CI AC4353 STmary 47 1942 Borough of St. Marylebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1942 H. A. BULMAN, M.R.C.S., D.P.H. London; Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Lewisham AC 43 2 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Despite various difficulties and restrictions associated with life in war-time, health conditions generally in the Borough continued to be satisfactory. The Registrar-General gave 52,470 as his estimate of the civilian population for 1942, the figure for 1941 being 49,260. The birth-rate (11.26) showed an increase over the figure for the previous year (9.34), while the death-rate decreased from 19.49 in 1941 to 15.76 in 1942. The infantile mortality rate at 49.07 was somewhat higher than the low record of 41.77 for 1941. Infectious disease cases, though not excessive in number, rose from 496 last year to 621 in 1942, pulmonary tuberculosis, dysentery, measles and whooping cough being mainly responsible for the increase. Diphtheria declined from 33 cases in 1941 to 19 in 1942, and the immunisation campaign against this disease was intensified with highly encouraging results. No deaths were recorded as due to the acute infectious diseases. Tuberculosis came to the forefront as a subject for discussion by various government departments and associations of local authorities, and particular attention was given to mass miniature radiography as a means of ear ly diagnosis ; additional institutional treatment facilities ; training and resettlement of tuberculous persons, and maintenance grants for patients and their dependents. Scabies, a concomitant of war, was especially active during the year and two treatment centres dealt with 1,151 cases. A full maternity and child welfare service continued to be provided and attendances at the ante-natal and infant clinics showed a marked increase. Two wartime day nurseries functioned throughout the year, and arrangements were made to increase this number. The sanitary administration of the Borough was adequately maintained, and close attention was devoted to the suptrvision of food supplies. In the absence of air-raids, opportunity was taken to review and modify the civil defence casualty services. Once more I acknowledge with gratitude the work of the staff, who have carried on untiringly and often in the face of difficulties. Thanks are also due to the Chairman and Members of the Public Health Committee for the support they have always afforded me. 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 Births 3 Marriages 3 Maternal Mortality 3 Deaths 4 Infantile Mortality 4 Mortuary 4 Crematorium 4 Section B—General Provision of Health Services :— Staff 5 Laboratory Facilities 5 Home Nursing 5 Health Centres 5 Maternity and Child Welfare :— Work of the Clinics 5 Home Visits 5 Milk and Food, etc 5 Day Nurseries 5,6 Play Centres 6 Home Helps 6 Child Life Protection 6 Dental Treatment 6 Maternity Cases 6 Convalescent Homes 6 Section C—Sanitary Circumstances :— Water 6 Drainage 6 Combined Drainage 6 Public Conveniences6 Public Cleansing 6 Shops 6 Bed Bugs 6 Verminous Persons 6 Rats and Mice 7 Sanitary Inspection 7 Mosquitoes 7 Pigeons 7 page Noise 7 Poisons 7 Factories 7 Civil Defence 7 Section d—Housing :— Inspection of Dwelling-houses 8 Common Lodging Houses 8 War-Damaged Dwellings 8 Public Air Raid Shelters 8 Section e—Food :— Milk Supply 8 Meat and Other Foods Unsound Food 8 Slaughterhouse 8 Food Premises 8 Ice Cream Premises 8 Butter and Margarine Premises 8 Bakehouses 8 Fried Fish Vendors and Fish Curers 8 Restaurants, Tea Rooms, etc. 8 Bacteriological Examinations 8 Food and Drugs Act, 1938 8 Section F—Infectious and Other Diseases :— Notifications 9 Immunisation :— Diphtheria 9 Whooping Cough 9 Typhus Fever 9 Vaccination 9 Scabies 9 Impetigo 10 Dysentery 10 Venereal Diseases 10 Tuberculosis :— New Cases and Mortality 10 Notifications 10 Dispensary .10 Institutional Treatment 11 Care Committee Disinfection Bacteriological Examinat ions 11 3 PUBLIC HEALTH COMMITTEE who are also the Committee appointed for Maternity and Child Welfare purposes.) 1942. HIS WORSHIP THE MAYOR : Councillor Douglalas Timins, O.B.E., J.P., M.A. ALDERMEN: F. W. Dean, J.P., L.C.C. J. Fettes, J.P. COUNCILLORS : Miss M. Barry. Mrs. C. M. Phillips. F. Y. Bright. The Hon. Mrs. A. E. Pleydell-Bouverie. F. V. Cullen, F.S.I., F.A.I. (Deputy Chairman) C. H. Press. Mrs. E. B. Davis. G. B. Ramsay. Dr. C. A. Fuller (Chairman). T. W. Robinson, A.C.A. Mrs. Carr Q. Henriques. Capt. Robert Whitney, M.B.E. Dr. Elizabeth Jacobs. 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 (used in calculating various rates in this report) : 1942—52,470. EXTRACTS FROM VITAL STATISTICS. Total M. F. Live Births —Legitimate 492 244 248 Birth Rate per 1,000 estimated Illegitimate 99 52 47 civilian population 11.26 Stillbirths- Legitimate 16 7 9 Rate per 1,000 total (live and still) Illegitimate — — - births 26.36 Deaths (all ages) 827 Death Rate per 1,000 estimated civilian population 15.76 Deaths. Rate per 1,000 total (live and still) births Maternal Mortality—Deaths from Puerperal causes (Post-abortive Sepsis) 1 1.65 Total M. F. Deaths of Infants under one year of age— -Legitimate 23 14 9 Illegitimate 6 5 1 Death Rate of Infants under one year of age—All infants per 1,000 live births, 49.07 ; legitimate infants per 1,000 legitimate live births, 46.75 ; illegitimate infants per 1,000 illegitimate live births, 60.61. Deaths—From Cancer (all ages), 137 ; from Measles (all ages), nil; from Whooping Cough (all ages), nil; from Diarrhoea (under 2 years), 8. Births—Notification.—The number of notifications received under the Public Health (London) Act, 1936, Section 255, was 1,107 : live births, 1,077 ; stillbirths, 30. The main sources of the notifications were : from parents, 1 ; from doctors, 11 ; from midwives, 60 ; from hospitals, nursing homes, etc., 1,035. Of the births notified, 541 took place at the Middlesex Hospital ; 192 at Paddington Hospital ; and 80 were born at home. Of those notified as having occurred in St. Marylebone, 585 belonged to other Boroughs. Of the 30 stillbirths (15 males and 15 females) notified direct to the Department, 12 (7 males and 5 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 16. Marriages.—The total number of marriages was 1,128, being 98 above the number for 1941, and 350 below the average for the previous 10 years. The rate for persons married in 1942 was 42 per 1,000 of the estimated civilian population. 4 TABLE 1.—Causes of, and Ages at Death during the Year 1942. Code No. CAUSE OF DEATH. Nett deaths at the sub-joined ages of " Residents " whether occurring within or without the Borough. Deaths in Institutions in the Borongh. Deaths in Sub-Districts. 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 All Souls. St. Mary. North Marylebone. 6 Tuberculosis of respiratory system 46 - 1 - 22 18 5 2 12 8 14 24 46 7 Other forms of tuberculosis 10 2 1 1 3 2 1 1 — 3 3 4 10 8 Syphilitic disease 9 1 — - 2 3 3 — 3 2 1 6 9 9 Influenza. 2 — — - — - 2 — — 1 — 1 2 13m Cancer of buccal cavity and oesophagus (males only) 8 - - - 1 3 4 1 11 - 4 4 8 13F Cancer of uterus. 7 — — - 2 2 3 2 6 2 1 4 7 14 Cancer of stomach and duodenum 18 - - - - 10 8 2 9 2 6 10 18 15 Cancer of breast 17 — — - 1 6 10 — 2 3 3 11 17 16 Cancer of all other sites 87 — — - 4 33 50 7 55 21 26 40 87 17 Diabetes 3 — — 1 — 1 1 1 2 — 2 1 3 18 Intra-cranial vascular lesions 70 - - - 1 15 54 6 19 15 16 39 70 19 Heart disease 209 — — 1 5 44 159 11 47 27 84 98 209 20 Other diseases of the circulatory system 34 - - - - 9 25 2 19 8 12 14 34 21 Bronchitis 64 1 — - 1 22 40 2 4 10 20 34 64 22 Pneumonia 50 4 — - 1 12 33 1 16 8 24 18 50 23 Other respiratory diseases 12 1 — - — 6 5 — 1 2 6 4 12 24 Ulceration of the stomach or duodenum 6 - - - 1 4 1 1 10 2 1 3 6 25 Diarrhoea (under 2 years of age) 8 8 - - - - - - - - 4 4 8 26 Appendicitis 3 — — - 1 1 1 1 — 2 1 — 3 27 Other digestive diseases 19 — — - 1 5 13 1 11 2 7 10 19 28 Nephritis 16 — — - 3 2 11 - 14 3 6 7 16 29 Puerperal and postabortive sepsis 1 - - - 1 - - - - 1 - - 1 30 Other maternal causes - - - - - - - - 1 - - - - 31 Premature birth 5 5 - - - - - 1 13 — 1 4 5 32 Congenital malformations, birth injury, infantile disease 10 7 - - 3 — — -- 5 1 5 4 10 33 Suicide 4 — — - 2 2 — 3 4 1 — 3 4 34 Road traffic accidents 4 — -- - 1 — 3 2 2 1 2 1 4 35 Other violent causes 26 — 1 - 5 9 11 2 14 6 9 11 26 36 All other causes 79 — 2 1 16 13 47 5 58 17 29 33 79 Totals 827 29 5 4 77 222 490 54 338 148 287 392 827 No deaths occurred from the following causes not shown in the table : Typhoid and paratyphoid fevers, cerebro-spinal fever, scarlet fever, whooping cough, diphtheria (Nos. 1—5), measles, acute poliomyelitis and polioencephalitis, acute infectious encephalitis (10—12). 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 9 and under 12 months All Souls. St. Mary. North Marylebone. Total 8 Enteritis — - 3 3 1 1 — 4 4 8 9 Tuberculous Meningitis — — — 1 — — — 1 — i 11 Other Tuberculous Diseases — — —- — — 1 1 — — 1 12 Congenital Malformation 2 1 1 — — — — 2 2 4 13 Premature Birth 4 1 — — —- - — 1 4 5 14 Atrophy, Debility and Marasmus — — — 1 — — — • — 1 1 16 Injury at Birth — 1 - - - - - 1 — 1 18 Syphilis — — — 1 — — — — 1 1 20 Meningitis (not Tuberculous) — — 1 — — — 1 — — 1 24 Bronchitis — — — 1 — — — — 1 1 25 Pneumonia {all forms) — — 3 1 — — — 3 1 4 27 Other Causes — 1 — — — — — — 1 1 Totals 6 4 8 8 1 2 2 12 15 29 No infantile deaths occurred in the age-group 2 and under 4 weeks, or from the following causes not shown in the table: Small-pox, chicken-pox, measles, scarlet fever, diphtheria and membranous croup, whooping cough, diarrhoea (Nos. 1—7), abdominal tuberculosis (10), atelectasis (15), erysipelas (17), rickets (19), convulsions, gastritis, laryngitis (21—23), suffocation, overlying (26). Mortuary.—Eight bodies (7 males, 1 female) were deposited at the Emergency Mortuary, No. 24, Hill Road. No post-mortem examinations were carried out. Crematorium.—One hundred and thirty-four certificates authorising cremation at the St. Marylebone Crematorium, Finchley, were issued—118 by the Medical Referee and 16 by the Deputy Medical Referees. 5 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. Staff.—The death of Mr. T. W. Forbes on the 17th June, 1942, is recorded with great regret. He had completed 30 years in the local government service, 17 years of which were spent as Sanitary Inspector in the Great Portland Street area of the Borough. Mr. Lawrence Newland, who had been a temporary Sanitary Inspector since 5th May, 1941, succeeded him on the permanent staff. The Department also mourned the loss of a promising Junior Clerk, Air. C. N. F. Downs, who was fatally injured in America on the 24th September, 1942, whilst training as a Pilot in the Royal Air Force. Dr. W. H. S. Wallace joined the Royal Army Medical Corps on the 17th October, 1942, and Dr. Hilda G. Johnson and Dr. Anna B. Broman were engaged in a temporary part-time capacity to carry out his duties as Maternity and Child Welfare Medical Officer. A half-time temporary woman clerk (Mrs. R. M. Woodman) commenced work in the Department on the 4th September, 1942. A student Health Visitor from the National Health Society spent twelve weeks at the Council's Centres, etc., to gain practical experience of a health visitor's duties. Mr. J. Calderbank, Sanitary Inspector, resigned on 31st December, 1942, to take up a similar position at Hornsey. 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. G. A. Stokes, F.I.C., F.C.S., is the Public Analyst for the Borough and his laboratory is situated at No. 159, Edgware Road, W.2. 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 1942, visits were paid to cases (number shown within brackets) as follow : Maternity, 927 (53) ; pneumonia, 126 (9); tuberculosis, 63 (5). 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 the Middlesex Hospital form 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.—Work of the Maternity and Child Welfare Clinics. Centre Clinic Sessions held Attendances (figures in brackets indicate new cases). Home Visits Maternity Infant Light Massage Maternity Clinics Infant Clinics Light Clinic Massage Clinic Antenatal Postnatal Under 1 year 1—5 years Under 1 year 1—5 years Under 1 year 1—5 years Health Centre No. 1 53 152 77 113 820 16 2,871 1,645 37 954 18 664 1,648 (240) (14) (211) (34) (8) (72) (12) (68) Health Centre No. 2 52 141 77 — 597 29 2,833 1,178 209 1,139 1,917 (131) (19) (188) (35) (20) (56) The Middlesex Hospital 211 154 - - 4,519 392 2,159 1,271 - - - - 2,315 (438) (370) (146) (14) *343 *22 *797 *414 *(32) *(16) *(52) *(8) *St. Marylebone residents attending the Middlesex Hospital. Home Visits.—The number of visits paid during the year by the five whole-time and two part-time health visitors was as follows : (a) to expectant mothers, first visits, 400, total visits, 859 ; (b) to children under 1 year of age, first visits, 514, total visits, 3,486 ; (c) to children between the ages of 1 and 5 years, total visits, 4,613. 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 29th December, 1941, to 2nd January, 1943 : liquid milk—79,1031 gallons (free, 17,645 1/8 gallons; at 2d. per pint, 61,458f gallons); full cream dried milk—1,767-20 oz. cartons, one carton being equivalent to 7 pints of liquid milk (free, 653 cartons ; at l/2d. per carton, 1,114) ; half cream dried milk—71 cartons (free, 38 cartons ; at l/2d. per carton, 33). Distribution of vitamin preparations was made as follow : cod liver oil, 2,065-6 oz. bottles (to young children and, from 1st December, 1942, to expectant mothers) ; black currant syrup—to children under 6 months—321 -13½, oz. bottles (until 8th February, 1942) ; black currant puree— to children 6 months to 2 years—1,276-8½ oz. cans (until 29th March, 1942). Black currant syrup and puree were replaced by orange juice of which 5,392-6 oz. bottles were issued during the remainder of the period. From 1st December, 1942, orange juice was made available to children up to 5 years of age and to expectant mothers. Special baby clothing coupons (increased from 50 to 60 on 1st June, 1942) were issued to 773 expectant mothers. Day Nurseries.—A war-time nursery (whole-time) for 60 children (0-5 years) was opened bv the Council in the Portman Day Nursery building, Salisbury Street, on 26th January, 1942. The average daily attendance of children was 44. The nursery is affiliated to the National Society of Children's Nurseries as a training centre. A small outbreak of enteritis among the younger children, all of whom made a satisfactory recovery, necessitated the closure of the building for 12 days in March. The generous assistance of the St. Marylebone Health Society and other voluntary associations contributed largely to the smooth-running of the nursery, particularly in the early days of its functioning. The Council's gratitude is due also to Mrs. Sigismund Goetze for placing at the disposal of the children her garden at Grove House, Park Road, and to various organisations for gifts of clothing and toys. 6 As from the 1st September, 1942, St. Vincent's Creche, No. 14, Blandlord Street, was approved by the Ministry of Health as a grant-aided war-time nursery (whole-time) for 35 children (0.5.years). Daily attendances averaged 29. Part of the Gardens, Paddington Street, was, with the approval of the Works Committee, set aside as a playground for children from this Nursery. At the end of the year negotiations were proceeding for the establishment of a third war-time nursery (wholetime) to accommodate 57 children (0-5) from the eastern area of the Borough. During the first half of 1942, play centres, at which children of women doing war work could have tea and spend the remainder of the evening until the parents returned home, were opened by the London County Council at Cosway Street School and All Souls' School, Foley Street. 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 37 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 five. 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. Statistics for 1942 : sessions held, 90 ; new cases—mothers 101, children 31 ; attendances—mothers 559, children 75 ; X-ray examinations, 11 ; extractions:—mothers 193, children 45 ; patients provided with dentures at cost price, 32 ; fillings, 168 ; other operations, 260. 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. Convalescent Homes.—During the second half of the year two mothers with their babies were sent for two weeks to a post-natal hostel near Hertford. In October the Council decided to take advantage of convalescent facilities for toddlers at Byfleet, Surrey, but no children could be sent during the remainder of the year as the institution was in quarantine for infectious disease. SECTION C.-SANITARY CIRCUMSTANCES. Water.—Thirty-four written complaints and a number made verbally were concerned mainly with absence of water, largely as a result of burst pipes caused by cold weather early in the year. A few complaints of chlorinous tastes were referred to the Metropolitan Water Board, who subsequently issued an explanatory statement with the conclusion that " there was the strongest evidence that standard of purity of supply was higher even than before the war." In accordance with the provisions of the Public Health (London) Act, 1936, the Board notified seven instances where water had been cut off in occupied premises for non-payment of rates. Water from private wells still in use for domestic purposes was examined periodically by the Public Analyst and the Council's Bacteriologist. In only one instance were unsatisfactory reports received. These related to a large block of flats where the water was found to be polluted. Effective chlorination was immediately carried out, pending provision of a supply from the mains of the Metropolitan Water Board. Drainage.—The number of drainage plans approved was 26, all relating to old buildings. In addition, 37 plans were deposited in connection with amenities in public air-raid shelters. Inspections made by the drainage inspectors numbered 2,288. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 3 premises. Public Conveniences.—The usual supervision was exercised over the 15 public sanitary conveniences (11 for men, 4 for .women). Public Cleansing.—The tonnages dealt with were : house and trade refuse, 19,343.1 tons ; salvage materials, 2,589 tons ; street sweepings and gulley slop, 8,551 tons. A kitchen waste collection service was established, 500 special bins being placed at intervals in the streets for the reception of waste food scraps required for pig and poultry feeding. A sum of £10,315 12s. 9d. was obtained from the sale of salvage materials. In addition, £284 6s. 9d. was received for the removal of trade refuse, green offal, and the cleansing of petrol interceptors. Shops.—Inspections under the Shops Act, 1934, numbered 163. In two instances scrvice of notice was necessary. Bed Bugs.—One Council house and 55 other houses where bugs were found were disinfested. Verminous furniture belonging to 17 families, 7 of whom were dishoused as the result of enemy action, was treated by the hydrogen cyanide process. The mobile hot-air disinfestor was used extensively for disinfestation of bedding from air-raid shelters, no fewer than 6,036 bundles being dealt with. Verminous Persons.—The numbers of adults and school children using the cleansing station were 552 (427 males, 125 females) and 1,175 (316 boys, 859 girls) respectively. Scabies statistics are shown separately on page 9. 7 Rats and Mice.—Under the Ministers of the Crown (Minister of Food) Order, 1942 (Statutory Rules and Orders, No. 807) dated 30th April, 1942, the functions of the Minister of Agriculture and Fisheries under the Rats and Mice (Destruction) Act, 1919, as amended by the Ministry of Health (Rats and Mice Destruction, Transfer of Powers) Order, 1922, except so far as they are exercisable in rural districts, were transferred, to the Minister of Food. The following is a summary of the work done during 1942 : 144 complaints were received and 75 food and 264 other premises were found to be infested. Of the 75 food premises, 54 were shops and 21 hotels and restaurants ; the 264 other premises included 167 dwelling houses, 39 shops, 58 stores, warehouses and factories., Ratproofing was carried out in 137 premises. The chief methods employed for the extermination of rats were poison 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 inspection of 497 premises and the sealing off of 345 sewer connections. Sanitary Inspection.—The total number of complaints received was 996 as against 933 in 1941. Details of the various nuisances detected and remedied, to the total number of 977, are set out in Table 4. In 145 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 17 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 it necessary to institute legal proceedings. 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 7 37 72 22 10 14 162 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired 5 12 18 11 10 14 70 Verminous dwellings disinfested 1 4 24 10 10 7 56 Dirty and verminous furniture and bedding cleansed — 1 5 6 3 2 17 Overcrowding abated. - - - - - 1 1 Underground rooms (illegal occupation) dealt witji- - - - - - -—- — Water closet defects remedied 1 21 55 13 10 18 118 Insufficient and unsuitable water closet accommodation r=emedied 7 12 11 3 33 Urinal defects remedied 1 — 3 — — 2 6 Drain and water closet stoppages cleared ... — 15 6 12 12 15 60 Drains relaid or amended 2 7 2 8 — 4 23 Soilpipes and ventilating shafts repaired or renewed — 8 3 — — 1 12 Waste pipe defects remedied... — 10 8 4 3 5 30 Yard defects remedied — — 14 6 — 4 24 Wash -house defects remedied — 5 12 1 — — 18 Area defects remedied — — 2 1 — 4 7 Basement defects remedied ... — — — — — — — Roofs and gutters repaired ... 13 21 38 16 4 11 103 Water supply to houses reinstated ... 1 7 7 5 — i 21 Water supply laid on to upper storeys — ■— — 2 ;— 1 3 Water cistern defects remedied — 2 2 — . 3 1 8 Dung or dust receptacles repaired or renewed 1 3 7 5 1 7 24 Rubbish, manure, etc., accumulations removed ... ; 15 30 8 10 18 81 Animal nuisances abated — 5 — — 4 9 Rat and mouse infestations dealt with 2 3 18 9 20 10 62 Bakehouses cleansed - Smoke nuisances abated - - - - - 1 1 Shops—sanitary defects remedied 1 —- 1 — — — 2 Miscellaneous 5 10 3 4 4 26 Mosquitoes.—Complaints regarding the breeding of mosquitoes in emergency water tanks were fewer in number than in 1941. Regular inspections were continued and, with the co-operation of the fire fighting authorities, systematic preventive measures were adopted. Pigeons.—Fifteen complaints of nuisance from these birds (eight relating to churches, five to private dwellings and two to public buildings) were dealt with. A contractor was employed, with satisfactory results, to reduce the pigeon population in serious cases. Noise.—During the year 8 complaints of noise were received, three relating to wireless loudspeakers, gramophones and similar instruments, two to machinery, one to tenants of a flat, one to licensed premises, and one to water fittings. The issue of a notice was necessary to obtain a remedy of nuisance caused by a wireless loudspeaker. 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 85. Factories.—The number of registered factories was 1,306. Frequent inspections were carried out, and conditions were remedied in 27 instances (want of cleanliness 3 ; insufficient or unsuitable sanitary conveniences 17 ; other defects 10). Outworkers lists were received from 66 employers relating to 305 contractors and 410 workpeople. Civil Defence.—Miscellaneous visits by the sanitary inspectors in connection with civil defence activities not referred to elsewhere in this report numbered 368 and included visits relating to arrangements for the gas cleansing of business personnel. 8 SECTION D.—HOUSING. Inspection of Dwelling-houses.—Number of houses inspected for defects under the Public Health or Housing Acts—1,656 ; number of inspections made—4,801 number of houses found not to be in all respects reasonably fit for human habitation—280; number of defective houses rendered fit in consequence of informal action—337; number of houses in which defects were remedied by owners after service of formal notices under the Public Health (London) Act, 1936—12 ; number of underground rooms in respect of which closing orders were made—3. Common Lodging Houses.—Thirty-seven visits were paid 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. War-Damaged Dwellings.—To ascertain their fitness or otherwise for habitation, inspections of 352 premises damaged as a result of enemy action were carried out and reports submitted to the War Damage Department. Public Air-Raid Shelters.—A number of people continued to use the shelters as sleeping places from time to time, and 917 inspections were made by day and night. SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 166 premises upon which milk is sold. Inspections made numbered 327. During the year 34 applications under the Milk (Special Designations) Orders, 1936 and 1938, were received from 16 milk purveyors and licences were granted as follows : 1 pasteurising, 19 dealers and 2 supplementary in the case of pasteurised milk ; 1 bottling, 10 dealers and 1 supplementary in respect of tuberculin tested milk. The average composition of the 127 samples of milk analysed was : total solids, 12.31% ; fat, 3.58% ; solids not fat, 8.73%. 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 9 tons of food condemned as unfit for human consumption included the following : meat, 17 cwts., 5 lbs. ; fish, 16 cwts., 2 qtrs., 18 lbs. ; fruit, 9 cwts., 19 lbs. ; vegetables, 14 cwts., 2 qtrs., 18 lbs. ; cereals, 2 qtrs., 25 lbs. ; canned goods, 8,733 tins ; miscellaneous, 11 cwts., 7 lbs. Practically all this unsound food was salvaged and diverted to other uses. Slaughterhouses.—The only licensed 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. Two licences to slaughter or stun animals, granted to skilled slaughtermen, were renewed. Food Premises.—At the end of 1942, 109 premises were registered for the preparation or manufacture of foods (other than ice cream) intended for sale, and 201 inspections were made. Ice Cream Premises.—The number of premises on the register was 71, and 140 inspections were made. 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. Fifty-six inspections were made. Bakehouses.—Number on register 31, 23 being underground bakehouses ; 126 inspections were made. Fried Fish Vendors and Fish Curers.—The number'of premises used by vendors of fried fish is 11 and by fish curers 3. Twenty-six inspections of fried fish shops and 24 inspections of fish curers' premises were carried out. Restaurants, Tea-Rooms, etc.—Premises in which meals are provided or food is sold already cooked or is prepared for sale numbered 192, including restaurant and dining-room kitchens, 140 ; tea-rooms and pastry-cookshops, 40 ; hotel kitchens, 12 : 675 inspections were made and 12 notices served. Bacteriological Examinations.—Apart from milk, one sample each of canned peas, pressed beef, meat roll, cooked salmon, canned chopped ham and canned cheese was examined bacteriologicall.v and reported to be satisfactory. A sample of pork, affected with multiple cysts, was declared to be unfit for human consumption, and the whole carcase and offal were salvaged for manufacturing purposes. Food and Drugs Act, 1938.—Samples taken under the Act numbered 700 (54 formal, 646 informal) and included : milk 127, butter 154, margarine 20, cheese 16. The sum paid in respect of each analysis was 12s. 6d. Three samples were found to be under standard : 2 samples (1 formal, 1 informal) of plum jam were each 3% deficient in soluble solids, and a warning was issued to the manufacturers ; 1 informal sample of saccharin tablets was deficient in saccharin to the extent of 63% of the minimum limit of the Saccharin (Control and Maximum Prices) Order, 1941, and action in this instance was taken by the Food Executive Officer. A fourth sample (formal), purchased as olive oil, was found to consist entirely of arachis (pea-nut) oil ; the vendor was prosecuted and fined £10 with £5 5s. Od. costs. 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 necessary. 9 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Infectious diseases notifiable in St. Marylebone are listed in Table 5, which gives also information regarding notifications and deaths during 1942. Four unconnected cases of food poisoning, which is also notifiable in the Borough, were reported. TABLE 5—Infectious Disease Notifications and Deaths. Notifiable Disease. Cases notified in whole Borough. Cases notified in Sub-Districts. Cases removed to hospital. Cases isolated at home. Total deaths. At all ages At Ages—years. All Souls. St. Mary. North Marylebone —1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Diphtheria, including 1 - Membranous Croup 19 — 2 1 1 — 1 3 9 1 — — 4 5 10 19 — — Erysipelas 23 — — — — — 1 1 5 — 2 10 4 6 10 7 18 5 — Scarlet Fever 55 — — 2 3 3 12 3 12 16 2 1 1 18 8 29 53 2 — Paratyphoid Fever 2 — — — — — — — — 1 1 — — — 2 — 2 — — Puerperal Fever 3 - - - - - - - - 3 - - - 2 1 — 2 1 1 Puerperal Pyrexia 14 — — — — — — — 1 12 1 — — 1 5 8 14 — — Cerebro-Spinal Fever Tuberculosis— 2 — — — — - 1 — 1 — - — — — - 2 2 — — Pulmonary 114 — 2 — — 1 1 3 12 44 21 24 6 30 33 51 58 56 46 Non-Pulmonary 15 2 — 1 1 — 1 — 1 6 1 2 — 5 5 5 10 5 10 Acute Poliomyelitis 1 — — — — 1 — — — — — — — — —. 1 1 — — Pneumonia 41 — — — 1 2 — — 5 11 1 13 8 10 7 24 35 6 501 Malaria 2 — — — — — — — — 1 — 1 — — 1 1 2 — — Dysentery 106 — — 3 1 -— 1 — — 2 2 23 74 1 99 6 105 1 — Measles 122 5 10 5 9 15 46 5 6 15 4 2 — 43 17 62 49 73 — Whooping Cough 102 18 13 17 15 17 18 — — 2 2 — — 18 14 70 42 60 — Totals 621 25 27 29 31 39 82 15 44 122 38 76 93 138 207 276 412 209 107 * There were no cases of the following diseases, which are also notifiable in the Borough :Smallpox, cholera, typhus fever, enteric fever, relapsing fever, continued fever, plague, glanders, farcy, anthrax, polio-encephalitis, ophthalmia neonatorum, encephalitis lethargica. ‡This figure is for all forms of pneumonia, including acute primary pneumonia and acute influenzal pneumonia which alone are notifiable. Immunisation.—Diphtheria.—Clinic facilities were available at Health Centres Nos. 1 and 2 and at the Middlesex Hospital. A.P.T. (Alum Precipitated Toxoid) was the diphtheria prophylactic employed. TABLE 6.—Work of the Diphtheria Immunisation Clinics. Pre-school children. School children. Adults. Totals. Attendances 1,355 1,341 172 2,868 New cases 534 425 52 1,011 Schick negative — — 6 6 Completely immunised but not retested 480 366 42 887 Retested 178 265 10 453 Positive after retest 9 20 - 29 Sustained local assistance was given to the national campaign urging the protection of children against diphtheria. This took the form of press advertisements, cinema films, poster displays, distribution of leaflets and special birthday cards, and visits to the homes of the children by the health visitors. At the end of the year 71%-of children between one and five years of age had been immunised. Nine general practitioners who wished to carry out immunisation of their patients in the home or at the surgery were supplied with the necessary prophylactic free of charge. Whooping Cough.—Ninety-eight children (war-time nurseries 88 ; infant welfare clinics 10) received immunising injections against this disease. Typhus Fever.—Twelve members of the Public Health Department staff and 29 voluntary workers trained in antityphus fever measures received courses of inoculations with typhus immunising vaccines supplied by the Medical Research Council at the request of the Ministry of Health. Vaccination.—Vaccinations carried out numbered 548 (primary, 337; re-vaccinations, 211). Vaccination was successful in 516 instances ; unsuccessful in 25 ; while 7 cases were awaiting inspection. Of the 388 children hose births were registered in 1941, 210 (54.1%) were successfully vaccinated. Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 763 cases of scabies : adults 208 (males 78, females 130) : children 555 (boys 257, girls 298). The scabies clinic in the Middlesex Hospital Annexe, opened on 18th April, 1942, to serve the eastern part of the Borough and grant-aided by the Council, treated 388 cases : adults 312 (males 142, females 170) ; children 76 (boys 32, girls 44). Homes visited in connection with scabies numbered 311. 10 Impetigo.—Forty-four boys and 66 girls received treatment for this condition at the Cleansing Station. Dysentery.—Early in the year 95 cases of Flexner dysentery, with five deaths, occurred among the 560 inmates (male and female) of the St. Marylebone Home. All possible steps were taken to limit the spread of infection, the source of which was presumably from carriers among the inmates, over whose movements little control can be exercised. The outbreak was reported to the Ministry of Health and a conference took place between medical officers of the London County Council (the authority responsible for the administration of the institution) and the Borough Council to discuss further measures of control and prevention. Venereal Diseases.—In view of the increased prevalence of these conditions, .additional publicity was given to the diagnostic and treatment facilities available in the area. Towards the end of the year routine tests for the Wassermann re-action were, with the assistance of a group laboratory of the London County Council, resumed at the ante-natal clinics. 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 3 2 1—5 2 1 2 1 1 — — 1 5—15 3 2 1 1 — 1 — 15—25 14 21 3 4 3 1 1 — 25—35 17 22 2 6 5 5 — 1 35—45 20 11 1 1 5 3 —- 1 45—55 12 7 1 1 6 3 1 — 55—65 8 2 — 2 7 2 1 — 65 and upwards 6 1 — - 3 2 ' — 1 Totals 82 67 10 19 30 16 4 6 *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, 1942, on the register of notifications was 551, 75 more than at the end of the previous year. TABLE 8—Tuberculosis Notifications : Localisation of Disease. Localisation of disease. Cases notified in whole Borough. Cases notified in Sub-Districts. Cases removed to hospital from Cases isolated at home. At ages—years. All Souls. St. Mary. North Maryleb one All Souls. St. Mary. North Marylebone At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Lungs 114 - 3 4 31 46 24 6 30 33 51 19 13 26 56 Glands 3 - 1 1 1 — — — 1 1 1 — 1 — 2 Peritoneum 4 - — — 2 2 — —' 2 1 1 1 1 1 1 Meninges 3 1 1 - - 1 - - - 1 2 — 1 2 — Cheek 1 - - - - 1 - - 1 - - - - - 1 Miliary 1 1 — — —- — — — 1 — — 1 - — — Uterus 1 - — — — — 1 — — — 1 — — 1 - Wrist 2 - — — — 1 1 — — 2 — — 1 — 1 Totals 129 2 5 5 34 51 26 6 35 38 56 21 17 30 61 Dispensary.—Statistics for 1942 : consultations 296 ; new cases 418 (including 128 contacts), old cases, 292 ; attendances 3,924 ; home visits by tuberculosis officer—new 76, old 107 ; hospital visits by tuberculosis officer 58 ; home visits by tuberculosis visitors—first visits 186, re-visits, 1,235. During the year 925 examinations (films, 483 ; screening only, 442) were made by means of the Council's X-ray plant. Twenty-two patients received artificial pneumothorax treatment on the premises and 253 refills were given. Sputum examinations carried out in the dispensary numbered 268. Expenditure on milk supplied to tuberculous persons amounted to £189 2s. lid. ; 351 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. 11 Institutional Treatment.—Admissions to hospital or sanatoria during the year numbered 185. Care Committee.—The Committee held 12 meetings and dealt with 283 cases. Disinfection.—During the year 601 rooms and 26,015 articles (including 230 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. Total. Throat and nasal swabs (for B. diphtherias and hæmolytic streptococci) 6 109 115 Sputa (for tubercle bacilli) 5 53 58 Pus (for tubercle bacilli) — 1 1 Faeces (for typhoid, paratyphoid and dysentery bacilli) — 3 3 Blood (for Widal reaction for typhoid and paratyphoid) — 2 2 Conjunctival Swab (for gonococci) —. 1 1 . Smears (for gonococci) —- 6 6 Urine (for chyluria) 1 — 1 Totals 12 175 187