STMARY5 I LIBRARY, • Ac4353 14 ET Borough of St. Marylebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946 H. A. BULMAN, M.R.C.S., D.P.H. London: Freame, Manning & Co., Ltd. (T.U.), 12a, Lee High Road, Letvisham - . . ■ \ « . .... . v:.: . i; ' * : ' . •/. V i c: a •, .1 .,r_ o 7:::-. 1 I ♦ * . 3 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Statistics for 1946 indicate that health standards in the Borough continued to be maintained at a satisfactory level, and there are no untoward happenings to record in this respect. The birth-rate (13.09) again exceeded the death-rate (11.47), and the infantile mortality rate reached a new low level, declining sharply from 46.54 (1945) to 36.64—one-fifth of the rate 50 years ago. The civilian population was estimated by the Registrar-General to be 70,920 as against 59,590 for 1945. Infectious disease notifications dropped from 1,036 (1945) to 675, due almost entirely to a greatly reduced incidence of measles. With the exception of tuberculosis and pneumonia, the infectious diseases caused but an insignificant proportion of all deaths—11 out of 813—and no case of diphtheria, scarlet fever or measles proved fatal. What have come to be known as the "personal health services" were again in great demand and it was found necessary to extend these in a number of directions. Under the provisions of the National Health Service Act, which received the Royal Assent on the 6th November, 1946, the more, important of these functions, including maternity and child welfare and the tuberculosis dispensary service, are to pass from the hands of the Borough Council into those of other authorities on the " appointed day." To the Chairman and Members of the Public Health and Maternity and Child Welfare Committee I wish to express my thanks and appreciation for their continued encouragement and support in the work of the Department, and to the staff my gratitude is due for loyal assistance willingly and efficiently rendered in connection with the post-war expansion of public health activities in the Borough. H. A. BULMAN, Medical Officer of Health. CONTENTS. page page Members of the Public Health Committee 4 Mosquitoes 9 Section A—Statistics and Social Conditions:— Noise 9 General Statistics 4 Smoke 9 Extracts from Vital Statistics 4 Poisons 9 Births 4 Factories 9 Marriages 4 Sanitary Inspection 9 Maternal Mortality 4 Deaths Section D—Housing:— Infantile Mortality 5 Re-organisation of Housing Department 10 Mortuary 5 Permanent Schemes 10 Crematorium 6 Temporary Housing 10 Section B—General Provision of Health Adaptation of Premises 10 Services: Squatters 10 Staff 6 Inspection of Dwelling Houses 11 Staff Medical Examinations 6 Common Lodging Houses 11 Laboratory Facilities 6 Section E—Food Home Nursing 6 Food Analysis 11 Maternity and Child WelfareLegal Proceedings 11 Weifare Centres 6 Bacteriological Examinations 11 work oi the Clinics 6 Milk Refresher Courses for Health Visitors 6 Butter and Margarine Premises"' 11 student Health Visitors 7 ICE Cream Visitors to Centres and Nurseries 7 Preserved Food 12 ,- Fried Fish Vendors and Fish Curers 12 Milk and Vitamin Products 7 Bakehouses 12 Sheets for Expectant Mothers 7 Restaurants, etc 12 Home hellp and domestic Help Swevices 7 Sale of Food and Drinks in Public Places 12 Child Life Protection 7 Unsound Food12 Illegitimate Children 7 Horseflesh 12 .Premature Infants 7 Dental Treatment 7 Slaughter of Animals12 Foot Clinic 7 Section F—Infectious and Other Diseases :— Remedial Exercises 7 Notifications 12 Child Guidance 7 Diphtheria Immunisation 13 Maternity Cases 7 Vaccination 13 Convalescent Homes 8 Scabies. 13 Maternity Survey8 Impetigo 13 Fathercraft 8 Venereal Diseases 13 Day Nurseries 8 Insulin 13 Section C—Sanitary Circumstance:— Food Poisoning 13 Water 8 Tuberculosis:— Drainage 8 New Cases and Mortality . 13 Combined Drainage 8 Notifications 14 Public Conveniences 9 Dispensary 14 Public Cleansing and Salvage 9 Institutional Treatment 14 Shops 9 Dental Treatment 14 Diseased or Infirm Persons 9 Maintenance Allowances 14 Bed Bugs 9 Government Rehabilitation Scheme 14 Verminous Persons 9 Care Committee 14 Rats and Mice 9 Disinfection 14 Dog Nuisance 9 Bacteriological Examinations 14 4 PUBLIC HEALTH COMMITTEE (who are also the Committee appointed for Maternity and Child Welfare purposes.) 1946. HIS WORSHIP THE MAYOR : Alderman C. S. Steel, F.C.A., J.P. ALDERMAN: R. Stiles Allen, D.L. COUNCILLORS : F. Y. Bright. Mrs. Can Q. Henriques. J. Brodie, LL.M. Dr. Elizabeth Jacobs. E. Carew-Shaw, F.R.C.S. †Mrs. M. Kiewe. T. K. Creamer. G. B. Ramsay. Mrs. H. I. H. Feiling. Miss D. A. Sharpe, F.R.C.S., M.R.C.O.G. Mrs. L. H. Fewster. H. Norman Toomey, L.D.S., R.C.S., Eng. F. Frame. Capt. Robert Whitney, M.B.E., J.P. (Chairman). Mrs. V. A. L. Freeman, J.P. (Deputy Chairman). Until April, 1946. †From July, 1946. 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) : 1946—70,920. EXTRACTS FROM VITAL STATISTICS. Total M. F. Live Births—Legitimate 804 412 392 Birth Rate per 1,000 estimated Illegitimate 124 71 53 civilian population 13.09 Stillbirths—Legitimate 22 12 10 Rate per 1,000 total (live and still) Illegitimate 5 3 2 births 28.27 Deaths (all ages) 813 395 418 Death Rate per 1,000 estimated civilian population 11.47 Rate per 1,000 Deaths, total (live and still) births. Maternal Mortality—Deaths from "Puerperal and Post-Abortive Sepsis" (Registrar- ) 3 3.14 General's Code No. 29) Total M. F. Deaths of Infants under one year of age—Legitimate 28 21 7 Illegitimate 6 3 3 Death Rate of Infants under one year of age—All infants per 1,000 live births, 36.64; legitimate infants per 1,000 legitimate live births, 34.95; illegitimate infants per 1,000 illegitimate live births, 48.39. Deaths—From Cancer (all ages), 161; from Measles (all ages), nil; from Whooping Cough (all ages), 1; from Diarrhoea (under 2 years), 4. Births—Notification.—The number of notifications received under the Public Health (London) Act, 1936, Section 255, was 1,877 ; five births, 1,837 ; stillbirths, 40. Sources of the notifications were : from parents, 8 ; from doctors, 28 ; from midwives, 109 ; from hospitals, nursing homes, etc., 1,732. Of the births notified, 558 took place at the Middlesex Hospital; 417 at Paddington Hospital; and 179 occurred at home. Of those notified as taking place in St. Marylebone, 850 belonged to other Boroughs. Of the 40 stillbirths (22 males and 18 females) notified direct to the Department, 24 (13 males and 11 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 27. Marriages.—The total number of marriages was 1,538, being 45 below the number for 1945, and 131 above the average for the previous 10 years. The rate for persons married in 1946 was 43 per 1,000 of the estimated civilian population. 5 No death occurred from the following causes not shown in the table : Typhoid and paratyphoid fevers (Code No. 1), scarlet fever (No. 3), diphtheria (No. 5), measles (No. 10), acute poliomyelitis and polioencephalitis (No. 11). 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 6 Whooping Cough - - - - - 1 - 1 7 Diarrhoea — - — 2 1 1 — 4 8 Enteritis — - — 1 1 — - 2 12 Congenital malformation 3 - — 1 — — — 4 13 Premature birth 5 - 1 — — — — 6 15 Atelectasis 4 - — — — — — 4 20 Meningitis (not tuberculous) . 1 - — — — — — 1 25 Pneumonia (all forms) 1 - — 3 1 3 — 8 27 Other causes . 1 - - 3 - - - 4 Totals 15 — 1 10 3 e — 34 No infantile death occurred from the following causes not shown in the table : Small-pox, chicken-pox, measles, scarlet fever, diphtheria and membranous croup (Code Nos. 1—5), tuberculous meningitis, abdominal tuberculosis, other tuberculous diseases (Nos. 9—11), atrophy, debility and marasmus (No. 14), injury at birth, erysipelas, syphilis, rickets (Nos 16—19), .convulsions, gastritis, laryngitis, bronchitis (Nos. 21—24), suffocation, overlying (No. 26). Mortuary.—Eighteen bodies (10 male, 8 female) were deposited at the Public Mortuary, Chiltern Street. No postmortem examinations were carried out. 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. I ; 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 - - - - 4 Wnooping cough 1 1 — — — — — — — 1 — — 1 6 Tuberculosis of respiratory system 41 — 18 19 4 1 2 10 14 17 41 7 Other forms of tuberculosis 4 - — — 1 1 2 — 5 1 1 2 4 8 Syphilitic disease 4 - — — — 2 2 1 2 1 1 2 4 9 Influenza 10 - — 1 1 5 3 4 1 1 4 5 10 12 Acute Infectious Encephalitis - - - - - - - - 1 - - - - 13 m Cancer of buccal cavity and oesophagus (males only) 8 - - - - 4 4 2 12 2 2 4 8 13 Cancer uterus 9 - — — 1 4 4 3 5 2 3 4 9 14 Cancer of stomach and duodenum 19 - - - - 6 13 6 23 5 4 10 19 15 Cancer ofbreast 20 - — — 4 9 7 4 11 6 4 10 20 i6 Cancer of all other sites. 105 - — — 6 49 50 11 114 24 25 56 105 17 Diabetes 6 - — — - 2 4 1 3 1 1 4 6 18 Intra-cranial vascular lesions 64 - - - 1 18 45 12 26 9 13 42 64 19 Heart disease 207 - — — 6 51 150 35 85 43 72 92 207 20 Other diseases of the circulatory system 33 - - - 1 8 24 8 9 5 13 15 33 21 | Bronchitis 52 - — — 3 13 36 10 5 11 15 26 52 22 23 Pneumonia Other respiratory diseases . 49 8 8 1 11 2 29 6 11 2 20 2 11 1 4 '5 49 8 24 Ulceration of the stomach or duodenum 6 — — 1 3 2 3 8 2 2 2 6 25 Diarrhoea (Under 2 years of age) 4 4 - - - - - - - - - 4 4 26 Appendioitis 2 2 1 -— — — 2 2 27 Other digestive diseases 24 — — — 2 7 15 7 11 4 8 12 24 28 Nephritis 21 — — — 1 10 10 4 9 3 9 9 21 29 Puerperal and postabortive sepsis 3 2 1 2 ' 1 3 30 Other maternal causes - — — — — — — — 1 — | — — 31 Premature birth 6 6 - - - - - 2 8 3 — 3 6 32 Congenital malformations, birth injury, infantile disease... 17 12 - - 3 2 - 2 6 7 1 9 17 33 Suicide 17 - — — 6 9 2 4 4 4 5 8 17 34 Road traffic accidents 3 - 1 — — — 2 1 7 — 1 2 3 35 Other violent causes .28 1 — - 4 5 18 7 13 4 8 16 28 36 All other causes 42 2 — 2 6 13 19 9 73 9 7 26 42 Totals 813 34 1 3 68 254 453 151 467 172 228 413 813 6 Crematorium.—Two hundred and forty-six certificates authorising cremation at the St. Marylebone Crematorium, Finchley, were issued—191 by the Medical Referee (Dr. H. A. Bulman); 22 by the Deputy Medical Referee (Dr. M. MacGregor), and 33 by the Deputy Medical Referee (Dr. W. H. S. Wallace). SECTION B—GENERAL PROVISION OF HEALTH SERVICES. Staff.—Many movements among the staff took place during the year. Dr. Murdoch MacGregor, Tuberculosis Officer and Assistant Medical Officer of Health for 7½ years, relinquished his appointment on the 22nd September, 1946, to take up the position of Medical Officer of Health of the Metropolitan Borough of Bethnal Green. Dr. W. H. S. Wallace, who had been Assistant Medical Officer of Health for 11 years, and returned to duty on the 27th May, 1946, after 3£ years' service in the Royal Army Medical Corps, was appointed Deputy Medical Officer of Health on the 1st December, 1946. Five other members of the staff (Miss M. T. Challis and Messrs. C. D. Turbayne, S. P. Fleming, V. A. Bignell and L. Newland) resumed service with the Council on demobilisation from His Majesty's Forces. Miss P. K. Pepler, Health Visitor and Tuberculosis Visitor, resigned on the 28th April, 1946, and Mr. M. Kelly, Clerical Assistant, on the 30th November, 1946, to take up appointments with other local authorities. Two Sanitary Inspectors retired—Mr. F. C. Cook on the 30th September, 1946, after 33 years' municipal service, including 25 years in St. Marylebone ; and Mr. T. A. Cartledge on the 30th November, 1946, after 39 years' service in local government, including 36 years in St. Marylebone. Both these officers had given efficient and devoted service to the Council and to the inhabitants of the Borough. Owing to shortage of sanitary inspectors, Mr. Cook remained on in a temporary capacity. Mrs. E. E. Spears retired on the 31st October, 1946, after 22 years' service—first in the unique position, for a woman, of Mortuary Keeper, and in later years as Matron-Housekeeper of the Lisson Grove Welfare Centre. Mr. A. W. P. Robinson was appointed as a Sanitary Inspector and commenced duty on the 1st July, 1946. Staff Medical Examinations.—Since the 24th June, 1946, medical examinations for the purposes of the Council's Superannuation Scheme, formerly conducted by a private practitioner, have been undertaken by the medical staff of the Public Health Department, and during the remainder of the year 49 examinations were carried out. Laboratory Facilities.—At the end of 1945, Sir Lionel Whitby, C.V.O., M.C., found it necessary to terminate his services as Bacteriologist to the Council, a position he had held since 1932. He was succeeded by Dr. C. J. C. Britton, of No. 121, Harley Street, W.l, on the 1st January, 1946. Mr. Thomas McLachlan, A.C.G.F.C., F.R.I.C., whose laboratory is situated at No. 4, Hanway Place, W.l, in 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 1946, visits were paid to cases (number shown within brackets) as follow: maternity, 1,702 (105); pneumonia, 244 (14); tuberculosis, 87 (3); puerperal pyrexia, 9 (1); measles and German measles, 4 (4); whooping cough, 15 (2); influenza, 177 (19); other ailments, 191 (40). 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. Owing to increased attendances at the ante-natal clinics it was found necessary to conduct an additional clinic at Welfare Centre No. 1, as from the 29th January, 1946 ; and, at the suggestion of the District Nursing Association, a special ante-natal clinic for midwives cases was established at that Centre on the 2nd October, 1946. A part-time clinic nurse was engaged on the 11th February, 1946, to relieve the health visitors of certain clinic duties and thus enable them to devote mOre time to home visitation. TABLE 3.—Work of the Maternity and Child Welfare Clinics. 0 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. 1 153 150 59 180 3180 169 5,125 2,148 68 787 144 923 (442) (84) (356) (56) (19) (47) (34) (48) Maternity and Child . ' Welfare Centre No. 2 102 255 41 214 1,971 112 4,353 2,681 223 918 134 937 (301) (62) (269) (90) (12) (96) (18) (58) The Middlesex Hospital 210 197 — — 4,882 572 2,176 1,704 — — — — (647) (214) (139) (6) .300 .55 .1,033 .765 .(42) .(21) .(67) .(1) .St. Marylebone residents attending the Middlesex Hospital. Refresher Courses for Health Visitors.—As recommended in the Second Report of the Nurses Salaries Committee (Ministry of Health) arrangements were again made to grant health visitors special paid leave to attend refresher courses and to pay their fees and travelling expenses. Miss E. D. Mann attended a course held in London during the fortnight commencing 18th May, 1946. 7 Student Health Visitors.—Student health visitors from King's College of Household and Social Science (University of London) and the National Health Society were 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.—Medical students from St. Mary's Hospital, Paddington, student health visitors from the Royal College of Nursing, and 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 and for visiting the welfare centres and day nurseries. Throughout the year lectures on maternity and child welfare were given by two of the health visitors at the A.T.S. Education Centre in the Borough to groups of girls due for demobilisation. On the 6th November, 1946, a recording of an infant welfare clinic in session at the Lisson Grove Centre was made by the B.B.C. for subsequent use in tae " Woman's Hou Home Visits.—The five whole-time health visitors and one part-time health visitor paid domiciliary visits as follow : (a) to expectant mothers, first visits, 529, total visits, 906 ; (b) to children under 1 year of age, first visits, 854, total visits, 3,018 ; (c) to children between the ages of 1 and 5 years, total visits, 3,113. 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 30th December, 1945, to 28th December, 1946 ; full cream, 3,176 20-oz. cartons at l/2d. per carton ; 127 cartons free : half cream, 256 cartons at l/2d. per carton ; 15 cartons free. Distribution of vitamin preparations was also made as follow : cod liver oil, 6,892 13|-oz. bottles ; orange juice, 45,305 6-oz. bottles ; vitamin A and D tablets, 2,011 packets, each packet containing 45 tablets. Sheets for Expectant Mothers.—On production of a midwife's certificate that sheets are needed for home confinement, expectant mothers are entitled to a maximum of three Board of Trade priority utility sheet dockets. During 1946, 45 applications were received by the Department and 131 dockets issued, as compared with 65 dockets supplied to 23 applicants in 1945. Home Help and Domestic Help Services.—The demand for assistance from these services increased considerably throughout 1946. Some difficulty was experienced in finding and keeping the right type of women for the work, but the scheme worked satisfactorily on the whole. Help was given to all genuine cases, though it was necessary to point out to certain applicants the limitations and intentions of the scheme, as it was found that the Town Hall was treated by some enquirers as a domestic agency to which all in need of domestic help, irrespective of their circumstances, could apply. In normal home help cases (confinements at home and after discharge from hospital or nursing home) the helper was generally sent into the home for two or three weeks, but where aged or infirm people were concerned, help was frequently continued for an indefinite period. Helpers were sent into 79 households—54 home help and 25 domestic help—and by the end of the year four full-time helpers were employed by the Council. 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 six, and the children in their care numbered eight. The Council's health visitors, acting as child protection visitors, made a fotal of 77 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. Financial aid was given by the Council in one case, the child being placed in a children's home. Premature Infants.—-The care of premature infants continued to receive special attention. Fifty-one premature births occurred in the Borough, of which 15 were to St. Marylebone mothers. Premature births to St. Marylebone mothers occurring in other districts numbered 33. 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. After acting as the Council's Dental Surgeon for 5|- years, Mr. L. J. Godden, L.D.S., R.C.S., resigned on the 31st December, 1945, and was succeeded on the 1st January, 1946, by Mr. E. H. Carroll-Clark, L.D.S., R.C.S. Statistics for 1946 : sessions held, 150 ; new cases—mothers 260, children 75 ; attendances—mothers 921, children 188 ; X-ray examinations, 13 ; extractions—mothers 411, children 25 ; patients provided with dentures at cost price, 33 ; fillings, 521 ; other operations, 593. Foot Clinic.—This clinic, conducted as part of the Council's Maternity, and Child Welfare Scheme from April, 1938, to July, 1939, was re-established at the end of November, 1946, and 15 persons attended the four sessions held during the remainder of the year. Remedial Exercises.—Classes for remedial exercises, held at Welfare Centres Nos. 1 and 2, were supported by 38 mothers who made a total of 117 attendances. Child Guidance.—Twenty-four clinic sessions were held during the year, and 41 cases made a total of 110 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. 8 Convalescent Homes.—'Five mothers and babies were sent to post-natal convalescent homes for periods varying from two to four weeks. As from the 1st April, 1946, the Council undertook the maintenance of two beds, for the use of pre-school children, at St. Christopher's Nursery Training College and Convalescent Home, Pembury Road, Tunbridge Wells, and nine cases were admitted from the Borough during the remainder of the year. Maternity Survey.—During April, 1946, the health visitors interviewed a number of women who had recently borne children, to assist a questionnaire survey inaugurated by a Joint Committee of the Royal College of Obstetricians and Gynaecologists and the Population Investigation Committee for the purpose of collecting information, unobtainable from any other source, to enable the Joint Committee to make informed suggestions as to whether and in what ways it would be possible to help mothers with the social and economic problems that they meet in bearing children. Fathercraft.—Towards the end of the year it was decided to afford facilities for the holding of classes in fathercraft at the Lisson Grove Welfare Centre under the direction of a lecturer to be provided by the London County Council. Day Nurseries.—Four day nurseries (whole-time), all recognised as training centres, continued to function throughout the year. The Ministry of Health approved the taking over by the Council of the Sieff Hall (which forms part of the nursery building at Salisbury Street) for the accommodation of 30 additional children, thus raising the total number of places in the extended nursery from 60 to 90. Consequently the number of children admitted gradually increased but owing to the difficulty of obtaining sufficient nursing staff some considerable time elapsed before it was found possible to accept the full complement of 90. The administration of the nurseries from the 1st April, 1946 (when total reimbursement by the Ministry of Health of local authority expenditure was replaced by a grant of approximately 50 per cent.) was discussed with representatives of the London County Council (as local education authority) and the Government departments concerned following the issue of a joint circular by the Ministry of Health and the Ministry of Education. The County Council indicated that although they were conducting nursery classes for 350 children aged 3—5 years in ten infants' schools in St. Marylebone, they had neither the buildings nor the teachers to deal with the 225 children aged 2—5 years accommodated at the four day nurseries in the Borough or on the waiting lists. It was therefore agreed that the only possible alternative was for the Borough Council (as welfare authority) to continue for the time being all their day nursery arrangements, including educational facilities, and the Minister of Health subsequently approved these proposals. After the 1st October, 1946, all applications for the admission of children to the nurseries were dealt with centrally at the Town Hall and the separate waiting lists at each nursery abolished. Under the new system vacancies in all nurseries are allotted to the best advantage after consideration of the needs of applicants for priority according to a '' points " scheme in operation. Arrangements were made for the nursery students to attend courses of instruction for the National Nursery Certificate examination, and for the younger students to receive part-time general education pending their eligibility for the nursery course. The Portman Day Nursery, which was evacuated from the Salisbury Street premises to Limpsfield in October, 1939, and later taken over by the Surrey County Council, closed down on the 31st March, 1946, and certain nursery equipment was rptnrnpd to the Salisburv Street Nurserv. Approved by the Ministry of Health as a grant-aided nursery. 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 three instances where water had been cut off in occupied premises for nonpayment of rate, and in all cases the supply was reinstated. 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 372, of which 296 related to old buildings and 76 to new buildings (including 67 prefabricated houses). During the year it was not found necessary to take advantage of the provisions of the Building Restrictions (War-Time Contraventions) Act, 1946, which is designed to secure, among other things, a measure of control over drainage and similar works carried out, in contravention of legal requirements, on properties occupied by or on behalf of the Crown during the war period. Combined Drainage.—Five orders under seal for combined drainage were issued. TABLE 4.—Day Nuesekies. 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 36 54 90 25 39 64 2 St. Vincent's Creche, 14, Blandford Street 1.9.1942 15 20 35 7 22 29 3 3, Devonshire Street 16.8.1943 21 36 57 17 34 51 4 86, Carlton Hill 1.12.1943 24 26 50 16 29 45 Totals 96 136 232 65 124 189 9 Public Conveniences.—-The usual supervision was exercised over the 15 public sanitary conveniences (12 for men, 4 for women). As from the 24th June, 1946, the Council undertook responsibility for the daily cleansing of the men's convenience attached to the " Pontefract Castle " Public House, No. 48, Chapel Street. Special arrangements were made to meet the sanitary convenience of the great crowds that thronged Oxford Street and its neighbourhood on the occasion of the Victory Celebrations on the 8th June, 1946. The additional accommodation erected temporarily in the vicinity of the route of the Victory March proved entirely satisfactory and the facilities provided were greatly appreciated by the public. Public Cleansing and Salvage.—Amounts dealt with: house and trade refuse, 32,606 tons; street sweepings and guiley slop, 2,762 tons; salvaged materials, 2,830 tons, including 2,079J 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 £6,787 12s. 8d. was obtained from the sale of salvaged materials. In addition, £587 4s. Id. was received for the removal of trade refuse, green offal, and the cleansing of petrol interceptors. On the 15th July, 1946, as part of the post-war re-organisation of the public cleansing services, a revised system of refuse removal was introduced, providing a minimum twice weekly collection throughout the district and fixing regular days and times of clearance for all premises in the Borough. Shops.—Inspections under the Shops Act, 1934, numbered 84. In 4 instances service of notice was necessary. Diseased or Infirm Persons.—Seventy-seven old people living on their own were visited, and a number of cases required continued observation. The domestic help service was able to render valuable assistance in many instances. In no case was it 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. Bed Bugs.—Sixty-six dwellings (including 18 requisitioned premises) where bugs were found were disinfested. No instance of verminous conditions in municipal flats was reported. The furniture of 196 families (of whom 162 were rehoused) was treated by the hydrogen cyanide process. Seven thousand air-raid shelter bunks were similarly dealt with before sale to the public. Verminous Persons.—The numbers of adults and school children using the Cleansing Station were 518 (435 men, 83 women) and 938 (203 boys, 735 girls) respectively. Rats and Mice.—Complaints received numbered 723, and 62 food and 494 other premises were found to be infested. Of the 62 food premises, 26 were shops and 36 hotels and restaurants ; the 494 other premises included 257 dwelling houses, 85 shops, 94 warehouses and stores, 10 factories, 28 hospitals and institutions, and 20 offices. Where necessary, ratproofing was carried out at infested premises. The chief methods employed for the extermination of rats were poison baiting and trapping, and the work was carried out on the fines recommended by the Ministry of Food. Sewer treatments were applied in January and July. Under the Council's rat destruction service, occupiers of residential properties and business premises are charged 5/- and 10/- per treatment respectively. Advantage of the scheme was taken in 556 cases, in four of which, on the ground of inability to pay, the charges against the occupiers of tenement dwellings were waived. The rat catchers made 7,781 visits in connection with this service—an increase of 803 visits on the total for 1945, due to the two wholetime operatives having the part-time assistance of the Mortuary Keeper on this work as from the 1st April, 1946. Dog Nuisance.—Contravention of the bye-law relating to the fouling of footways by dogs was reported by the Streets Nuisance Inspector in 41 cases and by police officers in one instance, in all of which (excepting one where the summons was not served) convictions were secured and penalties imposed. The total number of prosecutions since the bye-law came into operation in 1928 is 351, the amount of fines imposed being £134 6s. Od. Mosquitoes.—Nine complaints of mosquitoes were received. The nuisances were traced to breeding in emergency water tanks and bombed sites, and appropriate treatment proved effective. Noise.—Twenty-two complaints of noise were received. They were concerned with such diverse matters as dancing, orchestras, fire alarm bells, roller skating, motor cars, gramophones, wireless loudspeakers, printing press, furriers, night club, donkey engines, and dogs. In one case of a noisy dog a notice was served under the Bye-laws for the Good Rule and Government of the Administrative County of London, but in view of the fact that the complainants were unwilling to give evidence in Court, legal proceedings could not be instituted. Smoke.—Twelve complaints of nuisance from smoke were received, relating mainly to commercial premises and large blocks of flats. Abatement was seemed in all cases as a result of informal action. Poisons.—The names of 78 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 89. Factories.—The number of registered factories was 1,648 (with mechanical power, 1,261 ; without mechanical power, 387). Frequent inspections were carried out, and conditions were remedied in 64 instances (want of cleanliness 24; insufficient or unsuitable sanitary conveniences 27 ; other defects 13). Outworkers lists were received from 54 employers in respect of 87 contractors and 667 workpeople. Sanitary Inspection.—The total number of complaints received was 1,854, and rat infestations were again responsible for the largest number (723). Details of the various nuisances detected and remedied, to the total number of 2,932, are set out in Table 5. In 982 cases a preliminary (intimation) notice was issued, and in 72 instances this was followed by the service of a statutory notice to secure abatement of nuisances. In one case legal proceedings were instituted 10 under the Public Health (London) Act, 1936, in respect of failure to comply with a statutory notice requiring the repair of a defective water-closet. The necessary work having been completed before the Court hearing, the abatement order summons was withdrawn, but £3 3s. Od. costs were awarded to the Council. 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 39 92 214 62 54 92 583 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired 30 47 140 23 46 26 312 Verminous dwellings disinfested 2 4 26 27 5 2 66 Verminous furniture and bedding disinfested 37 59 40 34 7 19 196 Overcrowding abated — — — — 1 — 1 Underground rooms (illegal occupation) dealt with — — — — — — — Water closet defects remedied 11 25 48 59 55 19 217 Insufficient and unsuitable water closet accommodation remedied 1 3 6 8 11 16 45 Urinal defects remedied — — — 1 — 1 2 Drain and water closet stoppages cleared 2 6 12 17 16 1 54 Drains relaid or amended — 15 23 9 2 3 52 Soilpipes and ventilating shafts repaired or renewed — — 4 11 6 — 21 Waste pipe defects remedied 4 7 8 17 11 12 59 Yard defects remedied — - 1 9 5 2 17 Wash-house defects remedied 3 1 11 11 1 — 27 Area defects remedie 1 3 3 13 1 — 21 Basement defects remedied — — — — — - — Roofs and gutters repaired 24 72 126 67 37 35 361 Water supply to houses reinstated — 2 — 3 1 — 6 Water supply laid on to upper storeys 1 1 2 3 3 — 10 Water cistern defects remedied — — 3 8 1 — 12 Dung or dust receptacles repaired or renewed 9 6 25 14 18 9 81 Rubbish, manure, etc., accumulations removed — 7 18 19 33 12 89 Animal nuisances abated — — 1 — 4 2 7 Rat and mouse infestations dealt with 25 18 55 182 91 175 556 Bakehouses cleansed — 2 — 4 — — 6 Smoke nuisances abated — 3 1 6 1 1 12 Shops—sanitary defects remedied 1 — — 4 — 1 6 Miscellaneous 4 5 36 49 16 3 113 SECTION D.—HOUSING. Re-organisation of Housing Department.—The Council decided to co-ordinate their housing activities into a single department under the control of a Housing Director and steps to implement this decision are being taken. Permanent Schemes.—The erection of blocks of flats on the undermentioned sites was commenced during the year :— Site No. of flats Approximate cost Barrow Hill Road 172 £328,500 Church Street 140 £306,360 312 £634,860 A maternity and child welfare centre will be provided on the Barrow Hill Road Estate the Church Street Estate will include 11 shops. Both estates will have communal laundry facilities and central hot water. An Order was made by the Council on the 31st December, 1946, for the compulsory purchase of the Townshend Cottages site with a view to the erection thereon of further permanent flats. The Council have also planned for an extension of the Church Street site, and for the development for housing purposes of a small site at the corner of St. John's Wood Road and Lisson Grove, adjacent to Wharncliffe Gardens. The development of a number of other small vacant sites is under consideration. Temporary Housing.—Seventy-four temporary factory-made bungalows have been erected on five sites in the Borough, and let to applicants selected from the Council's waiting list. Adaptation of Premises.—All empty properties have been surveyed and further premises have been requisitioned and converted into residential units of suitable sizes. The number of such units held under requisition at the end of 1946 was 944. Requisitioning and adaptation works are proceeding as speedily as the limited resources of labour and materials permit. " Squatters."—A total of approximately 250 persons took possession of twb blocks of flats in the Borough for varying periods during September, 1946, and set up temporary homes there, in some cases taking in furfliture. These invasions created serious problems for the Public Health Department, mainly from the point of view of sanitary arrangements and water supply, and necessitated constant visits by the medical staff, sanitary inspectors and health visitors to safeguard the public health. The "squatters" included a number of expectant mothers and young children and special attention was devoted to their needs. 11 Inspection of Dwelling-houses.—Number of houses inspected for defects under the Public Health or Housing Acts—1,884; number of inspections made—5,494; number of houses found not to be in all respects reasonably fit for human habitation—922; number of defective houses rendered fit in consequence of informal action—850 ; number of houses in which defects were remedied by owners after service of formal notices under the Public Health (London) Act, 1936—71; number of underground rooms in respect of which closing orders were made—nil. Common Lodging Houses.—Forty-one 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. SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Food Analysis.—Samples of 84 different articles taken under the Food and Drugs Act, 1938, numbered 700 (65 formal, 634 informal and 1 private sample) and included : milk 102, butter 94, margarine 60. 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. Twelve 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 lower than for the two previous years, being only 1.7 per cent., though this is still higher than in pre-war years. A sample of coffee submitted informally was found to contain not more than 70 per cent, of coffee, and a formal sample obtained later was found to be even worse inasmuch as it contained only 60 per cent, of coffee and 40 per cent, of chicory. A novel type of adulteration was encountered in connection with two samples of sherbet, in which the sugar had been replaced by a small quantity of saccharin to sweeten it and a large volume of kaolin, or china clay, to give it bulk. Such a preparation is obviously unsuitable for children. A sample of meat received was found to consist of horseflesh. Whilst the shortage of beef continues there is a great temptation for restaurateurs to sell horseflesh steaks instead of beef steaks, because the general public is unable to distinguish between the two, though it is probable that the chief objection to eating horseflesh is one of prejudice rather than anything else. Exception was taken to a sample of mixed herbs which contained 14 per cent, of mineral matter and which was not labelled according to the provisions of the Labelling Order, which require the names of the herbs present to be declared. A sample of baking powder had become damp and consequently was 20 per cent, deficient in available carbon dioxide. The Baking Powder and Golden Raising Powder Order requires baking powder to contain not less than 8 per cent, of available carbon dioxide. This Order is an exa'mple of the fixing of a standard which is of benefit to the manufacturer, the vendor and the public, since there can now be no argu mcnt as to the fitness or otherwise of a baking powder for use. Salt is still being added by a certain vinegar brewer to his product to keep it from being attacked by moulds, but in the opinion of your Analyst this should be declared, if used, and an adverse report was therefore issued on a sample of vinegar from this source. A sample of tomato ketchup was fermenting when received at the laboratory, and one of gooseberry jam was deficient in sugar, the total sugar being only 58 per cent, instead of about 65 per cent., so that this jam would have moulded quite readily. A sample of whisky contained about 5 per cent, excess water, and one of tincture of iodine was 14 per cent, deficient in iodine. During the year the Labelling Order was revised to include various restrictions on wines, cocktails and spirits, and the Soft Drinks Order was amended to allow of the use of more sugar in soft drinks, but also, at the same time, to permit of the use of tartaric acid or phosphoric acid in place of citric acid, so long as the drink is merely a flavoured drink and does not contain actual fruit juice." Legal Proceedings.—Of the twelve samples adversely reported upon by the Public Analyst, proceedings were instituted under the Food and Drugs Act, 1938, in two instances. In regard to the sample of coffee found to contain 40 per cent, of chicory, taken under Section 3, the case was dismissed on payment of £4 4s. Od. costs by the defendants ; and for possessing horse flesh for the purpose of sale for human consumption without displaying the requisite notice, the defendant was fined £7 10s. Od. under Section 38, and £5 5s. Od. costs were awarded to the Council. In the remaining instances legal proceedings were not advised and the matter in each case was taken up with the manufacturer, wholesaler or retailer concerned. Bacteriological Examinations.—One sample each of yoghourt, cooked meat and clotted spread were examined bacteriologically and found to contain no food poisoning organisms. Examinations of milk and ice cream are referred to in succeeding paragraphs. Milk.—There are 156 premises from which milk is sold. Inspections made numbered 229. During the year 37 applications under the Milk (Special Designations) Regulations, 1936-1946, 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 102 samples of milk analysed was : total solids, 12.39% ; fat, 3.63% ; solids not fat, 8.76%. No sample was found to be below standard. At the request of the Ministry of Food, 99 samples of milk, taken from two authorised wholesale firms operating heattreatment 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. Six other samples of milk examined bacteriologically were found to comply with the requisite standards. Butter and Margarine Premises.—At the end of the year there were on the register 15 dealers in margarine and 2 butter manufacturers. Thirty-six inspections were made. Ice Cream.—The number of premises on the register was 78, and 167 inspections were made. Two samples of ice cream were examined bacteriologically and found to be satisfactory. One sample of ice cream showed a high bacterial content but no evidence of faecal contamination. As the ice cream in this case was manufactured outside the Borough, the matter was taken up with the Medical Officer of Health of the area concerned, who subsequently reported that changes in processing and sterilisation of equipment had been made and that further samples were being taken to ensure that a satisfactory hygienic standard was achieved and maintained. 12 Two prosecutions under the Food and Drugs Act, 1938, were instituted in relation to ice cream. In one instance the defendant was fined a total of £10, with £3 3s. Od. costs, for (a) storing ice cream in a yard and failing to take precautions against contamination (Section 13) and (b) storing ice cream on unregistered premises (Section 14). In the other case the defendant was fined 10s. for failing to display his name and address legibly and conspicuously on a box tricycle from which ice cream was being sold (Section 16). Preserved Food.—At the end of 1946, 107 premises were registered for the preparation or manufacture of preserved foods (sausages mainly) intended for sale, and 367 inspections were made. Fried Fish Vendors and Fish Curers.—The number of premises used by vendors of fried fish is 9 and by fish curers 3. Twenty-six inspections of fried fish shops and 36 inspections of fish curers' premises were carried out. Bakehouses.—Number on register—19, all basement bakehoiises ; 36 inspections were made. Restaurants, etc.—Premises in which meals are provided or food is sold already cooked or is prepared for sale numbered 473, including 420 restaurants and dining-rooms, and 53 hotels : 572 inspections were made and 35 notices served. As there appeared to be a need for a communal restaurant in the Lisson Grove district to replace the canteen which was established on the premises of the Florence Nightingale Hospital during the war, the London County Council were asked to consider the making of the necessary provision. Sale of Food and Drinks in Public Places.—In view of the difficulty of investigating complaints of the uncleanly condition of stalls, vehicles and containers from which food and drinks are sold in streets and other public places by vendors who frequently move from place to place, the Council resolved that, as from the 23rd August, 1946, Section 16 of the Food and Drugs Act, 1938, which requires'the name and address of such vendors to be legibly and conspicuously displayed on their-stalls, vehicles or containers, should apply within the Borough in relation to all kinds of food (other than milk, which is dealt with under other provisions) as it applies already in the case of ice cream. Unsound Food.—Some 10 tons of food condemned as unfit for human consumption included the following : meat (including bacon and rabbits), 10 cwts. 1 qtr. ; fish, 4 cwts. 20 lbs. ; fruit, 2 tons, 12 cwts. ; vegetables, 20 lbs. ; cereals, 2 tons, 15 cwts. 11 lbs. ; canned goods, 11,149 tins ; miscellaneous, 10 cwts. 20 lbs. Practically all this unsound food was salvaged and diverted to other uses. Horseflesh.—Twenty-six visits were paid to two shops selling horseflesh for human food. Slaughter of Animals.—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. Five inspections were made. One licence to slaughter or stun animals, granted to skilled slaughtermen, was renewed. 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 1946. TABLE 6.—Infectious Disease Notifications. Notifiable Disease. At all ages Cases notified in whole Borough. Cases notified in Sub-Districts. Cases Cases At ages—years. moved lated All St. North to at Souls. Mary. home. —1 1— 2— 3— 4— 5— 10—115— 20— 35— 45— 65— lebone tal. Diphtheria, including branous croup 10 — 2 1 2 — — — 2 1 1 1 — 3 2 5 10 — Erysipelas 19 — — — — — — — — 1 — 9 9 4 12 3 11 8 Scarlet fever 67 — 2 1 7 4 21 19 4 3 4 1 1 6 11 50 30 37 Puerperal fever 2 — - — — — — — — 2 — — — 1 — 1 2 — Puerperal pyrexia 5 _ - — — — — — 1 4 - — - 3 1 1 5 — Cerebrospinal fever 1 — — — — — — — — 1 — — -— — 1 1 — Acute poliomyelitis 2 — — - - - - - — 2 - — — 1 — 1 2 — Tuberculosis - - - - - - - - - - - - - - - - - - Pulmonary 100 - .— 1 — — — — 8 39 17 25 10 19 34 47 47 53 Non-pulmonary 11 - — — — — — 1 1 6 1 2 — 3 8 5 6 Ophthalmia neonatorum 3 3 — — — — — — — — — — — — 3 — 2 1 Pneumonia 56 — 2 3 1 2 6 2 1 5 7 13 14 8 19 29 48 8 Dysentery 12 1 — 1 — 1 1 — 2 2 2 1 1 1 4 7 8 4 Measles 145 4 23 18 15 20 39 7 6 10 3 — — 23 28 94 37 108 Whooping cough 86 12 9 21 11 12 18 1 — 2 — — — 19 17 50 28 58 Scabies ... 149 2 5 3 3 2 16 6 8 60 19 18 7 26 40 83 — 149 Malaria ... ... ... ... 6 — - — 4 2 — 1 1 4 2 4 Induced Malaria ... ... 1 — — — — — — __ — — — 1 — 1 — — 1 — Totals ... 675 22 43 49 39 41 101 36 33 142 56 71 42 119 172 384 239 436 * 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. 13 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 day nurseries, and at three elementary schools where, apart from new cases, 140 additional protective injections were given. Twelve 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. Action as suggested in paragraphs 7 and 9 of Ministry of Health Circular 194/45, dated the 14th November, 1945, was continued fully during the year, and follow-up of the comparatively small number of young children still not immunised was intensified. It will already have been noted that extensive arrangements for treatment were made throughout the district, and at the welfare centres, for example, immunisation is carried out at any clinic if necessary, in addition to the special sessions held for the purpose. As mentioned in last year's report, new record cards were brought into use in order to comply with the Minister's request for uniformity. TABLE 7.-—Work of the Diphtheria Immunisation Clinics. Pre-school children. School, children. Adults. Totals. AttendanceS. 1,703 398 20 2,121 New cases 543 90 5 638 Schick negative — — 1 1 Completely immunised but not retested 494 70 3 567 Ketested 348 39 4 391 Positive after retest 47 4 1 52 Vaccination.—Sir Lionel Whitby, C.V.O., M.C., who had held the appointment of Public Vaccinator for the Middlesex Hospital District for six years, resigned at the end of 1945, and his Deputy, Dr. C. J. C. Britton, was appointed to the position on the 1st January, 1946. Dr. P. T. J. C. P. Warner succeeded Dr. Britton as Deputy Public Vaccinator. Dr. C. R. McClure was re-appointed Public Vaccinator for the North Marylebone District as from the 1st April, 1946, on returning from service with H.M. Forces. Dr. Myles Colt, who had carried out vaccinations in both the North and South Districts throughout the war, continued in office as Public Vaccinator for South Marylebone as Dr. J. L. Boyd, the former Public Vaccinator for that District, did not, on demobilisation, desire reinstatement in the position. Vaccinations carried out in the whole Borough numbered 578 (primary, 494 ; re-vaccinations, 84). Vaccination was successful in 507 instances ; unsuccessful in 58 ; while 13 cases were not available for inspection. Of the 1,101 children whose births were registered in 1945, 782 (71.02%) were successfully vaccinated. Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 1,835 cases of scabies : adults 483 (men 332, women 151); children 1,352 (boys 564; girls 788). Domiciliary visits paid in connection with St. Marylebone cases numbered 167. Impetigo.—One woman, 17 boys and 34 girls received treatment for this condition at the Cleansing Station. 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. Under the grant received by the Central Council for Health Education from the London County Council, films dealing with sex education and venereal diseases were shown to the staff of a local hospital and to a nursing division of the St. John Ambulance Brigade, and lecture courses and talks on these subjects were given to health visitors, industrial nursing students, a youth club and to girls employed at a large general stores. 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 two cases, under the authority of Ministry of Health Circular 2734, dated 4th January, 1943. Food Poisoning.—Three cases of food poisoning, which is notifiable in the Borough, were reported. Sausage sandwich was the suspected article in two (unrelated) cases : in the third, the source of infection could not be traced. In no 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. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 - - - - - - - - 1—5 1 — 1 - - - - - 5—15 — — 1 1 - - - - 15—25 16 20 1 1 3 3 - - 25—35 15 16 6 1 5 3 - - 35—45 8 13 2 2 3 1 1 - 45—55 14 4 1 — 8 1 1 - 55—65 12 3 1 - 9 1 - - 65 and upwards 10 3 - 4 3 1 — 2 Totals 76 59 13 9 31 10 2 2 ncluding 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. 14 Notifications.—Table 6 (p. 12) 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, 1946, on the register was 677, 25 more than at the end of the previous year. Dispensary.—The work of the Dispensary continued to increase generally. Statistics for 1946 : new patients, 783 (including 141 contacts), old cases, 477; attendances, 5,924; tuberculosis officer called into consultation on 625 occasions; home visits by tuberculosis officer—new 31, old 62; hospital visits by tuberculosis officer, 50; home visits by tuberculosis visitors—first visits 125, re-visits 697. During the year 2,578 examinations (films, 1,238; screening only, 1,340) were made by means of the Council's X-ray plant. Fifty-six patients received artificial pneumothorax treatment on the premises and 931 refills were given. Sputum examinations carried out in the dispensary numbered 411. Expenditure on milk supplied to 101 tubereulous persons for varying periods amounted to £653 8s. 3d. 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 125. Dental Treatment.—A scheme for the provision of dental treatment for tuberculous persons, submitted for the approval of the London County Council in 1940 but deferred until after the war, was brought into operation on the 1st April, 1946, and arrangements were made for patients to be seen by the Borough Council's Dental Surgeon by special appointment. During the remainder of the year only one adult and one child received treatment under the scheme. 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 patients to secure early treatment and to stay in sanatorium until maximum benefit has been obtained. Daring the year, 39 patients applied for assistance and in 38 cases financial aid, totalling £2,043 18s. 6d., was afforded. Government Rehabilitation Scheme.—Nineteen patients were referred under this scheme to the Local Office of the Ministry of Labour and National Service. Care Committee.—The Committee held 10 meetings and dealt with 257 cases. Disinfection.—During the year 556 rooms and 23,384 articles (including 423 books) were disinfected after infectious diseases generally. In addition, 400 dressing drums from a local hospital were sterilised. Bacteriological Examinations.—Table 9 shows the numbef 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. diphtherias 16 405 421 Hsemolytic streptococci 72 349 Sputa—for tubercle bacilli 2 95 97 Pleural fluid—for tubercle bacilli — 1 1 Faeces—for dysentery 15 15