AC4353 STMARY 52 BOROUGH OF ST. MARYLEBONE REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1947 H. A. BULMAN, M.R.C.S., D.P.H. CONTENTS page Members of the Public Health Committee 4 Section A—Statistics and Social Conditions:— General Statistics 4 Extracts from Vital Statistics 4 Maternal Mortality 4 Births 4 Marriages 5 Deaths 5 Infantile Mortality 6 Mortuary 6 Crematorium 6 Section b—General Provision of Health Services:— Staff 6 Training of Sanitary Inspectors 6 Staff Medical Examinations 7 Laboratory Facilities 7 Home Nursing 7 Maternity and Child Welfare:— Welfare Centres 7 Work of the Clinics 7 Refresher Courses for Health Visitors 7 Student Health Visitors 7 Visitors to Centres and Nurseries 7 Home Visits 8 Milk and Vitamin Products 8 Sheets for Expectant Mothers 8 Home Help and Domestic Help Services 8 Child Life Protection 8 Illegitimate Children 8 Premature Infants 8 Dental Treatment 8 Foot Clinic 8 Remedial Exercises 8 Child Guidance 8 Maternity Cases 8 Convalescent Homes 8 Fathercraft 9 Care of Old People 9 Dav Nurseries 9 Section C—Sanitary Circumstances:— Sanitary Inspection 9 Water 10 Drainage 10 Combined Drainage 10 Public Conveniences 11 Public Cleansing and Salvage 11 Shops 11 Diseased or Infirm Persons 11 Bed Bugs 11 Verminous Persons 11 Shelter 11 Rats and Mice 11 page Dog Nuisance 11 Mosquitoes 11 Noise 11 Smoke 12 Poisons 12 Factories 12 Section d—Housing:— Re-organisation of Housing Department 12 Permanent Schemes 12 Adaptation of Premises 12 Hostels for Single Persons 12 St. Marylebone Housing Association 12 Inspection of Dwelling Houses 12 Common Lodging Houses 13 Rent Restriction Acts 13 Section e—Food Food Analysis 13 Legal Proceedings 13 Milk 13 Butter and Margarine Premises 14 IceCream 14 Preserved Food 14 Fried Fish Vendors and Fish Curers 14 Bakehouses 14 Restaurants, etc 14 Sale of Food and Drinks in Public Places 14 Unsound Food 14 Horseflesh 15 Slaughter of Animals 15 Section f—Infectious and Other Diseases:— Notifications 15 Acute Poliomyelitis 15 Rabies 16 Diphtheria Immunisation 16 Vaccination 16 Scabies 16 Impetigo 17 Venereal Diseases 17 Insulin 17 Food Poisoning 17 Tuberculosis:— New Cases and Mortality 18 Notifications 18- Dispensary 18 Institutional Treatment 18 Dental Treatment 18 Maintenance Allowances 18 Government Rehabilitation Scheme 18 Mass Miniature Radiography 18 Care Committee 19 Disinfection 19 Bacteriological Examinations 19 2 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St Marylebone. Mr. Mayor, Ladies and Gentlemen, The state of the public health in the Borough continued to be maintained at a satisfactory level throughout 1947. The birth-rate (13.21) again exceeded the death rate (12.29), and the infantile mortality rate—that most delicate indicator of public health progress—reached a new low level, declining sharply a second year from 46.54 in 1945 and 36.64 in 1946 to 26.55 in 1947, representing the lowest rate but one in the metropolitan area, and comparing favourably with the national rate of 41 and the County of London rate of 37. The civilian population again showed an upward trend, being estimated by the Registrar-General at 76,980, as against 70,920 in 1946 and 59,590 in 1945. Infectious disease notifications rose slightly from 675 (1946) to 709, of which no fewer than 330 related to measles. The prevalence of poliomyelitis throughout England and Wales in 1947 was four-and-ahalf times greater than it had ever been before. Fifteen cases occurred in St. Marylebone, and the fact that most of these appeared to be unconnected is a point of some epidemiological value. Maternity and child welfare and other personal health services were again in great demand throughout the area, and it is noteworthy that this is the last complete year of the Borough Council's responsibility for these services, which will be transferred to the care of other authorities on the 5th July, 1948, under the provisions of the National Health Service Act, 1946. The formation of the St. Marylebone Old People's Welfare Association during the year marked an important stage in the development and correlation of local effort directed towards the care of aged inhabitants in the Borough. Though in its infancy the Association has already provided a variety of services for the benefit of old people, and the scope of its activities is almost entirely governed by the number of volunteers who are prepared to devote a little time to this much needed and most useful work among the more helpless of our people. A considerable burden of work has fallen on the sanitary inspectors in dealing with dilapidations and sanitary defects, particularly in the older properties in the Borough, and despite the continuance of many post-war difficulties, including a shortage of labour and materials, much useful work has been accomplished during the year. Close touch has been kept with the Council's Housing Department on various aspects of housing, and many urgent cases for rehousing on medical grounds or on account of overcrowding have been referred to the Director of Housing for priority consideration. Assistance has also been rendered by the Department in connection with applications for building licences. Special attention has been paid to food inspection and supervision, and intensive efforts have been made to raise the standard of storage, preparation and handling of food in the large number of public eating places in the Borough. As regards weather, 1947 was a year of extremes and will long be remembered for severe frost, snow, floods and a hurricane, followed by a long and glorious summer with a drought that persisted into November. Several new monthly records were set up: it was, for instance, the wettest Maich on record with of inches of rain and a 77 m.p.h. wind; the dullest February, the sunniest August and the driest October since 1899. June had exceptionally high temperatures with the third hottest June day on record, when the thermometer registered 94 degrees Fahr.—and then fell 20 degrees the next day. I desire to thank the members of the Council for the support and sympathetic consideration always extended to me, and for their attention to the problems which it has been my duty to place before them. To the staff of the Department I again express my appreciation of their loyal assistance and co-operation in the public health work of the Borough. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. A. BULMAN, Medical Officer of Health. 3 4 PUBLIC HEALTH COMMITTEE. (who are also the Committee appointed for Maternity and Child Welfare purposes.) 1947. HIS WORSHIP THE MAYOR: Alderman C. S. Steel, F.C.A., J.p. Councillor A. E. Reneson Coucher, F.R.I.C.S., F.A.I., L.C.C., J.P. (from November, 1947) ALDERMAN: R. Stiles Allen, D.L. COUNCILLORS: F. Y. Bright. Mrs. Carr Q. Henriques E.Carew-Shaw, F.R.C.S. Dr. Elizabeth Jacobs. T. K. Creamer. Mrs. M. Kiewe. Mrs. H. I. H. Feiling. G. B. Ramsay. Mrs. L. H. Fewster. Miss D. A. Sharpe, F.R.C.S., M.R.C.O.G. F.Frame. H. Norman Toomey, L.D.S., R.C.S., Eng. Mrs. V. A. L. Freeman, J.P.(Deputy Chairman). Capt. Robert Whitney, M.B.E., J.P. (Chairman). Until October, 1947. 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): 1947—76,980. EXTRACTS FROM VITAL STATISTICS. Total M. F. Live Births—Legitimate 909 458. 451 Birth Rate per 1,000 estimated civilian population 13.21 Illegitimate 108 54 54 Stillbirths—Legitimate 20 10 10 Rate per 1,000 total (live and still) births 23.05 Illegitimate 4 3 l Deaths (all ages) 946 468 478 Death Rate per 1,000 estimated civilian population 12.29 Deaths. Rate per 1,000 total (live and still) births. Maternal Mortality—Deaths from "Puerperal and Post-Abortive Sepsis"and "Other Maternal Causes" (Registrar-General's 2 1.92 Code Nos. 29 and 30) Total M. F. Deaths of Infants under one year of age—Legitimate 21 9 12 Illegitimate 6 3 3 Death Rate of Infants under one year of age—All infants per 1,000 live births, 26.55; legitimate infants per 1,000 legitimate live births, 23.10; illegitimate infants per 1,000 illegitimate live births, 55.55. Births—Notification.—The number of notifications received under the Public Health (London) Act, 1936, Section 255, was 2,205: live births, 2,153; stillbirths, 52. Sources of the notifications were: from parents 8; from doctors 36; from midwives 147; from hospitals, nursing homes, etc., 2,014. Of the births notified, 875 took place at the Middlesex Hospital, 443 at Paddington Hospital, and 244 occurred at home. Of those notified as taking place in St. Marylebone, 1,142 belonged to other Boroughs. Of the 52 stillbirths (31 males and 21 females) notified direct to the Department, 18 5 (11 males and 7 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 1,736, being 198 above the number for 1946 and 323 above the average for the previous 10 years. The rate for persons married in 1947 was 45 per 1,000 of the estimated civilian population. TABLE 1.—Deaths—According to Age-Group and Sex. Code No. CAUSE OF DEATH Nett Deaths at the Sub-Joined Ages of Residents (Male and Female) whether occurring within or without the Borough. All Ages Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards M. F. M. F. M. F. M. F. M. F. M. F. M. F 2 Cerebro-spinal fever 2 1 1 1 1 - - - - - - - - - 4 Whooping cough 1 - - - 1 - - - - - - - - - 6 Tuberculosis of respiratory system 13 22 — — — 1 — — 4 10 7 7 2 4 7 Other forms of tuberculosis 4 2 — — 1 — — — 1 — 2 2 — — 8 Syphilitic disease 3 5 - - - - - - — 1 3 2 — 2 9 Influenza 1 1 - - - - - - - - 1 - - 1 10 Measles 1 - - - 1 - - - - - - - - - 11 Acute poliomyelitis and polioencephalitis 1 - - - - - - - 1 - - - - - 12 Acute infectious encephalitis — 1 - - - - - - - 1 - - - - 13M Cancer of buccal cavity and oesophagus (males only) 8 - - 2 3 3 13F Cancer of uterus — 12 — — - — — — - 1 — 7 — 4 14 Cancer of stomach and duodenum 7 18 - - — - - - - - 5 4 2 14 15 Cancer of breast — 20 — — - — — — - 3 — 9 — 8 16 Cancer of all other sites 68 47 - - - - - - 2 4 32 13 34 30 17 Diabetes 1 2 - - - - - - - — — 1 1 1 18 Intra-cranial vascular lesions 36 51 - - - - - - 1 3 13 7 22 41 19 Heart disease 133 123 — - - - - - 4 2 35 22 94 99 20 Other diseases of the circulatory system 12 24 - - - - - - - - 5 4 7 20 21 Bronchitis 40 20 - - - - - - 1 — 10 2 29 18 22 Pneumonia 32 33 — 3 - 3 — — 3 — 5 5 24 22 23 Other respiratory diseases 5 5 - - - — - - - 2 4 — 1 3 24 Ulceration of the stomach or duodenum 9 2 - - - - - - - 1 5 — 4 1 25 Diarrhoea (under 2 vears of age) 4 2 4 2 - - - - - — - - - - 26 Appendicitis 2 - - - - - - - 1 - - - 1 — 27 Other digestive diseases 8 9 - - - - - - 1 1 4 3 3 3 28 Acute and chronic nephritis 7 10 - - - - - - - 2 1 2 6 6 29 Puerperal and post-abortive sepsis — 1 - - - - - - - 1 - - - - 30 Other maternal causes — 1 - - - - - - - 1 - - - - 31 Premature birth 2 3 2 3 - - - - - - - - - - 32 Congenital malformations, birth injury, infantile disease 5 8 4 5 1 - - 1 - - - 1 - 1 33 Suicide 11 3 - - - - - - 4 2 4 1 3 — 34 Road traffic accidents 4 3 — — - — 1 — 1 — 2 1 — 2 35 Other violent causes 13 15 1 - - - - - 2 — 2 4 8 11 36 All other causes 35 34 — 1 1 — 1 1 3 4 10 7 20 21 Totals 468 478 12 15 6 4 2 2 31 39 153 104 264 314 946 27 7o 4 70 257 578 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). 6 No infantile death occurred from the following causes not shown in the table: Small-pox, chicken-pox, measles, scarlet fever, diphtheria and membranous croup, whooping cough (Code Nos. 1—6), tuberculous meningitis, abdominal tuberculosis, other tuberculous diseases (Nos. 9—11), atrophy, debility and marasmus (No. 14), erysipelas, syphilis, rickets (Nos. 17—19), convulsions, gastritis, laryngitis, bronchitis (Nos. 21—24), suffocation, overlying (No. 26). Mortuary.—Nine bodies (6 male, 3 female) were deposited at the Public Mortuary, Chiltern Street. No post-mortem examinations were carried out. Crematorium.—Three hundred and sixty-nine certificates authorising cremation at the St. Marylebone Crematorium, Finchley, were issued—262 by the Medical Referee (Dr. H. A. Bulman), and 107 by the Deputy Medical Referee (Dr. W. H. S. Wallace). SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. Staff.—Dr. F. H. Morrell commenced duty as Tuberculosis Officer on the 1st February, 1947. Mr. C. D. Turbayne, an able administrative assistant who had served the Department for 20 years, resigned on the 17th August, 1947, on his appointment as Chief Clerk in the Borough Engineer's Department of Ealing. Miss J. Jones, an administrative assistant with wide knowledge of the Council's maternity and child welfare service, retired on the 31st August, 1947, on account of impaired eyesight, after 31 years' service in the Department. She was succeeded by Miss S. L. Pritchard, whose position as home helps organiser was filled by Miss M. J. Wakeford on the 29th December, 1947. Miss M. T. Challis, a clerk-dispenser, resigned on the 30th June, 1947, on marriage, after 26 years' service in the Department, preceded by 7 years with the St. Marylebone Tuberculosis Dispensary when this was conducted by a voluntary body. With regard to the sanitary inspectorial staff, Mr. H. E. Scoble, M.B.E., seconded for civil defence duties during the war, resumed duty in the Department on the 1st January, 1947. Mr. J. W. Chanel! resigned on the 28th February, 1947, to take up a position as sanitary inspector in the Rural District of Battle, Sussex. Mr. P. H. Hill, a retired inspector who continued his appointment in a temporary capacity, finally terminated his service on the 30th June, 1947. Three new inspectors were appointed: Messrs. J. R. Baily and L. Pearson, who took up their duties on the 1st August, 1947, and Mrs. M. I. Tiplady, who commenced work on the 1st September, 1947. Miss J. Crowther was appointed as a Tuberculosis Visitor as from the 11th August, 1947, and an additional clerical assistant (Miss D. L. Offen) was allotted to the Tuberculosis Dispensary on the 13th October, 1947. Training of Sanitary Inspectors.—The Council expressed their willingness to co-operate in the scheme of the Ministry of Health to secure the supply and training of sanitary inspectors, and since April, 1947 two ex-service students at a time have been received into the Department for approximately three months' practical training in the duties. Also at the request of the Ministry of Health, a sanitary inspector from Ceylon was afforded facilities for studying food administration work in the Borough during July, 1947. 7 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 1947, 107 examinations were carried out. Laboratory Facilities.—Dr. C. J. C. Britton is the Council's Bacteriologist, and the work is carried out at No. 121, Harley Street, W.l. 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. Marvlebone District Nursing Association continued to provide adequate nursing services in the home under an arrangement made with the Council. During 1947, visits were paid to cases (number shown within brackets) as follow: maternity 335 (20) ; ophthalmia neonatorum 6 (1); measles and German measles 20 (3); whooping cough 22 (1); influenza 18 (3); erysipelas 10 (2): pneumonia 242 (15) ; tuberculosis 114 (6); shingles 30 (1); chicken-pox 8 (2); other ailments 109 (15); old age pensioners, 2,532 (128). Maternity and Child Welfare.—The Council have two maternity and child welfare centres : No. I 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, dental, and foot clinics. In addition, ante- and post-natal and infant welfare clinics held at the Middlesex Hospital form part of the Council's scheme. Two part-time clinic nurses continued 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. Clinic Sessions held Attendances (figures in brackets indicate new cases) Centre 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. 1 205 154 36 244 3,214 211 5,967 2,018 49 219 82 983 (388) (127) (386) (35) (4) (34) (7) (55) Maternity and Child Welfare Centre No. 2 103 256 37 326 1,965 149 5,217 2,444 41 634 34 1,828 (278) (82) (302) (45) (10) (54) (9) (88) The Middlesex Hospital 227 202 - -— 9,390 1,080 3,214 1,804 - - - -- (900) (389) (169) (8) *627 *80 *1,210 *718 *(71) *(35) *(54) *(4) * St. Marvlebone 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. Three health visitors attended courses held in London during the year. Student Health Visitors.—Student health visitors from the Royal College of Nursing 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.—Among visitors who were afforded facilities for seeing the Council's maternity and child welfare scheme at work and for visiting the welfare centres and day nurseries were Princess Ashraf of Persia; doctors, nurses and other health workers from the Socialist Medical Association; students from the Institute of Almoners; and a party of German journalists who were accompanied by the Deputy Chairman of the London County Council, the Chairman of the County Health Committee, and medical officers of the County Council. 8 Home Visits.—The six whole-time health visitors paid domiciliary visits as follows: (a) to expectant mothers, first visits 504, total visits 862; (6) to children under 1 year of age, first visits 941, total visits 3,232 ; (c) to children between the ages of 1 and 5 years, total visits 2,955. 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 year: full cream, 8,061 20-oz. cartons at 10£d. per carton ; 177 cartons free : half cream, 336 cartons at 10 $d. per carton; 5 cartons free. Distribution of vitamin preparations was also made as follow : cod liver oil, 7,779 131-oz. bottles; orange juice, 44,294 6-oz. bottles at 5d. per bottle; 1,060 bottles free: vitamin A and D tablets, 2,280 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 1947, 63 applications were received by the Department and 185 dockets issued, as compared with 131 dockets supplied to 45 applicants in 1946. Home Help and Domestic Help Services.—The demand for assistance from these services continued throughout 1947. Difficulty was again experienced in finding and keeping the right type of women for the work, but the scheme worked satisfactorily and it was found possible to help all genuine cases. 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, the services of a domestic help were frequently required for an indefinite period. Helpers were sent into 159 households—86 home help and 73 domestic help—and the number of women employed by the Council during the year varied from three to six. 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 two, and the children in their care numbered three. The Council's health visitors, acting as child protection visitors, made a total of 62 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 three cases, the children being placed in children's homes. Premature Infants.—The care of premature infants continued to receive special attention. One hundred and four 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 23. 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. Statistics for 1947: sessions held, 155; new cases—mothers 217, children 48; attendances—mothers 1,033, children 180; X-ray examinations, 37; extractions—mothers 573, children 36; patients provided with dentures at cost price, 50; fillings 410 : other operations 641. Foot Clinic.—This clinic, conducted as part of the Council's Maternity and Child Welfare Scheme, held 45 sessions attended by 151 persons. Remedial Exercises.—Classes for remedial exercises were well supported throughout the year, and mothers and young children made a total of 1,562 attendances at the 117 sessions held at Welfare Centres Nos. 1 and 2. Child Guidance.—Twenty-two clinic sessions were held during the year, and 48 cases made a total of 114 attendances. On the 23rd September, 1947, Dr. Mary D. Fletcher succeeded Dr. Grace Calver as Psychiatrist in charge of the clinic. 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 dining pregnancy or at or after confinement. Convalescent Homes.—The arrangement with St. Christopher's Nursery Training College and Convalescent Home, Tunbridge Wells, by which the Council had undertaken for some considerable time the maintenance of two beds for the use of pre-school children, unfortunately terminated at the end of August, 1947, owing to a change in ownership. As from the 1st November, 1947, an agreement was made with the Hart's Leap Toddlers' Convalescent Home, Sandhurst, Camberley, Surrey, for one bed to be reserved for young children from the Borough. 9 Fathercraft.—Last 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. The County Council subsequently decided to inaugurate a pioneer course of 12 lectures in parentcraft for married men and women and those of both sexes contemplating marriage. This course, the fee for which was one shilling, was held from April to July, 1947, at the Stanhope Institute, Stanhope Street, Euston Road, N.W.I, within easy reach of the Borough, and the syllabus covered home life and the family; pregnancy; confinement; feeding of infants; feeding the family; care of children; home management; and care and repair of household equipment (practical demonstrations). Care of Old People.—In view of the growing need of some special local voluntary organisation to undertake the welfare of old people and to co-ordinate as far as possible all existing activities on their behalf, the Public Health Committee decided in March, 1947, that a meeting of representatives of various voluntary associations, religious bodies, statutory authorities and other organisations and individuals concerned in any way with the care of old people, should be convened to discuss the desirability of establishing a voluntary association in the Borough. A well attended inaugural meeting, presided over by the Mayor (Alderman C. S. Steel, F.C.A., J.P.), was held at the Town Hall on the 19th May, 1947, when it was resolved that a St. Marylebone Old People's Welfare Association be set up on the lines of the model constitution laid down by the National Old People's Welfare Committee. Membership was extended to some 40 local bodies, and the Mayor was elected President of the new Association, supported by Councillor Mrs. L. H. Fewster as Chairman of the Association and of its Executive Committee, which subsequently met monthly and initiated a variety of schemes for the benefit of old people, including the formation of a panel of visitors, a mobile meals service (in association with the Women's Voluntary Services) distribution of food parcels from Australia, and arranging of concerts, Christmas parties and other social outings. At the end of the year the Committee were about to launch out in other directions and to set up further sub-committees to deal with the urgent need of hostel accommodation and the provision of clubs additional to the "Darby and Joan" clubs run by the Women's Voluntary Services. Day Nurseries.—Four day nurseries (whole-time), all recognised as training centres, continued to function throughout the year. Owing to the falling off in attendances on Saturday mornings and to effect economies in staffing, electricity, food, etc., it was decided in August that each of the Council's three nurseries should be open in turn on Saturday morning, the other two being closed. Miss Mary Bowles, Matron of the Salisbury Street Day Nursery since its opening in 1942, was appointed by the London County Council as a lecturer at the North Western Polytechnic, Kentish Town, in connection with the syllabus for the Nursery Nurses Certificate examination. Two displays of educational films dealing with the care of children were given to the staff and mothers at the Carlton Hill Nursery during February, 1947. SECTION C.—SANITARY CIRCUMSTANCES. Sanitary Inspection.—Complaints were received in respect of 2,819 premises. Details of the various nuisances detected and remedied, to the total number of 5,010, are set out in Table 5. In 1,589 cases a preliminary (intimation) notice was issued, and in 247 instances this was followed by the service of a statutory notice to secure abatement of nuisances. Legal proceedings were instituted in 27 cases under the Public Health (London) Act, 1936, in respect of failure to comply with statutory notices. In five of these cases penalties amounting to £13 were imposed, and in 19 instances costs amounting TABLE 4.—Day Nurseries. No. Nursery Date of Opening No 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 50 75 2 St. Vincent's Creche, 14, Blandford Street *1.9.1942 15 20 35 6 20 26 3 3, Devonshire Street 16.8.1943 21 36 57 16 31 47 4 86, Carlton Hill 1.12.1943 24 26 50 15 31 46 TOTALS 96 136 232 62 132 194 *Approved by the Ministry of Health as a grant-aided nursery. 10 to £38 12s. 0d. were awarded to the Council. One case was dismissed because of insufficient evidence of ownership, and in the remaining two cases abatement orders were made or the summonses were withdrawn, the necessary work having in the meantime been completed. TABLE 5.—Nuisances Detected and Remedied. Nature of Nuisance Districts No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 The Borough Houses damp, dirty or dilapidated remedied 74 139 522 236 100 341 1,412 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired 27 87 397 115 57 85 768 Verminous dwellings disinfested 8 13 13 17 4 7 62 Verminous furniture and bedding disinfested 47 5 28 25 4 13 122 Overcrowding abated - — — 2 2 — 4 Underground rooms (illegal occupation) dealt with - - - - - - - Water closet defects remedied 19 29 95 113 32 136 424 Insufficient and unsuitable water closet accommodation remedied 2 4 9 14 8 14 51 Urinal defects remedied — 1 2 — — — 3 Drain and water closet stoppages cleared 4 11 25 12 8 6 66 Drains relaid or amended 1 8 36 8 2 4 59 Soilpipes and ventilating shafts repaired or renewed 1 7 3 3 3 13 30 Waste pipe defects remedied 2 21 22 17 4 30 96 Yard defects remedied — 3 17 16 2 15 53 Wash-house defects remedied 11 — 14 25 — 15 65 Area defects remedied — 1 17 7 1 5 31 Basement defects remedied — 1 — — — — 1 Roofs and gutters repaired 45 88 185 140 55 81 594 Water supply to houses reinstate 1 3 1 5 1 38 49 Water supply laid on to upper storeys 1 — 7 3 4 5 20 Water cistern defects remedied 1 4 1 10 4 26 46 Dung or dust receptacles repaired or renewed 9 8 22 15 21 27 102 Rubbish, manure, etc., accumulations removed — 4 41 45 20 10 120 Animal nuisances abated 1 2 — 1 — 1 5 Rat and mouse infestations dealt with 26 33 58 119 86 230 552 Bakehouses cleansed 2 — — — — 1 3 Smoke nuisances abated 1 1 3 3 2 3 13 Shops—sanitary defects remedied 2 — 3 2 — 10 17 Miscellaneous 7 16 87 41 29 62 242 Water.—Apart from water obtained for domestic purposes from private wells at a small number of blocks of flats and offices, a constant supply throughout the Borough is provided through the mains of the Metropolitan Water Board, and no complaint as to quality was received during the year. Early in June complaints of insufficiency of supply, due to temporary lack of pressure, were received in respect of several large blocks of flats. The matter was reported to the Board and normal supplies were quickly re-established. In accordance with the provisions of the Public Health (London) Act, 1036, the Board notified thirteen instances where water had been cut off in occupied premises for non-payment of rate or for waste, and in all cases the supply was reinstated, in some instances after service of a notice. Private well waters continued to be examined periodically by the Public Analyst and the Council's Bacteriologist. In 1939 there were 39 borings in the Borough, and at that time 14 were in use. In view of the possibility of pollution from disused wells or borings of water obtained from the chalk under London a further survey was carried out at the request of the Ministry of Health in order to ascertain the present position. This investigation revealed that the number of private wells in use in 1947 was ten. Samples of water taken from each were examined chemically and bacteriologically and found to be satisfactory for drinking purposes, and the reports showed that the quality of these waters had changed very little since 1939, with the possible exception of the well water at a large business premises which is reserved for emergency fire use only. All other borings in the Borough have been abandoned entirely and, so far as can be ascertained, have been sealed off. Drainage.—The number of plans approved was 379, of which 367 related to old buildings and 12 to new buildings (including blocks of flats on the Sheringham Estate of the London County Council in the Cosway Street area and on the Cochrane Street Estate of the St. Marylebone Housing Association Limited). The Drainage Inspectors made a total of 3,653 visits. Combined Drainage.—Nine orders under seal for combined drainage were issued. 11 Public Conveniences.—The usual supervision was exercised over the 15 public sanitary conveniences (11 for men, 4 for women). Public Cleansing and Salvage.—The Director of Public Cleansing has kindly provided the following information on these services. The amounts dealt with during 1947 were: house and trade refuse, 32,115½ tons; street sweepings and gully slop, 2,881½ tons: salvaged materials, 2,648 tons, including 1,733¼ 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 £7,382 13s. Id. was obtained from the sale of salvaged materials. In addition, £710 7s. 2d. was received for the removal of trade refuse, green offal, and the cleansing of petrol interceptors. During the year the street cleansing and snow clearing services were further mechanised by the purchase of four mechanical road-sweeping collecting vehicles, three street gritting machines and two motor footpath snow ploughs. Orders were also placed for four road ploughs for attachment to the Council's vehicles. Mechanical night cleansing was re-introduced and the whole of the street cleansing and snow clearing services were re-organised with the object of reducing the number of street orderlies and improving the general standard of street cleanliness. Shops.—Inspections under the Shops Act, 1934, numbered 103. In 17 instances service of notice was necessary. Diseased or Infirm Persons.—One hundred and ninety-seven old people living on their own were visited, and the majority of the cases required continued observation. The domestic help service was able to render valuable assistance in many instances. In one case it was necessary to make application to Court to obtain an Order, under Section 224 of the Public Health (London) Act, 1936, for the removal of an infirm person to hospital. Bed Bugs.—Sixty-two dwellings (including 19 requisitioned premises and 11 municipal flats) where bugs were found were disinfested. The furniture of 122 families (of whom 92 were rehoused) was treated by the hydrogen cyanide process. Verminous Persons.—The numbers of adults and school children using the Cleansing Station were 561 (459 men, 102 women) and 1,207 (338 boys, 869 girls) respectively. Shelter.—The shelter accommodation provided at No. 217, Lisson Grove, under section 195(4) of the Public Health (London) Act, 1936, for families temporarily dishoused was used for one night only on three occasions while disinfestation of dwellings was being carried out. Rats and Mice.—Complaints received numbered 740, and 52 food and 500 other premises were found to be infested. Of the 52 food premises, 17 were shops, 29 hotels and restaurants and 6 clubs ; the 500 other premises included 261 dwelling houses, 86 shops, 104 warehouses and stores, 7 factories, 16 hospitals and institutions, and 26 offices. Where necessary ratproofing was carried out at infested premises. I lie chief methods employed for the extermination of rat s were poison baiting and trapping, and the work was carried out on the lines 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 5s. and 10s. per treatment respectively. Advantage of the scheme was taken in all cases, in two of which, on the ground of inability to pay, the charges against the occupiers were waived. The rat catchers made 9,390 visits in connection with this service—an increase of 1,609 visits on the total for 1946. A third whole-time rat catcher was engaged on the work as from the 24th November, 1947. Dog Nuisance.—Contravention of the bye-law relating to the fouling of footways by dogs was reported by the Streets Nuisance Inspector in 30 cases and by police officers in one instance, in all of which (excepting one where the case was dismissed) convictions were secured and penalties imposed. The total number of prosecutions since the bye-law came into operation in 1928 is 382, the amount of fines imposed being £152 12s. Od. Mosquitoes.—One complaint of mosquitoes was received. The nuisance was traced to breeding in emergency water tanks and bombed sites, and remedial treatment proved effective. Noise.—Complaints of eighteen noise nuisances were received. They were concerned with such diverse matters as a garage, an exhibition, factories, a students' home, a cockerel, street musicians, radio, night clubs, and the shovelling of coal. The majority of these nuisances were abated after informal 12 action by the Sanitary inspectors and the Streets Nuisance Inspector. In other cases, where upon investigation it appeared that the Department could not take effective action, the matters were referred to the Town and Country Planning Authority and to the Police. In no case was legal action necessary. Smoke.—Complaints were received in respect of smoke nuisances arising from thirteen premises, relating mainly to commercial undertakings and large blocks of flats. There appears to be no doubt that in certain instances, where oil is burned, the nuisance was due to the gradual change-over from wartime fuel to the type of oil normally used. The owners of these properties have, without exception, taken all practicable steps in the special circumstances to prevent or at least mitigate the nuisance when their attention has been drawn informally to it, but with a return to more normal conditions as regards the fuelling of these plants it has been decided to revert strictly to the procedure laid down in the Public Health (London) Act, 1936, and to consider the taking of formal action against future offenders. 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 90. Factories.—The number of registered factories was 1,760 (with mechanical power, 1,343; without mechanical power, 417). Frequent inspections were carried out, and conditions were remedied in 69 instances (want of cleanliness, 48; insufficient or unsuitable sanitary conveniences, 21). Outworkers lists were received from 70 employers in respect of 121 contractors and 946 workpeople. SECTION D.—HOUSING. Re-organisation of Housing Department.—The Council's housing activities were co-ordinated into a single department under the control of a Housing Director who commenced his duties on the 1st May, 1947. Permanent Schemes.—The erection of flats on the undermentioned sites continued but progress was slow owing to shortages of labour and materials:— 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 18 shops. Both estates will have communal laundry facilities and central hot water. Following a public inquiry on the 21st April, 1947, the Minister of Health confirmed the compulsory purchase order made by the Council respecting the Townshend Cottages site with a view to the erection thereon of further permanent flats. The Council have also planned for the development of a number of small vacant sites in the Borough. Adaptation of Premises.—Further unoccupied premises were surveyed during the year and, where suitable, were requisitioned to provide more housing accommodation. In addition, certain requisitioned houses formerly occupied by Government Departments were transferred to the Council for housing purposes. The total number of residential units held by the Council in requisitioned premises at 31st December, 1947, was 1,021. Hostels for Single Persons.—During the year the Council requisitioned suitable premises and prepared plans for the provision of accommodation for approximately 100 persons. St. Marylebone Housing Association.—The Council agreed to co-operate with the St. Marylebone Housing Association in the development of the Cochrane Street site for housing purposes and good progress was made in the building of 64 flats. The Association will accept nominees of the Council as the first tenants of the flats. Inspection of Dwelling-houses.—Number of houses inspected for defects under the Public Health or Housing Acts—3,750; number of inspections made—8,932; number of houses found not to be in all respects reasonably fit for human habitation—1,254; number of defective houses rendered fit in consequence of informal action—1,003; number of houses in which defects were remedied by owners after service of formal notices under the Public Health (London) Act, 1936—243; number of underground rooms in respect of which closing orders were made—43. 13 Common Lodging Houses.—Seventy 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, Bume Street and premises in Lisson Street; the other, accommodating 100 women, conducted by the Church Army at Portman House, No. 10, Daventry Street. Rent Restriction Acts.—In order to avoid delay in dealing with applications for certificates under these Acts relating to the sanitary condition and state of repair of dwelling-houses, the Council, as Sanitary Authority for the Borough, authorised the Medical Officer of Health, on the 30th October, 1947, to issue such certificates forthwith, reporting subsequently to the Public Health Committee. During the year five disrepair certificates and one revocation certificate were issued. Generally, a disrepair certificate enables a tenant, pending the repair of the dwelling-house, to withhold payment of certain of the "permitted increases" under the Acts of 1920-1938, but is of no avail in respect of premises controlled only by virtue of the 1939 Act. SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Food Analysis.—Samples of 60 different articles taken under the Food and Drugs Act, 1938, numbered 705 (64 formal, 641 informal) and included: milk 82, butter 62, margarine 61, cheese 43. 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. Eight 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 is again lower than in the previous years, being only 1.1 per cent. This figure would have been even lower had it not been for four samples of meat which consisted of horseflesh being sold without a disclosure to that effect. An informal and a formal sample of coffee were both found to consist of coffee and chicory, and the only two other samples found not to conform with requirements were one of a special kind of bread and one of pea flour, both of which were very old stock and had consequently become inedible. It may be remarked that the percentage of adulterated samples in St. Marylebone is lower than in most other areas largely because of the method of sampling. In St. Marylebone it is the custom to sample the general range of foods normally bought by the housewife and not to trouble to any appreciable extent with those preparations specially packed to catch the unwary purchaser's eye. Some other authorities pay particular attention to these so-called commodities and therefore find an apparently larger percentage of foods adulterated. Whichever method is, however, adopted it is the experience of your analyst that the percentage of adulterated samples has fallen considerably since the introduction of food standards and labelling requirements by the Ministry of Food. Whilst these standards have increased the work of the public analyst in many directions as regards the amount of analytical work required, they have, on the other hand, made it much easier for him to decide whether a sample is or is not satisfactory according to law. Where no standards exist it is the duty of the analyst in the first place to consider from the appearance, composition, and advertisements of a food, whether it complies with what a reasonable man would expect, and this is not always a simple matter to decide. One other tendency resulting from the introduction of these food standards is that defendants are finding that the Courts more readily accept pleas that no standard exists for a particular article. The result may be that the Minister of Food may find himself in the invidious position of being forced to increase greatly the number of standards for foods and consequently subjected to the complaint that the nation is being still further controlled by ministerial orders instead of by parliamentary-legislation." Legal Proceedings.—Of the eight samples adversely reported upon by the Public Analyst, proceedings were instituted under the Food and Drugs Act, 1938, in three instances involving the four samples of horseflesh and the sample of coffee. For possessing horseflesh for the purpose of sale for human consumption without displaying the requisite notice the defendent in one case was fined £7 10s. Od. under Section 38, and in the other a fine of £5 0s. Od. was imposed, £5 0s. Od. costs being awarded to the Council in each instance. In regard to the sample of coffee found to contain 27 per cent, of chicory, taken under Section 3, the ease was dismissed under the Probation of Offenders Act on payment of £3 3s. Od. costs by the defendants. In the remaining cases legal proceedings were not advised and the matters were taken up with the manufacturer, wholesaler or retailer concerned. A prosecution was also taken under Section 9 of the Food and Drugs Act, 1938, in regard to the sale of food unfit for human consumption, to wit, a bun containing glass. The case was dismissed under the Probation of Offenders Act on payment of £3 0s. Od. costs. Milk.—There are 156 premises from which milk is sold. Inspections made numbered 231. During the year 42 applications under the Milk (Special Designations) Regulations, 1936-1946, were received from 19 milk purveyors and licences were granted as follows: 1 pasteurising, 20 dealers' and 3 supplementary in the case of pasteurised milk: 1 bottling, 15 dealers' and 2 supplementary in respect of tubercuhn tested milk. 14 The average composition of the 82 samples of milk analysed was: total solids, 12.34%; fat, 3.53%; solids not fat, 8.81%. Xo sample was found to be below the legal minima, namely, 11.50%, 3.00% and 8.50% respectively. At the request of the Ministry of Food, 154 samples of milk, taken at the premises of two authorised wholesale firms operating heat-treatinent plants, were submitted to the tests preslcribed for the various designations. The Ministry's Area Milk Officer was adv'sed of the results which showed that four samples of pasteurised milk were unsatisfactory under the phosphatase test and that nine samples of pasteurised milk and one sample of sterilised milk were unsatisfactory according to the methylene blue test. Of thirty-two other samples of milk examined bacteriologically all hut two samples of pasteurised milk, which failed to pass the methylene blue test, 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. Twenty-six inspections were made. Ice Cream.—The number of premises on the register was 108, and 162 inspections were made. Three samples of ice cream were examined bacteriologically and found to be satisfactory. Legal proceedings were instituted in one case in relation to the storage of ice cream on unregistered premises, the defendants being fined a total of £4 0s. Od. Although under Section 14 of the Food and Drugs Act, 1938, there is a general requirement that premises used for the sale of ice cream or for the manufacture or storage of ice cream intended for sale must be registered by the local authority, certain classes of premises are specifically excluded bv Sub-section 7 of Section 14. Thus the requirement does not apply at all to premises used primarily as a club, hotel, inn or restaurant, whilst in relation to premises used as a theatre, music hall or concert hall, registration is only necessary where manufacture for sale takes place. There are large numbers of restaurants and cafes in the Borough selling ice cream and many are believed to be manufacturing ice cream or are in the process of applying for an allocation of raw materials for that purpose. These premises require supervision under the provisions of the Ice Cream (Heat Treatment) Regulations, 1947, but the administrative difficulties are greatly increased by the absence of registration. Under Section 14 of the Food and Drugs Act, 1938, "premises" and not "persons" are registered. By definition the term "premises" does not include any vehicle, barrow, tricycle, or the like, and the requirements of the Section consequently do not apply to itinerant vendors. This omission again makes adequate supervision extremely difficult. The Council therefore brought the matter to the notice of the Metropolitan Boroughs' Standing Joint Committee with a view to their taking steps to secure amendment of existing legislation so as to provide for the registration of all premises used for the manufacture, storage or sale of ice cream and of all vendors of this commodity. The Standing Joint Committee subsequently supported the Council's views and made representations accordingly to the Ministry of Health and Ministry of Food. Preserved Food.—At the end of 1947, 107 premises were registered for the preparation or manufacture of preserved foods (sausages mainly) intended for sale, and 256 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-four inspections of fried fish shops and 18 inspections of fish curers' premises were carried out. One application for registration of premises for the purpose of smoking fish was refused on grounds of unsuitability. Bakehouses.—There are 19 basement bakehouses on the register; 26 inspections were made. Restaurants, etc.—Premises in which meals are provided or food is sold already cooked or is prepared for sale numbered 634, including 287 restaurants, dining rooms and clubs, 42 hotels, 196 canteens and 109 snack bars: 970 inspections were made and 131 notices served. In view of the increasing number of eating places in the Borough and the demand of the public health service for a far higher hygienic standard in the preparation and serving of food—a demand reinforced in recent times by a more enlightened public opinion—a woman Sanitary Inspector (Mrs. Tiplady) was appointed on the 1st September, 1947, to devote the whole of her time to this important work. Unsound Food.—Some 25 tons of food condemned as unfit for human consumption included the following: meat, 3 tons, 4 cwts. 2 qtrs. 5 lbs.; fish, 1 ton, 6 cwts. 3 qtrs. 7 lbs.; fruit, 1 ton, 9 cwts. 3 qtrs. 2 lbs.; vegetables, 2 qtrs. 8 lbs.: cereals, 1 ton, 11 cwts. 1 qtr. 13 lbs.; canned goods, 25,332 tins; miscellaneous, 18 cwts. 5 qtrs. 10 lbs. Practically all this unsound food was salvaged and diverted to other uses. 15 During the hot weather in September many requests were received from butchers in the Borough to examine beef delivered to them under the Ministry of Food scheme. On examination a large amount was found to be decomposed and unfit for food. The quantity involved was 3,159 lbs. (homekilled, 2,062 lbs.: Danish, 1,097 lbs). The home-killed beef came from Irish cattle slaughterhouses in Liverpool and was sent by lorry to London; the Danish beef was slaughtered in Denmark and conveyed by ordinary cargo ship. Large consignments of canned foods from Army dumps were sent to the premises of a food distributing firm in the Borough for examination and sorting. Out of one delivery of 1,000 cases, 544 cases (containing 12,727 cans of various fruits equal in weight to 26,815 lbs.) were found to be unfit for human consumption. Horseflesh.—Forty-one visits were paid to two shops selling horseflesh for human food. There are no shops selling horseflesh other than for human consumption. 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. Six 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 1947. TABLE 6.—Infectious Disease Notifications. ♦Notifiable Disease Cases notified in whole Borough Cases removed to hospital Cases isolated at home At all ages At ages—years —1 1 — 2— 3— 4— 5— 10— 15- 20—. 35— 45— 65— Diphtheria, including membranous croup 4 - - - - - 3 - - 1 - - - 4 - Erysipelas 11 — — — — — - - 1 1 — 6 3 3 8 Scarlet fever 49 — 5 5 5 6 14 8 2 3 1 - -— 18 31 Puerperal fever 1 - - - - - - - 1 - - - - 1 — Puerperal pyrexia 7 — - — — — — — — 6 1 — — 6 1 Cerebro-spinal fever 2 — - — 1 — — — 1 — — — — 2 — Acute poliomyelitis 15 — - — — — 2 5 — 8 — — — 13 2 Encephalitis lethargica 1 - - - - - - - - - - 1 - - 1 Polio-encephalitis 1 - - - - - - - - -1 - - -— 1 Ophthalmia neonatorum 3 3 - - - - - - - - - - - 2 1 Pneumonia 43 - 2 — — 2 3 — 1 3 8 17 7 18 25 Dysentery 4 — — — — — — 2 — 1 — — 1 2 2 Measles 330 12 35 54 41 42 102 15 6 17 3 2 1 37 293 Whooping cough 71 13 15 10 6 7 18 2 — — — — — 23 48 Scabies 62 5 1 - 2 2 5 6 5 20 6 5 3 2 60 Malaria Tuberculosis— 1 — — - — - - - — 1 — - — 1 Pulmonary 94 — 2 — 1 — 1 3 8 35 10 27 7 36 58 Non-pulmonarv 10 — 1 2 1 — - 1 1 2 1 1 — 5 5 Totals 709 33 61 71 57 59 148 42 26 97 32 59 24 172 537 16 and public health officials, which was shown in the lecture hall of the Royal Institute of Public Health, No. 28, Portland Place. They were asked to co-operate with the Department by keeping a special watch for cases or suspected cases of the disease, while the Council's medical staff were requested to exercise a similar vigilance at the clinics and day nurseries, and to arrange for the postponement of operations on the nose and throat whenever possible as there is evidence that a recent tonsillectomy increases the risk of a child's contracting poliomyelitis. At the public baths arrangements were made to restrict admissions to the swimming pool in order to avoid possible overcrowding; to ensure that chlorination of the water was maintained; and to carry out heat treatment of all bathing apparel issued at the baths. The National Fire Service were approached to pump out all emergency water tanks in the Borough and as each tank was emptied the Borough Engineer gave instructions for refuse to be cleared and for holes to be made in the tank to prevent recurrence of nuisance by the accumulation of water in future. It was also arranged that the use of paddling pools in Regent's Park or elsewhere should be discontinued for the time being. In addition to accommodation available at London County Council infectious hospitals, and in accordance with an arrangement for all teaching hospitals in London to receive cases in the acute stage of the disease, special wards were set aside for the purpose at the Middlesex Hospital. The total number of cases among inhabitants of the Borough during the period 1st July, 1947 to 30th September, 1947, was 10, comprising 3 males and 7 females, the ages of the former being 5, 6 and 20 years, and the latter 12, 19, 20, 21, 21, 21 and 22 years. Five other cases occurred in 1947—2 in January (males 12 and 18 years); 2 in October (female 19 years, male 26 years); and 1 in December (male 20 years). St. Marylebone contacts of cases occurring outside the district were notified to the Department and kept under surveillance. Rabies.—Rabies (hydrophobia) in man is rare in this country, and the disease has not been reported in St. Marylebone for the past 30 years at least. A case which occurred in the Borough presented all the classical symptoms of rabies. The patient, aged 23 years, was bitten by a dog in the right hand approximately 3-4 months previously whilst serving in India. He returned to England on the 30th December, 1946, and on the 16th January, 1947, complained of pain at the site of the original injury. He continued, however, to go about his business in the ordinary way, but on the 21st January, 1947, when the case first came to the notice of the Department, he was suddenly taken gravely ill at his home in the Borough, and was immediately removed to University College Hospital where he died the same evening. All necessary precautionary measures, including thorough cleansing and disinfection of the home, were at once taken and a full report of the case was sent to the Ministry of Health, who advised against antirabic vaccination of the four immediate contacts. Diphtheria Immunisation.—Clinic facilities were available throughout the year at Maternity and Child Welfare Centres Nos. 1 and 2, and the Middlesex Hospital Clinic re-opened on the 10th October, 1947. Treatments were also carried out at the day nurseries, and at eight elementary schools where, apart from new cases, 415 additional protective injections were given. Five general practitioners who wished to carry out immunisation of their patients in the home or at the surgery were supplied with the necessary prophylactic free of charge. A.P.T. (Alum Precipitated Toxoid) was the agent generally employed. T.A.F. (Toxoid-Antitoxin Floccules) was used in a small proportion of cases. TABLE 7.—Wobk of the Diphtheria Immunisation Clinics. Pre-school children School children Adults Totals Attendances 1,609 583 7 2,199 New cases 512 104 3 619 Schick negative — — 1 1 Completely immunised but not retested 472 78 1 551 Retested 322 6 2 330 Positive after retest 41 2 - 43 Vaccination.—As from the 1st April, 1947, Mr. George Kelly Cargill Rettie, M.B., B.S., M.R.C.S., L.R.C.P., of No. 59, Courtland Gardens, S.W.5, was appointed as occasional deputy to the Public Vaccinator (Dr. C. J. C. Britton) of the Middlesex Hospital district in place of Mr. Peter Thomas John Christopher Plumbly Warner, M.R.C.S., M.R.C.P. Vaccinations carried out in the whole Borough numbered 942 (primary, 722; re-vaccinations, 220). Vaccination was successful in 719 instances; unsuccessful in 166: while 57 cases were not available for inspection. Of the 1,027 children whose births were registered in 1946, 715 (69.62%) were successfully vaccinated. Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 916 cases of scabies: adults 143 (men 61, women 82) ; children 773 (boys 408; girls 365). Domiciliary visits paid in connection with St. Marylebone cases numbered 114, 17 Impetigo.—Forty-five boys and 22 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, twenty-four talks on sex education were given at various youth centres in the Borough, and films were shown at the Lisson Grove Welfare Centre. 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 insuhn for the poorer inhabitants suffering from diabetes were provided free of cost by the Council in five cases, under the authority of Ministry of Health Circular 2734, dated 4th January, 1943. Food Poisoning.—Fifty-six cases of food poisoning, which is notifiable in the Borough, were reported. A mild outbreak occurred in February amongst the staff of a large organisation in the Borough. Fifty-five cases were notified but several more of the staff had some degree of diarrhoea. All the persons attacked had had lunch at the canteen. The cookhouse staff and others dining elsewhere on the premises, although they ate similar food, were not affected. The attack consisted of a severe diarrhoea; there was no vomiting, and all cases cleared up within 24 hours. Foods eaten at lunch were examined by the Council's Bacteriologist. They included stewed figs, meat pudding, potato flour, flour, egg powder, dried split peas, baking powder and salt. No evidence of bacterial infection with food poisoning organisms could be found. Specimens of faeces from twelve members of the kitchen staff were also examined with negative results. Upon investigation it was discovered that a similar slight outbreak of diarrhoea had occurred two weeks before, and that samples of milk, water, yeast and bouillon powder which had been taken previously and examined by the Bacteriologist were found to be satisfactory with the exception of one of the samples of milk which was found to be heavily infected with B. coli. A thorough inspection of the milk receptacles at the canteen counter was then made. Three old type dairyman's handcans were in use, one of which had about 2 ozs. of milk in the bottom and was in a dirty and greasy condition. In the course of discussion the assistant canteen manager stated that recently a quantity of milk had gone sour. The Bacteriologist subsequently reported:—" I have little doubt that the outbreaks were due to heavy contamination of the milk with B. coli while in the canteen, and that the contamination was perpetrated by imperfect cleansing and sterilization of the milk cans used in the canteen. The milk as received in the stores from the milk supplier appears above reproach." Instructions were issued to ensure that milk cans were regularly cleansed, scalded and washed with strong soda before use, and a new type of white enamelled receptacle with separate dipper was brought into use. No further cases were reported. In the remaining notified case, fish was the suspected article but bacteriological investigation failed to reveal the presence of food poisoning organisms. On a report that "galantine" or "haslet" or "liver sausage" purchased from a shop in the Borough during the warm weather in May had caused poisoning among residents of neighbouring districts, arrangements were made for the immediate withdrawal of the product from sale. A sample examined by the Bacteriologist revealed the presence of organisms (staphylococcus aureus) likely to cause food poisoning. It was ascertained that large quantities of the same batch had been sent out from the place of manufacture in the provinces for sale by retailers in widely separated parts of the country and had given rise to numerous cases of food poisoning. The makers withdrew unsold supplies and the full circumstances were reported to the Ministry of Health. A subsequent statement (with recommendations) on an exhaustive investigation carried out by the Central Public Health Laboratory, Colindale, London, N.W.9, expressed the view that the "glaze" or fatty layer between the meat and its outer cellophane wrapping had probably been infected during the process of preparation by an employee harbouring the type of staphylococcus liable to be carried in the nose of healthy persons and to be readily transferred to the hands either directly or through the medium of a contaminated handkerchief. There was no evidence of any St. Marylebone resident being affected by the outbreak. After a brief attack of vomiting in a small group of children, samples of lemonade and ice cream of which they had partaken were examined bacteriologically and found to be free from pathological organisms. The possibihty of the sickness having been caused by metallic contamination was investigated, also with negative results. Specimens of cooked meat and lard suspected of carrying food poisoning organisms were submitted to bacteriological examination but the presence of such organisms was not confirmed. 18 Tuberculosis—New Cases and Mortality.—Table 8 contains information with regard to age and sex distribution of, and mortality from, 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 — 3 1 3 — 1 1 — 5—15 4 1 1 — — — — — 15—25 7 13 2 4 1 1 1 — 25—35 21 26 1 1 1 6 — — 35—45 9 6 — — 2 3 — - 45—55 18 4 1 1 3 2 1 1 55—65 14 1 — 1 4 5 1 1 65 and upwards 9 2 — 2 2 4 — - Totals 82 56 6 12 13 22 4 2 *Including all primary notifications and also any other new cases of tuberculosis which came to the knowledge of the Medical Officer of Health durine the vear. Notifications.—Table 6 (p. 15) gives information regarding notifications of pulmonary and nonpulmonary tuberculosis received during the year. The total number of cases of tuberculosis remaining at the 31st December, 1947, on the register was 710, 33 more than at the end of the previous year. Dispensary.—The work of the Dispensary continued to increase generally. Statistics for 1947: new patients, 857 (including 166 contacts), old cases, 619; attendances, 7,352; tuberculosis officer called into consultation on 661 occasions; home visits by tuberculosis officer, 12; hospital visits by tuberculosis officer, 52; home visits by tuberculosis visitors—first visits 182, re-visits 800. During the year 3,837 examinations (films, 2,001; screening only, 1,836) were made by means of the Council's X-ray plant. Sixty-one patients received artificial pneumothorax treatment on the premises and 1,170 refills were given. Sputum examinations carried out numbered 737. Expenditure on milk supplied to 112 tuberculous persons for varying periods amounted to £842 2s. 10d. 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, whicli 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 91. Dental Treatment.—The arrangement for tuberculous persons to be seen by the Borough Council's Dental Surgeon by special appointment was continued throughout the year, and six pat ients received treatment. Maintenance Allowances.—The scheme of maintenance allowances, etc., for tuberculous persons and their dependants, 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. During the year, 46 patients applied for assistance and in all cases financial aid, totalling £2,686 6s. 3d., 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. Mass Miniature Radiography.—Whilst the London County Council miniature radiography unit was established at St. Pancras (L.C.C.) Hospital, 2,067 employees and others from firms and institutions in St. Marylebone were examined with the conclusions indicated in Table 9. 19 TABLE 9.—Results of Mass Radiography Examinations. Total examined Referred for large films No abnormality Old lesions— no further action required Pending, etc. Referred to General Practitioners Probably tuberculous Heart abnormality 636 men 17 4 7 1 5 — 1,431 Women 27 7 3 3 12 3 2,067 44 11 10 (0.5%) 4 17 (0.85%) 3 (0.15%) Care Committee.—The Committee held 10 meetings and dealt with 218 cases. Disinfection.—During the year 854 rooms and 17,620 articles (including 321 books) were disinfected after infectious diseases generally. In addition, 1,936 dressing drums from a local hospital were sterilised. Bacteriological Examinations.—Table 10 shows the number of specimens examined for the purposes of diagnosis and indicates also the organisms in relation to which the examinations were made. TABLE 10.—Work of the Bacteriological Laboratory. Nature of Specimen and Examination. Positive Negative Total Throat and nasal swabs for— B. diphtherias 9 343 352 Hæmolytic streptococci 42 324 366 Sputa—for tubercle bacilli 96 523 619 Fæces—for tubercle bacilli 1 1 Fæces—for dysentery — 31 31 Blood—for typhoid and Brucella abortus — 1 1 Totals 148 1,222 1,370