AC 4353 STMARY 39 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934 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., Ltd., OGLE STREET, W.1 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934 Including the Report of the Public Analyst and the Report on Factories ana Workshops. CHARLES PORTER, M.D.. B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. LONDON: VAIL & CO., Ltd., OGLE STREET, W.1 Vail & Co., Ltd. Printers, London. W.1 # Public Health Department, Town Hall, St. Marylebone, W.l. 6th June, 1935. 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 1934. As 1935 is a "survey" year the report with regard to the happenings during its course will be full and detailed. For that reason and in accordance with the instructions of the Minister of Health the present report is more or less in the nature of an outline. Even so I believe there will be found in it sufficient evidence to show that good and valuable work was done by every member of the staff, and to them for this reason and for the help they gave to me personally and the loyalty they displayed, I desire to offer my sincere thanks. To the Public Health Committee and its Chairman, Councillor G. B. Ramsay, appointed to this important position in November, 1933, I am particularly grateful for the unfailing support they gave me and the kindness and consideration they showed me on all occasions. 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). 1934. His Worship the Mayor (Alderman John Fettes, J.P.). ALDERMEN. G. B. Brooks. A. C. Rickatson, J.P. COUNCILLORS. Rev. Michael Adler, D.S.O., B.A. H. Jones. F. V. Cullen, F.S.I. Capt. J. T. O'Brien, J.P. Dr. C. A. Fuller. 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 General Statistics 6 Natural and Social Conditions of the Borough Population 6 Sanitary Circumstances 7 Water Supply 7 Drainage 7 Combined Drainage 8 Closet Accommodation 8 Public Sanitary Conveniences 8 Scavenging 10 Removal of House Refuse 10 The Crown Estate 10 Removal of Offensive Refuse 10 Sanitary inspection of the Borough. Staff 10 Nuisances 11 ,, Inspections 12 Legal Proceedings 13 Smoke Nuisances 13 Rat Repression 13 Pigeons 14 Fouling of Footways by Dogs 14 Premises and Occupations controlled by By-laws and Regulations. (a) Business Premises 14-15 Milk Premises 15 Slaughterhouses 15 Offensive Trades 15 Premises used for Food Preparation 15 Ice Cream Premises 15 Butter, Margarine, etc., Premises 15 Bakehouses 15 Fried Fish Vendors and Fish Curers 15 Factories and Workshops 16 Inspections 17 Defects found 17 Home Work 18 Registered Workshops 19 Other matters 19 Rag Flock Acts, 1911 and 1928 19 (b) Premises used for Human Habitation 19 Houses let in lodgings 19 Common Lodging Houses 20 Underground Rooms 20 (c) Premises that are not but should be Registered 20 Food Stalls 21 Food— (а) Milk Supply 21 Milk Analysis 21 Bacteriological examination of Milk 21 Dairies, Milkshops, etc. 21 The Milk (Special Designations) Order, 1923 21 Milk (Mothers and Children) Scheme 22 Milk for School Children Scheme 22 (b) Foods other than Milk 22 Food Inspections 22 Food, Unsound, Condemned 23 Food Premises 23 Bacteriological Examination 23 (c) Food and Drugs (Adulteration) Act. 1928 23 Reports of Public Analyst 24—20 Statistical— Births 26, 28 Birth Registration 26 Birth Notifications 26 Deaths and Death Rates 27,28.67 Sub-District Births and Deaths 28, 66 Deaths in relation to Age 28, 67 Causes of and ages at death 28,67 page Infantile Mortality 28,29,30 Maternal Mortality 31 Deaths in relation to Disease Diarrhoeal Diseases 31 Infectious (Communicable) Diseases 31 Phthisis and other Tuberculous Diseases 31 Respiratory Diseases 32 Cancer or Malignant Disease 32 Accident, Suicide and Manslaughter 33 Prevalence of and Control over Infectious Diseases Diphtheria and Membranous Croup 33 Schick Testing and Diphtheria Immunization 34 Scarlet Fever 34 Enteric Fever and Paratyphoid Fever 34 Cerebro-Spinal Fever 34 Encephalitis Lethargica 35 Polio-Encephalitis 35 Polio-Myelitis 35 Erysipelas 35 Puerperal Fever and Puerpral Pyrexia 35 Measles and German Measles 35 Whooping Cough 35 Glanders and Anthrax 35 Smallpox 35 Vaccination 35, 70 Infectious Diseases in Schools 36 Ophthalmia Neonatorum 36 Influenza 37 Pneumonia 37 Food Poisoning 37 Tuberculosis 37 Treatment 37 Public Health (Tuberculosis) Regulations, 1912 (Notifications) 38 Public Health (Tuberculosis) Regulations, 1930 39 Prevention 40 Care Committee 40 Bacteriological Diagnosis 41 Non-Pulmonary Tuberculosis 41 Work and Dispensaries 42-44 Deaths 45 Localisation of Disease 46 Disinfection 47 Cleansing of Persons 47 Bacteriological Examinations 48 Maternity and Child Welfare The Scheme 48-51 Infant Life Protection 52 Centres and Clinics 53,54 Health Visitors 11,54 Ante-Natal Work 54-56 Dental Clinic 57,60 Massage Clinics 57 Schick Testing, etc, Clinics 57 Three-year-old Pre School Clinic 57 Hospital Treatment 58 Maternity Cases 58 Infant Consultations—Work at 58.59 Day Nurseries 60 Home Helps 60 Sanitary Administration— Report of Mortuary Keeper 60 Hospitals and Nursing Homes 60 Local Acts and Orders 60 Housing, Inspections and Proceedings, etc 61—62 General Summary 62-64 Ministry of Health, Tables I—-V. 65—69 Vaccination Returns 70 6 GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921). 104,173. (1931) 97,620. (Estimated 1934) 92,320. Number of inhabited houses (1921), 18,507 ; (1931), 17,575. Number of inhabited houses (end of 1934) according to Rate Books, 17,613. Number of families or separate occupiers (1931), 27,352. Rateable value. £3,208,603. Sum represented by a penny rate. £12,635. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimarte 744 381 363 Illegitimate 89 46 43 Birth Rate, 9.00 Still Births, 30. Rate per 1,000 total births, 36. Deaths, 1,171. Death Rate, 12.6. Percentage of total deaths of residents occurring in public institutions, 12'7. Number of women dying in, or in consequence of, childbirth—from sepsis, 3; other causes, 1. Deaths of Infants under 1 year of age per 1,000 live births :— Legitimate 48. Illegitimate 169. Total 61. Deaths from Measles (all ages), 11. Deaths from Whooping Cough (all ages), 5. Deaths from Diarrhoea (under 2 years of age), 12. POPULATION. The population estimated to the middle of 1934 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 1934 and the Census of 1931. Year. The Borough. All Souls. St. Mary, Christ Church. St. John. Census 1931 97,620 22,380 25,667 29,636 19,937 Estimated to middle of 1931 93,460 21,422 24,575 28,375 19,088 ,, 1934 92,320 21,188 24,309 27,999 18,824 7 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 Council or from other bodies. In order, however, to comply with the requirements of the Ministry, and to assist in obtaining uniformity in reports, each of the more important matters is dealt with as fully as possible. Water. As usual, complaints as to water supply were few. All were dealt with, and a remedy found. Water Supply cut off.—In accordance with the requirements of the Public Health (London) Act, 1891, Section 49 (1), the Metropolitan Water Board reported that the water had been cut off in fourteen 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 9 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 nineteen. The number in 1933 was ten. In 22 instances intimation notices were served, calling for the provision of a supply of water to the upper storeys of tenement houses, as required by Section 78 of the London County Council (General Powers) Act, 1907. The supply was provided after receipt of the intimation notice in all cases. Drainage. There have been few changes in regard to work in this direction during the last five years. Duties in connection with drainage in the portion of the Borough north of Marylebone Road, which were allotted to Inspector Cook in 1929 have been in his hands ever since, duties in the southern half being performed by Inspector Draper. Engaged exclusively in drainage work, these officers between them in 1934 made 4,485 inspections. The total number of plans deposited was 570 in respect of 727 premises, as against 510 and 662 respectively in 1933. The number relating to new buildings was 63. The number deposited in 1933 was 47. In the case of old buildings, the number of plans received was 507. In 1933 the total number was 463. 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. 8 Since the 1930 by-laws of the London County Council with regard to sanitary conveniences and the amended code relating to drainage have been in operation the number of such cases has greatly diminished. Proceedings.—In no case was it found necessary to institute legal proceedings during the year. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 79 premises. The number in 1933 was 49. Closet Accommodation. In the table at page 12, summarising the work carried out by the district inspectors, figures indicating the number of defects in water closets remedied and of water closets erected are set out. In most instances the closets erected were with a view to providing additional accommodation in tenement houses, shops, or workshops or in order to afford suitable separate accommodation for women in places where both sexes were or were about to be employed. Though there may be here and there a small lock-up shop in which it is necessary for the individuals engaged on the premises to make use of a convenience in some other part of the building, or more rarely in an adjoining building, there are no premises in the Borough totally without sanitary conveniences of this type. The only class of closet is, of course, the water closet. One of the great difficulties experienced from time to time is in regard to finding a suitable place for a convenience and a position in which there will be complete compliance with the requirements of the regulations in respect of waterclosets. This is particularly the case in relation to closets in basements and in the more over-crowded business and shopping portions of the Borough. All plans showing proposals to construct water-closets are most carefully scrutinised, but as already noted, the 1930 by-laws having considerably modified the requirements so far as situation is concerned, the need for granting special approval now less frequently arises. Particularly by allowing of the introduction of closets in bathrooms entered directly from rooms used exclusively as sleeping or dressing-rooms they have met a demand that has been increasing for some time and that caused considerable administrative difficulties. Public Sanitary Conveniences.—The usual supervision was exercised over the public conveniences during the year, Inspector Hill, the outdoor superintendent, visiting those provided for the use of males; the women inspectors, especially Miss Baker, supervising those provided for females. Reports and comparative statements as to receipts for use of the underground conveniences were regularly submitted to and considered by the Public Health Committee. SCAVENGING. Refuse Collection.—The collection of house refuse in the Borough is under the jurisdiction of the Highways Committee of the Council and under the control of the Borough Engineer, Mr. James Gair, to whom I am indebted for the information given here. The system of collection is continually under revision and changes are made from time to time with a view of more efficient working. All premises in the Borough now receive at least a twice weekly collection. In addition, over a great portion of the Borough a daily collection is made, and in certain streets in which refuse collecting vehicles are prohibited by the Ministry of Transport during certain hours, collection is carried out from the kerb within the hours prescribed. This naturally entails a greater concentration of collecting vehicles in certain parts of the Borough and still further increases the number of calls made per annum. 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 they are emptied and cleansed and disinfected before being returned to the premises. This method, obviously more hygienic, is also quicker and less noisy in working and far more satisfactory than refuse bin collection. 9 In connection with it, in blocks of flats particularly, the use of dust chutes is possible, and though occasionally complaints are received that blockage is caused by bulky articles, e.g., cardboard boxes forced into them, or that empty meat cans give rise to noise, it may be said that actually real serious nuisance need not and does not arise if the ducts are properly constructed and looked after. In fact fears originally entertained that they might prove to be unhygienic and objectionable have been found to be groundless. On the contrary, more particularly where labour and economy are considerations, it may be claimed for the dust chute that it is extremely convenient and has many advantages over portable dust-bins, the only other alternative possible. The new fleet of house refuse collecting vehicles is now complete and in use. These are entirely enclosed and are end loading, steps being fitted to facilitate entry. 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 it 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 (in accordance with the recommendations of the Special Sub-Committee mentioned below), and so dealt with as to reduce risk of nuisance, is greatly diminished. A new 200 feet chimney shaft has been erected at the Council's Wharf at Paddngton to take the emanations from the two destructor plants. This replaces the two old shafts which have been demolished, and has resulted in the elimination of complaints regarding smoke. The question of refuse disposal in London as a whole is still under the consideration of 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. In the " Dawes " report on London Cleansing issued in 1928, it was suggested that a Central Authority should be set up to deal with London refuse as a whole. The terms of reference to the Sub-Committee referred to above were 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 inspections having been completed an interim report has now been issued and certain recommendations made. The adoption of these by the various Councils has lead to improvements being effected, though no step in the direction suggested in the Dawes report has been taken. Street Sweepings.—Street sweepings are collected by means of special vans and conveyed to the Council's Wharf, treated, loaded into boats and conveyed to the Council's Shoot. The Borough has been divided into beats and each sweeper is given a definite length of public way for which he is entirely responsible. This system applies also to the sweeping gangs employed at night. Each of the orderly barrows carries two galvanized refuse bins into which the sweepings are placed by the man in charge. Periodical calls are made during the day at prearranged collecting spots and the contents of the bins are loaded into lorries and conveyed to the Wharf as shown above, the collecting vehicles being specially constructed and fitted with covers to prevent the blowing of refuse over the public streets. Generally.—New plant has been installed at the Council's Shoot at Northolt to deal with refuse unloaded there, and the whole question of collection, disposal and dumping is constantly under supervision with a view of avoiding nuisance. Provision has been made for the purchase during the year 1935/6 of new street 10 watering and additional gully cleansing vehicles and further chassis for the collection of house refuse containers. 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, 1935 47,948 tons. Street Sweepings and Gully Refuse collected during the year ended 31st March, 1935 8,382 tons. In addition, a sum of approximately £1,100 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 218 premises at the request of the department, while 1,103 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. 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. 11 Assistant Medical Officer of Health : H. Allen Bulman, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. Assistant Medical Officer of Health for Tuberculosis Purposes : *J. Donaldson Saner, M.B., C.M. (Edin.), D.P.H. Public Analyst (Part time) : J. F. F. Rowland, B.A., A.I.C. Bacteriologist (Part Time) : L. 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. 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). Clerks 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. Tuberculosis Clerk. J. C. Kendall. J. Overton. Miss J. Jones. * Woman Sanitary Inspector. ‡Miss M. McA. Sharp (c, e, f, g, h). * 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 E. F. Catterall (e, /, g, h). Miss D. T. Connell (e) Miss L. Kilgallin (Matron). ‡Miss C. Hale (e, /). Miss E. D. Mann (e, f, g, h). Mortuary Keeper. ‡Miss M. C. Stewart (f). ‡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 by 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. f Central Midwives Board Certificate. g Certificate of State Registration for Nurses. • h Three or Four Years' Hospital General Training Certificate. t Resigned 31-8-1934. J} Appointed 15-10-1931. NUISANCES. In the following summary some idea of the amount of work done in relation to nuisances is given. For details of other works carried out by the inspectors, reference must be made to the sections dealing with housing, food, infectious diseases, etc. 12 In regard to nuisances, the first point to note is that the total number of complaints received was 2,614, as against 2,631 in 1933. 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, 65 statutory notices were issued, the figure being 129 in 1933. Of these notices, 32 related to ordinary nuisances (dirt, dampness, etc.), 10 to verminous rooms, 4 to insufficient w.c. accommodation, 11 to insufficient dustbins, 2 to underground rooms, 1 to the inadequacy of water supply to the premises, and 5 to overcrowding. The 10 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1922, and referred to 13 rooms. The number of notices in 1933 was 18. In 2,549 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. The total inspections made in 1934 by each inspector, and the number of nuisances of various kinds detected and remedied, are set out in the following table :— Districts. Nature of Nuisance No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Houses damp, dirty or dilapidated remedied 82 337 255 161 114 57 1006 Doors, windows, floors, ceilings sash cords, etc., repaired 133 47 116 54 50 16 416 Overcrowding abated - 13 5 7 3 - 28 Illegal occupation of underground rooms dealt with - 13 29 11 9 11 73 Water closet, defects remedied 115 56 172 79 71 51 544 Water closets erected - 3 - 7 2 7 19 Urinal defects remedied - - 1 2 2 - 5 Soil pipes and ventilating shafts repaired or renewed 2 1 - - 3 - 6 Yard defects remedied 58 37 141 50 81 4 324 Waste pipe defects remedied 15 10 25 24 12 10 96 Water cistern defects remedied 4 - 1 - 2 2 9 Rubbish, manure, etc., accumulations removed 7 10 32 18 19 8 94 Dung or dust receptacles repaired or renewed 18 21 81 22 25 7 174 Drains relaid or amended 20 7 32 21 9 2 91 Drains cleared 5 9 13 4 7 6 44 Rainwater pipes repaired or renewed 3 9 13 11 9 - 45 Water supply to houses reinstated - 1 2 3 - 1 7 Roofs and gutters repaired 50 28 36 15 12 2 143 Area defects remedied 3 - 24 25 8 4 64 Wash-house defects remedied 68 21 142 31 28 2 292 Animal nuisances abated 2 - 4 - 4 1 11 Basement defects remedied 11 - 5 1 12 1 30 Stables cleansed or repaired - - 1 7 - - 8 Water supply laid on to upper storeys of house - 2 5 3 12 - 22 Miscellaneous nuisances abated 168 38 97 43 37 5 388 Verminous rooms cleansed 56 181 248 107 59 41 692 13 LEGAL PROCEEDINGS IN CONNECTION WITH NUISANCES. No summonses were issued during the year. Smoke Nuisances. During the year 1934, 336 observations were made and 11 complaints were received and dealt with. In each case the attention of the offender was drawn to the matter. Complaints as to fumes from furnaces burning oil-fuel were fewer than in 1933. 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, 1933, 49, and in 1934, 44. The investigation of these complaints necessitated the inspection of 57 premises, 17 of which were found to be rat infested. Included in this latter number were 6 business premises (3 of these for the preparation or storage of food), the remaining 11 being private or tenement houses. In 5 of the cases investigated the infestation was directly attributable to defects in the drainage system, and the nuisance disappeared when repair or reconstruction was carried out. In every instance all advice and assistance was given to the owner or occupier by Inspector Willis, who acted as Rat Officer, and secured excellent results from the methods advocated. The following report submitted to the Public Health Committee on the 1934 Rat Week held in the Borough contains a certain amount of information that may be found interesting. National Rat Week (the sixteenth of the series) was held in the Borough during the week commencing November 5th, the Ministry of Agriculture again urging upon all local authorities responsible for the execution and enforcement of the Rats and Mice (Destruction) Act, 1919, the desirability of making special efforts during that week to secure concerted action with a view to the destruction of rats and mice. A campaign on lines found to be successful in previous years was carried out, and special communications were addressed to the large property owners and agents and to the occupiers of food and other premises, drawing attention to their responsibilities under the Act and offering to arrange for the Inspector (Mr. E. E. Willis), who has the matter specially in hand, to visit any rat-infested premises in the Borough for the purpose of suggesting suitable methods for adoption in getting rid of the vermin. The response to these invitations was particularly gratifying and is evidence of the greater willingness on the part of the public to co-operate in dealing with property infested with rats. On this occasion an unusually large number of enquiries and requests for assistance were received, and this may be claimed to be due to the publicity given by the Council to the aims and objects of National Rat Week. In this connection, in addition to the usual practice of distributing the latest literature, bait recipes, etc., use was made this year of a particularly striking poster in colour, copies of which were displayed throughout the Borough and on the Council's vehicles. Particular attention was again paid to the various railway sidings, warehouses, etc., in the Borough, and among the authorities actively co-operating with the Department may be mentioned the London Passenger Transport Board. Though their railway stations at Edgware Road, Baker Street, Great Portland Street, Regent's Park, Marlborough Road and St. John's Wood Road are regularly visited by the Board's staff for the purpose of catching rats, special investigations were carried out during Rat Week. The open spaces in the Borough also received close attention. In the Zoological Gardens, where every week, it is claimed, is a Rat Week, and all known methods of destruction are tried, efforts directed against the rat menace were intensified. As an experiment, traps of the wire cage and break-back pattern were purchased for use in the sewers. After a period of trial it was found that break-back traps of an improved type were more efficient than any other varieties, and in view 14 of this success it has been decided to reduce expenditure on poisons and to spend the money thus saved on a larger supply of break-back traps, which conceivably provide a more humane method of destruction. While the presence of the rat constitutes an important health—and economic —problem with which the Department is constantly dealing, this one week in the year devoted specially to the problem affords an opportunity of reviewing the situation in the Borough, of broadcasting the powers of the local authority and the responsibilities of the people themselves in the matter, and of altering old methods of rat destruction and devising new ones in the light of experience gained by the Department in this particular branch of public health work. Pigeons. In relation to the nuisances 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. Six compaints were made in 1934 as against seven in 1933, relating to business premises (in one case), and private dwellings (five). As in other years, as much assistance as possible was given by the inspector 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, 13 prosecutions undertaken being on the reports of police officers. In 11 cases the defendant pleaded guilty, and the fines imposed amounted to £3 4s. 6d. In one case the summons was dismissed and in another the summons was not served. Including these cases the total number of prosecutions since the bye-law came into operation in 1928 is 40, the amount of fines imposed being £16 4s. 6d. 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 inspec tions 1934 Number of notices 1934 Number of prose"cutions 1934 On register at end of 1933 Added in 1934 Removed in 1934 On register at end of 1934 A. Business Premises Milk premises 141 30 8 163 245 4 - Slaughterhouses 1 - - 1 12 - - Poultry Do. 1 - - 1 25 - - Offensive trade premises 2 - 1 1 12 - - Ice cream premises 78 - - - 120 6 - Butter and Margarine Manufacturers and Dealers 16 - - 16 30 - - Bakehouses 56 2 - 58 110 7 - Fried Fish Shops 25 - - 25 66 3 - Fish Curers 6 - - 6 64 - - B. Habitations Houses let in lodgings 1,055 - - 1,055 7,290 1,057 - Common lodging houses 3 - - 3 139 6 - 15 A.— BUSINESS PREMISES. Milk Premises.— The number of premises upon which milk is sold is 163, 22 more than in 1933. In practically every one of the new cases the proposal was to sell milk in carton or other container. Slaughter Houses.—At the moment the only slaughter house in the Borough is that at the Zoological Society's premises in Regent's Park. The slaughtering done is for the food of the animals in the Gardens and humane killers are used. Offensive Trades.—At the end of 1934 only one premises within the Borough carried on a trade classed as offensive, that being the slaughter of poultry. The Food Inspector made 37 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 1934, 89 premises had been registered for the preparation or manufacture of foods (other than ice cream) intended for sale. 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 1934 was 86, 2 more than in 1933. Regular inspections were made throughout 1934, and in 6 cases notices were served in respect of uncleanly conditions. Butter, Margarine, etc.. Premises.—Information with regard to the sampling of these substances will be found under the heading "Food and Drugs (Adulteration) Act, 1928." At the end of the year there were on the registers 14 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 1934 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 110 visits were paid and 7 notices with regard to defects were served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, etc., of the inside walls and other parts of the bakehouses were issued. It was not necessary to institute proceedings to enforce compliance with any notice. Fried Fish Vendors and Fish Curers.—The number of premises in the Borough used by vendors of fried fish is 25 and by fish curers 6. Notices calling for periodical lime-washing, etc., of such premises are 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. \ 16 Factories and Workshops. Factories are increasing in the Borough largely as a result of 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 2,471 ; 239 by the women and 2,232 by the men inspectors. The complaints received numbered 35. 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) 248 15 - Workshops (Including Workshop Laundries) 1,432 66 - Workplaces (Other than Outworkers' Premises included in Part 3 of this Report) 791 20 - Total 2,471 101 - 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 52 52 - - Want of ventilation 9 9 - - Overcrowding 3 3 - - Want of drainage of floors 4 4 - - Other nuisances 20 20 - - Sanitary accommodation insufficient 29 29 - = unsuitable or defective 31 31 - - not separate for sexes ... 7 7 - - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 7 7 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - T otal 162 162 - — 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. 62 225 877 - - - 12 - - - - - - - - Total 62 225 877 - - - 12 - - - - - - - - 19 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year (1) Number (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 1,937 Coffee Shop3, &c. 453 Bakehouses 56 Total number of workshops on Register 2,446 5.—OTHER MATTERS. Class (1) Number (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 Action taken in matters 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 35 Reports (of action taken) sent to H.M. Inspector 35 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 in respect of which there is a system of registration are what are called "Houses let in Lodgings" and "Common Lodging Houses." Rooms underground, if used as sleeping rooms or for human habitation apart from rooms on the upper floors, though they are not definitely registered, are under necessity 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 7,290 visits were paid to the 1,055 houses carried over from the old list. The number of intimation notices served was 1,057, relating to cleansing and other defects. Except in 36 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. 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 The Salvation Army Trustee Company 514 men "Portman House" (late Shaftesbury Institute), Harrow and Daventry Streets, Lisson Grove The Rev. Prebendary Wilson Carlile, O.H., D.D. 100 women 566 men 100 women Total 666 During 1934 139 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 1934 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 73 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. 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 fend of 1934 there were 391, this number including: restaurant, dining room and coffee shop kitchens, 224; tea-rooms and pastry-cooks, 108; hotel kitchens, 28; fried fish shops, 25; and fish-curers, 6. 21 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 1934, the total number of inspections was 420, the number of notices served being 10. Food Stalls.—Under the by-laws with regard to registration of street traders under the L.C.C. (General Powers) Act, 1927, food stalls, in common with other stalls, must be registered. The Committee actually responsible is the Highways Committee, who co-operate in the closest possible manner with the Public Health Committee and endeavour to limit the number of traders to whom registration is granted. Wherever possible, the Committee refuse to allot space for stalls from which food is to be sold, and in each case full enquiries are made and investigations of storage accommodation carried out. Where improvements are required and are possible, these are called for. If the conditions are unsatisfactory and irremediable, this is made a ground for refusal of registration. All food stalls are inspected daily by officers of the Public Health Department, a special feature being made of inspections over each week-end. Stalls from which meat is retailed though they must comply with certain requirements laid down in the Public Health (Meat) Regulations, 1925, are not registered. FOOD. A.—Milk Supply. Analysis of milk.—The quarterly returns as to the number of milk samples taken are as follows:—1st Quarter, 50; 2nd Quarter, 68; 3rd Quarter, 22; 4th Quarter, 47, making a total for the year of 187. 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, 17 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, 20 of certified milk were taken and submitted to bacteriological examination. The reports were almost invariably satisfactory and, in accordance with the usual arrangement, were forwarded to the Ministry of Health. Dairies, Milkshops, etc.—Frequent inspections of milk premises were made with the object of discovering whether or not the requirements of the regulations as to cleanliness, etc., under the Milk and Dairies Order, 1926, were being complied with. In no case was it necessary to take action. The Milk (Special Designations) Order, 1923.—Under this Order 58 applications were received from 22 dealers in the Borough for licences to sell milk as Certified Milk; Grade "A" (Tuberculin Tested) Milk; Grade "A" (Pasteurised) Milk; or "Pasteurised" Milk. As the milk in each case was obtained from a producer licensed under the Order and the premises of the applicants were found to be satisfactory, licences were granted as appropriate, the numbers being 12 in respect of "Certified" Milk, 17 for Grade "A" (Tuberculin Tested) Milk, 27 "Pasteurised" Milk, and 2 Grade "A" (Pasteurised). In addition there were granted 1 pasteurising licence, 1 bottling licence for Grade "A" (Tuberculin Tested) milk and 1 bottling licence for Grade " A " milk. 22 Milk (Mothers and Children) Scheme.— During 1934 there has been no change .1 the methods adopted in relation to the supply of milk to mothers and children. 5p to 31st March, 1935, the amount expended was £938 3s. 6d., as against £921 8s. 7d. in the year ended 31st March, 1934. The actual number of cases dealt with was 362, and the number of orders issued 2,262, which were slightly smaller figures than those for 1933, when the cases numbered 392 and the orders 2,283. 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 1934 than in previous years. The amount contributed in individual cases varies considerably, but from the very beginning what the amount should be has always been very carefully assessed, the size of the family and the family earnings and circumstances being taken into consideration. In every case formal application is required to be made by the individual whether recommended by the Medical Officer of a consultation or seeking assistance personally. Following receipt of the application, enquiries are made by the Health Visitors and on their report and the information provided in the application, assessment is made by the Medical Officer of Health. The period for which the grant is made varies, but is usually four weeks, and at the end of this period the case is again considered and alterations made in the amount ordered, and the contribution charged if necessary. The system, it may be said, has worked with absolute smoothness and has done a very great deal of good. Here and there an individual not quite deserving may have received assistance, but on the whole the efforts of the officers and of Councillor Mrs. 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. Milk for School Children Scheme.—During the year (on 1st October, 1934) the scheme for the provision of milk to school children under the auspices of the Milk Marketing Board came into operation. Following consultation with officers of the London County Council and Public Health and Education Departments, the lines to be followed were arranged and incidentally it was agreed that preference should be given to pasteurised milk and that samples for examination should be taken from time to time. It was largely on account of this that the increase in the number of applications for licences to deal in pasteurised milk were received. Up to the end of the year, up to the present indeed, the scheme has worked with absolute smoothness and doubtless greatly to the benefit of the children taking advantage of the provision. In no case has it been necessary to report adversely with regard to any firm supplying milk or as to the quality of any milk supplied. B.—FOODS OTHER THAN MILK. The main duties in relation to food protection generally in 1934, 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 the closest attention. During 1934, 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. 23 On a great manv occasions the inspector was called by vendors to examine articles of food under Section 47 (8) of the Public Health (London) Act, 1891, and to accept surrender of such as were unsound or unwholesome or unfit for food. Amongst the articles dealt with in this way were :— Unsound and Diseased Food Condemned and Destroyed During the Year 1934. Meat— Poultry— Beef 56 lbs. Turkeys 16 Mutton 30 „ Fowls 21 Bacon 2 cwt. 2 qr. 10 lbs. Miscellaneous (Tinned Goods, etc.). Rabbits 1 case Fish.- Corned Beef 350 tins Briskets of Beef 13 „ Skate 22½ Stone Hams, Gammons, etc. 395 „ Halibut 17 „ Brawn 34 „ Cod 17½ „ Tongues 63 „ Roes 16 „ Veal 15 „ Haddock 10 „ Pork and Stuffing 2 „ Soles 12 „ Pork (Tinned) 2 „ Salmon 9 „ Chicken and Ham Roll 11 „ Dabs 4½ „ Sausages 16 „ Prawns 1 case Cream 149 „ Fruit & Vegetables— Chicken 7 „ Roes 3 „ Tomatoes 14 boxes Crabs 122 „ Plums 4 „ 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 1934 was 1,055, the figure for 1933 being 1,012. 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, as in 1933, a percentage of adulteration of 0.50. 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. A sample of a drug submitted by a medical practitioner for analysis with a complaint as to a mistake made in connection with the filling of a prescription, was not examined. On enquiry it appeared that the mistake was the result of an oversight and that it had been remedied immediately it was reported by the practitioner himself who detected it before the remedy was administered. The assistant responsible for the mistake was cautioned and the manufacturers of the article were invited to adopt any other precautions that could be devised as safeguards against further possible and rather exceptional errors of the same sort. 24 The following Tables and Report from the Public Analyst, Mr. J. F. F. Rowland, give full information with regard to samples submitted to arid examined by him :— ANNUAL REPORT OF THE PUBLIC ANALYST, 1934. The number of samples taken under the Food and Drugs (Adulteration) Act and submitted for analysis, was 1,055. The following is a complete list of the articles sampled :— ANALYSES No. Article Number Examined Number Adulterated, etc. Formal Informal Private Total Formal Informal Private Total 1 Barley, Pearl - 16 - 16 2 Beans - 5 - 5 1 1 3 Butter 96 241 - 337 4 Cake, Sponge - 2 - 2 5 Cheese - 24 - 24 6 Chocolate Powder - 1 - 1 7 Cocoa - 14 - 14 8 Coffee - 25 - 25 9 Cream, Loose (1 Vericreme) 10 17 - 27 10 „ Tinued - 7 - 7 11 Fish Paste - 2 - 2 12 Gin - 6 - 6 13 Honey -. 20 - 20 14 Jam - 37 - 37 15 Lard - 103 - 103 16 Lemonade Powder - 6 - 6 17 Margarine - 32 - 32 18 Marmalade - 22 - 22 19 Meat Paste - 6 - 6 20 Milk 127 55 5 187 21 „ Condensed - 11 - 11 - - - - 22 „ Separated 3 - - 3 23 Mincemeat - 3 - 3 24 Mustard - 11 - 11 1 1 25 Mustard Pickles - 1 - 1 26 Ointment, Boric - 19 - 19 27 Olive Oil - 3 . - 3 28 Peas, Tinned - 4 - 4 29 Pepper - 12 - 12 30 „ Cayenne - 6 - 6 31 Phosphorized Quinine - 2 - 2 32 Rice - 2 - 2 33 Roll and Butter - 10 - 10 34 Rum - 1 - 1 1 1 35 Salmon—Tinned - 3 - 3 36 Sardines—Tinned - 2 - 2 37 Sauce, Tomato - 3 - 3 38 Suet, Shredded - 1 - 1 39 Sugar - 24 - 24 40 Tartaric Acid - 2 - 2 41 Tea - 33 - 33 42 Tomato Puree - 5 - 5 1 1 43 Tomatoes—Tinned - 2 - 2 44 Wine, Raisin - 1 - 1 1 1 45 Whisky - 12 - 12 Total 236 814 5 1,055 5 5 25 Adulterated Samples, etc. Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 19 Rum Informal Contained 0.5 grain of tin per pint. 142 Fino French Beans (Cirio brand) Informal Contained 2.4 grains of tin per lb. and 0.0047 grain of lead per lb. Internally the tin was crudely finished and its metallic joint was soldered for a quarter of its depth with a lead-containing solder which showed every evidence of being attacked by the contents of the tin. 329 Mustard Informal 4.0 % of added starch grains. 896 Tomato Puree Informal 1.12 grains of tin and 0.06 grains of copper per lb. 1,018 Raisin Wine (Non-alcoholic) Informal A synthetic wine containing 0.66 per cent. of alcohol by volume and coloured with a dye which is not present in the natural raisin. The sum paid in respect of each analysis was 12s. 6d. per sample. The Public Analyst (Mr. J. F. F. Rowland) comments, as follows, with regard to various articles examined:— Milk.—187 samples were examined. None proved to be adulterated. The average composition of the milks taken during the year, as compared with those of the two previous years, is set out in the subjoined table :— Year Sp. Gr. Total Solids. Fat. Solids not Fat. 1932 1031.3 12.2 3.57 8.63 1933 1031.4 12.2 3.50 8.70 1934 1031.5 12.17 3.46 8.71 Creams.—27 samples of loose cream and 7 samples of tinned cream were analysed. None was adulterated. The average fat content of each kind was as follows:— Fat. Preservatives. Loose Creams = 43.53% nil. Tinned Creams = 26.87% nil. Rum.— The only sample taken during the year contained 0.5 grain of tin per pint. With regard to tinned or canned foods it is generally assumed that anything over 2 grains of tin per lb. is undesirable if not harmful. However, in the case of foods, it is improbable that an individual would take day after day and month after month such an amount of tinned goods that a constant rate of ingestion of tin would result, but in the case of an habitual rum addict who takes a regular but excessive amount of rum daily the amount of tin ingested through tinned foods 26 plus rum may reach serious proportions. Also there is this further consideration —as to how far the alcohol present may influence the transference of the tin into the circulatory system, for much of the tin ingested in solid foods is excreted soon afterwards. From the point of view of the Analyst any definite evidence of the presence of tin is added testimony, if any be needed, to the genuineness of any particular sample of rum. Tinned Goods.— One sample of French beans contained 2.4 grains of tin per lb., the latter metal being derived from the lead-containing solder used. Tomato Puree.—1.12 grains of tin and 0.06 grains of copper per lb. were present in one sample. Quite possibly the copper may not have been added deliberately but may have been a contamination derived from the vessels used in the preparation of the puree. Raisin Wine.—Of the two samples taken one consisted mainly of sugar and water with a little flavouring matter and coloured with an aniline dye. It would seem most undesirable that the public should be charged a relatively high price for such a concoction which intrinsically is worth only very few pence. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1934 was 833* being 83 less than in 1933. Of the children born, 427 were boys and 406 girls. The birth rate per 1,000 of the population was 9.00, as against 9.71 in 1933. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1934, with those of each of the five previous years :— 1929 1930 1931 1932 1933 1934 All Souls 9.4 10.1 8.9 8.5 7.0 6.8 St. Mary 9.7 10.4 13.2 11.2 7.8 8.7 Christ Church 15.8 14.1 14.4 13.5 12.7 12.5 St. John 12.3 13.8 11.9 9.1 11.0 7.2 The Borough 11.9 12.1 11.4 10.9 9.7 9.0 Notifications.— The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,380; live births, 3,196; still births, 184. The total notifications in 1933 was 3,277. 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. * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 225 births which occurred outside the district, and which have been transferred as belonging to St. Marylehone :— Legitimate Males 96 ,, Females 89 Illegitimate Males 19 „ Females 21 Total 225 27 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 95 2.9 „ midwives 262 7.8 „ hospitals, nursing homes, etc. 3,013 89.0 3,380 100.0 Of the total births notified, 184 referred to still-births (107 males and 77 females); 2,151 took place at Queen Charlotte's Hospital; 100 at Middlesex Hospital; 106 at the St. Marylehone Home; and 419 were born at home. Of those notified as having occurred in St. Marylehone 2,535 belong to other Boroughs. Of the 184 still-births 30 (17 males and 13 females) were to St. Marylebone mothers. DEATHS AND DEATH RATES. The number of deaths registered in 1934 was 1,171. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but, exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. The corrected death-rate* per thousand for the year was 12.6. In the previous year, the rate was 12.2 and the number of deaths 1,224. The following short table shows the death-rates in the several registration sub-districts in 1934, and compares them with those of the years onward from 1928 :— 1928 1929 1930 1931 1932 1933 1934 All Souls 9.9 13.3 10.2 10.8 12.8 10.5 10.9 St. Mary 12.0 18.8 11.5 12.4 11.4 12.7 12.1 Christ Church 13.4 15.8 11.8 13.1 14.1 14.2 13.8 St. John 12.8 13.8 12.1 12.6 12.8 12.1 13.3 The Borough 11.1 13.2 10.6 12.3 12.4 12.2 12.6 *By a "corrected death rate" is meant one which has been treated in such a way, raised or lowered in a certain ratio, as to be comparable with the death rates similarly treated of other districts. That "correction'' is necessary is due to the fact that differences in death rates in various areas are not entirely dependent upon the sanitary conditions existing in these areas, but also on the constitution (age and sex) of the population. A population consisting of aged persons would show more deaths than one consisting entirely of young and vigorous adults ; a population made up of a large number of males and a small number of females has more deaths and a higher death rate than one in which the females outnumber the males. The death rates of such populations are not comparable the one with the other nor with those of populations differently constituted. To overcome this difficulty the Registrar General issues a "factor for correction" for each district which represents the number of times which the actual death rate of each must be raised in order to permit of its examination side by side with the rates of other districts. The "factor for correction" in the case of St. Marylebone in 1934 is 0 99, 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 31st December, 1934, are given in the following table. A further table giving the vital statistics of separate localities for 1934, and the ten preceding years, will be found amongst the Ministry of Health Tables on page 66. Sub-District. Population estimated to middle of 1934. Males. Births, Females. Total. Males. Deaths. Females. Total. All Souls 21,188 77 68 145 110 123 233 St. Mary 24,309 100 101 201 131 166 297 Christ Church 27,999 179 172 351 194 194 388 St. John 18,824 71 65 136 113 140 253 The Borough 92,320 427 406 833 548 623 1,171 The following table shows the number of deaths that took place amongst infants under 1 year and adults of 65 years and upwards in each of the four quarters of 1934. For purposes of comparison the table for 1933 is reproduced. 1934. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 17 11 9 14 51 Persons of 65 years and upwards 174 129 104 159 566 1933. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 14 18 10 14 51 Persons of 65 years and upwards 185 127 113 178 603 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 67. This same table gives the number of deaths from various specified causes which occurred in institutions, in hospitals, nursing homes, etc. In each of the groups all deaths, whether of residents or non-residents, are included, which accounts for the fact that the total comes up to 1,012. 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 1934 was 51, and the number of births in that year 833. The infantile mortality rate is therefore 61. In 1933 the figure was 56 per 1,000 births. 29 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 1934, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 18 were less than one month old when they died and 28 less than three months. The corresponding figures for 1933 were 20 and 28 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 13 in 1933, and 15 in 1934. Diarrhoea and enteritis (7 and 8) accounted for 14 in both 1933 and 1934. Respiratory diseases took 9 in 1933 and 7 in 1934. Amongst the other causes of death, mention may be made of whooping cough, measles and injury at birth which accounted for 2, 2 and 5 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 24 deaths amongst infants. In 1 933 the figure was 20. 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 2 Weeks 3 and under 4 Weeks Total under 1 Month 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year All Souls St. Mary Christ Church St. John Total 1 Small-Pox - - - - - - - - - - - - - - - 2 Chicken-Pox - - - - - - - - - - - - - - - 3 Measles - - - - - - - - 2 2 - 1 1 - 2 4 Scarlet Fever - - - - - - - - - - - - - - - 5 Diphtheria and Croup - - - - - - - - - - - - - - - 6 Whooping Cough - - - - - - 1 - 1 2 - - 2 - 2 Diarrhoea - - - - - - - 1 - 1 - - 1 - 1 8 Enteritis - - - - - 4 6 3 - 13 4 2 5 2 13 9 Tuberculous Meningitis - - - - - - - - - - - - - - - 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation 1 - - - 1 2 2 - - 5 1 1 3 - 5 13 Premature Birth 5 3 - 1 9 1 - '- - 10 1 3 4 2 10 14 Atrophy, Debility and Marasmus - - - - - - - - - - - - - - - 15 Atelectasis 1 - - - 1 - - - - 1 1 - - - 1 16 Injury at Birth 5 - - - 5 - - - - 5 3 1 1 - 5 .17 Erysipelas - - - - - - - - - - - - - - - 18 Syphilis - - - - - - - - - 1 - - 1 - 1 19 Rickets - - - - - - - - - - - - - - - 20 Meningitis (not Tuberculous) - - - - - - - - - - - - - - - 21 Convulsions - - - - - - - - - - - - - - - 22 Gastritis - - - - - - - - - - - - - - - 23 Laryngitis - - - - - - - - - - - - - - - 24 Bronchitis - - - - - 1 1 1 - 3 - 1 2 - 3 25 Pneumonia (all forms) - - - - - 2 - 1 1 4 - 2 1 1 4 26 Suffocation, Overlying - - - - - - - - - - - - - - - 27 Other Causes 2 - - - 2 - 1 - 1 4 - - 3 1 4 Totals 14 3 - 1 18 10 12 6 5 51 10 11 24 6 51 M. F. M. F. M. F. Nett Births in the Year Legitimate, 381 363 Nett Deaths in the Year Legitimate Infants 15 21 Nett Stillbirths in the Year Legitimate Infants, 15 21 Illegitmate, 46 43 Illegitimate Infants 5 10 Illegitimate Infants 3 2 Total 427 406 Total 20 31 Total 17 13 833 51 30 81 MATERNAL MORTALITY. In 1934 the number of deaths due to conditions connected with or consequent upon child-birth was 4, the Maternal mortality rate being 4.8 per 1,000 births. In 1933 there were 10 deaths, the death-rate being 10.5 per 1,000 births. With regard to the 1934 deaths it may be noted that in only one case death occurred at home, the patient being a woman 23 years of age, and the cause of death puerperal septicaemia. The three other deaths took place in hospitals and were attributed to (1) septicaemia following miscarriage, (2) haemorrhage following operation, and (3) abortion. The ages were 41, 29 and 25 respectively and all but one 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 67. This Table also shows the distribution of deaths according to causes in the various registration sub-districts. The following notes with regard to certain of the causes which contributed most largely to the death rate, may be of interest. DIARRHOEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 17, equal to 0.18 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1934 this was the case also, no fewer than 13 of the 17 being children under 1 year of age. In 1933, the deaths from diarrhœal diseases numbered 14, and of this number 12 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 12 deaths, and including diarrhoea (17 deaths) the total number registered as due to them was 37. Of these deaths, 11 were caused by measles and 5 by whooping cough. No death was caused by scarlet fever and only two by diphtheria. In 1933, 22 deaths were due to infectious diseases excluding influenza, which caused 41 deaths. The figure in 1932 was 64. 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 identical with that of 1933. The great bulk of the 68 deaths, viz., 62, was due to phthisis. The number in 1933 was 56. Of the total number of deaths registered (1,171), the percentage due to phthisis was 5.3, as against 4.6 in 1933. The age periods at which the deaths occurred were: 15—25, 11 (18%); 24—45, 19 (32%); 45—65, 28 (44%); 65 and over, 4 (6%). 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 119. This is lower by 16 than the figure (135) for 1933. The death-rate was 1.29 per thousand. In 1932 the rate was 1.35. The number of deaths certified to be due to bronchitis was 43. Of this number 22 were amongst persons aged 65 and upwards, and 8 amongst those of the group 45-—65. Three were under 35. The deaths traceable to pneumonia numbered 74, and, as in the case of bronchitis, the later age groups contributed the greatest numbers. The number of cases of pneumonia notified in 1934 was 70. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in the table on page 68. 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 180 and the death-rate 1.94 per 1,000 of the population. These figures are slightly lower than those for 1933, when the deaths numbered 195 and the rate was 1.95 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 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and upwards Total Vlales - - - 1 - 15 17 34 11 78 Females - - - 1 1 5 18 30 26 21 102 Totals - - - 1 2 5 83 47 60 32 180 Cancer,—Situation of the Disease. Parts of the body affected. Males, Females. Totals. Face, Tongue, Jaw 5 1 6 Throat, Neck, Gullet 19 2 21 Stomach 15 15 30 Intestines 14 19 33 Liver 5 12 17 Breast - 17 17 Uterus and Generative Organs 7 23 30 Various 13 13 26 Totals 78 102 180 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 1934 numbered 80. Of these 25 were due to suicide. There were no recorded deaths of babies certified as resulting from suffocation (overlaying). PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. A table showing, with regard to the infections, the total number of notifications received, the age distribution and the number of cases notified from each of the four registration districts will be found on page 68. The following table shows the number of cases of infectious disease notified during the past six years :— 1929 1930 1931 1932 1933 1934 Smallpox 3 6 2 - - - Diphtheria 180 271 154 83 78 104 Erysipelas 40 61 55 55 76 59 Scarlet Fever 237 226 258 192 198 212 Enteric Fever 5 9 9 3 7 3 Paratyphoid Fever 6 6 3 4 2 1 Continued Fever - - - - - - Puerperal Fever 4 8 11 5 8 3 Puerperal Pyrexia 19 25 22 26 17 18 Cerebro-spinal Meningitis 3 4 5 2 1 1 Tuberculosis (Pulmonary) 147 141 145 140 148 132 Tuberculosis (Non-Pulmonary) 26 20 17 23 16 25 Acute Poliomyelitis 2 2 1 - - - Polio-Encephalitis - - - - - - Ophthalmia Neonatorum 3 16 10 8 6 8 Encephalitis Lethargica 3 2 - - 1 - Pneumonia 92 42 80 77 74 70 Malaria 2 1 - 1 - 1 Dysentery 1 - - 2 1 2 Totals 773 840 772 622 633 639 Diphtheria and Membranous Croup. There were 104 cases of diphtheria notified during 1934, 2 deaths resulting. In 1933 there were 78 cases, 1 death being returned. 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 8 cases the source appeared to be a member of the family previously infected ; in 4 cases infection was counted to have been acquired in school, and in 10 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 633, a positive result being returned in 55 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 56. In All Souls the number was 14, in St. Mary 24, and in St. John 10. As usual, the age groups 1—5 and 5—15 were those most affected, 38 of the cases falling into each of these groups. One 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., 7. 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 14 74 89 Positive 1 9 37 47 Negative - 5 36 41 Not reported - - 1 1 Inoculated without Schick Test 140 423 7 570 Injections—1st 1 9 36 46 2nd 151 411 40 602 3rd 159 381 39 579 4th 4 5 9 18 5th 3 2 3 8 Retested 134 285 31 450 Completely immunised 124 274 32 430 Positive after retest 4 3 3 10 Not reported 6 8 — 14 Additional Injections 4 4 SUMMARY. Number of Sessions 97 Total Number of New Cases 659 „ „ under 5 141 „ „ over 5 437 „ „ Adults 81 Number of attendances 2,840 Average attendance per session 29 Scarlet Fever. Notifications of this disease numbered 212, the highest number of cases reported in any one week being 10. There were no deaths from scarlet fever during 1934. In 1933 there were 198 notifications, no deaths resulting. The districts to suffer most from the disease were Christ Church and St. Mary. In the former there were 86 cases and in the latter 57. In All Souls there were 32 and in St. John 37. As usual, the majority of the patients were children of school age, the age group, 0—15, giving nearly one-half (97) of the total. Of the remainder, 45 were aged under 5 years, and 70 over 15 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 28 instances that a definite connection could be made out. Defects in sanitation to the number of 11 were discovered. All these were want of cleanliness, etc. The nuisances were remedied after the service of notice in each case. Enteric Fever and Paratyphoid Fever. The notifications of Enteric Fever numbered 3. There was one death. Of Paratyphoid Fever there was 1 case and the patient 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, Polio-Encephalitis and Polio-Myelitis. These diseases were entirely absent from the Borough during the year. Erysipelas. The notifications of erysipelas numbered 59, and there were no deaths. Most of the cases were notified from the St. Charles' Hospital and the General Hospitals, and 37 patients were treated in such institutions. Puerperal Fever and Puerperal Pyrexia. The number of cases of Puerperal Fever notified was 3. Particulars of the 4 deaths attributed to 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 18 ; most of the notifications received came from institutions where, of course, the precautions taken would naturally result in the detection of any signs indicating the occurrence of pyrexia (fever) in the early stages of the lying-in period. No application was made for the services of a consultant or any other of the facilities the Council is empowered to provide under the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. The number notified in 1933 was 17. Measles and German Measles. These diseases showed epidemic tendency during 1934, and although they are not now notifiable, 12 cases were reported voluntarily by doctors and parents and 705 notices of cases and contacts were received from school teachers. There were 11 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 8 cases in which the attack was severe, 151 visits being paid. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1934 the number of deaths registered as due to whooping cough was 5. There were 6 deaths from the disease in 1933. Glanders and Anthrax. No cases were notified during the year. Small Pox. There have been no cases of this disease in the Borough. Vaccination.—The usual table has been prepared by the Vaccination Officer and will be found on page 70. The following statement gives some information with regard to the work done and the results obtained by Dr. Bulman during 1934. Number of visits paid 1,393 Number of vaccinations- Primary 467 Re-vaccinations 35 502 Number of successful vaccinations 479 Number of unsuccessful vaccinations 23 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 1934. INFECTIOUS DISEASE IN SCHOOLS. 1934. (CASES and CONTACTS) Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 3 2 - 22 28 Barrett Street - - - - - - Barrow Hill Road 43 9 18 1 92 3 Bell Street 12 9 2 4 14 6 Capland Street 19 5 8 9 73 32 Catholic, Richmond Street - - - - - - Christ Church, Cosway Street 6 9 4 18 54 5 Convent (St. Edward's), Little Union Place 1 3 - 1 3 2 Cosway Street (L.C.C.) 25 6 11 38 102 9 Emmanuel, Aberdeen Place 7 7 8 2 45 29 Gateforth Street 4 - - - - 1 Hampden Gurney 12 3 3 1 13 8 Homer Row, Catholic 25 - - - 23 3 Jewish, Hanway Street 1 - - - 4 - Polytechnic, Regent Street 1 1 - = - - Regent's Park Central - 1 - - - - St. James's, Marylebone Lane 2 - - - 1 1 St. Luke's, Nutford Place 8 - - - 7 5 St. Mark's, Violet Hill 6 1 4 1 21 2 St. Marylebone Central. High Street 13 10 10 10 69 28 St. Marylebone Grammar 5 1 - 5 14 - St. Mary's (Western) York Street 10 2 - 1 52 28 St. Paul's Bentinck, Rossmore Road 16 22 10 6 14 8 St. Thomas', Orchard Street - - - 4 - - St. Vincent, Wigmore Street 3 - - - 11 4 Upper Marylebone Street 15 6 1 48 56 10 Schools in other Boroughs 4 3 - 3 9 3 Totals 241 100 79 174 705 187 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 1934. The total number of cases notified was 8, the same as the previous year. Visits were paid to notified cases by the Health Visitors, but in no case was it found necessary to make arrangements for a nurse from the Paddington and Marylebone Nursing Association to attend and apply treatment. In bad cases removal to hospital is carried out, special arrangements having been provided at St. Margaret's Hospital for receiving and dealing with children suffering from this condition. The following table gives information with regard to the cases notified. Notified Cases Treated Vision Unimpaired Vision Impaired Total Blindness Deaths Removed etc. At Home At Hospital 8 1 7 5 - - 1 2 37 INFLUENZA. This disease was less prevalent than in 1933, though correct information as to the number of cases was, of course, unobtainable. The deaths certified as due to Influenza numbered 12, as against 41 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 32 and 68. The services of the nurses were requisitioned in 23 cases and 439 visits were paid. The number of deaths certified as due to all forms of this disease was 70. FOOD POISONING. Thirty-one notifications of food-poisoning or suspected food-poisoning were received under Section 7 of the London County Council (General Powers) Act, 1932, as against 17 in 1932 and 13 in 1933. Eighteen of the 1934 cases, however, were reported by medical officers attached to the Zoological Society's Gardens in Regent's Park, where an outbreak of acute intestinal disturbance amongst the restaurant employees occurred on 12th and 13th July, 1934. On the night of the 11th, 300 people had taken dinner in the restaurant and none was known to have been unwell subsequently, but two of the waitresses who had been working late were taken ill at home in the early hours of the next morning. On the 12th some 200 of the staff ate, amongst other things, remains of the previous night's food. Of these, ten were taken ill between 5 and 5.30 p.m., with sickness and diarrhoea so violent that removal to hospital was considered advisable. Several other employees who had taken the same foods were very ill during the evening and following morning, but were treated at home. Extensive enquiries were made and it was revealed that although the patients had consumed a large variety of food, tea and butter were the only common factors. Samples of the remains of the meal were examined chemically and bacteriologically, as were also faeces, vomit and urine from the patients, but no substance or organism which could definitely have been responsible for the outbreak was found. All the patients recovered during the course of a few days. Although evidence to support the view was not forthcoming the conclusion reached was that the causative agent was a chemical irritant accidentally—or otherwise—introduced into some article (tea?) prepared for and consumed by certain members of the staff. In 7 of the remaining 13 cases notified during the year some form of fish was thought to have been the cause, whilst in the others rabbit, oxtail, sausages, chip potatoes, steak and kidney pudding, ham and ice cream each came under suspicion. In no case was it necessary to remove the patient to hospital and all quickly recovered. TUBERCULOSIS. In all 157 notifications were received, 132 relating to pulmonary tuberculosis, the remainder (25) to cases in which structures other than the lungs were affected. The table given on page 38 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 12 3. The number of cases notified within a month of death 2 4. The number of cases notified within three months of death 11 5. The number of cases notified within six months of death 4 Treatment of Tuberculosis.—-Of the cases notified 259 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 93 were insured persons and were admitted and readmitted from time to time during the year to sanatoria and hospitals for treatment, the total admissions numbering 115. Non-insured persons numbered 64, the total admissions for these patients being 58, including 8 children. Nurses were sent in to 17 cases and 396 home visits were paid. 38 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1934, to the 31st December 1984. Age Periods. Number of Notifications on Form A. Number of Notifications on Form C. Primary Notifications. Total Notifications (i.e. including cases previously notified by other doctors). Hospitals. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Pulmonary Males - - - 2 2 10 24 16 17 6 3 80 95 57 73 „ Females - - - 1 4 18 20 3 3 1 2 52 58 24 44 Non-Pulmonary Males - - 1 - - 2 7 - 2 2 - 14 15 1 2 „ Females - - 4 - - 3 3 1 - - - 11 13 - 5 Totals - - 5 3 6 33 54 20 22 9 5 157 181 82 124 39 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.— Summary of Notifications during the period from the 1st January, 1934, to the 31st December, 1934. in the area of the Metropolitan Borough of St. Marylebone. Age Periods Formal Notifications. Number of Primary Notifications of new cases of tuberculosis. Total Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages.) Pulmonary, Males - - - 2 2 10 24 16 17 6 3 80 95 „ Females - - - 1 4 18 20 3 3 1 2 52 58 Non-pulmonary Males - - 1 - - 2 7 - 2 2 - 14 15 ,, Females - - 4 - - 3 3 1 - - - 11 13 Supplemental Return. Part II.— New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary, Males - - - 1 - - 7 2 4 3 - 17 „ Females - - - - - 1 4 4 1 1 - 11 Non-pulmonary males - - 1 - - - - - 1 - - 2 „ Females - 2 - 2 - - - - - - - 4 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 3 2 transferable deaths from Registrar General 4 1 Posthumous Notifications 1 1 " Transfers " from other areas (other than transferable deaths) 18 2 Other sources if any (specified) Form II 2 - 40 Part III.— Notification Register. Number of cases of Tuberculosis remaining at the 31st December, 1934, on the Registers of Notifications kept Pulmonary Non-Pulmonary Total cases Males Females Total Males Females Total by District Medical Officers of Health in the County the Medical Officer of Health of the County Borough or Metropolitan Borough 448 268 716 91 89 180 896 Number of cases removed from the Registers during the year by reason inter alia of:— (1) Withdrawal of Notification 1 - 1 - - - 1 (2) Recovery from the disease - - - 2 3 5 5 (3) Death 48 27 75 2 3 5 80 (4) Removed from district 40 36 76 4 8 12 88 Prevention of Tuberculosis.— As is in general the case the Dispensary continued to prove most valuable, the members of the staff rendering excellent service in relation to preventive work. Particulars with regard to patients dealt with during the year are shown in 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, 53 Old, 60 No. of cases at Dispensary New, 342 Old, 1,437 No. of attendances at Dispensary 2,616 No. of visits by Miss Baker First visits, 108 Re-visits, 1,624 No. of visits by Miss Kenion First visits, 81 Re-visits, 1,212 No. of Committee Meetings attended 25 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. Morris, Sir Francis (Chairman) Broadbent, Miss M. E. (Hon. Secretary) Sikes, Dr. A. W Marriott, Miss K. Mc William, Miss M. Higgin, Miss E. Lazarus, Miss O. Wetherall, Miss Hawthorn, Mrs. Ruddock, Mrs, C. Bennett, Miss A. M. Bowen, Miss E. A. (M.B.E.) Price, Miss H. M. Lesser, Mr. H. E. REPRESENTS. Public Assistance Committee. Invalid Children's Aid Association. Divisional School Medical Officer to the London County Council. London County Council and School Care Committee. Charity Organization Society Portland Town Association. Central Jewish Synagogue. St. Mary's Hospital, Paddington. Margaret Street Hospital. The Working Classes. Paddington & St. Marylebone District Nursing Association. War Pension Committee and United Services Fund. Middlesex Hospital. London Insurance Committee. 41 The following note by Dr. Saner upon the work of the year is of interest:— " Statistics for the year 1934 are set out in the tables in the form required by the Ministry of Health. The figures there given indicate to a great extent the condition of patients from year to year as a whole, but not individually. There has been a slight decrease in the number of definite cases and attendances at the Dispensary. This is not unexpected, having regard to the decrease in tuberculosis among the population generally. The early case of tuberculosis is still the difficult one to get hold of, due to the fact that the early symptoms are not severe and urgent enough to suggest to the individual that a visit either to his doctor or the Dispensary is necessary. The X-ray department of the Middlesex Hospital has proved most helpful in the doubtful cases. Child contacts have been examined at the Dispensary and those known to have been in contact with an " open," i.e., an infectious case, are notified to the School Medical Officer, so that special attention is paid to them at school. This co-operation is decidedly useful. The Care Committee under the Hon. Secretaryship of Miss Broadbent has met fortnightly during the year, and 424 cases have been brought before it, either as regards treatment or matters affecting such things as clothing, dentures, nourishment, housing or work. Of the patients dealt with, 87 went to sanatorium, 36 had been discharged from sanatorium, 83 cases received treatment in hospital and 19 of these went on to sanatorium. Nine children had convalescent treatment through the Invalid Children's Aid Association, Portland Town Association or Charity Organisation Society. One patient was supplied with clothing, 2 with dentures, 2 with extra food, 2 were recommended for better housing, 1 obtained suitable work and 1 was lost sight of. Deaths reported numbered 32. There were 168 progress reports on patients who had received treatment at Sanatorium sent to the London County Council. Of the 168 it is found that 44 men and 46 women are working full time, 2 men and 2 women part time; 22 men and 6 women are unfit for work; 7 men and 8 women have been transferred to another district; 6 men and 2 women have been lost sight of, having gone away without leaving an address. One patient, a man, is at Papworth Colony and 1 youth at a training college. Of the young patients 11 boys and 3 girls are working, 2 boys are in an institution, 1 girl is unfit, another has been lost sight of and 1 boy has died. This shows over 60% working full time after receiving treatment. Miss Bowen, M.B.E., has devoted her time to the Ex-Service men and their families." 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 209, as against 231 in 1933. Of these, 32 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis. — Seventeen of the total notifications—25 as against 16 in 1933—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 1934. 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 67 39 4 - 3 4 3 1 70 43 7 1 121 *(b) Diagnosis not completed - - - - - - - - 1 3 3 3 10 (c) Non-tuberculous - - - - - - - 31 33 15 15 94 B.— Contacts examined during the year:— (a) Definitely tuberculous 1 2 - 2 - - - - 1 2 - 2 5 *(b) Diagnosis not completed - - - - - - - - 7 4 4 6 21 (c) Non-tuberculous - - - - - - - - 7 25 25 17 74 C.— Cases written off the Dispensary Register as:— (a) Recovered - - - - - - 1 4 - - 1 4 5 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 39 62 41 35 177 D.— Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 198 138 81 20 26 21 26 16 224 159 57 36 476 (b) Diagnosis not completed - - - - - - - - 8 7 11 11 37 1. Number of cases on Dispensary Register on January 1st. 530 2 Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 18 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 114 1 4. Cases written off during the year as Dead (all causes) 64 5. Number of attendances at the Dispensary (including Contacts) 2,616 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 166 7. Number of consultations with medical practitioners :— (а) Personal (b) Other 24 96 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 113 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,175 10. Number of :— (a) Specimens of sputum, &c-, examined 184 (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 228 (B) Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment): Provided by the Council, One. Provided by Voluntary Bodies, One. Margaret St. Dispensary, Margaret St., W.l *i.e., remaining undiagnosed on 31st December. 43 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 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. 1934. 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. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. (a) Remaining on Dispensary : Register on 31st December. Disease Arrested Ad'lts M. 2 - - - 2 - - - - - - 1 - - 1 - - - - - 3 - - - 3 - - - - - - - - 1 1 - - - - - - - - - - - - - - - F. 2 - - 2 4 - - - - - - - - - - - - - - - 1 - - 3 4 1 - 1 - 2 - - - - - - - - - - - 3 - - 3 - - - - - Children 4 - - 3 7 1 - - 1 2 - - - 2 2 - - - 2 2 2 - - - 2 - - - 1 1 - 1 1 1 8 - - - - - - - - - - - - - - - Disease not Arrested. Ad'lts M. - - - - - - - - - - 1 - - - 1 1 - - - 1 1 - 1 - 2 - - - - - 1 - - - 1 2 - 1 - 3 2 - - 1 3 2 1 - - 3 F. - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 - - - - - 1 1 - - - - - - 1 2 - - 2 1 3 Children 1 - - 1 2 - - - - - 1 1 - - 2 1 - - - 1 - - - - - 1 - - - 1 3 1 - 2 6 2 - - - 2 1 - - 4 5 2 - - 2 4 Condition not ascertained during the year - - 1 - 1 - - - - - - - - - - - - - - - 1 - - - 1 - - - 1 1 - - - - - - - - - - 1 - 1 - 2 - - - - - Total on Dispensary Register at 31st December 9 - 1 6 16 1 - - 1 2 2 2 - 2 6 2 - - 2 4 8 - 1 3 12 2 — 2 2 6 4 2 1 4 11 5 1 1 - 7 5 3 1 6 15 4 1 2 3 10 (b) Not now- on Dispensary Register and reasons for removal therefrom. Transferred to Pulmonary 1 - - 1 2 - - - - - - - - 1 1 - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - Discharged as Recovered Ad'lts M. 1 - 1 - 2 1 - - - 1 - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 2 2 - 5 9 - - - 3 3 - - - - - 1 - - 1 2 - - - - - - - - 1 1 - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 22 4 1 5 32 8 1 1 - 5 4 - - 1 5 3 - - 3 6 4 2 3 5 14 4 2 - 8 9 3 2 1 2 8 3 1 1 3 8 - - - - - 1 - - - 1 Dead Ad'lts M. 2 1 - - - 1 - - - 1 - - - - - - - - - - 1 - - - 1 - - - 1 1 - - 1 - 1 - 1 - - 1 - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - Children 1 - - - - - - - - - - - - - - 1 - - - 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register 29 7 2 11 49 5 1 1 3 10 4 - - 2 6 5 - - 4 8 7 2 3 5 17 5 2 - 5 12 3 2 2 2 9 4 2 1 3 10 - - - - - 1 - - - 1 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 38 7 3 17 66 6 1 1 4 12 6 2 - 4 12 7 - - 6 13 15 2 4 8 29 7 2 2 7 18 7 4 8 6 20 9 3 2 3 17 5 3 1 6 15 5 1 2 3 1 February 7th, 1935. 44 Tuberculosis Scheme of the St. Marylebone Metropolitan Borough Council. Form T. 145a. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 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. 1934. 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 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). 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 - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 12 - - - - 2 - - - - - - - - - - - - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Disease not Arrested Adults m. 6 8 3 7 13 - - 3 1 4 - 2 2 3 7 2 - - 1 1 - 5 6 1 12 2 2 3 1 6 4 2 7 2 11 2 6 9 3 18 20 12 8 7 27 17 13 19 4 36 f. 2 4 1 3 8 1 - - - - 3 - 2 1 3 1 1 - 1 2 2 1 2 1 4 1 2 1 1 4 7 2 7 - 9 6 2 1 2 5 13 3 6 3 12 9 22 8 1 31 Children 4 - - - - - - - - - 2 1 - - 1 2 - - - - 3 1 - - 1 4 - - - - 4 - - - - 2 - - 1 1 3 1 - - 1 7 - - - - Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 30 11 4 10 25 3 2 3 1 6 6 5 4 4 13 5 3 - 2 5 7 8 8 2 18 7 4 4 2 10 15 4 14 2 20 10 8 10 6 24 37 16 14 10 40 33 35 27 5 67 (b) Not now on Dispensary Register and reasons for removal there from. Discharged as Recovered Adults m. 7 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - f. 10 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 11 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 68 54 9 3 66 29 12 5 5 22 27 15 8 1 24 29 17 8 27 30 28 7 2 37 23 13 5 3 21 38 13 6 2 21 20 8 3 - 11 7 6 10 18 2 5 4 12 21 Dead Adults m. 1 4 6 30 40 1 1 5 21 27 2 - 1 20 21 1 - 2 21 23 1 1 - 11 12 1 2 3 14 19 1 4 3 9 16 1 1 3 13 17 - 2 1 12 15 - - - - - f. 1 2 3 14 19 - - - 10 10 3 - 1 14 15 - - - 19 20 1 2 - 12 14 1 1 - 5 6 1 - 1 7 8 - - - 4 4 2 — 1 8 9 - - - 4 4 Children 2 - - - - 1 - - - - - - - - - - - - 1 1 - - - 2 2 1 - - - - - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register 100 61 18 47 126 31 13 10 36 59 32 15 10 35 60 30 17 11 43 71 32 31 7 27 65 26 16 8 22 46 40 17 10 18 45 21 9 6 17 32 9 8 12 22 42 2 5 4 16 25 Grand Totals 136 72 22 57 151 34 15 13 37 65 38 20 14 89 73 35 20 11 45 76 39 39 15 29 83 33 20 12 24 56 55 21 24 20 65 31 17 16 23 56 46 24 26 32 82 35 40 31 21 92 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 1934 the total number certified as due to this cause was 62, the deathrate being 0.66 per 1,000. In 1933 the deaths numbered 56, the death-rate being 0.56 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 1930-1934. Deaths from Phthisis. 1930—1934. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1934 92,320 62 9 13 32 8 The distribution of the 62 deaths was as follows :—In general and other hospitals, 38; at home, 19, and at addresses outside the Borough, 5. Of those who died 37 were insured (26 males and 11 females), and 25 uninsured (12 males and 13 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 62, the notified cases of pulmonary tuberculosis totalled 132. 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 N on-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0-1 - - - - - - - - 1-5 - - - 2 - - - 2 5-10 - - 2 4 - - - - 10-15 3 1 - 2 - - - 1 15-20 2 4 - - - 2 - - 20-25 10 19 2 3 3 6 - 1 25-35 31 24 7 3 8 2 1 - 35-45 18 7 - 1 4 5 - - 45 -55 21 i 3 - 8 4 1 - 55 -65 9 2 2 - 13 3 - - 65 and upwards 3 2 - - 2 2 - - Totals 97 63 16 15 38 24 2 4 62 *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, 1934. Localisation of Disease. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. At all Ages. At ages—years. All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals Cases Isolated at Home Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 05 and upwards Lungs 132 - - 3 34 63 27 5 25 44 44 19 132 9 21 20 7 57 75 Glands 9 - - 4 2 3 - - - 3 4 2 9 - 2 2 2 6 3 Eye 1 - - - - 1 - - - - - 1 1 - - - 1 1 - Spine 6 - - 1 3 2 - - 2 2 2 - 6 2 2 2 - 6 - Rib 1 - - - - - 1 - - - 1 - 1 - - - - - 1 Kidney 2 - - - - 2 - - - 1 1 - 2 - 1 - - 1 1 Hip 1 - - - - 1 - - - - - 1 1 - - - 1 1 - Lupus 1 - - - - 1 - - - 1 - - 1 - - - - - 1 Testicle 2 - - - - - 2 - 1 - 1 - 2 - - - - - 2 Neck (abscess) 1 - -- - - - 1 - - 1 - - 1 - 1 - - 1 - Urogenital tract 1 - - - - 1 - - 1 - - - 1 1 - - - 1 - Totals 157 - - 8 39 74 31 5 29 52 53 23 157 12 27 24 11 74 83 157 47 DISINFECTION. The work done in this connection during 1934 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 is shown hereunder :— Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other Causes. Total. Totals 4,426 263 630 378 2.576 8.273 The number of journeys made by the disinfecting vans during the year ended December, 1934, was :— January 97 August 91 February 92 September 84 March 86 October 88 April 92 November 87 May 87 December 88 June 94 July 99 1,085 The number of journeys made during 1933 was 1,081. The number of rooms disinfected and the reasons for carrying out disinfection are stated below :— Compulsorily Notifiable Diseases. Phthisis. Measles. Other causes. Total. Totals 375 72 129 187 763 The number of rooms disinfected in 1933 was 630. 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 222. The arrangements referred to in previous reports for placing a spraying apparatus and a supply of insecticide 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 1934 were 2,787 and 2,661 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. 1934. Positive. Negative. Total. Typhoid fever 2 2 Diphtheria 55 578 633 Phthisis 32 177 209 Totals 89 755 844 MATERNITY AND CHILD WELFARE. The Maternity and Child Welfare Scheme in St. Marylebone is made up of voluntary and official elements. Of the voluntary elements, to the nature of which reference is made later, those for which the St. Marylebone Health Society is responsible bulk largest. The Council, who made a grant of £1,819 in 1934 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, is the Home of the Little Company of Mary, where unmarried mothers particularly are provided for, both before and after the birth of their child. It will be noted that at the end of the year 1934 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 statement contains so much information with regard to the scheme and the work done that it will probably be found useful. It is required to be made by the Ministry of Health 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. Tables on pages 55 and 59 give particulars of the work done at the various clinic centres during the year 1934. 49 Statement Showing Arrangements Made for Maternity and Child Welfare. 1. Population of the area served by the Council, 92,320. 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, 815; (b) Still births, 30; (c) Total,* 845; (d) By midwives,* 262; (e) By doctors and parents, 105; By hospitals, 256; By Nursing Homes, 52; Inward transfers, 170.* 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,† 326; total visits, 518. (b) To children under 1 year of age, first visits,† 615; total visits, 5,323. (c) To children between the ages of 1 and 5 years, total visits, 7,021. *The total of the figures given under (d) and (e) should agree with the figure under (c). †Excluding cases which are known to have previously been visited in another district. 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, 7,780; (ii) By children between the ages of 1 and 5 years, 9,097 (including 111 3-year-olds). (d) Total number of children who attended at the Centres for the first time during the year and who, on the date of their first attendance, were: (i) Under 1 year of age,* 531; (ii) between the ages of 1 and 5 years, 253 (including 111 3-year-olds). (e) Total number of children who attended at the Centres during the year and who, at the end of the year, were: (i) Under 1 year of age, 445; (ii) between the ages of 1 and 5 years, 833. (f) Percentage of notified live births represented by the number in (d) (i), 65. 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, 2,051. (d) Total number of expectant mothers who attended at the Clinics during the year, 501. (e) Percentage of total notified births (live and still) represented by the number in (d), 59. 50 Supply of Milk and Food. Indicate what arrangements are made for this service by inserting "Yes" or "No" in each space in the following table :— Terms of supply. Milk. Other hood. Expectant Mothers. Nursing Mothers. Children under 5 years of age. Expectant Mothers. Nursing Mothers. Children under 5 years of age. Free, or at less than cost price, in necessitous cases Yes Yes Yes No No Yesdried milk At cost price in other cases (e.g., sale of dried milk at Centres) No Yes Yes Yes Yes Yes *Excluding children who are known to have previously attended a Centre in another district. †Including Ante-natal Clinics provided at institutions transferred to the Council under Part I of the Local Government Act, 1929. (Paragraphs 6-10, do not apply to St. Marylebone.) 11. 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, 15,193. 12. 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. (1) Ophthalmia Neonatorum 8* 5 - 7 (2) Pemphigus Neonatorum - - - - (3) Puerperal Fever 3 3 - 3 (4) Puerperal Pyrexia 18 1 - 17 (5) Measles and German Measles (in children under 5 years of age) Not Notifiable 300 8 - (6) Whooping Cough (in children under 5 years of age) 55 - - (7) Epidemic Diarrhoea (in children under 5 years of age) 4 - - (8) Poliomyelitis (in children under 5 years of age) - - - - 51 Information should be supplied as to the number of cases of Ophthalmia Neonatorum notified during the year in which— (a) vision was unimpaired, 5; (b) vision was impaired, nil; (c) vision was lost, nil; (d) the patient died, 1; (e) the patient removed from the district, 1; (f) the patient was still under treatment at the end of the year, nil; (g) (any other category), 1. Total, 8. This total should agree with the figure given at* in column 2 of the Statement above. 13. 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, 49. 14. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 20. (b) Number (i) employed by the Council, nil; (ii) subsidised by the Council, nil; (iii) employed by Voluntary Associations, nil. (c) Number of cases during the year in which the Council paid or contributed to the fee of a midwife, nil. 15. 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, 1. (b) Number of these cases which died: (i) at home, nil; (ii) in tions, 4. 16. Administration of Part I. of the Children Act, 1908, as amended by Part V. of the Children and Young Persons Act, 1932. (a) Number of persons on the Register who were receiving children for reward at the end of the year, 10. (b) Number of children on the Register: (i) at the end of the year, 14; (ii) who died during the year, nil; (iii) on whom inquests were held during the year, nil. (c) Number of Infant Protection Visitors at the end of the year who were: (i) Health Visitors, 6; (ii) Female, other than Health Visitors, nil; (iii) Male, nil. (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or societies authorised to visit under the proviso to Section 2 (2) of the Act of 1908, nil. (e) Proceedings taken during the year: No. of cases, nil; Act and Section under which proceedings were taken, nil. (f) Number of cases in which the local authority has given a sanction during the year: (i) under (a) of Section 3 of the Act of 1908, nil; (ii) under (b) of Section 3 of the Act of 1908, nil; (iii) under (c) of section 3 of the Act of 1908, nil. (g) Number of orders obtained during the year under Section 67 of the Act of 1932: (i) from a court of summary jurisdiction, nil; (ii) from a single justice, nil. 52 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. As stated in the report for 1933, 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 January, 1934 16 No. of foster mothers on register at 31st December, 1934 11 No. of foster children on register at 1st January, 1934 18 No. of foster children on register at 31st December, 1934 14 No. of foster mothers registered during the year 6 No. of foster children returned to parents 7 No. of foster children removed to Institutions 1 No. of foster children adopted 1 No. of inspections 328 53 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. Tuesday, 1.30 ,, Infant Consultation. Thursday, 1.30 ,, Toddlers (2—5 years). „ 9 a.m. Maternity Clinic. Friday, 1.30 p.m Infant Consultation, 118, Marylebone Road, 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— 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, Coswav Street. N.W. 1— Monday, 2 p.m. Infant Consultation, Thursday, 10 a.m. „ „ Church Army Dispensary, Little Harcourt Street, W.l— Tuesday, 2.15 p.m. Infant Consultation, 12, Salisbury Street, Wednesday, 2.80 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.I. The St. Vincent de Paul Day Nursery, 111, Wig-more Street, W.l. 54 Health Visitors.— There are six health visitors. A health visitor appointed by the Health Society is responsible mainly for work amongst pre-school children. Four of the women give whole time to health visiting, and two 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 1934 the health visitors made 8,887 visits to children and 518 visits to mothers. Children are visited up to school age, and thereafter for special purposes, e.g., measles, scabies, &c. These necessitated 582 visits to children over 5 years of age in 1934. 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, Infant Welfare and Light and Massage Clinics under medical supervision. The dental clinic and minor ailment treatment centre are in the same building. The Council's health visitors co-operate, one of them acting as superintendent.— (2) South Marylebone School of Mothercraft, St. Marylebone General Dispensary, 30, Marylebone Lane. An ante-natal 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 Middlesex Hospital, as at Queen Charlotte's, there are ante-natal clinics particularly for hospital patients. Ante-Natal Work.— There are two 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. STATEMENT SHOWING WORK OF THE ANTE-NATAL AND POST-NATAL CLINICS HELD AT THE MATERNITY AND CHILD WELFARE CENTRE, SALISBURY STREET, DURING 1984 :— Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. Totals No. of Sessions 5 4 4 3 5 4 4 5 4 5 4 3 50 New Ante-Natal cases 9 10 2 19 19 6 8 6 9 8 6 4 106 New Post-natal cases 5 9 7 3 5 4 4 4 11 3 - 7 62 Attendances Ante-natal 19 40 29 44 60 39 42 33 25 30 28 20 409 Attendances Post-natal 21 33 24 15 31 22 21 13 16 22 19 6 243 Total attendances 54 92 62 81 115 71 75 56 61 63 53 37 820 Transferred to Queen Charlotte's Hospital 1 1 - - - 1 - 4 - - - - 7 Transferred to St. Charles Hospital - - - - 1 - - 1 - - - - 2 Transferred to St. Marylebone Home - 2 3 5 4 3 4 4 4 5 2 1 37 Transferred to other Hospitals - 3 1 - - - - 1 - - - - 5 Put on special diet - 6 1 - 2 2 1 1 - - - - 13 Pads and belts provided 1 - - 2 - 1 3 1 3 1 - - 12 High blood pressure 5 5 1 - 2 1 1 2 1 1 - - 19 Low blood pressure - 1 - 2 - - - - - - - - 3 X-ray examinations - - - 1 2 - 2 2 - - - - 7 Referred to Dental clinic 2 1 1 3 6 - 3 2 2 - - - 20 Urine Tests 1 - 2 - - - - 3 - - - - 6 Sent to Royal Free Hospital for diagnosis 2 - - - - - - - - - - - 2 Undernourished - 1 - 2 - - - 4 - - - - 7 Miscarriage - - 1 1 2 - - - 2 - - - 6 Threatened miscarriage - - 2 - - - - 1 - - - - 3 Cases referred by— Hospitals 2 3 - 6 7 - - - 2 - - - 20 Midwives 2 - - - - - 2 - 2 - - 2 8 55 56 The following note by Dr. Marjory Yule with regard to the work done at the Ante-Natal Clinic at 14, Salisbury Street, contains a number of points of real interest and evidence of the value of the work done at the Clinic :— The total number of attendances at the Clinic during the year amounted to 820; 50 sessions were held, giving an average attendance of 16 cases per clinic. These cases are referred to the Clinic from various sources :— 1. By Health Visitors. 2. By local midwives. 3. By nurses who run a Maternity Home in the district. 4. By Rescue Workers at a home for unmarried mothers. 5. By the Marylebone Home. 6. By Queen Charlotte's Hospital. Two of the local midwives attend at the Clinic every week and help in the work there. They are encouraged to bring their cases along to the Clinic, and to keep these cases under the supervision of the doctor until the confinement is due. May I say here how pleased we are to have the midwives with us at the Clinic, and how much we appreciate their co-operation and help. Patients who go directly to the Marylebone Home to book up for their confinement, are referred to the Clinic by the Sister in charge, and they attend the Clinic then until their confinement is actually due. The cases referred from Queen Charlotte's Hospital are those who have delayed too long in booking up at the Hospital for their confinement, and they are then referred to the Salisbury Street Clinic for ante-natal attendance, and go to the Marylebone Home for their confinement. In regard to the actual confinement, when this is in charge of the midwives, the midwife is asked into the Doctor's room at the first and the final examinations, and given a full report on the case (verbal and written), and advised on any particular point of interest in the case. If any difficulty occurs during labour, e.g., uterine inertia or perineal tears, the midwife calls in a local Doctor to her assistance. Normal cases only go to the Marylebone Home for their confinements, as they do not accept complicated cases there. So the abnormal cases, for example cases requiring early induction of labour or Caesarian section, are sent to St. Mary Abbots Hospital. In every case, a written report is sent to the Nurse, Doctor or Institute dealing with the confinement, and after the confinement a written report is sent back to the Clinic with full details of the confinement, so that all the ante-natal findings are checked up, and a complete report of the case from beginning to end is kept. The patients are asked to attend the Clinic after their confinement is over, and they are then thoroughly examined and given any treatment which may be necessary. It is unfortunate that there is a tendency amongst midwives and others to use the Clinic for abnormal cases only. One tries to combat this as much as possible, and it is here that the Health Visitor is a tremendous help. She is in personal touch with the people of the district, and can persuade the mothers to attend the Clinic early. Many abnormalities can be prevented, but treatment is often very difficult when the abnormality has been in existence for some time. A criticism has been launched that although the number of Ante-Natal Clinics throughout the country has increased greatly during the last few years, they have achieved nothing, since the maternal mortality rate has not decreased. I maintain that the Salisbury Street Ante-Natal Clinic has definitely justified its existence. We have unfortunately had one maternal death in connection with the Clinic, but that is over a period of 3½ years. This case arrived at the clinic, 7½ months pregnant, and showing definite signs of toxaemia. She was under the care of the Clinic for a fortnight, and as she was not responding satisfactorily to treatment, I sent her into hospital, so that she could be under continual medical supervision. Apparently she had been too long in seeking medical advice, because she did not improve under treatment, and after her confinement she had complete collapse and died. 57 During the last year twelve breech cases have been seen at the Clinic, version performed successfully in each case, and normal confinements followed. One case attended where the foetus was found to be dead in utero; this case was sent into hospital where the pregnancy was terminated and the mother made a good recovery. Two cases of minor contraction of the pelvis were sent into Hospital for induction a fortnight before time, and had normal confinements and recoveries. One case of badly contracted pelvis was sent for Caesarian section. One case, who had suffered from puerperal insanity after her two previous confinements, was sent to the Middlesex Hospital for termination of pregnancy and sterilisation, and this was carried out. In addition there are the numerous cases of sickness, anaemia, high blood pressure, albuminuria, etc., which are treated at the Clinic, and which, without treatment, would undoubtedly turn into serious cases. But in no case is interference advised unless absolutely necessary. The spirit of co-operation at the Clinic is good. Voluntary workers, midwives and Health Visitors combine in their efforts to make the mothers feel welcome and happy at the Clinic, and render most valuable assistance to the Doctor in her work. 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 twice weekly at Salisbury Street, and weekly at 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 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, and a visit paid to the house to renew the invitation and explain more fully the objects, etc. Clinics are held once a month and speaking generally have been well attended. Of the 111 children who were examined during 1934, 41 needed treatment for one or more conditions. The following is a summary of the conditions found :— Enlarged tonsils and adenoids 11 Dental caries 12 Chronic bronchitis 5 Acute bronchitis 2 Recommended for circumcision 2 Rheumatism 1 Squint 1 Signs of old rickets 2 Mentally backward 1 Otitis Media 1 Impetigo 1 Heart Disease 1 Gonorrhoea 1 Oxyuris vermicularis (Thread worms) 1 Undernourished 5 These children were sent to the appropriate clinics at the Middlesex Hospital. 58 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 1934 was 2,357; the total births numbering 3,380. The midwives residing in the borough registered as intending to practise in the administrative County of London, number 20. 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 27 cases were dealt with under the arrangement, and 435 visits were paid, the services of the nurses being greatly appreciated by the patients. Work done during 1934.— 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. 59 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDED 31ST DECEMBER, 1934. 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 63 97 100 91 93 151 91 Toddlers 15 50 - 9 - 53 - Maternity - 49 345 - 24 100 - Massage - 86 90 - - - - Light - 68 - - 45 - - No. of attendances of mothers at clinic:— Ante-natal - 426 16.108 (1,169) - 42 4,492 (414) - Post-natal - 273 235 (22) - 1 147 (4) - No. of attendances of babies 1,099 2,162 3.116 (964) 1,225 857 3,780 (1,146) 170 No. of attendances of children over one year 733 2,101 1,240 (587) 972 918 3,366 (1,086) 288 No. of attendances at Light Clinic— Infants - 88 - - - - - Toddlers - 1,363 - - 71 - - No. of attendances at Massage Clinic— Infants - 62 59 (7) - - - - Toddlers - 808 147 (59) - - - - No. of orders issued for milk, etc. 233 968 146 305 184 249 - No. of home visits 2,171 2,605 421 1,323 676 3,060 - No. of new cases— Infants 82 128 204 (55) 65 44 276 (68) 71 Toddlers 26 41 2 (1) 10 10 34 (11) 33 Ante-natal - 109 2,953 (238) - 7 716 (98) - Post-natal - 60 192 (19) - - 147 (4) - Massage— Infants - 5 14 (3) - - - - Toddlers - 32 20 (9) - - - - Light— Infants - 10 - - - - - Toddlers - 33 - - 3 - - Note.— Figures in brackets refer to St. Marylebone residents attending Queen Charlotte's Hospital and Middlesex Hospital. 60 Day Nurseries.— Attendances during the year. The Crossley, Barrow Hill Road.— Whole day, 4,657; half-day, 642. The Portman.— Whole day, 4,818; half-day, 704. St. Vincent de Paul, 111, Wigmore Street.— Whole day, 3,441; half-day, 931. Dental Clinic, 12, Salisbury Street. Attendances during the year.— Mothers, 639; children, 66. Advice and treatment given in 443 cases. Extractions under gas, 262. Home Helps.— No calls for home helps were made during the year 1934. 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, 1934, was :— 1934. Males, Females Total, For burial only. For inquests Total. No. of P.M.'s held. No. of courts held. No. of Infectious cases. Totals. 65 47 112 110 2 112 44 - - 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. 61 HOUSING. The information asked for by the Ministry with regard to housing is contained in the following statement. The Increase of Rent and Mortgage Interest (Restrictions) 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. 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) 2,383 (b) Number of inspections made for the purpose 9,673 (2) (a) Number of dwelling-houses (included under sub-head 433 houses (1) above which were inspected and recorded under and 265 the Housing Consolidated Regulations, 1925) tenements (b) Number of inspections made for the purpose 2,076 (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 1,413 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 1,371 3. Action under Statutory Powers during the Year :— A.— Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners Nil (b) By local authority in default of owners Nil B.— Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 42 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 42 (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 62 E.— Proceedings under section 3 of the Housing Act, 1925 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners Nil (b) By local authority in default of owners Nil (3) N umber of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil F.— Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which Closing Orders were made Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which lition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil As to progress it may be noted that during the year considerable advance in the direction of improving housing conditions within the Borough has been made. Particularly is this so in the Carlisle Street area, where a fifth block has been completed and occupied, and the erection of another block 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) 86 Purveyors of Milk (Registered) 197 Offensive Trades (Registered) 1 Bakehouses 56 Restaurant, Dining Room and Coffee Shop Kitchens 224 Hotel Kitchens 28 Pastrycooks and Tea Rooms 108 Fried Fish Shops 25 Fish Curers 6 Workshops and Workplaces 2,446 Houses Let in Lodgings 1,055 Total 4,325 Smoke Nuisances. Number of Observations 336 Number of Complaints 11 Number of Intimation Notices Number of Summonses Nil served 5 Number of Convictions Nil Number of Statutory Notices Amount of Penalty and Costs served Nil imposed in each case Nil 63 Housing of the Working Classes. Number of Houses inspected— Number of Representations by Medical Officer or other person Nil (a) On account of complaints or illness (P. H. Act) 2,383 (b) House-to-house (Housing Consolidated Regulations, 1925) 438 Number of Houses included in such representations Nil Number of Closing Orders made Nil Tenements in blocks 265 Number of Closing Orders determined (i.e., Houses made fit) Nil Number of Notices served— (a) Under P.H. Act Number of Demolition Orders Nil (1) Intimation 1,413 Number of Houses demolished— (2) Statutory 42 (a) In pursuance of Orders Nil (b) Under Housing Act Nil (b) Voluntarily Nil Number of Houses repaired or nuisances remedied under P. H. Act, 1891 1,413 Total Number of Houses in the borough 18,020 Number of Houses and Flats occupied by the Working Classes 8,620 Number of Houses repaired under Section 3 of Housing Act, 1925— Number of Houses for the Working Classes—(b) In course of erection 250 (a) Erected during year (flats) 0147 (a) By Owners Nil Number of Houses registered under the new Bye-laws as to Houses Let in Lodgings 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 Inspections made of such Houses Nil Number of Prosecutions Nil Mortuary. Number of bodies received 112 Number of Infectious bodies received Nil Cleansing of Persons Act, 1897. Adults. Children. Total. 5,448 Number of persons cleansed Males. 2,193 Females. 594 Males. 686 Females. 1,974 Bakehouses. Number on Register at end of 1934 ... ... ... ... 56 Number above ground ... ... ... ... 7 Number underground ... ... ... ... 49 Number of Inspections ... ... ... ... 110 Number of Notices ... ... ... ... 7 Number of Prosecutions ... ... ... ... Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1934 ... ... ... ... 378 Number of Inspections ... ... ... ... 702 Number of Notices ... ... ... ... 10 Number of Prosecutions ... ... ... ... Nil House Refuse. Number of Inspections ... ... ... 1,103 Number of Old Brick Receptacles abolished ... ... ... Nil Number of New Metal Receptacles provided ... ... ... 218 Number of Notices issued. Intimations ... ... ... 218 Number of Statutory Notices ... ... ... 11 Number of Prosecutions ... ... ... Nil 64 Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water has been provided to Upper Storeys 22 Number of Statutory Notices served Nil Number of Prosecutions Nil Overcrowding. Number of Dwelling-Rooms overcrowded 28 Number remedied 28 Number of Prosecutions Nil Underground Rooms. Number dealt with 73 Number of Notices served under P.H. (L.) Act, 1891 73 Number of Notices served under the Housing Act, 1925 Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms cleansed after infectious disease 763 Number of rooms cleansed after vermin 692 Number of articles 8,273 Number of Statutory Notices served 10 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 4,485 Number of drainage plans deposited 570 Number relating to new buildings 63 ,, ,, old buildings 507 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops and Cowsheds 480 Number of Inspections 684 Sanitary Officers. Number of Sanitary Inspectors (Whole-time) Male 8 Female Nil ,, ,, „ (Part-time) Male 3 Female 2 ,, Health Visitors Whole-time 4 Part-time 2 ,, Tuberculosis Visitors Whole-time 1 Part-time 1 65 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1934 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Births. Nett. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of Age. At all Ages. Uncorrected No. No. Rate. No. Rate. No. Rate per 1,000 Nett No. Rate. 1 2 3 4 S 6 7 8 9 10 11 12 13 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 1,496 141 1,472 13.8 873 658 94 63.0 1,257 11.0 1926 105,800 3,220 1,359 12.7 1,325 12.4 748 740 111 81.6 1,356 11.9 1927 103,500 3,521 1,374 13.2 1,375 13.2 781 621 81 59.0 1,262 11.3 1928 104,000 3,662 1,317 12.6 1,335 12.8 787 690 105 79.0 1,238 11.1 1929 102,400 3,526 1,233 11.9 1,465 14.3 821 804 93 77.0 1,455 13.2 1930 102,400 3,162 1,247 12.1 1,373 13.3 831 618 77 62.0 1,171 10.6 1931 93,460 3,134 1,067 11.4 1,411 14.3 826 640 70 65.0 1,225 12.8 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 1934 92,320 3,007 833 9.0 1,462 15.6 885 594 51 61.0 1,171 12.6 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. TABLE II. Vital Statistics of Separate Localities in 1934 and the Ten Previous Years. Names of Localities The Whole Borough All Souls St. Mary Christ Church St. John Year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at ail 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. 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 1426 56 20,479 290 258 9 1926 105,800 1,359 1,356 111 25,353 230 244 17 27,095 276 369 25 82,931 594 450 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 1,817 1,238 105 24,915 232 248 21 26,638 285 299 17 32,371 533 434 46 20,076 313 257 21 1929 102.400 1,233 1,455 95 24,532 233 327 21 26,228 254 362 19 31,873 503 504 43 19,767 243 262 12 1930 102,400 1,247 1,171 77 24,532 249 250 16 26,228 273 302 20 31,873 452 379 27 19,767 273 240 14 1931 93,460 1,067 1,225 70 21,422 190 244 15 24,575 235 331 13 28,375 409 394 26 19,088 233 256 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 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 14 Averages of Years 1924 to 1933 101,347 1,261 1,289 90 23,987 224 253 16 26,149 276 344 19 31,329 510 431 40 19,881 254 261 15 1934 92,320 833 1,171 51 21,188 145 233 10 24,309 201 297 11 27,999 351 388 24 18,824 136 253 6 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. 66 TABLE III.—Causes of, and Ages at Death during the year 1934. 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. JUnder 1 1 and under 2 2 and under 5. 5 and under 15 15 and under 25 25 and under 45. 45 and under65. 65 and upwards 1 Typhoid and Paratyphoid Fevers 1 - - - - - 1 - - 1 - - - 1 1 2 Measles 11 2 5 4 - - - - - - 1 4 4 2 11 3 Scarlet Fever - - - - - - - - - 1 - - - - - 4 Whooping Cough 5 2 2 1 - - - - - 1 1 1 3 - 5 5 Diphtheria 2 - 1 - - 1 - - - - 1 1 - - 2 6 Influenza 12 - - - - - 2 7 3 6 4 3 3 2 12 7 Encephalitis Lethargica . - - - - - - - - - - - - - - - 8 Cerebro-Spinal Fever 1 - - 1 - - - - - - - - 1 - 1 9 Tuberculosis of Respiratory System 62 - - - - 11 19 28 4 13 9 13 32 8 62 10 Other Tuberculous diseases 6 - 1 1 1 1 3 - - 6 1 2 2 1 6 11 Syphilis 5 1 - - 1 1 - 1 1 5 1 1 2 1 5 12 General Paralysis of the Insane, Tabes Dorsalis 7 - - - - - 2 4 1 - 2 1 2 2 7 13 Cancer, Malignant Disease 180 - - - - 1 7 80 92 301 32 52 54 42 180 14 Diabetes 16 - - - - - 1 5 10 11 5 4 6 1 16 15 Cerebral Haemorrhage, etc. 54 - - - 1 - 2 16 35 38 11 13 19 11 54 16 Heart Disease 270 - - - - - 5 75 190 100 52 69 89 60 270 17 Aneurysm 7 - - - - - - 4 3 1 1 3 2 1 7 18 Other Circulatory Diseases 57 - 1 - - - 2 14 40 27 12 19 18 8 57 19 Bronchitis 33 - 1 - - - 2 8 22 27 6 7 13 7 33 20 Pneumonia (all forms) 74 8 4 - - 3 5 21 33 58 15 17 25 17 74 21 Other Respiratory Diseases . 12 - - 2 - - 1 6 3 23 4 3 2 3 12 22 Peptic Ulcer 24 - - - - 1 4 13 6 32 2 4 8 10 24 23 Diarrhoea, etc 17 13 2 - - - - 1 1 7 5 3 5 4 17 24 Appendicitis 9 - - - 3 2 - 3 1 20 3 2 3 1 9 25 Cirrhosis of Liver 8 - - - - - 3 5 - 7 3 1 3 1 8 26 Other Diseases of the Liver, etc. 5 - - 1 - - - 2 2 2 1 1 2 1 5 27 Other Digestive Diseases . 34 1 1 - 1 2 1 12 16 56 8 10 8 8 34 28 Acute and Chronic Nephritis . 28 - - - - 5 1 7 15 31 4 5 10 9 28 29 Puerperal Sepsis 3 - - - - 1 2 - - 1 1 1 1 - 3 30 Other Puerperal Causes . 1 - - - - - 1 - - 9 - 1 - - 1 31 Congenital Debility, Premature Birth, Malformation, etc. 17 16 - - 1 - - - - 63 4 3 8 2 17 32 Senility 12 - - - - - - - 12 10 2 2 6 2 12 33 Suicide 25 - - - - - 7 12 6 11 2 7 11 5 25 34 Other Violence 55 6 - 2 1 2 11 9 24 29 18 13 9 15 55 35 Other defined Diseases 118 2 3 2 7 4 16 38 46 115 22 31 37 28 118 36 Causes ill-defined or unknown - - - - - - - - - - - - - - - Totals 1171 51 21 14 16 35 97 371 566 1012 233 297 388 253 1171 67 TABLE IV. Cases of Infectious Disease Notified during the 52 weeks ended 31st December, 1934. 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 Ages—years. All Souls. St. Mary Christ Church St. John. Totals All Souls. St. Mary. Christ Church St. John. Totals. At all ages. —1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Smallpox - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria, including Membranous, Croup . 104 2 9 7 12 8 30 8 5 18 3 2 - 14 24 56 10 104 13 23 56 10 102 2 Erysipelas 59 2 - - - - - 2 3 2 14 26 10 12 21 17 9 59 5 18 11 3 37 22 Scarlet Fever. 212 - 7 12 6 20 73 24 19 38 8 5 - 32 57 86 37 212 26 59 79 32 196 Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - Enteric Fever 3 - - - - - - - - 2 1 - - 2 1 - - 3 2 1 - - 3 - Paratyphoid Fever 1 - - - - - - - - - - - - - - - 1 1 - - - 1 1 - Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever . - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 3 - - - - - - - - 2 1 - - - 3 - - 3 - 3 - - 3 - Puerperal Pyrexia . 18 - - - - - - - 1 14 2 1 - 4 11 - 3 18 3 11 - 3 17 1 Plague . - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - - Anthrax . Cerebro-Spinal Fever . 1 - - - - - - - - - - - - - - 1 - 1 - - 1 - 1 - Tuberculosis— 132 - - - - - - 3 6 72 19 27 5 25 44 44 19 132 9 21 20 7 57 75 Non-Pulmonary Acute Polimyelitis 25 - - - - - 5 - - 14 2 4 - 4 8 9 4 25 3 6 4 4 17 8 Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 8 8 - - - - - - - - - - - 1 2 4 1 8 1 2 3 1 7 1 Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 70 3 3 2 5 4 6 4 2 12 10 15 4 25 15 22 8 70 17 12 17 4 50 20 Malaria . 1 - - - - - - - - - 1 - - - 1 - - 1 - 1 - - 1 - Dysentery 2 - - - 1 - - - - - 1 - - 1 - 1 - 2 1 - 1 - 2 - Totals 639 15 19 22 24 32 114 41 36 174 63 80 19 120 187 240 92 639 80 157 192 65 494 145 68 Table v. Cases of Infectious Disease Notified during the 52 weeks ended 31st December, 1934. Notifiable Disease. Cases notified in whole District. Total number of cases removed to Hospital, Total Deaths. At Ages—years. At all ages. — 1 1- 2— 3— 4— 5— 10— 15— 20— 35— 45— 65- Smallpox - - - - - - - - - - - - - - - Diphtheria including Membranous Croup . 104 2 9 7 12 8 80 8 5 18 3 2 - 102 2 Erysipelas 59 2 - - - - - 2 3 2 14 26 10 37 - Scarlet Fever 212 - 7 12 6 20 73 24 19 38 8 5 - 196 - Enteric Fever 8 - - - - - - -- - 2 1 - - 3 - Paratyphoid Fever 1 - - - - - - - - - 1 - - 1 1 Puerperal Fever 3 - - - - - - - - 2 1 - - 3 3 Puerperal Pyrexia 18 - - - - - - - 1 14 2 - - 17 - Cerebro Spinal Fever 1 - - - - - - - - - - - - 1 1 TuberculosisPulmonary 132 - - - - - - 3 6 72 19 27 5 57 62 Non-Pulmonary 25 - - - - - 5 - - 14 2 4 - 17 6 Ophthalmia Neonatorum 8 8 - - - - - - - - - - - 7 - Pneumonia 70 3 3 2 5 4 6 4 2 12 10 15 4 50 74* Malaria 1 - - - - - - - - - 1 - - 1 - Dysentery . 2 - - - 1 - - - - - 1 - - 2 - Totals 639 15 19 22 24 32 114 41 36 174 63 80 19 494 149 * Note.— This figure is for all forms of pneumonia, including Acute Primary Pneumonia and Acute Influenzal Pneumonia, which alone are notifiable 69 VACCINATION RETURNS. Return for 1933. Return made to the Borough Council and Ministry of Health on the 9th February, 1935, 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, 1933, 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, 1933. Number of these Births duly entered by 31st January, 1935, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1935, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1935, 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 1934. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccinaton Officer lrre spective of the dates of birth of the children to which they relate during the calendar year 1934 Col. I. Col. If. Col. IV. Col. V. Postpone ment by Medical Certifi. cate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to places unknown or which cannot be reached and Cases not having been found. Success fully Vaccin ated. Insuscep tible of Vaccination. Had SmallPox. Number in respect of whom Certificates of Conscientious Objection have Deen received. Dead. Unvaccinated 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 305 218 4 - 48 8 1 9 12 5 2,190 420 2. St. Mary 2,122 1,382 5 - 291 92 3 327 18 4 3. All Souls 454 321 7 - 25 16 1 76 4 4 Total 2,881 1,921 16 - 364 116 5 412 34 13 2,190 420 Dated 6th February, 1935. (Signed) GEORGE H. BASSETT, Vaccination Officer. 70