ACC 353 STMARY 53 BOROUGH OF ST. MARYLEBONE REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 H. A. BULMAN, M.R.C.S., D.P.H. London : Vail &. Co., Ltd., 170 Farringdon Road, E.C.I 2 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 5 Marriages 5 Deaths .5 Infantile Mortality 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 Student Health Visitors 7 Visitors to Centres and Nurseries 7 Home Visits 7 Milk and Vitamin Products 7 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 Domiciliary Midwifery 8 Maternity Survey 8 Family Planning Clinic 9 Convalescent Homes 9 Care of Old People 9 Day Nurseries 9 Section C—Sanitary Circumstances :— Sanitary Inspection 9 Sanitary Provisions by Railway Authorities 10 Water 10 Drainage 11 Combined Drainage 11 Building Licences 11 Public Conveniences 11 Public Cleansing and Salvage 11 Shops 11 Diseased or Infirm Persons 11 Burial or Cremation of the Dead 12 Disinfestation 12 Verminous Persons 12 Shelter 12 Rats and Mice 12 Dog Nuisance 13 Pigeons 13 Noise 13 Smoke 13 page Poisons 13 Factories 13 Section D—Housing:— Permanent Schemes 13 Adaptation of Premises 14 St. Marylebone Housing Association 14 "'Half-way" Houses 14 Finchley Road and St. John's Wood Park Areas 14 Fisherton Street Housing Estate 14 Crawford Place Dwellings 14 Inspection of Dwelling Houses 14 Underground Rooms 14 Re-housing 14 Housing of Persons from Abroad 14 Common Lodging Houses 15 Rent Restriction Acts 15 Section E—Food :— Transfer of Ministerial Functions 15 Food Analysis 15 Legal Proceedings 16 Milk 16 Butter and Margarine Premises 16 Ice Cream16 Preserved Food 17 Fried Fish Vendors and Fish Curers17 Bakehouses17 Restaurants, etc.17 Hygienic Paper Drinking Vessels17 Unsound Food18 Horseflesh 18 Slaughter of Animals 18 Section F—Infectious and Other Diseases :— Notifications 18 Puerperal Fever 18 Psittacosis (Parrot Disease)18 Diphtheria Immunisation 19 Vaccination 19 International Certificates of Vaccination and Inoculation 19 Scabies 19 Impetigo 19 Venereal Diseases 19 Insulin 19 Food Poisoning 19 Tuberculosis :— New Cases and Mortality 20 Notifications 20 Dispensary 20 Institutional Treatment 20 Dental Treatment 20 Maintenance Allowances 20 Government Rehabilitation Scheme 20 Care Committee 20 Disinfection 20 Bacteriological Examinations 20 Appendix I — National Health Service Act, 1946 — Transfer of Functions 21 Appendix II — Maternity and Child Welfare in St. Marylebone, 1906-1948 22 3 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, my Lord, Ladies and Gentlemen, Health conditions in the Borough continued to be satisfactory throughout 1948. The birth-rate declined from 13.21 (1947) to 12.87, and the death-rate of 10.48 showed a decided decrease over the 1947 figure (12.29). The infantile mortality rate of 31.66 was somewhat higher than the record low level reached in 1947 (26.55). The civilian population of 75,980, as estimated by the RegistrarGeneral, showed a slight downward trend, being 1,000 less than the estimate for the previous year. Infectious disease notifications rose slightly from 708 (1947) to 732, of which nearly two-thirds related to measles (354) and whooping cough (128). The incidence of the major infectious diseases remained low. On the 5th July, 1948, under the provisions of the National Health Service Act, 1946, the maternity and child welfare and other personal health services were transferred from the Borough Council to the London County Council, and certain aspects of the tuberculosis dispensary service to the NorthWest Metropolitan Regional Hospital Board. Details of these changes and of the functions which still remain the responsibility of the Borough Council are given in Appendix I to this report. Two members of the Public Health Committee—Councillor Captain Robert Whitney, M.B.E., J.P. (Chairman) and Councillor Miss D. A. Sharpe, F.R.C.S., M.R.C.O.G.—represented the Borough Council upon the Divisional Health Committee set up by the London County Council under the Act for Division 2, comprising the City of Westminster and the Boroughs of Hampstead, Paddington, St. Marylebone and St. Pancras. As one of the local authorities concerned with maternity and child welfare since its earliest days it may interest the reader to have some account of the work carried out by the St. Marylebone Borough Council (in collaboration with the St. Marylebone Health Society and other voluntary organisations) during the past 42 years. A brief historical survey prepared at the time the service passed from the Borough Council is therefore reproduced as Appendix II. As from the 3rd June, 1948, the Public Health Committee took over from the Housing Committee the functions, powers and duties of the Council under sections 11 to 24 of the Housing Act, 1936, relating to underground rooms, insanitary houses and parts of buildings. The National Assistance Act, 1948, placed upon the Council new powers under three sections which came into operation on the 5th July, 1948. Section 31 enables a local authority to make contributions to the funds of any voluntary organisation whose activities include the provision of recreation or meals for old people ; section 50 requires the Council (as the local sanitary authority) to cause to be buried or cremated the body of any person who has died or been found dead in the Borough, in any case where it appears that no other suitable arrangements for the disposal of the body have been or are being made ; while section 47 contains amended provisions for the removal of diseased or infirm persons to a hospital or other institution, and replaces section 224 of the Public Health (London) Act, 1936. As regards weather the year 1948 will go down in history as a mild one. For example, in January— and again in the early part of December—it was as mild as the first three weeks of July, and in October there were temperatures of more than 70 degrees. The winter had comparatively few snowfalls, but was mainly wet. After the sunniest spring since 1909, the summer months were very poor, with cool, dull days and excessive rain. Except for the very hot, sunny days at the end of July, there were few compensating features. The most popular holiday week of the year, the first week in August, was "exceptionally wet." November had a continuous fog for 114 hours. My thanks are due to the Chairman (Councillor Captain Robert Whitney, M.B.E., J.P.) and members of the Public Health Committee for the consideration and encouragement they gave me throughout 1948; to my colleagues in other Departments of the Council for their co-operation and assistance; and to the staff of the Public Health Department for their continued loyalty and support in the public health work of the Borough. I am, Mr. Mayor, my Lord, Ladies and Gentlemen, Your obedient Servant, H. A. BULMAN, Medical Officer of Health. 4 PUBLIC HEALTH COMMITTEE (who, prior to the 5th July, 1948, were also the Committee appointed, for Maternity and Child Welfare purposes.) 1948. HIS WORSHIP THE MAYOR : Councillor A. E. Reneson Coucher, F.R.I.C.S., F.A.I., L.C.C., J.P. ALDERMEN: The Late R. Stiles Allen, D.L. (until February). Mrs. V. A. L. Freeman, J.P. (elected in March). COUNCILLORS : F. Y. Bright. Mrs. M. Kiewe (until April). E. Carew-Shaw, F.R.C.S. The Lord Mancroft, M.B.E. T. K. Creamer. E. R. Rawdon Smith, O.B.E., M A. (from April). Mrs. H. I. H. Feiling (Deputy Chairman). Miss D. A. Sharpe, F.R.C.S., M.R.C.O.G. Mrs. L. H. Fewster. L. Shilling (from July). F. Frame. H. Norman Toomey, L.D.S., R.C.S., Eng. Mrs. Carr Q. Henriques. Capt. Robert Whitney, M.B.E., J.P. (Chairman). Dr. Elizabeth Jacobs. SECTION A.—STATISTICS AND SOCIAL CONDITIONS. GENERAL STATISTICS. Area of Borough : (a) exclusive of area covered by water, 1,427.8 acres ; (b) including area covered by water, 1,473 acres. Resident population : 1921 census—104,173 ; 1931 census—97,620. Registrar-General's estimate of civilian population (used in calculating various rates in this report) : 1948—75,980, including 3,841 children under 5 years and 4,847 children 5-15 years. EXTRACTS FROM VITAL STATISTICS. Total M. F. Live Births—Legitimate 892 463 429 Birth Rate per 1,000 estimated Illegitimate 86 40 46 civilian population12.87 Stillbirths—Legitimate 23 9 14 Rate per 1,000 total (live and still) Illegitimate 2 — 2 births 25.56 Deaths (all ages) 796 405 391 Death Rate per 1,000 estimated civilian population 10.48 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 Nil — Code Nos. 29 and 30) Total M. F. Deaths of Infants under one year of age—Legitimate 28 14 14 Illegitimate 3 — 3 Death Rate of Infants under one year of age—All infants per 1,000 live births, 31.66; legitimate infants per 1,000 legitimate live births, 31.39; illegitimate infants per 1,000 illegitimate live births, 34.89. 5 *Births—Notification.—The number of notifications received under the Public Health (London) Act, 1936, Section 255, was 1,177: live births, 1,152; stillbirths, 25. Sources of the notifications were: from parents 3; from doctors 17 ; from midwives 56; from hospitals, nursing homes, etc., 1,101. Of the births notified, 419 took place at the Middlesex Hospital, 217 at Paddington Hospital, and 121 occurred at home. Of those notified as taking place in St. Marylebone, 389 belonged to other Boroughs. Marriages.—The total number of marriages was 1,659, being 79 below the number for 1947 and 227 above the average for the previous 10 years. The rate for persons married in 1948 was 43 per 1,000 of the estimated civilian population. Deaths.—The total number of deaths (796) shown in the following table is inclusive of persons who, though normally resident in the Borough, died elsewhere in England and Wales, but exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. TABLE 1.—Deaths—According to Age-Group and Sex. Code No. Nett Deaths at the Sub-Joined Ages of Residents (Male and Female) whether occurring within or without the borough. CAUSE OF DEATH 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. 6 Tuberculosis of respiratory system . 19 9 - - - - - - 11 8 6 — 2 1 7 Other forms of tuberculosis ... 1 2 — — 1 - — — — 1 - 1 — — 8 Syphilitic disease 3 2 - - - - - - - - 1 1 2 1 9 Influenza 1 - - - - - - - - - - - 1 — 13m Cancer of buccal cavity and oesophagus (males only) 4 - - - - - - - - - . 1 - 3 - 13f Cancer of uterus - 8 - - - - - - - 1 - 2 - 5 14 Cancer of stomach and duodenum 13 10 - - - - - - 1 - 6 3 6 7 15 Cancer of breast - 15 — — - - — — - 4 - 7 4 16 Cancer of all other sites 54 41 - - - - - - 8 9 15 9 31 23 17 Diabetes 1 4 - - - - - - 1 - - - - 4 18 Intra-cranial vascular lesions 29 54 - - - - - - 1 1 9 13 19 40 19 Heart disease ... 125 108 - - - - - - 8 3 35 12 82 93 20 Other diseases of the circulatory system 18 16 - - - - - - - — 3 3 15 13 21 Bronchitis 28 18 - - - - - - - — 7 2 21 16 22 Pneumonia 22 21 2 4 — - — — 1 — 4 6 15 12 23 Other respiratory diseases 5 3 - - - - - - 1 - 1 1 3 2 24 5 2 - - - - - - 3 - 1 2 1 - 25 Diarrhoea (under 2 years of age) 2 1 2 1 - - - - - - - - - - 26 Appendicitis 1 2 - - - - - - - 1 - - 1 1 27 Other digestive diseases 9 8 - - - - - - - - 5 2 4 6 28 Acute and chronic nephritis 3 11 - - - - - - - 1 1 3 2 7 31 Premature birth 2 7 2 7 - - - - - - - - - - 32 Congenital malformations, birth inj ury, infantile disease 7 2 7 2 - - - - - - - - - - 33 Suicide ... 13 6 - - - - - - 7 3 6 2 — 1 34 Road traffic accidents 6 4 - - - - - - - 1 3 1 3 2 35 Other violent causes 14 11 1 2 — - — - 4 — 3 3 6 6 36 All other causes 20 26 - 1 — - — — 3 4 7 11 10 10 Totals 405 391 14 17 1 — - - 49 37 114 83 227 254 796 31 1 - 86 197 481 No death occurred from the following causes not shown in the table ; Typhoid and paratyphoid fevers, cerebro-spinal fever, scarlet fever, whooping cough, diphtheria (Code Nos. 1-5), measles, acute poliomyelitis and polioencephalitis, acute infectious encephalitis (Nos. 10-12), puerperal and post-abortive sepsis, other maternal causes (Nos. 29-30). * The information contained in this paragraph relates to the period 1st January, 1948, to 4th July, 1948. 6 TABLE 2.—Infantile Mortality—According to Age-Group and Sex. 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 m. F. m. F. m. F. m. F. m. F. m. F. m. F. m. F. 7 Diarrhoea — — — — — — 1 2 — — — — — 2 1 8 Enteritis 12 Congenital malformation . 6 1 - - - - - - - - - - - - 6 1 13 Premature birth . 2 b — 2 - - - - - - - - - - 2 7 15 Atelectasis 1 - - - - - - - - - - - - - 1 — 16 Injury at birth — 1 - - - - - - - - - - - - - 1 25 Pneumonia (all forms) — — — — 1 — — — 1 2 — — — 2 2 4 26 Suffocation, overlying - - - - - - - - 1 - - 1 - - 1 1 27 Other causes — — — — — — — 2 — — — — — — — 2 Totals 9 7 — 2 1 — — 3 4 2 — 1 2 14 17 16 2 1 3 6 1 2 31 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, meningitis (not tuberculous), convulsions, gastritis, laryngitis, bronchitis (Nos. 17—24). Crematorium.—Three hundred and sixty certificates authorising cremation at the St. Marylebone Crematorium, Finchley, were issued—226 by the Medical Officer of Health as Medical Referee; 32 by the Deputy Medical Officer of Health (Dr. W. H. S. Wallace) as Deputy Medical Referee until the 4th July, 1948, and 102 by the occasional Deputy Medical Officer of Health (Dr. C. J. C. Britton) as Deputy Medical Referee from the 5th July, 1948. SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. Staff.—In consequence of the appointment of Dr. W. H. S. Wallace, Deputy Medical Officer of Health and Deputy Medical Referee for Cremation, to a position as Divisional Medical Officer under the London County Council, Dr. Cedric John Charles Britton, the Borough Council's Bacteriologist, was appointed as occasional Deputy Medical Officer of Health and Deputy Medical Referee for the St. Marylebone Crematorium as from the 5th July, 1948. Mr. George Smith, Senior Sanitary Inspector and Food Inspector, retired on the 31st January, 1948, after 42 years' service with the Council. As from the 1st February, 1948, Mr. E. E. Willis, Drainage Inspector, assumed the office of Senior Sanitary Inspector; Mr. H. E. Scoble, a District Sanitary Inspector, was appointed as Food Inspector; and Mr. H. E. P. Corline, a District Sanitary Inspector, took over the duties of Drainage Inspector for the northern part of the Borough. Mr. F. C. Cook, a retired Inspector who continued his appointment in a temporary capacity, finally terminated his service on the 12th January, 1948. Two newly-appointed Sanitary Inspectors commenced duty during the year—Mr. J. E. Broadhead on the 19th January, 1948, and Mr. A. H. Chappell on the 1st June, 1948. Miss C. E. Durant, Health Visitor, resigned on the 30th April, 1948, on account of ill-health, after 33 years in the local government service, including 27 years at St. Marylebone. Mr. P. C. Bedward, a General Division Assistant, was called up for military service on the 17th June, 1948. On the transfer of certain members of the staff of the Department to the London County Council or the North West Metropolitan Regional Hospital Board under the provisions of the National Health Service Act, 1946, the Council recorded their appreciation of the work carried out by these officers— medical, dental, nursing, administrative and clerical—during their period of service under the Borough Council. Training of Sanitary Inspectors.—The Council continued to participate in the Ministry of Health scheme to secure the supply and training of sanitary inspectors by providing practical training facilities for ex-service student sanitary inspectors taking intensive courses at the Battersea Polytechnic. Ten students spent about two months each in the Public Health Department, and it was subsequently announced that all had passed the officially recognised qualifying examination for sanitary inspectors conducted by the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. 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 1948, 102 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. Marylebone District Nursing Association continued to provide adequate nursing services in the home under an arrangement made with the Council, and visits were paid to cases (number shown within brackets) as follow: maternity 75 (4); midwifery 253 (37); measles and German measles 83 (11); mumps 10 (1); erysipelas 6 (1); pneumonia 49 (5); tuberculosis 113 (4) ; shingles 14 (2); other ailments 117 (18); old age pensioners, 3,304 (87). *Maternity and Child Welfare.—There are 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, dental, and foot clinics. In addition, ante-and post-natal and infant welfare clinics held at the Middlesex Hospital form part of the Borough 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. 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. 1 102 76 24 130 1,303 105 3,256 1,328 21 327 20 643 (184) (53) (203) (16) (3) (16) (5) (15) Maternity and Child Welfare Centre No. 2 51 129 25 176 1,009 76 2,828 1,763 25 439 49 1,057 (143) (43) (156) (33) (-) (19) (6) (49) The Middlesex Hospital 140 93 4,604 406 1,419 1,174 - - - - (488) (261) (76) (8) ‡435 ‡31 ‡729 ‡423 ‡(65) ‡(26) ‡(45) ‡(7) { St. Marylebone residents attending the Middlesex Hospital. *Student Health Visitors.—Student health visitors from the Royal College of Nursing and the National Health Society were again 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 a party of wives of members of the Institute of Actuaries who came from various parts of the world to the Institute's Centenary Assembly in London during June. *Home Visits.—The six whole-time health visitors paid domiciliary visits as follow:{a) to expectant mothers, first visits 256, total visits 433; (b) to children under 1 year of age, first visits 474, total visits 1,631 : (c) to children between the ages of 1 and 5 years, total visits 1,508. *Milk and Vitamin Products.—The Food Executive Officer has kindly provided the following information as to dried milk supplied under the National Scheme: full cream, 5,770 20-oz. cartons at 10½d. per carton; 122 cartons free: half cream, 376 cartons at 10½d. per carton; 7 cartons free. * The information contained in these paragraphs relates to the period 1st January, 1948, to 4th July, 1948. 8 Distribution of vitamin preparations was also made as follows: cod liver oil, 4,697 13½-oz. bottles: orange juice, 21,259 6-oz. bottles at 5d. per bottle; 1,008 bottles free: vitamin A and D tablets, 1,896 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. Forty-one applications were received by the Department and 121 dockets issued. *Home Help and Domestic Help Services.—The demand for assistance from these services continued. 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—and this type of case accounted for over 90 per cent. of the work—the services of a domestic help were frequently required for an indefinite period. Helpers were sent into an average of 55 homes each week, and the number of women employed by the Council varied from five to ten. *Child Life Protection.—The number of persons on the register who were undertaking for reward the nursing and maintenance of foster children, was three, and the children in their care numbered three. The Council's health visitors, acting as child protection visitors, made a total of 31 visits of inspection to the homes. *Illegitimate Children.—The Council participated in a scheme to provide increased financial assistance to voluntary moral w elfa e 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. Fifty premature births occurred in the Borough, of which 7 were to St. Marylebone mothers. Premature births to St. Marylebone mothers occurring in other districts numbered 28. *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 young children. Statistics: sessions held, 78; new cases—mothers 85, children 24; attendances—mothers 465, children 99; X-ray examinations, 19; extractions—mothers 303, children 14; patients provided with dentures at cost price, 29; fillings 201; other operations 267. *Foot Clinic.—This clinic, conducted as part of the local maternity and child welfare scheme, held 22 sessions attended by 103 persons. *Remedial Exercises.—Classes for remedial exercises were again well supported, and mothers and young children made a total of 847 attendances at the 63 sessions held at Welfare Centres Nos. 1 and 2. *Child Guidance.—Thirteen clinic sessions were held, and 18 cases made a total of 68 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 to any doctor in the area needing assistance in difficult or complicatsd cases arising during pregnancy or at or after confinement. *Domiciliary Midwifery.—As from the 15th February, 1948, the authorities of St. Mary's Hospital, Paddington, in conjunction with the Paddington and St. Marylebone District Nursing Association, arranged for a staff midwife to attend maternity patients in their own homes, the object being to encourage mothers to have their babies at home wherever practicable, and thus to reheve the pressure on the hospital wards. At the time of confinement the hospital obstetric officer is available and, if necessary, admission to hospital is arranged. The midwife continues to visit for the 10 days following the confinement, during which time the patient is seen by one of the hospital's consulting obstetricians. Ante-natal and post-natal care are also undertaken by the hospital. *Maternity Survey.—In 1946 the Council co-operated with the Royal College of Obstetricians and Gynaecologists in an investigation into certain aspects of childbearing in Britain. In view of the great value to social medicine of the data obtained from the survey, the Council afforded further asssistance during the year by carrying out a follow-up enquiry on the health and development of full-term and premature babies and the relation between childbearing and maternal ill-health in respect of a proportion of the original mothers who responded to the appeal for information. * The information contained in these paragraphs relates to the period 1st January, 1948, to 4th July, 1948. 9 *Family Planning Clinic.—At the Lisson Grove Welfare Centre the Council made accommodation available to the Family Planning Association to enable them to conduct a family planning clinic on one evening a week. The first session was held on the 3rd May, 1948. *Convalescent Home.—Convalescence for pre-school children continued to be available under an arrangement by which the Council undertook the maintenance of one bed at the Hart's Leap Toddlers' Convalescent Home, Sandhurst, Camberley, Surrey. Care of Old People.—The St. Marylebone Old People's Welfare Association, established in May, 1947, and supported by representatives of various voluntary organisations, religious bodies and statutory authorities, carried out a useful year's work in the interests of the aged inhabitants of the Borough. Progress was recorded in the more prominent aspects of the Association's activities, including the home visitation of old people and the delivery by the local branch of the Women's Voluntary Services of dinners to the aged in their homes. In this latter connection the Council took advantage of section 31 of the National Assistance Act, 1948, and made a contribution of £300 per annum to meet the expenses of providing transport for the " Meals on Wheels " service. The provision of much needed hostel accommodation for old people has been under active consideration throughout the year and it is hoped that, despite the shortage of suitable buildings for the purpose, it may be possible to start a scheme to meet the demand which exists for such accommodation. Arrangements have been made for the supply of food parcels to old people, and there are special facilities available for the delivery of coal and wood blocks to those urgently in need of fuel. The W.V.S. " Darby and Joan " clubs and several other clubs opened during the year are running successfully, and a number of wellattended concert parties for old people were organised by various local bodies. Representatives of the Association took part in national and regional conferences held to discuss the many problems affecting the aged, and the Executive Committee gave consideration to new legislative measures relating to their welfare, and brought to the notice of government departments matters in which old people were directly concerned. Though it may be necessary at a later date to launch a wide appeal for funds for major schemes which the Association has in view, the ordinary running expenses have been met in the meantime by contributions from friends of the Association. The extension of the various services provided by the Association is almost entirely dependent upon more helpers, and offers of assistance will be welcomed by the Honorary Secretary, Miss M. K. C. Macintosh, Room 103, Town Hall, St. Marylebone, W.l. (Telephone: Welbeck 7766). *Day Nurseries.—Four day nurseries (whole-time), all recognised as training centres, continued to function in the Borough. As from the 15th January, 1948, the number of places at the Devonshire Street nursery was, at the request of the Ministry of Health, reduced from 57 (21, 0-2 years ; 36, 2-5 years) to 50. During the year the Borough Council co-operated with the London County Council in a scheme intended to benefit nursery students in their training for the nursery nurses certificate, by receiving into the St. Marylebone day nurseries students from the County Council's residential nurseries to gain experience with children over two years of age. Reciprocal arrangements enabled students from the Borough Council's day nurseries to be sent to the County Council's residential nurseries for experience with small babies during the 24-hour period. *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 22 50 72 2 St. Vincent's Creche, 14, Blandford Street 11.9.1942 15 20 35 9 19 28 3 3, Devonshire Street 16.8.1943 20 30 50 16 28 44 4 86, Carlton Hill 1.12.1943 24 26 50 12 31 43 Totals 95 130 225 59 128 187 ‡ Approved by the Ministry of Health as a grant-aided nursery. SECTION C.—SANITARY CIRCUMSTANCES. Sanitary Inspection.—Complaints were received in respect of 1,585 premises. Details of the various nuisances detected and remedied, to the total number of 4,943, are set out in Table 5. In 1,501 cases a preliminary (intimation) notice was issued, and in 239 instances this was followed by the * The information contained in these paragraphs relates to the period 1st January, 1948, to 4th July, 1948. 10 service of a statutory notice to secure abatement of nuisances. Legal proceedings were instituted in 21 cases under the Public Health (London) Act, 1936, in respect of failure to comply with statutory notices. In 13 instances penalties amounting to £34 10s. Od. were imposed, and in 7 of these costs were awarded to the Council. Costs without the imposition of a fine were allowed in a further 5 instances. In the remaining three 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 The Borough No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Houses damp, dirty or dilapidated remedied 104 228 473 156 140 130 1,231 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired 72 134 290 131 46 43 716 Verminous dwellings disinfested 63 68 116 105 116 67 535 Verminous furniture and bedding disinfested 41 78 86 21 12 10 248 Overcrowding abated — — — 2 — — 2 Water closet defects remedied 26 39 86 49 55 41 296 Insufficient and unsuitable water closet accommodation remedied 1 - 1 2 - 6 10 Urinal defects remedied 1 — 1 — 2 4 Drain and water closet stoppages cleared 6 11 9 6 11 10 53 Drains relaid or amended 4 2 7 5 1 2 21 Soilpipes and ventilating shafts repaired or renewed 4 7 4 5 1 6 27 Waste pipe defects remedied 4 13 23 19 5 4 68 Yard defects remedied 4 — 24 17 — 1 46 Wash-house defects remedied 15 - 18 40 1 — 74 Area defects remedied 18 5 — 23 Roofs and gutters repaired 55 79 132 87 38 28 419 Water supply to houses reinstated 1 1 3 4 1 — 10 Water supply laid on to upper storeys 1 4 14 — — 1 20 Water cistern defects remedied 3 — 6 4 2 2 17 Dung or dust receptacles repaired or renewed 20 30 18 11 13 4 96 Rubbish, manure, etc., accumulations removed 15 1 45 16 16 11 104 Animal nuisances abated 3 1 - - 2 3 9 Rat and mouse infestations dealt with 39 47 84 139 169 227 705 Bakehouses cleansed 1 — 1 — — — 2 Smoke nuisances abated — — 6 3 4 — 13 Shops—sanitary defects remedied 1 — 9 3 2 4 19 Miscellaneous 17 46 65 21 22 4 175 Sanitary Provisions by Railway Authorities.—As metropolitan sanitary authorities have no jurisdiction over sanitary arrangements at railway stations and their officers have no power to enter railway premises (other than dwelling-houses) for the purpose of detecting nuisances, etc., the Council requested the Metropolitan Boroughs' Standing Joint Committee to consider taking the necessary steps to secure to sanitary authorities in London, either by amendment of the existing legislation or by provision in a General Powers Bill, the same powers in regard to sanitary arrangements at railway premises as they have in connection with commercial and other premises, in order to ensure that adequate sanitary accommodation is provided at railway stations and is properly maintained. 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 or quantity was received during the year. In accordance with the provisions of the Public Health (London) Act, 1936, the Board notified five instances where water had been cut off in occupied premises for non-payment of rates or for waste, and in all cases the supply was reinstated, in some instances after service of a notice. Further examinations of the private well waters from the ten borings still in use were made by the Public Analyst and the Council's Bacteriologist and these indicated that chemically there was no appreciable change since a report was submitted in 1947. No pathogenic contamination was found, but water from one source fell slightly short of the desired bacteriological standard and this well is being kept under special observation. In the event of geological and other conditions proving to be suitable, the Metropolitan Water Board expressed their intention of seeking parliamentary powers for the construction of a large storage reservoir in the Enborne Valley on the borders of Hampshire and Berkshire, which, when completed, 11 would assure the water supply to the Board's area for at least a quarter of a century. In urging the necessity for the reservoir, the Board felt that their case would be greatly strengthened if definite facts and figures relating to the number of premises which have what might be described as poor facilities for using water could be placed before the parliamentary committee. At the Board's request, therefore, the Council supplied information on certain aspects of water supply in the Borough. It was estimated, for example, that out of an approximate total of 21,500 dwellings (8,000 of lower wage earning groups) 5,500 dwellings were without a hot water system and a bath. The ultimate aim of the Council is to ensure that these facilities are provided in every dwelling but there is no statutory power at present to require such provision to be made. On the use of water generally, the view was expressed that with improved housing conditions the consumption per capita would rise ; that people should be encouraged to use more water in the interests of health ; and that even in the hottest and driest summer there should be no thought of curtailment of the supply either for domestic purposes or for public use, such as filling swimming pools, watering streets, etc. Drainage.—The number of plans approved was 378, of which 374 related to old buildings and 4 to new buildings. The Drainage Inspectors made a total of 3,356 visits. Combined Drainage.—Four orders under seal for combined drainage were issued. Building Licences.—During the year 627 applications for building licences were passed to the Department by the Borough Engineer for observations in relation to proposals concerning drainage, ventilation and underground rooms, and also in cases where works had been called for by sanitary notices. Public Conveniences.—The usual supervision was exercised over the 15 public sanitary conveniences (11 for men, 4 for women). In view of the need for all possible steps to be taken to encourage personal hygiene in the interests of the public health and to prevent the spread of disease, the question of providing free washing facilities in public conveniences was considered by the Council during the year, and after an experimental period of six months at two of the main conveniences (both men's and women's sections) where one free wash-basin, with liquid soap and paper towels, was set aside, it was finally decided to extend this service and to make all washing facilities at public conveniences in the Borough available to the public free of charge as from a date in 1949 to be fixed. In order to provide for a reduction in the attendants' working hours from 47 to 44 per week as from the 27th September, 1948, arrangements were made for the public conveniences to be opened slightly later and closed a little earlier than usual, as a recorded census had shown that there was an exceedingly small demand for the accommodation in the early morning or late at night. Public Cleansing and Salvage.—The Director of Public Cleansing has kindly provided the following information on these services. The amounts dealt with during 1948 were : house and trade refuse, 32,742½ tons; street sweepings and gully slop, 3,077½ tons; salvaged materials, 3,112¼ tons, including 1,937½ 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 £9,204 5s. 6d. was obtained from the sale of salvaged materials. In addition, £774 7s. 11d. was received for the removal of trade refuse, green offal and the cleansing of petrol interceptors. During the year delivery was taken of four mechanical sprinkler sweeping collecting machines, two of which were put into commission to work at night in the heavily trafficked streets in the Borough and two on day work in the residential areas. To renew the public cleansing transport, orders were placed for the following vehicles :—20 Pagefield "Paragon" refuse collectors; 4 Pagefield "Paladin" refuse container collection vehicles; 6 Karrier "Derby" type low loading machines for the collection of sweepings; and 2 Karrier "Yorkshire" type vacuum gully and cesspool emptiers. Shops.—Inspections under the Shops Act, 1934, numbered 227. In 19 instances service of notice was necessary. Diseased or Infirm Persons.—Two hundred and forty-eight 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 Court proceedings were commenced to obtain authority for the removal of an infirm person to hospital but the person died before an Order was issued. 12 Burial or Cremation of the Dead.—Arrangements were made to give effect to the provisions of Section 50 of the National Assistance Act, 1948, under which it is the duty of the Council to cause to be buried or cremated the body of any person who has died or been found dead in the Borough where no other suitable arrangements for disposal of the body have been or are being made. Between the 5th July, 1948, when the section became operative, and the end of the year the burial of four bodies was undertaken by the Council. Disinfestation.—During the year a campaign against the bed-bug was launched on a scale greater than any hitherto attempted. This was made possible by increased knowledge in the field of disinfestation brought about mainly by wartime conditions and centred more particularly round the use of D.D.T. (dichlorodiphenyltrichloroethane) and improved methods of application to verminous premises. Unlike many other disinfestants, D.D.T. is a stable substance and possesses distinct advantages in the eradication of the bed-bug and other insect pests. Used in a 5 per cent. concentration in kerosene, D.D.T. has been found not only to possess an immediate killing effect on bugs but to leave on walls and other surfaces a lethal deposit which remains effective for at least several weeks and possibly very much longer. The best known method of application of the solution is by means of a fine whirling spray under constant pressure, obtained by the use of a compressor unit driven by a petrol engine. To convey the apparatus, including the necessary hosing, to premises to be treated a special van is provided and two driver-operators are engaged to transport and operate the power unit. Wherever verminous conditions are found the new method is put into operation and extended, where necessary, after surveys of adjoining properties have been made. Circular letters are sent to owners and occupiers giving full information of the scheme, inviting their co-operation and notifying date and time the intended disinfestation is to be carried out. Detailed records of all work done are being kept and will be reviewed from time to time to ascertain the degree of efficacy attained. With the additional facilities provided by this special service, which is under the supervision of one of the sanitary inspectors, 419 dwellings, involving 987 rooms, were dealt with in the summer months. In addition, 116 other dwellings (including 24 requisitioned premises and 2 municipal flats) where bugs were found were disinfested during the year. Inspections of requisitioned properties for the presence of vermin were requested by the Housing Director in many instances to ensure, where necessary, disinfestation of vacant rooms before repairs and redecoration were carried out in readiness for a new tenant. Treatment of verminous furniture by hydrocyanic acid gas (HCN) which has been carried out, in specially constructed vans, under contract by the Council for many years, has been continued, more particularly in the case of removals to fresh housing accommodation. In 1948 the furniture of 248 families (of whom 227—including 72 families coming into the Borough from other districts—were rehoused) was dealt with by this method. In this limited sphere the process has given most successful results, but there are disadvantages and possible danger which preclude its application to house property in a built-up area. Verminous Persons.—The Council's Cleansing Station in Lisson Grove dealt with 1,671 vermin-infested persons : adults 518 (men 449, women 69); children 1,153 (boys 283, girls 870). 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 a total of 11 nights while disinfestation of dwellings was being carried out, one family and four separate persons occupying the accommodation for periods ranging from one to five nights. Rats and Mice.—Complaints received numbered 907, and 63 food and 642 other premises were found to be infested. Of the 63 food premises, 29 were shops, 29 hotels and restaurants and 5 clubs ; the 642 other premises included 353 dwelling houses, 87 shops, 108 warehouses and stores, 14 factories, 18 hospitals and institutions, 57 offices, 2 garages and 3 bombed sites. Where necessary, rat-proofing 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 lines recommended by the Ministry of Agriculture and Fisheries. Sewer treatments were applied in January and July. For this work the Borough is divided into three districts each having about 20 miles of sewers. Each district is operated by two sewermen with a van and driver. For the first two days the entrances and manholes are pre-baited with rusk and on the third day the poison is deposited. Recording of the "takes" is made on each following day. During the progress of the work visits are paid by an Inspector from the Ministry of Agriculture. The dates on which the baiting is done are agreed by the No. 4 London Workable Area Committee in order that similar work in adjoining Boroughs may be co-ordinated. As a result of this half-yearly systematic treatment of rat infestations in sewers it was computed that, in St. Marylebone, 1,495 rats were killed in January and 1,570 in July. 13 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 the large majority of cases of infestation brought to notice. The three rodent operatives made a total of 10,307 visits in connection with this service. Dog Nuisance.—Contravention of the bye-law relating to the fouling of footways by dogs was reported by the Streets Nuisance Inspector in 19 cases and by police officers in two instances, 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 403, the amount of fines imposed being £164 9s. 6d. Pigeons.—Nuisance from these birds was the subject of two complaints relating to blocks of flats. Both complaints were dealt with satisfactorily and in one case a contractor was employed to reduce the number of pigeons. Noise.—Complaints of fifteen noise nuisances were received. They were concerned with such diverse mattersas garages, demolition of buildings, machinery in factories, burglar alarms, street musicians, radio, a club, and cockerels. The majority of these nuisances were abated after informal 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.—Observations were made regularly throughout the year, and complaints were received in respect of smoke nuisances arising from eleven premises, relating mainly to commercial undertakings and large blocks of flats. In most cases the nuisance, recurrent in some instances, was abated after informal action. Continued attention was also given to complaints arising from emissions from the two electricity generating stations in the Borough. During 1948 the use of wartime fuel (creosote pitch) ceased and a return was made to the type of oil normally used in oil-fired boilers. This necessitated a considerable amount of experimental work and adjustments to plant, in connection with which there was close co-operation between officers of the Public Health Department and engineers in charge of the installations. It was during this changeover period that most of the complaints arose. The ultimate effect was an improvement in combustion and a consequent lessening of atmospheric pollution. Poisons.—The names of 79 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 95. Factories.—The number of factories in the Borough is estimated to be not less than 2,000, of which approximately 75 per cent, have mechanical power and 25 per cent. are without mechanical power. Since the war the number of factories has shown marked fluctuations from time to time, and next year it is intended, if the exigencies of other services permit, to carry out a complete re-survey of all factory premises in St. Marylebone. Following inspections carried out during 1948, conditions were remedied in 112 instances (want of cleanliness, 51; insufficient or unsuitable sanitary conveniences, 52; overcrowding, 8; defective floor drainage, 1). Outworkers lists were received from 76 employers in respect of 132 contractors and 988 workpeople. SECTION D.—HOUSING. Permanent Schemes.—Work on the construction of the undermentioned estates progressed during the year and it is anticipated that two blocks of flats and maisonettes on the Barrow Hill Estate will be available for letting early in 1949 :— Estate. No. of Flats. Approximate Cost. Barrow Hill 172 £386.777 Church Street 140 £317,010 312 £703,787 A maternity and child welfare centre is being provided on the Barrow Hill Estate ; the Church Street Estate will include 18 shops. Both estates will have communal laundry facilities and central hot water. Negotiations were commenced during the year for the acquisition of certain freehold interests on the Townshend Cottages site in preparation for the invitation of tenders for the demolition of properties on the first section of the estate and the commencement of building operations for the erection of 70 flats on this section during 1949. The approximate cost of acquiring and developing the whole site and providing for the erection of 221 flats is £578,340. 14 The Minister of Health confirmed the compulsory purchase order made by the Council respecting the St. John's Wood Road site with a view to the erection thereon of a block of 23 flats at a cost of £13,500, and application was made to the Minister of Health for authorisation to obtain tenders for the development of the site in order that building works could commence in 1949. The Council are also investigating a number of small sites with a view to housing development. Adaptation of Premises.—The extensive survey of unoccupied premises was completed during the year and, where suitable, such premises were requisitioned to provide more housing accommodation. The total number of residential units held by the Council in requisitioned premises at 31st December, 1948, was 1,091. St. Marylebone Housing Association.—Twenty-four flats on the Cochrane Street site were completed and occupied during the year. The tenants were nominated by the Council. "Half-way" Houses.—Ministry of Health approval was received by the Council for inviting tenders for the conversion of Nos. 45-49, Beaumont Street and 39-41, Nottingham Street into " half-way " houses. Finchley Road and St. John's Wood Park Areas.—The London County Council made Orders under the Housing Act, 1936, for the compulsory purchase for housing purposes of properties in St. John's Wood Park, Boundary Road and Finchley Road. Approximately 16.810 acres (gross) of land included in the proposed schemes are within the boundaries of the Borough. The orders have not yet been confirmed by the Minister of Health. Fisherton Street Housing Estate (Borough Council).—The laundry at this estate was modernised during the year at a cost of £729, and the renovation of the central hot water system was undertaken. The repair of outstanding war damage was also completed. Crawford Place Dwellings (Borough Council).—The work of reinstating four basement flats used as an air raid shelter was put in hand and they will be ready for occupation next year. Inspection of Dwelling-houses.—Number of houses inspected for defects under the Public Health or Housing Acts—3,952 ; number of inspections made—9,140; number of houses found not to be in all respects reasonably fit for human habitation—1,144; number of defective houses rendered fit in consequence of informal action—925; number of houses in which defects were remedied by owners after service of formal notices under the Public Health (London) Act, 1936—239. Underground Rooms.—Number of rooms in respect of which closing orders were made under section 12 of the Housing Act, 1936—40; number of closing orders determined—4. In one case of a basement dwelling where there had been contravention of a closing order, legal proceedings were instituted under section 14 of the Act. A fine of 10s. was imposed and costs were awarded to the Council. A number of undertakings from owners not to use or permit to be used underground rooms for human habitation were accepted by the Public Health Committee during the year. Rehousing.—During the year 550 enquiries were received from the Council's Housing Director, the County Medical Officer of Health and the Director of Housing of the London County Council, and from other authorities, regarding the circumstances of persons applying for re-housing. Many applicants sought priority on grounds of overcrowding; others complained of the dilapidated condition of their dwellings or a lack of amenities; yet another group claimed preference on account of ill-health. Each case necessitated an investigation by a sanitary inspector before the enquirer could be provided with a report to assist him in assessing the degree of priority to be given to the various applicants. The number of these enquiries has shown a marked increase because, with the shortage of housing accommodation generally, applicants for re-housing are not now confined to persons living in the poorer parts of the Borough but include practically all classes of the population who have to seek other accommodation. Housing of Persons from Abroad.—In view of the great shortage of housing accommodation in this country and the need for preventing overcrowding wherever possible, it appeared desirable that there should be some procedure whereby a local authority was given an opportunity of expressing views on the adequacy or otherwise of accommodation proposed to be offered to persons who intended entering this country from abroad. The matter was therefore brought to the notice of the Metropolitan Boroughs' Standing Joint Committee with a view to the Government Departments concerned being approached to ensure that the local authority of any district in which it was proposed to house persons from abroad should be advised of the fact before those persons entered the country, in order that a report might be submitted to the appropriate government or other authority as to the adequacy or suitability of the accommodation intended to be offered. Action along these lines was prompted by 15 the fact that the London Commissioner of the Cyprus Government had "in order to avoid the possibility of overcrowding in the Borough by immigrants from Cyprus "asked the Medical Officer of Health during the year to report whether suitable accommodation to the standards laid down in the Housing Act, 1936, could be offered in eight cases where Cypriots residing in St. Marylebone proposed to offer accommodation in their homes to fellow-countrymen. Common Lodging Houses.—Sixty-seven visits were paid to the two lodging houses in the Borough: one, registered for 436 men, owned by the Salvation Army and situated at No. 2, Burne Street and premises in Lisson Street; the other, accommodating 100 women, conducted by the Church Army at Portman House, No. 10, Daventry Street. Rent Restriction Acts.—Three certificates as to state of repair of dwelling-houses were granted during 1948. Generally, such a 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. Transfer of Ministerial Functions.—Consequent upon the Ministry of Food having become a permanent Department, the Transfer of Functions (Food and Drugs) Order, 1948, made under the Ministers of the Crown (Transfer of Functions) Act, 1946, which came into operation on the 1st March, 1948, provided for the transfer of certain ministerial functions as between the Ministry of Health and the Ministry of Food. The effect broadly is that, with certain exceptions, the Minister of Food takes the place of the Minister of Health in the administrative and related interests of the central department in the Food and Drugs Acts, 1938 and 1944, and relevant Regulations. The executive powers of local authorities under the Acts remain unchanged. Food Analysis.—Samples of 87 different articles taken under the Food and Drugs Act, 1938, numbered 700 (73 formal, 627 informal) and included : milk 91, butter 83, margarine 82, cooking fat 77, cheese 75. The sum paid in respect of each analysis was 15s. Od. (£1 1s. 0d. as from the 1st July, 1948), except in the case of sausages for which the fee was £1 1s. 0d. per sample throughout the year. The majority of the 21 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 higher this year than it has been generally in St. Marylebone, 3.0 per cent. of the samples submitted being reported as adulterated. Milk in London is not usually adulterated, but this year a formal sample was found to contain 20 per cent. of added water, and again later an informal sample was found to contain 27 per cent. of added water and a formal sample which was taken as a follow-up the next day contained 30 per cent. of added water. Several food samples were submitted during the year as a result of complaints or were found to be unsatisfactory when examined in the laboratory, and your public analyst welcomes the growing confidence of members of the public who bring their complaints to the local authority in the hope that they will be examined by the public analyst for the area. Complaints of this type are examined sympathetically, even though it is not always felt that they are justified. Shopkeepers feel that the local authority treats them fairly, the complainant is left with the belief that, even if no drastic action has been taken, the food inspectors now know which shops to watch, and, in these days of rationing and when it is not too easy to change one's supplier, much unnecessary friction is saved in consequence. A sample of honey possessed an objectionable odour and taste due to decomposing insect matter and was therefore unfit for human consumption without considerable clarification. A sample of tomato juice was fermenting as a result of imperfect sterilisation; another of soup powder was found to be attacked by weevils. A bottle of artificial vinegar was taken to the food inspector with the complaint that it had been filled into a dirty paraffin bottle and the complaint was found to be justified. A tin of grapefruit was brought with the complaint that the contents possessed a "tinny" flavour, and examination showed it to contain 1.25 grains of tin per pound. This is an example of the change in the public palate as a direct result of improvements in manufacturing processes. The Report to the Local Government Board in 1908 by Drs. Buchanan and Schryver recommended that tin in tinned foods should not exceed 2 grains of tin per pound, but the average member of the public would now taste tin in excess of about half a grain per pound. It is generally believed that acid foods, such as tomatoes, grapefruit, etc., always cause an initial attack on the tin surface, but that when the air in the can has been used up the corrosion ceases. Your analyst is not entirely convinced in this matter, but there can be no doubt that the canning of food has now reached a very high standard. In the case in question your analyst suggested that the grapefruit should only be served in admixture with other fruits. A sample of peach conserve was 2.5 per cent. deficient in total solid matter, there being only 66 per cent. of soluble solids and this is the minimum requirement of the Food Standards (Preserves) Order. A sample of orange 16 squash contained 445 parts of sulphur dioxide per million of squash, 350 parts per million being the largest permissible quantity. A sample of "Sirop Francais " was found to be simply a sample of an artificially flavoured, coloured product and contained no fruit juice, so that it should have been described as flavoured and not as though it contained actual fruit juice. A sample of ginger essence also contravened the Soft Drinks Order and was probably old stock, Some dried coffee extract was sold as coffee whereas it was obviously in the vendor's interest to call it a dried pure coffee extract, which must be more expensive than the original coffee, of which only about 25 per cent. can be extracted. Two samples of meat paste were found to be 20 and 30 per cent. deficient in meat respectively, whilst some canned mutton had been sterilised during the canning process, but had been obviously decomposed and unfit for consumption before it was canned. Only one sample of horseflesh was submitted to the public analyst this year and this was submitted as horseflesh because it was admitted by the restaurateur that it was horseflesh, although it had obviously been intended for human consumption without disclosure that it was not beef. The worst case examined during the year consisted of a sample of so-called salad oil, which was stated to be a mixture of teaseed oil, liquid paraffin, and apricot kernel oil, whereas it contained over 99 per cent. of liquid paraffin. Unfortunately, it was not found possible to obtain a formal sample of this oil, although action was taken in other areas where formal samples had been obtained." Legal Proceedings.—Of the twenty-one samples adversely reported upon by the Public Analyst, proceedings were instituted under the Food and Drugs Act, 1938, in three instances involving the two samples of milk containing added water and the sample of horseflesh. In regard to the milk samples the defendants were fined £3 and costs in one case, and £2 and costs in the other. For possessing horseflesh for the purpose of sale for human consumption without displaying the requisite notice the defendant was fined £5 0s. Od. and costs. In the remaining cases legal proceedings were not advised and the matters were taken up with the manufacturer, wholesaler or retailer concerned. Proceedings were also taken under the London County Council Bye-laws made under Section 183 of the Public Health (London) Act, 1936, against three itinerant sellers of soft drinks for having no facilities for the proper cleansing of utensils and for selling drinks from contaminated glasses. Fines of 20s. and costs and 10s. and costs were imposed in two cases, the third being dismissed under the Probation of Offenders Act on payment of costs. Milk.—There are 160 premises from which milk is sold. Inspections made numbered 260. During the year 49 applications under the Milk (Special Designations) Regulations, 1936-1946, were received from 22 milk purveyors and licences were granted as follows: 1 pasteurising, 25 dealers' and 3 supplementary in the case of pasteurised milk; 1 bottling, 17 dealers' and 2 supplementary in respect of tuberculin tested milk. The average composition of the 88 genuine samples of milk analysed was: total solids, 12.29 per cent.; fat, 3.51 per cent.; solids not fat, 8.78 per cent., as compared with the legal minima, namely, 11.50 per cent., 3.00 per cent. and 8.50 per cent. respectively. Fifty samples of milk were taken at the premises of two authorised wholesale firms operating heattreatment plants and submitted to the tests prescribed for the various designations. One sample of pasteurised milk was unsatisfactory under the phosphatase test and the Area Milk Officer of the Ministry of Food was advised accordingly. Of forty other samples of milk examined bacteriologically all but one sample 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. Thirty inspections were made. Ice Cream.—The number of premises on the register was 121, and 200 inspections were made. Two applications for registration were refused as the premises in each case were considered to be unsuitable for the sale of ice cream. Seven samples of ice cream were examined bacteriologically. Of these, three were found to be satisfactory and four were below standard. The question of the unsatisfactory samples was in each case taken up with the manufacturers either direct or through the medical officer of health of the district in which the factory was situated. In 1947 the Council requested the Metropolitan Boroughs' Standing Joint Committee to take 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 street vendors of this commodity. The Standing Joint Committee, after considering the views of their constituent Councils, concurred in the proposal and made representations to the Ministry of Health and the Ministry of Food accordingly. 17 In reply, the Ministry of Health stated that the question would be borne in mind in conjunction with any further legislative control which might be considered desirable and practicable relative to ice cream. The Minister was of opinion, however, that the provisions of sections 14 (registration of premises) and 16 (dealer's name and address to be legibly displayed on vehicles) of the Food and Drugs Act, 1938, together with the public health safeguards under section 13 of the Act and the Ice Cream (Heat Treatment) Regulations, 1947, already afforded a substantial measure of protection to the consumer. Nevertheless, the Council felt that the matter was one of urgency requiring attention at the earliest possible moment and not at some future date, and therefore asked the Standing Joint Committee to make further representations, especially as regards the display of vendors' names and addresses on vehicles in a more permanent manner than is frequently the case. Preserved Food.—At the end of 1948, 107 premises were registered for the preparation or manufacture of preserved foods (sausages mainly) intended for sale, and 250 inspections were made. Fried Fish Vendors and Fish Curers.—The number of premises used by vendors of fried fish is 10 and by fish curers 3. Thirty inspections of fried fish shops and 26 inspections of fish curers' premises were carried out. Bakehouses.—Re-inspection of basement bakehouses was carried out in accordance with the provisions of section 54 of the Factory Act, 1937, which require a local authority to examine, every fifth year, all basement bakehouses for which a certificate of suitability has been issued. As a result, 11 certificates were renewed unconditionally; 4 certificates were renewed after repairs and alterations had been carried out; notice of termination of occupation was given in 3 cases where the bakehouse was found to be totally unsuitable; and consideration of one case, where the premises had been extensively war-damaged, was deferred in view of the owner's intention to re-plan the bakehouse on the ground floor. In a further instance where a basement had recently been brought into use as a bakehouse, contrary to the provisions of the section, legal proceedings were taken against the owners and the hearing of the summons was adjourned to allow time for the arranging of acceptable alternative accommodation above ground. During the year 51 inspections were made of bakehouses generally in the Borough. Restaurants, etc.—Premises in which meals are provided or food is sold already cooked or is prepared for sale numbered 848, including 302 restaurants, snack bars and railway refreshment rooms, 49 hotels, 329 staff canteens and clubs and youth organisation canteens, 133 public houses, 12 fish caterers and cooked meat retailers, and 23 school and nursery canteens: 1,295 inspections were made and 92 notices served. Difficulty was frequently experienced, more particularly where restaurants and other food premises were concerned, in securing the execution of works necessary to comply with sanitary notices and estimated to cost more than £100, because of delay in the issue of Ministry of Works building licences and, in some instances, refusal to issue a licence. The Council therefore made representations to the Metropolitan Boroughs' Standing Joint Committee that the appropriate Government Department or Departments be approached with a view to priority being given to the granting of building licences in respect of works called for by sanitary notices. The Standing Joint Committee subsequently raised the matter with officers of the Ministry of Works who stated that discussions on the subject had taken place with the Ministry of Food and that, as a result, it was anticipated that applications for licences would in future be dealt with more speedily. The Ministry of Food stated later that the local authority concerned would be consulted in all cases where an application for a building licence or a licence to obtain materials for repairs to premises or equipment had been submitted by a food trader on the grounds that the building works or repairs were necessary to enable him to comply with section 13 of the Food and Drugs Act, 1938, relating to provisions as to rooms where food intended for sale is prepared or stored, etc. Hygienic Paper Drinking Vessels.—The practice of serving liquid refreshments in paper drinking vessels, which are used once only and then put to salvage, has grown considerably in recent years, more especially in restaurants in open spaces. In the Zoological Gardens, for example, over a million of these containers are used in a year. From the public health point of view this must be regarded as an improvement over the use of crockery and glass which, in view of present scarcity and high prices, restaurant proprietors are apt to retain in use after the vessels have become chipped and cracked and therefore a possible source of danger to health. On learning that the Government had imposed a 50 per cent. purchase tax on hygienic paper drinking vessels, and fearing that this might have the effect of discouraging the catering trade from using them, the Council requested the Metropolitan Boroughs' Standing Joint Committee to consider approaching the appropriate Government Department with a view to the purchase tax on these vessels being removed. 18 Unsound Food.—Some 30 tons of food condemned as unfit for human consumption included the following : meat, 2 tons, 5 cwts. 22 lbs.; fish, 3 tons, 1 cwt. 23 lbs.; fruit, 1 ton, 14 cwts. 3 qtrs. 24 lbs. ; vegetables, 1 ton, 14 cwts. 1 qtr. 24 lbs.; cereals, 4 tons, 3 cwts. 3 qtrs. 7 lbs. ; canned goods, 20,962 tins ; miscellaneous, 5 tons, 10 cwts. 3 qtrs. 7 lbs. Practically all this unsound food was salvaged and diverted to other uses. Horseflesh.—Fifty 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. Ten 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 1948. 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 7 1 1 1 1 1 1 — 1 — — — — 7 — Erysipelas 18 — — — — — — — — 1 2 7 8 7 11 Scarlet fever 35 — 2 3 5 6 11 4 1 1 1 1 — 15 20 † Puerperal fever 1 — — — — — — — — 1 •— — — 1 Puerperal pyrexia 8 — — — — — — — 3 5 — — — 7 1 Acute poliomyelitis 6 — — — — — — 2 1 2 1 — — 6 — Polio-encephalitis 1 — — — — — — 1 — — — — — 1 — Paratyphoid fever 1 — — — — — — — — — — 1 — — 1 Pneumonia 48 4 1 4 — — 1 1 — 6 8 14 9 32 16 Dysentery 13 — 1 3 — 1 — — — 1 2 5 10 3 Measles 354 22 58 38 48 48 105 9 4 17 4 1 — 44 310 Whooping cough 128 15 22 21 24 16 29 1 — — — — 18 110 Scabies 30 — — 1 2 — 1 2 2 11 4 5 2 — 30 Malaria 1 — — — — — — — — — 1 — — — 1 T uberculosis— Pulmonary 74 —— — 1 1 — — 1 6 27 18 17 3 28 46 Non-pulmonary 7 — 1 1 — — — 1 — 4 — — — 7 — Totals . 732 42 86 73 81 72 148 22 18 76 39 48 27 183 549 ‡ There were no cases of the following diseases, which are also notifiable in the Borough: Smallpox, cholera, typhus fever, enteric fever, relapsing fever, continued fever, plague, glanders, farcy, anthrax, induced malaria, encephalitis lethargica, ophthalmia neonatorum, cerebro-spinal fever. † Under section 50 of the London County Council (General Powers) Act, 1948, which came into force on the 30th July, 1948, puerperal fever ceased to be a notifiable and dangerous infectious disease for the purposes of the Public Health (London) Act, 1936. Puerperal pyrexia continues to be notifiable. Psittacosis (Parrot Disease).—Though not a notifiable infectious disease, a case of psittacosis, a comparatively rare condition believed to be communicable by parrots, presented some interesting features despite the fact that the investigation into the source of the disease proved inconclusive. The patient (a male, aged 34 years) was removed to hospital suspected to be suffering from cerebrospinal meningitis, but three weeks later his condition was diagnosed as acute psittacosis. From enquiries made it was ascertained that the patient was a keen bird fancier, and that prior to his illness he had attempted to cure a stray pigeon with a broken wing, but being unsuccessful had had to destroy the bird. About the same time he had visited Club Row, the East End market where parrots and other birds are offered for sale. Further investigation revealed that the patient had spent a fortnight's holiday at Ramsgate during which he went to a fun fair where tropical birds were exhibited. The medical officers of health of the various districts visited by the patient were advised of the circumstances 19 and made extensive enquiries locally, but no information of value in tracing the origin of infection could be obtained. The patient recovered and no other cases of psittacosis were notified. A full report of the occurrence was submitted to the Ministry of Health whose Medical Officers were especially interested in the case, particularly having regard to its sporadic nature and the opportunity it afforded of further research. *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 one elementary school where, apart from new cases, 114 additional protective injections were given. Four general practitioners who wished to carry out immunisation of their patients in the home or at the surgery were supplied with the necessary prophylactic free of charge. A.P.T. (Alum Precipitated Toxoid) was the agent generally employed. T. A. F. (Toxoid-Antitoxin Floccules) was used in a small proportion of cases. TABLE 7.—Work of the Diphtheria Immunisation Clinics. Pre-school children School children Adults Totals Attendances 1,043 110 - 1,153 New cases 305 35 - 340 Schick negative — — - — Completely immunised but not retested 267 4 - 271 Retested 224 3 - 227 Positive after retest 17 1 - 18 *Vaccination.—Vaccinations carried out in the Borough numbered 487 (primary, 347; re-vaccinations, 140). Vaccination was successful in 415 instances; unsuccessful in 68; while 4 cases were not available for inspection. Section 26(5) of the National Health Service Act, 1946, repealed the Vaccination Acts, 1867-1907, the effect being that vaccination against smallpox ceased to be compulsory after the 4th July, 1948. The powers of metropolitan borough councils in regard to vaccination were then transferred under the Act to the London County Council who prepared a scheme, approved by the Minister of Health, for making arrangements with medical practitioners for the vaccination of persons desiring it. International Certificates of Vaccination and Inoculation.—In accordance with the request of the Ministry of Health, arrangements were made for the authentication by the Medical Officer of Health of certificates of vaccination and inoculation issued by medical practitioners in St. Marylebone in respect of persons proceeding abroad. Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 352 cases of scabies : adults 55 (men 29, women 26) ; children 297 (boys 136, girls 161) Domiciliary visits paid in connection with St. Marylebone cases numbered 49. Impetigo.—Forty boys and 152 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, nine lectures on sex education were given at various youth centres in the Borough. Health films by the Central Office of Information were shown at a meeting arranged by a church organisation in St. John's Wood. 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 diabetics were provided free of cost by the Council in one case, under the authority of Ministry of Health Circular 2,734, dated 4th January, 1943. Food Poisoning.—No outbreak of food poisoning, which is notifiable in the Borough, occurred during the year but two unrelated cases were reported. In neither instance was the source discovered, and both patients recovered. * The information contained in these paragraphs relates to the period 1st January, 1948, to 4th July, 1948. 20 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 t NEW CASES DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 - - - - - - - - 1—5 - 2 1 1 - - 1 - 5—15 — 1 1 1 - - - - 15—25 6 23 - 3 - 1 - 1 25—35 25 11 — 2 4 3 - - 35—45 18 9 - 1 7 4 - - 45—55 9 5 1 - 3 - - - 55—65 6 3 - 1 3 - - - 65 and upwards 5 2 — — 2 1 - 1 Totals 69 56 3 9 19 9 1 2 ‡ Including all primary notifications and also any other new cases of tuberculosis which came to the knowledge of the Medical Officer of Health during the year. Notifications.—Table 6 (p. 18) 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, 1948, on the register was 774, 64 more than at the end of the previous year. *Dispensary.—The work of the Dispensary continued to increase generally. Statistics: new patients, 365 (including 76 contacts), old cases, 457; attendances, 3,485; tuberculosis officer called into consultation on 289 occasions; hospital visits by tuberculosis officer, 26; home visits by tuberculosis visitor, 266; 2,064 examinations (films, 1,017; screening only, 1,047) were made by means of the Council's X-ray plant. Sixty-three patients received artificial pneumothorax treatment on the premises and 682 refills were given. Sputum examinations carried out numbered 409. Expenditure on milk supplied to 105 tuberculous persons for varying periods amounted to £688 6s. 5d. 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.1, which is maintained by a voluntary organisation and possesses facilities for the treatment of tuberculosis. *Institutional Treatment.—Admissions to hospital or sanatorium numbered 54. *Dental Treatment.—The arrangement for tuberculous persons to be seen by the Borough Council's Dental Surgeon by special appointment was continued, and six patients 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. Twenty-two patients applied for assistance and in all cases financial aid, totalling £1,817 1s. 11d., was afforded. *Government Rehabilitation Scheme.—Sixteen patients were referred under this scheme to the Local Officer of the Ministry of Labour and National Service. *Care Committee.—The Committee held 6 meetings and dealt with 96 cases. Disinfection.—During the year, 1,198 rooms and 18,580 articles (including 342 books) were disinfected after infectious diseases generally. In addition, 3,767 dressing drums from a local hospital were sterilised. Bacteriological Examinations.—Table 9 shows the number of specimens examined for the purposes of diagnosis and indicates also the organisms in relation to which the examinations were made. * The information contained in these paragraphs relates to the period 1st January, 1948, to 4th July, 1948. 21 TABLE 9.—Work of the Bacteriological Laboratory. Nature of Specimen and Examination Positive Negative Total Throat and nasal swabs for— B. diphtheriae 1 202 203 Haemolytic streptococci 19 76 95 Monilia 4 4 8 Meningococci — 12 12 Sputa—for tubercle bacilli 114 612 726 Faeces—for parasites 17 30 47 Faeces—for dysentery and food poisoning organisms 1 29 30 Blood—for typhoid, paratyphoid and Brucella abortus 1 11 12 Vaginal swab—for trichomonas — 3 3 Skin scrapings—for ringworm 3 4 7 Urine—for organisms — 1 1 Foods—for food poisoning organisms — 4 4 Totals 160 988 1,148 APPENDIX I. NATIONAL HEALTH SERVICE ACT, 1946. TRANSFER OF FUNCTIONS. (I) Personal health services transferred from the St. Marylebone Borough Council to the London County Council or the Regional Hospital Board on the 5th July, 1948 :— (i) Tuberculosis Dispensary Service—to the Regional Hospital Board. (ii) Vaccination (iii) Diphtheria Immunisation (iv) Maternity and Child Welfare : (а) Clinic Provision (b) Home Visitation (c) Day Nurseries (d) Child Life Protection (e) Dental Treatment (/) Home Helps and Domestic Helps To the London County Council. (II) Functions which will continue to remain the responsibility of the Borough Council:— (i) Infectious Diseases (including Food Poisoning) (a) Notification, Investigation, etc. (b) General Epidemiological Work, e.g., Disinfection (c) Bacteriological Examination of Specimens (ii) Environmental Health Services (а) Nuisances (b) Drainage of New and Old Buildings (c) Smoke Abatement (d) Factories (e) Common Lodging Houses (f) Slaughterhouses (g) Offensive Trades (h) Rag Flock Regulations (i) Disinfestation (j) Rats and Mice Destruction (k) Pharmacy and Poisons Registration (l) Street Market Inspection (m) Private Water Supply Examination (n) Shops Act Inspection (o) Diseased or Infirm Persons (p) Street Nuisances 22 (iii) Food and Drugs (a) Food Adulteration and Labelling (b) Chemical Analysis and Bacteriological Examination of Food (c) Restaurants, Canteens, Hotels, etc. (d) Bakehouses (e) Milk Depots and Dairies (/) Inspection and Condemnation of Unsound Food (g) Fried Fish Vendors and Fish Curers (h) Butter and Margarine Premises (i) Preserved Food Manufacturers (j) Ice Cream Makers and Vendors (k) Horseflesh Premises (I) Slaughter of Animals (iv) Housing (a) Surveys of Areas (b) Inspections of Individual Properties (c) Building Licence Enquiries (d) Underground Rooms (v) Miscellaneous (a) Cremation—Issue of Certificates Authorising (b) Staff Medical Examinations (c) Authentication of Medical Certificates of Inoculation (d) Public Conveniences (e) Public Mortuary (/) Cleansing of Persons (g) Physical Training and Recreation (h) Health Propaganda (vi) Statistics (a) General Statistics (b) Vital Statistics (c) Birth, Death and Marriage Rates ————_—— APPENDIX n, THE STORY OF MATERNITY AND CHILD WELFARE IN ST. MARYLEBONE, 1906-1948. (On the 5th July, 1948, the functions of the St. Marylebone Borough Council as Welfare Authority pass into the hands of the London County Council under the provisions of the National Health Service Act, 1946). The Pioneers.—In any account of work carried out in the Borough to safeguard the health of expectant and nursing mothers and young children, it is necessary to give prominence to the important part played by voluntary organisations throughout the whole period under review, but particularly in the earlier years, in building up a welfare service second to none in its value to the community. Official and voluntary elements have always existed side by side in the development of the scheme in St. Marylebone, and opportunity will be taken in these notes to pay tribute to the pioneer efforts of the St. Marylebone Health Society and other voluntary bodies who have devoted their energies whole-heartedly to the welfare of mothers and infants during the past 42 years. As far back as 1906, the first infant welfare clinic in London was inaugurated, in collaboration with the Borough Council and the St. Marylebone Health Society, by the late Dr. Eric Pritchard, a foremost paediatrician of his day, at the St. Marylebone General Dispensary, No. 30, Marylebone Lane. This provided a great stimulus to others and was the means of bringing about the general setting up of infant welfare centres and schemes not only in the metropolis but throughout this and other countries. Although not then known as a "Maternity and Child Welfare Scheme," other works in this connection were commenced during that year, and in the discussions that arise from time to time as to which was the first district to begin infant welfare work, the name of St. Marylebone is always mentioned as at least being among the earliest in this field, as it has been in other major pioneering works in the realm of public health. 23 At that time a woman inspector from the Public Health Department visited a certain number of newly-born infants and reported that the mothers "show a real anxiety to follow the advice given to them." Reliance for the information of this group of births was placed upon lists supplied by registered midwives, but in the following year the Council adopted the Notification of Births Act, 1907 (extended in 1915 to make general the compulsory notification of births) which provided the Department with information of all births occurring in the Borough. It is of special significance that in these early years "Infantile Mortality" formed the main theme in discussing child welfare in the annual reports of the medical officer of health, and it will be necessary to refer again to it later in these notes. In 1912, three specially trained women inspectors devoted a considerable part of their time to what was then known as "baby work." The First Scheme.—It was not until 1914 that the term "Maternity and Child Welfare" was first used. In that year the Local Government Board (predecessor of the Ministry of Health) suggested in a memorandum the lines upon which a maternity and child welfare scheme might be constructed. This involved the establishment of ante-natal clinics, infant consultations and the provision of hospital accommodation for women during their confinement. In St. Marylebone it was seen that there was already in existence everything necessary for a complete scheme, as suggested by the Board, to ensure the fullest possible provision for both mother and child. The Maternity and Child Welfare Act of 1918 widened further the powers of the Council in this connection, and these powers were subsequently embodied in the Public Health (London) Act, 1936. Side by side with the home visitation carried out by the Council's health visitors, aided by voluntary workers, the St. Marylebone Health Society continued, from 1907, to open centres—or schools of mothercraft as they were named—in parts of the Borough where there appeared to be a need for them. Of the existence of the need there was no doubt, as with the proposed establishment of ante-natal clinics in 1914, for example, it was found that of 46 women questioned, 14 only had been examined or seen by a doctor during pregnancy, and of these 14,11 were first confinements. In 1919, after many changes of premises during the intervening twelve years, there were five centres providing ante- and post-natal and infant consultations under medical supervision at the following addresses: No. 14, Salisbury Street; No. 30, Marylebone Lane; No. 8, Ogle Mews; Lord Roberts' Club, Barrow Hill Road; and No. 101, Crawford Street. During this time, in addition to the normal functions of the clinics, the interest of the mothers was sustained by mothercraft competitions (making and adapting of garments, cooking, laundry work, etc.); lectures on health and sanitation; needlework and other classes; and summer outings. Four other welfare centres, also maintained by voluntary organisations, were established later at Queen Charlotte's Hospital and the Middlesex Hospital (at both of which maternity accommodation was available) and at the Western General Dispensary and Church Army Dispensary. In addition, the Health Society established a dental clinic for mothers and young children in 1917, and a year later opened at No. 20, Marlborough Hill a nursing home for 'wasting' babies which, unfortunately, had to close in 1922 owing to lack of funds despite the Council's contribution of £1,000 per annum. In 1918 also, a massage clinic was started at No. 101, Crawford Street. A number of other voluntary bodies assisted in the scheme, the connecting link between them all being the Public Health Department of the Council. It will be seen that the St. Marylebone Health Society were responsible for providing the bulk of the facilities at this time and on many occasions generous tribute was paid to this body and those who worked for it for all they had done in relation to maternal and child welfare. The Council's staff at this stage consisted of six health visitors. Two were engaged full time on the work, the remaining four giving part-time only as they held dual appointments as sanitary inspectors. Voluntary workers of the Health Society also assisted at the centres and in home visitation. At the present time, when the Home Help Service is an important ancillary to maternity and child welfare, it is interesting to note that home helps were employed by the Council in 1919 and that, moreover, it was intended to employ only women who had received special training in the work at one of the welfare centres. The difficulty of finding suitable women was apparently as acute then as it is today, for it was finally decided to engage women experienced merely in ordinary housework, and the arrangement is reported to have proved highly successful. In 1927 the Diphtheria Immunisation Clinic started and has continued until the present day when it may safely be claimed that the percentage of children protected against the disease is extremely high and compares favourably with the results obtained in other areas. In this year also the actinotherapeutic section of the Health Society was opened at the Salisbury Street Welfare Centre, the apparatus being presented by Mr. Frank Keevil, a member of a well-known firm in the Borough. 24 In 1931 a special three-year-old pre-school clinic was established as an experiment and achieved a most useful purpose for some years. The object of its initiation was to endeavour to make touch before they entered school with children who had never attended any clinic or welfare centre and to find out something with regard to their condition for their own benefit and for the information of the school medical officer. A New Era.—The year 1935 saw the beginning of fresh developments in the Maternity and Child Welfare Scheme of the Borough. It had been generally accepted that the St. Marylebone Health Society might continue indefinitely to take a prominent part in the Scheme, and year by year the Council had made substantial grants to the Society for the purpose. Early in 1935, however, mainly as a result of difficulties in connection with accommodation for centres, the Society decided that the time had arrived when it would be sufficient to confine their activities to the provision and management of day nurseries, and on the 1st April, 1935, all their other responsibilities as regards maternity and child welfare were taken over by the Borough Council. At this juncture the opportunity was taken by the Council to review the scheme as then constituted, to decide the immediate procedure to be adopted at the change-over and to plan for the future, the ultimate aim being to form two main centres in new and specially constructed buildings. In the meantime arrangements were made to carry on the various clinics in the centres already provided by the Health Society and to retain the services of their medical and other officers and workers. An important step was taken at this stage by appointing a full-time maternity and child welfare medical officer—Dr. W. H. S. Wallace, who has remained with the service ever since. During the next few years the work continued on these lines, often with difficulty. A "general post" of centres took place as a number of the old buildings, including a disused public house, which had served for clinic purposes for many years had to be vacated and temporary accommodation found in premises which were cramped and far from suitable. The Modern Welfare Centre.—The year 1938 saw the beginning of the realisation of the Council's concept of what a welfare centre should be, for in January of that year the Lisson Grove Welfare Centre (opened by the late Alderman R. Stiles Allen, J.P., as Mayor of the Borough) was brought into use. The facilities available here include clinics for :— Ante-natal cases Post-natal cases Infant welfare Family planning Artificial sunlight therapy Remedial exercises Massage Dental treatment Chiropody] Diphtheria immunisation Two years later—in April, 1940—the remainder of the Council's clinics, housed temporarily in the Old Baths Establishment, Marylebone Road, found a permanent home in the new Welfare Centre, forming part of the Town Hall Extension, where there is clinic provision for:— Ante-natal cases Post-natal cases Infant Welfare Artificial sunlight therapy Remedial exercises Massage Child guidance Diphtheria immunisation Both these modern centres, fitted out with the most up-to-date equipment, have served and continue to serve their purpose well. The Council are justly proud of them, and if further evidence of their excellence were needed it can be found in the fact that they have been visited by Ministers of Health, members and officers of the London County Council and other local authorities and, at the special request of the Ministry of Health, by many distinguished visitors from this country and abroad. Publicity experts have also realised their value for radio broadcasts and films. In addition to these two centres, ante- and post-natal and infant welfare clinics held at the Middlesex Hospital form part of the Council's scheme; and in 1944 the Public Health Committee suggested that, in order to ensure the provision of conveniently accessible centres in all parts of the Borough, the series should be completed by the inclusion of a branch Maternity and Child Welfare Centre in the planning of the Council's Barrow Hill Road Housing Estate. This building is now in course of erection. 25 The Day Nursery.—No review of maternity and child welfare would be complete without reference to one of its most important auxiliaries—the day nursery. Day nurseries existed in the Borough over 40 years ago for it is reported in 1906 that nurseries at St. Paul's, East Street; Portland Town ; St. Mark's, Violet Hill; and Ogle Mews were all found to be exceptionally well managed, clean and well ventilated. In 1917 the St. Marylebone Health Society added to its other responsibilities by opening the Portman Day Nursery at No. 45, Exeter Street (now Ashbridge Street), the building being equipped and given rent free by Lord and Lady Portman. In the same year the Health Society took over the Crossley Day Nursery at No. 38, Barrow Hill Road, founded and supported for many years by the late Mrs. Crossley. After several moves to temporary accommodation, the Portman Day Nursery finally found its permanent home in 1938 in the well-equipped nursery premises built and owned by the Health Society in Salisbury Street which remain a familiar feature among the modern welfare buildings of the Borough. A third nursery—the St. Vincent de Paul—has existed in the Borough for many years, first in Wigmore Street and later in Blandford Street. The Health Society's nurseries continued to function until the outbreak of war in 1939, when they were evacuated to the country and did not re-open in the Borough as voluntary nurseries after hostilities had ceased. Four day nurseries, all recognised as training centres for nursery students, were established during the war, three under the direct control of the Council and one maintained by a voluntary body. All continue to meet an urgent need in the Borough. The Reckoning.—After reading this summary the question may well be asked: "What results of benefit to the community have been achieved by over 40 years of effort in the field of maternity and child welfare ? " For reply it is necessary to refer to statistics, which have so far been avoided in these notes as they are available elsewhere in great detail. A reliable index to the state of child welfare in any area is to be found in the infantile mortality rate, which is the number of deaths of infants under one year of age per 1,000 of the births which occurred in the same year. Commenting on the infantile mortality rate of 173 per 1,000 births in 1871, the Medical Officer of Health at that time points to the "melancholy fact that out of every 100 children born in St. Marylebone about 37 die in the first five years of their existence, no inconsiderable number of them being victims of the great and glaring defects that still continue to characterize our social and sanitary enactments." A similarly high rate continued for 30 years ; from 1901 to 1906 it dropped to about 140, and from 1907 remained at approximately the 100 mark for 12 years, falling to 65 in 1920. During the next 20 years it varied between 60 and 90, but in 1941 declined sharply to 41. For the next 4 years it changed little—from 49 to 46—but in 1946 (the latest figure available) it reached a new low record of *36— one-fifth of the rate 50 years ago. If this statistical survey be extended to cover the past century, it is found that today five times as many children survive their infancy as in 1848; less than half as many mothers die in childbirth ; and the expectation of life at birth has risen by 20 years. This then is the brief record of maternity and child welfare in the Borough of St. Marylebone since the earliest days. Many factors have contributed to the success of the work, not least among them the keenness and enthusiasm of the Council at all times to improve and extend the service in any direction likely to bring benefit to the mothers and children; the never-failing support accorded by the Public Health and Maternity and Child Welfare Committee to successive Medical Officers of Health in the administration of the scheme ; the invaluable influence and assistance of numerous voluntary organisations, notably the St. Marylebone Health Society; and the efficiency and loyalty of the medical, nursing and administrative staff during a long period of years disturbed by two wars. To the generations of mothers, too, must be given credit for their participation and co-operation in the various services provided for their good. And finally, perhaps the most important element in the progressively successful results achieved in a service which is itself personal and homely is to be found in the intimate contact and close relationship which have always existed between the staff of all grades and the expectant and nursing mothers who have taken advantage of the scheme. It is to be hoped that it may be found possible to maintain this relationship when the work passes into other hands. Town Hall, St. Marylebone, W.l. July, 1948. *When the 1947 figure was subsequently published, it showed a still further remarkable drop in the infantile mortality rate to 26.55. .