C I. Ac 4353 Dav 11839 STMARY 50 Borough of St. Marylebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1945 H. A. BULMAN, M.R.C.S., D.P.H. London: Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Leuisham 2 Public Health Department, Town Hall, St. Mabylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. In presenting this report for the year in which hostilities in the second world war ended, it is gratifying to be able to place on record that, despite the various disabilities inseparable from war, the health of the inhabitants of the Borough was maintained at a satisfactory level throughout the period 1939-1945. In 1945, for the first time since 1930, the birth-rate (13.34) exceeded the death-rate (13.26): these rates in 1944 were 13.98 and 15.34 respectively. The already low infantile mortality rate declined slightly from 47.18 (1944) to 46.54: comparative figures for the County of London as a whole were given as 61 (1944) and 53 (1945). Infectious disease notifications rose from 671 (1944) to 1,036, due almost entirely to the measles epidemic which swept through the country in the spring, when 355 cases were reported in the Borough in eleven weeks. Fortunately, only one death from measles was recorded. The personal health services continued to be in great demand and it was necessary to hold additional maternity and child welfare clinics in the autumn. During the latter part of the year the civil defence casualty and emergency mortuary organisations, which had served the Borough so faithfully and efficiently during the war years, were disbanded. I am grateful to the Chairman and members of the Public Health and Maternity and Child Welfare Committee for the continued encouragement they gave me in connection with the work of the Department, and to the staff for their loyalty and support in the task of meeting the changing demands made upon the local health services by post-war conditions. H. A. BULMAN, Medical Officer of Health. CONTENTS. page Members op 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 Youth Centre 5 Maternity and Child Welfare Welfare Centres 5 Ministry of Health Investigation 5 Refresher Courses for Health Visitors 5 Student Health Visitors 5 Visitors to Centres and Nurseries 5 Work of the Clinics 5 Home Visits 6 Milk and Vitamin Products 6 Day Nurseries 6 Home Helps 6 Child Life Protection 6 Illegitimate Children 6 Premature-Infants 6 Dental Treatment 6 Child Guidance 6 Maternity Cases 6 Convalescent Homes 6 Section C—Sanitary Circumstances:— Water 7 Drainage 7 Combined Drainage 7 Public Conveniences 7 Public Cleansing and Salvage 7 Shops 7 Diseased or Infirm Persons 7 Bed Bugs 7 Verminous Persons 7 Rats and Mice 7 Dog Nuisance 7 Mosquitoes 7 Pigeons 7 page Noise 7 Smoke 7 Poisons 7 Factories 7 Sanitary Inspection 8 Section d—Housing:— War-damaged Dwellings 8 Adaptation of Premises 8 Empty Properties 8 Factory-made Houses 8 New Blocks of Flats 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, etc. 9 Horseflesh 9 Bacteriological Examinations 9 Food and Drugs Act, 1938 9 Section F—Infectious and Other Diseases:— Notifications 10 Epidemics—Assistance to Householders 10 Diphtheria Immunisation 10 Vaccin&tion 11 Scabies 11 Impetigo 11 Dysentery 11 Venereal Diseases 11 Insulin 11 Food Poisoning 11 Tuberculosis:— New Cases and Mortality 11 Notifications' 11 Dispensary 11 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.) 1945. HIS WORSHIP THE MAYOR: *Alderman R. Stiles Allen, D.L., J.P., L.C.C. †f Alderman C. S. Steel, F.C.A., J.P. ALDERMEN: †R. Stiles Allen, D.L. *C. S. Steel, F.C.A. COUNCILLORS: F. Y. Bright. J. Brodie, LL.M. †E. Carew-Shaw, F.R.C.S. †T. K. Creamer. *Mrs. E. B. Davis. Mrs. H. I. H. Feiling. Mrs. L. Fewster. †F. Frame. Mrs. V. A. L. Freeman, J.P. *Dr. C. A. Fuller (Chairman). *Until November, 1945. Mrs. Carr Q. Henriques Dr. Elizabeth Jacobs. *Mrs. C. M. Phillips. *The Hon. Mrs. Peter Pleydell-Bouverie. G. B. Ramsay. *T. W. Robinson, F.C.A. †Miss D. A. Sharpe, F.R.C.S., M.R.C.O.G. †H. Norman Toomey, L.D.S., R.C.S., Eng. Capt. Robert Whitney, M.B.E., J.P., (†Chairman). †From November, 1945. 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): 1945—59,590. EXTRACTS FROM VITAL STATISTICS. Total M. F. Live Births—Legitimate 648 329 319 Birth Rate per 1,000 estimated civilian population 13.34 Illegitimate 147 79 68 Stillbirths—Legitimate 19 9 10 Rate per 1,000 total (live and still) births 29.30 Illegitimate 5 4 1 Deaths (all ages) 790 397 393 Death Rate per 1,000 estimated civilian population 13.26 Deaths. Rate per 1,000 total (live and still) births Maternal Mortality—Deaths from " Puerperal and Post-Abortive Sepsis "and" Other 3 3.66 Maternal Causes " (Registrar-General's Code Nos. 29 and 30 Total M. F. Deaths of Infants under one year of age Legitimate 33 23 10 Illegitimate 4 1 3 Death Rate of Infants under one year of age—All infants per 1,000 live births, 46.54; legitimate infants per 1,000 legitimate live births, 50.92; illegitimate infants per 1,000 illegitimate live births, 27.21. Deaths—From Cancer (all ages), 159; from Measles (all ages), 1; from Whooping Cough (all ages), nil; from Diarrhoea (under 2 years), 9. Births—Notification.—The number of notifications received under the Public Health (London) Act, 1936, Section 255, was 1,721: live births, 1,668; stillbirths, 53. Sources of the notifications were: from parents, 4; from doctors, 23; from mid wives, 72; from hospitals, nursing homes, etc., 1,622. Of the births notified, 571 took place at the Middlesex Hospital; 267 at Paddington Hospital; and 99 occurred at home. Of those notified as taking place in St. Marylebone, 907 belonged to other Boroughs. Of the 53 stillbirths (31 males and 22 females) notified direct to the Department, 23 (14 males and 9 females) were to St. Marylebone mothers. In addition, information from another source received through the Registrar-General brought the total number of stillbirths allocated to St. Marylebone to 24. Marriages.—The total number of marriages was 1,583, being 486 above the number for 1944, and 185 above the average for the previous 10 years. The rate for persons married in 1945 was 53 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 Residents Nonresidents All Souls. St. Mary. North Marylebone. Total. 2 Cerebro-spinal fever 1 - - - 1 - - - 2 1 - - 1 6 Tuberculosis of respiratory system 36 - 1 - 17 12 6 1 3 12 7 17 36 7 Other forms of tuberculosis 10 - - 2 3 3 2 - 2 2 2 6 10 8 Syphilitic disease 10 - - - 1 7 2 1 1 3 2 5 10 9 Influenza 4 1 - - 1 1 1 2 - 1 - 3 4 10 Measles 1 1 - - - - - - 1 - - 1 13M Cancer of buccal cavity and oesophagus (males only) 10 - - - - 4 6 2 4 2 2 6 10 13F Cancer of uterus. 8 - - - - 5 3 1 11 2 2 4 8 14 Cancer of stomach and duodenum 21 - - - - 6 15 2 14 6 5 10 21 15 Cancer of breast. 21 - - - 1 12 8 1 5 5 2 14 21 16 Cancer of all other sites 99 - - 1 5 38 55 6 76 17 27 55 99 17 Diabetes 1 - - - - - 1 - 1 - - 1 1 18 Intra-cranial vascular lesions 64 - - - - 23 41 3 20 13 15 36 64 19 Heart disease 193 - - 1 6 31 155 11 75 40 56 97 193 20 Other diseases of the circulatory system 33 - - - - 8 25 3 7 5 10 18 33 21 Bronchitis 48 - - - 5 14 29 3 8 8 16 24 48 22 Pneumonia 40 2 1 — 4 6 27 3 12 7 11 22 40 23 Other respiratory diseases 9 — - — 2 5 2 — 4 2 2 5 9 24 Ulceration of the stomach or duodenum 12 - - - 1 2 9 2 7 3 4 5 12 25 Diarrhoea (under 2 years of age) 9 8 1 - - - - - - 5 1 3 9 26 Appendicitis 5 1 - 1 - - 3 1 7 — — 5 5 27 Other digestive diseases 23 1 - - 3 9 10 4 4 8 5 10 23 28 Nephritis 16 — - - 3 5 8 1 22 3 2 11 16 29 Puerperal and postabortive sepsis 1 - - - 1 - - - - 1 - - 1 30 Other maternal causes 2 - - - 2 - - - 2 - 1 1 2 31 Premature birth 13 13 - - - - - 2 13 1 4 8 13 32 Congenital malformations, birth injury, infantile disease 7 7 - - - - - - 8 5 - 2 7 33 Suicide0 13 — - — 3 8 2 1 6 2 4 7 13 34 Road traffic accidents 8 — - — 1 2 5 2 4 3 1 4 8 35 Other violent causes 31 3 - — 11 7 10 3 11 9 8 14 31 36 All other causes 41 — - — 12 6 23 2 51 10 9 22 41 Totals 790 37 3 5 83 214 448 57 380 177 198 415 790 No death occurred from the following causes not shown in the table : Typhoid and paratyphoid fevers (Code No. 1), scarlet fever (No. 3), whooping cough (No. 4), diphtheria (No. 5), acute poliomyelitis and polioencephalitis (No. 11), acute infectious encephalitis (No. 12) TABLE 2.—Infantile Mortality. Code No. CAUSE OF DEATH. Under 1 week 1 and under 2 weeks 2 and under 4 weeks 1 and under 3 months 3 and under 6 months 6 and under 9 months 9 and under 12 months Total 3 Measles - - - - - - 1 1 7 Diarrhoea - - - 1 — — - 1 8 Enteritis - - - 3 2 1 1 7 12 Congenital malformation 4 - - - - - - 4 13 Premature birth 13 - - - - - - 13 15 Atelectasis 2 - - - - - - 2 16 Injury at birth 1 - - - - - - 1 20 Meningitis (not tuberculous) - - - - 1 - - 1 24 Bronchitis -- - - 1 - - - 1 25 Pneumonia (all forms) — - 1 - 1 - - 2 26 Suffocation, overlying — - — 2 — — — 2 27 Other causes 1 - - — 1 — — 2 Totals 21 - 1 7 5 1 2 37 No infantile death occurred from the following causes not shown in the table: Small-pox, chicken-pox (Code Nos. 1 and 2), scarlet fever, diphtheria and membranous croup, whooping cough (Code Nos. 4—6), tuberculous meningitis, abdominal tuberculosis, other tuberculous diseases (Nos. 9—11), atrophy, debility and marasmus (No. 14), erysipelas, syphilis, rickets (Nos. 17—19), convulsions, gastritis, laryngitis (Nos. 21—23). Mortuary.—Five bodies (3 male, 2 female) were deposited at the Emergency Mortuary, No. 24, Hill Road, up to the 5 30th June, 1945, when the use of the premises for mortuary purposes was discontinued. On the 1st July, 1945, the furniture, equipment, etc., were transferred to the Reserve Mortuary in the Chiltern Street School playground, where 7 bodies (male) were received during the remainder of the year. No post-mortem examinations were carried out at either premises. Crematorium.—Two hundred and six certificates authorising cremation at the St. Maivlebone Crematorium, Finchley, were issued—166 by the Medical Referee (Dr. H. A. Bulman) and 40 by the Deputy Medical Referee (Dr. M. MacGregor). SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. Staff.— Owing to the illness of the Medical Officer of Health of Paddington, the duties of that office were, at the request of the Ministry of Health, undertaken by the Medical Officer of Health of St. Marylebone from May until October. In June, Dr. Murdoch MacGregor, Assistant Medical Officer of Health and Tuberculosis Officer, was called to the Bar. Owing to the acute shortage of inspectorial staff, two retired sanitary inspectors (Messrs. W. H. Draper and P. H. Hill) continued their appointments in a temporary capacity throughout 1945. During the second half of the year four members of the staff (Messrs. M. Kelly, J. W. Chanell, D. H. Drewell and R. G. Turner) returned to duty on demobilisation from His Majesty's Forces after approximately six years' service in each case. Miss K. M. M. Kelleher, a dispensary clerk, resigned on the 24th November, 1945, to take lip an appointment with a commercial firm. Laboratory Facilities.—Sir Lionel 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. Thomas McLachlan, A.C.G.F.C., F.R.I.C., whose laboratory is situated at No. 4, Hanway Place, W.l, is the Public Analyst for the Borough. 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 1945, visits were paid to cases (number shown within brackets) as follow: maternity, 51 (4); pneumonia, 85 (7); tuberculosis, 20 (1); puerperal pyrexia, 14 (1); ophthalmia neonatorum, 24 (1); measles and German measles, 74 (12); chicken pox, 7 (1); other ailments, 33 (7). Youth Centre.—Taking advantage of their powers under section 4 (4) of the Physical Training and Recreation Act, 1937, the Council agreed to contribute a sum not exceeding £1,000 towards the initial expenditure involved in establishing a Youth Centre in Paddington Street, and to consider at a later date the granting of financial assistance in the maintenance of the Centre. Maternity and Child Welfare.—The Council have two maternity and child welfare centres: No. 1 in the Town Hall Extension comprising ante- and post-natal, infant welfare, child guidance, 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 scheme. Ministry of Health Investigation.—On the 6th September, 1945, Ministry of Health inspectors conducted an investigation into the arrangements for maternity and child welfare in the Borough. This included a scrutiny of statistics, record-keeping systems and office procedure generally, a survey of the clinic and other facilities available, inspection of buildings and equipment, and visits to clinics in session at the welfare centres. Refresher Courses for Health Visitors.—As recommended in the Second Report of the Nurses Salaries Committee (Ministry of Health) arrangements were made to grant health visitors special paid leave to attend refresher courses and to pay their fees and travelling expenses. The first course to which a health visitor was sent was held in London during the fortnight commencing 31st December, 1945. Student Health Visitors.—A student health visitor from the National Health Society, a training body recognised by the Ministry of Health, was accepted every three months to gain practical experience of a health visitor's duties in the Council's welfare centres, etc. Visitors to Centres and Nurseries.—Parties of A.T.S. members from the London District Transit Camp were afforded facilities for seeing the Council's maternity and child welfare scheme at work. Explanatory talks were given by members of the staff and visits were paid to the welfare centres and day nurseries. Numerous other visitors included Princess Safiveh Firouz of Persia. 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 Massage Clinic Antenatal Postnatal Under 1 year 1—5 years Under 1 year 1—5 years Under 1 year 1—5 years Maternity and Child Welfare Centre No. 1 110 149 59 266 1,769 144 4,398 2,143 205 564 251 1,279 (317) (79) (287) (47) (23) (54) (56) (72) Maternity and Child Welfare Centre No. 2 100 210 39 229 1,361 90 4,265 2,267 85 742 235 1,027 (229) (53) (281) (58) (16) (82) (35) (74) The Middlesex Hospital 202 150 - - 3,794 489 2,278 1,587 - - - - (410) (269) (147) (14) *359 *46 *1,132 *717 *(41) *(14) *(65) *(10) *St. Marylebone residents attending the Middlesex Hospital. 6 Classes for remedial exercises, held at Welfare Centres Nos. 1 and 2, were supported by 44 mothers who made a total of 205 attendances. Home Visits.—The five whole-time and two part-time health visitors paid domiciliary visits as follow: (a) to expectant mothers, first visits, 497, total visits, 889; (b) to children under 1 year of age, first visits, 828, total visits, 3,453; (c) to children between the ages of 1 and 5 years, total visits, 3,117. Milk and Vitamin Products.—The Food Executive Officer has kindly provided the following information as to dried milk supplied under the National Scheme during the period 31st December, 1944, to 29th December, 1945; full cream, 3,356 20 oz. cartons at l/2d. per carton; 53 cartons free: half cream, 331 cartons at l/2d. per carton; 5 cartons free. Distribution of vitamin preparations was also made as follow: cod liver oil, 4,764 13£ oz. bottles; orange juice, 39,198 6 oz. bottles; vitamin A and D tablets, 1,366 packets, each packet containing 45 tablets. Day Nurseries.—Four war-time day nurseries (whole-time), all recognised as training centres for student probationers, continued to function throughout the year. The difficulty of obtaining and retaining sufficient nursing and domestic staff again constituted the major problem in operating this service. A.T.S. members from a local gun-site gave valuable voluntary assistance in one of the nurseries during the early part of the year, four of the girls being available for duty each day. Nursery hours, which throughout the war had been from 7 a.m. to 7 p.m., were reduced as from the 1st September, 1945, when the hours fixed were: 8 a.m. to 6 p.m. (Saturdays, 8 a.m. to 1 p.m.). In September the Devonshire Street Nursery took part in a B.B.C. programme in which British people greeted their American opposite numbers. The nurses and children broadcast to an old-established nursery in New York City, and a cable subseauentlv received stated that reception had been excellent and the feature greatly appreciated. TABLE 4.—War-time Day Nurseries. No. Nursery. Date of Opening. Number of Places. Average Daily Attendance. 0—2 years. 2—5 years. Total. 0—2 years. 2—5 years. Total. 1 12-18, Salisbury Street 26.1.1942 30 30 60 20 31 51 2 St. Vincent's Creche, 14, Blandford Street *1.9.1942 15 20 35 5 20 25 3 3, Devonshire Street 16.8.1943 21 36 57 9 25 34 4 86, Carlton Hill 1.12.1943 24 26 50 14 28 42 Totals 90 112 202 48 104 152 *Approved by the Ministry of Health as a grant-aided nursery. Home Helps.—Great difficulty was again expeiienced in securing women suitable and willing to undertake the duties of home help or domestic help. During the year a home help was provided in one case and a domestic help in two cases. Child Life Protection.—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 five, and the children in their care numbered six. The Council's health visitors, acting as child protection visitors, made a total of 53 visits of inspection to the homes. Illegitimate Children.—The Council participated in a scheme to provide increased financial assistance to voluntary moral welfare organisations in London and contributed at the rate of £318 per annum for the year commencing 1st April, 1945. Provision for illegitimate children was made by the Council in three cases: two were placed in children's homes and one with a foster mother. Premature Infants.—The care of premature infants continued to receive special attention. Sixty-four premature births occurred in the Borough, of which 10 were to St. Marylebone mothers. Premature births to St. Marylebone mothers occurring in other districts numbered 38. 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 local maternity and child welfare scheme. Modern dental X-ray apparatus was installed by the Borough Council during the year. Statistics for 1945: sessions held, 94; new cases—mothers 194, children 35; attendances—mothers 788, children 101; X-ray examinations, 29; extractions—mothers 346, children 29; patients provided with dentures at cost price, 28; fillings, 258; other operations, 599. Child Guidance.—The Child Cuidance Clinic, closed during the war, was re-established in Welfare Centre No. 1 on the 12th April, 1945. Between that date and the end of the year 15 sessions were held and 27 cases made a total of 57 attendances. 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.—One expectant mother and five mothers and babies were sent to convalescent homes for periods varying from ten days to three weeks. As from the 1st April, 1945, the Council undertook the maintenance of one bed, for the use of pre-school children, at St. Christopher's Nursery Training College and Convalescent Home, Pembury Road, Tunbridge Wells, and five cases were admitted from the Borough during the remainder of the year. 7 SECTION G.—SANITARY CIRCUMSTANCES. Water.—Apart from water obtained for domestic purposes from private wells at three laige 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 20 instances where w ater had been cut off in occupied premises for non-payment of rate; in all cases the supply was reinstated, in four instances 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 93, all relating to old buildings. Combined Drainage.—One order under seal for combined drainage was issued. Public Conveniences.—The usual supervision was exercised over the 15 public sanitary conveniences (11 for men, 4 for women). As from the 1st February, 1945, the charge for a wash and brush-up was increased from 2d. to 3d., except in the case of the Salisbury Street conveniences. Public Cleansing and Salvage.—Amounts dealt with: house and trade refuse, 28,197§ tons; street sweepings and gullev slop, 2,31 If tons; salvaged materials, 3,145 tons, including 2,249½ tons of kitchen waste for pig and poultry feeding collected from 550 bins placed at intervals in the streets for the reception of this material. A sum of £7,588 17s. 7d. was obtained from the sale of salvaged materials. In addition, £428 Is. 6d. was received for the removal of trade refuse, green offal, and the cleansing of petrol interceptors. Shops.—Inspections undei the Shops Act, 1934, numbered 437- In 24 instances service of notice was necessary. Diseased or Infirm Persons.—Twenty-three of these difficult and often distressing cases were dealt with during the year, including 7 old cases which required continued observation. In one instance it was necessary to make application to Court with a view to obtaining an Order, under Section 224 of the Public Health (London) Act, 1936, for the removal of an infirm person to hospital. Before the hearing of the case took place, however, the woman was found to be seriously ill and was immediately removed to hospital where she died the same day. A post-mortem examination revealed that death was due to natural causes. Bed Bugs.—Sixty-two dwellings where bugs were found were disinfested. No instance of verminous conditions in municipal flats was reported. Verminous furniture belonging to 25 families was treated by the hydrogen cyanide process. The mobile hot-air disinfestor continued in use, and 1,776 bundles of bedding from air-raid shelters and 43,297 blankets from hostels were dealt with. A public shelter near the centre of the Borough was adapted as a cyanide chamber, and 1,000 bunks were disinfested before sale to the public. Verminous Persons.—The numbers of adults and school children using the Cleansing Station were 701 (569 men, 132 women) and 1,361 (391 boys, 970 girls) respectively. Rats and Mice.—Complaints received numbered 683, and 81 food and 391 other premises were found to be infested. Of the 81 food premises, 47 were shops and 34 hotels and restaurants; the 391 other premises included 212 dwelling houses, 63 shops, 53 warehouses and stores, 26 factories, 2 hospitals and institutions, and 26 offices. Ratproofing was carried out at all infested premises. The chief methods employed for the extermination of rats were poison baiting and trapping. Among the sources of infestation were sewers and drains damaged as a result of enemy action, and bombed sites. In order to bring about a closer relation between income and expenditure it was found necessary, as from the 2nd July, 1945, to increase by 100 per cent, the charges to occupiers of residential properties and business premises for services rendered by the Council's rat catchers, previously fixed at 2/6d. and 5/- per treatment respectively. Advantage of the scheme was taken in 429 cases, in two of which, on the ground of inability to pay, the charges against the occupiers of tenement dwellings were waived. The two rat catchers made 6,988 visits in connection with this service. Dog Nuisance.—Contravention of the bye-law relating to the fouling of footwa ys by dogs was reported by police officers in six 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 310, the amount of fines imposed being £116 8s. 6d. The temporary streets nuisance inspector, whose work was largely connected with the administration of the bye-law, and who was recalled to the Police Force during the war, returned to his duties with the Council on the 3rd December, 1945. Mosquitoes.—Five complaints of mosquitoes were received. The nuisances were traced to breeding in emergency water tanks, dustbins and a defective water supply, and appropriate treatment proved effective. Pigeons.—Nuisance from these birds was the subject of five complaints—three relating to churches, one to a block of flats, and one to mews premises. All complaints were dealt with satisfactorily and a contractor was employed to reduce the number of pigeons in serious cases. Noise.—Eight complaints of noise were received. Two were concerned with wireless loudspeakers, two with tenants of a flat, and one each with a dog, a club orchestra, a public house, and machinery. Smoke.—Eighteen complaints of nuisance from smoke were received. These related mainly to commercial premises and large blocks of flats, and it was found that in most instance s unsuitable fuel was the cause of the nuisance. Abatement was secured in all cases as a result of informal action. Poisons.—The names of 74 traders 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), the premises concerned numbering 84. Factories.—The number of registered factories was 1,280. Frequent inspections were carried out, and conditions were remedied in 32 instances (want of cleanliness 12; insufficient or unsuitable sanitary conveniences 13; other defects 7). Outworkers lists were received from 73 employers in respect of 282 contractors and 511 workpeople. 8 Sanitary Inspection.—The total number of complaints received was ] ,829. Rat infestations were again responsible for the largest number (683) which were prompted mainly by continued publicity campaigns. Details of the various nuisances detected and remedied, to the total number of 1,849, are set out in Table 5. In 576 cases the nuisances were abated upon service of a preliminary (intimation) notice. Statutory notices were issued in 32 instances, and referred to such matters as dirt, dampness, verminous rooms, unsatisfactory water-closet accommodation, inadequate water supply, insufficient number of dustbins, defective roofs, defective and choked drains. In no case was it necessary to institute legal proceedings. TABLE 5.—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 19 16 106 59 19 52 271 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired 7 7 54 20 8 21 117 Verminous dwellings disinfested — — 30 17 — 15 62 Verminous furniture and bedding disinfested 3 4 5 4 1 8 25 Overcrowding abated — — — — 1 2 3 Underground rooms (illegal occupation) dealt with — — — '- — — — Water closet defects remedied 7 10 70 52 13 30 182 Insufficient and unsuitable water closet accommodation remedied - - 1 2 5 2 10 Urinal defects remedied — 1 — 1 — — 2 Drain and water closet stoppages cleared — — 14 12 5 17 48 Drains relaid or amended — 1 4 5 1 5 16 Roilpipes and ventilating shafts repaired or renewed — 6 1 5 3 5 20 Waste pipe defects remedied 3 1 16 12 4 12 48 Yard defects remedied — — 6 7 — 7 20 Wash-house defects remedied — 2 2 4 — 4 12 Area defects remedied 1 — 1 9 — 9 20 Basement defects remedied 2 — — —• — — 2 Roofs and gutters repaired 9 10 67 52 14 52 204 Water supply to houses reinstated 1 1 9 4 1 4 20 Water supply laid on to upper storeys — — — 2 — 2 4 Water cistern defects remedied — 2 — 4 — 4 10 Dung or dust receptacles repaired or renewed 1 6 18 12 2 12 51 Rubbish, manure, etc., accumulations removed 5 2 16 17 4 17 61 Animal nuisances abated — — — 2 2 2 6 Rat and mouse infestations dealt with 21 32 68 103 111 137 472 Bakehouses cleansed 3 4 6 7 3 2 25 Smoke nuisances abated 2 — 2 7 4 3 18 Shops—sanitary defects remedied — — — 3 9 12 24 Miscellaneous 1 5 16 30 13 31 96 SECTION D.—HOUSING. War-Damaged Dwellings.—Further war damage was caused in the Borough during the early part of the year, bringing the total number of dwellings damaged by enemy action to 14,989. Approximately 13,000 of these houses have been rendered reasonably fit for habitation, nearly 1,200 being repaired during 1945. Adaptation of Premises.—Although the conversion of buildings into self-contained flats continued, under instructions from the Ministry of Health, to be held in abeyance owing to shortage of labour and materials, it was found possible to carry out minimum works of adaptation to 38 premises, making available 96 units of accommodation. Empty Properties.—Three hundred and eighty-nine empty properties were surveyed during 1945 and, where suitable, were requisitioned and adapted for housing purposes. In addition, a number of requisitioned premises previously in the occupation of Government Departments were transferred to the Borough Council for housing purposes. Factory-Made Houses.—The Ministry of Health allocated 83 factory-made houses for erection on five sites in the Borough. Seven houses were completed and occupied during the year, and the erection of the remainder was proceeding. New Blocks of Flats.—The London County Council approved the Borough Council's plans for the erection of 172 flats on the Barrow Hill Road site in St. John's Wood, and 140 flats and 11 shops on the Church Street site in the Lisson Grove area. The two sites are being acquired under Compulsory Purchase Orders at an estimated cost of £194,000. The Barrow Hill Road scheme includes provision for a branch maternity and child welfare centre. Inspection of Dwelling-houses.—Number of houses inspected for defects under the Public Health or Housing Acts 1,125; number of inspections made—2,347; number of houses found not to be in all respects reasonably fit for human habitation—449; number of defective houses rendered fit in consequence of informal action—425; number of houses in which defects were remedied by owners after service of formal notices under the Public Health (London) Act, 1936—24; number of underground rooms in respect of which closing orders were made—nil. Common Lodging Houses.—Forty-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 during the early part of the year, and 240 inspections were made by day and night. 9 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 154 premises from which milk is sold. Inspections made numbered 246. During the year 37 applications under the Milk (Special Designations) Regulations, 1936-1943, were received from 15 milk purveyors and licences were granted as follows: 1 pasteurising, 18 dealers' and 3 supplementary in the case of pasteurised milk; 1 bottling, 12 dealers' and 2 supplementary in respect of tuberculin tested milk. The average composition of the 124 samples of milk analysed was: total solids, 12.51%; fat, 3.68%; solids not fat, 8.83%. No sample was found to be below standard. At the request of the Ministry of Food, 80 samples of milk, taken from two authorised wholesale firms operating heat-treatment plants, were submitted to the tests prescribed for the various designations. The Ministry's Area Milk Officer was advised of the results, which were satisfactory except in the case of one sample of sterilised milk which failed to pass the phosphatase test. Twenty-one other samples of milk examined bacteriologically were found to comply with the requisite standards. Meat and other Foods—Unsound Food.—Some 6 tons of food condemned as unfit for human consumption included the following: meat (including bacon and rabbits), 2 tons 4 cwts.; fish, 13 cwts. 3 qtrs. 20 lbs.; fruit, 5 cwts. 2 qtrs. 5 lbs.; vegetables, 1 cwt. 2 qtrs.; cereals, 2 cwts. 3 qtrs. 16 lbs.; canned goods, 5,447 tins; miscellaneous, 7 cwts. 1 qtr. Practically all this unsound food was salvaged and diverted to other uses. Slaughterhouse.—The only licensed slaughterhouse in the Borough is that at the Zoological Society's premises in Regent's Park. The slaughtering done in normal times is for the food for the animals in the gardens and humane killers are used. Three inspections were made. One licence to slaughter or stun animals, granted to skilled slaughtermen, was renewed. Food Premises.—At the end of 1945, 109 premises were registered for the preparation or manufacture of foods (other than ice cream) intended for sale, and 271 inspections were made. Ice Cream Premises.—The number of premises on the register was 73; 81 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. Forty-five inspections were made. Bakehouses.—Number on register—25, 19 being basement bakehouses; 76 inspections were made. Fried Fish Vendors and Fish Curers.—The number of premises used by vendors of fried fish is 8 and by fish curers 3. Thirty-eight inspections of fried fish shops and 25 inspections of fish curers' premises were carried out. Restaurants, etc.—Premises in which meals are provided or food is sold already cooked or is prepared for sale numbered 426, including resturant and dining-room kitchens, 375, hotel kitchens, 51: 958 inspections were made and 58 notices served. Horseflesh.—Thirty-six visits were paid to two shops selling horseflesh for human food. Bacteriological Examinations.—Apart from milk, one sample each of egg powder, ice cream, and tinned salmon were examined bacteriologically and found to contain no food poisoning organisms. Food and Drugs Act, 1938.—Samples taken under the Act numbered 700 (52 formal, 648 informal) and included: milk 124, butter 91, margarine 61. The sum paid in respect of each analysis was 15s. 0d., except in the case of sausages for which the fee was £1 Is. Od. per sample. Twenty-one samples reported as adulterated or otherwise giving rise to irregularity are referred to by the Public Analyst (Mr. Thomas McLachlan) in the following report: " The percentage of adulterated samples this year is slightly lower than in 1944, being 3.0 per cent., as compared with 3.6 per cent, last year, but this is still higher than in earlier years. Four samples (1 informal, 3 formal) of so-called sherry and sherry-type wine had not been prepared from grape juice, and it is satisfactory to note that the Ministry of Food has now issued an order amending the Labelling of Food (No. 2) Order, 1944, by which the composition and alcoholic strength of these so-called wines must be declared. Two samples (1 informal, 1 formal) of " blackcurrant nectarean linctus " were merely artificial jellies with artificial colour and flavour and without any sugar, whereas a blackcurrant linctus should be a thick syrupy preparation made from blackcurrant juice and sugar and containing a high proportion of vitamin C. Four informal samples of malt vinegar were found to contain small proportions of salt, which is added as a preservative, but which is not a normal constituent of vinegar. The practice of adding salt was adopted in certain vinegar breweries as a result of the air-raids on London, and the Ministry of Food is enquiring into the necessity of the practice being continued or the advisability of a notice l?eing placed on the label. It is the opinion of your Analyst that the presence of added salt must definitely be declared now under the Labelling of Food (No. 2) Order, 1944. Among other practices which have crept in during the war is the adulteration of pepper, and an informal sample of " compound pepper " was received for examination; the composition was wheat flour 75 per cent., cayenne pepper 15 per cent., and black pepper 10 per cent. Similarly, owing to the shortage of meat, many restaurants have been selling horseflesh without a notice being displayed in shops to inform their customers; two such samples (informal) were condemned. It is a common practice to smear horseflesh with flour immediately on receipt in order to make its identification more difficult, and it is also frequently soaked in vinegar in order to remove the slightly sweet taste natural to horseflesh and by which some people can detect it. It has for many years been the general custom in this country to describe " compound tincture of rhubarb "as" tincture of rhubarb," although this has never been an official description. With the passing of the Pharmacy and Medicines Act, 1941, it is now illegal to sell a medicine under any but an official description unless the names and quantities of the active ingredients are given. Adverse comment was therefore made on one informal sample on this account, and your Analyst sent a letter to the Pharmaceutical Journal as a result of which the term "tincture of rhubarb" may be given as an alternative synonym in the next Pharmacopoeia. A formal sample of chocolate oublis and one informal sample each of oatmeal, dried milk, baking powder, sauce, gelatine, and aromatic solution of ammonia, were also adversely reported upon but do not call for special comment." Legal proceedings were instituted under the Food and Drugs Act, 1938, section 3, and the Food Substitutes (Control) 10 Order, 1941, in the case of the blackcurrant nectarean linctus, but all summonses were dismissed, the magistrate holding that the article sold was a drug and not a food. Prosecutions taken under the Food and Drugs Act, 1938, sections 13 and 38, in connection with the sale of horseflesh resulted in the imposition of penalties amounting to £50. In certain other cases of adulteration or irregularity the facts were referred to the Ministry of Food; in others the matter was taken up with the manufacturers. From time to time reports received from the Public Analyst indicated the possibility that certain products sold as British wines contravened the provisions of the Food and Drugs Act, 1938, and the labelling requirements contained in Emergency Food Orders made by the Ministry of Food. Owing to the uncertain state of the law at the time, proceedings were not instituted in these cases but, in the public interest, the Minister of Food was again requested to consider prescribing suitable standards for wines. On the 10th December, 1945, the Minister issued an Order, amending the Labelling of Food (No. 2) Order, 1944, designed to secure that the labels of British wines should contain an appropriate description of the product, a clear indication of the fruit basis from which it is made and a statement of its alcoholic content, and imposing restrictions on the unqualified use of the word " wine " and the appellations of imported wines. 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) received during 1945. TABLE 6.—Infectious Disease Notifications. Notifiable Disease. Cases notified in whole Borough. Cases notified in Sub-Districts. Cases removed to hospital. Cases isolated at home. 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 13 - - - - - 6 3 1 2 1 - - 3 2 8 13 -_ Erysipelas 29 — — — — - — — 2 2 3 15 7 8 15 6 17 12 Scarlet fever 77 — 2 7 8 5 38 8 — 6 — 3 — 8 14 55 52 25 Puerperal fever 6 — — — — — — — 1 4 1 — — 1 5 — 6 — Puerperal pyrexia 10 — — — — — — — — 6 4 — — 1 2 7 10 — Cerebro-spinal fever 7 — 3 — — — — 2 1 1 — — 2 1 4 7 — Acute poliomyelitis 1 — — — — — 1 — — — — — — — — 1 1 — Tuberculosis— Pulmonary 91 — 1 — — — 5 2 9 34 14 23 3 15 27 49 41 50 Non-pulmonary 7 — — — — — 2 2 — 1 — 1 1 3 3 3 4 Ophthalmia neonatorum 3 3 — — — — — — — — — -— — 1 2 2 1 Pneumonia 50 4 - 2 2 — 2 1 1 6 10 12 10 9 15 26 31 19 Dysentery 71 2 3 1 — — 4 — 9 26 2 6 18 36 28 7 33 38 Measles 443 22 53 59 54 55 135 27 8 24 2 3 1 76 99 268 93 350 Whooping cough 21 4 4 2 5 1 3 1 1 — — — — 3 3 15 1 20 Scabies 207 7 6 9 7 23 17 16 64 33 16 9 58 45 104 - 207 Totals 1,036 42 66 77 78 68 219 61 50 176 72 78 49 221 260 555 310 726 * There were no cases of the following diseases, which are also notifiable in the Borough: Smallpox, cholera, typhus fever, enteric fever, paratyphoid fever, relapsing fever, continued fever, plague, glanders, farcy, anthrax, polio-encephalitis, encephalitis lethargica, malaria, induced malaria. Epidemics—Assistance to Householders.—Ministry of Health Circular 196/45, dated 15th November, 1945, drew attention to the action to be taken by local authorities to assist householders if influenza or other infectious disease should assume epidemic proportions during the winter. The necessary arrangements were made well in advance of any demands that might be made upon them, and in association with the London County Council and various voluntary organisations, including the British Red Cross Society, the St. John Ambulance Brigade and the Women's Voluntary Services, a comprehensive scheme was prepared for the Borough to enable the local medical, nursing and other services to be augmented at short notice. Fortunately, only one or two calls for assistance were received. 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 eight elementary schools where, apart from new cases, 214 additional protective injections were given. Six 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. (ToxoidAntitoxin 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 1,502 519 39 2,060 New cases 481 138 16 635 Schick negative — — 9 9 Completely immunised but not retested 425 111 4 540 Retested 286 56 2 344 Positive after retest 18 11 4 33 11 At the end of 1945 it was considered that 78% of children under 5 years of age and 72% of those ween 5 and 15 had been immunised. These estimates include, so far as can be assessed, children immunised in St. Marylebone by private arrangement and children who came into the Borough after being immunised elsewhere. Although the Council's individual case records had always been kept in a foim substantially simi r to that suggested in Ministry of Health Circulars 193/45 and 194/45, dated 14th November, 1945, new cards were p: spared in order to comply with the Minister's request for uniformity. Vaccination.—Vaccinations carried out numbered 511 (primary, 398; re-vaccinations, 113). Vaccination was successful in 502 instances; unsuccessful in 2; while 7 cases were awaiting inspection. Of the 875 children whose births were registered in 1944, 616 (70.4%) were successfully vaccinated. Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 875 cases of scabies: adults 236 (men 49, women 187); children 639 (boys 187, girls 452). The Scabies Clinic at the Middlesex Hospital treated 1,589 cases: adults 1,363 (men 761, women 602): children 226 (boys 113, girls 113). This Clinic closed down on the 31st December, 1945. Opened on the 18th April, 1942, it served a most useful purpose during the later years of the war in treating cases from the eastern part of the Borough and from adjoining areas. With its closure arrangements were made for all cases of scabies occurring in the Borough to be treated at the Council's Cleansing Station. Domiciliary visits paid in connection with St. Marylebone cases numbered 269. Impetigo.—Forty-seven boys and 62 girls received treatment for this condition at the Cleansing Station. Dysentery.—During April, 36 cases of Sonne dysentery were reported from the nurses' home of a large hospital in the Borough. The outbreak was mild in character and all the nurses recovered rapidly. No case occurred amongst the patients in the hospital. Venereal Diseases.—Continued assistance was given to the propaganda campaign for drawing public attention to the dangers of these conditions and to the adequate facilities which exist for those in need of treatment. Talks on sex education were given to members of local youth clubs and others, by lecturers of the Central Council for Health Education under the grant received by that body from the London County Council, and the larger firms in the Borough were supplied with copies of a leaflet dealing with the dangers of venereal diseases. Blood specimens from patients attending the Council's ante-natal clinics continued to be submitted, as a routine measure, to a group laboratory of the London County Council for the Wassermann reaction and Kahn test. Insulin.—Supplies of insulin for the poorer inhabitants suffering from diabetes were provided free of cost by the Council in three cases, under the authority of Ministry of Health Circular 2734, dated 4th January, 1943. Food Poisoning.—Six cases of food poisoning, which is notifiable in the Borough, were reported. In a group of 4 cases the suspected article was trifle eaten in a restaurant. The remaining 2 cases were alleged to be due to hens' eggs. In neither instance was the presence of food poisoning organisms revealed by bacteriological investigation. 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. N on-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. O—l - - - - - - - - 1—5 2 — 1 - 1 - - - 5—15 5 2 3 3 — — 1 1 15—25 13 15 1 5 2 3 — 1 25—35 17 19 — - 4 3 - - 35—45 17 7 2 - 4 1 2 - 45—55 10 2 — 1 7 - 2 1 55—65 11 4 - - 5 - - - 65 and upwards 4 1 - 1 5 1 - 2 Totals 79 50 7 10 28 8 5 5 *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 vear. Notifications.—Table 6 (p. 10) gives information regarding notifications of pulmonary and non-pulmonary tuberculosis received during the year. The total number of cases of tuberculosis remaining at the 31st December, 1945, on the register was 652, 44 more than at the end of the previous year. Dispensary.—The work of the Dispensary continued to increase generally. Statistics for 1945: new patients 729 (including 128 contacts), old cases, 454; attendances, 5,857; tuberculosis officer called into consultation on 601 occasions; home visits by tuberculosis officer—new 50, old 110; hospital visits by tuberculosis officer, 51; home visits by tuberculosis visitors-—first visits 151, re-visits 1,193. During the year 2,192 examinations (films, 975; screening only, 1,217) were made by means of the Council's X-ray plant. Forty-six patients received artificial pneumothorax treatment on the premises and 892 refills were given. Sputum examinations carried out in the dispensary numbered 390. Expenditure on milk supplied to 91 tuberculous persons for varying periods amounted to £545 19s. 6d. 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. 12 Institutional reatment.—Admissions to hospital or sanatorium during the year numbered 141. Maintenance Allowances.—The scheme of maintenance allowances, etc., for tuberculous persons and their dependents, prescribed by Ministry of Health Memorandum 266/T, continued to operate smoothly and to attain its object of encouraging aging patients to secure early treatment and to stay in sanatorium until maximum benefit has been obtained. During the year, 53 patients applied for assistance and in 49 cases financial aid, totalling £2,399 13s. 10d., was afforded. Government Rehabilitation Scheme.—Twenty-seven patients were referred under this scheme to the Local Office of the Ministry of Labour and National Service. Care Committee.—The Committee held 11 meetings and dealt with 308 cases. Disinfection.—During the year 584 rooms and 28,071 articles (including 311 books) were disinfected after infectious diseases generally. 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. Nature of Specimen and Examination. Positive. Negative. Total. Throat and nasal swabs for— B. diphtherial 7 293 300 Hemolytic streptococci 81 219 Sputa—for tubercle bacilli 3 62 65 Faeces—for general examinations and dysentery, etc. - 6 6 1 2 3 Blood—for typhoid - 1 1 Blood—for Wassermann reaction, etc. - 3 3 Rectal and urethral sw*wbs—for dysentery, etc. - 5 5