Ac 4353 M STMRY 41 Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936. 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 1936. 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 PRINTED BY VAIL AND CO., LTD., LONDON, W.I. Public Health Department, Town Hall, St. Marylebone, W.l. 22nd June, 1937. 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 the following report on the Health of the Borough of St. Marylebone during the year 1936, which in accordance with the instructions of the Minister of Health, like its predecessors of the last few years, is an "ordinary report" and does not enter deeply into detail of the year's happenings. At the same time, however, it contains sufficient to show that good and valuable work was done. In relation to Public Health generally in the metropolis, 1936 was noteworthy for the coming into operation on 1st October, of the Public Health (London) Act, 1936. During the year steps were taken in the direction of providing a suitable building for the conduct of infant welfare and other clinics serving the northern part of the borough. This building will be known as Health Centre No. 2 and will house various clinics for school children as well as a cleansing station. Progress was also made in connection with the planning of Health Centre No. 1 which will) form part of the building to be erected on the site adjoining and to the west of the Town Hall. Only two changes took place in the staff in 1936. Miss Stokes, who had been a Health Visitor since 1st August, 1910, retired on 31st December, 1936, and in her place the Council appointed Miss Dupont. Miss Kendall also filled another vacancy in the staff of Health Visitors. The whole staff during the year have done most excellent work, shouldering the extra duties and responsibilities imposed upon them and in carrying out the overcrowding surveys under the Housing Act with the utmost willingness. Their help in this and other connections was of the greatest value and I desire to express here my thanks and appreciation to all' of them. 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 Officer of Health. PUBLIC HEALTH COMMITTEE. (Which is also the Committee appointed for Maternity and Child Welfare purposes.) 1936. His Worship the Mayor (Councillor R. Stiles Allen, J.P.) ALDERMEN. G. B. Brooks. J. Fettes, J.P. A. C. Rickatson, J.P. COUNCILLORS. Rev. Michael Adler, D.S.O., B.A. H. Jones. F. 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 Deaths in relation to Disease Natural and Social Conditions of the Borough. Diarrhoeal Diseases 34 Infectious (Communicable) Population 6 Diseases 34 Sanitary Circumstances 7 Phthisis and other Tuberculous Diseases 34 Water Supply 7 Drainage 7 Respiratory Diseases 34 Closet Accommodation 8 Cancer or Malignant Disease 35 Accident, Suicide and Man-slaughter 36 Public Sanitary Conveniences 8 Scavenging 8 Removal of House Refuse 10 Sanitary Inspection of the Borough. Prevalence of and Control over Infectious Diseases Diphtheria and Membranous Staff 10 Croup 36 Swimming Baths 11 Diphtheria Immunisation 37,56 Shops Act, 1934 12 Scarlet Fever 37 Nuisances 12 Enteric Fever and Paratyphoid Fever 37 ,, Legal Proceedings 13 Smoke Nuisances 14 Cerebro-Spinal Fever 37 Rat Repression 14 Encephalitis Lethargica 37 Pigeons 15 Polio-Encephalitis 37 Vermin Disinfestation 15 Polio-Myelitis 37 Cleansing of Verminous Persons 15 Erysipelas 37 Fouling of Footways by Dogs 16 Puerperal Fever and Puerperal Pyrexia 37 Wireless Loudspeakers, etc. 16 Premises and Occupations controlled by By-laws and Regulations. Measles and German Measles 38 Whooping Cough 38 Glanders and Anthrax 38 (а) Business Premises 16-21 Smallpox 38 Milk Premises 16 Vaccination 38, 69 Slaughterhouses 16 Bacteriological Examinations 38 Offensive Trades 17 Infectious Diseases in Schools 39 Premises used for Food Preparation 17 Ophthalmia Neonatorum 39 Influenza 40 Ice Cream Premises 17 Pneumonia 40 Butter,Margarine, etc., Premises 17 Food Poisoning 40 Bakehouses 17 Tuberculosis 40 Fried Fish Vendors and Fish Curers 17 Treatment 40 Public Health (Tuberculosis) Regulations, 1930 (Notifications) 41 Pharmacy and Poisons Act, 1933 17 Factories and Workshops 18-21 Rag Flock Acts, 1911 and 1928 21 Prevention 42 (b) Premises used for Human Habitation 21 Care Committee 42 Work of Dispensary 42,44,45 Houses let in lodgings 21 Report of Tuberculosis Officer 43 Common Lodging Houses 22 Deaths 46 Underground Rooms 22 Localisation of Disease 47 (c) Premises that are not but should be Registered 22 Disinfection 48 Maternity and Child Welfare St. Marylebone General Dispensary 48 Food Stalls 23 Food— (а) Milk Supply 23 Summary of arrangements made for Maternity and Child Welfare 49-54 Milk Analysis 23 Bacteriological examination of Milk 23 Centres and Clinics52,54,58 Dairies, Milkshops, etc. 23 Health Visitors 11, 52 The Milk (Special Designations) Orders 23 Minor Ailments Treatment 53 Day Nurseries 53,58 Milk (Mothers and Children) Scheme 24 Ante-Natal and Post-Natal Work 55,57 MilkforSchool Children Scheme 25 Dental Clinic 56,58 (б) Foods other than Milk 25 Massage Clinics 56 Food Inspection 25 Pre-School Clinics 56 Food, Unsound, Condemned 25 Hospital Treatment 56 Food Premises 26 Maternity Cases 56 Bacteriological Examination 26 Infant Consultations 57 (c) Food and Drugs (Adulteration) Act, 1928 26 Home Helps 58 Sanitary Administration— Report of Public Analyst 26-29 Report of Mortuary Keeper 58 Statistical— Hospitals and Nursing Homes 58 Births 29,31 Local Acts and Orders 58 Deaths and Death Rates 30,31,66 Housing, Inspections and Proceedings, etc. 58-61 Sub-District Births and Deaths 31,65 Deaths in relation to Age 31,66 General Summary 61-63 Causes of and ages at death 31-36,66 Ministry of Health, Tables I—V. 64-68 Infantile Mortality 31-33 Vaccination Returns 69 Maternal Mortality 34 6 GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921) 104,173. (1931) 97,620. (Estimated 1936) 92,400. Number of inhabited houses (1921) 18,507; (1931) 17,575. Number of inhabited houses and flats (end of 1936) according to Rate Books, 19,420. Number of families or separate occupiers (1931) 27,352 Rateable value. £3,440,588 Sum represented by a penny rate. £13,069. Extracts from Vital Statistics of the Year. Live Births- Total M. F. Legitimate 781 405 376 Birth Rate, 9.8 per 1,000 of the estimated resident population. Illegitimate 125 56 69 Still Births, 32 Rate per 1,000 total births, 34 Deaths, 1,169 Death Rate, 12.5 per 1,000 of the estimated resident population. Percentage of total deaths of residents occuring in public institutions, 10.2. Deaths from Puerperal causes: Deaths Rate per 1,000 total births Puerperal Sepsis nil — Other Puerperal causes 2 2.1 Deaths of Infants under 1 year of age All infants per 1,000 live births 75 Legitimate infants per 1,000 legitimate births 64 Illegitimate infants per 1,000 illegitimate births 144 Deaths from Cancer, 195. Deaths from Measles, 8. Deaths from Whooping Cough, 5. Deaths from Diarrhoea, (under 2 years) 22. POPULATION. The population estimated to the middle of 1936 by the Registrar-General is shown below and is that used in calculating the various rates eiven 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 1931 93,460 21,422 24,575 28,375 19,088 middle of ” 1936 92,400 21,165 24,285 28,150 18,800 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 seventeen premises. The reason for discontinuing the supply was in sixteen cases the non-payment of rate, the other being by request of owner. 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 28 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 1935 was twelve. In 15 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 1936 made 3,376 inspections. The total number of plans deposited was 500 in respect of 630 premises, as against 540 and 743 respectively in 1935. The number relating to new buildings was 70. The number deposited in 1935 was 65. In the case of old buildings, the number of plans received was 430. In 1935 the total number was 475. In the bulk of the cases the arrangements shown were in accordance with the by-laws and the work was allowed to proceed under the preliminary approval of the Medical Officer of Health. In cases in which there was departure from the requirements a special report was made to the Public Health Committee, who rarely refused approval if satisfied that compliance was impossible and that there was no possibility of nuisance or injury to health arising. In the majority of cases the departure referred to closet accommodation and affected particularly convenisnces 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 51 premises. The number in 1935 was 41. 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 bath rooms 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 formerly 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 and in certain streets prescribed by the Council, collection is carried out from the kerb within stated hours. This naturally entails a greater concentration lof collecting vehicles in certain parts of the Borough in the early hours of the day. Increase continues in the number of large premises, such as blocks of flats, hotels, etc., using the "container" system of collection. 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, conveyed to the Council's Wharf (where they are emptied, cleansed and disinfected) and returned to the premises. This method, obviously more hygienic, is also quicker and less noisy in working and far more satisfactory than refuse bin collection. 9 In 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 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 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 most efficient and hygienic manner. 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 is installed to deal with 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. Unscreened refuse is conveyed by canal barges to the Borough Council's shoot at Northolt, where it is carefully covered in accordance with the regulations for controlled tipping issued by the Ministry of Health and the requirements of the Middlesex County Council and the Ealing Borough Council, pursuant to the Middlesex County Council Act, to reduce risk of nuisance. A 200 feet chimney shaft at the council's Wharf at Paddington takes the emanations from the two destructor plants, resulting 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. A special Sub-Committee set up by the Metropolitan Boroughs Standing Joint Committee 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, issued its report and made certain recommendations. These have generally been incorporated in the conditions governing the use of the Wharves and the Shoot. 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 pre-arranged collecting spots and the contents of the bins are loaded into lorries and conveyed to the Wharf as shown above. The collecting vehicles are specially constructed and fitted with covers to prevent the blowing of refuse over the public streets. Generally.—The whole question of collection, disposal and dumping is constantly under supervision with a view of avoiding any possibility of nuisance. Every precaution is taken to ensure that the service is carried out in a satisfactory and efficient manner and in such a way as to give as little annoyance as possible when dealing with objectionable material of this nature. Offals of various descriptions such as green offal, fish offal, refuse from petrol interceptors at garages, etc., are collected by the Council, a charge being made for this service as well as for the removal of other trade refuse. The effect of this has been to improve the general cleanliness of the Borough. Fish offal is disposed of to Contractors and green offal is treated in the same way as street sweepings. 10 Statistical.—The following figures will give some idea of the tonnages dealt with: House Refuse collected during the year ended 31st March, 1937 50,367 tons. Street Sweepings and Gully Refuse collected during the year ended 31st March, 1937 8,516 tons. A sum of approximately £3,100 was obtained from the sale of by-products (ashes, breeze, waste paper, metals, tins, rags, etc.). In addition, approximately £1,103 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 140 premises at the request of the department, while 1,043 visits were made by Inspector Hill, who gives part time to this work. The Grown 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. 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 staff of the department is contained in the following statement. For the purposes of survey under the provisions relating to overcrowding a number of temporary assistants were appointed and continued to act until the completion of that part} of the survey with which they were specially concerned. Excluding these, the staff of the Department consisted of 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 and another on housing), one chief and five assistant clerks and an office youth, with, in addition, at the Tuberculosis Dispensary, a sister and a clerk dispenser, and at the Salisbury Street Welfare Centre a clerk dispenser. The following list gives information with regard to qualifications, etc., of each of these officers as required by the Ministry of Health Medical Officer of Health and Administrative Medical Officer—Tuberculosis, and Maternity and Child Welfare: *Charles Porter, M.D., B.Sc., M.R.C.P. (Edin.), of the Middle Temple, Barrister-at-law. Deputy Medical Officer of Health and Public Vaccinator: H. Allen Bulman, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. Tuberculosis Officer and Assistant Medical Officer of Health: *B. W. Anderson, M.A., M.D., Ch.B., D.P.H. 11 Assistant Medical Officer of Health for Maternity and Child Welfare Purposes W. H. S. Wallace, M.D., B.S., D.P.H. Public Analyst (Part time): J. F. F. Rowland, B.A., A.I.C. Bacteriologist (Part time): L. E. H. Whitby, C.Y.O., M.C., M.A., M.D., B.Ch., F.R.C.P. (Lond.), M.R.C.S. (Eng.), D.P.H. Vaccination Officer: G. H. Bassett. *Food Inspector. Part-Time Health Visitors. G. Smith (Senior Sanitary Inspector) (a, b, d). Miss L. Donnell (b, h). Miss L. M. Hazel (h). *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. E.E. Willis M.M. (a, b, d) *Outdoor Superintendent. A. S. Wilson (a, b, d). P.H.Hill (a, b, d). *Drainage Inspectors Clerks. F.C. Cook (b, d). H. E. Curtis (Chief). W. H. Draper (a, b, d). A. H. James *Temporary Sanitary Inspector. W. J. Howe. V. A. Bignell (a, d). H. G. E. Brown. Disinfectors. C.D. Turbayne. C. J. Kendall. R. G. Turner. J. Overton. *Maternity and Child Welfare and Tuberculosis Clerk. * Woman Sanitary Inspector. Miss M. McA. Sharp (c, e, f, g, h). Miss J. Jones. * Women Sanitary Inspectors and Health Visitors. Maternity and Child Welfare Clerk-Dispenser. Miss C. E. Durant (b, e, h). Miss G. M. Courtenay. †Miss N. C. Stokes, R.R.C. Cleansing of Persons Baths 81 Shelter. (b, e, f, g, h). Miss L. Kilgallin (Matron). Health Visitors. Miss D. T. Connell (e) Mortuary Keeper. §Miss M. I. Kendall (c, e, f, g, h). Mrs. H. Spears. Miss E. D. Mann (e, f, g, h). *Tuberculosis Dispensary. Miss M. C. Stewart (e, f). E. D. Marston (Caretaker). '*Temporary Health Visitor. Messenger. ‡‡Miss H. K. Dupont (e, f, g). E. W. Broughton. * Officers to whose salary contribution is made under the Public Health Acts or by Exclieque: grants. a Royal Sanitary Institute Certificate. b Certificate Sanitary Inspectors' Examination Board (London). c Certificate of the Sanitary Inspectors' Examination Joint Board. d Heat and other Foods Certificate. e Health Visitors Diploma. f Central Midwives Board Certificate. g Certificate of State Registration for Nurses. h Three or Four Years' Hospital General Training Certificate. f Ketired 31st December. 1936. § Appointed 1st May. 1936. ‡‡ 8th June, 1936. 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. 12 THE SHOPS ACT, 1934. Under this Act, the Borough Council as Sanitary Authority is 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 maintainance of reasonable temperature. During the period under review 110 shops were inspected. In 19 instances notices were served in respect of contravention of the Act and in all cases the defects were remedied, a considerable amount of work, calling in some cases for a degree of reconstruction of premises, being done. NUISANCES. In the following summary some idea of the amount of work involved in dealing with 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 2,531, as against 2,473 in 1935. The majority of these complaints were made by the inspectors themselves, though a certain number came from other members of the Council's staff, from voluntary workers of the St. Marylebone Health Society, members of the Children's Care Committee, neighbours and others. In respect of nuisances, 22 statutory notices were issued, the figure being 53 in 1935. Of these notices, 6 related to ordinary nuisances (dirt, dampness, etc.), 3 to verminous rooms, 4 to insufficient w.c. accommodation, 6 to defective drains, and 3 under the Shops Act, 1934. The 3 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1922, and referred to fi rooms. The number of notices in 1935 was 12. In 2,509 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. 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 141 260 116 109 141 36 803 Doors, windows, floors, ceilings sash cords, grates and flues etc., repaired 110 212 92 41 83 3 541 Verminous rooms 38 143 264 37 42 74 598 Dirty and verminous furniture and bedding cleansed - 39 230 22 25 2 318 Overcrowding abated — 38 3 3 — — 44 Underground rooms (illegal occupation) dealt with - - 1 6 - - 7 Water closet defects remedied 49 66 61 56 23 45 300 Insufficient and unsuitable water closet accommodation remedied 6 9 14 21 12 27 89 Urinal defects remedied — 1 — 2 — — 3 Drains and water closet stoppages cleared 4 11 23 5 15 8 66 Drains relaid or amended 7 3 4 6 11 1 32 Soilpipes and ventilating shafts repaired or renewed 6 1 7 3 4 2 23 Waste pipe defects remedied 7 12 13 5 11 2 50 Yard defects remedied 26 5 30 34 21 1 117 Wash-house defects remedied 30 63 19 51 18 1 182 Area defects remedied 1 4 4 29 14 1 53 Basement defects remedied 1 2 — 2 6 — 11 Roof gutters, roofs repaired 31 27 50 23 21 3 155 Water supply to houses reinstated - 1 3 - - - 4 Water supply laid on to upper storeys - - 3 3 8 1 15 Water cistern defects remedied — 6 6 12 — 4 28 Dung or dust receptacles repaired or renewed 4 11 26 17 12 7 77 Rubbish, manure, etc., accumulations removed 16 17 56 25 28 14 156 Workshops, dirty — — — 8 12 7 27 „ overcrowded — — — 2 — 1 3 ,, insufficiently ventilated - - - 2 - 1 3 Animal nuisances abated — 3 — 6 5 1 15 Rats and mice infestation 3 1 3 12 3 1 23 Bakehouses dirty — — 1 2 — — 3 Smoke nuisances — 2 — 3 4 1 10 Shop insufficiently ventilated or heated 2 11 17 9 3 42 Miscellaneous 93 11 20 43 19 3 189 LEGAL PROCEEDINGS IN CONNECTION WITH NUISANCES. In only two cases was it found necessary to institute proceedings in Court in this connection, these being for failure to comply with Statutory Notices to carry out certain cleansing works. In one case the summons was withdrawn upon completion of the work, and in the other an Order was made for the work to be executed within 28 days. In the latter instance two guineas costs was awarded. 14 Smoke Nuisances. During the year 1936, 162 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 1931 it reached 74, in 1932, 52, in 1933, 49, in 1934, 44, in 1935, 45, and in 1936, 42. The investigation of these complaints necessitated the inspection of 45 premises, 9 of which were found to be rat infested. Included in this latter number were 6 business premises (3 of these for the preparation or storage of food), the remaining 3 being 2 private or tenement houses and 1 vacant site. In 2 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 1936 National Rat Week, contains a certain amount of information that may be found interesting: "For the past 18 years a "Rat week" has been held annually in the Borough, at the suggestion of the Ministry of Agriculture and Fisheries, during the early part of November, with the object of focussing public attention on the need for concerted action in order to secure the destruction of rats and mice. National Rat Week in 1936 was held from November 2nd to 7th, and, as on previous occasions, the Council, as the local authority responsible for the execution and enforcement of the Rats and Mice (Destruction) Act, 1919, sought, with marked success, the co-operation of neighbouring authorities and of owners and occupiers of property within the Borough in an endeavour to direct special attention to the problem during that week. In other years I have reported in detail to the Committee—and through the Committee to the Ministry of Agriculture and Fisheries—on the steps taken by the Department in this connection, and as experience has shown action on lines such as those described to be the most suitable in an area such as ours, it was taken again this year. I propose, therefore, on this occasion to refer only to one or two points that call for special mention. Publicity.—The Press has always given prominence to National Rat Week, and this year proved no exception in this respect. Daily, weekly and local papers all devoted space to articles—sometimes illustrated, sometimes poetic—on the rat. A poster of striking design was exhibited .throughout the Borough, and copies of the latest booklet on "Rats and How to Exterminate Them" (issued by the Ministry of Agriculture and Fisheries) were distributed to ratepayers likely to be concerned. Baits and Traps.— Prolonged experiments with traps of the break-back type having shown these to be the most satisfactory, it has been decided to use them in greater numbers in the sewers and to reduce considerably the amounts previously expended on baits of various kinds. The results obtained, being obvious, have created greater enthusiasm amongst the men engaged in the work, and the superiority of the trap over the poison bait has been demonstrated in other ways. In addition, it conceivably provides a more humane method of destruction. 15 Enquiries.—As usually happens during Rat Week, many enquiries for information were received in the Department, and the Inspector (Mr. Willis) who devotes special attention to this branch of the Council's work was able to offer advice and guidance in a number of cases, though it may be added that no serious instance of rat infestation was encountered during the week." 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. Three complaints were made in 1936, as against ten in 1935, relating to private dwellings. As in other years, as much assistance as possible was given by the inspector in charge of this work to reduce the nuisance. Vermin Disinfestation. The arrangements made last year for dealing with bugs in the Council's flats were continued, and during the year under review, new blocks of flats in private ownership were dealt with. Of 216 flats containing 521 rooms, vermin were found in 126, comprising 296 rooms. In 72 of these cases where the infestation was serious, the whole of the furniture and effects were removed and treated with hydrogen cyanide, and whilst the furniture was away the rooms were thoroughly sprayed with insecticide. In the remaining 54 cases, where the infestation was not so gross, tenants were instructed and encouraged to cleanse their rooms and furniture, insecticide being provided and sprayers loaned by the Council. The routine "following-up" work of the 303 London County Council and Borough Council flats was continued. Rooms and effects in 96 flats shewed evidence of new infestation or re-infestation. For the greater part the infestation was slight, and at the end of the year only 38 of these showed signs of bugs. A block of 60 flats on the London County Council estate was occupied in December, 1935. The furniture and effects of all the families were removed, treated with cyanide and delivered to the new homes. During the re-inspection this year, in 17 of these flats live bugs were found. In 12, second-hand articles showing signs of vermin were discovered. At the last re-inspection, live bugs (very few) were found in only 3 of these flats. Many fluid insecticides have been used with some degree of success in tenement houses, but their construction and age render all spraying and treatment difficult and expensive. Excellent results have been obtained in good class houses and flats with the use of ethylene oxide. Cleansing of Verminous Persons. The number of Adults and School Children using the Baths, originally provided under the Cleansing of Persons Act, 1897, during the period 1st January to 23rd June, 1936 was 1,134 and 1,273 respectively. During the month of June the building at No. 27, Grove Road, which housed the Shelter and Cleansing of Persons Baths, was demolished to make room for a new Health Centre, on the same site, comprising maternity and child welfare, massage, artificial sunlight, orthopaedic, minor ailments and dental clinics; cleansing of persons baths; and shelter for dispossessed persons. At the end of the year the work of reconstruction was in hand and the new building will be ready for occupation towards the end of 1937. While re-building operations are in progress, arrangements have been made for adults to attend the cleansing stations in neighbouring boroughs. In the case of school children a temporary centre has been provided by the London County Council at Emmanuel School, Aberdeen Place, 16 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, 22 prosecutions undertaken being on the reports ofi police officers and one on the report of the cleansing officer. In 21 cases the defendant pleaded guilty, and fines imposed amounted to £9 15s. Od. and in one instance ten shillings costs was allowed. In one case the summons was not served. Including these cases the total number of prosecutions since the by-law came into operation in 1928 is 87, the amount of fines imposed being £34 8s. Od. Wireless Loudspeakers, etc. During the year, four complaints were received relating to nuisance from wireless loudspeakers, gramophones and similar instruments. In two instances abatement of the nuisance was secured without the service of formal notice. In the remaining two cases notice was served in accordance with the bye-law made by the Council under Section 38 of the London County Council (General Powers) Act, 1934, signed in each case, as required, by not less than three householders residing within hearing of the instrument. In both these cases also abatement of the nuisance; followed. 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. Number of premises Number of inspections 1936 Number of notices 1936 Number of prosecutions, 1936 On register at end of 1935 Added in 1936 Removed in 1936 On register at end of 1936 A. Business Premises Milk premises 150 12 3 159 261 4 — Slaughterhouses 1 _ — 1 16 — — Offensive trade premises 1 - — 1 20 — — Purveyors of Sausages, etc. 90 4 1 93 194 4 — Ice cream premises 93 7 — 100 120 8 — Butter and Margarine Manufacturers and Dealers 22 - - 22 61 - - Bakehouses 57 — 3 54 106 3 — Fried Fish Shops 25 — — 25 52 4 - Fish Curers- 6 — — 6 38 — - B. Habitations Houses let in lodgings 1,055 — — 1,055 8,693 1,018 - Common lodging houses 2 - - 2 38 - - A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 159. 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. 17 Offensive Trades.—At the end of 1936 only one premises within the Borough carried on a trade classed as offensive, that being the slaughter of poultry. The Food Inspector made 20 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 intended for sale, and the Council have authorised the Public Health Committee to administer the powers given under the Act. At the end of 1936, 93 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 ol premises included in the register at the end of 1936 was 100,7 more than in 1935. Regular inspections were made throughout 1936, and in 8 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 19 dealers in margarine, 1 wholesale dealer in milk-blended butter and 2 butter manufacturers. All the registered premises were frequently visited. Bakehouses.—At the end of 1936 the number of bakehouses on the register was 54, 45 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 thi 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 106 visits were paid and 3 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. 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. Pharmacy and Poisons Act, 1933. On the 1st May, 1936 certain provisions of this Act, repealing Section 2 of the Poisons and Pharmacy Act, 1908, came into operation. The new Act provides, inter alia, that no person other than a registered pharmacist shall retail to the public and substance included in Part I of the Poisons List, and that persons retailing to the public the substances specified in Part II of the Poisons List shall be either registered pharmacists or persons registered for the purpose by the Borough Council. Part fl of the Poisons List comprises, amongst other things. 18 those substances to which Section 5 of the Poisons and Pharmacy Act, 1908, had applied (ammonia, carbolic disinfectants, sulphuric, nitric and hydrochloric acids and salts of lemon) and a number of substances used in agriculture and horticulture and also certain dyes. The Council authorised the Public Health Committee to administer the powers provided in the Act. Notice of the new requirements was given in the local press and in many instances shopkeepers who were known previously to have been selling the substances specified were communicated with. By the end of the year the number of traders whose names had beeni placed on the List was 112. 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 2,025. The complaints received numbered 53. 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. 19 1.—INSPECTION. Premises Number of Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories (Including Factory Laundries) 261 38 — Workshops (Including Workshop Laundries) 1,097 68 - Workplaces (Other than Outworkers' Premises included in Part 3 of this Report) 667 24 - Total 2,025 130 - 2—DEFECTS FOUND. Particulars Number of Defects Number of Prosecutions Found Remedied Referrec to H.M Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts— Want of cleanliness 21 21 — — Want of ventilation 5 5 — — Overcrowding 1 1 — — Want of drainage of floors 1 1 — — Other nuisances 16 16 — — Sanitary accommodation insufficient 6 6 — — unsuitable or defective 20 20 - - not separate for sexes 25 25 - - 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) 3 3 - - Other offences — — — — (Excluding offences relating to outwork which are included in Part 8 of this Report) - - - - Total 98 98 - - 3.—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109,110 NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S 110) Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 71 290 819 • • • ... ... 13 ... ... ... ... ... ... ... ... Total 71 290 819 ... ... ... 13 ... ... ... ... ... ... ... ... 20 21 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year (1) Number (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 1,781 Coffee Shops, &c. 469 Bakehouses 54 Total number of workshops on Register 2,304 5.—OTHER MATTERS. Class (1) Number (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 53 Reports (of action taken) sent to H.M. Inspector 53 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 45 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, 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 the Public Health (London) Act, 1891, and Section 6 of the Housing Act, 1925, 22 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, cleansing, etc. During the year some 8,693 visits were paid to the 1,055 houses carried over from the old register. The number of intimation notices served was 1,018, relating to cleansing and other defects. Except in 8 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. 2, Burne Street and Lisson Street The Salvation Army Trustee Company 436 men "Portman House" (late Shaftesbury Institute), Harrow and Daventry Streets, Lisson Grove The Rev. Prebendary Wilson Carlile, C.H., D.D. 100 women Total ... 536 During 1936, 38 visits were paid to Common Lodging Houses by officers of the department. In addition the premises were periodically inspected by a Fire Inspector (Mr. M. W. A. Davey) specially appointed for the purpose. Underground rooms.—The year 1936 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 105 in which the occupation was definitely illegal securing discontinuance of occupation. Regulations as to underground rooms 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 1936 there were 408, this number including restaurant, dining room and coffee shop kitchens, 225; tea-rooms and pastry-cookshops 120; hotel kitchens, 32; fried fish shops, 25; iand fish-curers, 6. As already explained legal provision has now been made for registration of premises in which ice cream is prepared or sold and certain articles of food are manufactured or prepared. At present the requirement does not apply to cookshops or cooked-food shops, but in time the difficulties with which the procedure is supposed to be surrounded in the case of such establishments may be met. As a matter of routine, a number of restaurants, food premises, etc., are visited each week by the Food Inspector, and any matters discovered at these inspections are dealt with at once. In 1936, the total number of inspections was 436, the number of notices served being 10. 23 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. FOOD. A.—MILK SUPPLY. Analysis of milk.—The quarterly returns as to the number of milk samples taken are as follows;—1st Quarter, 63; 2nd Quarter, 62; 3rd Quarter, 43; 4th Quarter, 51, making a total for the year of 219. One 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, 37 samples were taken and submitted to the Council's Bacteriologist for examination. In each case in which a result not entirely satisfactory was obtained communications were sent to the Local Authority of the district in which the milk was produced in order that an investigation might be carried out locally. On all occasions the greatest willingness to co-operate was shown by the officers of these authorities, and it is safe to claim that definite improvements have followed the taking of action on these lines. In addition to these samples, 18 of certified milk were taken and submitted to bacteriological examination. The reports were almost invariably satisfactory and, in accordance with the usual arrangement, were forwarded to the Ministry of Health. Dairies, Milkshops, etc.—Frequent inspections of milk premises were made with the object of discovering whether or not the requirements of the regulations as to cleanliness, etc., under the Milk and Dairies Order, 1926, were being complied with. In no case was it necessary to take action. The Milk (Special Designations) Orders.—Under these Orders 60 applications were received from 22 dealers in the Borough for licences. As the milk in each case was obtained from a producer licenced 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, 25 for "Pasteurised" Milk, and 2 for Grade "A" (Pasteurised) Milk. Seven supplementary licences were; issued. In addition there w-ere granted 1 pasteurising licence, 1 bottling licence for Grade "A" (Tuberculin Tested) milk and 1 bottling licence for Grade "A" milk. Dealers in designated milks were informed of the changes introduced by the Milk (Special Designations) Order, 1936, by means of the following letter issued on the instructions of the Public Health Committee on 19th May, 1936 "The Milk (Special Designations) Order, 1936 comes into operation on the 1st June, 1936, and revokes the Milk (Special Designations) Orders of 1923 and 1934. The new Order provides for three grades of milk—"Tuberculin Tested", "Accredited" and "Pasteurised". 24 "uberculin Tested" will replace tlie existing; designations "Certified" and "Grade A (tuberculin tested) It will be the only designation for raw milk from tuberculin tested cows. "Tuberculin Tested" milk may, if desired, be pasteurised subject to the conditions of the Order and, where this is done, it must be sold as "Tuberculin Tested Milk (Pasteurised)" In regard to raw milk of this grade it is prescribed that, until 31st December, 1936, it must be so produced that a sample taken at any time before delivery to the consumer shall not contain more than 200,000 bacteria per millilitre; after that date it must satisfy a prescribed methylene blue reduction test for cleanliness. At all dates it must contain no coliform bacillus in one hundredth of a millilitre. If pasteurised it must not contain more than 30,000 bacteria per millilitre. If it is bottled on the farm the word "(Certified)" may be added to its description. "Accredited" milk will replace the present "Grade A" milk. It will be raw milk from cows which are regularly inspected by a veterinary surgeon but which are not tuberculin tested. It will be subject to the same bacteriological test as "Tuberculin Tested" milk. As will be gathered from the designation, it will indicate that milk sold as "Accredited" comes from the herds of producers enrolled under the Accredited Producers Scheme initiated by the Milk Marketing Board. Where "Accredited" milk is bottled on the farm, the words "Farm Bottled" may be) added to the description. "Pasteurised" milk will, as at present, be milk which has been held at a temperature of 145°—150o F. for thirty minutes. The designation is applicable both where "Accredited" milk and where ungraded milk is pasteurised in accordance with the requirements of) the Order. In drawing attention to the change of designations, it is pointed out that after the 1st June, 1936, the abolished designations must not be used, except that, in order that present stocks may be utilised, caps and labels complying with the Orders of 1923 and 1934 may be used until the 31st December, 1936. Fresh licences will not be necessary when the new Order comes into force on the 1st June, 1936. The licence or licences at present held will be regarded as covering those designations which replace the grades in respect of which the licence or licences were originally granted. These will continue to operate until the 31st December, 1936. When licences are granted for the year 1937 the new designations will, of course, be used." Milk (Mothers and Children) Scheme.— During 1936 there has been no change in the methods adopted in relation to the supply of milk to mothers and children. Up to 31st March, 1937, the amount expended was £784 11s. 10d., as against £792 14s. 5d. in the year ended 31st March, 1936. The actual number of cases dealt with was 352, and the number of orders issued 2,190, which were slightly larger figures than those for 1935, when the cases numbered 340 and the orders 2,080. 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, was approximately the same as in 1935. 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, assessments 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. 25 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 which came into operation on 1st October, 1934, has worked with absolute smoothness and greatly to the benefit of the children taking advantage of the provision. In two cases the Council's Bacteriologist reported adversely in regard to samples and appropriate action was taken. Subsequent samples from the suppliers concerned were found to be satisfactory. B.—FOODS OTHER THAN MILK. The main duties in relation to food protection generally in 1936, as for some years past, have been carried out by Inspector Smith, who made inspections of premises in which food is sold, stored or prepared, and acted as Sampling Officer under the Food and Drugs (Adulteration) Act, 1928. The Public Health (Meat) Regulations, 1925, continue to work smoothly so far as the provisions relating to butchers' shops and to stalls are concerned, the butchers endeavouring to comply as completely as possible with the requirements. On the whole it may be claimed that as a result of the operation of the regulations there has been real improvement so far as regards exposure of meat, and that in the matter of protection from contamination conditions are very much better than they were when the regulations came into operation. Food Inspection.—The work of food inspection receives year by year the closest attention. During 1936, as formerly, the special Saturday night and Sunday inspections in market streets, etc., were made, and in carrying them out Inspector Smith received the assistance of other members of the staff having the necessary qualifications and experience. On a great many occasions the inspector was called by vendors to examine articles of food under Section 47 (8) of the Public Health (London) Act, 1891, and to accept surrender of such as were unsound or unwholesome or unfit for food. Amongst the articles dealt with in this way were:— Unsound Food Condemned and Destroyed During the Year 1936. Meat Grapes5 Boxes Beef 20 Stone Potatoes 14 cwt. Lamb 10 ,, Asparagus 12 Bundles Pork 4 ,, Brussels tops 30 cwt. Mutton 7 ,, Rape 7 Mats Poultry— Turkey 17 ,, Miscellaneous (Tinned Goods, etc.). Chicken 1 ,, Corned Beef 19 tins Chicken and Ham Roll 4 ,, Fish— Brawn 21,, Skate 5 Stone Pork and stuffing 2 ,, Lemon Soles 4 ,, Lunch Sausage 2 ,, Kippers 5 Boxes Briskets of Beef 2 „ Crabs 1 Case Jellied Veal 9 ,, Prawns 7 lbs Ox Tongues 12 ,, Winkles 1 1/2 Bushels Hams 112,, Escallops 9 Dozen Hocks 7 ,, Fruit & Vegetables— Lunch Tongues 5 „ Apples 1 barrel Cream 7 „ Pears 34 Boxes Salad Cream 14 bottles 26 Food Premises.— The points of importance in relation to food premises generally 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, preliminary to registration, premises used for the preparation of cooked and other foods intended for sale 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, 4 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 1936 was 1,067, the figure for 1935 being 1,065. The sum paid in respect of each analysis was 12s. 6d. Of this number four were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of 0.4 as against 0.1 in 1935. 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 "informal" 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, 1936. The number of samples taken under the Food and Drugs (Adulteration) Act and submitted for analysis, was 1,067. The following is a complete list of the articles sampled:— 21 Number Examined Number Adulterated, etc. No. Article Formal Informal Private Total Formal Informal Private Total 1 Almond, Essence of - 2 - 2 2 Apricots - 1 — 1 3 Aspirin - 1 — 1 4 Beans - 2 — 2 5 Butter 103 188 — 291 6 Butter and Rolls — 15 — 15 7 Butter Scotch — 1 — 1 8 Candied Peel — 3 — 3 9 Cochineal — 2 — 2 10 Cheese — 31 — 31 11 Cherries Glace — 4 — 4 12 Cinnamon, Essence of... — 3 — 3 13 Cocoa — 26 — 26 14 Coffee — 20 — 20 15 Cream (Ice) — 1 — 1 16 Cream (Loose) 10 15 — 25 17 Cream (Tinned) — 10 — 10 18 Currants — 7 — 7 19 Dripping — 2 — 2 20 Fish Paste — 4 — 4 21 Flour — 1 — 1 22 Gin — 4 — 4 23 Ginger (Ground) — 2 - 2 24 Glycerin and Thymol — 2 2 25 Gregory Powder — 3 - 3 26 Grey Powder — 2 - 2 27 Herbs — 2 - 2 28 Honey — 12 - 12 29 Iodine (Tincture of) — 9 - 9 30 Jam — 30 - 30 31 Jelly (Bramble) — 1 - 1 32 Lard — 53 - 53 33 Lemon Barley Water - 2 - 2 34 Lemon (Essence) — 3 - 3 35 Lemon Powder — 3 - 3 36 Lemonade Powder — 8 - 8 37 Liquorice Powder — 1 - 1 38 Margarine - 14 - 14 39 Marmalade - 17 - 17 40 Meat Paste — 6 - 6 41 Milk 119 100 - 219 1 1 42 Milk (Condensed) — 18 - 18 43 Mincemeat — 1 - 1 44 Mustard — 15 - 15 45 Oil (Cod Liver) — 1 - 1 46 Ointment, (Boric) — 16 - 16 47 Olive Oil — 2 - 2 48 Paraffin (Liquid) — 22 - 22 49 Parrish's Food — 5 - 5 50 Peas (Tinned) — 13 - 13 51 Pepper — 10 - 10 52 Pills (Blaud's with Cascara) — 2 - 2 53 Raisins — 7 - 7 54 Raisin Wine — 1 - 1 55 Rice — 4 - 4 56 Salmon (Tinned) — 1 - 1 Carried forward 232 731 - 963 1 1 28 ANALYSES. Number Examined. Number Adulterated, etc. No. Article. Formal Informal Private Total Formal Informal Privrte Total Brought forward 232 731 - 963 1 1 57 Sardines — 30 — 30 1 1 58 Sausages (Pork) - 6 - 6 59 Sild (Tinned) - 2 — 2 60 Soda (Bicarbonate of) - 4 - 4 61 Sodium Bicarbonate - 2 - 2 62 Sugar - 4 - 4 63 Sugar (Barbadoes) - 2 - 2 64 Sugar Corn - 1 - 1 65 Sugar (Demerara) - 1 - 1 66 Sugar (Granulated) - 2 - 2 67 Sultanas - 7 - 7 68 Sweets - 2 - 2 69 Tart (Apple) - 1 - 1 1 1 70 Tart (Blackcurrant) — 1 - 1 1 1 71 Tart (Gooseberry) — 1 - 1 72 Tea — 20 - 20 73 Toffee - 5 - 5 74 Tongue (Tinned) — 1 - 1 75 Vanilla (Essence of) — 2 - 2 76 Vermouth — 4 - 4 77 Whisky — 4 - 4 78 Witch Hazel — 2 — 2 Total 232 835 — 1,067 4 4 Adulterated Samples, etc. The Public Analyst (Mr. J. F. F. Rowland) comments, as follows, with regard to the samples found to be adulterated:— Serial Number Article Whether Formal, Informal, or Private Nature of Adulteration or Irregularity Observations 312 Milk Informal The sample was deficient in milk fat to the extent of 26.7 per cent. The milk had undergone no change which could interfere with the analysis. 525 Apple Tart Informal The fruit of this tart contained 04 grains of tin per lb. of fruit The sample had undergone no change which could interfere with the analysis, 531 Black Currant Tart Informal The fruit of this tart contained l.l grains of tin per lb. of fruit The sample had undergone no change which could interfere with the analysis. 843 Sardines (Sild) Informal 4.2 grains of tin per lb. 29 Milk.— Out of 219 samples analysed one only was found to be adulterated. This is the first example of an adulter ated milk since May 18th, 1934. The average composition of the milk examined during the year as well as that of the two years preceding was as follows:- Total Solids Year. Sp. Gr. Solids. Fat. not Fat. 1934 1031.5 12.17 3.56 8.61 1936 1031.0 12.07 3.47 8.60 1936 1031.3 12.29 3.60 8.69 Cream.—During the year 25 loose creams were examined, the amount of fat ranging from 45.0—53.5%, the average being 48.53%. The Tinned Creams numbered 10, and their fats ranged from a minimum of 22.0 to a maximum of 29.0%, giving an average of 24.66% being almost exactly half the value obtained for the loose creams. No preservative was present in any one of the samples examined, either loose or tinned. During the year 1936 a total of 4 samples was found to be adulterated. Of these the sample of miik was deficient in milk fat to the extent of 26.7% but contained no added water. On investigation it was found that the milk from which this sample was taken had not been properly mixed before sampling. Fruit Tart.—The fact that some sugars contain tin may possibly explain the reason why two of the three samples of fruit tart also contained tin. It is, much to be regretted that in the preparation of such a widely used food as Demerara or Barbadoes sugar it is still found necessary to use tin compounds. In this Borough the presence of tin in sugars was first reported on in September 1929, nearly 8 years ago. Sardines.—The contents of one of the tins of sardines contained no less than 4.2 grains of tin per pound. This is more than twice the maximum amount usually looked upon as permissible. Drugs.—All the samples examined during the year conformed to the limits laid down in the British Pharmacopoeia and no special comment is necessary. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1936 was 906,* being 10 more than in 1935. Of the children born, 461 were boys and 445 girls. The birth rate per 1,000 of the population was 9.78, as against 9.72 in 1935. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1936, with those of each of the five previous years:— 1931 1932 1933 1934 1935 1936 All Souls 8.9 8.5 7.0 6.8 8.5 8.3 St. Mary 13.2 11.2 7.8 8.7 8.3 8.1 Christ Church 14.4 13.5 12.7 12.5 12.3 12.9 St. John 11.9 9.1 11.0 7.2 8.9 8.0 The Borough 11.4 10.9 9.7 9.0 9.7 9.8 * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 261 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 109 ,, Females 97 Illegitimate Males 25 „ Females 30 Total 261 30 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 4,071; live births, 3,863; still births, 208. The total notifications in 1935 was 3,776. The provisions of the Act are now very generally known, and the necessity for notifying is not less well recognised than that for registration. Actually in 1936, failure to notify within 36 hours of birth, as required, did not occur, but in general when there is failure, a perfectly reasonable explanation is forthcoming, and proceedings against any of the parties are unnecessary. 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. From Parents 6 ,, doctors 89 ,, midwives 237 ,, hospitals, nursing homes, etc. 3,739 4,071 Of the total births notified, 208 referred to still-births (124 males and 84 females); 2,138 took place at Queen Charlotte's Hospital; 561 at Middlesex Hospital; 122 at the, St. Maryllebone Home; and 406 were born at home. Of those notified as having occurred in St. Marylebone 3,133 belong to other Boroughs. Of the 208 still-births 31 (20 males and 11 females) were to St Marylebone mothers. DEATHS AND DEATH RATES. The number of deaths registered in 1936 was 1,169. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but, exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. The corrected death-rate* per thousand for the year was 12.5. In the previous year, the rate was 11.7 and the number of deaths 1,094. The following short table shows the death-rates in the several registration sub-districts in 1936, and compares them with those of the preceding 5 years. 1931 1932 1933 1934 1935 1936 All Souls 10.8 12.8 10.5 10.9 11.2 11.9 St. Mary 12.4 11.4 12.7 12.1 10.9 12.2 Christ Church 13.1 14.1 14.2 13.8 12.9 13.5 St. John 12.6 12.8 12.1 13.3 11.8 12.2 The Borough 12.3 12.4 12.2 12.6 11.7 12.5 * 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 1936 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 ot the year. 31 District birth and deaths for the year ended 31st December. 1936 are given in the following table. A further table giving the vital statistics of separate localities for 1936, and the ten preceding years, will be found amongst the Ministry of Health Tables on Page 65. Sub-District. Population estimated to middle of 1936. Births, Deaths. Males. Females. Total. Males. Females. Total. All Souls 21,165 85 90 175 123 131 254 St. Mary 24,285 108 112 220 142 158 300 Christ Church 28,150 192 170 362 188 195 383 St. John 18,800 76 73 149 103 129 232 The Borough 92,400 461 445 906 556 613 1,169 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 1936. For purposes of comparison the table for 1935 is reproduced. 1936. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 20 17 15 16 68 Persons of 65 years and upwards 190 143 106 146 585 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 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 66. 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 1,137. 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 1936 was 68 and the number of births in that year 906. The infantile mortality rate is therefore 75. 32 The number of legitimate births was 781 and the deaths amongst these numbered 50, giving a rate of 64. Amongst the 125 illegitimate births there were 18 deaths, the rate being 144. In 1935 the death rate for all infants per 1,000 live births was 56. The means adopted in the Borough with a view to reducing this rate 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 33, 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 1936, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 16 were less than one month old when they died and 28 less than three months. The corresponding figures for 1935 were 23 and 32 respectively. The outstanding causes of death and the proportions traceable to them were those usually noted. Diarrhoea and enteritis, which .head the list, (numbers 7 and 8 irn the table) accounted for 22 in 1936 and 7 in 1935. Prematurity (12, 13 and 14), caused 15 in 1936, and 17 in 1935. Respiratory diseases took 8 in 1936 and 3 in 1935. The considerable increase in the number of deaths from diarrhoea and enteritis is noteworthy though search has failed to show any particular reason for it. Amongst the other causes of death, mention may be made of whooping cough and measles which accounted for 3 and 2 respectively. Injury at birth caused 5 deaths and there was one case of "overlaying". 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 probably most neglect of ordinary hygienic precautions, is again at the head of the list with 32 deaths amongst infants. In 1935 the figure was 20. Of the 32 deaths 10 were credited to diarrhoea and enteritis, nearly 50 per cent of the total for the borough. TABLE A. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year of age, and in Sub-Districts. No. CAUSE OF DEATH Under 1 Week 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 1 Month 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year All Souls St. Mary Christ Church St. John Total 1 Small-Pox - - - - - - - - - - - - - - - 2 Chicken-Pox — - — — — — — — — - - - - - - 3 Measles — - — — - — 1 — 2 3 1 — 2 - 3 4 Scarlet Fever — - — — — — — — — — - — — - — 5 Diphtheria and Croup - - - - - - - - - - - - - - - 6 Whooping Cough - - - - - 1 — 1 1 3 1 — 1 1 3 7 Diarrhœa — - — — — — — 1 — 1 1 — — - 1 8 Enteritis — - — — - 1 8 7 5 21 6 3 9 3 21 9 Tuberculous Meningitis - - — — — — — — — — — — — — — 10 Abdominal Tuberculosis - - - - - - - - - - - - - — — 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation - - - - - - 2 1 - 3 - - 2 1 3 13 Premature Birth 4 - — 1 5 1 — — — 6 — 2 4 — 6 14 Atrophy, Debility and Marasmus - - - - - 3 3 - - 6 1 3 1 1 6 15 Atelectasis 2 - — — 2 - - — — 2 1 — — 1 2 16 Injury at Birth 4 - — 1 5 — — — — 5 2 1 2 — 5 17 Erysipelas — - — — — — — — — — — — — — — 18 Syphilis — - — — — - 1 — — 1 1 — — — 1 19 Rickets — - — — — — — — — — — — — — — 20 Meningitis (not Tuberculous) - - - - - - - - - - - - - - - 21 Convulsions — - — — - — — — — - — — — — — 22 Gastritis — - — — — — — — — — — — — — — 23 Laryngitis — - — — - - — — — - — — — — — 24 Bronchitis - - - - - 1 - - - 1 - - 1 — 1 25 Pneumonia (all forms) 1 1 — 2 4 1 2 — — 7 — 1 4 2 7 26 Suffocation, Overlying — - — — — 1 — — — 1 — — 1 — 1 27 Other Causes - - - - - 3 3 2 - 8 1 2 5 — 8 Totals 11 1 - 4 16 12 20 12 8 68 15 12 32 9 68 M. F. Nett Deaths in the Year Legitimate Infants, M. F. M. F. Nett Births in the Year Legitimate, 405 376 26 24 Nett Stillbirths in the Year Legitimate Infants, 14 8 Illegitimate, 56 69 Illegitimate Infants 9 9 Illegitimate Infants, 4 1 Total 461 445 Total 35 33 Total 18 9 906 68 27 CO 00 34 MATERNAL MORTALITY. In 1936 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 1935 there were 2 deaths, the death-rate also being 2.2 per 1,000 births. With regard to the 1936 deaths it may be noted that both occurred in nursing homes, one of the women being 26 and the other 32. 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 66. 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 25, equal to 0.27 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1936 this was the case also, no fewer than 22 of the 25 being children under 1 year of age. In 1935, the deaths from diarrhceal diseases numbered 18, and of this number 17 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 14 deaths, and including diarrhoea etc., (25 deaths) the total number registered as due to them was 49. Of these deaths, 1 was caused by paratyphoid fever, 1 by scarlet fever, 6 by diphtheria. Two deaths were attributed to encephalitis lethargica and one to cerebro-spinal fever, whilst whooping cough and measles accounted for 5 and 8 respectively. In 1935, 26 deaths were due to infectious diseases excluding influenza, which caused 9 deaths. The figure in 1934 was 37. 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 69, 72 being recorded in 1935. The great bulk of the 69 deaths, viz., 62, was due to phthisis. The number in 1935 was 63. . Of the total number of deaths registered (1,169), the percentage due to phthisis was 5.2, as against 5.8 in 1935. The age periods at which the deaths occured were: 5—15, 1 ((1.6%); 15—25, 9 (14.7%); 25—45, 21 (34.5%); 45—65, 23 (37.7%); 65 and over, 7 ( 11.5%). 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 114. This is higher by 42 than the figure (72) for 1935, 35 The death-rate was 1.23 per thousand. In 1935 the rate was 0.78. The number of deaths certified to be due to bronchitis was 33. Of this number 21 were amongst persons aged 65 and upwards, and 9 amongst those of the group 45—65. Three were under 45. The deaths traceable to pneumonia numbered 72 and, as in the case of bronchitis, the later age groups contributed the greatest numbers. The number of cases of pneumonia notified in 1936 was 66. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in the table on page 67. Visits were paid to each of the notified cases when not already in si 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 St. Marylebone Nursing Association) offered. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 195 and the death-rate 2.11 per 1,000 of the population. The figures for 1935, were 181, and 1.95 per 1,000 respectively. Information with regard to the situation of the disease and the age at which death occurred is given in the following tables:— Cancer: Ages at Death. Ages under 1 2 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and upwards Total Males - - - - 2 4 20 24 26 12 88 Females - - - - 2 5 20 32 34 14 107 Totals - - - - 4 9 40 56 60 26 195 Cancer.—Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 12 1 13 Throat, Neck, Gullet 19 2 21 Stomach 14 11 25 Intestines 14 16 30 Liver 5 11 16 Breast — 29 29 Uterus and Generative Organs 6 25 31 Various 18 12 30 Totals 88 107 195 The fact, commonly accepted, that the number of deaths certified as due to Cancer is showing a definite tendency to increase receives confirmation from these figures. No reason, generally acceptable, to account for this has as yet been put forward, nor has any theory to account for the occurrence of the disease, to which the medical profession as a whole can subscribe, been submitted. One point upon which there is general agreement, however, is with regard to the importance, advisability and advantage of early treatment. Of the accuracy of the advice, now so widely given that there should never be any delay in seeking an authoritative opinion in any case of doubt and in securing treatment; there can be no question, 36 ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1936 numbered 66. Of these 22 were due to suicide. There was one recorded death of a baby 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 67. The following table shows the number of cases of infectious disease notified during the past six years:- 1931 1932 1933 1934 1935 1936 Smallpox 2 - - - - - Diphtheria 154 83 78 104 119 121 Erysipelas 55 55 76 59 35 28 Scarlet Fever 258 192 198 212 155 141 Enteric Fever. 9 3 7 3 3 5 Paratyphoid Fever 3 4 2 1 3 3 Continued Fever — — — — — — Puerperal Fever 11 5 8 3 10 4 Puerperal Pyrexia 22 26 17 18 36 28 Cerebro-spinal Meningitis 5 2 1 1 1 1 Tuberculosis (Pulmonary) 145 140 148 132 93 107 Tuberculosis (Non-Pulmonary) 17 23 16 25 19 23 Acute Poliomyelitis 1 1 — — 3 2 Polio-Encephalitis — — — — 1 1 Ophthalmia Neonatorum 10 8 6 8 10 7 Encephalitis Lethargica — — 1 — — — Pneumonia 80 77 74 70 33 66 Malaria — 1 — 1 1 — Dysentery — 2 1 2 3 1 Totals 772 622 633 639 525 538 Diphtheria and Membranous Croup. There were 121 cases of diphtheria notified during 1936, 6 deaths resulting. In 1935 there were 119 cases and 2 deaths. The cases were more or less evenly distributed, as usual, throughout the borough, and only in a few instances was it possible to determine accurately the source of infection. In 5 cases the source appeared to be a member of the family previously infected; in 12 cases infection was counted to have been acquired in school, and in 9 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 860, a positive result being returned in 79 instances. Of the registration districts, that contributing the largest number of cases was All Souls with 51. In Christ Church the number was 37, in St. Mary 19 and in St.John 14. The age group 5—15 was most affected, 61 of the cases falling into this group. Three applications were 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., 4. These were all remedied after service of notices. 37 Diphtheria Immunisation.— The Schick Testing- and Diphtheria Immunisation 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 2,517 New cases 828 Schick negative 182 Completely immunised (3 injections but not retested) 404 Retested 201 Positive after retest 1 Scarlet Fever. Notifications of this disease numbered 141, the highest number of cases reported in any one week being 7. There was one death from scarlet fever during 1936. In 1935 there were 155 notifications, no deaths resulting. The districts to suffer most from the disease were All Souls and Christ Church. In the former there were 44 cases and in the latter 43. St. Mary and St. John each reported 27. As usual, the majority of the patients were children, 98 being under 15 years of age. Of the remainder, 32 were in the age group 15-35 and 11 were over 33 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 12, instances, that a definite connection could be made out. Defects in sanitation to the number of 5 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. Five notifications of Enteric Fever and three of Paratyphoid Fever were received. There was one death. 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. The patient died. Encephalitis Lethargica, Polio-Encephalitis and Polio-Myelitis. No notification of Encephalitis Lethargica was received during the year, but two deaths of long standing cases were registered. One case of Polio-Encephalitis and two cases of Polio-Myelitis were notified during 1936. There were no deaths. Erysipelas. The notifications of erysipelas numbered 28, and there were no deaths. Most of the cases were notified from St. Charles' Hospital and the General Hospitals, and 23 patients were treated in such institutions. Puerperal Fever and Puerperal Pyrexia. The number of cases of Puerperal Fever notified was 4. 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 were suitable and possible offered. No death was recorded. Particulars of the 2 deaths attributed to other puerperal conditions are given under the heading "Maternal' Mortality.'' 38 The Puerperal Pyrexia cases notified during the year numbered 28; 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 1935 was 36. Measles and German Measles. These diseases showed an epidemic tendency during the first eight months of 1936, and although they are not now notifiable, 40 cases were reported voluntarily by doctors and parents and 741 notices of cases and contacts were received from school teachers. There were 8 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. The services of a Nurse, under the agreement between the Council and the Paddington and St. Marylebone District Nursing Association, were obtained in 33 cases. Whooping Cough. Most of the information obtained with regard to this disease is derived from notices received from school teachers, who reported 85 cases and contacts. There were 5 deaths. In 1935 the number of deaths registered as due to whooping cough was 4. 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 69. The following statement gives some information with regard to the work done and the results obtained by Dr. Bulman during 193C. Number of visits paid 1,380 Number of vaccinations— Primary 447 Re-vaccinations 96 543 Number of successful vaccinations 493 Number of unsuccessful vaccinations 50 BACTERIOLOGICAL EXAMINATIONS. The following table shews the number of specimens examined for the purposes of diagnosis, and indicates also the diseases in relation to which the examinations were made:- Disease Suspected. Positive. Negative. Total. Enteric Fever - 2 2 Diphtheria 79 781 860 Phthisis 25 191 216 Totals 104 974 1,078 39 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 1936. INFECTIOUS DISEASE IN SCHOOLS, 1936. (CASES and CONTACTS) Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 18 60 1 3 56 24 Barrett Street 2 — — — — — Barrow Hill Road 8 6 14 5 35 7 Bell Street 13 7 — 13 17 11 Capland Street 12 2 — 13 81 64 Catholic, Richmond Street 2 — — 5 — 1 Christ Church, Cosway Street 1 9 — 3 68 — Convent (St. Edward's), Little Union Place — 5 1 6 14 5 Cosway Street (L.C.C.) 11 12 3 16 80 4 Emmanuel, Aberdeen Place 1 2 — 8 76 45 Gateforth Street — 1 — — 1 - Hampden Gurney 5 1 — 4 75 5 Homer Row, Catholic 5 1 — 1 15 — Jewish, Hanway Street — 3 — — — — Polytechnic, Regent Street — 1 — 1 1 — Regent's Park Central — 2 — — 1 1 St. James's, Marylebone Lane 1 — — 1 — 1 St. Luke's, Nutford Place — 3 8 2 2 3 St. Mark's, Violet Hill 1 4 — 6 9 32 St. Marylebone Central, High Street 15 11 29 10 30 6 St. Marylebone Grammar — — 3 8 16 5 St. Mary's (Western) York Street 6 1 2 1 21 3 St. Paul's Bentinck, Rossmore Road 11 10 — 1 52 4 St. Thomas', Orchard Street — 2 — — 7 - St. Vincent, Wiginore Street 1 — — — — — Upper Marylebone Street 19 29 23 5 24 20 Schools in other Boroughs 4 10 1 13 60 10 Totals 136 182 85 125 741 251 Ophthalmia Neonatorum. This disease—inflammation of the eyes in newly-born children—was first made notifiable (by order of the London County Council) in 1911. The total number of cases notified in 1936 was 7 as against 10 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 St. 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 7 2 5 4 — — — 3 40 Influenza. This disease was rather more prevalent than in 1935, though correct information as to the number of cases was, of course, unobtainable. The district nurses paid 203 visits to 19 cases. The deaths certified as due to Influenza numbered 14 as against 9 in the previous year. Pneumonia. Figures with regard to notification, etc., in relation to this disease will be found on pages 36 and 67. The services of the nurses were requisitioned in 27 cases and 493 visits were paid. The number of deaths certified as due to all forms of this disease was 72. Food Poisoning. Only four notifications of food-poisoning or suspected food-poisoning were received under Section 7 of the London County Council (General Powers) Act, 1932. Enquiries were made into each case. Sausages, fish and pork pies each came under suspicion, but no definite evidence as to the responsibility of these articles was obtainable. In one case the patient was treated in hospital. All quickly recovered. TUBERCULOSIS. In all, 130 notifications were received, 107 relating to pulmonary tuberculosis, the remainder (23) to cases in which structures other than the lungs were affected. The table given on page 41 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, in, some instances, 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 70 2. The number of cases unnotified or notified at death 19 3. The number of cases notified within a month of death 4 4. The number of cases notified within three months of death 4 5. The number of cases notified within six months of death 3 Treatment of Tuberculosis.—Of the cases notified, 283 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 78 were insured persons and were admitted and re-admitted from time to time during the year to sanatoria and hospitals for treatment, the total admissions numbering 108. Non-insured persons numbered 52, the total admissions for these patients being 57, including 13 children. Nurses were sent in to 12 cases and 215 home visits were paid. Non-Pulmonary Tuberculosis.—Thirteen of the total notifications—23 as against 19 in 1935—in the case of this form of tuberculosis came from institutions where the patients were undergoing treatment. Visits were paid to the homes and, where necessary, advice with regard to the obtaining of treatment was offered. Particulars as to the parts affected by the disease will be found in the table on page 47. 41 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.—Summary of Notifications during the period from the 1st January, 1936, to the 31st December, 1936, 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 1 5 7 10 8 14 13 4 64 71 „ Females - - 1 - 10 7 18 5 - - - 43 46 Non-pulmonary, Males - - 2 - 1 1 3 1 — — — 8 8 ,, Females — 1 2 2 5 3 1 — - 1 — 15 16 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 2 3 4 2 14 „ Females - — 1 — 1 1 - 2 2 1 1 10 Non-pulmonary, Males - — — 2 — — — — - - 2 4 „ Females - — 1 - — - - 1 — - 1 3 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— SOURCE OF INFORMATION. No. of cases. Pulmonary NonPulmonary Death Returns- from local Registrars 2 — transferable deaths from Registrar General 8 4 Posthumous Notifications 5 2 "Transfers" from other areas (other than transferable deaths) 9 1 Other sources (if any) - - 42 Part III.—Notification Register. Pulmonary. Non-Pulmonary Total cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December, 1936, on the Register of Notiticatons kept by the Medical Officer of Health. 370 202 572 64 73 137 709 Number of cases removed from the Register during the year by reason inter alia of:— (1) Withdrawal of Notification 1 4 5 2 2 4 9 (2) Recovery from the disease 6 9 15 8 5 13 28 (3) Death 49 20 69 6 9 15 84 (4) Removed from district 99 68 167 19 17 36 203 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 tables at pages 44 and 45, while the following short table summarises the information as to visits paid by Dr. Anderson and the staff of the Dispensary:— No. of visits by Tuberculosis Officer New, 49 Old, 191 No. of cases at Dispensary New, 341 Old, 399 No. of attendances at Dispensary 2,311 No. of Contacts New, 126 Old, 115 No. of visits by Miss Baker First visits, 85 Re-visits, 2,137 No. of visits by Miss Kenion First visits, 69 Re-visits, 1,624 No. of Committee Meetings attended 24 No. of visits to St. Charles' Hospital by Dr. Anderson 85 The Tuberculosis Care Committee continued to meet fortnightly throughout the year, Dr. Anderson, Miss Baker and Miss Kenion attending and assisting in every way possible. The representatives of the Council on this Committee were: Councillors Dr. C. A. Fuller and G. B. Ramsay. In addition to the Council's representatives this Committee includes:- NAME. REPRESENTS. Bennett, Councillor J. (Chairman) Charity Organisation Society. Broadbent, Miss M. E. (Hon. Secretary) Invalid Children's Aid Association. Baldwin, Mrs. The Working Classes. Bell, Miss. London County Council and School Care Committee. Bennett, Miss A. M. Paddington & St. Marylebone District Nursing Association. Bowen, Miss E. A. (M.B.E.) War Pensions Committee & United Services Fund. Davis, Councillor Mrs. E. (appointed 2nd March, 1936) Public Assistance Committee. Fenn, Miss D.M. Margaret Street Hospital. Higgin, Miss E. Registration. Lazarus, Miss O. Central Jewish Synagogue. Lesser, Mr. H. E. London Insurance Committee. Price, Miss H. M. Middlesex Hospital. Simpson, Dr. R. H. Divisional School Medical Officer to the London County Council. Wetherall, Miss. St. Mary's Hospital, Paddington. 43 The following note by Dr. Anderson upon the work of the year is of interest: "The statistics for the year 1936 will be found in the tables in the form prescribed by the Ministry of Health. During the year, 185 patients received institutional treatment, 121 being sent to general hospital and 64 admitted direct to sanatorium. Some of the cases sent to hospital were admitted more than once during the year, the actual number of admissions being 142. Of 121 cases treated in general hospital, 45 were later transferred to sanatorium, making the total number of persons receiving sanatorium treatment 109. There were 113 discharges, 54 from hospital and 59 from sanatorium, while 4 were transferred back from sanatorium to hospital. Out of the 158 progress reports on patients who have had sanatorium treatment through the London County Council, 52 men, 41 women, and 12 children are working or at school; 6 are fit but have no work, 15 are unfit, 12 have been transferred toother districts, and 11 lost sight of. Six declined to attend, and 3 have to be reported as having died. The Care Committee under the Honorary Secretaryship of Miss Broadbent met fortnightly and 403 cases were reviewed. Persons requiring helf) to get food, clothing, fresh employment, etc., were referred to the different agencies in St. Marylebone most capable of dealing with their requirements. In a few cases articles of clothing, grants or pocket money and for payment of arrears of insurance were made from the Dispensary Fund to patients in sanatorium who could not otherwise obtain help. The amount that can be given in this way is necessarily limited by the smallness of the fund at the Committee's disposal. Miss Bowen continued her excellent work for the ex-service men and their families. The work of the Dispensary has been considerably helped since April by a grant from the Borough Council for the supply of extra nourishment to necessitous cases. It was considered advisable to limit the supply of extra nourishment to the giving of milk; this has proved valuable and has been appreciated. Persons in receipt of Poor .Law Relief are dealt with by the Public Assistance Committee, who also supply extra nourishment on receipt ot a request by the Tuberculosis Officer. In no case was this request refused, and actually at present all patients in receipt of outdoor relief who attend the Dispensary are getting this additional hel'p. The number of X-ray examinations has increased greatly. It is now considered necessary to X-ray practically every new case attending the Dispensary for diagnostic purposes, whether the patient is sent by an outside doctor or applies for examination. It is also necessary to re-X-ray cases at intervals, if an efficient check is to be kept on their progress. Adolescent and adult contacts are automatically X-rayed and, in some cases, re-X-rayed at intervals. The wide use of X-rays not only increases the efficiency with which the Dispensary can deal with cases, but the additional expenditure is justified by the fact that by this method alone can the really early case be detected. The re-housing of tuberculous persons continues to be a problem. While some have been placed in better and larger dwellings, there are still many who live under entirely unsatisfactory conditions. Preference is given to such cases by the London County Council, and they can, after a varying interval, be rehoused on one of the London County Council estates. Unfortunately the majority have to refuse this offer, either because the nature of their employment compels them to live centrally, or because the family income will not allow of paying rent plius travelling expenses. At present there does not appear to be any prospect of a solution of this as of many other largely economic difficulties." TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1936 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. Pulmonary Non-Pulmonary Previous to 1936 1936 Previous to 1936 1936 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Bones and joints Abdominal Other organs Peripheral glands Total Bones and joints Abdominal Other organs Peripheral glands Total 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. 6 7 8 2 17 — — — — — 3 1 — 1 5 — — — — — F. 9 2 4 — 6 - - - - - - 4 1 2 7 - - - - - Children 16 2 — — 2 — — — — — 6 2 1 7 16 - - - - - Disease not arrested Adults M. 16 19 32 20 71 9 8 15 3 26 4 — 1 — 5 3 — — — 3 F. 14 9 16 13 38 15 3 10 4 17 2 — 3 — 5 2 1 1 2 6 Children 9 1 1 2 4 5 — — — — 6 1 — 2 9 — 2 — 2 4 Condition not ascertained during the year 17 7 6 2 15 — — — — — 3 1 — 5 9 — — — — — Total on dispensary register at 31st December, 193P 81 47 67 39 153 29 11 25 7 43 24 9 6 17 56 6 3 1 4 13 (b) Not now on dispensary register and reasons for removal therefrom Discharged as recovered Adults M. 9 2 — — 2 - — — — — 6 1 1 — 8 - - - - - F. 15 8 1 — 9 - - - - - - - - - - - - - - - Children 21 — — — - — — — — — 6 2 — 15 23 — — — — — Lost sight of, or otherwise removed from dispensary register 357 216 101 29 346 8 4 2 1 7 61 12 11 35 119 — — — 2 2 Dead Adults M. 14 16 33 207 256 1 1 3 9 13 6 2 3 1 12 - - - - - F. 11 9 9 112 130 — — — 5 5 1 — 1 — 2 — — — — — Children 5 — — 3 3 — — — — — 3 1 — — 4 1 — 1 — 2 Total written off dispensary register 432 251 144 351 746 9 5 5 15 25 86 18 16 51 171 1 — 1 2 4 Grand totals 513 298 211 390 899 38 16 30 22 68 110 27 22 68 227 6 3 2 6 17 44 45 TUBERCULOSIS SCHEME. Return showing the work carried out in connection with the St. Marylebone Tuberculosis Dispensary during the year 1936. diagnosis. PULMONARY. NON-PULMONARY. TOTAL. GRAND TOTAL Adultb. 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 49 38 1 — 4 7 2 4 53 45 3 4 105 *(b) Diagnosis not completed - - - - - - - - 3 1 — — 4 (c) Non-tuberculous - - - - - - - - 25 47 15 7 94 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 7 2 2 — — — — 2 7 2 2 13 *(b) Diagnosis not completed - - - - - - - - - - 2 2 4 (c) Non-tuberculous - - - - - - - - 23 37 20 29 109 C.—Cases written off the Dispensary Register as:— (a) Recovered 2 6 4 1 2 1 2 2 4 7 6 3 20 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 53 85 42 38 218 d.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 158 109 24 15 15 21 20 13 173 130 44 28 375 (6) Diagnosis not completed - - - - - — — — 4 1 2 3 10 1. Number of cases on Dispensary Register on January 1st 419 2 Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 30 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 99 4. Cases written off during the year as Dead (all causes) 56 5. Number of attendances at the Dispensary (including Contacts) 2,311 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 125 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officer to homes (including personal consultations) 237 (a) Personal 13 (6) Other 79 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,749 10. Number of:— (a) Specimens of sputum, &c., examined 172 (b) X-ray examinations made in connection with Dispensary work 353 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (b) above Nil 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 195 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 1936 the total number certified as due to this cause was 62, the deathrate being 0.67 per 1000. In 1935 the deaths numbered 63, the death-rate being 0.68 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 1932-1936. Deaths from Phthisis. 1932—1936. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 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 1936 92,400 62 7 16 32 7 The distribution of the 62 deaths was as follows:- In general and other hospitals, 42, and at home, 20. Of those who died 40 were insured (35 males and 5 females), and 22 uninsured (12 males and 10 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 62, the notified cases of pulmonary tuberculosis totalled 107. 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 5—10 3 2 2 3 — — — 1 10—15 1 — 2 2 — 2 1 — 15—20 5 11 1 5 1 3 — — 20—25 7 8 1 3 5 — — — 25—35 12 19 3 1 8 2 1 — 35—45 10 7 1 1 7 3 — 1 45—55 17 2 — — 7 2 — — 55—65 17 3 — 1 14 2 — — 65 and upwards 6 1 2 1 6 — 1 2 Totals 78 53 12 18 48 14 3 5 62 *Including all cases known otherwise than by notification. The table on page 47, giving information as to localisation of the disease, brings out no fact to which attention has not already been directed. CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDED 3 31st DECEMBER, 1936. Localisation of Disease. Cases notified in whole District. Total cases notified in each Locality Number of cases removed to Hospital from each Locality. At all Ages. At ages—years. All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals Cases Isolated at Home Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Lungs 107 — - 4 29 41 29 4 25 27 42 13 107 14 13 16 2 45 62 Glands 9 — — 3 5 1 — — 2 2 4 1 9 1 2 — — 3 6 Peritoneum 4 — — 2 1 — 1 — 1 2 1 — 4 1 2 — — 3 1 Ankle 1 — 1 — — — — — 1 - — — 1 1 — — — 1 — Meninges 2 — — 1 1 — — — — _ 1 1 2 — — 1 1 2 — Spine 4 — — — 2 2 — — 2 2 — — 4 2 — - - 2 2 Kidney 1 — — — — 1 — — 1 — — — 1 1 — — — 1 — Sacro-iliac joint 1 - - - - - - - - - - - - - - - - - 1 Tibia and fibula 1 - - - 1 - - - - - 1 - 1 - - 1 - 1 - Totals 130 - 1 10 39 46 30 4 32 34 49 15 130 20 17 18 3 58 72 130 47 48 DISINFECTION. The work done in this connection during 1936 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 4,827 237 425 3,270 3,747 12,506 The number of journeys made by the disinfecting vans during the year ended December, 1936, was:— January 111 August 93 February 106 September 111 March 115 October 104 April 116 November 132 May 121 December 114 June 105 1,324 July 96 The number of journeys made during 1935 was 1,219. 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 398 66 97 598 163 1,322 The number of rooms disinfected in 1935 was 994 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 662. MATERNITY AND CHILD WELFARE. The fact that during the year the St. Marylebone General Dispensary ceased to conduct an infant consultation following the transference of its activities to the premises of the Western General Dispensary, Cosway Street, with which it became amalgamated, is one that should not pass unnoticed here. The claim that the first infant consultation in this country was first established at this dispensary is well founded and generally conceded. There can be no doubt that the success that attended the work done at this clinic, for which Dr. Eric Pritchard was in the main responsible, provided a great stimulus to others and was the 49 means of bringing about the general setting up of Infant Welfare Centres and schemes not only in the metropolis but in this and other countries. From the initiation of the scheme in St. Marylebone the centre at Marylebone Lane had been a part and it was with great regret that the Borough Council found itself unable to find a place for a further centre conducted on the premises of the amalgamated Dispensaries (the St. Marylebone and Western General Dispensary") at Cosway Street, the needs of the area being already most adequately met by the Council's own clinics at 113, Marylebone Road and 14, Salisbury Street and those at Queen Charlotte's Hospital and the Church Army. The following extract from a statement required by the Ministry of Health 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, contains much useful information on the work of this section. Tables on pages 55 and 57 give further particulars of the work done at the various clinic centres during the year. Statement Showing Arrangements Made for Maternity and Child Welfare. Number of births notified in the area during the year under the Notification of Births Act, 1907, as adjusted by any transferred notifications: (a) Live births, 907; (b) Still births, 31; (c) Total,* 938; (d) By midwives, 237; (e) By doctors and parents, 95; (f) By hospitals, 255; (g) By Nursing Homes, 74; (h) Inward transfers, 277.* 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, nil. (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,† 2 58; total visits, 538. (b) To children under 1 year of age, first visits,† 609; total visits, 5,496. (c) To children between the ages of 1 and 5 years, total visits, 9,023 *The total of the figures given under (d), (e), ,(f), (g) and (h) 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 a three year old pre-school clinic). (b) Number of Centres provided and maintained by Voluntary tions, 4 (one was closed down at the end of June and another at the end of October, 1936). (c) Total number of attendances at all Centres during the year: (i) By children under 1 year of age, 10,689 (7,625 St. Marylebone residents); (ii) By children between the ages of 1 and 5 years, 10,311 ( 7,611 St. Marylebone residents). 50 (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, *812 (536 St. Marylebone residents); (ii) between the ages of 1 and 5 years, 214 (197 St. Marylebone residents). (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, 621 (368 St. Marylebone residents); (ii) over 1 year of age, 1,315 (781 St. Marylebone residents). (f) Percentage of notified live births represented by the number in (d) (i), 59%. Ante-natal clinics (whether held at Infant Welfare Centres or at other premises):— Ante Post Natal. Natal. (a) Number of Clinicsf 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 24051 863 the year (1868) ‡ (180)‡ (d) Total number of women who attended at all Clinics 4262 510 during the year, (426)‡ (121)‡ (e) Percentage of total notified births (live and still) represented by the number in (d), 5% — *Excluding children who are known to have previously attended a Centre in another district. †ncluding Ante-natal Clinics provided at institutions transferred to the Council under Part I of the Local Government Act, 1929. ||One closed down at end of October, 1936. ‡igures in brackets refer to St. Marylebone mothers. Supply of Milk and Food. (a) Arrangements made for this service are indicated by "Yes" or "No" in each space in the following table Terms of supply. Milk. Meals supplied at Dining Centres Other Food. Expectant Mothers. Nursing Mothers. Children under 5 years of age. Expectant Mothers. Nursing Mothers. Children under 5 years of age. Expectant Mothers. Nursing Mothers. Children under 5 years of age. Free, or atless than cost price, in necessitous cases Yes Yes Yes No No No No No No At cost price in other cases (e.g., sale of dried milk at Centres) Yes Yes Yes No No No Yes Yes Yes 51 (b) Total quantity of milk supplied during the year to expectant and nursing mothers and young children Liquid Dried gallons pounds (i) by the Council 6895½ 5440 (ii) by Voluntary Associations — — 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, 18,237. 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 7 7 4 5 (2) Pemphigus Neonatorum — — — — (3) Puerperal Fever 4 4 - 4 (4) Puerperal Pyrexia 28 10 — 27 (5) Measles and German Measles (in children under 5 years of age) Not Notifiable 239 25 - (6) Whooping Cough (in children under 5 years of age) 80 4 - (7) . Epidemic Diarrhœa (in children under 5 years of age) 14 — — (8) Poliomyelitis (in children under 5 years of age) — — — Ophthalmia Neonatorum. Vision unimpaired 4 Removed from district 3 7 Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever: (i) by the Council, nil; (ii) by Voluntary Associations, the time of 1½ nurses. (b) Total number of cases attended during the year by these nurses, 69. 52 Home Helps. Number of cases in which Home Helps have been provided during the year, nil. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 22. (b) Number (i) employed by the Council, nil; (ii) subsidised by the Council, nil; (iii) employed by Voluntary Associations, nil. (c) Number of cases during the year in which the Council paid or contributed to the fee of a midwife, nil. 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, 6. (b) Number of children on the Register: (i) at the end of the year, 7; (ii) who died during the year, nil; (iii) on whom inquests were held during the year, nil; (iv) returned to parents during the year, 8; (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) 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, 244. Health Visitors and Home Visits.—There are four whole-time, one temporary and five part-time Health Visitors employed by the Council, whose duties include the carrying out of periodic visits to the homes of children of from 18 months to 5 years of age. Children of from 18 months to 2 years are visited every 3 months and those from 2 to 5 years every 6 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 1936 by Health Visitors to children between the ages of 1 to 5 years was 9,023. Clinics.—There are 3 Infant Welfare Centres provided and maintained by the Council at which children pf from 18 months to 5 years are seen. 53 At the Welfare Centre, 14, Salisbury Street, a special "Toddlers' Clinic" is held once a week. The mothers are encouraged to bring their children to this clinic once a month. Regular visits are carried out by the Health Visitor t6 encourage them to attend, and cards are sent to the mothers to remind them of the date of the clinic when their children should next be seen. 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 centres at 113, Marylebone Road and 24, Hill Road, children of from 18 months to 5 years may be seen at the ordinary clinics held twice a week. In addition to these centres, consultations are held weekly at Queen Charlotte's Hospital, Middlesex Hospital, Church Army Dispensary, and at the Western General Dispensary (until closed down in June for rebuilding operations), and the St. Marylebone General Dispensary at 30, Marylebone Lane (until the premises were closed in October, 1936). All these clinics are chiefly attended 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. At 113, Marylebone Road, a special clinic is, held for children of 3 years old. This clinic, which was established experimentally in 1931, has grown in importance. The object of its' initiation under Dr. Bulman, was to endeavour to make touch, before they entered school, with children who had never attended a clinic or welfare centre, and find out something with regard to their condition for their own benefit and for the information of the School Medical Officer. To this end all children who have reached the age of 3 years are found from a register, and unless they are already in attendance at a clinic, an invitation is sent and they are visited specially, if they have not been recently visited as part of the Health Visitor's routine visit, and attendance at the clinic advised. Figures with regard to the work done in 1936 are given on page 56. Treatment of Minor Ailments.—Children suffering from minor ailments and dental defects are treated at the London County Council clinics at 12, Salisbury Street. The co-operation between the two clinics has worked very satisfactorily. Special clinics for massage and artificial sunlight are held at 14, Salisbury Street. Children requiring hospital treatment are referred to hospitals and dispensaries in the borough. Special arrangements have been made with Middlesex Hospital and the Western General Dispensary. Day Nurseries.—There are 3 Day Nurseries in the borough provided by Voluntary Associations, as follows Crossley Day Nursery, 38, Barrow Hill Road Portman Day Nursery, 115, Marylebone Road St. Vincent de Paul, 111, Wigmore Street There is some shortage of accommodation at the Portman Day Nursery, chiefly for children under 18 months. When the new premises of this Day Nursery are complete the accommodation for children of all ages should be adequate, though the possibility of making further provision in the Southern half of the borough is in mind. The arrangements for home visits, clinics, treatment of defects found, and the provision of Day Nurseries for children of from 18 months to 5 years in the borough are therefore adequate and satisfactory for the needs of the area. 54 INFANT WELFARE CENTRES, MATERNITY CLINICS, DAY NURSERIES, DIPHTHERIA IMMUNISATION CLINIC., and CLINIC for PRE-SCHOOL CHILDREN. 14, Salisbury Street, N.W,8 — Monday, 2 p.m. Infant Consultation. Tuesday, 9.80 a.m. Light Clinic. „ 10 „ Massage Clinic. Wednesday, 10 „ Maternity Clinic. „ 2 p.m. Infant Consultation. „ 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, 9 a.m. Maternity Clinic. „ 1.80 p.m. Toddlers (2—5 years) Friday, 1.30 „ 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 Church Army Dispensary, Little Harcourt Street, W.l. Tuesday, 2.15 p.m. Infant Consultation. 113, Marylebone Road, N.W.1.— Monday, 2 p.m. Diphtheria Immunisation. Thursday 2 ,, „ „ Wednesday 2 „ 3 year old Clinic. Day Nurseries— The Crossley Day Nursery, 38, 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.l. 55 STATEMENT SHOWING WORK OF THE ANTE-NATAL AND POST-NATAL CLINICS HELD AT THE MATERNITY AND CHILD WELFARE CENTRE, SALISBURY STREET, DURING 1936 Jan Feb Mar Apl. May June July Aug. Sept. Oct. Nov. Dec. Totals No. of Sessions 5 4 4 - 5 4 4 5 4 5 4 4 5 53 New Ante-natal cases 14 12 12 5 15 6 13 8 10 7 8 8 118 New Post-natal cases 3 3 1 2 — 2 4 — — 1 1 2 19 Attendances Ante-natal 20 28 27 26 27 28 24 32 34 27 27 33 333 Attendances Post-natal 3 2 3 11 — 2 — 1 4 2 6 4 38 Total attendances 40 45 43 44 42 38 41 41 48 37 42 47 508 Transferred to Queen Charlotte's Hospital — — — — — - — — — 1 — — 1 Transferred to St. Charles Hospital — 1 — — , — - — — — — — — 1 Transferred to St. Marylebone Home 3 6 15 4 6 3 — — 3 — — — 40 Transferred to St. Mary Abbots Hospital - — — — — — — — — 5 4 5 14 Transferred to other Hospitals 1 1 1 4 — 1 — — - — — — 8 Put on special diet — — — — — — — — - — — - — Pads and belts provided — - — — — — —: — — — 1 — 1 High blood pressure — 2 — 1 — — — — — — — — 3 Low blood pressure — — — — — — — — - — — — — X-ray examinations — — — — - — — — - — - — — — Referred to Dental clinic 3 8 5 2 5 2 — — 4 1 2 1 33 Urine Tests — 1 — 1 — - — — 1 — — — 3 Undernourished 1 — —- — — 1 — — - 1 — — 3 Miscarriage — — — — — — — — — — — — — Threatened miscarriage . — — — — — — — - - — — — - Cases referred by— Hospitals 3 4 — — — — — - — — - — 7 Midwives — — 1 — — — — - — - - — 1 56 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. 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.—Of the 93 children who were examined during 1936, 45 needed treatment for one or more conditions. The following is a summary of the conditions found:— Enlarged tonsils and adenoids 14 Dental caries 28 Chronic bronchitis 3 Squint 4 Mentally backward 3 Undernourished and flabby 8 Impetigo 1 Whooping cough 2 Recommended for circumcision 2 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. 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 until September, 1936, in the Labour Wards at the St. Marylebone Home, Marylebone Road. The number of births notified from these institutions during 1936 was 2,821; the total births numbering 4,071. The midwives residing in the borough registered as intending to practise in the administrative County of London, number 22. Two conduct maternity homes which are registered by the London County Council. By an arrangement with the Paddington and St. 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 28 cases were dealt with under the arrangement, and 462 visits were paid, the services of the nurses being greatly appreciated by the patients. With regard to the Labour Wards at the St. Marylebone Home, it may be added that the decision of the London County Council to close them in September, 1936, was learned with great regret not only by the Borough Council but by large numbers of women in the Borough. The alternative accommodation provided at St. Mary Abbots Hospital, it is understood, is merely temporary pending the opening of modern Labour Wards at Paddington Hospital. Work done during 1936.—The following table gives some idea of the work done at the various centres during the year. Full details of the method adopted in relation to the granting of orders for milk under the Maternity and Child Welfare Act, 1918, are given elsewhere. The total number of orders issued is shown in the table. 57 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDED 31ST DECEMBER, 1936. CENTRE No. 24 Hill Road No. 14 Salisbury Street No 113 Marylebone Road Queen Charlotte's Hospl. The Middlesex Hospl. No. 30 Marylebone Lane The Westn Genl. Dispy. No. of consultations held:- Closed down: Oct. June Infants 80 101 94 105 150 71 48 Toddlers 8 52 1 — 53 — — Maternity — 53 — 381 135 13 — Massage — 92 - 38 — — — Light — 65 — - — 1 — No. of attendances of mothers at clinic:— Ante-natal — 451 — 18.188 (840) 5,382 (547) 30 — Post-natal — 57 — 344 (54) 460 (67) 2 — No. of attendances of babies 1,380 1,645 1,461 1,720 (1,074) 3,682 (1,265) 680 62 No. of attendances of children over one year 714 1,888 765 1,133 (522) 2,974 (925) 858 100 No. of attendances at Light Clinic— Infants — 22 — — — 15 — Toddlers — 940 — — — 18 — No. of attendances at Massage Clinic— Infants - 20 - 2(1) - - - Toddlers — 783 — 45(5) — - — No. of orders issued for milk 209 773 318 194 337 119 - No. of home visits 1,533 1,875 947 191 2.989 239 — No. of new cases— Infants 102 109 103 99(63) 216(76) 48 35 Toddlers 13 20 25 12(4) 19(10) 22 10 Ante-natal — 118 3.071(200) 742 (81) 6 — Post-natal — 19 — 266(43) 371(48) — — Massage— Infants — 4 - 2(1) - — — Toddlers — 45 — 4(1) - — — Light— Infants — 2 — — - — — Toddlers — 47 — — - — — Note.—Figures in brackets refer to St. Marylebone residents attending Queen Charlotte's Hospital and Middlesex Hospital. 58 Day Nurseries.—Attendances during the year. The Crossley, Barrow Hill Road.—Whole day, 4,702 ; half-day, 1,212. The Portman, 115, Marylebone Road.—Whole day, 5,136; half-day, 656. St. Vincent de Paul, 111, Wigmore Street.—Whole day, 5,343; half-day, 1,188. Dental Clinic, 12, Salisbury Street. Attendances during the year.—Mothers, 763; children, 77. Advice and treatment given in 585 cases. Extractions under gas, 255. Home Helps.—There were no requests for home helps during 1936. 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, 1936, was :— 1936. Males, Females Total, For burial only. For inquests. Total. No. of P.M.'s held. No. of courts held. No. of Infectious cases. Totals. 43 47 90 90 — 90 46 - — The fact that there are caretakers (a man and his wife) at the Tuberculosis Dispensary has already been noted. In addition to looking after the premises they also render great assistance in connection with the conduct of the clinics, taking notes, helping in the weighing of the patients, etc. (2) Hospital accommodation.— This being a matter with which the Borough Councils in London have no direct concern, it is not considered necessary to make special reference to it. Nursing homes in the Borough number 56, but with these, registration under the Nursing Homes (Registration) Act, 1927, being in the hands of the London County Council, the Borough Council, whose officers could very easily and efficiently carry out the duties involved, have no concern whatever. (3) Local Acts, special local orders and their administration.—There are no Acts or Orders applicable in the Borough which do not apply to other parts of London. The London County Council (General Powers) Acts contain a number of provisions under which a considerable amount of work is done, e.g., those relating to places where food is dealt with. Reference is made to these elsewhere HOUSING. The information asked for by the Ministry with regard to housing is contained in the following statement. The Increase of Rent and Mortgage Interest (Restrictions) Acts, so far as regards the provisions relating to certificates as to suitability for occupation of houses, were not taken advantage of during the year, no application being received. 59 1. Inspection of Dwelling-houses during- the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,330 (b) Number of inspections made for the purpose 12,322 (2) (a) Number of dwelling-houses (included under sub-head 316 houses (1) above which were inspected and recorded under and 611 the Housing Consolidated Regulations, 1925) tenements (b) Number of inspections made for the purpose 3,306 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,215 2. Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,205 3. Action under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By local authority in default of owners Nil B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 10 {2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 10 (b) By local authority in default of owners Nil C.—Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which lition Orders were made 2 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 D.— Proceedings under section 20 of the Housing Act, 1930, and Section 84 of the Housing Act, 1935 (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 105 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 4. Housing Act, 1935.—Overcrowding (a) (i) Number of dwellings overcrowded at the end of the year 1,582 (ii) Number of families dwelling therein 1,582 (iii) Number of persons (equivalent) dwelling therein 7,189 (b) Number! of new cases of overcrowding reported during the year (result of survey) 1,619 (c) (i) Number of cases of overcrowding relieved during the year 37 (ii) Number of persons concerned in such cases 217 60 Clearance and Improvement Schemes.—As to progress in this connection it may be noted that during the year advance continued in the direction of improving housing conditions within the Borough. Particularly is this so in the Carlisle Street area, the reconstruction of which was brought nearer to completion during the year. 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 31,000 349 Clearance Order confirmed by the Minister of Health 27th June, 1935. The London County Council are now negotiating for acquisition 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 June, 1935. 0.31 †Henry Place 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 J January, 1936. †Little Grove Street 0.23 6,000 69 †Byron Street 0.34 9,500 112 *Harrow Street (Together with certain 2.71 additional 120,000 lands.) 1,096 Clearance Order made by London County Council 19th November, 1935. Public - Local Inquiry held 15th June, 1936. Clearance Order made by the London County Council 2nd February, 1937. *Princess Street 2.496 74,000 655 Salisbury Street 0.903 50,000 306 Estate erected by St. Marylebone Housing Association, Ltd. Wilcove Place 1.05 15,000 269 Estate erected by St. Marylebone 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. 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. •Hatton Street 0.495 Compulsory Purchase Order made by London County Council, 1st December, 1936. Public Local Inquiry held 19th March, 1937. *Included in Borough Council's proposals. †Represented by London County Council. 61 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 for 182 persons. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Premises. No. at 31st December, 1936. No. of Inspections. No. of Prosecutions. Common lodging houses 2 38 Nil. Seamen's lodging houses Nil. Nil. Nil. Cowsheds (licensed) Nil. Nil. Nil- Slaughterhouses (licensed) 1 16 Nil Other offensive trades 1 20 Nil. Milkshops 159 261 Nil. Ice Cream premises 100 120 Nil. Purveyors of Sausages, etc. 93 194 Nil. Restaurants and eating houses 377 436 Nil. Registered foster mothers 6 244 Nil. Nurse children kept 7 Smoke Nuisances. Number of Observations 1(52 Number of Intimation Notices served 10 Number of Statutory Notices served Nil Number of Complaints 10 Number of Legal Proceedings Nil Number of Convictions Nil Amount of Penalty and Costs imposed in each case Nil Housing of the Working Classes. 1. Total number of houses and flats in the borough 19,420 2. Number of houses occupied by the working classes 8,579 Public Health Act. 3. No. of houses inspected on account of complaints or illness 3,330 4. Number of statutory notices served 10 5. Number of houses repaired or nuisances remedied 1,205 Housing Acts (1925-35). 6. Number of houses inspected—house to house (Housing- ConHouses 316 solidated Regs., 1925) Tenements 611 62 7. (a) Number of houses included in representations by the Borough Medical Officer under Section 1 of Housing Act, 1930 Nil (b) Number of houses demolished following representation by Borough Medical Officer under Section 1 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 Local Authority in default of owners Nil 9. Number of houses demolished: (а) in pursuance of orders under Section 19 of the Housing Act, 1930 2 (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 8,693 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 790 Number closed or modified occupation approved under Section 84, Housing Act, 1935 105 17. Overcrowding (Housing Act, 1935). Number of houses inspected under Section 1 of Housing Act, 1935 16,009 Number of families found to be living in overcrowded conditions, Section 1 of Housing Act, 1935 1,619 Number of overcrowded families who have obtained alternative accommodation 7 Mortuary. Number of bodies received 90 Number of Infectious bodies received Nil Bakehouses. Number on Register at end of 1936 54 Number above ground 9 Number underground 45 Number of Inspections 106 Number of Notices 3 Number of Prosecutions Nil 63 House Refuse. Number of Inspections 1,043 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 121 Number of Notices issued. Intimations 110 Number of Statutory Notices Nil 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 15 Number of Statutory Notices served Nil Number of Prosecutions Nil Cleansing and Disinfection. Number of rooms disinfected after infectious disease 561 Number of rooms disinfected (vermin) 598 Number of articles 1,324 Number of Statutory Notices served 3 Number of Prosecutions 2 *Cleansing of Persons Act, 1897. Adults Children Males Females Males Females Total. Number of Persons cleansed 912 222 399 874 2,407 *Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of Persons accommodated during the year 2 *The Cleansing of Persons Baths and Shelter were closed down on 18th June, 1936, for demolition in connection with the development of the site of 27, Grove Road. Drainage. Number of inspections made 3,376 Number of drainage plans deposited 500 Number relating to new buildings 72 ,, ,, old buildings 432 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 4 Part-time 5 Temporary 1 Tuberculosis Visitors Whole-time 1 Part-time 1 64 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1936 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 1926 105,800 3,220 1,359 12.7 1,325 12.4 748 740 111 81.6 1,356 11.9 1927 103,500 3,521 1,374 13.2 1,375 13.2 781 621 81 59.0 1,262 11.3 1928 104,000 3,662 1,317 12.6 1,335 12.8 787 690 105 790 1,238 11.1 1929 102,400 3,526 1,233 119 1,465 14.3 821 804 93 77.0 1,455 13.2 1930 102,400 3,162 1,247 12.1 1,373 13.3 831 618 77 62.0 1,171 10.6 1931 93,460 3.134 1,067 11.4 1,411 14.3 826 640 70 65.0 1,225 12.3 1932 96,430 2,952 1,055 10.9 1,444 14.3 859 680 92 87.2 1,265 12.4 1933 94,080 2,881 916 9.7 1,411 14.1 840 653 51 56.0 1,224 12.2 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 1936 92,400 3,624 906 9.8 1,544 16.5 1,045 670 68 75.1 1,169 12.5 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. 65 TABLE II. Vital Statistics of Separate Localities in 1936 and the Ten Previous Years. Names of Localities The Whole Borough All Souls St. Mary Christ Church St. John Year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all ages | Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all ages Deaths under 1 year a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 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 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 Averages of Years 1926 to 1935 98,659 1,129 1,246 78 23,156 202 252 15 25,594 248 324 16 30,346 457 417 33 19,583 222 253 14 1936 92,400 906 1,169 68 21,165 175 254 15 24,285 220 300 12 28,150 362 383 32 18,800 149 232 9 The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sub-District on the 1st April, 1916, but for the purposes of District comparison over previous years the figures have been allocated to the old Sub-Districts. 66 TABLE III.—Causes of, and Ages at Death during the year 1936. No. CAUSES OF DEATH. Net deaths at the subjoined ages of "Residents" whether occurring within or without the district Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church. St. John. Total. All Ages. Under 1 1 and under 2. 2 and under 5. 5 and under 15 15 and under25 25 and under45 45 and under65. 65 and upwards 1 Typhoid and Paratyphoid Fevers 1 — — - - - — 1 — 2 — 1 — - 1 2 Measles 8 2 1 4 1 - — — — 1 3 1 3 1 8 3 Scarlet Fever 1 — — — - - — — 1 — — — 1 - 1 4 Whooping Cough 5 3 2 - - - - - - — 1 1 2 1 5 5 Diphtheria 6 — — 4 2 - — — — — 5 1 — - 6 6 Influenza 14 — — 1 — 2 2 1 8 4 2 4 4 4 14 7 Encephalitis Lethargica 2 — — — — — 2 — — 2 1 — 1 - 2 8 Cerebro-Spinal Fever 1 — — — — — 1 — — — — 1 — - 1 S Tuberculosis of Respiratory System 62 - - - 2 9 21 23 7 14 7 16 32 7 62 10 Other Tuberculous diseases 8 — — 1 1 — 2 — 4 12 2 2 2 2 8 11 Syphilis 7 2 — — — — 1 2 2 5 2 1 2 2 7 12 General Paralysis of the Insane, Tabes Dorsalis 3 - - - - - - 2 1 3 1 - 2 - 3 13 Cancer, Malignant Disease 195 - - - - - 13 96 86 328 44 48 60 43 195 14 Diabetes 10 - - - - - - 4 6 14 2 2 2 4 10 15 Cerebral Hæmorrhage, etc. 41 - - - - - 1 13 27 72 8 13 12 8 41 16 Heart Disease 326 — 1 — 2 2 11 58 252 137 62 99 106 59 326 17 Aneurysm 9 — — — — — — 3 6 — 2 2 3 2 9 18 Other Circulatory Diseases 58 - - - - - 2 18 38 22 18 15 15 10 58 19 Bronchitis 33 2 — — — — 1 9 21 12 7 8 12 6 33 20 Pneumonia (all forms) 72 6 — 1 2 — 8 25 30 67 16 15 30 11 72 21 Other Respiratory Diseases 9 2 — — — 1 1 2 3 17 2 1 3 3 9 22 Peptic Ulcer 12 — — — — — 1 8 3 45 3 3 3 3 12 23 Diarrhœa, etc. 25 22 — — — 1 1 1 —. 8 6 4 11 4 25 24 Appendicitis 12 — — — — 1 4 6 1 21 4 2 3 3 12 25 Cirrhosis of Liver 7 - - - - - - 4 3 4 2 1 3 1 7 26 Other Diseases of the Liver, etc. 5 - - - - - - 4 1 7 1 1 2 1 5 27 Other Digestive Diseases 33 — 1 1 — — 3 16 12 51 12 6 7 8 33 28 Acute and Chronic Nephritis 19 - - - - - 1 8 10 51 5 4 5 5 19 29 Puerperal Sepsis — — — — — — — — — — — — - - - 30 Other Puerperal Causes 2 — — — — — 2 — — 20 1 — — 1 2 31 Congenital Debility, Premature Birth, Malformation, etc. 15 15 - - - - - - - 62 3 5 5 2 15 32 Senility 7 - - - - - - - 7 2 2 2 2 1 7 33 Suicide 22 — — — — 4 8 8 2 10 3 6 5 8 22 34 Other Violence 44 6 — — 1 — 11 8 18 37 10 12 11. 11 44 35 Other defined Diseases 95 8 — — 3 1 20 27 36 107 17 23 34 21 95 36 Causes ill-defined or unknown - - - - - - - - - - - - - - - Totals 1169 68 5 12 14 21 117 347 585 1137 254 300 383 232 1169 67 TABLE IV. Cases of Infectious Disease Notified during the 53 weeks ended 2nd January, 1937. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home. At all ages. At Ages—years. All Souls. St. Mary Christ Church St. John. Totals. All Souls. St. Mary. Christ Church St. John. Totals. —1 1— 2— 3— 4— 5 10— 15— 20— 35— 45— 65— Smallpox - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria, including Membranous Croup 121 2 3 6 8 14 46 15 5 16 4 1 1 51 19 37 14 121 51 19 37 14 121 - Erysipelas 28 — 1 — — — — — 2 5 7 5 8 6 12 5 5 28 5 9 5 4 23 5 Scarlet Fever 141 — 8 9 10 12 42 17 10 22 7 3 1 44 27 43 27 141 42 22 43 23 130 11 Typhus Fever — - — — - —. — - - —. — - - - - - - — - — - - — - Enteric Fever 5 - - - - - - - - 2 1 2 — 2 1 1 1 5 2 — 1 1 4 i Paratyphoid Fever 3 - — — 1 — — 1 - 1 — — — — — — 3 3 — — — 3 3 — Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 4 - - - - - - - - 4 - - - 1 1 1 1 4 1 1 1 1 4 — Puerperal Pyrexia 28 - - - - - - - 1 20 6 1 — 1 18 7 2 28 1 18 6 2 27 1 Plague - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever 1 - - - - - - - - 1 - - - - 1 - - 1 - 1 - - 1 - Tuberculosis— Pulmonary 107 - - - - - 3 1 15 42 13 29 4 25 27 42 13 107 14 13 16 2 45 62 Non-Pulmonary 23 - — — 1 — 4 2 6 8 1 1 — 7 7 7 2 23 6 4 2 1 13 10 Acute Poliomyelitis 2 - — — - — — 2 — — — — — 1 — — 1 2 — — — 1 1 1 Polio-Encephalitis 1 - — — - — — — — — — 1 — — 1 — — 1 — 1 — — 1 — Ophthalmia Neonatorum 7 7 - - - - - - - - - - - 1 2 3 1 7 1 1 2 1 5 2 Encephalitis Lethargica - - - - - - -. - - - - - - - - - - - - - - -. - - Pneumonia 66 2 2 2 - 4 4 3 2 14 4 15 14 17 20 19 10 66 16 16 15 7 54 12 Malaria — — — — - — — - — — — — — — — — — — — — — — — — Dysentery 1 - - - - - 1 — - — - — — - - 1 - 1 - - 1 - 1 - Totals 538 11 14 17 20 30 100 41 41 135 43 58 28 156 136 166 80 538 139 105 129 60 433 105 68 TABLE V. Cases of Infectious Disease Notified during the 53 weeks ended 2nd January, 1937. Notifiable Disease. Cases notified in whole District. Total number of cases removed to Hospital. Total Deaths. At all ages. At Ages—years. -1 1— 2— 3— 4— 5— 10— 15- 20— 35— 45— 65— Smallpox - - - - - - - - - - - - - - - Diphtheria including Membranous Croup 121 2 3 6 8 14 46 15 5 16 4 1 1 121 6 Erysipelas 28 — 1 — — - — - 2 5 7 5 8 23 — Scarlet Fever 141 — 8 9 10 12 42 17 10 22 7 3 1 130 1 Enteric Fever 5 - - - - - - - - 2 1 2 — 4 1 Paratyphoid Fever 3 — — — 1 — — 1 — 1 — — — 3 Puerperal Fever 4 - - - - - - - - 4 - - - 4 — Puerperal Pyrexia 28 - - - - - - - 1 20 6 1 — 27 — Cerebro Spinal Fever 1 - - - - - - - - - - - - 1 1 Tuberculosis- Pulmonary 107 - - - - - 3 1 15 42 13 29 4 45 62 Non-Pulmonary 23 - — — 1 — 4 2 6 8 1 1 — 13 8 Ophthalmia Neonatorum 7 7 - - - - - - - - - - - 6 Pneumonia 66 2 2 2 — 4 4 3 2 14 4 15 14 54 72* Malaria - - - - - - - - - - - - - - - Dysentery 1 — — — — — 1 — — — — — — 1 — Polio Encephalitis 1 — — — — — — — — — — 1 — 1 — Acute Poliomyelitis 2 — — — — — — 2 — — — — — 1 — Totals 538 11 14 17 20 30 100 41 41 135 43 58 28 433 151 *Note:-This figure is for all forms of pneumonia , including Acute Primary Pneumonia and Acute Influenzal Pneumonia 69 VACCINATION RETURNS. Return for 1935. Return made to the Borough Council and Ministry of Health on the 11th February, 1987, 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, 1935, 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, 1935. Number of these Births duly entered by 31st January, 1937, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1937, remained unentered in the " Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1937, 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 1936. 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 1936 Col. I. Col. ii. Col. IV. Col. V. Removal to Success fully Vaccinated. Insuscep tible of Vaccination. Had Small- Pox. Number in respect of whom Certificates of Conscientious Objection have been received. Dead. Unvaccinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. places unknown or which cannot be reached and Cases not having been found. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 305 204 2 — 59 7 5 8 15 5 2.420 610 2. St. Mary 2,252 1,391 3 — 376 94 11 301 73 3 3. All Souls 840 551 10 — 85 16 6 148 22 2 Total 3,397 2,146 15 — 520 117 22 457 110 10 2,420 610 Dated 11th February, 1937. (Signed) GEORGE H. BASSETT, Vaccination Officer.