AC. 435B STMARY 45 Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1940 H. A. BULMAN, M.R.C.S., D.P.H. London: Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Lewisham Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1940 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 1940. In view of paper shortage the report is brief, but contains all necessary statistical and other information on essential matters. Health conditions continued to be satisfactory and there are no untoward happenings to record in this respect. The increase in the death rate is partly accounted for by deaths due to enemy action which are included in the classification of deaths under "Other violent causes." A note on the civil defence activities of the Department is, for the first time, included in this report. An outstanding feature of the year was the completion of the Town Hall Extension, in which the Public Health Department, including Health Centre No. 1, is now housed. The offices were transferred from the Town Hall to the new building on the 20th April, 1940, and Health Centre No. 1 (which comprises maternity and child welfare and various auxiliary clinics and a tuberculosis dispensary) removed from temporary accommodation at the Old Baths Establishment, Marylebone Road, to its new quarters on the 24th April, 1940. My grateful thanks are due to the Chairman (Councillor Dr. C. A. Fuller) and members of the Public Health Committee for the kindness, consideration and encouragement they gave me throughout the year. To the staff my obligations are too numerous to mention individually, but to every member I acknowledge my great indebtedness. War conditions have made new and unprecedented demands on the Department, and these additional burdens and responsibilities, involving duty by night as well as by day, have been shouldered with commendable willingness, resourcefulness and efficiency. I desire also to express appreciation of the valuable assistance rendered by the Local Medical War Committee through whose co-operation the services of a large number of medical practitioners in the Borough have been made available for various branches of the Council's civil defence scheme. Other organisations—notably the British Red Cross Society and the St. John Ambulance Association—who have been closely connected with the local casualty services since their inception have been unsparing in the help they have given to the Council, and to these bodies my gratitude is warmly extended. Finally, tribute must be paid to the citizens of the Borough. By their co-operation and by the courage and fortitude they have displayed, often under the most trying circumstances, the work of the Department has been assisted in many ways, difficulties have been surmounted, and a fuller use of the manifold services provided by the Council in war-time made possible. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. A. BULMAN, Medical Officer of Health. 4 CONTENTS. page Members of the Public Health Committee 5 Staff of the Public Health Department 5 Civil Defence 7 Section A—Statistics and Social Conditions 8 Section B—General Provision of Health Services 16 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 Health Propaganda 43 Index 44 5 PUBLIC HEALTH COMMITTEE. (who are also the Committee appointed for Maternity and Child Welfare purposes.) 1940. HIS WORSHIP THE MAYOR. Councillor A. Douglas Waite, J.P., F.A.I. Councillor Douglas Timins, J.P., O.B.E., M.A. (from November, 1940). ALDERMEN. R. Stiles Allen, D.L. J. Fettes, J.P. (resigned April, 1940). COUNCILLORS. Rev. Michael Adler, D.S.O., B.A. Dr. Elizabeth Jacobs. (resigned July, 1940). Capt. Gerald Lowry. Miss M. Barry. Miss Joyce Marsh. F. V. Cullen, F.S.I., F.A.I. G. B. Ramsay. Mrs. E. B. Davis. T. W. Robinson, A.C.A. Dr. C. A. Fuller (Chairman). H. Norman Toomey, L.D.S., R.C.S. L. W. Hammond (fromApril, 1940). Capt. Robert Whitney, M.B.E. Capt. C. Hargreaves. (from October, 1940). Mrs. M. G. Harris. Mrs. Carr Q. Henriques. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health, Vaccination Officer, and Medical Referee for Cremation: H. Allen Bulman, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. Tuberculosis Officer and Assistant Medical Officer of Health: *Murdoch MacGregor, M.D., Ch.B., D.L.O., D.P.H. Assistant Medical Officer of Health for Maternity and Child Welfare purposes, and Deputy Medical Referee for Cremation: W. H. S. Wallace, M.D., B.S., D.P.H. Public Vaccinators. North Marylebone District: C. R. McClure, M.R.C.S., L.R.C.P. Mobilised 29th January, 1940. Deputy—J. L. Boyd, M.R.C.S., L.R.C.P. South Marylebone District: J. L. Boyd, M.R.C.S., L.R.C.P. Queen Charlotte's Hospital: W. H. S. Wallace, M.D., D.P.H. Middlesex Hospital: L. E. H. Whitby, C.V.O., M.C., M.A., M.D., F.R.C.P., D.P.H. Mobilised September 1939. Deputy—C. J. C. Britton, M.D., 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., F.R.C.P., D.P.H. Mobilised September, 1939. Acting Bacteriologist (Part time): C. J. C. Britton, M.D., D.P.H. Dental Surgeon (Part time): J. Arthur Smith, L.D.S., R.C.S. (Eng.), resigned 31st May, 1940. Leslie J. Godden, L.D.S., R.C.S. (Eng.)—from 4th June, 1940. Chiropodist (Part time): Miss Margaret Percy, M.L.I.Ch. 6 Clerical Staff. A. H. James (Chief Clerk). H. G. E. Brown: C. D. Turbayne. D. H. Drewell, mobilised 1st Sept., 1939. R. G. Turner, mobilised 1st Sept., 1939. S. P. Fleming. M. Kelly, joined Royal Air Force Volunteer Reserve, 17th April, 1940. C. N. F. Downs. J. H. Manning—temporary (from 30th April, 1940). Miss S. L. Pritchard. One Temporary Male Clerk. †Miss K. M. M. Kelleher. †Miss B. Wray. †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. Miss I. M. L. Bell—temporary (resigned 17th August, 1940). Miss F. L. Brown—temporary (from 19th August, 1940). *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 (b, 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; retired 31st July, 1940. M. F. G. Randall (c)—temporary. *District Sanitary Inspectors—contd. J. Calderbank (c, d)—temporary (transferred to permanent staff 1st November, 1940). *Drainage Inspectors. F. C. Cook (b, d). W. H. Draper (a, b, d). *Outdoor Superintendent. P. H. Hill (a, b, d). * Woman Sanitary Inspector. Miss M. McA. Sharp (c,f, g, h, i). * Woman Sanitary Inspector and Health Visitor. Miss C. E. Durant (b,f, 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. M. Oldfield (f, g, h, i)— temporary (from 12th August, 1940). Miss M. C. Stewart (f, g)—resigned 31st July, 1940. Part-time Health Visitors. Miss L. J. Donnell (b, f, i). Miss L. M. Hazel] (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—retired 14th May, 1940. Mrs. E. E. Spears (from 8th July, 1940). Mortuary Keeper. Mrs. E. E. Spears (until 7th July, 1940). Mr. F. Bushnall (from 8th July, 1940). *Tuberculosis Dispensary Caretaker. E. D. Marston. Disinfectors. W. J. Jones. F. Payne. Messenger. E. W. Broughton—joined Royal Air Force Volunteer Reserve, 28th June, 1940. *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 CIVIL DEFENCE. The war imposed upon the Public Health Department numerous additional and unfamiliar tasks, and in 1940 these increased in number and variety. During the course of the year many of these duties took on a closer relationship to the public health, more particularly in connection with the new problems created by large numbers of the inhabitants resorting to public air-raid shelters. For this reason alone it is not inappropriate that a brief note of this side of the Department's work should be included in a report on the health of the Borough. The following list gives some indication of the more important of these war-time activities:— First aid posts—fixed and mobile. Anti-gas cleansing centres. Stretcher party organisation. Food decontamination. Emergency mortuaries. Air-raid shelter sanitation. Medical aid posts at shelters. Vermin disinfestation of shelters and bedding. Diphtheria immunisation in shelters. Typhoid fever inoculation. Examination, for chest conditions, of recruits for H.M. Forces. Damaged foodstuffs disposal. Medical supervision of rest centres and hostels. Maternity and child welfare for refugees. Emergency water supply distribution. Private water supply examinations. Contaminated water purification. War-damaged property inspections. Damaged drainage investigations. Evacuation of young children, expectant mothers and infirm and aged persons. Refuges for children lost in air raids. Health and war-time propaganda in shelters and elsewhere. Report and Control Centre duties. The great amount of administrative work associated with these functions, together with the recruitment of personnel for the casualty services, arrangements for training in first-aid for the whole of the Council's Civil Defence organisation, and the provision and maintenance of transport, stores and equipment for the services generally, have been carried out by the permanent officers of the Department with the assistance of temporary clerical staff. From time to time it has been found necessary, in the light of experience under working conditions, to modify or extend certain services. During the year several such changes took place, and improvements in the organisation and development of the branches of Civil Defence for which the Department is responsible were effected. 8 SECTION A.—STATISTICS AND SOCIAL CONDITIONS. GENERAL STATISTICS. Area of Borough: (a) exclusive of area covered by water, 1,427.8 acres ; (b) including area covered by water, 1,473 acres. Resident population : 1921 census—104,173; 1931 census—97,620. Registrar-General's estimate of civilian population: 1940—62,240. 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, £3,537,820. Sum represented by a penny rate (1939), £13,974. SOCIAL CONDITIONS AND CHIEF INDUSTRIES. St. Marylebone is mainly a residential area occupied to a great extent by the professional classes. Hotel and catering businesses constitute the largest single industry, while the chief trades, carried on almost entirely in the southern part of the Borough, are tailoring, dressmaking and millinery. UNEMPLOYMENT. The compilation of unemployment statistics under local authority areas was suspended by the Ministry of Labour and National Service at the outbreak of hostilities. Consequently, it is not possible to give information, included in previous reports, as to the number of insured persons resident in the Borough recorded at employment exchanges as unemployed. During the year under review, however, there was a considerable improvement in the employment situation in London generally and this resulted in an exceptionally heavy fall in the number of persons registered for employment at the local and other exchanges of the Ministry. EXTRACTS FROM VITAL STATISTICS. Live Births— Total M. F. Legitimate 449 235 214 Birth Rate per 1,000 estimated civilian population 8.52 Illegitimate 81 36 45 Stillbirths 15 Rate per 1,000 total (live and still) births 27 Deaths (all ages) 1,223 Death Rate per 1,000 estimated civilian population 18.07 Deaths from Puerperal causes— Deaths. Rate per 1,000 total (live and still) births Puerperal Sepsis — — Other Puerperal causes 1 1.98 Total 1 1.98 Death Rate of Infants under one year of age— All infants per 1,000 live births 67.07 Legitimate infants per 1,000 legitimate live births 60.68 Illegitimate infants per 1,000 illegitimate live births 100.00 Deaths from Cancer (all ages) 155 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years) 4 The various causes contributing to the mortality of the Borough are referred to later in this section of the report. Apart from deaths due to enemy action, there was no unusual or excessive mortality during the year which calls for comment. 9 NOTEWORTHY CAUSES OF SICKNESS. The Ministry of Health require information as to any causes of sickness or invalidity which have been specially noteworthy in the area during the year; any conditions of occupation or environment which appear to have had a prejudicial effect on health; and any evidence, statistical or otherwise, that unemployment has exercised any significant influence on the health or physique of children or adults. There is nothing to report in respect of any of the questions raised by the Ministry under this head. POPULATION. The civilian population of the Borough for the year 1940, as estimated by the Registrar-General, is 62,240, and this figure is used in calculating the various rates given in this report. Owing to abnormal fluctuations in movements of population throughout the Borough as a result of the war, and the consequent inability to present figures with any degree of accuracy, it has been decided reluctantly to discontinue for the time being certain tables of vital statistics, relating to the four sub-districts of St. Marylebone, which have been a feature of these reports for many years. For information, the sub-district populations at the last census year (1931) were as follow : All Souls, 22,380; St. Mary, 25,667; Christ Church, 29,636; St. John, 19,937 ; giving a total population of 97,620 for the Borough for that year. BIRTHS. Registration.—The number of births registered during 1940 was 530, being 307 less than in 1939. Of the children born, 271 (235 legitimate; 36 illegitimate) were boys and 259 (214 legitimate; 45 illegitimate) girls. The birth rate per 1,000 of the population was 8.52 as against 9.06 in 1939. Notification.—The total number of notifications received during the year, under the Public Health (London) Act, 1936, Section 255, was 1,838; live births, 1,767; stillbirths, 71. The total notifications in 1939 was 3,177. 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 11 ,, midwives 88 „ hospitals, nursing homes, etc. 1,735 1,838 Of the total births notified, 984 took place at Queen Charlotte's Hospital; 320 at Middlesex Hospital; 163 at Paddington Hospital; and 120 were born at home. Of those notified as having occurred in St. Marylebone, 1,366 belonged to other Boroughs. Of the 71 stillbirths (39 males and 32 females) notified direct to the Department, 7 (5 males and 2 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 15—10 males (8 legitimate; 2 illegitimate) and 5 females (3 legitimate; 2 illegitimate). MARRIAGES. The total number of marriages in the Borough during the year was 1,495, being 410 below the number for 1939, and 4 above the average for the last 10 years. The rate for persons married in 1940 was therefore 48 per 1,000 of the estimated civilian population. DEATHS. Registration.—The number of deaths registered in 1940 was 1,223. 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 10 ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures if they occur in the Borough. Applying the Registrar-General's areal comparability factor (1939) of 0.92, the corrected death-rate per 1,000 of the population was 18.07. In the previous year, the rate was 12.62 and the number of deaths 1,046. Causes of and ages at Death.—Information with regard to the deaths which occurred in the Borough during the year, mainly as to causes, the ages at which death took place, and the distribution of the deaths among the several Registration Sub-districts, is given in Table 5, on page 14. This Table conforms to the new classification of deaths by cause, which is based upon the Fifth Decennial Revision by the International Commission, and is to be used, on the authority of the RegistrarGeneral, during the ten-year period commencing 1st January, 1940. It will be noted that deaths from road traffic accidents are shown separately for the first time. 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 609. 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 1940 was 33 and the number of births allocated by the Registrar-General for the calculation of infantile and maternal mortality rates in that year, 492. The infantile mortality rate is therefore 67.07. The Registrar-General's figure for legitimate births was 412 and the deaths amongst legitimate infants numbered 25, giving a rate of 60.68. There were 80 illegitimate births and 8 deaths, the rate being 100.00. In 1939 the death-rate for all infants per 1,000 live births was 60.64. 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 1 shows, in addition to the causes of infantile mortality, the distribution of the deaths according to age and locality. 11 TABLE 1. 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 1 Small-Pox — — — — — — — — — — — — — — — 2 Chicken-Pox — — — — — — — — — — — — — — — 3 Measles — — — — — — — — — — — — — — — 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Diphtheria and Membranous Croup — — — — — — — — — — — — — — — 6 Whooping Cough — — — — — — — — — — — — — — — 7 Diarrhœa 1 — 1 1 3 — — 1 — 4 1 1 1 1 4 8 Enteritis — — — — — — — — — — — — — — — 9 Tuberculous Meningitis — — — — — — — — — — — — — — — 10 Abdominal Tuberculosis — — — — — — — — — — — — — — — 11 Other Tuberculous Diseases — — — — — — 1 — — 1 — 1 — — 1 12 Congenital Malformation 4 — — — 4 1 — — — 5 — 3 1 1 5 13 Premature Birth 8 —. — 1 9 1 — — — 10 2 3 3 2 10 14 Atrophy, Debility and Marasmus — — — — — 1 — — — 1 — — 1 — 1 15 Atelectasis — — — — — — — — — — — — — — — 16 Injury at Birth 2 — — 1 3 — — — — 3 1 1 1 — 3 17 Erysipelas — — — — — — — — — — — — — — — 18 Syphilis — — — — — — — — — — — — — — — 19 Rickets — — — — — — — — — — — — — — — 20 Meningitis (not tuberculous) — — — — — — 1 1 — 2 — — 2 — 2 21 Convulsions — — — — — — — — — — — — — — — 22 Gastritis — — — — — — — — — — — — — — — 23 Laryngitis — — — — — — — — — — — — — — — 24 Bronchitis — — — 1 1 — — — — 1 — 1 — — 1 25 Pneumonia (all forms) — — — 1 1 2 1 — — 4 — 2 2 — 4 26 Suffocation, overlying — — — — — — — — — — — — — — — 27 Other Causes — — 1 — 1 — 1 — — 2 — 1 1 — 2 Totals 15 — 2 5 22 5 4 2 — 33 4 13 12 4 33 M. F. M. F. M. F. Nett Births in the Year Legitimate, 215 197 Nett Deaths in the Year Legitimate Infants, 15 10 Nett Still births in the Year Legitimate Infants, 7 3 Illegitimate, 35 45 Illegitimate Infants, 4 4 Illegitimate Infants, 2 2 Total 250 242 Total 19 14 Total 9 5 492 33 14 12 MATERNAL MORTALITY. In 1940 the number of deaths due to conditions connected with or consequent upon child-birth was 1, the maternal mortality rate being 1.98 per 1,000 births. The death occurred at home, the age of the mother being 32 years. The child 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 1939 there was 1 death, the death-rate being 1.22 per 1,000 births. DEATHS IN RELATION TO DISEASE. 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 4, giving a rate of 0.06 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1940 this was the case also, all being children under one year of age. In 1939, the number of deaths from diarrhoeal diseases was 10. All were babies. Infectious (Communicable) Diseases.—Excluding influenza, which caused 11 deaths, and including diarrhoea, etc. (4 deaths) the total number registered as due to infectious diseases was 11. Of these deaths, 1 was caused by diphtheria, 1 by measles, and 5 by cerebro-spinal fever. In 1939,13 deaths were caused by infectious diseases, excluding influenza which caused 14 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 42, 62 being recorded in 1939. The great bulk of the 42 deaths, viz., 34, giving a death-rate of 0.67 per 1,000 of the population, was due to phthisis. The number in 1939 was 57, with a death-rate of 0.69. 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 171. This is higher by 77 than the figure (94) for 1939. The death-rate was 2.75 per thousand. In 1939 the rate was 1.14. The number of deaths certified to be due to bronchitis was 88. Of this number 70 were amongst persons aged 65 and upwards, and 17 amongst those of the group 45-65. The deaths traceable to pneumonia numbered 65 and, as in the case of bronchitis, the later age-groups contributed the greatest numbers. Four were infants of under one year of age. Cancer or Malignant Disease.—The number of deaths due to cancer was 155 and the death-rate 2.49 per 1,000 of the population. The figures for 1939 were 139 and 1.69 per 1,000 respectively. Information with regard to the age at which death occurred and the situation of the disease is given in Tables 2 and 3. 13 TABLE 2. Cancer : Ages at Death. Ages. Under 1. 2 and under 5. 5 and under 15. 15 and under 45. 45 and under 65. 65 and upwards. Total. Males — — — 5 32 42 79 Females — — — 6 37 33 76 Totals — — — 11 69 75 155 TABLE 3. Cancer : Situation of the Disease. Parts of the body affected. Males. Females. Totals. Buccal Cavity and Oesophagus (males only) 12 — 12 Uterus — 6 6 Stomach and Duodenum 15 9 24 Breast — 21 21 Other sites 52 40 92 Totals 79 76 155 TABLE 4. Vital Statistics for 1940 and Ten Previous Years. Year 1 Population estimated to middle of each Year 2 Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Uncorrected 3 Nett of Nonresidents registered in the District 8 of Residents not registered in the District 9 Under 1 year of Age At all Ages No. 4 Rate S No, 6 1 Rate 7 No. 10 Rate per 1,000 Nett Births 11 No. 12 Rate 13 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 1936 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 1940 t62,240 1,616 530 8.5 1,036 15.3 521 708 33 67.1 1,223 18.1 *The estimated average population appropriate to the calculation of death-rates for the year 1939 was 82,040. †Estimated civilian population. Total population at all ages at Census of 1921, 104,173. „ „1931, 97,620. 14 TABLE 5.—Causes of, and Ages at Death during the Year 1940. No. CAUSES OF DEATH. Nett deaths at the sub-joined ages of "Residents" whether occurring within or without the Borough. Deaths 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 Residents Nonresidents 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — — 2 Cerebro-spinal fever 5 1 1 — — — 1 1 i — 1 1 2 1 1 5 3 Scarlet fever — — — — — — — — — — — — — — — — 4 Whooping cough — — — — — — — — — — — — — — — — 5 Diphtheria 1 — — 1 — — — — — — — — 1 — — 1 6 Tuberculosis of respiratory system 34 — — — — 9 11 11 3 — 2 6 6 18 4 34 7 Other forms of tuberculosis 8 1 — — — 1 4 1 1 1 2 1 5 1 1 8 8 Syphilitic disease 12 — — — — — 3 3 6 1 — 2 5 3 2 12 9 Influenza 11 — — — — — 3 4 4 1 2 1 5 2 3 11 10 Measles 1 — — 1 — — — — — — — — — 1 — 1 11 Acute poliomyelitis and polioencephalitis — — — — — — — — — — — — — — — — 12 Acute infectious encephalitis — — — — — — — — — — — — — — — — 13m Cancer of buccal cavity and oesophagus (males only) 12 — — — — — — 4 8 1 9 1 8 2 1 12 13f Cancer of uterus 6 — — — — — — 4 2 — 12 1 1 1 3 6 14 Cancer of stomach and duodenum 24 — — — — — 2 11 11 2 15 1 6 9 8 24 15 Cancer of breast 21 — — — — — 2 11 8 — 7 5 4 10 2 21 16 Cancer of all other sites 92 — — — — — 7 39 46 6 76 19 19 37 17 92 17 Diabetes 7 — — — — — — 2 5 — 1 1 2 2 2 7 18 Intra-cranial vascular lesions 72 — — — — 1 1 17 53 — 20 11 28 20 13 72 19 Heart disease 285 — — — — — 4 43 238 18 71 42 125 78 40 285 20 Other diseases of the circulatory system 37 — — — — — 1 11 25 2 9 7 10 12 8 37 21 Bronchitis 88 — — — — — 1 17 70 3 3 15 26 24 23 88 22 Pneumonia 65 4 — — 1 1 4 8 47 4 18 13 29 14 9 65 23 Other respiratory diseases 18 — — — — 1 1 5 11 — 1 4 4 5 5 18 24 Ulceration of the stomach or duodenum 22 — — — — 1 3 8 10 4 6 4 6 6 6 22 25 Diarrhoea (under 2 years of age) 4 4 — — — — — — — — — 1 1 1 1 4 26 Appendicitis 6 — — — — — 2 4 — 2 8 1 — 2 3 6 27 Other digestive diseases 19 — — — — — 3 8 8 4 15 2 6 9 2 19 28 Nephritis 25 — — — — 1 — 10 14 2 12 4 7 10 4 25 29 Puerperal and post-abortive sepsis — — — — — — — — — — — — — — — — 30 Other maternal causes 1 — — — — — 1 — — — 3 — — 1 — 1 31 Premature birth 10 10 — — — — — — — 5 37 2 3 3 2 10 32 Congenital malformations, birth injury, infantile disease 8 8 — — — — — — — — 6 1 4 2 1 8 33 Suicide 19 — — — — — 9 6 4 8 6 6 4 4 5 19 34 Road traffic accidents 10 — — — — 1 2 3 4 2 4 1 3 5 1 10 35 Other violent causes 217 3 1 4 10 26 59 62 52 23 112 50 67 74 26 217 36 All other causes 83 2 — — — 5 6 14 56 3 59 8 30 31 14 83 Totals 1,223 33 2 6 11 47 130 307 687 92 517 211 417 388 207 1,223 15 MORTUARY. Forty-one bodies (26 males, 15 females) were deposited, and 12 post-mortem examinations carried out at the mortuary during the year. From the 18th October, 1940, when the premises were destroyed by enemy action, accommodation for the bodies of St. Marylebone residents was secured, through the courtesy of the Paddington Borough Council, at the Public Mortuary, St. Philip's Place, Paddington Green, W.2. Temporary living quarters for the Mortuary Keeper were provided in a cottage at No. 7, Elm Tree Road, St. John's Wood, N.W.8, as from the 20th November, 1940. CREMATORIUM. One hundred and sixty-two certificates authorising cremation at the St. Marylebone Crematorium, Finchley, were issued—134 by the Medical Referee and 28 by the Deputy Medical Referee. 16 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 and two retirements are recorded. Miss C. M. L. Kilgallin, having reached the age limit, retired on the 14th May, 1940, after 44 years' service with the Council, the greater part of it as Matron of the old Shelter House and Cleansing of Persons Baths at what was formerly No. 27, Grove Road, upon the site of which Health Centre No. 2 was erected in 1937, Miss Kilgallin being appointed the first Matron-Housekeeper. After 43 years in the local government service (30 with the St. Marylebone Borough Council), Mr. A. S. Wilson, Sanitary Inspector, retired for health reasons as from the 31st July, 1940. To both these officers the Council expressed their appreciation of the long period of devoted service which they had rendered in connection with the public health work of the Borough. LABORATORY FACILITIES. Dr. L. E. H. Whitby, C.V.O., M.C., is the Council's Bacteriologist, but during his absence on military duties, Dr. C. J. C. Britton, Assistant Pathologist, Middlesex Hospital, has acted in that capacity. 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.1. A report on the work done during 1940, together with a statement of food and drugs analysed, will be found on pages 30—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 cases. The ambulances of the County Council may also be utilised, on payment, for private and non-infectious cases. NURSING IN THE HOME. The Paddington and St. Marylebone District Nursing Association continue to provide adequate nursing services in the home under an arrangement made with the Council. Table 6 gives full particulars of the work carried out in 1940. TABLE 6. Home Nursing Service. Condition. No. of cases nursed. No. of visits paid. Maternity 22 347 Influenza 15 76 Pneumonia 9 130 Tuberculosis 6 81 Measles or German measles 3 21 Miscellaneous 18 144 17 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 two health centres:— No. 1. Accommodated temporarily at the Old Baths Establishment, No. 181, Marylebone Road, during the early part of the year. On the 24th April, 1940, the Centre was transferred to the new Town Hall Extension, and comprises a tuberculosis dispensary (with X-ray plant), maternity and child welfare and various auxiliary clinics, and a diphtheria immunisation clinic. No. 2. At No. 217, Lisson Grove, with provision for maternity and child welfare clinics and auxiliary services of various kinds, including dental treatment, light therapy and massage. 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. There are no municipal hospitals in the Borough. St. Marylebone is, however, fortunate in the number of voluntary hospitals and dispensaries of various kinds situated within its boundaries, and to these cases from the welfare centres are referred as and when necessary. The Middlesex Hospital is available for ante-natal and complicated maternity cases and so also was Queen Charlotte's Hospital until the 19th September, 1940, when the in-patients were transferred from the old Marylebone Road building to the new hospital in Goldhawk Road, Hammersmith. Nursing homes in the Borough number 35. MATERNITY AND CHILD WELFARE. A normal service was provided throughout the year and full advantage was taken of the facilities available at all centres, at each of which a health visitor acts as superintendent. Table 7 gives an account of the work done during 1940. In addition to the centres named in this table, consultations are held weekly at the St. Marylebone and Western General Dispensary. 18 TABLE 7. Work of the Infant Consultations and Other Clinics. Centre. Health Centre No. 1. Health Centre No. 2. Queen Charlotte's Hospital. The Middlesex Hospital. No. of Consultations held:— Infants 140 204 105 158 Toddlers — — — 43 Maternity 33 51 347 167 Massage 26 71 — — Light 28 54 — — No. of attendances of mothers at clinic:— Ante-natal 108 439 9,841 (527) 2,983 (216) Post-natal 3 16 855 (70) 106 (1) No. of attendances of babies 1,514 1,739 1,142 (702) 1,581 (685) No. of attendances of children over one year 1,302 1,852 517 (327) 1,838 (598) No. of attendances at Light Clinic: Infants 62 6 — — Toddlers 420 332 — — No. of attendances at Massage Clinic:— Infants 12 — — — Toddlers 118 563 — — No. of Orders issued for milk 349 598 162 85 No. of Home Visits 976 1,923 104 2,343 No. of new cases:— Infants 83 123 72 (34) 115 (35) Toddlers 55 40 4 (4) 21 (8) Ante-natal 40 101 1,688 (102) 363 (32) Post-natal 1 14 626 (43) 32 (-) Massage Infants 3 — — — Toddlers 39 18 — — Light Infants 14 2 — — Toddlers 54 12 — — 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 four 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. * The number of visits paid during the year by all health visitors was as follows: (a) to expectant mothers, first visits, 249, total visits, 426; (b) to children under 1 year of age, first visits, 228, total visits, 1,854; (c) to children between the ages of 1 and 5 years, total visits, 3,575. 19 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 3,905½ gallons (liquid) and 1,502 pounds (dried). The amount expended was £728 17s. 9d., as against £1,289 9s. 3d. in 1939. The number of cases dealt with was 205, and the number of orders issued 1,095, showing a decrease over the figures for 1939, when the cases numbered 478 and the orders 2,914. This decrease is accounted for by the fact that, as from the 1st August, 1940, the National Milk Scheme, administered by the Ministry of Food through Milk Officers attached to local Food Offices, came into operation. Under this scheme, one pint of milk daily is made available to all expectant and nursing mothers and young children, normally at a price of 2d. per pint, but in necessitous cases free of charge, and there is no obligation on the part of mothers or children to attend a maternity and child welfare centre. The Milk Officer received the full co-operation of the Public Health Department in the inauguration of the new scheme and in ensuring its subsequent smooth working. Later, when national dried milk became available, the Milk Officer was assisted by the Department in organising its distribution to mothers and children. The Food Executive Officer has kindly provided the following information as to milk supplied under the National Scheme from its inception (1st August, 1940) to the 29th December, 1940:— Liquid Milk. Dried Milk. Free 5,309¼ gallons. Free 70 cartons. At 2d. per pint 8,454i „ At l/2d. per *carton 54 „ Total 13,7633/8 „ Total 124 *Contains 1¼lbs., equivalent to approximately 8 pints of liquid milk. The Council's arrangements for the supply of milk under maternity and child welfare powers remain in force to meet the needs of those who, on medical grounds, require the milk provided under the national scheme to be supplemented or replaced by a modified milk product. The Council have also made arrangements for the supply of dinners at certain voluntary centres to expectant and nursing mothers and young children but no advantage was taken of this service during 1940. Mention should, however, be made of the communal feeding centres which have been established in various parts of the Borough since the outbreak of war and to which large numbers of the inhabitants, in general, resort. Clothing, etc. During the winter months particularly, mothers and children evacuated from the Borough were supplied with clothing and footwear despatched from a depot established by the Department. Reception authorities were invited to send lists of their requirements, and parcels were sent to all areas from which requests for assistance were received. 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. No home helps were provided during the year. 20 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 child protection visitors and made a total of 65 inspections. 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. Minor Ailments. Children suffering from minor ailments were treated at the London County Council clinic at Health Centre No. 2. Dental Treatment. By arrangement, certain sessions at the Dental Clinic of the London County Council at Health Centre No. 2 are set aside for the inspection and treatment of mothers and children under the maternity and child welfare scheme of the Borough Council. Table 8 contains statistics for the year 1940. TABLE 8. Work of the Dental Clinic. Attendances—mothers 455 „ children 100 Cases receiving advice and treatment 417 Extractions under gas—mothers 119 „ „ „ children 17 Dentures provided at cost price—full 7 „ „ „ „ „ partial 7 Actinotherapy. At Health Centre No. 1, transferred to the new Town Hall Extension, the installation of the artificial sunlight equipment, consisting of 12 wall lamps and 1 centralised lamp, with control cabinets in an adjoining room, was completed on the 22nd May, 1940. Table 7 shows the number of children who received treatment during the remainder of the year. Child Guidance. Early in the year the Dorset Clinic for the psychological treatment of children was established at No. 18, Dorset Square, N.W.1, by a voluntary organisation closely in touch with the London County Council. The clinic was conducted by Dr. R. L. Moody, a well-known psychologist, and afforded facilities similar to those provided at the child guidance clinic which functioned at Health Centre No. 2 until the outbreak of war. The Borough Council were invited to refer to the clinic from the infant welfare centres any difficult or maladjusted children or those with behaviour problems who would be likely to benefit from the specialised treatment available. Unfortunately, the premises were damaged by enemy action, but during the few months that the clinic was able to remain open, advantage of the offer was taken in two cases. 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. 21 Maternity Cases. Accommodation for maternity cases was available within the borough at Queen Charlotte's Hospital (until 19th September, 1940) and the Middlesex Hospital, and also at the Paddington Hospital of the London County Council. 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 Plying 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. During the very cold weather in January and February, 29 written complaints and a large number of verbal complaints were received regarding absence of water, mainly as a result of burst pipes. Stand-pipes were erected by the Metropolitan Water Board in various parts of the Borough, and a normal service was resumed as soon as the numerous repairs were carried out. During the remainder of the year complaints were few and all were dealt with satisfactorily. In October and November it was found necessary, owing to damaged mains as a result of enemy action, to assist the Water Board by arranging for emergency supplies to be drawn from the nearest available point and transported in the Council's vehicles to the areas affected, where the water was made conveniently accessible to residents needing it. Water Supply cut off. In accordance with the provisions of the Public Health (London) Act, 1936, section 98 (1), the Metropolitan Water Board are required to notify the local authority of instances where water has been cut off in occupied premises. No such notification was received during 1940. Water Supply in Dwelling Houses. One certificate was granted under section 95 (2) of the Public Health (London) Act, 1936, in respect of a new block of flats which included a rebuilt public house. The number in 1939 was 3. In 4 instances intimation notices were served, calling for the provision of a supply of water to the upper storeys of tenement houses, as required by section 95 (5) of the Public Health (London) Act, 1936. The supply was provided in all cases after receipt of an intimation notice. A bye-law of the Council requires that storage cisterns shall be emptied and cleansed every six months. During the year 9 notices were served in regard to defects in cisterns and the need for cleansing. DRAINAGE. The number of drainage plans of new premises deposited and approved during the year was 13 (northern district, 7; southern district, 6), and of old buildings, 46 (northern district, 18; southern district, 28). Inspections made by the Drainage Inspectors numbered 1,022 (northern district, 371 ; southern district, 651). Combined Drainage. Orders under seal as to combined drainage were issued in respect of 2 premises. CLOSET ACCOMMODATION. In Table 9 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. Chemical closets were commonly installed in public air-raid shelters when these were first constructed, but this type of sanitary convenience has now largely been replaced by the water-closet. 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 provided for the use of males; the women inspectors, especially Miss Sharp, supervising those provided for females. Two of the men's public conveniences, closed at the outbreak of war, were re-opened on the 1st January, 1940. 23 PUBLIC CLEANSING. House refuse and salvage collections, refuse 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 and Salvage Collections. All premises in the Borough are visited at least twice weekly, the first call being made for the collection of house refuse, and the second for salvage to be used for war purposes. Much valuable raw material has been obtained in this way. In addition, at premises in over sixty streets scheduled for collection from the "kerb" a thriceweekly collection of house refuse and salvage is carried out. During the year 35 intimation notices and 4 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, and are collected on alternate days 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 in side-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 day 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. Night cleansing is performed if and when required. Gully cleansing is carried out by means of three entirely enclosed mechanicallyoperated gully emptying 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 1940 were:— House and trade refuse 27,511¼ tons. Salvage materials 1,407¾ ,, Street sweepings and gulley slop 3,797¾ ,, A sum of £4,449 18s. ld. was obtained from the sale of salvage materials. In addition, £824 1s. 0d. 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, more particularly as to the provision of proper receptacles, etc., are complied with. 24 SANITARY INSPECTION. Complaints. The total number of complaints received was 1,298 as against 1,387 in 1939. Details of the various nuisances detected and remedied, to the total number of 1,850, are set out in Table 9. TABLE 9. Nuisances Detected and Remedied. Nature of Nuisance. Districts. The Borough. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. Houses damp, dirty or dilapidated remedied 18 66 124 39 73 52 372 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired 10 56 41 29 54 24 214 Verminous rooms disinfested 3 20 26 17 8 18 92 Dirty and verminous furniture and bedding cleansed - - 7 14 8 17 46 Overcrowding abated — 3 18 — 2 — 23 Underground rooms (illegal occupation) dealt with 1 — — — — — 1 Water closet defects remedied 7 46 76 16 18 28 191 Insufficient and unsuitable water closet accommodation remedied — 1 17 1 11 2 32 Urinal defects remedied 4 — — — 1 — 5 Drains and water closet stoppages cleared 1 5 3 8 13 19 49 Drains relaid or amended 1 5 3 1 8 3 21 Soilpipes and ventilating shafts repaired or renewed — 9 5 — 5 6 25 Waste pipe defects remedied 5 14 6 4 3 11 43 Yard defects remedied 3 14 52 12 12 9 102 Wash-house defects remedied 2 8 46 13 10 6 85 Area defects remedied — 5 35 5 1 7 53 Basement defects remedied — — — — — — — Roofs and gutters repaired 10 33 65 17 21 47 193 Water supply to houses reinstated 1 5 1 — 7 3 17 Water supply laid on to upper storeys — 3 — — — 1 4 Water cistern defects remedied — 1 — 1 5 2 9 Dung or dust receptacles repaired or renewed — 12 4 4 4 11 35 Rubbish, manure, etc., accumulations removed — 24 11 15 15 31 96 Animal nuisances abated — — 3 — — 2 5 Rats and mice infestations dealt with 1 3 8 4 5 14 35 Bakehouses cleansed — — — — — — — Smoke nuisances abated — — — — 2 5 7 Shops (insufficiently ventilated or heated) dealt with — — 6 3 4 1 14 Miscellaneous 5 20 12 2 23 19 81 Intimation Notices. In 323 cases the nuisances were abated by the persons responsbile 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 130 instances. Of this number, 112 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 water supply, and to other defects and conditions 25 Legal Proceedings. During the year legal proceedings in connection with nuisances wore instituted in respect of alleged infringements of the relative provisions of the Public Health (London) Act, 1936, London County Council Bye-laws and the Bye-laws of the St. Marylebone Borough Council, eleven separate premises being involved. The total number of summonses served was 111, and 45 abatement orders, three closing orders and one prohibition order, were obtained. The total fines imposed amounted to £56 and the costs awarded were £102 2s. 6d. SHOPS. During the period under review 111 shops were inspected. Fourteen informal notices, served in respect of contraventions of the provisions of the Shops Act, 1934, were complied with. SMOKE ABATEMENT. During the year, 119 observations were made and 13 complaints were received and dealt with. In each case the attention of the offender w as drawn to the matter. Seven 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. Six Council houses and 86 other houses where bugs were found wpre disinfested. CLEANSING OF VERMINOUS PERSONS. The numbers of adults and school children using the cleansing station during 1940 were 582 (387 males, 195 females) and 1,976 (690 boys, 1,286 girls) respectively. SHELTER. During 1940 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. Forty-six complaints were received in 1940, necessitating the inspection of 98 premises, 35 of which were found to be rat infested. Included in this latter number were 13 business premises (5 of these for the preparation or storage of food), 20 private or tenement houses and 2 vacant sites. In 5 of the cases investigated the infestation was directly attributable to defects in the drainage system, and the nuisance disappeared when repair or reconstruction was carried out. PIGS, HENS AND RABBITS. Under a Defence Regulation (No. 62B) the keeping of pigs, hens and rabbits is permitted on any land, notwithstanding any term to the contrary in any lease, tenancy or contract, provided that health is not prejudiced or nuisance caused. 26 PIGEONS. Five complaints of nuisance from these birds (four relating to private dwellings and one to a public building) were dealt with in 1940. The small number of complaints received may be attributed to a reduction in the pigeon population which, owing to the conservation of foodstuffs generally, may have migrated to other districts where natural food suppliee are more readily obtainable. FOULING OF FOOTWAYS BY DOGS. Breaches of the bye-law were detected by police officers in 5 cases, in 3 of which, following prosecution, convictions were secured and penalties imposed. The total number of prosecutions since the bye-law came into operation in 1928 is 295, the amount of fines imposed being £108 19s. Od. NOISE. During the year 18 complaints of noise were received, six relating to wireless loudspeakers, gramophones and similar instruments, two to machinery, two to dustbins, one to dogs, one to cats, one to a cockerel, one to street hawking, one to building operations, one to a bakery, one to a sawmill, and one to tenants of a flat. The issue of 7 notices was necessary to obtain a remedy of nuisance caused by wireless loudspeakers at 4 premises. In carrying out investigations into a number of complaints of disturbance from this cause it was claimed by the owners of certain types of factory, more particularly where girls are employed, that production is materially increased by the provision of broadcast music and that, indeed, the workers demand it as a relief from the monotony of watching machines or carrying out work of a repetitive nature. 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 104 at the end of 1940. 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 tho sale of poisons by a listed seller of Part II poisons. FACTORIES. The number of registered factories at the end of tho year was 1,213. In addition there were 288 restaurants, tea rooms, coffee shops, etc., and 34 bakehouses (25 underground). Frequent inspections were carried out, and defects were remedied in 46 instances (want of cleanliness 13; overcrowding 2; unreasonable temperature 11; inadequate ventilation 5; insufficient or unsuitable sanitary conveniences 15). Outworkers' lists were received from 67 employers relating to 100 contractors and 461 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. Reliable figures for the year under review are not available. 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) ... 1,253 (b) Number of inspections made for the purpose ... ... 3,435 (2) (a) Number of dwelling-housos (included under sub-heath (1) above) which were inspected and recorded under the Housing Consolidated Amendment Regulations, 1932 457 (b) Number of inspections made for the purpose 1,369 (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-housos (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 447 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 579 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 130 (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 Nil (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 8 (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:- It is not possible to give dependable statistics under this heading. There is, however, no doubt that, as a result of evacuation and other factors, overcrowding was considerably reduced during 1940. 28 HOUSING IN WAR-TIME. Since the outbreak of hostilities no steps have been taken by the Borough Council in regard to the provision of new housing accommodation or the making of clearance orders under the Housing Act, 1936. To conserve all available housing accommodation no orders have been made for the demolition of houses but 8 closing orders were made in respect of premises deemed to be unfit for human habitation. The Lilestone Housing Estate, erected by the London County Council, and the Wilcove Place and Salisbury Street Estates, built by the St. Marylebone Housing Association, suffered considerable damage as the result of enemy action. Families displaced from these estates and from other damaged working-class property were rehoused in flats and houses requisitioned under the Defence (Emergency) Regulations, 1939. A separate department of the Council was established to deal with all questions relating to the effects of war damage and the finding of alternative accommodation for persons whose homes had been destroyed. Hostels have been established to provide temporary refuge for these persons, pending the allocation of more permanent accommodation, and the Council have arranged for the medical supervision of these hostels and of the rest centres established by the London County Council. 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 them there must be compliance with certain requirements as to sanitation, cleansing, etc. During the year some 4,041 visits were paid to the 1,426 houses of the tenement type. The number of intimation notices served was 291, relating to cleansing and other defects. Except in 121 cases, where statutory notices were issued, all of these notices were complied with without the necessity for further proceedings arising. COMMON LODGING HOUSES. During 1940, 37 visits were paid by officers of the department to the two lodging houses 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. 29 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 follow : 1st Quarter, 26 ; 2nd Quarter, 55 ; 3rd Quarter, 23 ; 4th Quarter, 23, making a total for the year of 127. One sample was found to be adulterated. Bacteriological Examination of Milk. With a view of testing the purity of milk from the bacteriological point of view, 16 samples were taken and submitted to the Council's bacteriologist for examination. All were found to comply with the Ministry of Health standard. Dairies, Milkshops, etc. There are 162 premises upon which milk is sold. During the year 201 inspections were made with the object of discovering whether or not the requirements of the regulations as to cleanliness, etc., under the Milk and Dairies Order, 1926, were being complied with. In no case was it necessary to take action. k Milk (Special Designations) Orders, 1936 and 1938. During the year 36 applications under the Orders were received from 17 milk purveyors and licences were granted as follows : 1 pasteurising, 19 dealers and 3 supp'ementary in the case of pasteurised milk ; 1 bottling, 11 dealers and 1 supplementary in respect of tuberculin tested milk. Milk for School Children Scheme. In no case was an adverse report received from the Council's bacteriologist in regard to samples taken in connection with the scheme for the provision of milk to school children. MEAT AND OTHER FOODS. Food Inspection. The work of food protection continues to receive the closest attention. As for some years past, the main duties have been carried out by Inspector Smith, who made inspections of premises in which food is sold, stored or prepared, and acted as sampling officer under the Food and Drugs Act, 1938. During 1940, as formerly, the special Saturday night and Sunday inspections in market streets, etc., were made, and in carrying them out Inspector Smith received the assistance of other members of the staff having the necessary qualifications and experience. Unsound Food. On a great many occasions the inspector was called by vendors to examine articles of food, and to accept surrender of such as were unsound or unwholesome or unfit for food. Table 10 contains a list of the articles dealt with in this way. 30 TABLE 10. Unsound Food Condemned and Destroyed. Meat- Tinned Goods (cont.) - Beef 234 lbs. Sausages 48 lbs. Lamb 60 Casserole Steak 38 tins Pork 19 Jellied Veal 14 Pigs Heads 836 Ham 11 Pork Trimmings 120 lbs. Meat Roll 3 Pigs Kidneys 3½ cwt. Peas 203 Pigs Livers 2½ Cream 15 Pigs Plucks 6 Runner Beans 10 „ Ox Sweetbreads 27 lbs. Tongue 6 „ Spinach 9 „ Fish- Beetroot 2 „ Cod 15 stone Baked Beans 2 „ Cod Fillets 7½cwt. Haddock 10 stone Plaice 21 lbs. Miscellaneous- Herring 4 boxes Bacon 3 tons, 16 cwt., 2 qrs. Eels 1 box Eggs 139 Chickens 38 Tinned Goods- Raisins 4 boxes Corned Beef 42 tins Sultanas 1 box Boiled Beef 23 „ Dried Pears 2 boxes Brisket Beef 11 „ Mushrooms 1 box Brawn 12 tins Tomatoes 7 bundles 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. The only slaughterhouse 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. Six inspections were made in 1940. Slaughtermen. Two 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 12 visits, but no cause for complaint was found. Premises used for Food Preparation. At the end of 1940, 108 premises were registered for the preparation or manufacture of foods (other than ice cream) intended for sale, and 180 inspections were made by the food inspector. Ice Cream Premises. The number of premises included in the register at the end of 1940 was 71. 31 Throughout the year, 90 inspections were made, and in 4 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. Thirty-one visits were paid to the registered premises during 1940. Bakehouses. At the end of 1940 the number of bakehouses on the register was 34, 25 being underground bakehouses. During the year 86 inspections were made and 2 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 10 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 30 inspections of fried fish shops and 15 inspections of fish curers' premises were made by the food inspector. Restaurants, Tea-Rooms, etc. At the end of 1940 there were 288 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, 200 ; tea-rooms and pastry-cookshops, 61 ; and hotel kitchens, 27. During the year the total number of inspections was 301, the number of notices served being 6. 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 roast beef were examined bacteriologically. Both were found to be satisfactory. FOOD AND DRUGS ACT, 1938. The total number of samples taken in 1940 under the Food and Drugs Act, 1938, was 931, the figure for 1939 being 1,005. 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 11 contains a complete list of the articles submitted for analysis during 1940, while Table 12 gives details of a sample found to be adulterated. 32 TABLE 11. Food and Drugs Analysed. No. Article. Number examined. Number adulterated or otherwise giving rise to irregularity. Formal. Informal. Private. Total. Formal. Informal. Private. Total. l Almond Essence - 1 - 1 2 Almonds, Ground - 8 - 8 3 Bicarbonate of Soda - 7 - 7 4 Blancmange Powder - 2 - 2 5 Blaud's Pills - 2 - 2 6 Boric Ointment - 10 - 10 7 Brandy - 1 - I 8 Butter 53 6 - 59 9 Butter and Broad - 1 - 1 10 Butter and Roll 1 103 - 104 11 Camphorated Oil - 3 - 3 12 Candied Peel - 3 - 3 13 Castor Oil - 1 - 1 14 Cheese - 38 - 38 15 Cinnamon, Essence of - 2 - 2 16 Cocoa - 18 - 18 17 Coffee - 34 - 34 18 " Cookeen " - 1 - 1 19 Cornflour - 4 - 4 20 Cream, loose 14 - - 14 21 Cream, tinned - 6 - 6 22 Currants - 12 - 12 23 Custard Powder. - 5 - 5 24 Dripping - 17 - 17 25 Epsom Salts - 2 - 2 26 Fat, Cooking 1 3 - 4 27 Fish Paste -. 6 - 6 28 Flour, Self-raising - 27 - 27 29 Friar's Balsam - 1 - 1 30 Fruit, Dried - 2 - 2 31 Ginger, Ground - 2 - 2 32 Halibut Liver Oil - 1 - 1 33 Honey - 16 - 16 34 Iodine, Tincture of - 6 - 6 35 Jam - 33 - 33 36 J elly - 7 - 7 37 Lard 1 27 - 28 38 "Lardex" - 2 - 2 39 LemonCurd - 3 - 3 40 Lemon Essence - 3 - 3 41 Lemonade Powder - 2 - 2 42 Margarine 1 47 - 48 43 Marmalade - 28 - 28 44 Meat Paste - 6 - 6 45 Mercuric Ointment - 2 - 2 46 Milk 87 40 - 127 1 - - 1 47 Milk, Condensed - 9 - 9 48 Milk, Dried - 5 - 5 49 Mincemeat - 3 - 3 50 Mint, Dried - 1 - 1 51 Mint Sauce - 1 - 1 52 Mustard - 19 - 19 53 Mustard, French - 2 - 2 54 Oatmeal - 4 - 4 55 Olive Oil - 14 - 14 56 Paraffin, Liquid - 2 - 2 57 Pearl Barley - 2 - 2 58 Peas, Tinned - 8 - 8 59 Pepper - 14 - 14 60 Pickle, Mustard - 5 - 5 61 Pineapple Curd - 1 - 1 Carried forward 158 641 - 799 I - - 1 33 No. Article. Number examined. Number adulterated or otherwise giving rise to irregularity. Formal. Informal. Private. Total. Formal. Informal. Private. Total. Brought forward 158 641 799 I 1 62 Raisins 9 - 9 63 Rennet - 1 - 1 64 Rice - 19 - 19 65 Rice Flour 1 - 1 66 Rice, Ground - 4 - 4 67 Sardines - 5 - 5 68 Sausages - 13 - 13 69 Sauce, Tomato - 4 - 4 70 Spice, Mixed - 2 - 2 71 Sponge Cake - 2 - 2 72 Suet, Shredded - 12 - 12 73 Sultanas 19 - 19 74 Syrup, Golden - 5 - 5 75 Tapioca - 2 - 2 76 Tartar, Cream of - 2 - 2 77 Tartaric Acid - 8 8 78 Tea - 7 - 7 79 Treacle, Black - 2 - 2 80 " Trex " - 1 - 1 81 Vinegar, Malt - 14 - 14 Total 158 773 - 931 1 - - 1 TABLE 12. Adulterated Samples, etc. Serial Number. Article. Whether Formal, Informal or Private. Nature of adulteration or irregularity. Observations. 288 Milk Formal 13.3% deficient in milk fat. Legal proceedings instituted. Summons withdrawn on technical irregularity. Council awarded £3 3s. Od. costs. Milk. During the year 127 samples were examined, of which one was found to be adulterated. This adulterated sample was 13.3% deficient in milk fat. The average composition of the milks for the last three years is given below. As will be seen, the figures for 1940 (which do not include, those of the adulterated sample) are distinctly below the averages of the previous two years : indeed, until 1940 the figures remained practically constant for several years. Year. Sp. Gr. Total Solids Fat. Solids not Fat. 1938 1031.5 . 12.24% 3.52% 8.72% 1939 1031.6 12.26% 3.51% 8.75% 1940 1031.3 11.94% 3.37% 8.57% Cream. The fat content of the 14 loose creams examined varied from 39.7% to 47.6%, giving an average value of 43.77%. Six tinned creams were analysed, the fat content ranging from 22.5% to 26.3%, with an average value of 24.12%. All these tinned+ 34 samples contained tin, the amount of which varied from 0.08 to 0.9 grain of tin per lb., with an average amount of 0.31 grain of tin per lb. Butter. During the year 59 samples were examined, all of which were genuine and contained neither preservative nor colouring matter. 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 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 statute called for. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927 During the year 9 samples of condensed milk were examined and all were found to comply with the regulations. The Condensed Milk (Milk Content) Order, 1940, issued by the Ministry of Food, permitted the reduction of the content of full-cream unsweetened condensed milk to 7.8% milk fat and 25.5% solids not fat to allow the importation of American unsweetened condensed milk. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. Five samples of dried milk were taken during 1940, and in no case was there contravention of the regulations. 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. It was not found necessary to take any action under the provisions relating to this matter. Under Orders made during the year the addition of borax to bacon and to margarine was permitted subject to the issue of a licence by the Ministry of Food. 35 SECTION F.-PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Under this section of tho report the Minister of Health requires information with regard to the prevalence of notifiable infectious diseases during tho year. Table 13 gives a list of diseases which were notifiable in St. Marylebone during the year under review. TABLE 13. 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 14 shows the number of cases of infectious disease notified during the past six years:- TABLE 14. Infectious Disease Notifications. 1935 1936 1937 1938 1939 1940 Smallpox - - - - - - Diphtheria 119 121 108 93 42 25 Erysipelas 35 28 47 35 23 26 Scarlet Fever 155 141 121 88 43 33 Enteric Fever 3 6 5 8 5 2 Paratyphoid Fever 3 3 4 3 - - Continued Fever - - - - - - Puerperal Fever 10 4 13 3 11 5 Puerperal Pyrexia 36 28 34 18 12 8 Cerebro-spinal Meningitis 1 1 3 4 - 12 Tuberculosis (Pulmonary) 63 107 117 105 92 99 Tuberculosis (Non-Pulmonary) 19 23 17 24 12 14 Acute Poliomyelitis 3 2 2 4 1 1 Polio-Encephalitis 1 1 - - - - Ophthalmia Neonatorum 10 7 10 4 5 3 Encephalitis Lethargica - - - - - - Pneumonia 33 66 61 24 20 31 Malaria 1 - 1 2 - 1 Dysentery 3 1 6 16 2 17 Measles 1 from 1st October, - - - 3 17 120 Whooping Cough I 1938. - - - 17 114 10 Totals 525 538 549 451 399 407 Table 15 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 1040. 36 TABLE 15. Cases of Infectious Disease Notified during 1940. Notifiable Disease. Cases notified in whole District. Cases notified in each locality. 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 25 - - 3 1 2 4 3 4 7 - - 1 8 6 10 1 25 8 6 10 1 25 - 1 Erysipelas 26 - - - - - - - - - 1 16 9 6 12 6 2 26 4 11 3 1 19 7 - Scarlet Fever 33 2 1 4 4 2 5 1 3 8 1 1 1 4 6 16 7 33 2 5 16 4 27 6 - Typhus Fever. - - - - - - - - - - - - - - - - - - - - - - - - - Enteric Fever. 2 - - - - - - - - 1 1 - - 2 - - - 2 2 - - - 2 - - Paratyphoid Fever - - - - - - - - - - - - - - - - - - - - - - - - -- Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 5 - - - - - - - - 3 2 - - - 2 3 - 5 - 2 3 - 5 - - Puerperal Pyrexia 8 - - - - - - 7 1 - - 1 4 2 1 8 1 3 2 - 6 2 - Plague. - - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - - --- Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - Co robro-Spinal Fever 12 3 1 1 - - - - - 3 2 2 - 1 4 4 3 12 1 4 4 3 12 5 Tuberculosis- Pulmonary 99 - - - - - - 2 9 40 25 20 3 27 30 30 12 99 15 16 8 3 42 57 34 Non- Pulmonary 14 - 1 - 1 - 3 - - 5 2 1 1 6 5 1 2 14 4 3 1 2 10 4 8 Acute Poliomyelitis 1 - 1 - - - - - - - - - - - - 1 - 1 - - 1 - 1 - - Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 3 3 - - - - - - - - - - - - - - 3 3 - - - 3 3 - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 31 - - - - - 1 - 1 4 6 9 10 9 11 9 2 31 4 5 7 1 17 14 65 Malaria 1 - - - - - - - - - - 1 - - - - 1 1 - -- - - --- 1 - Dysentery 17 - - - - 1 - 3 12 1 - 16 - 1 17 - -- - - - 17 - Measles 120 8 18 13 20 16 4 11 2 9 - 14 13 87 6 120 8 4 63 1 76 44 1 Whooping Cough 10 3 2 3 - 2 - - - - - - - 4 2 4 - 10 3 - - - 3 7 - Totals 407 19 24 32 19 26 30 10 25 101 44 52 25 98 95 174 40 407 52 59 118 19 248 159 114 * This figure is for all forms of pneumonia, including acute primary pneumonia and acute influenzal pnoumonia which alone are notifiable. 37 IMMUNISATION. Diphtheria.-The Schick Testing and Diphtheria Immunisation Clinic continued to operate at Health Centre No. 1 and at the Middlesex Hospital. T.A.F. (Toxoid-Antitoxin-Floccules in suspension) was the only diphtheria prophylactic employed. Table 16 gives details of the work carried out during the year. TABLE 16. Work of the Diphtheria Immunisation Clinics. Pre-school children. School children. Adults. Totals. Attendances 551 53 105 709 New cases 170 17 41 228 Schick negative - 1 1 2 Completely immunised 120 13 27 160 (three injections but not retested) Retested 62 8 - 70 Positive after retest 2 1 - 3 One application was made for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910. Typhoid Fever. A special municipal clinic offering inoculations against this disease free of charge to all was opened towards the end of the year. The supply of typhoid vaccine to medical practitioners in the Borough was also authorised. Influenza. Tho personnel of certain branches of the Council's Civil Defence Service received inoculations against influenza during the autumn of 1940. 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 tho 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. The County of London (Measles and Whooping Cough) Amendment Regulations, 1940, dated 9th February, 1940, superseded and have the same effect as the Provisional Regulations. VACCINATION. Table 17, prepared by the Vaccination Officer, contains tho vaccination return relating to the year 1939. The following statement gives some information with regard to the work done and the results obtained during 1940 Number of vaccinations- Primary 435 Re-vaccinations 34 469 Number of successful vaccinations 335 Number of unsuccessful vaccinations 83 Awaiting inspection 51 38 TABLE 17. Vaccination Return-1939. Return made to the Borough Council and Ministry of Health on the 13th February, 1941, 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, 1939, to 31st December, 1939, 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 1939. Number of these Births duly entered by 31st January, 1941, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz. : Number of these Births which on 31st January, 1941, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1941, 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 1940. 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 1940. Col. I. Col. II. Col. IV. Col. V. Postpone ment ky Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to places unknown, or which cannot be reached; and Cases not having been found. Success fully Vaccinated. Insuscep tible of Vaccination. Had SmallPox. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Died unvacci nated. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. All Souls 866 488 4 - 96 22 1 188 62 5 2. St. Mary 1,770 895 4 - 291 87 4 437 50 2 1,158 275 3. North Marylebone 175 92 1 - 26 6 1 15 26 8 Total 2,811 1,475 . 9 - 413 115 6 640 138 15 1,158 275 39 OPHTHALMIA NEONATORUM. The number of cases of this disease notified in 1940 was 3. All were treated in hospital, and in no case was vision impaired. DYSENTERY. Sixteen cases of sonne dysentery occurred amongst the nursing staff of the Middlesex Hospital. The outbreak was mild in character and all the patients recovered. The source of the infection was not definitely ascertained. FOOD POISONING. Three notifications of food poisoning were received during the year. Various foodstuffs came under suspicion but no definite evidence as to the responsibility of these articles was obtainable. All those affected recovered. BLINDNESS. Under an arrangement with the London County Council the borough council has undertaken that provision for blind children up to the age of five years shall bo made by the child welfare ccntres, 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 tho knowledge of the Department during 1940. 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 tho handling of milk containers. During tho year no case occurred which called for attention under the regulations. Compulsory Removal of Tuberculous Patients to Hospital. No action was required during 1940 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 1S, 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 18. Tuberculosis : New Cases and Deaths. Age Periods. NEW CASES. DEATHS. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. m. f. m. f. m. f. m. f. 0-1 - 1 - - - - - 1 1-5 - - 1 1 - - - - 5-15 1 2 1 2 - - - - 15-25 9 17 1 1 2 5 - 1 25-35 16 17 2 2 2 2 1 1 35-45 15 15 2 - 6 3 - 2 45-55 8 5 1 1 3 2 1 - 55-65 10 1 - - 6 - - - 65 and upwards 3 1 1 - 2 1 1 - Totals 62 59 9 7 21 13 3 5 Tuberculosis Notifications. Table 19 gives information regarding notifications and the localisation of the disease. The total number of cases of tuberculosis remaining at the 31st December, 1940, on the register of notifications kept by the Medical Officer of Health was 546, nine less 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 42 2. Number of cases unnotified or notified at death 7 3. Number of cases notified within a month of death 4 4. Number of cases notified within three months of death - 5. Number of cases notified within six months of death 3 Seven 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 19. 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. X to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Lungs 99 - - 2 23 51 20 3 27 30 30 12 99 15 16 8 3 42 57 Kidney 3 - - - 1 2 - - 2 1 - - 3 1 1 - - 2 1 Sternum 1 - - 1 - - - - 1 - - - 1 - - - - - 1 Glands 3 - 1 1 - - 1 - - 2 1 - 3 - 1 1 - 2 1 Spine 1 - - - - 1 - - - 1 - - 1 - - - - - 1 Genito-urinary 3 - - - - 3 - - 3 - - - 3 3 - - - 3 - Foot 1 - - 1 - - - - 1 - - - 1 1 - - - 1 - Peritoneum 1 - - - - 1 - - - - - 1 1 - - - 1 1 - Finger 1 - 1 - - - - - - - - 1 1 - - - 1 1 - Totals 113 - 2 5 24 58 21 3 34 34 31 14 113 2 18 9 5 52 61 113 42 Treatment of Tuberculosis. Admissions to hospital and sanatoria during the year numbered 175, and . every effort was made to obtain institutional treatment for all suitable cases. 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. Artificial Pneumothorax Therapy. This form of treatment, for which patients were previously referred to hospital, w as, with the installation of the X-ray plant, commenced in the Council 's Dispensary on the 20th July, 1940. Eighteen patients were dealt with and a total number of 136 refills were given between that date and the end of the year. These facilities have been fully appreciated not only by the dispensary staff but by the patients in tho great saving of time effected in securing treatment. The expense involved in making provision for refills to be given in hospital has also been avoided. Extra Nourishment for Tuberculous Persons. Under arrangements made by tho Council and sanctioned by tho 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 351, the amount expended being £126 2s. 5d. Prevention of Tuberculosis. On the 24th April, 1940, the dispensary removed from temporary accommodation at the Old Baths Establishment, Marylebone Road, to the new Health Centre forming part of fie Town Hall Extension. The work proceeded on practically a normal basis throughout 1940. Particulars with regard to patients dealt with during the year are shown in Table 18, while the following short table summarises the information as to visits, etc., paid by tho Tuberculosis Officer and other members of the dispensary staff:No. of cases at dispensary New, 276 Old, 364 No. of attendances at dispensary 1,926 No. of contacts New, 86 Old, 25 No. of homo visits by Tuberculosis Officer New, 11 Old, 119 No. of hospital visits by Tuberculosis Officer 53 No. of home visits by Tuberculosis Visitors- First visits, 93 Re-visits, 1,264 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. X-Ray Examinations. The new plant installed in the basement of the Town Hall Extension as part of the Council's Dispensary Service was brought into use on the 13th June, 1940, and during the remainder of the year 373 examinations were made. Tho advantages of having radiological facilities on the premises have been appreciated by the staff, and loss of working time to patients has been reduced to a minimum. The apparatus 43 has proved invaluable in diagnosis and supervision and may also be considered an excellent investment financially as it is no longer necessary to incur expenditure in sending patients to hospital for X-ray investigation. Military Training and Tuberculosis. At the request of the Ministry of Health, the Tuberculosis Officer continued to provide, 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, held 13 meetings in 1940 and dealt with a total of 338 cases. DISINFECTION. During the year 737 rooms and 25,007 articles (including 262 books) were disinfected. BACTERIOLOGICAL EXAMINATIONS. Table 20 shows tho number of specimens examined for the purposes of diagnosis, and indicates also the organisms in relation to which the examinations were made. TABLE 20. Work of the Bacteriological Laboratory. Examination. Positive. Negative. Suspicious. Total. Throat ancl Nasal swabs (for B. diphtheria: and haomolytie streptococci) 8 143 - 151 Sputa (for tubercle bacilli) 15 98 - 113 Urine (for typhoid) - 1 - 1 Smears (for gonococcus) 1 3 - 4 Smear (for anthrax) - 1 - 1 Swabs (for cerebro-spinal meningitis) - 2 - 2 Totals 24 248 - 272 HEALTH PROPAGANDA. War conditions have brought to the inhabitants of tho Borough a greater appreciation of the numerous services which the local authority has provided for their benefit and well-being. Circumstances arising out of the war have also presented additional opportunities for drawing the attention of the public to the various health services available. In addition to tho usual channels through which publicity has been obtained, air-raid shelters have been utilised for the exhibition of posters dealing with subjects of public health importance, including immunisa ticn against diphtheria and typhoid fever and vermin repression. By this means alone, large numbers of people, not easily reached otherwise, have been made aware of the many facilities which the Public Health Department is anxious to place at their disposal. 44 INDEX. page Actinotherapy 20 Adulterated Food Samples 33 Ambulance Facilities 16 Analysis of Butter 34 ,, Cream 23 „ Drugs 34 Milk 29, 33 Analyst, Public 5, 16 ,, ,, Report of 31-34 Ante-Natal Clinics 18 Anti-Toxin, Diphtheria 37 Appendicitis 14 Artificial Cream 34 „ Pneumothorax Therapy 42 „ Sunlight Clinic 20 Atrophy 11 Bacteriological Examinations 31, 43 of Milk 29 „ „ of Water 25 Bacteriologist 5, 16 Bakehouses 26, 31 ,, Underground 26, 31 Baths, Cleansing of Persons 95 ,, Swimming 25 Bed Bugs, Eradication of 25 Birth, Injury at 11,14 ,, Premature 11, 14 „ Rate 8 Births, Notification of 9 „ Registration of 9 ,, Vital Statistics 8, 11 Blindness, Prevention of 39 Books, Library 43 Bronchitis 11, 12, 14 Bugs 25 Business, Offensive 30 Butter, Analysis of 34 ,, and Margarine Premises 31 Cancer 8, 12, 13, 14 Care Committee, Tuberculosis 43 Causes of, and Ages at, Death 10, 14 Census Population 9 Centres, Treatment and Clinics 17 „ Infant Welfare 18 Cerebro-Spinal Fever 12, 14, 35, 36 Chicken Pox 11 Child Life Protection 20 „ Guidance Clinic 20 „ Welfare, Maternity and 17 „ „ Statistics 18 Children Act, 1908 20 Chiropodist 5 Circulatory Diseases 14 Cisterns 22 Civil Defence 7 Cleansing, Public 23 ,, Street 23 „ Station 25 „ of Verminous Persons 25 Clerical Staff 6 PAGE Clinics, Ante-Natal 18 „ Artificial Sunlight 20 „ Child Guidance 20 „ Dental 20 ,, Diphtheria Immunisation 37 „ Massage 18 „ Minor Ailments 20 „ Post-Natal 18 ,, Treatment Centres and 17 Closet Accommodation 22 Closing Orders 27 Clothing, etc., for Evacuees 19 Coffee Shops. 26 Collection, Refuse 23 Combined Drainage 22 Committee, Public Health 5 „ Tuberculosis Care 43 Common Lodging Houses 28 Communal Feeding Centres 19 Complaints 24 Compulsory Removal, Tuborculosis 39 Condensed Milk 34 Congenital Malformation 14 Consultants, Honorary 21, 42 „ Obstetric 21 Containers, Refuse 23 Conveniences, Public Sanitary 22 Cook Shops 31 Corrected Death Rate 10 Cream, Analysis of 33 „ Artificial 34 Cremation 15 Crematorium 15 Crossley Day Nursery 19 Curers, Fish 31 Dairies, Milkshops 29 Day Nurseries 19 Deaths, Causes of and Ages at 10,14 ,, Infantile Mortality 10, 11 ,, Infectious Diseases 12 „ Maternal Mortality 12 Rate 3, 8, 10 ,, Registration of 9 ,, Tuberculosis 11, 12, 14 ,, Vital Statistics 8 Debility 11 Demolition Orders 27 Dental Clinic 20 ,, Surgoon 5 Diabetes 14 Diarrhoea 8, 11, 12, 14 Digestivo Diseases 14 Diphtheria 35, 36, 37 „ Anti-Toxin 37 „ Immunisation Clinic 37 Diseases, Notifiable 35 Disinfection 43 Disinfestation 25 Dispensary, St. Marylebone and Western General 17 Disposal, Refuse 23 District Nursing Association 16 Dogs, Fouling of Footways by 26 Dorset Clinic 20 45 IND EX-contin ued. page Infantile Mortality 10, 11, 14 Infectious Diseases, Deaths due to 12 „ ' „ Notification of 35, 36 „ „ Prevalence of and Control over 35 ,, ,, Statistics 35, 36 Influenza 14, 16, 37 Injury at Birth 11 Inspection, Sanitary 24 Inspection of Food 29 Intimation Notices 24 Intra-cranial Vascular Lesions 14 Legal Proceedings 25 Library Books 42 Local Medical War Committee 3 Malformation, Congenital 11, 14 Malaria 35, 36 Marasmus 11 Margaret Street Dispensary 42 Margarine and Butter Premises 31 Marriages 9 Massage Clinic 18 Maternal Mortality 12 Maternity and Child Welfare 5, 17, 20 ,, ,, ,, ,, Home Nursing 16 „ ,, „ „ Statistics 18 „ Flying Squad 21 Measles 8, 12, 14, 16, 36, 37 Meat 29 Medical War Committee 3 Medical Referee (Cremation) 5 Middlesex Hospital 9, 17, 18, 21 Military Training and Tuberculosis 43 Milk, Analysis 29, 32, 33 ,, Bacteriological Examination of 29 „ Condensed 34 „ Dried 34 ,, National Scheme 19 „ Pasteurised 29 ,, (Special Designation) Orders, 1936 and 1938 29 ,, Trade and Tuberculosis 39 „ School Children 29 „ Shops 29 „ Tuberculin Tested 29 „ and Food, Supply of 19 Minor Ailment Clinic 20 Mortality, Infant 10, 11 „ Maternal 12 Mortuary 15 National Milk Scheme 19 Nephritis 14 Noise Nuisance 26 Noteworthy Causes of Sickness 9 Notification of Births 9 ,, Infectious Diseases 35, 36 ,, Tuberculosis 36, 40, 41 Nuisances 24 ,, Noise 26 Nurseries, Day 19 page Drainage 22 „ Combined 22 Dried Milk 34 Drugs 34 Duodenal Ulcers 14 Dysentery 36, 39 Encephalitis Lethargica 35, 36 Enteric Fever 35,36 Enteritis 11 Erysipelas 35, 36 Evacuees Clothing, etc. 19 Extra Nourishment, Tuberculous Persons 42 Factories and Workshops 26 Feeding Centres 19 Fish Curers 31 „ Fried, Vendors 31 Flock, Rag 26 Food 29-34 „ Inspection 29 „ Poisoning 39 „ Premises 30 „ Preservatives in 34 „ Stalls 31 „ Samples 31, 32, 33 ,, Unsound 29 Fouling of Footways by Dogs 26 Fried Fish Vendors 31 Gastritis 11 General Statistics 8 German Measles 16 Health Centre No. 1 3, 17, 18 „ 2 17, 18 „ Propaganda 43 ,, Visiting 18 „ Visitors 6, 18 Heart Disease 14 Hens, Pigs and Rabbits 25 Hogwash 23 Home Helps 19 „ Nursing 16 Honorary Consultants 2, 21, 42 Hospital, Middlesex 9, 17, 18, 21 „ Paddington 9, 21 „ Queen Charlotte's 9, 17, 18, 21 „ St. Charles' 42 Hospitals 17 Houses let in Lodgings 28 Housing 27, 28 „ Closing Orders 27 „ Demolition Orders 27 Huntsworth Terrace 24 Ice Cream 30, 31 „ „ Premises 30, 31 Illegitimacy 8, 11 Immunisation, Diphtheria 37 Industries, Chief 8 Infant Life Piotection 20 Infant Welfare Centres 18 46 IN DEX-continued. page Nursing Association, District 16 Nursing, Home 16 „ Homes 17 Obstetric Consultants 21 Offensive Businesses 30 * Refuse 23 Ophthalmia Neonatorum 36,39 Orthopaedic Treatment 20 Outworkers 26 Overcrowding 27 Paddington and St. Marylebone District Nursing Association 16 Paddington Hospital 9, 21 Paratyphoid Fevor 35,36 Pasteurised Milk 29 Pharmacy and Poisons Act, 1933 26 Phthisis, see Tuberculosis Pigs, Hens and Rabbits 25 Pigeons 26 Pneumonia 11, 12, 14, 16, 36 Poisoning, Food 39 Poisons Act, 1933, Pharmacy and 26 Polioencephalitis 35, 36 Poliomyelitis 35, 36 Population 8, 9 Portman Day Nursery 19 Post-Natal Clinics 18 Prematurity 11, 14 Premises used in Food Pieparation 30 Preservatives in Food 34 Prevalence of and Control over Infectious Diseases 35 Prevention of Blindness 39 „ Tuberculosis ... 42 Proceedings, Legal 25 Propaganda 43 Public Analyst 5, 16 „ „ Report of 31-34 „ Baths 25 „ Cleansing 23 ,, Health Committee 5 „ Sanitary Conveniences 22 Public Health (Condensed Milk) Regulations, 1923 and 1927 34 Public Health (Dried Milk) Regulations, 1923 and 1927 34 Public Health (Meat) Regulations, 1924 30 Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1939 34 Puerperal Fever 35, 36 „ Pyrexia 35, 36 ,, Sepsis 8, 14 Pulmonary Tuberculosis and Milk Trade 39 Queen Charlotte's Hospital 9, 17, 18, 21 PAGE Rabbits, Pigs and Hens 25 Rag Flock 26 Rateable Value 8 Rats 25 Referee, Modical (Cremation) 5 Refuse Collection and Salvage 23 „ „ ,, „ Statistics 23 ,, Containers 23 ,, Offensive 23 Registration of Births 9 ,, Deaths 9 Removal of Tuberculosis, Compulsory 39 Rent Restriction Acts 28 Respiratory Diseases 12, 14 Restaurants, Tea Rooms, etc. 26, 31 Road Traffic Accidents 10,14 Royal National Orthopaedic Hospital 20 Salvage Collection, Refuse and 23 Samples, Food and Drugs 31, 32, 33 Sanitary Conveniences, Public 22 „ Inspection 24 „ Inspectors 6 Scarlet Fever 36 Shelter 25 Shops 25 ,, Coffee 26 ,, Milk 29 Sickness, Noteworthy Causes of ... 9 Slaughterhouses 30 Slaughtermen 30 Smoke Abatement 25 Social Conditions 8 Sonne Dysentery 39 St. Charles' Hospital 42 St. Marylebone & Western General Dispensary 17 St. Marylebone Housing Association 28 St. Vincent de Paul Dav Nursery 19 Staff 5, 6, 16 Stalls, Food 31 Statistics, General 8 ,, Infectious Disease ... 35, 36 ,, Maternity and Child Welfare 18 ,, Refuse Collection 23 „ Tuberculosis 41 Vital 8, 13 „ Vaccination 37, 38 Statutory Notices 24 Stillbirths 8, 9, 11 Street Cleansing 23 Suicide 14 Supply of Milk and Food 19 Swimming Baths 25 Syphilis 14 Tea Rooms, Restaurants, etc. 26, 31 Tenement Houses 22 ,, „ Water Supply 22 Tinned Cream 33,34 Town Hall Extension 3 47 INDEX-continued. page Treatment Centres and Clinics 17 „ of Tuberculosis 41 Tuberculin Tested Milk 29 Tuberculosis Care Committee 43 ,, Compulsory Removal 39 „ Consultants 42 „ Deaths 11, 12 ,, Extra Nourishment 42 ,, Home Nursing 16 ,, Military Training 43 ,, New Cases and Mortality 39, 40 ,, Notifications 36. 40, 41 ,, Officer 5 „ Prevention of 42 ,, Pulmonary and Milk Trade 39 „ Respiratory System 14 ;, Statistics 41 „ Treatment of 41 Typhoid Fever 37 Underground Bakehouses 26, 31 ,, Rooms 27 Unemployment 8 Unsound Food 29, 30 page Vaccination 5, 37, 38 Vermin 25 Verminous Persons, Cleansing of 25 Vital Statistics 8,13 War Committoe, Local Medical 3 Water 22 „ Supply cut off 22 „ Closets 22 Western Geneial Disponsaiy, St. Marylebone and 17 Whooping Cough 8, 11, 15, 35, 36, 37 Wireless Loudspeaker Nuisance 25 X-Ray Examinations 43 Zoological Society of London 30