he4353 STAMARY 43 Brough of st marglebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938 CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. London : Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Lewisham Brough of st marglebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938 CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. London : Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Lewisham 1 3 Public Health Department, Town Hall, St. Marylebone, W.1. 4th August, 1939. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, I have the honour as Medical Officer of Health to submit the following report on the Health of the Borough of St. Marylebone during the year 1938, 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. Health Centre No. 2 at No. 217, Lisson Grove, which was completed in 1937, was brought fully into use at the beginning of the year. Details of the accommodation provided, with plans and photographs of the building, were included in last year's report. Considerable progress was also made in connection with the planning of the new Public Health Department which, including Health Centre No. 1, will form part of the building to be erected on the site adjoining and to the west of the Town Hall. As this is the last report covering a full year I shall be privileged to submit the first referred to the year 1909 and, as may be gathered from the accompanying comparative statement, dealt with conditions and circumstances in some respects very unlike those existing in 1938—I may be permitted to take the opportunity of making acknowledgment of all the kindness and help I have received from the Borough Council and from those with whom I have been associated in work for and on behalf of St. Marylebone and its inhabitants. Naturally, so far as the Council are concerned, it is to the Public Health Committee that my gratitude is deepest. Uniformly throughout the years of my service, individually and as a Committee they showed themselves seriously concerned to perform the functions and carry out the powers and duties delegated to them by the Council. To myself they always showed the greatest consideration and sympathy. The choice of Chairman made by the Committee was always sound and happy, and I have nothing but pleasant recollections of the many men of high distinction with whom it was my pride and privilege to work in this connection. Since he is the last with whom I served, and he was Chairman for several years, Councillor Dr. Fuller is, of course, most prominently in my mind. To him in particular I would express gratitude for many kindnesses and much most valuable advice and assistance during his occupation of the chair. Of colleagues it is to those in the Public Health Department itself my debt is greatest. The loyalty of all the members to me personally throughout all the years I worked with them never lessened ; the keenness and devotion of all of them never varied. No matter what new duties were given to them—and every year saw addition to the number—they remained enthusiastic and never complained. Into my retirement I take, indeed, very many happy memories, and those who have helped to make them for me—Members of Council, Chairmen and Members of Committee, colleagues and fellow workers—I ask to believe that I am truly grateful. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER, " Medical Officer of Health. 4 THE YEARS 1909 AND 1938—A COMPARISON. 1909 1938 Vital Statistics— Population (estimated) 126,027 90,680 Births 2,532 802 Birth Rate 20.0 8.84 Deaths 1,849 1,008 Death Rate 15.4 11.0 Infantile Mortality Rate 102 60 Deaths from:— Diarrhœal Diseases 45 12 Rate 35 .13 Zymotic Diseases (smallpox, measles, scarlet fever, whooping cough, diphtheria and membranous croup, typhus, enteric and continued fevers, diarrhoea and enteritis) 113 18 Rate 0.89 0.2 Tuberculosis (all forms) 200 44 Rate 1.58 0.49 Respiratory Diseases 324 102 Rate 2.57 1.12 Cancer 156 180 Rate 1.2 1.98 Infectious Diseases— Diphtheria— Cases notified 109 93 Deaths 9 2 Scarlet Fever— Cases notified 458 88 Deaths 8 2 Enteric Fever— Cases notified 22 8 Deaths — — Cerebro-spinal Fever— Cases notified 6 4 Deaths — - Erysipelas— Cases notified 134 35 Deaths 2 — Puerperal Fever- Cases notified 3 3 Deaths 1 - Pulmonary Tuberculosis— Cases notified 334 105 Deaths 170 33 Maternity and Child Welfare— Welfare Centres—attendances 334 45,104 Day nurseries—attendances — 20,445 Food— Unsound food—seizures and prosecutions 11 — Fines and costs imposed £95 — Cowhouses (licensed for 105 cows) 5 — Milkshops 264 187 Offences against Dairies, Cowsheds and Milkshops Orders 6 Prosecutions 3 - Milk samples examined 403 175 Milk samples adulterated 23 — Prosecutions 15 - Fines and costs imposed £30 2s. 6d. — Ice Cream Premises 80 145 Prosecutions 3 — Bakehouses 78 40 Number below ground level 70 29 Food and Drug samples taken 756 1,067 Number adulterated 41 — Prosecutions 31 — Fines and costs imposed £93 4s. 6d. - Butter samples examined 155 291 Number adulterated 11 — Cream samples examined 9 24 Number adulterated 2 — Common Lodging Houses 17 2 Nuisances—Prosecutions 30 1 5 CONTENTS. Members of the Public Health Committee page 6 Staff of the Public Health Department 7 Section A—Statistics and Social Conditions 8 Section B—General Provision of Health Services 21 Section C—Sanitary Circumstances 39 Section D—Housing 53 Section E—Inspection and Supervision of Food 57 Section F—Prevalence of, and Control over, Infectious and other Diseases 63 Health Propaganda 82 Index 83 6 PUBLIC HEALTH COMMITTEE. (Who are also the Committee appointed for Maternity and Child Welfare purposes.) 1938. HIS WORSHIP THE MAYOR. 1937-38: Alderman R. Stiles Allen, D.L., J.P. 1938-39 : Councillor A. Douglas Waite, J.P., F.A.I. ALDERMEN. R. Stiles Allen, D.L. J. Fettes, J.P. COUNCILLORS. Rev. Michael Adler, D.S.O., B.A. Mrs. M. C. Q. Henriques. Miss M. T. Barry. Dr. Elizabeth Jacobs. F. V. Cullen, F.S.I. Robert S. Lazarus. Mrs. E. B. Davis. Capt. Gerald Lowry. Dr. C. A. Fuller (Chairman). Miss Joyce C. Marsh. Capt. C. L. Hargreaves. G. B. Ramsay. Mrs. M. G. Harris. H. Norman Toomey, L.D.S., R.C.S. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medial Officer of Health and Administrative Medical Officer—Tuberculosis, and Maternity and Child Welfare; Vaccination Officer; and Medical Referee for Cremation: *Charles Porter, M.D., B.Sc., M.R.C.P. (Edin.), of the Middle Temple, Barrister-at-law. Deputy Medical Officer of Health; Public Vaccinator; and Deputy Medical Referee for Cremation: 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, MA., 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. E. 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.). Chiropodist (Part time): Miss Margaret Percy, M.L.I.Ch. Clerks. A. H. James (Chief) H. G. E. Brown. C. D. Turbayne. D. H. Drewell. H. J. Payne. R. G. Turner. S. P. Fleming. M. Kelly. Miss S. L. Pritchard (ShorthandTypist). Two temporary Shorthand-Typists for Air Raid Precautions work. *Maternity and Child Welfare and Tuberculosis Clerk. Miss J. Jones. Maternity and Child Welfare ClerkDispenser. Miss G. M. Courtenay. *Tuberculosis Clerk-Dispenser. Miss M. T. Challis. *Food Inspector. G. Smith (Senior Sanitary tor) (a, b, d). *District Sanitary Inspectors. V. A. Bignell (c, d, e). T. A. Cartledge (a, b, d). H. E. P. Corline (b, d). T. W. Forbes (b, d). H. E. Scoble (c, d). E. E. Willis (a, b, d). A. S. Wilson (a, b, d). H. Ridler (c, d)—temporary. * Drainage Inspectors. F. C. Cook (b, d). W. H. Draper (a, b, d). *Outdoor Superintendent. P. H. Hill (a, b, d). * Woman Sanitary Inspector. Miss M. McA. Sharp (c,f, g, h, i). * Woman Sanitary Inspector and Health Visitor. Miss C. E. Durant (6, /, i). Health Visitors. Miss F. H. M. Chapman (/, g, h, i). Miss D. T. Connell (/). Miss M. I. Kendall (c, /, g, h, i). Miss E. D. Mann (/, g, h, i). Miss M. C. Stewart (/, g). Part-time Health Visitors. Miss L. J. Donnell (b, i). Miss L. M. Hazell (i). *Tuberculosis Visitors. Miss S. Kenion (c,/, g, h, i). Miss P. K. Pepler (c, /, g, h, i). Matron-Housekeeper, Health Centre No. 2. Miss L. Kilgallin. Mortuary Keeper. Mrs. H. Spears. *Tubercuhsis Dispensary Caretaker. E. D. Marston. Streets Nuisance Inspector (Temporary). D. Telford. Disinfectors. J. Overton. W. J. Jones. Messenger. 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. fHealth Visitors Diploma. g Central Midwives Board Certificate. h Certificate of State Registration for Nurses. i Three or Four Years' Hospital General Training Certificate. 8 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-1938—90,680. Number of inhabited houses: 1921—18,507; 1931—17,575. Number of inhabited houses and flats (end of 1938) according to Rate Books, 20,352. Number of families or separate occupiers (1931), 27,352. Rateable value, £3,600,680. Sum represented by a penny rate, £14,018. SOCIAL CONDITIONS AND CHIEF INDUSTRIES. During recent years St. Marylebone has become increasingly important as a commercial centre, particularly in the southern part of the Borough bounded by Oxford Street. It is still, however, mainly a residential area occupied to a great extent by the professional classes, as shown in Table 1, which indicates how various professions and callings are represented by those engaged in the classified industries. TABLE 1. Occupations of Inhabitants—Census 1931. Commerce and finance Learned professions Public administration Males. Females. 44% 30% Domestic service, hotel and catering work 18% 54% Transport 7% — Building trades 6% — Clothing manufacture 6% 11% 9 UNEMPLOYMENT. The extent of unemployment in the Borough is shown in Table 2, supplied by the Ministry of Labour. TABLE 2. Number of Insured Persons recorded as Unemployed at Employment Exchanges on the dates indicated. Males Females Total (aged 16-64). (aged 16-64). (aged 16-64). 1938 17 th January 2,327 429 2,756 4th April 2,116 433 2,549 18th July 1,637 368 2,005 17th October 1,840 500 2,340 1937 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 EXTRACTS FROM VITAL STATISTICS. Live Births:—Total M.F. Legitimate705 362 343 Birth Rate per 1,000 of the estimated resident Illegitimate974849 population8.84 Stillbirths29 Rate per 1,000 total (live and still) births35 Deaths1,008 Death Rate per 1,000 of the estimated resident population 11.0 Rate per 1,000 Deaths from Puerperal causes—Deaths. total (live andstill) births Puerperal Sepsis Other Puerperal causes22.41 Total22.41 Death Rate of Infants under one year of age— All infants per 1,000 live births60 Legitimate infants per 1,000 legitimate live births 47 Illegitimate infants per 1,000 illegitimate live births 155 Deaths from Cancer (all ages) 180 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years) 10 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. 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. 10 POPULATION. The population estimated to the middle of 1938 by the Registrar-General is shown in Table 3, 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 Census and estimated figures for 1931. TABLE 3. Basis Year. Borough. All Souls. St. Mary. Christ Church. St. John. Census Estimated to middle of ,, 1931 97,620 , 22,380 25,667 29,636 19,937 1931 93,460 21,422 24,575 28,375 19,088 1938 90,680 20,774 ' 23,837 27,625 18,444 BIRTHS. Registration:—The number of births registered during 1938 was 802,* being 57 less than in 1937. Of the children born, 410 were boys and 392 girls. The birth rate per 1,000 of the population was 8.84 as against 9.32 in 1937. Table 4 contains a comparison of the rates in the several registration subdistricts and the Borough as a whole for 1938, with those of each of the five previous years. TABLE 4. Sub-District 1933 1934 1935 1936 1937 1938 All Souls 7.0 6.8 8.5 8.3 8.0 7.6 St. Mary 7.8 8.7 8.3 8.1 7.2 6.0 Christ Church 12.7 12.5 12.3 12.9 11.9 10.8 St. John 11.0 7.2 8.9 8.0 9.9 9.1 The Borough 9.7 9.0 9.7 9.8 9.3 8.8 District births for the year ended 31st December, 1938, are given in Table 5. Vital statistics of separate localities for 1938, and the ten preceding years, will be found in Table 14 on page 18. TABLE 5. Sub-District. Population estimated to middle of 1938. Births. Males. Females. Total. All Souls 20,774 79 79 158 St. Mary 23,837 74 68 142 Christ Church 27,625 146 153 299 St. John 18,444 111 92 203 The Borough 90,680 410 392 802 *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 332 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males121 ,,Females139 Illegitimate Males38 „Females34 Total332 11 Notification:—The total number of notifications received during the year under the Public Health (London) Act, 1936, Section 255, was 3,980; live births, 3,799; stillbirths, 181. The total notifications in 1937 was 3,877. 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 parents6 „doctors66 „midwives175 „hospitals, nursing homes, etc.3,733 3,980 Of the total births notified, 181 referred to still-births (89 males and 92 females); 2,155 took place at Queen Charlotte's Hospital; 562 at Middlesex Hospital; 172 at St. Mary Abbots Hospital; and 311 were born at home. Of those notified as having occurred in St. Marylebone, 3,116 belonged to other Boroughs. Of the 181 still-births 29 (14 males and 15 females) were to St. Marylebone mothers. DEATHS. Registration:—The number of deaths registered in 1938 was 1,008. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures if they occur in the Borough. The corrected death-rate* per thousand for the year was 11.0. In the previous year, the rate was 12.98 and the number of deaths 1,202. Table 6 shows the death-rates in the several registration sub-districts in 1938, and compares them with those of the preceding five years. TABLE 6. Sub-District 1933 1934 1935 1936 1937 1938 All Souls 10.5 10.9 11.2 11.9 11.4 9.6 St. Mary 12.7 12.1 10.9 12.2 12.6 12.6 Christ Church 14.2 13.8 12.9 13.5 14.4 10.1 St. John 12.1 13.3 11.8 12.2 12.8 12.1 The Borough. 12.2 12.6 11.7 12.5 12.98 11.0 *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 1938 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. 12 District deaths for the year ended 31st December, 1938, are given in Table 7. Vital statistics of separate localities for 1938, and the ten preceding years, will be found in Table 14 on page 18. TABLE 7. Sub-District. Population estimated to middle of 1938. Deaths. Total. Males. Females. All Souls 20,774 80 119 199 St. Mary 23,837 156 145 301 Christ Church 27,625 157 128 285 St. John 18,444 95 128 223 The Borough 90,680 488 520 1,008 Table 8 shows the number of deaths that took place amongst infants under 1 year and adults 65 years and upwards in each of the four quarters of 1938. For purposes of comparison the table (No. 9) for 1937 is reproduced. 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 15, on page 19. This same table gives the number of deaths from various specified causes which occurred in institutions, in hospitals, nursing homes, etc. In each of the groups all deaths, whether of residents or non-residents, are included, which accounts for the fact that the total comes up to 1,030. Fuller information than is possible in the table is given in the following pages, in which also the figures relating both to causes of death and the ages at which these causes were operative are analysed. TABLE 8. 1938. Infanta under 1 year JanuaryMarch. AprilJune. JulySeptember. October. December. Total. 18 10 9 11 48 Persons of 05 years and upwards 158 158 107 130 553 TABLE 9. 1937. JanuaryMarch. AprilJune. JulySeptember. OctoberDecember. Total. Infants under 1 year 17 16 14 16 63 Persons of 65 years and upwards 216 132 111 168 617 13 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 1938 was 48 and the number of births in that year 802. The infantile mortality rate is therefore 60. The number of legitimate births was 705 and the deaths amongst legitimate infants numbered 33, giving a rate of 47. There were 97 illegitimate births and 15 deaths, the rate being 155. In 1937 the death-rate for all infants per 1,000 live births was 73. 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 1938, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 19 were less than one month old when they died and 26 less than three months. The corresponding figures for 1937 were 31 and 40 respectively. The outstanding causes of death were those usually noted. Prematurity, etc. (numbers 12, 13 and 14 in the Table), headed the list with 19 deaths in 1938, as against 24 in 1937, whilst respiratory diseases (numbers 24 and 25) accounted for 15 in 1938 and 14 in 1937. The number of deaths due to diarrhoea and enteritis (numbers 7 and 8) was 8 in 1938, 10 being recorded in 1937. 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 16 deaths amongst infants. Table 10 on the following page shows, in addition to the causes of death, the distribution of the deaths according to age and locality. 14 TABLE 10. INFANTILE MORTALITY. Nett Deaths from Stated Causes at various ages under One Year, and in Sub-Districts. ##] CAUSE OF DEATH. Under 1 Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under 4 Weeks. Total under 1 Month. 1 and under 3 Months. 3 and under 6 Months. 6 and under 9 Months. 9 and under 1 2 Months. Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Total 1 Small-Pox - - - - - - - - - - - - - - - 2 Chicken-Pox - - - - - - - - - - - - - - - 3 Measles - - - - - - - - - - - - - - - 4 Scarlet Fever - - - - - - - - - - - - - - - 5 Diphtheria and Membranous Croup - - - - - - - - - - - - - - - 6 Whooping Cough - — - - -_ - - - - - - - - - - 7 Diarrhoea - — — — — - 1 - - 1 - 1 - - - 8 Enteritis - — - - - - 2 2 2 1 7 1 3 2 1 9 Tuberculous Meningitis - - - - - - - - - - - - - - - 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation - - - - - - 1 - - 1 - - 1 - 1 13 Premature Birth 9 3 2 - 14 2 - - - 16 3 3 5 5 16 14 Atrophy. Debility and Marasmus - 1 - - 1 1 - - - 2 - - - 2 2 15 Atelectasis 1 — - - 1 - - - - 1 - 1 - - 1 16 Injury at Birth 1 - - - 1 - - - - 1 1 - - - 1 17 Erysipelas - - - - - - - - - - - - - - - 18 Syphilis — 1 - - 1 - - - - 1 - - - 1 1 19 Rickets - - - - - - - - - - - - - - - 20 Meningitis (not Tuberculous) - - - - - - - 1 - 1 - - - 1 1 21 Convulsions - - - - - - - - - - - - - - - 22 Gastritis — — - - - - 1 - - 1 - 1 - - 1 23 Laryngitis — '- - - - - - - - - - - - - - 24 Bronchitis — — — - - - 2 2 - 4 1 1 2 - 4 25 Pneumonia (all forms) - - - - - 2 5 3 1 11 3 3 5 - l 1 26 Suffocation, Overlaying — 1 - - 1 - - - - 1 - - 1 - 1 27 Other Causes — — — — — — — — - - — - - — - Totals 11 6 2 — 19 7 12 8 2 48 9 13 16 10 48 M. F. M. F. M F Nett Births I legitimate, 362 343 Nett Deathsf Legitimate Infants, 18 15 Nett Stillbirths f Legitimate Infants, 12 10 I Illegitimate, 48 49 ln th< Yt,ar ( Illegitimate Infants, 7 8 ln tlle Year { Illegitimate Infants, 2 5 Total ... 410^ 392 Total 25 23 Total 14 15 802 48 29 15 MATERNAL MORTALITY. In 1938 the number of deaths due to conditions connected with or consequent upon child-birth was 2, the maternal mortality rate being 2.41 per 1,000 births. In 1937 there were 4 deaths, the death-rate being 4.46 per 1,000 births. With regard to the 1938 deaths it may be noted that one occurred in hospital and one in a nursing home, the ages of the women being respectively 30 and 39. DEATHS IN RELATION TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table 15 on page 19. This Table also shows the distribution of deaths according to causes in the various registration sub-districts. The following notes with regard to certain of the causes which contributed most largely to the death rate, may be of interest. Diarrhoeal Diseases:—The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 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 1938 this was the case also, no fewer than 8 of the 12 being children under one year of age. In 1937, the number of deaths from diarrhoeal diseases was 12. Of these, 9 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 10 deaths, and including diarrhoea, etc. (12 deaths) the total number registered as due to them was 18. Of these deaths, 2 were caused by diphtheria and 2 by scarlet fever. One death was attributed to measles and one to whooping cough. In 1937, 23 deaths were due to infectious diseases, excluding influenza which caused 44 deaths. 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 44, 54 being recorded in 1937. The great bulk of the 44 deaths, viz., 34, was due to phthisis. The number in 1937 was 51. Of the total number of deaths registered (1,008), the percentage due to phthisis was 3.4 as against 4.5 in 1937. The age periods at which the deaths occurred were : 1—5, nil; 5—15, nil; 15—25, 3 (9%); 25-5, 13 (38%); 45—65, 14 (41%); 65 and over, 4 (12%). 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 102. This is lower by 37 than the figure (139) for 1937. The death-rate was 1.12 per thousand. In 1937 the rate was 1.52. The number of deaths certified to be due to bronchitis was 26. Of this number 14 were amongst persons aged 65 and upwards, and 7 amongst those of the group 45—65. Four were infants of under one year of age. The deaths traceable to pneumonia numbered 70 and, as in the case of bronchitis, the later age-groups contributed the greatest numbers. 16 Cancer or Malignant Disease:—The number of deaths due to cancer was 180 and the death-rate 1.98 per 1,000 of the population. The figures for 1937 were 179 and 1.95 per 1,000 respectively. Information with regard to the age at which death occurred and the situation of the disease is given in Tables 11 and 12. TABLE 11. Cancer : Ages at Death.  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 4 11 17 30 14 77 Females — - — - 3 4 14 25 42 15 103 Totals — — - — 4 8 25 42 72 29 180 TABLE 12. Cancer : Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 7 2 9 Throat, Neck, Gullet 13 3 16 Stomach 14 13 27 Intestines 13 16 29 Liver 3 10 13 Breast - 25 25 Uterus and Generative Organs 4 18 22 Various 23 16 39 Totals 77 103 180 It is a commonly accepted fact that the number of deaths due to cancer is, over a long period, showing a definite tendency to increase. No reason, generally acceptable, to explain this has as yet been put forward, nor has any theory to account for the occurrence of the disease, to which the medical profession as a whole can subscribe, been submitted. One point upon which there is general agreement, however, is with regard to the importance, advisability and advantage of early treatment. Of the accuracy of the advice, now so widely given that there should never be any delay in seeking an authoritative opinion in any case of doubt and in securing treatment, there can be no question. • Accident, Suicide and Manslaughter:—Accidental or violent deaths during 1938 numbered 58. Of these 21 were due to suicide. 17 TABLE 13. Vital Statistics for 1938 and Ten Previous Years. Year 1 Population estimated to middle of each Year 2 Uncorrected 3 Births Nett Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District 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 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 90 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 1938 90,680 3,520 802 8.8 1,312 14.3 917 613 48 60.0 1,008 11.0 Total population at all ages at Census of 1921, 104,173. 1931, 97,620. Area of district in acres (exclusive of area covered by water), 1,427.8 acres. „ „ (including area covered by water), 1,473 acres. 18 TABLE 14. Vital Statistics of Separate Localities for 1938 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. j Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. 6. c. d. a. b. c. d. 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 1936 92,400 906 1,169 68 21,165 175 254 15 24,285 220 300 12 28,150 362 383 32 18,800 149 232 9 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 Averages of Years 1928 to 1937. 96,180 1,033 1,221 72 22,368 191 253 14 25,083 232 311 15 29,452 406 410 30 19,277 204 247 13 1938 90,680 802 1,008 48 20,774 158 199 9 23,837 142 301 13 27,625 299 285 16 18,444 203 223 10 19 TABLE 15. Causes of, and Ages at Death during the year 1938 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 - - - - - - - - - 1 - - - - - 2 Measles 1 - 1 - - - - - - - - 1 — — 1 3 Scarlet Fever 2 - - - - - 2 - - 3 - 1 1 2 4 Whooping Cough 1 - - 1 - - - - - - - — 1 1 1 5 Diphtheria 2 1 1 1 — 1 — 2 6 Influenza 10 - - - 1 - - 3 6 3 1 3 4 2 10 7 Encephalitis Lethargica — — - - - - - - - 1 - - - - - 8 Cerebro-Spinal Fever — - - - - - - - - 3 - - - — — 9 Tuberculosis of Respiratory System 34 - - - - - 13 1 4 4 15 6 5 10 13 34 10 Other Tuberculous Diseases 10 - - 2 2 - 3 1 2 14 - 3 7 - 10 11 Syphilis 3 1 - - - - - 2 - 4 1 - 2 — 3 12 General Paralysis of the Insane, Tabes Dorsalis 5 - - - - - 1 3 1 3 1 - 2 - 5 13 Cancer, Malignant Disease 180 - - - - - 12 67 101 324 44 52 41 43 180 14 Diabetes 16 - - - - - - 7 9 17 4 4 6 2 16 15 Cerebral Haemorrhage, etc. 48 - - - - - 1 17 30 43 10 16 13 9 48 16 Heart Disease 264 - - - - 1 4 59 200 97 10 16 13 9 48 17 Aneurysm 7 - - - - 1 - 4 2 4 46 78 74 66 264 18 Other Circulatory Diseases 57 - - - - - - 12 45 33 2 3 1 1 7 19 Bronchitis 26 4 - - - - 1 7 1 4 8 10 21 18 8 57 20 Pneumonia (all forms) 70 11 2 - 1 1 6 17 32 40 4 6 8 8 26 21 Other Respiratory Diseases 6 - - 1 - - 2 3 25 14 25 20 11 70 22 Peptic ulcer 13 - - - - - 3 6 4 24 - 1 3 2 6 23 Diarrhoea, etc. 12 8 2 1 - - 1 - - 2 1 9 2 1 13 24 Appendicitis 10 - - 1 1 - 2 2 4 10 J 3 4 3 12 25 Cirrhosis 00of Liver 8 - - - - - 3 4 1 7 4 1 3 2 10 26 Other Diseases of the Liver, etc 7 - - - - - - 2 5 12 3 2 2 1 8 27 Other Digestive Diseases 25 1 - - 2 1 5 5 5 23 5 — 2 — 7 28 Acute and Chronic Nephritis 22 - - - - - 2 7 13 40 3 12 6 4 25 29 Puerperal Sepsis - - - - - - - - - 1 6 5 7 4 22 30 Other Puerperal Causes 2 - - - - - 2 - - 12 - — — - — 31 Congenital Debility, Premature Birth, Malformation, etc. 20 19 - 1 - - - - - 71 1 - - 1 2 32 Senility 10 - - - - - - - 10 10 2 6 9 3 20 33 Suicide 21 - - - - 1 5 12 3 10 2 3 3 2 10 34 Other Violence 37 1 - - 1 1 11 5 18 40 9 11 9 8 37 35 Other defined Diseases 78 3 - - 1 5 11 24 34 120 13 22 21 22 78 36 Causes ill-defined or unknown 1 - — — - - - - 1 - - 1 - - 1 Totals 1,008 48 6 6 11 14 88 282 553 1,030 199 301 285 223 1,008 19 MORTUARY. The number of bodies deposited from 1st January to 31st December, 1938, was as follows:— TABLE 16. Males. Females. Total. No. of post-mortems held. No. of infectious cases. 34 32 66 39 — CREMATORIUM. The St. Marylebone Crematorium, situated at East End Road, Finchley, has now been in use for over a year. Cremation facilities are available for St. Marylebone and other districts at fees ranging from three to five guineas. In pursuance of No. 10 of the Cremation Regulations, 1930, the Secretary of State appointed the Medical Officer of Health to be Medical Referee, and the Deputy Medical Officer of Health to be Deputy Medical Referee, in respect of the Crematorium and during the year 91 certificates authorising cremation were issued—79 by the Medical Referee, and 12 by the Deputy Medical Referee. TRANSPORTATION OF BODIES ABROAD. In certain cases where bodies are transported overseas, the Medical Officer of Health of the district in which death has taken place is called upon to furnish to the shipping company a certificate to the effect that the body is not infectious and that it has not been exposed to infection. During 1938 one such certificate was issued in respect of a body transported to Australia. 21 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. STAFF. Information with regard to the staff of the department is contained in a statement on page 7, as required by Ministry of Health Circular 359. During the year a number of changes took place. On the 15th December, Dr. Anderson relinquished his position as Tuberculosis Officer and Assistant Medical Officer of Health to take up an appointment as Deputy Medical Officer of Health of Fifeshire. On the 1st April, 1938, Mr. A. H. James succeeded Mr. Curtis as Chief Clerk of the department. The death, on the 20th January, of Mr. William John Howe, a Principal Assistant, is recorded with great regret. He had served the Council and their predecessors, the St. Marylebone Vestry, for nearly 39 years. Vacancies in the clerical staff were filled by the transfer, from other departments of the Council, of Messrs. D. H. Drewell, H. J. Payne and M. Kelly. Two temporary shorthandtypists were engaged in connection with the Air Raid Precautions work of the Department. In the Maternity and Child Welfare section of Health Centre No. 2, Mr. J. A. Smith was engaged in January as part-time Dental Surgeon, and Miss Percy, in April, as part-time chiropodist. The services of a temporary sanitary inspector were found to be necessary to relieve Inspectors Scoble and Wilson, upon whom heavy calls were made in connection with the work of air raid precautions, and Mr. H. Ridler was engaged in this capacity as from the 2nd May. Miss H. K. Dupont, a health visitor, resigned on marriage as from the 1st September, and Miss F. H. M. Chapman was appointed on the 1st November to fill the vacant position. Miss F. A. Baker, who had served the Council for 37 years and gained the affection and esteem of her colleagues and a wide circle of friends in the Borough, though retired from the permanent staff of the Council as from the 22nd March, 1937, continued duty as a temporary tuberculosis visitor until the 29th January, 1938. Reluctant to sever her association with the department, Miss Baker then undertook, in an honorary capacity, work in connection with the Dental and Foot Clinics when these services were first established as part of the Maternity and Child Welfare Scheme of the Borough in the early part of the year. The vacancy created by the retirement of Miss Baker was filled by Miss Pepler, whose appointment took effect on the 3rd January. Mr. C. J. Kendall, the Senior Disinfector, retired as from the 14th July on the completion of 40 years' service. He was succeeded by Mr. J. Overton, whose position as Assistant Disinfector was filled by the appointment of Mr. W. J. Jones. 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, 57, 60 and 82. 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.1. A report on the work done during 1938, together with a statement of food and drugs analysed, will be found on pages 60—62. 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. 22 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. The number of cases of pneumonia nursed fell from 171 in 1937 to 11 in 1938. Thirty-eight cases of measles or German measles were nursed during 1938 as against none in the previous year. Table 17 gives full particulars of the work carried out in 1938. TABLE 17. Home Nursing Service. No. of cases nursed. No. of visits paid. Maternity 25 507 Ophthalmia neonatorum 3 82 Pemphigus neonatorum 3 40 Puerperal pyrexia 1 3 Influenza 10 43 Erysipelas 2 40 Pneumonia 11 175 Tuberculosis 3 86 Mumps 2 38 Measles or German measles 38 348 Chicken pox 1 6 TREATMENT CENTRES AND CLINICS. Under this heading a description is required of any developments or changes in regard to treatment centres and clinics, including clinics solely for diagnosis or consultation. The Council has three health centres:— No. 1. Accommodated temporarily at the Old Baths Establishment, No. 181, Marylebone Road, pending transfer, during 1939 it is hoped, to the new building in course of erection on a site adjoining the Town Hall. This centre comprises a tuberculosis dispensary, maternity and child welfare clinics and a diphtheria immunisation clinic. No. 2. A new building at No. 217, Lisson Grove with provision for maternity and child welfare clinics and auxiliary services of various kinds, including dental treatment, chiropody, child guidance, light therapy and massage. No. 3. A new and smaller centre inaugurated during the year at No. 21a, Paddington Street, and providing ante-natal and child welfare clinics. In addition, consultations held at the Middlesex and Queen Charlotte's Hospitals form part of the Council's maternity and child welfare scheme. 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. Nursing homes in the Borough number 59, but with these, registration under the Nursing Homes (Registration) Act, 1927, being in the hands of the London County Council, the Borough Council have no concern. 23 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 26) and 21 (page 29) 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, 833; (b) Still-births, 29; (c) Total, *862; (d) By midwives, 175; (e) By doctors and parents, 72; (f) By hospitals, 347; (g) By nursing homes, 64; (h) inward transfers, 204.* *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, 6½; (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, †349; total visits, 706. (b) To children under 1 year of age, first visits, †1627; total visits, 4,428. (c) To children between the ages of 1 and 5 years, total visits, 7,153. †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, 4 (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, 11,011 (7,709 St. Marylebone residents); (ii) By children between the ages of 1 and 5 years, 9,082 (6,785 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, *687 (484 St. Marylebone residents) (ii) between the ages of 1 and 5 years, 213 (199 St. Marylebone residents). *Excluding children who are known to have previously attended a centre in another district. 24 (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, 600 (402 St. Marylebone residents); (ii) over 1 year of age, 1,085 (716 St. Marylebone residents). (f) Percentage of notified live births represented by the number in (d) (i), 58. During the year show-cases were provided at the Council's health centres for the display of maternity and child welfare exhibits. Ante-Natal and Post-Natal Clinics (whether held at infant welfare centres or at other premises): Ante- PostNatal. Natal. (a) Number of clinics provided and maintained by the Council 2* 2* (b) Number of clinics provided and maintained by voluntary associations 2 2 (c) Total number of attendances at all clinics during the year 25,011 2,804 (l,766)† (147)† (d) Total number of women who attended at all clinics during the year 4,055 1,766 (403)† (112)† (e) Percentage of total notified births (live and still) represented by the number in (d) 47 13 *One clinic opened 3rd August, 1938. †Figures in brackets refer to St. Marylebone mothers. Supply of Milk and Food. (a) Arrangements made for this service are indicated by "Yes" or "No" in each space in Table 18. TABLE 18. 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 9,067 gallons (liquid) and 2,488 pounds (dried), No milk was supplied by voluntary associations. 25 During 1938 there has been no change in the methods adopted in relation to the supply of milk and dinners to mothers and children. Up to 31st December, 1938, the amount expended was £973 14s. 1d., as against £784 8s. 1d. in the year ended 31st December, 1937. The actual number of cases dealt with was 377, and the number of orders issued 2,325, varying slightly from those for 1937, when the cases numbered 358 and the orders 2,059. The system, it may be said, has worked with absolute smoothness and has done a very great deal of good. 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 continued to meet with success. 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, 150. (c) Total number of attendances of children at these nurseries during the year, 20,445. The situation of the three day nurseries in the Borough, together with details of the attendances for the year, are shown in Table 19. TABLE 19. Day Nursery. Address. Attendances, 1938. Whole-day. Half-day. The Portman (St. Marylebone Health Society). Carton Hall, Carton Street (temporary premises). Removed in August to new premises at Nos. 12-18, Salisbury Street. 6,348 608 The Crossley (St. Marylebone Health Society). 38, Barrow Hill Road 4,206 1,327 St. Vincent's Creche (Convent of the Sisters of Charity of St. Vincent de Paul). 14, Blandford Street 7,632 324 The St. Marylebone Health Society's new Portman Day Nursery in Salisbury Street, erected on a freehold site presented by Capt. The Hon. G. B. Portman, was formally opened by the Rt. Hon. The Viscount Stonehaven, P.C., G.C.M.G., D.S.O., LL.D., D.L., on the 13th July, 1938, and brought into use on the 29th August, 1938. The scheme was designed and carried out by Mr. Howard Robertson, F.R.I.B.A. The contractors were Messrs. Prestige & Co. The Nursery is situated on the first and second floors of the new building. For the infants, from one month to two years, there are two large nurseries, each accommodating 15 cots. There is also a small room between these two nurseries, where a child who is fretful or unwell can be isolated. The infants' reception room is on one side, with convenient bathing arrangements. On the other side of the landing are the toddlers' reception rooms, where there are baths and small basins fixed at a height for the children to wash their own faces and hands, and to clean their teeth. From specially designed wall-fixtures each child's towel, face-cloth, comb and toothbrush are suspended separately. Special racks are fixed in niches on the landing for 26 their home clothes, as they wear the Nursery clothes all day; and there are cupboards for coats and racks for shoes. The 40 children of nursery school age pass through the toddlers' reception rooms to the large nursery at the end of the building. There is a kitchenette with a hatch from which their meals are served. On the floor above, the playroom, sleepingporch and open-air playground are situated. On this floor the staff quarters are also arranged. There is a sitting-room for probationer nurses, a bed-sitting room for the Matron, bedrooms for two staff nurses and the cook-housekeeper, bedrooms for six probationers, and two bathrooms. The dining room also serves as a sitting-room for the staff nurses. The kitchen for the Nursery is placed on the ground floor, and the Matron's and Secretary's offices and linen room adjoin the entrance, which is in Whitehaven Street. There is an indoor perambulator room, and two service lifts, electrically operated, one from the kitchen, for the meals, and the other from the laundry in the basement, for the linen. The central heating and the hot water are provided by a boiler, operated by a patent mechanical stoker. Pursuant to the provisions of the Maternity and Child Welfare Contributions (London) Scheme, 1937, the Council make a grant at the rate of £546 per annum to the Health Society in respect of the services provided at the Portman Day Nursery. Incorporated in the new building are the Sieff Hall and the Christine Murrell Memorial. The hall, which occupies the greater part of the ground floor, is licensed for music and dancing and let to Clubs, or for social evenings, meetings, or such activities as "Keep Fit" classes. The Christine Murrell Memorial Unit was presented by friends and associates of the late Dr. Christine Murrell, who established an Infant Consultation in Salisbury Street 32 years ago. It is intended to carry on in the memorial unit medical work of a remedial and preventive character. Infectious Diseases. Table 20 gives information regarding infectious disease notifications, and the number of cases visited and for whom home nursing or hospital accommodation was provided. TABLE 20. 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 4 4 3 4 (2) Pemphigus Neonatorum — — 3 — (3) Puerperal Fever 3 3 — 2 (4) Puerperal Pyrexia 18 18 1 17 *(6) Measles and German Measles (in children under 5 years of age) 2 197 26 — *(6) Whooping Cough (in children under 5 years of age) 17 33 — 11 (7) Epidemic Diarrhœa (in children under 5 years of age) Not Notifiable 5 — — (8) Poliomyelitis (in children under 5 years of age) 1 — — 1 *Notifiable as from 1st October, 1938. 27 Ophthalmia Neonatorum. Four cases of ophthalmia neonatorum, of which details are given below, were notified during the year. The number in 1937 was ten. Vision unimpaired 3 Removal from district 1 Died — 4 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 1¼ nurses. (b) Total number of cases attended during the year by these nurses, 66. 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—accommodation maintained by the Council at the Zachary Merton Convalescent Home, Rustington, Sussex, for nursing mothers, and children under 5 years of age. (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—15 mothers and 20 babies. (d) Total number of such cases sent by the Council during the year to other convalescent institutions—nil. Midwives. After a review of the arrangements for a domiciliary midwifery service in London which were inaugurated on the 1st January, 1938, under the Midwives Act, 1936, the London County Council expressed satisfaction that the service was operating with considerable success and decided to continue the existing arrangements with voluntary organisations, subject to further consideration before the 31st December, 1939. The co-operative arrangements with the borough councils' maternity and child welfare services are also reported to have functioned satisfactorily, and periodical conferences between the County Medical Officer of Health and the Medical Officer of Health in each area will continue to be held as may be necessary. In September medical practitioners in the Borough were notified of the coming into operation on the 1st November, 1938, of the County of London (Midwifery— Prohibition of Unqualified Persons) Order, 1938, made by the Minister of Health under section 6 (2) of the Midwives Act, 1936. By virtue of the Order and section 6 of the Act of 1936, any unqualified woman or any male person who receives any remuneration for attending in the Administrative County of London as a nurse on a woman in childbirth, or at any time during the ten days immediately after childbirth, becomes liable on summary conviction to a fine not exceeding ten pounds. Persons not debarred from such attendance are:— (a) Women certified under the Midwives Act, 1902, or registered in the general part of the register of nurses required to be kept under the Nurses Registration Act, 1919. 28 (b) Persons who, while undergoing training with a view to becoming a duly qualified medical practitioner or a certified midwife, attend on a woman as aforesaid as part of a course of practical instruction in midwifery recognised by the General Medical Council or by the Central Midwives Board. (c) Persons attending on a woman as aforesaid in any nursing home which is registered or which is exempt from registration under Part XI of the Public Health (London) Act, 1936, or in any hospital or other premises excluded from the definition of "nursing home" in section 304 of the same Act. (d) Women, who before 1st January, 1937, have been certified by the authorities of a hospital or institution approved by the Minister to have been trained in obstetric nursing and who have notified the local supervising authority in writing accordingly. 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, 9. (b) Number of children on the register: (i) at the end of the year, 11; (ii) who died during the year, nil; (iii) on whom inquests were held during the year, nil; (iv) returned to parents during the year, 2; (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, 242. 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 continued 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. 1. 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 from birth 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. 29 The number of visits paid in 1938 by health visitors to children between the ages of 1 and 5 years was 7,153. Infant Welfare Clinics. At Health Centres Nos. 1, 2 and 3, maintained by the Council, children up to 5 years are seen. At Health Centre No. 2, 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 visitors 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. 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 referred to in this paragraph are open to other than St. Marylebone babies. Clinic for Pre-School Children. At Health Centre No. 1, 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. Of the 46 children who were examined during 1938, 28 needed treatment for one or more conditions. Table 21 gives a summary of the conditions found. TABLE 21. Condition. Cases. Dental caries 12 Enlarged tonsils necessitating removal 9 Under-nourisliment and flabbiness (referred to massage and sunlight clinic) 2 Difficult and spoilt children (referred to child guidance clinic) 2 Rheumatic heart 2 Congenital heart 1 Treatment of Minor Ailments. Children suffering from minor ailments were treated at the London County Council clinic at Health Centre No. 2. 30 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. Table 22 contains statistics for the year 1938. TABLE 22. Attendances—mothers 434 ,, children 97 Cases receiving advice and treatment 390 Extractions under gas—mothers 109 „ „ „ children 32 Dentures provided at cost price—full 12 „ „ „ „ „ partial 10 The following report is submitted by the Dental Surgeon (Mr. J. Arthur Smith, L.D.S., R.C.S.):— "The dental clinic at Health Centre No. 2 has been working throughout the year with satisfactory results. The need for dental treatment for expectant and nursing mothers cannot be emphasised too much. Oral sepsis affects the gastric mucosa, and infective foci in the jaws lead to untold infections and damage which could so easily be prevented. Fortunately, the mothers are attending the clinic regularly. It is most necessary, too, that the temporary teeth of the children should receive attention and not be neglected in that important period prior to coming under the care of the school dental surgeon. Apart from other ills there is a definite relationship between a septic temporary dentition and the chronically enlarged tonsil. The interest of the mothers goes to show that they appreciate the services offered them by the Borough Council." Foot Clinic. For some time attention had been directed to the need of making provision for care of the feet, particularly in the case of the mothers attending the welfare centres, many of whom were, in fact, more or less disabled as a result of conditions affecting the feet, for which treatment could readily and effectually be provided. The Council, therefore, decided that as from the 1st April, 1938, a foot clinic should be established in the orthopaedic department of Health Centre No. 2 as part of the maternity and child welfare scheme of the Borough. The fee charged per attendance is l/6d. or 1/- or 6d. according to the circumstances of the patient. In necessitous cases treatment is provided free of cost. Sessions have been held twice weekly, but owing to the demands on the clinic it will be necessary to arrange for an additional session per week in the near future. Miss Margaret Percy, M.L.I.Ch., the chiropodist in charge, submits the following report on the first nine months' working of the clinic:— "Actually the time has been too short to see anything very striking in the way of progress, though from the beginning there has been a steady increase in numbers. By way of general comment on the figures, which relate to the period 1st April, 1938 to 31st December, 1938, I should like to say that, as regards individual patients, progress has been quite steady. In the majority of cases the conditions seen and dealt with are corns and callosities, the patient paying regular visits on an average at intervals of a month. Undoubtedly the 31 work has been retarded by the footwear worn by most patients. This is a usual exparienes, although it is interesting to find that a great deal more concern has been shown by the women in this subject. On the whole I feel they are becoming more " foot conscious," and this in every way I have tried to bring about. Summary of Attendances and Treatment. A. All Aqes. During the nine months 63 sessions were held and 271 attendances made. First Attendances (New Cases) Subsequent Attendances Total Attendances Mothers 100 161 261 Young Children 8 2 10 Totals 108 163 271 B. Mothers—Defects Treated. Anidrosis 7 Bursitis 15 Callosities 61 Dropped anterior transverse arch 11 Heloma durum 76 Heloma molle 7 Hallux valgus 10 Hyperidrosis 2 Hammer toe 1 Metatarsalgia 3 Morton's toe 1 Onychocryptosis 4 Onychogryphosis 8 Pes cavus 7 Pes planus 2 Septic conditions 2 Subungual clavus 3 Conditions due to sprain 1 Nine patients were referred to their medical practitioners for medical or surgical treatment for the following conditions:— Exostosis and bursitis 1 Oedema 5 Eczema 1 Varicose condition 2 Three patients were referred for massage for the following conditions:— Pes piano valgus 1 Bunions 1 Arthritis 1 One patient was referred to hospital for surgical treatment for the following condition:— Stiff pes piano valgus. C. Young Children—Defects Treated. Heloma durum 2 Onychocryptosis 1 32 Patients referred for massage for the following conditions:— Pes cavus 2 Pes planus 1 One patient was referred to hospital for surgical treatment for the following condition:— Congenital talipes equino varus. Two patients were referred to their medical practitioners for the following conditions:— Verruca vulgaris 1 Adducted digit 1." Child Guidance Clinic. During 1937 the question of the establishment of a child guidance clinic in connection with infant welfare centres was discussed with the Child Guidance Council, a body which has as one of its objects the encouragement of local authorities and other bodies to set up clinics at which various nervous and behaviour disorders in children are investigated and treated. The reason for desiring to make treatment available at such centres was mainly to bring out the preventive effect of the measures, since investigation had shown that it was in the earlier years, before the child entered school and while he was still or should be attending the welfare centre, that the difficulties occurred and the nervous trouble was established. Though a clinic of this kind had been in operation in the provinces for some time, no similar scheme had been tried in London. As a result of the discussions, the Child Guidance Council decided that it would be worth while to make a trial of the arrangement at two of the better-known centres in the metropolis, and of these St. Marylebone Health Centre No. 2, it was felt, should be one. The Borough Council approved the proposal and the Child Guidance Council placed at their disposal, for the purpose of conducting a clinic on one afternoon per week, one of their specialist medical officers for a period of one year, and themselves undertook to meet all expenses. The officer appointed was Dr. Grace Sherwood Calver, Physician, Children's Department, Tavistock Clinic; Medical Psychologist, Aural Department, Infants' Hospital; Demonstrator in Mental Hygiene, King's College ; and Lecturer in Mental Hygiene, Mothercraft Training Society. The first session of the clinic was held at Health Centre No. 2 on the 20th January, 1938, cases being referred during the experimental period by the Deputy Medical Officer of Health and the Maternity and Child Welfare Medical Officer. The following report on the first year's working is submitted by Dr. Grace Calver:— "The purpose of the work was to discover whether in an infant welfare centre there were cases which the doctor in charge would refer to a child guidance unit attached to the centre. If such cases were referred, the type of cases, and how these could most effectively be dealt with: (a) advice to the mother; (b) simple play therapy with the child; (c) referral to an organised child guidance clinic. This report covers the work done in such a unit for a period of roughly twelve months, during which 64 new cases have been seen and a total number of 118 attendances made. Age Groups. i. Greatest number of cases fall between 1 year and 2 years. Boys predominate. ii. Second largest group is between 2 and 3 years old, and in this group the number of boys and girls are equal. 3 Types of Symptoms. 1. The symptoms complained of in these age-groups are practically all associated with assertive tendencies and their results. Screaming fits, feeding difficulties and disturbances of sleep predominate as symptoms. 2. Anxiety symptoms after severe illness or operations. Environmental Factors. I. Marked anxiety in mother. II. Lack of understanding of what is natural behaviour in young children. III. Commonly associated history of marital unhappiness. IV. Grandparents. V. Pre-marital conception. Value of the Work. (a) Enables one to instruct mother in what is to be expected at various stages in a child's natural development. (b) To suggest methods of dealing with objective situations accentuating the child's difficulties, such as marital or family problems. A change of environmental conditions may completely alter child's behaviour. (c) Dealing with mother's own emotional problems, anxiety, guilt, etc. Most mothers respond well to suggestions and advice, but we have to accept the fact that there are always a certain proportion of parents who are quite incapable of being helped, and others in whom the emotional conditions are too severe to be dealt with by advice alone. (d) With very young children difficulties and problems have not become fixated, and simple forms of play therapy can release tension and anxiety. (e) This play therapy in the presence of the mother has a great educative value, and increases her understanding of childhood behaviour. Prevention of Neurosis and Production of Mental Health. The greatest value of this work lies in its preventive aspect. We tackle problems easily, eradicate the child's emotional difficulties, and help its more positive attitude to life and living. If at this early stage we can help the parents in the development of right attitude towards children, and help to make the parents conscious of the effects of their own emotional difficulties both on their children and themselves, we can do much more to produce mental health in the growing child than any amount of child guidance work at later periods when emotional attitudes have become more complicated and fixated. The work with young children and their parents more than repays all the money and energy expended on it. As a typical instance of a difficulty in a child exaggerated by parental difficulties, I take the case of a 2½ year old boy with very marked obsessional tendencies, who was eating badly, sleeping badly, and failing to gain weight. He looked miserable and terrified. At the end of a month, and as the result of four visits, he was eating well, sleeping peacefully, and had already begun to gain weight. All his obsessional traits had disappeared. The symptoms were the result of too repressive treatment, especially by the father who had a very quick temper and completely lacked understanding of small children. The case was dealt with by helping the mother to understand that the child's desire to do things was perfectly natural, and also by talking over her own emotional problems which were very marked. Unfortunately, the father could not be seen, but the mother was able to gain his co-operation. The child was helped through play with material suitable for his age to be less afraid of his own assertive urges, and by these means, his environment becoming much more suitable, he was able to develop more happily." 34 It is certain that clinics of this sort are necessary, and it is inevitable that in a short time they will come to be regarded as an essential part of every properly constituted maternity and child welfare scheme. As the Child Guidance Council intimated that they would be unable to bear the cost of the clinic beyond the end of March, 1939, the Borough Council decided to take over the clinic, with Dr. Calver as psychiatrist, as part of the maternity and child welfare scheme of the Borough as from the 1st April, 1939, the Minister of Health approving the arrangement for a year from that date and requesting to be furnished in due course with a further report on the working of the clinic. Food and Diet (Weight Control) Clinic. Many of the mothers attending the welfare centres have noticed that they have put on weight excessively, particularly after the birth of their children. As errors of diet are frequently the cause of obesity and other disorders among the clinic mothers, it was decided to try experimentally at Health Centre No. 2, under the supervision of Dr. Wallace, the Maternity and Child Welfare Medical Officer, a food and diet clinic at which mothers could obtain advice on diet with a view to reduction of their weight or the correction of digestive or other disorders resulting from eating the wrong foods. In the operation of the Clinic the Council have been fortunate in obtaining the voluntary assistance of Miss Margaret Grant, B.Sc., who is a specialist in dietetics, having held the appointment of Dietician at the Edinburgh Royal Infirmary, and who is at present Dietician at King's College for Social Science. Since the clinic was established on the 8th April, 1938, sessions have been held weekly, first at 8 p.m. and subsequently at 5 p.m., on Fridays. The mothers are weighed and a complete physical examination made to find any physical cause for the obesity or any condition which might render a special diet unsuitable. A careful history of the food consumed daily by the patient is taken and a daily menu advised in which the amounts of fat and carbohydrate are reduced. Each patient is dealt with individually, the menu given being modified from the diet they have previously been consuming. During the experimental period 28 patients have between them made a total number of 114 attendances. The mothers who have kept to the diets advised and have continued to attend have all lost weight, and their general health has also benefited from the treatment. Only 6 mothers have, however, attended regularly for a period of three months or more. The chief difficulty appears to be the regular continuance on the diet; as a result the rules are dropped and they cease to attend. The effects of such a chnic are not confined to the simple reduction of weight among a certain group of women. The vast majority of mothers of the working classes consume diets which have a great excess of sugar and other carbohydrates and are lacking in proteins, minerals and protective foodstuffs. The clinic has been a valuable means of propaganda for teaching the principles of correct feeding. Massage Clinic. Sessions were held twice weekly at Health Centre No. 2. 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 thrice weekly at Health Centre No. 2. 35 Diphtheria Immunisation Clinics. As indicated on pages 65 and 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 1938 was 2,717, the total births numbering 3,980. The midwives residing in the borough, registered as intending to practise in the administrative County of London, number 31. 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 25 cases were dealt with and 507 visits were paid, the services of the nurses being greatly appreciated by the patients. Maternity beds are also provided by the London County Council. The new maternity ward at Paddington Hospital was taken into use on the 1st November, 1938. From that date maternity patients from St. Marylebone were admitted to Paddington Hospital instead of St. Mary Abbots Hospital, Kensington, as formerly. To secure the closer linking up of the maternity and child welfare services of the London County Council with those of the Borough Council, arrangements have been made for the Borough Council's two Assistant Medical Officers of Health to be associated, in an honorary capacity, with the Paddington Hospital, where every facility has been afforded them for seeing not only their own patients, but the work generally of the hospital, and the maternity department in particular. This arrangement makes for greater co-operation, and cannot fail to re-act beneficially so far as the patients are concerned. Obstetric Consultants. During the year the Council approved the provision of the services of obstetric consultants to be available for any doctor in the area needing assistance in difficulties or complications arising during pregnancy or at or after confinement in the case of patients resident in the Borougb. The panel of consultants consists of the undermentioned obstetric surgeons:— Mr. Louis Carnac Rivett, F.R.C.S., 135, Harley Street, W.l. Mr. Frederick William Roques, F.R.C.S. 90a, Harley Street, W.l. Mr. William Ralph Winterton, F.R.C.S., 41, Harley Street, W.l. Maternity and Child Welfare Centres—Statistics. Tables 23 and 24 on pages 36 and 37 give some idea of the work done at the various centres during the year. 36 TABLE 23. Statement Showing Work of the Infant Consultations and Other Clinics. Centre. Health Centre No. 1. Health Centre No. 2. Health Centre No. 3. Queen Charlotte's Hospital. The Middlesex Hospital. No. of Consultations held:— Infants 97 202 92 99 152 Toddlers — 53 — — 52 Maternity — 52 14 364 252 Massage — 90 — — — Light — 87 — — — No. of attendances of mothers at clinic:— Ante-natal — 587 53 18,959 (741) 5,412 (385) Post-natal — 68 3 2,171 (46) 562 (30) No. of attendances of babies 1,400 3,347 859 1,599 (1,059) 3,806 (1,044) No. of attendances of children over one year 1,278 3,368 754 802 (621) 2,834 (718) No. of attendances at Light Clinic:— Infants — 96 — — — Toddlers — 1,776 — — — No. of attendances at Massage Clinic:— Infants — 48 — — — Toddlers — 1,098 — — — No. of Orders issued for milk 556 1,072 208 255 203 No. of Home visits ... 648 3,380 460 210 3,126 No. of new cases:— Infants 91 196 61 119 (67) 220(69) Toddlers 31 54 65 1 16(3) Ante-natal — 145 14 3,035 (158) 604 (45) Post-natal — 44 1 1,421 (45) 366 (20) Massage Infants — 2 — — — Toddlers — 54 — — — Light Infants — 13 — — — Toddlers — 120 — — — Note.—Figures in brackets refer to St. Marylebone residents attending Queen Charlotte's Hospital and Middlesex Hospital. TABLE 24. Statement Showing Work of the Municipal Ante-Natal and Post-Natal Clinics. 1938. Jan. Feb. Mar. Apl. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals. No. of Sessions 4 4 5 4 4 6 5 6 6 6 7 6 63 Now Ante-natal cases 17 13 13 12 15 14 6 15 17 9 24 4 159 New Post-natal cases 3 6 6 4 4 2 3 6 3 7 3 2 49 Attendances Ante-natal 58 55 77 47 45 62 46 45 50 41 68 43 637 Attendances Post-natal 7 9 7 6 5 5 4 8 5 8 5 4 73 Transferred to Queen Charlotte's Hospital — — — — — — — — — — — — — Transferred to St. Mary Abbots Hospital 7 4 12 8 10 13 6 6 8 4 — — 78 Transferred to Paddington Hospital — — — — — — — — — — 10 4 14 Put on special diet — — — — — — — — — — — — — Pads and belts provided 1 1 — 1 — 1 1 — — — — — 5 High blood pressure 1 — — — — 1 — — — — — — 2 Low blood pressure — — — — — — — — — — — — — X-ray examinations 2 — — — 2 — — 1 1 1 — 1 8 Referred to Dental clinic 1 — 6 5 7 7 4 3 3 1 6 — 43 Urine Tests — — — — — — — — — — — — — Undernourished — — — 1 — — 2 — — — — — 3 Miscarriage — — — — — — 1 — — — — — 1 Threatened miscarriage — — — — — — — — 1 — — — 1 Cases referred by— Hospitals — — 2 1 1 1 — — — — 3 — 8 Midwives — 5 3 — 2 1 — 4 1 1 5 2 24 37 38 PHYSICAL TRAINING AND RECREATION ACT, 1937. In connection with this Act, which came into force on the 13th July, 1937, various preliminary matters were considered during the year. After consultation with the London County Council in regard to facilities which the County Council were providing under the statute, it was arranged that the Borough Council would be consulted at an early stage in the event of any further provision in St. Marylebone being proposed. On the 9th March, 1938, the Medical Officer of Health presided over a meeting associated with the Health, Sport and Fitness Exhibition of the Royal Institute of British Architects, held at the headquarters of the Institute in the Borough. Survey. At the request of the Regional Fitness Committee, an exhaustive survey of the facilities available in the Borough for physical training and recreation was carried out and a tabulated statement of detailed information forwarded to the Committee. "Fitter Britain" Exhibit. The excellent exhibit, "Towards a Fitter Britain," which occupied one of the four halls of the British Government Pavilion at the Empire Exhibition at Glasgow, and was seen by nearly four million visitors, was shown, by arrangement with the Ministry of Health, at Messrs. Selfridge's store in Oxford Street for several weeks. The exhibition, exceptionally comprehensive, included the following sections: 1. Model Health Clinic; 2. Health Statistics; 3. Enemies of Health; 4. Mother and Child; 5. Health at School; 6. Health at Play; 7. Good Food; 8. Good Housing. Afterwards the whole exhibit was handed over to the Central Council for Health Education, to whose funds the Borough Council make an annual contribution. Holiday Camps. Towards the end of the year arrangements were made for the Council to be represented at conferences of local authorities convened by the National Fitness Committee (London and Middlesex) to consider the question of the provision of municipal holiday camps under section 4 of the Act. 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 accordance 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 10 occupied premises. The reason for discontinuing the supply was in all cases the non-payment of rate. In cases in which the premises were tenement houses, action was taken immediately on receipt of the Board's notice, in order to secure that the tenants should suffer no hardship as a result of being deprived of water. Cisterns. The bulk of the houses in the Borough, in accordance with the requirements of the Metropolitan Water Board, are provided with a cistern, and though in a considerable percentage water for drinking purposes is drawn direct from the main, there are still a number in which supplies for all purposes are obtained from a cistern. A bye-law of the Council requires that such cisterns shall be emptied and cleansed every six months. During the year 15 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 17. The number in 1937 was four. In 28 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 in all cases after receipt of the intimation notice. DRAINAGE. During the year a large number of blocks of flats and commercial premises have been erected, replacing private houses where the leases have expired. Business and commercial premises are rapidly displacing private houses in the southern portion of the Borough; while moderate and high-class flats, together with detached residences, are still being constructed in the northern part of the Borough. 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 1938 made 3,564 inspections, as shown in Table 25. 40 TABLE 25. Drainage of Premises. 1938. Northern District. Southern District. Total. Number of plans deposited—New Buildings 28 25 53 „ „ „ „ Old Buildings 163 198 361 Number of inspections made 1,823 1,741 3,564 The total number of plans deposited in 1937 was 480, 63 relating to new buildings, and 417 to old buildings. In the bulk of the cases the arrangements shown were in accordance with the bye-laws of the London County Council, 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 12 premises. The number in 1937 was 22. CLOSET ACCOMMODATION. In Table 26 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 were erected 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 water-closet is, of course, the only type of closet in general use, though it may be mentioned that, in connection with air-raid precautions shelters, chemical closets are commonly being installed. One of the great difficulties experienced from time to time is in regard to finding a suitable position for a convenience in which there will be complete compliance with the requirements of the bye-laws in respect of water-closets. 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 noted in previous reports, the 1930 bye-laws having considerably modified the requirements so far as situation is concerned, the need for granting special approval now less frequently arises. Particularly by allowing of the introduction of closets in bath-rooms entered directly from rooms used exclusively as sleeping or dressing-rooms, they have met a demand that has been increasing for some time and that formerly caused considerable administrative difficulties. 41 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 Pepler, supervising those provided for females. Reports and comparative statements as to receipts for the use of the public conveniences were regularly submitted to and considered by the Public Health Committee. 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 should be continued was reviewed towards the end of the year, and the Council decided that these Conveniences should remain open nightly until 2 a.m. for a further experimental period of one year. London Passenger Transport Board. Under an arrangement with the Transport Board, certain classes of their employees who use the accommodation provided at the public conveniences are given receipts on payment of the normal charges, in order that they may be reimbursed by the Board. 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 hours, 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 111 intimation notices and 5 statutory notices were served by the Sanitary Authority in respect of defective bins; approved type metal dustbins were provided at 114 premises; while 913 visits were made by Inspector Hill, who gives part-time to this work. An important part of the collection system is the use of the "container" in large business premises, blocks of flats, hotels, etc. This system was first introduced at the end of 1925, when containers were purchased by several of the large business houses in Oxford Street and other main thoroughfares in the Borough. By the end of 1936, 16 containers were in use. The system has since that date made steady progress and has been adopted by the owners or builders of most of the newer large blocks of flats, restaurants, etc. There are now 220 containers in use: they are purchased by the owners or occupiers of the premises concerned, and are collected daily by specially designed vehicles, removed to the Council's wharf, and there emptied, cleansed, and disinfected before return. This arrangement has proved to be more hygienic, quicker, less noisy in working and altogether more satisfactory than the use of a number of small bins. In this connection approach has been made to the Royal Institute of British Architects to obtain their co-operation 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. Immediately plans of buildings to be erected in the Borough are deposited, representations are made to the architects regarding incorporation of the refuse container system, and considerable progress has been achieved in this direction. 42 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, collection and disposal of refuse shall be to the satisfaction 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 vehicles used for the normal collection consists of entirely enclosed end-loading motor vans, steps being fitted to facilitate entry. 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 are 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 wharf 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 regulations of the Ministry of Health regarding controlled tipping and 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 have under consideration the erection of a complete new incineration plant to a specification prepared by the Borough Engineer in conjunction with Consulting Engineers appointed by the Council. If adopted this will deal with the whole of the refuse collected in the Borough. 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 on 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 transferred to 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 gulleys are pumped into vehicles entirely under cover during the whole process and conveyed direct to the Council's wharf, where the material is deposited into a pit to allow for drainage and settling and final conveyance to the shoot. 43 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. Statistics. The tonnages dealt with during 1938 were:- House and trade refuse 49,943 tons. Street sweepings and gulley refuse 8,115¼ ,, A sum of approximately £2,444 was obtained from the sale of by-products (ashes, breeze, wastepaper, rags, metal and tins). In addition, approximately £1,159 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 (hogwash) 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. Complaints. The total number of complaints received was 2,291, as against 2,589 in 1937. 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. Intimation Notices. In 2,231 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. Statutory Notices. Statutory notices were issued in 60 instances. Of these notices, 37 related to ordinary nuisances (dirt, dampness, etc.), 4 to verminous rooms, 6 to insufficient water-closet accommodation, 2 to defective drains, 8 to inadequate staircase lighting and 3 to rat infestations. The number of statutory notices served in 1937 was 37. Legal Proceedings. In no case was it found necessary to institute proceedings in court for failure to comply with statutory notices to abate nuisances. Details of the various nuisances detected and remedied, to the total number of 4,737, are set out in Table 26. 44 TABLE 26. Nature of Nuisance. Districts. The Borough. No. 1. No. 2. No. 3 No. 4 No. 5 No. 6. Houses damp, dirty or dilapidated remedied 88 253 225 114 131 45 856 Doors, windows, floors, ceilings, sash cords, grates and flues, etc. repaired 96 132 88 39 52 21 428 Verminous rooms 19 155 165 62 51 37 479 Dirty and verminous furniture and bedding cleansed - 4 93 22 8 18 145 Overcrowding abated 43 51 213 25 42 26 400 Underground rooms (illegal occupation) dealt with - - 3 1 1 - 5 Water closet defects remedied 63 74 167 90 54 50 498 Insufficient and unsuitable water closet accommodation remedied - 3 8 30 15 25 81 Urinal defects remedied 1 — — — 2 3 6 Drains and water closet stoppages cleared 1 10 7 13 24 11 66 Drains relaid or amended — — 11 10 10 4 35 Soilpipes and ventilating shafts repaired or renewed 3 2 17 8 18 5 53 Waste pipe defects remedied 2 35 47 9 21 8 122 Yard defects remedied 44 28 143 62 33 10 320 Wash-house defects remedied 34 28 134 59 27 11 293 Area defects remedied 1 10 19 67 10 4 111 Basement defects remedied — — 1 — 8 12 21 Roofs and gutters repaired 17 51 48 37 31 8 192 Water supply to houses reinstated — 1 1 3 2 — 7 Water supply laid on to upper storeys — — 4 21 3 — 28 Water cistern defects remedied — 1 — 9 14 4 28 Dung or dust receptacles repaired or renewed 15 15 17 17 29 21 114 Rubbish, manure, etc., accumulations removed 5 28 32 32 39 8 144 Animal nuisances abated — — 4 1 — — 5 Rats and mice infestation 2 1 10 18 7 — 38 Bakehouses dirty — — 2 1 — — 3 Smoke nuisances — 7 3 2 1 1 14 Shops insufficiently ventilated or heated - 3 9 4 2 20 38 Miscellaneous 64 24 42 25 37 15 207 SHOPS. Under the Shops Act, 1934, the Borough Council as Sanitary Authority are 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 351 shops were inspected. In 38 instances notices were served in respect of contravention of the Act and in 37 cases the defects were remedied without the need for further action. In one case proceedings were instituted for failure to provide and maintain suitable and sufficient sanitary conveniences available for the use of persons employed in or about the shop. The magistrate found the case proved, and ordered the defendant to pay £5 costs. CAMPING SITES. No sites in the Borough were used for camping purposes during 1938. 45 SMOKE ABATEMENT. During the year, 228 observations were made and 52 complaints were received and dealt with. In each case the attention of the offender was drawn to the matter. Fourteen 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 contains two swimming pools, slipper baths, laundries, and a squash rackets court. The water of the swimming pools is treated by modern filtration and purification plant. Samples, taken periodically, have, under bacteriological examination, yielded entirely satisfactory results. There are three privately owned swimming pools in the Borough; one at the Middlesex Hospital for the use of the staff; one at the Polytechnic in Regent Street, available only to members of the Institute; and one at the Mansergh Woodall Club in Hill Road, for the use of members (boys from 10 to 14 years). ERADICATION OF BED BUGS. As in previous years a considerable amount of work was carried out in 1938 in connection with disinsection. Much of it had reference to the removal of furniture and bedding from old houses to new 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 79 Number of other houses found to be infested 235 Number of Council houses disinsected 79 Number of other houses disinsected 235 (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 themselves, 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 disinsection. (b) Bedding is treated in the Council's steam disinfector. (4) Whether the work of disinsection 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 treated either by builders using blow lamps or an ticide (the latter supplied by the Council with loan of sprayer), or by the Council's staff using a sprayer and insecticide. 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, and her work continued on the lines indicated in the report for 1937. Table 27 provides evidence that improvement has taken place since her appointment in November, 1934. It may be noted that instances of the slightest infestation or of re-infestation are included in the figures given. TABLE 27. Municipal or privately owned. Flats first occupied. Total number of flats. Number found to be verminous Flats. Year. Municipal Prior to 1935 303 201 1935 96 1936 70 1937 63 1938 Municipal December, 1935 60 17 1936 15 1937 10 1938 Municipal February, 1937 72 8 1937 5 1938 Privately owned Prior to 1936 204 59 1936 30 1937 25 1938 During May, Miss Sharp and one of the male sanitary inspectors specially concerned with vermin disinfestation attended a course of lectures and demonstrations on the subject, organised by the Royal Sanitary Institute. CLEANSING OF VERMINOUS PERSONS. The new Cleansing Station, which forms parts of Health Centre No. 2 at No. 217, Lisson Grove, was brought into use at the beginning of the year. The numbers of adults and school children using the baths during 1938 were 714 (535 males, 179 females) and 3,575 (1,070 boys, 2,505 girls) respectively. SHELTER. The shelter included as part of Health Centre No. 2 under section 195 (4) of the Public Health (London) Act, 1936, became available for occupation at the beginning of 1938, and during the year two families (eight persons) made use of the accommodation. RAT REPRESSION. Though activity in this connection continues unabated, the number of complaints received varies little year by year. In 1933 it reached 49, in 1934, 44, in 1935, 45, in 1936, 42, in 1937, 43, and in 1938, 48. The slight increase in the number of complaints received and of premises inspected was due mainly to the demolition of old buildings and sites left vacant for a while pending development. In a number of these cases infestations of a temporary nature occurred. The investigation of the complaints necessitated the inspection of 71 premises, 38 of which were found to be rat infested. Included in this latter number were 12 business premises (6 of these for the preparation or storage of food), 23 private or tenement houses and 47 3 vacant sites. In 8 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 1938 National Rat Week, contains information on this subject that may be found interesting: "At the direction of the Ministry of Agriculture and Fisheries, Rat Week this year commenced on Monday, the 7th November, and all local authorities responsible for the execution and enforcement of the Rats and Mice (Destruction) Act, 1919, were urged to make a special effort to secure concerted action during that week with a view of the destruction of rats and mice. As in previous years the courses of action suggested by the Ministry have been followed as far as possible, and again there has been considerable success not only in obtaining the whole-hearted cooperation and support of neighbouring local authorities, but also of the general public. The following gives some indication of the procedure that has been adopted, and the results obtained:— Press Publicity. The editors of the local newspapers were invited to co-operate with the Department by publishing special articles on Rat Week, and in stimulating interest in the campaign that was conducted in St. Marylebone. Attention was drawn to the fact that rats and mice were responsible for an immense loss to the country each year in the destruction of foodstuffs and other materials and as the agents and carriers of disease germs. It was pointed out that advice on the subject was always available at the Town Hall, and that an inspector would call at any premises within the Borough believed to be rat-infested, with a view of the most suitable action being taken to get rid of the vermin. Poster Campaign. Copies of the Ministry's illustrated poster were exhibited prominently in various parts of the Borough and on the notice board in the Public Health Department. Opportunity was taken of making use particularly of the hoarding on the site adjoining the Town Hall for a special display of these posters, where they attracted considerable attention. Circularisation of Business and Trade Premises, etc. An invitation to participate in the organised attack on the vermin was extended to railways, commercial undertakings, business houses, property owners, builders, estate agents, power stations, restaurants, and other food premises. The response was most encouraging, and the Department was asked to assist in several cases where difficulty was experienced in exterminating rats and mice. Steps were also taken by the Zoological Society of London to intensify the campaign at the Zoological Gardens by every means at their disposal. Bulletin on Rat Extermination. The Ministry's booklet on "Rats and How to Exterminate Them," as formerly, was supplied free of charge on request to ratepayers. Several applications were made during the week by firms for copies of this Bulletin to be sent to them. Co-operation with Neighbouring Local Authorities and Treatment of Sewers. Special attention was given to the sewers and the number of baits normally laid down was increased; in this respect adjoining local authorities took concerted action with St. Marylebone, and the combined effort was again rewarded with encouraging results. Experience has shown that trapping by means of traps of the "break-back" variety is most efficacious, and in this connection it is interesting to note that the Council of a neighbouring Borough last year decided to adopt this 48 method of extermination, as a result of information contained in my Annual Report. The Medical Officer of Health of that district has informed me that this departure met with great success. That the determined efforts of the Council to focus attention on the necessity for extermination of rats and mice, and their insistence that measures to this end should be promptly adopted, once again captured the interest of the public, cannot be doubted. Though no serious cases of rat or mice infestation were reported during the week, Mr. E. E. Willis, the inspector who is in charge of this branch of the Council's activities, was able to offer valuable advice and assistance in the cases where information was solicited or where special difficulty was being encountered. It may be claimed, as a result of the activities of the Department and the concerted action that was secured, that the steady improvement noted last year has been maintained." PIGEONS, ETC. Under section 121 of the Public Health (London) Act, 1936, 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. Nine complaints (six relating to private dwellings and three to public buildings) were made in 1938, as against ten in 1937. As in other years, as much assistance as possible was given by the inspector in charge of this work to reduce the nuisance. During the year complaints were received of annoyance and nuisance from fouling of the footway caused by flocks of starlings and sparrows which made use of a number of large plane trees which are still in the forecourts of premises in one of the principal thoroughfares in the Borough. The nuisance was considerably minimised in some instances by drastic lopping and pruning of the trees. In another case an attempt was made to get rid of the birds by systematic scaring but this proved less effectual. FOULING OF FOOTWAYS BY DOGS. As a result of the carrying out of close and routine observations by the temporary streets nuisance inspector, breach of the bye-law was detected in 40 cases, in 36 of which, following prosecution, convictions were secured and penalties imposed. In their efforts to deal with this most objectionable nuisance the Council received great assistance from the police, 18 prosecutions undertaken being on the reports of police officers. The total number of prosecutions since the bye-law came into operation in 1928 is 282, the amount of fines imposed being £101 4s. Od. NOISE. During the year 30 complaints of noise were received, eleven relating to nuisance at night (rowdy disturbances, door slamming, etc.), four to motor vehicles, four to operation of machinery in industrial premises, three to roller skating on the public way, three to itinerant newsvendors, two to dogs, two to milk delivery, and one to street hawking. Street Musicians and Singers. On the 28th July, 1938, the Council made the following bye-law in pursuance of section 38 of the London County Council (General Powers) Act, 1938:— "(1) No person shall sound or play upon any musical or noisy instrument or sing in any street or public place within 100 yards of any dwelling-house, office, or business or professional premises to the annoyance or disturbance of 49 any inmate or occupant thereof, after being requested to desist by any constable, or by any inmate or occupant so annoyed or disturbed, or by any person acting on his behalf. Provided that this byelaw shall not apply to— (a) any person taking part in a properly conducted religious service, except where the request to desist is made on the ground of the serious illness of any inmate of the house; or (b) any person (i) whilst playing under the order of his commanding officer, in any band belonging to any branch of His Majesty's Naval, Army, Air Reserve or Territorial Forces; or (ii) whilst playing in any band performing with the sanction of and in a place appointed by the London County Council or the St. Marylebone Borough Council. (2) Any person offending against the foregoing byelaw shall be liable on summary conviction to a fine not exceeding £5." The bye-law was duly confirmed by the Home Secretary and came into operation on the 1st November, 1938. Eight complaints were received and dealt with informally. Wireless Loudspeakers, etc. During the year, seven complaints were received relating to nuisance from wireless loudspeakers, gramophones and similar instruments. In six cases, abatement of the nuisance was secured without the service of formal notice. In the remaining instance, the issue of a notice was necessary to obtain a remedy. In securing attention to the several provisions relating to noise nuisances, the temporary streets nuisance inspector rendered valuable assistance, and also cooperated with the police in regard to a number of the complaints received. PHARMACY AND POISONS ACT, 1933. 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 1937 117 Added to list in 1938 8 Deleted from list in 1938 8 On list at end of 1938 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 factories and workshops, many of them of the domestic type, is considerable, and work in relation to them bulks very large amongst the duties of the sanitary 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 following report, which the Medical Officer of Health is required to make to the Secretary of State, relates to administration of the Factory and Workshop Act, 1901, and the Factories Act, 1937 (which superseded the Act of 1901 on 1st July, 1938). 50 TABLE 28. 1.—Inspections for Purposes of Provisions as to Health. Number of Premises. Inspections. Written Notices. Occupiers prosecuted (1) (2) (3) (4) Factories with mechanical power 156 28 — Factories without mechanical power 772 63 — †Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 504 51 - Total 1,432 142 - † Electrical Stations are reckoned as factories. TABLE 29. 2.—Defects Found. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S.1) 29 28 - — Overcrowding (S.2) 3 3 - — Unreasonable temperature (S.3) 1 1 - — Inadequate ventilation (S.4) 21 21 - — Ineffective drainage of floors (S.6) 2 2 - — Sanitary Conveniences (S.7) insufficient 10 10 - — unsuitable or defective 39 39 - - not separate for sexes 15 14 - - Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and reenacted in the Third Schedule to the Factories Act, 1937.) 4 4 - - Total 124 122 — — 51 TABLE 30. 3.—Home Work. OUTWORKERS' LISTS (S.110). OUTWORK IN UNWHOLESOME PREMISES. (S.1ll) NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Lists Outworkers. Failing to keep lists. Failing to send lists. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Wearing Apparel— (1) Making, etc. 77 183 729 9 - - 80 80 - (2) Cleaning and washing 3 13 56 - - - - - - Total 80 196 785 9 — — 80 80 — TABLE 31. 4.—Registered Factories and Workplaces. Factories and Workshops on the Register at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 1,365 Coffee Shops, &c. 375 Bakehouses 40 Total 1,780 52 TABLE 32. 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factories Act (s.114) 8 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factories Act (s.9). Notified by H.M. Inspector... 45 Reports (of action taken) sent to H.M. Inspector 45 Other — Underground Bakehouses (s.54):— Certificates granted during the year — In use at the end of the year 29 During the year two certificates relating to approval of source of supply of drinking water in a factory were issued under section 41 (1) of the Factories Act, 1937. 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 1938 was 20,352, the number occupied by the working classes being 8,231. The information asked for by the Ministry of Health 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) 2,872 (b) Number of inspections made for the purpose 11,365 (2) (a) Number of dwelling-houses (included under sub-head 528 houses (1) above) which were inspected and recorded under and 53 the Housing Consolidated Regulations, 1925 tenements. (b) Number of inspections made for the purpose 2,314 (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 841 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 825 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 60 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 57 (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 3 (2) Number of dwelling-houses demolished in pursuance of demolition orders 3 (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 168 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 3 54 4. Housing Act, 1936—Part IV.—Overcrowding :— (a) (i) Number of dwellings overcrowded at the end of the year 650 (ii) Number of families dwelling therein 650 (iii) Number of persons dwelling therein 3,011 (b) Number of new cases of overcrowding reported during the year 4 (c) (i) Number of cases of overcrowding relieved during the year 420 (ii) Number of persons concerned in such cases 1,628 (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:— Steady progress has been made in the efforts to secure abatement of overcrowding and the situation has improved. Continued observations are kept to prevent re-overcrowding. CLEARANCE AND IMPROVEMENT SCHEMES. As to progress in this connection it may be noted that advance continued in the direction of improving housing conditions within the Borough. Especially was this so in the Boscobel (late Princess) Street area, the reconstruction of which was commenced during the year. Table 33 gives particulars of the various areas dealt with by the London County Council, the Borough Council, and the St. Marylebone Housing Association. 55 TABLE 33. 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. Dwellings on this site included in Lilestone Estate *Providence Place and Sun Cottages. 0.46 10.500 122 Sites cleared in accordance with Clearance Order confirmed by Minister of Health, 19th June, 1935. *Tucker's Place, Becketts' Place and Eamont Place. 0.5 12,500 145 Sites cleared in accordance with Clearance 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 certain additional lands) *Boscobel Street (late Princess Street) 2.496 74,000 655 Clearance Orders confirmed by Minister of Health, 31st March, 28th July and 15th November, 1938. Salisbury Street 0.903 50,000 306 Estate erected by St. Marylebone Housing Association, Ltd. Wilcove Place 1.06 15,000 269 Estate erected by St. Marylebone Housing Association, Ltd. Financial assistance given by the London County Council and the Borough Council. Penfold Street (late Carlisle Street) 7.55 410,000 2,777 Clearance under London County Council (Carlisle Street Improvement) Order, 1927. (Lilestone Estate). 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 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. 56 HOUSES LET IN LODGINGS. Included under this head are all ordinary tenement houses in which the rooms or floors are let out separately. A large proportion of the houses in the Borough are so let, and under bye-laws made by the London County Council under Section 6 of the Housing Act, 1936, all houses which are occupied, or are of a type suitable for occupation, by persons of the working classes and let in lodgings or 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 6,896 visits were paid to the 1,645 houses of the tenement type. The number of intimation notices served was 639, relating to cleansing and other defects. Except in 34 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 artificial lighting arrangements in staircases is called for by the bye-laws. During 1938, 58 intimation notices and 9 statutory notices were served in regard to this matter, and all were complied with. COMMON LODGING HOUSES. During 1938, 51 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 34. 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) 100 women Total 536 UNDERGROUND ROOMS. During the year the number of underground rooms occupied was still further reduced, action taken in respect of 168 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. Three certificates as to state of repair of premises were granted during 1938 under section 12 of the Rent, etc., Restrictions (Amendment) Act, 1933, and two reports were subsequently issued under section 5(2) of the 1923 Act. In order to avoid delay in dealing with applications for certificates, the Council delegated their powers and duties under the Act of 1933 to a sub-committee of the Public Health Committee consisting of the Mayor and the Chairman of the Committee for the time being. 57 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, 44; 3rd Quarter, 17; 4th Quarter, 59, making a total for the year of 175. No sample was found to be adulterated. Bacteriological Examination of Milk. With a view to testing the purity of milk from the bacteriological point of view, 57 samples were taken and submitted to the Council's bacteriologist for examination. In each case in which a result not entirely satisfactory was obtained communications were sent to the local authority of the district in which the milk was produced in order that an investigation might be carried out locally. On all occasions, the greatest willingness to co-operate was shown by the officers of these authorities, and it is safe to claim that definite improvements have followed the taking of action on these lines. Dairies, Milkshops, etc. There are 187 premises upon which milk is sold. During the year 240 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 53 applications were received from 26 milk purveyors for licences under the Order. As in each case all relevant requirements had been complied with, appropriate licences were granted as shown in Table 35. TABLE 35. Milk (Special Designations) Order, 1936. Grade of Milk. Type of Licence. No. of Licences issued. Pasteurised Pasteurising 1 Dealers 27 Supplementary 4 Tuberculin Tested Bottling 1 Dealers 15 Supplementary 3 Accredited Bottling 1 Dealers — Supplementary 1 Total 53 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. 58 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 1938, 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 36 contains a list of the articles dealt with in this way. TABLE 36. Unsound Food Condemned and Destroyed. Meat— Tinned Goods— Beef 160 lbs. Corned Beef 97 tins Lamb 80 „ Hams 31 „ Pork 30 „ Veal 4 „ Brawn 30 „ Herring Roe 191 „ Fish— Kipper Snacks 72 „ Cod 3 stone Dressed Crab 48 „ Cod Fillets 8 „ Lunch Tongue 1 „ Cod Roe 8 „ Ox Tongue 1 „ Kippers 2 boxes Miscellaneous— Haddock 2 stone Whiting 1½ „ Bacon 2½ cwt. Cheddar Cheese 196 lbs. Warwick Cheese 140 „ Fruit— Turkeys 8 Oranges 23 cases Partridges 5 Apples 16 boxes Beef Extract 480 jars Mayonnaise 516 „ Salad Cream 648 „ Public Health (Meat) Regulations, 1924. 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. Slaughterhouses. 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. Ten inspections were made in 1938. 50 Slaughtermen. Three licences to slaughter or stun animals, granted to skilled slaughtermen pursuant to section 3 of the Slaughter of Animals Act, 1933, were renewed during the year. Offensive Businesses. At the end of 1938 there was only one premises within the Borough where a business classed as offensive was carried on, that being the slaughter of poultry. The food inspector made 13 visits, but no cause for complaint was found. 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 1938, 98 premises were registered for the preparation or manufacture of foods (other than ice cream) intended for sale, and 245 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 1938 was 145, 40 more than in 1937. Throughout 1938, 130 inspections were made, and in 3 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. Sixty-three visits were paid to the registered premises during 1938. Bakehouses. At the end of 1938 the number of bakehouses on the register was 40, 29 being underground bakehouses. During the year 94 inspections were made and 3 notices with regard to defects were served. In one case proceedings were instituted in respect of three occasions upon which (1) refuse was allowed to accumulate in the bakehouse, and (2) there was failure to observe due cleanliness in the bakehouse. The defendants were fined £1 on each of three summonses, and were ordered to pay £5 5s. costs. In accordance with the requirements of the Factories Act, notices were issued calling for the limewashing, etc., of the inside walls and other parts of the bakehouses once at least in every six months. Fried Fish Vendors and Fish Curers. The number of premises in the Borough used by vendors of fried fish is 19 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 56 inspections of fried fish shops and 35 inspections of fish curers' premises were made by the food inspector. In the case of the fried fish shops, 4 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 1938 there were 374, this number including restaurant and dining room kitchens, 210; tea-rooms and pastry-cookshops, 106; and hotel kitchens, 36, As already explained, legal provision has now been made for registration of 60 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 and other food premises are visited each week by the food inspector, and any matters discovered at these inspections are dealt with at once. In 1938, the total number of inspections was 421, the number of notices served being 10. 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, 5 samples of ice cream and 1 pork 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 1938 was 1,067, the figure for 1937 being 1,066. The sum paid in respect of each analysis was 12s. 6d. No sample was reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. The percentage of adulteration in 1937 was 0.5. 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. Table 37 contains a complete list of the articles submitted for analysis during 1938. 61 TABLE 37. Statement of Food and Drugs Analysed No. Article. Number Examined. Number Adulterated, etc. Formal. Informal. Private. Total. Formal. Informal. Private. Total. 1 Apricots - 1 - 1 2 Benger's Food — 1 — 1 3 Bicarbonate of Soda — 8 - 8 4 Blaud's Pills - 2 - 2 5 Boric Ointment - 17 - 17 6 Butter 84 207 - 291 7 Butter and Roll — 12 — 12 8 Candied Peel — 6 — 6 9 Cheese — 25 - 25 10 Cherries, Glace - 5 - 5 11 Cinnamon Essence - 4 - 4 12 Cocoa - 15 - 15 13 Cod Liver Oil - 2 - 2 14 Coffee — 7 - 7 15 Crab (Tinned) — 1 — 1 16 Cream (Loose) 12 2 — 14 17 Cream (Tinned) — 10 - 10 18 Currants - 15 - 15 19 Dripping — 4 — 4 20 Fish Paste - 8 - 8 21 Fruit, Homogenised (Tinned) — 1 — 1 22 Gin - 1 - 1 23 Glycerine and Thymol — 1 — 1 24 Honey — 10 — 10 25 Iodine, Tincture of — 5 - 5 26 Jam - 41 - 41 27 Lard 1 77 - 78 28 Margarine — 33 — 33 29 Marmalade — 25 - 25 30 Meat Paste - 8 - 8 31 Milk 96 78 1 175 32 Milk, Condensed — 23 — 23 33 Milk, Dried - 9 - 9 34 Mincemeat - 1 - 1 35 Mustard - 8 - 8 36 Mustard, French - 3 - 3 37 Olive Oil - 15 - 15 38 Paraffin, Liquid — 5 - 5 39 Peas (Tinned) — 6 — 6 40 Pepper — 6 — 6 41 Pickles - 2 - 2 42 Raisins - 15 - 15 43 Rice - 8 - 8 44 Rice Flour - 1 - 1 45 Rice Powder - 1 - 1 46 Salmon (Tinned) - 1 - 1 47 Sardines - 16 - 16 48 Sauce - 5 - 5 49 Sausages, Pork - 40 - 40 50 Sild - 2 - 2 51 Sugar — 6 - 6 52 Sultanas - 15 - 15 53 Syrup, Golden — 3 - 3 54 Tea - 30 - 30 55 Treacle, Black - 3 - 3 56 Vegetables, Homogenised (Tinned) — 1 — 1 57 Vermouth — 2 - 2 58 Vinegar, Malt — 6 - 6 59 Wine, Raisin - 1 - 1 60 Witch Hazel — 7 — 7 193 873 1 1,067 — — — — 62 Milk. Of the 175 samples analysed, none was found to be adulterated. The average composition of the milk examined during 1938, as well as that for the two years preceding, was as follows:— Year. Sp. Gr. Total Solids. Fat. Solids not Fat. 1936 1031.3 12.29% 3.60% 8.69% 1937 1031.5 12.36% 3.62% 8.74% 1938 1031.5 12.24% 3.52% 8.72% Cream. During the year 14 loose creams were examined. The fat content of these ranged from 30.0% to 50.0%, the average being 42.53%. The tinned creams numbered 10, and the fat varied from 20.2% to 25.0%. Each of these tinned creams was specifically examined for tin. This metal was found to be present in every sample, the amounts ranging from 0.075 to 0.32 grains per lb., with an average of 0.19 grains per lb. In every instance the cream was contained in an unlacquered container. Possibly the use of some such interior protective lining might prove efficacious in preventing the interaction between the constituents of the cream and the metal. Butter. Of the 291 samples examined, none was found to be adulterated. The whole of the 12 samples of butter and roll taken were genuine. Preservatives. In no instance was preservative found in any sample not permitted to contain it. In those cases where preservative was allowed it was never found to be present in amount exceeding that permitted by the regulations. Drugs. All the samples examined conformed to the standards 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 23 samples of condensed milk were examined and all were found to comply with the regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. Nine samples of dried milk were taken during 1938, and in no case was there failure to comply with the requirements. 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. 63 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 38 gives a list of diseases which were notifiable in St. Marylebone during the year under review. TABLE 38 List or Notifiable Diseases. Smallpox Acute Encephalitis Lethargica Cholera Polio-Encephalitis Diphtheria Ophthalmia Neonatorum Membranous Croup Tuberculosis Erysipelas Malaria* Scarlatina or Scarlet Fever Induced Malaria Typhus Fever Dysentery* Typhoid Fever Acute Primary Pneumonia Paratyphoid Fever Acute Influenzal Pneumonia Enteric Fever Plague Relapsing Fever Glanders Continued Fever Anthrax Cerebro-Spinal Fever Farcy Puerperal Fever Food Poisoning Puerperal Pyrexia Measles from 1st October, 1938. Acute Poliomyelitis Whooping Cough *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 39 shows the number of cases of infectious disease notified during the past six years TABLE 39. Infectious Disease Notifications. 1933 1934 1935 1936 1937 1938 Smallpox — — - - - - Diphtheria 78 104 119 121 108 93 Erysipelas 76 69 35 28 47 35 Scarlet Fever 198 212 155 141 121 88 Enteric Fever 7 3 3 5 5 8 Paratyphoid Fever 2 1 3 3 4 3 Continued Fever — — — — — - Puerperal Fever 8 3 10 4 13 3 Puerperal Pyrexia 17 18 36 28 34 18 Cerebro-spinal Meningitis 1 1 1 1 3 4 Tuberculosis (Pulmonary) 148 132 93 107 117 105 Tuberculosis (Non-Pulmonary) 16 25 19 23 17 24 Acute Poliomyelitis — — 3 2 2 4 Polio-Encephalitis — — 1 1 — — Ophthalmia Neonatorum 6 8 10 7 10 4 Encephalitis Lethargica 1 — — — — — Pneumonia 74 70 33 66 61 24 Malaria - 1 1 — 1 2 Dysentery 1 2 3 1 6 16 Measles from 1st October, 1938. — — — — — 3 Whooping Cough — — — — — 17 Totals 633 639 525 538 649 461 Table 40 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 1938. TABLE 40. Cases of Infectious Disease Notified during 1938. 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 93 7 4 7 7 8 29 7 8 9 6 1 - 29 23 30 11 93 29 23 30 11 93 - 2 Erysipelas 35 1 — — — — — — 2 3 4 14 11 6 14 6 9 35 5 10 3 7 25 10 — Scarlet Fever 88 - 6 5 6 8 28 10 6 10 4 5 - 23 14 39 12 88 23 14 39 11 87 1 2 Typhus Fever - - - - - — - - - — — — - — — — - - - - - - - - - Enteric Fever. 8 - - - - - - - - 2 1 3 2 5 1 1 1 8 5 1 1 1 8 - - Paratyphoid Fever 3 - - - - - 1 - - 1 - 1 - - 1 1 1 3 - - - 1 1 2 - Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 3 - - - - - - - - 3 - - - - - 2 1 3 — — 1 1 2 1 - Puerperal Pyrexia 18 - - - - - - - 1 15 2 — — 1 5 6 6 18 1 5 5 6 17 1 - Plague - - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever 4 1 - - - - - - 2 1 - - - - 1 2 1 4 - 1 2 1 4 - - Tuberculosis— Pulmonary 105 - - - 1 - 2 4 6 43 23 21 5 27 25 34 19 105 13 12 13 7 45 60 34 Non-Pulmonary 24 1 — — — — 2 1 3 10 5 2 — 4 12 6 2 24 — 5 5 1 11 13 10 Acute Poliomyelitis 4 1 — — — 1 1 1 — — — — — 1 — 1 2 4 1 — 1 2 4 — — Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 4 4 - - - - - - - - - - - - 2 2 - 4 2 2 - 4 - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 24 2 — 1 — 1 1 - 1 5 7 5 1 5 8 8 3 24 2 8 5 1 16 8 70* Malaria 2 - — - - - - - - 1 1 — — — — 1 1 2 — — 1 1 2 — — Dysentery 16 1 - - 2 1 3 - 1 2 1 3 2 3 - 9 4 16 2 - 8 1 11 5 2 †Measles 3 - - — 1 1 1 - - - - - - - 1 1 1 3 - - 1 - 1 2 1 †Whooping Cough 17 4 2 3 4 1 3 — — — — — — 2 5 7 3 17 1 2 2 2 7 10 1 Totals 451 22 12 16 21 21 71 23 30 105 54 55 21 106 112 156 77 451 82 83 119 54 338 113 122 64 *This figure is for all forms of pneumonia, including acute primary pneumonia and acute influenzal pneumonia which alone are notifiable, †Notifiable from 1st October, 1938. 65 DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). There were 93 cases of diphtheria notified during 1938, 2 deaths resulting. The highest number of cases reported in any one week was 6. In 1937 there were 108 cases and 3 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 7 cases the source appeared to be a member of the family previously infected; in 11 cases infection was counted to have been acquired in school, and in 12 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 678, a positive result being returned in 47 instances. Of the registration districts, that contributing the largest number of cases was Christ Church with 30. In All Souls the number was 29, in St. Mary 23 and in St. John 11. The age group 5—10 was mo3t affected, 29 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 Health Centre No. 1 (temporary premises, No. 181, Marylebone Road) and at the Middlesex Hospital. T.A.F. (Toxoid-Antitoxin-Floccules in suspension) was the only diphtheria prophylactic employed. Table 41 gives details of the work carried out during the year. TABLE 41. Work of the Diphtheria Immunisation Clinics. Pre-school children. School children. Adults. Totals. Attendances 734 272 534 1,540 New cases 191 76 236 503 Schick negative — 4 53 57 Completely immunised (three injections but not retested) 169 70 79 318 Retested 99 27 19 145 Positive after retest 2 1 — 3 Table 42 provides interesting information in respect of diphtheria amongst the child population of the Borough and the results of immunisation against the disease during the last three years. 66 TABLE 42. Diphtheria Immunisation of Children (Ages 0—15 Years). 1936 1937 1938 Estimated child population (0—15 years) 13,500 13,300 13,300 Number of cases of diphtheria notified amongst child population 94 82 69 Number of notified cases of diphtheria in which diagnosis was confirmed Attack rate per 1,000 child population 6.96 6.16 5.19 Deaths from diphtheria amongst child population 6 2 2 Death rate from diphtheria per 1,000 child population 0.44 0.15 0.15 Number of children Schick negative on preliminary test 5 2 5 Number of children given course of immunising injections who on subsequent test proved negative 127 104 132 Number of cases of diphtheria amongst immunised children Nil Nil Nil Deaths from diphtheria amongst immunised children Nil Nil Nil Immunising agent used T.A.F. T.A.F. T.A.F. SCARLET FEVER. Notifications of this disease numbered 88, the highest number of cases reported in any one week being 9. There were two deaths from scarlet fever during 1938. In 1937 there were 121 notifications, no death resulting. The districts to suffer most from the disease were Christ Church and All Souls. In the former there were 39 cases and in the latter 23. St. Mary and St. John reported 14 and 11 respectively. As usual, the majority of the patients were children, 63 being under 15 years of age. Of the remainder, 16 were in the age-group 15-35 and 9 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 12 instances that a definite connection could be made out. ENTERIC FEVER AND PARATYPHOID FEVER. Eight notifications of enteric fever and three of paratyphoid fever were received. There were no deaths. In none of the cases was any information obtainable indicating that the source of infection arose within the Borough. CEREBRO-SPINAL FEVER. There were four cases of cerebro-spinal fever notified during the year. No death was attributed to this disease. ENCEPHALITIS LETHARGICA AND POLIO-ENCEPHALITIS. No notification of either of these diseases was received during the year, neither were any deaths reported as due to them. ACUTE POLIOMYELITIS. Four cases of acute poliomyelitis were notified during the year. No death from this disease was recorded. ERYSIPELAS. The notifications of erysipelas numbered 35, no death resulting directly from 67 the disease. Most of the cases were notified from St. Charles' Hospital and the general hospitals, and 29 patients were treated in such institutions. In 1937, 47 cases were notified. PUERPERAL FEVER AND PUERPERAL PYREXIA. The number of cases of puerperal fever and puerperal pyrexia notified was 3 and 18 respectively. 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. All other cases, however, were visited by one of the health visitors and assistance and advice as were suitable and possible offered. No application was made for the services of a consultant or any other of the facilities which the Council is empowered to provide. No death from puerperal sepsis was recorded. MEASLES. The total number of cases of measles reported by school teachers during the twelve months was 663. There was one death. On the 1st October, 1938, the County of London (Measles and Whooping Cough) Regulations, 1938, brought into operation a limited form of compulsory notification, no notification being required where to the knowledge of the medical practitioner a case of measles or whooping cough, as the case may be, has occurred in the house and has been notified within the two months immediately preceding the date on which he first became aware of the disease in the case he is attending. During the remainder of the year three notifications were received under the regulations. 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 found necessary to call upon the services of a nurse, under the agreement between the Council and the Paddmgton and St. Marylebone District Nursing Association, in 38 cases. WHOOPING COUGH. Previously most of the information obtained with regard to this disease was derived from notices received from school teachers, who reported 10 cases during the year. On the 1st October, 1938, however, whooping cough became compulsorily notifiable in the Borough under conditions similar to those already noted in regard to measles. In the last three months of the year, 17 cases of the disease were notified. There was one death due to whooping cough in 1938, as against three in 1937. GLANDERS, ANTHRAX AND FARCY. No cases were notified during the year. DYSENTERY. During 1938, 16 cases of this disease were notified, mainly from hospitals. Two deaths were recorded, but the majority of the cases were of a very mild type. MALARIA. Two cases of induced malaria were reported. 68 SMALLPOX. There have been no cases of this disease in the Borough. Vaccination. Table 43, prepared by the Vaccination Officer, contains the vaccination return relating to the year 1937. The following statement gives some information with regard to the work done and the results obtained by Dr. Bulman during 1938:— Number of visits paid 1,239 Number of vaccinations— Primary 1,000 Re-vaccinations 163 1,163 Number of successful vaccinations 918 Number of unsuccessful vaccinations 136 Awaiting inspection 109 TABLE 43. Vaccination Return—1937. Return made to the Borough Council and Ministry of Health on the 11th February, 1939. 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, 1937, to 31st December, 1937, 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, 1937. Number of these Births duly entered by 31st January, 1939, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz. : Number of these Births which on 31st January, 1939, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Total number of these Births remaining on 31st January, 193 9, 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 1938. 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 1938. 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 Statutory Declarations of Conscientious Objection have been received. Died unvacci nated. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. All Souls 1,181 725 15 — 138 33 3 220 46 1 2. St. Mary 1,898 1,041 5 — 347 77 1 386 40 1 - 1,942 585 3. North Marylebone 249 164 1 — 44 U 4 11 9 5 Total 3,328 1,930 21 — 529 121 8 617 95 7 1,942 585 69 70 OPHTHALMIA NEONATORUM. The number of cases of this disease notified in 1938 was 4, and information with regard to these is given in Table 44. Ten cases were notified in 1937. Visits were paid to the 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. During the year the nurses paid 82 visits to three cases. Where the condition is serious, 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 44. Ophthalmia Neonatorum. Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Removed, etc. At Home. At Hospital. 4 1 3 3 — — — 1 INFLUENZA. This disease was less prevalent than in 1937, though correct information as to the number of cases was, of course, unobtainable. The district nurses paid 43 visits to 10 cases. The deaths certified as due to influenza numbered 10 as against 44 in the previous year. PNEUMONIA. Notifications of this disease numbered 24. The services of the nurses were requisitioned in 11 cases. The number of deaths certified as due to all forms of this disease was 70. FOOD POISONING. Three notifications of food poisoning or suspected food poisoning were received during the year. Various foodstuffs came under suspicion, but no definite evidence as to the responsibility of these articles was obtainable. All those affected quickly recovered. PSITTACOSIS. During March, cases of psittacosis (parrot disease) occurred at the Zoological Gardens. Exhaustive pathological investigations were carried out on parrots that died or were destroyed, but actually in only three instances was it possible to declare with any degree of certainty that they had suffered from the disease. Complement fixation tests on the blood serum of five attendants suspected of psittacosis infection were found to be strongly positive, and one patient unfortunately died. Immediately on the occurrence of the outbreak, all necessary steps were taken, including the closure of the parrot house, etc. At a conference on the 25th May, 1938, with representatives of the staff of the Zoological Society and the Ministry of Health, all the circumstances were fully considered and reviewed, and on the 15th June, 1938, when the period of isolation extending over three months had elapsed, permission was given for the parrot house to be reopened. As a further measure of safety and with the object of preventing a possible recurrence of the disease, instructions were given that, in future, all consignments of parrots or other birds liable to infection with psittacosis should be quarantined for a period of at least three months in a special building situated at some distance from the Gardens, 71 Certain suggestions with regard to the hygiene of the parrot house cages, quarantine station, etc., were also offered, and these were readily adopted by the Zoological Society. 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 Acts, 1920 and 1938. Under an arrangement with the London County Council the borough council has undertaken that provision for blind children up to the age of five years shall be made by the child welfare centres, and that home visiting in such cases shall 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. Only in very exceptional circumstances, however, is a blind child removed from its own home. No case came to the knowledge of the Department during 1938. INFECTIOUS DISEASES IN SCHOOLS. Table 45 shows the number of cases of notifiable and other infectious diseases reported from schools during 1938. TABLE 45. Infectious Diseases in Schools. SCHOOL. Scarlet fever. Diphtheria Whooping cough. Chickenpox. Measles All other Diseases. All Souls, Foley Street 2 3 - 1 32 6 Barrow Hill Road 2 — — 5 61 7 Bell Street 1 1 — 4 10 7 Capland Street 3 1 7 15 35 17 Christ Church, Cosway Street 3 — — — 28 Clipstone Street 1 1 — 7 8 1 Convent (St. Edward's) Golford Place — 1 — 2 33 Cosway Street 2 — — 13 110 8 Emmanuel, Aberdeen Place — — — — — 1 Gateforth Street 1 4 — 3 4 Hampden Gurney 3 — — 4 37 6 Homer Row, Roman Catholic 1 — — — 4 Jewish, Hanway Street — — — — — Orchardson Street, Roman Catholic 1 9 1 3 29 Regent's Park Central — — — — 3 St. James's, Marylebone Lane — 1 — — 1 _ St. Mark's, Violet Hill 3 3 — 13 31 1 St. Marylebone Central, Marylebone High Street 2 3 — 71 96 9 St. Marylebone Grammar, Marylebone Road 1 — 1 — 15 1 St. Mary's (Western), York Street — 2 1 12 28 3 St. Paul's Bentinck, Rossmore Road 4 — — 25 54 8 St. Thomas's, Picton Place — 4 — 31 - St. Vincent's, Wigmore Street 1 — — — — - Schools in other Boroughs 1 1 — 8 13 — Totals 32 34 10 186 663 75 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 72 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 1938 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 46, prepared at the request of the Ministry of Health, contains information with regard to age and sex distribution of all forms of tuberculosis. TABLE 46. 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—5 1 — 1 — — — 3 — 5—10 1 1 2 1 — — — 2 10—15 1 3 — 1 — — — — 15—20 4 2 2 2 — — — — 20—25 9 14 2 1 1 2 — — 25—35 17 12 6 2 5 5 2 — 35—45 18 8 1 4 1 2 — — 45—55 13 3 1 1 9 1 — 2 55—65 6 4 — 1 1 3 — — 65 and upwards 2 4 — 2 3 1 — 1 Totals 72 51 16 15 20 14 5 5 * 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, 129 notifications were received, 105 relating to pulmonary tuberculosis, the remainder (24) to cases in which structures other than the lungs were affected. Table 47 gives information regarding the localisation of the disease, while Table 48 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:— 73 1. Total number of deaths from tuberculosis in the borough 44 2. Number of cases unnotified or notified at death 10 3. Number of cases notified within a month of death 7 4. Number of cases notified within three months of death 3 5. Number of cases notified within six months of death 4 Six cases of tuberculosis were unnotified at death. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was therefore 1:7. 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. TABLE 47. 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. At all Ages. At ages—years. 65 and upwards. All Souls. St. Mary. Christ Church St. John. Totals. All Souls. St. Mary. Christ Church St. John. Totals. Cases isolated at home. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. Lungs 105 — 1 6 26 46 21 5 27 25 34 19 105 13 12 13 7 45 60 Cervical adenitis 7 1 — 2 — 3 1 — 1 3 3 — 7 — — 2 2 5 Kidney 3 — — — — 3 — — 1 2 — — 3 — 2 2 1 Meninges 2 — — 1 — 1 — — — — 1 1 2 — 1 1 1 Fistula in ano 2 — — — — 2 — — — 1 — 1 2 — 1 — 1 2 Epidydimis 2 — — — 2 — — — — 1 1 — 2 — 1 1 2 Knee 1 — — — 1 — — — — 1 — — 1 - - - - - 1 Neck 1 — — — 1 — — — 1 — — — 1 - - - - - 1 Eyebrow 1 — — — — 1 — — 1 — 1 - - - - - 1 Peritoneum 1 — — — — 1 — — — 1 1 - - - - - 1 Rib 1 — — — 1 — — — — 1 1 - - - - - 1 Spine 1 - - - - - 1 — — 1 — — 1 1 1 _ Bladder 1 — — — — 1 — — — — 1 — 1 — 1 1 Hand 1 — — — 1 — — — — 1 — — 1 - - - - - 1 Totals 129 1 1 9 32 58 23 5 31 37 40 21 129 13 17 18 8 56 73 129 74 75 TABLE 48. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.—Summary of notifications during the period from the 1st January, 1938, to the 31st December, 1938, in the area of the Metropolitan Borough oi 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 7 13 16 10 6 2 61 64 „ females — — 1 3 2 13 10 7 3 2 3 44 50 Non-pulmonary, males 1 — 2 — 2 2 5 1 1 — - 14 15 „ females — — — 1 1 1 2 4 — 1 - 10 11 Supplemental Return. Part II.—New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total. Pulmonary, males — — — — — 2 4 2 3 — — 11 „ females - - - - - 1 2 1 — 2 1 7 Non-pulmonary, males - 1 - - - - 1 - - - - 2 „ females — — 1 — 1 — - — 1 — 2 5 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. No. of cases. Pulmonary. Nonpulmonary. from local registrars 2 I Death returns transferable deaths from Registrar-General — 3 Posthumous notifications 1 — " Transfers " from other areas (other than transferable deaths) 15 3 Other sources (Form II) — — 76 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, 1938, on the register of notifications kept by the Medical Officer of Health 324 153 477 30 46 76 553 Number of cases removed from the register during the year by reason inter alia of:— (1) Withdrawal of notification 2 3 5 4 3 7 12 (2) Recovery from the disease 7 11 18 8 5 13 31 (3) Death 20 14 34 5 5 10 44 (4) Removal from district 63 58 121 21 22 43 164 Treatment of Tuberculosis. Of the cases notified, admissions to hospital and sanatorium numbered 218, 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, 79 were insured persons who were admitted and re-admitted from time to time during the year to sanatoria and hospitals for treatment, the total admissions numbering 90. Noninsured persons numbered 50, the total admissions for these patients (including 5 children) being 48. District nurses were sent in to 3 cases and 86 home visits were paid. The London County Council continued the arrangement whereby the Borough Tuberculosis Officer is deemed to be an honorary consultant for tuberculosis in the general hospitals under the County Council's control. The hospital attended by the Tuberculosis Officer for this purpose is St. Charles', Ladbroke Grove, North Kensington, W.10, to which the majority of St. Marylebone patients for hospital treatment are admitted. Extra Nourishment for Tuberculous Persons. Under arrangements made by the Council and sanctioned by the Minister of Health under section 219 of the Public Health (London) Act, 1936, milk was supplied to tuberculous persons under the tuberculosis dispensary scheme. The number of orders issued during the year ended 31st December, 1938, was 284, the amount expended being £119 lls. 31/2d. Non-Pulmonary Tuberculosis. Eleven of the total notifications—24 as against 17 in 1937—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 offered. Prevention of Tuberculosis. The dispensary continued to occupy 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. As is in general the case the dispensary continued to prove most valuable, the members of the staff rendering excellent service in relation to preventive work. 77 Particulars with regard to patients dealt with during the year are shown in Tables 46 and 48, while the following short table summarises the information as to visits, etc., paid by the Tuberculosis Officer and other members of the dispensary staff:— No. of cases at dispensary New, 445 Old, 371 No. of attendances at dispensary 2,334 No. of contacts New, 170 Old, 77 No. of home visits by Tuberculosis Officer New, 34 Old, 122 No. of hospital visits by Tuberculosis Officer 61 No. of home visits by Tuberculosis Visitors— First visits, 146 Re-visits, 2,170 No. of Care Committee meetings held 23 The Tuberculosis Officer has submitted the following report upon the work of the year: "Out of the 168 progress reports on patients who have had sanatorium treatment through the London County Council, 40 men, 32 women, and 14 children are working or at school; 8 are fit but have no work, 17 are unfit, 41 have been transferred to other districts, and 6 lost sight of. Six declined to attend the dispensary, and four have 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 361 cases were reviewed. 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 outrelief, by the Public Assistance Committee on the receipt of a certificate from the Tuberculosis Officer. The number of X-ray examinations made during 1938 was 409, an increase of 39 on the previous year. The practice of X-raying all new cases and adolescent contacts was continued as in the previous year. By this means only can it be definitely ascertained that all early cases of pulmonary tuberculosis are detected and sanatorium treatment provided at the stage when most benefit can be derived from it. Cases on discharge from sanatorium have likewise been supervised by radiograms at frequent intervals to ensure that improvement from sanatorium treatment has been maintained. The number of patients who have returned from sanatorium and were receiving artificial pneumothorax treatment as out-patients of hospitals was 18 at the end of 1938, an increase of two on the previous year. The treatment in such cases was continued mainly at the Brompton and Middlesex Hospitals at a fee of 10/6d. per refill, which includes X-ray supervision. Now that facilities for X-ray examinations for diagnostic purposes are more generally available, it is hoped that, with earlier detection of the disease, artificial pneumothorax treatment or a similar form of collapse therapy will be suitable for more patients than has previously been the case. It is a hopeful sign to see the continued increase in the number of patients having successful treatment by this means, as it usually ensures a shorter stay in sanatorium and a quicker return to their occupation. Most of the patients on the dispensary register who are at present continuing this treatment are successfully following their original occupation without adverse effects to themselves or danger of infection to others." 78 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 1938 the total number certified as due to this cause was 34, the deathrate being 0.38 per 1,000. In 1937 the deaths numbered 51, the death-rate being 0.56 per 1,000. The distribution of the deaths according to registration districts is shown in Table 49 which gives also the figures for each of the 5 years 1934-1938. TABLE 49. Phthisis Mortality, 1934—1938. Year. Estimated population. Deaths at All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 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 1938 90,680 34 6 5 10 13 The places at which the 34 deaths occurred were as follow: In general and other hospitals, 23; at home, 11. Of those who died 19 were insured (12 males and 7 females), and 15 uninsured (8 males and 7 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 34, the notified cases of pulmonary tuberculosis totalled 105. 79 TABLE 50. Tuberculosis Scheme. Return showing the work carried out in connection with the Dispensary during the year 1938. 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 52 31 1 1 8 8 3 — 60 39 4 1 104 *(b) Diagnosis not completed - - - - - - - - 7 3 1 2 13 (c) Non-tuberculous - - - - - - - - 42 69 13 11 135 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 5 4 3 — — — — 2 5 4 3 14 *(b) Diagnosis not completed - - - - - - - - 2 — 2 2 6 (c) Non-tuberculous - - - - - - - - 21 72 33 24 150 C.—Cases written off the Dispensary Register as :— (a) Recovered 3 7 — 2 2 1 2 1 5 8 2 3 18 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 64 145 47 36 292 D.—Number or Cases on Dispensary Register on December 31st :— - - - - - - - - - - - - - (a) Definitely tuberculous 157 98 15 13 16 19 14 10 173 117 29 23 342 (b) Diagnosis not completed — — — — — — — — 11 3 2 4 20 1. Number of cases on Dispensary Register on January 1st 356 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 36 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 106 4. Cases written off during the year as Dead (all causes) 36 5. Number of attendances at the Dispensary (including Contacts) 2,334 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 116 7. Number of consultations with medical practitioners:— (a) Personal 33 8. Number of visits by Tuberculosis Officer to homes (including personal consultations) 156 (b) Other 202 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,117 10 Number of:— (a) Specimens of sputum, &c., examined 191 (6) X-ray examinations made in connection with Dispensary work 409 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 173 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 Street Dispensary, Margaret Street, W.l *i.e., remaining undiagnosed on 31st December. TABLE 51. Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 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 1938. 1938. Previous to 1938. 1938. Class | . T.B. minus. Class T.B. plus Class TB. minus. Class T.B. plus Bones and joints. Abdominal. Other organs Peripheral glands. Total. Bones and joints. Abdominal. Other organs Peripheral glands. Total. Group 1- Group 2. Group 3. Total (Class TB.plus) Group 1. Group 2. Group 3. Total (Class TB.plus) (a) Remaining on dispensary register on 31st December. Disease arrested. Adults m. 7 11 4 — 15 — — — — — 1 1 — — 2 — — — — — F. 6 4 2 — 6 — — — — — 1 2 — 2 5 — — — — — Children. 11 - - - - - - - - - - 2 1 8 11 - - - - - Disease not arrested. Adults M. 22 10 46 20 76 11 9 10 4 23 6 — 1 1 8 1 — 3 1 5 F. 22 8 21 6 35 14 5 9 — 14 2 — 3 3 8 — — 3 1 4 Children. 6 — 1 1 2 7 1 — — 1 6 2 — 2 10 — — — 3 3 Condition not ascertained during the year. 2 — 3 — 3 — — — — — — 1 2 — 3 — — — — — Total on dispensary register at 31st December, 1938. 76 33 77 27 137 32 15 19 4 38 16 8 7 16 47 1 — 6 5 12 (b) Not now on dispensary register and reasons for removal therefrom. Discharged as recovered. Adults M. 11 5 1 — 6 - - - - - 8 1 1 1 11 — — — — — F. 22 10 5 — 15 — — — — — 3 1 — 1 5 — — — — — Children. 29 1 1 — 2 — — — — — 9 3 — 18 30 — — — — — Lost sight of. or otherwise removed from dispensary register 431 252 149 40 441 8 3 5 3 11 78 14 16 51 159 1 — 5 6 Dead. Adults M. 17 19 41 245 305 — — 1 6 7 6 2 2 2 12 — — 1 — 1 F. 16 9 14 128 151 — — — 1 1 2 — 1 — 3 — 1 — — 1 Children. 5 — — 4 4 1 — — — — 4 1 1 — 6 — — — — — Total written off dispensary register. 531 296 211 417 924 9 3 6 10 19 110 22 21 73 226 1 1 6 — 8 Grand Totals 607 329 288 444 1061 41 18 25 14 57 126 30 28 89 273 2 1 12 5 20 80 81 Tuberculosis Care Committee. The Committee continued to meet fortnightly throughout the year, Dr. Anderson, Miss Pepler and Miss Kenion attending and assisting in every way possible. Table 52 contains a list of the members. TABLE 52. Tuberculosis Care Committee. NAME. REPRESENTS. Bennett, Councillor J. (Chairman) Charity Organisation Society. Broadbent, Miss M. E. (Hon. Secretary) Invalid Children's Aid Association. Fuller, Councillor Dr. C. A. St. Marylebone Borough Council. Ramsay, Councillor G. B ditto. Bennett, Miss A. M. Paddington & St. Marylebone District Nursing Association. Bowen, Miss E. A. (M.B.E.) (resigned October, 1938). War Pensions Committee & United Services Fund. Davis, Councillor Mrs. E. Public Assistance Committee. Dover, Miss W. M The Middlesex Hospital. Fenn, Miss D. M. Margaret Street Hospital. Higgin, Miss E. St. Marylebone Registration. Lazarus, Miss o. Central Jewish Synagogue. Lesser, Mr. H. E. London Insurance Committee. St. Hill, Miss M London County Council and School Care Committee. Simpson, Dr. R. H. Divisional School Medical Officer, London County Council. Williams, Miss M. H St. Mary's Hospital, Paddington. Fisher, Mr. J. (resigned March, 1938) Weaver, Miss H. (appointed April, 1938) The Working Classes, 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 used. Articles. The number of articles disinfected is shown hereunder:— TABLE 53. Compulsorily Notifiable Infectious Diseases. Other Infectious Diseases. \7 Vermin. Miscellaneous. Total. 3,564 260 17,419 4,275 25,518 The number of journeys made by the disinfecting vans during the year ended December, 1938, was:— January 114 August 88 February 88 September 100 March 48 October 192 April 88 November 104 May 100 December 166 June 87 July 193 1,368 The number of journeys made during 1937 was 1,291. 82 Rooms. The number of rooms dealt with and the reasons for carrying out disinfection are stated below:— TABLE 54. Compulsorily Notifiable tious Diseases. Other Infectious Diseases. Vermin. Miscellaneous. Total. 308 56 87 218 669 The number of rooms disinfected in 1937 was 997. 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 671. BACTERIOLOGICAL EXAMINATIONS. Table 65 shows the number of specimens examined for the purposes of diagnosis, and indicates also the organisms in relation to which the examinations were made. TABLE 55. Examination. Positive. Negative. Suspicious. Total. Throat and Nasal swabs (for B. diphtherias and haemolytic streptococci) 47 619 12 678 Sputa (for tubercle bacilli) 12 152 — 164 Faeces (for typhoid) 2 5 — 7 Widal test (for typhoid) 3 3 — 6 Urine (for typhoid) 1 4 — 5 Swab (for gonococcus) - 1 - 1 Totals 65 784 12 861 HEALTH PROPAGANDA. The special efforts made locally, during the last four months of 1937, to secure a wider use of the health services, following the inauguration of a national campaign by the Prime Minister on the 30th September, 1937, were continued throughout the year 1938. The arrangements included, in addition to the usual forms of propaganda practised through the health centres and by the officers of the sanitary authority, the distribution of large quantities of leaflets and other literature throughout the Borough and the exhibition of posters. In the latter connection the Marylebone Road hoarding of the new Town Hall extension, which was placed at the disposal of the Public Health Committee for publicity purposes, again proved a valuable site for the display of attractive poster sets drawing attention to the various health services available to the inhabitants of the Borough. 83 INDEX. page Abdominal Tuberculosis 14 Abstract of Factories and Workshop Act 52 Accident 16 Accredited Milk 57 Ambulance Facilities 21 Analysis of Butter 62 „ ,, Cream 62 „ „ Drugs 62 „ „ Milk 62 „ „ Preservatives 62 Analyst, Public 7, 21 „ „ Report of 60 Aneurysm 19 Analytical Examinations 60, 61, 62 Annual Returns, Tuberculosis 74, 75, 79, 80 Ante-Natal Clinics 24 Anti-Toxin, Diphtheria 65 Anthrax 67 Appendicitis 19 Artificial Cream Act, 1929 62 „ Pneumothorax Treatment 77 „ Sunlight Clinic 34 Atelectasis 14 Atrophy 14 Bacteriological Examinations 60, 65, 82 „ „ of Milk 57 Bacteriologist 7, 21 Bakehouses 51, 59 „ Underground 52, 59 Baths Establishment, Old 22 „ Cleansing of Persons 46 „ Swimming 45 Bed Bugs, Eradication of 45 Birth, Injury at 14 ,, Rate 9, 10 Births, Notification of 11, 23 „ Registration of 10 „ Vital Statistics 9, 10, 11, 12, 13, 14 Blindness, Prevention of 71 Bodies, Transportation Abroad 20 Books, Library 82 Bronchitis 14, 15, 19 Bugs 45 Business, Offensive 59 Butter, Analysis of 62 „ and Margarine Premises 59 Camping Sites 44 Camps, Municipal Holiday 38 Cancer 9, 16, 19 Care Committee, Tuberculosis 81 Causes of, and Ages at, Death 12 Census, Population 8 Centres, Treatment and Clinics 22 „ Infant Welfare 23, 29 Cerebral Haemorrhage 19 Cerebro-Spinal Fever 19,63,64,66 Chicken Pox 14, 22 Child Life Protection 28 „ Guidance Clinic 32, 33,34 „ Welfare, Maternity and 23 „ ,, Statistics 35, 36, 37 Children Act, 1908 28 Chiropodist 7, 21, 30 Chiropodist's Report 30-32 page Christine Murrell Memorial Unit 26 Church Army Dispensary 29 Circulatory Diseases 19 Cirrhosis of Liver 19 Cisterns 39 Cleansing, Public 41 ,, Street 42 ,, Station 46 „ of Verminous Persons 46 Clearance and Improvement Schemes 54 Clinics, Ante-Natal 24 „ Artificial Sunlight 34 „ Child Guidance 32, 33, 34 „ Dental 21 „ Diphtheria Immunisation 35, 65, 66 „ Massage 34 „ Minor Ailments 29 „ Post-Natal 24 „ Pre-School Children 29 „ Toddlers 29 ,, Treatment Centres and 22 Closet Accommodation 40 Closing Orders 53 Coffee Shops 51 Collection, Refuse 41, 42 Combined Drainage 40 Committee, Public Health 6 „ Tuberculosis Care 77, 81 Common Lodging Houses 56 Comparison, The Years 1909 and 1938 4 Compulsory Removal, Tuberculosis 72 Condensed Milk 62 Conditions, Social 8 Congenital Malformation 14,19 Consultants, Honorary 35 „ Obstetric 35 Containers, Refuse 41 Continued Fever 63 Convalescent Homes 27 Conveniences 41 ,, Oxford Circus, All Night Opening 41 Convulsions 14 Cook Shops 60 Corrected Death Rate 11 Cream 62 „ Artificial Cream Act, 1929 62 „ Tinned 62 Cremation 20 Crematorium 20 Crossley Day Nursery 25 Crown Estate, Refuse Collection 43 Curers, Fish 59 Dairies, Milkshops 57 Day Nurseries 25 Deaths, Accident, Suicide and Manslaughter 16 ,, Causes of and Ages at 12, 15, 19 „ Infantile Mortality 9, 12, 13, 14 „ Infectious Diseases ... 15 „ Maternal Mortality ... 15 „ Rate ... ... ... 9, 11 „ Registration of ... ... 11 „ Tuberculosis 15 „ Vital Statistics ... ... 9 Debility ... ... ... ... 14 Demolition Orders ... ... ... 53 84 INDEX—continued. page Dental Clinic 21 „ Surgeon 7, 21, 30 Diabetes 19 Diarrhoea 9, 15, 19, 26 Diet Clinic, Food and 34 Dietician 34 Digestive Diseases 19 Diphtheria 14, 15, 19, 63, 64, 65 „ Anti-Toxin 65 „ Immunisation Clinic 35, 65, 66 Diseases, Notifiable 63 Disinfection 81, 82 Disinfestation 45, 46 Disinsection 45, 46, 81 Dispensary, Tuberculosis 79 ,, Church Army 29 „ St. Marylebone and Western General 29 Disposal, Refuse 42 Distribution of Industry 8 District Nursing Association 22, 35, 70 Dogs, Fouling of Footways by 48 Domiciliary Midwifery Service 27 Drainage 39, 40 „ Combined 40 Dried Milk 62 Drugs 62 ,, Food and Drugs (Adulteration) Act, 1928 60 Dysentery 63, 64, 67 Encephalitis Lethargica 19, 63, 66 Enteric Fever 63, 64 Enteritis 14, 15 Erysipelas 14, 22, 63, 64, 66 Examinations, Analytical 60, 61, 62 ,, Bacteriological 60, 65, 82 Extra Nourishment, Tuberculous Persons 76 Factories and Workshops 49, 50, 51, 52 Farcy 67 Fish Curers 59 „ , Fried, Vendors 59 " Fitter Britain " Exhibit 38 Flats, Vermin in 46 Flock, Rag 52 Food 57-62 ,, Inspection 58 „ Poisoning 70 „ Premises 59 „ Preservatives in 62 „ Stalls 60 „ and Drugs (Adulteration) Act, 1928 60 „ Samples 60, 61 ,, Unsound 58 ,, and Diet Clinic 34 Foot Clinic 21, 30, 31, 32 Fouling of Footways by Dogs 48 Fried Fish Vendors 59 Fruit 58 Gastritis 14 General Paralysis of the Insane 19 General Statistics 8 German Measles 22 Glanders 67 page Health Centre No. 1 3, 22, 36 „ „ „ 2 3, 22, 29-34, 36 „ „ „ 3 22, 36 „ Propaganda 82 „ Sport and Fitness Exhibition 38 „ Visiting 23 „ Visitors 7, 23, 28 Heart Disease 19 Holiday Camps 38 Home Helps 27 „ Nursing 22,27 Honorary Consultant 35 Hospital, Middlesex 11, 22, 29, 35, 36 „ Queen Charlotte's 11, 22, 29, 35, 36 „ St. Mary Abbots 11, 35 Hospitals 22 Houses let in Lodgings 56 „ ,, „ Water Supply 39 Housing 53 ,, Closing Orders 53 ,, Demolition Orders 53 Hydrogen Cyanide Disinfestation 45 Ice Cream 60 ,, „ Premises 59 Illegitimacy 9, 10, 14 Immunisation, Diphtheria 35, 65, 66 Improvement and Clearance Schemes 54 Industries, Chief 8 Infant Life Protection 28 Infant Welfare Centres 23, 29 Infantile Mortality 9, 12, 13, 14 Infectious Diseases, Deaths due to 15 ,, „ Notification of 26, 63 ,, ,, Prevalence of and Control over 63 ,, „ in Schools 71 „ „ Statistics 63, 64 Influenza 15, 19, 22, 70 Injury at Birth 14 Insane, General Paralysis of 19 Insecticide 45 Inspection, Sanitary 43 Inspection of Food 58 Intimation Notices 43 Laboratory Facilities 21 Laryngitis 14 Legal Proceedings 43 Library Books 82 Liver, Cirrhosis of 19 ,, Other Diseases of 19 London Passenger Transport Board 41 Malformation, Congenital 14, 19 Malaria 63, 64, 67 Manslaughter 16 Marasmus 14 Margarine and Butter Premises 59 Massage Clinic 34 Maternal Mortality 15 Maternity Homes 35 „ and Child Welfare 23 „ „ „ Statistics 35,36,37 Measles 9, 14, 15, 19, 22, 26, 63, 64, 67 „ Regulation of 67 Meat 58 Medical Referee 20 Meningitis 14 „ Tuberculous 14 85 INDEX—continued. page Middlesex Hospital 11, 22, 29, 35, 36 Midwifery Service, Domiciliary 27 Midwives 27, 35 Milk, Accredited 57 „ Analysis 57, 62 ,, Bacteriological Examination of 57 ,, Condensed 62 ,, Dried 62 „ (Special Designation) Order, 1936 57 „ Trade and Tuberculosis 71,72 „ Pasteurised 57 „ Purveyors 57 „ Schoolchildren 57 „ Shops 57 „ Tuberculin Tested 57 ,, and Food (to Mothers and Children), Supply of 24 Minor Ailment Clinics 29 Mortality, Infant 9, 12, 13, 14 „ Maternal 15 Mortuary 20 Mothers and Children, Supply of Milk and Food to 24 Mumps 22 National Hat Week 47 Nephritis 19 Night Opening, Oxford Circus Convenience 41 Noise Nuisance 48 „ „ from Street Musicians 49 ,, „ from Wireless Loudspeakers 49 Non-Pulmonary Tuberculosis 76 Noteworthy Causes of Sickness 9 Notification of Births 11 „ Infectious Diseases 26, 63 ,, Tuberculosis 63, 64, 72, 73, 74 Nuisances 44 „ Noise 48 ,, Streets Nuisance Inspector 48 Nurseries, Day 25 Nursing Association, District 22, 35 ,70 Nursing, Home 22, 27 „ Homes 22 Obstetric Consultants 35 Occupations of Inhabitants 8 Offal 43 Offensive Businesses 59 ,, Refuse 43 Old Baths Establishment 22 Ophthalmia Neonatorum 22, 26,27,63,64,70 Orthopaedic Treatment 34 Outworkers 51 Overcrowding 54 Overlaying 14 Oxford Circus Convenience 41 Paddington and St. Marylebone District Nursing Association 22, 35, 70 ,, Hospital 35 Paralysis of Insane, General 19 Paratyphoid Fever 19, 63, 64 page Parrot Disease 70 Pasteurised Milk 57 Pemphigus Neonatorum 22, 26 Peptic Ulcer 19 Pharmacy and Poisons Act, 1933 49 Phthisis, see Tuberculosis Physical Training and Recreation Act, 1937 38 „ —Survey 38 Pigeons 48 Pneumonia 14, 15, 19, 22, 63, 64, 70 Pneumothorax Treatment, Artificial 77 Poisoning, Food 70 Poisons Act, 1933, Pharmacy and 49 Polioencephalitis 63, 66 Poliomyelitis 26, 63, 64, 66 Population 8, 10 Portman Day Nursery 25, 26 Post-Natal Clinics 24 Prematurity 14, 19 Pre-School Children Clinic 29 Premises used in Food Preparation 59 Preservatives in Food 62 Prevalence of and Control over Infectious Diseases 63 Prevention of Blindness 71 „ Tuberculosis 76 Proceedings, Legal 43 Propaganda, Health 82 Psittacosis 70 Public Analyst 7, 21 „ „ Report of 60 „ Cleansing 41 „ Health Committee 6 „ Sanitary Conveniences 41 Public Health (Condensed Milk) Regulations, 1923 and 1927 62 „ „ (Dried Milk) Regulations, 1923 and 1927 62 „ „ (Meat) Regulations, 1924 58 „ „ (Preservatives, etc., in Food) Regulations 62 Puerperal Fever 26, 63, 64, 67 „ Pyrexia 22, 26, 63, 64, 67 „ Sepsis 9, 19 Pulmonary Tuberculosis and Milk Trade 71 Purveyors, Milk 57 Queen Charlotte's Hospital 11, 22, 29, 35, 36 Rag Flock 52 Rate, Birth 9, 10 „ Death 9, 11 Rateable Value 8 Rat Week, National 47 Rats 46 Referee, Medical 20 Refuse, Collection and Disposal of 41,42 „ ,, ,, „ Statistics 43 ,, Containers 41 „ Crown Estate 43 ,, Offensive 43 Registration of Births 10 ,, Deaths 11 86 IND EX—continued. page Rehousing Schemes 55 Relapsing Fever 64 Removal of Tuberculosis, Compulsory 72 Rent Restrictions Acts 56 Respiratory Diseases 15, 19 Restaurants, Tea Rooms, etc 59, 60 Rickets 14 Royal Institute of British Architects 38, 41 Royal National Orthopaedic Hospital 34 Samples, Food and Drugs 60, 61 Sanitary Conveniences, Public 41 „ Inspection 43 „ Inspectors 7 Scarlet Fever ... 14, 15, 19, 63, 64, 66 Schools, Infectious Diseases in 71 Selfridge's Exhibition 38 Senility 19 Shelter 46 Shops Act, 1934 44 „ Coffee 51 ,, Dressmaking, Millinery, Laundry, Cabinet Making, etc 51 Shops, Milk 57 Sickness, Noteworthy Causes of 9 Sieff Hall 26 Slaughterhouses 58 Smallpox 14, 63, 64, 68 Smoke Abatement 45 Social Conditions 8 St. Mary Abbots Hospital 11, 35 St. Marylebone & Western General Dispensary 29 „ Health Society ... 25, 26 St. Vincent de Paul Day Nursery 25 Staff 7, 21 Stalls, Food 60 Statistics, General 8 „ Infectious Disease 63, 64 „ Maternity and Child Welfare 35, 36, 37 „ Refuse Collection 43 ,, Tuberculosis 71-80 Vital 17, 18 „ Vaccination 68, 69 Statutory Notices 43 Stillbirths 9, 11, 14, 23 Street Cleansing 42 Street Musicians and Singers 48 Streets Nuisance Inspector 48 Suffocation 14 Suicide 16, 19 Supply of Milk and Food (to Mothers and Children) 24 Survey, Physical Training 38 Swimming Baths. 45 Syphilis 14, 19 Tabes Dorsalis 19 Tea Rooms, Restaurants, etc. 59, 60 page Tenement Houses 39 „ „ Water Supply 39 Tinned Cream 62 Toddlers Clinic 29 Transportation of Bodies Abroad 20 Treatment Centres and Clinics 22 „ of Tuberculosis 76 Tuberculin Tested Milk 57 Tuberculosis Abdominal 14 ,, Annual Returns 74, 75, 76, 79, 80, 81 „ Care Committee 77, 81 „ Compulsory Removal 72 „ Deaths 15, 72, 78 „ Dispensary 79 „ Extra Nourishment 76 „ Home Nursing 22 „ New Cases 72 „ Non-Pulmonary 76 „ Notifications 63, 64, 72, 73, 74 „ Prevention of 76 „ Pulmonary and Milk Trade 71, 72 „ Regulations 75 „ Respiratory System 19 „ Treatment of 76 Tuberculosis Officer's Report 77 Tuberculous Meningitis 14 Typhoid Fever 19, 64 Underground Bakehouses 52, 59 „ Rooms 53, 56 Unemployment 9 Unsound Food 58 Vaccination 68, 69 Vermin 45, 46 „ in Flats 46 Verminous Persons, Cleansing of 46 Vital Statistics 17, 18 Water 39 „ Supply, Factory 52 „ „ cutoff 39 „ Closets 40 Western General Dispensary, St. Marylebone and 29 Whooping Cough9, 14, 15, 19, 26, 63, 64, 67 Wireless Loudspeakers 49 Workshops 49, 50, 51, 52 „ Registered 51 Years 1909 and 1938, A Comparison 4 Zachary Merton Convalescent Home 27 Zoological Society of London 70