AC4353 STmARY 48 Borough of St.Marylebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943 t H. A. BULMAN, M.R.C.S., D.P.H. London : Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Lewisham 2 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Statistics for 1943 indicate that health standards are being maintained at a satisfactory level in the fifth year of the war. The civilian population was estimated by the Registrar-General to be 55,700 as against 52,470 for 1942. The birth-rate (12.50) showed an increase over the figure for the previous year (11.26). The death-rate rose from 15.76 in 1942 to 17.02 in 1943. The infantile mortality rate at 47.41 was below the figure (49.07) for 1942, though somewhat higher than the low record of 41.77 for 1941. Public health work in the Borough has, to a large extent, returned to its peace-time volume and practically all services available to the inhabitants have operated fully during the year. Attention is directed specially to the following subjects of current interest which are dealt with briefly in the report at the suggestion of the Minister of Health : War-time day nurseries (p. 6), head lice (p. 7), rats and mice (p. 7), diphtheria immunisation (p. 10), scabies (p. 11), venereal disease propaganda (p. 11), tuberculosis, including the new allowances scheme (pp. 11-12). The Civil Defence Casualty Services, which operate under the direction of the Public Health Department, have not, fortunately, had the calls upon them which were such a severe trial earlier in the war, and full advantage has been taken of the respite to intensify and broaden their training and state of preparedness for action. The personnel have also given valuable assistance in a number of directions outside their normal functions. My thanks are due to the Chairman and Members of the Public Health and Maternity and Child Welfare Committee for their encouragement and continued understanding of the difficulties of the Department brought about by war-time circumstances. The staff, both permanent and temporary, have worked well and the smoothness with which the health services have functioned throughout the year is due largely to their assistance and loyal support. 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 5 Section B—General Provision of Health Services :— Staff 5 Laboratory Facilities 5 Home Nursing 5 Maternity and Child Welfare :— Welfare Centres 5 Work of the Clinics 5 Home Visits 5 Milk, Vitamins ete. 6 Day Nurseries 6 Home Helps 6 Child Life Protection 6 Illegitimate Children 6 Dental Treatment 6 Maternity Cases 6 Convalescent Homes 6 Section C—Sanitary Circumstances :— Water 6 Drainage 6 Combined Drainage 6 Public Conveniences 6 Public Cleansing and Salvage 6 Shops 6 Bed Bugs 7 Verminous Persons 7 Head Lice 7 Rats and Mice 7 Dog Nuisance 7 Mosquitoes 7 Pigeons 7 Noise 7 Poisons 7 page Factories 7 Civil Defence 7 Sanitary Inspection 8 Section d—Housing :— Survey 8 War-damaged Dwellings 8 Provision of Further Housing Accommodation 8 Housing of the Working Classes 8 Inspection of Dwelling Houses 8 Common Lodging Houses 8 Public Air-Raid Shelters 8 Section e—Food :— Milk Supply 9 Meat and Other Foods :— Unsound Food 9 Slaughterhouse 9 Food Premises 9 Ice Cream Premises 9 Butter and Margarine Premises 9 Bakehouses 9 Fried Fish Vendors and Fish Curers 9 Restaurants, Canteens, etc. 9 Horseflesh 9 Bacteriological Examinations 9 Food and Drugs Act, 1938 9-10 Section f—Infectious and Other Diseases :— Notifications 10 Diphtheria Immunisation 10 Vaccination 11 Scabies 11 Impetigo 11 Influenza Venereal Diseases Insulin 11 Tuberculosis :— New Cases and Mortality 11 Notifications 11-12 Dispensary 12 Institutional Treatment 12 Maintenance Allowances 12 Government Rehabilitation Scheme 12 Care Committee 12 Disinfection 12 Bacteriological Examinations 12 3 PUBLIC HEALTH COMMITTEE (who are also the Committee appointed for Maternity and Child Welfare purposes.) 1943. HIS WORSHIP THE MAYOR : Councillor Douglas Timins, O.B.E., J.P., M.A. Alderman R. Stiles Allen, D.L., J.P., L.C.C. (from November, 1943). ALDERMEN: F. W. Dean, J.P., L.C.C. (until November,. 1943). ' J. Fettes, J.P. COUNCILLORS : Miss M. Barry. Dr. Elizabeth Jacobs. F. Y. Bright. Mrs. C. M. Phillips. J. Brodie, LL.M. (from November, 1943). The Hon. Mrs. A. E. Pleydell-Bouverie. F. V. Cullen, F.S.I., F.A.I. (Deputy Chairman). C. H. Press (until November, 1943). 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. SECTION A.—STATISTICS AND SOCIAL CONDITIONS. GENERAL STATISTICS. Areaof 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. Rsgistrar-General's estimate of civilian population (used in calculating various rates in this report) : 1943—55,700. EXTRACTS FROM VITAL STATISTICS. • Total M. F. Live Births —Legitimate 571 301 270 Birth Rate per 1,000 estimated Illegitimate 125 69 56 civilian population 12.50 Stillbirths- Legitimate 18 9 9 Rate per 1.000 total (live and still) Illegitimate 9 3 6 births 37.34 Deaths (all ages) 948 480 468 Death Rate per 1,000 estimated civilian population 17.02 Deaths. Rate per 1,000 total (live and still) births Maternal Mortality—Deaths from " Other Maternal Causes " (Registrar-General's Code No. 30). 1 1.38 Total M. F. Deaths of Infants under one year of age- —Legitimate 24 16 8 Illegitimate 9 5 4 Death Rate of Infants under one year of age—All infants per 1,000 live births, 47.41 ; legitimate infants per 1,000 legitimate live births, 42.03 ; illegitimate infants per 1,000 illegitimate live births, 72.00. Deaths—From Cancer (all ages), 161 ; from Measles (all ages), nil ; from Whooping Cough (all ages), nil; from Diarrhoea (under 2 years), 3. Births—Notification.—The number of notifications received under the Public Health (London) Act, 1936, Section 255, was 1,497: live births, 1,461 ; stillbirths, 36. Sources of the notifications were : from doctors, 13 ; from midwives, 74 ; from hospitals, nursing homes, etc., 1,410. Of the births notified, 591 took place at the Middlesex Hospital; 233 at Paddington Hospital; and 87 were born at home. Of those notified as having occurred in St. Marylebone, 813 belonged to other Boroughs. Of the 36 stillbirths (18 males and 18 females) notified direct to the Department, 18 (6 males and 12 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 27. Marriages.—The total number of marriages was 1,119, being 9 below the number for 1942, and 340 below the average for the previous 10 years. The rate for persons married in 1943 was 40 per 1,000 of the estimated civilian population. 4 TABLE 1.—Deaths—All Ages. 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 Borough. Deaths in Sub-Districts. All Ages Under 1 1 and under 5 5 and under 15 15 and | under 45 45 and under 65 65 and upwards All Souls. St. Mary. North Marylebone. Total. Residents Nonresidents 3 Scarlet fever 1 - - 1 - - - - 1 - 1 - 1 5 Diphtheria 1 - 1 — - - - - - - - 1 1 6 Tuberculosis of respiratory system 42 - - 2 20 13 7 1 1 11 9 22 42 7 Other forms of tuberculosis 6 - - — 3 2 1 2 3 - - 6 6 8 Syphilitic disease 14 ^ - — - 10 4 — . _ 5 4 5 14 9 Influenza 15 - - — 1 4 10 3 4 4 4 7 15 12 Acute infectious encephalitis 1 - - - - 1 - - - - 1 - 1 13m Cancer of buccal cavity and oesophagus (males only) 9 - - - - 3 6 2 13 3 3 3 9 13f Cancer of uterus. 10 — - — 1 7 2 1 5 4 3 3 10 14 Cancer of stomach and duodenum 25 - - - - 11 14 - 11 4 9 12 25 15 Cancer of breast. 18 - - - 1 11 6 1 13 5 6 7 18 16 Cancer of all other sites 99 - 1 — 3 29 66 5 75 17 26 56 99 17 Diabetes 6 - - — - 1 5 - 3 1 2 3 6 18 Intra-cranial vascular lesions 77 - - - 1 23 53 4 32 15 20 42 77 19 Heart disease 231 - - — 6 43 182 9 69 45 70 116 231 20 Other diseases of the circulatory system 50 - - - 3 11 36 3 7 4 21 25 50 21 Bronchitis 52 - - — — 19 33 3 4 12 15 25 52 22 Pneumonia 62 5 - — 2 13 42 6 13 11 23 28 62 23 Other respiratory diseases 12 — — — . 2 5 5 — 5 1 4 7 12 24 Ulceration of the stomach or duodenum 6 - - - - 3 3 - 6 1 2 3 6 25 Diarrhoea (under 2 years of age) 3 3 - - - - - - - 1 1 1 3 26 Appendicitis .2 -— - — 2 — — — 5 — 1 1 2 27 Other digestive diseases 26 — - 1 3 7 15 4 13 3 13 10 26 28 Nephritis 20 — - — 1 8 11 1 13 5 5 10 20 30 Other maternal causes 1 — - — 1 — — — 2 — — 1 1 31 Premature birth 10 10 - — - - — — 8 2 4 4 10 32 Congenital malformations, birth injury, infantile disease. 18 12 - 1 1 2 2 1 6 5 4 9 18 33 Suicide 10 — - — 5 3 2 1 5 1 5 4 10 34 Road traffic accidents 3 — - — 1 2 — 1 4 2 1 - 3 35 Other violent causes 46 1 2 4 9 12 18 5 12 9 20 17 46 36 All other causes 72 2 2 — 6 12 50 3 37 18 22 32 72 Totals 948 33 6 9 72 255 573 56 370 189 299 460 948 No death occurred from the following causes not shown in the table : Typhoid and paratyphoid fevers (Code No. 1), cerebro-spinal fever (No. 2), whooping cough (No. 4), measles (No. 10), acute poliomyelitis and polioencephalitis (No. 11), puerperal and post-abortive sepsis (No. 29). TABLE 2.—Infantile Mortality. Code No. CAUSE OF DEATH. Under 1 week 2 and under 4 weeks 1 and under 3 months 3 and under 6 months All Souls. St. Mary. North Marylebone. Total 7 Diarrhoea - - 1 2 1 1 1 3 8 Enteritis — — — 1 — — 1 1 12 Congenital malformation 6 — — — 2 1 3 6 13 Premature birth 10 — — — 1 4 5 10 14 Atrophy, debility and marasmus — 1 — "—. 1 - — 1 16 Injury at birth 2 — — — — 1 1 2 20 Meningitis (not tuberculous) 2 - — — — 1 1 2 25 .Pneumonia (all forms) — . — 2 3 2 1 2 5 26 Suffocation, overlying 1 — — — •— — 1 1 27 Other causes 1 — — 1 1 1 — 2 Totals 22 1 3 7 8 10 15 33 No infantile death occurred in the age-groups 1 and under 2 weeks, 6 and under 9 months, 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, whooping cough (Code Nos. 1—6), tuberculous meningitis, abdominal tuberculosis, other tuberculous diseases (Nos. 9—11), atelectasis (No. 15), erysipelas, syphilis, rickets (Nos. 17—19), convulsions, gastritis, laryngitis, bronchitis (Nos. 21—24). Mortuary.—Ten bodies (4 male, 6 female) were deposited at the Emergency Mortuary, No. 24, Hill Road. No post-mortem examinations were carried out. 5 Crematorium.—One hundred and eighty-one certificates authorising cremation at the St. Marylebone Crematorium, Finchley, were issued—-132 by the Medical Referee (Dr. H. A. Bulman) and 49 by the Deputy Medical Referee (Dr. M. MacGregor). SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. Staff.—Mr. L. Newland and Mr. V. A. Bignell, Sanitary Inspectors, joined the Royal Air Force on the 28th April, 1943, and 3rd June, 1943, respectively. Miss L. M. Hazell retired on the 25th May, 1943, on account of ill-health, after serving the St. Marylebone Health Society as a part-time Health Visitor for six years, and subsequently the Council for eight years in a similar capacity when the local authority took over the maternity and child welfare centres from the Society. Her death on the 13th February, 1944, was greatly regretted. Miss P. K. Pepler, released for service as a temporary inspector in the Ministry of Health as from the 7th July, 1941, relinquished that position on the 31st July, 1943, and resumed duty under the Council on the 3rd August, 1943. Mr. C. D. Turbayne, a Principal Assistant, joined the Royal Navy on the 4th October, 1943. Miss F. H. M. Chapman resigned her position as Health Visitor on the 31st October, 1943. to take up an appointment as tutor with the National Health Society, an organisation recognised by the Ministry of Health for the training of health visitors. Miss F. A. Baker, on retiring in 1938, after 38 years' service with the Council as Sanitary Inspector and Health Visitor, acted as almoner at the dental clinic which forms part of the Borough Maternity and Child Welfare Scheme. On leaving London in October, 1943, Miss Baker reluctantly had to give up these duties which she had undertaken voluntarily and carried out efficiently for five years. Mr. W. H. Draper, Sanitary Inspector, having reached the age limit, retired on the 30th November, 1943, after 38 years in the local government service. Mr. Draper, whose reputation as an authority on drainage matters extends far beyond the Borough which he has served devotedly and with conspicuous success for the past 33 years, . has been re-engaged by the Council in a temporary capacity. 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., Public Analyst for the Borough since November, 1941, died on the 23rd January, 1943. He was succeeded in the appointment by Mr. Thomas McLachlan, A.C.G.F.C., F.I.C., whose laboratory is situated at No. 4, Han way Place, W.l. Home Nursing.—The Paddington and St. Marylebone District Nursing Association continued to provide adequate nursing services in the home under an arrangement made with the Council. During 1943, visits were paid to cases (number shown within brackets) as follow: Maternity, 1,070 (61); pneumonia, 159 (6); tuberculosis, 42 (2); puerperal pyrexia, 28 (4) ; measles, 9 (1) ; influenza, 73 (6) ; other ailments, 206 (21). Maternity and Child Welfare.—An account of the year's work of this service may fittingly be prefaced by a reference to the death of Dr. Eric Pritchard, in his seventy-eighth year, on the 20th April, 1943. A foremost paediatrician of his day, Dr. Pritchard was a pioneer, if not, indeed, the pioneer, of the infant welfare centre in this country, the clinics inaugurated by him in St. Marylebone, notably at the St. Marylebone General Dispensary, No. 30, Marylebone Lane, in 1908, in collaboration with the Borough Council and the St. Marylebone Health Society, having been the first of their kind in London. The Council have two maternity and child welfare centres : No. 1 in the Town Hall Extension comprising anteand post-natal, infant welfare, artificial sunlight, massage, and diphtheria immunisation clinics ; No. 2 at No. 217, Lisson Grove with provision for ante- and post-natal, infant welfare, artificial sunlight, massage, and dental clinics. In addition, ante- and post-natal and infant welfare clinics held at the Middlesex Hospital form part of the Council's m iternity and child welfare scheme. 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). Maternity Infant Light Massage Maternity Clinics Infant Clinics Light Clinic Massags Clinic Antenatal Postnatal Under 1 year 1—5 years Under 1 year 1—5 years Under 1 year 1—5 years Maternity and ChiId Welfare Centre No. 1 87 150 80 268 1,365 81 3,667 1,690 202 901 261 1,038 (322) (43) (202) (24) (26) (51) (22) (46) Maternity and Child Welfare Centre No. 2 59 156 80 182 953 92 2,997 1,503 227 1,241 171 459 (163) (50) (209) (32) (27) (81) (22) (36) The Middlesex Hospital 214 151 - - 4,099 432 2,075 l,538 - — - - (432) (180) (138) (13) *282 *55 *939 *524 *(61) *(13) *(69) *(8) *St. Marylebone residents attending the Middlesex Hospital. Home Visits.-The five whole-time and two part-time health visitors paid domiciliary visits as follow : (a) to expsctant mothers, first visits, 360, total visits. 700 ; (b) to children under 1 year of age, first visits, 633, total visits, 3,242 ; (c) to children between the ages of 1 and 5 years, total visits, 4,135. 6 • , Milk, Vitamins, etc.—The Food Executive Officer has kindly provided the following information as to dried milk supplied under the National Scheme during the period 3rd January, 1943, to 1st January, 1944 : full cream, 1,929-20 oz. cartons ; half cream, 220 cartons—'total 2,149 (free, 527 cartons ; at l/2d. per carton, 1,622 cartons). Distribution of vitamin preparations was also made as follow : cod liver oil, 4.201 -13½ oz. bottles ; orange juice, 25 496-6 oz. bottles ; vitamin A and D tablets (available to expectant mothers from 18th April, 1943), 625 packets, each packet containing 45 capsules—a six weeks' supply. From 1st January, 1943, to 24th July, 1943, special baby clothing coupons were issued to 531 expectant mothers. Since the scheme came into operation on 6th August, 1941', the Department had distributed coupons to 1,602 expectant mothers. As from 26th July, 1943, the issue of coupons was undertaken by the local Food Office. Day Nurseries.—At the end of the year four war-time day nurseries (whole-time) with a total of 202 places for children 0—5 years of age, were functioning in the Borough. Two, opened in 1942, are established in premises built specially for the purpose before the war ; the remaining two, opened in 1943, are conducted in large private houses taken over temporarily and adapted for nursery use. The last nursery in operation has the advantage of a spacious garden at the rear ; playing space on grass for the children in the other three nurseries has been set aside in nearby public or private gardens. All the nurseries are affiliated to the National Society of Children's Nurseries as training centres for the Nursery Nurses' Diploma. Though these nurseries have been established primarily for the purpose of enabling mothers to take up full-time war work, they provide conditions which must be of great benefit to the children themselves ; indeed, improvement in their health has been consistently noted. Home Helps.—Great difficulty was again experienced in securing women suitable and willing to undertake this essential work and thus enable more confinements to take place at home with a corresponding lessening of the demand for institutional accommodation. Advertisements for a full-time home help were published in the local press, but no replies were received, probably because in these times there are more attractive and more highly paid positions available to women who migh normally be prepared to carry out the duties of a home help. Assistance in the home was actually provided in four cases during the year. Child Life Protection.—The Council's eight, health visitors acted as child protection visitors and made a total of 36 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 three, and the children in their care numbered three. In a prosecution for failure to give notice of the reception of a foster child, an Order was obtained for removal of the child to a place of safety ; the defendant was bound over on the condition not to undertake the care of foster children. Illegitimate Children.—Following the issue of Ministry of Health Circular No. 2866 (revised) on the 16th November, 1943. the problems arising under war conditions in regard to illegitimate children were, at the end of the year, receiving special consideration by the official bodies and voluntary organisations concerned with the welfare of these children. Dental Treatment.—By arrangement, certain sessions at the Dental Clinic of the London County Council at No. 217, Lisson Grove 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 1943 : sessions held, 96 ; new cases—mothers 148, children 22 ; attendances—mothers 667, children 51 ; X-ray examinations, 11 ; extractions—mothers 390, children 13; patients provided with dentures at cost price, 28 ; fillings, 175 ; other operations, 494. 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. After consultations with the County Council and the Middlesex Hospital authorities, arrangements were made for the Hospital to take in, as from the 28th August, 1943, the whole of the Borough as its extern district for domiciliary midwifery. 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.—One mother and baby were sent for four weeks to a post-natal home near Hertford ; a mother and twins to a post-natal home in Reading for four weeks ; and one child to a convalescent home at Byfleet for six weeks. SECTION C.—SANITARY CIRCUMSTANCES. Water.—Apart from water obtained for domestic purposes from private wells at three large blocks of flats, a constant supply throughout the Borough is provided through the mains of the Metropolitan Water Board, and no complaint as to insufficiency or quality was received during the year. In accordance with the. provisions of the Public Health (London) Act, 1936, the Board notified ten instances where water had been cut off in occupied premises for nonpayment of rate ; in all cases the supply was reinstated after service of an intimation notice. Private well waters were examined periodically by the Public Analyst and the Council's Bacteriologist with satisfactory results. Drainage.—The number of plans approved was 54 (52 relating to old buildings and 2 to new premises). In addition, one plan was deposited in connection with amenities in a public air-raid shelter. Inspections made by the sanitary inspectors numbered 1,447. 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). Public Cleansing and Salvage.—Amounts dealt with : house and trade refuse, 20,517 tons ; street sweepings and gulley slop, 2,015¼ tons ; salvaged materials, 3.043¾ tons, including 1,215¾ tons of kitchen waste for pig and poultry feeding collected from 550 bins placed at inteivals in the streets for the reception of this material. A sum of £10,440 7s. 9d. was obtained from the sale of salvaged materials. In addition, £128 Is. 4d. was received for the removal of trade refuse, green offal, and the cleansing of petrol interceptors. Shops.—Inspections under the Shops Act, 1934, numbered 317. In 11 instances service of notice was necessary. 7 Bed Bugs.—Sixty-four dwellings where bugs were found were disinfested. No Council flats were reported to be infested. Verminous furniture belonging to 36 families, 5 of whom were dishoused as the result of enemy action, was treated by the hydrogen cyanide process. The mobile hot-air disinfestor continued in use for the disinfestation of bedding from air-raid shelters, and 1,612 bundles were dealt with. Verminous Persons.—The numbers of adults and school children using the Cleansing Station were 615 (532 males, 83 females) and 1,136 (317 boys, 819 girls) respectively. Head Lice.—The number of St. Marylebone children of all ages treated for this condition at the Council's Cleansing Station was 731. Seven females aged between 14 and 35 years, sent from their places of employment, were also dealt with. Treatment of school children was carried out with a tar oil compound followed by washing with soft soap and borax. In other cases attending the Cleansing Station similar treatment was given with subsequent application of Lethane oil. Where a preparation is needed for cases treated at home the use of Lethane oil is recommended. Thorough combing of the hair with a steel nit comb is essential whatever method of treatment is employed. Infestation by head lice was the subject of a circular (2831) issued by the Ministry of Health on the 2nd July, 1943, in which action along certain lines was suggested to welfare authorities. Generally, these lines have been followed where there is no risk of antagonising the mothers, whose co-operation in other health matters affecting the children is so vitally important. The heads of children attending the welfare clinics are conveniently inspected in the doctor's room, and there is no difficulty in examining children who are to be evacuated or admitted to hospital. Families known to be in need of special attention are constantly visited by the health visitors, and infested school children, together with their contacts of pre-school age, are also followed up in the home. A favourable opportunity of warning mothers against infestation by head lice and of impressing the need for cleanliness of the scalp and hair is afforded wheji a child is about to attend school. To give mothers all practical assistance in dealing with the problem, nit combs and small bottles of Lethane oil are issued at the welfare centres. Rats and Mice.—Following a conference of local authorities in the London area, the Minister of Food issued to the Council in June a formal direction under the Defence Regulations to report on the extent to which land in the Borough was subject to infestation by rats and mice. After a three months' survey, involving the inspection of food and other premises, a report was submitted to the Ministry of Food indicating the extent of major and minor infestations throughout the district. Further directions were subsequently issued by the Minister requiring the Council (i) to take all necessary steps for the systematic destruction of rats in sewers in accordance with a programme devised by the Ministry, and (ii) to make the maximum use of statutory powers under the Rats and Mice (Destruction) Act, 1919. During the autumn the Ministry of Food launched a rodent publicity campaign in the national and local press. Posters were also displayed throughout the Borough urging every person seeing a rat to report the fact to the Town Hall or nearest wardens' post. As a result 51 reports were received and dealt with. On the 1st October, 1943, two rat-catchers were employed for duty under the Infestation Order, 1943. Both receive an inclusive wage of £5 per week, and work under the supervision of the Council's Rodent Officer. The following is a summary of the work done during 1943 : 293 complaints were received and 60 fopd and 226 other premises were found to be infested. Of the 60 food premises, 33 were shops and 27 hotels and restaurants ; the 226 other premises included 166 dwelling houses, 43 shops. 17 stores, warehouses and factories. Ratproofing was carried out in 104 premises. The chief methods employed for the extermination of rats were poison baiting and trapping. Among the main sources of infestation were sewers and drains damaged as a result of enemy action, and bombed sites with their collection of debris. Preventive measures taken in this connection included the inspection of 579 premises and the sealing off of 96 sewer connections. Dog Nuisance.—Contravention of the bye-law relating 'to the fouling of footways by dogs was detected by police officers in three 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 301, the amount of fines imposed being £112 6s. Od. Mosquitoes.—Nine complaints of mosquitoes were received. In one instance stagnant water in the basement of a bomb-damaged building was found to be the source of a troublesome biting species (culex molestus). The nuisance in the remaining cases was traced to breeding in emergency water tanks. Larvicidal treatment given in every instance proved effective. Pigeons.—Five complaints of nuisance from these birds (four relating to private dwellings and one to a church) were dealt with. A contractor was employed, with satisfactory results, to reduce the number of pigeons in serious cases. Noise.—-Eleven complaints of noise were received. Two were concerned with wireless loudspeakers, and in each instance the issue of a notice was necessary to obtain a remedy of the nuisance. Noisy dogs were the subject of two complaints, and in one case the owner was prosecuted and fined £1 and ordered to pay £3 costs for permitting the nuisance to continue after notice by three householders. Other complaints referred to such diverse causes as tenants of a flat, children, restaurant customers, members of a club, crowing cocks, crickets, and machinery. 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 79. Factories.—The number of registered factories was 1,292. Frequent inspections were carried out, and conditions were remedied in 24 instances (want of cleanliness 4 ; insufficient or unsuitable sanitary conveniences 12 ; other defects 8). Outworkers lists were received from 63 employers and concerned 225 contractors and 511 workpeople. Civil Defence.—Miscellaneous visits by the sanitary inspectors in connection with civil defence activities not referred to elsewhere in this report numbered 237 and included visits relating to maintenance of first-aid posts. 8 Sanitary Inspection.—The total number of complaints received was 1,243 as against 996 in 1942. the increase being due to the larger number of rat complaints received as a result of publicity campaigns during the year. Details of the various nuisances detected and remedied, to the total number of 1,438, are set out in Table 4. In 489 cases the nuisances were abated by the person responsible for their removal after receipt of a preliminary (intimation) notice advising them of the existence ef the defects. Statutory notices were issued in 28 instances, and referred to such matters as dirt, dampness, verminous rooms, inadequate ventilation, unsatisfactory water-closet accommodation, inadequate water supply, defective roofs, defective drains, and to other defects and conditions. In one case legal proceedings were instituted for failure to comply with a statutory notice and the defendant was ordered to abate the nuisance within 14 days and to pay £5 5s. 53. od costs. Subsequently a fine of £20 was imposed for failure to comply with the Abatement Order. TABLE 4.—-Nuisances Detected and Remedied. Nature of Nuisance. Districts. The Borough. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. Housed damp, dirty or dilapidated remedied 10 18 86 58 14 22 208 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired 7 10 12 19 11 25 84 Verminous dwellings disinfested 1 3 35 16 6 3 64 Dirty and verminous furniture and bedding cleansed 1 2 14 8 2 4 31 Overcrowding abated — - — — 1 — 1 Underground rooms (illegal occupation) dealt with — — ' — — — — — Water closet defects remedied 4 15 48 32 13 30 142 •Insufficient and unsuitable water closet accommodation remedied - - 3 8 5 9 25 Urinal defects remedied — — 4 1 — 5 . 10 Drain and water-closet stoppages cleared 2 8 15 12 3 8 48 Drains relaid or amended — — 14 5 3 4 26 Soilpipes and ventilating shafts repaired or renewed — 2 2 ' 1 2 5 12 Waste pipe defects remedied 1 5 8 9 3 5 31 Yard defects remedied 1 4 25 16 — 2 48 Wash-house defects remedied — 2 12 5 — — 19 Area defects remedied — 1 8 20 — —. 29 Basement defects remedied — — — 1 — — 1 Roofs and gutters repaired 10 13 37 34 15 8 117 Water supply to houses reinstated 1 3 — 1 1 - 6 Water supply laid on to upper storeys 1 — — 1 — — 2 Water cistern defects remedied 2 2 2 1 6 — 13 Dung or dust receptacles repaired or renewed 5 10 5 17 4 10 51 Rubbish, manure, etc., accumulations removed 3 12 44 18 9 16 102. Animal, nuisances abated — — 4 2 — — 6 Rat and mouse infestations dealt with 20 33 50 39 68 76 286 Bakehouses cleansed — ' — — 1 — 9 10 Smoke nuisances abated — — — — — — — Shops—sanitary defects remedied — -— 3 1 1 — 5 Miscellaneous 3 8 17 19 6 8 61 SECTION D.—HOUSING. Survey.—A comprehensive survey of housing conditions in the Borough was carried out by the Department to determine areas which should be dealt with in relation to post-war housing. Altogether 69 areas were reported upon to the Housing Committee under the following heads : (1) houses probably unfit; (2) houses of doubtful category ; (3) areas cleared or on which orders had been made ; (4) premises demolished or seriously damaged by enemy action. War-Damaged Dwellings.—Steady progress was made with the repair of houses damaged by enemy action, and a scheme formulated by the Government, which provided for the release of the necessary labour, enabled a number of houses and flats to be put into a state fit for occupation. Provision of Further Housing Accommodation.—The Council were also actively engaged in relieving the urgent need for housing accommodation generally in the Borough by (a) requisitioning houses for conversion into flats, and (b) granting licences to private house owners to encourage repair work to their properties. Housing of the Working Classes.—The Council agreed to the development of certain areas in the Borough for the construction of blocks of flats as soon as circumstances permit. Inspection of Dwelling-houses.—Number of houses inspected for defects under the Public Health or Housing Acts—1,211 ; number of-inspections made—3,457 ; number of houses found not to be in all respects reasonably fit for human habitation—298"; number of defective houses rendered fit in consequence of informal action—312;' number of houses in which defects wer6 remedied by owners after service of formal notices under the Public Health (London) Act, 1936—14 ; number of underground rooms in respect of which closing orders were made—36. Common Lodging Houses.—Thirty-three 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, No. 10, Daventry Street. Public Air-Raid Shelters.—The shelters continued to-be used as sleeping places from time to time, and 400 inspections were made by day and night. 9 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 162 premises upon which milk is sold. Inspections made numbered 243. During the year 33 applications under the Milk (Special Designations) Orders, 1936 and 1938, were received from 15 milk purveyors and licences were granted as follows : 1 pasteurising, 17 dealers' and 2 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 113 samples of milk analysed was : total solids, 12.73% fat, 3.85% ; solids not fat, 8.88%. No sample was found to be below standard. Thirty-four 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, 1 ton 2 cwts. 1 qtr. 16 lbs. ; fish, 2 tons 6 cwts. 2 qtrs. 5 lbs. ; fruit, 8 cwts. 22 lbs. ; vegetables, 3 tons 6 cwts. ; cereals, 3 cwts. 2 qtrs. 27 lbs. ; canned goods, 5,988 tins ; miscellaneous, 7 cwts. 2 qtrs. 22 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 for the animals in the gardens and humane killers are used. Four inspections were made. Two licences to slaughter or stun animals, granted to skilled slaughtermen, were renewed. Food Premises.—At the end of 1943, 109 premises were registered for the preparation or manufacture of foods (other than ice cream) intended for sale, and 241 inspections were made. Ice Cream Premises.—The number of premises still on the register was 71. The manufacture of ice cream was prohibited throughout the year under a Ministry of Food Order. 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-seven inspections were made. Bakehouses.—Number on register—26, 20 being basement bakehouses ; 92 inspections were made. Re-inspection of basement bakehouses was carried out in accordance with Section 54 (2) of the Factories Act, 1937, which requires a local authority to examine, every fifth year, all basement bakehouses for which a certificate of suitability has been issued. Certificates of suitability were permitted to continue to operate in the case of 20 such bakehouses. Entries relating to 7 basement bakehouses were removed from the register as in each instance the bakehouse had not been used for the purpose for a period exceeding twelve months. Fried Fish Vendors and Fish Curers.—The number of premises used by vendors of fried fish is 8 and by fish curers 3. Thirty-one inspections of fried fish shops and 12 inspections of fish curers' premises were carried out. Restaurants, Canteens, etc.—Premises in which meals are provided or food is sold already cooked or is prepared for sale numbered 656, including restaurant and dining-room kitchens, 362 ; canteens, 251 ; hotel kitchens, 43 : 1,841 inspections were made and 57 notices served. Horseflesh.—Twenty-three visits were paid to two shops selling horseflesh for human food. Service of notice in one case was necessary. Bacteriological Examinations.—Apart from milk, one sample of Cornish pasty was examined bacteriologically and reported to be satisfactory. Food and Drugs Act, 1938.—-Samples taken under the Act numbered 700 (57 formal, 643 informal) and included : milk 113, butter 129, margarine 41, cheese 10. The sum paid in respect of each analysis was 12s. 6d. (except in the case of sausages for which the fee was £1 Is. Od. per sample). Nine samples were adversely reported upon :— TABLE 5.—Adulterated Samples, Etc. No. Article. Whether Formal, Informal or Private. Nature of Adulteration or Irregularity Public Analyst's Observations. Action Taken. 1 Curry Powder Informal. Contained 50 parts of lead per million. Excess of lead. Manufacturers warned. 2 Lemonade Powder Informal. One teaspoonful contained full adult dose of sodium acid phosphate. Lemonade powder should not contain phosphate. Manufacturers warned. Sale discontinued. 3 Medical Prescription. Private. Contained four times the prescribed quantity of potassium bicarbonate. - - 4 Orange Flavouring Informal. Misleading label. Citric acid absent. The term " essence " should be employed for solutions of volatile oils, and the term "flavouring" for watery solutions of acids. Manufacturers warned. 5 Beef Formal. Consisted of horseflesh. Sold without declaration. Vendor fined £5 with £5 5s. Od. costs. 6 Spaghetti Informal. Contained 12 per cent, soya flour. Soya flour is not a recognised ingredient of spaghetti. Vendors warned. Name of article changed to " sorghetti." 7 Spaghetti Formal. Contained 20 per cent, soya flour. Ditto. 8 Baking Powder Informal. Contained only 2.7 per cent, of available carbon dioxide. Should contain not less than 8.0 per cent, of available carbon dioxide. Vendors warned against r prolonged storage. 9 Baking Powder Formal. Contained only 3.3 per cent, of available carbon dioxide. Ditto. 10 The Public Analyst (Mr. Thomas McLachlan) comments as follows : " In view of the increased amount of adulteration generally, the percentage (1.3) in St. Marylebone is remarkably low. It is anticipated that several of the articles reported as adulterated will be found to infringe new Orders which are in process of being issued by the Minister of Food under the Defence (Sale of Food) Regulations, 1943. Spaghetti containing soya flour seems now to have disappeared from the market. Standards are being laid down for baking powder, and there appears to be a more decided opinion in the trade regarding the use of the terms ' essence,' ' flavour ' and ' flavouring ' as the result of two unsuccessful appeals against convicti'ons for misleading labels." 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. SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Infectious diseases notifiable in St. Marylebone are listed in Table 6, which gives also information regarding notifications (civilians) and deaths (civilians) during 1943. Four unconnected cases of food poisoning, which is also notifiable in the Borough, were reported. v TABLE 6.—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 membranous croup 17 1 3 1 - 2 2 2 1 5 - - - 4 3 10 17 - 1 Erysipelas 24 — — — 1 - — — 1 3 3 6 10 12 — 12 13 11 — Scarlet fever 147 3 7 11 11 14 65 10 6 16 — 3 1 14 17 116 128 19 1 Paratyphoid fever 1 — — — — — — - — — 1 — — — — 1 1 — Puerperal fever 8 — — — — — — — — 5 3 — — 1 1 6 7 1 — Puerperal pyrexia 14 - - - - - - - 1 10 3 — — 1 3 10 13 1 — Cerebro-spinal fever 2 1 - - - - 1 - - - - - - - - 2 2 — — Tuberculosis— Pulmonary 122 — 1 — — — — 1 12 41 32 30 5 24 39 59 58 64 42 Non-pulmonary 17 - - - - - 2 1 1 7 2 2 2 5 3 9 11 6 6 Ophthalmia neonatorum 1 1 - - - 1 - - 1 - - Pneumonia 45 1 1 — — 2 1 3 7 5 5 11 9 12 4 29 36 9 162 Dysentery 22 1 2 — 1 1 1 — — 2 1 — 13 15 1 6 22 — 3 Measles 373 19 55 46 35 48 130 11 7 17 3 1 1 60 55 258 107 266 — Whooping cough 52 11 5 9 5 6 14 — 1 1 — — — 13 13 26 16 36 — †Scabies 104 1 . 3 3 4 3 14 10 9 21 15 15 6 26 13 65 1 103 — Totals 949 39 77 70 57 76 230 38 46 133 68 68 47 188 152 609 433 516 115 "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, encephalitis lethargica, acute poliomyelitis, malaria. †This figure is for all forms of pneumonia, including acute primary pneumonia and acute influenzal pneumonia which alone are notifiable. — †Notifiable from 1st August, 1943. Diphtheria Immunisation.—Clinic facilities were available at Maternity and Child Welfare Centres Nos. 1 and 2 and at the Middlesex Hospital. Treatments were also carried out at the war-time day nurseries and at certain elementary schools. Eleven 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. A.P.T. (Alum Precipitated Toxoid) was the agent generally employed. T.A.F. (Toxoid-Antitoxin Floccules) was used in a small proportion of cases. TABLE 7.—Work of the Diphtheria Immunisation Clinics. Pre-school children. School children. Adults. Totals. Attendances 1,374 603 28 2,005 New cases 376 111 12 499 Schick negative — 2 8 10 Completely immunised but not retested 872 92 — 464 Retested 341 193 3 537 Positive after retest 37 11 1 49 Continued local assistance was given to the national campaign urging the protection of larger numbers of children against diphtheria, and propaganda on recognised lines was again carried out. It was found, however, that the best results were achieved by personal approach to the parents by the medical staff or health visitors either at the welfare centres or in the home3. At the end of 1943 it was considered that 78% of children under 5 years of age and 72% of those between 5 and 15 had been immunised. These estimates include, so far as can be assessed, children immunised jn St. Marylebone by private arrangement and children who came into the Borough after being immunised elsewhere. 11 Vaccination.—-Vaccinations carried out numbered 352 (primary, 286 ; re-vaccinations, 66). Vaccination was successful in 344 instances ; unsuccessful in 6 ; while 2 cases were awaiting inspection. Of the 782 children whose births were registered in 1942, 537 (68.7%) were successfully vaccinated. Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 759 cases of scabies : adults 198 (males 60, females 138) ; children 561 (boys 260, girls 301). The Scabies Clinic at the Middlesex Hospital treated 1,497 cases : adults 1,160 (males 599, females 561) ; children 337 (boys 150, girls 187). Included in the figures for both centres are a number of patients who came from outside the Borough. Homes visited in connection with St. Marylebone cases numbered 412. The increase in the total number of patients treated is due to scabies being compulsorily notifiable as from the 1st August, 1943, and to the treatment of contacts wherever this could be secured. There is no evidence of an actual increase in the prevalence of the disease. An important amendment to the Ministry of Health's Memorandum on Scabies stated that recent investigations had shown that, with the standard' methods of treatment, routine disinfestation of clothing and bedding was unnecessary. Emphasis, it was pointed out, should rather be laid on the follow-up and treatment of family and other close contacts of original cases. A Ministry of Health film dealing with modern methods used in the diagnosis and treatment of the disease was shown to local medical practitioners and others concerned with scabies. Impetigo.—Fifty-four boys and 75 girls received treatment for this condition at the Cleansing Station. Influenza.—-During the epidemic of influenza, generally not severe in character, which spread throughout the country in November and December, arrangements were made in the Borough for Army doctors to assist general practitioners who were unable to cope with the demands made upon them, and for additional domiciliary nursing of the milder cases to be undertaken by members of the auxiliary nursing staffs of first-aid posts. A scheme for supplying meals to the homes of patients was also established. Though the extent of the outbreak in St. Marylebone was limited and there was no great call upon the special services provided, it was possible in a number of instances to tide the family over a domestic crisis and indirectly to reduce the setback to war production to a minimum. Venereal Diseases.—In view of the increasing prevalence of these conditions, action was taken to assist in the campaign to ensure that proper treatment is obtained by all those requiring it. Medical practitioners resident or practising in the Borough were supplied with detailed information on the examination of pathological specimens from patients, the treatment of gonorrhoea, the places and times of venereal disease clinics throughout London, and how to obtain-approved arsenical drugs. Posters giving clinic addresses and hours, and inviting application to the Medical Officer of Health for a leaflet on the dangers of venereal diseases, were displayed in public conveniences and, through the co-operation of the local Licensed Victuallers' Association and of individual licensees, in conveniences within or attached to public houses. Nineteen talks on sex education were given in the Borough to youth organisations, employees of firms, etc., by lecturers of the Central Council for Health Education under the grant received by that body from the London County Council. Routine tests for the Wassermann reaction were continued at the Council's ante-natal clinics. Insulin.—Supplies of insulin for the poorer inhabitants suffering from diabetes were provided free of cost by the Council in five cases, under the authority of Ministry of Health Circular 2734, dated 4th January, 1943. Tuberculosis.—New Cases and Mortality.—Table 8. prepared at the request of the Ministry of Health, contains information with regard to age and sex distribution of all forms of tuberculosis. TABLE 8.—Tuberculosis : New Cases and Deaths. At ages— years *NEW CASES. DEATHS. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. f. M. f. M. f. M. f. 0—1 - - - - - - - - 1—5 1 - - - - - - - 5—15 1 — 2 2 — 2 — 1 15—25 14 21 2 1 4 1 1 - 25—35 14 18 3 4 3 4 - 1 35—45 26 13 1 2 5 3 - - 45—55 19 6 1 - 5 3 1 - 55—65 13 — 1 — 5 - 1 - 65 and upwards 5 3 — 2 6 1 — 1 Totals 93 61 10 11 28 14 3 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 9 gives information regarding notifications and the localisation of the disease. The total number of cases of tuberculosis remaining at the 31st December, 1943, on the register of notifications was 582, 31 more than at the end of the previous year. 12 TABLE 9.—Tuberculosis Notifications : Localisation of Disease. Localisation of disease. Cases notified in whole Borough. Cases notified in Sub-Districts. Cases removed to hospital from Sub-Districts 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 122 - 1 1 27 58 30 5 24 39 59 11 18 29 64 Glands 8 - - 3 1 4 —. — 3 2 3 3 1 1 3 Peritoneum 1 - - — — 1 — - - — 1 — — 1 - Meninges 1 - - — 1 — — — 1 — — 1 — — — Cheek 1 - - — — — — 1 — — 1 — — — 1 Palate 1 - - — — — 1 — — — 1 — — — 1 Skin 1 - - — - - 1 — — — 1 — — — 1 Epididymis 2 - - — — 2 - — 1 1 — 1 1 — — Kidney 1 - - — — — — 1 — — 1 — — 1 — Hip 1 — - — 1 — — — — — 1 — . — 1 — Totals 139 — 1 4 30 65 32 7 29 42 68 16 20 33 70 Dispensary.—The work of the Dispensary showed a marked increase in a number of directions during the year. General medical practitioners, influenced probably by the publicity given to the prevalence of tuberculosis, made greater use of the Council's facilities as revealed by the fact that the Tuberculosis Officer was called into consultation on 455 occasions as against 296 in the previous year. Other statistics for 1943 : new cases 636 (including 148 contacts), old cases, 325 ; attendances 4,127 ; home visits by tuberculosis officer—new 46, old 88 ; hospital visits by tuberculosis officer, 65 ; home visits by tuberculosis visitors—first visits 172., re-visits 1,502. During the year 1,414 examinations (films, 770 ; screening only, 644) were made by means of the Council's X-ray plant. Thirty-one patients received artificial pneumothorax treatment on the premises and 387 refills were given. Sputum examinations carried out in the dispensary numbered 351. Expenditure on milk supplied to tuberculous persons amounted to £307 12s. 8d. ; 479 orders were issued. In addition to the Council's Tuberculosis Dispensary, forming part of the Town Hall Extension, there is situated in the Borough the Margaret Street Hospital for Diseases of the Chest, No. 26, Margaret Street, Cavendish Square, W.l, which is maintained by a voluntary organisation and possesses facilities for the treatment of tuberculosis. Institutional Treatment.—Admissions to hospital or sanatorium during the year numbered 183. Maintenance Allowances.—The new scheme of maintenance allowances, etc., for tuberculous persons and their dependents, prescribed by Ministry of Health Memorandum 266/T, was inaugurated in the Council's Dispensary on the 22nd June, 1943. During the last six months of the year, 64 patients applied for assistance and in 54 cases financial aid, totalling £1,055 2s. 5d., was afforded. There is little doubt that the scheme is attaining its object of encouraging patients to secure early treatment and to stay in sanatorium until maximum benefit has been obtained. In five cases it is csrtain that without an allowance the patients would have refused sanatorium treatment on account of financial obligations in the home. Government Rehabilitation Scheme.—Ten patients were referred for training under this scheme. Care Committee.—The Committee held 11 meetings and dealt with 326 cases. Disinfection.—During the year 598 rooms and 27,352 articles (including 301 books) were disinfected after infectious diseases generally. Bacteriological Examinations.—Table 10 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 10.—Work of the Bacteriological Laboratory. Examination. Positive. Negative. Total. Throat and nasal swabs for— B. diphtheriae 5 477 561 Hsemolytic streptococci 79 Sputa—for tubercle bacilli 14 51 65 Pleural fluid—for tubercle bacilli — 1 1 Urine—for tubercle bacilli — 3 3 Faeces—for typhoid, paratyphoid and dysentery bacilli — 4 4 Blood—for Widal reaction for typhoid and paratyphoid — 2 2 Totals 98 538 636