ackd simary 40 Borough of st. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1935. 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.l Borough of st. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1935. 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.l Vail & Co., Ltd. Printers London, W.l Public Health Department, Town Hall, St. Marylebone, W.i. 25th June, 1936. 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 1935. In accordance with the instructions of the Minister of Health the present report, like its predecessors of the last few years, is an "ordinary report" and more or less in the nature of an outline. In it I believe there will be found sufficient evidence to show that good and valuable work was done. As is indicated in the body of the report considerable changes were made in the personnel of the staff on the medical side particularly. Owing to the retirement of Dr. J. Donaldson Saner a vacancy occurred and this was filled by the appointment of Dr. B. W. Anderson. Though he had actually only been in the service of the Council as Tuberculosis Officer since 1921, Dr. Saner has been in charge of the Dispensary for over seven years previously as an officer of the Voluntary Committee. During that period he had co-operated with the other members of the Public Health staff, proving himself indeed the very acceptable colleague that he ultimately became when the Council took over the conduct of the Tuberculosis Scheme. As evidence of the value attached by the Council to the work done by Dr. Saner it may be mentioned he was twice granted an extension of service of one year, and on his departure the Council placed on record an expression of their appreciation of the value of the work he had done. I desire here to associate myself with the views of the Council and to express my regret at the loss of a colleague so skilled and so kindly and loyal. To Dr. Anderson, the successor to Dr. Saner, I should like to offer a word of welcome here, as I would also to Dr. W. H. S. Wallace, whose appointment as Assistant Medical Officer of Health and Maternity and Child Welfare Officer was necessitated by the transfer from the Marylebone Health Society of the duties in relation to Maternity and Child Welfare work at various clinics to the Council. In addition to welcoming these officers I express to them, as I do to all the members of the staff, my sincere thanks for the help they gave me personally and the loyalty they displayed. Finally, to the Public Health Committee, and its Chairman, Councillor Dr. Fuller, who has occupied this important position on a number of occasions, I am particularly grateful for the unfailing support they gave me and the kindness and consideration they have always shown me. I am, Mr. Mayor, Ladies and Gentlemen, your obedient Servant, CHARLES PORTER, Medical Ofjicer of Health PUBLIC HEALTH COMMITTEE. (Which is also the Committee appointed for the purposes of the Maternity and Child Welfare Act, 1918). 1935. 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. Y. Bright. Capt. Gerald Lowry. F. V. Cullen, F.S.I. Mrs. Anne Parker. Mrs. E. B. Davis. G. B. Ramsay. Dr. C. A. Fuller (Chairman). Mrs. E. M. Shirley. Mrs. C. Q. Henriques. H. Norman Toomey. Dr. Elizabeth Jacobs. CONTENTS. page page General Statistics 6 Infantile Mortality 28,29,30 Natural and Social Conditions Maternal Mortality 31 of the Borough. Deaths in relation to Disease Population 6 Diarrhoeal Diseases 31 Sanitary Circumstances 7 Infectious (Communicable) Water Supply 7 Diseases 31 Drainage 7 Phthisis and other Tuberculous Combined Drainage 8 Diseases 31 Closet Accommodation 8 Respiratory Diseases 31 Public Sanitary Conveniences 8 Cancer or Malignant Disease 32 Scavenging 8 Accident, Suicide and Man- Removal of House Refuse 10 slaughter 33 The Crown Estate 10 Prevalence of and Control over Removal of Offensive Refuse 10 Infectious Diseases Sanitary Inspection of the Diphtheria and Membranous Borough. Croup 33 Staff 10 Schick Testing and Diphtheria Swimming Baths 12 Immunization 34,59,62 Shops Act, 1934 12 Scarlet Fever 34 Nuisances 12 Enteric Fever and Paratyphoid ,, Legal Proceedings 14 Fever 34 Smoke Nuisances 14 Cerebro-Spinal Fever 34 Rat Repression 14 Encephalitis Lethargica 34 Pigeons 14 Polio-Encephalitis 34 Fouling of Footways by Dogs 15 Polio-Myelitis 34 Premises and Occupations con- Erysipelas 34 trolled by By-laws and Puerperal Fever and Puerperal Regulations. Pyrexia 34 (a) Business Premises 14-15 Measles and German Measles 35 Milk Premises 15 Whooping Cough 35 Slaughterhouses 15 Glanders and Anthrax 35 Offensive Trades 15 Smallpox 35 Premises used for Food Prepar- Vaccination 35, 81 ation 15 Infectious Diseases in Schools 36 Ice Cream Premises 16 Ophthalmia Neonatorum 36 Butter,Margarine, etc., Premises 16 Influenza 37 Bakehouses 16 Pneumonia 37 Fried Fish Vendors and Fish Food Poisoning 37 Curers 16 Tuberculosis 37 Factories and Workshops 16 Treatment 37 Inspection 17 Public Health (Tuberculosis) Defects found 17 Regulations, 1912 (Notifi- Home Work 18 cations) 38 Registered Workshops 19 Public Health (Tuberculosis) Other matters 19 Regulations, 1930 39 Rag Flock Acts, 1911 and Prevention 40 1928 19 Care Committee 40 (b) Premises used for Human Work and Dispensaries 41-45 Habitation 19 Deaths 46 Houses let in lodgings 19 Localisation of Disease 47 Common Lodging Houses 20 Disinfection 48 Underground Rooms 20 Vermin Disinfestation 48 (c) Premises that are not but should Cleansing of Persons 49 be Registered 20 Bacteriological Examinations 49 Food Stalls 21 Maternity and Child Welfare Food The Scheme 50-55 (a) Milk Supply 21 Summary of arrangements made for Milk Analysis 21 Maternity and Child Welfare 55-58 Bacteriological examination of Centres and Clinics 59, 60 Milk 21 Health Visitors 11, 60 Dairies, Milkshops, etc. 21 Ante-Nataliand Post-Natal Work 60-64 The Milk (Special Designations) "Toddlers" 60 Order, 1923 21 Dental Clinic 62, 64 Milk (Mothers and Children) Massage Clinics 62 Scheme 21 Schick Testing, etc., Clinics 32,59,62 Milk for School Children Scheme 22 Three-year-old Pre-School Clinic 62 (b) Foods other than Milk 22 Hospital Treatment 62 Food Inspections 22 Maternity Cases 62 Food, Unsound, Condemned 23 Infant Consultations—Work at 63 Food Premises 23 Day Nurseries 64 Bacteriological Examination 23 Home Helps 64 (c) Food and Drugs (Adulteration) Sanitary Administration— Act, 1928 23 Report of Mortuary Keeper 64 Reports of Public Analyst 23-26 Hospitals and Nursing Homes 64 Statistical— Local Acts and Orders 64 Births 26, 28 Housing, Inspections and Pro- Birth Registration 26 ceedings, etc 65-68 Birth Notifications 26 Housing Act, 1935 Deaths and Death Rates 27,28,78 Overcrowding Survey 68-73 Sub-District Births and Deaths 28,77 General Summary 73-75 Deaths in relation to Age 28,78 Ministry of Health, Tables I— V. 76—80 Causes of and ages at death 28, 31, 78 Vaccination Returns 81 6 GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921). 104,173. (1931) 97,620. (Estimated 1935) 92,200. Number of inhabited houses (1921), 18,507 ; (1931), 17,575. Number of inhabited houses (end of 1935) according to Rate Books, 18,645. Number of families or separate occupiers (1931), 27,352. Rateable value. £3,343,992. Sum represented by a penny rate. £12,702. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimate 781 374 407 Birth rate, 9.72 Illegitimate 115 53 62 Still Births, 34. Rate per 1,000 total births, 38. Deaths, 1,094. Death Rate, 11.7. Percentage of total deaths of residents occurring in public institutions, 12.0. Number of women dying in, or in consequence of, childbirth— from sepsis, 2; other causes, nil. Deaths of Infants under 1 year of age per 1,000 live births :— Legitimate 50. Illegitimate 96. Total 56. Deaths from Measles (all ages), nil. Deaths from Whooping Cough (all ages), 4. Deaths from Diarrhoea, 18. POPULATION. The population estimated to the middle of 1935 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 estimated figures for 1931 and of 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 1935 92,200 21,159 24,275 27,969 18,797 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 six premises. The reason for discontinuing the supply was in five cases the non-payment of rate, the other being for waste of water. 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 34 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 twelve. The number in 1934 was nineteen. In 10 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 1935 made 4,242 inspections. The total number of plans deposited was 540 in respect of 743 premises, as against 570 and 727 respectively in 1934. The number relating to new buildings was 65. The number deposited in 1934 was 63. In the case of old buildings, the number of plans received was 475. In 1934 the total number was 507. In the bulk of the cases the arrangements shown were in accordance with the by-law s 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 41 premises. The number in 1934 was 79. Closet Accommodation. In the table at page 13, 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 receive at least a twice weekly collection. In addition, over a great portion of the Borough a daily collection is made. In those 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, 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. In conjunction 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 9 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 fleet of house refuse collecting vehicles in use consists of entirely enclosed, end loading motor vans, steps being fitted to facilitate entry. As a result refuse collection is 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. A magnetic separator has been recently installed to to increase the tin and metal output. 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. As a result the quantity of unscreened refuse 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 practically nil. A 200 feet chimney shaft erected at the Council's Wharf at Paddington takes the emanations from the two destructor plants. This replaced two old shafts which have been demolished, and has resulted in the elimination of complaints regarding smoke. The Council also has under consideration a scheme for constructing an incineration plant to deal with the whole of the refuse collected. 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 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 content's 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 any possibility of a nuisance. During the year 1935/6 new street watering and additional gully cleansing vehicles and further chassis for the collection of house refuse containers were purchased. 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. 10 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, 1936 48,853 tons. Street Sweepings and Gully Refuse collected during the year ended 31st March, 1936 8,417 tons. A sum of approximately £2,700 was obtained from the sale of by-products (ashes, breeze, waste paper, metals, tins, rags, etc.). In addition, 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 135 premises at the request of the department, while 1,123 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.— Information with regard to the composition of the staff of the department at the end of the year is contained in the following statement. Actually during 1935, on the medical side especially, partly as a result of the retirement of Dr. J. Donaldson Saner from the post of tuberculosis officer and partly as a result of the transference by the St. Marylebone Health Society to the Council of their activities in relation to maternity and child welfare at various centres, considerable changes took place. Dr. H. Allen Bulman, originally appointed Assistant Medical Officer of Health and Public Vaccinator, was formally designated Deputy Medical Officer of Health. Dr. B. W. Anderson was appointed successor to Dr. Saner as Assistant Medical Officer of Health and Tuberculosis Officer, and Dr. W. H. S. Wallace as Assistant Medical Officer of Health and Maternity and Child Welfare Officer to conduct at the various welfare centres, in addition to other duties of a maternity and child welfare officer, the infant and other clinics formerly taken by a number of part-time medical officers appointed by the Health Society. Apart from these officers, some of whom acted only during part of the year, there was upon the staff of the Department 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 11 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. Deputy 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. Tuberculosis Officer and Assistant Medical Officer of Health : *‡B. W. Anderson, M.A., M.D., Ch.B. Assistant Medical Officer of Health for Maternity and Child Welfare Purposes: ‡W. H. S. Wallace, M.D., B.S. 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. *Tuberculosis Visitors. T. A. Cartledge, M.S.M. (a, b, d). Miss F. A. Baker (b). H. E. P. Corline (b, d). Miss S. Kenion (e, f, g, h). T. W. Forbes (b, d). *Tuberculosis Clerk-Dispenser. H. E. Scoble (c, d). Miss M T Challis. li. E. Willis, M.M. (a, b, d). *Outdoor Superintendent. A. S. Wilson (a, b, d). P. H. Hill (a,b,d) *Drainage Inspectors. , F. C. Cook (b, d). clerks. W. H. Draper (a, b, d). J. E. Curtis (Chief). *Food Inspector. W.J. Howe G. Smith (Senior Sanitary H.G.E Brown Inspector) (a, b, d). c D Turbayne. *Temporary Sanitary Inspector. R.G.Turner Disinfectors *Maternity and Child Welfare and J. C. Kendall. Tuberculosis Clerk. J. Overton. MlSS J. Jones. * Woman Sanitary Inspector. Maternity and Child Welfare Clerk- Miss M. McA. Sharp (c, e, f, g, h). Dispenser. * Women Sanitary Inspectors and Health Miss G. M. Courtnay. Visitors. Part-Time Midwives. Miss C. E. Durant (b, e, h). Nurse G. Dobbs. Miss N. C. Stokes, R.R.C. Nurse R. Topley. (b, e, f, g, h). Cleansing of Persons—Baths & Shelter. Health . V isitors. Miss L. Kilgallin (Matron). Miss E. F. Catterall (e, f, g, h). Mortuarv Keeper Miss D. T. Connell (e) Mortuary peeper. Miss E. D. Mann (e, f, g, h). Mrs. H SPears Miss M. C. Stewart (e,f). *Tuberculosis Dispensary. Part-Time Health Visitors. E. D. Marston (Caretaker). Miss L. Donnell (b, h). Messenger. Miss L. M. Hazel (h). E. W. Broughton. * Officers to whose salary contribution is made under the Public Health Acts or by Exchequer grants. a Royal Sanitary Institute Certificate. b Certificate Sanitary Inspectors' Examination Board (London). c Certificate of the Sanitary Inspectors' Examination Joint Board. d Meat and other Foods Certificate. e Health Visitors Diploma. f Central Midwives Board Certificate. g Certificate of State Registration for Nurses. h Three or Four Years' Hospital General Training Certificate. †Retired 30th September, 1935. ‡‡ Appointed 1st, October, 1935. § ,, 1st, April, 1935. 12 SWIMMING BATHS. At the Public Baths, in Marylebone Road, there are four swimming baths, viz.: large first class, small first class, second class and children's baths. The water from the two first class baths is dealt with by a filtration plant and that in the second class and children's baths is treated chemically. Samples, taken periodically, have, under bacteriological examination in the case of filtered water, yielded very satisfactory results, thereby showing the undoubted merits of the filtration system applied to swimming bath water. THE SHOPS ACT, 1934. Under this Act, the provisions of which came into operation on the 1st January, 1935, the Sanitary Authority became responsible for the inspection of shops and warehouses in connection with (1) the provision of suitable and adequate sanitary accommodation for the workpeople, (2) the provision of proper ventilation, and (3) the maintenance of reasonable temperature. During the period under review 368 shops were inspected. In 98 instances notices were served in respect of contravention of the Act and in all cases the defects were remedied. NUISANCES. In the following summary some idea of the amount of work done in relation to nuisances is given. For details of other works carried out by the inspectors, reference must be made to the sections dealing with housing, food, infectious diseases, etc. In regard to nuisances, the first point to note is that the total number of complaints received was 2,473, as against 2,614 in 1934. The majority of these complaints were made by the inspectors themselves, thought 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, 53 statutory notices were issued, the figure being 65 in 1934. Of these notices, 32 related to ordinary nuisances (dirt, dampness, etc.), 12 to verminous rooms, 5 to insufficient w.c. accommodation, 1 to insufficient dustbins, 1 to overcrowding, and 2 to defective drains. The 12 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1922, and referred to 27 rooms. The number of notices in 1934 was 13. In 2,420 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 one instance it was necessary to institute legal proceedings to enforce compliance with the statutory notices. 13 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 100 228 119 127 10 43 717 Doors, windows, floors, ceilings sash cords, grates and flues etc., repaired 117 157 81 17 17 19 408 Verminous rooms 33 713 108 68 42 75 1039 Dirty and verminous furniture and bedding cleansed 4 703 12 19 5 4 747 Overcrowding abated - 7 10 - - - 17 Underground rooms (illegal occupation) dealt with 1 1 9 12 6 - 29 Water closet defects remedied 98 45 59 72 34 30 338 Insufficient and unsuitable Water closet accommodation remedied 5 4 1 2 3 16 31 Urinal defects remedied - - - 1 1 - 2 Drains and Water closet stoppages cleared 5 12 8 8 14 18 65 Drains relaid or amended 19 12 5 3 9 1 49 Soilpipes and ventilating shafts repaired or renewed 4 1 5 1 3 5 19 Waste pipe defects remedied 18 11 13 7 6 6 61 Yard defects remedied 46 33 21 23 18 9 150 Wash-house defects remedied 53 22 20 28 15 3 141 Area defects remedied 5 5 6 19 17 1 53 Basement, defects remedied 5 - 1 - - - 6 Roof gutters, roofs repaired 65 62 49 22 22 10 230 Water supply to houses reinstated - 5 l - 1 - 7 Water supply laid on to upper storeys 1 3 l 4 1 - 10 Water cistern defects remedied 8 5 5 11 2 3 34 Dung or dust receptacles repaired or renewed 11 20 20 26 4 6 87 Rubbish, manure, etc., accumulations removed 14 23 28 23 32 12 132 Workshops, dirty - - 2 3 2 2 9 „ overcrowded - - - - 2 7 9 ,, insufficiently ventilated 1 - - 1 - 3 5 Animal nuisances abated - 3 1 1 5 6 16 Rats and mice infestation - 1 4 17 1 1 24 Bakehouses dirty 1 - - - - - 1 Smoke nuisances 1 7 - 4 - 3 15 Shop insufficiently ventilated or heated 2 26 15 26 - - 69 Miscellaneous 84 44 22 55 21 3 229 14 LEGAL PROCEEDINGS IN CONNECTION WITH NUISANCES. In only one case was it found necessary to institute proceeding's in Court in this connection, this being for failure to comply with a Statutory Notice to carry out certain cleansing works. The summons was withdrawn upon completion of the work. Smoke Nuisances. During the year 1935, 255 observations were made and 10 complaints were received and dealt with. In each case the attention of the offender was drawn to the matter. As a result of frequent observations and co-operation with the owners of the property, the trouble arising from fumes from furnaces burning oil-fuel has been almost entirely eliminated, and there was no complaint of nuisance from this source. 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, in 1933, 49, in 1934, 44, and in 1935, 45. The investigation of these complaints necessitated the inspection of 55 premises, 19 of which were found to be rat infested. Included in this latter number were 8 business premises (4 of these for the preparation or storage of food), the remaining 11 being 3 vacant sites and 8 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 1935 National Rat Week, contains a certain amount of information that may be found interesting : National Rat Week (the seventeenth of the series), was held from November 4th to 9th, 1935. So far as St. Marylebone was concerned, the suggestions of the Ministry of Agriculture were adopted wherever practicable, and the lines of the campaign followed closely those which have been found effective in the past, details of which have been reported to the Council and to the Ministry from year to year since the series of Rat Weeks was inaugurated in 1919, the year of the passing of the Rats and Mice (Destruction) Act. It was again pointed out that, while attention was specially concentrated on the problem of rat infestation during the one week in November specifically set aside for the purpose, the question is one with which the Council is constantly dealing, and that mainly as a result of the measures taken there would appear to be little doubt that the situation is improving and that the problem has become less acute in the Borough in recent years. A point of minor importance noted was that since the use of poisons has been replaced by the employment of an improved type of break-back trap in the sewers, the visual results obtained have created a greater interest on the part of the men engaged in the 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. Ten complaints were made in 1935, as against six in 1934, relating to business premises (in five cases), 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 15 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, 25 prosecutions undertaken being on the reports of police officers. In 21 cases the defendant pleaded guilty, and the fines imposed amounted to £8 8s. 6d. In three cases the summonses were not served, and in a fourth summons was withdrawn, the defendant being under sixteen years of age. Including these cases the total number of prosecutions since the bye-law came into operation in 1928 is 65, the amount of fines imposed being £24 13s. Od. PREMISES AND OCCUPATIONS CONTROLLED BY BY-LAWS AND REGULATIONS. The following list sets out the majority of the premises and occupations of the class referred to in the heading to this part of the report, and contains a certain amount of information with regard to registration, inspection, etc. Underground rooms and underground sleeping rooms, though controlled, the former under the Public Health (London) Act, 1891, and the latter under special regulations under the Housing Acts, are not registered. Number of premises Number of inspections 1935 Number of notices 1935 Number of prosecutions, 1935 On register at end of 1934 Added in 1935 Removed in 1935 On register at end of 1935 A. Business Premises Milk premises 163 16 29 150 260 6 - Slaughterhouses 1 - - 1 14 - - Poultry Do. 1 - - 1 22 - - Offensive trade premises 1 - - 1 22 - - Ice cream premises 86 7 - 93 126 7 - Butter and Margarine Manufacturers and Dealers 16 - - 16 60 - - Bakehouses 58 - 1 57 113 4 - Fried Fish Shops 25 - - 25 55 6 - Fish Curers 6 - - 6 76 - - B. Habitations Houses let in lodgings 1,055 - - 1,055 7,107 829 - Common lodging houses 3 - 1 2 77 - - A.—BUSINESS PREMISES. Milk Premises.— The number of premises upon which milk is sold is 150. 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 1935 only one premises within the Borough carried on a trade classed as offensive, that being the slaughter of poultry. The Food Inspector made 22 visits, but no cause of complaint was found. Premises used for Food Preparation.— The London County Council (General Powers) Act, 1932, in 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 16 intended for sale, and the Council have authorised the Public Health Committee to administer the powers given under the Act. At the end of 1935, 90 premises were 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 1935 was 93, 7 more than in 1934. Regular inspections were made throughout 1935, and in 7 cases notices were served in respect of uncleanly conditions. Butter, Margarine, etc., Premises.— Information with regard to the sampling of these substances will be found under the heading "Food and Drugs (Adulteration) Act, 1928." At the end of the year there were on the registers 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 1935 the number of bakehouses on the register was 57, 48 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 that 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 113 visits were paid and 4 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. During the year four summonses were issued against the owner of a bakehouse where refuse and filth had been allowed to accumulate, and in which due cleanliness had not been observed. The defendant was fined 10/- and 21/- costs on each of the four summonses. 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. 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 2,419. The complaints received numbered 57. 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 215 32 - (Including Factory Laundries) Workshops 1,384 51 - (Including Workshop Laundries) Workplaces 820 54 - (Other than Outworkers' Premises included in Part 3 of this Report) Total 2,419 137 - 2,—DEFECTS FOUND. Particulars (1) Number of Defects Number of Prosecutions (5) Found (2) Remedied (3) Referred to H.M. Inspector (4) Nuisances under the Public Health Acts— Want of cleanliness 22 22 - - Want of ventilation 5 5 - - Overcrowding 9 9 - - Want of drainage of floors 2 2 - - Other nuisances 30 30 - - Sanitary accommodation insufficient 4 4 - - unsuitable or defective 35 35 - - not separate for sexes 9 9 - - 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) 4 4 - - Other offences - - - - (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 120 120 -- 3.—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN ON WHOLESOME 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 lisis. Failing to send lists. Outworkers. Outworkers. Lists. Contrac tors. Workmen. Lists. Contrac tors. Workmen. (1) (2, (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 67 277 879 ... ... ... 17 ... ... ... . . . ... ... ... ... Total 67 227 879 ... ... ... 17 ... ... ... ... ... ... ... ... 18 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. 1,756 Coffee Shops, &c. 459 Bakehouses 57 Total number of workshops on Register 2,272 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 were originally 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 5.— OTHER MATTERS. Class Number (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 57 Reports (of action taken) sent to H.M. Inspector 57 Other - Underground Bakehouses (s. 101) :— Certificates granted during the year - In use at the end of the year 48 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 7,107 visits were paid to the 1,055 houses carried over from the old list. The number of intimation notices served was 829, relating to cleansing and other defects. Except in 45 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 436 men "Porfcman House" (late Shaftesbury Institute), Harrow and Daventry Streets, Lisson Grove The Rev. Prebendary Wilson Carlile, C.H., D.D. 100 women 488 men 100 women * Closed down 26th December, 1935 Total 588 During 1935 77 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 1935 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 25 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 end of 1935 there were 398, this number including: restaurant, dining room and coffee shop kitchens, 227; tea-rooms and pastry-cooks, 110; hotel kitchens, 30; 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 1935, the total number of inspections was 126, the number of notices served being 12. 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, 43; 2nd Quarter, 34; 3rd Quarter, 46; 4th Quarter, 46, making a total for the year of 169. 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, 25 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, 10 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 21 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 11 in respect of "Certified" Milk, 13 for Grade "A" (Tuberculin Tested) Milk, 29 "Pasteurised" Milk, 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. Milk (Mothers and Children) Scheme.—During 1935 there has been no change in the methods adopted in relation to the supply of milk to mothers and children. 22 Up to 31st March, 1936, the amount expended was £792 14s. 5d., as against £938 3s. 6d. in the year ended 31st March, 1935. The actual number of cases dealt with was 340, and the number of orders issued 2,080, which were slightly smaller figures than those for 1934. when the cases numbered 362 and the orders 2,262. 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 approximately the same as in 1934. 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. Davis, 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.—The scheme for the provision of milk to school children under the auspices of the Milk Marketing Board came into operation on 1st October, 1934. 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. 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 1935, 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 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 1935, as formerly, the special Saturday night and Sunday inspections in market streets, etc., were made, and in carrying them out Inspector Smith received the assistance of other members of the staff having the necessary qualifications and experience. On a great many occasions the inspector was called by vendors to examine articles of food under Section 47 (8) of the Public Health (London) Act, 1891, and to accept surrender of such as were unsound or unwholesome or unfit for food. 23 Amongst the articles dealt with in this way were:— Unsound and Diseased Food Condemned and Destroyed During the Year 1935. Meat— Beef 35 Stone Lamb 34½ „ Pork 11 „ Mutton 8 „ Veal 4 „ Rabbits 4 doz. Bacon 7 cwt. Fish— Rock Salmon 5 Stone Lemon Soles 4 „ Cod 13 „ Cod Fillets 7 „ Roe 1 Box Smoke Haddock 4 Boxes Kippers 10 „ Crabs 1 Barrell Prawns 6 Gallons Fruit & Vegetables— Apples 1 cwt. Oranges 14½ Boxes Apricots 26 „ Grapes 2 „ Potatoes 4 Bags Miscellaneous (Tinned Goods, etc.). Corned Beef 395 tins Chicken and Ham Roll 36 „ Brawn 47 „ Pork 5 „ Sausages 9 „ Briskets of Beef 24 „ Veal 23 „ Ox Tongues 46 „ Chicken 16 „ Hams, Gammons, etc. 418 „ Lunch Tongues 7 „ Cream 434 „ Lambkins 16 „ Cheese 104 boxes 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 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 1935 was 1,065, the figure for 1934 being 1,055. Of this number only one was reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of 0.1 as against 0.5 in 1934. 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. The following Tables and Report from the Public Analyst, Mr. J. F. F. Rowland, give full information with regard to samples submitted to and examined by him:— ANNUAL REPORT OF THE PUBLIC ANALYST, 1935. The number of samples taken under the Food and Drugs (Adulteration) Act and submitted for analysis, was 1,065. The following is a complete list of the articles sampled:— 24 ANALYSES Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total 1 Ale 1 1 1 1 2 Arnica Tincture of — 1 — 1 3 Bicarbonate of Soda — 6 — 6 4 Brandy — 1 — 1 5 Butter 112 238 — 350 6 Butter and Roll — 31 — 31 7 Butter and Bread — 1 — 1 8 Camphorated Oil — 1 — 1 9 Candied Peel — 1 — I 10 Cheese — 47 — 47 11 Cinnamon — 1 — 1 12 Cinnamon Essence — 3 — 3 18 Cocoa — 16 — 16 14 Cod Liver Oil — 1 — 1 15 Coffee — 17 — 17 16 Cream (Loose) 22 4 — 26 17 Cream (Tinned) — 6 — 6 18 Flour — 1 — 1 19 Gin — 12 — 12 20 Gregory Powder — 2 — 2 21 Herbs, Mixed — 4 — 4 22 Honey — 16 — 16 23 Honey Jelly — 1 — 1 24 Iodine (Tincture of) — 9 — 9 25 Jam — 48 — 48 26 Lard — 60 — 60 27 Lardeen — 1 — 1 28 Liquorice Powder — 2 — 2 29 Margarine — 17 — 17 30 Marmalade — 9 — 9 81 Milk 125 44 — 169 82 „ Condensed — 10 — 10 33 Mincemeat — 2 — 2 34 Mint (Dried) — 2 — 2 35 Mustard — 18 — 18 36 Mustard Mixtures — 1 — 1 37 Ointment, (Boric) — 10 — 10 38 Ointment (Iodine) 2 — 2 39 Ointment (Sulphur) — 2 — 2 40 Olive Oil 2 — 2 41 Paraffin Liquid — 4 — 4 42 Parrish's Food — 10 — 10 43 Paste (Fish) — 6 — 6 44 Paste (Meat) 11 — 11 45 Peas, Tinned — 3 — 3 46 Pepper — 10 — 10 47 Pills (Blaud's) — 1 — 1 48 Powder (Lemonade) — 6 — 6 49 Powder (Seidlitz) — 2 — 2 50 Raisins — 2 — 2 51 Repova — 1 — 1 52 Rice — 13 — - 13 53 Salmon (Tinned) — 3 — 3 54 Sardines (Tinned) — 12 — 12 55 Sausages (Beef) — 2 — 2 56 Sausages (Pork) — 4 4 57 Sherbert 3 3 58 Spice (Mixed) — 5 — 5 59 Sponge Cakes — 2 — 2 60 Sugar — 10 — 10 61 Sultanas — 2 — 2 62 Sweets 8 — 8 63 Tartaric Acid — 4 — 4 64 Tea — 17 — 17 65 Vinegar — 1 — 1 66 Whisky — 10 — 10 67 Wine (Ginger) — 1 — 1 68 Wine (Raisin) — 1 — 1 69 Witch Hazel — 1 — 1 Total 259 805 1 1,065 1 1 25 Adulterated Samples, etc. 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 the only sample found to be adulterated:— Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 162 Ale Private The sample contained at least 0.003 per cent. of phenol. The sample had undergone no change which would interfere with the analysis. Milk.—Of the 169 samples examined, none was adulterated. The average composition of the milk taken during the year as well as those of the two years preceding was as follows:— Total Solids Solids Year. Sp. Gr. Fat. not Fat. 1933 1031.4 12.2 3.50 8.70 1934 1031.5 12.17 3.56 8.71 1935 1031.0 12.07 3.47 8.60 Cream.—26 loose creams were examined during the year and 6 tinned creams. None was adulterated and the average composition of each kind was as follows:— Fat. Preservatives. Loose 46.45 Nil. Tinned 26.40 Nil. It is very satisfactory to note that of the samples taken during the year 1935 only one was adulterated and that probably by accidental contamination; but new food products previously unheard of keep appearing in commerce, and as naturally no standards are avilable for such newcomers, it becomes necessary to determine their exact chemical composition and to decide whether they contravene the Food and Drugs (Adulteration) Act in any way or are likely to be injurious to the consumer. Equally also it is necessary to determine if their real food value bears any reasonable relationship to the price charged or to the claims, if any, made for it by the manufacturer. During the year two such new products were investigated—"Repova" and "Honey Jelly." The directions given for using "Repova" were as follow: "Always replace at least a quarter of your egg content with the same quantity of Repova (i.e., instead of using 4 lbs. of eggs to a mixture use 3 lbs. eggs and 1 lb. Repova, etc.)." Suggesting that 1 lb. eggs = 1 lb. Repova. On the analysis, the calorific value of Repova as compared with eggs proved to be:— 1 lb. Repova = 95.0 calories. 1 lb. eggs (with shells) = 635 calories. On analysis this article was found to consist mainly of the carbohydrates, soluble starch, dextrine and dextrose and was in no way equal in food value to the same weight of egg; Indeed, not one but 6—7 lbs. of Repova must be taken to obtain even the theoretical calorific value only of an equal weight of egg, leaving out of all account the wonderful balance existing between the various food constituents present in the egg itself which Repova makes no attempt to imitate. When foods bearing new and fanciful names are put upon the market the purchasing housewife has to rely solely upon her native wit and acumen. No legal ruling is at her elbow and nothing in the way of guidance is available to help 26 her decide whether to purchase or not to purchase. And in the case of a substance bearing such a name as "Honey Jelly" her decision would depend upon her reaction to the name and whether in its market dress the food made a strong enough appeal. Under such a designation she would scarcely expect to obtain pure honey, but she might expect to obtain a fair proportion of honey incorporated in a new and attractive form. Yet in this instance the compound consists essentially of gulcose gelatinized in agar-agar and containing at the most not more than 2.0 per cent, of honey. Having such a composition, the substance, it may be said, has a certain food value, is inexpensive and contains nothing injurious to health. Ale.—The sample of ale (serial No. 162) was private and was submitted for examination on account of a taste of phenol having been noted. The presence of a trace of phenol was in fact detected, but extensive enquiries about the methods used for cleaning beer bottles at large bottling establishments having failed to yield evidence that phenol in any form was used for such purpose and in view of the fact that no other complains were made a safe conclusion would appear to be that the presence of phenol in this ale was an instance of isolated and possibly accidental contamination.—(Signed) J. F. F. Rowland. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1935 was 896,* being 63 more than in 1934. Of the children born, 427 were boys and 469 girls. The birth rate per 1,000 of the population was 9.72, as against 9.00 in 1934. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1935, with those of each of the five previous years:— 1930 1931 1932 1933 1934 1935 All Souls 10.1 8.9 8.5 7.0 6.8 8.5 St. Mary 10.4 13.2 11.2 7.8 8.7 8.8 Christ Church 14.1 14.4 13.5 12.7 12.5 12.3 St. John 13.8 11.9 9.1 11.0 7.2 8.9 The Borough 12.1 11.4 10.9 9.7 9.0 9.7 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,776; live births, 3,581; still births, 195. The total notifications in 1934 was 3,380. 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 235 births which occurred outside the district, and which have been transferred as belonging to St Marylebone:— Legitimate Males 87 ,, Females 103 Illegitimate Males 24 ,, Females 21 Total 235 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. From parents 8 „ doctors 100 „ midwives 261 „ hospitals, nursing homes, etc. 3,407 3,776 Of the total births notified, 195 referred to still-births (115 males and 80 females); 2,178 took place at Queen Charlotte's Hospital; 257 at Middlesex Hospital; 143 at the St. Marylebone Home; and 427 were born at home. Of those notified as having occurred in St. Marylebone 2,998 belong to other Boroughs. Of the 195 still-births 20 (11 males and 9 females) were to St. Marylebone mothers. DEATHS AND DEATH RATES. The number of deaths registered in 1935 was 1,094. 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 11.7. In the previous year, the rate was 12.6 and the number of deaths 1,171. The following short table shows the death-rates in the several registration sub-districts in 1935, and compares them with those of the preceding 5 years. 1930 1931 1932 1933 1934 1935 All Souls 10.2 10.8 12.8 10.5 10.9 11.2 St Mary 11.5 12.4 11.4 12.7 12.1 10.9 Christ Church 11.8 18.1 14.1 14.2 13.8 12.9 St. John 12.1 12.6 12.8 12.1 13.3 11.8 The Borough 10.6 12.3 12.4 12.2 12.6 11.7 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 1935 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, 1935, are given in the following table. A further table giving the vital statistics of separate localities for 1935, and the ten preceding years, will be found amongst the Ministry of Health Tables on page 77. Sub-District. Population estimated to middle of 1955. Males. Births. Females. Total. Males. Deaths. Females. Total. All Souls 21,159 99 89 181 112 128 240 St. Mary 24,275 109 94 203 118 150 268 Christ Church 27,969 149 196 345 190 173 363 St. John 18,797 77 90 167 113 110 223 The Borough 92,200 427 469 896 533 561 1,094 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 1935. For purposes of comparison the table for 1934 is reproduced. 1935. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 15 14 9 12 50 Persons of 65 years and upwards 144 159 129 156 588 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 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 78. 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 1,030. 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 1935 was 50, and the number of births in that year 896. The infantile mortality rate is therefore 56. In 1934 the figure was 61 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 1935, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 23 were less than one month old when they died and 32 less than three months. The corresponding figures for 1934 were 18 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 17 in 1935 and 15 in 1934. Diarrhoea and enteritis (7 and 8) accounted for 7 in 1935 and 14 in 1934. Respiratory diseases took 3 in 1935 and 7 in 1934. Amongst the other causes of death, mention may be made of whooping cough and injury at birth, both of which accounted for 3. Again this year, "overlaying" does not appear on the list of death-causes. Christ Church, which always contributes most largely to the infantile as to most of the other mortality rates, being the most thickly populated area and that in which there is most poverty, most overcrowding and most neglect of ordinary precautions, is again at the head of the list with 20 deaths amongst infants. In 1934 the figure was 24. TABLE A. Infant Mortality Nett Deaths from Stated Causes at various ages under 1 Year of age, and in Sub-Districts. No. CAUSE OF DEATH Under 1 Week 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 1 Month 1 and under 3 Months 3 and under 6 Month* G and under 9 Months 9 and under 12 Months Total Deaths under 1 Year All Souls St. Mary Christ Church St. John Total 1 Small-Pox - - - - - - - - - - - - - - - 2 Chicken-Pox - - - - - - - - - - - - - - - 3 Measles — — — — - — - - — — - - - - - 4 Scarlet Fever — — — — - - - - — - - - - - - 5 Diphtheria and Croup — — — — — — — — — — - - - - - 6 Whooping Cough — — — — — — 1 2 — 3 - — 2 1 3 7 Diarrhoea — — — — — — 1 1 — 2 1 - 1 - 2 8 Enteritis 1 — — — 1 3 4 3 4 15 4 4 6 1 15 9 Tuberculous Meningitis — — — — — — - — — - - - - - - 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation 1 - - - 1 1 - - - 2 1 1 - - 2 13 Premature Birth 10 3 — — 13 1 — — — 14 3 2 5 4 14 14 Atrophy, Debility and Marasmus - - - - - - - 1 - 1 - - 1 - 1 15 Atelectasis - - - - - - - - - - - - - - - 16 Injury at Birth 8 - — — 3 — — — 3 1 - 1 1 3 17 Erysipelas — - — — — — - - — - - - - - - 18 Syphilis - - - - - - - - - - - - - - - 19 Rickets — - — — — - - - - - - - - - - 20 Meningitis (not Tuberculous) - - - - - - - - - - - - - - - 21 Convulsions — - - - - - - - - - - - - - - 22 Gastritis — ___ - - - - - - - 23 Laryngitis — - — — - - - - 24 Bronchitis — - — — 1 1 - 1 - - 1 25 Pneumonia (all forms) — - — 1 1 1 — 2 - 1 1 2 26 Suffocation, Overlying — - — — — — - - - - 27 Other Causes 4 - — — 4 2 1 — — 7 - 2 3 2 7 Totals 19 3 — 1 23 9 7 7 4 50 10 10 20 10 50 30 M. F. Nett Births Legitimate, 874 407 Nett Deaths ln the Year Legitimate Infants, M.F. 17 22 Illegitimate Infants, M.F. 6 5 Total 23 27 50 Nett Stillbirths in the year. Legitimate Infants' M. F. 9 13 illegitimate Infants, M.F. 2 4 Totals 11 17 28 in the Year, Illegitimate 53 62 Total 427 469 896 31 MATERNAL MORTALITY. In 1935 the number of deaths due to conditions connected with or consequent upon child-birth was 2, the Maternal mortality rate being 2.2 per 1,000 births. In 1934 there were 4 deaths, the death-rate being 4.8 per 1,000 births. With regard to the 1935 deaths it may be noted that both occurred in hospital, one of the women being 29 and the other 35. In each case death was stated to be due to puerperal sepsis. 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 78. This Table also shows the distribution of deaths according to causes in the various registration sub-districts. The following notes with regard to certain of the causes which contributed most largely to the death rate, may be of interest. DIARRHOEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 18, equal to 0.19 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1935 this was the case also, no fewer than 17 of the 18 being children under 1 year of age. In 1934, the deaths from diarrhoeal diseases numbered 17, and of this number 13 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 9 deaths, and including diarrhoea (18 deaths) the total number registered as due to them was 26. Of these deaths, 2 were caused by paratyphoid fever and 4 by whooping cough. No death was caused by scarlet fever or by measles, and only two by diphtheria. In 1934, 37 deaths were due to infectious diseases excluding influenza, which caused 12 deaths. The figure in 1933 was 22. 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 72, 68 being recorded in 1934. The great bulk of the 72 deaths, viz., 63, was due to phthisis. The number in 1934 was 62. Of the total number of deaths registered (1,094), the percentage due to phthisis was 5.8, as against 5.3 in 1934. The age periods at which the deaths occurred were: 15—25, 9 (14%); 25—45, 22 (35%); 45—65, 22 (35%); 65 and over, 10 (16%). The subject of phthisis is further discussed in connection with the notification and prevention of tuberculosis. RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 72. This is lower by 47 than the figure (119) for 1934. 32 The death-rate was 0.78 per thousand. In 1934 the rate was 1.29. The number of deaths certified to be due to bronchitis was 19. Of this number 13 were amongst persons aged 65 and upwards, and 3 amongst those of the group 46—65. Three were under 45. The deaths traceable to pneumonia numbered 41 and, as in the case of bronchitis, the later age groups contributed the greatest numbers. The number of cases of pneumonia notified in 1935 was 33. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in the table on page 78. Visits were paid to each of the notified cases, 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 181 and the death-rate 1.95 per 1,000 of the population. These figures are almost identical with those for 1934, when the deaths numbered 180, and the rate was 1.94 per 1,000. Information with regard to the situation of the disease and the age at which death occurred is given in the following tables:— Cancer : Ages at Death. Ages under 1 2 and under 5 5 and under 15 15 and under 25 25 and 35 and under 35 under 45 45 and under 55 55 and under 65 65 and under 75 75 and upwards Total Males _ _ _ _ 1 4 14 25 24 5 73 Females _ _~ _ _ 3 6 17 28 30 24 108 Totals — — — — 4 10 31 53 54 29 181 Cancer.—Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 4 2 6 Throat, Neck, Gullet 10 2 12 Stomach 14 13 27 Intestines l5 16 31 Liver 5 7 12 Breast — 23 23 Uterus and Generative Organs 5 15 20 Various 20 30 50 Totals 73 108 181 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 1935 numbered 58. Of these 11 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 79. The following table shows the number of cases of infectious disease notified during the past six years:— 1930 1931 1932 1933 1934 1935 Smallpox 6 2 — - - — Diphtheria 271 154 83 78 104 119 Erysipelas 61 55 55 76 59 35 Scarlet Fever 226 258 192 198 212 155 Enteric Fever 9 9 3 7 3 3 Paratyphoid Fever 6 3 4 2 1 3 Continued Fever — — — — - — Puerperal Fever 8 11 5 8 3 10 Puerperal Pyrexia 25 22 26 17 18 36 Cerebro-spinal Meningitis 4 5 2 1 1 1 Tuberculosis (Pulmonary) 141 145 140 148 132 93 Tuberculosis (Non-Pulmonary) 20 17 23 16 25 19 Acute Poliomyelitis 2 1 1 — — 3 Polio-Encephalitis — — — — — 1 Ophthalmia Neonatorum 16 10 8 6 8 10 Encephalitis Lethargica 2 — — 1 — — Pneumonia 42 80 77 74 70 33 Malaria 1 — 1 — 1 1 Dysentery — — 2 1 2 3 Totals 840 772 622 633 639 525 Diphtheria and Membranous Croup. There were 119 cases of diphtheria notified during 1935, 2 deaths resulting. In 1934 there were 104 cases, 2 deaths 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 6 cases the source appeared to be a member of the family previously infected; in 5 cases infection was counted to have been acquired in school, and in 13 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 804, a positive result being returned in 71 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 61. In All Souls the number was 13, in St. Mary 32 and in St. John 13. The age group 5—15 was most affected, 61 of the cases falling into this group. No application was made for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910. The nuisances detected during the course of investigating the notified cases were: Dirty premises, etc., 5. These were all remedied after service of notices. 34 Diphtheria Immunization.-The Schick Testing and Diphtheria Immunization Clinic opened at the beginning of 1928, continued to operate under Dr. Bulman at 113, Marylebone Road. The following table and summary give details of the work of the clinic during the year. Attendances 2,308 New cases 628 Schick negative 25 Completely immunised (3 injections but not retested) 485 Retested 299 Positive after retest 5 Visits re patients 201 Scarlet Fever. Notifications of this disease numbered 155, the highest number of cases reported in any one week being 9. There were no deaths from scarlet fever during 1935. In 1934 there were 212 notifications, no deaths resulting. The districts to suffer most from the disease were Christ Church and St. Mary. In the former there were 82 cases and in the latter 39. In All Souls there were 24 and in St. John 10. As usual, the majority of the patients were children of school age, the age group, 5—15, giving over one-halfl (80) of the total. Of the remainder, 37 were aged under 5 years, and 38 15 years of age and over. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 19 instances that a definite connection could be made out. Defects in sanitation to the number of 8 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. Three notifications of Enteric Fever and three of Paratyphoid Fever were received. There were two deaths. 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. Encephalitis Lethargica, Polio-Encephalitis and Polio-Myelitis. The first of these diseases was entirely absent from the Borough during the year, but one case of Polio-Encephalitis and three cases of Acute Polio-Myelitis were notified. No death resulted. Erysipelas. The notifications of erysipelas numbered 35, and there were no deaths. Most of the acses were notified from St. Charles' Hospital and the General Hospitals, and 24 patients were treated in such institutions. Puerperal Fever and Puerperal Pyrexia. The number of cases of Puerperal Fever notified was 10. Particulars of the 2 deaths attributed to these conditions are given under the heading Maternal Mortality. In each case, other than where the notification was in respect of a non-resident in-patient of an institution, a visit was paid by one of the Health Visitors and assistance and advice as was suitable and possible offered. 35 The Puerperal Pyrexia cases notified during the year numbered 36; 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 1934 was 18. Measles and German Measles. These diseases showed no epidemic tendency during 1934, but although they are not now notifiable, 8 cases were reported voluntarily by doctors and parents and 26 notices of cases and contacts were received from school teachers. There were no deaths. The course adopted in relation to the reported cases was the same as in previous years. Practically every case was visited by the Health Visitors, particular attention being given to such as occurred in tenement houses. It was not found necessary to obtain the services of a Nurse under the agreement between the Council and the Paddington and Marylebone Nursing Association. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1935 the number of deaths registered as due to whooping cough was 4. There were 5 deaths from the disease in 1934. 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 81. The following statement gives some information with regard to the work done and the results obtained by Dr. Bulman during 1935. Number of visits paid 1,698 Number of vaccinations— Primary 520 Re-vaccinations 96 616 Number of successful vaccinations 578 Number of unsuccessful vaccinations 38 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 1935. INFECTIOUS DISEASE IN SCHOOLS, 1935. (CASES and CONTACTS) Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 2 4 7 1 - 14 Barrett Street — — — — — — Barrow Hill Road 2 6 15 10 4 2 Bell Street 8 20 2 7 1 6 Capland Street 6 18 14 60 2 12 Catholic, Richmond Street — — — — — — Christ Church, Cosway Street 20 6 3 9 1 1 Convent (St. Edward's), Little Union Place — 1 — — — — Cosway Street (L.C.C.) 20 11 5 23 1 9 Emmanuel, Aberdeen Place — 7 3 18 1 6 Gateforth Street 1 1 — 1 — 1 Hampden Gurney 5 3 12 8 3 9 Homer Row, Catholic 2 4 19 2 — — Jewish, Hanway Street — — — — — — Polytechnic, Regent Street — — — — — — Regent's Park Central 4 2 — 2 — — St. James's, Marylebone Lane — 1 — — — — St. Luke's, Nutford Place 8 — — 8 — 2 St. Mark's, Violet Hill 4 8 4 19 — 1 St. Marylebone Central, High Street 16 17 9 7 6 43 St. Marylebone Grammar 7 — 1 8 2 3 St. Mary's (Western) York Street 5 15 13 32 — 2 St. Paul's Bentinck, RoBsmore Road 70 27 12 12 3 12 St. Thomas', Orchard Street 1 15 2 1 — 2 St. Vincent, Wigmore Street — 1 — 4 — 28 Upper Marylebone Street 2 6 6 8 1 19 Schools in other Boroughs 12 3 1 8 1 18 Totals 195 171 128 248 26 190 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 1935. The total number of cases notified was 10, as against 8 in 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 10 2 8 8 — — — 2 37 INFLUENZA. This disease was less prevalent than in 1934, though correct information as to the number of cases was, of course, unobtainable. The deaths certified as due to Influenza numbered 9, as against 12 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 79 and 32. The services of the nurses were requisitioned in 12 cases and 242 visits were paid. The number of deaths certified as due to all forms of this disease was 41. FOOD POISONING. Only three notifications of food-poisoning or suspected food-poisoning were received under Section 7 of the London County Council (General Powers) Act, 1932, as against 31 in 1934 and 13 in 1933. Enquiries were made into each case. Pork pie, sardine and beef each came under suspicion, but no definite evidence as to the responsibility of these articles was obtainable. In no case was it necessary to remove the patient to hospital and all quickly recovered. TUBERCULOSIS. In all 112 notifications were received, 93 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 72 2. The number of cases unnotified or notified at death 18 3. The number of cases notified within a month of death 11 4. The number of cases notified within three months of death 7 5. The number of cases notified within six months of death 3 Treatment of Tulberculosis.—Of the cases notified 234 received some form of institutional treatment, and during the year every effort was made to obtain admission to sanatoria of cases deemed suitable for such treatment. Of the total new cases notified 65 were insured persons and were admitted and readmitted from time to time during the year to sanatoria and hospitals for treatment, the total admissions numbering 88. Non-insured persons numbered 47, the total admissions for theee patients being 58, including 8 children. Nurses were sent in to 10 cases and 522 home visits were paid. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1935, to the 31st December 1985. 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 85 35 to 45 45 to 55 55 to 65 65 and upwards. Total Pulmonary Males — — 2 2 3 8 14 6 11 5 4 55 60 61 48 „ Females — 1 — 4 6 10 6 5 3 2 1 38 42 27 35 Non-Pulmonary Males — 1 4 1 1 1 1 — 1 1 1 12 12 1 5 „ Females " 1 1 1 1 2 - 1 - - 7 7 1 1 Totals — 2 7 8 11 20 23 11 16 8 6 112 121 90 89 38 39 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.—Summary of Notifications during the period from the 1st January, 1935, to the 31st December, 1935, 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 3 8 14 6 11 5 4 55 60 „ Females — 1 — 4 6 10 6 5 3 2 1 38 42 Non-pulmonary Males — 1 4 1 1 1 1 — 1 1 1 12 12 Females — — 1 1 1 1 2 — 1 — — 7 7 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 2 1 4 5 1 3 17 „ Females — - - — — 4 — 1 2 - 3 10 Non-pulmonary males — — — 1 — 1 — 1 — - — 3 Females - - - - 1 1 1 — — 2 — 5 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of information. No. of cases. Pulmonary NonPulmonary Death Returns from local Registrars 6 1 transferable deaths from Registrar General 7 2 Posthumous Notifications 2 — "Transfers" from other areas (other than transferable deaths) 12 5 Other sources if any (specified) Form II — — 40 Part III.—Notification Register. Number of cases of Tuberculosis remaining at the 31st December, 1935, on the Registers of Notifications kept District Medical Officers of Health in by he County the Medical Officer of Health of the County Borough or Metropolitan Borough Pulmonary. Non-Pulmonarv Total cases Males Females Total Males Females Total 438 245 683 87 88 175 858 Number of cases removed from the Registers during the year by reason inter alia of:— (1) Withdrawal of Notification 1 1 2 — — — 2 (2) Recovery from the disease 2 4 6 3 2 5 11 (3) Death 44 23 67 8 4 12 79 (41 Removed from district 39 43 82 8 8 16 98 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 43, while the following short table summarises the information as to visits paid by Dr. Saner, and subsequently Dr. Anderson, and the staff of the Dispensary:— No. of visits by Tuberculosis Officer New, 38 Old, 96 No. of cases at Dispensary New, 310 Old, 1,493 No. of attendances at Dispensary 2,326 No. of visits by Miss Baker First visits, 89 Re-visits, 1,841 No. of visits by Miss Kenion First visits, 71 Re-visits, 1,099 No. of Committee Meetings attended 23 The Tuberculosis Care Committee continued to meet fortnightly throughout the year, Dr. Saner, Miss Baker and Miss Kenion attending and assisting in every way possible. The representatives of the Council on this Committee were: 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) Simpson, Dr. R. H. Bell, Miss Higgin, Miss E. Lazarus, Miss O. Wetherall, Miss Fenn, Miss D. M. Baldwin, Mrs, Bennett, Miss A. M. Bowen, Miss E. A. (M.B.E.) Price, Miss H. M. Lesser, Mr. H. E. Duncan, Miss A. (resigned Oct. 1935) Bennett, Councillor J. (appointed 27 Nov. 1985). 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. Registration 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. Charity Organisation Society. Do. 41 The following note by Dr. Saner upon the work of the year is of interest. "The statistics for the year 1935 will be found in the tables in the form required by the Ministry of Health. "During the year 64 patients received Sanatorium treatment, 87 were sent to general hospitals; 24 of these passed on to sanatorium. Eleven patients were returned to hospital as failing to respond to treatment at the sanatorium. There were 68 discharges from sanatorium and 27 from general hospital; these include cases who go into hospital for short periods, improve and discharge themselves. Seven patients passed through St. George's Home to sanatorium. St. George's Home is being used as a sort of half-way house, to see whether or no a patient will respond to treatment. "Out of the 169 progress reports on patients who have had sanatorium treatment through the London County Council 45 men, 47 women, and 20 children are working or at school. Six are fit but have no work, 14 are unfit. Sixteen have been transferred to other districts, fourteen lost sight of. Three declined to attend. Three have to be reported as having died, and one is abroad. "The Care Committee under the Honorary Secretaryship of Miss Broadbent met fortnightly and 347 cases were brought to its notice. The various agencies in St. Marylebone were used for any of these patients who were found to be necessitous either in food, clothing, housing, work, or in need of attention to their teeth. "Miss Bowen, M.B.E., dealt with the discharged soldiers and their families." 42 For the following Table, showing an analysis of the cases on the register at the end of the year, Dr. Anderson, who took office on 1st October, 1935, is responsible. ANALYSIS OF 345 CASES OF PULMONARY TUBERCULOSIS ON DISPENSARY REGISTER ON l/l/36. Adults. Children. Total. Total. Grand Total. 1. F+ F— M+ M— F+ F— M+ M— T.B.+ T.B— 2. No. of patients 53 43 107 41 — 8 1 9 161 101 262* 3. % in hospital, 1.1.36 28.3 16.3 26.2 14.6 — 12.5 — 22 26.7 15.8 22.5 4. % in hospital during 1935 39.6 27.9 45.8 19.5 — 75 100 33 44.1 28.7 38.2 5. No of occupants in houses occupied by patients— Adults 149 117 276 121 - 15 2 21 427 274 701 Children 31 39 79 34 — 23 3 25 113 121 234 6. No. of rooms 138 111 277 100 — 20 4 18 414 249 663 7. Rooms per person (1 child = ½ adult). .82 .82 .88 .72 — .73 1.14 .54 .86 .75 .81 8. % occupying separate rooms 41.5 30.2 37.4 36.6 — — 100 11 39 28.7 35.1 9. % occupying separate bed (including colm. 8). 62.3 48.9 55.2 48.8 — 37.5 100 44 57.7 47.0 53.8 10. % labelled "Home conditions unsatisfactory.'' 20.8 9.3 28 22 - 12.5 - 33 25.5 16.8 22.5 11. % working (whole or part time). 47.2 74.4 43 68.3 - 75 - 77 44.1 72.2 54.9 *Note.—The remaining 83 cases were accounted for as follows, bringing the grand total up to 345:— In 10 cases—2 children (T.B. negative) and 8 adults (7 T.B. positive, 1 T.B. negative), complete details could not be obtained. 6 of these were in hospital on 1.1.36. 24 cases (19 T.B. positive) had "no fixed abode," 15 were in hospital on 1.1.36, and 21 had been in hospital during 1935. Thus of 296 cases, 80, or 30.5%, were in hospital on 1.1.36, and 127, or 48.5%, had been in hospital or sanatorium during 1935. Of the T.B. positive cases (187), 64 or 34.2% were in hospital on 1.1.36, and 99 or 53% were in 1935. 49 (24 T.B. positive, 25 T.B. negative) cases could not be traced and were classed as "lost sight of." Non-Pulmonary Tuberculosis.—Eleven of the total notifications—19 as against 25 in 1934—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 were offered. Particulars as to the parts affected by the disease will be found in the table on page 47. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1935 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. 1935. 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 Class T.B. minus. Class T.B.lus 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). Group 1. Group 2. Group 3. Total (Class [/##] T.B. plus). (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 1 — — — — — 2 — — 2 1 1 — — 1 — — — — — — 2 — — 2 — — — — — — 1 — — 1 — — — — — — — 1 — 1 — — — — — — — — — F 2 1 — — 1 — — — — — — 1 1 — 2 — — — — — 1 1 — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 9 — — — 2 — — — 1 — — — — — — — — 2 — — — — 1 — — — 1 — — — — 1 — — — — — — — — — — — — — — — — — — — Disease not Arrested Ad'lts M. 4 1 2 6 9 — — 3 1 4 — 1 — 2 3 2 1 — 1 2 — 1 4 — 5 2 2 2 2 6 4 — 5 1 6 — 4 8 3 15 7 6 6 5 17 10 10 16 6 32 6 12 14 6 32 F. 5 1 1 2 4 1 — — — 3 — 1 1 2 1 1 — 1 2 1 — 1 — 1 1 1 — 1 2 5 — 6 3 9 4 1 — 1 2 6 1 1 4 6 4 9 6 1 16 16 6 6 1 13 Children 2 — — — — — — — — — 1 — — — — 1 — — — — 1 1 — — 1 2 — — — — — — — — — 1 — — 1 1 3 — 1 1 6 — — — 9 1 — — 1 Condition not ascertained during the year 1 — 1 1 — — — — — — — — — — — 1 — — 1 — 1 — — 1 — — — — — — 1 1 1 — 1 — 1 — — — — — — 1 — — 1 — — — — — Total on Dispensary Register at 31st December 24 3 1 8 15 2 3 1 6 6 3 2 3 8 4 3 — 2 5 5 6 5 — 11 7 8 2 3 8 10 1 12 4 17 7 5 9 5 19 16 7 9 9 25 20 20 22 7 49 31 19 20 7 46 (b) Not now on Dispensary Registerl and reasons for removal therefrom. Dischargeed as Recovered Adults M. 7 2 — — 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. 13 4 — — 4 — — — — — — 1 — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 14 — — — — - - — — — — — — — — — — — — 1 — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 74 56 9 3 68 29 12 5 5 22 27 16 8 1 25 30 17 8 2 27 31 30 9 3 42 22 14 5 3 22 43 15 7 2 24 22 9 5 — 14 27 11 16 2 29 11 17 9 — 26 4 — 1 1 2 Dead Ad'lts | M. 1 4 6 32 42 1 1 5 21 27 2 — 1 23 24 1 — 2 21 23 1 1 1 11 13 1 2 3 14 19 1 4 3 12 19 1 1 3 15 19 — 3 1 15 19 3 — 16 16 — — — 9 9 F. 1 2 3 15 20 — — — 10 10 3 — 1 14 15 — — 1 19 20 1 2 — 18 15 1 1 — 6 7 1 — 1 8 9 — — — 5 5 3 — 2 8 10 — 3 — 6| 9 — — — 5 5 Children 2 — — — — 1 — — — — — — — — — — — — 1 1 — — — 2 2 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 112 68 18 50 136 31 13 10 36 59 32 17 10 38 65 31 17 11 43 71 34 33 10 29 72 26 17 8 23 48 45 19 11 22 52 23 10 8 20 38 30 14 19 25 58 14 20 9 22 51 4 — 1 15 16 Grand Totals 136 71 22 58 151 34 15 13 37 65 38 20 12 41 73 35 20 11 45 76 39 39 15 29 83 33 20 10 26 56 55 20 23 26 69 30 15 17 25 57 46 21 28 34 83 34 40 31 29 100 35 19 21 22 62 44 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1935 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. 1935. 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. 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 1 - - - 1 2 - - - 2 - - - - - - - - 1 1 - - - - - - - - - - - 1 - - 1 - - - - - F. 1 - - 1 2 - - - - - - - - - - - - - - - - 1 - - 1 - 1 - 2 - - - - - - - - - - - 3 - - 3 - - - - - - - - - - Children 2 - — — 2 1 — — 1 2 — - — 1 1 — — - 2 2 2 — — — 2 — — — — — 2 2 1 3 8 — — - — — 1 — — 2 3 — — — 1 1 — — — — Disease not Arrested. Ad'lts M. - - 1 - 1 - - - - - - - - - - - - - - - 1 - - - 1 - - - 1 1 - - - - - 1 - - - 1 1 - - - 1 - - - - 1 2 — 1 1 4 F. 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - 1 - - 1 - - - - - - - 1 1 2 1 1 1 2 5 Children 1 — 1 2 — — — — - - 1 — 1 2 1 - - - 1 - - - - - 1 - - - 1 1 - - - 1 - - - - - - - - - - 2 - - 1 3 1 - - 3 4 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 7 — 1 2 10 1 — - 1 2 1 1 — 2 4 2 — — 2 4 5 — - — 1 2 — 2 1 5 8 2 1 4 10 1 1 — 2 2 3 - 2 7 3 1 1 8 8 4 1 2 6 13 (b) Not now on Dispensary Register 1 and reasons for removal therefrom. Transferred to Pulmonary l| - - - - - - - - - - - 1 1 - - - - 1 - - - 1 - - - - - - - - 1 1 - - - - - - - - - - - - - - - - - - - - Discharged as Recovered Ad'lts] M. 1 — 1 - 2 1 - - - 1 - 1 - - 1 - - - - - 2 — - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 1 - - - 1 - - - - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 4 2 — 7 13 — — — 3 3 — — — — - 1 — — 1 2 — — — — _ _ _ — 1 1 — — — — — — — — — — — — — — - — — — — - — — — — — Lost sight of, or otherwise removed from Dispensary Register 22 3 1 6 32 3 1 1 5 5 - - 1 6 3 - - 3 6 4 2 3 7 16 4 2 - 4 10 4 2 1 2 9 7 1 2 3 13 3 - 1 4 8 1 - 1 - 2 1 - - - 1 Dead Ad'lts M. 2 1 - - 3 1 - - - 1 - - - - - - - - - - 2 - 1 - 3 - - - 1 1 - - 1 - 1 - 1 - - 1 - - - - - 1 - - - 1 - - 1 — 1 F. - - -- - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - Children 1 1 - - 2 - - - - - - - - - - 1 - - - 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register 31 7 2 13 53 5 1 1 3 10 5 1 - 1 7 5 - - 4 9 9 2 4 8 23 5 2 - 6 13 4 2 2 2 10 8 2 2 3 15 3 - 1 4 8 2 - 1 - 3 1 - 1 — 2 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary). 38 7 3 15 63 6 1 1 4 12 6 2 - 3 11 7 - - 6 13 14 2 4 8 28 7 2 2 7 18 7 4 3 6 20 9 3 2 3 17 5 3 1 6 15 5 1 2 3 11 5 1 3 6 15 45 TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1935. 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 46 35 3 5 6 4 3 1 52 39 6 6 103 *(b) Diagnosis not completed — — — — — — — — — — — — — (c) Non—tuberculous — — — — — — — — 27 32 16 14 89 B.—Contacts examined during the year:— (a) Definitely tuberculous 3 2 1 1 — — — 3 2 1 1 7 *(b) Diagnosis not completed — — — — — — — — 2 1 2 — 5 (c) Non—tuberculous — — — — — — — — 15 26 24 26 91 C.—Cases written off the Dispensary Register as:— (a) Recovered 1 8 2 3 2 2 4 1 3 10 6 4 23 (b) Non—tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 51 69 54 49 223 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 180 115 28 19 18 17 21 14 198 132 49 33 412 (b) Diagnosis not completed — — — — — — — — 2 1 2 2 7 1. Number of cases on Dispensary 2. Number of cases transferred from Register on January 1st 513 other areas and cases returned after discharge under Head 3 in previous years 22 3. Number of cases transferred to 4. Cases written off during tile year other areas, cases not desiring I as Dead (all causes) 53 further assistance under the scheme, and cases " lost sight of " 112 5. Number of attendances at the 6. Number of Insured Persons under Dispensary (including Contacts) 2,366 Domiciliary Treatment on the 31st December 105 7. Number of consultations with 8. Number of visits by Tuberculosis medical practitioners:— Officers to homes (including personal consultations)134 (a) Personal 8 (b) Other 98 9. Number of visits by Nurses or 10. Number of:— Health Visitors to homes for (a) Specimens of sputum, &c., Dispensary purposes 1,966 examined 179 (b) X—ray examinations made in connection with Dispensary work 90 11. Number of "Recovered" cases 12. Number of " T.B. plus" cases on restored to Dispensary Register Dispensary Register on December 31st 209 and included in A (a) and A(b) above Nil (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. 46 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 1935 the total number certified as due to this cause was 63, the deathrate being 0.68 per 1,000. In 1934 the deaths numbered 62, the death-rate being 0.66 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 1931-1935. Deaths from Phthisis. 1931—1985. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1935 92,200 63 12 16 23 12 The distribution of the 63 deaths was as follows:—In general and other hospitals, 45, and at home, 18. Of those who died 29 were insured (22 males and 7 females), and 34 uninsured (18 males and 16 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 63, the notified cases of pulmonary tuberculosis totalled 93. The following table prepared at the request of the Ministry of Health contains information with regard to age and sex distribution of all forms of tuberculosis that may be found interesting. Age Periods *NEW CASES ALL DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 — — — — — — — — 1—5 — 1 1 — — — 1 — 5—10 2 — 4 1 — — 1 — 10—15 2 4 2 1 — — — — 15—20 4 6 1 2 2 — — 1 20—25 10 14 2 2 4 3 — 1 25—35 15 6 1 3 7 6 2 — 35—45 10 6 1 — 6 3 2 — 45—55 16 5 1 1 10 4 — — 55—65 6 2 1 2 4 3 — 1 65 and upwards 7 4 1 — 7 4 — — Totals 72 48 15 12 40 23 6 3 63 *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. 47 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 31st DECEMBER, 1935. 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 1 45 to 65 65 and upwards Lungs 93 — 1 8 27 31 21 5 21 27 32 13 93 10 14 12 11 47 46 Glands 4 — — 4 — — — — 2 2 4 — — — — — 4 Abdomen 1 — — 1 — — — — 1 — — — 1 1 — — — 1 — Hip 1 — — 1 — — — — — — — 1 1 — — — 1 1 — Kidney 3 — — — — 1 2 — — 1 2 — 3 — 1 1 — 2 1 Bladder 1 — — — — 1 — — — — 1 — 1 — — 1 — 1 — Rt. tarsus 1 — — — 1 — — — — — 1 — 1 — — 1 — 1 — Meninges 3 — 1 1 1 — — — — — 2 1 3 — — 2 1 3 — Clavicular joints 1 — — — — — 1 — — 1 — — 1 — 1 — — 1 — Peritoneum 1 — — — — 1 — — — — — 1 1 — — — — — 1 Knee 2 — — — 2 — — — — 1 1 — 2 — — — — — 2 Testicle 1 — — — — — — 1 — 1 — — 1 — 1 — — 1 — Totals 112 — 2 15 31 34 24 6 22 31 41 18 112 11 17 17 13 58 54 112 48 DISINFECTION. The work done in this connection during 1935 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 4,095 457 — 4,858 2,484 11,894 The number of journeys made by the disinfecting vans during the year ended December, 1934, was:— January 91 August 88 February 95 September 94 March 85 October 122 April 93 November 104 May 97 December 121 June 97 July 132 1,219 The number of journeys made during 1934 was 1,085. The number of rooms disinfected and the reasons for carrying out disinfection are stated below:— Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin Other causes. Total. Totals 354 64 12 356 208 994 The number of rooms disinfected in 1934 was 763. 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 443. VERMIN DISINFESTATION. In consequence of reports of the presence of bugs in the Council's flats, it was decided to pay special attention to these properties, and also to the new flats erected in the borough by the London County Council, with the view of minimising infestation. For this purpose two of the district inspectors were given the duty of primary inspection and a woman sanitary inspector (Miss Sharp) was appointed, whose duty it is to follow-up and give advice to tenants as to how best they can keep free from vermin. To enable the two male inspectors to give sufficient time to these duties a temporary sanitary inspector was appointed to assist them with district work. 49 Arrangements were made with the Kensington Borough Council for removal to their depot of furiture and effects from these flats, and there to treat all articles other than bedding, which is separately disinfected by steam, with hydrogen cyanide gas. In all 370 flats were examined during the year, 714 rooms in 211 different flats being found to contain vermin. At first only infested articles were removed for cyanide treament, but later in the year so many re-infestations were reported that the policy was adopted of clearing and treating the entire contents of each flat dealt with. The occupants having gone to temporary accomodation, and all covermouldings eased, an insecticide was then brought into use on the flat itself. Although disinfestation in these cases has not been entirely successful, owing to the difficulty, with the insecticides at our disposal, of ridding the structure of the flat completely from bugs, a very great improvement has been effected, this, with the careful following-up by Miss Sharp, who has acquired a very great influence with the tenants, should at least be maintained. During the month of December sixty-three families were removed to flats on the London County Council's Estate. As a precaution against introducing bugs and causing infestation, the whole of the furniture was in every case treated with hydrogen cyanide gas before the tenants were transferred. In tenement houses some 325 verminous rooms were discovered. These were all spray-treated by the Council's staff with quite good results, although complete disinfestation is practically impossible in premises of this class, that are generally old structures. In all cases tenants have been taught to use insecticide and to apply it by means of a spray or brush to cracks in furniture and other places likely to harbour vermin. Fluid for this purpose, generally, is supplied free of charge by the Council and every endevour being made to bring about a higher standard of cleanliness and encourage the destruction of vermin. 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 1935 were 2,730 and 2,898 respectively. BACTERIOLOGICAL EXAMINATIONS. The following table shows the number of specimens examined for purposes of diagnosis, and indicates also the diseases in relation to which the examinations were made. Disease Suspected. 1935. Positive. Negative. Total. Typhoid fever — 2 2 Diphtheria 71 733 804 Phthisis 8 169 177 Totals 79 904 983 50 MATERNITY AND CHILD WELFARE. As originally planned early in 1906 the Maternity and Child Welfare Scheme in St. Marylebone consisted 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 have been responsible have for many years bulked largest, and inhabitants of the Borough are greatly indebted to this body and its workers for what they have done in relation to maternity and child welfare. That the Society might continue indefinitely to participate largely in the scheme, staffing and nursing centres and clinics in various parts of the Borough, was more or less generally accepted, and year by year provision was made for making grants to the Society for the purpose. Early in 1935, however, largely as a result of difficulties in connection with accommodation for centres, the Society decided that the time had arrived when it would be sufficient to confine themselves to the provision and managment of day nurseries, and on the 1st April, 1935, all their other responsibilities, so far as maternity and child welfare are concerned, were transferrd by them to and were taken over by the Borough Council. The following note extracted from a report on the general position is interesting historically as indicating the lines suggested as suitable to be followed, and that in fact eventually were adopted by the Borough Council. "The situation created by the decision of the St. Marylebone Health Society to limit their activities in relation to maternity and child welfare to the provision and management of day nurseries and to leave the performance of all other works to the Borough Council, though it possesses advantages, permitting the re-arangement and re-casting of the scheme as a whole, is not free from difficulties. These exist perhaps more particularly in relation to the course to be adopted at present and pending the final handing over by the Society and the provision of all the machinery, equipment, etc., necessary for carrying on the re-organised scheme. That the Borough Council must accept responsibility for the work is inevitable; it is the body required by law to act as the maternity and child welfare authority and to provide and operate a scheme. Being a municipal authority and directly responsible for the details of a scheme and its conduct, much more, it may be taken, will be expected of the Council by the Ministry of Health." "The Scheme as at Present Constituted.—So far as centres are concerned, the composition of the scheme as it exists at present and the method' of its operation have been described regularly in my annual reports and elsewhere. Actually there are in operation, at the moment, eight centres in the Borough. Of these the Health Society is fully responsible for three:— (1) The North Marylebone School of Mothercraft, 14, Salisbury Street, (2) 24 Hill Road, and (3) 113 Marylebone Road. "The Salisbury Street centre is the largest of the three and occupies the site given by Capt. Portman. At it are provided, in addition to the usual infant welfare clinics, ante-natal and toddlers' clinics, such things as massage and light clinics and classes of various sorts. In addition, there is accommodation for a dental clinic and minor ailment treatment centre. For the conduct of the clinics and the work in connection with them there is a staff of part-time doctors receiving one guinea and a half per session, a part-time health visitor receiving £2 15s. Od. per week for 3½ days' service, two midwives who receive an honorarium of 5/per session and a voluntary worker who receives 5/- per week towards fares. These payments are made by the Health Society, other paid workers being paid by the Council. The staffing of the dental clinic and minor ailment treatment centre is in the hands of the London County Council and the Paddington and St. Marylebone District Nursing Association. At the Hill Road centre there is one part-time Doctor who receives one and a half guineas per session and a part-time health visitor receiving £2 15s. 0d. per week for 31 days' service. There are two sessions per week. At 113 Marvlebone Road there are two clinics per week also, the only official paid by the Society being the doctor who receives the usual fee of one guinea and a half per session. As the Committee is aware, 113 Marylebone Road is the property of the Council, the Society paying an inclusive rent of £20 per annum for the accommodation provided," 51 "For the premises at Salisbury Street the rent paid to the Portman Estate is £80 per annum, exclusive of rates, which amount to £26 per annum, but the Society receives from the London County Council towards the upkeep of the dental and aural clinics a rent of £260 per annum. In respect of the minor ailments treatment centre the Society receives from the Paddington and St. Marylebone District Nursing Association £56 10s. 0d. per annum for the use of the premises. For the use of the rooms, etc., at Hill Road an inclusive rent of £65 per annum is paid." "Of the remaining five centres, one is at Middlesex Hospital, one at the St. Marylebone General Dispensary, 30 Marylebone Lane, one at Queen Charlotte's Hospital, one at the Church Army Dispensary, Little Harcourt Street, and one at the Western General Dispensary, Cosway Street. With none of these does the Health Society have any particularly close relations. The institutions themselves are responsible for staffing, though they receive financial assistance from the Council, and at most of them the official health visitors attend in the capacity of superintendent and otherwise. Though certain of them will cease to operate sooner or later, the fact that the Health Society has ceased to function will not affect them at all." "Procedure at the Change Over—Immediate.—Indeed, as and when the Health Society hands over to the Borough Council, the provision that will have to be made immediately will be for carrying on the three centres first named—Salisbury Street, Hill Road and 113, Marylebone Road. So far as premises are concerned the only one that need give any trouble is Salisbury Street, and the time it may continue to be used depends upon the Health Society. No doublt, however, arrangements could be made for the Council to have the use of such rooms as are necessary as tenants (or sub-tenants) of the Society, pending closure and demolition." "The Hill Road premises are the property of the Mansergh Woodall Club, who, I am sure, would be quite pleased to continue to let the Council have the use of the rooms for even more than two days each week as at present. This is important, as later on, when Salisbury Street is closed and until other quarters have been provided, it may be necessary to make more extended use of such quarters as are available at 24, Hill Road." "The letting of 113, Marylebone Road, being in the hands of the Council, no difficulty need arise until the time for clearing the site and preparing it for, amongst other things, a maternity and welfare centre and a tuberculosis dispensary." "Intermediate and Future.—It is because two out of three of the premises in which centres are now located are so very temporary, as well as because the Centre at 30, Marylebone Lane is due to close down towards the end of the year and that at Queen Charlotte's Hospital in a year or two, that the situation is so very difficult, and there is necessity for making provision not only for the immediate present but for the future as well." "So far as the present is concerned I have already shown that the matter of premises may be met by continuing to make use of those now provided. When Salisbury Street is no longer available, what I suggest is that fuller use should be made of Hill Road and 113, Marylebone Road until such time as other quarters are found. Such new quarters should be in the form of two main centres in new and specially constructed buildings, localised one in the area north of Marylebone Road and equally easily accessible from Lissonia and St. John's Wood ; the other which would serve the area south of Marylebone Road mainly would be located in the new building on the site adjoining the Town Hall. The proposals connected with these new provisions are more fully discussed later." "Staffing—Temporary.—In the meantime the question of staffing of the temporary centres calls for reference. The suggestion I have to offer is that for the present the same staff as has been employed by the Health Society should be allowed to operate, the Council making itself responsible for the payment of the fees to the doctors and other helpers at the same rates as are paid by the Society. The amount paid per month at present, I gather, is approximately £100, excluding 52 the dental clinic, and it is unlikely that this will be exceeded. The appointments of the various assistants, I suggest, should be entirely temporary, and if in fact any notice is necessary it should not be longer than one month. This more particularly in the case of the doctors, for the reason that, I suggest, there should be no delay in appointing a whole-time maternity and child welfare medical officer. Actually I believe by making such an appointment there may be a certain saving; in any case, however, there would be greater convenience and readier supervision and control. Moreover, there would be the advantage of having the person who would be responsible for the operation of the revised scheme concerned in its preparation and initiation." ''The services of the part-time health visitors it might be convenient to retain for some time; even so, however, their engagement should be on a temporary basis and subject to one month's notice. Such an arrangement would I feel sure be satisfactory to the workers. It would no doubt be acceptable to the Health Society also, who would like to feel that the transference of their activities to the Council did not mean hardship for workers who had given valuable service to the maternity and child welfare scheme as operated by them. The decision of the Society so far as the giving up of the work is concerned has been conveyed to all their paid workers, and they have been given notice that their services will not be required by the Society after 31st March, 1935." "What I suggest is: that as from the 1st April, 1935, the work be allowed to continue as before; that the voluntary workers be thanked for the splendid work they have done in the past and that the hope be expressed that they will continue to assist; that the paid workers be engaged by the Council on the terms already indicated and that in fact the Council take over from the Health Society everything, including furniture, fittings, etc., of clinics and all liabilities, everything, in short, except the day nurseries, as a going concern and work the scheme on the same lines as at present until the full-time maternity and child welfare officer already referred to has been appointed. When the time arrives that the Society feel they are in a position to proceed with the day nursery building in Salisbury Street, no doubt they will allow time for the Council to vacate the premises and find other quarters. These quarters, the Committee may decide, following investigation and report, should be found partly at 113, Marylebone Road and partly at 24, Hill Road. If the period allowed is sufficiently long (which is unlikely) the new welfare centre for North Marylebone to which reference has already been made may be available." The Future—Maternity and Child Welfare Centres. " (a) North Marylebone.—As was noted at the meeting of the Committee on the 19th December, 1934, when the question of capital expenditure was under consideration, the finding of a site for a centre north of Marylebone Road is no easy matter. It is particularly difficult since it is essential that the premises should be located somewhere in the block formed by Grove Road, Edgware Road, St. John's Wood Road and North Street, and should front one or other of these thoroughfares. Having regard to the fact that provision will have to be made for accommodating certain of the school clinics of the London County Council—the dental clinic and the minor ailment treatment centre—the site will have to be adequate in size. So far as can be made out, in order to obtain what is required it will be necessary (1) to try to secure a piece of the land of the London Power Company fronting on Grove Road and lying between the canal and Lodge Road, or (2) to make use of the site, No. 27, Grove Road, now occupied by the Cleansing Station and shelter, or (3) to try to arrange with the London County Council for accommodation or space in or in connection with the housing schemes in North Street or Richmond Street." " In a general way it may be said that, provided constructional difficulties can be overcome, site (2)—27, Grove Road, has most to recommend it. In the first place though there may be necessity for obtaining concessions from the Grand Union Canal, the site belongs to the Council. Further it has a frontage to Grove Road and properly developed it can. be made to provide, in addition to all the accommodation for welfare and public health committee purposes, an increased amount of storage space for the Works Department of the Council." 53 "A site on the land of the London Power Company appeared to possess so many advantages that the possibility of securing it was early investigated. In an interview with a representative of the Company it emerged that there were others who had designs upon the land in question and that though the Company might be prepared to consider an offer from the Council, there was no very great amount of anxiety to dispose of such a quantity of land as might be required on the Grove Road frontage. In my view it would be useless to devote time to a consideration of a site in this position." "The possibility of arranging for accommodation in connection with the housing schemes is one that has been before the Committee already. The arrangement is one that has certain advantages, but on the whole my own preference is for a site in Grove Road, and I am all the more ready to recommend it to the favourable consideration of the Committee because, even though building operations may be costly, the site will cost nothing to acquire and there are other advantages connected with its use as well. I should like to say in regard to it that, of course, as I am not fully qualified I have been unable to go very fully into the question of how exactly the site may be used. In fact only an architect can properly advise as to this. For this reason in the event of the Committee accepting this suggestion no doubt they will make such acceptance conditional upon a favourable report from an architect and will appoint an architect to report and assist in preparing a scheme." "(b) South Marylebone.—The question of the southern centre on the site adjoining the Town Hall is less urgent, although I understand that there is a possibility that works of demolition will be commenced within the next twelve months. Even so, no doubt the Committee will be consulted as to the amount of space required in the new building for tuberculosis dispensary and welfare purposes and the situation and layout of the various clinics." " Pending closure of the premises now in use preparatory to demolition, work can go forward as at present, and when the time approaches when activities on the site must cease other arrangements for carrying on can be made. No special recommenrations, therefore, need be made at present." "Recommendations and Summary.—The recommendations I have to submit which will serve largely also as a summary of this report are:— (1) That instructions be given that the maternity and child welfare services, except those at the day nurseries, shall be carried out under the directions of the medical officer of health as from the 1st April, 1935, when they are handed over by the St. Marylebone Health Society. (2) That the various clinics shall be carried on as at present in the centres now provided by the St. Marylebone Health Society. (3) That the services of the medical and other, officers and workers at present engaged at the centres be retained subject to notice not exceeding one month. (4) That a full-time maternity and child welfare officer be appointed at the earliest possible moment at a salary of £800 per annum, rising by annual increments of .£ 25 to £ 1,000. (5) That having regard to the fact that the welfare centre at Salisbury Street may be closed at an early date, arrangements be made for securing temporary accommodation at 24, Hill Road and eventually providing a permanent centre for North Marylebone, to accommodate all the clinics required under the maternity and child welfare scheme and by the London County Council in the neighbourhood of North Street, Grove Road and St. John's Wood Road. (6) That the possibility of making use of the site at 27, Grove Road, now occupied by the Cleansing Station and Shelter, for the erection of the northern centre and the provision of other accommodation, be fully investigated and that for the purpose the services of an architect he secured. 54 (7) That the attention of the Committee of the Council concerned with the development of the site adjoining the Town Hall be directed to the necessity of having in mind the needs of the Public Health Committee in relation to maternity and child welfare and tuberculosis. (8) That in preparing the estimates for the next year adequate provision be made for the carrying on of the maternity and child welfare activities handed over by the St. Marylebone Health Society and for any developments that may result from the operations of the Maternity and Child Welfare Committee, including the payment of fees to clinic medical officers (approximately 9 sessions per week at £1 11s. 6d. per session), the payment of the salary of a full-time maternity and child welfare medical officer at a commencing salary of £800 per annum, the payment of the salary of part-time health visitors (£286 per annum), payment of rent of premises used as clinics (£171 plus rates £26), payment of wages of caretakers, cleaners, etc. (£141 14s. Od. per annum plus £40 per annum in respect of dental clinic). The question of whether or not provision may have to be made to meet commitments of the Health Society or for fittings, appliances, etc., to be taken over or for additional capital expenditure in connection with the erection of a North Marylebone centre may have to be considered later." "Having considered the report of recommendations set out, the Public Health Committee, in turn, reported to the Council as follows:— "Having given the matter most careful consideration, we generally approved the proposals of the Medical Officer of Health and authorised him to proceed accordingly, subject to the following observations and modification, namely: — (i) Temporary staff.—The medical and other assistants and workers retained after the 1st April, 1935, are to be employed on a purely temporary basis at the same fees or rates of remuneration as were paid by the Health Society, and are to be subject to notice at any time not exceeding one month. (ii) Proposed Assistant Medical Officer of Health for Maternity and Child Welfare and other purposes.—We are conferring hereon with the General Purposes Committee with a view of their submitting appropriate recommendations to the Council relative to the appointment of a whole-time maternity and child welfare officer, see paragraph 4 (ii) of the concurrent report of the General Purposes Committee). We would mention, however, that included in the annual grant of £1,527, which has hitherto been paid to the Health Society in respect of the welfare clinics, has been a sum of approximately £1,000 towards the cost of the medical services, etc. (iii) Utilisation of Site of No. 27, Grove Road.—We have requested Sir Edwin Cooper, A.R.A., to advise and report as to the possibility of erecting on the site of No. 27, Grove Road, a maternity and child welfare centre for North Marylebone, and also a new disinfecting and cleansing station which is very much needed; and have authorised the Medical Officer of Health to confer with him accordingly. (iv) South Marylebone Centre.—We propose to draw the attention of the General Purposes Committee to the needs of the Maternity and Child Welfare and Tuberculosis services in connection with the development of the site adjoining the Town Hall. (v) Financial Position.—The Council at the last Meeting decided that a sum of £1,000 should be included in the Annual Estimates for 1935-36 to meet expenditure of a revenue or capital nature in consequence of the re-allocation of the Maternity and Child Welfare services; and it will be observed from the consolidated Estimates of Expenditure which are circulated as a separate document that, apart from the amount already approved, it is anticipated that other additional expenditure in consequence of the change over will be comparatively small for the ensuing financial year owing to the proposal not to continue to make to the Health Society the grant of £1,527, which has hitherto been paid yearly to 55 the Society pursuant to the Schemes made by the Minister of Health under Section 101 (6) of the Local Government Act, 1929. We have requested the Town Clerk to communicate hereon with the Ministry of Health, in due course, in case any amendment to the Scheme is involved, as we feel that inasmuch as the Society will not be carrying out on behalf of the Council any maternity and child welfare services (other than those relating to day nurseries, for which the prescribed grants will continue to be made by the Council) as from the 1st April, 1935, the Council should not be called upon to afford, except in very special circumstanccs arising in connection with the change over and the meeting of outstanding liabilities, further financial assistance to the Society so far as welfare centres, clinics and services are concerned." Later in the year plans showing the lay-out of the new Maternity and Child Welfare Centre, Cleansing of Persons Baths and Shelter, on the site of No. 27, Grove Road, were submitted by the Architect, Sir Edwin Cooper. It is required by the Ministry of Health to make a statement showing the arrangements made 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. The following extract from the statement submitted in accordance with the requirement contains much useful information on the work of this section. Tables on pages 61 and 63 give further particulars of the work done at the various clinic centres during the year. Statement Showing Arrangements Made for Maternity and Child Welfare. Population of the area served by the Council, 92,220. Number oj births notified in that area during the year under the Notification of Births Act, 1907, as adjusted by any transferred notifications: (a) Live births, 858; (b) Still births, 20; (c) Total,* 878; (d) By midwives,* 328; (e) By doctors and parents, 108; By hospitals, 169; By Nursing Homes, 58; Inward transfers, 215.* Health Visiting. (i) Number of officers employed for health visiting at the end of the year : (a) by the Council, 8 ; (b) by Voluntary Associations, 0. (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, 6 ; (b) in the case of Health Visitors employed by Voluntary Associations, nil. (iii) Number of visits paid during the year by all Health Visitors:—(a) To expectant mothers, first visits,† 295; total visits, 597. (b) To children under 1 year of age, first visits,† 773; total visits, 5,533. (c) To children between the ages of 1 and 5 years, total visits, 7,204. *The total of the figures given under .(d) and (e) agree with the figure under (c). †Excluding cases which are known to have previously been visited in another district. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council, four (including three year old pre-school clinic). (b) Number of Centres provided and maintained by Voluntary tions, 4. (c) Total number of attendances at all Centres during the year: (i) By children under 1 year of age, 7,408; (ii) By children between the ages of 1 and 5 years, 8,943 (including 112, 3-year-olds). 56 (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,* 515; (ii) between the ages of 1 and 5 years, 221 (including 112, 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, 382; (ii) between the ages of 1 and 5 years, 993 (including 112, 3-year-olds). (f) Percentage of notified live births represented by the number in (d) (i), 60. Ante-natal clinics (whether held at Infant Welfare Centres or at other premises):— Ante Post Natal. Natal. (a) Number of Clinics† provided and maintained by the Council 1 1 (b) Number of Clinics provided and maintained by Voluntary Associations, 3 3 (c) Total number of attendances at all Clinics during the year 2006 245 (d) Total number of women who attended at all Clinics during the year, 475 159 (e) Percentage of total notified births (live and still) represented by the number in (d), 54 — Supply of Milk and Food. Arrangements made for this service are indicated by " Yes " or " No " in each space in the following table :— Terms of supply. Milk. Other Food. 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 Yes— (dried milk) At cost price in other cases (e.g., sale of dried milk at Centres) No No 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. 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, 13,110. 57 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 10* 8 4 8 (2) Pemphigus Neonatorum — — 1 — (3) Puerperal Fever 10 6 — 10 (4) Puerperal Pyrexia 36 6 2 35 (5) Measles and German Measles (in children under 5 years of age) Not Notifiable 20 — — (6) Whooping Cough (in children under 5 years of age) 62 — — (7) Epidemic Diarrhœa (in children under 5 years of age) 8 — — (8) Poliomyelitis (in children under 5 years of age) — — — — Opthalmia Neonatorum. Vision unimpaired 8 Removed from district 2 10 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, 1. (b) Total number of cases attended during the year by these nurses, 48. Home Helps. Number of cases in which Home Helps have been provided during the year, 2. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 18. (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. Maternal Deaths. (a) Number of women who died in, or in consequence of, childbirth in the area served by the Council for maternity and child welfare during the year (i) from sepsis, 2; (ii) from other causes, nil. (b) Number of these cases which died: (i) at home, nil; (ii) in tions, 2. 58 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, 12. (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; (iv) returned to parents during the year, 7; (v) removed to institutions during the year, 1; (vi) adopted 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(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. (h) Number of inspections, 329. 59 INFANT WELFARE CENTRES, MATERNITY CLINICS, DAY NURSERIES, DIPHTHERIA IMMUNIZATION CLINIC, and CLINIC for PRE—SCHOOL CHILDREN. 14, Salisbury Street, N.W.8— Monday, 2 p.m. Infant Consultation. Tuesday, 9.30 a.m. Light Clinic. „ 10 „ Massage Clinic. Wednesday, 10 „ Maternity Clinic. „ 2 p.m. Infant Consultation. „ 2 „ Needlework Class. „ 2.30 „ Dental Clinic. Thursday 9.30 a.m. Light Clinic. „ 10 „ Massage Clinic. „ 2 p.m. Toddlers (2—5 years). 24, Hill Road, N.W.8— Tuesday, 2 p.m. Infant Consultation. Friday, 10 a.m. Toddlers (2—5) years. 113, Marylebone Road, N.W. 1— Tuesday, 10 a.m. Infant Consultation. Thursday, 2 p.m. Needlework Class. Friday, 2 „ Infant Consultation. Middlesex Hospital, Mortimer Street, W. 1— Monday 9 a.m. Maternity Clinic. „ 1.30 p.m. Infant Consultation (No Doctor). Tuesday, 1.30 „ Infant Consultation. Wednesday 1.30 „ Ante—natal talks and sewing class. Thursday, 1.30 „ Toddlers (2—5 years). „ 9 a.m. Maternity Clinic. Friday, 1.30 p.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 p.m. Ditto 30, Marylebone Lane, W.1— Tuesday, 10 a.m. Infant Consultation. Thursday, 2 p.m. Ditto „ 2 „ Maternity Clinic Western General Dispensary, Cosway Street, N.W. 1— Monday, 2 p.m. Infant Consultation, Thursday, 10 a.m. „ „ Church Army Dispensary, Bryanston Street, W.1.— Tuesday, 2.15 p.m. Infant Consultation. 113, Marylebone Road, N.W.1.— Monday, 2 p.m. Diphtheria Prevention. Thursday 2 „ Schick Testing, etc. Wednesday 2 „ 3 year old Clinic. Day Nurseries— The Crossley Day Nursery, Barrow Hill Road, N.W.8. The Portman Day Nursery, 115, Marylebone Road, N.W.1. The St. Vincent de Paul Day Nursery, 111, Wigmore Street, W.1. 60 Health Visitors and Home Visits.—There are eight health visitors. Four the women give whole time to health visiting, two are part—time health visitors, holding appointments also as sanitary inspectors, and two are part—time workers who have been transferred to the Borough Council from the St. Marylebone Health Society. Children of from 18 months to 2 years are visited every three months and those from 2 to 5 years every six months. At these visits the Health Visitors make enquiries into the health of the children and persuade the mothers to attend the clinic, or otherwise obtain treatment of any illness or defect that may be present. Many of the children of from 3 to 5 years attend school, but routine visits are still made to the homes of these children. The number of visits paid in 1935 by Health Visitors to children between the ages of 1 to 5 years was 7,204. The Borough for the purposes of health visiting is divided into six districts, and in 1935 the health visitors made 12,737 visits to children and 597 visits to mothers. Children are visited up to school age, and thereafter for special purposes, e.g., measles, scabies, &c. These necessitated 315 visits to children over 5 years of age in 1935. Centres.—There are in all eight centres, at which consultations are held. Three of these originally under the Health Society, are now Municipal, and are situated as follows:—(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.—(2) 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.—(3) Western Centre, 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, at the St. Marylebone General Dispensary, 30, Marylebone Lane, 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. At the St. Marylebone General Dispensary there is the South Marylebone School of Mothercraft. 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. 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. " Toddlers."—At all the three centres of the Borough Council children of from 18 months to 5 years are also seen at any of the other consultations held at the centre if it is more convenient for the mothers to attend then. At the Welfare Centre, 24, Hill Road, children of from 18 months to 5 years may be seen at the ordinary clinics held twice a week, but the clinic held on the first F riday in the month is set apart especially for children from 2 to 5 years of age. At the Welfare Centre, 113, Marylebone Road, children of 18 months to 5 years are seen at the ordinary clinics which are held twice a week. The weekly consultations at Queen Charlotte's Hospital, the Middlesex Hospital, the Church Army Dispensary and the Western General Dispensary are attended chiefly by infants, but children up to the age of 5 years are also seen. At the Middlesex Hospital a special clinic for toddlers is held once a week. All the consultations are open to other than St. Marylebone babies, who, however, constitute the bulk of those attending. 61 STATEMENT SHOWING WORK OF THE ANTE—NATAL AND POST—NATAL CLINICS HELD AT THE MATERNITY AND CHILD WELFARE CENTRE, SALISBURY STREET, DURING 1935:— Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. Totals No. of Sessions 5 4 4 4 5 4 5 4 4 5 4 3 51 New Ante—natal cases 22 14 10 12 18 10 13 8 9 8 9 4 137 New Post—natal cases 2 3 10 14 9 7 3 3 4 2 — 1 58 Attendances Ante—natal 71 54 41 22 36 38 32 26 34 28 14 16 412 Attendances Post—natal 9 5 14 13 16 9 22 12 17 11 9 6 143 Total attendances 104 76 75 61 79 64 70 49 64 49 32 27 750 Transferred to Queen Charlotte's Hospital 1 — — — — — — — 1 1 — — 3 Transferred to St. Charles Hospital — — 1 — — — — — — — — — 1 Transferred to St. Marylebone Home 4 3 3 2 5 6 — 3 5 1 1 3 36 Transferred to other Hospitals — 3 — — 1 1 — 1 — 1 — 2 9 Put on special diet 4 3 1 2 — — — 2 2 — — — 14 Pads and belts provided 3 — 1 2 — — — — 1 — — — 7 High blood pressure 6 4 2 2 — — — — 1 1 — — 16 Low blood pressure — — — — — — — — — — — — — X—ray examinations 3 — 2 1 — 1 1 1 1 — — — 10 Referred to Dental clinic 8 4 5 5 6 — — — 2 — 5 3 38 Urine Tests — — — 3 1 — — — 1 1 — 1 7 Undernourished — 7 — — — 1 — — 2 1 — 1 12 Miscarriage . — — — — — — — — — — — — Threatened miscarriage — — — — — — — — — — — — — Cases referred by— Hospitals 2 — — 1 1 1 1 2 — — — 1 9 Midwives 1 — — 2 — — 1 — 2 — — 1 7 62 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 112 children who were examined during 1935, 73 needed treatment for one or more conditions. The following is a summary of the conditions found:— Enlarged tonsils and adenoids 10 Dental caries 28 Chronic bronchitis 5 Acute bronchitis 1 Rheumatism 1 Squint 1 Signs of old rickets 2 Mentally backward 4 Undernourished and flabby 7 Impetigo 1 Heart disease 1 Nephritis 1 Influenza 5 Whooping cough 3 Chickenpox 1 Measles 1 Stammers 1 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 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 1935 was 2,578; the total births numbering 3,776. The midwives residing in the borough registered as intending to practise in the administrative County of London, number 18. 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 29 cases were dealt with under the arrangement, and 500 visits were paid, the services of the nurses being greatly appreciated by the patients. Work done during 1935.—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. 63 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE—NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDED 31ST DECEMBER, 1935. CENTRE No. 24 Hill Road No. 14 Salisbury Street 113 Marylebone Road Queen Charlotte's Hospl. The Middlesex Hospl. No. 30 Marylebone Lane The Westn Genl. Dispy. No. of consultations held:— Infants 49 99 83 97 151 72 75 Toddlers 12 51 9 — 51 — — Maternity — 51 — 362 102 21 — Massage — 119 — 97 — 1 — Light — 70 — — — 40 — No. of attendances of mothers at clinic:— Ante—natal — 533 — 15,379 (894) 5,532 (548) 31 — Post—natal — 191 — 186 (18) 300 (31) 5 — No. of attendances of babies 1,205 1,880 1,152 2,875 (1,118) 3,454 (956) 814 100 No. of attendances of children over one year 756 2,183 960 1,279 (621) 3,230 (1,043) 968 172 No. of attendances at Light Clinic— Infants — 57 — — — 5 — Toddlers — 1,219 — — — 60 — No. of attendances at Massage Clinic— Infants — 109 — 41 (11) — 1 — Toddlers — 839 — 219 (122) — — — No. of orders issued for milk, etc. 253 870 312 220 254 197 — No. of home visits 1,902 2,374 1,211 301 3,150 432 — No. of new cases— Infants 81 131 82 201 (71) 232 (62) 31 30 Toddlers 21 27 11 4 (3) 8 (3) 21 12 Ante—natal — 132 — 3,122 (222) 902 (93) 4 — Post—natal — 57 — 96 (7) — — — Massage— Infants — 20 — 17 (6) — 1 — Toddlers — 55 — 21 (13) — — — Light— Infants — 5 — — — — — Toddlers — 38 — — — 2 — Note.—Figures in brackets refer to St. Marylebone residents attending Queen Charlotte's Hospital and Middlesex Hospital. 64 Day Nurseries.—Attendances during the year. The Crossley, Barrow Hill Road.—Whole day, 4,605; half-day, 742. The Portman, 115, Marylebone Road.—Whole day, 5,354; half-day, 618. St. Vincent de Paul, 111, Wig-more Street.—Whole day, 1,261: half-day, 530. Dental Clinic, 12, Salisbury Street. Attendances during the year.—Mothers, 845; children, 69. Advice and treatment given in 632 cases. Extractions under gas, 282. Home Helps.—Home Helps were provided in only two cases during 1935, the total expended during the financial year ended 31st March, 1936, amounting to £3 10s. Od. SANITARY ADMINISTRATION. Under this, which is made a separate heading by the Ministry of Health, the Medical Officer of Health is required to make reference to a number of matters, e.g., staff, hospital accommodation and some others, most of which will be found dealt with elsewhere. (1) Staff: Work of sanitary inspectors and other officers engaged in sanitary work. This matter, so far as the inspectors are concerned, is fully discussed in an early part of the report. The report of the Mortuary Keeper (Mrs. Spears) is as follows:— Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1935, was:— 1935. Males, Females Total. For burial only. For inquests. Total. No. of P.M.'s held. No. of courts held. No. of Infectious cases. Totals. 41 37 78 76 2 78 37 — — 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 65 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) (b) Number of inspections made for the purpose ... (2) (a) Number of dwelling-houses (included under sub-head (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925) (b) Number of inspections made for the purpose (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (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 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 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 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners (b) By local authority in default of owners B.—Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied... (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners (b) By local authority in default of owners 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 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 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 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2,568 10,070 408 houses and 316 tenements 2,506 Nil 1,309 1.271 Nil Nil Nil 38 38 Nil Nil Nil 25 1 66 E.—Proceedings under section 3 of the Housing Act, 1925 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners Nil (b) By local authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 : (1) Number of dwelling-houses in respect of which Closing Orders were made Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which lition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil Clearance and Improvement Schemes.—As to progress in this connection 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 sixth block has been completed and occupied, and the clearance of the site for another block commenced. 67 The following Table, supplied by the Housing- Officer, gives particulars of the various areas dealt with by the London County Council, the Borough Council, and the St. Marylebone Housing Association :— Situation. Area (Approximate) Acres. Estimated cost of rehousing. No. of persons involved. Position. *Richmond Street 1.01 £ 31,000 364 Clearance Order confirmed by the Minister of Health 27 th June, 1935. The London County Council are now negotiating for requisition of the various properties included in the Area. *Providence Place and Sun Cottages. 0.46 10,500 122 Sites cleared in accordance with Clearance Order confirmed by Minister of Health, 19th June, 1935. *Tucker's Place, Becketts' Place and Eamont Place. 0.5 12,500 145 Sites cleared in accordance with Clearance Order confirmed by Minister of Health, 19th J June, 1935. †Henry Place 0.31 8,500 97 *Vine Cottages 0.03 1,400 17 Clearance Order made by the London County Council, 14th May, 1935. Public Local Inquiry held 18th November, 1935. Confirmed by Minister of Health 30th January, 1936. fLittle Grove Street 0.23 6,000 69 f Byron Street 0.34 9,500 112 *Harrow Street (Together with certain 2.71 additional 176,000 lands.) 1,096 Clearance Order made by London County Council 19th November, 1935. Public Local Inquiry held 15th June, 1936. Borough Council's proposals stil 1 J under consideration. *Princess Street 1.2 — 615 Salisbury Street 0.903 50,000 306 Estate erected by St. Maryle bone Housing Association, Completed. Wilcove Place 1.05 15,000 269 Estate erected by St. Mariebone Housing Association, Ltd. Financial assistance given by the London County Council and the Borough Council. Carlisle Street 7.55 410,000 2,777 Clearance under London County Council (Carlisle Street Improvement) Order, 1927. Building still in progress. Fisherton Street 1.845 114,000 659 Site presented to Borough Council by Lord Portman. Displacements and building operations from 1919 to 1927. 112 flats built under Housing, etc.. Act, 1919, and 18 flats under Housing (Financial Provisions) Act, 1924. * Included in Borough Council's proposals, † Represented by London County Council. 68 In addition, the Borough Council are the owners of Crawford Place Dwellings, which were constructed in 1902 at an approximate cost of £18,000, and comprise 52 flats and provide housing accommodation of 182 persons. Housing Act, 1935—Overcrowding Survey. Although the year 1935 did not see the completion of the Overcrowding Survey of the Borough, so far as the compilation of the final figures and estimates for the abatement of overcrowding was concerned, a great deal of the work was done between 1st November, 1935, and the end of December. It seems proper, therefore, that some reference should be made to it in the Annual Report for 1935, and the following extract from a report submitted to the Housing Committee will be found to contain a considerable amount of interesting information. In accordance with instructions, the Survey was begun on the 1st November, 1935, and was carried out by the officers of the Public Health Department with the assistance of a temporary staff of 12 enumerators for the purposes of Form A (the enumeration form), 6 survey assistants-—later increased to 12—for the preparation of Form B (the survey form) and 4 clerks. The sanitary inspectors acted as supervisors in their own districts, the whole of the work being co-ordinated by members of the Public Health clerical staff under the direction of the Medical Officer of Health. The period of employment of the enumerators was 4 to 5 weeks, each receiving £3 5s. Od. per week. The surveying work occupied 4 weeks and each individual engaged upon it received £4 0s. Od. per week. The clerical assistants were employed throughout the whole period of the Survey and completed their work on the 20th January, 1936, the remuneration being £2 15s. Od. per week. The estimated cost of the Survey (half of which is to be borne by the London County Council) was £570. The amount actually expended was £489 16s. 8d. Enumeration Form A. The enumeration for the purposes of Form A, to decide on information obtained as to number of occupants and, on the basis of the scales set out in the Act (see Tables I and II attached) as to the number of houses that might be written off as "not overcrowded" or classed as "overcrowded" and therefore liable to be "surveyed," was commenced on the 1st November and completed by the 29th November . The number of structurally separate dwellings to be inspected was 9,454. The analysis of these enumerations gave the following results :— Table A. District. Not Overcrowded. Doubtful Overcrowding. Overcrowded. 1 684 234 88 2 1,622 628 266 3 1,635 802 376 4 1,209 487 149 5 304 222 129 6 827 203 57 Total 6,281 2,576 1,065 Survey Form B. The premises surveyed on Form B were those marked on Form A as cases in which there was "doubtful overcrowding" and numbered 2,576. The Survey commenced on the 25th November, 1935, 6 survey assistants being engaged. Following a request from the County Council that there should be a speeding up, the number of survey assistants was increased to 12 as from the 9th December and by the 20th December the work, which included measuring up of rooms and the making of fuller enquiries than those carried out for the purposes of Form A, was completed. 69 Table B below summarizes the results obtained. Table B. District. Not Overcrowded. Overcrowded. 1 182 52 2 504 124 3 597 205 4 392 95 5 135 87 6 146 57 Total 1,956 620 These various enquiries having been completed, what remained to be done was mainly clerical and involved the preparation of special forms and returns for the London County Council. Before any description of these or of the Form C of the London County Council is given' it may be interesting to summarize the results obtained by the enumerators and survey assistants. First it should be noted that in the enumeration on Form A and the survey on Form B the figures given represent tenements and not families and that a "structurally separate tenement "in many cases houses more than one family. Actually of the families enumerated on Form A the "not overcrowded" numbered 21,178. Those included in the columns headed "doubtful overcrowding" and " overcrowded " numbered 3,022 and 1,245 respectively. The surveys on Form B revealed that the number of families "not overcrowded" was 5,762 and of "overcrowded "815. The number of rooms measured by the survey assistants was 13,551. It was not until the 20th November, 1935, that it was learned from the London County Council that the results of the Survey and the grouping to be furnished on Form C were to be on a Ward basis. Prior to this, as the figures given above reveal, the details were dealt with on an inspectorial district basis. A complete recasting of the forms into Ward groups became necessary in order that details might be furnished under the following heads on Form C :— 1. The total number of dwellings belonging to the Borough Council in the Borough. 2. The total number of dwellings belonging to the London County Council in the Borough. 3. The total number of dwellings belonging to any other local authority in the borough. 4. The total number of dwellings in each ward in the borough, including any dwellings in that ward belonging to the Borough Council or the County Council (a separate form for each ward). 5. The total number of dwellings in the borough as a whole, including those of the Borough Council and the County Council. In addition the County Council sought particulars on separate forms in respect of each of the London County Council's estates in the borough and of each of the Borough Council's estates, together with a statement showing the total population (actual, not " equivalent ") on each estate. 70 In Table C, below, are summarized the results obtained (1) for each ward; (2) for the borough as a whole; (3) for the London County Council estates; and (4) for the Borough Council estates :— Table C. Ward. Families Overcrowded. Families Not Overcrowded. Total. No. % (1) 1 50 3.2 1,526 1,576 2 118 6.4 1,720 1,838 3 786 16.8 3,879 4,664 4 100 5.7 1,655 1,755 5 147 6.4 2,142 2,289 6 95 7.6 1,149 1,244 7 224 15.7 1,199 1,423 8 78 7.3 990 1,068 9 17 11.1 135 152 (2) The Borough 1,614 10.1 14,395 16,009 (3) L.C.C. Estate 34 14.6 198 232 (4) Borough Council Estates. 23 12.7 158 181 The actual population at the date of the Survey accommodated on the County Council and Borough Council Estates is set out on the following table :— Table D. Estate. Total number of flats. Total number of rooms. Number of persons Over 10 yrs. Under 10 yrs. Total. L.C.C 232 689 806 201 1,007 Borough Council 182 552 597 107 704 71 Form c housing act, 1935. overcrowding survey. Distribution of working-class families in relation to size of family and size of dwelling occupied. METROPOLITAN BOROUGH OF ST. MARYLEBONE. *0=a dwelling of 1 room under 50 square feet : 1/2 =a dwelling of 1 room between 50 and 70 square feet, † Including 5 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 72 In the absence of any definite instructions the cases which were shown to be definitely overcrowded on Form A have not been surveyed and measured and empty premises have not been recorded on Form C. Reviewing the results of the Survey, it should be possible to estimate within certain limits the accommodation required to abate the overcrowding ascertained, amounting according to the Survey to 10% of the families dealt with. Generally with regard to the Survey, it proceeded smoothly from the start, the enumerators and the survey assistants, supervised in their work by the District Inspectors, carried out their duties well and met with very little difficulty in obtaining admission to the tenements and next to no opposition in getting the information required as to the number of persons occupying the premises under review. The clerical staff were most helpful in dealing with the matters arising out of the analyses of the enumeration and survey forms and with the compilation of the various returns. The standard of overcrowding adopted under the Act is based upon three factors :— APPENDIX HOUSING ACT, 1935—OVERCROWDING SURVEY. (a) Table II. Number of habitable rooms occupied by a family. Number of persons permitted. Actual. Reduced. 1 2 11/2 2 3 3 5 4 4 71/2 6 5 10 8 6 12 91/2 and two persons extra for each additional room. No room under 50 square feet to be counted. *Note.—This table is based on the assumption that in the ordinary dwelling some of the rooms will be below 110 square feet in area and that consequently the permitted number ascertained solely from the number of rooms, without regard to their size, would normally be in excess of the exact permitted number of persons in respect of a given premises. The allowance for this factor in this table is about one-fifth. (b) Table II. Size of room. Permitted number. 110 square feet or over 2 90 square feet or over but under 110 square feet 11/2 70 square feet or over but under 90 square feet 1 50 square feet or over but under 70 square feet 1/2 Under 50 square feet Nil. 73 (c) Two persons of different sexes over the age of ten years must not sleep in the same room unless they be living together as husband and wife. Note.—It should be noted that children under one year of age have not been counted in reckoning the equivalent number in the family and children of one year and under ten years of age have been counted as one-half. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision :— Tiemises. No. in boro' on 31st December, 1935. No. of Inspections. No. of Prosecution. Common lodging houses 3 77 Nil. Seamen's lodging houses Nil. Nil. Nil. Cowsheds (licensed) Nil. Nil. Nil. Slaughterhouses (licensed) 1 14 Nil. Other offensive trades 1 22 Nil. Milkshops 150 260 Nil. Ice Cream premises 93 126 Nil. Restaurants and eating houses 224 426 Nil. Registered foster mothers 12 329 Nil. Nurse children kept 14 Smoke Nuisances. Number of Observations 255 Number of Complaints 10 Number of Intimation Notices Number of Legal Proceedings Nil served 10 Number of Convictions Nil Number of Statutory Notices Amount of Penalty and Costs served Nil imposed in each case Nil Housing of the Working Classes. 1. Total number of houses in the borough 18,645 2. Number of houses occupied by the working classes 8,638 Public Health Act. 3. No. of houses inspected on account of complains or illness 2,568 4. Number of statuory notices served 38 5. Number of houses repaired or nuisances remedied 1,309 Housing Acts (1925-35). 6. Number of houses inspected—house to house (Housing Con- Houses 408 solidated Regs., 1925) Tenements 316 74 7. (a) Number of houses included in representations by the Borough Medical Officer under Sec. I of H.A. 1930 Nil (b) Number of houses demolished folowing representation by Borough Medical Officer under Section I of Housing Act, 1930 Nil . 8 Number of houses repaired under Sections 17 and 18 of Housing Act, 1930 (a) by owners Nil (b) by L.A. in default of owners Nil 9. Number of houses demolished : (a) in pursuance of orders under Section 19 of the Housing Act, 1930 Nil (b) Voluntarily Nil 10. Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) Nil 11. Number of Closing Orders determined (i.e., houses made fit) Nil 12. Number of houses in accepted schemes for redevelopment or reconditioning by owners under Part V of the Housing Act, 1935 Nil 13. Number of certificates of fitness issued under Section 55 of Housing Act, 1935 Nil 14. Number of houses erected by the Borough Council for working classes during year Nil 15. Houses Let in Lodgings. Number in Borough 1,055 Number of inspections 7,107 Number of prosecutions Nil Number of complaints remedied under the By-laws (not included under any other heading) Nil 16. Underground Rooms. Number occupied but unfit under Section 18 of Housing Act, 1925, as modified by Section 84 of Housing Act, 1935 815 Number closed or modified occupation approved under Section 84, Housing Act, 1935 25 17. Overcrowding (Housing Act, 1935). Number of houses inspected under Section I of Housing Act, 1935 16,009 Number of families found to be living in overcrowded conditions, Section I of Housing Act, 1935 1,614 Mortuary. Number of bodies received 78 Number of Infectious bodies received Nil Bakehouses. Number on Register at end of 1935 57 Number above ground 9 Number underground 48 Number of Inspections 113 Number of Notices 4 Number of Prosecutions Nil 75 Places where Food is Prepared for Sale (excluding Bakehouses), Number on Register at end of 1935 385 Number of Inspections 712 Number of Notices 23 Number of Prosecutions Nil House Refuse. Number of Inspections 1,123 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 135 Number of Notices issued. Intimations 135 Number of Statutory Notices 1 Number of Prosecutions Nil Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water has been provided to Upper Storeys 10 Number of Statutory Notices served Nil Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms disinfected after infectious disease 430 Number of rooms disinfected (vermin) 1,039 Number of articles 8,273 Number of Statutory Notices served 12 Number of Prosecutions 1 Cleansing of Persons Act, 1897. Adults Children Males Females Males Femnles Total. Number of Persons cleansed 2,117 613 800 2,098 5,628 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 4,242 Number of drainage plans deposited 540 Number relating to new buildings 65 „ ,, old buildings 475 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops and Cowsheds 487 Number of Inspections 692 Sanitary Officers. Number of Sanitary Inspectors (Whole-time) Male 10 Female 1 (Temporary) Male 1 Female Nil ,, ,, „ (Part-time) Male Nil Female 2 ,, Health Visitors Whole-time 6 Part-time 4 ,, Tuberculosis Visitors Whole-time 1 Part-time 1 76 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1935 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered In the District. of Residents not registered in the District. Under 1 year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1925 106,100 3,418 1,496 14.1 1,472 13.8 873 658 94 63.0 1,257 11.0 1926 105,800 3,220 1,359 12.7 1,325 12.4 748 740 111 81.6 1,356 11.9 1927 103,500 3,521 1,374 13.2 1,375 13.2 781 621 81 59.0 1,262 11.8 1928 104,000 3,662 1,317 12.6 1,335 12.8 787 690 105 79.0 1,238 11.1 1929 102,400 3,526 1,233 11.9 1,465 14.3 821 804 93 77.0 1,455 13.2 1930 102,400 3,162 1,247 12.1 1,373 13.3 831 618 77 62.0 1,171 10.6 1931 93,460 3,134 1,067 11.4 1,411 . 14.3 826 640 70 65.0 1,225 12.8 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 1935 92,200 3,397 896 9.7 1,401 15.0 927 620 50 56.0 1,094 11.7 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. 77 TABLE II. Vital Statistics of Separate Localities in 1935 and the Ten Previous Years. Names of Localities The Whole Borough All Sodls St. Mary Christ Chdrch St. John Year Population estimated to middle of each year Births registered Deaths at Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all ages Deaths under 1 year ... . a. b. c. d. a. b. C. a. a. b. C. d. a. b. c. d. a. b. c. d. 1925 106,100 1,496 1,257 94 25,425 265 234 10 27,172 348 339 19 33,024 593 426 56 20,479 290 258 9 1926 105,800 1,359 1,356 111 25,353 230 244 17 27,095 276 369 25 32,931 594 450 53 20,421 259 293 16 1927 103,500 1,374 1,262 81 24,794 225 241 14 26,509 282 377 17 32,218 615 406 37 19,979 252 238 13 1928 104,000 1,317 1,238 105 24,915 232 248 21 26,638 285 299 17 32,371 533 434 46 20,076 267 257 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 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 Averages of Years 1 1925 to 1934 100,049 1,189 1,262 83 23,583 210 251 15 25,883 263 331 17 30,852 482 423 37 19.731 234 257 14 1935 92,200 896 1,094 50 21,159 181 240 10 24,275 203 268 10 27,969 345 363 20 18,797 167 223 10 The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sub-District on the 1st April, 1916, but for the purposes of District comparison over previous years the figures have been allocated to the old Sub-Districts. 78 TABLE III.—Causes of, and Ages at Death during the year 1935. No. CAUSES OF DEATH, Net deaths at the subjoined ages ot " Residents " whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church, St. John. Total. All Ages. | Under 1 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards 1 Typhoid and Paratyphoid Fevers 2 — — — i — 1 1 — 2 1 1 — — 2 2 Measles — — — — — — — — — — — — 3 Scarlet Fever — — — — — — — — 4 Whooping Cough 4 3 1 — — 2 1 1 2 — 4 5 Diphtheria 2 — — 2 — — — — 1 1 — 2 6 Influenza 9 — — — — — 4 5 5 2 2 3 2 9 7 Encephalitis Lethargica . — — — — — — — — — — — — 8 Cerebro-Spinal Fever — — — — — — — — — — — — — — — 9 Tuberculosis of Respiratory System 63 — — 9 22 22 10 14 12 16 23 12 63 10 Other Tuberculous diseases 9 — 1 1 2 4 1 — 9 4 — 2 3 9 11 Syphilis 1 — — — — — — 1 — 3 — 1 — — 1 12 General Paralysis of the Insane, Tabes Dorsalis 6 — — — — — 2 2 2 1 1 2 2 6 13 Cancer, Malignant Disease 181 — — — 14 84 83 304 47 44 60 30 181 14 Diabetes 18 — — — — 5 13 13 3 5 2 8 18 15 Cerebral Haemorrhage, etc. 50 — — — — — 1 15 34 36 9 11 20 10 50 16 Heart Disease 307 — — — — 3 8 73 223 128 64 91 94 58 307 17 Aneurysm 9 — — — — — 1 3 5 1 1 1 4 3 9 18 Other Circulatory Diseases 68 — — — — — 1 11 56 30 15 18 15 20 68 19 Bronchitis 19 1 — — — — 5 3 13 11 2 3 11 3 19 20 Pneumonia (all forms) 41 2 — — o — 4 15 18 36 5 12 14 10 41 21 Other Eespiratory Diseases . 12 — — — — — 1 3 8 25 4 2 3 3 12 22 Peptic Ulcer 16 — — — — — 3 8 5 30 5 5 4 2 16 23 Diarrhoea, etc 18 17 — — — — — 1 6 4 3 9 2 18 24 Appendicitis 8 — — — — i o 4 1 20 2 1 8 2 8 25 Cirrhosis of Liver 4 — — — — — — 2 2 4 1 1 1 1 4 26 Other Diseases of the Liver, etc. 8 — — — — — — 3 5 3 2 2 2 2 8 27 Other Digestive Diseases . 29 1 1 — i 5 12 9 52 6 7 10 6 29 28 Acute and Chronic Nephritis . 32 6 6 20 36 5 8 12 7 32 29 Puerperal Sepsis 2 — — — — — 2 — — — — 1 1 — 2 30 Other Puerperal Causes . — — — — — — — — — 10 — — — — — 31 Congenital Debility, Premature Birth, Malformation, etc. 23 20 1 1 1 67 5 4 9 5 23 32 Senility 13 — — — — — — I8 12 4 2 5 2 13 33 Suicide 11 — — — — 7 3 1 7 3 2 6 — 11 34 Other Violence 47 3 1 1 1 4 10 9 18 30 14 13 14 6 47 35 Other defined Diseases 82 3 1 4 4 14 27 29 134 17 9 32 24 82 36 Causes ill-defined or unknown — — — — — — — — — — — — — — — Totals 1094 50 4 3 11 24 110 318 574 1030 239 268 364 223 1094 79 TABLE IV. Cases of Infectious Disease Notified during the 52 weeks ended 31st December, 1935. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number ol cases removed to Hospital from each locality. Cases isolated at home. At all ages. At Ages—years. All Souls. St. Mary Christ Church St. John. Totals. All Souls. St. Mary. Christ Church St. John. Totals. —1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Cholera . — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria, including Membranous, Croup . 119 4 3 8 11 10 52 9 9 9 2 2 13 32 61 13 119 13 32 61 13 119 — Erysipelas 35 — — 1 — — — — 2 1 5 17 9 4 13 11 7 35 4 11 5 4 24 11 Scarlet Fever. 155 — 3 6 9 19 63 17 13 17 8 24 39 82 10 155 22 37 81 9 149 6 Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever 3 — — — — — — — — 1 1 1 — — 1 2 — 3 — — 1 — 1 2 Paratyphoid Fever 3 — — — 1 1 1 3 3 3 3 Relapsing Fever . — — — — — — — — — — — — — — — — — — — — — — — — Continued Fever . — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 10 — — — — — — — — 8 2 — — 4 3 3 — 10 4 3 3 — 10 — Puerperal Pyrexia . 36 — — — — — — — 4 25 7 — — 5 23 5 3 36 5 23 5 3 36 — Plague . — — — — — — — — - Glanders — — — — — — — — — — — — — — — — — — — — — — — — Farcy — — — — — — — — — — — — — — — — — — — — — — — — Anthrax . — — — — — — — — — — — — — — — — — — — — — — — — Cerebro- Spinal Fever 1 1 — — — — — — — — — — — — 1 — — 1 — 1 — — 1 — Tuberculosis— Pulmonary 93 — — — 1 2 6 9 38 11 21 5 21 27 32 13 93 10 14 12 11 47 46 Non-Pulmonary 19 — — — 1 — 5 2 2 5 — 3 1 1 4 9 5 19 1 3 5 2 11 8 Acute Polimyelitis 3 — — — — — 1 2 — — — — — 2 — 1 — 3 2 — 1 — 3 — Polio-Encephalitis 1 — — — — 1 — — — — — — — — — 1 — 1 — — 1 — 1 — Ophthalmia Neonatorum 10 10 — — — — — — — — — — — 3 3 2 2 10 2 2 2 2 8 2 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia 33 i 2 i 1 2 2 3 10 6 1 4 9 7 11 6 33 6 5 9 6 26 7 Malaria . 1 — — — 1 1 1 1 1 ___ Dysentery 3 — — — — — — — — — — — — 1 1 1 — 3 1 1 1 — 3 — Totals 525 16 8 16 23 33 125 36 43 117 42 47 19 87 157 222 59 525 70 132 191 50 443 82 80 TABLE V. Cases of Infectious Disease Notified during the 52 weeks ended 31st December, 1935. Notifiable Disease. Cases notified in whole District. Total number of cases removed to Hospital Total Deaths. At all ages. At Ages—years. — 1 1— 2— 1 3— 4— 5 — 10— 15— 20- 35— 45— 65— Smallpox — — — — — — — — — — — — — — — Diphtheria including Membranous Croup . 119 4 3 8 11 10 52 9 9 9 2 2 — 119 2 Erysipelas 35 — — 1 — — — — 2 1 5 17 9 24 — Scarlet Fever 155 — 3 6 9 19 63 17 13 17 8 — — 149 — Enteric Fever 3 — — — — — — — — 1 1 1 — 1 2 Paratyphoid Fever 3 — — — — — — 1 1 — 1 — 3 Puerperal Fever 10 — — — — — — — — 8 2 — — 10 3 Puerperal Pyrexia 36 — — — — — — — 4 25 7 — — 36 — Cerebro Spinal Fever 1 1 — — — — — — — — — — — 1 — TuberculosisPulmonary 93 — — — 1 — 2 6 0 38 11 21 5 47 63 Non-Pulmonary 19 — — — 1 — 5 2 2 5 — 3 1 11 9 Ophthalmia Neonatorum 10 10 — — — — — — — — — — — 8 — Pneumonia 33 1 2 1 1 2 2 — 3 10 6 1 4 26 41 Malaria 1 — — — — — — — — — — 1 — 1 — Dysentery . 3 — — — — — — — — — — — — 3 — Polio Encephalitis 1 — — — — — — — — — — — — 1 — Acute Poliomyelitis . 3 — — — — — 1 2 — — — — — 3 — Totals 525 16 8 16 23 33 125 36 43 117 42 47 19 443 120 * Note.—This figure is for all forms of pneumonia, including Acute Primary Pneumonia and Acute Influenzal Pneumonia which alone are notifiable 81 Return made to the Borough Council and Ministry of Health on the 7th February, 1936, 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, 1934, 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, 1934. Number of these Biiths duly entered by 31st January, 1936, in Columns I, II, IV and V of the "Vaccination'Register " (Birth List Sheets), viz. : Number of these Births which on 31st January, 1936, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1936, 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 1935. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1935. Col. I. Col. II. Col. IV. Col. V. Removal to places unknown or which cannot be reached and Cases not having been found. Success fully Vaccinated. Insuscep tible of Vaccination. Had Small- Pox. Number in respect of whom Certificates of Conscientious Objection have been received. Dead. Un vaccinated Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 290 183 — — 60 11 4 8 18 6 2,141 495 2. St. Mary 2,204 1,449 5 — 333 69 5 322 19 2 3. All Souls 515 359 8 — 28 15 4 94 6 1 Total ... 3,009 1,991 13 — 421 95 13 424 43 9 2,141 495 VACCINATION RETURNS. Return for 1934. Dated 7th February, 1936. (Signed) GEORGE H. BASSETT, Vaccination Officer.