Metropolitan Borough of St. Marylebone. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1916, CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. LONDON: GEO. PULMAN AND SONS, LTD. 1917. STMARY 21 Public Health Department, 24, Somerset Street, Portman Square, London, W. 1. 29th June, 1917. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Madam, and Gentlemen, In submitting my Annual Report for the year 1916, I have to say that the instructions issued by the Local Government Board with regard to Annual Reports of Medical Officers of Health, included a suggestion that, in view of paper shortage, they should be as brief as possible. Practically, therefore, I have contented myself with providing little more than a summary of the work done in respect of the more important matters. In submitting the report I desire to place on record my appreciation of the kindness and consideration shown to me throughout the year by Sir Horatio Shephard, the chairman, and the members of the Public Health Committee. The staff of the Public Health Department have faced and carried out their increased duties at all times cheerfully and well and I wish to thank them for this and for their loyalty to myself. I am, Mr. Mayor, Madam, and Gentlemen, Your obedient Servant, CHARLES PORTER. . 3 POPULATION. In the following pages, two figures representing population are employed, viz.: 98,573, used in connection with the calculation of all rates, except the birthrate, for which in accordance with the instructions of the Registrar-General, the figure 107,249 is used. BIRTHS. Registration.—Births registered, numbered 1,814 (Boys, 915 : Girls, 899). The birth rate was 16'8 per 1,000. Notifications of births received, including 2,027 belonging to other districts, numbered 3,891, the chief sources being: Parents, 218: Doctors, 296; Midwives, 819; and from Hospitals, 2,755 (Queen Charlotte's, 2,240: Middlesex, 387). In 1,357 cases, the birth occurred at home. Still births notified, numbered 172. DEATHS AND DEATH-RATES. After making allowance for deaths occurring outside the Borough boundaries and excluding those which, though registered here, belonged to other districts, the total deaths amounted to 1,588 (males, 791 : females, 797). The death-rate for the Borough was 16'03 and for the registration sub-districts: All Souls, 13'7 : St. Mary, 14'9: Christ Church, 18'8: St. John, 16'5. Causes of and Ages at Death.—Table III of the Local Government Board series (p. 23) contains an analysis of the deaths in relation to cause and age. It shows that of the total 1,588, 11.1 per cent, were of infants under 1; 12.2 per cent, of persons between 25 and 45; 26.7 per cent, of persons between 45 and 65, while 38.5 per cent, were aged over 65. INFANTILE MORTALITY. The number of babies under 1 year of age who died during 1916, was 188 : in the same period the number ot births was 1814 ; the infantile mortality rate was therefore, 103.6. It is regrettable that this figure is higher than that for 1915 (96.1) by 7.5 per 1,000, particularly as in 1916 far greater efforts and advances were made in connection with infantile mortality prevention, than in any year since the work was really seriously commenced. The table on page 5, in which the deaths are analysed, shows that over one-third (65) of the total were due to causes generally classified under the head of " Prematurity." The causes included in this group are "congenital malformation," " premature birth," "atrophy," "debility and marasmus" {i.e. wasting), all of them, obviously, difficult to control. In 1916, they were the chief causes contributing to the increase in the total number of infant deaths and of the infantile mortality rate. In 1915 the total figure for prematurity was 51, i.e., 14 below that for 1916, the figures for other outstanding causes of death, viz., diarrhcea and enteritis, and respiratory diseases, being, the former 11 (31 against 20) above and the latter 8 below (28 against 36.) Why there should be so marked a difference in the prematurity figures is difficult to say. The readiest explanation is, of course, that the trying circumstances and conditions arising out of the War had most to do with it and having regard to the commonly recognized influence of the mental state on the mother in the period preceding the birth of the child, it may well be so. In any case, and this is the chief 4 point, it seems perfectly clear that the increase in the rate was not the result of any slackening in the efforts of those charged with or assisting in the prevention of infantile mortality. Than 1916, indeed, no year has seen greater progress in connection with works designed to preserve infant life. In previous reports full descriptions have been given of the system in operation in the Borough and it has been shown how steadily the official effort of the Borough Council and the voluntary effort of the Marylebone Health Society have developed, and how closely the two efforts have united. During the year under review the development has been continued and the union strengthened. At the end of the year the scheme in operation was taking on a good shape. Under it much work of the greatest value and importance was done and the time brought appreciably nearer, when it may be said that no mother in the Borough need go far to find someone ready, willing and able to help and guide her in the difficult task of motherhood. The following summary prepared for the Local Government Board shows the lines taken in connection with the work and gives much statistical information with regard to what was done in 1916. "Health Visitors.—One whole-time Health Visitor who works only in connection with the Church Street Centre of the Health Society, and three parttime Health Visitors who are also Sanitary Inspectors. The voluntary workers of the St. Marylebone Health Society and of the League of Social Service also do visiting in co-operation with the work of the Council. The borough is divided into three districts, and in 1916 the Municipal Health Visitors made 5,067 visits to 1,840 infants, and the voluntary visitors attached to the St. Marylebone School for Mothers made 3,343 visits to 502 infants. Children are visited up to school age. Centres—Voluntary.—The St. Marylebone Health Society have four centres: (1) North Marylebone School of Mothercraft, Church Street, has an ante- and postnatal consultation under medical supervision. The Municipal Health Visitors co-operate. The ante-natal work is linked up with the Queen Charlotte's Lying-in Hospital. (2) South Marylebone School of Mothercraft, St. Marylebone General Dispensary, 77, Welbeck Street, W. An ante-natal clinic which is linked up with the Middlesex Hospital, is held once weekly, and an infant consultation is held twice weekly, both under medical supervision. There is a superintendent and a part-time assistant, both of whom are nurses. Children attend up to school age, and the Municipal Health Visitors co-operate. 264 Children attended in 1916 and there were altogether 1,591 attendances. The Municipal Health Visitor attends. No treatment is given. (3) Ogle Mews, Ogle Street, IV. 150 children attended in 1916, and there were altogether 813 attendances at the infant consultations. Classes for cookery, needlework and hygiene are held weekly: and (4) Henry Street. Infant consultation held weekly, attended by the Municipal Health Visitor. 125 children attended in 1916, and there were altogether 852 attendances. Ante-natal work as indicated above. There are two voluntary ante-natal clinics. Visiting is undertaken by the Municipal Health Visitors and by the workers attached to the societies, and there is a system of co-operation with the Middlesex and Queen Charlotte's Lying-in Hospitals. Hospital Treatment.— Children's cases are referred from the centres to the dispensary and hospitals, and the Queen Charlotte's Lying-in and Middlesex Hospitals are available for ante-natal and complicated maternity cases." 5 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages, and in Sub-Districts, under 1 Year of Afre. No. CAUSE OF DEATH. Under 1 Week. X and under 2 Weeks. 2 and under 3 Weeks. 3 and under4 Weeks. Total under 1 month. 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Total. 1 Small-Pox — — — — — — — — — — — — — — — 2 Chicken-Pox — — — — — — — — — — — — — — — 3 Measles — — — — — 1 — — 1 2 1 — — 1 2 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Diphtheria and Croup — — — — — — — 1 2 3 1 2 — — 3 6 Whooping Cough — — — — — — 2 5 3 10 1 — 6 3 10 7 Diarrhœa — 1 — — 1 1 1 3 — 6 — 2 4 — 6 8 Enteritis — 1 — — 1 4 6 2 1 14 3 4 6 l 14 9 Tuberculous Meningitis 1 — — — 1 — 1 — — 2 1 — 1 — 2 10 Abdominal Tuberculosis — — — — — — — — — — — — — — — 11 Other Tuberculous Diseases — — — — — 1 — — — 1 — — — l 1 12 | Congenital Malformation 2 3 — — 5 — — — — 5 — 1 8 l 5 13 Premature Birth 21 4 8 1 29 1 1 — 1 32 10 7 11 4 32 14 Atrophy, Debility and Marasmus 5 1 — 1 7 16 4 1 — 28 1 4 17 6 28 15 Atelectasis 1 — — — 1 1 — — — 2 1 1 — — 2 16 Injury at Birth 2 — — — 2 — — — — 2 1 — — 1 2 17 Erysipelas — — — — — — — — — — — — — — — 18 Syphilis 1 — — — 1 — 1 — — 2 — 1 1 — 2 19 Rickets — — — — — — — — — — — — — — — 20 Meningitis (not Tuberculous) — — — — — — 1 3 — 4 — 1 3 — 4 21 Convulsions 2 — — — 2 3 2 — — 9 2 — 4 3 9 22 Gastritis — — — — — — — — — — — — — — — 23 Laryngitis — — — — — — — — — — — — — — — 24 Bronchitis 1 — — 1 2 3 3 3 2 13 1 8 3 1 13 25 Pneumonia (all forms) — 1 — — 1 4 6 8 4 23 3 5 13 2 23 26 Suffocation, Overlying 4 — — — 4 — — 1 — 5 1 1 3 — 5 27 Other Causes 9 2 — 3 14 4 2 3 2 25 5 3 13 4 25 Totals 49 13 3 6 71 39 30 32 16 188 32 40 88 . 28 188 Nett Births in the Year Nett Deaths in the Year Legitimate, 1,649 Illegitimate, 165 Total 1,814 Legitimate Infants, 144 Illegitimate Infants, 44 Total 188 6 DEATHS IN RELATION TO DISEASE. Diarrhœal Diseases.—The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels) was 28, equal to 0.28 per 1,000 of the population. The majority of the deaths, viz., 21, occurred amongst infants under 1 year of age. In 19-15 the number of deaths was 38, and the rate 0.37 per 1,000. Tuberculosis.—The total deaths caused by phthisis (consumption) and other conditions due to the germ of tuberculosis was 186. Of these, 151, were due to phthisis; the age periods at which they occurred being 2-5 years, 1 (.6 per cent.); 5-15 2 (1.3 per cent.); 15-25, 21 (13.8 per cent.); 25-45, 52 (34.4 per cent.); 45-65, 68 (45 per cent.) ; 65 and over, 14 (9.2 per cent.) Respiratory Diseases.—The number of deaths due to bronchitis, pneumonia and other diseases of the organs of respiration was 364, and the death rite 3.67 per 1,000. Of this number, bronchitis caused 191 and pneumonia 149. Cancer or Malignant Disease caused 144 deaths, the death-rate being 1.4 per 1,000 of the population. INFECTIOUS OR COMMUNICABLE DISEASES. The table with regard to these diseases will be found on page 23. The total number of notifications received during 1916 was 1,317, the actual number of cases notified being 1,249. Diphtheria and, Membranous Croup.—The number of cases notified was 135, of whom 127 were removed to hospital and 7 died. The case mortality rate was 5.2 per cent. The cases were not limited to any particular district. The number of swabs submitted from doubtful cases for bacteriological examination was 195 and a positive result was returned in 39 instances. Scarlet Fever.—The notifications numbered 120, the lowest figure for some years. The disease was of a mild type and there was only 1 death. Enteric Fever.—There were 13 cases notified, none of which calls for special comment. The deaths from enteric fever numbered 3. Cerebro-Spinal (Spotted) Fever.—-The notifications received numbered 8. The actual number of cases being 7 Of the 7, 3 had died before notification was received. The first notification came to hand on 22nd January, the total number for that month being 2, and in each of the months of Maich, April, June, August and September there was 1 case. Of the patients 3 were males and 4 females; 2 were less than 1 year old; 1 was less than 2; 1 was aged 18½ (this was a military case and proved rapidly fatal); 1 was 13½ and was notified after admission to a nursing home in the Borough ; 1 was 17 and another 14. The fatal cases were a girl of 14, who died within 24 hours of the onset of symptoms ; a child 1 year and 3 months, who was ill for over a fortnight. The third case was the military one referred to above. There was no connection between the various cases and none of them gave rise to further cases amongst persons immediately in contact with them. In each 7 instance an attempt was made to trace the source of infection but with comparatively little success. As far as possible all contacts were swabbed, and in 4 instances a positive result was obtained. All of these were members of the same family and had been in contact with one of the fatal cases. None of the persons showed any symptoms either before or after the discovery of the presence of the germs and subsequent examinations gave negative results. Erysipelas.—Of this disease 74 cases were notified, mainly from the Workhouse Infirmary and other institutions Erysipelas was stated to be the cause of death in 4 cases. Puerperal Fever.—No notifications were received. One death which occurred outside the Borough was stated to have been due to puerperal fever. Ophthalmia Neonatorum.—The total number of cases notified was 11, as against 14 in 1915. Visits were paid to all cases by the women inspectors. Measles and German Measles.—The Public Health (Measles and German Measles) Regulations, 1915) came into operation on 1st January, 1916, and in all 461 cases (Measles 257 ; German Measles 204) were notified during the year. In every way possible the fact that it was incumbent upon the parents to notify was made public, nevertheless only 12 of the total notifications were made by a parent. Medical practitioners, to whom a special notice had been sent, notified the remainder. Notices from school teachers with regard to cases that had occurred numbered 172. The deaths from measles numbered 7, as against 53 in 1915. As in previous years visits were paid to all houses in which measles was known to exist and advice given with regard to the prevention of the spread of infection and as to the necessity for taking care of the patient. In addition, under an agreement, entered into between the Council and the Paddington and Marylebone Nursing Association, the services of a nurse were provided for most of the cases in which the attack was severe. For several reasons, amongst them that the accommodation was required for other purposes, it was possible to arrange for hospital isolation for only 90 of the cases. Whooping Cough.—This being a non-notifiable disease it is impossible to state the number of cases that occurred. The deaths registered as due to it, however, numbered 21 as against 14 in 1915. Tuberculosis.—-The total number of cases of tuberculosis notified during the year was 418, of which 342 were pulmonary cases, the remaining 76 notifications relating to cases in which other structures than the lungs were affected. The table which follows, contains the information required by the Local Government Board with regard to notifications. Notifications made on Form B. relate to school children. The number it will be noted was 43, as aginst 20 in 1915. Of the 76 cases in which parts other than the lungs were affected, in 22 the infection was limited to the glands of the neck: in 38 one of the joints, and in 2 the spine was the part attacked. Treatment of Tuberculosis.—Of the cases notified 90 in all received some form of institutional treatment, and during the year every eftort was made to obtain admission to sanatoria of cases deemed suitable for such treatment. In this connection it may be noted that the arrangements made by the London County Council, for providing treatment for children and others, though there were delays, continued to work smoothly and little difficulty was experienced in obtaining the information required in respect of patients to be removed. Of the total cases notified, 95 were insured persons, and of these 37 applied for sanatorium benefit, 2 dying before gaining admission. 8 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 3rd January, 1916, to the 30th December, 1916. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Age Periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications Form A No. of Primary Notifications. Total Notifications Form B. Poor Law Notifications. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Primary Notifications. Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary, Males 1 1 8 6 9 11 31 40 34 23 9 173 211 - 4 3 7 7 52 24 ,, Females — 2 9 12 11 20 36 20 15 11 6 142 171 - 5 6 11 12 13 38 Non-pulmonary, Males 2 6 3 3 3 1 3 1 1 1 — 24 27 - 9 5 14 17 1 4 ,, Females 1 4 8 6 2 4 2 — 2 — — 29 32 - 2 3 5 7 2 9 Totals 4 13 28 27 25 36 72 61 52 35 15 368 441 — 20 17 37 43 68 75 9 Prevention of Consumption.—So far as preventive measures against tuberculosis are concerned it is probably sufficient to say that during 1916 the council's scheme took more definite shape, and despite the fact that all the official consents necessary were not formally given, a beginning was made. At the beginning of April Miss Baker gave up general health visiting and inspecting work and devoted herself entirely to tuberculosis; visiting notified cases, arranging for contacts, and, if necessary, patients to attend at the dispensaries, attending clinics, particularly those at Middlesex Hospital and Margaret Street Hospital, and arranging for the removal of those who required sanatorium and hospital treatment. By the end of the year the scheme was working very smoothly, and it is largely because of the fact that Miss Baker has proved acceptable both to the patients and to the authorities at the various institutions that it is possible to say so. Though it is really impossible to represent by means of figures, the exact amount of work done and the effect which has followed it, the following statistics with regard to visits paid and patients examined may be useful and interesting. The number of visits paid by Miss Baker was 1,718. The consultations at Middlesex Hospital were attended 65 times, and those at Margaret Street 49 times, between April 1st, when the work commenced, and the end of the year. Attendances at Allsop Place were fewer (27), the tuberculosis nurse at that dispensary being generally in attendance. The Interim Care Committee, which meets fortnightly at Allsop Place, was attended on 23 occasions. Of the new patients visited, 95 were insured, 132 non-insured. Amongst the patients were included 5 discharged soldiers. As regards sanatorium treatment, Miss Baker was concerned in obtaining admission for 14 children, 35 insured and 24 uninsured persons, obtaining amongst other information all that related to the condition of the patient's home-surroundings. All contacts from the homes of patients were referred for examination to the various institutions included in the scheme. At Allsop Place 382 patients were examined. Of these, 125 were found to be suffering from pulmonary tuberculosis, 128 were suspected, and 15 had some other form of tuberculosis. Of the patients examined, 189 were under 16, and 30 (15.3 per cent.) were consumptive. Of patients above 16, 95 (54.4 per cent.) were found to be suffering. The total number of insured persons examined was 116. The total attendances at the Dispensary numbered 3,498; the Medical Officer paid 1,228 visits, and the nurse 1,033. Of the total number of cases, 41 were referred from the Public Health Department. The total number of patients examined under the scheme from April 1st to December 31st at the various institutions was 201. Of these, 51 were found to be suffering, and 76 were "suspected." Patients found to be suffering from other forms of tuberculosis than the pulmonary numbered 10. The total number of insured amongst the patients was 33. Deaths from Phthisis.—The table given below shows the number of deaths certified as due to consumption, and compares the figure for 1916 (151) with those of preceding years. The death rate was 1.5 per 1,000. Of those who died 80 were insured and 71 uninsured. 10 DEATHS FROM PHTHISIS. Estimated Population. Year, All Ages. Sub.Districts. All Souls. St. Mary. Christ Church. St. John. 98,573 1916 151 32 35 61 23 100,260 1915 135 31 37 52 15 112,892 1914 152 18 38 73 23 114,532 1913 149 32 40 67 20 116,155 1912 149 26 32 66 25 117,844 1911 172 51 30 65 26 125,195 1910 133 28 37 56 12 126,027 1909 170 43 41 66 20 126,867 1908 154 35 33 61 25 127,718 1907 179 42 46 64 27 127,960 1906 197 36 64 73 24 Venereal Diseases.—During the year the Local Government Board issued the Public Health (Venereal Diseases) Regulations, 1916, in which authorities are given power to provide facilities for persons suffering from various forms of venereal disease to obtain advice and treatment free and secretly. Unfortunately, in some respects, the London County Council is the authority under the regulations, and the Council and the Medical Officer of Health are only expected to do what they can to help make the scheme of the first-named body public. The Middlesex Hospital, the only great hospital in the borough, is one of the institutions included in the scheme which had not come into operation when the year came to an end. Disinfection.—The total number of rooms disinfected during the year was 1120, and of articles (beds, bedding, etc.) 24,842. In the majority of instances the reason for disinfection was on account of infectious disease, but in 44 cases it was rendered necessary by reason of the presence of vermin. BACTERIOLOGICAL EXAMINATIONS. The number of specimens examined bacteriologically, by Dr. Foulerton, and the diseases in relation to which the examinations were made, are shown in the following table. 1916. Positive. Negative. Total. Typhoid Fever 3 25 28 Diphtheria 39 156 195 Phthisis 105 209 314 Wassermann Reaction 2 — 2 Totals 149 390 539 11 Apart from the above Dr. Foulerton also examined 11 samples of Milk. In respect of these he reported that 4 were " good," 5 " fair," and 2 " bad." In 1 case the examination revealed the presence of tubercle bacilli. Careful enquiries were made but it was found impossible to trace the milk further back than to the wholesale dealer, who was cautioned. ANALYSIS AND EXAMINATION OF FOOD. The following summary contains all the necessary information with regard to the work done under the Sale of Food and Drugs Acts in repect of the protection of the food supply. Proceedings on account of food adulteration were taken in 11 cases and related to Milk in 7 instances, and Butter in 4. Warranty was pleaded in 4 cases and the summons dismissed. Fines and costs to the amount of £ 19 10s. 6d. were imposed in 8 cases. A complete list of the samples will be found in the annexed table. The articles analysed, comprise in this year, only a few type6 of food consumed in the Borough, no beer, spirits or aerated waters, no drugs, save a sample of cream of tartar, no canned goods, no condiments ; in short analytical investigation has been practically limited to dairy produce. LIST OF SAMPLES TAKEN DURING THE YEAR 1916. Article. Genuine. Adulterated. Total. Milk 466 12 478 Butter 274 9 283 Cream 6 — 6 Lard 1 — 1 Flour 2 — 2 Baking Powder 7 — 7 Egg Powder 4 — 4 Coftee 5 — 5 Lovage 1 — 1 Cream of Tartar 1 - 1 767 21 788 Milk.—466 samples of milk were analysed, of these 12 or about 2'5 per cent, were adulterated. This figure compares favourably w th the corresponding one for 1915, in which year, the adulteration of milk was 7 per cent, of the samples taken. About half the samples certified to be wrong, were abstractions of cream (up to 30 per cent.) the rest were dilutions, the worst case being an addition of 23 per cent, water. As usual a large number of the samples were coloured artificially, but no preservatives were detected. The milk generally was poorer in quality than in any 12 one of the previous four years, the milk fat, the solids not fat and the total solids being all appreciably lower. Butter.—Out of 283 samples of butter, 9 (3.1 per cent.) were adulterated. Five of the nine proved to be margarines, the remainder were mixtures of butter and margarine. In 1916, 16 per cent., as against 8 per cent, in 1915, were not preserved by any chemical addition save common salt. The actual number containing boric acid was 236. Arsenic in Baking Powders and Sugars.—Arsenic has been found in the constituents of baking powders, and also in certain sugars ; it has therefore become necessary to test such articles very carefully for arsenical contamination. The results in all the articles so examined were practically negative. Cream o* Tartar. —The solitary representative of Drugs was found to conform in all particulars to the tests for purity laid down in the British Pharmacopoeia. Public Health (Milk and Cream) Regulations, 1912.—The following report is submitted in accordance with requirements of the Local Government Board : 1. Milk; and Cream not sold as Preserved Cream. (a) Number of samples examined for the presence of a preservative. (6) Number in which a preservative was reported to be present. Milk 478 — Cream 6 — 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correction statements made 6 (ii.) Statements incorrect — Total 6 (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent. 6 (ii.) Below 35 per cent. — Total 6 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (l) and the proviso in Article V. (2) of the Regulations have not been observed—Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken—Nil. 3. Thickening substances.—Any evidence of their addition to cream or to preserved cream—None. 4. Other observations", if any—None. 13 SANITARY WORK OF THE YEAR. The following general summary contains practically all the information necessary with regard to the Sanitary Work carried out during the year. Premises under Constant Supervision. Milk Premises 201 Cowhouses 5 Slaughterhouses 4 Offensive Trades 2 Ice Cream Premises 117 Bakehouses 65 Restaurant, Dining Room and Coffee Shop Kitchens 156 Hotel Kitchens 38 Pastrycooks and Tea Rooms 45 Fried Fish Shops 25 Fish. Curers 6 Houses Let in Lodgings 1169 Workshops 4779 Total 6612 A statement with special reference to the list set out above, is contained in the following tables:— Number of places Number of inspections, 1915. Number of notices, 1915. Number of prosecutions, 1915. On register at end of 1915. Added in 1916. Removed in 1916. On register at end of 1916. Milk premises 194 7 20I 75 1 Cowsheds 5 — — 5 18 1 — Slaughterhouses 4 — — 4 5 - — Offensive trade premises 2 — — 2 2 - — Ice cream premises 117 — — 117 6 - - Houses let in lodgings 1169 — 2 1167 2026 510 - mortuary. Removed by Inspectors. Number of bodies received 346 — Number of Infectious bodies received . — 4 Disinfection. Number of rooms disinfected 1,120 Number of articles disinfected 24,842 14 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 1,919 1.158 905 1,288 5,270 Bakehouses. Number on register at end of 1916 65 Number above ground 10 Number underground 55 Number of inspections 99 Number of Notices 74 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1916 270 Number of Inspections 1046 Number of Notices 25 House to House Inspections. Number of Inspections Houses Nil Number of Notices issued Intimations Nil Statutory Notices Nil Number of Prosecutions Nil House Refuse. Number of Inspections 7,188 Number of Old Brick Receptacles abolished 6 Number of New Metal Receptacles provided 36 Number of Complaints of Non-removal received 166 Number of Letters received re Removal 176 Number of Refusals of Occupiers to have House Refuse removed 98 Number of Notices served—Intimations, 52; Statutory Notices, 6 58 Number of Prosecutions Nil. Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 15 Number of Statutory Notices served 8 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 17 Number remedied 17 Number of Prosecutions Nil 15 Underground Rooms. Number dealt with 4 Number of Notices served under P. H. (L.) Act, 1891 Nil) 4 Number of Notices served under H. T. P., &c., Act, 1909 4) Number of Prosecutions Nil Insanitary Houses. Number closed under Public Health (London) Act, 1891 Nil Number closed under Part II of the Housing of the Working Classes Act Nil Number closed under Section 17 Housing, Town Planning, &c., Act, 1909 Nil Verminous Rooms. [London County Council (General Powers) Act, 1904, Section 20 (1) Number of rooms cleansed 83 Number of Prosecutions ... Nil Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year Nil Inland Revenue Act. Number of houses for which applications were received 7 Number of tenements comprised therein 19 Number of tenements for which certificates were granted 19 ,, ,, ,, refused Nil ,, ,, ,, ,, deferred Nil The total number of inspections made was 6,905. The total number of plans deposited was 146, the number relating to new buildings being 17 (north 5, south 12). In the case of old buildings, the number was 129 (north 59, south 70). 16 WORK OF SANITARY INSPECTORS. The following summary shows the number of inspections made by each of the inspectors, and the nuisances detected by them :— Districts. Borough. No. I. No. 2. No. 3. No. 4. Total. Total Inspections 4093 3596 3882 4364 15935 Houses damp, dirty or dilapidated remedied 52 70 87 10 219 Doors, windows, floors, ceilings, sash cords, etc., repaired 9 17 28 1 55 Overcrowding abated 0 6 4 0 10 Illegal occupation of underground rooms dealt with 1 0 3 0 4 Water closet defects remedied 25 27 84 16 152 Water closets erected 6 I 2 0 9 Urinal defects remedied 3 0 7 0 10 Soilpipe and ventilating shaft repaired or renewed ... ... 20 3 17 10 50 Yard defects remedied 120 122 144 35 421 Waste pipe defects remedied 9 5 11 11 36 Water cistern defects remedied 2 4 11 2 19 Rubbish, manure, etc., accumulations removed 12 7 59 15 93 Dung or dust receptacles repaired or renewed 20 17 20 1 58 Drains relaid or amended 45 9 12 7 73 Drains cleared 30 4 22 1 57 Rainwater pipes repaired or renewed 19 6 11 4 40 Water supply to houses reinstated 6 7 3 0 16 Roofs and gutters repaired 22 19 20 5 66 Area defects remedied 22 8 36 35 101 Wash-house defects remedied 25 14 33 3 65 Animal nuisances abated 0 2 10 0 12 Basement defects remedied 5 14 22 1 40 Stables cleansed or repaired 11 12 1 0 24 Water supply laid on to upper storeys of house 4 12 2 0 18 Miscellaneous nuisances abated 14 24 56 150 244 Verminous rooms cleansed 30 15 34 4 83 Workshops, damp, dirty or dilapidated, remedied 2 38 5 1 46 17 FACTORIES AND WORKSHOPS. The total number of visits to factories, workshops and workplaces during the year was 994, 657 by the women and 337 by the men inspectors. The complaints received numbered 6. The following report is made in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901. I—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 15 (Including Factory Laundries.) Workshops 869 15 - (Including Workshop laundries.) Workplaces 110 — - (Other than Outworkers' premises included in Part 3 of this Report.) Total 994 15 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Hemedied. Keferred to H.M. Inspector. (i) (2) (3) (4) (5) Nuisances under the Public Health Acts-.— Want of cleanliness 43 43 Want of ventilation 1 1 — Overcrowding 1 1 — — Want of drainage of floors 1 1 Other nuisances - - - - Sanitary accommodation insufficient unsuitable or defective 2 - 2 - - - - - not separate for sexes 1 1 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences - - - - (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 49 49 — — 18 3.—HOME WORK. outworkers' lists, section 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. nature of wokk. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 120 946 1246 2 ... 4 84 ... ... ... ... ... ... ... ... Umbrellas, etc 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Total 122 948 1246 2 ... 4 84 ... ... ... ... ... ... ... ... 19 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Dressmaking, Millinery, l.aundry, Cabinet Making, &c. 4,476 Coffee Shops, &c. 238 Bakehouses 65 Total number of workshops on Register 4,779 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 14 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5.) Notified by H.M. Inspector 6 Reports (of action taken) sent to H.M. Inspector 6 Other Underground Bakehouses (s 101):— Certificates granted during the year In use at the end of the year 65 20 LOCAL GOVERNMENT BOARD AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1916 AND PREVIOUS YEARS. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. No. Rate per 1,000 Nett No. Rate. No. Rate. No. Rate. 1 2 3 4 6 6 7 8 9 10 11 12 13 1910 125,195 4,111 2,556 201 ] ,566 129 658 699 253 989 1,607 13 3 1911 117,844 4,130 2,375 202 1,578 14'2 600 840 261 1098 1,818 16 3 1912 116,155 4,111 2,246 193 1,652 15 0 769 752 209 93 0 1,635 148 1913 114,532 3,804 2,146 186 1,629 14'9 755 753 195 900 1,627 149 1914 112,892 3,847 2,128 18*7 1,631 151 813 787 210 986 1,605 149 1915 100,260 3,647 1,852 16*2 1,741 172 817 773 178 961 1,697 178 1916 98,573 3,936 1,814 168 1,681 169 855 720 188 1036 1,588 160 Total population at all ages, 118,221, at Census of 1911. Area of district in acres (exclusive of area covered by water), 1427. 8 acres. 21 TABLE I. (A). Vital Statistics of Separate Localities in 1916 and the ten Previous Years. Names of Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. , Deaths at all Ages Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. | Deaths at all Ages. Deaths under i year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1906* 127,960 2,648 1,931 322 33,974 520 408 64 36,428 627 556 72 37,951 1,088 652 141 19,607 413 315 45 1907 127,718 2,583 1,931 264 33,908 537 415 47 36,358 629 510 51 37,881 1,029 683 131 19,571 388 323 35 1908 126,867 2,559 1,845 267 33,683 460 419 55 36,177 588 506 77 37,628 1,107 675 105 19,439 404 245 26 1909 126,027 2,534 1,849 259 33,460 674 424 59 35,878 502 461 49 37,379 1,041 681 123 19,310 317 283 28 1910 125,195 2,556 1,607 252 33,239 716 355 59 35,641 432 417 48 37,133 1,016 582 115 19,182 392 253 31 1911 117,844 2,375 1,818 261 29,392 502 400 40 32,025 485 440 49 36,425 1,041 690 137 20,002 347 288 35 1912 116,135 2,246 1,635 209 28,971 452 379 45 31,566 453 411 30 35,903 971 588 108 19,715 370 257 26 1913 114,532 2,146 1,627 195 28,567 388 343 30 31,124 400 367 34 35,402 998 652 110 19,439 360 265 21 1914 112,892 2,128 1,605 210 28,158 435 317 36 30,678 418 388 33 34,895 937 630 113 19,161 338 270 28 1915 100,260 1,852 1,697 178 25,002 367 341 21 27,312 337 422 35 30,901 801 639 94 17,015 347 295 28 Averages of Years 1906 to 1915) 119,543 2,362 1,754 241 30,830 505 380 45 33,326 487 448 48 36,145 1,003 647 118 19,240 367 279 30 1916 98,5 73 1,814 1,588 188 24,540 392 337 32 26,892 353 400 40 30,403 755 574 88 16,738 314 277 28 •The Rectory and St. Mary's Registration Sub-Districts were amalgamated this year. to K> TABLE II. Cases of Infectious Disease Notified during the Year ending 30TH December, 1916. Notifiable Disease. Gases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home At all ages. At ages—years. All S011I9 St. Mary Christ Church St. John Totals. All Souls St. Mary Christ Church St. John Totals Under 1 1 to 5 5 to 15 15 to 25 25 to 46 45 to 65 ti5 and upwards Diphtheria, including Membranous Croup 135 3 41 62 11 16 2 ... 40 31 56 8 135 37 29 53 8 127 8 Erysipelas 74 6 3 2 8 16 30 9 10 22 34 8 74 2 4 2 ... 8 66 Scarlet Fever 120 4 28 49 22 13 4 ... 35 35 35 15 120 33 25 37 10 105 15 Ophthalmia 11 11 ... ... ... ... ... ... 3 3 5 ... 11 ... ... ... ... ... 11 Enteric Fever and Continued Fever 14 ... ... 1 3 8 2 ... 3 4 5 2 14 3 3 2 2 10 ... Poliomyelitis 2 ... 1 1 ... ... ... ... 1 1 ... .. 2 1 1 ... ... 2 ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever Tuberculosis 8 3 2 1 2 ... ... ... ... 3 4 1 8 ... 1 2 ... 3 5 Pulmonary 342 1 3 48 60 128 88 14 71 83 131 57 312 14 16 18 ... 54 288 Non-Pulmonary 76 4 10 43 9 6 4 ... 12 17 34 13 76 4 5 7 3 19 57 Measles 257 17 79 75 42 43 1 ... 80 58 68 51 257 19 14 17 7 57 200 German Measles 204 6 21 52 69 53 3 ... 59 41 53 51 204 14 6 6 7 33 171 Measles (Notified by Parents) 6 2 2 2 ... ... ... ... 1 ... 5 ... 6 ... ... ... ... ... 6 Totals 1249 57 190 33S 226 283 134 23 315 298 430 206 1249 127 104 144 43 418 831 1249 23 TABLE III.—Causes of,and Ages at Death during the year ending 30th December, 1916. Net deaths at the subjoined ages of '' Residents'' whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church St. John. Total. No. CAUSES OF DEATH. All Ages. Under 1. 1 and under 2. 2 and under 5. 6 and under 15. 15 and under 96. 25 and under 45. 45 and under 65. 65 and upwards. 1 Enteric Fever 3 - - - - 1 2 - - 1 1 1 1 - 3 2 Small Pox - — — — — — - - - - - - - - - 3 Measles 7 2 3 2 — — - - - - 1 - 5 1 7 4 Scarlet Fever 1 - - 1 - - - - - - - - 1 - 1 5 Whooping Cough 21 10 8 2 1 — - - - 1 1 1 14 5 21 6 Diphtheria and Croup 7 3 1 1 2 — - - - 2 2 3 1 1 7 7 Influenza 36 — — - - - 4 10 22 4 4 17 5 10 36 8 Erysipelas 4 1 - - - - - - 3 - - 1 2 1 4 9 Phthisis (Pulmonary Tuberculosis) 151 - - 1 1 21 52 62 14 10 32 35 61 23 151 10 Tuberculous Meningitis 17 2 5 2 5 3 - - - 12 4 2 7 4 17 11 Other Tuberculous Diseases 18 1 - 2 5 1 6 0 1 13 3 3 10 2 18 12 Cancer 144 — — — 2 — 14 61 67 305 32 31 49 32 144 13 Rheumatic Fever 5 — — 1 — 2 - 1 1 2 1 5 14 Meningitis 10 4 o 1 2 1 12 1 3 6 - 10 15 Organic Heart Disease 163 — 1 — — 5 24 47 86 53 30 51 55 29 163 16 Bronchitis 191 13 — 2 3 - 4 44 125 13 40 55 68 28 191 l7 Pneumonia (all forms) 149 22 7 6 3 2 28 32 49 50 3." 33 56 25 149 18 Other Diseases of Respiratory Organs 24 2 — 2 — — 3 7 10 10 7 4 10 3 24 19 Diarrhrea and Enteritis (under 2 years) 28 21 5 2 - - - - - 18 4 8 15 1 28 20 Appendicitis and Typhlitis 6 — — — 2 1 — 3 — 25 2 — 1 3 6 21 Cirrhosis of Liver 14 - - - - - - 11 3 10 3 3 4 4 14 21a Alcoholism 6 — — — — — 3 3 — 2 — 3 3 — 6 22 Nephritis and Bright's Disease 44 — — 1 1 — 3 28 11 24 7 14 14 9 44 23 Puerperal Fever 1 — — — — — 1 — — 8 — 1 — — 1 24 Other accidents and diseases of Pregnancy and Parturition 5 — — — — 3 o — — 20 1 1 2 1 5 25 Congenital Debility and Malformation, including Premature Birth 57 55 2 - - - - - - 55 12 13 23 9 57 26 Violent Deaths, excluding Suicide 80 6 3 3 8 8 10 17 25 59 16 19 33 12 80 27 Suicides 7 — — — — 1 2 4 — 6 3 2 1 1 7 28 Other defined Causes 389 46 4 3 5 7 36 93 195 252 95 95 125 74 389 29 Diseases ill defined or unknown — — — — — — — — — — — — — — — Totals 1588 188 41 31 39 53 196 427 613 965 337 400 574 277 1588