C.I AC4353 STMARY 37 Metropolitan Borough of st Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1932 Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. LONDON: VAIL & CO., 170, FARRINGDON ROAD. . ~ '> ' -- ' - t:. : r- •• Metropolttan Borough of st. Marplebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1932 Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. LONDON: VAIL & CO., 170, FARRINGDON ROAD Vail & Co., Printers, London, E.C. Public Health Department, Town Hall, Marylebone Road, N.W.I. 6th May, 1933. 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 1932. In accordance with the instructions of the Ministry of Health it is mainly a record of the happenings of the year and contains less of detail than did that 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 from Dr. C. A. Fuller and his successor in the chair, Mr. Councillor G. B. Ramsay. 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). 1932. His Worship the Mayor (Alderman Frederick White, J.P., F.R.I.B.A.) ALDERMEN. G. B. Brooks J. Fettes, J.P. A. C. Rickatson, J.P. COUNCILLORS. Rev. Michael Adler, D.S.O., B.A. H Jones. F. V. Cullen, F.S.I. Capt. J. T. O'Brien, J.P. Dr. C. A. Fuller (Chairman). P. O'Connell. Dr. H. D. Haldin-Davis. Dr. E. Curnow Plummer. Mrs. M. G. Harris. G. B. Ramsay. Dr. Elizabeth Jacobs. Mrs. E. M. Shirley. CONTENTS. page page General Statistics 6-7 Deaths in relation to Disease 45, 74 Census, Tables 8-20 Diarrhceal Diseases 45 Natural and Social Conditions Infectious (Communicable) of the Borough. Diseases 4-5 Sanitary Circumstances 21 Phthisis and other Tuberculous Water Supply 21 Diseases 45 Drainage 21 Respiratory Diseases 46, 52 Combined Drainage 22 Cancer and Malignant Disease 4fi Closet Accommodation 22 Accident, Suicide and Man- Public Sanitary Conveniences 22 slaughter 47 Scavenging 22 Prevalence of and Control over In- Removal of House Refuse 24 fectious Diseases 47, 75 The Crown Estate 24 Diphtheria and Membranous Removal of Offensive Refuse 24 Croup 47 Sanitary inspection of the Borough 24 Schick Testing and Diphtheria Staft 24 Immunization 48 Nuisances 25 Scarlet Fever 49 Inspections 26 Enteric Fever and Paratyphoid Fever 49 Nuisances—Legal Proceedings 27 Cerebro-Spinal Fever 49 Smoke Nuisances 27 Encephalitis Lethargica 49 Rat Repression 27 Polio-Myelitis 49 Pigeons 2a Polio-Encephalitis 49 Fouling of Footways by Dogs 28 Erysipelas 49 Premises and Occupations controlled Puerperal Fever and Puerperal by By-laws and Regulations 28 Pyrexia 49 Business Premises 29 Measles and German Measles 50 Milk Premises 29 Whooping Cough 50 Slaughterhouses 29 Glanders and Anthrax 50 Offensive Trades 29 Smallpox 50 Premises used for Food Prepara- Vaccination 50, 77 tion 29, 37 Infectious Diseases in Schools 50 Ice Cream Premises 29 Ophthalmia Neonatorum 51 Butter, Margarine, etc., Premises 29 Influenza 52 Bakehouses 29 Pneumonia 52 Fried Fish Vendors and Fish Food Poisoning 52 Curers 30 Tuberculosis 52, 59 Factories and Workshops 30 Treatment 52 Inspections 31 Public Health (Prevention of Defects found 31 Tuberculosis) Regulations, 1925 52 HomeWork 32 Public Health (Tuberculosis) Registered Workshops 33 Regulations, 1912 (Notifica- Other matters 33 tions 53 Rag Flock 33 Public Health (Tuberculosis) Premises used for Human Habitation 33 Regulations, 1930 54 Houses let in lodgings 33 Prevention of 55 Common Lodging Houses 34 Care Committee 55 Underground Rooms 34 Bacteriological Diagnosis of 56 Premises that are not but should be Non-Pulmonary Tuberculosis 56 Registered 35 Work and Dispensaries 57 Food Stalls 35 Deaths 58 Food Localisation of Diseses 59 Milk Supply 35 Disinfection 60 Milk Analysis 35 Cleansing of Persons 60 Bacteriological examination of Bacteriological Examinations 48, 56, 60 Milk 35 Maternity and Child Welfare .. 61-63 Dairies Milkshops, etc. 36 Health Visitors 25.64 The Milk (Special Designations) Centres Order 36 Ante-Natal Work 65 Milk (Mothers and Children) Dental Clinic 65,67 Scheme Massage Clinics 65 Foods other than Milk 3b Schick Testing, etc., Clinics 65 Food Inspections 87 Hospital Treatment 65 Food, Unsound, Condemned 37 Maternity Cases 65 Fppd Premises 29 37 Infant Consultations—Work at. 66 Food and Drugs (Adulteration) Act, 1928 37 Day Nurseries 67 Reports of Public Analyst 38-40 Home Helps 67 Statistical Birtjjs. 41 Sanitary Administration— Birth Registration 41 Staff 67 Birth Notifications 41 Report of Mortuary Keeper 67 Deaths and Death Rates 41-43 Hospital Accommodation 67 Sub-District Births and Deaths 42,73 Local Acts and Orders 67 Deaths in relation to Age 42, 43, 74 Housing, Inspections and Proceed- Causes of and ages at death 43,74 ings, etc. 68 Infantile Mortality 43-44 General Summary 69,71 Infant Mortality Causes 44 Ministry of Health, Tables I V. 72-76 Maternal Mortality 45 Vaccination Returns 77 6 GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921). 104,173. (1931) 97,620 (estimated 1932) 96,430. Number of inhabited houses (1921), 18,507 ; (1931), 17,575. Number of inhabited houses (end of 1932) according to Rate Books, 17,200. Number of families or separate occupiers (1931), 27,352. Rateable value. £3,187,671. Sum represented by a penny rate. £12,365. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimate 933 477 456Birth Rate, 10.97 Illegimate 122 73 49 } Birth Rate, 10.97. Still Birth's, 37. Rate per 1,000 total births, 35. Deaths, 1,265. Death Rate, 12.4. Percentages of total deaths of residents occurring in public institutions, 11.6 Number of women dying in, or in consequence, of, childbirth—from sepsis, ; other causes, 2. Deaths of Infants under 1 year of age per 1,000 live births:— Legitimate 83. Illegitimate 115. Total 87. Deaths from Measles (all ages), 18 Deaths from Whooping Cough (all ages), 14. Deaths from Diarrhcea (under 2 years of age), 29. 7 Population.—The Census returns of the year 1931 for the County of London were published too late for the tables referring- to St. Marylebone to be included in the Annual Report for that year. Though belated, it has been thought well, following the usual practice, to set out here for convenience of reference, Tables taken from the report upon the Census containing an analysis of the information obtained as a result of the enumeration. The population estimated to the middle of 1932 by the Registrar-General is shown below and is that used in calculating the various rates given in this report. For information the estimated population of each of the Wards is also set out and for comparison the figures for 1931 and the Census of 1931. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. Census 1931 96,620 22,380 25667 29,636 19,937 Estimated to 1931 93,460 21,421 24,574 28,374 19087 1932 96,430 22,103 25,349 29,278 19,700 "J oc METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931 TABLE 2 POPULATION 1911—1931 and INTERCENSAL VARIATIONS. Note.—Columns (b)—(m) all refer to the districts as constituted in 1931. Column (n) shows the net 1921 population of the areas (if any) transferred to or from (—) the district in the intercensal period 1921-1931. POPULATION Increase or Decrease (—) Net 1921 Popu lation of areas added or deducted (—) in Intercensal Period 192131 1911. 1921 1931 1911- 21 1921-1931 Persons Persons Males Females Persons Males Females Per cent Amount Per cent Total By Births & Deaths By Migration b c d e f g h i j k 1 m n 118,160 104,173 41,007 63,166 97,627 38,789 58,838 —11.8 —6,546 —6.3 1.0 —7.3 - METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931 TABLE No. 3 . Acreage, Population, Private Families and Dwellings Private Family.—Any person or group of persons included in a separate return as being in separate occupation of any premises or part of premises is treated as a separate family for Census purposes, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i) Institutions or (ii) business establishments or boarding houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Structurally Separate Dwellings.—A structurally separate dwelling has been defined for the Census as any room or set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit ; a private house which has not been structurally sub-divided is similarly a single unit whether occupied by one family or by several families. But where a private house has been sub-divided into maisonettes or portions, each having its front door opening on to the street, or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Rooms.—For the purposes of the Census, the rooms enumerated are the usual living rooms, including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office, or shop rooms. Administrative Area (and Registration Reference No) Acreage (Land and Inland Water) Total Population Private Families and Dwellings, 1931 1921 1931 Private Families Population in Private Families Structurally Separate Dwellings Occupied Rooms Occupied Persons per Room Persons Persons Males Females Persons per Acre Cols. a b c d e f g h i j k 1 St. Marylebone M.B. and C.P. (7 : 1-3) 1,473 104,173 97,627 38,789 58,838 66.3 27,352 84,453 17,575 103,695 081 Wards:— No. 1 Hamilton Terrace (7 : 3) 274 10,129 10,388 3,397 6,991 37.9 3,263 9,839 2,552 16,634 0.59 No. 2 St. John's Wood Terrace (7:3) 132 9,980 9,551 4,061 5,490 72.4 2,879 9,176 1,633 10,574 0.87 No. 3 Church Street (7:3) 107 22,690 20,513 9,937 10,576 191.7 5,536 19,197 3,460 14,841 1.29 No. 4 Dorset Square and Regent's Park (7:3) 493 9,738 9,122 3,416 5,706 18.5 2,953 7,956 1,845 10,515 0.76 No. 5 Bryanston Square (7 : 2) 106 13,292 13,408 5,159 8,249 126.5 3,839 11,382 2,252 14,040 0.81 No. 6 Portman (7 : 2) 118 13,388 12,258 4,664 75,94 103.9 3,227 8,828 2,175 12,308 0.72 No. 7 Park Crescent (7:1) 105 12,446 11,862 4,330 7,532 113.0 3,187 10,414 1,758 13,918 0.75 No. 8 Langham (7:1) 66 8,855 8,052 2,879 5,173 122.0 1,856 6,020 1,484 8,833 0.68 No. 9 Cavendish (7:1) 72 3,655 2,473 946 1,527 34.3 612 1,641 416 2,032 0.81 10 METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931 TABLE No. 6 Comparison of Census and Resident Populations Note.—In connection with the return of the address of "usual residence" which was required in respect of every person enumerated at the Census, the undermentioned classes of persons were instructed to return their usual residence as follows. Boarders, Lodgers, etc.—The boarding house, club, hotel, etc., at which they have a settled place of residence if they have no more usual residence elsewhere. Resident Domestic Servants.—Their place of employment. Scholars, Students, Undergraduates of residential schools, Universities, etc.—The school, university or associated lodgings at which they reside in term time. Inmates of Institutions.—The institution if discharge was not expected within 6 months, otherwise the home address. Crews of ships.—The ship if they usually reside on board. Persons with no settled place of residence were instructed to indicate the fact by the reply "None." Enumerated Population, 1931 Enumerated in the Area but resident elsewhere in England and Wales Resident in the Area, but enumerated elsewhere in England and Wales Excess or Deficiency (—) of Residents in relation to enumerated. Numbers Per 1,000 enumerated Persons Males Females Males Females Males Females Persons Males Females Persons b c d e f g h i j k l 97,627 38,789 58,838 1,563 2,970 1,814 3,756 1,037 251 786 11 11 METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931 TABLE No. 7 POPULATION and PARLIAMENTARY ELECTORS (1931 REGISTER). Acreage (Land and Inland Water) Population Parliamentary Electors (1931 Register) Residence Qualification per 1,000 Population (Persons) Other Qualifications per 1,000 Population (Persons) 1921 1931 All qualifications Residence Qualifications only Persons Persons Males Females Persons Males Females Persons b c d e f g h i j k l 1,473 104,173 97,627 38,789 58,838 72,601 28,233 44,368 65,607 672 72 Note.—The 1931 Register is the Register of Electors prepared in respect of the qualifying period of three months ending on the 1st June, 1931. METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931 TABLE No. 9 Population and Constitution by Metropolitan Boroughs—Petty Sessional Divisions Acreage (land and Inland Water) Population Constitution 1921 1931 Persons Persons Males Females 1,473 104,173 97,627 38,789 58,838 St. Marylebone Metropolitan Borough p—' to METROPOLITAN BOROUGH, OF ST. MARYLEBONE CENSUS, 1931 TABLE No. 10 Dwellings, Rooms and Families Dwellings or parts of dwellings unoccupied on Census night, whether through their being tenantless or through the temporary absence of the occupying family, have all been classified as "vacant." They have been apportioned between "furnished" and "others" from such indications as could be obtained from enquiry or external scrutiny. Structurally Separate Dwellings of Number of rooms 1 room 2 rooms 3 rooms 4 rooms 5 rooms 6-8 rooms 9 or more rooms All sizes Total Occupied Vacant Furnished Others Dwellings occupied by 1 private family 539 2,267 2,614 2,397 1,101 2,524 2,239 13,681 74,297 73,155 493 649 Dwellings occupied by 2 private families — 18 41 254 146 644 221 1,324 8,813 8,392 199 222 Dwellings occupied by 3 or more private families 9 69 100 1,288 1,103 2,570 22,794 22,148 376 270 Total Dwellings occupied 539 2,286 2,664 2,720 1,347 4,456 3,563 17,575 105,904 103,695 1,068 1,141 Dwellings wholly vacant Furnished 74 139 169 123 91 111 31 738 2,865 — 2,865 Others 17 70 118 254 65 339 241 1,104 6,942 — — 6,942 Total dwellings occupied and vacant 630 2,495 2,951 3,097 1,503 4,906 3,835 19,417 115,711 103,695 3,933 8,083 No. of private families therein 539 2,306 2,725 3,124 1,727 8,544 8,387 27,352 — — — — Miscellaneous habitations and institutions housing -non-private families 448 CO- Private Families classified by Size of Family, Rooms Occupied, and Density of Population Note.— The following table contains an analysis of the private families within each area according to (a) the number of persons in the family, and (b) the number of rooms occupied by the family. Where more than one family are enumerated within a strucutrally separate dwelling, each is classified according to the rooms it severally occupies and not to the total number of rooms in the dwelling. For this purpose rooms shared by more than one family are excluded as are sculleries or bathrooms, etc., each family being classified to the next lower integral number of rooms occupied, save in the exceptional case of a family housed in a portion of a room only when it is classified as living in 1 room. The total rooms in column (h) may on this account differ slightly from the corresponding totals of rooms shown in Tables 3 or 10. No. of Persons in Family No. of Private Families occupying the Following Number of Rooms. Total Private Families Population in Private Families Rooms Occupied Density of Occupation. Average No. Persons per room Pop. at following densities of occupation (Persons per room) 1 2 3 4 5 6-7 8-9 10 or more Over 3 3 and over 2 2 and over 1½ 1½ and over 1 a b c d e f g h i j k 1 m n o P q 1 3,507 1,368 758 463 178 143 42 29 6,488 6,488 12,858 0.50 - - - - 2 1,134 2,232 1,290 920 428 462 133 133 6,741 13,482 21,099 0.4 - - 2,268 - 3 336 1,565 1,113 734 322 572 223 198 5,063 15,189 19,378 0.78 - 1,008 - 4,695 4 153 929 781 544 269 407 224 268 3,575 14,300 15,770 0.91 612 - 3,716 3,124 5 86 536 427 409 151 259 168 258 2,294 11,470 11,188 1.03 430 2,680 2,135 2,045 6 31 215 219 249 64 153 141 260 1,332 7,992 7,932 1.01 186 1,290 1,314 1,878 7 7 149 110 131 47 75 74 197 790 5,530 5,189 1.07 1,092 770 917 630 8 4 61 57 88 25 26 32 160 453 3,624 3,523 1.03 520 456 904 208 9 4 20 27 46 8 17 10 117 249 2,241 2,359 0.95 216 657 72 216 10 — 18 21 21 6 11 9 86 172 1,720 1,691 1.02 390 210 130 130 11 — 6 8 8 4 4 2 53 85 935 1,006 0.93 154 132 44 55 12 — 1 2 6 — 1 — 38 48 576 721 0.80 36 72 12 24 13 — — — 2 — 1 1 15 19 247 269 0.92 26 13 13 26 14 — 2 1 2 1 — 1 12 19 266 266 1.00 70 14 14 28 15 and — 1 1 — 2 — — 20 24 393 441 0.89 34 30 — 99 over h-1 TABLE No. 11—continued. No. of Persons in Family No. of Private Families occupying the Following Number of Rooms. Total Private Families Population in Private Families Rooms Occupied Density of Occupation. Aevrage No. Persons per room Pop. at following densities of occupation (Persons per room) 1 2 3 4 5 6-7 8-9 10 or more Over 3 3 and over 2 2 and over 1½ 1½ and over 1 a b c d e f g h i i k l m n o P q 2 persons and over 1,755 5,735 4,066 3,160 1,327 1,988 1,018 1,815 20,864 77,965 90,382 0.86 3,766 7,332 11,539 13,158 Total Private Families 5,262 7,103 4,824 3,623 1,505 2,131 1,060 1,844 27,352 - - - - - - - Population in Private Families 8,128 20,225 15,092 12,679 4,964 7,689 4,562 11,114 84,453 0-81 3,766 7,332 11,539 13,158 Rooms Occupied 5,262 14,206 14,472 14,492 7,525 13,681 8,869 25,183 — — 103,690 — — — - — 19.2 260 17.6 13.3 5.5 7.8 3.9 6.7 1000 1931. Percentage of Families living in various units of occupation. ditto 21.2 27.3 16.7 11.5 4.6 7.3 41 7.3 1000 1921. METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931 TABLE 12 Population in Non-Private Families classified by Habitations Note.—Both Staff and Inmates are included in the population of Institutions. Population in Dwellings occuTotal pied by Private Enumer- Families ated In Hotels, Boarding Houses, Lodging Houses, etc. In Schools, Orphanages and other Educational Institutions (excluding Reformatories) In Civilian Hospitals, Nursing Homes and other Institutions for the Temporary Sick (a) In Institutions for Insane or Mentally Deficient, Cripples, Blind and other permanently Disabled In Workhouses and other Poor Law Institutions (excluding Infirmaries and Educational Institutions) (b) In Prisons and other places of Detention (including Reformatories) Persons 0/ /o Persons % Persons % Persons % Persons % Persons % Persons % 97,627 84,453 86.6 8,435 8.6 420 0.4 2,925 3 0 10 .00 1,180 1.2 — In Naval, Military and Air In Civilian All others Force Premises Ships, Boats and (including (including Ships Barges Vagrants) and Hospitals) . Persons j % Persons % Persons % 129 0.1 — — 75 0.1 (a) Including Poor Law Institutions appropriated to Public Health Act or Maternity (b) Excluding{ and Child Welfare purposes at the date of the Census. 16 METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931 TABLE 13 Institutions and Special Premises: Number Total Population and Inmates. Note.— Poor Law Institutions, appropriated to Public Health Act or Maternity and Child Welfare purposes at the date of the Census, are classified as Hospitals, Nursing Homes, etc., and not as Poor Law Institutions. Number of Institutions Total Population Inmates only (Classes 1-12) Persons Males Females Persons Males Females Workhouses 1 1,180 677 503 1,133 671 462 Homes for Insane, etc. 1 10 — 10 2 — 2 Hospitals (Not Military, etc.) 11 1,745 420 1,325 1,035 373 662 Convalescent and Nursing Homes 55 1,180 204 976 553 174 379 Naval, Military and Air Force Barracks 1 129 111 18 — - — METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931. TABLE 14. Ages (Grouped) by Marital Condition. Age last Birthday. Persons Males Females Total Single Married Widowed Divorced Total Single Married Widowed Divorced. All Ages 97,627 38,789 20,044 17,027 1,529 189 58,838 34,687 17,771 6,020 360 0—4 4,485 2,248 2,248 - - - 2,237 2,237 - - - 5—9 4,932 2,450 2,450 — — — 2,482 2,482 - - - 10—14 5,092 2,459 2,459 — — — 2,633 2,633 - - - 15—19 8,080 3,159 3,147 12 — — 4,921 4,863 58 - - 20—24 10,140 3,664 3,241 420 3 — 6,476 5,605 860 10 1 25—29 9,397 3,566 2,128 1,424 9 5 5,831 3,833 1,937 31 30 30—34 8,064 2,894 1,023 1,818 24 29 5,170 2,631 2,328 144 67 35—39 7,642 2,703 620 2,025 27 31 4,939 2,238 2,397 228 76 40—44 7,578 2,842 558 2,206 52 26 4,736 1,879 2,380 406 71 45—49 7,211 2,784 461 2,196 93 34 4,427 1,578 2,267 537 45 50—54 6,725 2,665 433 2,069 131 32 4,060 1,407 1,987 632 34 55—59 5,787 2,444 371 1,857 202 14 3,343 1,050 1,514 763 16 60—64 4,589 1,912 365 1,330 208 9 2,677 819 989 856 13 65—69 3,534 1,420 273 901 242 4 2,114 651 589 870 4 70—74 2,292 877 159 475 239 4 1,415 421 317 674 3 75—79 1,257 457 81 202 174 - 800 219 112 469 - 80—84 576 170 17 72 81 — 406 97 29 280 - 85—89 204 61 8 18 34 1 143 34 7 102 - 90—94 36 13 2 2 9 — 23 7 — 16 - 95 over 6 1 — 1 — 5 3 — 2 - 18 METROPOLITAN BOROUGH OF ST. MARYLEBONE. CENSUS, 1931. TABLE No. 16. Ages (Individual years) under 21. Age last Birthday. Males. Females. . 0-21 11,001 13,470 0 489 491 1 463 415 2 430 431 3 460 469 4 406 431 5 452 432 6 479 463 7 481 498 8 494 515 9 544 574 10 587 624 11 604 637 12 394 411 13 386 409 14 488 552 15 506 663 16 628 877 17 630 1,016 18 726 1,099 19 669 1,266 20 685 1,197 METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS, 1931. TABLE IX. Increase or Decrease (—) in Occupied Dwellings. Increase or Decrease (—) in Private Families. *Vacant Unfurnished Dwellings (1931). Average size of Occupied Dwelling (Rooms). Average Family Occupation (Rooms). Families per Occupied Dwelling. Average size of Private Family (Persons). Average Persons per Room. No. % No. % No. % 1931 1921 1931 1921 1931 1921 1931 1921 1931 1921 438 2.56 138 0.51 1,104 5.69 5.90 6.14 3.79 3.79 1.56 1.59 3.09 3.33 0.81 0.88 More than 2 per room Density. Private Families, 1931. Population. 1931. 1921. No. % No. % No. % 1,950 7.1 11,098 13.1 16,159 17.9 *As ascertained from external inspection during the enumeration. METROPOLITAN BOROUGH OF ST. MARYLEBONE CENSUS 1931. TABLE XIV. Local Age and Condition Distributions. Average Age. Age Distribution per 1,000 of each sex. (Ages last birthday.) Marital condition distribution per 1,000 of each sex. Males. Females. Males. Females. M. F. 0-4 5—19 20—39 40— 0—4 5—19 2.0—39 40— Single Married Widowed and Divorced Single Married Widowed and Divorced 34.9 36.4 58 208 331 403 38 171 381 410 517 439 44 590 302 108 Number of Married Women Number of Females aged less than 45 per per 1,000 Males. 1,000 females of all ages. 169 1,517 Note.—Generally, it will be found that neighbourhoods of similar residential, commercial or industrial character present similar features in regard to the constitution of their respective populations. The Western and North Western. Boroughs of Kensington, Hampstead, St. Marylebone, Chelsea and Paddington possess a preponderance of females each in excess of 1,300 per 1,000 males and reaching the proportions of 1,547 and 1,544 per 1,000 in Hampstead and Kensington. In those areas the numbers of children are below the county average and the average ages consequently higher than in other areas. But while, as might be expected from the higher average ages, the proportion of married and widowed is high in the case of men, for women the reverse is the case, due no doubt to the inclusion amongst them of considerable numbers of domestic servants. 21 INTRODUCTORY. 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, etc. In respect of some of these matters, on account of the circumstances and arrangements existing in London Boroughs, there is little to he said, and much of the information is obtainable only from other departments of the Councils 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 that the water had been cut off in six premises. The reason for discontinuing the supply was in all cases the non-payment of rate. 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 six. The number in 1931 was 4. In 23 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 direction 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 1932 made 4,012 inspections. The total number of plans deposited was 380 in respect of 442 premises, as against 374 and 470 respectively in 1931. The number relating to new buildings was 21. The number deposited in 1931 was 28. In the case of old buildings, the number of plans received was 359. In 1931 the total number was 346. 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 22 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 conveniences 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 Drovision having been made for accepting as compliance a number of arrangements which were definitely outside the provisions of the earlier by-laws. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 56 premises. The number in 1931 was 34. Closet Accommodation. In the table at page 26, summarising the work carried out by the district inspectors, figures indicating the number of defects in water closets remedied and of water closets erected are set out. In most instances the closets erected were with a view to providing additional accommodation in tenement houses, shops, or workshops or in order to afford suitable separate accommodation for women in places where both sexes were or were about to be employed. Though there may be here and there a small lock-up shop in which it is necessary for the individuals engaged on the premises to make use of a convenience in some other part of the building, or more rarely in an adjoining building, there are no premises in the Borough totally without sanitary conveniences of this type. The only class of closet is, of course, the water closet. One of the great difficulties experienced from time to time is in regard to finding a suitable place for a convenience and a position in which there will be complete compliance with the requirements of the regulations in respect of waterclosets. This is particularly the case in relation to closets in basements and in the more over-crowded business and shopping portions of the Borough. All plans showing proposals to construct water-closets are most carefully 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. 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. 23 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 made financial provision for the purchase of a new fleet of house refuse collecting vehicles, and trials are at present being carried out to ascertain the most suitable type of vehicle. 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 on the Canal at Paddington Basin 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 are, during the winter months, disposed of to brickmakers and others. The residue from the picking belt is conveyed to a series of destructor cells and WoodallDuckham refuse destructor, which is mechanically fed, and clinkered. In this way the quantity of crude refuse to be conveyed to the Council's Shoot at Northolt, where it is carefully covered and so dealt with us to reduce risk of nuisance, is greatly diminished. 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. 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 lorries and conveyed to the Wharf as shown above, the collecting vehicles being specially constructed and fitted with covers to prevent the blowing of refuse over the public streets. Generally.—New plant has been 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 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 general cleanliness of the Borough. Fish offal is disposed of to Contractors and green offal is treated in the same way as street sweepings. Statistical.—The following figures will give some idea of the tonnages dealt with. House Refuse collected during the year ended 31st March, 1933 43,583 tons. Street Sweepings collected during the year ended 31st March, 1933 7,891 tons. In addition, a sum of approximately £1,300 was received for the removal of Trade Refuse, Green and Fish Offal and for the cleansing of petrol interceptors. 24 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. During the year approved type metal dustbins have been provided at 159 premises at the request of the department, while 1,058 visits were made by Inspector Hill, who gives part time to this work. 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 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): K. H. Whittingham, O.B.E., M.B., B.S., D.P.H. Public Vaccinator : Dr. H. Allen Bulman. Vaccination Officer : G. H. Bassett. 25 *Outdoor Superintendent. P. H. Hill {a, b, d). Clerks. H. E. Curtis (Chief). A. H. James. W. J. Howe. H. G. E. Brown. C. D. Turbayne. R. G. Turner. *Maternity and Child Welfare and Tuberculosis Clerk. Miss J. Jones. Maternity and Child Welfare. Clerk-Dispenser. Miss G. M. Courtnay. Cleansing of Persons—Baths & Shelter. Miss L. Kilgallin (Matron). Mortuary Keeper. Mrs. H. Spears. *Tuberculosis Dispensary. E. D. Marston (Caretaker). Messenger. J. Eatwell (died 17th Feb., 1932). E. W. Broughton (appointed 21st April, 1932). *District Sanitary Inspectors. T. A. Cartledge, M.S.M. (a, b, d). H. E. P. Corline (b, d). T. W. Forbes (b, d). ††E. Lumley (a, b). H. E. Scoble (c, d). E. E. Willis, M.M. (a, b, d). A. S. Wilson (a, b, d,). *Drainage Inspectors. F. C. Cook (b, d). W. H. Draper (a, b, d). *Food Inspector. G. Smith (Senior Sanitary Inspector) (a, b, d). Disinfectors. J. C. Kendall. J. Overton. * Women Sanitary Inspectors and Health Visitors. Miss C. E. Durant (b, e, h). Miss N. C. Stokes, R.R.C. (b, e, f, g, h). *Health Visitors. †Miss D. T. Connell (e) Miss C. Hale (e, f). Miss E. D. Mann (e, f, g, h). Miss K. Stewart (e). *Tuberculosis Visitors. Miss F. A. Baker (b). Miss S. Kenion (e, f, g, h). *Tuberculosis Clerk—Dispenser. Miss M. T. Challis. * Officers to whose salary contribution is made under the Public Health Acts or by Exchequer grants. a Royal Sanitary Institute Certificate. b Certificate Sanitary Inspectors' Examination Board (London). c Certificate of the Sanitary Inspectors' Examination Joint Board. d Heat 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. † Appointed temporarily 9th November, 1931. ‡‡ Retired 14th January. 1932. 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 2,598, practically the same (2,600) as in 1931. 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, 81 statutory notices were issued, the figure being 84 in 1931. 26 Of these notices, 53 related to ordinary nuisances (dirt, dampness, etc.), 12 to verminous rooms, 6 to drains, 1 to insufficient w.c. accommodation, 5 to insufficient dustbins, 3 to underground rooms. There was 1 with regard to rats. The 12 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1922, and referred to 25 rooms. The number of notices in 1931 was 8. In 2,517 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 for 1932 by each inspector, and the number of nuisances of various kinds detected and remedied, are set out in the following table :— Districts. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Houses damp, dirty or dilapidated remedied 119 227 311 152 95 69 973 Doors, windows, floors, ceilings sasli cords, etc., repaired 182 125 173 79 71 34 664 Overcrowding abated 1 – 4 2 1 1 9 Illegal occupation of underground rooms dealt with – 2 67 12 4 3 88 Water closet defects remedied Water closet erected 113 77 321 77 7 74 16 52 10 714 33 Urinal defects remedied 2 – – 3 6 – 11 Soilpipes and ventilating shafts repaired or renewed – 1 1 2 13 – 17 Yard defects remedied 44 31 212 67 37 4 395 Waste pipe defects remedied 33 18 10 9 25 8 98 Water cistern defects remedied 16 1 5 14 8 2 46 Rubbish, manure, etc., accumulations removed 10 12 71 46 37 11 187 Dung or dust receptacles repaired or renewed 9 7 72 31 34 6 159 Drains relaid or amended 48 18 46 42 16 11 181 Drains cleared 1 11 12 14 13 2 53 Rainwater pipes repaired or renewed 8 12 21 2 13 4 60 Water supply to houses reinstated 2 2 3 3 1 – 11 Roofs and gutters repaired 60 55 41 17 27 4 204 Area defects remedied 5 — 90 64 20 3 182 Wash-house defects remedied 57 45 173 51 39 1 266 Animal nuisances abated – – 5 4 4 – 13 Basement defects remedied 54 10 27 11 18 2 122 Stables cleansed or repaired 2 – 1 2 2 — 7 Water supply laid on to upper storeys of house 8 8 5 – 2 – 23 Miscellaneous nuisances abated 251 20 161 75 39 14 560 Verminous rooms cleansed 31 50 294 93 58 35 561 27 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 :— [##3]Premises. Offence. (Proceedings taken under the Public Health (London) Act 1891, etc.) Result. 91, St. Johns Wood Terrace Failure to comply with a statutory notice to execute certain sanitary requirements. Order made for work to be executed within two months. Smoke Nuisances. During the year 1932, 592 observations were made and 37 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 proceedings in court. Amongst the complaints several had reference to fumes from furnaces burning oil-fuel. These give rise to considerable difficulty, but as a result of frequent observations and co-operation with the owners of the property, the trouble in practically every case was greatly mitigated. Rat Repression. Though activity in this connection continues unabated, the number of complaints received varies little year by year. In 1930 it reached 60, in 3 931, 74 and in 1932, 52. The investigation of these complaints necessitated the inspection of 123 premises, G5 of which were found to be rat infested. Included in this latter number were 27 business premises (5 of these for the preparation or storage of food), the remaining 38 being private or tenement houses. In 17 of the cases investigated the infestation was directly attributable to defects in the drainage system, and the nuisance disappeared when repair or reconstruction was carried out. 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 1932 Rat Week held in the Borough contains a certain amount of information that may be found interesting. "National Rat Week (the fourteenth of the series) was, at the suggestion of the Ministry of Agriculture, held in the Borough during the week commencing Monday, November 7th, 1932, the Ministry once more urging upon all local authorities responsible for the execution and enforcement of the Rats and Mice (Destruction) Act, 1919, the desirability of making a special effort during that week to secure concerted action with a view to the destruction of rats and mice. "Arrangements similar to those of previous years were made with the object of bringing to the notice of the inhabitants the importance of the matter from a health and economic point of view. Posters were displayed and leaflets distributed throughout the district, while the local press gave considerable prominence to the subject in their columns. Special communications (with copies of a new booklet issued by the Ministry of Agriculture) were sent to occupiers of food premises, to property owners and agents, to the railways companies, and to the large business houses and institutions in the Borough, drawing attention to the duties imposed by statute in connection with rat destruction and, at the same time, offering to assist them in every way possible with technical advice as to the best means to be adopted in any particular circumstances for ridding property of rats and mice. "Complaints of nuisance from rat infestation are fewer in number than formerly, and from careful observations made by Inspector Willis (who has the matter specially in hand) and by other members of the staff of the Department over a period of many years, it appears that the large majority of people in the Borough 28 .—from the great commercial and railway concerns to the individual householder— as a result of the publicity given to the matter and the continuous propaganda of the Council, are fully alive to the nuisance and possible danger from rats and mice, and to the fact that the responsibility for getting rid of the vermin rests upon them. Other factors probably contributing to the comparative freedom from rat infestation have been the gradual modernisation of drainage systems throughout the Borough, and the demolition of blocks of old buildings in many parts of the district and their replacement by new structures." 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 made in 1931, and a similar number were received in 1932, relating to business premises (in three cases), public buildings (3), private dwellings (3) and a church in 1 instance. As in other years, as much assistance as possible was given by the inspector (Mr, Willis) in charge of this work to reduce the nuisance. Fouling of footways by dogs In enforcing the provisions of the bye-law with regard to this matter, great assistance was obtained from the police, 19 prosecuions undertaken being on the reports of police officers. In 16 cases the defendant pleaded guilty, and the fines amounted to £8 5s. Od. In three cases service of the summons was not made. Including these cases the total number of prosecutions since the bye-law came into operation in 1928, is 21, the amount of fines imposed being £10 15s. 0d. PREMISES AND OCCUPATIONS CONTROLLED BY BY-LAWS AND REGULATIONS. The following list sets out the majority of the premises and occupations of the class referred to in the heading to this part of the report, and contains a certain amount of information with regard to registration, inspection, etc. Underground rooms and underground sleeping rooms, though controlled, the former under the Public Health (London) Act, 1891, and the latter under special regulations under the Housing Acts, are not registered. Number of premises Number of inspections 1932 Number of notices 1932 Number of prosecutions, 1932 On register at end of 1931 Added in 1932 Removed in 1932 On register at end of 1932 A. Business Premises Milk premises 123 18 6 135 266 5 — Slaughterhouses 1 — — 1 40 — — Poultry Do. 1 — — — 20 — — Offensive trade premises 2 — — 2 50 — — Ice cream premises 73 6 1 78 125 7 — Butter and Margarine Manufacturers and Dealers 16 — 16 27 Bakehouses 54 2 — 56 110 8 — Fried Fish Shops 25 — — 25 65 4 — Fish Curers 6 1 — 6 60 3 — B. Habitations Houses let in lodgings 1,055 — — 1,055 8,088 1,043 — Common lodging houses 4 — — 4 — — — 29 A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 135. This is 12 more than in 1931, 18 having been added and 6 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 but the amount of slaughtering now done is comparatively small: during the year only 36 sheep, 6 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. Offensive Trades.—At the end of 1932 there were only two premises within the Borough upon which trades classed as offensive were carried on, the business in one being that of tripe boiling and the other the slaughter of poultry. The Food Inspector made 50 visits, but no cause of complaint was found. Premises used for Food Preparation.—For many years past I have commented on premises that are not but should be registered and the passing of the London County Council (General Powers) Act, 1932 under Sec. 5, gave powers to the Borough Council to register all those premises used for the sale or the manufacture for the purpose of sale of ice cream or other similar commodity intended for sale or for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale. This Act received the Royal Assent on the 12th July, 1932, and the Council authorised the Public Health Committee to administer the powers given under the Act. Applications for registration were received, the premises inspected and orders issued for amendment where required to conform to a standard of cleanliness before registration and this inspection and registration is proceeding. Ice Cream Premises.—These also are now required to be registered under Section 5 of the London County Council (General Powers) Act, 1932. The actual number of premises included in the register at the end of 1932 was 78, 5 more than in 1931. Regular inspections were made throughout 1932, and in 7 cases notices were served in respect of uncleanly conditions. Butter, Margarine, etc., Premises.-—Information with regard to the sampling of these substances will be found under the heading " Food and Drugs (Adulteration) Act, 1928." At the end of the year there were on the registers 13 dealers in margarine, 1 wholesale dealer in butter and milk-blended butter and 2 butter manufacturers. All the registered premises were frequently visited. Bakehouses.—At the end of 1932 the number of bakehouses on the register was 56, 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. 30 During the year 110 visits were paid and 8 notices with regard to defects were served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the lime-washing, 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. Factories are increasing in the Borough by the introduction of small electric motors in tailors' and dressmaking establishments. The number of workshops, many of them domestic workshops, is considerable however, 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 2,639; 219 by the women and 2,420 by the men inspectors. The complaints received numbered 41. 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. 31 1.—INSPECTION. Premises Number of Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories (Including Factory Laundries) 239 40 – Workshops (Including Workshop Laundries) 1,426 79 –– Workplaces (Other than Outworkers' Premises included in Part 3 of this Report) 1.307 49 –– Total 2,972 168 – 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 53 23 – – Want of ventilation 13 13 – – Overcrowding 7 7 – – Want of drainage of floors 12 12 – – Other nuisances 45 45 – – Sanitary accommodation - insufficient 10 10 – – unsuitable or defective 32 32 – – not separate for sexes 7 7 – – 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) 14 14 –– –– Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) –– –– –– –– Total 193 193 – – 32 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 lints. Failing to send lists. Outworkers. Lists. Outworkers. Lists. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 65 283 833 ... ... ... 14 ... ... ... ... ... ... ... ... Total 65 283 833 ... ... ... 14 ... ... ... ... ... ... ... ... 33 4,—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year (1) Number (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 2,343 Coffee Shops, &c. 358 Bakehouses 56 Total number of workshops on Register 2,757 5.—OTHER MATTERS. Class (1) Number (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 4 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 41 Reports (of action taken) sent to H.M. Inspector ... 41 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. 34 Under these a new register is being formed, and during the year in connection with this and for purposes of supervision, some 8,088 visits were paid to the 1,055 houses on the old list. The number of intimation notices served was 1,043, relating to cleansing and other defects. Except in 59 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. fil 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 necessaryparticulars 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 1931 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 The Rev. Prebendary Wilson Carlile, C.H., D.D. 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 1932 saw some improvement in conditions so far as underground rooms are concerned ; but 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 88 in which the occupation was definitely illegal and discontinuance secured. Regulations for the control of underground rooms occupied for sleeping purposes having been approved by the Minister of Health, were in operation throughout the year, and assisted considerably in securing improvement of conditions in a number of cases. 35 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 1032 there were 358, this number including: restaurant, dining room and coffee shop kitchens, 210; tea-rooms and pastry-cooks, 93; hotel kitchens, 24; fried fish shops, 25; and fish-curers, 6. Very largely as a result of pressure brought to bear by the Council, the law has now been extended in order (as already explained) to provide for registration of the premises in which ice cream is prepared or sold and certain articles of food are manufactured or prepared. At present the requirement does not apply to cookshops or cooked-food shops, but in time the difficulties with which the procedure is supposed to be surrounded in the case of such establishments may be met. 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 1932, the total number of inspections was 450, the number of notices served being 16. 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 the number of milk samples taken are as follows:—1st Quarter, 58; 2nd Quarter, 51; 3rd Quarter, 39; 4th Quarter, 45, making a total for the year of 193. Only one sample was found to be adulterated. This contained 6.70 deficiency in fat. Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 13 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, 25 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. 36 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 49 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 11 in respect of "Certified" Milk, 15 for Grade "A" Tuberculin Tested Milk, 23 "Pasteurised" Milk, and 1 Pasteurising Licence. In accordance with the instruction of the Ministry 25 samples were taken during the year and submitted to the Council's Bacteriologist. Copies of the reports made were duly forwardd to the Ministry. Milk (Mothers and Children) Scheme.—During 1932 there has been no change in the methods adopted in relation to the supply of milk to mothers and children. Up to 31st March, 1933, the amount expended was £778 Is. 2d., as against £444 in the year ended 31st March, 1932. The actual number of cases dealt with was 388, and the number of orders issued 2,183, which were larger figures than those for 1931, when the cases numbered 295 and the orders 1,539. The number of instances in which the supply was granted absolutely free, having regard to the total number of cases and circumstances generally, though comparatively small, on account of the economic situation, was larger in 1932 than in previous years. 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 and of Mrs. Councillor Harris, who has given most valuable help as representative of the Public Health Committee, to make a just assessment have been helped rather than hindered. B.—FOODS OTHER THAN MILK. The main duties in relation to food protection generally in 1932, 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. 37 Food Inspection.—The work of food inspection receives year by year adequate attention. During 1932, 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 1932. Meat— Fruit— Beef 46 lbs. Apples 26 boxes Mutton 38 „ Pears 26 boxes Pork 2 carcases Tomatoes 3 trays Bacon 4 cwt. 2 qr. 10 lbs. Bananas 1 crate Poultry, etc.— Miscellaneous (Tinned Goods, etc.). Turkey 1 Corned Beef 268 Fowls 10 Briskets of Beef 9 Rabbits 2 Hams, Gammons, etc. 16 Fish— Brawn 68 Tongues 14 Veal 4 Haddock 1 box Pork and Stuffing 4 Shell—Mussels I bag Chicken and Ham Roll 19 Sausages 25 Cream 195 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. The necessity for inspecting premises used for the preparation of cooked and other foods intended for sale preliminary to registration led to a considerable increase in work and also to the detection of a certain number definitely unsuitable or requiring alteration or amendment before registration could be made. C.— FOOD AND DRUGS (ADULTERATION) ACT, 1928. The total number of samples taken under this Act in 1932 was 1,102, the figure for 1931 being 1,108. Of this number 6 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 0.54. In 1931 it was 0.17. 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. 38 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, 1932. The number of samples taken under the Food and Drugs (Adulteration) Act and submitted for analysis, was 1,102. The following is a complete list of the articles sampled :— ANALYSES No. Article Number Examined Number Adulterated, etc. | Formal Informal Private Total Formal Informal Private Total 1 Bacon – 1 – 1 2 Butter 93 144 – 237 3 Butter and Roll – 3 – 3 4 Candied Peel – 1 – 1 5 Cheese – 38 – 38 6 Cinnamon, Ground – 4 – 4 7 Cloves, Ground – 1 – 1 8 Cocoa – 23 – 23 9 Coffee 1 37 – 38 1 1 2 10 Coffee Essence – 3 – 3 11 Cornflour – 2 – 2 12 Cream 24 1 – 25 13 „ Tinned – 14 – 14 14 Currants – 1 – 1 15 Curry Powder 1 9 – 10 16 Dripping – 5 – 5 17 Egg Powder – 2 – 2 18 Flour – 4 – 4 • 19 Ginger, Ground – 3 – 3 20 Grape Fruit Preserve – 1 – 1 21 Herbs, Mixed – 6 – 6 22 Honey – 16 – 16 23 Jam – 33. – 33 24 Jelly – 3 – 3 25 Lard – 63 – 63 26 Lemonade Powder – 7 – 7 27 Margarine – 34 – 34 28 Marmalade – 30 – 30 29 Milk 156 37 – 193 1 1 30 Milk, Condensed – 19 – 19 31 Mincemeat – 5 – 5 32 Mustard 1 16 – 17 33 Ointment, Boric – 14 – 14 34 „ Yellow Mercuric – 1 – 1 35 „ Zinc – 1 – 1 36 Olive Oil – 4 – 4 37 Parrish's Food – — 1 1 38 Paste, Fish – 15 – 15 39 „ Meat – 15 – 15 40 Peas, Tinned – 13 – 13 1 1 41 Pepper – 23 – 23 42 Pickles – 5 – 5 43 Raisins – 4 – 4 44 Rice – 3 – 3 45 Sago – 2 – 2 46 Salmon—Tinned – 8 – 8 47 Sauce – 2 – 2 48 „ Tomato – 6 – 6 Carried forward 276 682 1 1059 2 2 4 39 ANALYSES No. Article Number Examined Number Adulterated, etc. Formal Informal Private Total Formal Informal Private Total Brought forward 276 682 1 1059 2 2 4 49 Sausages, Beef – 4 – 4 50 „ Pork – 5 – 5 51 Soup, Dessicated – 5 – 5 52 Spice, Mixed – 4 – 4 53 Suet, Shredded 1 12 – 13 1 1 2 54 Sugar – 37 – 37 55 Sultanas – 13 – 13 56 Syrup, Golden – 1 – 1 57 Tea – 60 – 60 58 Wine, Red – — 1 1 Total 277 823 2 1102 3 3 6 Adulterated Samples, etc. Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 74 Shredded Suet Informal Contains at least 15.5% of added starch grains. 185 Shredded Suet Formal Contains 13.5 % of added starch grains. 205 Tinned Peas Informal Contains 2.5 grain3 of tin per lb, together with an appreciable amount of iron and a small amount of zinc dissolved from the container. Although it may not be possible to say that these amounts are injurious to health, I am of opinion that they are certainly undesirable and may easily prove an irritant to a sensitive digestive tract. 440 Coffee Informal Contained 70.0 % of Chicory 523 Coffee Formal Contained 76.7 % of Chicory. 711 Milk Formal Deficient in fat to the extent of 3.7%. 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:— 40 Milk.—As milk is one of our chief articles of diet it has been the custom for some years to begin the comments on various samples examined during the year with a short statement about the composition of the milks. In 1932, 193 samples of milk were examined, of which one only proved to be adulterated. The average composition of the other samples compared with previous years is as follows:— Total Solids Sp. Gr. Solids. Fat. not Fat. 1930 1031 12.2 3.59 8.61 1931 1031.4 12.2 3.50 8.70 1932 1031.3 12.2 3.57 8.63 Cream.—The average figures obtained for both loose and tinned creams are again given so that the great disparity between the qualities may be seen. Only 25 samples were examined but the figures obtained for both the loose and tinned samples are much the same as those obtained in previous years. Loose Creams. Tinned Creams. Average Fat = 4932 Average Fat = 2352 In no instance was the fat content of tinned creams notified in any way on the label or container. Coffee.—One informal sample was found to consist of 70.0% of chicory. A formal sample taken from the same vendor contained 76.7% of chicory. Tinned Peas.—13 samples of tinned peas were taken during the year. All except one contained some negligible traces of dissolved tin. But this one had 2.5 grains of dissolved tin per lb., together with an appreciable amount of iron and a small amount of zinc. As stated in the report made on the sample, " Although it may not be possible to say that these amount are injurious to health I am of opinion that they are certainly undesirable and may easily prove an irritant to a sensitive digestive track." Jam.— 33 samples of Jam were examined during 1932. Such of those as came in their original jars and possessed the label of guarantee of The Food Manufacturers' Federation were found to conform closely with the standards laid down. These guaranteed products provide jams of greatly increased purity, quality, and value as compared with most jams not guaranteed. Therefore it rests now with the purchaser to protect himself by seeing that he asks for and obtains a guaranteed article. It is to be hoped that in the not too distant future further steps may be taken along the same lines and that finally jams may have the qualities in full which correspond to those hopefully imaginative ideals usually held by the purchaser. Parrish's Food.—One sample was received from a private source. It was suspected of being of abnormal composition but a detailed quantitative analysis gave figures which corresponded almost exactly with the amount of constituents mentioned on the label of the bottle. Other Samples call for no detailed comment as in every instance the results obtained by analysis were such that each one came up to the standard expressed or implied peculiar to each kind.—(Signed) J. F. F. Rowland. 41 BIRTHS. Registration.—The number of births registered during 1932 was 1,055,* being 12 less than in 1031. Of the children born, 550 were boys and 505 girls. The birth rate per 1,000 of the population was 10.97, as against 11.4 in 1931. STATISTICAL. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1932, with those of each of the five previous years :— 1927 1928 1929 1930 1931 1932 All Souls 9.0 9.7 9.4 10.1 8.9 8.5 St. Mary 10.6 10.7 9.7 10.4 13.2 11.2 Christ Church 19.1 16.4 15.8 14.1 14.4 13.5 St. John 12.6 13.2 12 8 13.8 11.9 9.1 The Borough 18 2 12.6 11.9 12.1 11.4 10.9 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,332; live births, 3,152; still births, 180. The total notifications in 1931 was 3,514. 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 against 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 16 0.5 „ doctors 102 3.6 ,, midwives 879 11.9 „ other persons 58 1.4 „ hospitals, etc. 2,782 83.6 3,832 100.0 Of the total births notified, 180 referred to still-births (100 males and 80 females); 2,091 took place at Queen Charlotte's Hospital; 79 at Middlesex Hospital; 161 at the St. Marylebone Home; and 550 were born at home. Of those notified as having occurred in St. Marylebone, 2,246 belong to other Boroughs. Of the 180 still-births only 30 (13 males and 17 females) were to St. Marylebone mothers. DEATHS AND DEATH RATES. The number of deaths registered in 1932 was 1,265. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but, exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 271 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate M ales 113 Females 117 Illegitimate Males 25 Females 16 Total 271 42 The corrected death-rate* per thousand for the year was 12.4. In the previous year, the rate was 12.3 and the number of deaths 1,225. The following short table shows the death.rates in the several registration sub-districts in 1932, and compares them with those of the years onward from 1926 •— 1928 1927 1928 1929 1930 1931 1932 All Souls 9.6 9.7 9.9 13.3 10.2 10.8 12.8 St. Mary 13.6 14.2 12 0 13.8 11.5 12.4 11.4 Christ Church 13.6 12.6 13.4 15.8 11.8 131 141 St. John 14.3 11.9 12.8 13.8 12.1 12.6 12.8 The Borough 11.9 11.3 111 13.2 10.6 12.3 12.4 District births and deaths for the year ended 29th December, 1932, are given in the following table. A further table giving the vital statistics of separate localities for 1932, and the ten preceding years, will be found amongst the Ministry of Health Tables on page 73. Sub.District. Population estimated to middle of 1932. Males. Births, Females Total. Males. Deaths, Females. Total All Souls 22,103 101 85 186 112 137 251 St. Mary 25,349 158 130 283 159 147 306 Christ Church 29,278 209 198 407 139 203 440 St. John 19,700 87 92 179 117 151 268 The Borough 96,430 550 505 1,055 627 638 1,265 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 1932. For purposes of comparison the table for 1931 is reproduced. 1932. January. March April. June July. September October. December Total Infants under 1 year 29 22 20 21 92 Persons of 65 years and upwards 213 135 121 128 597 *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 overborne 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" iu the case of St. Marylebone in 1932 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. 43 1931. JanuaryMarch AprilJune JulySeptember \ October December Total Infants under 1 year 20 17 12 21 70 Persons of 65 years and upwards 196 137 106 150 592 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 74. 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 1,005. 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 1932 was 92, and the number of births in that year 1,055. The infantile mortality rate is therefore 87. 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 44, 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 1932, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 32 were less than one month old when they died and 46 less than three months. Having regard to the increase in the death-rate from 65 to 87, these figures are important and may be compared with the corresponding figures for 1931, 18 and 29 respectively. The outstanding causes of death and the proportions traceable to them were those usually noted. Prematurity (numbers 12, 13 and 14 in the table), which, as usual heads the list, caused 20 in 1931, and 33 in 1932. Diarrhœa and enteritis (7 and 8) accounted for 11 in 1931 and 32 in 1932. Respiratory diseases took 24 in 1931 and only 5 in 1932. Amongst the other causes of death, those which call for mention are the commoner infectious diseases, which together led to (! deaths among infants, whooping cough accounting for 5. No death was stated to be due to over-laying and only 1 to meningitis and 1 to measles. 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 36 deaths amongst infants. In 1931 the figure was 26. 44 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year of age, and in Sub-Districts. No. CAUSE OF DEATH Under 1 Week 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 1 Month 1 and under 3 Months 3 and under 6 Month; 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year All Souls St. Mary Christ Church St. John Total 1 Small-Pox – – – – – – – – – – – – – – – 2 Chicken-Pox – — — — — — — — — — — — – — 3 Measles – — — — — — — 1 — 1 — — — 1 1 4 Scarlet Fever – — — — — — — — — — — — — – — 5 Diphtheria and Croup – – – – – – – – – – – – – – – 6 Whooping Cough – – – – – 1 2 1 1 5 2 — 3 – 5 7 Diarrhœa – – – – – 2 5 1 — 8 3 1 3 1 8 8 Enteritis 1 — — 1 2 3 9 4 6 24 4 3 11 6 24 9 Tuberculous Meningitis – — — — — — — — 2 2 — — 2 — 2 10 Abdominal Tuberculosis – – – – – – – – – – – – – – – 11 Other Tuberculous Diseases – – – – – – – – – – – – – – – 12 Congenital Malformation 3 – 2 – 5 2 2 1 1 11 2 4 3 2 11 13 Premature Birth 8 2 2 – 12 3 2 — — 17 5 6 3 3 17 14 Atrophy, Debility and Marasmus 1 2 – 3 2 – – – 5 – – 3 2 5 15 Atelectasis 1 1 — — 2 — – — – 2 – 2 — — 2 16 Injury at Birth 4 — — — 4 1 – — – 5 –– — 2 3 5 17 Erysipelas – – – – – – – – – – – – – – – 18 Syphilis – – – – – – – – – – – – – – – 19 Rickets — – – – – – – – – – – – – – – 20 Meningitis (not Tuberculous) – – – – – 1 – – – 1 – 1 – – 1 21 Convulsions — — — — — 1 – — – 1 – — 1 — 1 22 Gastritis – – – – – – – – – – – – – – – 23 Laryngitis – – – – – – – – – – – – – – – 24 Bronchitis – – – – – – – 2 – 2 1 — 1 — 2 25 Pneumonia (all forms) 1 — — — 1 — – 2 – 3 – 1 2 — 3 26 Suffocation, Overlying — — — — — — – — – — – — — — — 27 Other Causes — — 2 1 3 — – 1 1 5 1 1 2 1 5 Totals. 19 5 6 2 32 16 20 13 11 92 18 19 36 19 92 M. F. M. F. M. F. Nett Births Legitimate 477 456 Nett Deaths Legitimate infants 41 37 Nett Stillbirths Legitimate infants 17 16 in the Year illegitimate, 73 49 in the year Illegitimate Infants, 9 5 in the Year illegitimate Infants, 2 2 Total 550 505 Total 50 42 Total 19 18 1,055 92 37 45 MATERNAL MORTALITY. In 1932 the number of deaths due to conditinos connected with or consequent upon child-birth was 4, the Maternal mortality rate being 3.8 per 1,000 births. In 1931, the deaths numbered 3, and the rate was 2.7 per 1,000. The main facts with regard to the 1932 deaths are: In 1 case death was found to be due to septicaemia, following the birth of twins, who survived. In another, in which operation was performed, incomplete miscarriage was followed by portal pyaemia. The ages were 40 years and 36 years respectively. A third case was that of a woman of 39 years of age, who gave birth to female twins, one of which survived. The cause of death was toxœmia of pregnancy. The fourth died from cardiac failure following post partum haemorrhage, her age being 29 years. The child survived. In all four instances the woman was married. DEATHS IN RELATION TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table III. of the Ministry of Health series on page 74. 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 enterities (inflammation of the bowels), was 29, equal to 0.28 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1932 this was the case also, no fewer than 24 of the 29 being children under 1 year of age. In 1931, the deaths from diarrhœal diseases numbered 17, and of this number 13 were babies. This increase in 1932 is difficult to understand since there was no slackening of any of the efforts in relation to public health work generally and the milk supply particularly, which have been held to be responsible in the past for reducing and keeping under control this at one time serious menace to infancy. 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 35 deaths, and including diarrhoea (29 deaths) the total number registered as due to them was 64. Of these deaths, 18 were caused by measles and 14 by whooping cough. No death was caused by scarlet fever and only one by diphtheria. In 1931, 31 deaths were due to infectious diseases excluding influenza, which caused 28 deaths. The figure in 1930 was 70. 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 75, a figure lower by 17 than that for 1931. The great bulk of the 75 deaths, viz., 67, was due to phthisis. The number in 1931 was 81. Of the total number of deaths registered (1,265), the percentage due to phthisis was 6.0, as against 6.6 in 1931. The age periods at which the deaths occurred were: 15—25, 12 (17.9%); 25—45, 26 (38.8%); 45—65, 21 (31.4%); 65 and over, 8 (11.9%). The subject of phthisis is further discussed in connection with the notification and prevention of tuberculosis. 46 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 125. This is lower by 41 than the figure (166) for 1931. The death-rate was 1.25 per 1,000. In 1931 the rate was 1.6. The number of deaths certified to be due to bronchitis was 34. Of this number 28 were amongst persons aged 65 and upwards, and 3 amongst those of the group 45—65. The deaths traceable to pneumonia numbered 77, and, as in the case of bronchitis, the later age groups contributed the greatest numbers, though 10 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified in 1932 was 77. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in the table on page 75. Visits were paid to each of the notified cases, when not already in a Hospital or other Institution, 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 179 and the death-rate 1.75 per 1,000 of the population. These figures are slightly lower than those for 1931, when the deaths numbered 189 and the rate was 1.9 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 under 1 2 and under 5 5 and under 15 15 and under 25 25 and 35 and under 35 under 45 1 45 and under 55 55 and under 65 65 and under 75 75 and upwards Totals Males 1 2 1 – 1 12 28 36 9 90 Females – – – – 16 12 27 28 15 89 Totals 1 2 1 — 1 7 24 55 64 24 179 Cancer.—Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 8 8 11 Throat, Neck, Gullet 11 4 15 Stomach 15 5 20 Intestines 28 23 51 Liver 5 5 10 Breast – 16 16 Uterus and Generative Organs 3 22 25 Various 20 11 81 Totals 90 89 179 47 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 so far as males are concerned. 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, sucide and manuslaughter Accidental or violent deaths during 1932 numbered 77. Of these 27 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 75. The following table shows the number of cases of infectious disease notified during the past six years :— 1927 1928 1929 1930 1931 1932 Smallpox — 30 3 6 2 – Diphtheria 160 177 180 271 154 83 Erysipelas 36 67 40 61 55 55 Scarlet Fever 178 223 237 226 258 192 Enteric Fever 5 13 5 9 9 3 Paratyphoid Fever 12 10 6 6 3 4 Continued Fever — 1 — — — – Puerperal Fever 1 3 4 8 11 5 Puerperal Pyrexia 35 32 19 25 22 26 Cerebro-spinal Meningitis 2 — 3 4 5 2 Tuberculosis (Pulmonary) 155 139 147 141 145 140 Tuberculosis (Non-Pulmonary) 35 22 26 20 17 23 Acute Poliomyelitis 3 — 2 2 1 1 Polio-Encephalitis — 1 — — — — Ophthalmia Neonatorum 12 7 3 16 10 8 Encephalitis Lethargica 3 3 3 2 — — Pneumonia 45 44 92 42 80 77 Malaria 3 1 2 1 — 1 Dysentery 1 2 1 — — 2 Totals 686 775 773 840 772 622 Diphtheria and Membranous Croup. There were only 83 cases of diphtheria notified during 1932, 1 death resulting, as against 154 cases and 4 deaths in 1931. The number of cases per thousand of the population was 1.1. 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 3 cases the source appeared to be a member of the family previously infected; in 1 case infection was counted to have been acquired in school, and in 4 cases in an institution. 48 The number of swabs from doubtful cases submitted for bacteriological examination was 2,349. The bulk of these were from institutions, St. Charles' and the Royal National Orthopaedic Hospitals, and were taken from ward contacts with notified cases. Towards the latter part of the year, however, arrangements were made to have specimens from St. Charles' Hospital, which is actually in Kensington, examined elsewhere, the cost not being chargeable to St. Marylebone under the new scheme. Fortunately nearly all proved negative, a positive result actually being returned in 72 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 33. In All Souls the number was 18, in St. Mary 22, and in St. John 10. As usual, the age groups 1—5 and 5—15 were those most affected, 27 of the cases falling into the former and 38 in the latter group. Four 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., 5. These were all remedied after service of notices. Diphtheria Immunisation.—The Schick Testing and Diphtheria Immunization Clinic opened at the beginning of 1.928, 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 4 2 41 47 Positive 2 2 25 29 Negative 1 — 13 14 Not reported 1 — 3 4 Inoculated without Schick Test 199 142 4 345 Injections—1st 3 2 31 86 2nd 177 142 33 352 3rd 171 128 33 332 4th 23 24 32 79 5th 15 18 29 62 Retested 145 138 39 317 Completely immunised 118 102 34 254 Positive after retestd 16 22 5 48 Not reported 11 9 — 20 Additional Injections 7 6 7 20 SUMMARY. Number of Sessions 83 Total Number of New Cases 395 „ „ under 5 198 ,, „ over 5 149 „ „ Adults 48 Number of attendances 1,865 Average attendance per session 22 49 scarlet Fever. That there is a liability for scarlet fever to show epidemic tendencies at intervals of five years, more or less, is well known. This year, however, only 192 notifications of this disease were received, the highest number of cases reported in any one week being 10. There were no deaths from scarlet fever during 1932. The districts to suffer most from this disease were All Souls and Christ Church. In the former there were 81 cases and in the latter 46. In St. Mary there were 40 and in St. John 25. As usual, the majority of the patients were children of school age, the age group, 5—15, giving over one-half (109) of the total. Of the remainder 53 were aged between 1 and 5 years, and 30 over 15 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 21 instances that a definite connection could be made out. Defects in sanitation to the number of 12 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 3. There were no deaths. Of Paratyphoid Fever there were 4 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. Two 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 31 patients were treated in one or other of these institutions. Puerperal Fever and Puerperal Pyrexia. The number of cases of Puerperal Fever notified, viz., 5, was below the average of the last few years. Two 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. 50 The Puerperal Pyrexia cases notified during the year numbered 26; 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, 1926. The number notified in 1931 was 22. Measles and German Measles. These diseases showed epidemic tendency during the ten months 1st November, 1931, to 31st August, 1932, and although they are not now notifiable, 7 cases were reported voluntarily by doctors and parents and 467 by school teachers. There were 18 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 1932 the number of deaths registered as due to whooping cough was 14. There were 2 deaths from the disease in 1931. 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, there being no cases in 1932 and only 2 in 1931. Vaccination.—The usual table has been prepared by the Vaccination Officer and will be found on page 77, while the following statement gives some information with regard to the work done and the results obtained by Dr. Bulman during 1932. Number of visits paid 1,519 Number of vaccinations— Primary 570 Re-vaccinations 281 851 Number of successful vaccinations 831 Number of unsuccessful vaccinations 20 Number of refusals 5 Infectious Diseases in Schools. The accompanying table shows the number of cases and contacts of measles, whooping cough, chicken-pox and the notifiable infectious diseases reported from Schools during 1932. During the year in certain of the schools, one or more classrooms were closed on account of measles. 51 INFECTIOUS DISEASE IN SCHOOLS, 1932. scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 85 6 – – 29 6 Barrett Street 1 — — 2 — — Barrow Hill Road 5 5 27 8 23 2 Bell Street 16 3 — 3 23 16 Cap land Street 8 16 19 8 84 38 Catholic, Richmond Street — — — — – — Christ Church, Cosway Street 12 6 24 — 49 8 Convent (St Edward's), Little Union Place 3 7 — — 26 6 Cosway Street (L.C.C.) 24 8 23 13 56 101 Emmanuel, North Street — — — — — Emmanuel, Aberdeen Place 3 8 — 28 41 19 Gateforth Street — — — 3 — — Hampden Gurney 12 2 — — 12 2 Homer Row, Catholic — — 2 4 4 1 L.C.C. Grove Road — — — — — — Jewish, Han way Street — — — — — — Polytechnic, Regent Street – – – – – – St. James's, Marylebone Lane 1 — — 1 — — St. Luke's, Nutford Place 5 5 10 18 12 7 St. Mark's, Violet Hill 13 1 22 7 34 13 St. Marylebone Central. High Street 21 — 14 4 95 21 St. Marylebone Grammar — — 1 — 4 — St. Mary's (Western) York Street 12 4 20 — 51 1 St. Paul's Bentinck, Ross more Road 34 18 26 11 47 33 St. Paul's, Bradley Terrace — — — — — — St. Thomas', Orchard Street — — 1 — 7 — St. Vincent, Wig more Street — 8 — — 11 1 Upper Marylebone Street 35 7 24 71 49 35 Schools in other Boroughs 12 1 1 2 14 1 Totals 302 105 214 183 671 311 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 1932. The total number of cases notified was 8, as against 10 in 1931. Visits were paid to notified cases by the Health Visiiors, and in 4 cases arrangements were made for one of the nurses of the Paddington and Marylebone Nursing Association to attend and apply treatment. In this connection 66 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 T reated Vision Unimpaired Vision Impaired Total Blindness Deaths At Home At Hospital 8 4 8 — — — 52 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 35, as against 28 in 1931. 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 46 and 75. The services of the nurses were requisitioned in 23 cases and 431 visits were paid. The number of death's certified as due to all forms of this disease was 77. FOOD POISONING. Section 7 of the London County Council (General Powers) Act, 1932, under which conditions due to food poisoning or suspected to be due to food poisoning became compulsorily notifiable, came into operation at the end of August. By the close of the year 17 such cases had been reported but there has since been a very marked falling-off in the number of notifications received. In 6 instances some form of fish, either fresh or tinned, was the food suspected, whilst in other cases tinned peaches, tinned soup, meat pie, pork, rabbit, bacon, mushrooms and tomatoes came under suspicion. In the case of the suspected tinned soup three persons living together were reported ill and analytical examinations were made of both the residue in the tin and the excreta of the patients but no definite conclusions were arrived at. In no case was it necessary to remove the patients to hospital and all fully recovered within the course of a few days. TUBERCULOSIS. In all 163 notifications were received, 140 relating to pulmonary tuberculosis, the remainder (23) to cases in which structures other than the lungs were affected. The table given on page 54 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 75 2. The number of cases unnotified or notified at death 26 3. The number of cases notified within a month of death 11 4. The number of cases notified within three months of death 8 5. The number of cases notified within six months of death 5 Treatment of Tuberculosis.—Of the cases notified 214 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 86 were insured persons; of those 57 were admitted to sanatorium or hospital treatment, 21 to St. Charles' Hospital and 6 to St. Mary Abbots' Hospital. Non-insured persons numbered 77, of whom 44 (18 being children) received sanatorium treatment. Seven were admitted to St. Charles' Hospital and 2 St. Mary Abbots' Hospital. Nurses were sent in to 7 cases and 246 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. 53 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 3rd January, 1982, to the 31st December 1932. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Notifications on Form A. Notifications on Form B. Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. No. of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Age Periods. 0 to 1 1 to 5 S to 10 10to15 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 – – – 2 5 11 20 15 16 15 6 90 104 – – – – – 45 60 „ Females — — 1 3 3 10 17 7 5 3 1 50 57 – – – – – 15 33 Non-Pulmonary Males 2 1 2 – – 1 – 6 6 – – – – – – 8 „ Females 1 3 2 – 3 3 8 1 1 – 17 18 – – – – – – 7 Totals — 3 5 9 8 24 40 25 22 20 7 163 185 — — — — — 60 108 54 Form T. 137—1931. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. PartI—Summary of Notifications during the period from the 3rd January, 1932, to the 31st December, 1932. in the area of the 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 — — — 2 5 11 20 15 16 15 6 90 104 „ Females — — l 3 3 10 17 7 5 8 1 50 57 Non-pulmonary Males 2 1 2 – – – – – – 1 — 6 6 Females ' a 2 — 3 3 3 1 1 — — 17 18 Supplemental Return. PartII.—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.[/##3] Pulmonary, Males – – – – – 2 3 2 5 2 2 16 „ Females – – – – – 2 1 1 3 5 — 12 Non-pulmonary males — 1 1 — 1 1 – 1 – — 5 „ Females — — 1 1 — – – — – I 3 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 4 4 transferable deaths from Registrar General 16 — Posthumous Notifications 1 — " Transfers " from other areas (other than transferable deaths) 6 4 Other sources if any (specified) 1 — f f 55 Part III.—Notification Register. Number of cases of Tuberculosis remainining at the 31st December, 1932, on the Registers of Notifications kej.t by the Medical Officer of Health of the Metropolitan Borough • Pulmonary. Non-Pulmonarv • Total cases Males Females Total Males Females Total 899 252 651 88 78 166 817 Number of cases removed from the Register(s) during the year by reason intet alia of:— (l) Withdrawal of Notification — (2) Recovery from the disease 1 1 — — — 1 (3) Death 52 21 73 4 4 8 81 (4) Removed from district 20 27 47 6 8 14 61 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 the table at page 57, 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, 51 ... Old, 103 No. of cases at Dispensary New, 334 ... Old, 1,580 No. of attendances at Dispensary 2,899 No. of visits by Miss Baker First visits, 110 ... Re-visits, 1,725 No. of visits by Miss Kenion First visits, 70 ... Re-visits, 1,138 No. of Committee Meetings attended ... 23 The Tuberculosis Care Committee continued to meet fortnightly throughout the year, Dr. Saner, Miss Baker and Miss Kenion attending and assisting in every way possible. The representatives of the Council on this Committee were : Councillor Dr. C. A. Fuller and Councillors G. B. Ramsay and Mrs. E. M. Shirley. In addition to the Council's representatives this Committee includes :— NAME. Morris, Sir Francis (Chairman) ... Broadbent, Miss M. E. (Hon. Secretary) Sykes, Dr. A. W. ... Marriott, Miss K McWilliam, Miss M. Higgin, Miss E. Lazarus, Miss O. ... Wetherall, Miss ... Hawthorn, Mrs. Hastings, Mrs. Somerville Bennett, Miss A. M. Bowen, Miss E. A. (M.B.E.) Price, Miss H. M. ... Lesser, Mr. H. E. ... REPRESENTS. Public Assistance Committee. Invalid Children's Aid Association. Divisional School Medical Officer to the London County Council. London County Council and School Care Committee. Charity Organization Society Portland Town Association. Central Jewish Synagogue. St. Mary's Hospital, Paddington. Margaret Street Hospital. The Working Classes. Paddington & St. Marylebone District Nursing Association. War Pension Committee and United Services Fund. Middlesex Hospital. London Insurance Committee. 56 The following note by Dr. Saner upon the work of the year is of interest:— " The statistical figures for the year 1932 are given in full in the tables, copies of which have been forwarded to the Ministry of Health and the London County Council. They need no comment except perhaps to note that the number of new cases shows a slight decrease whereas the attendances at the Dispensary show an increase. Altogether 627 examinations were made in the 12 months and 204 specimens of sputum were tested. In all 232 progress reports have been forwarded to the London County Council on those patients who have been at a sanatorium either for pulmonary or surgical tuberculosis. Out of these one finds that 107 are working, 106 at their original occupation and one at a new occupation; 8 are unable to obtain work, 9 are doing light house work—these are mostly the married women —18 have transferred to other districts, 3 have been crossed off the register as " recovered," 3 have died and 31 are unfit for work. Some 52 failed to attend for examination for some reason or other, as lost sight of or refusal to attend, but 29 were reported as being well and working. The Care Committee has met fortnightly during the year and 361 patients have been brought to their notice, either because they were going to sanatorium or had returned from treatment, or were recommended to the Charity Organization for assistance in connection with work or convalescence. Some children were referred to the Invalid Childrens' Aid Association while 41 patients were sent to general hospitals, 21 of them receiving sanatorium treatment following the rest or nursing in hospital. Miss Bowen, M.B.E., as usual, has looked after the ex-service men and their families. The X-ray department of the Middlesex Hospital has again been of assistance particularly in doubtful cases. • A supply of suitable clothing is now provided for those patients who are to undergo institutional treatment who do not possess it and cannot afford to buy." 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 623, as against 801 in 1931. Of these, 126 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.— Fifteen of the total notifications—23 as against 17 in 1931—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 59. 57 TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1932. DIAGNOSIS. PULMONARY. NON-PULMONARY. TOTAL. GRAND TOTAL Adultb. Children. Adults. Children. 1 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 47 39 1 8 4 6 3 3 51 35 4 6 96 *f(b) Diagnosis not completed – – – – – – – – 5 1 9 16 31 c) Non-tuberculous – – – – – – – – 31 44 17 24 116 B.—Contacts examined during the year:— (a) Definitely tuberculous 4 1 – – – – – – 4 1 – – 5 (b) Diagnosis not completed – – – – – – – – 1 5 11 8 ! 25 (c) Non-tuberculous — – – – – – — – 5 17 11 15 48 C.—Cases written of the Dispensary Register as:— (a) Recovered 1 – – – 3 – – – 4 – – – 4 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) – – – – – – – – 43 64 44 53 204 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 202 156 32 25 21 25 35 25 223 181 67 50 | 521 (6) Diagnosis not completed – – – – – – – — 6 8 41 39 I 94 1. Number of cases on Dispensary Register on January 1st 590 2 Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 22 3. Number of cases transferred to other areas, cases not desiring further assistance under the 6cheme, and cases " lost sight of " 74 4. Cases written off during the year as Dead (all causes) 36 5. Number of attendances at the Dispensary (including Contacts) 2,899 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 202 7. Number of consultations with medical practitioners :— (a) Personal 13 8. Number of visits by Tuberculosis Officers to homes (including personal consultations 154 (6) Other 120 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,081 10. Number of :— (a) Specimens of sputum, &c., examined 204 (b) X-ray examinations made ... in connection with Dispensary work 40 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(6) above Nil 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 231 (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. 58 Deailis 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 1932 the total number certified as due to this cause was 67, the deathrate being 0.7 per 1,000. In 1931 the deaths numbered 81, the death-rate being 0.8 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 1927-1932. Deaths from Phthisis. 1927—1932. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1932 96,430 67 15 18 23 11 The distribution of the 67 deaths was as follows:—In Poor Law Institutions, 36 ; in general and other hospitals, 16; and at home, 15. Of those who died 30 were insured (27 males and 3 females), and 37 uninsured (20 males and 17 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 67, the notified cases of pulmonary tuberculosis totalled 140. 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 – – 2 1 – – 1 1 1—5 — — 2 3 — — 1 — 5—10 — 1 2 3 — — – 1 10—15 2 3 1 – – – – 15—20 5 3 — 4 4 — – — 20—25 13 12 1 S 6 2 1 — 25—35 23 18 1 3 7 6 – 1 35—45 17 8 — 1 10 3 1 — 45-55 21 8 1 1 7 1 – — 55 -65 17 8 1 — 7 7 – — 65 and upwards 8 1 — 1 7 1 – 1 Totals 106 62 11 20 48 20 4 4 •Including all cases known otherwise than by notification. The following table, giving information as to localisation of the disease, brings out no fact to which attention has not already been directed. 59 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 31ST DECEMBER, 1932. Localisation of Disease. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. At all Ages. At ages—years. All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals Cases Isolated at Home Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Lungs 140 - - 6 29 59 39 7 29 47 53 11 140 10 14 20 3 47 93 Spine 1 - - - - 1 - - 1 - - - 1 1 - - - 1 - Shoulder 1 - - - 1 - - - - 1 - - 1 - 1 - - 1 - Glands 4 - - 2 2 - - - - - 2 2 4 - - - 1 1 3 Face 1 - - - - - - - - - - 1 1 - - - - - 1 Knee... 4 1 2 1 - - - - 1 1 2 - 4 1 - 1 - 2 2 Meninges 4 2 2 - - - - - 1 - 3 - 4 1 - 2 - 3 1 Abdomen 3 - - 1 1 - 1 - 1 1 - 1 3 1 1 - 1 3 - Hand 1 - - - 1 - - - - - 1 - 1 - - - - - 1 Kidney 1 - - - - 1 - - - - 1 - - - - 1 - - - Caecum 1 - - - - 1 - - - - - 1 1 - - - 1 1 - Ilium 1 - - - - 1 - - 1 - - - 1 1 - - - 1 - Fallopian tubes 1 - - - 1 - - - - - - 1 1 - - - 1 1 - Totals 163 3 4 10 35 63 41 7 34 50 62 17 163 15 16 24 7 62 101 163 60 DISINFECTION. I he work done in this connection during' 1932 is shown in the following' tables. I he 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. 1 he number of the articles disinfected are shown hereunder Compulsorily Notifiable Diseases. Phthisis Measles. Vermin. Other causes. Total. Totals 4,592 334 225 199 1,891 7,241 The number of journeys made by the disinfecting vans during the year ended December, 1932, was :— January 92 August 93 February 84 September 100 March 101 October 92 April 90 November 96 May 88 December 88 June 88 July 90 1,102 The number of journeys made during 1931 was 1,068. The number of rooms disinfected and the reasons for carrying out disinfection are stated below — Compulsorily Notifiable Diseases. Phthisis. Measles. Other causes. Total. Totals 436 69 104 113 722 The number of rooms disinfected in 1931 was 911. 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 307. 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 VERMINOUS PERSONS. The numbers of Adults and School Children using the Baths originally provided under the Cleansing of Persons Act, 1897, during the year 1932 were 3,179 and 3,147 respectively. 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. 61 Disease Suspected. 1932. Positive. Negative. Total. Typhoid fever 2 25 27 Diphtheria 72 2,277 2,349 Phthisis 126 497 623 Totals 200 2,799 2,999 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 Society is responsible bulk largest. The Council, who made a grant of £1,000 in 1932 to the Society, and the inhabitants of the Borough are greatly indebted to this body and those who work for it for what they have done and what they are doing in relation to maternity and child welfare. Apart from the Health Society, however, there are other bodies that assist and that are more or less definitely linked up to the main scheme, the connecting link being the Public Health Department of the Council. Amongst these bodies may be mentioned Queen Charlotte's Hospital and Middlesex Hospital, which in addition to providing lying-in accommodation, arrange for attention to be given to out-door patients as well, and conduct ante-natal clinics and infant consultations. At the Western General Dispensary the special clinic for children under Dr. Bernard Myers does most useful work. Less definitely part of the scheme,. but still doing very valuable work and helping whenever possible, are St. Agatha's Home, 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 1932. 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. 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 1982. 62 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 tion of Births Act, 1907, as adjusted by any transferred notifications : (a) Live births, 1,037; (b) Still births, 30; (c) Total, 1,067; (d) By midwives, 379; (e) By doctors and parents, 118; (f) By hospitals, 334; (g) By matrons of Nursing Homes and transferred notifications, 236. 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, 372; total visits, 523. (b) To children under 1 year of age, first visits, 1,068; total visits, 6,326. (c) To children between the ages of 1 and 5 years, total visits, 6,641. 4. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council, one. (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, 15,279; (ii) By children between the ages of 1 and 5 years, 14,781 + 91 (3 year olds). (d) Total number of children who attended at the Centres for the first time during the year : (i) Children under 1 year of age, 1,100 ; (ii) Children between the ages of 1 and 5 years, 153 + 91 (3 year olds). 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, 20,194.* (d) Total number of expectant mothers who attended at the Clinics during the year, 3,712.* (e) Percentage of total notified births represented by the number in (d), 89.* *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. 63 (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, 15,132. 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 tlie Council. Number of cases removed to hospitals or nursing homes. (1) Opthalmia Neonatorum ... 8 8 4 4 (2) Pemphigus Neonatorum ... - - - - (a) Puerperal Fever 5 5 - 5 (4) Puerperal Pyrexia ... 26 20 - 23 (5) Measles and German Measles tin'* children under 5 years of age) ... Not Notifiable 144 25 - (6) Whooping Cough (in children under 5 years of age) 83 2 - (7) Epidemic Diarrhoea (in children under 5 years of age) ... ...' - - - 18) Poliomyelitis (in children under 5 years of age) 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 1½ nurses. (b) Total number of cases attended during the year by these nurses, 75. 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. 14. Maternal deaths. (a) Number of women who died in, or in consequence of, childbirth in the area .served by the Council for maternity and child welfare during the year (i) from sepsis, 2 ; (ii) from other causes, 3. (b) Number of these cases which died: (i) at home, 1; (ii) in tions, 4. 64 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 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, 1.30 p.m. Infant Consultation, Cosway Street, N.W. 1— 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. Monday, 2 p.m. Infant Consultation. Wednesday, 2 „ Ditto 14, Salisbury Street, Lisson Grove, N.W. 8— Monday, 2 p.m. Infant Consultation. Tuesday, 9 30 a.m. Light Clinic. „ 10 „ Massage Clinic. „ 2 p.m. Infant Consultation. Wednesday, 2 „ Maternity Clinic. „ 2 „ Needlework Class. Thursday, 1.30 „ Toddlers (2—5 years). Friday, 9.30 a.m. Light Clinic. „ 10 „ Massage Clinic. „ 2 p.m Infant Consultation. 24, Hill Road, N.W.8— ' Tuesday, 2 p.m. Infant Consultation. Western General Dispensary, Cosway Street, N.W.I — Monday, 2 p.m. Infant Consultation, Thursday, 10 am „ „ Church Army Dispensary, BryaDSton 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 „ 3 year old Clinic. Day Nurseries— The Crossley Day Nursery, Barrow Hill Road, N.W. 8. The Portman Day Nursery. Exeter Street. Lisson Grove, N.W.8. The St. Vincent de Paul, 111, Wig-more Street, W.l. 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 six districts, and in 1932 the health visitors made 13,300 visits to children and 523 visits to mothers. Children are visited up to school age. 65 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 Motliercraft, Salisbury Street, has an ante- and post-natal consultation under medical supervision, The dental clinic and minor ailment treatment centre are in the same building. The Council's health visitors cooperate, one of them acting as superintendent.—(2) South Marylebone School of Mother era ft, 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 Charloties Hospital, at Middlesex Hospital, at the Church Army Dispensary, and at the Western General Dispensary, One ot 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 figure given elsewhere shows, 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 lact that a special centre has been established at the Western General Dispensary has already been mentioned. Maternity Cases.—The Council has 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 1932 was 2,333; the total births numbering 3332. 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 37 cases were dealt with under the arrangement, and 592 visits were paid, the services of the nurses being greatly appreciated by the patients. Work done during 1932.—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 numbers of orders issued is shown in the table. 66 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDED 31ST DECEMBER, 1932. 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 72 148 100 90 93 152 90 Toddlers 24 51 - 10 - 52 90 Maternity - 49 306 - 12 184 - Massage - 90 87 - 4 - - Light - 76 - - 33 - - No. of attendances of mothers at clinic;— Ante-natal - 346 16,046 - 16 3,786 - Post-natal - 479 11 - - 103 - No. of attendances of babies 1,478 3,140 3,620 1,644 850 4,058 195 No. of attendances of children over 1 year 848 2,615 872 1,412 935 3,852 406 No. of attendances at Light Clinic— Infants - 53 - - 8 - - Toddlers - 2,156 - - 57 - - No. of attendances at Massage Clinic— Infants - 27 194 - 12 - - Toddlers - 1,437 185 - 6 - - No. of orders issued for milk, etc. 163 856 149 275 121 254 - No. of home visits 2,218 3,418 249 1,293 545 3,023 - No. of new cases:— Infants 100 194 286 74 49 309 88 Toddlers 9 46 6 4 8 25 55 Ante-natal - 81 3,016 - 4 611 - Fost-natal - 56 7 - - 103 - Massage— Infants - 5 24 - - - - Toddlers - 51 9 - - - - Light— Infants - 7 - - 2 - - Toddlers - 50 - - 5 - - 67 Day Nurseries.—Attendances during the year. The Crossley, Barrow Hill Road.—Whole day, 4,502 ; half-day, 795. The Portman, Exeter Street.—Whole day, 5,032 ; half-day, 393. St. Vincent de Paul, 111, Wigmore Street.—Whole day, 3,228; half-day, 1,182. Dental Clinic, 12, Salisbury Street. Attendances during the year.—Mothers, 785 ; children, 74. Advice and treatment given in 563 cases. Extractions under gas 296. Hoine Helps.—Home helps were provided by request in 1932 in 4 cases only, the total amount expended during the financial year to 31st March, 1933, being £6 2s. Od. SANITARY ADMINISTRATION. Under this, which is made a separate heading by the Ministry of Health, the Medical Officer of Health is required to make reference to a number of matters, e.g., staff, hospital accommodation and some others, most of which will be found dealt with elsewhere. (1) Staff: Work of sanitary inspectors and other officers engaged in sanitary work. This matter, so far as the inspectors are concerned, is fully discussed in an early part of the report. The report of the Mortuary Keeper (Mrs. Spears) is as follows:— Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1932, was:— 1932. Males. Females. Total. For burial only. For inquests. Total. No. of P.M 's held. No. of courts held. No. of Infectious cases. Totals 61 87 148 144 4 148 38 - - 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 56, 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. 68 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) 2,009 (b) Number of inspections made for the purpose 10,756 (2) (a) Number of dwelling-houses (included under sub-head (1) above which were inspected and recorded under 581 houses and the Housing Consolidated Regulations, 1925 253 tenements (b) Number of inspections made for the purpose 2,983 (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 1,320 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 1,257 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 63 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 63 (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: (!) 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 69 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 As to progress it may be noted that during the year considerable advance in the direction of improving housing conditions within the Borough has been made. Particularly is this so in the Carlisle Street area, where two new blocks have been completed and occupied, and the erection of a third block commenced. Part of the south side of North Street has now been cleared as have portions of Venables Street and Luton Street. The east side of Lyons Place has been cleared in connection with a road widening scheme. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 135 Slaughterhouses 1 Offensive Trades 2 Ice Cream Premises 78 Bakehouses 56 Restaurant, Dining Room and Coffee Shop Kitchens 210 Hotel Kitchens 24 Pastrycooks and Tea Rooms 93 Fried Fish Shops 25 Fish Curers 6 Houses Let in Lodgings 1,055 Workshops and Workplaces 2,757 Total 4,442 Smoke Nuisances. Number of Observations 592 Number of Nuisances and Complaints Nil Number of Intimation Notices Number of Summonses Nil served 14 Number of Convictions Nil Number of Statutory Notices Amount of Penalty and Costs served 37 imposed in each case Nil 70 Housing of the Working Classes Number of Houses inspected— (a) On account of complaints or illness (P.H. Act) 2,009 (b) House-to-house (Housing Consolidated Regulations, 1925) 581 Tenements in blocks 253 Total 2,843 Number of Notices served— (a) Under P.H. Act (1) Intimation1,257 (2) Statutory 63 (b) Under Housing Act Nil Number of Houses repaired or nuisances remedied under P.H. Act, 1891 1,320 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 Numbe. of Houses for the Working Classes— (a) Erected during year (flats) 44 (b) In course of erection 63 Number of Representations by Medical Officer or other person Nil Number of Houses included in such representations Nil Number of Closing Orders made Nil Number of Closing Orders determined (i.e., Houses made fit) Nil Number of Demolition Orders... Nil Number of Houses demolished— (a) In pursuance of Orders Nil (b) Voluntarily Nil Total Number of Houses in the borough 17,200 Number of Houses occupied by the Working Classes 8,587 Number of Houses registered under the new Bye-laws as to Houses Let in Lodgings Nil Number of Inspections made of such Houses Nil Number of Prosecution Nil Mortuary. Number of bodies received 148 Number of Infectious bodies received 4 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total Number of persons cleansed 2,482 697 905 2,242 6,326 Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of .1932 858 Number of Inspections 450 Number of Notices 16 Number of Prosecutions Nil Bakehouses. Number on Register at end of 1932 56 Number above ground 7 Number underground 49 Number of Inspections 110 Number of Notices 8 Number of Prosecutions Nil 71 House ro House Inspections. Number of Inspections Houses 581 Tenemsnts 253 Number of Notices issued Intimations 603 Statutory Notices 63 Number of Prosecutions Nil House Refuse. Number of Inspections 1,058 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 159 Number of Notices issued. Intimations 159 Number of Statutory Notices 5 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 23 Number of Statutory Notices served Nil Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 19 Number Remedied 19 Number of Prosecutions Nil Underground Rooms. Number dealt with 88 Number of Notices served under P. H. (L.) Act, 1891 88 Number of Notices served under the Housing Act, 1925 Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms cleansed after infectious disease 722 Number of rooms cleansed from vermin 561 Number of articles 4,592 Number of Statutory Notices served 12 Number of Prosecutions Nil Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of Persons accommodated during the year Nil Drainage. Number of inspections made 4.012 Number of drainage plans deposited 380 Number relating to new buildings 21 „ „ old buildings 359 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops and Cowsheds 408 Number of Inspections 810 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 72 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1932 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Birth No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1,531 145 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 1,356 119 1927 103,500 3,521 1,374 13.2 1,375 18.2 781 621 81 59.0 1,262 113 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 12.3 1932 96,430 2,952 1,055 10.9 1,444 14.3 859 680 92 87.2 1,265 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. 73 TABLE II. Vital Statistics of Separate Localities in 1932 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 estimated to middle of each year Births registered ... Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 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 1925 106,100 1,496 1,257 94 25,425 265 234 10 27,172 348 339 19 33,024 593 426 56 20,479 290 258 9 1926 105,800 1,359 1,356 111 25,353 230 244 17 27,095 276 369 25 32,931 594 450 53 20,421 259 293 16 1927 103,500 1,374 1,262 81 24,794 225 241 14 26,509 282 377 17 32,218 615 406 37 19,979 252 238 13 1928 104,000 1,317 1,238 105 24,915 232 248 21 26,688 285 299 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 1980 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 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 Averages of Years 1922 to 1931 103,356 1,397 1,309 98 24,667 255 255 17 26,535 303 355 19 32,099 563 436 45 20,055 280 266 17 1932 96,430 1,055 1,265 92 22,103 186 251 18 25,349 283 306 19 29,278 407 440 36 19,700 179 268 19 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. 74 TABLE III.—Causes of, and Ages at Death during the year 1932. No. CAUSES OF DEATH. Net deaths at the subjoined ages ot "Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Resident in Institutions in the District. All Souls. St. Mary. Christ Church. St. John. Total. All Ages. Under 1 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and unrfer65. 65 and upwards 1 Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - 2 MeasleS 18 1 10 4 3 - - - - - 1 4 12 1 18 3 Scarlet Fever - - - - - - - - - - - - - - - 4 Whooping Cough 14 8 3 2 1 - - - - 2 5 3 5 1 14 5 Diphtheria 1 - - 1 - - - - - - - 1 - - 1 6 Influenza 35 2 - - - 2 4 14 13 20 5 10 13 7 35 7 Encephalitis Lethargica . 1 - - - - 1 - - - 1 - - 1 - 1 8 Cerebro-Spinal Fever 1 - - - - - 1 - - 1 - - 1 - 1 9 Tuberculosis of Respiratory System 67 - - - - 12 26 21 8 14 15 18 23 11 67 10 Other Tuberculous diseases 8 2 1 - 1 1 1 1 1 13 2 3 2 1 8 11 Syphilis 5 - - - - - 4 - 1 3 2 - 2 1 5 12 General Paralysis of the Insane, Tabes Dorsalis 5 - - - - - - 4 1 - - 5 - - 5 13 Cancer, Malignant Disease 179 1 - 2 1 - 8 79 88 268 38 39 57 45 179 14 Diabetes 10 - - 1 - - 3 3 3 6 1 3 4 2 10 15 Cerebral Haemorrhage, etc- 41 - - - - - - 13 28 58 4 14 10 13 41 16 Heart Disease 327 - - - 2 5 16 74 230 123 67 78 112 70 327 17 Aneurysm 5 - - - - - 1 2 2 - 1 1 2 1 5 18 Other Circulatory Diseases 51 2 11 38 7 10 14 13 14 51 19 Bronchitis 34 1 1 - - - 1 3 28 19 4 7 20 3 34 20 Pneumonia (all forms) 77 9 1 2 2 1 6 22 34 78 20 16 29 12 77 21 Other Respiratory Diseases . 14 - - - - 1 1 4 8 17 5 3 6 - 14 22 Peptic Ulcer 22 - - - - 5 12 5 23 6 3 7 6 22 23 Diarrhoea, etc. (under 2 years) . 29 24 1 - - 1 3 - 13 6 3 13 7 29 24 Appendicitis 11 - - - - - 2 6 3 21 6 2 2 1 11 25 Cirrhosis of Liver 6 - - - - - - 5 1 6 1 2 1 2 6 26 Other Diseases of the Liver, etc. 6 - - - - - 1 4 1 6 1 1 2 2 6 27 Other Digestive Diseases . 32 2 1 - - 2 6 11 10 32 9 10 10 3 32 28 Acute and Chronic Nephritis . 30 - - - - 1 4 10 15 49 7 6 12 5 30 29 Puerperal Sepsis 2 - - - - - 2 - - 1 1 1 - - 2 30 Other Puerperal Causes . 2 - - - - - 2 - - 10 1 - - 1 2 31 Congenital Debility, Premature Birth, Malformation, etc. 37 37 - - - - - - - 51 5 13 11 8 37 32 Senility 18 - - - - - - - 18 27 2 8 6 2 18 33 Suicide 27 - - - - - 7 15 5 7 5 6 10 6 27 34 Other Violence 40 4 - 1 1 4 6 8 16 24 7 12 13 8 40 35 Other defined Diseases 110 1 2 1 7 3 15 41 40 105 4 20 41 35 110 36 Causes ill-defined or unknown - - - - - - - - - - - - - - M F M F M F M F M F 111 140 159 147 240 200 117 151 627 638 Totals • 1265 92 20 14 18 33 125 366 597 1005 251 306 440 268 1265 75 TABLE IV. Cases of Infectious Disease Notified during the 52 weeks ended 31st December, 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 - - - - - - - - - - - - - - - - - - - - - - - - Cholera . - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria, including Membranous. Croup . 83 2 5 9 6 5 23 15 5 10 1 2 - 18 22 33 10 83 18 22 33 10 83 - Erysipelas 55 1 - - - - 1 1 1 4 3 19 25 14 18 18 5 55 7 10 13 1 31 24 Scarlet; Fever. 192 3 10 13 7 20 97 12 9 16 4 1 — 81 40 46 25 192 81 38 46 22 187 5 Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - Enteric Fever 8 - - - - - - - 2 - 1 - - - 1 - 2 3 - - - 2 2 1 Paratyphoid Fever 4 - - - - - - - 2 - 1 1 - 1 2 - 1 4 1 - - 1 2 2 Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever . - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 5 - - - - - - - - 4 1 - - - 3 2 - 5 - 3 2 - 5 - Puerperal Pyrexia . 26 - - - - - - - 3 16 7 - - 4 7 9 6 26 3 7 9 4 23 3 Plague . - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever . 2 - - - - - - - 1 1 - - - - - 2 - 2 - - 2 - 2 - Tuberculosis— Pulmonary 140 - - - - - 1 5 8 58 22 39 7 29 47 53 11 140 10 14 20 3 47 93 Non-Pu lmonary 23 3 1 1 - 2 4 - 3 6 1 2 - 5 3 9 6 23 5 2 4 4 15 8 Acute Poliomyelitis 1 - - - - - - - - 1 - - - 1 - - - 1 1 - - - 1 - Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 8 8 - - - - - - - - - - - 2 1 4 1 8 1 1 2 1 5 - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 77 6 5 2 2 3 8 4 3 12 11 13 8 11 9 42 15 77 5 4 23 6 38 39 Malaria . 1 - - - - - - - - 1 - - - - 1 - - 1 1 - - 1 - Dysentery 2 - - - - 1 1 - - - - - - - 2 - 2 - - 2 - 2 - Totals 622 28 21 25 15 31 135 37 37 129 52 77 40 166 154 220 82 622 132 102 156 54 444 178 76 TABLE V. Cases of Infectious Disease Notified during the 52 weeks ended 31st December, 1982. I Notifiable Disease. Cases notified in whole District. Total umber of cases removed to Hospital. Total Deaths. 1 At all ages. At Ages—years. —1 1— 2— 3— 4— 5 — 10— 15— 20— 35— 45— 65— Smallpox - - - - - - - - - - - - - - - Diphtheria including Membranous Croup . 83 2 5 9 6 5 23 15 5 10 1 2 - 83 1 Erysipelas 55 - - - - - 1 1 1 4 8 19 25 31 - Scarlet Fever 192 3 10 13 7 20 97 12 9 16 4 1 - 187 - Enteric Fever 3 - - - - - - - 2 - 1 - - 2 - Paratyphoid Fever 4 - - - - - - - 2 - 1 1 - 2 - Puerperal Fever 5 - - - - - - - - 4 1 - - 5 2 Puerperal Pyrexia 26 - - - - - - - 3 16 7 - - 23 - Cerebro Spinal Fever 2 - - - - - - - 1 1 - - - 2 - Tuberculosis— Pulmonary 140 - - - - - 1 5 8 58 22 39 7 47 67 Non-Pulmonary 23 3 1 1 - 2 4 - 3 6 1 2 - 15 8 Acute Poliomyelitis . 1 - - - - - - - - 1 - - - 1 - Ophthalmia Neonatorum 8 8 1 - - - - - - - - - 5 - Pneumonia 77 6 5 2 2 3 8 4 3 12 13 8 38 77* Totals 619 23 21 25 15 30 134 37 37 128 52 77 40 441 155 Note. This figure is for all forms of pneumonia, including Acute Primary Pneumonia, and Acute Influenzal Pneumonia, which alone are notifiable 77 VACCINATION RETURNS Return for 1931. Return made to the Borough Council and Ministry of Health on the 8th February, 1933, 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, 1931, 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., 1931. Number of these Births duly entered by 31st January, 1933, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1933, remained unentered in the''Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1933, neither duly entered in the "Vaccination Rsgister" (columns 3, 4, 5, 6. and 7 of this Returu) nor temporaily ac counted for in the " Report Book " (column 8, 9 and 10 of this return) Number of Certificates of Successful Primary Vaccination of children under ' 14 years received during the calendar year 1932 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1932. Col. I. Success fully Vaccinated Col. II. Col. IV. Col. V. Dead, Unvaccinated Postpone ment by Medical Certificate Removal to Districts. the Vaccination Officer of which has been dulv apprised Removal to Places unknown or which cannot be reached and Cases not having been found Insuscep tible ol Vaccination Had SmallPox Number in respect of whom Certificates of Conscientious Objection have been received 1 2 3 4 5 6 7 8 9 10 11 12 13 1, North Marylebone 449 297 5 - 77 14 4 12 23 17 - 2. St. Mary 2,304 1,533 4 - 285 86 3 350 30 13 I 2.169 338 3. All Souls 381 246 13 - 23 12 3 70 10 4 - Total 3,134 2,076 22 - 385 112 10 432 63 34 2.169 338 Dated 8th February, 1933. (Signed) GEORGE H. BASSETT, Vaccination Officer. '