CHE 21 Metropolitan Borough of Thelsea. Annual (Abridged) Reports OF THE MEDICAL OFFICER OF HEALTH, LOUIS G. PARKES, M.D.. D.P.H., FOR THE YEARS 1915 and 1916. LONDON. Printed by Pite and Thynne, 278a, King's Road, Chelsea, S.W. 1917. Metropolitan Borough of Chelsea. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1915. POPULATION OF CHELSEA. The estimated population of the Borough for the middle of the year 1915 is 61,830. A decrease of 200 below the estimated population of 1914 has been assumed, as a considerable number of houses in the Camera Square area were closed and demolished in the course of the year. A further reduction of 5,370 males of military age, called into the ranks of the Army, has been made in accordance with the figures given by the Registrar-General, to obtain the civil population of the Borough. Births and Birth-Rate. In 1915, 1,100 births were registered in the Borough. Excluding 118 births of non-parishioners, and including 86 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 1,069, the corresponding figure for 1914 being 1292. The birth-rate for 1915 was 17.3 per 1,000, which is 1.9 per 1,000 lower than the rate of 1914. Notification of Births. Number. Living children 871 Still-born children 26 897 Notified by Medical Practitioners 295 „ St. George's Hospital 117 ,, Midwives 404 „ Chelsea Workhouse 37 „ Parents 61 914 Dual notification—deduct 17 897 Total number of Chelsea births registered in Borough, 982. 2 The notifications, therefore, formed 91 per cent, of the total births registered in the Borough. It is estimated that, on an average, 49 per cent, of the total births are attended by medical practitioners in private practice or in institutions; 11 per cent, are attended by hospital students; and the remaining 40 per cent, by midwives. Deaths, Death-Rates, and Disease Prevalence. The total number of deaths registered in the Borough was 1,983. Of this number 1,124 were deaths within the Borough of nonparishioners; and 225 deaths of parishioners occurred outside the Borough. There were, therefore, 1,084 deaths of Chelsea residents, the death-rate being 17.5 per 1,000, as against 13.3 in 1914, in which year, however, no deduction was made for men of military age called up for service with the Colours. In 1915 there were a considerable number of deaths amongst children under 5 years from measles and bronchitis; and amongst old people over 65 years of age there was an increased mortality from bronchitis, pneumonia and organic heart disease. There were 107 deaths of infants under 1 year of age, equivalent to an infant mortality rate of 100 per 1,000 births. In 1914 the rate was only 67 per 1,000. During the year the homes of 647 recently born infants were visited by the Woman Sanitary Inspector, who is also a half-time Health Visitor. Ninety-one re-visits were made, and there were 246 miscellaneous calls at houses in connection with this work. Measles caused 39 deaths in 1915, as compared with 1 only in 1914, 32 of the deaths occurring in the second quarter of the year. Nine of the fatal cases were of infants under 1 year, 19 of children between 1 and 2 years, and 10 of children of 2 to 5 years. In addition, there were 31 deaths of infants under 1 year from bronchitis and pneumonia, and 14 deaths from the same diseases of children aged 1 to 2 years. Probably a considerable number of these deaths from bronchitis and pneumonia were the after effects of measles. During the year 416 children were excluded from schools as suffering from measles, and 226 as contacts. During the year 142 cases of scarlet fever were notified in Chelsea, as against 281 in 1914. Five deaths were registered as due to scarlet fever, which gives a case mortality of 3.7 per cent., as compared with 1.4 per cent, in 1914; 94 per cent. of the cases were removed to hospital. There was no special incidence on any particular school in the Borough. The percentage of cases of school age (3 to 13 years) was 64, as against 76 in 1914. In 1915, 105 cases of diphtheria were notified in Chelsea, as compared with 76 in 1914. The type of the disease was mild, 6 deaths only being attributed to diphtheria, the case mortality being 6.4, as compared with 10.5 per cent. in 1914. Until the latter end of September the prevalence of the disease was very slight; but after this date there was an increase, which tended, however, to subside in December. Of the notified cases 89 per cent, were removed to hospital, as against 93 per cent. in 1913. There was no special incidence on any school, and the percentage of cases of school age (3 to 13 years) was 61, as against 58 in 1914. 3 During the year medical practitioners sent 142 throat swabbings to the Lister Instiute for bacterioscopic diagnosis, as compared with 115 in 1914. Of the 142 specimens, 97, or 68 per cent., were 6ent by the Victoria Hospital in respect of Chelsea children. Of the total 142 specimens, 30, or 21 per cent., afforded positive evidence of the diphtheria bacillus, and 112, or 79 per cent., were negative. In 1914 the positives were 19 per cent., and the negatives 81 per cent. The number of cases of enteric fever notified was 19, as against 23 in 1914. Of the total of 19 cases, 2 were soldier patients in military hospitals, and not ordinarily Chelsea residents. Of the remaining 17 cases, in 4 the diagnosis was not confirmed at the hospitals to which the patients were removed. In another case, kept at home, the disease was probably not enteric fever. In 2 cases the patients were infected prior to arrival in Chelsea—one in Spain and the other whilst caravanning in Oxfordshire. There were, therefore, only 10 cases of enteric fever out of the 19 notified in which it seems probable that the infection was contracted within the Borough. There were no deaths; 79 per cent. of the cases were removed to hospital. Six specimens of blood from suspected cases were sent to the Lister Institute. Three gave positive and 3 negative results. The deaths in Chelsea in 1915 from diarrhoea and enteritis were 18 in number, as compared with 28 in 1914. Fifteen of the deaths were of infants under 1 year, and 2 were between 1 and 2 years of age. Only 5 deaths occurred in the summer quarter of the year, as compared with 11 in 1914, 13 in 1913, 2 in 1912, and 48 in 1911. Only 7 cases of infantile diarrhoea were visited by the Health Visitor in 1915, as compared with 64 cases in 1914. Influenza caused 19 deaths in 1915, as against 13 in 1914. The number of deaths from respiratory diseases was 276 in 1915, as compared with 180 in 1914. Under 5 years of age there were 48 deaths, against 24 in 1914; over 45 years of age there were 200 deaths, as against 136 in 1914. The year was one of marked prevalence and fatality from diseases of the respiratory organs. The deaths from pulmonary tuberculosis in 1915 numbered 88 (57 males and 31 females). Other tubercular diseases caused 19 deaths (11 males, 8 females). Of the pulmonary tuberculosis cases ending fatally, 37.5 per cent. died in the Chelsea Infirmary, and 27.3 per cent. in other public institutions: that is to say, 64.8 per cent. died away from their homes. In 1914 the corresponding figure was 63.1 per cent. During the year 119 new cases of pulmonary tuberculosis were notified, as against 157 in 1914, 63 being males and 56 females. Of the notified cases of pulmonary tuberculosis on the register, 54 died during the course of the year. Seventy-five specimens of sputum were sent by medical practitioners to the Lister Institute for examination, as against 70 in 1914. Of the 75 specimens, 32 per cent, were positive for T B., and 68 per cent, negative; the figures for 1914 being 37 per cent. positive and 63 per cent. negative. During 1915, 40 cases of pulmonary tuberculosis were discharged from open-air sanatoria, in which they had received institutional treatment as "insured persons" under the sanatorium benefit provided by the London Insurance Committee. The average duration of the stay of these 40 persons in the sanatoria was 3.3 months, as against 3.2 in 1914 and 4 2.5 in 1913. Five of the patients died in sanatoria. In addition to the 40, 8 insured persons have had hospital treatment, the average duration of stay in hospital being 2.8 months. Two patients had both sanatorium and hospital treatment. Seven uninsured persons received open-air sanatorium institutional treatment under the London County Council scheme for the uninsured. The average duration of stay in a sanatorium was 2.4 months. In addition, 2 cases had treatment in Brompton Hospital; average stay, 4 months. Compared with previous years, the amount of open-air sanatorium treatment provided for pulmonary tuberoulosis cases under the Insurance Committee and the London Connty Council has been exceptionally good. The number of new cases of pulmonary tuberculosis visited in the course of the year was 105, and of non-pulmonary cases 15. The total number of visits paid in respect of all cases of tuberculosis was 596. Five patients were lent beds and bedding by the Borough Council, and 18 pocket spittoons were given away. Sixteen contacts were sent for medical examination: 7 to Brompton Hospital, of whom 3 were found to be tuberculous; and 9 to St. George's Hospital, of whom 5 were found to be tuberculous. Twenty-two new cases of non-pulmonary tuberculosis were notified in 1915, 11 being children under 15 years and 11 adults. Thirteen cases were helped to obtain proper surgical treatment in hospitals, and 8 were sent to country or seaside homes. As in previous years, a great deal of this work was carried out by the Invalid Children's Aid Association. Ten cases of cerebrospinal meningitis were notified in Chelsea in 1915, 5 of the cases proving fatal. Seven of the cases were under 15 years of age ; 9 cases were removed to hospital. Three cases of poliomyelitis (infantile paralysis) were notified in Chelsea in 1915—a girl of 2 years and 2 baby boys of 8 and 10 months. All 3 children were attending as out-patients at the Victoria Hospital. The illnesses were mild, and no permanent paralysis ensued. Twelve cases of ophthalmia neonatorum were notified in Chelsea in 1915, and an additional 14 cases of eye trouble in infants, which were not notified, were visited by the Woman Sanitary Inspector. Of these 26 cases, 17 made complete recoveries; 6 were left with some eye weakness; in 1 case the eyesight was permanently injured, involving more or less blindness; in another case the infant died; and one was removed out of the Borough. Steps were taken in every case to insure that the affected eyes received appropriate treatment. Five cases of puerperal fever were notified in Chelsea in 1915, as compared with 8 in 1914. One case ended fatally. Two of the cases were attended in their confinements by medical practitioners and 3 by midwives. Three of the cases were removed from their homes to hospitals. Whooping cough caused 8 deaths in 1915, as compared with 7 in 1914. Five of the fatal cases were of infants under 1 year. The schools notified 55 children as suffering from this disease, and 16 contacts were also excluded from school attendance. 5 Work of the Public Health Department. During the year 1915, 1,013 separate premises were reported on by the staff, 362 of this number being with reference to cases of notifiable infectious disease, and 270 in the course of house-to-house inspections made in certain of the poorer streets of the Borough. No legal proceedings were taken for breaches of the Public Health (London) Act. During the year 504 inspections were made of factories and workshops. Verminous School Children.—During the year 65 children attending elementary schools in the Borough were reported as being found by the school nurses to be in a verminous condition as regards their heads, their bodies, or both heads and bodies. The corresponding number in 1914 was 266 children. The decrease in 1915 is the result of the great depletion in the staff of school nurses, owing to the war. All the houses of the verminous children reported were visited by the Woman Sanitary Inspector. Disinfection During the year 1915, 426 premises were disinfected after cases of infectious or other disease, 76 of these being rooms which had been occupied by tuberculous persons. In addition, 396 rooms were disinfected for the presence of bugs and other vermin. At the disinfecting station 4,708 separate articles of bedding or clothing were disinfected, and 131 articles were destroyed in the incinerator. Of the total 4,708 articles disinfected, 3,626 were blankets, clothing and uniforms sent by the Military Authorities, viz., 1,661 from Duke of York's headquarters, 49 from No. 2 General Military Hospital, and 1,916 from the B.A.M.C. (T.) Sanitary Company, Manor Street. No charge was made for this work. Of the 3,626 articles disinfected, 2,068 were for lice, 49 for scarlet fever, 60 for scabies, 835 for cerebro-spinal meningitis, 293 for measles, 69 for ringworm, 44 for tuberculosis, and 207 various. Most of these articles of clothing were the belongings of soldiers who were contacts, and not actual sufferers from any of the above diseases. Sale of Food and Drugs Acts.—Of the 400 samples taken for analysis in 1915, 182 were milk, 175 being genuine, and 7 adulterated, equivalent to 3.8 per cent. of the total milks examined, as against 6 per cent. in 1914. Of the 7 adulterated samples, proceedings were taken and convictions obtained in 3 cases. In 2 cases the vendors were protected by warranties and no proceedings were taken. In 2 cases the amounts of adulteration were considered insufficient to warrant proceedings. Of butter 181 samples were taken, 170 being genuine and 11 adulterated. Proceedings were taken and convictions obtained in 2 cases. In 6 cases the samples were not taken under the Act, and in the remaining 3 cases (excessive water in small amounts) no proceedings were taken. Samples of other foods taken were found genuine, with the exception of 5 samples of cocoa, containing excessive husk. The vendors of these samples were cautioned. Staff.—Mr. F. C. Cook, sanitary inspector, and Mr. A. B. J. Hayden, clerk, joined the Sanitary Company, R.A.M.C. (T.), early in August. Mr. Cook's duties have been performed by the sanitary inspectors (2 men, 1 woman) remaining in the Council's service. Mr. Hayden's duties as clerk were performed by Miss Ingleson, who was specially engaged for the work. 6 ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1916. POPULATION OF CHELSEA. The estimated population of the Borough for the middle of the year 1916 is 63,130. An increase of 1,300 above the estimated population of of 1915 has been assumed, owing to the opening and occupation of the Lewis Trust Dwellings in 1916. The same deduction of 5,370 males of military age serving with the Forces has been made as in 1915. Births and Birth-Rate. For 1916, 1,123 births were registered in the Borough. Excluding 120 births of non-parishioners, and including 93 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 1,096, the corresponding figure for 1905 being 1,069. The birth-rate for 1916 was 17.4 per 1,000, which is practically the same as the birth-rate for 1915 (17-3 per 1,000). Notification of Births. Number. Living children 887 Still-born children 24 911 Notified by Medical Practitioners 304 „ St. George's Hospital 119 „ Midwives 393 „ Chelsea Workhouse 43 „ Parents 73 932 Dual Notifications—deduct 21 911 Total number of Chelsea births registered in the Borough—1,003. The notifications, therefore, formed 91 per cent. of the total births registered in the Borough, the same percentage as in 1915. The number of births notified by midwives was 42 per cent, of the total, the average for previous years being 40 per cent. Deaths, Death-Rates and Disease Prevalence. The total number of deaths registered in the Borough was 1,926. Of this number 1,175 were deaths within the Borough of non-parishioners ; 7 and 204 deaths of parishioners occurred outside the Borough. There were, therefore, 955 deaths of Chelsea residents, the death-rate being 15.1 per 1,000, as against 17.5 in 1915. There were 100 deaths of infants under one year of age, equivalent to an infant mortality rate of 91 per 1,000 births. In 1915, the rate was 100 per 1,000, and, in 1914, 67 per 1,000. During the year, the homes of 515 recently born infants were visited by the Woman Health Visitor; there were 140 re-visits, and 174 miscellaneous calls at houses in connection with the work. The health visitor also paid 19 visits to expectant mothers in connection with the newly started scheme of an ante-natal clinic at the Chelsea Health Society's premises, 49, Sydney Street. Measles caused 5 deaths in 1916, as compared with 39 in 1915. Two of the fatal cases were of infants under 1 year, and 3 of children between 1 and 2 years. Measles and German measles (Rubella) have been compulsorily notifiable during 1916. The following table shows the numbers of cases notified, and by whom :— Measles. Rubella. Notified by Doctor 375 179 ,, School 23 11 ,, Parent 3 — „ Others 27 6 428 196 Notified in 1st Quarter 55 22 ,, 2nd „ 216 116 ,, 3rd „ 88 49 ,, 4th „ 69 9 428 196 Of the total measles cases notified 72 per cent, were children between the ages of 2 and 15 years, the corresponding figure for German measles being 61 per cent.; 45 per cent, of the measles cases were children under 5 years, and 25 per cent, of the German measles cases. On the 21st June, 1916, the Council entered into an arrangement with the Chelsea Nursing Association to supply nursing assistance, on the requisition of the Medical Officer of Health, to poor families one or more of whose members are suffering from measles or other diseases in which nursing is required. As a result of this arrangement, 156 visits were made by the nurses to 12 families in the year who had children ill with measles. The average number of visits per family was 13. The Woman Sanitary Inspector in the course of the year made 685 visits in connection with measles and German measles inquiries, this number including visits paid by a temporary assistant health visitor during her six weeks' engagement. The case mortality of measles for the year (1.2 per cent. of attacks proving fatal) was a very low one, and shows that the disease was mild in type. During the year 155 children were excluded from elementary schools as suffering from measles, and 87 as contacts. 8 During the year 109 cases of scarlet fever were notified in Chelsea, as against 142 in 1915. There were no deaths registered as due to scarlet fever, as compared with 5 in 1915; 90 per cent, of the cases were removed to hospital. There was no special incidence on any particular school in the Borough, with the exception of the Oratory Free School where 5 cases occurred amongst school children late in November and early in December. It was not found necessary to close any of the class-rooms. The percentage of cases of school age (3 to 13 years) was 75, as against 64 in 1915. In 1916, 109 cases of diphtheria were notified in Chelsea, as compared with 105 in 1915. The disease caused 15 deaths, the case mortality being 14 per cent., as compared with only 6.4 per cent. in 1915, so that the type of the disease was more severe than that recently prevailing. The disease was most prevalent in the early part of the year, 46 of the 109 cases being notified in February, March and April. All but one of the notified cases were removed to hospital, as against 89 per cent. in 1915. There was no special incidence on any particular school with the exception of Tadema Road School, where, late in January, 3 children attending school were attacked within a few days of each other. The throats of children in the infants' department, first standard, were swabbed, but all the swabs gave negative results as regards the presence of diphtheria bacillus. For the year the percentage of cases of school age (3 to 13 years) was 71, as against 61 in 1915. During the year medical practitioners sent 108 throat swabbinga to the Lister Institute for bacterioscopic diagnosis, as compared with 142 in 1915. Of the 108 specimens, 77 or 71 per cent. were sent by the Victoria Hospital in respect of Chelsea children. Of the total 108 specimens 21 or 20 per cent. afforded positive evidence of the diphtheria bacillus, and 87 or 80 per cent. were negative. In 1915 the positives were 21 per cent., and the negatives 79 per cent. The number of cases of enteric fever notified was 8, as against 19 in 1915. Of the total 8 cases, in 3 the diagnosis was not confirmed at the hospitals to which the patients were removed. In 3 cases the patients were infected prior to their arrival in Chelsea—1 at Harrogate, 1 at Ilfracombe, and 1 in Haute Savoie, France. There were, therefore, only 2 cases of enteric fever out of the 8 notified in which it seems probable that the infection was contracted within the Borough. This is the smallest number as yet recorded in Chelsea. Only 1 of the cases ended fatally and that was a case of enteritis, not enteric fever, the diagnosis being altered at the M.A.B. Hospital to which the patient was removed. One specimen of blood from a suspected case was sent to the Lister Institute. The result was negative. During the year information was received from the Military Authorities that a chronic carrier of enteric fever had been discharged from the Army to a house in College-place. The man is a packer by trade. The deaths in Chelsea in 1916 from diarrhœa and enteritis were 26 in number, as compared with 18 in 1915. Fifteen of the deaths were of infants under 1 year, and 5 were between 1 and 5 years of age. Only 3 deaths occurred in the summer quarter of the year, showing the exceedingly slight prevalence of summer diarrhoea. Twenty cases of infantile diarrhoea were visited by the Health Visitor in 1916, as compared with 7 in 1915. The 20 cases involved the paying of 121 visits to homes affected. Influenza caused 24 deaths in 1916, as against 19 in 1915. 9 The number of deaths from respiratory diseases was 195 in 1916, as compared with 276 in 1915. Under 5 years of age there were 37 deaths, as against 48 in 1915; over 45 years of age there were 148 deaths, as against 200 in 1915. The deaths from pulmonary tuberculosis in 1916 numbered 80 (53 males and 27 females). Other tubercular diseases caused 12 deaths (6 males and 6 females). Of the pulmonary tuberculosis cases ending fatally, 42.5 per cent. died in the Chelsea Infimary and 19 per cent. in other public institutions; that is to say 61.5 per cent. died away from their homes. In 1915 the corresponding figure was 64 8 per cent. During the year 167 new cases of pulmonary tuberculosis were notified, as against 119 in 1915, 93 being males and 74 females. Of the notified cases of pulmonary tuberculosis on the register 83 died during the course of the year. Sixty-one specimens of sputum were sent by medical practitioners to the Lister Institute for examination, as against 75 in 1915. Of the 61 specimens 26 per cent, were positive for T.B., and 74 per cent. negative; the figures for 1915 being 32 per cent. positive and 68 per cent. negative. In 1916, 17 cases of pulmonary tuberculosis were discharged from open-air sanatoria, in which they had received institutional treatment as "insured persons" under the sanatorium benefit provided by the London Insurance Committee. In 1915, 40 cases of "insured persons" were discharged from sanatoria. The average duration of the stay of the 17 cases in sanatoria was 3 months, as against 3.3 months in 1915, 3.2 in 1914, and 2.5 in 1913. In addition to the 17, 5 insured persons had hospital treatment, the average duration of stay in hospital being 2.6 months. Six uninsured persons received open-air sanatorium institutional treatment under the London Couuty Council scheme for the uninsured, as against 7 in 1915. The average duration of stay in a sanatorium was 3.7 months, as compared with only 2.4 months in 1915. In addition, 6 cases had treatment in Brompton Hospital; average stay, 2.2 months. The number of new cases of pulmonary tuberculosis visited in the course of the year was 72, and of non-pulmonary cases 15. The total number of visits paid in respect of all cases of tuberculosis was 353. Five patients were lent beds and bedding by the Borough Council, and 23 pocket spittoons were given away. Twenty-seven contacts were sent for medical examination: 22 to Brompton Hospital, of whom 9 were found to be tuberculous; and 5 to St. George's Hospital, of whom 2 were found to be tuberculous. Thirty-two new cases of non-pulmonary tuberculosis were notified in 1916, 16 being children under 15 years of age and 16 adults. Several cases were helped to obtain proper surgical treatment in hospitals, and 8 were sent to country or seaside homes. As in previous years, a great deal of this work was carried out by the Invalid Children's Aid Association, the Chelsea branch of which is now acting as an Interim Tuberculosis Care Committee for Chelsea. Five cases of cerebrospinal meningitis were notified in Chelsea in 1916, as against 10 in 1916. Four of the cases had a fatal termination. Four of the cases were under 15 years of age. Four cases were removed to hospital. 10 Only 1 case of poliomyelitis (infantile paralysis) was notified in Chelsea in 1916 —a boy of 1½ years, who was removed to St. George's Hospital. Twenty-two cases of ophthalmia neonatorum were notified in Chelsea in 1916, and an additional 3 cases of eye trouble in infants, which were not notified, were visited by the Woman Sanitary Inspector. Of these 25 cases, 14 made complete recoveries; 8 were left with some eye weakness; in 1 case the sight of 1 eye was permanently lost; in 1 case the infant died; and 1 was untraced. Steps were taken in every case to ensure that the affected eyes received appropriate treatment. Only 2 cases of puerperal fever were notified in Chelsea in 1916, as compared with 5 cases in 1915, and 8 in 1914. One case ended fatally. Both cases were attended in their confinements by midwives. One case was removed to the Chelsea Infirmary. Whooping cough caused 17 deaths in 1916, as compared with 8 in 1915. Six of the fatal cases were of infants under 1 year. The schools notified 149 children as suffering from this disease, and 66 contacts were also excluded from school attendance. Work of the Public Health Department. During the year 1916, 810 separate premises were reported on by the staff, 292 of this number being with reference to cases of notifiable infectious disease, and 213 in the course of house-to-house inspections made in certain of the poorer streets of the Borough. Legal proceedings were taken in 1 case to enforce compliance with notices under the Public Health (London) Act, the owner being fined £2 and an order made for the execution of the works. During the year 374 inspections were made of factories and workshops. Verminous School Children. — In 1916, 72 children attending elementary schools in the Borough were reported as being found by the school nurses to be in a verminous condition, as regards their heads, their bodies, or both heads and bodies. The corresponding number in 1915 was 65 children, and in 1914 266 children. All the homes of the verminous children reported were visited by the Woman Sanitary Inspector; altogether 43 visits were paid in connection with this work, several cases occurring in one family. Nineteen persons (all but 1 children) suffering from scabies attended at the disinfecting station for baths, and altogether 91 baths were given for this complaint. Disinfection.—During the year 463 premises were disinfected after cases of infectious or other disease, and an additional 259 rooms were disinfected for bugs and other vermin. At the disinfecting station 1,191 separate articles of bedding and clothing were disinfected, and 158 articles were destroyed in the incinerator. Of the total 1,191 articles disinfected, 1,002 were blankets, clothing and uniforms sent by the Military Authorities, for which no charge was made. In 1915, 3,626 articles were disinfected for the military, so that there was a very large reduction in 1916 in the amount of disinfection done for the Army. Sale of Food and Drugs Acts.— Of the 400 samples taken for analysis in 1916, 137 were milk, 129 being genuine, and 8 adulterated, equivalent to 6.0 per cent, of the total milks examined, as against 3.8 per cent. in 1915 and 6.0 per cent. in 1914. Of the 8 adulterated samples, 110 proceedings were taken and convictions obtained in 2 cases. In 2 cases the vendors were protected by warranties, and no proceedings were taken. In 3 cases the amounts of adulteration were insufficient to warrant proceedings, and 1 sample was the result of private purchase. Of butter 127 samples were taken; 125 being genuine and 2 adulterated. In 1 case proceedings were taken and a conviction obtained. The other sample was not taken under the Act. Samples of baking powder, egg powder and self-raising flour were examined for arsenic on the suggestion of the Local Government Board, but none was found. All other samples of food taken were found to be genuine. Staff.—During the year the chief disinfector was called up for military duty, and the temporary woman clerk sought work elsewhere. The work of the department was carried on by the 2 male sanitary inspectors, 1 woman sanitary inspector, 2 disinfectors (one of whom acts as office assistant), and the part-time services of the mortuary-keeper as disinfector. For 6 weeks in the spring a temporary woman health visitor was engaged to assist in the visitation of measles cases.