr. C. A. Fuller. These things I very greatly appreciate, and would here express my grateful recognition and thanks, as I do also to the staff of the department, who, as always, worked steadily and well and showed a real devotion to the important duties they are required to perform. 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). 1931. His Worship the Mayor (Councillor Lt.-Col. R. Q. Henriques, J.P.) ALDERMEN. G. B. Brooks J. Fettes. J.P. A. C. Rickatson, J.P. COUNCILLORS. Mrs. V. A. L. Freeman. Capt. J. T. O'Brien, J.P. Dr. C. A. Fuller (Chairman). P. O'Connell. S. H. Haynes. G.B.Ramsay. Mrs. C. Q. Henriques. Mrs. E. M. Shirley. Dr. E. Jacobs. Mrs. M. G. Harris. H. Jones. CONTENTS. page page Natural and Social Conditions Infant Mortality Causes 32 of the Borough. Maternal Mortality 34 Population 7 Deaths in relation to Disease 34,77 Sanitary Circumstances 7 Diarrhœal Diseases 34 Water Supply 7 Infectious (Communicable) Drainage 7 Diseases 34 Combined Drainage 8 Phthisis and other Tuberculous Sewer Emanations 9 Diseases 34 Closet Accommodation 9 Respiratory Diseases 35 Public Sanitary Conveniences 9 Cancer and Malignant Disease 35 Scavenging 10 Accident, Suicide and Man- Removal of House Refuse 11 slaughter 36 The Crown Estate 11 Removal of Offensive Refuse 12 Prevalence of and Control over In- tectious Diseases 36 Sanitary inspection of the Borough 12 Isolation of Cases 37 Staff.: 12 Discharge Notices 37 Nuisances . 13 Diphtheria and Membranous Inspections 14 Croup 37 Nuisances—Legal Proceedings 14 Schick Testing and Diphtheria Smoke Nuisances 14 Immunization 38 ' Rat Repression 15 Scarlet Fever 39 Pigeons 15 Enteric Fever and Paratyphoid Fever 39 Fouling of Footways by Dogs 16 Cerebro-Spinal Fever 39 Encephalitis Lethaigica 39 Premises and Occupations controlled Polio-Myelitis . 39 by By laws and Regulations 16 Polio-Encephalitis 39 Business Premises 16 Erysipelas 39 Milk Premises 16 Puerperal Fever and Puerperal Slaughterhouses 16 Pyrexia 39 Offensive Trades 17 Measles and German Measles 40 Ice Cream Premises 17 Whooping Cough 40 Butter, Margarine, etc., Premises 17 Glanders and Anthrax 40 Bakehouses 17 Smallpox 40 Fried Fish Vendors and Fish Vaccination 40,80 Curers 17 Infectious Diseases in Schools 40 Factories and Workshops 17 Ophthalmia Neonatorum 41 Inspections 18 Influenza 42 Defects found 18 1 HomeWork 19 Tuberculosis 42 Registered Workshops 20 Other matters 20 PublicHealth (Prevention of Rag Flock 20 Tuberculosis) Regulations, 1925 42 Notifications 43-45,51 Premises used for Human Habitation 20 Prevention of 45 Houses lei in lodgings 20 Care Committee 45 Common Lodging Houses 21 Bacteriological Diagnosis of 46 Underground Rooms 21 Non-Pulmonary Tuberculosis 46 Work and Dispensaries 47-49 Premises that are not but should be Deaths 50 Registered 21 Localisation of Diseses 51 Food Stalls 22 Disinfection 52 Food Cleansing of Persons 53 Milk Supply 22 Bacteriological Examinations 54 Milk Analysis 22 Maternity and Child Welfare 54-60 Bacteriological examination of Health Visitors 57 Milk 23 Centres 58-60 Dairies, Milkshops, etc. 23 Ante-Natal Work 58 The Milk (Special Designations) Dental Clinic 58, 60 Order 23 Massage Clinics 58 Milk (Mothers and Children) Schick Testing, etc., Clinics 58 Scheme 23 Hospital Treatment 58 Foods other than Milk 24 Maternity Cases 58 Food Inspections 24 Infant Consultations—Work at 59 Food, Unsound, Condemned 24 Day Nurseries 59,60 Food and Drugs (Adulteration) Act, 1928 24 Home Helps 60 Reports of Public Analyst 25-27 Sanitary Administration— Staff 12,60 Statistical Report of Mortuary Keeper 60 Births Staff 12,60 Hospital Accommodation 60 2 Local Acts and Orders 60 Birth Notifications 28 Deaths and Death Kates 28 Housing 61-72 Sub-District Births and Deaths 29 Statistics 72,73 Deaths in relation to Age 30 Sanitary Inspection (Summary) . 73, 74 Causes of and ages at death 30-31 Ministry of Health, Tables I—IV. 75-79 Infantile Mortality ., 30 Vaccination Returns ,. 80 6 GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921). 104,173. (1931) 97,620 (estimated 1931) 93,460. Number of inhabited houses (1921), 18,507. Number of inhabited houses (end of 1931) according to Rate Books, 19,764. Number of families or separate occupiers (1921) 27,214. Rateable value. £3,138,221. Sum represented by a penny rate. £12,400. Extracts from Vital Statistics of the Year. Births- Total M. F. Legitimate 947 844 463 Birth Rate, 11.4 Illegitimate 120 67 53 Still Births, 42. Rate per 1,000 total births, 3.9. Deaths, 1,225. Death Rate, 12.3. Percentages of total deaths of residents occurring in public institutions, 9.9. Number of women dying in, or in consequence of, childbirth—from sepsis, 1; other causes, 2. Deaths of Infants under 1 year of age per 1,000 live births :— Legitimate . 50. Illegitimate . 15. Total 65. Deaths from Measles (all ages), 2. Deaths from Whooping Cough (all ages), 2. Deaths from Diarrhoea (under 2 years of age), 13. 7 INTRODUCTORY. Population.—The population when the census was taken on April 27th, 1931, was found to be 97,620, made up of 38,829 males and 58,791 females, the latter exceeding the former by 19,962. The following table abstracted from the census returns by the Registrar-General shows the population of each of the Electoral Wards of the Borough. Ward. Males. Females. Persons. No. 1. Hamilton Terrace 3,410 6,978 10,388 No. 2. St. John's Wood Terrace 4,064 5,485 9,549 No. 3. Church Street 9,938 10,576 20,514 No. 4. Dorset Square & Regents Park 3,419 5,703 9,122 No. 5. Bryanston Square 5,163 8,247 13,410 No. 6. Portman 4,671 7,586 12,257 No. 7. Park Crescent 4,334 7,526 11,860 No. 8. Langham 2,884 5,164 8,048 No. 9. Cavendish 946 1,526 2,472 Total of Borough 38,829 58,791 97,620 According to the Registrar-General the population at the middle of 1931 for statistical purposes is to bt taken as 93,460, being a decrease of 4,160 (4.2%) since the census was taken, and this figure is used in calculating the various rates given in the report. The following table shows the population at the census of 1921 and that of 1931 and the population estimated to the middle of 1931 in the registration subdistricts, the Northern District being subdivided on the old registrations districts Christ Church and St. John. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. Census 1921 104,178 24,956 26,680 32,428 20,109 Census 1931 97,620 22,380 25,667 29,636 19,937 Estimated to middle of 1931 93,460 21,421 24,574 28,374 19,087 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, complaints as to water supply 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 8 that the water had been cut off in eleven premises. The reason for discontinuing the supply was in nine cases the non-payment of rate, and in two cass the premises were reported empty. In cases in which the premises were tenement houses, 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. 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 55 notices were served in regard to defects in and necessity for cleansing cisterns. 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 four. The number in 1930 was 10. In 11 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. 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 Draper. Engaged exclusively in drainage work, these officers between them in 1931 made 4,309 inspections. The total number of plans deposited was 374 in respect of 470 premises, as against 380 and 461 respectively in 1930. The number relating to new buildings was 28. The number deposited in 1930 was 41. In the case of old buildings, the number of plans received was 346. In 1930 the totnl number was 339. In the bulk of the cases the arrangements shown were in accordance with the 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 conveni;nces 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 is diminishing-, provision having been made for accepting as compliance a number of arrangements which were definitely outside the provisions of the earlier by-laws. In two cases it was discovered that drainage work had been executed improperly and without notice to the Sanitary Authority as required by the By-laws. In one case the defendant was cautioned, in the other legal proceedings were taken and the defendant was fined £2 10s. with £3 3s. costs. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 34 premises. The number in 1930 was 46. 9 Sewer Emanations.—At intervals during 1930 and to an extent also in previous 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. These complaints in 1931, it is interesting to note, were not renewed, the steps taken by the London County Council of closing a large number of the sewer ventilating openings apparently having abated the nuisance. 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 onveniences 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 scrutinised, but as already noted, the 1930 by-laws having considerably modified the requirements so far as situation is concerned, the need for granting special approval now less frequently arises. 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 was 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. The following is a statement showing the total receipts at each of the conveniences for the year ended March, 1932, and the amount of increase or decrease as compared with the previous year. 1932 1931 Increase Decrease £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus —Men's Department 798 8 1 865 7 4 — 66 19 3 „ Women's „ 1,693 1 1 1,642 11 5 50 9 8 — Gt, Portland Street—Men's „ 205 15 8 233 5 7 — 27 9 11 „ Women's „ 224 1 1 245 13 3 — 21 12 2 Marylebone Road—Men's „ 274 19 8 313 0 2 — 38 0 6 „ Women's „ 355 19 1 360 7 0 — 4 7 11 Foley Street—Men only „ 131 0 7 145 7 1 — 14 6 6 St. John's Wood Road—Men only 101 11 0 108 4 10 — 6 13 10 Barrett Street—Men only „ 220 11 11 247 11 9 — 26 19 10 Salisbury Street— Men's Department 72 14 7 74 16 10 — 2 2 3 „ Women's „ 107 17 0 111 19 5 —- 4 2 5 £4,185 19 9 4,348 4 8 50 9 8 212 14 7 * One free urinette provided. ‡Two free urinettes provided. 10 SCAVENGING. Refuse Collection.—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. All premises in the Borough now receive at least a twice weekly collection. 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 Sunday, Christmas Day, Good Friday 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. The Council have decided to purchase a complete new fleet of house refuse collecting vehicles, spread over a period of three years, and it is anticipated that the first quota will be obtained during the year 1932. It is hoped that the acquisition of these vehicles will enable the house refuse collection to be carried out in a more efficient and hygienic manner than previously. 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 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 elinkered. 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. 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. During the year a new fleet of motor vehicles was purchased and put into commission. These replaced the old horse-drawn vehicles and together with the use of improved orderly barrows has enabled the system of street sweeping to be reorganised. The Borough has been divided into beats and each sweeper is given a definite length of public way for which he is entirely responsible. This system applies also to the sweeping gangs employed at night. Each of the orderly barrows carries two galvanized refuse bins into which the sweepings are placed by the man in charge. 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 motors is complete, it is the intention entirely to dispense with horse-drawn vehicles and 11 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 beat system so that in the near future the whole will be dealt with by this method 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 to 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 genera! 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. House Refuse collected during the year ending 31st March, 1932 44,308¼ tons. Street Sweepings collected during the year ending 31st March, 1932 7,999¾ tons. 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. The following figures with regard to action taken as to the provision of dustbins, etc., are of interest :— Dustholes and ashpits abolished 198 Premises where approved type metal dustbins have been provided in lieu of dustholes 201 Metal dustbins provided by owners in place of dustholes 467 Defective bins replaced by owners 460 Total number of new metal bustbins provided during the year 927 During the year the inspectors made 3,803 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, 68 notices were served. Remedies in each case were carried out, legal proceedings not being necessary in any instance. The Crown 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 12 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. (Eng;.), L.R.C.P. (Lond.), D.P.H. Assistant Medical Officer of Health for Tuberculosis Purposes : *J. Donaldson Saner, M.B., C.M. (Edin.'), D.P.H. Public Analyst (Part time) : J. F. F. Rowland, B.A., A.I.C. **Bacteriologist (Part time) : A. G. R. Foulerton, O.B.E., F.R.C.S., L.R.C.P., D.P.H. ***K. H. Whittingham, O.B.E., M.B., B.S., D.P.H., R.C.P.S. Public Vaccinator : Dr. H. Allen Bulman. Vaccination Officer : G. H. Bassett. *District Sanitary Inspectors. *Outdoor Superintendent. T. A. Cartledge, M.S.M. (a, b, d). P. H. Hill (a, b, d). H. E. P. Corline (b, d). , T. W. Forbes (b, d). Clerks. E. Lumley (a, b). H. E. Curtis (Chief). H. E. Scoble (c, d). A. H. James. E. E. Willis, M.M. (a, b, d). i Howe. A. S. Wilson (a, b, d). G w Matthews. *Dramage Inspectors. (died 13th Sept., 1931). F. C. Cook (b, d). W. H. Draper (a, b, d). H. G. E. Brown, appointed 1st Oct., 1931. *Food Inspector. G. Smith (Senior Sanitary C.D. Turbayne. Inspector) (a, b, d). R. G. Turner. Disinfectors. *Maternity and Child Welfare and J C Kendall Tuberculosis Clerk. J. Overton. Miss J. Jones. 13 * Women Sanitary Inspectors and Health Maternity and Child Welfare. Visitors. ‡Miss D. Chabot (b, e, f). Clerk-Dispenser. † †Miss D. T. Connell. Miss G. M. Courtnay. Miss C. E. Durant (b, e, h). Miss N. C. Stokes, R.R.C. (b,e,f,g,h). Cleansing of Persons—Baths & Shelter. *Health Visitors. Miss L. Kilgallin (Matron). Miss C. Hale (e, f). Mortuary Keeper. Miss E. D. Mann (e, f, g, h). Mrs H. Spears. Miss K. Stewart (e). *Tuberculosis Visitors. *Tuberculosis Dispensary. Miss F. A. Baker (b). E. D. Marston (Caretaker). Miss S. Kenion (e, f, g, h). *'l'uberculosis Clerk—Dispenser. Messenger. Miss M. T. Challis. J. Eatwell. * Officers to whose salary contribution is made under the Public Health Acts or by Exchequei grants. a Royal Sanitary Institute Certificate. b Certificate SaniLary 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. g Certificate of State Registration for Nurses. h Three or Four Years' Hospital General Training Certificate. "Died 2nd February, 1931. *** Appointed 19th March, 1931. † Appointed 1st October, 1931 † † Appointed temporarily 9th November, 1932. ‡ Resigned November, 1931. 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 2,600, as against 2,335 in 1930. 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, 84 statutory notices were issued, the figure being 79 in 1930. Of these notices, 58 related to ordinary nuisances (dirt, dampness, etc.), 8 to verminous rooms, 8 to drains, 3 to insufficient w.c. accommodation, and 7 to insufficient dustbins. The 8 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1922, and referred to 20 rooms. The number of notices in 1930 was 9. In 2,510 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 connection with Nuisances." The total inspections made fot 1931 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 157 170 238 138 171 61 935 Doors, windows, floors, ceilings sash cords, etc., repaired 272 64 70 52 104 30 592 Overcrowding abated - 4 5 2 — 1 12 Illegal occupation of underground rooms dealt with - 1 2 5 3 2 13 Water closet defects remedied 134 73 172 121 142 94 736 Water closets erected - 3 4 2 12 30 51 Urinal defects reemedied 6 2 — 7 1 3 19 Soilpipes and ventilating shafts repaired or renewed - 2 - - 9 2 13 Yard defects remedied 69 35 108 89 82 12 395 Waste pipe defects remedied 50 6 16 9 58 16 155 Water cistern defects remedied 25 1 1 11 16 1 55 Rubbish, manure, etc., accumulations removed 3 14 55 17 39 30 158 Dung or dust receptacles repaired or renewed 12 16 23 16 48 12 127 Drains relaid or amended 37 25 17 5 31 17 132 Drains cleared 3 7 11 3 17 3 44 Rainwater pipes repaired or renewed 14 11 12 9 18 22 86 Water supply to houses reinstated 1 2 2 3 1 2 11 Roofs and gutters repaired 43 49 53 30 35 13 223 Area defects remedied 12 1 23 71 24 6 137 Wash-house defects remedied 110 32 100 56 51 7 356 Animal nuisances abated 2 1 6 4 3 — 16 Basement defects remedied — 9 2 12 24 — 47 Stables cleansed or repaired 3 — 1 — 2 2 8 Water supply laid on to upper storeys of house 3 2 4 2 - - 11 Miscellaneous nuisances abated 399 95 278 56 58 26 712 Verminous rooms cleansed 68 56 201 62 64 30 481 Workshops dirty, overcrowded, unventilated or defective, remedied 1 1 2 21 18 31 74 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:— Offence. Premises. (Proceedings taken under the Public Health (London) Act 1891, etc.) Result. 3, Stalbridge Street. Failure to comply with a statutory notice to execute certain sanitary requirements. Order made for work to be executed withing 28 days. Smoke Nuisances. During; the year 1931, 262 observations were made and 17 complaints were received and dealt with. In each case the attention of the offender was drawn to the matter. In no case was it necessary to institute proceeding's in court. 15 Rat Repression. Though activity in this connection continues unabated, the number of complaints received varies little year by year. In 1930 it reached 60, and in 1931, 74. The investigation of these complaints necessitated the inspection of 82 premises, 33 of which were used for business purposes (5 of these for the preparation or storage of food), the remaining 49 being private or tenement houses. In 35 of the cases investigated the infestation was directly attributable to defects in the drainage system, 20 being disused single drains of buildings recently demolished. The nuisance disappeared when the drains were sealed off, and in the other 15 cases the repair or reconstruction of the drainage system led to the desired result. In every instance all advice and assistance was given to the owner or occupier by Inspector Willis, who acted as Rat Officer, and secured excellent results from the methods advocated. The following report submitted to the Public Health Committee on the 1931 Rat Week held in the Borough contains a certain amount of information that may be found interesting. " In accordance with the suggestion of the Ministry of Agriculture, National Rat Week (the thirteenth of the series), was held in St. Marylebone during the week commencing Monday, November 2nd, 1931, the action taken following more or less that of previous years. The general public were notified of the importance of rat and mouse destruction by means ot special posters and leaflets displayed and distributed throughout the district, and considerable prominence was also given to the subject in the daily and local press. Owners and occupiers of premises known to be infested with rats were supplied with the latest bait recipes, and received from the Inspector specially detailed for the work advice and guidance as to the methods to be adopted to rid their property of the vermin. In addition, circulars were sent to the occupiers of food premises (butchers, restaurants, grocers, dairies, provision dealers, fishmongers, etc.), property agents, large business houses and institutions within the Borough, drawing their attention to, among other things, the menace to health which the presence of rats constitutes, and their responsibilities under the provisions of the Rats and Mice (Destruction) Act, 1919. The sewers, which are regularly baited, received additional attention during the week, and a greatly increased number of barium carbonate baits were laid. Close co-operation with neighbouring boroughs was also again secured in this direction. The several railway companies having stations, etc., in the Borough, showed great activity in connection with their embankments, sidings and warehouses, and the occupiers of the larger open spaces all took part in the campaign. While St. Marylebone may be less affected by the rat nuisance than other districts, constant vigilance is necessary on the part of the local authority and of all occupiers of lands and premises in order to keep the numbers down. Although there is no slackening of effort by the Council at any period of the year, Rat Week serves a most useful purpose in affording an opportunity of carrying out propaganda on the rat problem in the Borough and securing concerted action throughout the district with a view to the destruction of rats and mice." 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. Ten complaints were received from churches and other institutions, and as much assistance as possible was given by the inspector (Mr. Willis) in charge of this work to reduce the nuisance. 16 Fouling of Footways by Dogs. In enforcing the provisions of the bye-law with regard to this matter, great assistance was obtained during the year from the police, the only prosecution undertaken being on the report of a police officer. In this case the defendant, who pleaded guilty, was fined £1. Including this case the total number of prosecutions since the bye-law came into operation in 1928 is 5, the amount of fines imposed being £2 10s. Od. 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 inspectionons 1931 Number of notices 1931 Number of prosecutions, 1931 On register at end of 1930 Added in 1931 Removed in 1931 On register at end of 1931 A. Business Premises Milk premises 113 16 6 123 311 7 — Slaughterhouses 1 — — 1 58 — — Offensive trade premises 2 1 1 3 60 — — Ice cream premises . 72 4 — 76 130 6 — Butter and Margarine Manufacturers and Dealers . 16 — — 16 33 — — Bakehouses 54 — — 54 108 7 — Fried Fish Shops 24 1 — 25 70 3 — Fish. Curers 5 1 — 6 80 4 — B. Habitations Houses let in lodgings 1,055 — — 1,055 7,874 1,053 — Common lodging houses . 4 — — 4 — — A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 123. This is 10 more than in 1930, 16 having been added and (5 removed. Slaughter Houses.—At the moment the only slaughter house in the Borough is that at 32a, Union Street, W.l, which is held by Mr. E. J. Barclay, of 70, Great Titchfield Street, W.L No conditions are attached to the licence and the amount of slaughtering now done is comparatively small : during the year only 30 sheep, f> lambs and one bullock were dealt with. Humane killers, in accordance with the requirements of the L.C.C. by-laws, are being used in this slaughter house, and apparently with complete success. 17 Offensive Trades.—At the end of 1931 there were three 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 60 visits, but no cause of complaint was found. Ice Cream Premises.—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 1931 was 78, 6 more than in 1930. Regular inspections were made throughout 1931, and in 6 cases notices were served in respect of uncleanly conditions. Butter, Margarine, etc., Premises.—Information with regard to the sampling of these substances will be found under the heading "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 1931 the number of bakehouses on the register was 54, 49 being underground bakehouses. 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. During the year 108 visits were paid and 7 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 25 and by fish curers 6. Notices calling for periodical lime-washing, etc., of such premises is required by the by-laws of the London County Council, made under Section 9 of the London County Council (General Powers) Act, 1908, were issued, and regular visits of inspection made and action taken where necessary to have any defects noted remedied. Factories and Workshops. Though factories are comparatively few in the Borough, the number of workshops, many of them domestic workshops, is considerable, and work in relation to them bulks very large amongst the duties of the district inspectors, more especially those in charge of districts on the south of Marylebone Road. The staple industry is, of course, dressmaking, millinery and tailoring in all its branches, but in a number of places other trades are carried on. The total number of visits to factories, workshops and workplaces during the year was 3,014, 270 by the women and 2,744 by the men inspectors. The complaints received numbered 127. 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. 18 1.—INSPECTION. Premises Number of Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories (Including Factory Laundries) 189 33 — Workshops (Including Workshop Laundries) 1,688 131 - Workplaces (Other than Outworkers' Premises included in Part 3 of this Report) 1,137 14 - Total 3,014 178 — 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 59 59 - - Want of ventilation 29 28 - - Overcrowding 11 11 - - Want of drainage of floors 2 2 - - Other nuisances 48 48 - - Sanitary accommodation insufficient 16 16 - - unsuitable or defective 52 52 - - not separate for sexes 22 22 - - 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) 7 7 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 246 245 — — 19 3.—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109,110 NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S 110) Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 63 186 923 ... ... ... 9 ... ... ... ... ... ... ... ... Total 63 186 923 ... ... ... 9 ... ... ... ... ... ... ... ... 20 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. 346 Bakehouses 54 Total number of workshops on Register 3,738 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 127 Reports (of action taken) sent to H.M. Inspector 127 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 49 RAG FLOCK ACTS, 1911 AND 1928. There are no premises within the district where rag flock is manufactured, used 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 6 of the Housing Act, 1925, all houses suitable for the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to sanitation, cleanliness, cleansing, etc. 21 Under these a new register is being formed, and during the year in connection with this and for purposes of supervision, some 7,874 visits were paid to the 1,055 houses on the old list. The number of intimation notices served was 1,053, relating to cleansing and other defects. Except in 37 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.—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. Established many years ago by Miss Meredith Brown, this was one of the first of its kind and under the management of Miss Ellen Homewood must have done an incalculable amount of good and conferred great benefit on large numbers of women. Towards the end of the year arrangements were made for the transference of the premises and all its activities to the Church Army under whom there is every indication work no less valuable and splendid will be carried on. 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 637 men 102 women Total 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.—The year 1931 saw little improvement in conditions so far as underground rooms are concerned. On account of difficulty in obtaining other accommodation it is often impossible to deal with cases that should be dealt with. Actually during the year action was taken in respect of 13 in which the occupation was definitely illegal and discontinuance secured. New regulations for the control of underground rooms occupied for sleeping purposes were prepared and submitted to the Minister of Health for approval, which, however, had not been received before the year ended. 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 1931 there were 346, this number including: restaurant, dining room and coffee shop kitchens, 201; tea-rooms and pastry-cooks, 90; hotel kitchens, 24, fried fish shops, 25; and fish-curers, 6. In addition, there were a number of shops in which sausages were manufactured, and meat, ham, &c., cooked and sold only over the counter. 22 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 premises in which such articles as sausages are made or food is prepared or cooked also. Before establishing a food manufacturing business, a restaurant or eating rooms of any description, a cook-shop or a cooked-food shop, it should 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 during the year the London County Council at the suggestion of the Metropolitan Boroughs' Standing Joint Committee undertook the preparation of a Bill for submission to Parliament containing a number of clauses dealing with this and certain allied questions. As a matter of routine, a number of restaurants, food premises, etc., are visited each week by the Food Inspector, and any matters discovered at these inspections are dealt with at once. In 1931, the total number of inspections was 672, the number of notices served being 20. 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 restaurants and cooked-foods shops, even of all premises in which food is prepared for sale is warranted. Food Stalls.—Under the by-laws with regard to registration of street traders under the L.C.C. {General Powers) Act, 1927, food stalls, in common with other stalls, must be registered. The Committee actually responsible is the Highways Committee, who co-operate in the closest possible manner with the Public Health Committee and endeavour to limit the number of traders to whom registration is granted. Wherever possible, the Committee refuse to allot space for stalls from which food is to be sold, and in each case full enquiries are made and investigations of storage accommodation carried out. Where improvements are required and are possible, these are called for. If the conditions are unsatisfactory and irremediable, this is made a ground for refusal of registration. All food stalls are inspected daily by officers of the Public Health Department, a special feature being made of inspections over each week-end. 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.—The quarterly returns as to milk samples are as follows:— 1st Quarter, 54; 2nd Quarter, 55; 3rd Quarter, 49; 4th Quarter, 53, making a 23 total for the year of 211. No sample was found to be adulterated. As this is the first occasion on which such a report has been submitted, perhaps it should be specially noted, and congratulation offered both to the consumer and to those engaged in the trade within the Borough. Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 10 samples were taken and submitted to the Council's Bacteriologist for examination. In each case in which a result not entirely satisfactory was obtained communications were sent to the Local Authority of the district in which the milk was produced in order that an investigation might be carried out locally. On all occasions the greatest willingness to co-operate was shown by the officers of these authorities, and it is safe to claim that definite improvements have followed the taking of action on these lines. In addition to these samples, 35 of certified milk were taken and submitted to bacteriological 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 48 applications were received from 15 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 12 in respect of "Certified" Milk, 12 for Grade "A" Tuberculin Tested Milk, 22 "Pasteurised" Milk, 1 Grade "A," 1 Grade "A" Bottlers, and 1 Pasteurising Licence. In accordance with the instruction of the Ministry 35 samples were taken during the year and submitted to the Council's Bacteriologist. Copies of the reports made were duly forwarded to the Ministry. Milk (Mothers and Children) Scheme.—During 1931, 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, 1932, the amount expended was £444 0s. 0d., as against £314 7s. lld. in the year ended 31st March, 1931. The actual number of cases dealt with was 295, and the number of orders issued 1,539, which were larger figures than those for 1930, when the cases numbered 234 and the orders 1,116. 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. 24 b.—foods other than milk. The main duties in relation to food protection generally in 1931, 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, continue to work smoothly so far as the provisions relating to butchers' shops and to stalls and the slaughtering of animals are concerned, the butchers endeavouring to comply as completely as possible with 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 regards exposure of meat, and that in the matter of protection from contamination conditions are very much better than they were when the regulations came into operation. I Food Inspection.—The work of food inspection receives year by year adequate attention. During 1931, 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 1931. Meat— Beef 72 lbs. Mutton 68 „ Bacon 5 cwt. 1 qr. 6 lbs. Poultry— Ducks 3 Fish— Wet—Cod Fillet 12 lbs. Skate 2 stone Roe 8 „ Haddock 2 „ Fruit— Apples 4 barrels Pears 2 baskets Tomatoes 2 boxes Miscellaneous (Tinned Goods, etc.). Corned Beef 396 Hams. Gammons, etc. 166 Chicken 48 Brawn 81 Tongues 85 Veal 9 Pork and Stuffing 15 Chicken and Ham Roll 24 Sausages 62 Cream 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 1931 was 1,108, the figure for 1930 being 1,103. Of this number 2 were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of 0.17 per cent., which is lower than that for 1930, when it was 1.2. 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. 25 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:— ANNUAL REPORT OF THE PUBLIC ANALYST, 1931. The number of samples taken under the Food and Drugs (Adulteration) Act and submitted for analysis, was 1,108. The following is a complete list of the articles sampled:— No. Article ANALYSES Number Adulterated, etc. Number Examined Formal Informal Private Total Formal Informal Private Total 1 Bacon - 1 - 1 2 Bread - 2 — 2 3 Butter 44 131 — 175 4 Cakes — 3 — 3 5 Candied Peel — 6 — 6 6 Cheese — 56 — 56 7 „ Cream — 8 — 8 8 Chocolates — — 1 1 9 Cocoa — 27 — 27 10 Coffee — 51 — 51 11 Condensed Milk 1 17 — 18 12 Cornflour — 2 — 2 13 Cream 21 — — 21 14 „ Tinned — 11 — 11 15 Currants — 4 — 4 16 Curry — 1 — 1 17 Custard Powder — 1 — 1 18 Dripping — 13 — 13 19 Eucalyptus Oil — 2 — 2 20 Fish Paste — 5 — 5 21 Flour — 1 — 1 22 Glucose — 2 — 2 23 Gregory Powder — 1 — 1 24 Honey — 18 — 18 25 Jam — 25 — 25 26 Jelly — 3 — 3 27 Lard — 83 — 83 28 Lemonade Powder — 3 — 3 29 Liquorice Powder — 3 — 3 80 Margarine — 30 — 30 81 Marmalade — 17 — 17 82 Medicine — 1 — 1 33 Milk 163 47 1 211 34 Mincemeat — 1 - 1 35 Mustard — 27 — 27 1 1 36 Oatmeal — 4 - 4 37 Ointment — 8 - 8 38 Ointment, Boric — 16 — 16 39 „ Mercuric — 1 — 1 40 „ Sulphur — 3 — 3 41 Olive Oil — 5 — 5 42 Paste, Fish — 7 — 7 43 „ Meat — 12 — 12 44 Peas, Tinned — 9 — 9 45 Pepper — 20 — 20 46 Pickles — 2 — 2 47 Raisins — 8 — 8 48 Ridge's Food — 1 — 1 49 Roll and Butter — 12 — 12 Carried forward 229 711 2 942 1 1 26 No. Article ANALYSES Number Adulterated, etc. Number Examined Formal Informal Private Total Formal Informal Private Total Brought forward 229 711 2 942 1 1 50 Salmon—Tinned — 7 —— 7 51 Sauce — 6 — 6 1 1 52 „ Tomato — 3 — 3 53 Sausages — 11 — 11 54 „ Beef — 3 — 3 55 „ Pork — 2 — 2 56 „ Pork and Veal — 1 — 1 57 Self Raising Flour — 1 — 1 58 Sherbert — 2 — 2 59 Shredded Suet — 3 — 3 60 Spirits of Nitre — 1 — 1 61 Sugar — 44 — 44 62 Sultanas — 16 — 16 63 Sweets — 6 — 6 64 Tartaric Acid — 2 — 2 65 Tea — 47 — 47 66 Tincture of Quinine — 3 — 3 67 Tripe — 2 — 2 68 Whisky — 1 — 1 69 Wine, Black Elder — 1 - 1 70 „ Ginger — 1 — 1 71 „ Orange — 1 — 1 72 „ Raisin — 1 — 1 73 „ Ruby — 1 — 1 Total 229 877 2 1108 2 2 Adulterated Samples, etc. Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 646 Sauce Informal Contains 27 parts of sulpur dioxide per million. 1018 Mustard Informal Contains not less than 5 per cent. of added starch. The sum paid in respect of each analysis was 12s. 6d. per sample. The Public Analyst (Mr. J. F. F. Rowland) comments, as follows, with regard to various articles examined :— Milk.—For the first time on record in this Borough not one of the samples (211) taken during the year was found to be adulterated. This is most satisfactory from every point of view and particularly so from that of the public. The average composition of the milks taken during the year varies out litue from that of the previous two years. The figures for this year are given below and also those for the years 1929 and 1930. Year, Sp: Gr: Total Solids. Fat. Solids not Fat. 1929 1031.4 12.34 3.62 8.72 1930 1031.0 12.20 3.59 8.61 1931 1031.4 12.20 3.50 8.70 27 Creams.—Next to milk itself, cream is one of the most important articles of dairy produce, so the practice adopted in previous years is again followed and the fig-ures obtained for both loose and tinned creams are given not only for 1931 but also for the four previous years:— Year. Loose Creams. Tinned Creams. 1927 51.4 25.6 1928 42.33 28.73 1929 47.39 29.92 1930 49.63 29.46 1931 50.3 28.3 The numbers of loose creams taken during the year was 21, while the tinned creams numbered 11 for the same period. Eleven samples spread over a year are not sufficient upon which to base a very dogmatic opinion on the quality of the tinned variety but the general tendency seems to be a continued falling off in fat content as compared with that of the year 1929. I have stressed the disparity in quality between these two classes continuously, chiefly for the reason that medical men frequently recommend cream for the weak, sickly, or convalescent, and as the public are not aware of the great difference in quality between the tinned and the loose, the tinned is often selected because it can be obtained at most shops while the loose can only be obtained at a dairy, and a family may be making a financial sacrifice for an invalid under the impression that the tinned is equal in quality to the loose. If every tin bore a label stating the percentage amount of fat present, purchasers would then know exactly what quality was being supplied. jams.—Owing to the agreement reached in October, 1930, between a joint committee of Public Analysts and the representatives of the Jam Section of the Food Manufacturers the interests of the public have received a long overdue but very definite measure of protection. The Manufacturers have agreed to fix two standards for all jams made by members of the Federation. These are to be First Quality Jams and Second Quality Jams; also they agree to have every sample properly labelled with its standard, at the same time guaranteeing quality and purity. In addition they have undertaken not to manufacture any jam of quality below the Second Standard. For the moment, however, it is the public itself who can make most effective use of the means available for their protection by seeing that whenever jam is bought it should bear the label of guarantee of purity and standard which the Food Manufacturers' Federation now issue.—(Signed) J. F. F. Rowland. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1931 was 1,067,* being 180 more than in 1930. Of the children born, 551 were boys and 516 girls. The birth rate per 1,000 of the population was 11.4, as against 12.1 in 1930. *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 264 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 128 „ Females 100 Illegitimate Males 22 „ Females 14 28 The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1931, with those of each of the five previous years:— 1926 1927 1928 1929 1930 1931 All Souls 9.0 9.0 9.7 9.4 10.1 8.9 St. Mary 10.1 10.6 10.7 9.7 10.4 13.2 Christ Church 18.0 19.1 16.4 15.8 14.1 14.4 St. John 12.6 12.6 13.2 12.3 13.8 11.9 The Borough 12.7 132 12.6 11.9 12.1 11.4 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,514; live births, 3,312; still births, 202. The total notifications in 1930 was 3,530. 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 proceeding's ap-ainst anv of the parties. The main sources of the notifications are set out below. 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 154 4.4 „ midwives 639 18.2 „ other persons 270 7.7 „ hospitals, etc. 2,430 69.1 8,514 100.0 Of the total births notified, 202 referred to still-births (120 males and 82 females): 2,202 took place at Queen Charlotte's Hospital; 79 at Middlesex Hospital; 166 at the St. Marylebone Home; and 918 were born at home. Of those notified as having occurred in St. Marylebone, 2,133 belong to other Boroughs. Of the 202 still-births only 42 (19 males and 23 females) were to St. Marylebone mothers. DEATHS AND DEATH RATES. The number of deaths registered in 1931 was 1,225. This figure re inclusive of persons who, though normally resident in the Borough, died in institutions outside, but, exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. The corrected death-rate* per thousand for the year was 12.3. In the previous year, the rate was 10.6 and the number of deaths 1,171. *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” ie the case of St. Marylebone in 1931 is 0 944, and the corrected death rate is obtained by multiplying with this figure the number of deaths per 1,000, calculated from the total deaths and the population estimated to the middle of the year. 29 The following short table shows the death-rates in the several registration sub-districts in 1931, and compares them with those of the years onward from 1925:— 1925 1928 1927 1928 1929 1930 1931 All Souls 9.2 9.6 9.7 9.9 13.3 102 10.8 St. Mary 12.5 13.6 14.2 12.0 13.8 11.5 12.4 Christ Church 12.9 13.6 12.6 13.4 15.8 11.8 13.1 St. John 12.5 14.3 11.9 12.8 13.8 12.1 12.6 The Borough 11.0 11.9 11.3 11.1 13.2 10.6 12.3 District births and deaths for the year ended 2nd January, 1932, are given in the following table. A further table giving the vital statistics of separate localities for 1931, and the ten preceding years, will be found amongst the Ministry of Health Tables on page 76. Sub-District. Population estimated to middle of 1931. Males. Births. Deaths. Females. Total. Males. Females. Total. All Souls 21,425 98 92 190 123 121 244 St. Mary 24,574 129 106 235 148 183 331 Christ Church 28,374 204 205 409 202 192 394 St. John 19,087 120 113 233 132 124 256 The Borough 93,460 551 516 1,067 605 619 1,225 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 1931. For purposes of comparison the table for 1930 is reproduced. The considerable increase in the number of deaths amongst the aged, particularly in the March quarter, will be noted, as well as the fact that except in the last quarter of the year the number of infant deaths showed a slight reduction. 1931. January- April- July- October- Total March June Septembei December Infants under 1 year 20 17 12 21 70 Persons of 65 years and upwards 196 137 106 150 592 1930. January- April- July- October- Total March June September December Infants under 1 year 25 20 16 16 77 Persons of 65 years and upwards 158 116 122 180 526 30 DEATHS IN RELATION TO AGE. The percentage relation of each group to the total number of deaths in 1931 is shown below:— Under 1 year 57 per cent. 1 and „ 2 years 0.6 „ 2 „ „ 5 10 „ 5„ „ 15 1.7 „ 15 „ „ 25 „ 3 4 „ 25 „ „ 45 98 „ 45 „ „ 65 „ 29.5 65 „ upwards 48.3 „ Of the total, 161 at death were aged between 65 and 70; 269 between 70 and 80; 144 between 80 and 90 ; and 18 between 90 and 100. The age distribution of the deaths that occurred in 1931 is shown in the following table, which gives also, for the purpose of comparison, the figures for each age group in each of the five preceding years. 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 upwards At all Ages 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 1,455 1930 77 25 17 24 38 133 331 526 1,171 1931 70 7 11 21 42 120 362 592 1,225 Causes of and ages at Death.—General information with regard to the deaths which occurred in the Borough during the year, mainly as to causes and the ages at which death took place, is given in Table III. of the Ministry of Health series at page 77. 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 919. Fuller information than is possible in the table is given in the following pages, in which also the figures relating both to causes of death and the ages at which these causes were operative are analysed. INFANTILE MORTALITY. The infantile mortality rate of any district is the number of deaths of infants under one year of age per 1,000 of the births which occurred in the same year. The number of babies under one year who died in St. Marylebone in 1931 was 70, and the number of births in that year 1,067. The infantile mortality rate is therefore 65. The course which the rate has taken is graphically shown in the chart on page 33, which indicates clearly that the only really serious interruption to the decline was in 1917. 31 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 32 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 1931, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 18 were less than one month old when they died and 29 less than three months. The figures for 1930 were 29 and 40. 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 26 in 1930, and 20 in 1931. Diarrhoea and enteritis (7 and 8) accounted for 14 in 1930 and 11 in 1931. Respiratory diseases, the third of the main causes, took 14 in 1930 and in 1931, 24. 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. No death was stated to be due to over-laying or to measles, and only 1 to meningitis. 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 26 deaths amongst infants. In 1930 the figure was 27. Sub-District. Under 1 week. 1 and under 2 weeks. 2 and under 3 weeks. 3 and under 4 weeks. Total under one month. 4 weeks and under 3 months. 3 and under 6 months. 6 and under 9 months. 9 and under 12 months. Totals. All Souls 3 - 1 - 4 4 3 3 1 15 St. Mary 3 1 — — 4 1 5 2 1 13 Christ Church 7 - — — 7 3 9 4 3 26 St. John 2 - 1 — 3 3 6 2 2 16 Totals 15 1 2 — 18 11 23 11 7 70 cc to 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 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 1 Month 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year All Souls St. Mary Christ Church St. John Total 1 Small-Pox - - - - - - - - - - - - - - -- 2 Chicken-Pox - - - - - - - - - - - - - - - 3 Measles — — — — — — — — — — — — — — — 4 Scarlet Fever — - - - - - - - - - - — — — — 5 Diphtheria and Croup - - - - - - - - - - - - - - - 6 Whooping Cough — — — — — — 1 1 — 2 — — 1 1 2 7 Diarrhoea — — — — — — — — — — — — — — — 8 Enteritis - - - - - 2 4 4 1 11 2 3 2 4 11 9 Tuberculous Meningitis - - - - - - - - 1 1 1 — — — 1 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation 1 - - - 1 - 2 - 1 4 1 1 2 - 4 13 Premature Birth 7 1 — — 8 3 — — — 11 3 4 2 2 11 14 Atrophy, Debility and Marasmus - - - - - - 3 1 1 5 1 1 2 1 5 15 Atelectasis 1 — — — 1 — — — — 1 — — 1 — 1 16 Injury at Birth 3 — — — 3 — — — — 3 — — 3 — 3 17 Erysipelas - - - - - - - - - - - - - - - 18 Syphilis 1 — — — 1 1 — — — 2 1 — — 1 2 19 Rickets — — — — — - - - - - — — — - — 20 Meningitis (not Tuberculous) - - 1 - 1 - - - - 1 - - - 1 1 21 Convulsions - — — — — — — — — — — — — — — 22 Gastritis - - - - - - - - - - - - - - - 23 Laryngitis - — — — — — — — — — — — — — — 24 Bronchitis - — — — — 1 4 — — 5 1 1 2 1 5 25 Pneumonia (all forms) 1 — 1 — 2 3 8 4 2 19 4 3 8 4 19 26 Suffocation, Overlying - — — — — — — — — — — — — — — 27 Other Causes 1 —- — — 1 1 1 1 1 5 1 — 3 1 5 Totals 15 1 2 — 18 11 23 11 7 70 15 13 26 16 70 Nett Births in the Year M. F Legitimate, 484 463 Illegitimate, 67 53 Total 551 516 1,067 Nett Deaths in the Year M. F. Legitimate Infants, 33 10 Illegitimate Infants, 21 6 Total 54 16 70 Nett Stillbirths in the Year M. F. Legitimate Infants, 13 18 Illegitimate Infants, 6 5 Total 19 28 42 33 INFANTILE MORTALITY FIGURES. Number of deaths of children under one year of age. Rate per 1,000 registered births. 34 MATERNAL MORTALITY. In 1931 the number of deaths due to conditions connected with or consequent upon child-birth was 3, the Maternal mortality rate being 2.7 per 1,000 births. In 1930, the deaths numbered 7, and the rate was 5 per 1,000. Of the 3 cases in 1931 it was possible to obtain full information with regard to 2 only, and the main facts with regard to these are: In 1 case death was found to be due to septicaemia following' abortion, and in the other Oedema of lungs and eclamptic abortion, the child in this case being still-born. The age in the first case was 27, and she was single; the other, aged 22, was married. In both cases it was the first pregnancy. 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 77. 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 17, equal to 0.17 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1931 this was the case also, no fewer than 13 of the 17 beingchildren under 1 year of age. In 1930, the deaths from diarrhœal diseases numbered 18, and of this number 14 were babies. In 1931, therefore, there was a slight decrease in the total over 1930. 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 improvements 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 28 deaths, and including diarrhoea (17 deaths) the total number registered as due to them was 31. The figure for 1930 was 70, a measles epidemic in that year contributing 35 deaths to the total. Amongst diseases contributing to the total may be mentioned diphtheria 4; whooping cough, 2; scarlet fever, 3; enteric fever, 3; and measles, 2. Phthisis and Other Tuberculous Diseases. The total deaths due to the diseases dealt with under this heading, viz., phthisis (pulmonary tuberculosis or consumption of the lungs), tuberculous meningitis, general tuberculosis, tabes mesenterica, and all conditions due to the germ of consumption, numbered 92, a figure higher by 8 than that for 1930. The great bulk of the 92 deaths, viz., 81, was due to phthisis. The number in 930 was 84. Of the total number of deaths registered (1,225), the percentage due to phthisis was 6.6, as against 6.4 in 1930. The age periods at which the deaths 35 occurred were: 5—15 1, (1.2 percent.); 15—25, 11 (13,5 per cent.); 25—45, 31 (38.2 per cent.); 45—65, 32 (39.2 per cent.); 65 and over, 6 (7.4 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 Rate 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 1931 92 93,460 .92 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 166. This is higher by 33 than the figure (133) for 1930. The death-rate was 1.6 per 1,000. In 1930 the rate was 1.2. The number of deaths certified to be due to bronchitis was 41. Of this number 25 were amongst persons aged 65 and upwards, and 9 amongst those of the group 45—65. The deaths traceable to pneumonia numbered 106, and, as in the case of bronchitis, the later age groups contributed the greatest numbers, though 22 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified in 1931 was 80. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in the table on page 78. 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. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 189 and the death-rate 1.9 per 1,000 of the population. These figures are higher than those for 1930, when the deaths numbered 170 and the rate was 1.5 per 1,000. 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 2 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and upwards Totals Males - - 1 - 4 13 22 28 16 84 Females 1 - 2 — 7 18 26 26 25 105 Totals 1 - 3 — 11 31 48 54 41 189 36 Cancer,—Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 6 3 9 Throat, Neck, Gullet 14 7 21 Stomach 3 4 7 Intestines 31 29 60 Liver 2 5 7 Breast — 20 20 Uterus and Generative Organs 9 21 30 Various 19 16 35 Totals 84 105 189 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 1931 numbered 83. Of these 25 were due to suicide. There were no recorded deaths of babies certified as resulting from suffocation (overlaying). 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 78. The following table shows the number of cases of infectious disease notified during the past six years:— 1926 1927 1928 1929 1930 1931 Smallpox 2 - 30 3 6 2 Diphtheria 193 160 177 180 271 154 Erysipelas 41 36 67 40 61 65 Scarlet Fever 121 178 223 237 226 258 Enteric Fever 9 5 13 5 9 9 Paratyphoid Fever 2 12 10 6 6 3 Continued Fever — — 1 — — — Puerperal Fever 12 1 3 4 8 11 Puerperal Pyrexia 9 35 32 19 25 22 Cerebro-spinal Meningitis 2 2 — 3 4 5 Tuberculosis (Pulmonary) 151 155 139 147 141 145 Tuberculosis (Non-Pulmonary) 30 35 22 26 20 17 Acute Poliomyelitis 1 3 — 2 2 1 Polio-Encephalitis — — 1 — — — Ophthalmia Neonatorum 7 12 7 3 16 10 Encephalitis Lethargica 3 3 3 3 2 — Pneumonia 86 45 44 92 42 80 Malaria 3 3 1 2 1 — Dysentery 2 1 2 1 — — Totals 674 686 775 773 840 772 37 The total number of notifications coming to hand was 772. The bulk of the notifications related to diphtheria and scarlet fever, which contributed 154 and 258 respectively to the total. Other diseases in respect of which considerable numbers of notifications were received were tuberculosis (162), erysipelas (55), and pneumonia (80). In 1930 the number of cases notified was 840. The notification rate (proportion to population of notified cases of infectious diseases) in 1931 was 8.3 per 1,000, as against 8.2 in 1930. 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 154 or 100-0 per cent. of the cases notified. Erysipelas 25 „ 46.0 „ „ „ Scarlet Fever 250 „ 97.0 „ „ „ Enteric and Paratyphoid Fever 11 „ 92.0 „ „ „ Puerperal Fever 10 „ 91.0 „ „ „ Puerperal Pyrexia 17 „ 77.0 „ „ „ Tuberculosis 68 „ 42.0 „ „ „ Pneumonia 88 „ 47.0 „ „ „ Smallpox 2 „ 100.0 „ „ „ Ophthalmia Neonatorum 7 „ 70.0 „ „ „ Acute Poliomyelitis 1 „ 100.0 „ „ „ Cerebro-spinal Fever 5 „ 100.0 „ „ „ The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notifications was £72 16s. 6d., equal to 15s. 7d. per 1,000 of the population. The cost and rate per 1,000 for each of the five preceding years are shown in the following table:— Year Amounts paid to Medical Practitioners Cost per 1,000 of Population £ s. d. £ s. d. 1926 49 1 6 0 9 8 1927 51 14 0 0 10 0 1928 56 16 0 0 10 11 1929 55 4 0 0 10 9 1930 61 13 0 0 12 0 1931 72 16 0 0 15 7 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 154, the number in 1930 being 271. Of the cases 4 died, and the case mortality rate was 2.6 per cent. 38 The number of cases per thousand of the population was 1.6. The cases were more or less evenly distributed, as usual, throughout the borough, and only in a few instances was it possible to determine accurately the source of infection. In 6 cases the source appeared to be a member of the family previously infected; in 4 cases infection was counted to have been acquired in school, and in 9 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 2,967. The bulk of these were from institutions, St. Charles, and the Royal National Orthopaedic Hospitals, and were taken from ward contacts with notified cases. Fortunately nearly all proved negative, a positive result actually being returned in 152 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 60. In All Souls the number was 39, in St. Mary 40, and in St. John 15. As usual, the age groups 1—5 and 5—15 were those most affected, 69 of the cases falling into the former and 147 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., 9. These were all remedied after service of notices. The Schick Testing and Diphtheria Immunization Clinic opened at the beginning of 1928, continued to operate under Dr. Bulman at 113, Marylebone Road, to which address it had been transferred from the Lissonia Centre on 12th January, 1931. In the main the children dealt with were those attending the Welfare Centres. The following table and summary give details of the work of the clinic during the year. Children under 5. Children over 5. Adults. Total. Tested 3 78 85 166 Positive 2 55 60 117 Negative 1 18 23 42 Not reported — 5 2 7 Inoculated without Schick Test 335 118 2 455 Injections—1st 2 56 57 115 2nd 321 158 53 532 3rd 288 141 53 482 4th 22 32 34 88 5th 11 14 26 51 Retested 163 79 29 271 Completely immunised 134 60 17 211 Positive after retest 16 16 10 42 Not reported 13 3 2 18 Additional injections 1 4 22 27 SUMMARY. Number of Sessions 85 Total Number of New Cases 621 „ „ under 5 338 „ „ over 5 196 „ „ Adults 87 Number of attendances 2,398 Average attendance per session 28 39 Scarlet Fever. The notifications of this disease numbered 258. That there is a liability for scarlet fever to show epidemic tendencies at intervals of five years, more or less, is well known. The highest number of cases reported in any one week it may be noted was 13. The total deaths from scarlet fever numbered 3, and the number of deaths per cent. of the cases was 1.2. The districts to suffer most from this disease were Christ Church and St. Mary. In the former there were 143 cases and in the latter 46. In all Souls there were 35 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 (158) of the total. Of the remainder 69 were aged between 1 and 5 years, and 42 over 15 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 15 instances that a definite connection could be made out. Defects in sanitation to the number of 19 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 were 3 deaths. Of Paratyphoid Fever there were 3 cases. All the patients recovered. In none of the cases was any information obtainable indicating that the source of infection arose within the Borough. Cerebro-Spinal Fever. Five cases of this disease were notified during the year. Encephalitis Lethargica. There were no cases of this disease notified. Polio-Encephalitis. No cases of this disease were notified. Polio-Myelitis. There was 1 case of this disease notified during the year. Erysipelas. The notifications of erysipelas numbered 55, and there were no deaths. Most of the cases were notified from the St. Charles Hospital and the General Hospitals, and 25 patients were treated in one or other of these institutions. Puerperal Fever and Puerperal Pyrexia. The number of cases of Puerperal Fever notified, viz., 11, was above the average of the last few years. Three 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 assistance and advice as was suitable and possible offered. 40 The Puerperal Pyrexia cases notified during the year numbered 22; 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 1930 was 25. Measles and German Measles. Though these conditions are not now notifiable, 1,251 cases were reported: 8 voluntarily by doctors and parents and 121 by school teachers. There were 2 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. 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, the same number as in 1930. 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 annually for some years the Borough has remained remarkably free. In 1931, the number of notifications received was 2. In both instances the infection was of the mild type and both the patients recovered. Active steps to guard against spread of infection were taken, including the vaccination or revaccination of contacts and were uniformly successful. Vaccination.—The usual table has been prepared by the Vaccination Officer and will be found on page 79, while the following statement gives some information with regard to the work done and the results obtained by Dr. Bulman during 1931, the first full year he has held the post of Public Vaccinator. Number of visits paid 1,653 Number of vaccinations— Primary 502 Re-vaccinations 54 556 Number of successful vaccinations 550 Number of unsuccessful vaccinations 6 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 41 during 1931. During the year in certain of the schools, one or more classrooms were closed on account of measles. INFECTIOUS DISEASE IN SCHOOLS. 1931. Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 35 8 4 16 11 1 Barrett Street — 5 — — — — Barrow Hill Road 5 10 19 55 38 18 Bell Street 41 22 15 40 4 4 Blandford Square 6 — — — — — Capland Street 48 15 22 18 3 21 Catholic, Richmond Street — — — — — — Christ Church, Cosway Street 33 11 5 1 — 1 Convent (St Edward's), Little Union Place — — — — — — Cosway Street (L.C.C.) 56 29 16 47 5 82 Emmanuel, Aberdeen Place 7 8 6 — — 4 Emmanuel, North Street — — — — 1 — Gatetorth Street 15 8 3 — 6 — Hampden Gurney 4 1 — 1 4 — Homer Row, Catholic — 2 — 3 — 3 L.C.C. Grove Road — — — — — — Jewish, Hanway Street — — — — — — Polytechnic, Regent Street — 1 1 — — St. James's, Marylebone Lane — — — 4 — 1 St. Luke's, Nutford Place 2 2 — 5 1 — St. Mark's, Violet Hill 5 4 9 49 7 21 St. Marylebone Central, High Street 32 10 25 113 15 3 St. Marylebone Grammar — — 1 — — 1 St. Mary's (Western) York Street 11 8 1 1 3 1 St. Paul's Bentinck, Rossmore Road 23 4 1 17 5 6 St. Paul's, Broadley Terrace 24 — 4 27 8 3 St. Thomas', Orchard Street 5 — — 13 — — St. Vincent, Wigmore Street 7 5 — 36 — 1 Upper Marylebone Street 25 10 4 25 9 19 Schools in other Boroughs 4 3 1 6 1 3 Totals 388 161 137 477 121 143 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 1931. The total number of cases notified was 10, as against 16 in 1930. Visits were paid to 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 33 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 10 6 4 10 — — — 42 INFLUENZA. This disease showed some epidemic tendencies during the year, though correct information as to the number of cases was, of course, unobtainable. The deaths certified as due to Influenza numbered 28, as against 8 in 1930. 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 85 and 78. The services of the nurses were requisitioned in 33 cases and 463 visits were paid. The number of deaths certified as due to all forms of this disease was 106. TUBERCULOSIS. In all 162 notifications were received, 145 relating to pulmonary tuberculosis, the remainder (17) 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. From time to time reference is made to the difficulty associated with the obtaining of notifications sufficiently early, and the following figures are introduced because they are interesting in this connection. They relate, as will be seen, to cases in which death had taken place before the fact that the individual was suffering from the disease had been brought to the notice of the Medical Officer of Health, as required by the regulations:— 1. Total number of deaths from tuberculosis in the Borough 92 2. The number of cases unnotified or notified at death 36 3. The number of cases notified within a month of death 18 4. The number of cases notified within three months of death 4 5. The number of cases notified within six months of death 5 Treatment of Tuberculosis.—Of the cases notified 197 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 65 were insured persons; of those 38 were admitted to sanatorium or hospital treatment, and 14 to St. Charles' Hospital. Non-insured persons numbered 97, of whom 42 (13 being children) received sanatorium treatment and 19 were admitted to St. Charles' Hospital and St. Mary Abbots Hospital. Nurses were sent in to 8 cases and 321 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. 43 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 28th December, 1930, to the 2nd January, 1982. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Age Periods. 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. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Primary Notifications Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males - - 1 8 8 11 11 19 14 8 4 79 93 - - - - - 29 50 „ Females — — — — 9 7 24 12 8 4 2 66 72 - - - - - 13 51 Non-Pulmonary Males - 1 3 1 1 - 2 - - - - 8 9 - - - - - - 7 „ Females - 1 1 1 - 4 2 - - — — 9 10 — — —~ - — — 9 Totals — 2 5 5 18 22 39 81 22 12 6 162 184 — — — — — 42 117 44 Form T. 137—1931 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.—Summary of Notifications during the period from the 28th December, 1930, to the 2nd Janaury, 1932, in the area of the County, County Borough, or Metropolitan Borough of St. Marylebone (to which this Return relates). Formal Notifications. Age Periods Number of Primary Notifications of new cases of tuberculosis. Total Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total all ages. Pulmonary, Males — — 1 3 8 11 11 19 14 8 4 79 93 „ Females — — — — 9 7 24 12 8 4 2 66 72 Non-pulmonary Males — 1 3 1 1 — 2 — - — — 8 9 „ Females — 1 1 1 — 4 2 — - - — 9 10 Supplemental Return. Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total. Pulmonary, Males - - - - - - 3 5 5 2 2 17 „ Females - — — — 1 3 4 6 - 2 1 17 Non-pulmonary males 1 — 1 1 — 1 — - 2 3 - 9 ,, Females — — — 1 — 1 2 - - - 1 5 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of information. No. of cases. Pulmonary NonPulmonary Death Returns from local Registrars 18 10 transferable deaths from Registrar General 7 — Posthumous Notifications 1 — "Transfers" from other areas (other than transferable deaths) 8 4 Other sources if any (specified) - — 45 Part III.—Notification Register. Number of cases of Tuberculosis remaining at the 31st December, 1931, on the Registers of Notifications kept Pulmonary. Non-pulmonary, Total cases Males Females Total Males Females Total by District Medical Officer or Health in the County The Medical Officer of Health of the County Borough or Metropolitan Borough 360 238 598 87 70 157 755 Number of cases removed from the Register(s) during the year by reason inter alia of (1) Withdrawal of Notification — — - — — — — (2) Recovery from the disease 3 2 5 1 1 2 7 (3) Death 47 44 91 9 6 15 106 (4) Removed from district 32 39 71 8 9 17 88 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 tables at pages 47/49, 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, 40 Old, 78 No. of cases at Dispensary New, 386 Old, 1,572 No. of attendances at Dispensary 2,822 No. of visits by Miss Baker First visits, 133 Re-visits, 1,730 No. of visits by Miss Kenion First visits, 90 Re-visits, 1,163 No. of Committee Meetings attended 23 The Tuberculosis Care Committee continued to meet fortnightly througho,lt 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 Councillors G. B. Ramsay and Mrs. E. M. Shirley. In addition to the Council's representatives this Committee includes:— NAME. REPRESENTS. Morris, Sir Francis (Chairman) Public Assistance Committee. Broadbent, Miss M. E. (Hon. Secretary) Invalid Children's Aid Association. Sykes, Dr. A. W. Divisional School Medical Officer to the London County Council. Marriott, Miss K. London County Council and School Care Committee. McWilliam, Miss M. Charity Organization Society Higgin, Miss E. Portland Town Association. Lazarus, Miss O. Central Jewish Synagogue. Wetherall, Miss St. Mary's Hospital, Paddington. Hawthorn, Mrs. Margaret Street Hospital. Hastings, Mrs. Somerville The Working Classes. Bennett, Miss A. M. Paddington & St. Marylebone District Nursing Association. Bowen, Miss E. A. (M.B.E.) War Pension Committee and United Services Fund. Price, Miss H. M. Middlesex Hospital. Lesser, Mr. H. E. London Insurance Committee. 46 The following extract from a report by the Tuberculosis Officer (Dr. Donaldson Saner) contains reference to a number of points that may be of interest:— "The statistics of the year will be found in the tables set forth on the special forms issued by the Ministry of Health. These forms vary slightly from those issued for the previous five years. The use of the word "cured" is done away with and "recovered" substituted. The columns are divided so as to show those patients who remain on the Dispensary Register on December 31st and those patients who have been crossed off as having been transferred to other districts, lost sight of through removal and no address left, and those who are deceased. The Form for surgical cases is similarly split up. During the year 173 cases have been sent for or returned from Sanatorium treatment through the London County Council. 194 Progress reports have been forwarded to the London County Council of those patients who have received public treatment. Of those patients, 80 are now working at their original occupation; 1 at a new occupation; 6 were fit for work but unable to obtain employment; 7 doing light work; 69 failed to attend for reasons of their own, 25 of whom were reported to be in good health and working full time, 2 marked as recovered, 2 getting about not fit for work, 1 as worse; 8 transferred to other districts ; 14 as unfit and 4 deceased. These reports cover Pulmonary and Non-Pulmonary cases. The Care Committee, meeting fortnightly throughout the year, had 324 cases brought to their notice. Six children were recommended to the Invalid Children's Aid Association direct, 6 adults referred to the Charity Organisation Society, 10 were dealt with by the Public Assistance Committee of the London County Council. The School Care Committee with two children and 8 families came under the London County Council Contact Scheme. Miss Bowen looked after the Ex-Service men and families. The X-ray department of the Middlesex Hospital has been used frequently for diagnosis in doubtful cases and surgical cases sent there for diagnosis or preliminary treatment. Some cases of children whose signs and symptoms point to a rheumatic diathesis have been referred to the Western General Dispensary. The clinics for minor ailments have also been used for cases which need attention and for temporary skin complaints such as Impetigo," 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 801, as against 776 in 1930. Of these, 154 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—Eleven of the total notifications—17 as against 20 in 1930—in the case of this form of tuberculosis came from institutions where the patients were undergoing treatment. Visits were paid to the homes and, where necessary, advice with regard to the obtaining of treatment was offered. Particulars as to the parts affected by the disease will be found in the table on page 51. TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1931. DIAGNOSIS. PULMONARY. NON-PULMONARY. TOTAL. GRAND TOTAL Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 45 38 4 1 3 3 5 4 48 41 9 5 103 (b) Diagnosis not completed - - - - - - - - 5 3 14 7 29 (c) Non-tuberculous - - - - - - - - 38 50 14 16 118 b.—Contacts examined during the year:— (a) Definitely tuberculous 1 3 — 1 — — 1 — 1 3 1 1 6 *(b) Diagnosis not completed - - — — - — — — — — 5 6 11 (c) Non-tuberculous - - — — — — — — 16 29 27 30 1102 C.—Cases written off the Dispensary Register as:— (a) Recovered (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 61 88 60 59 268 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 187 153 35 21 26 23 33 26 213 181 68 47 509 (b) Diagnosis not completed — — - — — — — 7 5 39 30 81 47 1. Number of cases on Dispensary Register on January 1st 550 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 60 5. Number of attendances at the Dispensary (including Contacts) 2,822 7. Number of consultations with medical practitioners:— (a) Personal 12 (b) Other 107 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 1,987 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above Nil 2 Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 27 4. Cases written off during the year as Dead (all causes) 28 6. Number of Insured Persons under Domiciliary Treatment on the 31st December175 8. Number of visits by Tuberculosis Officers to homes (including personal consultations 118 10- Number of:— (а) Specimens of sputum, &c., examined 242 (b) X-ray examinations made 39 in connection with Dispensary work 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 218 (B) Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment): Provided by the Council, One. Provided by Voluntary Bodies, One. Margaret St. Dispensary, Margaret St., W.l *i e., remaining undiagnosed on 31st December. 48 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. 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 1931 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. n inus. 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 (Cla 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). (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 1 2 - - 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 9 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 2 — — - — — - - — - - - - — — — - — - - - - — — — — — — - — — — - Disease not Arrested Adults M. 11 10 4 6 20 3 3 2 1 6 2 5 3 3 11 5 1 5 2 8 — 12 8 4 24 5 9 8 3 20 19 20 8 7 35 F. 4 5 4 2 11 2 2 - — 2 3 1 4 3 8 1 3 4 1 8 11 4 6 1 11 6 5 2 1 8 26 6 11 — 17 Children 17 - - - - 4 - - - - 1 1 - - 8 Condition not ascertained during the year 7 4 — — 4 2 — — — — 3 2 — — 2 3 4 2 — 6 5 4 1 — 5 3 3 — 1 4 — — — - — Total on Dispensary Register at 31st December 51 24 8 8 40 12 5 2 1 8 9 10 7 6 23 14 8 11 3 22 22 21 15 5 41 22 17 10 5 32 53 26 19 7 52 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 9 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 11 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 56 46 7 2 55 21 11 5 4 20 21 12 5 1 18 20 14 2 1 17 16 15 3 - 18 9 3 2 1 6 3 1 1 1 3 Dead Adults M. 1 4 6 27 37 1 1 5 21 27 2 - 1 18 19 1 — 2 16 18 1 1 — 6 7 — — 2 9 11 — — — 1 1 F. 1 2 3 |13 18 — - — 10 10 3 - 1 12 13 — — 1 17 18 1 1 — 10 11 1 — — 4 4 — - — 2 2 Children 1 - - - - 1 - - - - - - - - - - - - 1 1 - - - 2 2 1 - - - - - - - - - Total written off Dispensary Register 86 52 16 42 110 23 12 10 35 57 26 12 7 31 50 21 14 5 35 54 18 17 3 18 38 11 3 4 14 21 3 1 1 4 6 Grand Totals 137 76 24 50 150 35 17 12 36 65 35 22 14 37 73 35 21 16 38 76 40 38 18 23 79 33 20 14 19 53 56 27 20 11 58 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. 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 1931 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. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 — 1 — 3 1 - — 1 2 — 1 - - 1 — - - - - 1 — - — 1 - - — — — — — — — — F. 2 — — 2 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 4 1 — 4 9 — — — 4 4 1 — — 1 2 1 — — 1 2 — — - — — - — — — — — — 1 — 1 Disease not Arrested Adults M. 1 — — — 1 - — — — — 1 — — — 1 1 — — — 1 6 — 1 2 9 — — — 1 1 1 1 1 1 4 F. - - - - - - - - - - - - - - - - - - - - 1 1 1 3 6 3 1 2 1 7 1 1 1 — 3 Children 5 — — 3 8 3 - — — 3 1 1 - 1 3 2 1 - 2 5 2 — — 3 5 2 — — 3 5 4 2 — 4 10 Condition not ascertained during the year 4 — — — 4 — - — — — — — - - - 1 - — — 1 1 — 1 — 2 — 1 — — 1 — — — — Total on Dispensary Register at 31st December 18 1 1 9 28 4 - - 5 9 3 2 - 2 7 5 1 - 3 9 11 1 3 8 23 5 2 2 5 14 6 4 3 5 18 Transferred to Pulmonary 1 — — 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Not now on Dispensary- Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 1 1 — 2 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 15 4 1 5 25 1 1 1 - 3 3 - - 1 4 1 - - 3 4 1 - 2 1 4 1 - - 1 2 1 - - - 1 Dead Adults M. 2 1 - - 3 - - - - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - 1 1 - - - - - - - - - - - - - - - 1 - - - 1 - - - - - Total written off Dispensary Register 18 6 1 7 32 1 1 1 1 4 3 - - 1 4 1 - - 3 4 2 - 2 1 5 2 - - 1 3 1 - - - 1 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 36 7 2 16 61 5 1 1 6 13 6 2 — 3 11 6 1 — 6 1 13 1 5 9 28 7 2 2 6 17 7 4 3 5 19 49 50 Deaths from Phthisis.—Some reference has already been made to the matter of deaths from tuberculosis and at this point it is proposed only to deal with the figures relating to tuberculosis of the lungs (consumption or phthisis). During 1931 the total number certified as due to this cause was 81, the deathrate being 0.8 per 1,000. In 1930 the deaths numbered 75, the death rate being 0. 7 per 1,000. The distribution of the deaths according to registration districts is shown in the accompanying table, which gives also the figures for each of the 6 years 1926-1931. Deaths from Phthisis. 1926—1981. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1931 93,460 81 19 21 26 15 The distribution of the 81 deaths was as follows:—In Poor Law Institutions, 40 ; in general and other hospitals, 13; and at home, 28. Of those who died 36 were insured (28 males and 8 females), and 45 uninsured (17 males and 28 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 81, the notified cases of pulmonary tuberculosis totalled 145. The following table prepared at the request of the Ministry of Health contains information with regard to age and sex distribution of all forms of tuberculosis that may be found interesting. Age Periods *NEW CASES ALL DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 - - 1 - - - 1 - 1—5 — — 1 1 — — - — 5—10 1 — 4 1 - — 1 1 10—15 3 — 2 2 1 — — 1 15—20 8 10 1 - 1 3 - - 20—25 11 10 1 5 2 5 1 - 25—35 14 28 2 4 6 8 - 1 35—45 24 18 — — 10 7 - - 45-55 19 8 2 — 11 7 2 - 55-65 10 6 3 — 10 4 1 1 65 and upwards 6 3 - 1 4 2 — 1 Totals 96 83 17 14 45 36 6 5 *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. 51 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 2nd JANUARY, 1932. Localisation of 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. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals Lungs 145 — — 4 35 66 34 6 33 40 54 18 145 14 16 19 8 57 88 Glands 4 — 2 2 - - - - 2 2 - - 4 1 - - - 1 3 Knee 1 - — 1 - — - — 1 - - - 1 1 - - — 1 — Peritoneum 2 - - - 1 1 - - - - 2 - 2 - - 1 — 1 1 Spine 1 - - - — 1 - - - - 1 - 1 - - 1 - 1 - Abdomen 2 — - 1 1 - - - 1 1 - - 2 1 1 — - 2 - Meninges 2 - - 2 - - - - 1 - 1 - 2 1 - 1 - 2 — Skin 1 - - - 1 - - - - - 1 - 1 - - - - - 1 Cheek 1 - - - 1 - - - — — 1 - 1 - - 1 — 1 — Kidney 1 - - - - 1 - - - 1 — - 1 - 1 — — 1 — Hip 1 - - - 1 - - - - - 1 — 1 - - - - - 1 Fallopian tubes 1 — - - - 1 - - 1 - - - 1 1 - - - 1 — Totals 162 - 2 10 40 70 34 6 39 44 61 18 162 19 18 23 8 68 94 162 52 DISINFECTION. The work done in this connection during 1031 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 208 5 1 4 5 218 Mattresses 1,042 18 4 24 72 1,160 Bolsters 378 8 1 4 25 416 Pillows 2,348 34 11 16 293 2,702 Sheets 809 15 3 18 5 850 Blankets 1,989 27 5 484 16 2,521 Sundries 10,500 113 5 136 68 10,822 Totals 17,269 220 30 686 484 18,689 In 1930 the number of articles disinfected was 10,483. The number of journeys made by the disinfecting vans during the year ended December, 1931, was:— January 94 August 89 February 84 September 100 March 95 October 89 April 74 November 86 May 94 December 84 June 92 July 87 1,068 The number of journeys made during 1930 was 1,132. The number of rooms disinfected and the reasons for carrying out disinfection are stated below:— Reasons for Disinfection. Compulsorily Notifiable Diseases. Phthisis. Measles. Other causes. Total. January 60 6 1 15 82 February 47 6 3 4 60 March 49 6 6 5 66 April 63 2 3 4 72 May 58 2 2 8 70 June 82 13 1 7 103 July 66 6 2 12 86 August 66 3 — 5 74 September 53 — — 2 55 October 60 12 — 9 81 November 52 5 — 3 60 December 72 23 — 7 102 Totals 728 84 18 81 911 The number of rooms disinfected in 1930 was 1,13.2. 53 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 258. 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 1931 and annually since 1921:— 1931 ADULTS CHILDREN Males Females Total Males Females Total January 258 72 330 65 144 209 February 255 55 310 107 231 338 March 221 64 285 105 257 362 April 207 63 270 45 104 149 May 200 64 264 69 165 234 June 234 66 300 140 370 510 July 247 61 308 124 222 346 August 201 62 263 12 55 67 September 232 59 291 120 240 360 October 263 67 330 60 198 258 November 232 50 282 127 235 362 December 245 51 296 30 133 163 Totals 2,795 734 3,529 1,004 2,354 3,358 Cleansing Station Attendances, 1921-1931. Year. ADULTS CHILDREN Males Females Total Males Females Total 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 1931 2,795 734 3,529 1,104 2.354 2,358 The total attendances since the Baths were opened in 1898 number 267,017 (adults, 188,596 ; children, 78,421). It will be noted that there was a considerable number of school children cleansed during 1931, and this is accounted for by the activity of the School Nurses. Of the number, 3,260 children were sent from schools in the Borough, but not all 54 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 £283 8s. for this service. BACTERIOLOGICAL EXAMINATIONS. The following table shows the number of specimens examined for purposes of diagnosis, and indicates also the diseases in relation to which the examinations were made. 1931. Positive. Negative. Total. Typhoid fever 4 46 50 Diphtheria 152 2,815 2,967 Phthisis 154 647 801 Totals 310 3,508 3,818 MATERNITY AND CHILD WELFARE. The Maternity and Child Welfare Scheme in St. Marylebone is made up of voluntary and official elements. Of the voluntary elements, to the nature of which reference is made later, those for which the St. Marylebone Health Soceity is responsible bulk largest. The Council, who made a grant of £1,000 in 1931 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 stiil doing very valuable work and helping whenever possible, are The Home of the St. Marylebone Female Protection Society, which for financial and other reasons unfortunately had to abandon its very useful work towards the end of the year; St. Agatha's Home, and the Home of the Little Company of Mary, 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 1931. 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. 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. 55 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 1931. Statement Showing Arrangements Made for Maternity and Child Welfare. 1. Population of the area served by the Council, 93,460. 2. Number of births notified in that area during the year under the tions of Births Act, 1907, as adjusted by any transferred notifications: (a) Live births, 1,335; (b) Still births, 46; (c) Total, 1,381; (d) By midwives, 522; (e) By doctors and parents, 175; (f) By hospitals, 265; (g) By matrons of Nursing Homes and transferred notifications, 419. 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) Equivalent of whole time services devoted by the whole staff to health visiting (including attendance at infant welfare centres) (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, 405; total visits, 522. (b) To children under 1 year of age, first visits, 973; total visits, 7,657. (c) To children between the ages of 1 and 5 years, total visits, 6,052. 4. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council, one. Opened 24th March, 1931. (Three year old pre-school clinic.) (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 1 year of age, 12,788; (ii) By children between the ages of 1 and 5 years, 15,287 + 104 (3 year olds). (d) Average attendance of children per session at all Centres during the year, 22.07. (e) Total number of children who attended at the Centres for the first time during the year: (i) Children under 1 year of age, 1,092; (ii) Children between the ages of 1 and 5 years, 323 + 104 (3 year olds). (f) Percentage of total notified births represented by the number in (e) (i), 79.07. 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 tions, 4. (c) Total number of attendances by expectant mothers at all Clinics during the year, 19,254.* (d) Average attendance of expectant mothers per session at all Clinics during the year, 41.5.* (e) Total number of expectant mothers who attended at the Clinics during the year, 3,601.* 56 (f) Percentage of total notified births represented by the number in (e), 102.* *These figures apply to all mothers attending the clinics at Queen Charlotte's Hospital, Middlesex Hospital, etc. The figure for Marylebone residents is not obtainable. 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, 13,145: (ii) half-day, 1,898. 11. Infectious Diseases. Disease. Number of cases notified during the year. 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 or nursing homes. (1) Ophthalmia Neonatorum 10 9 3 4 (2) Pemphigus Neonatorum — — 2 — (3) Puerperal Fever 11 10 — 9 (4) Puerperal Pyrexia 22 11 — 19 (5) Measles and German Measles (in children under 5 years of age) 104 — — (6) Whooping Cough (in children under 5 years of age) Not Notifiable 61 — — 7) Epidemic Diarrhoea (in children under 5 years of age) — 1 — (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, the time of 1/3 nurses. (b) Total number of cases attended during the year by these nurses, 58. 13. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 22. (b) Number (i) employed by the Council, nil; (ii) subsidised by the Council, nil; (iii) employed by Voluntary Associations, nil. 1.4, 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, 1; (ii) from other causes. 2. (b) Number of these cases which died: (i) at home, nil; (ii) in tions, 2. 57 INFANT WELFARE CENTRES, MATERNITY CLINICS, DAY NURSERIES, DIPHTHERIA IMMUNIZATION CLINIC, and CLINIC for PRE-SCHOOL CHILDREN. 30, Marylebone Lane, W, 1— Tuesday, 10 a.m. Infant Consultation. Thursday, 2 p.m. „ „ „ 2 „ Maternity Clinic. Middlesex Hospital, Mortimer Street, W.1— Monday and 9 a.m. Maternity Clinic. „ 1.30 p.m. Infant Consultation. Wednesday, 1.30 ,, Toddlers (2—5 years). Thursday, 1.30 ,, Infant Consultation. „ 9 a.m. Maternity Clinic. Friday, 2 p.m. Infant Consultation, Cosway Street, N.W.I— Tuesday, 1 p.m. Infant Consultation. Thursday, 2 „ Needlework Class. Friday, 10 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, 9.30 a.m. Light Clinic. Do. 10 „ Massage Clinic. Do. 2 p.m. Infant Consultation. Wednesday, 2 „ Maternity Clinic. „ 2 „ Needlework Class. Thursday, 2 „ Toddlers (2—5 years). Friday, 9.30 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, Bryanston Square, W. 1— Tuesday, 2.15 p.m. Infant Consultation. 12, Salisbury Street, Wednesday, 2.30 p.m. Dental Clinic. 113, Marylebone Road— Monday, 2 p.m. Diphtheria Prevention Schick Testing, etc. Thursday 2 „ Ditto Wednesday 2 „ Pre School children. 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. 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 1931 the health visitors made 9,838 visits to children and 522 visits to mothers. Children are visite up to school age. 58 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 anr ante- and post-natai 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 113, Marylebone Road. The clinic was held twice 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 1931 was 2,447 ; the total births numbering 3,514. The midwives residing in the borough registered as intending to practise in the administrative County of London, number 22. Two conduct maternity homes which are registered by the London County Council. By an arrangement with the Paddington and Marylebone Nursing Association all women in the borough attended by externs of St. Mary's Hospital, are provided with nursing attention by the Association. During the year 39 cases were dealt with under the arrangement, and 624 visits were paid, the services of the nurses being greatly appreciated by the patients. Work done during 1931.—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. 59 II. STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDING 31ST DECEMBER, 1931. 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 82 146 64 89 94 149 92 Toddlers 20 50 — 10 — 53 91 Maternity — 50 305 — 12 97 — Massage — 84 68 — 8 — — Light - 85 - - 26 - - No. of attendances of mothers at clinic:— Ante-natal - 240 15,328 — 14 3,672 - Post-natal - 452 16 — — 168 - No. of attendances of babies 1,127 2,933 1,514 1,260 1,125 4,373 186 No. of attendances of children over 1 years 1,118 2,966 933 1,283 838 3,402 1,049 No. of attendances at light Clinic— Infants — 93 — — 19 — — Toddlers — 2,538 — — 32 — — No. of attendances at massage Clinic— Infants — 33 115 — 10 — — Toddlers — 962 168 — 3 — — No. of orders issued for milk, etc. 61 623 82 186 94 168 1 No. of home visits 2,318 3,141 153 1,132 454 2,886 — No. of new cases:— Infants 113 201 156 81 73 327 87 Toddlers 14 37 6 21 4 28 122 Ante-natal — 60 2,951 — 4 586 — Post-natal — 52 14 — — 168 — Massage — 51 18 — 10 — — Light — 52 — — 14 — — Day Nurseries—Attendances during the year. The Crossley, Barrow Hill Road 5,178 The Portman, Exeter Street 7,199 60 Dental Clinic, 12 Salisbury Street. Attendances daring the year : Mothers, 874; Children 104 Advice and treatment given in 639 cases—extractions under gas 839. Home Helps.—Home helps were provided by request in 1931 in 5 cases only, the total amount expended during the financial year to 31st March, 1932, being £6 8s. 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, 1931. 1931. Males. Females. Total. For burial only. For inquests. Total. No. of P.M 's held. No. of courts held. No. of Infectious cases. January. 7 12 19 18 1 19 6 - - February 8 8 16 14 2 16 7 — — March 6 14 20 19 1 20 9 — — April 3 4 7 7 — 7 3 — — May 6 2 8 6 2 8 4 — — June 8 7 15 11 4 15 7 — — July 5 3 8 7 1 8 4 — — August 6 1 7 6 1 7 4 — — September 8 7 15 11 4 15 3 3 — October . 7 7 14 13 1 14 6 — — November 5 2 7 7 — 7 3 — — December 6 8 14 12 2 14 8 - — Totals 75 75 150 131 19 150 64 3 — The fact that there are caretakers (a man and his wife) at the Tuberculosis Dispensary has already been noted. In addition to looking after the premises they also render great assistance in connection with the conduct of the clinics, taking notes, helping in the weighing of the patients, etc. (2) Hospital accommodation.—This being a matter with which the Borough Councils in London have no direct concern, it is not considered necessary to make special reference to it. Nursing homes in the Borough number 55, but with these registration under the Nursing Homes (Registration) Act, 1927, being in the hands of the London County Council, the Borough Council, whose officers could very easily and efficiently carry out the duties involved, have no concern whatever. (3) Local Acts, special local orders and their administration.—There are no Acts or Orders applicable in the Borough which do not apply to other parts of London. The London County Council (General Powers) Acts contain a number of provisions under which a considerable amount of work is done, e.g., those relating to places where food is dealt with. Reference is made to these elsewhere. 61 HOUSING. The information asked for by the Ministry with regard to housing is contained in the following statement. The Increase of Rent and Mortgage Interest (Restrictions) Act, 1920, so far as regards the provisions of Section 2 (2), and the Rent and Mortgage Interest Restrictions Act, 1923, Section 18 (1) relating to certificates as to suitability for occupation of houses, were not taken advantage of during the year, no application being received. 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,859 (b) Number of inspections made for the purpose 10,296 (2) (a) Number of dwelling-houses (included under sub-head (1) above which were inspected and recorded under 639 houses and the Housing Consolidated Regulations, 1925 373 tenements (b) Number of inspections made for the purpose 3,472 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,311 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 1,260 3. Action under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (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 B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 51 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 51 (b) By local authority in default of owners Nil C.—Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which lition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 62 E.—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 F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which Closing Orders were made Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which lition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil Note.—Sections 11 to 15 of the Housing Act, 1925, have been repealed by the Housing Act, 1930, but the proviso to Section 64 of the Act of 1930 continues in force any Closing Orders and Demolition Orders made before the operation of the Act (15th August, 1930), and houses subject to those Orders must continue to be dealt with under the relative provisions of the Act of 1925. In the report for 1930, which was a "Survey" report, a considerable amount of space was devoted to a discussion with regard to the housing conditions within the Borough. During 1931, speaking generally, very little change occurred and anything now said would be largely repetition of statements made in the report of last year. As to progress it may be noted that by the end of the year part of the Carlisle Street area, on the north side of North Street, had been cleared and though no accommodation had actually been got ready for families de-housed and temporarily accommodated elsewhere, two blocks were well on the way to completion. During the year the survey of housing in St. John's Wood, particularly in what has been named the Henry Street area, was completed. The following is the report submitted to and adopted by the Public Health Committee and referred by them to the Housing Committee:— To the Chairman and Members of the Public Health Committee. Mr. Chairman, Ladies and Gentlemen, HOUSING—ST. JOHN'S WOOD. I have now completed the survey in St. John's Wood of the area to which the general name of Henry Street area may be applied, and herewith I submit summaries relating to particular parts of this area, these parts being the same as in the report submitted by you in 1926 and printed in the Housing Memorandum (smail blue book). The information, it will be noted, in addition to being partly general, is more or less detailed with regard to the conditions relating to occupation of the houses, extent of overcrowding, etc. As a result of my investigations I do not find any reason for submitting any different recommendation from that already given, viz., that in the meantime the question of making a clearance or improvement scheme by the Borough Council might remain in abeyance. 63 Speaking generally, although there are exceptions, the bulk of the persons occupying the houses are of a good working-class type, and the houses, so far as they are concerned, are kept in a good condition. There are exceptions, but these are comparatively few, in which the tenants, as a result of carelessness or poverty or for other reasons, maintain the houses in bad condition, and in a few instances even have permitted the places to become almost of the type found in what are commonly called slums. These cases are, however, extremely few, and as a result of the house-to-house inspection which has been made, marked improvement, even in these, has been obtained. In other directions, as a result of the investigations and the service of notices and of personal appeal to the landlords, quite considerable alterations have been carried out. These improvements, in the case of one of the blocks, have resulted in the formation of a large open space and the providing of greatlyimproved lighting and ventilation to a number of premises. The actual number of notices that have been served during the course of the inspections is noted in the summaries, but apart from these, as indicated, there has been a great deal of informal communication with the owners. In response to an enquiry as to proposals for future development of the property, I have received a letter from the agents from which it appears quite certain that at the earliest possible opportunity steps will be taken, and that it is mainly legislative difficulties which are holding up advance. In the meantime the owners are prepared to exercise a careful supervision of the properties, and to carry out a considerable amount of work in maintaining the premises in a habitable condition. Close supervision, of course, is also kept by the Public Health Department, and wherever necessary, notices are served or communications sent with regard to matters calling for attention. It will presumably be the desire of the Public Health Committee that this supervision should be maintained, and to instruct me accordingly. The Housing Committee of the Council naturally being interested in the inspections which have been made and the results that have been obtained, the Public Health Committee no doubt will consider it proper to give instructions for a copy of the summaries and this note to be sent to that Committee. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER, Medical Officer of Health. HOUSING CONDITIONS—PORTLAND TOWN, HENRY STREET AREA, ST. JOHN'S WOOD. (Note.—The areas referred to below are as set out in the Memorandum on Housing (small blue book), dated July, 1926. AREA No. 1. Boundaries. This area has a frontage of dwelling-houses and other buildings in Henry Street, Upper William Street, Barrow Hill Road and Charlbert Street, and contains a small court, Henry Place, entered by a passageway 9 feet wide between Nos. 75 and 77, Henry Street. Area Measurements. The total superficial area is approximately 76,263 square feet, and the total uncovered yard and garden space is approximately 22,980 square feet. 64 Light and Ventilation. Nos. 7 and 8, Henry Place are of the single type of house with through ventilation provided only by means of an opening staircase skylight, and in a number of the houses in Barrow Hill Road the lighting of the ground floor back rooms is impeded by the two storey back addition buildings. Generally, the lighting and ventilation of the houses are satisfactory. General Conditions. In Henry Street between Charlbert Street and Henry Place there are two unoccupied derelict premises and several occupied premises in a worn-out condition. A number of the latter were unoccupied and derelict in the year 1919, but owing to the shortage of housing accommodation the owners were persuaded to make them habitable and to open them for occupation. In Henry Place, Upper William Street and Barrow Hill Road the premises are generally in a fair state of repair. Dampness. There is a tendency to dampness in the walls of some of the ground floor rooms but steps are being taken to remedy the defect by re-rendering the inside surfaces of the walls with waterproof cement compo and by the repair of exterior pointing and rendering when necessary. Sites not Concreted. In every instance it is probable that the sites of the house are not protected by a layer of concrete. Under-Floor Ventilation. In most houses satisfactory means of ventilation to the space under the ground floor is provided by means of gratings in the front and back walls. Drains. In 22 premises the drains have been reconstructed since 1901, and in two instances notices to reconstruct the drains have been served. Generally the drains are adequate. Water-Closets. A satisfactory water-closet is provided to each house in the area. Refuse. One or more sanitary bustbins are provided to each house for the storage of domestic refuse. Vermin. Out of a total of 347 rooms, 28 were found to be bug-infested. Cooking Accommodation. In each tenement a gas cooker or range is provided for cooking purposes. Food Storage. Properly ventilated food cupboards are not provided in the tenement houses. Water Supply. A drinking water supply direct from the main is available in each tenement. 45 notices have been served requiring the owner to repair defective floors, cooking ranges, windows, roofs, yard paving, to remedy dampness in the walls of ground floor rooms, to provide ventilating gratings to the space under the ground floor rooms and to deal with verminous rooms and rooms in need of cleansing and repair. Assistance and advice have also been given to a number of tenants in regard to methods to be employed to cleanse verminous articles of furniture. 65 Area No. 1. Total premises 65 Total dwelling houses 61 Premises used for dwelling and business (included in total dwelling houses) 16 Used for business only 2 Derelict Number of owner occupiers 3 Total number of living and sleeping rooms 347 Number of separate tenements 133 Number of adults 340 Number of children under 14 112 Total population 452 Population per room for area 1.3 Analysis of Tenements. No. Adults. Children under 14. Total Population. 1 room 21 30 6 36 2 room 60 135 53 188 3 room 24 67 24 91 4 room 16 53 16 69 5 room 6 26 7 33 6 room 5 21 4 25 7 room — — — — 8 room 1 8 2 10 Totals 133 340 112 452 AREA No. 2. Boundaries. This long rectangular-shaped area includes the houses on both sides of Townshend Cottages and a frontage of houses in Henry Street in addition to a few houses at each end in Charlbert Street and Townshend Road. Area Measurements. The total superficial area is approximately 94,284 square feet, and the total uncovered space is approximately 30,356 square feet. Lighting and Ventilation. Eleven of the houses in Townshend Cottages are of the type known as single houses without through ventilation. Generally the lighting and ventilation of the houses throughout the area are satisfactory. Seven of the houses in Henry Street have basement rooms used for dwelling purposes. In three instances they are also used for sleeping purposes. General Conditions. The houses are in a structually sound condition, and are kept in a fair stall- of repair, although minor defects due to age and wear are constantly recurring Dampness. Owing to the absence of horizontal damp courses there is a tendency to dampness in the lower storeys of the houses. In the instances discovered during inspections action has been taken to ensure the protection of the walls by means of a waterproof coating of cement or other suitable materials. 66 Sites not Concreted. Except in houses where wooden floors in the lower storeys have been replaced by concrete, it is probable that the house sites are unprotected by a layer of concrete. In one case on the north-west side of Townshend Cottages (No. 8) the site was recently uncovered in one room in preparation for re-flooring and was discovered to consist of soft wet earth. As all these houses abut on the gardens at the rear of St. John's Wood Terrace, and it is likely that the sites are in a similarly wet condition, the owners should be required to provide a protecting concrete layer to each house. Under-Floor Ventilation. In most houses the space under the ground floor is ventilated by means of gratings in the front and rear walls. Drains. In 36 premises the drains have been reconstructed since 1901. Generally the drains are adequate. Water-Closets. A satisfactory water-closet is provided to each house in the area. Refuse. One or more sanitary dustbins are provided to each house for the storage of domestic refuse. Vermin. Out of a total of 405 rooms only 23 were found to be bug-infested. Cooking Accommodation. In each tenement a gas cooker or range is provided for cooking purposes. Food Storage. Properly ventilated food cupboards are not provided by the owners for the storage of food. Water Supply. A drinking water supply direct from the main is available to each tenement. Service of notices for defects discovered is continuing. Area No. 2. Total premises 100 Total dwelling houses 93 Premises used for dwelling and business (included in total dwelling houses) 23 Used for business only 7 Derelict — Number of owner occupiers — Total number of living and sleeping rooms 405 Number of separate tenements 159 Number of adults 423 Number of children under 14 145 Total population 568 Population per room for area 1.4 67 Analysis of Tenements. No. Adults. Children under 14. Total Population. 1 room 38 44 9 53 2 room 49 115 69 184 3 room 36 116 31 147 4 room 23 92 21 113 5 room 10 43 15 58 6 room 2 9 — 9 7 room l 4 — 4 8 room — — — — Totals 159 423 145 568 AREA No. 3. Boundaries. This wedge-shaped area has a frontage of terrace houses in Henry Street, Townshend Road, Frederick Street, and Eamont Street, and contains three courts, Beckett's Place and Tucker's Place entered from Frederick Street, and Eamont Place entered from Eamont Street, in addition to a large garage entered from No. 18, Eamont Street, and a building used as a coal and wood store entered from No. 41, Henry Street. Area Measurements. The total superficial area is approximately 89,700 square feet, and the total uncovered garden and yard space is approximately 32,626 square feet. lighting and Ventilation. The lighting and ventilation of the houses on the frontages generally are satisfactory although in some instances in Henry Street, Townshend Road and Frederick Street the lighting of the rear ground floor rooms is impeded by back addition buildings. The houses in Beckett's Place back on to the houses on the east side of Tucker's Place, and the two are separated by very small yards. In front of Beckett's Place, however, there is a large open space used as a garden, and between the two sides of Tucker's Place there are long forecourts. The houses on the west side of Tucker's Place have similar small yards, three of which back on to the small yards of the houses in Eamont Place ,and five on to the rear wall of the garage at No. 18, Eamont Street. No. 1a, Tucker's Place, consisting of a builder's store on the ground floor with dwelling rooms above, has a forecourt only. The houses in Eamont Place are separated from the rear yard wall of premises in Eamont Street by a narrow court approached from Eamont Street. General Condition. With few exceptions the houses in the area have been inconveniently occupied for many years by more families than they were intended to accommodate and the consequent wear and tear to such parts as windows, doors and stairs has been excessive, although structurally the houses remain generally sound. Dampness. Owing to the absence of horizontal damp courses, there is a tendency to dampness in the walls of the ground floor rooms. In the instances discovered during the survey the walls have been re-rendered inside with damp-proof Portland cement and sand and external rendering or pointing has been made good where necessary. Sites not Concreted. Except in the few cases where wooden floors have been replaced by concrete it is probable that the sites of the houses are not protected by a layer of concrete, 68 Under Floor Ventilation. In most instances satisfactory means of ventilation to the space under the ground floor is provided by means of gratings in the front and rear walls. Drains. The drains of the houses are generally adequate, and in many instances of modern design. In 31 premises the drains have been reconstructed since 1901, the total number of dwelling houses being 87. Water-Closets. Two of the tenement houses in the area are provided with two water-closets, the remainder having one only for the use of the numerous occupants. Of the latter, six houses have more than twelve occupants over seven years of age. Refuse. One or more sanitary dustbins are provided to each house for the storage of domestic refuse. Vermin. During the recent survey of 475 rooms, 37 were found to be more or less buginfested. In every instance action has been taken by the owners and occupiers to render them free. Cooking Accommodation and Food Storage. In most tenements satisfactory cooking accommodation in the shape of a gas cooker or cooking range is provided, but properly ventilated food cupboards are generally lacking. Water Supply. A. drinking water supply direct from the main is available to each tenement. In consequence of representation to the owners a large building used as a wood and coal store at the rear of Nos. 35, 37, 39 and 41, Henry Street has been demolished and considerable improvement in the lighting and ventilation of the rooms at the rear have been gained. A small dilapidated building used as a stable and store at the rear of No. 34, Frederick Street has also been demolished and the space thrown open to Tucker's Place, and, in addition, the badly ventilated rooms on the first floor of No. Ia, Tucker's Place have been vacated and the premises are now used as a builder's store. 87 notices have been served requiring the owner to repair defective floors, cooking ranges, windows, roofs, yard paving, to remedy dampness in the walls of ground floor rooms, to provide ventilating gratings to the space under the ground floor rooms, and to deal with verminous rooms and rooms in need of cleansing and repair. Assistance and advice have been given to tenants in regard to methods to be employed to cleanse verminous articles of furniture. Area No. 3. Total premises 89 Total dwelling houses 87 Premises used for dwelling and business (included in total dwelling houses) 20 Used for business only 1 Derelict 1 Number of owner occupiers — Total number of living and sleeping rooms 475 Number of separate tenements 188 Number of adults 512 Number of children under 14 161 Total population 673 Population per room for area 1,4 69 Analysis of Tenements. No. Adults. Children under 14. Total Population. 1 room 35 47 18 65 2 room 69 159 75 234 3 room 46 135 36 171 4 room 31 140 32 172 5 room 2 8 — 8 6 room 5 23 — 23 7 room — — — — 8 room — — — — Totals 188 512 161 673 AREA No. 4. Boundaries. This area has a frontage of terrace houses in Eamont Street, Frederick Street and Charlbert Street, and contains a large interior space partly covered by stables and workshops. Area Measurements. The total superficial area is approximately 57,600 square feet, and the total interior uncovered garden and yard space is approximately 20,300 square feet. The north-west corner of the area is occupied by No. 53a, Henry Street, a Mission Hall and School House, the property of St. Stephen's Church, Avenue Road, and the De Walden Institute. No. 53a, Henry Street, let to two families (total 6 persons), is a brick built dwelling house of three storeys above ground, containing 9 rooms and a basement scullery. The ground floor back room and basement kitchen are dark and hemmed in by adjoining buildings. Generally the premises are in a fair condition. The School House is a brick built premises of three storeys containing eleven rooms used for living and sleeping purposes by five families of nine adults and four children under fourteen years of age, in addition to two large rooms at the rear used for meetings by Boy Scouts and boys from the Parish Hall and Mission. Generally the premises are in fair condition. The De Walden Institute, which was built in the year 1897, contains well designed accommodation for the caretaker and his family, in addition to club rooms, a billiard room, and rooms used for public and other meetings. The first floor is occupied during the daytime by the London School of Opera. The superficial area, less School, Mission, Institute and 53a, Henry Street, is 41,440 square feet approximately. Yard and garden space of the reduced area is approximately 17,277 square feet. Lighting and Ventilation. The lighting and ventilation are satisfactory at the front and rear of the dwelling houses, except in the case of No. 35, Eamont Street, close at the rear of which is a two-storeyed builder's workshop and store, and No. 33, Eamont Street, at the rear of which is a one-storeyed building used as a store. Dampness. Owing to the absence of horizontal damp courses, there is a tendency to dampness in the walls of the ground floor rooms, but in the instances discovered the walls have been re-rendered inside with waterproof cement and sand, and, where necessary, the exterior pointing and rendering have been repaired. 70 Sites not Concreted. In every instance it is probable that the sites of the houses are unprotected by a layer of concrete. Under-Floor Ventilation. Satisfactory means of ventilation to the space under the ground floor is provided by means of iron gratings in the front and rear walls. Drains. The drains of the houses are generally adequate and in many instances of modern design. In 15 cases the drains have been reconstructed since 1901. Watcr-Closets. Two houses in the area (53a, Henry Street and 36-38, Charlbert Street) are provided with two water-closets, the remainder having only one. In none of the houses are there more than twelve occupants over seven years of age. Refuse. One or more sanitary dustbins are provided to each house for the storage of domestic refuse. Vermin. Out of a total of 186 rooms, nine were found to be bug-infested. (Prompt action by the owners and occupiers has been taken in every instance to render them free). Cooking Accommodation. Cooking accommodation in the shape of a range or gas cooker is provided to each tenant with two or three exceptions. Food Storage Accommodation. Ventilated food cupboards provided by the owners are generally lacking throughout this area. In a few instances the tenants have food safes hanging on staircase walls or in the yards. Water Supply. A drinking water supply direct from the main is available to each tenement. 30 notices have been served directing the attention of the owner to minor structural defects and want of cleanliness as in Area No. 3, and representation to the owners resulted in the improvement of the lighting and ventilation of the ground floor back room at No. 22, Charlbert Street through the removal of an obstructive roof structure. Area No. 4. Total premises 45 Total dwelling houses 38 Premises used for dwelling and business (included in total dwelling houses) 4 Used for business only 3 Derelict 3 Number of owner occupiers - Total number of living and sleeping rooms 186 Number of separate tenements 75 Number of adults 177 Number of children under 14 46 Total population 223 Population per room for area 1.2 71 Analysis of Tenements. No. Adults. Children under 14. Total population. 1 room 24 35 11 46 2 room 19 41 13 54 3 room 10 27 5 32 4 room 18 58 16 74 5 room 2 6 1 7 6 room 2 10 — 10 7 room - — — — 8 room - — — — Totals 75 177 46 223 AREA No. 5. Boundaries. This area has a frontage of eight houses in Frederick Street, two in Eamont Street, and a rear boundary of six stables in Eamont Mews. It occupies about one-third of an island site bounded by Albert Road, Charlbert Street, Frederick Street and Eamont Street, with a superior type of house in Albert Road and Charlbart Street. Area Measurements. The total superficial area is approximately 11,875 square feet, and the total uncovered space including yards and Eamont Mews is approximately 4,617 square feet. Lighting and Ventilation. The lighting and ventilation of the dwellings are generally satisfactory. General Conditions. No. 5, Frederick Street is unoccupied, and No. 6, Frederick Street is unoccupied and derelict. The remainder of the houses in Frederick Street and Eamont Street and the stables in Eamont Mews are in fair state of repair. Dampness. In some of the houses in the area there are indications of dampness in the ground floor rooms. Sites not Concreted. Except in the case of No. 3, Eamont Street, and No. 8, Frederick Street, the basement of which is concreted, the sites of the houses are not protected by a layer of concrete. Under-Floor Ventilation. Ventilation to the space under the floors of occupied rooms is provided by meaas of gratings in the front and rear walls. Drains. In three premises the drains have been reconstructed since 1901. Generally the drains are adequate. Water-Closets. A water-closet is provided to each of the occupied houses in the area. Refuse. One or more sanitary dustbins are provided to each house for the storage of domestic refuse. 72 Vermin. Out of the total of 56 rooms, 9 were found to be bug-infested. Food Storage. Properly ventilated food cupboards are lacking throughout the houses in the area. Water Supply. A drinking water supply direct from the main is available to each tenement. Area No. 5. Total premises Total dwelling houses Premises used for dwelling and business (included in total dwelling houses) Used for business only Derelict Number of owner occupiers Total number of living and sleeping rooms Number of separate tenements Number of adults Number of children under 14 Total population Population per room for area 16 8 1 6 1 56 16 52 21 73 1.3 Analysis of Tenements. No. Adults. Children under 14. Total population. 1 room 1 1 - 1 2 room 4 11 4 15 3 room 6 19 11 30 4 room 2 11 1 12 5 room 3 10 5 15 6 room — — — — 7 room — — — — 8 room — — — — Totals 16 52 21 73 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 128 Slaughterhouses 1 Offensive Trades 3 Ice Cream Premises 76 Bakehouses 54 Restaurant, Dining Room and Coffee Shop Kitchens 201 Hotel Kitchens 24 Pastrycooks and Tea Rooms 90 Fried Fish Shops 25 Fish Curers 6 Houses Let in Lodgings 1,055 Workshops and Workplaces 3,36a Total 5,021 73 Smoke Nuisances. Number of Observations Number of Intimation Notices served Number of Statutory Notices served 262 Number of Nuisances and Complaints 17 Number of Summonses Nil Number of Convictions Nil Amount of Penalty and Costs 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) 1,859 (b) House-to-house (Housing Consolidated Regulations, 1925) 639 Tenements in blocks 373 Number of Representations by Medical Officer or other person Number of Houses included in such representations Total 1,012 Number of Notices served— (a) Under P.H. Act:— (1) Intimation 1,260 (2) Statutory 51 (b) Under Housing Act Nil Number of Houses repaired or nuisances remedied under P.H. Act, 1891 1,311 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 13 (b) In course of erection 60 Mortuary. Number of bodies received Number of Infectious bodies received Cleansing of Persons Act, 1897. Adults. Males. Females. Number of persons cleansed 2,795 734 Bakehouses. Number on Register at end of 1931 Number above ground Number underground Number of Inspections Number of Notices Number of Prosecutions Number of Closing Orders made Number of Closing Orders determined (i.e., Houses made fit) Number of Demolition Orders Number of Houses demolished— (a) In pursuance of Orders (b) Voluntarily Total Number of Houses in the borough Number of Houses occupied by the Working Classes Number of Houses registered under the new Bye-laws as to Houses Let in Lodgings Number of Inspections made of such Houses Number of Prosecutions Nil Nil Nil Nil Nil Nil 80 19,764 8,543 Nil Nil Nil Children. Males. Females. 1,004 2,343 150 Nil Total. 6,887 54 5 49 108 7 Nil 74 Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1931 346 Number of Inspections 672 Number of Notices 20 Number of Prosecutions Nil House To House Inspections. Number of Inspections Houses 639 Tenements 373 Number of Notices issued Intimations 541 Statutory Notices 28 Number of Prosecutions Nil House Refuse. Number of Inspections 3,803 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 167 Number of Notices issued. Intimations 167 Number of Statutory Notices 7 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 ... 11 Number of Statutory Notices served Nil Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 12 Number Remedied 12 Number of Prosecutions Nil 30 Underground Rooms. Number dealt with 13 Number of Notices served under P. H. (L.) Act, 1891 Number of Notices served under the Housing Act, 1925 Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms cleansed after infectious disease 911 Number of rooms cleansed from vermin 481 Number of articles 17,627 Number of Statutory Notices served 8 Number of Prosecutions Nil Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of Persons accommodated during the year 11 Drainage. Number of inspections made 4,309 Number of drainage plans deposited 374 Number relating to new buildings 28 „ „ old buildings 346 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops and Cowsheds 400 Number of Inspections 790 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 75 MINISTRY OF HEALTH AND OTHER TABLES. table i. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1931 AND PREVIOUS YEARS. Year. / Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered in the District. of Resi. dents not registered in the District. Under 1 year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate 1 2 3 4 6 7 8 9 10 11 12 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 18.2 781 621 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 1931 93,460 3,134 1,067 11.4 1,411 14.3 826 640 70 65.0 1,225 12.4 Total population at all ages at Census of 1921, 104,173. „ ,, 1931, 97,620 Area of district in acres (exclusive of area covered by water), 1427.8 acres. ,, „ (including area covered by water), 1473 acres. 76 TABLE II. Vital Statistics of Separate Localities in 1931 and the Ten Previous Years. Names of Localities The Whole Borough All Souls St. Mary Christ Church St. John Year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimatec to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population esti mated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. a. 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 26,943 405 415 21 32,747 673 459 50 20,308 283 291 26 1923 105,400 1,668 1,235 111 25,258 323 226 14 26,992 340 333 18 32.806 643 410 52 20,344 362 266 27 1924 105,300 1,531 1,436 123 25,233 280 245 22 26,967 336 422 30 32,775 629 472 55 20,325 286 297 16 3925 106,100 1,496 1,257 94 25,425 265 234 10 27,172 348 339 19 33,024 593 426 56 20,479 290 258 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 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 Averages of Years 1921 to 1930 104,530 1,484 1,322 104 25,143 275 257 18 26,948 324 356 20 32,505 594 439 47 19,932 293 268 18 1931 93,460 1.067 1,225 70 21,421 190 244 15 24,574 235 331 13 28,374 409 394 26 19,087 233 256 16 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. Net deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church. St. John. Total. No. CAUSES OF DEATH. All Ages. Under 1 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards 1 Typhoid and Paratyphoid Fevers 3 - — — — 1 2 — — — — 2 1 3 2 Measles 2 - — 2 - - - - - - - - - 2 2 3 Scarlet Fever 3 - — 2 1 - - - - - - - 2 1 3 4 Whooping Cough 2 2 - - - - - - - - - - 1 1 2 5 Diphtheria . 4 — — 1 3 - - — - - - 1 2 1 4 6 Influenza 28 — - 1 1 - 5 8 13 5 4 11 8 5 28 7 Encephalitis Lethargica . - - - - - - — — - 1 - - - - - 8 Cerebro-Spinal Fever — — — — — - — — - - - - - - - 9 Tuberculosis of Respiratory system 81 - - - 1 11 31 32 6 14 19 3 26 15 81 10 Other Tuberculous diseases 11 1 — — 3 1 1 4 1 14 3 2 1 4 11 11 SvDhilis 6 3 - - - - - 2 1 3 1 5 2 l 6 12 General Paralysis of the Insane, Tabes Dorsalis 12 - - - - - 4 5 3 — 2 52 4 1 12 13 Cancer, Malignant Disease 189 — — 1 — 3 11 79 95 264 39 4 66 32 189 14 Diabetes 9 — — — — - — 4 5 1 - 6 5 - 9 15 Cerebral Hæemorrhage, etc- 42 — — — — 3 14 25 36 9 69 1U 17 42 16 Heart Disease 253 — — — 1 4 12 62 174 88 46 6 77 61 18 17 Aneurism 18 — — — — 1 1 7 9 4 4 I n 11 12 3 43 18 Other Circulatory Diseases 43 — — — — 5 38 12 10 15 15 10 41 19 Bronchitis 41 4 — 1 — 2 9 25 13 8 27 43 3 106 20 Pneumonia (all forms) 106 17 5 — 2 5 8 26 43 68 15 3 9 21 19 21 Other Respiratory Diseases 19 — — 2 2 4 11 19 4 5 3 4 14 22 Peptic Ulcer 14 — — — — - 11 3 24 2 5 4 4 17 23 Diarrhcea, etc. (under 2 years) 17 18 — — — — 2 - 2 6 4 3 1 1 8 24 Appendicitis 8 — — - — 2 3 3 - 28 3 4 3 10 25 Cirrhosis of Liver 10 2 6 2 8 3 1 2 1 5 26 Other Diseases of the Liver, etc. 5 — — — — — - 2 3 3 1 8 12 8 39 27 Other Digestive Diseases 39 2 — — 2 — 3 16 16 22 11 13 7 4 35 28 Acute and Chronic Nephritis 35 — — — — 2 3 7 23 34 11 io - - 1 29 Puerperal Sepsis 1 — — — — — 1 - - - 1 1 - - 2 30 Other Puerperal Causes 2 — — — — 1 1 — - 18 1 1 31 Congenital Debility, Premature Birth, Malformation, etc. 18 16 1 — 1 — - 55 4 5 6 3 18 32 Senility 19 — — — — — — - 19 15 3 7 8 3 6 19 33 Suicide 25 — — — 1 4 12 8 12 5 7 5. 25 34 Other Violence 58 6 — — 3 5 5 16 23 25 11 13 20 14 58 35 Other defined Diseases 102 6 2 2 4 4 14 26 44 127 20 - 37 22 102 36 Causes ill-defined or unknown - - - - - - - - — - — - - - - M F M F M F M F M F 123 121 148 184 202 193 133 121 606 619 Totals 1225 70 7 11 21 42 120 362 592 919 244 332 395 254 1225 ^3 CO TABLE IV. Cases of Infectious Disease Notified during the 52 weeks ending 2nd January, 1932. 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. —1 1 — 2 — 3 — 4— 5 — 10 — 15 — 20 — 35 — 45 — 65 — Smallpox 2 - - - - - - 1 - - 1 - - 2 - - - 2 2 - - - 2 - Cholera . - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria, including Membranous. Croup . 154 4 12 16 10 11 45 25 10 16 3 2 - 39 40 60 15 154 38 40 60 15 153 1 Erysipelas 55 2 — — — — 2 1 1 3 5 23 18 12 21 15 7 55 3 1 6 1 25 30 Scarlet Fever. 258 4 9 18 11 27 106 41 11 25 4 2 — 35 46 143 34 258 34 44 141 31 250 8 Typhus Fever — — — — — — - — — — — - — - - - - - - - - - - - Enteric Fever 9 — — — — — — — - 5 4 - - 1 1 4 3 9 1 1 3 3 8 1 Paratyphoid Fever 3 — — — — — — 1 1 — — 1 — 1 2 - - 3 1 2 - - 3 - Relapsing Fever — — — — — - - - - — - - - - - - - - - - - - - - Continued Fever — — — — — - - - - - - - - - - - - - - - - - - - Puerperal Fever 11 - - - - - - - 3 7 1 - - 3 4 4 - 11 3 4 3 - 10 - Puerperal Pyrexia 22 - - - - - - - 3 15 4 - - 5 6 6 5 22 3 5 5 4 17 1 Plague — — — — — — — — - - - - - - - - - - - - - - - 5 Glanders - - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever . 5 1 - - - - - 2 1 1 - - - - 3 1 1 5 - 3 1 1 5 - Tuberculosis— Pulmonary 145 - - - - - 1 3 17 53 31 34 6 33 40 54 18 145 14 16 19 8 57 88 Non-Pulmonary 17 — — — 1 1 4 2 1 8 — - — 6 4 7 17 5 2 4 - 11 6 Acute Poliomyelitis 1 — — 1 — — — - - - - - - 1 - - - 1 1 - - - - - Polio-Encephalitis — — — — — - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 10 10 - - - - - - - - - - - 3 3 1 3 10 2 - 2 3 Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 80 8 4 8 1 9 8 1 3 13 13 15 9 13 12 39 16 80 6 4 19 9 38 42 Malaria . — - — — - - - - - - - - - - - - - - - - - - - 42 Dysentery - - - - - - — — — — — — — — — — — — — — — — — — Totals 772 29 25 38 23 41 166 77 51 146 66 77 33 154 182 334 102 772 113 136 263 75 587 185 ^3 cd TABLE V. Cases of Infectious Disease Notified during the 52 weeks ending 2nd January, 1932. Notifiable Disease. Cases notified in whole District. Total number of cases removed to Hospital. Total Deaths. At all ages. At Ages—years. — 1 1— 2— 3— 4— 5— 10- 15— 20- 35— 45— 65— Smallpox 2 — — — — — — 1 — — 1 — 2 — Diphtheria including Membranous Croup . 154 4 12 16 10 11 45 25 10 16 3 2 — 153 4 Erysipelas 55 2 — - — — 2 1 1 3 5 23 18 25 — Scarlet Fever 258 4 9 18 11 27 106 41 11 25 4 2 — 250 3 Enteric Fever 9 - - - - - - - - 5 4 — — 8 3 Paratyphoid Fever 3 — — — — — — 1 1 — - 1 - 3 — Puerperal Fever 11 - - - - - - - 3 7 1 — — 10 1 Puerperal Pyrexia 22 - - - - - - — 3 15 4 — — 17 — Cerebro Spinal Fever 5 1 — — — — — 2 1 1 — — — 5 — Tuberculosis— Pulmonary 145 - - - - - 1 3 17 53 31 34 6 57 81 Non-Pulmonary 17 — — — 1 1 4 2 ] 8 — — — 11 11 Acute Poliomyelitis . 1 - - 1 - - - - - - - - - 1 — Ophthalmia Neonatorum 10 10 - - - - - - - - - - - 7 - Pneumonia 80 8 4 3 1 2 8 1 8 13 13 15 9 38 31 Totals 772 29 25 38 23 41 166 77 51 146 66 77 33 587 134 VACCINATION RETURNS. Return for 1930. Return made to the Borough Council and Ministry of Health on the 9th February, 1932, 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, 1930, 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., 1930 Number of these Births duly entered by 31st January, 1932, in Columns 1, 11, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1932, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1932, neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nnr 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 1931 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccinaticn Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1931 Col. 11. Col. IV. 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 Col. 1. Success fully Vaccinated Insuscep tible of Vaccination Had SmallPox Number in respect of whom Certificates of Conscientious Objection have been received Col. V. Dead, Un vaccinated 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 479 298 6 — 88 27 2 15 8 35 2. St. Mary 2,274 1,564 2 — 250 106 13 293 23 23 2,229 375 3. All Souls 407 2a8 3 — 27 13 6 54 6 10 Total 3,160 2,150 11 - 365 146 21 362 37 68 2,229 375 Dated 6th February, 1932. (Signed) GEORGE H. BASSETT, Vaccination Officer. co o