AC 4353 STMARY 42 Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. London: Freame, Manning & Co., Ltd., 12a, Lee High Road, Lewisham 3 Public Health Department, Town Hall, St. Marylebone, W.l. 30th June, 1938. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, I have the honour aa Medical Officer of Health to submit the following report on the Health of the Borough of St. Marylebone during the year 1937, 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. Towards the end of the year Health Centre No. 2 was completed at No. 217, Lisson Grove (formerly No. 27, Grove Road), but was not brought into use until the beginning of January, 1938. Details of the accommodation provided, with plans and photographs of the building, will be found elsewhere in this report. Other major works with a public health bearing completed by the Council during the year were the Public Baths Establishment in Seymour Place and the Crematorium in the Cemetery at East Finchley. 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. The whole staff during the year have done most excellent work, shouldering with the utmost willingness the extra duties and responsibilities imposed upon them by the coming into operation of the Housing Act, 1936, the National Health Campaign, the Air Raid Precautions Scheme, and in preparing for the carrying out of additional work necessitated by the coming into operation of the Midwives Act, 1936, and the Factories Act, 1937. 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. The retirement of Mr. H. E. Curtis (Chief Clerk) on the 31st October, 1937, after nearly 42 years' service with the Council and of Mr. G. H. Bassett (Vaccination Officer under the Council since 1921) on the 30th November, 1937, are events I cannot allow to pass without mention. 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 mo 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. 4 CONTENTS. page Members of the Public Health Committee 5 Staff of the Public Health Department 6 Section A—Statistics and Social Conditions 7 Section B—General Provision of Health Services 20 Section C—Sanitary Circumstances 39 Section D—Housing 53 Section E—Inspection and Supervision of Food 58 Section F—Prevalence of, and Control over, Infectious and other Diseases 64 Health Propaganda 80 Index 81 ILLUSTRATIONS. New Health Centre 25, 26, 27 Health Propaganda Poster Display 28 5 PUBLIC HEALTH COMMITTEE. (Which is also the Committee appointed for Maternity and Child Welfare purposes.) 1937. His Worship the Mayor (Alderman 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 (died 1st October, 1937) ‡Miss M. Barey. JR. S. Lazarus. *F. Y. Bright. Capt. Gerald Lowry. F. V. Cullen, F.S.I. ‡Miss J. Marsh. Mrs. E. B. Davis. *Mrs. Anne Parker. Dr. C. A. Fuller (Chairman). G. B Ramsay. ‡Capt. C. Hargreaves. Mrs. E. M. Shirley. †Mrs. M. G. Harris. H. Norman Toomey, L.D.S. Mrs. C. Q. Henriques. Dr. Elizabeth Jacobs. *Retired November, 1937. †Appointed February, 1937. ‡Appointed November, 1937. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT. 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. (Appointed Vaccination Officer as from 1st December, 1937). 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. 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.V.O., M.C., M.A., M.D., B.Ch., F.R.C.P. (Lond.), M.R.C.S. (Eng.), D.P.H. Dental Surgeon (Part time): J. Arthur Smith, L.D.S., R.C.S. (Eng.). Vaccination Officer: G. H. Bassett (retired 30th November, 1937). *Food Inspector. *Tuberculosis Clerk-Dispenser. G. Smith (Senior Sanitary Miss M. T. Challis. Inspector) (a, b, d). *Outdoor Superintendent. *District Sanitary Inspectors. P.H. Hill (a,b,d). V. A. Bignell (c, d, e T. A. Cartledge, M.S.M. (a, b, d). Clerks. H. E. P. Corline (b, d). †H. E. Curtis (Chief). T. W. Forbes (b, d). A. H. James. H. E. Scoble (c, d). W. J. Howe. E. E. Willis, M.M. (a, b, d). H. G. E. Brown. A. S. Wilson (a, b, d). C. D. Turbayne. *Drainage Inspectors. R. G. Turner. F. C. Cook (b, d). ††S.P. Fleming. W. H. Draper (a, b, d). †*Miss S. L. Pritchard (Shorthand- Disinfectors. Typist). C.J. Kendall. *Maternity and Child Welfare and J.Overton. Tuberculosis Clerk. *Woman Sanitary Inspector. Miss J. Jones. Miss M. McA. Sharp (c, f, g, h, i). * Woman Sanitary Inspector and Health Maternity and Child Welfare Clerk- Visitor. Dispenser. Miss C. E. Durant (b, f, i). Miss G. M. Courtenay. Health Visitors Cleansing of Persons Baths and Shelter. Miss H. K. Dupont (f, g, h). Miss L. Kilgallin (Matron). Miss M. I. Kendall (c, f, g, h, i). Mortuary Keeper. Miss E. D. Mann (f, g, h, i). Mrs. H. Spears. Miss M. C. Stewart (f, g) *Tuberculosis Dispensary. Part-Time Health Visitors E. D Marston (Caretaker). Miss L. M. Hazel (i) Streets Nuisance Inspector (Temporary). * Tuberculosis Visitors. ** D. Telford. Miss F. A. Baker (6). Messenger. Miss S. Kenion (f, g, h, i). E. W. Broughton. *Officers to whose salary contribution is made under the Public Health Acts or by Exchequer grants. a Royal Sanitary Institute Certificate. b Certificate of the Sanitary Inspectors' Examination Board (London). c Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. d Meat and other Foods Certificate. e Smoke Inspector's Certificate. f Health Visitors Diploma. g Central Midwives Board Certificate. h Certificate of State Registration for Nurses. i Three or Four Years' Hospital General Training Certificate † Retired 31st October, 1937. †† Appointed 25th January, 1937. †* „ 12th April, 1937. ** ,, 22nd February, 1937. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS. GENERAL STATISTICS. Area (in acres) 1,427.8 (exclusive of water); 1,473 (including water). Resident population: 1921—104,173; 1931—97,620; estimated mid-1937—92,110. Number of inhabited houses: 1921—18,507; 1931—17,575. Number of inhabited houses and flats (end of 1937) according to Rate Books, 19,974. Number of families or separate occupiers (1931) 27,352. Rateable value, £3,566,794. Sum represented by a penny rate, £13,505. SOCIAL CONDITIONS AND CHIEF INDUSTRIES. St. Marylebone, in the main, is a residential area, a large proportion of its inhabitants being of the professional classes. As commercial districts, Oxford Street, Edgware Road, Baker Street and many of the neighbouring thoroughfares have become increasingly important during recent years. The census figures for 1931 show that 6,400 males and 4,000 females are engaged in commerce and finance, whilst 2,500 males and 3,600 females follow the learned professions and a further 2,000 males and 600 females are employed in the business of public administration. Together, these three groups account for 10,900 males and 8,200 females or 44 per cent. and 30 per cent. respectively of the total males and femalos engaged in the classified industries. In connection with the professional callings, it may be noted that 1,021 males and 2,480 females are concerned with "medicine and care of the sick and infirm." Personal service (domestic service, hotel and catering work) accounts for 4,400 males and 15,000 females (18 per cent and 54 per cent., respectively). These relatively large figures are to be expected, having regard to the nature of the better residential portions of the district and to the fact that the position of the Borough and proximity of the railway termini from the north and west has given rise to a great number of hotels and catering establishments. The presence of the railways also explains, no doubt, the relatively large number of men employed in transport. This is given as 1,800 or 7 per cent., and includes 500 men working at garages. Of the persons in the remaining industrial groups, 1,600 men (6 per cent.) are engaged in building, and mention may be made of the 1,400 males and 3,000 females (6 per cent, and 11 per cent.) employed in connection with the manufacture of clothing. This industry, centred in the south-western district of the Borough, mainly around Great Portland Street, is based on the demand of the West End. It is almost entirely a high class trade, and is to a large extent carried on in small workshops, the advent of cheap and convenient power in the form of electricity having done much to foster its development. Of interest also is the number of artists, painters and sculptors living in St. Marylebone, particularly in St. John's Wood. This is given as 238, and as the home of artists, the district appears to be second only to Chelsea among the London boroughs. 8 UNEMPLOYMENT. The extent of unemployment in the Borough is shown in Table 1, supplied by the Ministry of Labour. TABLE 1. Number of Insured Persons recorded as Unemployed at Employment Exchanges on the dates indicated. 1937. Males (aged 16—64). Females (aged 16—64). Total (aged 16—64). 25th January 1,933 413 2,346 19th April 1,985 315 2,300 26th July 1,480 351 1,831 18th October 1,940 326 2,266 1930. Men (aged 18 and over). Women (aged 18 and over). Juveniles (aged 14—17). Total (aged 14 and over). 20th January 2,216 499 42 2,757 27th April 1,855 455 32 2,342 20th July 1,442 320 18 1,780 26th October 1,765 354 19 2,138 It is pointed out that the method of compiling these statistics was changed in 1937, and that as a result the figures quoted for that year are not strictly comparable with those for 1936. Allowing for this change the total figures in the agegroup 16-64 for 1936 have been estimated to be as follows: 20th January 2,882 27th April 2,503 20th July 1,937 26th October 2,252 EXTRACTS FROM VITAL STATISTICS. Live Births— Total M. F. Legitimate 749 379 370 Birth Rate per 1,000 of the estimated resident Illegitimate 110 50 60 population 9.32 Stillbirths 36 Rate per 1,000 total (live and still) births 40 Deaths 1,202 Death Rate per 1,000 of the ma ted resident population 12.98 Rate per 1,000 Deaths from Puerperal causes— Deaths. total (live and still) births. Puerperal Sepsis 2 2.23 Other Puerperal oauses 2 2.23 Total 4 4.46 Death Rate of Infants under one year of age— All infants per 1,000 live births 73 Legitimate infants per 1,000 legitimate live births 59 Illegitimate infants per 1,000 illegitimate live births 173 Deaths from Cancer (all ages) 179 Deaths from Measles (all ages) Nil. Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhœa (under 2 years) 9 The various causes contributing to the mortality of the Borough are referred to later in this section of the report. There was no unusual or excessive mortality during the year which calls for comment. 9 NOTEWORTHY CAUSES OF SICKNESS. The Ministry of Health require information as to any causes of sickness or invalidity which have been specially noteworthy in the area during the year; any conditions of occupation or environment which appear to have had a prejudicial effect on health; and any evidence, statistical or otherwise, that unemployment has exercised any significant influence on the health or physique of children or adults. There is nothing to report in respect of any of the questions raised by the Ministry. POPULATION. The population estimated to the middle of 1937 by the Registrar-General is shown in Table 2, and is that used in calculating the various rates given in this report. For information, the estimated population of each of the Sub-Districts is also set out and for comparison the estimated figures for 1931 and of the Census of 1931. TABLE 2. Basis Year. The Borough. All Souls. St. Mary. Christ Church. St. John. Census 1931 97,620 25,667 22,380 28,060 19,937 Estimated to middle of 1931 93,460 24,575 21,422 29,636 19,088 ,, 1937 92,110 24,210 21,100 28,375 18,740 BIRTHS. Registration.—The number of births registered during 1937 was 859,* being 47 less than in 1936. Of the children born, 429 were boys and 430 girls. The birth rate per 1,000 of the population was 9.32, as against 9.78 in 1936. Table 3 contains a comparison of the rates in the several registration subdistricts and the Borough as a whole for 1937, with those of each of the five previous years. TABLE 3. Sub-District 1932 1933 1934 1935 1936 1937 All Souls 8.5 7.0 6.8 8.5 8.3 8.0 St. Mary 11.2 7.8 8.7 8.3 8.1 7.2 Christ Church 13.5 12.7 12.5 12.3 12.9 11.9 St. John 9.1 11.0 7.2 8.9 8.0 9.9 The Borough 10.9 9.7 9.0 9.7 9.8 9.3 *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 312 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 117 ,, Females 114 Illegitimate Males 39 „ Females 42 Total 312 10 Notification.—The total number of notifications received during the year under the Public Health (London) Act, 1936, Section 255, was 3,877; live births, 3,687; stillbirths, 190. The total notifications in 1936 was 4,071. The provisions of the Act relating to this requirement, it is interesting to note, were fully complied with. Speaking generally, it may be said that nowadays the necessity for notifying is not less well recognised than that for registration. 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 8 „ doctors 86 „ midwives 212 ,, hospitals, nursing homes, etc. 3,571 3,877 Of the total births notified, 190 referred to still-births (104 males and 86 females); 1,956 took place at Queen Charlotte's Hospital; 580 at Middlesex Hospital; 179 at St. Mary Abbots Hospital; and 380 were born at home. Of those notified as having occurred in St. Marylebone, 2,948 belonged to other Boroughs. Of the 190 still-births 32 (19 males and 13 females) were to St. Marylebone mothers. DEATHS. Registration.—The number of deaths registered in 1937 was 1,202. 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 persona 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 12.98. In the previous year, the rate was 12.5 and the number of deaths 1,169. Table 4 shows the death-rates in the several registration sub-districts in 1937, and compares them with those of the preceding five years. TABLE 4. Sub-District 1932 1933 1934 1935 1936 1937 All Souls 12.8 10.5 10.9 11.2 11.9 11.4 St. Mary 11.4 12.7 12.1 10.9 12.2 12.6 Christ Church 14.1 14.2 13.8 12.9 13.5 14.4 St. John 12.8 12.1 13.3 11.8 12.2 12.8 The Borough 12.4 12.2 12.6 11.7 12.5 12.98 *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 1937 is 0.99, and the corrected deathrate is obtained by multiplying with this figure the number of deaths per 1,000, calculated from the total deaths and the population estimated to the middle of the year. 11 District deaths, and also births, for the year ended 31st December, 1937, are given in Table 5. Vital statistics of separate localities for 1937, and the ten preceding years, will be found in Table 12 on page 17. TABLE 5. Sub-District. Population estimated to middle of 1937. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 21,100 77 91 168 118 124 242 St. Mary 24,210 90 83 173 150 157 307 Christ Church 28,060 171 162 333 204 207 411 St. John 18,740 91 94 185 105 137 242 The Borough 92,110 429 430 859 577 625 1,202 Table 6 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 1937. For purposes of comparison the table (No. 7) for 1936 is reproduced. TABLE 6. 1937. JanuaryMarch. AprilJune. JulySeptember. OctoberDecember. Total. Infants under 1 year 17 16 14 16 63 Persons of 65 years and upwards 216 132 111 158 617 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 13, on page 18. 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 1,062. 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. TABLE 7. 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 12 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 1937 was 63 and the number of births in that year 859. The infantile mortality rate is therefore 73. The number of legitimate births was 749 and the deaths amongst legitimate infants numbered 44, giving a rate of 59. There were 110 illegitimate births and 19 deaths, the rate being 173. In 1936 the death-rate for all infants per 1,000 live births was 75. 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.—So far as age and causation are concerned, conditions vary little year by year. In 1937, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 31 were less than one month old when they died and 40 less than three months. The corresponding figures for 1936 were 16 and 28 respectively. The outstanding causes of death were those usually noted. Prematurity, etc. (numbers 12, 13 and 14 in the Table), headed the list with 24 deaths in 1937, as against 15 in 1936, whilst respiratory diseases (numbers 24 and 25) accounted for 14 in 1937 and 8 in 1936. There was a decline in the number of deaths due to diarrhœa and enteritis (numbers 7 and 8) which caused 10 deaths in 1937 and 22 in 1936. Amongst the other causes, mention may be made of injury at birth, atelectasis, convulsions and gastritis, each of which was responsible for two deaths. 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, the same figure as in 1936. Of the 32 deaths, 12 were due to premature birth and congenital malformation. Table 8 on the following page shows, in addition to the causes of death, the distribution of the deaths according to age and locality. CO TABLE 8. INFANT MORTALITY. Nett Deaths from Stated Causes at various ages under One Year, 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 C Months. 6 and under 9 Months. 9 and under 12 Months. Total Doaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Total 1 / Small-Pox 2 Chicken-Pox ... 3 J Measles 4 Scarlet Fever ... 5 Diphtheria and Croup 6 Whooping Cough — — — — — — — — 1 1 — — 1 — 1 7 1 Diarrhoea — — — — — 1 — — — 1 — — 1 — 1 8} Enteritis — — — — — 3 2 2 1 8 — 2 5 1 8 9 Tuberculous Meningitis — — — — — — — — 1 1 — — 1 — 1 10 J Abdominal Tuberculosis U( Other Tuberculous Diseasos ... 12 ( Congenital Malformation ... 3 3 3 1 2 _ 3 13 1 Premature Birth 15 1 1 — 17 1 — — — 18 5 10 3 18 14 ^ Atrophy, Debility and Marasmus ... 1 1 1 1 _ 3 _ _ _ 3 3 15 Atelectasis 2 — — — 2 — — — — 2 1 — 1 — 2 16 Injury at Birth 2 — — — 2 — — — — 2 — — 1 1 2 17 Erysipelas 18 Syphilis 19 Rickets 20 Meningitis (not Tuberculous) ... 1 1 1 1 1 21 Convulsions ... — — — — 1 — — 1 2 — — 1 1 2 22 Gastritis — — — — 1 1 — — 2 1 — 1 — 2 23 Laryngitis 24 Bronchitis — — — — — 2 — — 2 — 1 1 — 2 25 Pneumonia (all forms) 1 — 1 2 — 4 4 2 12 3 3 6 — 12 26 Suffocation, Overlaying 1 1 1 — — — 1 27 Other Causes ... 2 1 — 3 1 — — — 4 — 2 1 1 4 Totals 27 1 2 1 31 9 10 6 7 63 7 14 32 10 63 M. F. M. F. M. F. Nett Births | Legitimate, 379 370 Nott Deaths f Legitimate Infants, 26 18 ^ gtmbirthfl ( Legitimate Infants, 14 15 in tho Year | illegitimate, 50 00 'n ^'K ^oar ( Illegitimate Infants, 12 7 ^oar ( Illegitimate Infants, 6 1 Total ... 429 430 Total 38 25 Total 20 16 859 63 36 14 MATERNAL MORTALITY. In 1937 the number of deaths due to conditions connected with or consequent upon child-birth was 4, the maternal mortality rate being 4.46 per 1,000 births. In 1936 there were 2 deaths, the death-rate being 2.2 per 1,000 births. With regard to the 1937 deaths it may be noted that throe occurred in hospital and one in a nursing home, the ages of the women, two of whom were unmarried, being respectively 27, 27, 28, and 40. DEATHS IN RELATION TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table 13 on page 18. 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. Diarrhceal Diseases.—The total number of deaths registered as due to diarrhœa and enteritis (inflammation of the bowels), was 12, giving a rate of 0.13 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1937 this was the case also, no fewer than 9 of the 12 being children under one year of age. In 1936, the number of deaths from diarrhceal diseases was abnormally high, 25 being recorded. Of these, 18 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 and other Diseases." It is interesting to note here, however, that excluding influenza, which caused 44 deaths, and including diarrhœa, etc. (12 deaths) the total number registered as due to them was 23. Of these deaths, 2 were caused by typhoid fever, and 3 by diphtheria. Two deaths were attributed to encephalitis lethargica, one to cerebrospinal fever, and one to whooping cough. There was no death from measles. In 1936, 49 deaths were due to infectious diseases, excluding influenza which caused 14 deaths. The figure in 1935 was 26. 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 54, 69 being recorded in 1936. The great bulk of the 54 deaths, viz., 51, was due to phthisis. The number in 1936 was 62. Of the total number of deaths registered (1,202), the percentage due to phthisis was 4.5, as against 5.2 in 1936. The age periods at which the deaths occurred were: 1—5, 1 (2%); 5—15, nil; 15—25, 6 (11%) ; 25-^5, 21 (40%); 45—65, 22 (40 %); 65 and over, 4 (8%). 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 139. This is higher by 25 than the figure (114) for 1936. The death-rate was 1.52 per thousand. In 1936 the rate was 1.23. The number of deaths certified to be due to bronchitis was 44. Of this number 27 were amongst persons aged 65 and upwards, and 12 amongst those of the group 45—65. Two were infants of under one year of age. The deaths traceable to pneumonia numbered 89 and, as in the case of bronchitis, the later age-groups contributed the greatest numbers. 15 The number of cases of pneumonia notified in 1937 was 61. Further particulars with regard to distribution of the cases, both in relation to age and residence, will be found in Table 13 on page 18. Visits were paid to each of the notified cases when not already in a hospital or other institution, and any assistance possible offered in the way of removal to hospital or nursing (under the Council's arrangement with the Paddington and St. Marylebone District Nursing Association). Cancer or Malignant Disease.—The number of deaths due to cancer was 179 and the death-rate 1.95 per 1,000 of the population. The figures for 1936 were 195 and 2.11 per 1,000 respectively. Information with regard to the age at which death occurred and the situation of the disease is given in Tables 9 and 10. TABLE 9. 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 - - - - 1 2 9 19 30 16 77 Females - - - 1 — 3 17 26 32 23 102 Totals - - -| 1 1 5 26 45 62 39 179 TABLE 10. Cancer : Situation or the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 7 2 9 Throat, Neck, Gullet 10 4 14 Stomach 14 16 30 Intestines 11 15 26 Liver 1 13 14 Breast — 22 22 Uterus and Generative Organs 1 22 23 Various 33 8 41 Totals 77 102 179 Though there was a decrease in the mortality from cancer during 1937 as against 1936 it is a commonly accepted fact that the number of deaths due to the disease is, over a long period, showing a definite tendency to increase. No reason, generally acceptable, to account for this has as yet been put forward, nor has any thoery to account for the occurrence of the disease, to which the medical profession as a whole can subscribe, been submitted. One point upon which there is general agreement, however, is with regard to the importance, advisability and advantage of early treatment. Of the accuracy of the advice, now so widely given that there should never be any delay in seeking an authoritative opinion in any case of doubt and in securing treatment, there can be no question. Accident, Suicide and Manslaughter.—Accidental or violent deaths during 1937 numbered 68. Of these 23 were due to suicide. There was one recorded death of a baby certified as resulting from suffocation (overlaying). TABLE 11. Vital Statistics for 1937 and Previous Ten Years. Year I Population estimated to middle of each Year 2 Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Uncorrected 3 Nett of Nonresidents registered in the District 8 of Residents not registered in the District 9 Under 1 year of Age At all Ages No. 4 Rate 5 No. 6 Rate 7 No. 10 Rate per 1,000 Nett Births 11 No. 12 Rate 13 1927 103,500 3,521 1,374 13.2 1,375 13.2 781 621 81 59.0 1,262 11.3 1928 104,000 3,662 1,317 12.6 1,335 12.8 787 690 105 79.0 1,238 11.1 1929 102,400 3,526 1,233 11.9 1,465 14.3 821 804 93 77.0 1,455 13.2 1930 102,400 3,162 1,247 12.1 1,373 13.3 831 618 77 62.0 1,171 10.6 1931 93,460 3,134 1,067 11.4 1,411 14.3 826 640 70 65.0 1,225 12.3 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 1937 92,110 3,339 859 9.3 1,461 15.8 948 689 63 73.3 1,202 13.0 Total population at all agos at Census of 1921, 104,173. 1931, 97,620. Area of district in acros (exclusive of area covered by water), 1427-8 acres. ,, „ (including area covered by water), 1,473 acres. 17 TABLE 12. Vital Statistics of Separate Localities for 1937 and 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. 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 1930 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 Averages of Years 1 1927 to 1936. 97,319 1,084 1,227 74 22,737 196 253 15 25,313 243 317 15 29,868 434 410 31 19,401 211 247 13 1937 92,110 859 1,202 63 21,100 168 243 7 24,210 173 307 14 28,060 333 410 32 18,740 185 242 10 The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sub-District on the 1st April, 1916, but for the purposes of District comparison ovor provious years the figures have been allocated to the old Sub-Districts. 18 TABLE 13.—Causes of, and Ages at Death during the year 1937. No. causes of death. Nett 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 under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 Typhoid and Paratyphoid Fevers 2 - - - - - - 2 - 1 - 1 1 - 2 2 Measles - - - - - - — - — - - - - - — 3 Scarlet Fever - - - - - - - - - - - - - - - 4 Whooping Cough 3 2 - 1 — — — — — - — 1 2 — 3 5 Diphtheria 3 — 1 1 — — 1 — — — 2 — 1 — 3 6 Influenza 44 — - - — 2 7 15 20 12 8 15 14 7 44 7 Encephalitis Lethargica 2 — - - — — — 2 — — — 1 — 1 2 8 Cerebro-Spinal Fever 1 — - 1 — — — — — - - - 1 — 1 9 Tuberculosis of Respiratory System 51 1 - - - 6 19 22 3 8 13 9 21 8 51 10 Other Tuberculous Diseases 3 - - - - - 2 1 — 10 1 - 2 — 3 11 Syphilis 6 - - - - - - 4 2 5 2 1 2 1 6 12 General Paralysis of the Insane, Tabes Dorsalis 6 - - - - - 1 2 3 3 1 1 4 - 6 13 Cancer, Malignant Disease 179 — - - — 1 6 71 101 258 38 46 52 43 179 14 Diabetes 18 - - - - - 1 8 9 8 3 8 5 2 18 15 Cerebral Haemorrhage, etc. 60 - - - - - 4 25 31 35 11 12 22 15 60 16 Heart Disease 297 — - - — 1 6 81 209 155 67 81 88 61 297 17 Aneurysm 9 - - - - - — 6 3 3 2 2 3 2 9 18 Other Circulatory Diseases 56 - - - - - 1 12 43 29 8 23 11 14 56 19 Bronchitis 44 2 - - — - 3 12 27 12 7 7 19 11 44 20 Pneumonia (all forms) 89 12 - 1 1 1 3 32 39 55 13 20 46 10 89 21 Other Respiratory Diseases 6 - - - - - 1 2 3 30 2 1 2 1 6 22 Peptic Ulcer 18 - - - - - 2 10 6 31 4 5 5 4 18 23 Diarrhoea, etc. 12 9 - - - - - 1 2 2 4 3 4 1 12 24 Appendicitis 8 - - - - - 3 4 1 19 3 2 2 1 8 25 Cirrhosis of Liver 10 — - - - 1 2 5 2 13 2 - 6 2 10 26 Other Diseases of the Liver, etc 5 - - - - - - 3 2 12 1 1 2 1 5 27 Other Digestive Diseases. 26 1 - - — 1 3 8 13 50 5 7 10 4 26 28 Acute and Chronic Nephritis 27 — - - - 1 2 11 13 46 6 6 9 6 27 29 Puerperal Sepsis 2 - - - - - 2 — — 2 — - 1 1 2 30 Other Puerperal Causes 2 — - - — - 2 — — 14 1 - - 1 2 31 Congenital Debility, Premature Birth, Malformation, etc. 28 28 - - - - - - - 63 1 6 13 8 28 32 Senility 21 - - - - - - - 21 22 4 10 4 3 21 33 Suicide 23 - - - — 4 5 9 5 10 5 6 6 6 23 34 Other Violence 45 4 - - 1 2 9 15 14 29 9 14 13 9 45 35 Other defined Diseases 94 4 - - 2 5 14 26 43 125 19 17 39 19 94 36 Causes ill-defined or unknown. 2 - - - — — — — 2 — 1 1 — — 2 Totals 1,202 63 1 4 4 25 99 389 617 1,062 243 307 410 242 1,202 19 MORTUARY. The number of bodies deposited from 1st January to 31st December, 1937, was as follows:— TABLE 14. 1937. Males. Females. Total. No. of post-mortems held. No. of infectious cases. Totals 44 61 105 47 — CREMATORIUM. The St. Marylebone Crematorium, situated in the Borough Cemetery at East Finchley, was officially opened by the Chairman of the Cemetery Committee (Councillor G. B. Ramsay) on the 15th December, 1937. Cremation facilities are available for St. Marylebone and other districts at fees ranging from three to five guineas. The Secretary of State, in pursuance of No. 10 of the Cremation Regulations, 1930, appointed the Medical Officer of Health to be Medical Referee in respect of the Crematorium, and the Deputy Medical Officer of Health to be Deputy Medical Referee. At the close of the year 1937, the Medical Referee had issued three certificates authorising cremation. 20 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. STAFF. Information with regard to the staff of the department is contained in a statement on page 6, as required by Ministry of Health Circular 359. 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, seven district inspectors, seven women sanitary inspectors and health visitors (one engaged exclusively in tuberculosis work and another on housing), one chief and seven assistant clerks, with, in addition, at the Tuberculosis Dispensary, a sister and a clerk dispenser, and at the Salisbury Street Welfare Centre a clerk dispenser. LABORATORY FACILITIES. Dr. L. E. H. Whitby, C.V.O., M.C., continues to act as the Council's Bacteriologist. The work is carried out in the Bland Sutton Institute of Pathology at the Middlesex Hospital, and details of investigations in relation to (a) the water of the Council's swimming pools, (b) milk, ice cream and other foods, and (c) infectious disease, are set forth under the appropriate headings of this report at pages 45, 58, 61 and 80. Mr. J. F. F. Rowland, B.A., A.I.C., is the Public Analyst for the Borough, and his laboratory is situated at No. 133, Gloucester Place, N.W.I. A report on the work done during 1937, together with a statement of food and drugs analysed and of samples found to be adulterated, will be found on pages 61—63. AMBULANCE FACILITIES. The efficient ambulance service of the London County Council is available in the Borough for the conveyance of persons suffering from infectious disease, for cases of accident, sudden illness and for maternity cases. The ambulances of the County Council may also be utilised, on payment, for private and non-infectious cases. NURSING IN THE HOME. The Paddington and St. Marylebone District Nursing Association continue to provide adequate nursing services in the home under an arrangement made with the Council. Table 15 gives particulars of the work carried out in 1937. TABLE 15. Home Nursing Service. No. of eases nursed. No. of visits paid. Maternity 18 360 Ophthalmia neonatorum 6 118 Pemphigus neonatorum 3 73 Puerperal pyrexia 1 15 Influenza 28 233 Erysipelas 1 14 Pneumonia 171 420 Tuberculosis 8 294 Mumps 1 22 HEALTH CENTRE No. 2 (Lower Ground Floor Plan) 21 Scale : 16 feet to 1 inch. HEALTH CENTRE No, 2 (Ground Floor Plan) Scale: 16 feet to 1 inch. 22 HEALTH CENTRE No. 2 (First Floor Plan) 23 Scale: 16 feet to 1 inch HEALTH CENTRE No. 2 (Second Floor Plan) 24 Scale: 16 feet to 1 inch 25 HEALTH CENTRE No. 2 Details of main entrance. The perambulator garage is to the right of the tree and is not shown. HEALTH CENTRE No. 2 26 Showing at the rear of the building the children's entrance to the Cleansing Station; the entrances for adults (separate for males and females) are seen through the iron railings on the side of the building. HEALTH CENTRE No. 2 27 View from the canal. The medicinal (cleansing) baths are on the lower ground floor, with the maternity and child welfare centre on the ground floor, and the dental, massage, minor ailments, and other special clinics on the first floor. The doorway at the rear is the children's entrance to the medicinal (cleansing) baths. 28 Health Propaganda Poster Display—Town Hall Extension Site. 29 TREATMENT CENTRES AND CLINICS. During the year practically all the Borough Council's centres and clinics took part in a "general post" pending the completion of new health centres—one in Lisson Grove and the other on a portion of the site adjoining the Town Hall. The old premises at No. 14 Salisbury Street, rented from the St. Marylebone Health Society and occupied by the Council for maternity and child welfare purposes, were vacated on the 31st July, 1937, prior to demolition of the property to make room for the Health Society's new day nursery to be erected on the site. The services were transferred first to the maternity and child welfare centre temporarily held at No. 113, Marylebone Road and later (on the 7th October, 1937) together with the Tuberculosis Dispensary (No. Ill, Marylebone Road) and other clinics, to further temporary accommodation at the Old Baths Establishment, Marylebone Road. An outstanding event so far as the health services of the Borough are concerned was the completion during the year of Health Centre No. 2 at No. 217, Lisson Grove (formerly No. 27, Grove Road) on the site of the old Shelter House and Cleansing of Persons Baths. The opening ceremony was performed on Friday, the 3rd December, 1937, by His Worship the Mayor of St. Marylebone (Alderman R. Stiles Allen, J.P.), who was accompanied by the Mayoress, and supported by the Rt. Hon. Lord Snell, C.B.E., J.P., Chairman of the London County Council; Captain A. S. Cunningham-Reid, D.F.C., Member of Parliament for St. Marylebone; Councillor Dr. C. A. Fuller, Chairman of the Public Health and Maternity and Child Welfare Committee; Alderman John Fettes, J.P., and other members of the Council. The building, which was designed by Sir Edwin Cooper, R.A., has been erected for its special purpose, taking full advantage of the contours of a difficult site upon the bank of the Grand Union Canal. It has its main entrance with a paved forecourt directly upon Lisson Grove. From the forecourt, at the side of which a Shelter has been provided for perambulators, the ground and first floors of the building, which will be used mainly for the Maternity and Infant Welfare and School Medical Service Departments, are reached. The secondary entrance at the back, owing to the slope of the site, is on the lower ground floor level and advantage has been taken of this by planning the Children's Bathing Station on this floor, so that there shall be no contact for the children with the other departments. The Bathing Station for adults and the accommodation for families temporarily excluded from their homes to permit of disinfection, etc., are also here, the former provided with separate entrances for men and women on the side of the building. The external elevations of the building are on simple lines, relying upon proportion and scale for the effect, and are of red bricks with a red tile roof. The interior has been planned to obtain the maximum of light and floor space. The walls are finished in hard plaster with a painted surface suitable for washing in all parts, except in the bathrooms, etc., where white glazed tiles have been employed. A suitable Laundry is provided on the lower ground floor for the various departments. The contractors were Messrs. John Mowlem and Company, Limited. Plans of the various floors and photographs of the building are shown on pages 21-27. It may be noted with regard to the second floor plan that, as it is possible that the premises may be used as a first aid post under the Air Raid Precautions Scheme, and in any case classes for medical practitioners and first aid personnel are being held, the space through which the emergency exit from the matron-housekeeper's flat passes has been transformed into a store for respirators and other air raid precautions equipment. 30 HOSPITALS: PUBLIC AND VOLUNTARY. Hospital accommodation 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. St. Marylebone is fortunate in the number of voluntary hospitals and dispensaries of various kinds that are situated within its boundaries, and to these cases from the welfare centres are referred as and when necessary. Queen Charlotte's and the Middlesex Hospitals are available for ante-natal and complicated maternity cases. MATERNITY AND CHILD WELFARE. 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 20 (page 37) and 21 (page 38) 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 Section 255 of the Public Health (London) Act, 1936, as adjusted by any transferred notifications: (a) Live births, 897; (b) Still-births, 32; (c) Total, *929; (d) By midwives, 212; (e) By doctors and parents, 94; (f) By hospitals, 331; (g) By nursing homes, 74; (h) Inward transfers, 218.* *The total of the figures given under (d), (e), (f), (g) and (h) agree with the figure under (c). 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, 2. (ii) Equivalent of whole time services devoted by the whole staff to health visiting (including attendance at infant welfare centres): (a) in the case of health visitors employed by the Council, 6|; (b) in the case of health visitors employed by voluntary associations, 2. (iii) Number of visits paid during the year by all health visitors: (a) To expectant mothers, first visits, †313; total visits, 622. (b) To children under 1 year of age, first visits, †652; total visits, 5,277. (c) To children between the ages of 1 and 5 years, total visits, 7,367. †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, 3. (c) Total number of attendances at all centres during the year: (i) By children under 1 year of age, 10,036 (7,298 St. Marylebone residents); (ii) By children between the ages of 1 and 5 years, 9,331 (7,034 St. Marylebone residents). (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, *609 (437 St. Marylebone residents); (ii) between the ages of 1 and 5 years, 267 (253 St. Marylebone residents). *Excluding children who are known to have previously attended a centre in another district. 31 (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, 479 (298 St. Marylebone residents); (ii) over 1 year of age, 859 (586 St. Marylebone residents). (f) Percentage of notified live births represented by the number in (d) (i). 49. Ante-Natal and Post-Natal Clinics (whether held at infant welfare centres or at other premises): Ante Post Natal. Natal. (a) Number of clinics provided and maintained by the Council 1 1 (b) Number of clinics provided and maintained by voluntary associations 2 2 (c) Total number of attendances at all clinics during the year 24,043 2,921 (1,916)* (230)* (d) Total number of women who attended at all clinics during the year 3,842 1,591 (373)* (155)* (e) Percentage of total notified births (live and still) represented by the number in (d) 40 17 *Figures in brackets refer to St. Marylebone mothers. Supply of Milk and Food. (a) Arrangements made for this service are indicated by ''Yes" or "N " in each space in Table 16. TABLE 16. 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 at less than cost price, in necessitous cases. Yes. Yes. Yes. Yes. Yes. Yes. No. No. No. At cost price in other cases (e.g., sale of dried milk at Centres). Yes. Yes. Yes. — — — Yes. Yes. Yes. (b) The total quantity of milk supplied during the year to expectant and nursing mothers and young children was 7,571½ gallons (liquid) and 6,637 pounds (dried). No milk was supplied by voluntary associations. 32 During 1937 there has been no change in the methods adopted in relation to the supply of milk to mothers and children. Up to 31st March, 1938, the amount expended was £920, as against £784 lis. l0d. in the year ended 31st March, 1937. The actual number of cases dealt with was 388, and the number of orders issued 2,059, varying slightly from those for 1936, when the cases numbered 352 and the orders 2,190. 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 1936. The amount contributed in individual cases varies considerably, but from the very beginning what the amount should be has always been very carefully assessed, the size of the family and the family earnings and circumstances being taken into consideration. In every case formal application is required to be made by the individual whether recommended by the medical officer of a consultation or seeking assistance personally. Following receipt of the application, enquiries are made by the health visitors and on their report and the information provided in the application, assessment is made by the Medical Officer of Health. The period for which the grant is made varies, but is usually four weeks, and at the end of this period the case is again considered and alterations made in the amount ordered, and a contribution charged if necessary. The system, it may be said, has worked with absolute smoothness and has done a very great deal of good. Here and there an individual not quite deserving may have received assistance, but on the whole the efforts of the officers and of Councillor Mrs. Davis, who has given most valuable help as representative of the Maternity and Child Welfare Committee, to make a just assessment have been helped rather than hindered. Day Nurseries. (a) Number of day nurseries: (i) provided by the Council, nil; (ii) vided by voluntary associations, 3. (b) Number of places for children under 5 years of age in the nurseries: (i) provided by the Council, nil; (ii) provided by voluntary associations, 93. (c) Total number of attendances of children at these nurseries during the year, 16,302. The situation of the three day nurseries in the Borough, together with details of the attendances for the year, are shown in Table 17. TABLE 17. Day Nursery. Address. Attendances, 1937. Whole-day. Half-day. Crossley 38, Barrow Hill Road. 5,017 1,302 Portman 115, Marylebone Road (removed in October to Carton Hall, Carton Street). 4,230 521 St. Vincent de Paul Ill, Wigmore Street. 4,112 1,220 33 Infectious Diseases. Table 18 gives information regarding infectious disease notifications, and the number of cases visited and for whom home nursing or hospital accommodation was provided. TABLE 18. 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 hospital. (1) Ophthalmia Neonatorum 10 10 6 0 (2) Pemphigus Neonatorum — — 3 — (3) Puerperal Fever 15 8 — 15 (4) Puerperal Pyrexia 35 18 1 35 (5) Measles and German Measles (in children under 5 years of age Not Notifiable 30 — — (6) Whooping Cough (in children under 5 years of age) 38 — — (7) Epidemic Diarrhoea (in children under 5 years of age) — — — (8) Poliomyelitis (in children under 5 years of age) 2 1 — 2 Ophthalmia Neonatorum. Ten cases of ophthalmia neonatorum, of which details are given below, were notified during the year. The number in 1936 was seven. Vision unimpaired 8 Removal from district 1 Died 1 10 Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever: (i) by the Council, nil; (ii) by voluntary associations, the time of 1½ nurses. (b) Total number of cases attended during the year by these nurses, 40. Home Helps. Number of cases in which home helps have been provided during the year, 3. Convalescent Homes. (a) Number of convalescent institutions with accommodation for expectant or nursing mothers or children under 5 years of age : (i) provided by the Council—nil. (ii) provided by voluntary associations—2 beds maintained by the Council for nursing mothers and children under 5 years of age at the Zachary Merton Convalescent Home, Rustington, Sussex. 34 (b) Number of beds for such cases in convalescent institutions : (i) provided by the Council—nil. (ii) provided by voluntary associations—2. (c) Total number of cases admitted to the beds included in (b) during the year—18. (d) Total number of such cases sent by the Council during the year to other convalescent institutions—nil. Midwives. (a) Number (i) employed by the Council, nil; (ii) subsidised by the Council, nil; (iii) employed by voluntary associations, nil. (b) Number of cases during the year in which the Council paid or buted to the fee of a midwife, nil. Child Life Protection. 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, 8. (b) Number of children on the register: (i) at the end of the year, 10; (ii) who died during the year, nil; (iii) on whom inquests were held during the year, nil; (iv) returned to parents during the year, 4; (v) removed to institutions during the year, nil; (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. (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, 216. For the information of those desiring to receive or to place children, and with the object of providing protection for the latter particularly, the Public Health Committee arranged for the publication at regular intervals throughout the year in newspapers published in the Borough of an advertisement to the following effect: Infant Life Protection.—Persons accepting or proposing to accept payment or reward for accommodating infants and children in their homes and those desirous of finding accommodation for children should apply to the Medical Officer of Health at the Town Hall, Marylebone Road, N.W.I. Advice is given free and there is no fee on registration. Health Visitors and Home Visits. There are five whole-time and three 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. 35 The number of visits paid in 1937 by health visitors to children between the ages of 1 and 5 years was 7,367. Clinics. There are three infant welfare centres provided and maintained by the Council at which children of from 18 months to 5 years are seen. 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 to 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 St. Marylebone and Western General Dispensary. 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. Clinic for Pre-School Children. At 113, Marylebone Road, a special clinic is held for 3 year old children. The object of this clinic, which was established experimentally in 1931, 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 seen during one of the health visitor's routine calls, and attendance at the clinic advised. Owing to re-building operations, it was possible to conduct the clinic during the first half of the year only. Of the 57 children who were examined during 1937, 45 needed treatment for one or more conditions. Table 19 gives a summary of the conditions found. TABLE 19. Condition. Cases. Dental caries 21 Enlarged tonsils necessitating removal 8 Under-nourished and flabby children recommended to massage and sunlight cli nic 7 Bronchitis 2 Difficult and spoilt children advised to attend child guidance clinic 4 Enuresis 1 Impetigo 1 Scabies 1 Treatment of Minor Ailments. Children suffering from minor ailments were treated at the London County Council clinic at 12, Salisbury Street, and (from August, 1937) at the Council's Health Centre, 217, Lisson Grove. 36 Dental Clinic. By arrangement, certain sessions at the Dental Clinic of the London County Council are set aside for the inspection and treatment of mothers and children under the maternity and child welfare scheme of the Borough Council. Statistics for 1937 are set out below:— Mothers—attendances 542 Children— „ 43 Cases receiving advice and treatment 433 Extractions under gas 152 Massage Clinic. Sessions were held twice weekly at the Salisbury Street Centre. Orthopaedic Treatment. Cases requiring orthopaedic treatment are referred by the medical officers at the welfare centres to the Royal National Orthopaedic Hospital, which is situated in the Borough. Artificial Sunlight Therapy. Clinics for providing this form of treatment were held twice weekly at the Salisbury Street Centre. Diphtheria Immunisation Clinics. As indicated on page 66, these clinics continued to operate throughout the year, and were largely attended. 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 and Middlesex Hospital. The number of births notified from these institutions during 1937 was 2,536, the total births numbering 3,877. The midwives residing in the borough registered as intending to practise in the administrative County of London, number 14. Two conduct maternity homes which are registered by the London County Council. By an arrangement with the Paddington and St. Marylebone District 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 18 cases were dealt with under the arrangement, and 360 visits were paid, the services of the nurses being greatly appreciated by the patients. Maternity beds have been provided by the London County Council at St. Mary Abbots Hospital, Kensington, pending, it is understood, opening of modern labour wards at Paddington Hospital. Maternity and Child Welfare Centres—Statistics. Tables 20 and 21 on pages 37 and 38 give some idea of the work done at the various centres during the year. PHYSICAL TRAINING AND RECREATION ACT, 1937. This Act came into force on the 13th July, 1937, but up to the end of the year the Public Health Committee, to whom the duty of carrying out its provisions had been passed, had taken no action. 37 TABLE 20. Statement Showing Week of the Infant Consultations and Other Clinics. Centre. No. 24 Hill Road. No. 14 Salisbury Street. No. 113 Marylebone Road. Queen Charlotte's Hospital. The Middlesex Hospital. Held at the Old Baths. No. of Consultations held:— Infants 100 99 100 103 151 Toddlers - 52 - - 51 Maternity - 51 - 358 244 Massage - 78 - - - Light - 48 - - - No. of attendances of mothers at clinic:— Ante-natal - 464 - 17,230 (862) 6,349 (590) Post-natal - 98 - 2,213 (85) 610 (47) No. of attendances of babies 1,658 1,599 1,679 1,722 (1,234) 3,333 (1,083) No. of attendances of children over one year 1,049 1,691 1,329 814 (518) 2,844 (843) No. of attendances at Light Clinic:— Infants - 20 - - - Toddlers - 888 - - - No. of attendances at Massage Clinic:— Infants - 25 - - - Toddlers - 659 - - - No. of Orders issued for milk 297 777 442 153 256 No. of Home visits 1,344 1,686 657 228 3,061 No. of new cases:— Infants 78 107 121 105 (69) 188 (52) Toddlers 16 29 62 3 (2) 17 (4) Ante-natal - 105 - 3,207 (179) 705 (84) Post-natal Massage - 51 - 1,254 (76) 365 (33) Infants - 7 - - - Toddlers - 49 - - - Light Infants - 3 - - - Toddlers - 34 - - - Note.—Figures in brackets refer to St. Marylebone residents attending Queen Charlotte's Hospital and Middlesex Hospital. 38 TABLE 21. Statement Showing Woek of the Municipal Ante-Natal and Post-Natal Clinics. 1937. Jan. Feb. Mar. Apl. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals. No. of Sessions 4 4 5 4 3 5 4 4 5 4 4 5 51 New Ante-natal cases 13 7 10 7 7 10 5 8 8 5 13 12 105 New Post-natal cases - - 6 7 8 9 3 3 7 1 2 5 51 Attendances Ante-natal 35 35 50 43 26 47 36 33 35 30 43 51 464 Attendances Post-natal 3 1 13 10 16 18 7 4 11 4 6 6 99 Transferred to Queen Charlotte's Hospital - - - - - - - - - - - - Transferred to St. Mary Abbots Hospital 6 6 7 6 3 4 3 6 2 4 6 8 61 Transferred to other Hospitals - - - - - - - - 1 - - - 1 Put on special diet - - - - - - - - - - - - Pads and belts provided 1 - 1 - - - - 1 - 1 - - 4 High blood pressure - - - - - - - - - - - - - Low blood pressure - - - - - - - - - - - - - X-ray examinations - 1 - - 1 - - - - - - - 2 Referred to Dental clinic 5 4 - 7 3 - - - - 5 4 - 28 Urine Tests - - - - - - - - - - - - - Undernourished - 1 - - - - 1 - - - - - 2 Miscarriage - - - - - - - - - - - - - Threatened miscarriage - - - - - - - - - - - - - Cases referred byHospitals - - - - 1 - - 2 - 1 - - 4 Midwives - 1 - - 1 - - - - - - - 2 39 SECTION C.-SANITARY CIRCUMSTANCES. Under this heading the Minister of Health calls for a report with regard to Water, Closet Accommodation, Public Cleansing, Sanitary Inspection, and many other matters. In respect of certain of these, 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 ccordance with the requirements of the Public Health (London) Act, 1936, section 98 (1), the Metropolitan Water Board reported that the water had been cut off in six premises. The reason for discontinuing the supply was in all cases the nonpayment of rate. In cases in which the premises were tenement houses, action was taken immediately on receipt of the Board's notice, in order to secure that the tenants should suffer no hardship as a result of being deprived of water. Cisterns. The bulk of the houses in the Borough, in accordance with the requirements of the Water Board, are provided with a cistern, and though in a considerable percentage water for drinking purposes is drawn from the main, there are still many in which supplies for all purposes are obtained from the cistern. In many cases this leaves much to be desired, both as regards situation and accessibility, and despite the fact that a bye-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 17 notices were served in regard to defects in and necessity for cleansing cisterns. Water Supply in Dwelling Houses. The certificates granted under section 95 (2) of the Public Health (London) Act, 1936, in respect of new and rebuilt premises numbered four. The number in 1935 was twelve. In 21 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 95 (5) of the Public Health (London) Act, 1936. The supply was provided after receipt of the intimation notice in all cases. DRAINAGE. During the past ten years there have been extensive building operations in all parts of the Borough, blocks of flats or commercial premises replacing dwellings and other buildings which have become worn out or the leases of which have expired. 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 1937 made 3,528 inspections. The total number of plans deposited was 480 in respect of 591 premises, as against 500 and 630 respectively in 1936. The number relating to new buildings was 63. The number deposited in 1936 was 70. 40 In the case of old buildings, the number of plans received was 417. In 1936 the total number was 430. In the bulk of the cases the arrangements shown were in accordance with the by-laws and the work was allowed to proceed under the preliminary approval of the Medical Officer of Health. In cases in which there was departure from the requirements a special report was made to the Public Health Committee, who rarely refused approval if satisfied that compliance was impossible and that there was no possibility of nuisance or injury to health arising. In the majority of cases the departure referred to closet accommodation and affected particularly conveniences proposed to be constructed in basements. 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 22 premises. The number in 1936 was 51. CLOSET ACCOMMODATION. In Table 22 on page 44, 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 overcrowded business and shopping portions of the Borough. All plans showing proposals to construct water-closets are most carefully scrutinised, but as already noted, the 1930 by-laws having considerably modified the requirements so far as situation is concerned, the need for granting special approval now less frequently arises. Particularly by allowing of the introduction of closets in bathrooms entered directly from rooms used exclusively as sleeping or dressing-rooms, they have met a demand that has been increasing for some time and that 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. During the first half of 1937, both the men's and women's departments of the Great Portland Street Public Convenience, built in 1891, were reconstructed. Reports and comparative statements as to receipts for use of the underground conveniences were regularly submitted to and considered by the Public Health Committee. 41 All Night Opening at Oxford Circus. The Council arranged for the Oxford Circus Men's and Women's Conveniences to be kept open throughout the whole of the day and night for twelve months commencing on the 1st November, 1937. The question as to whether or not all night opening shall be continued will be reviewed at the end of the experimental period. Special Provision during Coronation Period. Special arrangements were made to meet the sanitary convenience of the great crowds that thronged Oxford Street and its neighbourhood on the occasion of the Coronation of Their Majesties King George VI and Queen Elizabeth. The additional accommodation erected temporarily for the purpose proved entirely satisfactory and the facilities provided were greatly appreciated. PUBLIC CLEANSING. The collection and disposal of house refuse in the Borough is under the jurisdiction of the Highways Committee and the scheme is administered by the Borough Engineer (Mr. James Gair) to whom I am indebted for the following information. Refuse Collection. All premises in the Borough receive at least a twice-weekly collection, but over a great portion of the Borough a daily collection is made. In certain thoroughfares, more particularly in those streets in which refuse collection vehicles are prohibited by the Ministry of Transport during certain hours, collection is carried out from the kerb within stated hornrs, the bins being placed by the occupiers ready for collection by the Council's vehicles. This entails concentration of a large number of collecting vehicles in certain parts of the Borough in the early hours of the day. During the year 101 intimation notices and 2 statutory notices were served by the Sanitary Authority in respect of defective bins; approved type metal dustbins were provided at 117 premises; while 897 visits were made by Inspector Hill, who gives part-time to this work. An important part of the collection system is the use in large premises, such as blocks of flats, hotels, etc., of the "container." This method provides for the provision of special containers by the Council, which are purchased by the owners of the respective properties, and collection is made daily by specially designed vehicles. The containers are removed bodily from the premises, conveyed to the Council's Wharf and are there emptied, cleansed and disinfected before return. This system has proved to be more hygienic, quicker, less noisy in working and altogether more satisfactory than the use of a number of refuse bins. In this connection approach has been made to the Royal Institute of British Architects to obtain their cooperation with a view to attention being given to the problem of refuse storage and collection, by members of the Institute when planning and designing new buildings. In so far as new buildings erected in the Borough are concerned, immediately plans are deposited representations are made to the architects to suggest incorporation of the refuse container system, and considerable progress has been achieved in this direction. As a result of action taken by the Borough Council, the London County Council now include in appropriate cases in their consent under the Town and Country Planning Act, a condition that the storage and collection of refuse shall be to the satisfaction and requirements of the Borough Council. In conjunction with the "container" system of collection, the use of dust chutes is possible in suitable buildings, and where adopted, this system has proved efficient and worked very satisfactorily. The fleet of lorries used for the normal collection consists of entirely enclosed end-loading motor vans, steps being fitted to facilitate entry. 42 Refuse Disposal. The whole of the house refuse collected in the Borough is discharged into a collecting pit at the Council's wharf situated at Paddington Basin on the Grand Union Canal. From this pit it is lifted by an electric crane and passed through a graded screen which separates large and small material and extracts the fine ashes and breeze. From the larger material is extracted saleable articles such as waste paper, rags, bones, scrap metal, etc. A magnetic separator deals with the tin and metal output. The whole of the material obtained by screening and separation is readily disposed of to scrap merchants, brick makers and others. The residue is taken by a conveyor belt to a series of furnaces and a Woodall Duckham destructor, mechanically fed and clinkered. The steam thus produced is used to generate current for lighting and heating at the wharves and to drive the electrical machinery of the incineration plant. Part of the refuse, together with the clinker from the furnaces is conveyed by barge to the Council's shoot at Northolt where it is carefully covered in accordance with the Ministry of Health's regulations regarding controlled tipping and also to meet the requirements of the Middlesex County Council and the Ealing Borough Council, pursuant to the Middlesex County Council Act of 1934. The emanations from the two destructor plants at the Wharf are dealt with by means of a 200 ft. chimney shaft. The Council has under consideration the erection of a complete new incineration plant to deal with the whole of the refuse collected and an advertisement has been issued through the press asking for quotations and details to a specification prepared by the Borough Engineer in conjunction with Consulting Engineers appointed by the Council. The work of refuse collection, screening, incineration, barging and tipping is continually under supervision with a view to avoiding any possibility of nuisance. Every precaution is taken to ensure satisfactory and efficient working and to give as little annoyance as possible. Street Cleansing. For cleansing purposes the Borough is divided into beats and each sweeper is entirely responsible for a definite length of public way. A similar system applies to the night sweeping gangs. Sweepings are collected and placed in galvanized refuse bins, two of which are mounted op each orderly barrow which has pneumatic tyres and is pushed by the sweeper. Periodical calls are made during the day at pre-arranged collecting spots and the contents of the bins are loaded into specially constructed side-loaded and covered collecting lorries and conveyed to the Council's wharf, treated, loaded into boats and conveyed to the shoot. The covers fitted to these vehicles prevent the possibility of the refuse being blown over the public streets. Gulley cleansing is carried out by means of three mechanically operated gulley cleansing machines. The contents of the guileys are pumped into vehicles entirely under cover during the whole process and conveyed direct to the Council's wharf, where it is deposited into a pit to allow for drainage and settling and final conveyance to the shoot. Offal. Various classes of offal, e.g., fish and green offal, and refuse from petrol interceptors at garages, are collected by the Council, a charge being made for these services and for the removal of certain trade refuse. Fish offal is sold to a contractor, other offal being treated in the same way as street sweepings. 43 Statistics. The tonnages dealt with during 1937 were:— House and trade refuse 51,353½ tons. Street sweepings and gulley refuse 8,291¾ „ A sum of approximately £3,650 was obtained from the sale of by-products (ashes, breeze, wastepaper, rags, metal and tins). In addition, approximately £1,135 was received for the removal of trade refuse, green and fish offal and for the cleansing of petrol interceptors. The Crown Estate. In that part of the Borough 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 refuse is still in the hands of the Crown authorities. 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. The total number of complaints received was 2,589, as against 2,531 in 1936. 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 various organisations, occupiers of premises, neighbours and others. In respect of nuisances, 37 statutory notices were issued, the figure being 22 in 1936. Of these notices, 29 related to ordinary nuisances (dirt, dampness, etc.), 2 to verminous rooms, 1 to insufficient water supply, 2 to insufficient water-closet accommodation, 6 to defective drains, whilst 3 were issued under the Shops Act, 1934. In 2,552 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. The number of nuisances of various kinds detected and remedied are set out in Table 22. 44 TABLE 22 Nature of Nuisance. Districts. The Borough. No.1. No. 2. No. 3. No. 4. No. 5. No. 6. Houses damp, dirty or dilapidated remedied 102 169 126 127 103 36 663 Doors, windows, floors, ceilings, sash cords, grates and flues, etc.. repaired 70 48 55 48 68 16 305 Verminous rooms 41 264 180 63 43 27 618 Dirty and verminous furniture and bedding cleansed 2 96 146 12 19 14 289 Overcrowding abated — — 2 6 — 1 8 Underground rooms (illegal occupation) dealt with - 1 4 2 - 1 8 Water closet defects remedied 38 22 76 85 31 37 289 Insufficient and unsuitable water closet accommodation remedied 1 2 7 59 13 27 109 Urinal defects remedied - - - - — - - Drains and water closet stoppages cleared 12 12 12 20 12 6 73 Drains relaid or amended 3 2 1 5 6 1 17 Soilpipes and ventilating shafts repaired or renewed 22 - 8 15 9 - 54 Waste pipe defects remedied 5 4 8 6 12 4 39 Yard defects remedied 52 5 52 68 8 4 189 Wash-house defects remedied 43 2 44 73 19 3 184 Area defects remedied — 1 6 78 5 3 93 Basement defects remedied 1 1 1 - - - 3 Roofs and gutters repaired 34 18 24 29 25 5 135 Water supply to houses reinstated 1 2 4 — — 3 10 Water supply laid on to upper storeys — — 3 4 14 — 21 Water cistern defects remedied 1 2 4 8 — 2 17 Dung or dust receptacles repaired or renewed 11 7 20 25 17 1 81 Rubbish, manure, etc., accumulations removed 12 11 26 25 20 14 108 Workshops, dirty — 1 2 9 8 9 29 „ overcrowded — — 1 1 — 1 3 „ insufficiently ventilated — — — 11 — 1 12 Animal nuisances abated — 2 6 5 5 — 17 Rats and mice infestation 5 — 5 11 8 3 32 Bakehouses dirty — - 4 3 — — 7 Smoke nuisances — - 1 3 5 — 9 Shops insufficiently ventilated or heated - 2 2 9 - 5 18 Miscellaneous 72 13 32 29 23 8 177 Legal Proceedings. In no case was it found necessary to institute proceedings in court for failure to comply with statutory notices to abate nuisances. SHOPS. Under the Shops Act, 1934, 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 maintenance of reasonable temperature. During the period under review 100 shops were inspected. In 14 instances notices were served in respect of contravention of the Act and in 13 cases the defects were remedied, a considerable amount of work, calling in some cases for a degree of reconstruction of premises, being done. In one case proceedings for non-compliance were instituted, but had not been completed when the year closed. 45 SMOKE ABATEMENT. During the year, 186 observations were made and 27 complaints were received and dealt with. In each case the attention of the offender was drawn to the matter. Four intimation notices were issued, but in no instance was the service of a statutory notice or the institution of legal proceedings called for. SWIMMING BATHS. The new Public Baths Establishment in Seymour Place was officially oponed by the Chairman of the Baths Committee (Alderman William C. Cole) on the 29th April, 1937. The building, which involved an expenditure of approximately £250,000, covers an area of 37,000 square feet and contains two swimming pools, slipper baths, laundries, and a squash rackets court. The water from the swimming pools is treated by modern filtration and purification plant. Samples, taken periodically, have, under bacteriological examination, yielded entirely satisfactory results. There are two privately owned swimming pools in the Borough ; one at the Middlesex Hospital for the use of the staff, and the other at the Polytechnic in Regent Street, available only to members of the Institute. ERADICATION OF BED BUGS. As in previous years a considerable amount of work was carried out in 1937 in connection with vermin disinfestation. Much of it had reference to the removal of furniture and bedding from old houses to the new municipal flats. In addition, the routine following-up of old cases of infestation was actively pursued. Particulars of the action taken for the eradication of bed bugs are set out below : (1) Number of Council houses found to be infested 93 Number of other houses found to be infested 295 Number of Council houses disinfested 93 Number of other houses disinfested 295 (2) Methods employed for freeing infested houses from bed bugs:— (a) In badly infested premises. Furniture is removed in vans, treated with hydrogen cyanide, and returned to the premises. Rooms are stripped of wooden mouldings and sprayed with an insecticide. (b) In moderately infested premises. Wallpaper is stripped, wooden ings are removed, and treatment is carried out either by a blow lamp or with an insecticide applied with a sprayer loaned by the Council (c) In slightly infested premises. Cleansing is carried out by tenants selves, and use is made by them of an insecticide applied with a sprayer loaned by the Council. (3) Methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses:— (a) Belongings are collected from the old homes in vans, treated with hydrogen cyanide, and delivered to the new homes after disinfestation. (b) Bedding is treated in the Council's steam disinfector. (4) Whether the work of disinfestation is carried out by the local authority or by a contractor:— (a) Hydrogen cyanide treatment of furniture, etc., is carried out by a contractor. (b) Buildings are troated eithor by builders using blow lamps or an insecticide (the latter supplied by the Council with loan of sprayer), or by the Council's staff using a sprayer and inseoticide. 46 (5) Measures taken by way of supervision or education of tenants to prevent infestation or re-infestation after cleansing:— A woman sanitary inspector (Miss Margaret Sharp) devotes the whole of her time to the matters referred to in this heading. The following report submitted by her on the progress made with regard to vermin disinfestation since her appointment in November, 1934, is of special value and interest:— “ My work has mainly been directed to the modern working-class flats in the Borough, although I have on occasions given advice and help to the tenants of tenement houses. In the latter type of property the work has not met with great success, owing to structural defects in the houses due to age, which makes the task of complete disinfestation almost impossible. In the flats, however, a marked improvement in the conditions has resulted and although the state of perfection aimed at has not yet been reached, I feel that with continued help and advice to the tenants further progress will be made. During the year 1935, 303 Borough Council and London County Council flats were examined by the sanitary inspectors. The inspections revealed that 201 of these flats were verminous either in the structure or the contents or both. When the treatment of the tenants' furniture with hydrogen cyanide was commenced, it was thought that it would probably be sufficient to treat those articles of furniture in which evidence of vermin had been found. While the furniture was away for disinfestation the rooms were sprayed with an insecticide. As a result of this procedure, in 29 cases only were all the effects removed ; in 80 cases, only the articles showing evidence of vermin were taken, and in 92 cases the evidence was so slight that it was thought that the tenants would be able to cleanse the verminous articles themselves. The reason for the last-named decision was that although evidence of vermin was discovered, it appeared to be an old infestation which had in all probability been cured. In my following-up work in 1936, after I had advised the tenants how to cleanse their furniture and to try to remove all evidence of vermin, I found vermin in 96 cases. In every instance live bugs were found, often in furniture which had not been treated. This indicated that the procedure adopted of removing part only of the contents of flats was unsuccessful. In 1937, bugs were found in 70 of the flats, the infestation in many cases being slight, and due partly to second-hand verminous articles which had been acquired. In December, 1935, 60 new flats were occupied by tenants who had had the whole of their furniture treated with hydrogen cyanide and the bedding steam disinfested on removal from their old houses. During re-inspection of these flats in 1936, I found vermin in 17. In 12 cases second-hand verminous furniture had been taken into the flats after moving in. In 1937, I still found vermin in 6 of these flats and there were 9 fresh cases in other flats, 4 of them being due to second-hand furniture. In no instance had the infestation become really serious, and I am hopeful that these tenants will, with help and advice, be able to rid their homes completely of vermin. In February, 1937, another block of 72 flats was occupied, and the whole of the tenants' furniture was removed and treated with hydrogen cyanide and the bedding steam disinfested before delivery. During the inspections of 1937, vermin, chiefly one or two bugs, were found in 8 cases, one being due to a second-hand article. In no case was the trouble serious. On the last inspection, no bugs were found. In 1936, 196 flats belonging to private owners were inspected. In 59 cases where vermin were found, the whole or part of the contents were 47 removed for treatment and the rooms sprayed with an insecticide. During re-inspections in 1937, vermin were found in 30 flats, while 12 were suspect as some evidence of infestation was found. As a result of my three years' experience in this work, I would say how necessary it appears to be to continue to treat the furniture and effects of all tenants before removal to clean flats from verminous premises or where the furniture shows any evidence of vermin. On the whole the tenants are co-operating very well in the endeavour to get rid of the bed bug. Second-hand furniture is still a great source of re-infestation, not only that which is bought from shops but articles acquired from friends. Tenants are constantly being warned of the danger from this source, and advised that if they should take a second-hand article into the home, the Public Health Department should be notified immediately so that an examination, and disinfestation if considered necessary, may be carried out." CLEANSING OF VERMINOUS PERSONS. Throughout the whole of the year the Cleansing Station, designed to form part of Health Centre No. 2, was in course of reconstruction. Arrangements were made for adults to attend the cleansing stations in neighbouring boroughs and in the case of school children a temporary centre was provided by the London County Council. SHELTER. During the year no case arose in which shelter accommodation was required. This was fortunate since the shelter included as part of Health Centre No. 2 under section 195 (4) of the Public Health (London) Act, 1936, did not become available until the beginning of 1938. RAT REPRESSION. Though activity in this connection continues unabated, the number of complaints received varies little year by year. In 1932 it reached 52, in 1933, 49, in 1934, 44, in 1935, 45, in 1936, 42, and in 1937, 43. The investigation of these complaints necessitated the inspection of 56 premises, 28 of which were found to be rat infested. Included in this latter number were 9 business premises (3 of these for the preparation or storage of food), 18 private or tenement houses and 1 vacant site. In 5 of the cases investigated the infestation was directly attributable to defects in the drainage system, and the nuisance disappeared when repair or reconstruction was carried out. In every instance all advice and assistance was given to the owner or occupier by Inspector Willis, who acted as rat officer, and secured excellent results from the methods advocated. The following report, submitted to the Public Health Committee on the 1937 National Rat Week, contains information on this subject that may be found interesting: "In common with all other local authorities responsible for the execution and enforcement of the Rats and Mice (Destruction) Act, 1919, the Council made a special effort during Rat Week (1st to the 6th November) to reduce the numbers of rats and mice. Not only was particular attention given to the nuisance arising from the presence of rats in sewers, but special efforts were made in connection with publicity to secure the whole-hearted co-operation of the general public. The Ministry of Agriculture and Fisheries, in their letter to local authorities with regard to the making of arrangements for the holding of Rat Week, stressed the importance of this aspect of the campaign, and the Council may claim to have succeeded in gaining the support of the public and of adjoining local authorities. Information with regard to Rat Week generally, and especially to the facilities available through the Public Health Department, was sent to the looal press; and 48 railways, commercial undertakings, business houses, property agents, builders and others concerned in the Borough, including, in particular, the occupiers of premises where food is prepared or sold, were circularised and invited to join in the organised attack which was made. That these methods of disseminating knowledge of the problem and the means of destroying the vermin stimulated widespread interest, was evidenced by the number of enquiries received in the Department. It is apparent that the larger stores and railways keep a vigilant watch for the presence of rats and mice, and are very keen to do all they can to prevent the likelihood of infestation. With the circulars sent from the Department there was issued the Ministry's booklet on " Rats and how to exterminate them " together with a copy of an extract from the annual report of the Medical Officer of Health for 1936, dealing with rat repression. The advice contained in the booklet, it is understood, was found to be helpful, and full advantage was taken of the special experience of the Public Health Department in dealing with the problem. Co-operation with neighbouring boroughs was once more secured, and added interest in this connection was given to this year's campaign in the attention directed towards the best methods of rat destruction in sewers. Practical tests in the Borough have shown that trapping by means of traps of the so-called " break-back " variety has particular value. A great point to be borne in mind about rats in relation to sewers is that the channels are only feeding and not nesting places, being too wet for the latter purpose. The rat always prefers and seeks for a dry spot in which to make his living and breeding place, which renders the problem of extermination all the more difficult. The Ministry of Agriculture and Fisheries has repeatedly insisted that the destruction of rats and mice is essentially a matter for combined effort, and reviewing the results of past Rat Weeks, when determined attempts have been made by the Council to secure co-operation, which has been so successfully continued this time, it is evident that reduction in, if not abatement of, the nuisance has been achieved." PIGEONS. Under section 52 of the London County Council (General Powers) Act, 1927, the Council is empowered to seize and destroy, sell, or otherwise dispose of, or cause to be seized, etc., house doves or pigeons in excessive numbers, if they believe them to be without an owner. Ten complaints (seven relating to private dwellings and three to public buildings) were made in 1937, as against three in 1936. As in other years, as much assistance as possible was given by the inspector in charge of this work to reduce the nuisance. MOSQUITOES. During the month of August complaints were received from residents in the Abbey Road area of a serious infestation by mosquitoes, and upon investigation it was found that these insects were breeding in a number of unprotected water supply cisterns, and, in particular and more seriously, in an ornamental pool at the rear of an unoccupied house, and in the stagnant water lying in the basement of an unfinished building. In every instance steps were taken by the owners to prevent a continuance of the trouble by cleansing and protecting the cisterns and by continued oiling of the pools. FOULING OF FOOTWAYS BY DOGS. Early in the year the Public Health Committee determined to undertake more intensive action in connection with this matter. With this object, and in order to obtain more effective enforcement of the provisions of the bye-law, the Committee, with the permission of the Council, engaged the services of a temporary officer (graded as “Streets Nuisance Inspector”) as from the 22nd February, 1937. As a result of the carrying out of close and routine observations, breach of the byelaws was detected in 89 cases, in all of which, following prosecution, convictions 49 were secured and penalties imposed. In addition to these, two convictions were obtained on reports submitted by other members of the staff of the Department. In their efforts to deal with this most objectionable nuisance the Council received great assistance from the police, 33 prosecutions undertaken being on the reports of police officers. The total number of prosecutions since the bye-law came into operation in 1928 is 227, the amount of fines imposed being £91 13s. Od. NOISE. Section 66 of the London County Council (General Powers) Act, 1937, provides that a noise nuisance may be dealt with summarily under the Public Health (London) Act, 1936. In securing attention to this provision the temporary streets nuisance inspector rendered valuable assistance, and also co-operated with the police in regard to complaints relating to street musicians, noisy hawkers, etc. During the year, five complaints were received relating to nuisance from wireless loudspeakers, gramophones and similar instruments. In each instance abatement of the nuisance was secured without the service of formal notice. Early in the year complaints were received of noise and disturbance caused by the violent slamming of doors of motor vehicles. The attention of taxicab and car drivers was drawn to the matter by the display of the following poster at cab ranks and garages:— BOROUGH OF ST. MARYLEBONE. NOISE. Nuisance From Motor Vehicles. The Borough Council receive many complaints of the noise and disturbance caused by the violent slamming of doors of motor vehicles, and have been urged to take action with a view of preventing the nuisance. Drivers and users of motor-cars and taxicabs are particularly requested to show consideration for others by reducing the occasions for closing car doors and to avoid slamming as far as possible. Town Hall, CHARLES PORTER, St. Marylebone, W.1. Medical Officer of Health. Publicity was also given to the matter in the Press and as a result of this and the co-operation of garage proprietors and others concerned with cars it may be hoped that some mitigation of the door-slamming nuisance has been secured. The Council continue to subscribe to the funds of the Anti-Noise League. PHARMACY AND POISONS ACT, 1933. The provisions of this Act, which came into operation on the 1st May, 1936, are now generally known amongst the shopkeepers concerned. The number of traders whose names are on the Council's list of persons entitled to sell poisons included in Part II of the Poisons List is as follows:— On list at end of 1936 112 Added to list in 1937 9 Deleted from list in 1937 4 On list at end of 1937 117 Inspections of all premises were carried out during the year, and in no instance was there failure to comply with the requirements which apply to the sale of poisons by a listed seller of Part II poisons. FACTORIES AND WORKSHOPS. In St. Marylebone the number of workshops, many of them domestic workshops, is considerable, and work in relation to them bulks very large amongst the duties 50 of the district inspectors, more especially those in charge of districts on the south of Marylebone Road. The staple industry is 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 1,596. The complaints received numbered 107. 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. TABLE 23. 1.—Inspection. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries). 188 30 — Workshops (Including Workshop Laundries). 749 72 — Workplaces (Other than Outworkers' Premises included in Part 3 of this Report). 659 57 -- Total 1,596 159 — TABLE 24. 2.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts— Want of cleanliness 26 26 - - Want of ventilation 16 16 - - Overcrowding 4 4 - - Want of drainage of floors 1 1 - - Other nuisances 17 17 - - Sanitary accommodation insufficient 9 9 - - unsuitable or defective 36 36 - - not separate for sexes 13 13 — — Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 7 7 - - Other offences — — — - (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 129 129 — — 51 TABLE 25. 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 (Section 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. 73 244 805 - - - 9 - - - - - - - - Total 73 244 805 - - - 9 - - - - - - - - 52 TABLE 26. 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 1,487 Coffee Shops, &c. 386 Bakehouses 67 Total number of workshops on Register 1,930 TABLE 27. 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) 11 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 107 Reports (of action taken) sent to H.M. Inspector 107 Other — Underground Bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 45 RAG FLOCK. There are no premises within the district where rag flock is manufactured, used in the making of mattresses, etc., or sold. Frequent inspections have been made but in no instance has the use of flock for repairs been discovered. 53 SECTION D-HOUSING. The total number of houses and flats in the Borough at the end of 1937 was 19,974, the number occupied by the working classes being 8,473. The information asked for by the Ministry with regard to housing is contained in the following statement. 1. Inspection of Dwelling-houses. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,610 (b) Number of inspections made for the purpose 13,398 (2) (a) Number of dwelling-houses (included under sub-head 143 houses (1) above which were inspected and recorded under and 457 the Housing Consolidated Regulations, 1925 tenements, (b) Number of inspections made for the purpose 2,795 (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 1,273 2. Remedy of Defects without Service of formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the local authority or their officers 1,236 3. Action under Statutory Powers :— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936 : (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 37 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 37 (b) By local authority in default of owners Nil (c) Proceedings under sections 11 and 13 of the Housing Act, 1936 :— (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 12 of the Housing Act, 1936 :— (1) Number of separate tenements or underground rooms in respect of which closing orders were made 140 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 7 54 4. Housing Act, 1936—Part IV.—Overcrowding :— (a) (i) Number of dwellings overcrowded at the end of the year 1,064 (ii) Number of families dwelling therein 1,064 (iii) Number of persons dwelling therein 4,639 (b) Number of new cases of overcrowding reported during the year Nil (c) (i) Number of cases of overcrowding relieved during the year 550 (ii) Number of persons concerned in such cases 3,025 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil (e) Any other particulars with respect to overcrowding ditions upon which the Medical Officer of Health may consider it desirable to report:— The Housing Act, 1935, continued by the Act of 1936, set up standards by which occupied houses were to be considered overcrowded. A survey of the Borough was commenced on the 1st November, 1935 and completed on the 20th January, 1936, and upon the results of that survey the London County Council based their calculations for the necessary amount of new housing accommodation required to abate this overcrowding. By the Housing Act, 1936, it is provided that after a certain date—1st January, 1938, in the case of St. Marylebone—it is an offence against the statute for a landlord to let houses and rooms to families whose numbers are in excess of that allowed by the " permitted number," and also for families to occupy new dwellings so as to cause overcrowding. To fix the responsibility as well as to give guidance to landlord and tenant, it is enacted that all rent books shall contain a statement of the permitted number of persons allowed to live in the house or rooms to which the rent book refers. The Act requires further that a local authority shall furnish such particulars of " permitted numbers " to a landlord, and it was in order to obtain these that measurements of rooms, additional to those already made during the first survey, were undertaken. A card register has been compiled which records, first the measurements and areas of all rooms in houses, and secondly the families with the number of persons and the rooms each family occupy. In this connection it may be noted that though there may be different groupings of rooms by subsequent lettings, the sizes, of course, will remain constant, and in future it will be a comparatively easy matter to give, from the register, " permitted numbers " for new lettings. In addition, the register, by a simple device, shows at a glance all cases of overcrowding. Six carefully selected measuring assistants were engaged to do this work under the supervision of the district inspectors. They commenced duties on the 5th April, 1937, and completed the work on the 3rd July, 1937, office accommodation being provided at the Mortuary in Paddington Street. The total expenditure on wages for the temporary assistants amounted to £285, one half of this being borne by the London County Council. Very little difficulty was met with in the course of the work, and a visit by the sanitary inspector was sufficient to overcome any opposition to entry. At the time of the visit and inspection opportunity was taken of bringing up to date the particulars of occupation of all working class houses. A considerable amount of work, particularly of revision, was done by the district inspectors themselves. Great credit is due to them and to the clerical staff for the smoothness with which the whole task was carried out. Table 28 gives the final result of the survey. 55 TABLE 28. Overcrowding . Ward No. Families Recorded. Rooms Occupied. Families Overcrowded. 1 1,273 3,711 36 2 1,510 4,095 65 3 4,602 12,592 545 4 1,453 3,722 54 5 2,343 5,280 106 6 1,221 2,825 62 7 1,149 2,334 125 8 824 2,139 53 9 121 274 18 The Borough 14,496 36,972 1,064 In compiling the register, it should be noted, houses which at the first survey had been found not to be strictly of working class character were omitted. The table shows that a remarkable reduction in the number of overcrowded families has taken place since January, 1936, when the first survey was completed. The figure then was 1,614. In part this reduction may be accounted for by demolitions, ordinary movements (which have been considerably augmented of late), etc. The Council's activities in recent times in connection with clearance areas, closure of underground rooms, as well as transferences to London County Council estates under arrangements with that body, would also account for a fairly large part of the removals and the reduction in the number of cases of overcrowding still to be dealt with. The issuing of certificates of "permitted numbers" to landlords of working class properties in the Borough was completed before the end of the year. 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. Especially was this so in the Carlisle Street area, the reconstruction of which was completed during the year. Table 29 gives particulars of the various areas dealt with by the London County Council, the Borough Council, and the St. Marylebone Housing Association. 56 Re-Housing Schemes. 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. Building operations are proceeding. *Providence Place and Sun Cottages. 0.40 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 Orders confirmed by Minister of Health, 19th - June, 1935 and 30th January, 1936. †Henry Place 0.31 8,500 97 *Vine Cottages 0.03 1,400 17 †Little Grove Street 0.23 6,000 69 †Byron Street 0.34 9,500 112 *Harrow Street 2.71 120,000 1,096 Clearance Order confirmed by the Minister of Health, 7th October, 1936. The London County Council are now negotiating for the acquisition of the various properties included in the Area. (Together with certa in additional lands) *Princess Street 2.490 74,000 655 Clearance Order confirmed by Minister of Health, 14th April, 1938. 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, 1930. Confirmed by Minister of Health, 17th June, 1937. *Included in Borough Council's proposals. †Represented by London County Council. 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. 57 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 bye-laws made by the London County Council under the Public Health (London) Act, 1891, and Section 0 of the Housing Act, 1925, all houses suitable for the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to sanitation, cleansing, etc. During the year some 6,164 visits were paid to the 852 houses carried over from the old register. The number of intimation notices served was 898, relating to cleansing and other defects. Except in 22 cases, where statutory notices were issued, all of these notices were complied with without the necessity for further proceedings arising. In all tenement houses the provision of lighting arrangements in staircases is called for by the bye-laws relating to houses let in lodgings. During 1937 the need for the taking of formal action in this respect did not arise. COMMON LODGING HOUSES. During 1937, 34 visits were paid by officers of the department to the two lodging houses in the Borough. In addition, the premises were periodically inspected by a Fire Inspector (Mr. M. W. A. Davey) specially appointed for the purpose. Apart from minor matters calling for attention, no action was found to be necessary in respect of either of the common lodging houses. TABLE 30. Common Lodging Houses. Address. Registered Owner. Registered number of Occupants. 2, Burne Street, and premises in Lisson Street The Salvation Army Trustee Company, Limited 436 men Portman House, Daventry Street, and Harrow Street, Lisson Grove The Rev. Prebendary Wilson Carlile, C.H., D.D. (The Church Army) Total 100 women 536 UNDERGROUND ROOMS. Dining the year the number of underground rooms occupied was still further reduced, action taken in respect of 140 in which the occupation was definitely illegal securing discontinuance of such occupation. In addition, improvement of conditions in a number of cases was secured under the regulations as to underground rooms. RENT RESTRICTION ACTS. 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. 58 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. Analysis of Milk. The quarterly returns as to the number of milk samples taken are as follows : 1st Quarter, 55 ; 2nd Quarter, 56 ; 3rd Quarter, 35 ; 4th Quarter, 53, making a total for the year of 199. 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, 80 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 bo 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. Dairies, Milkshops, etc. There are 182 premises upon which milk is sold. During the year 250 inspections 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. Milk (Special Designations) Order, 1936. During the year 52 applications were received from 26 milk purveyors for licences under the 1936 Order, which reduced the number of grades of milk from five to three. As in each case all relevant requirements of the Order had been complied with, appropriate licences were granted as shown in Table 31. TABLE 31. Milk (Special Designations) Order, 1936. Grade of Milk. Type of Licence. No. of Licences issued. Pasteurised Pasteurising 1 Dealers 26 Supplementary 4 Tuberculin Tested Bottling 1 Dealers 15 Supplementary 2 Accredited Bottling 1 Dealers 1 Supplementary 1 Total 52 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 no case was an adverse report received from the Council's bacteriologist in regard to samples taken. 59 MEAT AND OTHER FOODS. Food Inspection. The work of food protection receives year by year the closest attention. As for some years past, the main duties 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. During 1937, 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. Unsound Food. On a great many occasions the inspector was called by vendors to examine articles of food under section 180 (8) of the Public Health (London) Act, 1936, and to accept surrender of such as were unsound or unwholesome or unfit for food. Table 32 contains a list of the articles dealt with in this wav. TABLE 32. Unsound Food Condemned and Destroyed. Meat— Tinned Goods— Beef 147 lbs Corned Beef 37 tins Lamb 85„ Hams 21„ Pork 28„ Jellied Veal 12„ Suet 59„ Lunch Tongues 16„ Sausages 18„ Ox Tongues 5„ Liver 17„ Chicken & Ham Roll 6„ Veal Fillet 3„ Fish— Brawn 2„ Cod 16 stone Roast Pork 1„ Fillets 10 boxes Ham & Tongue 1„ Kippers 4„ Tunny 1 (3601bs.) Miscellaneous— Bacon 1 cwt Fruit— Rabbits 2 boxes Grapes 56 boxes Chickens 17½ lbs Apples 40„ Horseflesh 56„ Pears 12„ Dripping 24„ Public Health (Meat) Regulations, 1925. These regulations 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. 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. Twelve inspections were made in 1937. Offensive Trades. At the end of 1937 only one premises within the Borough carried on a trade classed as offensive, that being the slaughter of poultry. The Food Inspector made 14 visits, but no cause for complaint was found. 60 Premises used for Food Preparation. The Public Health (London) Act, 1936, in section 187, 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 1937, 99 premises were registered for the preparation or manufacture of foods (other than ice cream) intended for sale, and 230 inspections were made by the Food Inspector. Ice Cream Premises. These are also required to be registered under Section 187 of the Public Health (London) Act, 1936. The actual number of premises included in the register at the end of 1937 was 105, 5 more than in 1936. Throughout 1937, 125 inspections were made, and in 7 cases notices were served in respect of uncleanly conditions. Butter, Margarine, etc., Premises. At the end of the year there were on the register 16 dealers in margarine, 1 wholesale dealer in milk-blended butter and 2 butter manufacturers. Fifty-eight visits were paid to the registered premises during 1937. Bakehouses. At the end of 1937 the number of bakehouses on the register was 57, 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 the Act contains no requirement as to application for renewal, all that can be done is to exercise a close supervision in order to see that the places are kept in as good condition as possible. During the year 110 visits were paid and 2 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 20 and by fish curers 3. Notices calling for periodical lime-washing, etc., of such premises, as required by the bye-laws of the London County Council, were issued quarterly, and during the year 54 inspections of fried fish shops and 30 inspections of fish curers' premises were made by the Food Inspector. In the case of the fried fish shops, 2 notices were served and complied with. Restaurants, Tea-rooms, etc. 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 1937 there were 386, this number including restaurant, dining room and coffee shop kitchens, 216 ; tea-rooms and pastry-cookshops, 113 ; hotel kitchens, 34 ; fried fish shops, 20 ; and fish-curers, 3. 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 cook-shops 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 1937, the total number of inspections was 442, the number of notices served being 12. 61 Food Stalls. Under the bye-laws with regard to registration of street traders under the London County Council (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. Bacteriological Examinations. During the year, apart from milk samples, 4 samples of ico cream and 1 meat pie were examined bacteriologically. All were found to be satisfactory. FOOD AND DRUGS (ADULTERATION) ACT, 1928. The total number of samples taken under this Act in 1937 was 1,066, the figure for 1936 being 1,067. The sum paid in respect of each analysis was 12s. 6d. Of this number five 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 0.5 as against 0.4 in 1936. 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. " The number of samples taken under the Food and Drugs (Adulteration) Act and submitted for analysis during 1937 was 1,066. Table 33 gives details of those samples found to be adulterated, while Table 34 contains a complete list of the articles sampled. TABLE 33. Food and Drugs Analyses—Adulterated Samples. Serial Number. Article. Whether Formal, Informal or Private. Nature of Adulteration or Irregularity. Observations. 620 Milk Formal. 11.3% of extraneous water. Legal proceedings were taken. No fines were imposed, but £2 2s. Od. costs were awarded to the Council in each case. 621 Bread and Butter Formal. The "butter" consisted of margarine fats only. 624 Bread and Butter Informal. The " butter " consisted of margarine fats only. 820 Cream, Tinned Informal. Contained 0.2 grain of tin per lb. 933 Cream, Tinned Formal. Contained 0.1 grain of tin per lb. No action taken. Ministry of Health notified. TABLE 34 Statement of Food and Drugs Analysed No. Article. Number Examined. Number Adulterated, etc. Formal. Informal. Private. Total. Formal. Informal. Private. Total. 1 Almond Essence - 1 1 2 Baked Beans (Tinned) — 1 — 1 3 Bicarbonate of Soda - 2 - 2 4 Blaud's Pills - 1 - 1 5 Boric Ointment - 14 - 14 6 Bramble Jelly - 2 - 2 7 Butter 75 206 - 281 8 Butter and Bread 2 4 - 6 1 1 2 9 Butter and Roll - 34 - 34 10 Camphorated Oil — 4 — 4 11 Candied Peel — 6 — 6 12 Cherries, Glace - 2 - 2 13 Cinnamon Essence - 5 - 5 14 Cocoa - 22 - 22 15 Coffee — 17 — 17 16 Coffee and Chicory Essence 1 — 1 17 Cookeen - 4 — 4 18 Cream (Loose) 18 3 — 21 19 Cream (Tinned) 1 22 — 23 1 1 2 20 Currants — 6 — 6 21 Custard Powder — 1 — 1 22 Dates — 2 • — 2 23 Figs — 2 — 2 24 Fish Paste — 6 — 6 25 Gin 4 — 4 26 Glycerine and Thymol — 2 — 2 27 Grey Powders — 2 — 2 28 Honey — 12 — 12 29 Iodine, Tincture of — 13 — 13 30 Jam — 39 — 39 31 Lard — 47 — 47 32 Lemonade Powder — 11 — 11 33 Margarine — 26 — 26 34 Marmalade — 30 — 30 35 Mayonnaise — 1 — 1 36 Meat Paste — 6 — 6 37 Milk 108 91 — 199 1 1 38 Milk, Condensed — 26 — 26 39 Mincemeat — 1 — 1 40 Mustard — 10 — 10 41 Mustard, French — 4 — 4 42 Olive Oil — 5 — 5 43 Paraffin, Liquid — 7 — 7 44 Parrish's Food — 4 — 4 45 Peas, Tinned — 16 — 16 46 Pepper — 15 — 15 47 Pickles — 2 — 2 48 Prawn and Tongue Paste — 1 — 1 49 Raisins — 6 — 6 50 Rice — 14 — 14 51 Salmon, Tinned — 5 — 5 52 Sardines — 15 — 15 53 Sausages, Pork — 21 — 21 54 Savora Appetiser — 1 — 1 55 Semolina — 1 — 1 56 Soda, Bicarbonate of — . 2 — 2 57 Spice, Mixed — 2 — 2 58 Sugar — 3 — 3 59 Sultanas — 6 — 6 60 Tea 23 — 23 61 Vaseline — 1 — 1 62 Vermouth — 3 — 3 63 Vinegar — 5 — 5 64 Whiskey — 2 — 2 65 Witch Hazel — 8 — 8 66 Yeast Vite — — 1 1 Total 204 861 1 1,066 3 2 5 62 63 Milk. Of the 199 samples analysed one was found to be adulterated. This is only the second case of a milk found to be adulterated since May, 1934. The average composition of the milk examined during 1937 as well as that for the two years preceding was as follows:— Year. Sp. Gr. Total Solids. Fat. Solids not Fat. 1935 1031.0 12.07 3.47 8.60 1936 1031.3 12.29 3.60 8.69 1937 1031.5 12.36 3.62 8.74 Cream. During the year 21 loose creams were taken. The amount of fat varied from 31.6% to 50.3%, the average being 43.05%. The tinned creams numbered 23, and their fats ranged between a minimum of 19.25% to a maximum of 25.0%, giving an average of 22.88%. An interesting point about two of the tinned creams was that a small amount of tin was present in each. Although the quantity found in each of these instances was very small, it may be that larger amounts might be found in creams kept unsold for long periods and possibly under conditions tending to be more favourable for the mutual action between the metal and the constituents of the cream. As no doubt tinned cream is often used as a convenient substitute for loose cream when the latter is recommended by the medical attendant for sick or ailing children or other invalids, it is quite conceivable that on occasions a delicate constitution might react very unfavourably to the tin so introduced. In order to check the possibility of tin being present in either large or small amount in any sample to be examined during the year 1938, tin will be specifically tested for in each sample. Butter. During the year 281 samples were taken. Of these none was found to be adulterated, but of the six samples of bread and butter taken, the butter on two of these was found to consist of margarine fats only. Drugs. All the samples examined conformed to the standard laid down for them in the British Pharmacopoeia." ARTIFICIAL CREAM ACT, 1929. Under this Act the Council are required to keep a register of all premises where artificial cream is manufactured, sold or exposed or kept for sale for human consumption. At the end of the year four premises appeared on the register, and in no instance was action under the Act called for. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. During the year 26 samples of condensed milk were examined and all were found to comply with the regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. No samples of dried milk were taken during 1937. PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS, 1925 to 1927. The public analyst devotes special attention to investigations for the detection of the presence of preservatives in food. During the year it was not found necessary to take any action under the provisions relating to this matter. 64 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Under this section of the report the Minister of Health requires information with regard to the prevalence of notifiable infectious diseases during the year, with any noteworthy facts of the source or spread of infection. The various diseases are each dealt with and commented upon under their respective headings and notes are also included with regard to immunisation and preventive treatment. Table 35 gives a list of diseases which were notifiable in St. Marylebone during the year under review. TABLE 35 List of Notifiable Diseases. Smallpox Acute Poliomyelitis Cholera Acute Encephalitis Lethargica Diphtheria Polio-Encephalitis Membranous Croup Ophthalmia Neonatorum Erysipelas Tuberculosis Scarlatina or Scarlet Fever Malaria * Typhus Fever Induced Malaria Typhoid Fever Dysentery * Paratyphoid Fever Acute Primary Pneumonia Enteric Fever Acute Influenzal Pneumonia Relapsing Fever Plague Continued Fever Glanders Cerebro-Spinal Fever Anthrax Puerperal Fever Farcy Puerperal Pyrexia Food Poisoning * A Medical Practitioner is not required to notify cases of Malaria, or Dysentery, if the case has already, to his knowledge, been notified within the period of 6 months immediately preceding the date on which he first became aware of it. Table 36 show3 the number of cases of infectious disease notified during the past six years TABLE 36. Infectious Disease Notifications. 1932 1933 1934 1935 1936 1937 Smallpox - — — — - - Diphtheria 83 78 104 119 121 108 Erysipelas 55 76 59 35 28 47 Scarlet Fever 192 198 212 155 141 121 Enteric Fever 3 7 3 3 5 5 Paratyphoid Fever 4 2 1 3 3 4 Continued Fever — — — — — — Puerperal Fever 5 8 3 10 4 13 Puerperal Pyrexia 26 17 18 36 28 34 Cerebro-spinal Meningitis 2 1 1 1 1 3 Tuberoulosis (Pulmonary) 140 148 132 93 107 117 Tuberculosis (Non-Pulmonary) 23 16 25 19 23 17 Acute Poliomyelitis 1 — — 3 2 2 Polio-Encephalitis — — — 1 1 — Ophthalmia Neonatorum 8 6 8 10 7 10 Encephalitis Lethargica — 1 — — — — Pneumonia 77 74 70 33 66 61 Malaria 1 — 1 1 — 1 Dysentery 2 1 2 3 1 6 Totals 622 633 639 525 538 549 Table 37 shows, with regard to the infections, the total number of notifications received, the age distribution, the number of cases notified from each of the four registration districts, and the total deaths during 1937. 05 TABLE 37. Cases of Infectious Disease Notified during 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. Total deaths. 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 108 - 9 8 8 8 36 13 7 13 5 1 - 28 22 48 10 108 28 22 48 9 107 1 3 Erysipelas 47 2 1 — — — 1 — — 6 8 22 7 9 19 10 9 47 8 15 5 4 32 15 — Scarlet Fever 121 — 1 6 8 9 40 22 8 20 5 2 — 24 33 40 24 121 23 32 39 20 114 7 — Typhus Fever - — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever 5 — — 3 — 2 1 2 2 — 5 1 2 2 — 5 — 2 Paratyphoid Fever 4 1 - - 2 - - - - 1 - - - 1 — 1 2 4 1 — 1 — 2 2 — Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 13 11 2 1 6 5 1 13 1 6 5 1 13 — 2 Puerperal Pyrexia 34 - - - - - - - 4 28 2 — — 4 19 4 7 34 4 19 4 7 34 — — Plague - - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever 3 1 1 1 - - - - - - - 1 — 1 1 3 1 — 1 1 3 — 1 Tuberculosis— Pulmonary 117 - 1 - 1 - 1 1 10 51 20 29 3 34 34 37 12 117 11 21 15 6 53 64 51 Non-Pulmonary 17 — — — 1 2 3 1 1 5 1 3 — 7 1 3 6 17 5 — 3 4 12 5 3 Acute Poliomyelitis 2 1 — — — — 1 — — — — — — — 1 — 1 2 — 1 — 1 2 — — Polio-Encephalitis Ophthalmia - - - - - - - - - - - - - - - - - - - - - - - - - Neonatorum 10 10 - - - - - - - - - - - 2 2 2 4 10 1 2 1 4 8 2 — Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 61 2 1 1 2 1 4 2 5 8 6 20 9 10 16 25 10 61 10 11 19 6 46 15 89 Malaria 1 - - - - - - - - - - 1 - — — 1 — 1 — — 1 — 1 — — Dysentery 6 1 — — — — 2 - — 1 l - 1 1 1 2 2 6 1 1 2 1 5 1 ~ Totals 549 17 14 15 23 21 88 39 35 147 50 80 20 123 156 181 89 549 95 132 146 64 437 112 151 * This figure is for all forms of pneumonia, including acute primary pneumonia and acute influenzal pneumonia which alone are notifiable. 66 DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). There were 108 cases of diphtheria notified during 1937, 3 deaths resulting. The highest number of cases reported in any one week was 5. In 1936 there were 121 cases and 6 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 14 cases infection was counted to have been acquired in school, and in 7 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 669, a positive result being returned in 29 instances. Of the registration districts, that contributing the largest number of cases was Christ Church with 48. In All Souls the number was 28, in St. Mary 22 and in St. John 10. The age group 5—15 was most affected, 49 of the cases falling into this group. Diphtheria Antitoxin. Two applications were made for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910. 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, and later at 181, Marylebone Road. The following statement gives details of the work of the clinic during the year. Attendances 1,408 New cases 456 Schick negative 7 Completely immunised (3 injections but not retested) 331 Retested 112 Positive after retest 2 SCARLET FEVER. Notifications of this disease numbered 121, the highest number of cases reported in any one week being 9. There were no deaths from scarlet fever during 1937. In 1936 there were 141 notifications, one death resulting. The districts to suffer most from the disease were Christ Church and St. Mary. In the former there were 40 cases and in the latter 33. All Souls and St. John each reported 24. As usual, the majority of the patients were children, 86 being under 15 years of age. Of the remainder, 28 were in the age-group 15-35 and 7 were over 35 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 15 instances that a definite connection could be made out. ENTERIC FEVER AND PARATYPHOID FEVER. Five notifications of enteric fever and four of paratyphoid fever were received. There were two deaths. In none of the cases was any information obtainable indicating that the source of infection arose within the Borough. With the object of securing closer co-operation, if possible, with the medical practitioners in the Borough, a communication in the following terms was addressed to each member of the profession from whom notifications of infectious disease are more or less regularly received. The number of these is 51. The number of members 67 of the profession actually practising or residing in the Borough varies, but is regarded as being in the neighbourhood of 1,500. Public Health Department, Town Hall, St. Marylebone, W.l. 22nd November, 1937. Dear Sir, Though there appears to be no particular reason to fear an invasion of typhoid in St. Marylebone, in spite of the presence of the infection in Kensington, the pronouncement of these leaders of our profession, Lord Dawson of Penn and Sir Kaye Le Fleming, on the subject of co-operation suggests to me that it might not be out of place to write to you and offer you an assurance of my extreme readiness, and that of the whole staff of the Public Health Department, to receive any help you can render that is likely to secure protection of the inhabitants of the Borough from this as from any other infection. The cordial relations that have always existed between us, you may consider, renders such an assurance unnecessary. It renders unnecessary also the other assurance that for our part—mine, and that of my colleagues in the Department—we shall as always be ready to assist you in every way possible in connection with the isolation and treatment of any who may, unfortunately, become infected. Of the fact that typhoid fever is one of the diseases of which you as a medical practitioner are required to make notification to the Medical Officer of Health immediately you become aware of the existence of the disease—a fee being payable by the local authority in respect of each notification received— it is not necessary for me to issue a reminder. Nor, I think, need I remind you that so far as diagnosis is concerned, the services of the Council's bacteriologist (Dr. L. E. H. Whitby, C.V.O., M.C.) at the Middlesex Hospital are freely at your disposal, and I, myself, am ready at any time to see any case of doubt or difficulty with you—without fee, of course. I would add that if there is any other direction in which you consider we could co-operate for the benefit of the people of the Borough and the prevention of disease, I should be very glad indeed if you would let me know. Yours sincerely, Charles Porter, Medical Officer of Health. CEREBRO-SPINAL FEVER. There were three cases of this disease notified during the year. One death was recorded. ENCEPHALITIS LETHARGICA AND POLIO-ENCEPHALITIS. No notification of either of these diseases was received during the year, but two deaths of long standing cases of encephalitis lethargica were registered. ACUTE POLIOMYELITIS. Two cases of this disease were notified during the year. ERYSIPELAS. The notifications of erysipelas numbered 47, no death resulting directly from the disease. Most of the cases were notified from St. Charles' Hospital and the general hospitals, and 32 patients were treated in such institutions. In 1936, 28 cases were notified. PUERPERAL FEVER AND PUERPERAL PYREXIA. The number of cases of puerperal fever notified was 13. 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 68 were suitable and possible offered. Two deaths were recorded. Particulars of these and of the 2 deaths attributed to other puerperal conditions are given under the heading " Maternal Mortality." The puerperal pyrexia cases notified during the year numbered 34. As with puerperal fever, 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 which the Council is empowered to provide. The number of cases notified in 1936 was 28. MEASLES AND GERMAN MEASLES. These diseases showed no epidemic tendency during 1937, but although they are not now notifiable, 7 cases were reported voluntarily and 127 notices of cases and contacts were received from school teachers. There were no deaths. The course adopted in relation to the reported cases was the same as in previous years. Practically every case was visited by the health visitors, particular attention being given to such as occurred in tenement houses. It was not found necessary to call upon the services of a nurse, under the agreement between the Council and the Paddington and St. Marylebone District Nursing Association. WHOOPING COUGH. Most of the information obtained with regard to this disease is derived from notices received from school teachers, who reported 65 cases and contacts. There were 3 deaths. In 1936 the number of deaths registered as due to whooping cough was 5. GLANDERS, ANTHRAX AND FARCY. No cases were notified during the year. DYSENTERY. During 1937, six cases of this disease were notified, mainly from hospitals. In each instance the infection was of a very mild type, and no death was recorded. MALARIA. One case of induced malaria was reported. SMALLPOX. There have been no cases of this disease in the Borough. Vaccination. Table 38, prepared by the Vaccination Officer, contains the vaccination return relating to the year 1936. The following statement gives some information with regard to the work done and the results obtained by Dr. Bulman during 1937:— Number of visits paid 1,220 Number of vaccinations— Primary 437 Re-vaccinations 107 544 Number of successful vaccinations 506 Number of unsuccessful vaccinations 38 69 TABLE 38. Vaccination Return—1936. Return made to the Borough Council and Ministry of Health on the 12th February, 1938, by Dr. Charles Porter, 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, 1936, 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, 1936. Number of these Births duly entered by 31st January, 1938, in Columns I, II, IV and V of the “Vaccination Register “(Birth List Sheets), viz. : Number of these Births which on 31st January, 1938, remained unentered in the "Vaccination Register“on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1938, 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 1937. 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 1937. Col. I. Col.II. Col. IV. Col. V. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to places unknown or which cannot be reached and Cases not having been found. Success fully Vaccinated. Insuscep tible of Vaccination. Had SmallPox. Number in respect of whom Certificates of Conscientious Objection have been received. Dead. Unvacci nated. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 286 185 — — 52 11 5 10 17 6 2. St. Mary 2,188 1,331 4 — 365 76 8 329 70 5 2,036 546 3. All Souls 1,175 766 15 — 153 21 4 180 34 2 Total 3,649 2,282 19 — 570 108 17 519 121 13 2,036 546 Dated 12th February, 1938. (Signed) CHARLES PORTER, Vaccination Officer. 70 OPHTHALMIA NEONATORUM. The total number of cases of this disease notified in 1937 was 10, and information with regard to these is given in Table 39. Seven cases were notified in 1936. Visits were paid to notified cases by the health visitors, and where necessary arrangements were made for a nurse from the Paddington and St. Marylebone District 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. TABLE 39. Ophthalmia Neonatorum. Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Removed, etc. At Home. At Hospital. 10 4 6 8 — — 1 1 INFLUENZA. This disease was rather more prevalent than in 1936, though correct information as to the number of cases was, of course, unobtainable. The district nurses paid 233 visits to 28 cases. The deaths certified as due to influenza numbered 44 as against 14 in the previous year. PNEUMONIA. Notifications of this disease numbered 61. The services of the nurses were requisitioned in a large number of cases. The number of deaths certified as due to all forms of this disease was 89. FOOD POISONING. Seven notifications of food poisoning or suspected food poisoning were received during the year, six of these relating to an outbreak of acute intestinal disturbance among persons who had partaken of food at a private school function. Various foodstuffs came under suspicion, but no definite evidence as to the responsibility of these articles was obtainable. All those affected quickly recovered. PREVENTION OF BLINDNESS. No action was taken under section 66 of the Public Health Act, 1925, the London County Council undertaking the welfare of blind persons in the County of London by means of their scheme formulated under the Blind Persons Act, 1920, and approved by the Minister of Health. The Borough Council has arranged with the London County Council for provision for blind children up to the age of five years to be made by the child welfare centres, and for home visiting in such cases to be carried out by the health visitors. Where the home conditions are unsuitable for a blind child, arrangements are made for its reception into an approved institution on the understanding that a blind child should not, save in very exceptional circumstances, be removed from its own home. No case came to the knowledge of the Department during 1937. 71 INFECTIOUS DISEASES IN SCHOOLS. Table 40 shows the number of cases and contacts of whooping cough, chickenpox, measles, and the notifiable infectious diseases reported from schools during 1937. TABLE 40. Infectious Diseases in Schools. SCHOOL. Scarlet Fever. Diphtheria Whooping Cough. Chickenpox. Measles All other Diseases. All Souls, Foley Street 14 2 - - 2 - Barrett Street — — — 1 — 1 Barrow Hill Road 21 6 16 27 3 11 Bell Street 9 8 — 5 4 4 Capland Street 2 4 — 1 1 26 Christ Church, Cosway Street 9 15 — 1 2 — Clipstone Street 3 11 1 11 76 7 Convent (St. Edward's) Golford Place 3 13 — 7 — — Cosway Street 36 43 2 15 — 9 Emmanuel, Aberdeen Place 3 8 1 — 17 Gateforth Street ... - - - - — — Hampden Gurney 6 1 6 18 10 4 Homer Row, Roman Catholic 2 2 — 1 3 — Jewish, Hanway Street - - - - - Orchardson Street, Roman Catholic — — — 3 — — Polytechnic, Regent Street - - - 3 1 - Regent's Park Central 4 2 — — — 17 St. James's, Marylebone Lane — 2 — 1 — — St. Luke's, Nutford Place — — — — — — St. Mark's, Violet Hill 4 2 — 11 3 16 St. Marylebone Central, High Street 19 8 1 24 8 43 St. Marylebone Grammar — — — 2 — 1 St. Mary's (Western), York Street 11 - 4 6 4 St. Paul's Bentinck, Rossmore Road 1 2 14 1 1 20 St. Thomas's, Picton Place — — 7 1 4 4 St. Vincent's, Wigmore Street 5 — — 1 7 Schools in other Boroughs 2 9 7 7 2 5 Totals 146 138 62 145 127 196 TUBERCULOSIS. Pulmonary Tuberculosis and the Milk Trade. Provision is made in the Public Health (Prevention of Tuberculosis) Regulations, 1925, designed to secure that no person suffering from respiratory tuberculosis who is in an infectious condition, shall be engaged in any form of dairy work involving the milking of cows, the treatment of milk or the handling of milk containers. During the year no case occurred which called for attention under the regulations. Compulsory Removal of Tuberculous Patients to Hospital. No action was required during 1937, under section 62 of the Public Health Act, 1925, which relates to the compulsory removal to hospital of persons suffering from tuberculosis. Tuberculosis : New Cases and Mortality. Table 41, prepared at the request of the Ministry of Health, contains information with regard to age and sex distribution of all forms of tuberculosis. 72 TABLE 41. Tuberculosis : New Cases and Deaths. Age Periods. *NEW CASES. †DEATHS. Pulmonary Non-Pulmonary Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 - - - 1 - 1 - - 1—5 1 2 2 1 — — — — 5—10 1 - 3 1 - - - — 10—15 1 1 1 1 - - - — 15—20 4 7 1 - 1 4 - - 20—25 4 8 1 5 - 1 — — 25—35 28 26 - 3 6 9 — 1 35—45 14 10 2 - 3 1 1 — 45—55 10 9 1 1 7 3 — — 55—65 15 1 1 2 10 2 — 1 65 and upwards 2 2 — — — 3 — — Totals 80 66 12 15 27 24 1 2 51 * Including all primary notifications and also any other new cases of tuberculosis which came to the knowledge of the Medical Officer of Health during the year. † Excluding deaths occurring in the district amongst temporary residents, which were transferred to another district, but including deaths occurring outside the district amongst persons normally resident in the district. Subject to this, the figures in the table relate to the total deaths in the district during the year. Tuberculosis Notifications. In all, 134 notifications were received, 117 relating to pulmonary tuberculosis, the remainder (17) to cases in which structures other than the lungs were affected. Table 42 gives information regarding the localisation of the disease, while Table 43 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 54 2. The number of cases unnotified or notified at death 12 3. The number of cases notified within a month of death 5 4. The number of cases notified within three months of death 7 5. The number of cases notified within six months of death 2 Nine cases of tuberculosis were unnotified at death. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was therefore 1 : 6. So far as the Borough itself is concerned, notification of tuberculosis may be regarded as efficient. The local medical practitioners fulfil their obligations in this respect, and take advantage of the facilities provided by the municipal tuberculosis scheme and co-operate with the officers of the local authority for the benefit of their patients. The comparatively high percentage of cases unnotified or notified at death is a matter for regret, but investigation into the circumstances invariably shows that in each case a satisfactory explanation for non-notification is forthcoming. The institution of proceedings was not called for in regard to any case of wilful neglect or refusal to notify. 73 TABLE 42. Tuberculosis Notifications—Localisation of Disease. Localisation of disease. Cases notified in whole district. Total cases notified in each locality. Number of cases removed to hospital from each locality. Cases isolated at home. At ages—Years. All Souls. St. Mary. Christ Church St. John. Totals. All Souls. St. Mary. Christ Church St. John. Totals. At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Lungs 117 2 2 18 63 29 3 34 34 37 12 117 11 21 15 6 53 64 Glands 8 — 2 4 1 — 1 — 5 1 — 2 8 3 — — 1 4 4 Peritoneum 2 - - - - - - - - - 1 1 2 — — 1 1 2 — Fistula 2 — — — — 1 1 — 1 — — 1 2 1 — — 1 2 — Meninges 1 — 1 — — — — — — — 1 — 1 — — 1 — 1 — Spine 1 1 1 — — — 1 1 — Kidney 1 1 1 1 Knee 1 — — — 1 — — — 1 — — — 1 1 — — — 1 — Hip 1 - - - 1 - - - - - 1 - 1 - - 1 - 1 - Totals 134 — 5 6 22 66 32 3 41 35 40 18 134 16 21 18 10 65 69 134 74 TABLE 43. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.—Summary of Notifications during the period from the 1st January, 1937, to the 31st December, 1937, 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 — 1 1 1 4 3 24 12 10 13 2 71 76 „ females — 1 — — 6 5 18 9 6 — 1 46 48 Non-pulmonary, males — 2 2 — 1 1 — 1 — 1 — 8 8 „ females — 1 1 1 — 2 2 — 1 1 — 9 9 Supplemental Return. Part II.—New cases of tuberculosis coming to the knowledge of the Medical Officer of Health dining 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 4 2 — 2 — 9 „ females — 1 — 1 1 3 8 1 3 1 - 20 Non-pulmonary, males — — 1 1 — — — 1 1 — — 4 „ females 1 — — — — 3 1 — — 1 — 6 The source or sources from which information as to the above-mentioned oases was obtained is stated below :— SOURCE OF INFORMATION. No. of cases. Pulmonary. Nonpulmonary. Death returns from local registrars transferable deaths from Registrar-General 8 2 Posthumous notifications 1 2 “ Transfers ” from other areas (other them transferable deaths) 19 5 Other sources (Form II) 1 1 75 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, 1937, on the register of notifications kept by the Medical Officer of Health 353 188 541 48 67 115 656 Number of cases removed from the Register during the year by reason inter alia of:— (1) Withdrawal of notification 6 6 12 2 — 2 14 (2) Recovery from the disease 8 6 14 5 4 9 23 (3) Death 28 24 52 3 4 7 59 (4) Removed from district 61 49 110 19 15 34 144 Treatment of Tuberculosis. Of the cases notified, admissions to hospital and sanatorium numbered 281, 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, 77 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 115. Noninsured persons numbered 57, the total admissions for these patients being 54, including 9 children. Nurses were sent in to 8 cases and 294 home visits were paid. Non-Pulmonary Tuberculosis. Twelve of the total notifications—17 as against 23 in 1936—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. Prevention of Tuberculosis. The dispensary removed on the 7th October, 1937, from No. 1ll, Marylebone Road to temporary accommodation at the Old Baths Establishment, Marylebone Road, pending the erection of Health Centre No. 1 (of which the dispensary will form part) on a portion of the site adjoining the Town Hall. Particulars with regard to patients dealt with during the year are shown in Tables 41 and 43, 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, 39 Old, 255 No. of cases at dispensary New, 372 Old, 355 No. of attendances at dispensary 2,241 No. of contacts New, 104 Old, 113 No. of visits by tuberculosis visitors First visits, 168 Re-visits, 3,525 No. of Committee Meetings attended 22 No. of hospital visits by Dr. Anderson 78 The following note by Dr. Anderson upon the work of the year is of interest: " Out of the 104 progress reports on patients who have had sanatorium treatment through the London County Council, 29 men, 28 women, and 7 children are working or at school ; 5 are fit but have no work, 8 are unfit, 10 have been transferred to other districts, and 12 lost sight of. Four declined to attend, and one has to be reported as having died. The Care Committee, with Councillor J. Bennett as Chairman and Miss M.E. Broadbent as Honorary Secretary, met fortnightly and 343 cases were reviewed. 76 The work of the Committee now consists chiefly of considering the needs of the patients as regards extra nourishment, clothing, fresh employment, re-housing, and financial aid. In a few cases help was given direct from the Committee ; others were referred to different charitable agencies within the borough, while the majority were dealt with, on the Committee's recommendation, by the London County Council. Miss Bowen continued her excellent work for the ex-service men and their families. Extra nourishment in the form of milk is supplied to necessitous cases either by the Borough Council or, in the case of patients already in receipt of out-relief, by the Public Assistance Committee on the receipt of a certificate from the Tuberculosis Officer. The number of X-ray examinations made during 1937 was 370, an increase of 17 on the previous year. X-ray examination remains the best method of detecting the early case and of excluding disease in the doubtful. It has, therefore, become a routine procedure in all new patients and in all adult and adolescent contacts. It is, in addition, one of the most efficient methods of checking progress after sanatorium treatment is completed. This is particularly true of the early case, and the greater the number of cases detected in an early stage the greater will be the number of follow-up radiograms. This must be regarded as money well spent, for it is in such cases that, with adequate active treatment, there is hope of ultimately obtaining a cure. At the first sign of an extension of the disease, re-admission to sanatorium for further treatment can be obtained without further delay. The number of patients who had returned from sanatorium and were receiving artificial pneumothorax refills as out-patients was 16 at the end of 1937. This number has been increasing steadily in recent years. It does not necessarily mean that a greater percentage of the cases are being diagnosed in an earlier stage, although this may partly account for the increase It is in the main due to improved technique resulting in a larger number of successful pneumothoraces. In suitable cases, artificial pneumothorax treatment improves the patient's chances of recovery, frequently shortens the duration of residential treatment, and in many instances allows the patient to return to work when he would otherwise be unfit to do so. The saving effected by the two factors last named more than compensates for the cost of the treatment. The increasing number is a welcome and hopeful sign." 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 1937 the total number certified as due to this cause was 51, the deathrate being 0.56 per 1,000. In 1936 the deaths numbered 62, the death-rate being 0.67 per 1,000. The distribution of the deaths according to registration districts is shown in Table 44 which gives also the figures for each of the 5 years 1933-1937. TABLE 44. Deaths from Phthisis, 1933—1937. Year. Estimated population. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 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 1937 92,110 51 13 9 21 8 The places at which the 51 deaths occurred were as follow : In general and other hospitals, 37, and at home, 14. Of those who died 34 were insured (21 males and 13 females), and 17 uninsured (6 males and 11 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 51, the notified cases of pulmonary tuberculosis totalled 117. 77 TABLE 45. Tuberculosis Scheme. Return showing the work carried out in connection with the Dispensary during the year 1937. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts) :— (a) Definitely tuberculous 51 29 1 2 5 7 2 2 56 36 3 4 99 (b) Diagnosis not completed - - - - - - - - 3 3 - 1 7 (c) Non-tuberculous — — — - — — — — 50 64 7 10 131 B.—Contacts examined during the year :— (a) Definitely tuberculous — 2 1 1 - - - - - 2 1 1 4 *(6) Diagnosis not completed - - - - - - - - - 1 - - 1 (c) Non-tuberculous - - - - - - - - 19 44 13 23 99 C.—Cases written off the Dispensary (a) Recovered 5 4 8 — 1 2 2 2 6 6 10 2 24 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous)... - - - - - - - - 75 112 21 35 243 D.—Number of Cases on Dispensary Register on December 31st :— (a) Definitely tuberculous 147 101 12 15 17 25 18 12 164 126 30 27 347 (6) Diagnosis not completed — — — — — — — — 3 4 1 1 9 1. Number of cases on Dispensary Register on January 1st 385 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 43 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 109 4. Cases written off during the year as Dead (all causes) 37 5. Number of attendances at the Dispensary (including Contacts) 2,141 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 144 7. Number of consultations with medical practitioners :— (a) Personal 23 8. Number of visits by Tuberculosis Officer to homes (including personal consultations) 298 (6) Other 165 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,818 10 Number of:— (a) Specimens of sputum, &c., examined ... 213 (b) X-ray examinations made in connection with Dispensary work 370 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 182 Number of dispensaries for the treatment of tuberculosis (excluding centres used only for special forms of treatment) : Provided by the Council, One. Provided by voluntary bodies, One—Margaret St. Dispensary, Margaret St., W.1 remaining undiagnosed on 31st December. go TABLE 46. Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1937 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 1937. 1937. Previous to 1937. 1937. Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Bones and joints. Abdominal. Otherorgans. Peripheral glands. Total. Bones and joints. Abdominal. j Otherorgans. Peripheral glands. . Group 1. Group 2. Group 3. Total (Class) T.B.plus Group 1. J Group 2. Group 3. Total (Class T.B.plus) (a) Remaining on dispensary register on 31st December. Disease arrested. Adults m. 8 10 8 1 19 — — — — — 3 1 — — 4 — — — — — f. 9 5 3 — 8 — — — — — — 3 — 2 5 — — — — — Children. 12 — 1 — 1 — — — — — 4 4 1 6 15 Disease not arrested. Adults m. 9 10 36 22 68 15 3 13 5 21 7 — 2 — 9 3 — i — 4 f. 21 7 21 9 37 6 5 14 — 19 4 — 3 3 10 2 — 2 4 8 Children. 6 1 — 3 4 5 — — — — 4 2 1 3 10 1 — — 3 4 Condition not ascertained during the year. 2 4 1 — 5 — — — — — 1 — — 2 3 — — — — — Total on dispensary register at 31st December, 1937. 67 37 70 35 142 26 8 27 5 40 23 10 7 16 56 6 — 3 7 16 (6) Not now on dispensary register and reasons for removal therefrom. Discharged as recovered. Adults m. 10 5 1 — 6 - - - - - 6 1 1 1 9 - - - - f. 18 8 2 — 10 — — — — — 3 1 — 1 5 — — — — — Children. 28 1 — — 1 — — — — — 9 2 — 16 27 — — — — — Lost sight of, or otherwise removed from dispensary register 404 238 121 36 395 7 2 4 1 7 67 13 13 44 137 - - - - - Dead. Adults m. 16 19 38 225 282 — — — 9 9 6 2 2 2 12 - - - - - f. 12 9 13 123 145 2 — — 1 1 1 — 1 — 2 — — — — — Children. 5 — — 3 3 — — — — — 4 1 1 — 6 - - - - - Total written off dispensary register. 493 280 178 387 842 9 2 4 11 17 96 20 18 64 198 - - - - - Grand Totals 560 317 245 422 984 35 10 31 16 57 119 30 25 80 254 6 — 3 7 16 79 Tuberculosis Care Committee. The 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. Table 47 contains a list of the members of the Committee in addition to the Council's representatives. TABLE 47. Tuberculosis Care Committee. NAME. REPRESENTS. Bennett, Councillor J. (Chairman) Charity Organisation Society. Broadbent, Miss M. E. (Hon. Secretary) Invalid Children's Aid Association. 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. Public Assistance Committee. Fenn, Miss D. M. Margaret Street Hospital. Higgin, Miss E. Registration. Lazarus, Miss 0. Central Jewish Synagogue. Lesser, Mr. H. E. London Insurance Committee. Senior Almoner Middlesex Hospital. Simpson, Dr. R. H. Wetherall, Miss Divisional School Medical Officer to the London County Council. St. Mary's Hospital, Paddington. Winterbottom, Mrs. G. (resigned May, 1937). The Working Classes. Fisher, Mr. J. (appointed May, 1937) ditto. DISINFECTION AND DISINSECTION. The methods employed 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. Articles. The number of articles disinfected is shown hereunder :— TABLE 48. Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other Causes. Total. Totals 6,701 775 10 23,153 2,220 32,859 The number of journeys made by the disinfecting vans during the year ended December, 1937, was :— January 122 August 130 February 138 September 114 March 103 October 78 April 98 November 103 May 93 December 116 June 95 July 101 1,291 The number of journeys made during 1936 was 1,324. 80 Rooms. The number of rooms disinfected and the reasons for carrying out disinfection are stated below :— TABLE 49. Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other causes. Total. Totals 437 65 35 278 182 997 The number of rooms disinfected in 193G was 1,322. Library Books. 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 997. BACTERIOLOGICAL EXAMINATIONS. Table 50 shews the number of specimens examined for the purposes of diagnosis, and indicates also the organisms in relation to which the examinations were made. TABLE 50. Examination. Positive. Negative. Suspicious. Total. Throat and Nasal swabs (for B. diphtheriae and haemolytic streptococci) 29 625 15 669 Sputa (for tubercle bacilli) 12 198 — 210 Faeces (for typhoid) 1 4 — 5 Widal test (for typhoid) — 4 — 4 Urine (for typhoid) — 1 — 1 Eye swab (for gonococci) 1 " 1 Totals 42 833 15 890 HEALTH PROPAGANDA. In addition to the usual forms of propaganda practised in the Borough through the various Health Centres and by the officers of the Sanitary Authority, special campaigns of a national character were arranged during 1937. On the 30th September a national health campaign was inaugurated by the Prime Minister. The Minister of Health and the President of the Board of Education invited the Central Council for Health Education to co-operate in a campaign to increase the use of the health services provided by local authorities and voluntary organisations. St. Marylebone played an active part in this work and large quantities of leaflets and other literature were distributed and poster displays arranged. In connection with the latter, the Council rented six hoarding sites in various parts of the Borough for exhibition of the larger posters. Towards the end of the year the hoardings surrounding the site of the Town Hall extension in Marylebone Road were placed at the disposal of the Public Health Committee for publicity purposes, and full advantage was taken of the opportunity of displaying striking poster sets dealing with the National Health and National Fitness Campaigns. The illustration on page 28 shows the extent and lay-out of the site. Copies of this photograph were sent to the Prime Minister, the Minister of Health, and to Lord Aberdare, Chairman of the National Fitness Council, who in acknowledgment congratulated the Public Health Committee on a very attractive poster display. 81 INDEX. page Abstract of Factories and Workshop Act 52 Accident, Suicide, Manslaughter 15 Accredited Milk 58 Air Raid Precautions, Health Centre No. 2 29 Ambulance Facilities 20 Analysis of Bread and Butter 63 „ „ Butter 63 „ „ Cream 63 „ „ Drugs 63 „ Milk 63 Analyst, Public 6, 20 „ ,, Report of 61 Aneurysm 18 Analytical Examinations 61, 62, 63 Annual Returns, Tuberculosis 74, 75, 77 Ante-Natal Clinics 31,38 Anti-Toxin, Diphtheria 66 Anthrax 68 Appendicitis 18 Artificial Cream Act, 1929 63 „ Pneumothorax Treatment 76 „ Sunlight Clinic 36 Atelectasis 12, 13 Atrophy 13 Bacteriological Examinations 45, 58, 61, 80 „ „ of Milk 58 Bacteriologist 6, 20 Bakehouses 52, 60 „ , Underground 52, 60 Baths Establishment, Old 29 „ Cleansing of Persons 47 „ Swimming 45 Bed Bugs, Eradication of 45 Birth, Injury at 12, 13 „ Rate 8, 9 Births, Notification of 10,30 „ Registration of 9 ,, Vital Statistics 8, 9, 13 Blindness, Prevention of 70 Books, Library 80 Bread and Butter . 63 Bronchitis 13, 14, 18, 35 Bugs 45 Butter, Analysis of 63 „ and Margarine Premises 60 Cancer . 8,15, 8 Care Committee, Tuberculosis 79 Causes of, and Ages at, Death 11 Census, 1931, Distribution of Industry 7 ,, Population 7,9,11 Centres, Treatment and Clinics 21 ,, Infant Welfare ... 30, 35, 37 Cerebral Haemorrhage 18 „ Meringitis 64 Cerebro-Spinal Fever 14, 18, 67 Chicken Pox 13 Child Life Protection 34 „ Guidance Clinic 35 „ Welfare, Maternity and 30 ,, „ Statistics 36, 37 Children Act, 1908 34 Church Army Dispensary 35 Circulatory Diseases 18 Cirrhosis of Liver 18 Cisterns 39 Cleansing, Public 41 „ Street 42 ,, Station 47 „ of Verminous Persons 47 Clearance and Improvement Schemes 55 page Clinics, Ante-Natal 31, 38 „ Artificial Sunlight 36 „ Child Guidance 35 „ Dental 36 „ Diphtheria Immunisation 36 „ Massage 36 „ Minor Ailments 35 „ Post-Natal 31, 38 „ Pre-School Children 35 „ Toddlers 35 „ Treatment Centres and 29 Closet Accommodation 40 Closing Orders 53 Coffee Shops 52 Collection, Refuse 41 Combined Drainage 40 Committee, Public Health 5 ,, Tuberculosis Care 79 Common Lodging Houses 57 Compulsory Removal, Tuberculosis 71 Condensed Milk 63 Conditions, Social 7 Congenital Malformation 12, 13, 18 Containers, Refuse 41 Continued Fever 64 Convalescent Homes 33 Conveniences 40 „ , Coronation 41 „ , Great Portland Street 40 „ , Oxford Circus, All Night Opening 41 Convulsions 12, 13 Cook Shops 60 Coronation 41 Corrected Death Rate 10 Cream 63 ,, Artificial Cream Act, 1929... 63 „ Tinned . 19 Crematorium 3, 19 Crossley Day Nursery 32 Crown Estate, Refuse Collection 43 Curers, Fish 60 Dairies, Milkshops 58 Day Nurseries 32 Deaths, Accident, Suicide and Manslaughter 15 „ Causes of and Ages at 11 „ Infantile Mortality 8, 12 „ Infectious Diseases 14 „ Maternal Mortality 14 „ Rate 8, 10 „ Registration of 10 „ Tuberculosis 76 ,, Vital Statistics 8 Debility 13, 18 Demolition Orders 53 Dental Clinic. 36 Destruction of Refuse 42 Diabetes 18 Diarrhoea 8, 12, 13, 14, 18, 33 Digestive Diseases 18 Diphtheria 14, 18, 64, 66 „ Anti-Toxin 66 „ Immunisation Clinic 36, 66 Diseases, Notifiable 64 Disinfection 79 Disinfestation 45 Disinsection 79 Dispensary, Tuberculosis 75 „ Church Army 35 ,, St. Marylebone and Western General 35 82 INDEX—continued. page Disposal, Refuse 42 Distribution of Industry 7 District Nursing Association 20, 36 Dogs, Fouling of Footways by 48 Drainage 39 „ Combined 40 Dried Milk 63 Drugs 61, 63 „ Food and Drugs (Adulteration) Act, 1928 59, 61 Dysentery 64,68 Encephalitis Lethargica 14, 18, 64, 67 Enteric Fever 64, 66 Enteritis 12, 13, 14 Enuresis 35 Erysipelas 20, 64, 67 Examinations, Analytical 61, 62, 63 „ Bacteriological 45, 58, 61, 80 Factories and Workshops 49, 50 Farcy 68 Fish Curers 60 „ , Fried, Vendors 60 Fitness Campaign, National 80 Flats, Vermin in 46 Flock, Rag 52 Food 58-63 ,, Inspection and Supervision 58 ,, Poisoning 70 „ Premises 60 „ Preservatives in 63 „ Stalls 61 „ and Drugs (Adulteration) Act, 1928 59. 61 „ Samples 61 ,, Unsound 59 Fouling of Footways by Dogs 48 Fried Fish Vendors 60 Fruit 59 Gastritis 12, 13 General Paralysis of the Insane 18 General Statistics 7 German Measles 33,68 Glanders 68 Great Portland Street Convenience 40 Grove Road, No. 27 3, 29 Health Propaganda 28,80 Health Centre No. 2, 3, 21, 22, 23, 24, 25, 26, 27, 29, 47 „ ,, „ „ Air Raid Precautions 29 Health Visiting 30, 34 „ Visitors 6 Heart Disease 18 Hill Road, No. 24 35, 37 Home Helps 33 „ Nursing 20, 22 „ Visits 34 Hospital, Middlesex 10, 35, 36, 37 ,, Queen Charlotte's 10, 35, 36, 37 „ St. Mary Abbots 10, 36 Hospitals 30 Houses let in Lodgings 57 ,, „ „ Water Supply 39 Housing 53, 56 „ Closing Orders 53 „ Demolition Orders 53 „ Survey 54,55 Hydrogen Cyanide Disinfestation 45 Ice Cream Premises 60 Illegitimacy 8, 9, 12 Impetigo 35 Immunisation, Diphtheria 33,66 page Improvement and Clearance Schemes 55 Industries, Chief 7 Infant Life Protection 34 Infant Welfare Centres 30, 35, 37 Infantile Mortality 8,12 Infectious Diseases, Deaths due to 14 „ „ Notification of 64, 65 ,, ,, Prevalence of and Control over 64 „ „ in Schools 71 „ „ Statistics 64, 65 Influenza 14, 18, 20, 70 Injury at Birth 13 Insane, General Paralysis of 18 Insecticide 45 Inspection, Sanitary 43 Inspection and Supervision of Food 58 Laboratory Facilities 20 "Laryngitis 13 Legal Proceedings 40, 44, 49 Library Books 80 Liver, Cirrhosis of 18 „ Other Diseases of 18 Lisson Grove, No. 217 29 Malformation, Congenital 12, 13, 18 Malaria 64, 68 Manslaughter 15 Marasmus 13 Margarine and Butter Premises 60 Marylebone Road, No. Ill 29, 75 „ , No. 113 29, 35, 37 Massage Clinic 36 Maternal Mortality 14 Maternity and Child Welfare 30 „ „ „ Statistics 36,37 Measles 8, 14, 33, 68 Meat 59 Medical Referee 19 Meningitis 13 „ Cerebral-Spinal 64 ,, Tuberculous 13 Middlesex Hospital 10, 35, 36, 37 Midwives 34 Milk, Accredited 58 „ Analysis 63 ,, Bacteriological Examination of 58 ,, Condensed 63 „ Dried 62 „ (Special Designations) Order, 1936 58 „ Trade and Tuberculosis 71 „ Pasteurised 58 ,, Purveyors 58 „ Shops 58 „ Tuberculin Tested 58 „ and Food (to Mothers and Children), Supply of 31 Minor Ailment Clinics 35 Mortality, Infant 8, 12 „ Maternal 14 Mortuary 19 Mosquitoes 48 Mothers and Children, Supply of Milk and Food to 31 Motor Vehicles, Noise from 49 Mumps 20 National Fitness Campaign 80 Rat Week 47 Nephritis 18 Noise Nuisance 49 „ „ from Motor Vehicles 49 Non-Pulmonary Tuberculosis 75 Noteworthy Causes of Sickness 9 83 INDEX—continued. page Notification of Births 10, 30 „ Infectious Diseases 64, 65 „ Tuberculosis 72, 73, 74, 75 Nuisances 44 „ Noise 49 „ Streets Nuisance Inspector 6, 48, 49 Nurseries, Day 32 Nursing Association, District 20, 36 Nursing, Home 20, 33 Offal 42 Offensive Refuse 43 „ Trades 59 Old Baths Establishment 29 Ophthalmia Neonatorum 20, 33, 64, 70 Orthopaedic Treatment 36 Outworkers 51 Overcrowding 54 Overlaying 12, 13, 15 Oxford Circus Convenience 41 Paddington and St. Marylebone District Nursing Association 20, 36 Paralysis of Insane, General 18 Paratyphoid Fever 64,66 Pasteurised Milk 58 Pemphigus Neonatorum 20,33 Peptic Ulcer 18 Petrol Interceptors, Cleansing of 42 Pharmacy and Poisons Act, 1933 49 Phthisis, see Tuberculosis Physical Training and Recreation Act, 1937 36 Pigeons 48 Pneumonia 13,14,15,18, 20,64,70 Pneumothorax Treatment, Artificial 76 Poisoning, Food 70 Poisons Act, 1933, Pharmacy and 49 Polioencephalitis 64,67 Poliomyelitis 33,64,67 Population 7, 9, 11 Portman Day Nursery 32 Post-Natal Clinics 31,38 Prematurity 12,13,18 Pre-School Children Clinic 35 Premises used in Food Preparation 60 Preservatives in Food 63 Prevalence of and Control over Infectious Diseases 64 Prevention of Blindness 70 „ Tuberculosis 75 Proceedings, Legal 40,44,49 Propaganda, Health 28,80 Public Analyst 6,20 „ „ Report of 61 „ Cleansing 41 „ Health Committee 5 ,, Sanitary Conveniences 40 Public Health (Condensed Milk) Regulations, 1923 and 1927 63 „ „ (Dried Milk) tions, 1923 and 1927 63 „ „ (Preservatives, etc. in Food) Regulations 63 Puerperal Fever 33,64,67 „ Pyrexia 20, 33, 64, 67 „ Sepsis 8, 18 Pulmonary Tuberculosis and Milk Trade 71 Purveyors, Milk 58 Queen Charlotte's Hospital 10, 35, 36, 37 page Rag Flock 52 Rate, Birth 8, 9 „ Death 8, 10 Rat Week, National 47 Rats 47 Referee, Medical 19 Refuse, Collection and Disposal of 41,42 „ „ „ „ Statistics 42 ,, Containers 41 ,, Crown Estate 43 „ Destruction 42 „ Offensive 43 Registration of Births 9 „ Deaths 10 Rehousing Schemes 56 Relapsing Fever 64 Removal of Tuberculosis, Compulsory 71 Rent Restrictions Acts 57 Respiratory Diseases 12, 14, 18 Restaurants, Tea Rooms, etc. 60 Rickets 13 Salisbury Street, No. 14 29, 35, 37 Samples, Food and Drugs 61 Sanitary Conveniences, Public 40 „ Inspection 43 ,, Inspectors 6 Scabies 35 Scarlet Fever 64, 66 Schools, Infectious Diseases in 71 Senility 18 Shelter 47 Shops Act, 1934 44 „ Coffee 53 ,, Dressmaking, Millinery, Laundry, Cabinet Making, etc. 52 Shops, Milk 58 Sickness, Noteworthy Causes of 9 Slaughterhouses 59 Smallpox 64, 68 Smoke Abatement 45 Social Conditions 7 St. Mary Abbots Hospital 10, 36 St, Marylebone & Western General Dispensary 35 St. Vincent de Paul Day Nursery 32 Staff 6,20 Stalls, Food 61 Statistics, General 7 „ Infectious Disease 64, 65 „ Maternity and Child Welfare 36, 37 „ Refuse Collection 43 „ Tuberculosis 72-78 Vital 8, 16,18 „ Vaccination 68,69 Stillbirths8, 9, 10, 13, 30 Street Cleansing 42 Streets Nuisance Inspector 6, 48, 49 Suffocation 13 Suicide 15, 18 Supply of Milk and Food (to Mothers and Children) 31 Survey, Housing 54,55 Swimming Baths 45 Syphilis 18 Tabes Dorsalis 18 Tea Rooms, Restaurants, etc. 60 Tenement Houses 39,57 „ „ Water Supply 39 Tinned Cream 63 Toddlers Clinic 35 Trades, Offensive 43 84 INDEX—continued. page Treatment Centres and Clinics 29 „ of Tuberculosis 75 Tuberculin Tested Milk 58 Tuberculosis, Annual Returns 74, 75, 77, 78 „ Care Committee 79 „ Compulsory Removal 71 „ Deaths 14, 18, 76 „ Dispensary 75 „ Home Nursing 20 „ New Cases 71 „ Non-Pulmonary 75 „ Notifications 64, 72, 73, 74, 75 „ Prevention of 75 „ Pulmonary and Milk Trade 71 „ Regulations 74 „ Treatment of 75 Tuberculosis Officer's Report 75,76 Typhoid Fever 14,18 page Underground Bakehouses 52,60 ,, Rooms 57 Unemployment 8 Unsound Food 59 Vaccination 68, 69 Vermin 45,46 „ in Flats 46 Verminous Persons, Cleansing of 47 Vital Statistics 8, 16, 17 Water 39 „ Supply cut off 39 Water Closets 40 Western General Dispensary, St. Marylebone and 35 Whooping Cough 8,13,14,18, 33, 68 Workshops 49,50 „ Registered 52 Zachary Merton Convalescent Home 33 Zoological Society of London 59