AC4353 STMARY 46 1941 Borougb of St. Marylebone. * REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1941 H. A. BULMAN, M.R.C.S., D.P.H. London : Freame, Manning & Co., Ltd. (T.V.), 12a, Lee High Road, Lewisham 64891 2 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. In view of paper shortage the report on the health of the Borough during 1941 is brief but contains all necessary statistical and other information on essential matters. Health conditions continued to be satisfactory throughout the year. Both the birth-rate (9.34) and death-rate (19.49) showed an increase over the figures for 1940 (8.52 and 18.07 respectively), while the infantile mortality rate reached the low record of 41.77 as against 67.07 for the previous year. Erratic population movements of recent years, however, render difficult a reliable interpretation of the variations in the rates. The Registrar-General gave 49,260 as his estimate of the civilian population for 1941, the figure for 1940 being 62,240. Infectious disease incidence remained practically constant and, as in the previous two years, compared favourably with that of the immediate pre-war period. An increase in scabies and bug infestations, as a result of greater personal contact brought about by war conditions, necessitated an extension of cleansing and disinfection facilities to cope with these important public health problems. A full maternity and child welfare service was provided and worked to capacity .through the greater part of the year. My thanks are due to the Chairman (Councillor Dr. C. A. Fuller) and members of the Public Health Committee for the consideration and encouragement they gave me throughout 1941, and to the staff for their continued loyalty and support. Called upon to undertake additional responsibilities arising out of the war, they have responded with commendable resourcefulness and efficiency. H. A. BULMAN, Medical Officer of Health. contents. page Members of the Public Health Committee 3 Section A— Statistics and Social Conditions:— General Statistics . 3 Extracts from Vital Statistics 3 Population 3 Births 3, 4 Marriages 4 Deaths . 4,5 Infantile Mortality 5 Maternal Mortality 5 Mortuary 5 Crematorium 5 Section B—General Provision or Health Services:— Staff 5 Laboratory Facilities 5 Home Nursing 6 Health Centres 6 Maternity and Child Welfare:— Work of Infant Consultations 6 Health Visitors and Home Visits 6 Milk and Food, etc. 6,7 Day Nurseries 7 Home Helps 7 Child Life Protection 7 Dental Treatment 7 Maternity Cases . 7 Section C—Sanitary Circumstances:— Water 7 Drainage . 7 Public Conveniences 7 Public Cleansing 7 Sanitary Inspection 8 Shops 8 Bed Bugs 8 Verminous Persons 8 Rats and Mice 8,9 Mosquitoes 9 Pigeons 9 Dog Nuisance 9 Noise 9 Poisons 9 Factories 9 Civil Defence 9 page Section d—Housing:— Statistics 9 10 Tenement Houses 10 Common Lodging Houses 10 War Damaged Dwellings 10 Public Air Raid Shelters 10 Section e—Food:— Milk Supply 10 Meat and Other Foods :— Unsound Food 10 Slaughterhouse 10 Offensive Business 10 Food Premises 10 Ice Cream Premises 10 Butter and Margarine Premises 10 Bakehouses 10 Fried Fish Vendors and Fish Curers 10 Restaurants, Tea Rooms, etc. 11 Bacteriological Examinations 11 Food and Drugs Act, 1938 11 Food Decontamination 11 Section f—Infectious and Other Diseases:— Notifications . 11, 12 Immunisation:— Diphtheria 11 TyphoidFever 11 Influenza 11 Vaccination 11 Typhus Fever 11 Anthrax 11 Scabies 11 Ophthalmia Neonatorum 13 Dysentery 13 Tuberculosis:— New Cases and Mortality . 13 Notifications 13 Dispensary 13 Dental Treatment 13 Institutional Treatment 13 Care Committee 13 Disinfection 14 Bacteriological Examinations 14 3 PUBLIC HEALTH COMMITTEE (who are also the Committee appointed for Maternity and Child Welfare purposes.) 1941. HIS WORSHIP THE MAYOR : Councillor Douglas Timins, J.P., O.B.E., M.A. ALDERMEN: {F. W. Dean, J.P., L.C.C. J. Fettes, J.P. COUNCILLORS : Miss M. Barry. †Capt. Gerald Lowry. ‡F. Y. Bright. *Miss Joyce Marsh. F. V. Cullen, F.S.I., F.A.I. (Deputy Chairman). ‡Mrs. C. M. Phillips. Mrs. E. B. Davis. ‡The Hon. Mrs. A. E. Pleydell-Bouverie. Dr. C. A. Fuller (Chairman). ‡C. H. Press. *L. W. Hammond. G. B. Ramsay. *Capt. C. Hargreaves. T. W. Robinson, A.C.A. *Mrs. M. G. Harris. *H. Norman Toomey, L.D.S., R.C.S. Mrs. Carr Q. Henriques. Capt. Robert Whitney, M.B.E. Dr. Elizabeth Jacobs. *Members until November, 1941. ‡Members from November, 1941. †Resigned April, 1941. 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 : 1941—49,260. Number of inhabited houses : 1921—18,507 ; 1931—17,575. Number of families or separate occupiers (1931), 27,352. EXTRACTS FROM VITAL STATISTICS. Live Births— Total M. F. Legitimate 377 192 185 Birth Rate per 1,000 estimated Illegitimate 83 50 33 i civilian population 9.34 Stillbirths 17 Rate per 1,000 total (live and still) births 35.64 Deaths (all ages) 960 1 Death Rate per 1,000 estimated civilian population 19.49 Rate per 1,000 Deaths from Puerperal causes— Deaths. total (live and still) births Puerperal Sepsis — — Other Puerperal causes 1 2.43 Total 1 2.43 Death Rate of Infants under one year of age— All infants per 1,000 live births 41.77 Legitimate infants per 1,000 legitimate live births 36.92 Illegitimate infants per 1,000 illegitimate live births 60.98 Deaths from Cancer (all ages) 124 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years) 5 Population.—The civilian population of the Borough for the year 1941, as estimated by the Registrar-General, is 49,260, and this figure is used in calculating the various rates given in this report. Births—Registration.—The number of births registered during 1941 was 460, being 70 less than in 1940. Of the children born, 242 (192 legitimate ; 50 illegitimate) were boys and 218 (185 legitimate ; 33 illegitimate) girls. The birth rate per 1,000 of the population was 9.34 as against 8.52 in 1940. 4 Notification.—The total number of notifications received during the year, under the Public Health (London) Act, 1936, Section 255, was 616 : live births, 596 ; stillbirths, 20. The total notifications in 1940 was 1,838. The main sources of the notifications were : from parents, 1 ; from doctors, 2 ; from midwives, 22 ; from hospitals, nursing homes, etc., 591. Of the total births notified, 309 took place at the Middlesex Hospital; 111 at Paddington Hospital; and 30 were born at home. Of those notified as having occurred in St. Marylebone, 290 belonged to other Boroughs. Of the 20 stillbirths (16 males and 4 females) notified direct to the Department, 8 (6 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 17—14 males (10 legitimate ; 4 illegitimate) and 3 females (1 legitimate ; 2 illegitimate). Marriages.—The total number of marriages in the Borough during the year was 1,030, being 465 below the number for 1940, and 478 below the average for the previous 10 years. The rate for persons married in 1941 was therefore 42 per 1,000 of the estimated civilian population. Deaths.—The number of deaths registered in 1941 was 960, and information 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 1. The figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures if they occur in the Borough. TABLE 1.—Causes of, and Ages at Death during the Year 1941. 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. North Marylebone. Total All Ages Under 1 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards Residents Nonresidents 1 Typhoid and paratyphoid fevers - - - - - - - - - - - - - 2 Cerebro-spinal fever 4 - - - 2 2 — — 1 2 — 2 4 3 Scarlet fever — - - - — — — — — — - — — 4 Whooping cough 1 1 - - - - - - - - 1 — 1 5 Diphtheria - - - - - - - - - - - - - 6 Tuberculosis of respiratory system 46 - - - 29 13 4 2 4 13 10 23 46 7 Other forms of tuberculosis 3 - 2 - 1 — — — 4 1 1 1 3 8 Syphilitic disease 13 - — - 1 6 6 — 2 4 3 6 13 9 Influenza 5 - 1 - — 2 2 — — 1 2 2 5 10 Measles — - — - — — — — — — — — — 11 Acute poliomyelitis and polioencephalitis - - - - - - - - 1 - - - - 12 Acute infectious encephalitis 1 - - - 1 - - - - - - 1 1 13m Cancer of buccal cavity and oesophagus (males only) 4 - - - - 2 2 1 11 1 1 2 4 13p Cancer of uterus. 8 - — - 1 4 3 — 15 2 1 5 8 14 Cancer of stomach and duodenum 17 - - - 2 6 9 8 16 1 5 11 17 15 Cancer of breast 15 - — - 2 5 8 — 16 2 4 9 15 16 Cancer of all other sites 80 1 — - 4 39 36 4 61 7 29 44 80 17 Diabetes 8 - — - 2 4 2 2 2 1 — 7 8 18 Intra-cranial vascular lesions 71 - - - - 18 53 6 16 12 30 29 71 19 Heart disease 235 - — - 6 48 181 19 53 36 99 100 235 20 Other diseases of the circulatory system 37 - - - - 9 28 8 11 5 16 16 37 21 Bronchitis 62 - — - - 18 44 1 — 7 24 31 62 22 Pneumonia 57 - 1 - 7 16 33 4 18 8 20 29 57 23 Other respiratory diseases 6 - — - 1 3 2 — 3 1 2 3 e 24 Ulceration of the stomach or duodenum 15 - - - 3 7 5 3 9 3 3 9 15 25 Diarrhoea (under 2 years of age) 5 5 - - - - - - - 1 1 3 5 26 Appendicitis 1 — — - — 1 — 1 3 1 — — 1 27 Other digestive diseases 23 — — - 5 9 9 4 10 5 2 16 23 28 Nephritis 14 — — - — 9 5 2 14 4 2 8 14 29 Puerperal and postabortive sepsis - - - - - - - - - - - - - 30 Other maternal causes 1 - - - 1 - - - - 1 — — 1 31 Premature birth 2 2 - - - - - - - - - 2 2 32 Congenital malformations, birth injury, infantile disease 10 6 1 - 3 - - - 3 2 3 5 10 33 Suicide 7 — — - 2 3 2 2 6 2 1 4 7 34 Road traffic accidents 4 — — - — 1 3 1 1 1 2 1 4 35 Other violent causes 130 2 2 3 48 42 33 15 38 58 25 47 130 36 A11 other causes 75 — 1 1 8 23 42 5 40 10 32 33 75 Totals 960 17 8 4 129 290 512 88 359 192 319 449 960 5 The corrected death-rate per 1,000 of the population was 19.49. In the previous year, the rate was 18.07 and the number of deaths 1,223. The variety and magnitude of local population movements throughout the country and the uneven incidence of civilian war deaths have together combined to frustrate the attempt to secure comparability between local deathrates by the use of areal comparability factors. The Registrar-General has therefore suspended, for the time being, the preparation and issue of such factors ; consequently the usual comparability adjustment has not been made in calculating the death-rate for the year 1941. Infantile Mortality.—The number of babies under one year who died in St. Marylebone in 1941 was 17 and the number of births allocated by the Registrar-General for the calculation of infantile and maternal mortality rates in that year, 460. The infantile mortality rate is therefore 41.77. The Registrar-General's figure for legitimate births was 325 and the deaths amongst legitimate infants numbered 12, giving a rate of 36.92. There were 82 illegitimate births and 5 deaths, the rate being 60.98. In 1940 the death-rate for all infants per 1,000 live births was 67.07. Table 2 shows, in addition to the causes of infantile mortality, the distribution of the deaths according to age and locality. TABLE 2. INFANTILE MORTALITY. Nett Deaths from Stated Causes at various ages under One Year, and in Sub-Districts. Code No. CAUSE OF DEATH. Under 1 Week. 1 and under 2 Weeks. 1 and under 3 Months. 3 and under 6 Months. 6 and under 9 Months. All Souls. St. Mary. North Marylebone. Total 6 Whooping Cough — - 1 - - — 1 — 1 7 Diarrhoea — — — 1 1 — — 2 2 8 Enteritis 1 — 1 1 — 2 — 1 3 12 Congenital Malformation 3 1 2 — — 1 2 3 6 13 Premature Birth 2 — — — — — — 2 2 27 Other Causes 2 — — — 1 1 — 2 3 Totals 8 1 4 2 '2 4 3 10 17 No infantile deaths occurred in the age-groups 2 and under 4 weeks, 9 and under 12 months, or from the following causes not shown in the table : Small-pox, chicken-pox, measles, scarlet fever, diphtheria and membranous croup (Nos. 1—5), tuberculous meningitis, abdominal tuberculosis, other tuberculous diseases (9—11), atrophy, debility and marasmus, atelectasis, injury at birth, erysipelas, syphilis, rickets, meningitis (not tuberculous), convulsions, gastritis, laryngitis, bronchitis, pneumonia (all forms), suffocation, overlying (14—26). Nett Infantile Nett Births. Deaths. Nett Stillbirths. M. F. M. F. M. F. Legitimate 166 159 7 — 7 1 Illegitimate 50 32 5 5 4 2 216 191 12 5 11 3 407 17 . 14 Maternal Mortality.—In 1941 the number of deaths due to conditions connected with or consequent upon childbirth was 1, the maternal mortality rate being 2.43 per 1,000 births. The death occurred in hospital following miscarriage, the age of the woman being 26 years. In 1940 there was 1 death, the death-rate being 1.98 per 1,000 births. Mortuary.-—Use continued to be made of the Paddington Public Mortuary until the 20th January, 1941, when the Council's Emergency Mortuary at No. 24, Hill Road, St. John's Wood, became available for normal mortuary purposes. During the year 18 bodies (11 males, 7 females) were deposited, but no post-mortem examinations were carried out at the Hill Road premises. Further emergency mortuary accommodation was provided in Chiltern Street in 1941. Crematorium.—One hundred and forty-two certificates authorising cremation at the St. Marylebone Crematorium, Finchley, were issued—127 by the Medical Referee and 15 by the Deputy Medical Referee. SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. Staff.—The details normally required by the Ministry of Health with regard to the staff of the department are omitted on this occasion. By the death of Mr. J. F. F. Rowland a long association, extending over 36 years, with the analytical work of the Council was terminated. He had held the office of Public Analyst for the Borough since April, 1921, and at all times his work was characterised by a high sense of public duty. The death of Miss L. J. Donnell (part-time Health Visitor) at her home as a result of enemy action is also recorded with great regret. On the 7th July, 1941, Miss P. K. Pepler (Tuberculosis Visitor) was released by the Council for service as a Ministry of Health Inspector for the duration of the war. Sergeant-Observer M. Kelly, R.A.F. (Third class clerk) first reported missing, is now a prisoner of war in Germany. 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. Mr. J. F. F. Rowland, B.A., A.I.C., of No. 133, Gloucester Place, N.W.I, was Public Analyst for the Borough until his death on the 2nd November, 1941. He was succeeded in that office by Mr. G. A. Stokes, F.I.C., F.C.S., whose laboratory is situated at No. 159, Edgware Road, W.2. 6 Home Nursing.—The Paddington and St. Marylebone District Nursing Association continue to provide adequate nursing services in the home under an arrangement made with the Council. During 1941, visits were paid to cases (number shown within brackets) as follow : Maternity, 291 (14) ; pneumonia, 73 (5) ; tuberculosis, 49 (4) ; influenza, 40 (4) ; puerperal pyrexia, 16 (1). Health Centres.—The Council has two health centres : No. 1 in the Town Hall Extension, comprising 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. In addition, consultations held at Queen Charlotte's Hospital (until 4th March, 1941) and at the Middlesex Hospital formed part of the Council's maternity and child welfare scheme. 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 3 gives an account of the work done during 1941. In addition to the centres named in this table, consultations were held weekly at the St. Marylebone and Western General Dispensary until June, 1941. TABLE 3. 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 153 112 18 154 Maternity 50 53 33 209 Massage 74 — — — Light 89 5 — — No. of attendances of mothers at clinic:— Ante-natal 270 313 595 (42) 3,450 (266) Post-natal 8 13 25 (-) 196 (11) No. of attendances of babies 1,903 1,564 30 (21) 1,509 (415) No. of attendances of children over one year 1,460 966 33 (29) 1,048 (297) No. of attendances at Light Clinic : Infants 47 6 - — Toddlers 2,094 84 - — No. of attendances at Massage Clinic:— Infants 40 - — — Toddlers 609 — — — No. of Orders issued for milk 17 20 — — No. of Home Visits 1,592 2,107 6 2,388 No. of new cases :— Infants 165 137 5 (2) 142 (29) Toddlers 53 28 - 13 (10) Ante-Natal 65 90 139 (8) 558 (42) Post-natal 7 12 19 (-) 340 (27) Massage:— Infants 6 — — — Toddlers 43 — — — Light- Infants 4 — — — Toddlers 97 — — — Note.—Figures in brackets refer to St. Marylebone residents attending Queen Charlotte's Hospital (last clinic held on 4th March, 1941) and the Middlesex Hospital. Health Visitors and Home Visits.—The number of visits paid during the year by the five whole-time and four part-time health visitors was as follows : (a) to expectant mothers, first visits, 327, total visits, 665 ; (b) to children under 1 year of age, first visits, 321, total visits, 3,271; (c) to children between the ages of 1 and 5 years, total visits, 4,740. In April the Minister of Health requested that health visitors who had been diverted from their ordinary work to first-aid posts and other civil defence activities should be released for their normal welfare duties. Arrangements were made accordingly. Milk and Food, etc.—The Food Executive Officer has kindly provided the following information as to milk supplied under the National Scheme during the period 30th December, 1940, to 28th December, 1941 : liquid milk—36,022i gallons (free, 12,212J gallons ; at 2d. per pint, 23,809J gallons) ; full cream dried milk—850-20 oz. cartons, one carton being equivalent to 7 pints of liquid milk (free, 301 cartons ; at l/2d. per carton, 549) ; half cream dried milk—introduced on the 30th June, 1941—35 cartons (free, 18 cartons ; at 1 /2d. per carton, 17). 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 quantity of dried milk supplied free or at reduced price under the Council's scheme to expectant and nursing mothers and young children was 282 lbs., no liquid milk being ordered. The amount expended was £22 6s. 6d. The number of cases dealt with was 13 and the number of orders issued 37. 7 At the close of the year the Council, on the request of the Ministry of Health, assisted in the scheme for the free distribution of vitamin preparations to young children, and from the 8th to the 28th December, 1941, issues were made as follow : cod liver oil, 232-6 oz. bottles ; fruit juice (to children under 6 months) 108-13½ oz. bottles ; fruit puree (to children 6 months to 2 years) 353-8½ oz. cans. It was estimated that 75 per cent, of eligible children were receiving the preparations. During 1941 no advantage was taken of the arrangements for the supply of dinners at certain voluntary centres to expectant and nursing mothers and young children. Under ah arrangement made by the Ministry of Health and the Board of Trade, expectant mothers were provided with 50 special coupons for baby clothing. From the 6th August, 1941 (when the scheme came into operation) to the end of the year, coupons were issued to 298 expectant mothers. 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. On the 13th October, 1941, the premises at No. 14, Blandford Street re-opened as a whole-time emergency day nursery for 40 children. Towards the end of the year arrangements were made by the Council, at the request of the Ministry of Health and Ministry of Labour and National Service, to establish a war-time day nursery (whole-time) in the Portman Day Nursery building, Salisbury Street, for the children of women in full-time employment. A voluntary committee was set up, the more important staff appointments were filled, and the nursery actually opened on the 26th January, 1942, with accommodation for 60 children (0-5 years), the mothers paying Is. per day per child. Home Helps.—Home helps were provided in two cases during the year. Child Life Protection.—In connection with the administration of Part XIII of the Public Health (London) Act, 1936, six health visitors acted as child protection visitors and made a total of 52 inspections. The number of persons on the register who, at the end of the year, were undertaking for reward the nursing and maintenance of foster children, was four, and the children in their care numbered four. During March and April, 280 children in public air-raid shelters were examined for the dual purpose of ascertaining whether any child was a source of infection or was suffering in health as a result of war operations and, therefore, a fit subject for compulsory evacuation under Defence Regulation 31C. The general standard of health of the children was found to be very satisfactory. Dental Treatment.—By arrangement, certain sessions at the Dental Clinic of the London County Council at Haalth 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. Statistics for 1941 : sessions held, 74 ; new cases—mothers 68, children 22 ; attendances—mothers 307, children 59 ; cases receiving advice and treatment, 319 ; extractions under gas—mothers 37, children 10 ; dentures provided at cost price—full 6, partial 9. Maternity Cases.—Accommodation for maternity cases was available within the borough at the Middlesex Hospital, and also at the Paddington Hospital of the London County Council. The emergency obstetric service of the London County Council and a panel of local obstetric consultants continued to be available for any doctor in the area needing assistance in difficulties or complications arising during pregnancy or at or after confinement. SECTION C.—SANITARY CIRCUMSTANCES. Water.—As a result of the very cold weather in January, 12 written complaints and a number of verbal complaints were received regarding absence of water, mainly as a result of burst pipes. During the remainder of the year complaints were few and all were dealt with promptly. In view of the possibility of pollution from sewers and drains damaged by enemy action, water from all private wells still in use for domestic purposes was examined periodically by the Public Analyst and the Council's Bacteriologist who reported that in all cases the supply was satisfactory. Drainage.—The number of drainage plans of new premises approved during the year was 2, and of old buildings, 23. In addition, 72 plans were deposited in connection with amenities in public air-raid shelters. Inspections made by the drainage inspectors numbered 2,017. It was decided that in suitable cases approval could be given, during the period of the war, to the use of asbestos-cement soilpipes, etc. General acceptance, under the byelaws, of this material was not advocated as consideration of each case on its merits was held to be essential. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 2 premises. Public Conveniences.—The usual supervision was exercised over the 15 public sanitary conveniences (11 for men, 4 for women). The charge for a wash and brush-up was reduced from 3d. to 2d. as from 1st March, 1941, as the service was used mainly by members of H.M. Forces, Civil Defence workers and air-raid shelterers. The free use of water-closets by Army units engaged on demolition and debris-clearance work was permitted. Public Cleansing.—The arrangements for house refuse and salvage collection, refuse disposal and street cleansing were described in the report for 1940. The tonnages dealt with during 1941 were: house and trade refuse, 21,043 tons; salvage materials, 1,690J tons; street sweepings and gulley slop, 2,1111 tons. A sum of £6,916 16s. 2d. was obtained from the sale of salvage materials. In addition, £417 8s. 9d. was received for the removal of trade refuse, green and fish offal and for the cleansing of petrol interceptors. 8 Sanitary Inspection.—The total number of complaints received was 933 as against 1,298 in 1940. Details of the various nuisances detected and remedied, to the total number of 671, are set out in Table 4. In 262 cases the nuisances were abated by the persons responsible for their removal after receipt of a preliminary (intimation) notice advising them of the existence of the defect. Statutory notices were issued in 21 instances, and referred to such matters as dirt, dampness, verminous rooms, unsatisfactory water-closet accommodation, inadequate water supply, defective drains, and to other defects and conditions. In no case was the institution of legal proceedings called for. TABLE 4. 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 9 10 48 34 11 11 123 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired - 4 12 12 6 7 41 Verminous rooms disinfested. 1 3 15 9 3 5 36 Dirty and verminous furniture and bedding cleansed 2 1 2 4 1 2 12 Overcrowding abated — — — 1 — 1 2 Underground rooms (illegal occupation) dealt with — — — — — — — Water closet defects remedied 2 — 21 14 1 23 61 Insufficient and unsuitable water closet accommodation remedied - 7 17 - 11 1 36 Urinal defects remedied — — — — 1 — 1 Drain and water closet stoppages cleared 1 1 8 12 10 23 55 Drains relaid or amended 2 1 — 2 — 1 6 Soilpipes and ventilating shafts repaired or renewed — 1 3 3 — 1 8 Waste pipe defects remedied — 2 2 4 4 14 26 Yard defects remedied — . — 8 4 — — 12 Wash-house defects remedied — — 7 3 — — 10 Area defects remedied — — 2 3 1 1 7 Basement defects remedied — — — — — — — Roofs and gutters repaired 10 6 21 14 4 7 62 Water supply to houses reinstated — 5 5 1 — — 11 Water supply laid on to upper storeys — — 1 — — — 1 Water cistern defects remedied — — — 1 — — 1 Dung or dust receptacles repaired or renewed — — 5 5 — — 10 Rubbish, manure, etc., accumulations removed 5 7 21 8 13 17 71 Animal nuisances abated — — 4 — — — 4 Rat and mouse infestations dealt with 2 1 10 4 7 5 29 Bakehouses cleansed - - - - - - - Smoke nuisances abated - - - - - - - Shops—sanitary defects remedied - - - - - 5 5 Miscellaneous 1 — 15 2 14 9 41 Shops.—Inspections under the Shops Act, 1934, numbered 282. In no instance was the service of notice necessary. Bed Bugs.— A mobile hot-air disinfestor, loaned to the Council by the Government, was erected on the site of the old Public Mortuary in Paddington Street and used extensively for the treatment of verminous bedding from air-raid shelters, no fewer than 4,705 bundles being dealt with from the beginning of August (when the apparatus was installed) to the end of the year. The shelters themselves were under constant supervision and were regularly sprayed with an insecticide. To assist in the early detection of bug infestations, practical talks and demonstrations to shelter marshals and others concerned, were given by the Sanitary Inspectors. During the year no Council houses were reported to be verminous ; 36 other houses where bugs were found were disinfested. Verminous furniture belonging to 62 families dishoused as a result of enemy action and 12 loads of bunks and wooden strengthening material from 5 public airraid shelters were disinfested by the hydrogen cyanide process. Verminous Persons.—The numbers of adults and school children using the cleansing station during 1941 were 394 (295 males, 99 females) and 422 (78 boys, 344 girls) respectively. In a report on the prevalence of lousiness in the Borough, submitted to the Central Government Departments following the issue of a joint circular 2306 (Ministry of Health) and 1544 (Board of Education) dated the 17th March, 1941, stressing the importance of an active campaign against lice infestations, it was shown that during the Easter term (1st January to 17th April, 1941) 13.4 per cent, of the school children attending the Council's cleansing station had verminous heads but no body vermin, while 6 per cent, of the children examined in public air-raid shelters were verminous. Scabies statistics are shown separately at the foot of page 11. Rats and Mice.—Under a Ministry of Food Circular (F.I.G. 463), dated the 9th December, 1940, wide powers were conferred upon Food Control Committees to secure the destruction of rats and mice in all places where stocks of food are held. Special officers have been appointed by the Ministry of 5"ood to deal with infested premises and there has been close co-operation between the Public Health Department and the Ministry's officials, whose attention has been drawn to premises where evidence of rat infestation has been found. A campaign against rats and mice was inaugurated by the Ministry of Food at a meeting held in London on the 4th March, 1941, which was attended by the Council's Rat Officer appointed under the Destruction of Rats & Mice Order No. 2069, dated the 3rd December, 1940. Regular inspections of all food premises have been made during the year and since April, 1941, monthly reports have been submitted to the Rodent Officer of the London Divisional Food Office. The following is a summary of the work done : 89 complaints were received and 68 food and 168 other premises were found to be infested. Of the 68 food premises, 37 were shops, 29 hotels and restaurants and 2 dwelling houses ; the 168 other premises included 129 9 dwelling houses, 5 shops, 16 stores and warehouses, and 14 factories. In one case rats were found on an open space. Ratproofing was carried out in 22 premises. The chief methods employed in dealing with nuisance from rats were baiting and trapping. The main sources of infestation were sewers and drains damaged as a result of enemy action, and bombed sites with their collections of debris. Preventive measures taken in this connection included the sealing off of a considerable number of sewer connections. Mosquitoes.—During the summer months a considerable number of complaints were received regarding the breeding of mosquitoes in emergency water tanks, bomb craters and other sites where water collected. Appropriate methods of treatment, including oiling and the use of other larvicidal agents, resulted in the abatement of the nuisance in all cases. Collaboration with the fire fighting authorities was secured in instances where their tanks were found to be infested with the insects. Pigeons.—Four complaints of nuisance from these birds (two relating to private dwellings and two to allotments) were dealt with in 1941. Dog Nuisance.—Breaches of the bye-law relating to the fouling of footways by dogs were detected by police officers in 3 cases, in all 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 298, the amount of fines imposed being £110 lis. 6d. Noise.—During the year 11 complaints of noise were received, five relating to wireless loudspeakers, gramophones and similar instruments, two to machinery, two to tenants of a flat, one to a lorry, and one to a brass band. The issue of notices were necessary to obtain a remedy of nuisance caused by wireless loudspeakers at 2 premises. Poisons.—Traders whose names were on the Council's list of persons entitled to sell poisons included in Part II of the Poisons List (Pharmacy and Poisons Acts, 1852 to 1941) numbered 94 at the end of 1941. Inspections of premises were carried out during the year, and in no instance was there failure to comply with the requirements which apply to the sale of poisons by a listed seller of Part II poisons. The Pharmacy and Medicines Act, 1941, which received the Royal Assent on the 7th August, 1941, amends certain provisions of the Pharmacy and Poisons Act, 1933, and, among other things, prohibits certain types of medical advertisement and requires disclosure of composition of medicines. No action under the new statute was called for during the remainder of the year. Factories.—The number of registered factories at the end of the year was 1,228. In addition there were 236 restaurants, tea rooms, coffee shops, etc., and 34 bakehouses (25 underground). Frequent inspections were carried out, and defects were remedied in 17 instances (want of cleanliness 3 ; insufficient or unsuitable sanitary conveniences 14). Outworkers' lists were received from 62 employers relating to 196 contractors and 647 workpeople. Civil Defence.—Miscellaneous visits by the sanitary inspectors in connection with civil defence activities not referred to elsewhere in this report numbered 762 and included 400 visits relating to arrangements for the gas cleansing of business personnel. SECTION D.—HOUSING. Reliable figures as to the number of occupied houses and flats in the Borough for the year under review are not available. 1. Inspection of Dwelling-houses:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,681 (b) Number of inspections made for the purpose 3,793 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consohdated Amendment Regulations, 1932 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 234 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 312 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 18 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 16 (b) By local authority in default of owners Nil 10 (c) Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which demolition orders were made Nil (2) Numbe r 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 3 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit Nil 4. Housing Act, 1936—Part IV.—Overcrowding:— It is not possible to give dependable statistics under this heading. As a result of various factors arising out of the war, however, overcrowding was, as in 1940, considerably reduced. Tenement Houses.—During the year 4,594 visits were paid to the 1,558 houses of the tenement type. The number of intimation notices served was 242, relating to cleansing and other defects. Except in 18 cases, where statutory notices were issued, all informal notices were complied with without the necessity for further proceedings arising. Common Lodging Houses.—During 1941, 34 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. War Damaged Dwellings.—To ascertain their fitness or otherwise for habitation, inspections of 80 premises damaged as a result of enemy action were carried out by the Sanitary Inspectors and reports submitted to the War Damage Department. On the 16th October, 1941, the Medical Officer of Health was appointed the authorised officer of the Council for the purpose of issuing certificates under section 1(5) of the Landlord and Tenant (War Damage) (Amendment) Act, 1941. No action under the section was, however, called for between that date and the end of the year. Public Air-Raid Shelters.—Mention may appropriately be made here of the 2,413 visits to public air-raid shelters, which were used by large numbers of people as their regular sleeping places, particularly during the first half of the year, and called for constant inspection by day and night. SECTION E.- INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 163 premises upon which milk is sold. During the year 351 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. During the year 36 applications under the Milk (Special Designations) Orders, 1936 and 1938, were received from 17 milk purveyors and licences were granted as follows : 1 pasteurising, 19 dealers and 3 supplementary in the case of pasteurised milk ; 1 bottling, 11 dealers and 1 supplementary in respect of tuberculin tested milk. The average composition of the 111 samples of milk analysed was : total solids, 12.33% ; fat, 3.58% ; solids not fat, 8.75%. Thirty samples of milk were submitted to bacteriological examination, and all were found to comply with the Ministry of Health standard. Meat and other Foods.—Unsound Food.—Some 13 tons of food condemned as unfit for human consumption included the following : meat, 8 tons, 15 cwts., 3 qtrs., 15 lbs. ; fish, 6 cwts., 3 qtrs., 14 lbs. ; fruit, 4 cwts., 2 qtrs., 2 lbs. ; vegetables, 1 cwt., 3 qtrs., 12 lbs. ; canned goods, 8,234 tins ; miscellaneous, 2 cwts., 3 qtrs., 5| lbs. Practically all this unsound food was salvaged and diverted to other uses. 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. Ten inspections were made in 1941. 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. 10 visits, but no cause for complaint was found. Food Premises.—At the end of 1941,109 premises were registered for the preparation or manufacture of foods (other than ice cream) intended for sale, and 192 inspections were made by the food inspector. Ice Cream Premises.—The number of premises included in the register at the end of 1941 was 71. Throughout the year, 110 inspections were made, and in 5 cases notices were served in respect of uncleanly conditions. Butter and Margarine 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. Forty-two visits were paid to the registered premises during 1941. Bakehouses.—The number of bakehouses on the register was 34, 25 being underground bakehouses. During the year 192 inspections were made, but service of notice with regard to defects was not called for in any instance. 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. During the year 24 inspections of fried fish shops and 21 inspections of fish curers' premises were made by the food inspector. 11 Restaurants, Tea-Rooms, etc.—At the end of 1941 there were 236 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, 160 ; tea-rooms and pastry-cookshops, 50 ; and hotel kitchens, 26. During the year the total number of inspections was 715, the number of notices served being 21. Bacteriological Examinations.—During the year, apart from milk samples, six samples of canned meat roll were examined bacteriologically. All were found to be satisfactory. Food and Drugs Act, 1938.—The total number of samples taken in 1941 under the Food and Drugs Act, 1938, was 700 (70 formal, 630 informal) and included : milk 111, butter 73, margarine 30, cheese 16. No sample was found to be adulterated. The sum paid in respect of each analysis was 12s. 6d. The fee payable for the examination of, and the determination of meat in, sausages was increased to £1 Is. Od. per sample as from 1st September, 1941. Samples of food and drugs analysed in 1940 numbered 931. At the end of the year five premises appeared on the register of premises where artificial cream is manufactured, sold or exposed or kept for sale for human consumption. In no instance was action under the statute called for. Food Decontamination.—Arrangements for. dealing with gas-contaminated foodstuffs included the appointment of three sanitary'inspectors as gas contamination officers; the provision of a decontamination depot in Paddington to be used jointly by the Paddington and St. Marylebone Borough Councils; the earmarking of the necessary transport, and the training of food treatment squads obtained from the personnel of the light rescue service. SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Table 6 on page 12 lists the diseases notifiable in St. Marylebone, and shows the number of notifications received, the age distribution, the number of cases notified from each of the three registration sub-districts, and the total deaths during the year. No cases of food poisoning, which is also notifiable in the Borough, were reported in 1941. 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 diphtheria prophylactic employed until September, 1941, when a change over to A.P.T. (Alum Precipitated Toxoid) was made. Table 5 gives details of the work done during the year. TABLE 5. Work of the Diphtheria Immunisation Clinics. Pre-school children. School children. Adults. Totals. Attendances 743 1,643 311 2,697 New cases 228 455 105 788 Schick negative 2 3 10 15 Completely immunised but not retested 191 379 73 643 Retested 84 169 2 255 Positive after retest 8 27 1 36 These figures, which are more than treble those of 1940, include the following numbers of children completely immunised elsewhere than at the clinics : in five of the larger public air-raid shelters, 71 ; in London County Council elementary schools—Barrow Hill Road, 41 ; Gateforth Street, 23. Typhoid Fever.—Forty-one persons were inoculated against this disease at the special municipal clinic opened towards the end of 1940. Influenza.—Forty-six members of the Council's Civil Defence Service received inoculations against influenza during the autumn of 1941. Vaccination.—Vaccinations carried out during 1941 numbered 264 (primary, 209 ; re-vaccinations, 55). Vaccination was successful in 231 instances ; unsuccessful in 30 ; while 3 cases were awaiting inspection. Of the 1,565 children whose births were registered in the Borough in 1940, 760 (48.56%) were successfully vaccinated. Typhus Fever.—With the existence of louse-borne typhus fever in Europe and North Africa and the possibility of its introduction into this country, provisional arrangements were made, in conjunction with neighbouring boroughs, for dealing with cases and contacts and for preventing spread of the disease. Anthrax.—Early in June a number of deaths from anthrax occurred among the animals in the Zoological Gardens, Regent's Park, as a result of the consumption of a diseased carcase. Steps were taken to prevent spread of the disease, and all human contacts (keepers, etc.) with the animals or the food were kept under close observation. No case in man was reported. Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 751 cases of scabies during the year : adults 251 (males 139, females 112) ; children 500 (boys 231, girls 269). The benzyl benzoate preparation used for treatment purposes proved very effective. Owing to the increasing prevalence of the disease, arrangements were made for the establishment of a scabies clinic, with the necessary disinfecting plant, in the Middlesex Hospital Annexe to serve the eastern part of the Borough, and works of adaptation were put in hand by the hospital authorities towards the end of the year. The Council will contribute to the hospital's expenses in maintaining the clinic. The Scabies Order, 1941, made by the Minister of Health on the 28th October, 1941, provides local authorities with extended powers for dealing with verminous conditions. 12 table 6. cases of infectious disease notified during 1941. 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. North Marylebone Totals. All Souls. St. Mary. North Marylebone Totals. —1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Smallpox - - - - - - - - - - - - - - - - - - - - - - - Cholera — - - - - - - - - - - - - - - - - - - - - - - Diphtheria, including Membranous Croup 33 - 1 2 3 3 4 2 6 10 1 - 1 7 6 20 33 7 6 20 33 - Erysipelas 45 - — — — — — — — 5 2 20 18 4 27 14 45 1 23 9 33 12 - Scarlet Fever 40 1 1 1 7 2 7 1 8 7 3 1 1 12 9 19 40 12 9 18 39 1 - Typhus Fever — - - - - - - - - - - - - - - - - - - - - - - Enteric Fever - - - - - - - - - - - - - - - - - - - - - - - Paratyphoid Fever 5 - - - - - - - 2 3 - - - - 1 4 5 - 1 4 5 - - Relapsing Fever — - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 1 - - - - - - - - - 1 - - - 1 - 1 - 1 - 1 - - Puerperal Pyrexia 4 - - - - - - - 1 3 - - - - 1 3 4 - 1 3 4 - - Plague — - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever 15 - - - - - 1 3 - 3 6 2 - 5 3 7 15 6 3 7 15 - 4 Tuberculosis— Pulmonary 85 - 1 — 1 — 4 2 10 33 11 17 6 21 26 38 85 11 15 23 49 36 46 Non-Pulmonary 6 - — 1 — — — — — 1 1 1 2 1 2 3 6 1 2 2 5 1 3 Acute Poliomyelitis 2 - — — — — — — 1 1 1 1 2 1 1 2 - - Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 3 3 - - - - - - - - - - - - 2 1 3 - 2 1 3 - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 43 1 1 1 — — — 1 5 9 5 15 5 12 9 22 43 7 6 14 27 16 57* Malaria 2 - - - - - - - - 1 1 - - - 1 1 2 - 1 1 2 - - Dysentery 40 — — 1 — — 2 — — — — 6 31 - 36 4 40 - 36 3 39 1 1 Measles 93 5 8 17 13 9 18 3 6 12 — 2 - 33 22 38 93 21 9 12 42 51 — Whooping Cough 79 16 12 12 10 7 18 — 1 3 — — — 42 6 31 79 29 5 8 42 37 1 Totals 496 26 24 35 34 21 54 12 40 91 31 64 64 138 152 206 496 95 120 126 341 155 112 *This figure is for all forms of pneumonia, including acute primary pneumonia and acute influenzal pneumonia which alone are notifiable. 13 Ophthalmia Neonatorum.—The number of cases of this disease notified in 1941 was 3. All were treated in hospital, and in no case was vision impaired. Dysentery.—At the beginning of the year 16 cases of sonne dysentery occurred among the men in an infirm ward at the St. Marylebone Home. During August a further 19 cases were reported from the women's wards at the institution. Both outbreaks were mild in character. The source of the infection was presumably from carriers among the inmates, over whose movements little control can be exercised. Tuberculosis.—New Cases and Mortality.—Table 7, prepared at the request of the Ministry of Health, contains information with regard to age and sex distribution of all forms of tuberculosis. TABLE 7. 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—5 1 1 1 - - - - - 5—15 1 5 - - - - - - 15—25 11 14 - - 3 8 - - 25—35 21 11 - 4 6 1 - 3 35—45 9 8 - 2 7 4 - — 45—55 10 — - — 3 3 - — 55—65 8 3 - 1 6 1 - — 65 and upwards 5 4 - 2 3 1 - — Totals 66 46 1 9 28 18 — 3 ♦Including all primary notifications and also any other new cases of tuberculosis which came to the knowledge of the Medical Officer of Health during the year. Notifications.—Table 8 gives information regarding notifications and the localisation of the disease. The total number of cases of tuberculosis remaining at the 31st December, 1941, on the register of notifications kept by the Medical Officer of Health was 476, 70 less than at the end of the previous year. TABLE 8. Tuberculosis Notifications—Localisation of Disease. Localisation of disease. Cases notified in whole district. Cases notified in each locality. Cases removed to hospital from each locality. Cases isolated at home. At all Ages. At ages—years. All Souls. St. Mary. North Marylebone All Souls. St. Mary. North Marylebone Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Lungs 85 - 2 6 22 32 17 6 21 26 38 11 15 23 36 Glands 3 - 1 — — — — 2 - 1 2 — 1 1 1 Wrist 1 - — — — 1 — - 1 - - 1 - - - Ilium 1 - — — — 1 — - - 1 - - 1 - - Renal tract 1 — — — — — 1 — — — 1 — — 1 — Totals 91 3 6 22 34 18 8 22 28 41 12 17 25 37 Dispensary.—Work proceeded on practically a normal basis in the new dispensary forming part of Health Centre No. 1 at the Town Hall Extension. Statistics for 1941 : new cases 338, old cases 210 ; attendances 2,769 ; contacts 187 ; home visits by tuberculosis officer—new 29, old 88 ; hospital visits by tuberculosis officer 55 ; home visits by tuberculosis visitors—first visits 132, re-visits, 1,166. During the year 537 examinations (films, 358 ; screening only, 179) were made by means of the Council's X-ray plant on the dispensary premises. Twenty-six patients received artificial pneumothorax treatment in the dispensary and 237 refills were given. Expenditure on milk supplied to tuberculous persons amounted to £161 3s. 9d. ; 336 orders were issued. 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. Special air-raid shelter accommodation for tuberculous persons was set aside in a central position in the Borough. Dental Treatment.—Consideration of a scheme for providing dental treatment for tuberculous persons under the direct control of the Borough Council was deferred until after the War. Institutional Treatment.—Admissions to hospital or sanatoria during the year numbered 134. Care Committee.—The Committee held 12 meetings and dealt with 262 cases. 14 Disinfection.—During the year 935 rooms and 25,995 articles (including 201 books) were disinfected. Bacteriological Examinations.—Table 9 shows the number of specimens examined for the purposes of diagnosis, and indicates also the organisms in relation to which the examinations were made. TABLE 9. Work of the Bacteriological Laboratory. Examination. Positive. Negative. Suspicious. Total. Throat and Nasal swabs (for B. diphtheriae and hsemolytic streptococci) 9 114 2 125 Sputa (for tubercle bacilli) 6 61 — 67 Pleural fluid (for tubercle bacilli) — 1 — 1 Urine (for typhoid) — 1 — 1 Blood (for typhoid) — 2 — 2 Swab (for meningococcus) 1 — — 1 Totals 16 179 2 197