Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1933 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. Metropolitan Borough of St. Marylebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1933 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 June, 1934. 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 1933. Relating to a "non-survey" year it consists merely of a record of the happening's of the year. The same kindness, help and support that I have always received came during the year from the Public Health Committee and the chairman, Mr. Councillor G. B. Ramsay. These things I very greatly appreciate, and for them I express here 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. To the staff as to the Public Health Committee and the Council also no doubt it was a source of great satisfaction that following the survey of the public health services of the Council conducted on his behalf during the year by members of the staff of the Ministry, the Minister of Health should have found himself in a position to commend the Council upon the standard of efficiency and progress maintained in the Borough. In particular it was gratifying not only to the officers concerned but to the staff as a whole to learn that the Minister had expressed himself as "glad to learn of the excellent work which is being done in the immunisation of children and those in charge of them against diphtheria. In the Maternity and Child Welfare services he notes with appreciation the satisfactory co-ordination or the work of the voluntary organisations and hospitals with that of the Municipal -staff, and the increased attention which has recently been given to the supervision of the health of children between tbe ages of 1 and 5." 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). 1933. His Worship the Mayor (Alderman John Fettes, J.P.). ALDERMEN. G. B. Brooks. A. C. Rickatsom, 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. P. O'Connell. Dr. H. D. Haldin-Davis. Dr. E. Curnow Plummer. Mrs. M. G. Harris. G. B. Ramsay (Chairman). Dr. Elizabeth Jacobs. Mrs. E. M. Shirley. CONTENTS. page page General Statistics 6 Deaths in relation to Disease 31, 65 Natural and Social Conditions Diarrhoeal Diseases 31 of the Borough. Infectious (Communicable) Population 7 Diseases 31 Sanitary Circumstances 7 Phthisis and other Tuberculous Water Supply 7 Diseases 31 Drainage 7 Respiratory Diseases 32 Combined Drainage 8 Cancer and Malignant Disease 32 Closet Accommodation 8 Accident, Suicide and Man- Public Sanitary Conveniences 8 slaughter 33 Scavenging 9 Prevalence of and Control over Removal of House Refuse 10 Infectious Diseases 33,66 The Crown Estate 10 Diphtheria and Membranous Removal of Offensive Refuse 10 Croup 33 Sanitary inspection of the Schick Testing and Diphtheria Borough. Immunization 34 Staff 10 Scarlet Fever 34 Nuisances 12 Enteric Fever and Paratyphoid Inspections 13 Fever 34 Nuisances— Legal Proceedings 13 Cerebro-Spinal Fever 34 Smoke Nuisances 13 Encephalitis Lethargica 35 Rat Repression 13 Polio-Encaphalitis 35 Pigeons 14 Polio-Myelitis 35 Fouling of Footways by Dogs 14 Erysyipelas 35 Premises and Occupations con- Puerperal Fever and Puerperal trolled by By-laws and Pyrexia 35 Regulations. Measles and German Measles 35 (а) Business Premises 15 Whooping Cough 35 Milk Premises 15 Glanders and Anthrax 35 Slaughterhouses 15 Smallpox 35 Offensive Trades 15 Vaccination 35, 68 Premises used for Food Prepar- Infectious Diseases in Schools 36 ation 15 Ophthalmia Neonatorum 36 Ice Cream Premises 16 Influenza 37 Butter,Margarine, etc., Premises 16 Pneumonia 37 Bakehouses 16 Food Poisoning 37 Fried Fish Vendors and Fish Tuberculosis 37 Curers 16 Treatment 37 Factories and Workshops 16 Public Health (Prevention of Inspections 17 Tuberculosis) Regulations, Defects found 17 1925 37 Home Work 18 Public Health (Tuberculosis) Registered Workshops 19 Regulations, 1912 (Notifi- Other matters 19 cations) 38 Rag Flock 19 Public Health (Tuberculosis) (b) Premises used for Human Regulations, 1930 39 Habitation 19 Prevention of 40 Houses let in lodgings 19 Care Committee 40 Common Lodging Houses 20 Bacteriological Diagnosis of 41 Underground Rooms 20 Non-Pulmonary Tuberculosis 41 (c) Premises that are not but should Work and Dispensaries 42—44 be Registered 21 Deaths 45 rood Stalls 21 Localisation of Diseases 46 Disinfection 47 (a) Milk Supply 21 Cleansing of Persons 47 Milk Analysis 21 Bacteriological Examinations 48 Bacteriological examination of Milk 21 Maternity and Child Welfare 48 Dairies, Milkshops, etc. 21 Infant Life Protection 51 The Milk (Special Designations) Health Visitors 11,52 Order 22 Centres and Clinics 52,53 Milk (Mothers and Children) Ante-Natal Work 53, 54 Scheme .22 Dental Clinic 55,58 (b) Foods other than Milk 22 Massage Clinics 55 Food Inspections 22 Schick Testing, etc., Clinics 55 Food, Unsound, Condemned 23 Three-year-old Pre-School Clinic 55 Food Premises 23 Hospital Treatment 56 Bacteriological Examination 23 Maternity Cases 56 (c) Food and Drugs (Adulteration) Infant Consultations Work at 57 Act, 1928 23 Day Nurseries 58 Reports of Public Analyst 24-26 Home Helps 58 Statistical— Sanitary Administration— Births 26 Staff 58 Birth Registration 26 Report of Mortuary Keeper 58 Birth Notifications 27 Hospital and Nursing Homes 58 Deaths and Death Rates 27, 28, 63 Local Acts and Orders 58 Sub-District Births and Deaths 28, 64 Housing, Inspections and Pro- Deaths in relation to Age 28, 65 ceedings, etc. 58, 59 Causes of and ages at death 28, 65 General Summary 60-62 Infantile Mortality 28 Infantile Mortality Causes 29-30 Ministry of Health, Tables I—V. 63-67 Maternal Mortality 31 Vaccination Returns 68 6 GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921). 104,173. (1931) 97,620 (estimated 1933) 94,080. Number of inhabited houses (1921), 18,507; (1931), 17,575. Number of inhabited houses (end of 1933) according to Rate Books, 17,508. Number of families or separate occupiers (1931), 27,352. Rateable value. £3,246,569. Sum represented by a penny rate. £12,510. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimate 802 435 367 Illegitimate 114 61 53} Birth Rate, 9.71 Still Births, 36. Rate per 1,000 total births, 39. Deaths, 1,224. Death Rate, 12.2. Percentages of total deaths of residents occurring in public institutions, 11.7. Number of women dying in, or in consequence of, childbirth— from sepsis, 3; other causes, 7. Deaths of Infants under 1 year of age per 1,000 live births:— Legitimate 54. Illegitimate 61. Total 56. Deaths from Measles fall ages), nil. Deaths from Whooping Cough (all ages), 6. Deaths from Diarrhoea (under 2 years of age), 12. 7 POPULATION. The population estimated to the middle of 1933 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 1932 and the Census of 1931. Year. The Borough. All Souls. St. Mary, Christ Church. St. John. Census 1931 96,620 22,380 25,667 29,636 19,937 Estimated to middle of } 1931 93,460 21,421 24,574 28,374 19,087 1933 94,080 21,564 24,734 28,570 19,212 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 be 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 eighteen 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 43 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 ten. The number in 1931 was four. In 25 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 22 cases, and after service of Statutory Notices in the remaining 3. 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 1933 made 4,315 inspections. 8 The total number of plans deposited was 510 in respect of 662 premises, as against 380 and 442 respectively in 1932. The number relating to new buildings was 47. The number deposited in 1932 was 21. ' In the case of old buildings, the number of plans received was 463. In 1932 the total number was 359. In the bulk of the cases the arrangements shown were in accordance with the by-laws and the work was allowed to proceed under the preliminary approval of the Medical Officer of Health. In cases in which there was departure from the requirements a special report was made to the Public Health Committee, who rarely refused approval if satisfied that compliance was impossible and that there was no possibility of nuisance or injury to health arising. In the majority of cases the departure referred to closet accommodation and affected particularly conveniences proposed to be constructed in basements. Since the new by-laws (1930) of the London County Council with regard to sanitary conveniences have been in operation the number of such cases has greatly diminished and further reduction will follow when the amended code relating to drainage is approved. Proceedings.— In one case it was discovered that drainage work had been executed improperly and without notice to the Sanitary Authority as required by the By-laws. Legal proceedings were taken and the defendant was fined £3 0s. Od. No costs were granted. Combined Drainage.— Orders under seal as to combined drainage were issued in respect of 49 premises. The number in 1932 was 56. Closet Accommodation. In the table at page 60, 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. The fact that partly as a result of the introduction of these provisions the erection of the first hotel in the metropolis, if not in the country to provide each bedroom with en suite a bath-room containing all the sanitary conveniences (The Cumberland Hotel at Marble Arch, opened during the year) may be noted. 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. 9 SCAVENGING. Refuse Collection.— The collection of house refuse in the Borough is under the jurisdiction of the Highways Committee of the Council and under the control of the Borough Engineer, Mr. James Gair, to whom I am indebted for the information given here. The system of collection is continually under revision and changes are made from time to time with a view of more efficient working. All premises in the Borough now receive at least a twice weekly collection. In addition, over a great portion of the Borough a daily collection is made, and in certain streets in which refuse collecting vehicles are prohibited by the Ministry of Transport during certain hours, collection is carried out from the kerb within the hours prescribed. This naturally entails a greater concentration of collecting vehicles in certain parts of the Borough and still further increases the number of calls made per annum. Considerable increase continues in the number of large premises, such as blocks of flats, hotels, etc., where the "container" system of collection is in operation. This method provides for the provision of special containers, which are purchased by the owners of properties. Collection is made daily. The containers are removed bodily from the premises and conveyed to the Council's Wharf, where Lhey 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. During the year progress was made in the direction of providing the new fleet of house refuse collecting vehicles. These are entirely enclosed and are end loading, steps being fitted to facilitate entry, and as a result refuse collection is being 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 furnaces and a Woodall-Duckham refuse destructor, the latter being mechanically fed, and clinkered. The steam produced is used to generate electric current for lighting, heating and power at the wharf. 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 as to reduce risk of nuisance, is greatly diminished. In consequence of complaints received in regard to the emanations from the two existing chimney shafts the Council have decided to have erected a new 200 feet shaft and this is in course of construction. This new shaft will take the emanations from the two destructor plants. The question of refuse disposal in London as a whole is now being considered by a special Sub-Committee set up by the Metropolitan Boroughs' Standing Joint Committee, of which St. Marylebone forms part of Group 1 of the North-West District. It is anticipated that the report of this Sub-Committee will shortly be issued. Since the issue of the "Dawes" report on London Cleansing in 1928, when it was suggested that a Central Authority should be set up to deal with London refuse as a whole, practically no forward move has been made. The terms of reference to the Sub-Committee referred to above are to examine and. report upon the existing methods, etc., of the Metropolitan Boroughs and to suggest the most satisfactory and efficient method of dealing with disposal of refuse on scientific lines. The Committee has now completed its inspections and it is hoped that the publication of the report will be productive of such action being taken as will prevent further stagnation and will give a strong lead to the Metropolitan Borough Councils for institution of methods of disposal which will be scientific, sanitary and economical. 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 10 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 beirig 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, 1934 46,014 tons. Street Sweepings and Gully Refuse collected during the year ended 31st March, 1934 8,413 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. 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 154 premises at the request of the department, while 1,142 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. Attempts have been made recently 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. 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. ii Donaldson Saner), two drainage inspectors, one outdoor superintendent, one meat and food 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.), I..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): JJL. E. H. Whitby, C.V.O., M.C., M.A., M.D., B.Ch., F.R.C.P. (Lond.), M.R.C.S. (Eng.), D.P.H. fK. H. Whittingham, O.B.E., M.B., B.S. Public Vaccinator: Dr. H. Allen Bulman. Vaccination Officer: G. H. Bassett. *District Sanitary Inspectors. -Outdoor Superintendent. T. A. Cartledge, M.S.M. (a, b, d). P. H. Hill (a, b, d). H. E. P. Corline (b, d). T. W. Forbes (b, d). Clerks. H. E. Scoble (c, d). H. E. Curtis (Chief). E. E. Willis, M.M. (a, b, d). a. H. James. A. S. Wilson (a, b, d). W. J. Howe *Drainage Inspectors. F. C. Cook (b, d). H- G- E- Brown. W. H. Draper (a, b, d). C. D. Turbayne. *Food Inspector. R. G. Turner. G. Smith (Senior Sanitary Inspector) (a, b, d). *Maternity and Child Welfare and Disinfectors. ' ' J. C. Kendall. Tuberculosis Clerk. J. Overton. Miss J. Jones. *Women Sanitary Inspectors and Health Maternity and child Welfare. Visitors. ' Miss C. E. Durant (b, e, h). Clerk-Dispenser. Miss N. C. Stokes, R.R.C. Miss G. M. Courtnay. (b, e, f, g, h). *Health Visitors. Cleansing of Persons—Baths & Shelter. Miss D. T. Connell (e) Miss C. Hale (e, f). MlSS L. Kilgallin (Matron)- Miss E. D. Mann (e, f, g, h). Mortuary Keeper. Miss K. Stewart (e). Mrs. H Spears. *Tuberculosis Visitors. Miss F. A. Baker (b). *Tuberculosis Dispensary. Miss S. Kenion (e, f, g, h). E. D. Marston (Caretaker). *Tuberculosis Clerk-Dispenser. Messenger. Miss M. T. Challis. E. W. Broughton. * Officers to whose salary contribution is made under the Public Health Acts or bv Exchequei grants. a Royal Sanitary Institute Certificate. b Certificate Sanitary Inspectors' Examination Board (London). c Certificate of the Sanitary Inspectors' Examination Joint Board. d Meat and other Foods Certificate. e Health Visitors Diploma. 1 Central Miawives Board Certificate. xt Certificate of State Registration for Nurses. h Three or Four Years' Hospital General Training Certificate. † Resigned 31st January. 1933. ‡‡ Appointed 1st February, 1933. 12 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 2,631, as against 2,598 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, 129 statutory notices were issued, the figure being 81 in 1932. Of these notices, 85 related to ordinary nuisances (dirt, dampness, etc.), 18 to verminous rooms, 9 to drains, 3 to insufficient w.c. accommodation, 8 to insufficient dustbins, 3 to underground rooms and 3 for the provision of water supply to the upper storeys of tenement houses. The 18 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1922, and referred to 33 rooms. The number of notices in 1932 was 12. In 2,502 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 no instance was it necessary to institute legal proceedings to enforce compliance with the statutory notices. 13 The total inspections made in 1933 by each inspector, and the number oi 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 170 249 274 184 103 64 1044 Doors, windows, floors, ceilings sash cords, etc., repaired 172 56 81 43 55 20 427 Overcrowding abated — 4 13 5 4 — 26 Illegal occupation of underground rooms dealt with - 3 36 18 6 - 63 Water closet defects remedied 172 68 202 89 62 54 447 Water closet erected — 3 3 7 3 11 27 Urinal defects remedied — — 4 5 4 — 13 Soilpipes and ventilating shafts repaired or renewed 4 6 - - 8 1 19 Yard defects remedied 66 19 90 78 32 4 289 Waste pipe defects remedied 35 7 30 25 17 21 135 Water cistern defects remedied 17 2 11 4 5 4 43 Rubbish, manure, etc., accumulations removed 11 22 50 58 21 9 171 Dung or dust receptacles repaired or renewed 15 20 52 19 22 13 141 Drains relaid or amended 43 8 38 — 12 1 102 Drains cleared 4 7 7 4 8 3 33 Rainwater pipes repaired or renewed 10 9 10 4 11 1 45 Water supply to houses reinstated 1 1 2 - 2 1 7 Roofs and gutters repaired 46 59 24 28 13 3 173 Area defects remedied 15 — 24 38 15 — 92 Wash-house defects remedied 79 30 90 47 37 2 285 Animal nuisances abated 1 1 5 5 5 2 19 Basement defects remedied 36 — 8 3 12 2 61 Stables cleansed or repaired — — — — 2 — 2 Water supply laid on to upper storeys of house 6 5 8 - 6 - 25 Miscellaneous nuisances abated 228 64 165 76 35 9 577 Verminous rooms cleansed 71 148 288 142 47 33 739 Legal Proceedings in Connection with Nuisances. No summonses were issued during the year. Smoke Nuisances. During the year 1933, 420 observations were made and 19 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. Complaints as to fumes from furnaces burning oil-fuel were fewer than in 1932. 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 1931, 74, in 1932, 52, and in 1933, 49. The investigation of these complaints necessitated the inspection of 119 premises, 42 of which were found to be rat infested. Included in this latter number were 12 business premises (5 of these for the preparation or storage of food), the remaining 30 being private or tenement houses. In 14 of the 14 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 1933 Rat Week held in the Borough contains a certain amount of information that may be found interesting. "National Rat Week (the fifteenth of the series) was, at the suggestion of the Ministry of Agriculture, held in the Borough during the week commencing Monday, November 6th, 1933, 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 and the fact that rats and mice are responsible for an immense loss to the country each year both directly, in the destruction of foodstuffs and other materials, and indirectly as the agents and carriers of disease germs. Suitable posters were displayed and leaflets distributed throughout the district, and reference was also made to the subject in the columns of the daily and local press. In addition, circulars were again sent to owners and occupiers of food premises of all kinds; to property agents, and to the large business houses and institutions in St. Marylebone, drawing attention to the provisions of the Rats and Mice (Destruction) Act, and indicating methods to be adopted in complying with the requirements. On this occasion also, the opportunity was taken of sending with the circular a copy of a new leaflet on the destruction of rats and mice, issued by the Ministry of Agriculture; and in each case an offer was made to arrange for the Inspector who has the matter specially in hand to call and give all possible advice and assistance on the question. The authorities concerned with the various tube and railway stations, sidings, warehouses, etc., power stations and open spaces in the Borough all made a prompt response to the appeal to increase activities in the way of rat destructive measures, and co-operated with the Department by arranging joint inspections by their representatives and the Council's Inspector, and in other ways. The sewers, as usual, received additional attention, the baits normally laid down being greatly increased in number during the period, and neighbouring Boroughs also co-operated in this connection. No serious instance of rat infestation was met with during the course of the work, and it is gratifying to be able to record that, mainly as a result of the propaganda carried on by the Council, not only during Rat Week but continuously throughout the year, the public generally show an active interest in dealing' with this important health and economic problem." 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. Seven complaints were made in 1933 as against ten in 1932, relating to business premises (in one case), public buildings(three), and private dwellings (three). 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, 10 prosecutions undertaken being on the reports of police officers. In all cases the defendant pleaded guilty, and the fines amounted to £2 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 28, the amount of fines imposed being £13 0s. 0d. 15 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 1933 Number of notices 1933 Number of prosecutions, 1933 On register at end of 1932 Added in 1933 Removed in 1933 On register at end of 1933 A. Business Premises Milk premises 135 25 19 141 250 7 - Slaughterhouses 2 — 1 1 25 — — Poultry Do. 1 — — 1 20 — — Offensive trade premises 2 - — 2 46 — — Ice cream premises — — — 78 126 5 — Butter and Margarine Manufacturers and Dealers 16 - - 16 36 - - Bakehouses 56 — — 56 105 6 — Fried Fish Shops 25 — — 25 63 5 — Fish Curers 6 — — 6 60 3 — B. Habitations Houses let in lodgings 1,055 - - 1,055 8,589 1,182 - Common lodging houses 4 - 1 3 96 9 - A.— BUSINESS PREMISES. Milk Premises.— The number of premises upon which milk is sold is 141. This is 6 more than in 1932, 25 having been added and 19 removed. Slaughter Houses.— At the moment the only slaughter house in the Borough is that at the Zoological Society's premises in Regent's Park, that at 32a, Union Street, W.l, which was held by Mr. E. J. Barclay, of 70, Great Titchfield Street, W.l, having been closed down. The slaughtering done at the premises registered is for the food of the animals in the Gardens and humane killers are used. Offensive Trades.— At the end of 1933 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 46 visits, but no cause of complaint was found. Premises used for Food Preparation.— The London County Council (General Powers) Act, 1932 under Sec. 5, gives powers to the Borough Council to register all 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, and the Council have authorised the Public Health Committee to administer the powers given under the Act. By the end of 1933, 89 premises had been registered for the preparation or manufacture of foods (other than ice cream) intended for sale. 16 Ice Cream Premises.— These are 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 1933 was 84, 6 more than in 1932. Regular inspections were made throughout 1933, and in 5 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 1933 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. During the year 105 visits were paid and 6 notices with regard to defects were served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, etc., of the inside walls and other parts of the bakehouses were issued. It was not necessary to institute proceedings to enforce compliance with any notice. Fried Fish Vendors and Fish Curers.— The number of premises in the Borough used by vendors of fried fish is 25 and by fish curers 6. Notices calling for periodical lime-washing, etc., of such premises is required by the by-laws of the London County Council, made under Section 9 of the London County Council (General Powers) Act, 1908, and 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 2,543; 190 by the women and 2,353 by the men inspectors. The complaints received numbered 36. 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. 17 1.— INSPECTION. Premises Number of Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories (Including Factory Laundries) 250 24 — Workshops (Including Workshop Laundries) 1,339 53 - Workplaces (Other than Outworkers' Premises included in Part 3 of this Report) 954 12 - Total 2,543 89 - 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 46 46 - - Want of ventilation 10 10 - — Overcrowding 9 9 - — Want of drainage of floors 10 10 - — Other nuisances 35 35 - — Sanitary accommodation insufficient 11 11 - — unsuitable or defective 34 34 - - not separate for sexes 11 11 - - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 8 8 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 174 174 - - 18 3.— HOME WORK. OUTWORKERS' LISTS. SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES. SECTIONS 109,110 NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S 110) Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 64 191 875 ... ... ... 10 ... ... ... ... ... ... ... ... Total 64 191 875 ... ... ... 10 ... ... ... ... ... ... ... ... 19 4.— REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year Number (1) (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 2,014 Coffee Shops, &c. 378 Bakehouses 56 Total number of workshops on Register 2,448 5.— OTHER MATTERS. Class Number (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 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 36 Reports (of action taken) sent to H.M. Inspector 36 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. Frequent inspections have been made but in no instance has the use of flock for repairs been discovered. B.— PREMISES USED FOR HUMAN HABITATION. The only premises used for human habitation is 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 20 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. Under these a new register is being formed, and during the year in connection with this and for purposes of supervision, some 8,589 visits were paid to the 1,055 houses carried over from the old list. The number of intimation notices served was 1,182, 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. 61 of the L.C.C. (General Powers) Act, 1927, has now been made and appears to be working satisfactorily. Common Lodging Houses.— By the Transfer of Powers (London) Order, 1933, of the Ministry of Health made under Section 64 of the Local Government Act, 1929, the powers and duties of the London County Council in connection with Common Lodging Houses were transferred to the Borough Councils as from 1st April, 1933. At this date four premises of this class were in existence in the Borough and applications for renewal of their licences were invited. Three new licenses were in fact granted as from 1st June, 1933, but an application in respect of the fourth Common Lodging House at 29, Circus Street was withdrawn and the premises shut down. Of those still on the list which are shown on the table below, 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, and now under that of the Church Army, has done and is doing an incalculable amount of good conferring great benefit on large numbers of women. 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 514 men "Portman House" (late Shaftesbury Institute), Harrow and Daventry Streets, Lisson Grove The Rev. Prebendary Wilson Carlile, C.H., D.D. 102 women 566 men 102 women Total 668 During the year 96 visits were paid to Common Lodging Houses by officers of the department and the premises are periodically inspected by a Fire Inspector (Mr. M. W. A. Davey) specially appointed for the purpose. Underground rooms.— The year 1933 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. During the year, however, the number occupied was still further reduced, action taken in respect of 63 in which the occupation was definitely illegal, securing discontinuance of occupation. Regulations for the control of underground rooms occupied for sleeping purposes were in operation throughout the year, and assisted considerably in securing improvement of conditions in a number of cases. 2i 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 1933 there were 378, this number includingrestaurant, dining room and coffee shop kitchens, 220; tea-rooms and pastry-cooks, 101; hotel kitchens, 26; fried fish shops, 25; and fish-curers, 6. As already explained legal provision has now been made for registration of 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 1933, the total number of inspections was 430, the number of notices served being 14. 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. v FOOD. A.— Milk Supply. Analysis of milk.— The quarterly returns as to the number of milk samples taken are as follows:— 1st Quarter, 46; 2nd Quarter, 45; 3rd Quarter, 42; 4th Quarter, 20, making a total for the year of 153. No sample was found to be adulterated. Bacteriological Examination of Milk.— With a view to testing the purity of milk from the bacteriological point of view, 12 samples were taken and submitted to 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, 18 of certified milk were taken and submitted to bacteriological examination. The reports were almost invariably satisfactory and, in accordance with the usual arrangement, were forwarded to the Ministry of Health. Dairies, Milkshops, etc.— Frequent inspections of milk premises were made with the object of discovering whether or not the requirements of the regulations as to cleanliness, etc., under the Milk and Dairies Order, 1926, were being complied with. In no case was it necessary to take action. 22 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 10 in respect of "Certified" Milk, 15 for Grade "A" Tuberculin Tested Milk, 22 "Pasteurised" Milk, and 2 Grade "A" (Pasteurised). In accordance with the instruction of the Ministry 18 samples were taken during the year and submitted to the Council's Bacteriologist. Copies of the reports made were duly forwarded to the Ministry. Milk (Mothers and Children) Scheme.— During 1933 there has been no change in the methods adopted in relation to the supply of milk to mothers and children. Up to 31st March, 1934, the amount expended was £921 8s. 7d., as against £778 Is 2d. in the year ended 31st March, 1933. The actual number of cases dealt with was 392, and the number of orders issued 2,283, which were larger figures than those for 1932, when the cases numbered 388 and the orders 2,183. 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 1933 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 ol Mrs. Councillor Harris, who has given most valuable help as representative of the Maternity and Child Welfare 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 1933, 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 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. Food Inspection.— The work of food inspection receives year by year adequate attention. During 1933, 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. 23 Amongst the articles dealt with in this way were:— Unsound and Diseased Food Condemned and Destroyed During the Year 1933. Meat— Beef 78 lbs. Miscellaneous (Tinned Goods, etc.). Mutton 24 „ Bacon 7 qr. 3 lbs. Corned Beef 482 tins Pigs Pluck (Cysts). — Briskets of Beef 16 „ Hams, Gammons, etc. 130 „ Fish— Shell— Mussels 3 bags Brawn 110 „ Tongues 47 „ Smoked Fillets 15 boxes Veal 4 „ Kippers 16 „ Pork and Stuffing 11 „ Pork (Tinned) 4 „ Fruit& Vegetables— Apples 6 barrels Chicken and Ham Roll 16 „ Chicken and Tongue 7 „ Bananas 1 box Sausages 27 „ Dates Savoys 9 cases ½ Railway Cream 235 „ Truck 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. Bacteriological examination.— During the year, apart from milk samples, 3 samples of ice cream and 1 sample of dried peas'were examined bacteriologically. All were found to be satisfactory. C.— FOOD AND DRUGS (ADULTERATION) ACT, 1928. The total number of samples taken under this Act in 1933 was 1,012, the figure for 1932 being 1,102. Of this number 5 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 0.50. In 1932 it was 0.54. 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. 24 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, 1933. The number of samples taken under the Food and Drugs (Adulteration) Act and submitted for analysis, was 1,012. The following is a complete list of the articles sampled:— ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal 1 Private Total 1 Apples - 2 - 2 2 Beans, Tinned — — 1 1 1 1 3 Bread — 5 — 5 4 Butter 109 174 — 283 5 Candied Peel - 3 — 3 6 Cheese — 24 — 24 7 Cocoa 1 24 — 25 1 1 8 Cod Liver Oil — 3 — 3 9 Coffee — 27 — 27 10 Cream 26 — — 26 11 „ Tinned — 6 — 6 12 Currants — 5 — 5 13 Curry Powder — 3 — 3 14 Dripping — 2 — 2 15 Fish Paste — 3 - 3 16 Flour, Self Raising — 1 — 1 17 Gin — 1 — 1 18 Ground Ginger — 2 — 2 19 Herbs, Mixed — 2 - 2 20 Honey — 18 — 18 21 Ice Cream — 1 — 1 22 Jam — 40 — 40 23 Lard — 71 — 71 24 Lemonade Powder — 5 — 5 25 Margarine — 19 — 19 26 Marmalade — 33 — 33 27 Milk 141 12 — 153 28 Milk, Condensed — 20 — 20 29 Mincemeat — 3 — 3 30 Mint — 2 — 2 31 Mustard 1 24 — 25 1 1 2 32 Ointment, Boric — 12 — 12 33 Olive Oil — 5 — 5 34 Onions, Pickled — 2 — 2 35 Paraffin, Liquid Medicinal — 1 - 1 36 Paste, Meat — 14 — 14 37 Pears — 2 — 2 38 Peas, Tinned — 8 — 8 39 Pepper — 20 — 20 40 Pickles — 2 — 2 41 Quinine, Ammoniated Tincture of - 4 - 4 42 Raisins — 5 — 5 43 Roll and Butter — 13 — 13 44 Salmon—Tinned - 5 — 5 45 Sardines — 4 — 4 46 Sauce, Tomato — 2 — 2 47 Sausages, Beef — 12 — 12 48 „ Pork — 11 — 11 Carried forward 278 657 1 936 1 2 1 4 25 ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total Brought forward 278 657 1 936 1 2 1 4 49 Sodium, Bicarbonate — 3 — 3 50 Spice, Mixed — 4 — 4 51 Sugar — 25 — 25 52 Sultanas — 4 — 4 53 Syrup, Golden — 1 — 1 54 Tea — 27 — 27 55 Tomato Ketchup — 2 — 2 56 Treacle, Black — 2 — 2 57 Whiskey 1 4 — 5 1 1 58 Wine, Orange — 1 — 1 59 „ Raisin — 2 — 2 Total 279 732 1 1012 1 3 1 5 Adulterated Samples, etc. Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 47 Tinned Beans Private Methylene Blue present as colouring matter, and, in addition, the contents of the tin were distinctly acid in reaction, while the lining of the tin was of such thinness that the acid liquid could easily cause corrosive action. In this particular tin 0.5 grains per 1b. of tin had been dissolved, but it is quite conceivable that in other similar tins the action might be of a much more serious nature. The Beans were of Italian origin. 152 Cocoa Informal 7.0 % of added starch grains. 308 Mustard Informal Contains 13.0 % of added starch grains. 383 Mustard Formal Contains 13.5 % of added starch grains. Legal proceedings were taken in this case. No fine was imposed but £3 3s. 0d. costs were awarded to the Council. 756 Whisky Informal Sample consisted of 98.76 parts whisky 35 degrees under proof and 1.24 parts of water. The sample had undergone no change which would interfere with the analysis. 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:— 26 Milk.—The samples examined numbered 153, all of which were free from adulteration and of good quality. Compared with previous years the average composition was as follows:— Total Solids Sp. Gr. Solids. Fat. not Fat. 1931 1031.4 12.2 3.5 8.70 1932 1031.3 12.2 3.57 8.63 1933 1031.4 12.2 3.50 8.70 Cream.—26 samples of loose cream were examined, together with 6 samples of tinned cream. The average fat composition of each was as follows:— Loose Cream. Tinned Cream. Fat = 481% Fat = 226% None of the tinned creams had any notification of the percentage of fat content on its label. Beans, Tinned.—One private sample was examined; this contained methylene blue as colouring matter. This is not one of the dyes the use of which in foods is prohibited in England but its presence is most undesirable. The sample was marked acid in reaction apd 0.5 grain of tin per lb. of beans had been dissolved. Considerable intestinal irritation was stated to have occurred to those who had partaken of the contents of a similar tin. The beans were of Continental origin. Mustard.—25 samples were examined, of which two contained added starch grains to the extent of 13.0 and 13.5% respectively. Cocoa.—25 samples were taken during the year, of which one contained 7.0% of added starch grains. 1 Whisky.—Of the 5 samples examined one consisted of 98.76 parts of whisky 35 degrees under proof and 1.24 parts of water. Other samples.—These call for no particular comment, as in every instance each sample fulfilled the legal or implied standard of its kind. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1933 was 916,* being 139 less than in 1932. Of the children born, 496 were toys and 420 girls. The birth rate per 1,000 of the population was 9.71, as against 10.97 in 1932. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1933, with those of each of the five previous years:— 1928 1929 1930 1931 1932 1933 All Souls 9.7 9.4 10.1 8.9 8.5 7.0 St. Mary 10.7 9.7 10.4 13.2 11.2 7.8 Christ Church 16.4 15.8 14.1 14.4 18.5 12.7 St. John .2 12.3 13.8 11.9 9.1 11.0 The Borough 12.6 11.9 12.1 11.4 10.9 9.7 *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 251 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 98 „ Females 107 Illegitimate Males 20 ,, Females 26 Total 251 27 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1007, was .'5,'277; live births, 3,094 ; still births, 183. The total notifications in 1932 was 3,332. The provisions of the Act are now very generally known, and the necessity for notifying is not less well recognised than that for registration. Failures to notify within 36 hours of birth, as required, were comparatively few. In such cases as there was failure, a perfectly reasonable explanation was forthcoming, and it was not considered necessary to take proceedings against any of the parties. The main sources of the notifications are set out below. In some cases duplicate notifications, from different sources, were received with regard to the same birth. No. Per cent. From parents ... ... 10 0.3 „ doctors ... ... 102 3-8 „ mid wives ... ... 280 8*6 „ other persons ... 57 1*4 „ hospitals, etc. ... 2,828 86'4 3,277 100"0 Of the total births notified, 183 referred to still-births (111 males and 72 females); 2,05)4 took place at Queen Charlotte's Hospital; 90 at Middlesex Hospital ; 99 at the St. Marylebone Home; and 449 were born at home. Of those notified as having occurred in St. Marylebone 2,317 belong to other Boroughs. Of the 183 still-births 36 (19 males and 17 females) were to St. Marylebone mothers. DEATHS AND DEATH RATES. The number of deaths registered in 1933 was 1,224. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but, exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. The corrected death-rate* per thousand for the year was 12.2. In the previous year, the rate was 12.4 and the number of deaths 1,265. The following short table shows the death-rates in the several registration sub-districts in 1933, and compares them with those of the years onward from 1927 :— 1927 1928 1929 1930 1931 1932 1933 All Souls ... 9-7 9-9 13-3 10-2 10-8 12-8 10.5 St. Miry . 14-2 120 13-8 11-5 12-4 11-4 12-7 Christ Church . 12 6 13-4 15-8 11-8 13-1 14-1 14-2 St. John .. 11-9 12-8 13-8 12-1 12 6 12-8 121 The Borough .. us 11-1 13-2 10-6 12-3 12-4 12-2 •By a " corrected death rate " is meant one which has been treated in such a way, raised or lowered in a certain ratio, as to be comparable with the death rates similarly treated of other districts. That " correction " is necessary is due to the fact that differences in death rates in various areas are not entirely dependent upon the sanitary conditions existing in these areas, but also on the constitution (age and sex) of the population. A population consisting of aged persons would show more deaths than one consisting entirely of young and vigorous adults ; a population made up of a large number of males and a small number of females has more deaths and a higher death rate than one in which the females outnumber the males. The death rates of such populations are not comparable the one with the other nor with those of populations differently constituted. To overcome this difficulty the Registrar General issues a " factor for correction " for each district which represents the number of times which the actual death rate of each must be raised in order to permit of its examination side by side with the rates of other districts. The " factor for correction " in the case o St. Marylebone in 1933 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. 28 District births and deaths for the year ended 30th December, 1933, are given in the following table. A further table giving the vital statistics of separate localities for 1933, and the ten preceding years, will be found amongst the Ministry of Health Tables on page 64. Sub-District. Population estimated to middle of 1933. Males. Births, Females. Total. Males. Deaths, Females. Total All Souls 21,564 79 72 151 124 117 241 St. Mary 24,734 106 86 192 149 185 334 Christ Church 28,570 189 173 362 205 203 408 St. John 19,212 122 89 211 105 136 241 The Borough 94,080 496 420 916 583 641 1,224 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 1933. For purposes of comparison the table for 1932 is reproduced. 1933. quarters of 1933. For purposes of comparison the table for 1932 is reproduced. 1933. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 14 13 10 14 51 Persons of 65 years and upwards 185 127 113 178 603 1932. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 29 22 20 21 92 Persons of 65 years and upwards 213 135 121 128 597 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 65. 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 992. 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 1933 was 51, and the number of births in that year 916. The infantile mortality rate is therefore 56. In 1932 the figure was 87 per 1,000 births and this being phenomenally high gave rise to a considerable amount of comment. The following report prepared for the Public Health Committee explanatory of some of the variations that occur, contains some interesting information and has been thought worth reproducing. 29 "The Medical Officer of Health draws attention to the fact that the infantile mortality rate during the month of November, 1933, was 44 per 1,000 live births, and points out that statistics relating to short periods are of little value for comparative purposes, and only to a limited extent serve as a guide to what the rate for the complete year might be. Indeed, the rate for 1933, though it may be a little lower than that for 1932, may quite conceivably be just as high. There are great difficulties generally in comparing the rates experienced in various boroughs throughout the metropolis because of the influences exerted on the infantile mortality rate particularly by local circumstances. In the case of St. Marylebone, where the number of births is so very steadily falling and is in general so low, a very slight variation in the number of deaths of infants under one year of age makes a difference that might almost be described as 'enormous' in the total rate. One death, for example, actually represents over 1 per 1,000 in the total death rate. The Borough is unfavourably placed, statistically at any rate, in this way, but also in other ways, since on account of the presence of large Maternity Hospitals, nursing homes and homes for unmarried expectant mothers, the number of deaths amongst illegitimate children—always high—affects the infantile mortality rate. Moreover, many of the women concerned, although they actually are not St. Marylebone residents, give an address in St. Marylebone as their home address, and therefore in the event of the death of the infant this is recorded in the St. Marylebone statistics. Similarly, if the domicile of the mother is outside the borders of England and Wales the death is counted as a St. Marylebone death. Another cause of increase in the Borough infantile mortality rate arises because of the fact that a considerable portion of the Grand Union Canal passes through the Borough, and, unfortunately, from time to time unwanted infants are disposed of by drowning or are abandoned in the neighbourhood of the canal. In 1932 there were three such deaths which were included as deaths of infants in the Borough, making an addition of over 3 per 1,000 to the non-preventable infantile mortality rate. During 1932 a number of deaths were put down as due to gastritis. This is a condition which is always much more prevalent when the weather in the late summer and early autumn is particularly warm. The conditions in 1933 were favourable to the occurrence of gastritis, and it was in spite of the increased efforts made at the welfare centres and by the health visitors and the Public Health Department generally to assist the mothers, that a somewhat larger number than usual of such cases were lost." 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 A.) will be found on page 30, 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 1933, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 20 were less than one month old when they died and 28 less than three months. Having regard to the decrease in the death-rate from 87 to 56, these figures are important and may be compared with the corresponding figures for 1932, 32 and 46 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 33 in 1932, and 13 in 1933. Diarrhoea and enteritis (7 and 8) accounted for 32 in 1932 and 14 in 1933. Respiratory diseases took 5 in 1932 and 9 in 1933. Amongst the other causes of death, mention may be made of whooping cough and injury at birth which accounted for 4 and 3 respectively. Again this year, "overlaying" does not appear on the list of death-causes. 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 20 deaths amongst infants. In 1932 the figure was 36, 30 TABLE A. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year of age, and in Sub-Districts. No. CAUSE OF DEATH. Under 1 Week 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 1 Month 1 and under 3 Months 3 and under 6 Months C and under 9 Months 9 and under 12 Months Total Deaths under 1 Year All Souls St. Mary Christ Church St. John Total 1 Small-pox - - - - - - - - - - - - - - - 2 Chicken-Pox — — — — • — — — — — — — - - - - 3 Measles — — — — — — — — — — — — - - - 4 Scarlet Fever — — — — — — — — — — — - - - - 5 Diphtheria and Croup - - - - - - - - - - - - - - - 6 Whooping Cough — — — — — 1 1 1 1 4 1 2 1 — 4 7 Diarrhœa — — — — — — ] — — 1 1 — - - 1 8 Enteritis — — — — — 5 5 3 — 13 — 2 7 4 13 9 Tuberculous Meningitis - - - - - - - - - - - - - - - 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - 1 - - 1 - 1 - - 1 12 Congenital - - - - - - - - - - - - - - - 13 Premature Birth 9 — 2 — 11 — - — — 11 - 3 5 3 11 14 Atrophy, Debility and Marasmus 1 - - - 1 - 1 - - 2 1 1 - - 2 15 Atelectasis 1 — — — 1 — - — - 1 - - 1 - 1 16 Injury at Birth 3 — — — 3 — - — — 3 — - 1 2 3 17 Erysipelas — — — — — — - — — — — - - - - 18 Syphilis — — — — — — - — — — — - - - - 19 Rickets — — — — — — - — — - — - - - - 20 Meningitis (not Tuberculous) - - - - - - - 1 - 1 - - 1 - 1 21 Convulsions - — — — — — - - - - - - - - - 22 Gastritis - — — — — - - - - - - - - - - 23 Laryngitis - — — — — — - — — - - - - - - 24 Bronchitis - — — — — — 1 - - 1 - - 1 - 1 25 Pneumonia (all forms) 2 — — — 2 2 1 2 1 8 1 3 2 2 8 26 Suffocation, Overlying — — — — — — - — — - - - - - - 27 Other Causes 2 — — — 2 — 1 1 1 5 1 — 1 3 5 Totals 18 — 2 — 20 8 12 8 3 51 5 12 20 14 51 M. F. M. F. M. F. Nett Births j Legitimate, 435 367 Nett Deaths ! Infants, 23 21 stillbirths 1 Legitimate Infants, 17 16 in the Yeai 1 Illegitimate, 61 58 in the Year j jnegjtimate infants, 2 5 in the Year^ f illegitimate Infants, 1 2 Total ... 496^*20 Total ^25^ ^26^ Total 18 18 916 51 3V 31 MATERNAL MORTALITY. In 1933 the number of deaths due to conditions connected with or consequent upon child-birth was 10, the Maternal mortality rate being 10.5 per 1,000 births. These are the highest figures for a number of years, those for 1932, for example, being as follows: Deaths 4 and death-rate 3.8 per 1,000 births. The main facts with regard to the 1933 deaths are: In two cases death was due to puerperal septicaemia, the ages being 31 and 43, one of these instances following the birth of twins. Two, ages 27 and 29, died of septic abortion. One death was found to be due to puerperal toxaemia and another to anaemia and operative shock. Both these women were 30 years of age. A seventh case was that of a woman of 28 years who died of chronic endocarditis and myocarditis, pregnancy being terminated by abdominal hysterectomy. The eighth death was of a woman 37 years of age, and was due to cardiac failure, the child being still-born. 1 he remaining two deaths were attributed to haemorrhage, one following miscarriage. The ages were 34 and 20. All but one of these women were married. DEATHS IN RELATION TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table III. of the Ministry of Health series on page 65. This Table also shows the distribution of deaths according to causes in the various registration sub-districts. The following notes w ith regard to certain of the causes which contributed most largely to the death rate, may be of interest. DIARRHOEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 14, equal to 0.14 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants', and in 1933 this was the case also, no fewer than 12 of the 14 being children under 1 year of age. In 1932, the deaths from diarrhœal diseases numbered 29, and of this number 24 were babies. 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 41 deaths, and including diarrhoea (14 deaths) the total number registered as due to them was 22. Of these deaths, 6 were caused by whooping cough. No death was caused by scarlet fever and only one by diphtheria. In 1932, 64 deaths were due to infectious diseases excluding influenza, which caused 35 deaths. The figure in 1931 was 31. 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 68, a figure lower by 7 than that for 1932. The great bulk of the 68 deaths, viz., 56, was due to phthisis. The number in 1932 was 67. Of the total number of deaths registered (1,224), the percentage due to phthisis was 4.6, as against 6.0 in 1932. The age periods at which the deaths occurred were: 15—25, 4(7%); 25—45, 24 (43%); 45—65, 24 (43%); 65 and over, 4 (7%). The subject of phthisis is further discussed in connection with the notification and prevention of tuberculosis. 32 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 135. This is higher by 10 than the figure (125) for 1932. The death-rate was 1.35 per 1,000. In 1932 the rate was 1.25. The number of deaths certified to be due to bronchitis was 33. Of this number 17 were amongst persons aged 65 and upwards, and 9 amongst those of the group 45—65. The deaths traceable to pneumonia numbered 83, and, as in the case of bronchitis, the later age groups contributed the greatest numbers. The number of cases of pneumonia notified in 1933 was 74. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in the table on page 66. 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 195 and the death-rate 1.95 per 1,000 of the population. These figures are slightly higher than those for 1932, when the deaths numbered 179 and the rate was 1.75 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 under 35 85 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and upwards Totals Males - - - - 2 1 10 24 30 15 82 Females — — - — 2 11 21 24 32 23 113 Totals — — — — 4 12 31 48 62 38 195 Cancer.—Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 1 - 1 Throat, Neck, Gullet 13 7 20 Stomach 15 10 25 Intestines 20 85 55 Liver 10 11 21 Breast — 17 17 Uterus and Generative Organs 8 18 26 Various 15 15 30 Totals 82 113 195 The fact, commonly accepted, that the number of deaths certified as due to Cancer is showing a definite tendency to increase receives confirmation from these figures. No reason, generally acceptable, to account for this has as yet been put forward, nor has any theory to account for the occurrence of the disease, to which the medical profession as a whole can subscribe, been submitted. One point upon which there is general agreement, however, is with regard to the importance, advisability and advantage of early treatment. Of the accuracy of the advice, now. so widely given that there should never be any delay in seeking an authoritative opinion in any case of doubt and in securing treatment, there can be no question. 33 ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1933 numbered 58. Of these 19 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 65. The following table shows the number of cases of infectious disease notified during the past six years:— 1928 1929 1930 1931 1932 1933 Smallpox 30 3 6 2 - - Diphtheria 177 180 271 154 83 78 Erysipelas 67 40 61 55 55 76 Scarlet Fever 223 237 226 258 192 198 Enteric Fever 13 5 9 9 3 7 Paratyphoid Fever 10 6 6 3 4 2 Continued Fever 1 — -— — — — Puerperal Fever 3 4 8 11 5 8 Puerperal Pyrexia 32 19 25 22 26 17 Cerebro-spinal Meningitis - 3 4 5 2 1 Tuberculosis (Pulmonary) 139 147 141 145 140 148 Tuberculosis (Non-Pulmonary) 22 26 20 17 23 16 Acute Poliomyelitis — 2 2 1 1 — Polio-Encephalitis 1 — — — — — Ophthalmia Neonatorum 7 3 16 10 8 6 Encephalitis Lethargica 3 3 2 — — 1 Pneumonia 44 92 42 80 77 74 Malaria 1 2 1 — 1 - Dysentery 2 1 — — 2 1 Totals 775 773 840 772 622 633 Diphtheria and Membranous Croup. There were only 78 cases of diphtheria notified during 1933, 1 death resulting. In 1932 the figures were much the same: 83 cases and 1 death being returned. The number of cases per thousand of the population was 0.8 in 1933. The cases were more or less evenly distributed, as usual, throughout the borough, and only in a few instances was it possible to determine accurately the source of infection. In 5 cases the source appeared to be a member of the family previously infected; in 2 cases infection was counted to have been acquired in school, and in 5 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 654, a positive result being returned in 74 instances. Of the registration districts, that contributing the largest number of cases, naturally, since in respect of child population it is the largest, was Christ Church, with 37. In All Souls the number was 9, in St. Mary 26, and in St. John 6. As usual, the age groups 1—5 and 5—15 were those most affected, 31 of the cases falling into the former and 25 in the latter group. No application for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, was 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. 34 Diphtheria Immunization.—The Schick Testing and Diphtheria Immunization Clinic opened at the beginning- of 1928, continued to operate under Dr. Bulman at 113. Marylebone Road. 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 — 1 49 50 Positive — — 35 35 Negative — 1 14 15 Not reported — — — •— Inoculated without Schick Test 127 105 1 233 Injections—1st — — 35 35 2nd 106 96 38 240 3rd 90 89 32 211 4th 15 9 26 50 5th 12 9 21 42 Retested 91 93 25 209 Completely immunised 76 76 24 176 Positive after retest 7 12 5 24 Not reported — — — - Additional Injections 3 2 10 15 SUMMARY. Number of Sessions 82 Total Number of New Cases 284 „ „ under 5 127 „ „ over 5 106 „ „ Adults 51 Number of attendances 1,281 Average attendance per session 16 Scarlet Fever. Notifications of this disease numbered 198, the highest number of cases reported in any one week being 10. There were no deaths from scarlet fever during 1933. The districts to suffer most from the disease were Christ Church and St. Mary. In the former there were 69 cases and in the latter 60. In All Souls there were 48 and in St. John 21. As usual, the majority of the patients were children of school age, the age group, 5—15, giving nearly one-half (95) of the total. Of the remainder, 57 were aged under 5 years, and 46 over 15 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 24 instances that a definite connection could be made out. Defects in sanitation to the number of 10 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 7. There were no deaths. Of Paratyphoid Fever there were 2 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. There was one case of this disease notified during the year. 35 Encephalitis Lethargica. One case of this disease was notified. Polio-Encephalitis and Polio-Myelitis. These diseases were entirely absent from the Borough during the year. Erysipelas. The notifications of erysipelas numbered 76, and there were no deaths. Most of the cases were notified from the St. Charles' Hospital and the General Hospitals, and 55 patients were treated in such institutions. Puerperal Fever and Puerperal Pyrexia. The number of cases of Puerperal Fever notified was 8. Particulars of the 3 patients who died of these conditions 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. The Puerperal Pyrexia cases notified during the year numbered 17; most of ihe 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 1932 was 26. Measles and German Measles. These diseases showed no epidemic tendency during 1933. Although they are not now notifiable, 12 cases were reported voluntarily by doctors and parents and 87 notices of cases and contacts were received from school teachers. There were no 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 1933 the number of deaths registered as due to whooping cough was 6. There were 14 deaths from the disease in 1932. 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 since 1931, when there were two. Vaccination.—The usual table has been prepared by the Vaccination Officer and will be found on page 68. The following statement gives some information with regard to the work done and the results obtained by Dr. Bulman during 1933. Number of visits paid 1,426 Number of vaccinations— Primary 587 Re-vaccinations 163 700 Number of successful vaccinations 657 Number of unsuccessful vaccinations 48 Number of refusals 6 36 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 1933. INFECTIOUS DISEASE IN SCHOOLS, 1933. (CASES and CONTACTS) Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 36 - - 4 - 60 Barrett Street — — — — — — Barrow Hill Road 16 13 2 45 1 86 Bell Street 16 11 1 1 1 10 Capland Street 17 13 8 6 15 46 Catholic, Richmond Street — — — — — — Christ Church, Cosway Street 16 — — 2 — 30 Convent (St. Edward's), Little Union Place 4 2 — — 6 8 Cosway Street (L.C.C.) 46 12 6 5 12 31 Emmanuel, Aberdeen Place 4 — 7 5 2 69 Gateforth Street — — — — — — Hampden Gurney 8 6 6 4 2 2 Homer Row, Catholic — 2 — — — 20 Jewish, Hanway Street — — — — — — Polytechnic, Regent Street — — — — — — Regent's Park Central - - - - - 95 St. James's, Marylebone Lane — — — — — — St. Luke's, Nutford Place 6 4 1 1 — 3 St. Mark's, Violet Hill 11 — 8 2 4 118 St. Marylebone Central, High Street 41 12 25 8 12 11 St. Marylebone Grammar 4 — — 4 7 — St. Mary's (Western) York Street 18 4 8 5 — 18 St. Paul's Bentinck, Rossmore Road 24 18 4 12 21 54 St. Thomas', Orchard Street 2 - - 6 — 20 St. Vincent, Wigmore Street — — — — — — Upper Marylebone Street 9 2 — 4 4 94 Schools in other Boroughs 6 9 3 - - 4 Totals 284 108 79 114 87 779 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 1933. The total number of cases notified was 6, as against 8 in 1932. Visits were paid to notified cases by the Health Visitors, and in 5 cases arrangements were made for one of the nurses of the Paddington and Marylebone Nursing Association to attend and apply treatment. In this connection 156 visits were made. In bad cases removal to hospital is carried out, special arrangements having been provided at St. Margaret's Hospital for receiving and dealing with children suffering from this condition. The following table gives information with regard to the cases notified. Notified Cases Treated Vision Vision Total Deaths At Home At Hospital Unimpaired Impaired Blindness 6 1 5 6 - - - 37 INFLUENZA. This disease seemed to he slightly more prevalent than in 1932, though correct information as to the number of cases was, of course, unobtainable. The deaths certified as due to Influenza numbered 41, as against 35 in the previous year. 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 82 and 66. The services of the nurses were requisitioned in 21 cases and 388 visits were paid. The number of deaths certified as due to all forms of this disease was 83. 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 of that year. By the close of the year 1932, 17 such cases had been reported but there has since been a falling-off in the number of notifications received, the total for the year 1*933 being only 13. In 9 instances some form of fish, either fresh or tinned, was the food suspected, whilst in the other cases pork, cheese and egg and milk came under suspicion. In no case was it necessary to remove the patient to hospital and all fully recovered within the course of a few days. TUBERCULOSIS. In all 164 notifications were received, 148 relating to pulmonary tuberculosis, the remainder (16) to cases in which structures other than the lungs were affected. The table given on page 39 contains the information required by the Ministry of Health with regard to notifications. 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 68 2. The number of cases unnotified or notified at death 23 3. The number of cases notified within a month of death 10 4. The number of cases notified within three months of death 8 5. The number of cases notified within six months of death 4 Treatment of Tuberculosis.—Of the cases notified 230 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 105 were insured persons; of those 85 were admitted to sanatorium or hospital treatment, 30 to St. Charles' Hospital and 8 to St. Mary Abbots' Hospital. Non-insured persons numbered 59, of whom 30 (5 being children) received sanatorium treatment. Twelve were admitted to St. Charles' Hospital and 1 St. Mary Abbots' Hospital. Nurses were sent in to 6 cases and 84 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. 38 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1983, to the 31st December 1988. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Notifications on Form A. Notifications on Form B. Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. No. of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Primary Notifications. Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males — 1 — - 4 12 14 19 1ft 1ft 6 92 109 - - - - - 46 66 „ Females 1 1 — — 5 9 23 8 4 3 2 56 62 - - - - - 19 34 Non-Pulmonary Males — 1 — — 1 — 2 — 1 — — 5 5 - - - - - 1 1 „ Females - - 1 1 2 3 1 2 1 - - 11 11 - - - - - - 3 Totals 1 3 1 1 12 24 40 29 24 21 8 164 187 — — — — — 66 104 39 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.—Summary of Notifications during the period from the 1st January, 1933, to the 31st December, 1933, in the area of the Metropolitan Borough of St. Marylebone. Age Periods Formal Notifications. Number of Primary Notifications of new eases of tuberculosis. Tota Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 55- 65- Total all ages. Pulmonary, Males — 1 — — 4 12 14 19 IS 18 6 92 109 „ Females 1 1 — — 5 9 23 8 4 3 2 56 62 Non-pulmonary Males — 1 - — 1 — 2 — 1 - — 5 5 „ Females - — 1 1 2 3 1 2 1 — — 11 11 Supplemental Return. Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during tile above-mentioned period, otherwise than by formal notification. Age periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total. Pulmonary, Males — — - — — — 4 — 4 3 — 11 „ Females - - - - - 2 5 2 1 2 1 13 Non-pulmonary males 1 1 1 ~~ 1 — 1 1 1 2 — 9 „ Females — - 4 - 1 1 1 - — 1 — 8 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 8 3 transferable deaths from Registrar General 5 4 Posthumous Notifications — 2 "Transfers" from other areas (other than transferable deaths) 10 8 Other sources if any (specified) Form 11 1 — 40 Part III.—Notification Register. Pulmonary. Non-Pulmonary Total cases Number of cases of Tuberculosis remainining at the 31st December, 1933, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough Males Females Total Males Females Total 436 269 705 85 86 171 876 Number of cases removed, from the Register(s) during the year by reason inter alia of:— (1) Withdrawal of Notification - - - - - - - (2) Recovery from the disease — — — — 1 1 1 3) Death 42 21 63 8 5 13 76 (4) Removed from district 29 28 57 9 6 15 72 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 the table at page 42, 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, 50 Old, 72 No. of cases at Dispensary New, 354 Old, 1,583 No. of attendances at Dispensary 2,949 No. of visits by Miss Baker First visits, 113 Re-visits, 1,5 No. of visits by Miss Kenion First visits, 84 Re-visits, 1,0 No. of Committee Meetings attended 24 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: Councillors G. B. Ramsay, Mrs. M. G. Harris and Mrs. E. M. Shirley. In addition to the Council's representatives this Committee includes:— NAME. REPRESENTS. Morris, Sir Francis (Chairman) Public Assistance Committee. Broadbent, Miss M. E. (Hon. Secretary) Invalid Children's Aid Association. Sikes, Dr. A. W. Divisional School Medical Officer to the London County Council. Marriott, Miss K. London County Council and School Care Committee. McWilliam, Miss M. Charity Organization Society Higgin, Miss E. Portland Town Association. Lazarus, Miss O. Central Jewish Synagogue. Wetherall, Miss St. Mary's Hospital, Paddington. Hawthorn, Mrs. Margaret Street Hospital. Ruddock, Mrs, C. The Working Classes. Bennett, Miss A. M. Paddington & St. Marylebone District Nursing Association. Bowen, Miss E. A. (M.B.E.) War Pension Committee and United Services Fund. Price, Miss H. M. Middlesex Hospital. Lesser, Mr. H. E. London Insurance Committee. 41 The following note by Dr. Saner upon the work of the year is of interest:— "For the statistics of the work for 1933, see tables on pages 42 to 44. These figures, it may be noted, do not indicate all the work carried out at the Dispensary, showing only the number of new patients examined during the year and their grouping, along with the regrouping of those in previous years. Each year's patients are kept separately—for instance, those patients who came under treatment in 1926 remain in the table headed 1926 and their grouping according to their condition is brought up to the end of 1933—so that it is known how many remain inactive and how many are still active, indicated by the TB— and TB+ columns. These tables show, too, how many have been crossed off the books as recovered, lost sight of or dead. The whole of the tables therefore show a complete record from 1926 and of those patients who came under treatment previous to 1926 but not in their several years. TB— means those patients who are not infectious; TB+ those who are. 181 reports following an examination have been sent to the L.C.C. of those patients who have had at any time Institutional treatment under their scheme. Out of these we find 54 men and 47 women are working full time, 16 men and 9 women are unfit for work, 11 children are back at ordinary school, 35 men, women and children have left the district, 7 patients are fit for work but cannot obtain it. The Care Committee under the Chairmanship of Sir Francis Morris, and the Honorary Secretaryship of Miss Broadbent, has met fortnightly during the year and have had 356 patients under consideration, some more than once, for various reasons, e.g., for assessment, clothing, dentures, work and nourishment and convalescence. The Charity Organization Society, Portland Town Association and the Invalid Children's Aid Association have assisted and the United Services' Fund has helped the ex-Service man and his family. 85 patients have been sent for Sanatorium treatment—73 to hospital, 16 of whom were transferred to Sanatorium. 195 sputa have been examined at the Dispensary, but this number does not include those sputa sent by the practitioners to the Town Hall. Special attention is given to the examination of contacts, i.e., those who have been living in close connection with positive cases, but to get them to attend for examination is not always so easy as it sounds." 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 231, as against 623 in 1932. Of these, 23 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—Nine of the total notifications—16 as against 23 in 1932—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 46. 42 TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1933. diagnosis. pulmonary. non-pulmonary. total. grand total Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 70 38 1 1 4 3 1 2 74 41 2 3 120 *(b) Diagnosis not completed - - - - - - - - - 1 — 1 2 (c) Non-tuberculous - - - - - - - - 25 39 19 24 107 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 2 — 1 - — — — 1 2 — 1 4 *(b) Diagnosis not completed - - - - - - - - 1 1 2 - 4 (c) Non-tuberculous - — - - - - - — 15 34 23 25 97 C.—Cases written off the Dispensary Register as:— (a) Recovered — 1 — — 1 — i 5 1 1 1 5 8 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 47 82 81 82 292 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 217 L45 29 23 24 25 32 21 241 170 61 44 516 (b) Diagnosis not completed - - - - - - — — 1 2 6 5 14 1. Number of cases on Dispensary Register on January 1st 615 2 Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 20 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 109 4. Cases written off during the year as Dead (all causes) 30 5. Number of attendances at the Dispensary (including Contacts) 2,949 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 183 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations 120 (a) Personal 18 (b) Other 101 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 1,987 10. Number of:— (a) Specimens of sputum, &c., examined 195 (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(b) above Nil 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 245 (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.1 *i.e., remaining undiagnosed on 31st December. 43 Form T. 145a. Tuberculosis Scheme. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates. Previous to 1926. 1926. 1927. 1928. 1929. 1930. 1931 1932 1933 Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus* Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1 Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus) Group 1. Group 2. Group 3. Total (Class T.B. plus) Group 1. Group 2. Group 3. Total (Class T.B. plus) Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 1 — — 1 — 2 — — 2 1 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 10 3 - - 3 - - - - - - 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 12 — — — — 2 — — — — — — - — — - — — — — — — — — — - - — — — — — — — — — - - — — — — — — Disease not Arrested Ad'lts M. 7 3 4 9 16 — - 4 1 5 2 3 1 5 9 3 — 3 — 3 1 9 6 3 18 3 6 4 1 11 9 11 8 1 20 8 10 13 5 28 22 16 18 8 42 F. 2 4 2 2 8 1 - — 1 1 3 1 3 2 6 1 1 1 — 2 4 4 4 1 9 3 2 2 — 4 10 3 11 3 17 12 5 1 3 9 16 5 15 2 22 Children 6 — — — — 1 — — — — 2 1 — — I 3 — — — — 5 1 — — 1 6 — — — 6 — — — - 3 1 — 1 3 1 - — 1 Condition not ascertained during the year - - - - - - - - - - - 1 - - 1 - 2 - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 39 11 6 11 28 4 2 4 2 8 8 8 4 7 19 7 3 4 — 7 10 14 10 4 28 12 8 6 1 15 25 14 19 4 37 28 15 15 8 38 41 22 33 10 65 (b) Not now on Dispensary -Register and reasons for removal therefrom. Discharged as Recovered Ad'lts M. 7 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 10 — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 11 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 66 54 9 2 65 29 12 5 4 21 25 13 7 1 21 27 17 7 2 26 27 21 6 1 28 18 11 4 2 17 28 5 2 2 9 7 2 2 - 4 4 3 5 1 9 Dead Ad'lts M. 1 4 6 28 38 1 1 5 20 26 2 - 1 18 19 1 — 2 20 22 1 1 - 10 11 1 — 3 14 17 1 3 3 9 15 1 1 1 8 10 — — — 5 5 F. 1 2 3 14 19 - — — 10 10 3 - 1 13 14 — — 1 19 20 1 2 - 11 13 1 1 — 5 6 1 — — 3 3 — — — 3 3 — — — 2 2 Children 1 - - - - 1 - - - - - - - - - - - - 1 1 - - - 2 2 1 - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register 97 61 18 44 123 31 13 10 34 57 30 13 9 32 54 28 17 10 42 69 29 24 6 24 54 21 12 7 21 40 30 8 5 14 27 8 3 3 11 17 4 3 5 8 16 Grand Totals 136 72 24 55 151 35 15 14 36 65 38 21 13 39 73 35 20 14 42 76 39 38 16 28 82 33 20 13 22 55 55 22 24 18 64 31 18 18 19 55 45 25 38 18 81 44 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates. Previous to 1926. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints Abdominal. Other Organs. Peripheral Glands Total. Bones and Joints* Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints.] j Abdominal. Other Organs. Peripheral Glands' Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Ad'lts M. 2 - - - 2 - - - - - - 1 - - 1 - - - - - 3 - - - 3 - - - - - - - - 1 1 - - - - - - - - - - F. 2 - - 2 4 - - - - - - - - - - - - - - - 1 - - 3 4 1 — 1 — 2 1 — — — 1 1 — — - 1 — - — — — Children 5 1 — 4 10 1 — — 1 2 1 - — 1 2 — — — 3 3 2 — — 1 3 - — — 3 3 — 1 — 2 3 — — — — — — - — — — Disease not Arrested. Ad'lts M. — — 1 — 1 - — — — - 1 - - - 1 1 - — - 1 2 — 1 — 3 — — — 1 1 1 — — — 1 2 1 1 — 4 3 - - 1 4 F. 1 - - - 1 - - - - - - - - - - - - - - - - 1 - - 1 1 — 1 1 3 - - - - - 1 1 1 — 3 1 3 - 1 5 Children 1 — — 2 3 1 — — — 1 1 1 — 1 3 2 — — — 2 — — - 1 1 2 — — — 2 4 1 — 1 6 3 — — 1 4 1 - — 4 5 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 — 1 Total on Dispensary Register at 31st December 11 1 1 8 21 2 — — 1 3 3 2 — 2 7 3 - - 3 6 8 1 1 5 15 4 — 2 5 11 6 2 — 4 12 7 2 2 1 12 5 3 1 6 15 1 (6) Not now on Dispensary Register and reasons for removal therefrom. Transferred to Pulmonary 1 - - - 1 - - - - - - - - 1 1 - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - Discharged as Recovered Ad'lts M. 1 — 1 - 2 1 - - - 1 - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 2 1 — 3 6 - - - 3 3 - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 21 4 1 5 31 2 1 1 - 4 3 - - 1 4 3 - - 3 6 4 - 4 3 11 2 2 - 1 5 1 2 1 2 6 1 1 - 2 4 - - - - - Dead Ad'lts M. 2 1 - - 3 1 - - - 1 - - - - - - - - - - 1 - - - 1 - - - 1 1 - - 1 - 1 - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - Children - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - Total written off Dispensary Register 27 6 2 8 43 4 1 1 3 9 3 — - 2 5 4 - - 3 7 7 — 4 3 14 3 2 — 2 7 1 2 2 2 7 2 1 - 2 5 — — — — Grand Totals of (a) and (ft) (excluding those transferred to Pulmonary). 38 7 3 16 64 6 1 1 4 12 6 2 - 4 12 7 — — 6 18 15 1 5 8 29 7 2 2 7 18 7 4 2 6 19 9 3 2 8 17 5 3 1 6 15 February 12th, 1934. 45 Deaths from Phthisis.—Some reference has already been made to the matter of deaths from tuberculosis and at this point it is proposed only to deal with the figures relating; to tuberculosis of the lungs (consumption or phthisis). During 1933 the total number certified as due to this cause was 56, the deathrate being 0.16 per 1,000. In 1932 the deaths numbered 67, the death-rate being 0.7 per 1,000. The distribution of the deaths according to registration districts is shown in the accompanying table, which gives also the figures for each of the 5 years 1929-1933. Deaths from Phthisis. 1929—1983. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1933 94,080 56 4 17 23 12 The distribution of the 56 deaths was as follows:—In Poor Law Institutions, 30; in general and other hospitals, 9; and at home, 17. Of those who died 36 were insured (27 males and 9 females), and 20 uninsured (12 males and 8 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 56. the notified cases of pulmonary tuberculosis totalled 148. The following table prepared at the request of the Ministry of Health contains information with regard to age and sex distribution of all forms of tuberculosis that may be found interesting. Age Periods •NEW CASES ALL DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 - 1 1 - - - 1 - 1—5 1 1 2 - - - 2 1 5—10 - - 1 5 - - - 2 10—15 — — — 1 — — - — 15—20 4 5 2 3 - 1 - 1 20—25 12 11 - 4 1 2 - - 25—35 18 28 3 2 10 6 1 — 35—45 19 10 1 2 6 2 1 — 45-55 22 5 2 1 10 3 1 — 55 -65 21 5 2 1 10 2 1 1 65 and upwards 6 3 - - 2 1 - - Totals 103 69 14 19 39 17 7 5 *Including all cases known otherwise than by notification. The following table, giving information as to localisation of the disease, brings out no fact to which attention has not already been directed. 46 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 ages—years. All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals Cases Isolated at Home At all Ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Lungs 148 1 2 — 30 64 43 8 23 57 39 29 148 10 22 11 14 57 91 Spine 1 — — — 1 — — — — 1 — — 1 — — — — — 1 Peritoneum 2 — — — 1 1 — — 1 1 — — 2 1 1 — — 2 — Glands 8 — — 2 3 3 — — 1 4 3 — 8 1 3 2 — 6 2 Testicle 1 - - - - - 1 — 1 — — — 1 — — — — — 1 Knee 1 — — — — — 1 — 1 — — — 1 — — — — — 1 Meninges 2 — 1 — 1 — — — 1 — 1 — 2 1 — 1 — 2 — Larynx 1 — — — — 1 — — — — — 1 1 - - - - - 1 Totals 164 1 3 2 36 69 45 8 28 63 43 • 30 164 13 26 14 14 67 97 163 47 DISINFECTION. The work done in this connection during 1933 is shown in the following tables. The methods employed during the greater part of the time were substantially the same as in previous years, articles suitable for treatment by steam were dealt with in the Washington-Lyons Disinfector, while for rooms either formalin or sulphur was generally employed. The number of the articles disinfected are shown hereunder:— Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other Causes. Total. Totals 3,600 277 394 372 2,104 6.747 The number of journeys made by the disinfecting vans during the year ended December, 1932, was:— January 100 August 92 February 86 September 92 March 90 October 95 April 73 November 99 May 93 December 85 June 86 July 90 1,081 The number of journeys made during 1932 was 1,102. The number of rooms disinfected and the reasons for carrying out disinfection are stated below:— Compulsorily Notifiable Diseases. Phthisis. Measles. Other causes. Total. Totals 370 58 40 162 630 The number of rooms disinfected in 1932 was 722. 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 170. 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 1933 were 2,907 and 2,899 respectively. 48 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. Disease Suspected. 1933. Positive. Negative. Total. Typhoid fever 1 — 1 Diphtheria 48 606 654 Phthisis 23 208 231 Totals 72 814 886 MATERNITY AND CHILD WELFARE. The Maternity and Child Welfare Scheme in St. Marylebone is made up of voluntary and official elements. Of the voluntary elements, to the nature of which reference is made later, those for which the St. Marylebone Health Soceity is responsible bulk largest. The Council, who made a grant of £1,000 in 1933 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 1933. 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 1983. 49 Statement Showing Arrangements Made for Maternity and Child Welfare. 1. Population of the area served by the Council, 94,080. 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, 888; (b) Still births, 36; (c) Total 924; (d) By midwives, 343; (e) By doctors and parents, 112; (f) By hospitals, 236; (g) By matrons of Nursing Homes and transferred notifications, 233. 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, 414; total visits, 548. (b) To children under 1 year of age, first visits, 854; total visits, 5,422. (c) To children between the ages of 1 and 5 years, total visits, 6,136. 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, 8,907; (ii) By children between the ages of 1 and 5 years, 10,545 + 84 (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, 598; (ii) Children between the ages of 1 and 5 years, 139 + 84 (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, 2,390. (d) Total number of expectant mothers who attended at the Clinics during the year, 627. (e) Percentage of total notified births represented by the number in (d), 67.8. 6, 7, 8, 9. * * * * * 50 10. Day Nurseries. (a) Number of day nurseries: (i) provided by the Council, nil; (ii) vided by Voluntary Associations, 3. (b) Number of places for children under 5 years of age in the nurseries : (i) provided by the Council, nil; (ii) provided by Voluntary Associations, 93. (c) Total number of attendances of children at these nurseries during the year, 16,326. 11. Infectious diseases. Disease. Number of cases notified during the year. Number of cases visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals or nursing homes. (1) Opthalmia Neonatorum 6 6 5 5 (2) Pemphigus Neonatorum — — 1 — (3) Puerperal Fever 8 8 — 8 (4) Puerperal Pyrexia 17 14 1 16 (5) Measles and German Measles (in children under 5 years of age) Not Notifiable 54 4 — (6) Whooping Cough (in children under 5 years of age) 62 — — (7) Epidemic Diarrhœa (in children under 5 years of age) 24 — — (8) Poliomyelitis (in children under 5 years of age) - — — — 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, 55. 13. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 16. (b) Number (i) employed by the Council, nil; (ii) subsidised by the Council, nil; (iii) employed by Voluntary Associations, nil. 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, 3; (ii) from other causes, 7. (b) Number of these cases which died: (i) at home, nil; (ii) in institu- tons, 10. 51 INFANT LIFE PROTECTION. By the Transfer of Powers (London) Order, 1933, of the Ministry of Health made under Sec. 64 of the Local Government Act, 1929, the powers and duties of the London County Council in connection with Infant Life Protection were transferred to the Borough Council as from 1st April, 1933. The provisions to be administered are comprised in Part 1 of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932, together with the provisions in the Second and Fourth Schedules to that Act which relate to Part 1 of the Children Act, 1908. The transferred powers provide for the reception of notices given by persons who undertake for reward the nursing and maintenance in a dwelling of infants and the inspection of premises by infant protection visitors or other persons appointed by the Council for that purpose; fixing the number of infants to be kept in a dwelling in which any infant is received for reward; applications to a court or justice for an order directing the removal of an infant to a place of safety. The Health Visitors were appointed Infant Protection Visitors and the following Table, which supplements the information asked for by the Ministry of Health, shows the number of foster mothers and foster children in the Borough, together with the work in connection therewith carried out by the Health Visitors:— No. of foster mothers on register at 1st April, 1933 14 No. of foster mothers on register at 31st December, 1933 16 No. of foster children on register at 1st April, 1933 14 No. of foster children on register at 31st December, 1933 18 No. of foster mothers added to register 4 No. of foster children returned to parents 5 No. of foster children removed to Institutions 1 No. of foster children adopted l No. of inspections 199 52 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.1— Monday, 2 p.m. Infant Consultation, Thursday, 10 a,m. „ „ Church Army Dispensary, Bryanston Square, W. 1 — Tuesday, 2.15 p.m. Infant Consultation, 12, Salisbury Street, Wednesday, 2.30 p.m. Dental Clinic. 113, Marylebone Road— Monday, 2 p.m. Diphtheria Prevention Schick Testing, etc. Thursday 2 „ Ditto Wednesday 2 „ 3 year old Clinic. Day Nurseries— The Crossley Day Nursery, Barrow Hill Road, N.W.8. The Portman Day Nursery, 115, Marylebone Road, N.W.1. The St. Vincent de Paul, 111, Wigmore Street, W.1. 53 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 1933 the health visitors made 8,374 visits to children and 548 visits to mothers. Children are visited up to school age, and thereafter for special purposes, e.g., measles, scabies &c. These necessitated 155 visits to children over 5 years of age in 1933. Centres.—There are in all eight centres, all "voluntary," at which consultations are held. Four of these are under the Health Society, viz.:—(1) North Marylebone School of Mothercraft, Salisbury Street, has an ante- and post-natal consultation under medical supervision. The dental clinic and minor ailment treatment centre are in the same building. The Council's health visitors cooperate, one of them acting as superintendent.—(2) South Marylebone School of Mothercraft, St. Marylebone General Dispensary, 30, Marylebone Lane. An antenatal clinic is held once weekly, and an infant consultation twice weekly, both under medical supervision. One of the Health Visitors acts as superintendent. Children attend up to school age.—(3) 24, Hill Road. Infant consultations under medical supervision are held weekly. One of the Health Visitors acts as superintendent, and a nurse is employed three days a week by the Health Society for the purpose of visiting.—(4) Western Centre. Formerly held at Western General Dispensary, Cosway Street. Since October, 1933, has been accommodated at 113, Marylebone Road. Infant consultations under medical supervision are held weekly. There are also classes for needlework. One of the health visitors is specially attached to this centre and acts as superintendent. In addition to these centres, consultations are held weekly at Queen Charlotte's Hospital, at Middlesex Hospital, at the Church Army Dispensary, and at the Western General Dispensary. One of the Council's health visitors attends at Queen Charlotte's Hospital, and Middlesex Hospital, which has a paid Health visitor in addition. All the consultations are open to other than St. Marylebone babies, who, however, constitute the bulk of those attending. At the hospital, as at Queen Charlotte's, there are ante-natal clinics particularly for hospital patients. Ante-Natal Work.—There are three voluntary Ante-Natal Clinics. Visiting is undertaken by the Council's health visitors and there is a system of co-operation with the Middlesex and Queen Charlotte's Hospitals. 54 Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. Totals The statement set out below shows the work of the Ante-natal and Post-natal Clinics held at the Maternity and Child Welfare Centre, Salisbury Street, during the year, 1933:— No. of Sessions 4 5 5 3 5 4 4 4 4 4 5 3 50 New Ante-natal cases 9 5 14 7 4 6 1 10 2 8 7 1 74 New Post-natal cases — — — 1 3 1 2 2 — 3 3 — 15 Attendances Ante-natal 28 29 35 33 41 22 20 24 19 18 27 18 314 Attendances Post-natal 28 34 45 16 25 17 14 14 18 24 26 10 271 Total attendances 56 63 80 49 66 39 34 38 37 42 53 28 585 Transferred to St. Mary's Hospital 1 — 1 - - - - - - - - - 2 Transferred to Queen Charlotte's Hospital 1 - - - - - - - - - - - 1 Put on special diet 2 - - - - - - - - - - - 2 Pads and belts provided — 2 - - - - - - - - - - 2 Transferred to St. Marylebone Home — — 4 — 8 — — — — — 2 1 15 High blood pressure, put on special diet — — 4 3 — 3 - - - - - - 10 X-ray examinations — — — 1 1 — — 1 — 2 — 5 Epilepsy - - - 1 - - - - - - - - 1 Hydramnics - - - - 1 - - - - - - - 1 St. Charles Hospital for Caesarian Section (2nd baby) - - - - - 1 - - - - - - 1 Appendix and ? T.B. - - - - - - - - - - 1 — 1 Sent to Royal Free Hospital for diagnosis - - - - - - - 1 - - - - 1 Undernourished - - - - - - - 1 - - - - 1 Threatened miscarriage - — — - — — — — — 1 - - 1 55 Dental Clinic.—This was originally established for the treatment of women, and children of pre-school age. By arrangement with the London County Council school children are also dealt with. Massage Clinics are held weekly at Salisbury Street, Marylebone Lane, and Queen Charlotte's Hospital. Schick Testing, etc., Clinics.—As already indicated arrangements for holding clinics of this kind are made at 113, Marylebone Road. The clinic was held twice weekly throughout the year and, as the figures given elsewhere show, was largely used. THREE-YEAR-OLD PRE-SCHOOL CLINIC. This clinic, established in an experimental kind of way in the early part of 1931, has continued to grow in importance and favour. The object of its initiation under Dr. Bulman was to endeavour to make touch before they entered school with children who had never attended any clinic or welfare centre and to find out something with regard to their condition for their own benefit and for the information of the School Medical Officer. To this end children who would attain the age of three years in the various months of the year were picked out of the register, care being taken to confirm that they were still alive and had not been in attendance at the centres. To the parents of those thought suitable for approach a note in the following form was sent:— Dear Mr. and Mrs Three years ago in I had a notification about the birth of your little one and this letter is an invitation to you to visit the Borough Council's clinic provided for the medical examination of little children just before they start on school life. It is a great advantage for anyone to be medically examined from time to time but in childhood the advantage is greatest of all, because the chances of putting right anything that may unfortunately be wrong are so very much greater in the early years. As you know, arrangements are made for medical inspection in school and experience shows that the more the school doctor knows about a child's health in early days, the greater the amount of good that can be done or care that can be taken. The Council's clinic, though it is held at No. 113, Marylebone Road (two doors from the Town Hall), is attached to my department and is open on Wednesday afternoons at 2 o'clock, and if you will bring your little one up next Wednesday, Dr. Bulman will make the examination and have a chat with you and give you any advice or suggestions that he thinks necessary. Yours faithfully, Charles Porter, Medical Officer of Health. Thereafter a visit was paid to the house to renew the invitation and to explain more fully the objects, etc. Clinics are held once a month and speaking generally have been well attended. The following table gives information with regard to number of attendances, and other matters. Of the 84 children who were examined during 1933, 39 needed treatment for one or more conditions. The following is a summary of the conditions found :— Enlarged tonsils and adenoids ... ... ... ... 14 Dental caries ... ... ... ... ... ... 15 Chronic bronchitis ... ... ... ... ... ... 7 Incontinence of urine ... ... ... ... ... 2 Recommended for circumcision ... ... ... ... 1 Rheumatism ... ... ... ... ... ... 3 Squint ... ... ... ... ... ... ... 3 Signs of old rickets... ... ... ... ... ... 3 Mentally backward ... ... ... ... ... ... 3 Infantile paralysis ... ... ... ... ... ... 1 These children were sent to the appropriate clinics at the Middlesex Hospital. 56 Hospital Treatment.—Children's cases are referred from the centres to the dispensaries and hospitals in the borough, and the Queen Charlotte's and Middlesex Hospitals are available for ante-natal and complicated maternity cases. By arrangement cases calling for special examination or treatment are referred by the doctors at the centres to Middlesex Hospital. The fact that a special centre has been established at the Western General Dispensary has already been mentioned. Maternity Cases.—The Council 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 1933 was 2,283; the total births numbering 3,277. The midwives residing in the borough registered' as intending to practise in the administrative County of London, number 21. 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 603 visits were paid, the services of the nurses being greatly appreciated by the patients. Work done during 1933.—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. 57 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDED 31st DECEMBER, 1933. CENTRE No. 24 Hill Road No. 14 Salisbury Street Queen Charlotte's Hospl. 113 Marylebone Road No. 30 Marylebone Lane The Middlesex Hospl. The Westn. Genl. Dispy. No. of consultations held:- Infants 72 147 100 93 88 152 92 Toddlers 24 51 — 10 — 52 — Maternity — 49 309 — 21 96 — Massage — 86 80 — — — — Light — 68 — — 25 — — No. of attendances of mothers at clinic:— Ante-natal — 306 15,793 (1,509) — 26 3,461 (549) — Post-natal — 278 67 (4) — — 105 (9) — No. of attendances of babies 1,336 2,407 2,989 (1,120) 1,156 887 4,134 (1,684) 120 No. of attendances of children over one year 1,023 2,552 1,140 (587) 1,353 769 3,572 (1,148) 279 No. of attendances at Light Clinic— Infants — 105 - - 5 - - Toddlers — 1,603 — - 69 - - No. of attendances at Massage Clinic— Infants — 73 68 (14) - — - - Toddlers — 1,039 174 (123) - - - - No. of orders issued for milk, etc. 340 853 202 • 367 166 300 No. of home visits 2,372 3,193 324 1,219 607 2,977 - No. of new cases— Infants 94 161 226 (63) 66 49 294 (95) 70 Toddlers 28 42 4 (1) 6 13 29 (18) 31 Antenatal — 71 3,220 (333) — 8 538 (98) — Post-natal — 37 40 (2) - — 105 (15) — Massage— Infants — 9 19 (7) - - - - Toddlers — 40 12 (5) - - - - Light— Infants — 10 - - 1 - - Toddlers — 36 — — 4 - — 58 Day Nurseries.—Attendances during the year. The Crossley, Barrow Hill Road.—Whole day, 5,412; half-day, 712. The Portman.—Whole day, 4,411; half-day, 798. St. Vincent de Paul, 111, Wigmore Street.-—Whole day, 3,825; half-day, 1.168. Dental Clinic, 12, Salisbury Street. Attendances during the year.—Mothers, 651; children, 83. Advice and treatment given in 473 cases. Extractions under gas, 261. Home Helps.—Home helps were provided by request in 1933 in 3 cases only, the total amount expended during the financial year to 31st March, 1934, being £3 10s. 0d. 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, 1933, was:— 1932. Males, 81 Females Total, For burial only. For inquests. Total. No. of P.M.'s held. No. of courts held. No. of Infectious cases. Totals 95 176 172 4 176 56 — — 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. 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) Acts, so far as regards the provisions relating to certificates as to suitability for occupation of houses, were not taken advantage of during the year, no application being received. 59 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) 2,316 (b) Number of inspections made for the purpose 10,955 (2) (a) Number of dwelling-houses (included under sub-head (1) above which were inspected and recorded under 430 houses and the Housing Consolidated Regulations, 1925) 309 tenements (b) Number of inspections made for the purpose 2,108 i(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 1,489 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 1,457 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 seived requiring defects to be remedied 32 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 32 (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 Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 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 60 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 a third block has been completed and occupied, and the erection of two further blocks commenced. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Common Lodging Houses (Licensed) 3 Slaughterhouses (Licensed) 1 Premises used for Preparation of Food (Registered) 89 Ice Cream Premises (Registered) 84 Purveyors of Milk (Registered 141 Offensive Trades (Registered) 2 Bakehouses 56 Restaurant, Dining Room and Coffee Shop Kitchens 220 Hotel Kitchens 26 Pastrycooks and Tea Rooms 101 Fried Fish Shops 25 Fish Curers 6 Workshops and Workplaces 1,055 Houses Let in Lodgings 2,014 Total 3,823 Smoke Nuisances. Number of Observations 428 Number of Intimation Notices served 6 Number of Statutory Notices served Nil Number of Nuisances and Complaints 19 Number of Summonses Nil Number of Convictions Nil Amount of Penalty and Costs imposed in each case Nil Housing of the Working Classes. Number of Houses inspected— (a) On account of complaints or illness (P.H. Act) 2,316 (b) House-to-house (Housing Consolidated Regulations, 1925) 430 Tenements in blocks 309 Number of Notices served— (a) Under P.H. Act (1) Intimation 1,457 (2) Statutory 32 (b) Under Housing Act Nil Number of Houses repaired or nuisances remedied under P.H. Act, 1891 1,489 Number of Representatioss 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 17,508 Number of Houses occupied by the Working Classes 8,596 61 Number of Houses repaired under Section 3 of Housing Act, 1925— (a) By Owners Nil (b) By Local Authority in default of Owners Nil Number of Houses closed on Notice by Owner that they could not be made fit Nil Number of Houses for the Working Classes— (a) Erected during year (flats) 63 (b) In course of erection 178 Number of Houses registered under the new Bye-laws as to Houses Let in Lodgings Nil Number of Inspections made of such Houses Nil Number of Prosecutions Nil Mortuary. Number of bodies received 176 Number of Infectious bodies received Nil Cleansing of Persons Act, 1897. Adults. Children. Total. Number of persons cleansed 2,256 651 698 2,201 5,806 Bakehouses. Number on Register at end of 1933 56 Number above ground 7 Number underground 49 Number of Inspections 105 Number of Notices 7 Number of Prosecutions Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1933 378 Number of Inspections 430 Number of Notices 14 Number of Prosecutions Nil House Refuse. Number of Inspections 1,142 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 154 Number of Notices issued. Intimations 154 Number of Statutory Notices 7 Number of Prosecutions Nil Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water has been provided to Upper Storeys 25 Number of Statutory Notices served 3 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 26 Number remedied 26 Number of Prosecutions Nil Underground Rooms. Number dealt with 63 Number of Notices served under P.H. (L.) Act, 1891} Number of Notices served under the Housing Act, 1925}63 Number of Prosecutions Nil 62 Cleansing and Disinfection. Number of rooms cleansed after infectious disease 722 Number of rooms cleansed from vermin 739 Number of articles 6,747 Number of Statutory Notices served 18 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 4,315 Number of drainage plans deposited 510 Number relating to new buildings 47 ,, ,, old buildings 463 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops and Cowsheds 453 Number of Inspections 642 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 63 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1933 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1923 105,400 3,601 1,668 15.8 1,468 13.9 827 594 111 66.0 1,235 11.7 1924 105,300 3,432 1,531 14.5 1,686 15.9 936 688 123 78.0 1,436 13.6 1925 106,100 3,418 1,496 14.1 1,472 13.8 873 658 94 63.0 1,257 11.0 1926 105,800 3,220 1,359 12.7 1,325 12.4 748 740 111 81.6 1,356 11.9 1927 103,500 3,521 1,374 13.2 1,375 13.2 781 621 81 59.0 1,262 11.8 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 1933 94,080 2,881 916 9.7 1,411 14.1 840 653 51 56.0 1,224 12.2 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. 64 TABLE II. Vital Statistics of Separate Localities in 1933 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 t0 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. 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 26,638 285 299 17 32,371 533 434 46 20,076 313 257 21 1929 102,400 1,233 1,455 95 24,532 233 327 21 26,228 254 362 19 31,873 503 504 43 19,767 243 262 12 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 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 Averages of Years 1923 to 1932 102,479 1,335 1,290 96 24,357 241 251 17 26,375 291 344 20 31,752 538 431 43 19,994 269 263 16 1933 94,080 916 1,224 51 21,564 151 241 5 24,734 192 334 12 28,570 362 408 20 19,212 211 241 51 The Christ Church and St. John Registration Sub-Districts were amalgamated and re named Northern Sub-District on the 1st April, 1916, but for the purposes of District comparison over previous years the figures have been allocated to the old Sub-Districts. 65 TABLE III.—Causes of, and Ages at Death during the year 1933. No. CAUSES OF DEATH. Net deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church. St. John. Total. All Ages. Under 1 1 and under 2. 2 and under 5. 5 and under 15 15 and under25 25 and under45 45 and under 65. 65 and upwards 1 Typhoid and Paratyphoid Fevers - - - - - - - - - - — — — — — 2 Measles - - — - - - — — — — — — — — — 3 Scarlet Fever — - — - - - — — — — — — — — — 4 Whooping Cough 6 3 1 2 - - - - - 1 2 1 3 — 6 5 Diphtheria 1 — — 1 - - — — — — — — — 1 1 6 Influenza 41 1 — — - 1 6 16 17 20 9 10 10 12 41 7 Encephalitis Lethargica 1 — — — - - 1 — — 1 — — — 1 1 8 Cerebro-Spinal Fever — — — — - - 1 — — 2 — — — — — 9 Tuberculosis of Respiratory System 56 — — — - 4 24 24 4 6 4 17 23 12 56 10 Other Tuberculous diseases 12 1 2 1 2 1 2 3 — 18 4 1 6 1 12 11 Syphilis 12 — — — — — 3 7 2 6 3 2 3 4 12 12 General Paralysis of the Insane, Tabes Dorsalis 8 - - - - - 3 5 - 1 2 2 3 1 8 13 Cancer, Malignant Disease 195 - - - - - 16 79 100 239 47 45 70 33 195 14 Diabetes 14 — — 1 — — — 6 8 10 2 3 4 5 14 15 Cerebral Hæmorrhage, etc. 35 — — — 1 — 1 9 24 36 5 13 8 9 35 16 Heart Disease 317 — — — 2 — 6 71 237 121 60 94 104 59 317 17 Aneurysm 11 - - - - - 1 6 4 1 2 4 3 2 11 18 Other Circulatory Diseases 50 - - - - - - 17 25 9 14 15 10 11 50 19 Bronchitis 33 1 — — — 1 5 9 17 26 6 5 17 5 33 20 Pneumonia (all forms) 83 4 2 — 1 2 7 32 35 56 13 22 34 14 83 21 Other Respiratory Diseases 19 — — — — 1 3 8 7 13 2 5 5 7 19 22 Peptic Ulcer 18 — — — — — 5 11 2 35 3 4 9 2 18 23 Diarrhoea, etc. 14 12 — — — 1 1 — — 8 1 2 8 3 14 24 Appendicitis 4 — — — 1 — — 2 1 29 — — 1 3 4 25 Cirrhosis of Liver 10 - - - - - 1 5 4 11 2 4 2 2 10 26 Other Diseases of the Liver, etc. 3 - - - - - - 3 — 6 — 2 1 — 3 27 Other Digestive Diseases 25 1 — — — 1 9 7 7 24 11 4 7 3 25 28 Acute and Chronic Nephritis 37 — 1 1 — 1 3 12 20 31 8 10 9 10 37 29 Puerperal Sepsis 3 — — — — — 3 — — - 1 1 1 — 3 30 Other Puerperal Causes 7 — — — — — 7 — — 14 : — — 4 3 7 31 Congenital Debility, Premature Birth, Malformation, etc. 21 20 - - - - - 1 - 70 1 4 8 8 21 32 Senility 22 — — — — — — — 22 22 5 7 6 4 22 33 Suicide 19 — — — — 1 6 10 2 15 6 5 8 — 19 34 Other Violence 39 2 2 2 2 3 8 4 16 40 9 13 11 6 39 35 Other defined Diseases 108 6 1 4 3 5 14 34 41 112 19 39 30 20 110 36 Causes ill-defined or unknown — — — — — — — — — — — — — — — M F M F M F M F M F 124 117 150 184 206 202 105 136 585 639 Totals 1224 51 8 12 12 22 135 381 603 983 241 334 408 241 1224 66 TABLE IV. Cases of Infectious Disease Notified during the 52 weeks ended 31st December, 1933. 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 78 3 8 8 7 5 15 10 2 14 3 3 - 9 26 37 6 78 9 25 37 6 77 1 Erysipelas 76 2 — 1 — — 1 2 — 18 8 31 13 15 21 29 11 76 11 15 25 4 55 21 Scarlet Fever 198 2 12 20 10 13 63 32 10 26 5 5 — 48 60 69 21 198 44 56 68 18 186 12 Typhus Fever — — — — — — — — — — — — — — — — — — - - - - - - Enteric Fever 7 - - - - - - - 1 4 1 1 — 2 4 — 1 7 2 2 - - 4 3 Paratyphoid Fever 2 — — — — — — — — 1 — 1 — 2 — — — 2 2 - - - 2 - Relapsing Fever — — — — — — — — — — — — — — — — — — - - - - - - Continued Fever — — — — — — — — — — — — — — — — — - - - - - - - Puerperal Fever 8 - - - - - - - 1 5 2 — — 1 3 3 1 8 1 3 3 1 8 - Puerperal Pyrexia 17 - - - - - - - 1 14 2 — — 3 7 6 1 17 2 7 6 1 16 1 Plague — — — — — — — — — — — — — — — — — — — - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - Cerebro Spinal Fever 1 - - - - - - 1 - - - - - - 1 - - 1 - 1 - - 1 - Tuberculosis— Pulmonary 148 1 1 1 — — — — 9 58 26 43 9 23 57 39 29 148 10 22 11 14 57 91 Non-Pulmonary 16 - 1 — — — 1 1 3 6 2 1 1 5 6 4 1 16 3 4 3 - 10 6 Acute Polimyelitis — - — — — — — — — — — — — — — - — — - - - - - - Polio-Encephalitis — - — — — — — — — — — — — — — — — - - - - - - - Ophthalmia Neonatorum 6 6 - - - - - - - - - - - - 4 2 - 6 - 3 2 - 5 1 Encephalitis Lethargica 1 - - - - - - - - 1 - - - 1 - - - 1 - - - - - 1 Pneumonia 74 2 4 2 2 2 10 3 2 11 10 18 8 9 16 32 17 74 3 10 24 9 46 28 Malaria — — — — — — — — — — -— - — — — — - - - - - - - - Dysentery 1 - - 1 - - - - - - - - - - - 1 — 1 — 1 — - 1 — Totals 633 16 26 33 19 20 90 49 29 158 59 103 31 118 205 222 88 633 87 148 180 53 468 165 67 TABLE V. Cases of Infectious Disease Notified during the 52 weeks ended 31st December, 1933. Notifiable Disease. Cases notified in whole District. Total number of cases removed to Hospital Total Deaths. At all ages. At Ages—years. —1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Smallpox - - - - - - - - - - - - - - - Diphtheria including Membranous Croup 78 3 8 8 7 5 15 10 2 14 3 3 — 77 1 Erysipelas 76 2 — 1 — — 1 2 — 18 8 31 13 55 — Scarlet Fever 198 2 12 20 10 13 63 32 10 26 5 5 — 186 — Enteric Fever 7 - - - - - - - 1 4 1 1 — 4 — Paratyphoid Fever 2 — — — - — — — — 1 — 1 - 2 — Puerperal Fever 8 - - - - - - - 1 5 2 — — 8 3 Puerperal Pyrexia 17 - - - - - - — 1 14 2 — — 16 — Cerebro Spinal Fever 1 - - - - - - - - - - - - 1 — Tuberculosis— Pulmonary 148 1 1 1 — — — — 9 58 26 43 9 57 56 Non-Pulmonary 16 — 1 — — — 1 1 3 6 2 1 1 10 12 Encephalitis Lethargica 1 - - - - - - - - - - - - - 1 Ophthalmia Neonatorum 6 6 - - - - - - - - - - — 5 — Pneumonia 74 2 4 2 2 2 10 3 2 11 10 18 8 46 83* Dysentery 1 - - 1 - - - - - - - - - 1 - Totals 633 16 26 33 19 20 90 49 29 158 59 103 31 468 156 *Note.—This figure is for all forms of pneumonia, including Acute Primary Pneumonia and Acute Influenzal Pneumonia, which alone are notifiable 68 VACCINATION RETURNS. Return for 1932. Return made to the Borough Council and Ministry of Health on the 9th February, 1934, 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, 1932, 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 December, 1932. Number of these Births duly entered by 31st January, 1934, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1934, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1934, neither duly entered in the "Vaccination Register' (columns 3, 4, 5, 6, and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9 and 10 of this Return). Number of Certificates of Successful Primary Vaccination of children under 14 years received during the calendar year 1933. 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 1933. Col. I. Col. II. Col. IV. Col. V. Removal to places unknown or which cannot be reached and Cases not having been found. Success fully Vaccinated. Insuscep tible of Vaccination. Had SmallPox. Number in respect of whom Certificates of Conscientious Objection have been received. Dead. Un vaccinated Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 395 275 4 — 60 15 — 8 27 6 2,116 374 2. St. Mary 2,198 1,533 8 — 239 76 4 309 26 3 3. All Souls 359 231 11 — 23 9 5 72 4 4 Total 2,952 2,039 23 — 322 100 9 389 57 13 2,116 374 Dated 9th February, 1934. (Signed) GEORGE H. BASSETT, Vaccination Officer.