Ac 4353 STMARY 44 Borough of St Marglebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1939 H. A. BULMAN, M.R.C.S., D.P.H. London: Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Lewiisham Borough of St. Marglebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1939 H. A. BULMAN, M.R.C.S., D.P.H. London: Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Lewisham 3 Public Health Department, Town Hall, St. Marylebone, W.l. 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 1939. My responsibility for the information it contains extends from the 16th March, 1939, to the end of the year. Before that period the work of the Department was in the hands of my distinguished predecessor, Dr. Charles Porter. In accordance with the instructions of the Minister of Health, the report is brief in view of paper shortage. The more important matters are, however, dealt with as fully as possible. During the year continued progress was made in the erection of the Town Hall Extension, in which the Public Health Department, including Health Centre No. 1, will be housed. I gladly avail myself of this opportunity of expressing my thanks to the Chairman (Councillor Dr. Fuller) and members of the Public Health Committee for the kindness and consideration they showed me and the help they gave me during the year. To the staff of the Department I offer thanks and credit for the splendid work they have done and for the many additional responsibilities they have cheerfully undertaken as a result of the War. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. A. BULMAN, Medical Officer of Health. CONTENTS. PAGE Members of the Public Health Committee 5 Staff of the Public Health Department 5 Section A—Statistics and Social Conditions 7 Section B—General Provision of Health Services 17 Section C—Sanitary Circumstances 22 Section D—Housing 27 Section E—Inspection and Supervision of Food 29 Section F—Prevalence of, and Control over, Infectious and other Diseases 35 Index 44 5 PUBLIC HEALTH COMMITTEE. (who are also the Committee appointed for Maternity and Child Welfare purposes.) 1939. HIS WORSHIP THE MAYOR. 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. Dr. Elizabeth Jacobs. Miss M. T. Barry. Robert S. Lazarus (resigned May, 1939) F. V. Cullen, F.S.I., F.A.I. Capt. Gerald Lowry. Mrs. E. B. Davis. Miss Joyce C. Marsh. Dr. C. A. Fuller (Chairman). G. B. Ramsay. Capt. C. L. Hargreaves. T. W. Robinson, A.C.A. (from June, 1939) Mrs. M. G. Harris. H. Norman Toomey, L.D.S., R.C.S. Mrs. M. C. Q. Henriques. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health, Vaccination Officer, and Medical Referee for Cremation (until 15th March, 1939): *Charles Porter, M.D., B.Sc., M.R.C.P. (Edin.), of the Middle Temple, Barrister-at-law. Medical Officer of Health (from 1st June, 1939), Public Vaccinator, and Medical Referee for Cremation (from 16th March, 1939) : H. Allen Bulman, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. Tuberculosis Officer and Assistant Medical Officer of Health: *Murdoch MacGregor, M.D., Ch.B., D.P.H. (from 6th March, 1939) Assistant Medical Officer of Health for Maternity and Child Welfare Purposes, and (from 16th March, 1939) Deputy Medical Referee for Cremation: W. H. S. Wallace, M.D., B.S., D.P.H. Public Analyst (Part time) : J. F. F. Rowland, B.A., A.I.C. Bacteriologist (Part time): L. E. H. Whitby, C.V.O., M.C., M.A., M.D., B.Ch., F.R.C.P. (Lond.), M.R.C.S. (Eng.), D.P.H. 6 Dental Surgeon (Part time): J. Arthur Smith, L.D.S., R.C.S. (Eng.). Chiropodist (Part time): Miss Margaret Percy, M.L.I.Ch. Clerical Staff. A. H. James (Chief Clerk and, from 16th March, 1939, Acting Vaccination Officer). H. G. E. Brown. C. D. Turbayne. D. H. Drewell. mobilised 1st Sept., 1939. H. J. Payne, died 1st March, 1939. R. G. Turner, mobilised 1st Sept., 1939. S. P. Fleming. M. Kelly. C. N. F. Downs (from 27th March, 1939). Miss S. L. Pritchard. One Temporary Male Clerk. †Miss K. M. M. Kelleher (from 1st February, 1939). †Miss B. Wray (from 27th February, 1939). †One temporary Male Clerk. †Two temporary Shorthand-Typists. *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, mobilised 3rd Sept., 1939. *Food Inspector. G. Smith (Senior Sanitary Inspector) (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 (6, d). H. E. Scoble (c, d)—seconded for Civil Defence duties. E. E. Willis (a, b, d). A. S. Wilson (a, b, d)—seconded for Civil Defence duties. H. Ridler (c, d)—temporary (until 31st May, 1939). * District Sanitary Inspectors—contd. J. W. Chanell (c, d)—temporary (from 12th June, 1939 to 12th October, 1939): mobilised. M. F. G. Randall (c)—temporary (from 19th June, 1939). J. Calderbank (c, d)—temporary (from 17th October, 1939). * Drainage Inspectors. F. C. Cook (6, d). W. H. Draper (a, b, d). *Outdoor Superintendent. P. H. Hill (a, b, d). * Woman Sanitary Inspector. Miss M. McA. Sharp (c,/, g, h, i). *Woman Sanitary Inspector and Health Visitor. Miss C. E. Durant (6, /, i). Health Visitors. Miss F. H. M. Chapman (c,f, g, h, i). Miss D. T. Connell (f, g). Miss M. I. Kendall (c, f, g, h, i). Miss E. D. Mann (f, g, h, i). Miss M. C. Stewart (f, g). Part-time Health Visitors. Miss L. J. Donnell (b, f, i). Miss L. M. Hazell (i). * Tuberculosis Visitors. Miss S. Kenion (c,f, g, h, i). Miss P. K. Pepler (c,f, g, h, i). Matron-Housekeeper, Health Centre No. 2. Miss L. Kilgallin. Mortuary Keeper. Mrs. H. Spears. *Tuberculosis Dispensary Caretaker. E. D. Marston. Streets Nuisance Inspector (Temporary). D. Telford—mobilised 26th Aug., 1939. Disinfectors. J. Overton—retired 4th November, 1939. W. J. Jones—leading Disinfector from 6th November, 1939. Messenger. E. W. Broughton. *Officers to whose salary contribution is made under the Public Health Acts or by Exchequer grants, †For civil defence duties. a Royal Sanitary Institute Certificate. b Certificate of the Sanitary Inspectors' Examination Board (London). c Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. d Meat and other Foods Certificate, e Smoke Inspector's Certificate. f Health Visitors Diploma. g Central Midwives Board Certificate. h Certificate of State Registration for Nurses. i Three or Four Years' Hospital General Training Certificate. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS. GENERAL STATISTICS. Area (in acres) 1,427.8 (exclusive of water); 1,473 (including water). Resident population: 1921 census—104,173; 1931 census—97,620. Registrar-General's estimate of (a) resident population, mid. 1939—89,160. (b) average population appropriate to the calculation of death rates—82,040. Number of inhabited houses: 1921—18,507; 1931—17,575. Number of inhabited houses and flats (end of 1939) according to Rate Books, 20,548. Number of families or separate occupiers (1931), 27,352. Rateable value, £3,641,529. Sum represented by a penny rate, £13,974. 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 The chief industry is tailoring, dressmaking and millinery. The Borough is still, however, mainly a residential area occupied to a great extent by the professional classes, as indicated by the fact that 44 per cent. males and 30 per cent. females are engaged in one or other of the occupations in the group which includes commerce and finance, the learned professions, and public administration. UNEMPLOYMENT. The extent of unemployment in the Borough is shown in Table 1, supplied by the Ministry of Labour and National Service. TABLE 1. Number of Insured Persons Resident in the Borough of St. Marylebone, recorded AS unemployed AT employment exchanges on the dates indicated. Males (aged 16—64). Females (aged 16—64). Total (aged 16—64). 16th January 2,555 569 3,124 1939 17th April 2,156 524 2,680 10th July 1,615 425 2,040 17th January 2,327 429 2,756 1938 4th April 2,116 433 2,549 18th July 1,637 368 2,005 17th October 1,840 500 2,340 Figures subsequent to July, 1939, are not available as the compilation of unemployment statistics under local authority areas was suspended at the outbreak of hostilities. EXTRACTS FROM VITAL STATISTICS. Live Births— Total M. F. Legitimate 750 336 414 Birth Rate per 1,000 estimated resident pop- Illegitimate 87 41 46 ulation, mid-1939 9.06 Stillbirths 32 Rate per 1,000 total (five and still) births 37 Deaths (all ages) 1,046 Death Rate per 1,000 estimated average population 12.62 Rate per 1,000 Deaths from Puerperal causes— Deaths. total (five and still) births Puerperal Sepsis Other Puerperal causes 1 1.22 Total 1 1.22 8 Death Rate of Infants under one year of age— All infants per 1,000 live births 60.64 Legitimate infants per 1,000 legitimate live births 48.54 Illegitimate infants per 1,000 illegitimate live births 160.92 Deaths from Cancer (all ages) 139 Deaths from Measles (all ages) — 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 under this head. POPULATION. The population at the middle of 1939, and the average population for that year, as estimated by the Registrar-General, are shown in Table 2, and these figures are 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 2. Basis Year. The Borough. All Souls. St. Mary. Christ Church. St. John. Census 1931 97,620 22,380 25,667 29,636 19,937 Estimated to middle of 1931 93,460 21,422 24,575 28,375 19,088 | 1939 89,160 20,230 23,445 27,115 18,370 Estimated average for year 1939 82,040 18,610 21,570 24,950 16,910 BIRTHS. Registration.—The number of births registered during 1939 was 837, being 35 more than in 1938. Of the children born, 377 were boys and 460 girls. The birth rate per 1,000 of the population was 9.06 as against 8.84 in 1938. Table 3 contains a comparison of the rates in the several registration subdistricts and the Borough as a whole for 1939, with those of each of the five previous years TABLE 3. Sub-District 1934 1935 1936 1937 1938 1939 All Souls 6.8 8.5 8.3 8.0 7.6 8.7 St. Mary 8.7 8.3 8.1 7.2 6.0 7.3 Christ Church 12.5 12.3 12.9 11.9 10.8 10.9 St. John 7.2 8.9 8.0 9.9 9.1 10.6 The Borough 9.0 9.7 9.8 9.3 8.8 9.06 District births for the year ended 31st December, 1939, are given in Table 4. Vital statistics of separate localities for 1939, and the ten preceding years, will be found in Table 11 on page 14. 9 TABLE 4. Sub-District. Population estimated to middle of 1939. Births. Males. Females. Total. All Souls 20,230 79 96 175 St. Mary 23,445 78 94 172 Christ Church 27,115 132 163 295 St. John 18,370 88 107 195 The Borough 89,160 377 460 837 Notification.—The total number of notifications received during the year, under the Public Health (London) Act, 1936, Section 255, was 3,177; five births, 3,030; stillbirths, 147. The total notifications in 1938 was 3,980. The main sources of the notifications are set out below. In some cases duplicate notifications, from different sources, were received with regard to the same birth. From parents 4 „ doctors 43 „ midwives 139 „ hospitals, nursing homes, etc. 2,991 3,177 Of the total births notified, 1,824 took place at Queen Charlotte's Hospital; 400 at Middlesex Hospital; 174 at Paddington Hospital; and 240 were born at home. Of those notified as having occurred in St. Marylebone, 2,087 belonged to other Boroughs. Of the 147 stillbirths (73 males and 74 females) notified direct to the Department, 21 (10 males and 11 females) were to St. Marylebone mothers. In addition, information from other sources received through the Registrar-General brought the total number of stillbirths allocated to St. Marylebone to 32 (19 males and 13 females). DEATHS. Registration.—The number of deaths registered in 1939 was 1,046. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures if they occur in the Borough. The corrected death-rate* per thousand for the year was 12.62. In the previous year, the rate was 11.0 and the number of deaths 1,008. Table 5 shows the death-rates in the several registration sub-districts in 1939, and compares them with those of the preceding five years. *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 dependont 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 1939 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 estimated average population for the year. 10 TABLE 5. Sub-District 1934 1935 1936 1937 1933 1939 All Souls 10.9 11.2 11.9 11.4 9.6 10.0 St. Mary 12.1 10.9 12.2 12.6 12.6 14.7 Christ Church 13.8 12.9 13.5 14.4 10.1 12.5 St. John 13.3 11.8 12.2 12.8 12.1 12.7 The Borough 12.6 11.7 12.5 12.98 11.0 12.62 District deaths for the year ended 31st December, 1939, are given in Table 6. Vital statistics of separate localities for 1939, and the ten preceding years, will be found in Table 11 on page 14. TABLE 6. Sub-District. Estimated average population, 1939. Deaths. Males. Females. Total. All Souls 18,610 96 97 193 St. Mary 21,570 159 162 321 Christ Church 24,950 158 157 315 St. John 16,910 111 106 217 The Borough 82,040 524 522 1,046 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 12, on page 15. 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 831. Fuller information than is possible in the table is given in the following pages, in which also the figures relating both to causes of death and the ages at which these causes were operative are analysed. INFANTILE MORTALITY. The infantile mortality rate of any district is the number of deaths of infants under one year of age per 1,000 of the births which occurred in the same year. The number of babies under one year who died in St. Marylebone in 1939 was 49 and the number of births allocated by the Registrar-General for the calculation of infantile and maternal mortality rates in that year, 808. The infantile mortality rate is therefore 60.64. The Registrar-General's figure for legitimate births was 721 and the deaths amongst legitimate infants numbered 35, giving a rate of 48.54. There were 87 illegitimate births and 14 deaths, the rate being 160.92. In 1938 the death-rate for all infants per 1,000 five births was 60. 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. Table 7 shows, in addition to the causes of infantile mortality, the distribution of the deaths according to age and locality. TABLE 7. INFANTILE MORTALITY. Nett Deaths from Stated Causes at various ages under One Year, and in Sub-Districts. No. CAUSE OF DEATH. Under 1 Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under 4 Weeks. Total under 1 Month. 1 and under 3 Months. 3 and under 6 Months. 6 and under 9 Months. 9 and under 12 Months. Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Total l Small-Pox - - - - - - - - - - - - - - - 2 Chicken-Pox - - - - - - - - - - - - - - - 3 Measles - - - - - - - - - - - - - - - 4 Scarlet Fever - - - - - - - - - - - - - - - 5 Diphtheria and Membranous Croup - - - - - - - - - - - - - - - 6 Whooping Cough — — — — — — — — 1 1 — — 1 — 1 7 Diarrhoea — — — — — — - 8 Enteritis — — — — — 5 3 1 1 10 3 2 4 1 10 9 Tuberculous Meningitis - - - - - - - - - - - - - - - 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation - - - - - 1 - - - 1 - - 1 - 1 13 Premature Birth 11 2 1 — 14 3 2 1 20 4 9 3 4 20 14 Atrophy, Debility and Marasmus - - - - - 1 - - - 1 - 1 - - 1 15 Atelectasis 3 — — — 3 — - - 3 2 - 1 - 3 16 Injury at Birth 1 — — — 1 1 1 1 17 Erysipelas - - - - - - - - - - - - - - - 18 Syphilis — — — — — — 19 Rickets - - - - - - - - - - - - - - - 20 Meningitis (not Tuberculous) - - - - - - - - - - - - - - - 21 Convulsions — — — — — 22 Gastritis — — — 1 _ 1 1 1 23 Laryngitis — — 24 Bronchitis 2 2 2 2 25 Pneumonia (all forms) 1 — — — 1 1 1 1 1 5 1 3 1 5 26 Suffocation, Overlaying — — — — — — — _ 27 Other Causes 2 — — 1 3 — — 1 — 4 2 — 1 1 4 Totals 18 2 1 1 22 12 8 3 4 49 12 12 17 8 49 11 M. F. M. F. M. F. Nett Births Legitimate, 336 Nett Deaths Legitimate Infants, 18 17 Nett Stillbirths Legitimate Infants, 12 12 in the Year Illegitimate, 41 46 in the Year Illegitimate Infants, 8 6 in the Year Illegitimate Infants, 7 1 Total 377 460 Total 26 23 Total 19 13 837 49 32 12 MATERNAL MORTALITY. In 1939 the number of deaths due to conditions connected with or consequent upon child-birth was 1, the maternal mortality rate being 1.22 per 1,000 births. The death occurred in a nursing home, the age of the mother being 26 years. Twins survived. As is usual in these cases a careful investigation into the circumstances of the death was made and a report submitted to the Ministry of Health. In 1938 there were 2 deaths, the death rate being 2.41 per 1,000 births. DEATHS IN RELATION TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table 12 on page 15. 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. Diarrhœal Diseases.—The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 10, giving a rate of 0.12 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1939 this was the case also, all being children under one year of age. In 1938, the number of deaths from diarrhceal diseases was 12. Of these, 8 were babies. Infectious (Communicable) Diseases.—Excluding influenza, which caused 14 deaths, and including diarrhoea, etc. (10 deaths) the total number registered as due to infectious diseases was 13. Of these deaths, 1 was caused by whooping cough and 2 by cerebro-spinal fever. In 1938, 18 deaths were caused by infectious diseases, excluding influenza which caused 10 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 62, 44 being recorded in 1938. The great bulk of the 62 deaths, viz., 57, giving a death-rate of 0.69 per 1,000 of the population, was due to phthisis. The number in 1938 was 34, with a death-rate of 0.38. The age periods at which the deaths in 1939 occurred were: 1—5, nil; 5—15, 1 (2%); 15—25, 12 (20%); 25-45, 20 (35%); 45—65, 14 (25%); 65 and over, 10 (18%). 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 94. This is lower by 8 than the figure (102) for 1938. The death-rate was 1.14 per thousand. In 1938 the rate was 1.12. The number of deaths certified to be due to bronchitis was 27. Of this number 18 were amongst persons aged 65 and upwards, and 8 amongst those of the group 45-65. The deaths traceable to pneumonia numbered 60 and, as in the case of bronchitis, the later age-groups contributed the greatest numbers. Five were infants of under one year of age. Cancer or Malignant Disease.—The number of deaths due to cancer was 139 and the death-rate 1.69 per 1,000 of the population. The figures for 1938 were 180 and 1.98 per 1,000 respectively. Information with regard to the age at which death occurred and the situation of the disease is given in Tables 8 and 9. 13 TABLE 8. Cancer : Ages at Death. Ages. Under 1. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and upwards. Total Males - - - 1 1 1 10 15 20 14 62 Females — — — 1 3 6 12 17 18 20 77 Totals — — 2 4 7 22 32 38 34 139 TABLE 9. Cancer : Situation of the Disease. Parts of the body affected. Males. Females. Totals. Face, Tongue, Jaw 6 2 8 Throat, Neck, Gullet 6 3 9 Stomach 13 10 23 Intestines 11 12 23 Liver 2 3 5 Breast 1 20 21 Uterus and Generative Organs 3 12 15 Various 20 15 35 Totals 62 77 139 TABLE 10. Vital Statistics for 1939 and Ten Previous Years. Year Population estimated to middle of each Year Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Uncorrected Nett of Nonresidents registered in the District of Residents not registered in the District Under 1 year of Age At all Ages No. Rate No. Rate No. Rate per 1,000 Nett Births No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1929 102,400 3,526 1,233 11.9 1,465 14.3 821 804 93 77.0 1,455 13.2 1930 102,400 3,162 1,247 12.1 1,373 13.3 831 618 77 62.0 1,171 10.6 1931 93,460 3,134 1,067 11.4 1,411 14.3 826 640 70 65.0 1,225 12.3 1932 96,430 2,952 1,055 10.9 1,444 14.3 859 680 92 87.2 1,265 12.4 1933 94,080 2,881 916 9.7 1,411 14.1 840 653 51 56.0 1,224 12.2 1934 92,320 3,007 833 9.0 1,462 15.6 885 594 51 61.0 1,171 12.6 1935 92,200 3,397 896 9.7 1,401 15.0 927 620 50 56.0 1,094 11.7 1936 92,400 3,624 906 9.8 1,544 16.5 1,045 670 68 75.1 1,169 12.5 1937 92,110 3,339 859 9.3 1,461 15.8 948 689 63 73.3 1,202 13.0 1938 90,680 3,520 802 8.8 1,312 14.3 917 613 48 60.0 1,008 11.0 1939 *89,160 2,829 837 9.1 1,191 14.4 775 630 49 60.6 1,046 12.6 *The estimated average population appropriate to the calculation of death-rates for the year 1939 was 82,040. 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. TABLE 11. Vital Statistics of Separate Localities fob 1939 and Ten Previous Years. Names or Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. 1929 a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 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 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 Averages of Years 1929 to 1938. 94,848 981 1,198 67 21,954 184 248 13 24,803 218 311 14 28,977 382 395 28 19,114 198 244 12 1939 *89,160 837 1,046 49 20,230 175 193 12 23,445 172 321 12 27,115 295 315 17 18,370 195 217 8 ♦The estimated average population appropriate to the calculation of death-rates for the year 1939 was 82,040. 14 TABLE 12.—Causes of, and Ages at Death during the year 1939. No. CAUSES OF DEATH. Nett deaths at the subjoined ages of "Residents " whether occurring within or without the district. Total Deaths. whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church. St. John. Total. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - 2 Measles - - - - - - - - - _ - - - - 3 Scarlet Fever — — — — — - - - - 4 Whooping Cough 1 1 — — — — - __ 1 - 1 5 Diphtheria — — — — — — - - - 6 Influenza 14 — — — — 1 5 8 5 3 5 2 4 14 7 Encephalitis Lethargica — — — — — — — - - - - - 8 Cerebro-Spinal Fever 2 1 — — — l — — 1 2 - 2 9 Tuberculosis of Respiratory System 57 l 12 20 14 10 7 11 13 25 8 57 5 10 Other Tuberculous Diseases 5 — — — — 1 3 1 10 2 1 2 11 Syphilis 6 - - - - - - 4 2 1 1 2 2 I 6 12 General Paralysis of the Insane, Tabes Dorsalis 5 _ __ - - 1 2 2 - 1 1 3 - 13 Cancer, Malignant Disease 139 — — — — 2 11 54 72 223 28 43 39 29 139 14 Diabetes 14 - - - - - 1 2 11 16 2 3 7 2 14 15 Cerebral Haemorrhage, etc. 54 - - - - - 1 14 39 20 12 15 18 9 54 16 Heart Disease 312 - - - - - 7 86 219 64 48 98 87 79 312 17 Aneurysm 7 - - - - - - 2 5 2 1 2 2 2 7 18 Other Circulatory Diseases 72 - - - - - - 18 54 53 12 24 19 17 72 19 Bronchitis 27 - - - - - 1 8 18 9 5 8 10 4 27 20 Pneumonia (all forms) 60 5 — 1 — 2 3 12 37 26 7 18 23 12 60 21 Other Respiratory Diseases 7 - - - - - 1 3 3 10 2 1 3 1 7 22 Peptic Ulcer 7 - - - - - 2 3 2 22 2 1 3 1 7 23 Diarrhoea, etc. 10 10 — 2 2 3 3 2 10 24 Appendicitis 12 1 — — — 2 1 6 2 9 4 3 3 2 12 25 Cirrhosis of Liver 3 - - - - - 1 1 1 6 1 1 - 1 3 26 Other Diseases of the Liver, etc 8 — — — — 1 — 2 5 6 2 2 3 1 8 27 Other Digestive Diseases 21 1 — 1 — — 3 3 13 33 4 7 6 4 21 28 Acute and Chronic Nephritis 19 — — — — 1 3 6 9 33 5 4 7 3 19 29 Puerperal Sepsis — — — — — — — — — 1 - - - - - 30 Other Puerperal Causes 1 — — — — — 1 — — 9 - 1 - - 1 31 Congenital Debility, Premature Birth, Malformation, etc. 26 25 - - 1 - - 88 7 8 7 4 26 32 Senility 17 - - - - - - - 17 14 3 6 4 4 17 33 Suicide 26 — — — — 3 11 8 4 17 5 8 8 5 26 34 Other Violence 38 2 — — l 5 2 6 22 17 8 15 9 0 38 35 Other defined Diseases 76 3 — — 3 5 9 14 42 127 13 28 19 16 76 36 Causes ill-defined or unknown - - - - - - - - - - - - - - - Totals 1,046 49 — 2 5 35 84 274 597 831 193 321 315 217 1,046 15 16 MORTUARY. Seventy-eight bodies (43 males, 35 females) were deposited, and 40 post-mortem examinations carried out at the mortuary during the year. CREMATORIUM. One hundred and six certificates authorising cremation at the St. Marylebone Crematorium, Finchley, were issued—86 by the Medical Referee and 20 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 1939 one such certificate was issued in respect of a body transported to Italy. 17 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. STAFF. Information as required by the Ministry of Health with regard to the staff of the department is contained in a statement on page 5. During the year a number of changes took place. After nearly 30 years' service with the Council, Dr. Charles Porter retired from the office of Medical Officer of Health, and the Council placed on record their appreciation of his skilled administration in the Borough during that period. Dr. Porter had raised the local health services to a high level, and enjoyed a reputation in the world of preventive medicine which extended far beyond the area which he had served with such distinction. At the outbreak of hostilities three members of the permanent staff were called to the Colours: Miss Challis (Clerk-Dispenser), to serve with a Voluntary Aid Detachment; Mr. Drewell (Second Class Clerk) with the Lincolnshire Regiment, and Mr. Turner (Second Class Clerk) with a Sanitary Company of the Royal Army Medical Corps. Of the temporary staff, Mr. Chanell (Sanitary Inspector) was mobilised with the Royal Naval Volunteer Reserve in October, and Mr. Telford (Streets Nuisance Inspector) rejoined the Police Reserve in August. The death of Mr. Payne (Second Class Clerk) is recorded with great regret. Mr. Overton (Leading Disinfector) having reached the age-limit, retired as from the 4th November, after 27 years' service with the Council. 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 25, 29, 31 and 43. Mr. J. F. F. Rowland, B.A., A.I.C., is the Public Analyst for the Borough, and his laboratory is situated at No. 133, Gloucester Place, N.W.I. A report on the work done during 1939, together with a statement of food and drugs analysed, will be found on pages 31—34. 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 case3. The ambulances of the County Council may also be utilised, on payment, for private and non-infectious cases. NURSING IN THE HOME. The Paddington and St. Marylebone District Nursing Association continue to provide adequate nursing services in the home under an arrangement made with the Council. The number of cases of measles nursed fell from 38 in 1938 to one in 1939. Influenza cases nursed numbered 31 as against 10 in the previous year. Table 13 gives full particulars of the work carried out in 1939. TABLE 13. Home Nursing Service. No. of cases nursed. No. of visits paid. Maternity 9 180 Influenza 31 191 Pneumonia 8 88 Tuberculosis 3 53 Measles or German measles 1 1 18 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 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 at No. 21a, Paddington Street, providing ante-natal and child welfare clinics. (This centre was closed permanently at the end of July, 1939). 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 35. MATERNITY AND CHILD WELFARE. There were no developments or changes in the maternity and child welfare services apart from those occasioned by the war. From September, owing to the evacuation of mothers and young children, only three of the five welfare centres were in use as these were found to be sufficient to meet the demands made upon the services. The clinics at Health Centres Nos. 1 and 3 were therefore closed down for several months. With the return of the great majority of mothers and children from the reception areas towards the end of the year it became necessary to provide a normal service and all the centres were brought fully into use again. Table 14 gives an account of the work done during 1939. In addition to the centres named in this table, consultations are held weekly at the Church Army Dispensary and the St. Marylebone and Western General Dispensary. 19 TABLE 14. 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 57 190 57 99 122 Toddlers — 21 — - 35 Maternity — 49 16 556 175 Massage — 68 — — — Light — 79 — — — No. of attendances of mothers at clinic:— Ante-natal — 480 67 14,819 (481) 3,302 (389) Post-natal — 39 12 1,806 (19) 216 (7) No. of attendances of babies 882 2,611 484 1,623 (872) 2,727 (972) No. of attendances of children over one year 720 2,653 562 808 (608) 2,053 (538) No. of attendances at Light Clinic:— Infants — 60 — — — Toddlers — 1,301 — — — No. of attendances at Massage Clinic:— Infants — 16 — — — Toddlers 986 — — — No. of Orders issued for milk 561 1,130 144 248 252 No. of Home visits 577 3,099 245 192 2,421 No. of new cases:— Infants 70 188 29 111 (53) 137 (54) Toddlers 12 38 27 — 6 (2) Ante-natal — 128 20 2,090 (104) 409 (36) Post-natal — 15 3 1,085 (21) 158 (7) Massage Infants - 1 _ _ Toddlers 45 — — Light Infants - 4 - - - Toddlers 51 — — Note.—Figures in brackets refer to St. Marylebone residents attending Queen Charlotte's Hospital and Middlesex Hospital. 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. 20 The number of visits paid during the year by all health visitors was as follows: (a) to expectant mothers, first visits, 341, total visits, 632 ; (b) to children under 1 year of age, first visits, 514, total visits, 4,202; (c) to children between the ages of 1 and 5 years, total visits, 5,018. During the summer one of the health visitors (Miss Kendall) visited Canada and the United States and took part in a public health educational tour which included visits to hospitals, health centres and clinics of various kinds. Supply of Milk and Food. The quantity of milk supplied free or at a reduced price under the Council's scheme to expectant and nursing mothers and young children was 8,806 gallons (liquid) and 1,996 pounds (dried). The amount expended was £1,289 9s. 3d., as against £973 14s. Id. in 1938. The number of cases dealt with was 478, and the number of orders issued 2,914, showing an increase over the figures for 1938, when the cases numbered 377 and the orders 2,325. There is also an arrangement for supplying dinners at certain voluntary centres but no advantage was taken of this service during 1939. Day Nurseries. The three day nurseries in the Borough were evacuated on the outbreak of war : the Portman (St. Marylebone Health Society) from new premises at Nos. 12-18, Salisbury Street to Limpsfield, Surrey; the Crossley (St. Marylebone Health Society) from No. 38, Barrow Hill Road to Watlington, Oxfordshire; and St. Vincent's Creche (Convent of the Sisters of Charity of St. Vincent de Paul) from No. 14 Blandford Street to Taplow, Buckinghamshire. In their temporary quarters in the country the nurseries are carrying on their valuable work with marked success and with undoubted benefit to the health of the children. Home Helps. Home helps were provided in three cases during the year. Convalescent Home. During the first eight months of the year, 18 mothers, 17 babies and 3 toddlers were admitted to the accommodation maintained by the Council at the Zachary Merton Convalescent Home, Rustington, Sussex. On the 24th August the Home closed down and the premises were used for other purposes. Child Life Protection. In connection with the administration of Part I of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932, six health visitors acted as infant protection visitors and made a total of 155 inspections. During 1939 two foster mothers left the Borough, and in the latter part of the year six children were evacuated under the Government scheme. The number of persons on the register who were receiving children for reward at the end of the year was four, and the children in their care numbered four. Treatment of Minor Ailments. Children suffering from minor ailments were treated at the London County Council clinic at Health Centre No. 2. 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 15 contains statistics for the period January to July inclusive. The clinic was closed during the remainder of the year. 21 TABLE 15. Attendances—mothers 188 „ children 66 Cases receiving advice and treatment 178 Extractions under gas—mothers 63 „ „ „ children 13 Dentures provided at cost price—full 5 „ „ „ „ „ partial 3 Foot Clinic. This clinic remained open for the first seven months of the year only and during this period 45 new cases (mothers 33, children 12) were dealt with, the total number of attendances being 335 (mothers 303, children 32). Child Guidance Clinic. Twenty-three new cases (with a total of 118 attendances) were investigated and treated. The clinic was closed for the last five months of the year. 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. Maternity Cases. Accommodation for maternity cases is available within the borough at Queen Charlotte's Hospital and the Middlesex Hospital, and also at the Paddington Hospital of the London County Council. The number of births notified from these institutions during 1939 was 1,824, 400 and 174 respectively, the total births notified in the Borough from all sources numbering 3,177. 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. Obstetric Services. The emergency obstetric service of the London County Council (the so-called "Maternity Flying Squad") and a panel of four local obstetric consultants are available for any doctor in the area needing assistance in difficulties or complications arising during pregnancy or at or after confinement. 22 SECTION C.—SANITARY CIRCUMSTANCES. 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 5 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. 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 three. The number in 1938 was 17. In 13 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 10 cases after receipt of the intimation notice. In the three remaining instances the service of a statutory notice was necessary to secure compliance with the requirements. A bye-law of the Council requires that storage cisterns shall be emptied and cleansed every six months. During the year 18 notices were served in regard to defects in and necessity for cleansing cisterns. Private Wells and Borings. Early in the year, at the request of the Minister of Health, an investigation was made into the possibility of pollution from disused wells or borings of water. Of 39 private wells discovered in the Borough, only 14 were found to be in actual use. No evidence of pollution in connection with any of the borings (in use or abandoned) was obtained. In the case of those still used for drinking or domestic purposes, chemical and bacteriological examinations yielded satisfactory results. In a few instances, where the waters were used only for industrial or other nondomestic purposes, certain features not entirely satisfactory were discovered, but in no case could the water be described as a bad one. DRAINAGE. The number of drainage plans of new premises deposited and approved during the year was 27 (northern district 8; southern district 19), and of old buildings, 185 (northern district 79; southern district 106). Inspections made by the Drainage Inspectors numbered 2,246 (northern district 1,122; southern district 1,124). Combined Drainage. Orders under seal as to combined drainage were issued in respect of 8 premises. CLOSET ACCOMMODATION. In Table 16 on page 24, 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. 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 shelters, chemical closets are commonly being installed. PUBLIC SANITARY CONVENIENCES. The usual supervision was exercised over the 15 public conveniences (11 for men, 4 for women). Inspector Hill, the outdoor superintendent, visited those 23 provided for the use of males; the women inspectors, especially Miss Pepler, supervising those provided for females. During the year one free water-closet was made available at certain of the men's conveniences. PUBLIC CLEANSING. Refuse collection and disposal and street cleansing are under the jurisdiction of the Cleansing Committee and the scheme is administered by the Cleansing Superintendent (Mr. Stanley G. Martin, M.J.Inst.C.E., M.R.San.I., A.M.Inst.P.C.). Refuse Collection. All premises in the Borough receive at least a twice-weekly collection, although a great proportion are visited daily, including over 60 streets scheduled for " kerb " collection during statutory hours. During the year 79 intimation notices and 12 statutory notices were served by the Sanitary Authority in respect of defective bins. All were complied with. The "container" system for business premises, hotels, etc., introduced in 1925, has extended yearly and over 230 containers are now in use. These are purchased by the owners or occupiers concerned, and are collected daily by specially designed vehicles and emptied, cleansed and disinfected before return. Immediately plans of new buildings in the Borough are deposited, the architects concerned are urged to introduce containers in suitable cases. The fleet of vehicles used for normal collections consists of totally enclosed inside-loading petrol-driven lorries with steps fitted to facilitate entry. Street Cleansing. The "beat" system, with each sweeper responsible for a definite section, is in operation for both day and night gangs, who are provided with pneumatic-tyred orderly barrows with two galvanised bins, fitted with lids, for the reception of sweepings, which are collected periodically at pre-arranged points by specially designed side-loading and covered collecting lorries. Gully cleansing is carried out by means of three entirely enclosed mechanicallyoperated gully machines. Disposal. All house and trade refuse, street sweepings and gully slop are conveyed to the Council's Wharf and discharged into contractors' boats at the canal side for disposal. Statistics. The tonnages dealt with during 1939 were:— House and trade refuse 43,690 tons. Street sweepings and gulley slop 6,650 „ A sum of approximately £972 was obtained from the sale of by-products (ashes, breeze, wastepaper, rags, metals and tins). In addition, approximately £1,076 was received for the removal of trade refuse, green and fish offal and for the cleansing of petrol interceptors. 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 1,387, as against 2,291 in 1938. 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 24 Intimation Notices. In 771 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 198 instances. Of this number, 150 related to one block of tenement buildings (Huntsworth Terrace). The notices referred to such matters as dirt, dampness, verminous rooms, insufficient water-closet accommodation, inadequate staircase lighting, and to other defects and conditions. Details of the various nuisances detected and remedied, to the total number of 2,202, are set out in Table 16. TABLE 16. Nature of Nuisance. Districts. The Borough. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. Houses damp, dirty or dilapidated remedied 32 72 117 42 82 49 394 Doors, windows, floors, ceilings, sash cords, grates and flues, etc. repaired 23 101 57 18 51 17 267 Verminous rooms 3 15 264 8 14 11 315 Dirty and verminous furniture and bedding cleansed 4 - 15 5 - 5 29 Overcrowding abated 18 5 79 3 — 2 107 Underground rooms (illegal occupation) dealt with - 3 - - - - 3 Water closet defects remedied 19 47 68 19 25 15 193 Insufficient and unsuitable water closet accommodation remedied 12 3 5 8 10 1 39 Urinal defects remedied - - - - - — - Drains and water closet stoppages cleared 6 10 19 10 12 5 62 Drains relaid or amended - 2 2 4 10 1 19 Soilpipes and ventilating shafts repaired or renewed - 5 2 3 4 2 16 Waste pipe defects remedied 1 12 18 7 7 5 50 Yard defects remedied 2 12 49 19 15 5 102 Wash-house defects remedied 14 12 29 15 12 4 86 Area defects remedied — 8 1 - — — 9 Basement defects remedied — 8 1 4 — — 13 Roofs and gutters repaired 15 37 52 20 15 26 165 Water supply to houses reinstated — — 1 — — 1 2 Water supply laid on to upper storeys — — 4 1 5 3 13 Water cistern defects remedied 4 2 3 — — 13 22 Dung or dust receptacles repaired or renewed 8 15 9 12 7 9 60 Rubbish, manure, etc., accumulations removed 3 22 21 11 8 13 78 Animal nuisances abated - - — — - - - Rats and mice infestation - 2 3 7 5 8 25 Bakehouses dirty — — 1 — 2 1 4 Smoke nuisances — - 2 2 — 3 7 Shops insufficiently ventilated or heated - 2 3 3 9 8 25 Miscellaneous — 17 16 25 17 22 97 SHOPS. During the period under review 223 shops were inspected. In 25 instances informal notices were served in respect of contraventions of the provisions of the Shops Act, 1934, and in 22 cases the defects were remedied without the need for further action. Statutory notices were served in three instances before compliance with the requirements was obtained. 25 SMOKE ABATEMENT. During the year, 218 observations were made and 31 complaints were received and dealt with. In each case the attention of the offender was drawn to the matter. Six 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 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 two privately owned swimming pools in the Borough; one at the Middlesex Hospital for the use of the staff; and one at the Polytechnic in Regent Street, available only to members of the Institute. ERADICATION OF BED BUGS. As in previous years a considerable amount of work was carried out in 1939 in connection with disinfestation. 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: Number of Council houses found to be infested 32 Number of other houses found to be infested 141 Number of Council houses disinfested 32 Number of other houses disinfested 141 The methods employed for freeing infested houses from bed bugs and for ensuring that the belongings of tenants are free from vermin before removal to Council houses were described in the report for 1938. The Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938, made by the Secretary of State under section 1 of the Hydrogen Cyanide (Fumigation) Act, 1937, came into force on the 1st February, 1939. The regulations prescribe detailed precautions to be taken by persons undertaking the fumigation of premises by hydrogen cyanide and aim at preventing a repetition of the unfortunate accidents associated with the use of this agent. Later in the year, in view of representations made to the Home Secretary that the regulations were not working satisfactorily, the Home Office intimated that an inquiry would be held to ascertain if any amendments were necessary. CLEANSING OF VERMINOUS PERSONS. The numbers of adults and school children using the cleansing station during 1939 were 577 (438 males, 139 females) and 2,413 (717 boys, 1,696 girls) respectively. SHELTER. During 1939 there was no occasion for the occupation of the shelter for the special purpose for which it was provided under section 195 (4) of the Public Health (London) Act, 1936. RAT REPRESSION. Thirty-two complaints were received in 1939, necessitating the inspection of 53 premises, 25 of which were found to be rat infested. Included in this latter number were 5 business premises (4 of these for the preparation or storage of food), 17 private or tenement houses and 3 vacant sites. In 3 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. 26 PIGEONS. Eight complaints of nuisance from pigeons (six relating to private dwellings and two to public buildings) were made in 1939. As in other years, as much assistance as possible was given by the inspector in charge of this work to reduce the nuisance. FOULING OF FOOTWAYS BY DOGS. 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 14 cases, in 10 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, 5 prosecutions undertaken being on the reports of police officers. The total number of prosecutions since the bye-law came into operation in 1928 is 292, the amount of fines imposed being £104 16s. 6d. NOISE. During the year 35 complaints of noise were received, fourteen relating to street hawking, seven to street musicians, seven to wireless loudspeakers, gramophones and similar instruments, two to children, two to dogs, two to building operations, and one to a motor vehicle. 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. In two instances of nuisance caused by wireless loudspeakers the issue of a notice was necessary to obtain a remedy. PHARMACY AND POISONS ACT, 1933. Traders whose names were on the Council's list of persons entitled to sell poisons included in Part II of the Poisons List numbered 111 at the end of 1939. 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. The number of registered factories at the end of the year was 1,318. In addition there were 340 restaurants, tea rooms, coffee shops, etc., and 40 bakehouses (29 underground). Frequent inspections were carried out, and defects were remedied in 56 instances (want of cleanliness 16; overcrowding 2; unreasonable temperature 1; inadequate ventilation 9; insufficient or unsuitable sanitary conveniences 28). Outworkers' lists were received from 76 employers relating to 232 contractors and 696 workpeople. 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. 27 SECTION D.—HOUSING. The total number of houses and flats in the Borough at the end of 1939 was 20,548, the number occupied by the working classes being 8,438. 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) 1,624 (b) Number of inspections made for the purpose 7,321 (2) (a) Number of dwelling-houses (included under sub-head 198 houses (1) above) which were inspected and recorded under and the Housing Consolidated Amendment Regulations, tenements. 1932 (b) Number of inspections made for the purpose 831 (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 602 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 731 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 198 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 48 (b) By local authority in default of owners Nil (c) Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which lition orders were made 2 (2) Number of dwelling-houses demolished in pursuance of demolition orders Nil (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 34 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 1 4. Housing Act, 1936—Part IV.—Overcrowding :— (a) (i) Number of dwellings overcrowded at the end of the year 543 (ii) Number of families dwelling therein 543 (iii) Number of persons dwelling therein 2,604 28 (b) Number of new cases of overcrowding reported during the year Nil (c) (i) Number of cases of overcrowding relieved during the year 107 (hi Number of persons concerned in such cases 407 (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 conader it desirable to report:— Towards the end of the year there was a considerable number of vacaint tenements as a result of the war. and overcrow ding was further reduced temporariy by the evacuation of school children CLEARANCE AND IMPROVEMENT SCHEMES. In view of the outbreak of hostilities and the necessity of conserving all available housing accommodation, the Minister of Health decided that the holding of inquiries into slum clearance orders should be deferred and that no further steps should be taken for the time being in connection with orders already confirmed by the Minister. Action in respect of individual demolition orders and re-development schemes was also postponed, and building operations to provide relief for overcrowded areas suffered considerable curtailment as a result of the war. It may, however, be noted that during the year the St. Marylebone Housing Association made a farther contribution to modern bousing accommodation in the Borough for persons of limited means by the erection of fourteen flats in Allitsen Road, St. John's Wood at a cost of £14,430. HOUSES LET IN LODGINGS. Included under this head are all ordinary tenement houses in which the rooms or floors are let out separately. A considerable proportion of the houses in the Borough are so let. and under revised bye-laws made by the London County Council under Section 6 of the Housing Act, 1936. which came into operation on the 1st January, 1939, 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 than there mast be compliance with certain requirements as to sanitation, cleansing, etc. During the year some 3,291 visits were paid to the 1.605 houses of the tenement type. The number of intimation notices served was 423, relating to cleansing and other defects. Except in 49 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 1939, 5 intimation notices and 5 statutory notices were served in regard to this matter, and all were complied with. COMMON LODGING HOUSES. During 1939. 47 visits were paid by officers of the department to the two lodging bouses in the Borough: one, registered for 436 men. owned by the Salvation Army and situated at No. 2, Burne Street and premises in Lisson Street; the other, accommodating 100 women, conducted by the Church Army at Portman House. Daventry Street and Harrow Street. In addition, the premises were periodically inspected by a Fire Inspector 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. RENT RESTRICTION ACTS. No applications under these Acts for certificates as to suitability for occupation of houses were received during the year. 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 folly: 1st Quarter, 22; 2nd Quarter, 44; 3rd Quarter, 4th Quarter, 30, making a total for the year of 110. No sample was found to be adulterated. The sale of Milk Regulations, 1939, made by the Minister of Agriculture under section 23 of the Food and Drugs Act, 1938, are a re-enactment of earlier regulations and their object is to provide, as heretofore, that a sample of milk containing less than 3 per cent. of milk-fat or less than 8.5 per cent. of milk-solids other than milk-fat shall "until the country is proved" be held to be " not genuine" because of abstraction of the constituents named or the addition of water. A sample of separated milk containing less than 8.7 per cent. of milk-solids other than milk-fat is to be similarly regarded. The new regulations came into force on the 1st October, 1939. Bacteriological Examination of Milk. With a view of testing the purity of milk from the bacteriological point of view, 20 samples were taken and submitted to the Council's bacteriologist for examination. In the case of one sample of pasteurised milk, the bacterial content was found to be in excess of the legal limit, and the matter was taken up with the pasteurising from concerned. Dairies, Milkshops, etc. There are 190 premises upon which milk is sold. During the year 210 inspections were made with the object of discovering whether or not requirements of the regulations as to cleanliness etc., under the milk and dairies order, 1936 were being occupied with In no cases was it necessary to take action. Milk (Special Designations) Order, 1936 and 1938. During the year 48 applications were received from 23 milk purveyors for licences under the order. As in each all relevant requirement's had been plied with , appropriate licensees were granted as follows : 1 pas Turing 24 licensees and 5 supplementary in the case of pasteurised milk; 1 bottling, 15 dealers and 2 men try in respect of tuberculin tested milk. Milk for School Children Scheme. In no cases was an adverse report received from the Council.,s bacteriologist in required to samples taken in connection with the scheme for the provision of milk to school children. MEAT AND OTHER FOODS. The work of food protection precipices year by the closest attention. As for same years past, the main duties have been occurred out by Inspector Smith, who made inspections of premises in which food is sold, stitched or prep read, and acted as sampling officer under the food and Drugs (Adulteration) Act, 1928, and, from the list October, 1939, under the food and Drugs Act, 1938. During 1939, as formerly, the Special Stationary might and Sunday infectious in market streets, etc., were made, and in carrying them out Inspector Smith the assistance of other members of the having the necessary qualification and experience. 30 Unsound Food. On a great many occasions the inspector was called by vendors to examine articles of food, and to accept surrender of such as were unsound or unwholesome or unfit for food. Table 17 contains a list of the articles dealt with in this way. TABLE 17. Unsound Food Condemned and Destroyed. Meat— Tinned Goods— Beef 256 lbs. Corned Beef 131 tins Mutton 68 „ Ham 22 „ Pork 20 „ Canned Pork 13 „ Calf 1 Gammons 7 „ Pigs Heads 4 Brawn 26 „ Pigs Plucks 6 cwt. 7 lbs. Veal 22 „ Lambs Livers 50 „ Ox Tongue 5 „ Lambs Brains 180 „ Sausages 2 „ Ox Livers 123 „ Plums 480 „ Beef Caul Fat 6 cwts. Pears 432 „ Strawberries 80 „ Tomato Puree 5 „ Fish— Condensed Milk 36 „ Cod Fillets 10 stone Sprats 2 kits Miscellaneous— Herring 5 boxes Bacon 19 cwts. Kippers 4 „ Chickens 140 lbs. Mackerel 2 „ Rabbits 35 lbs. Haddock 2 „ Cucumbers 56 boxes Public Health (Meat) Regulations, 1924. These regulations continue to work smoothly. Frequent inspections were made, but in no case was action found to be necessary. 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. Eight inspections were made in 1939. 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. 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 10 visits, but no cause for complaint was found. Premises used for Food Preparation. At the end of 1939, 105 premises were registered for the preparation or manufacture of foods (other than ice cream) intended for sale, and 221 inspections were made by the food inspector. 31 Ice Cream Premises. The number of premises included in the register at the end of 1939 was 70. Throughout the year, 150 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. Fifty-one visits were paid to the registered premises during 1939. Bakehouses. At the end of 1939 the number of bakehouses on the register was 40, 29 being underground bakehouses. During the year 92 inspections were made and 4 notices with regard to defects were served. Fried Fish Vendors and Fish Curers. The number of premises in the Borough used by vendors of fried fish is 14 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 60 inspections of fried fish shops and 32 inspections of fish curers' premises were made by the food inspector. In the case of the fried fish shops, 2 notices were served and complied with. Restaurants, Tea-rooms, etc. At the end of 1939 there were 340 premises in the Borough in which meals are provided or food is sold already cooked or is prepared for sale. This number includes restaurant and dining room kitchens, 208 ; tea-rooms and pastry-cookshops, 98; and hotel kitchens, 34. During the year the total number of inspections was 406, the number of notices served being 8. Food Stalls. 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, one sample of ice cream and one of cooked sausage were examined bacteriologically. Both were found to be satisfactory. FOOD AND DRUGS ACT. The total number of samples taken in 1939 under the Food and Drugs (Adulteration) Act, 1928, and, since 1st October, 1939, the Food and Drugs Act, 1938, was 1,005, the figure for 1938 being 1,067. The sum paid in respect of each analysis was 12s. 6d. 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 18 contains a complete list of the articles submitted for analysis during 1939, while Table 19 give details of those samples found to be adulterated. 32 TABLE 18. Statement of Food and Drugs Analysed. No. Article. Number examined. Number adulterated or otherwise giving rise to irregularity. Formal. Informal. Private. Total. Formal. Informal. Private. Total. 1 Almonds, Ground - 3 - 3 2 Arrowroot — 2 — 2 3 Asparagus — 1 — 1 4 Baking Powder — 4 — 4 5 Bramble Jelly — 2 — 2 6 Butter 38 113 — 151 7 Butter and Bread — 2 — 2 8 Butter and Roll — 66 — 66 9 Camphorated Oil — 2 — 2 10 Candied Peel — 2 — 2 11 Capsules, Halibut Liver Oil — 1 — 1 12 Carrots — 1 — 1 13 Castor Oil — 1 — 1 14 Cheese — 34 - 34 15 Chocolate Sponge — 1 — 1 16 Cinnamon, Essence of — 3 — 3 17 Citric Acid — 2 — 2 18 Cocoa — 13 — 13 19 Cod Liver Oil — 1 — 1 20 Coffee — 33 — 33 21 Cooking Fat — 1 — 1 22 Cornflour — 4 — 4 23 Cream, Loose 10 2 — 12 24 Cream, Tinned — 19 - 19 25 Cream Cheese — 3 — 3 26 Currants — 10 — 10 27 Custard Powder — 2 — 2 28 Dripping — 4 — 4 29 Epsom Salts — 2 — 2 30 Flour — 1 — 1 31 Flour, Self-Raising — 8 — 8 32 Ginger Beer — 1 — 1 33 Ginger, Ground — 2 — 2 34 Glace Cherries — 4 — 4 35 Glycerine and Thymol — 6 — 6 36 Golden Syrup — 5 — 5 • 37 Gregory Powder — 5 — 5 38 Herbs, Mixed — 2 — 2 39 Honey — 22 — 22 40 Icing Sugar — 2 — 2 41 Iodine, Tincture of — 6 — 6 42 Jam — 31 — 31 43 Lard - 44 - 44 44 Lemonade — 1 - 1 45 Lemonade Powder — 8 - 8 46 Liquorice Powder — 4 — 4 47 Margarine — 36 — 36 48 Marmalade — 20 — 20 49 Milk 51 59 — 110 50 Milk, Condensed — 31 — 31 51 Mincemeat — 4 - 4 52 Mint, Dried — 2 - 2 53 Mixed Spice — 5 — 5 54 Mustard — 27 — 27 55 Ointment, Boric — 14 - 14 56 Ointment, Iodine - 2 - 2 57 Ointment, Zinc - 3 - 3 58 Olive Oil - 8 - 8 59 Paste, Fish - 6 - 6 60 Paste, Meat - 7 - 7 61 Peas, Tinned - 9 - 9 62 Pepper — 11 — 11 Carried forward 99 730 - 829 - - - - 33 No. Article. Number examined. Number adulterated or otherwise giving rise to irregularity. Formal. Informal. Private. Total. Formal. Informal. Private. Total. Brought forward 99 730 - 829 - - - - 63 Pickles — 3 — 3 64 Pills, Blaud's - 1 - 1 65 Quinine, Ammoniated Tincture of - 2 - 2 66 Raisins — 15 — 15 67 Rice — 16 - 16 68 Rice, Ground — 15 - 15 69 Sago — 2 — 2 70 Salmon, Tinned — 2 — 2 71 Sal Volatile - 1 - 1 72 Sardines - 11 - 11 73 Sauce - 6 - 6 74 Sausages, Pork — 28 — 28 75 Sponge Cake — 2 — 2 76 Soda, Bicarbonate of - 4 - 4 77 Suet, Shredded - 7 — 7 78 Sugar, Granulated — 1 — 1 79 Sultanas — 13 - 13 80 Sweets - 2 - 2 81 Tapioca — 2 — 2 82 Tartaric Acid — 10 - 10 83 Tea - 18 - 18 84 Vermouth - 1 - 1 85 Vinegar — 10 — 10 86 Witch Hazel — 2 - 2 87 Wine, Orange 1 1 — 2 1 1 — 2 Total 100 905 - 1,005 1 1 - 2 TABLE 19. Adulterated Samples, etc. Serial Number. Article. Whether Formal, Informal or Private. Nature of adulteration or irregularity. Observations. 689 Orange Wine Informal Consisted of sugar 25.8%, phosphoric acid 0.6%, made up to 100% with water and contained no detectable orange constituent. Formal sample (see serial number 795) taken. 795 Orange Wine Formal Consisted of sugar 26.0%, phosphoric acid 0.45%, citric acid 0.1%, water 73.45%. Legal proceedings were taken. Vendors pleaded a warranty and case against them was dismissed. Action against the manufacturers was not proceeded with. 34 Milk. During the year 110 samples were examined; none was found to be adulterated. As will be seen from the following figures the composition of the milks examined remains remarkably constant and varies but little from year to year:— Year. Sp. Gr. Total Solids. Fat. Solids not Fat. 1937 1031.5 12.36% 3.62% 8.74% 1938 1031.5 12.24% 3.52% 8.72% 1939 1031.6 12.26% 3.51% 8.75% Cream. The fat content of the twelve loose creams examined varied from 25.7% to 46.3%, with an average value of 41.5%. All were genuine. Nineteen tinned creams were analysed, the fat content ranging from 20.7% to 24.6%, with an average value of 22.6%. All these tinned samples contained tin, the amount of which varied from 0.075 to 0.9 grains of tin per lb., with an average amount of 0.39 grains of tin per lb. Butter. During the year 151 samples were examined; all were genuine. So also were the butters on the 68 samples of bread and butter or roll and butter taken during the same period. Preservatives. In no instance was any preservative found in any sample in which it was not specifically allowed by the Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1939, and in those instances in which preservative was found it was present only in nature and amount which conformed with these Regulations. Drugs. All the samples examined conformed to the standards laid down for them in the British Pharmacopoeia." ARTIFICIAL CREAM. Under the Artificial Cream Act, 1929, and, since the 1st October, 1939, the Food and Drugs Act, 1938, 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 statutes called for. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. During the year 31 samples of condensed milk were examined and all were found to comply with the regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. No samples of dried milk were taken during 1939. PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS, 1925 to 1939. 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. Amending regulations which came into force in October, 1939, made provision (i) that the direct addition of sodium or potassium nitrite to bacon, ham or cooked pickled meat should not be prohibited by the principal regulations issued in 1925; and (ii) that the total amount of nitrites which might be contained in cooked pickled meat other than bacon and ham should not exceed in all two hundred parts per million, including both nitrites derived from any added sodium, or potassium nitrate (salpetre), and nitrites added directly. 35 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. Table 20 gives a list of diseases which were notifiable in St. Marylebone during the year under review. TABLE 20. List of 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 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 21 shows the number of cases of infectious disease notified during the oast six years:— TABLE 21. Infectious Disease Notifications. 1934 1935 1936 1937 1938 1939 Smallpox - - - - - - Diphtheria 104 119 121 108 93 42 Erysipelas 59 35 28 47 35 23 Scarlet Fever 212 155 141 121 88 43 Enteric Fever 3 3 5 5 8 5 Paratyphoid Fever 1 3 3 4 3 — Continued Fever — — — — — - Puerperal Fever 3 10 4 13 3 11 Puerperal Pyrexia 18 36 28 34 18 12 Cerebro-spinal Meningitis 1 1 1 3 4 — Tuberculosis (Pulmonary) 132 93 107 117 105 92 Tuberculosis (Non-Pulmonary) 25 19 23 17 24 12 Acute Poliomyelitis — 3 2 2 4 1 Polio-Encephalitis — 1 1 — — — Ophthalmia Neonatorum 8 10 7 10 4 5 Encephalitis Lethargica — — — — — — Pneumonia 70 33 66 61 24 20 Malaria 1 1 1 2 - Dysentery 2 3 1 6 16 2 Measles from 1st October, 1938. — — — — 3 17 Whooping Cough — — — — 17 114 Totals 639 525 538 649 451 399 Table 22 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 1939. 36 TABLE 22. Cases of Infectious Disease Notified during 1939. 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 42 1 4 5 5 4 9 2 3 8 — 1 - 10 8 16 8 42 10 8 16 7 41 1 — Erysipelas 23 — — — — — — — — 4 5 6 8 5 10 3 5 23 3 8 1 3 15 8 — Scarlet Fever 43 1 2 1 1 1 11 4 5 14 2 1 - 10 13 13 7 43 10 11 13 6 40 3 — Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever 5 — — — — — — — — 1 2 1 1 1 2 1 1 5 1 2 1 — 4 1 — Paratyphoid Fever — — — — — — — — — - - - — — — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 11 — — — — — — — 1 8 2 — — 1 6 2 2 11 1 5 2 2 10 1 — Puerperal Pyrexia 12 — — — — — — — — 11 1 — — 3 4 4 1 12 3 4 2 1 10 2 — Plague — — — — — — — — — — — — — — — — — — — — — — — — — Glanders — — — — — — — — — — — — — — — — — — — — — — — — — Farcy — — — — — — — — — — — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — — — — — 2 Tuberculosis • Pulmonary 92 — — 1 — — 1 3 11 39 17 14 6 21 22 37 12 92 7 10 8 7 32 60 57 Non-Pulmonary 12 1 — — 1 — 1 1 — 2 — 6 — 2 3 6 1 12 2 2 4 1 9 3 5 Acute Poliomyelitis 1 — — — — — — — 1 — — — — — — 1 — 1 — — 1 — 1 — — Polio-Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 5 5 — — — — — — — — — — — — 1 2 2 5 — — — 1 1 4 — Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia 20 — — — 1 — — — — 4 2 9 4 5 5 5 5 20 3 2 2 4 11 9 60* Malaria — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery 2 — — — — — 2 — — — — — — — — — 2 2 — — — 2 2 — — Measles 17 — 2 1 1 1 4 2 3 2 — 1 — 2 8 4 3 17 1 4 2 1 8 9 — Whooping Cough 114 17 16 23 15 15 21 3 1 1 2 — — 13 34 50 17 114 5 11 18 6 40 74 1 Totals 399 25 24 31 24 21 49 15 25 94 33 39 19 73 116 144 66 399 46 67 70 41 224 175 125 *This figure is for all forms of pneumonia, including acute primary pneumonia and acute influenzal pneumonia which alone are notifiable. 37 DIPHTHERIA. Immunisation. Except for the five months July to November inclusive, the Schick Testing and Diphtheria Immunisation Clinic continued to operate 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 23 gives details of the work carried out. TABLE 23. Work of the Diphtheria Immunisation Clinics. Pre-school children. School children. Adults. Totals. Attendances 497 117 141 755 New cases 116 28 55 199 Schick negative — 1 3 4 Completely immunised (three injections but not retested) 92 26 27 145 Retested 89 17 8 114 Positive after retest 2 — — 2 Antitoxin. One application was made for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910. MEASLES AND WHOOPING COUGH. On the 23rd October, 1939, the County of London (Measles and Whooping Cough) Regulations, 1938, were amended by Provisional Regulations made by the Minister of Health requiring all cases of measles and whooping cough to be notified (whereas, under the 1938 Regulations, notification was not required in certain cases if a similar illness occurring in the same house had been notified within the previous two months), and fixing the fee payable to a medical practitioner for each certificate at one shilling. VACCINATION. Table 24, prepared by the Vaccination Officer, contains the vaccination return relating to the year 1938. The following statement gives some information with regard to the work done and the results obtained during 1939:- Number of visits paid 1,116 Number of vaccinations— Primary 881 Re-vaccinations 26 - 907 Number of successful vaccinations 737 Number of unsuccessful vaccinations 84 Awaiting inspection 86 38 TABLE 24. Vaccination Return—1938. Return made to the Borough Council and Ministry of Health on the 12th February, 1940, by Dr. H. A. Bulman, Vaccination Officer of the Borough of St. Marylebone, respecting the Vaccination of Children whose Births were registered in St. Marylebone from 1st January, 1938, to 31st December, 1938, 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 1938. Number of these Births duly entered by 31st January, 1940, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1940, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1940, 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). Total number of Certificates and copies of Certificates of Successful Primary Vaccination of children under 14 received during the calendar year 1939. 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 1939. Col. I. Success fully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Died unvacci nated. 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. Insuscep tible of Vaccination. Had SmallPox. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. All Souls 1,188 737 10 — 148 25 1 210 53 4 1,912 510 2. St. Mary 2,091 1,130 6 — 365 83 — 448 65 4 3. North Marylebone 229 141 2 — 46 10 2 11 12 5 Total 3,508 2,008 18 — 559 118 3 669 120 13 1,912 510 39 OPHTHALMIA NEONATORUM. The number of cases of this disease notified in 1939 was 5. Four cases were treated at home and one in hospital. Vision was unimpaired in four cases. In the remaining instance the child left the district. FOOD POISONING. There were no notifications of food poisoning during 1939. RHEUMATISM AND ARTHRITIS. On the 7th January, 1939, a new department was opened at the Hospital of St. John and St. Elizabeth, No. 60, Grove End Road, for the reception of women suffering from rheumatism and arthritis, and the Council decided to contribute towards the cost of carrying on the work on condition that accommodation was made available for St. Marylebone patients recommended for admission by their medical attendant. Up to the 31st August, 1939, when the unit closed down, one woman had been received into the hospital for treatment. 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 Comity 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 1939. TUBERCULOSIS. Pulmonary Tuberculosis and the Milk Trade. Provision is made in the Public Health (Prevention of Tuberculosis) Regulations, 1925, designed to secure that no person suffering from respiratory tuberculosis who is in an infectious condition shall be engaged in any form of dairy work involving the milking of cows, the treatment of milk or the handling of milk containers. During the year no case occurred which called for attention under the regulations. Compulsory Removal of Tuberculous Patients to Hospital. No action was required during 1939 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 25, prepared at the request of the Ministry of Health, contains information with regard to age and sex distribution of all forms of tuberculosis. 40 TABLE 25. 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 — — — — — 5—15 2 3 1 1 — 1 — — 15—25 15 18 — — 6 6 — 1 25—35 15 14 — 4 4 4 1 2 35—45 12 6 — — 9 3 — — 45—55 5 3 4 2 2 2 — — 55—65 7 1 — 1 9 1 1 — 65 and upwards 5 4 — — 6 4 — — Totals 62 49 7 8 36 21 2 3 *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, in respect of the first three quarters, 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. Table 26 gives information regarding notifications and the localisation of the disease. The total number of cases of tuberculosis remaining at the 31st December, 1939, on the register of notifications kept by the Medical Officer of Health was 555, two more than at the end of the previous year. From time to time reference is made to the difficulty associated with the obtaining of notifications sufficiently early, and the following figures are of interest in this connection:— 1. Total number of deaths from tuberculosis in the borough 62 2. Number of cases unnotified or notified at death 12 3. Number of cases notified within a month of death 5 4. Number of cases notified within three months of death 6 5. Number of cases notified within six months of death 3 Ten cases of tuberculosis were unnotified at death. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was therefore 1:6. The institution of proceedings was not called for in regard to any case of wilful neglect or refusal to notify. There was no evidence of excessive incidence of, or mortality from, tuberculosis in any particular occupation in the Borough. 41 TABLE 26. Tuberculosis Notifications—Localisation of Disease. Localisation of disease. Cases notified in whole district. Total cases notified in each locality. Number of cases removed to hospital from each locality. Cases isolated at home. At all Ages. At ages—years. All Souls. St. Mary. Christ Church St. John. Totals. All Souls. St. Mary. Christ Church St. John. Totals. Under 1. 1 to 5. 5 to 15. X5 to 25. 25 to 45. 45 to 65. 65 and upwards. Lungs 92 — 1 4 25 42 14 6 21 22 37 12 92 7 10 8 7 32 60 Glands 3 — 1 2 — — — — — — 3 — 3 — — 1 — 1 2 Kidney 3 — — — — 1 2 — — 2 1 — 3 — 2 1 — 3 — Meninges 1 1 — — — — — — — — 1 — 1 — — 1 — 1 — Hip 1 — — — — — 1 — 1 — — — 1 1 — — — 1 — Elbow 1 — — — — — 1 — — 1 — — 1 — — — — — 1 Neck 1 — — — — 1 — — — — — 1 1 — — — 1 1 — Spine 1 — — — — — 1 — — —• 1 — 1 — — 1 — 1 — Miliary 1 — — — — — 1 — 1 — — — 1 1 — — — 1 — Totals 104 1 2 6 25 44 20 6 23 25 43 13 104 9 12 12 8 41 63 104 42 Treatment of Tuberculosis. Of the cases notified, admissions to hospital and sanatorium numbered 201, and during the year every effort was made to obtain admission to sanatoria of cases deemed suitable for such treatment. 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 was 253, the amount expended being £111 4s. 8d. 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, and except for a lessening of activities during August and September the work proceeded on practically a normal basis throughout 1939. Particulars with regard to patients dealt with during the year are shown in Table 25, 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, 273 Old, 310 No. of attendances at dispensary 1,762 No. of contacts New, 97 Old, 90 No. of home visits by Tuberculosis Officer New, 25 Old, 128 No. of hospital visits by Tuberculosis Officer 53 No. of home visits by Tuberculosis Visitors— First visits, 125 Re-visits, 1,564 No. of Care Committee meetings held 16 In addition to the Borough Council's dispensary there is another—the Margaret Street Dispensary—which is provided by a voluntary body and also possesses facilities for the treatment of tuberculosis. Military Training and Tuberculosis. From June onwards, at the request of the Ministry of Health, the Tuberculosis Officer provided, for the information of medical boards established under the Military Training Act, 1939, a specialist opinion regarding men called up who were either known to him as patients or were referred to him because of some doubt as to their respiratory condition. Tuberculosis Care Committee. The Committee, under the chairmanship of Councillor J. Bennett, continued to meet during the greater part of the year, and dealt with a total of 336 cases. DISINFECTION. During the year 572 rooms and 21,555 articles (including 266 books) were disinfected. 43 BACTERIOLOGICAL EXAMINATIONS. Table 27 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 27. Examination. Positive. Negative. Suspicious. Total. Throat and Nasal swabs (for B. diphtherias and haemolytic streptococci) 9 291 3 303 Sputa (for tubercle bacilli) 9 137 - 146 Faeces (for typhoid) - 1 - 1 Widal test (for typhoid) — 2 — 2 Urine (for typhoid) — 1 — 1 Smears (for gonococcus) — 2 — 2 Swab (for Vincent's organisms) — 1 — 1 Totals 18 435 3 456 44 INDEX. page Adulterated Food Samples 33 Ambulance Facilities 17 Analysis of Butter 34 „ „ Cream 34 „ „ Drugs 32 „ Milk 29, 32, 34 Analyst, Public 5, 17 „ „ Report of 31-34 Aneurysm 15 Ante-Natal Clinics 19 Anti-Toxin, Diphtheria 37 Appendicitis 15 Arthritis 39 Artificial Cream Act, 1929 34 „ Sunlight Clinic 19 Atelectasis 11 Atrophy 11 Bacteriological Examinations 31,43 of Milk 29 Bacteriologist 5, 17 Bakehouses 26, 31 „ Underground 31 Baths, Cleansing of Persons 25 „ Swimming 25 Bed Bugs, Eradication of 25 Birth, Injury at 11 „ Premature 11, 15 „ Rate 7 Births, Notification of 9 „ Registration of 8 ,, Vital Statistics 7 Blindness, Prevention of 39 Bodies, Transportation Abroad 16 Books, Library 42 Bronchitis 11, 12, 15 Bugs 25 Business, Offensive 30 Butter, Analysis of 34 „ and Margarine Premises 31 Cancer 8, 12, 13, 15 Care Committee, Tuberculosis 42 Causes of, and Ages at, Death 10, 15 Census Population 8 Centres, Treatment and Clinics 18 ,, Infant Welfare 19 Cerebral Haemorrhage 15 Cerebro-Spinal Fever 12, 15, 35, 36 Chicken Pox 11 Child Life Protection 20 „ Guidance Clinic 21 „ Welfare, Maternity and 18 „ „ Statistics 19 Children Act, 1908 20 Chiropodist 6, 21 Church Army Dispensary 18 Circulatory Diseases 15 Cirrhosis of Liver 15 Cisterns 22 Cleansing, Public 23 „ Street 23 „ Station 25 „ of Verminous Persons 25 Clearance and Improvement Schemes 28 Clerical Staff 6 page Clinics, Ante-Natal 19 ,, Artificial Sunlight 19 ,, Child Guidance 21 „ Dental 20, 21 „ Diphtheria Immunisation 37 „ Foot 21 „ Massage 19 „ Minor Ailments 20 „ Post-Natal 19 ,, Treatment Centres and 18 Closet Accommodation 22 Closing Orders 27 Coffee Shops 26 Collection, Refuse 23 Combined Drainage 22 Committee, Public Health 5 ,, Tuberculosis Care 42 Common Lodging Houses 28 Compulsory Removal, Tuberculosis 39 Condensed Milk 34 Conditions, Social 7 Congenital Malformation 11 Consultants, Honorary 21, 42 ,, Obstetric 21 Containers, Refuse 23 Convalescent Home 20 Conveniences, Public Sanitary 22, 23 Cook Shops 31 Corrected Death Rate 9 Cream, Analysis of 34 „ Artificial Cream Act, 1929 34 Cremation 16 Crematorium 16 Crossley Day Nursery 20 Curers, Fish 31 Dairies, Milkshops 29 Day Nurseries 20 Deaths, Causes of and Ages at 10, 15 „ Infantile Mortality 10 ,, Infectious Diseases 12 „ Maternal Mortality 12 „ Rate 7, 9 ,, Registration of 9 ,, Tuberculosis 12, 15 ,, Vital Statistics 7 Debility 11 Demolition Orders 27 Dental Clinic 20, 21 „ Surgeon 6 Diabetes 15 Diarrhoea 8, 12, 15 Digestive Diseases 15 Diphtheria 35, 36, 37 ,, Anti-Toxin 37 ,, Immunisation Clinic 37 Diseases, Notifiable 35 Disinfection 42 Disinfestation 25 Dispensary, Church Army 18 ,, St. Marylebone and Western General 18 Disposal, Refuse 23 Distribution of Industry 7 District Nursing Association 17 Dogs, Fouling of Footways by 26 45 INDEX—continued. page Drainage 22 „ Combined 22 Dried Milk 34 Drugs 32 Dysentery 35, 36 Encephalitis Lethargica 35,36 Enteric Fever 35, 36 Enteritis 11 Erysipelas 35, 36 Extra Nourishment, Tuberculous Persons 42 Factories and Workshops 26 Fish Curers 31 „ Fried, Vendors 31 Flock, Bag 26 Food 29-34 „ Inspection 29 ,, Poisoning 39 „ Premises 30 „ Preservative in 34 „ Stalls 31 „ Samples 31, 32, 33 „ Unsound 30 Foot Clinic 21 Fouling of Footways by Dogs 26 Fried Fish Vendors 31 Gastritis 11 General Paralysis of the Insane 15 General Statistics 7 German Measles 17 Health Centre No. 1 3, 18, 19 2 18, 19 „ 3 18, 19 „ Visiting 19, 20 „ Visitors 6, 19 Heart Disease 15 Home Helps 20 „ Nursing 17 Honorary Consultants 21 Hospital, Middlesex 18, 19, 21 „ Paddington 9, 21 ,, Queen Charlotte's 18, 19, 21 „ St. Charles' 42 „ St. John and St. Elizabeth 39 Hospitals 18 Houses let in Lodgings 28 Housing 27 „ Closing Orders 27 „ Demolition Orders 27 Hydrogen Cyanide Disinfestation 25 Ice Cream 31 ,, ,, Premises 31 Illegitimacy 7, 11 Immunisation, Diphtheria 37 Improvement and Clearance Schemes 28 Industries, Chief 7 Infant Life Protection 20 Infant Welfare Centres 19 page Infantile Mortality 8 Infectious Diseases, Deaths due to 12 ,, „ Notification of 35, 36 ,, „ Prevalence of and Control over 35 „ „ Statistics 35, 36 Influenza 12, 15, 17 Injury at Birth 11 Insane, General Paralysis of 15 Inspection, Sanitary 23 Inspection of Food 29 Intimation Notices 24 Laboratory Facilities 17 Library Books 42 Liver, Cirrhosis of 15 „ Other Diseases of 15 Malformation, Congenital 11, 15 Malaria 35, 36 Marasmus 11 Margaret Street Dispensary 42 Margarine and Butter Premises 31 Massage Clinic 19 Maternal Mortality 12 Maternity and Child Welfare 18 „ „ „ Statistics 19 Measles 8, 17, 35, 36, 37 „ Notification of 37 Meat 29 Medical Referee (Cremation) 5 Middlesex Hospital 18,19,21 Military Training and Tuberculosis 42 Milk, Analysis 29, 32, 34 „ Bacteriological Examination of 29 „ Condensed 34 „ Dried 34 „ (Special Designation) Orders, 1936 and 1938 29 „ Trade and Tuberculosis 39 „ Pasteurised 29 ,, Purveyors 29 „ Schoolchildren 29 ,, Shops 29 „ Tuberculin Tested 29 ,, and Food (to Mothers and Children), Supply of 20 Minor Ailment Clinic 20 Mortality, Infant 10 „ Maternal 12 Mortuary 16 Mothers and Children, Supply of Milk and Food to 20 Nephritis 15 Noise Nuisance 26 Noteworthy Causes of Sickness 8 Notification of Births 9 ,, Infectious Diseases 35, 36 „ Tuberculosis 35, 36, 40, 41 Nuisances 24 „ Noise 26 Nurseries, Day 20 46 INDEX—continued. page Nursing Association, District 17 Nursing, Home 17 „ Homes 18 Obstetric Consultants 21 Occupations of Inhabitants 7 Offensive Businesses 30 „ Refuse 23 Ophthalmia Neonatorum 35, 36, 39 Orange Wine 33 Orthopaedic Treatment 21 Outworkers 26 Overcrowding 27, 28 Paddington and St. Marylebone District Nursing Association 17 „ Hospital 9, 21 Paralysis of Insane, General 15 Paratyphoid Fever 35,36 Pasteurised Milk 29 Peptic Ulcer 15 Pharmacy and Poisons Act, 1933 26 Phthisis, see Tuberculosis Pigeons 26 Pneumonia 11, 12, 15, 35, 36 Poisoning, Food 39 Poisons Act, 1933, Pharmacy and 26 Polioencephalitis 35, 36 Poliomyelitis 35, 36 Population 7, 8 Portman Day Nursery 20 Post-Natal Clinics 19 Prematurity 11, 15 Premises used in Food Preparation 30 Preservatives in Food 34 Prevalence of and Control over Infectious Diseases 35 Prevention of Blindness 39 „ Tuberculosis 42 Private Wells 22 Public Analyst 5, 17 „ „ Report of 31-34 ,, Cleansing 23 ,, Health Committee 5 ,, Sanitary Conveniences 22, 23 Public Health (Condensed Milk) Regulations, 1923 and 1927 34 „ „ (Dried Milk) Regulations, 1923 and 1927 34 „ „ (Meat) Regulations, 1924 30 „ „ (Preservatives, etc., in Food) Regulations 34 Puerperal Fever 35, 36 „ Pyrexia 35, 36 ,, Sepsis 7, 15 Pulmonary Tuberculosis and Milk Trade 39 Purveyors, Milk 29 Queen Charlotte's Hospital 18, 19, 21 page Rag Flock 26 Rate, Birth 7, 8 „ Death 7, 9 Rateable Value 7 Rats 25 Referee, Medical (Cremation) 5 Refuse, Collection and Disposal of 23 „ „ ,, ,, Statistics 23 „ Containers 23 ,, Offensive 23 Registration of Births 8 „ Deaths 9 Removal of Tuberculosis, Compulsory 39 Rent Restriction Acts 28 Respiratory Diseases 12, 15 Restaurants, Tea Rooms, etc. 26, 31 Rheumatism and Arthritis 39 Royal National Orthopaedic Hospital 21 Samples, Food and Drugs 31, 32, 33 Sanitary Conveniences, Public 22, 23 ,, Inspection 23 „ Inspectors 6 Scarlet Fever 35,36 Senility 15 Shelter 25 Shops 24 ,, Coffee 26 „ Milk 29 Sickness, Noteworthy Causes of 8 Slaughterhouses 30 Slaughtermen 30 Smoke Abatement 25 Social Conditions 7 St. Charles' Hospital 42 St. John and St. Elizabeth, Hospital of 39 St. Marylebone & Western General Dispensary 18 „ Housing Association 28 St. Vincent de Paul Day Nursery 20 Staff 5, 6, 17 Stalls, Food 31 Statistics, General 7 „ Infectious Disease 35, 36 ,, Maternity and Child Welfare 19 „ Refuse Collection 23 „ Tuberculosis 39-42 Vital 7, 13, 14 „ Vaccination 37, 38 Statutory Notices 24, 27, 28 Stillbirths 7, 9, 11 Street Cleansing 23 Suicide 15 Supply of Milk and Food (to Mothers and Children) 20 Swimming Baths 25 Syphilis 15 Tabes Dorsalis 15 Tea Rooms, Restaurants, etc. 26, 31 Tenement Houses 22 „ „ Water Supply 22 Tinned Cream 34 Town Hall Extension 3 Transportation of Bodies Abroad 16 47 INDEX—continued. page Treatment Centres and Clinics 18 „ of Tuberculosis 41 Tuberculin Tested Milk 29 Tuberculosis Care Committee 42 ,, Compulsory Removal 39 „ Consultants 42 „ Deaths 12, 15 „ Extra Nourishment 42 „ Home Nursing 17 „ Military Training 42 ,, New Cases and Mortality 39, 40 ,, Notifications 35, 36, 40, 41 „ Prevention of . 42 ,, Pulmonary and Milk Trade 39 „ Respiratory System 15 „ Treatment of 41 Underground Bakehouses 31 „ Rooms 27 page Unemployment 7 Unsound Food 30 Vaccination 37, 38 Vermin 25 Verminous Persons, Cleansing of 25 Vital Statistics 7, 13, 14 Water 22 „ Supply cut off 22 „ Closets 22 Wells, Private 22 Western General Dispensary, St. Marylebone and 18 Whooping Cough 8, 11, 12, 15, 35, 36, 37 Zachary Merton Convalescent Home 20 Zoological Society of London 30