STMARY 23 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1918. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed) Of the Middle Temple, Barrister-at-Law. Public Health Department, 146/148, Marylebone Road, London, N.W. 1. 28th June, 1919. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, My Annual Report is again merely a brief summary of the work done in respect of certain of the more important matters. The birth-rate, it will be noted, reached the extraordinarily low figure of 12.4 while the death-rate rose from 17 in 1917 to 18.53. In regard to these rates it should be pointed out that the population figures upon which the calculations were made are quite conceivably wrong and matters may not, in fact, be so bad as they appear to be. The year on the whole was not an unsatisfactory one so far as work was concerned. As always, the task was lightened by the interest taken in it by the Public Health Committee and by the loyalty and willingness of the staff of the Department. I desire to tender my thanks to both parties: to the Committee which, under the Chairmanship of Councillor E. Sanger, L.C.C., was always ready to give assistance, guidance and sympathy and to share enthusiasm, and to the staff for taking their part always ungrudgingly and uncomplainingly. I owe a great debt of gratitude to both. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER. 4 POPULATION. In the following pages, two figures representing population are employed, viz.: 98,526, used in connection with the calculation of all rates, except the birth-rate, for which, in accordance with the instructions of the Registrar-General, the figure 110,395 is used. BIRTHS. Registration.—Births registered numbered 1,375 (Boys, 725: Girls, 650). The birth-rate was 12.4 per 1,000. Notifications of births received, including 1,764 belonging to other districts, numbered 3,281, the chief sources being : Parents, 69: Doctors, 253; Midwives 690; and from Hospitals, 2,057 (Queen Charlotte's, 1,662: Middlesex, 395). In 1,129 cases, the birth occurred at home. Still births notified, numbered 137. DEATHS AND DEATH-RATES. The total deaths of Marylebone persons, whether occurring within or outside the boundaries, amounted to 1,835 (males, 894 : females, 941). The death-rate for the Borough was 18.53 and for the registration sub-districts: All Souls, 14.8: St. Mary, 15.9: Christ Church, 23.2: St. John, 19.8. 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 1,835, 8.3 per cent, were of infants under 1; 18.5 per cent, of persons between 25 and 45 ; 26.3 per cent, of persons between 45 and 65, while 31.0 per cent, were aged over 65. INFANTILE MORTALITY. The number of babies under 1 year of age who died during 1918 was 152; in the same period the number of births was 1,375; the infantile mortality rate was therefore 110.5, as against 120.9 in 1917. Apart from "Prematurity," (including" congenital malformation," "premature birth," "atrophy," and "debility and marasmus,") which caused 43 deaths, and, as usual, heads the list, the outstanding causes were diarrhcea and enteritis (26 deaths), pneumonia (16) and bronchitis (12). Measles, which in 1917 caused 16 deaths, was responsible for 2 only in 1918. It is largely because of the comparative absence of measles as a death cause that the rate in 1918 is lower by 10 per 1,000 than in 1917. Considerable as this reduction was, it still leaves the rate higher than in 1916 (103.6) and in preceding years. Being a reduction, however, it is encouraging and gives reason to hope that with the organization and the will to work existing in the Borough, a figure much more satisfactory to everybody will be obtained. The organization in respect of maternity and child welfare has very frequently been described in these reports, and, as is well-known it contains voluntary and official elements. Of the voluntary elements, those for which the St. Marylebone Health Society is responsible, bulk largest, and the Council are greatly indebted to this body and those who work for it, for what they have done and what they are doing. Apart from the Health Society, however, there were other bodies that rendered assistance, viz.: The Women's League of Social Service,Queen Charlotte's 5 Hospital, and Middlesex Hospital. The chief parts of the scheme are shown in the following summary, which indicates that at the end of the year there were available in the Borough no fewer than seven centres where attention was given to infant and child welfare, and if those at the hospitals are included, four ante-natal clinics. In addition, there was a dining centre for nursing and expectant mothers, a dental clinic for mothers and young children, a day nursery and a nursing home for wasting babies; the latter opened during the year. The following is the summary referred to. It is based upon a return made to the Local Government Board and gives much statistical information with regard to work done in 1918. "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 1918 the Municipal Health Visitors made 2,828 visits to 1,525 infants, and the voluntary visitors attached to the St. Marylebone School for Mothers made 8,324 visits to 606 infants. Children are visited up to school age. Centres—Voluntary.—The St. Marylebone Health Society have five 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. 187 Children attended in 1918 and there were altogether 767 attendances. The Municipal Health Visitor attends. No treatment is given. (3) Ogle Mews, Ogle Street, W. 255 children attended in 1918, and there were altogether 682 attendances at the infant consultations. Classes for cookery, needlework and hygiene are held weekly: (4) Henry Street. Infant consultation held weekly, attended by the Municipal Health Visitor. 64 children attended in 1918, and there were altogether 1,129 attendances; and (5) 101, Crawford, Street.—Infant consultation held weekly, attended by Municipal Health Visitor. This Centre was only opened early in 1917, and up to the end of the year, 100 children had attended and made 623 attendances. In addition to these Centres, consultations are held weekly at Queen Charlotte's Hospital and the Branch of the Women's League of Social Service, 35, Lisson Street. Each is presided over by a specially appointed Medical Officer. One of the Municipal Health Visitors attends the former. The Women's League Centre is attended by a Health Visitor appointed by the League, who, however, submits a weekly report to the Medical Officer of Health. The Centre at Queen Charlotte's Hospital is open to others than St. Marylebone babies, of whom 215 attended and made 1,150 attendances. The number attending the Centre in Lisson Street was 38 and the total attendances 592. 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. 6 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages, and in Sub-Districts, under 1 Year of Age. No. CAUSE OF DEATH. Under 1 Week. 1 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 — — — — — — — — — — — — — — — 6 Whooping Cough — — — — — — 1 3 1 5 2 2 1 — 5 7 Diarrhoea — — — 1 1 — 3 1 — 5 1 2 2 — 5 8 Enteritis — 2 1 3 6 5 6 4 — 21 5 8 6 2 21 9 Tuberculous Meningitis — — — — — — — — — — — — — — — 10 Abdominal Tuberculosis — — — — — — — — — — — — — — — 11 Other Tuberculous Diseases — — — — — — — — — — — — — — — 12 Congenital Malformation 2 — — — 2 1 — — — 3 1 — 2 — 3 13 Premature Birth 18 1 — — 19 2 — — — 21 7 5 8 1 21 14 Atrophy, Debility and Marasmus 1 1 1 — 3 6 7 2 1 19 2 5 9 3 19 15 Atelectasis 1 — — — 1 — — — — 1 — 1 — — 1 16 Injury at Birth — — — — — — — — — — — — — — — 17 Erysipelas — 1 — — 1 — 1 — — 2 1 — 1 — 2 18 Syphilis — 1 — — 1 1 — — — 2 — 1 1 — 2 19 Rickets — — — — — — — — — — — — — — — 20 Meningitis (not Tuberculous) — — — — — — 1 1 — 2 — — 1 1 2 21 Convulsions 2 — — — 2 — 1 — 3 6 — 2 2 2 6 22 Gastritis — — — — — 2 — — 1 3 2 — — 1 3 23 Laryngitis — — — 1 1 — — — — 1 — 1 — — 1 24 Bronchitis — — — 1 1 3 5 2 1 12 4 2 6 — 12 25 Pneumonia (all forms) 1 1 — — 2 5 4 1 4 16 3 3 7 3 16 26 Suffocation, Overlying 1 — — — 1 — — — — 1 1 — — — 1 27 Other Causes 12 3 3 1 19 4 4 2 1 30 — 12 12 6 30 Totals 38 10 5 7 60 30 33 17 12 152 30 45 58 19 152 Nett Births in the Year Legitimate, 1,150 Illegitimate, 225 Total 1,375 Nett Deaths in the Year Legitimate Infants, 118 Illegitimate Infants, 34 Total 152 7 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." During the year the Health Society, through a special Committee upon which the Borough Council was strongly represented and of which the Medical Officer of Health was Chairman, purchased and fitted up a house at 20, Marlborough Place, N.W., as a Nursing Home for wasting babies. This was opened on March 22nd and between that date and the end of the year 53 babies were treated; of this number 44 were discharged cured, 6 were transferred to Children's Hospitals and 3 died. The Council make a grant of £500 per annum towards the cost of running the Home which has proved of immense value in connection with the Scheme. DEATHS IN RELATION TO DISEASE. Diarrheal Diseases.—The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels) was 35, equal to 0.35 per 1,000 of the population. The majority of the deaths, viz., 28, occurred amongst infants under 1 year of age. In 1917 the number of deaths was 27, and the rate 0.29 per 1,000. Tuberculosis.—The total deaths caused by phthisis (consumption) and other conditions due to the germ of tuberculosis was 190. Of these, 167 were due to phthisis; the age periods at which they occurred being 1-2 years, 1 (0.6 per cent.) ; 5-15, 6 (3.5 per cent.) ; 15-25, 15 (9.0 per cent.) ; 25-45, 70 (41.8 per cent.) ; 45-65, 62 (37'1 per cent.) ; 65 and over, 13 (7.7 per cent.). Respiratory Diseases.—The number of deaths due to bronchitis, pneumonia and other diseases of the organs of respiration was 406, and the death rate 4.10 per 1,000. Of this number, bronchitis caused 191 and pneumonia 177. Cancer or Malignant Disease caused 143 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 22. The total number of notifications received during 1918 was 1,567, the actual number of cases notified being 1,530, the bulk being measles and German measles. Diphtheria and Membranous Croup.—The number of cases notified was 157, of whom 150 were removed to hospital and 11 died. The case mortality rate was 7'0 per cent. The cases were not limited to any particular district. The number of swabs submitted from doubtful cases for bacteriological examination was 151 and a positive result was returned in 58 instances. Scarlet Fever.—The notifications numbered 80, the lowest figure for some years. The disease was of a mild type and there were no deaths. Enteric Fever.—There were 9 cases notified, none of which calls for special comment. There were 2 deaths. Cerebro-Spinal (Spotted) Fever.—The notifications received numbered 4. Of the cases 2 proved fatal. 8 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 30th December, 1917, to the 28th December, 1918. 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 on Form A No. of Primary Notifications. Total Notifications on Form B. Poor I-aw Institions. Sanatorium. 0 to 1 to 5 5 to 10 10 to 15 15 to 20 30 to 25 25 to 35 35 to 45 45 to 55 55 to 65 6s and upwards Total Primary Notifications. Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary, Males — 2 10 7 11 15 52 37 35 13 9 191 247 — — — — — 37 53 „ Females — 3 3 7 14 13 38 29 9 7 1 124 147 — 1 2 3 5 19 29 Non-pulmonary, Males — 3 6 3 4 — 1 — 1 — — 18 19 — 1 — 1 2 — 1 ,, Females — 2 1 5 4 2 4 2 2 — — 22 24 — — 2 2 6 1 1 Totals — 10 20 22 33 30 95 68 47 20 10 355 437 — 2 4 6 13 57 84 9 The first notification came to hand on 4th March, the total number for that month being 2. In the month of April there were also 2 cases. Of the patients, 2 were males and 2 females; 1 was an adult, aged 57, and the others children ot 9, 10 and 15 respectively. There was no connection between the various cases and none of them gave rise to further cases amongst persons immediately in contact with them. Polio-Myelitis.—Of this disease 3 cases were notified and 2 died. All the patients were females, aged 2, 5 and 14 respectively. Erysipelas.—In all 51 cases were notified, mainly from the Workhouse Infirmary and other institutions. Ery. ipelas was stated to be the cause of death in 5 cases. Puerperal Fever.—Six notifications were received. Of the patients 3 died. Ophthalmia Neonatorum.—The total number of cases notified was 28, as against 21 in 1917. Visits were paid to all cases by the Health Visitors and in addition 258 visits were paid by the Nurses of the Paddington and Marylebone Nursing Association at a cost of £8 12s. Measles and German Measles.—Measles, which had attained markedly epidemic proportions in 1917, quietened down somewhat in 1918. Under the regulations which came into force in 1916, 773 notifications were received (measles, 607 ; German measles, 166) of which 90 came from parents or guardians. The total for 1917 being 2,171. The deaths numbered 11, as against 95 in 1917 and 7 in 1916. Practically every case was visited by the Health Visitors. Particular attention was given to such as occurred in tenement houses, and under an agreement entered into between the Council and the Paddington and Marylebone Nursing Association the services of a nurse were obtained in cases in which the attack was severe. The nurses made 411 visits and the amount expended was £13 14s. Od. Hospital accommodation was found for 63 of the patients. Whooping Cough.—This disease was apparently more prevalent than in 1917, the deaths registered as due to it numbering 24 as against 9 in the previous year. Tuberculosis.—In all, 355 cases were notified, 315 being pulmonary cases, the remainder of the notifications (40) relating to cases in which structures other than the lungs were affected. The table given on page 8 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 13 as against 18 in 1917. Treatment of Tuberculosis.—Of the cases notified 171 received some form of institutional treatment, and during the year every effort was made to obtain admission to sanatoria of cases deemed suitable for such treatment. Of the 10 total cases notified, 156 were insured persons, and of these 78 were admitted to sanatorium or hospital treatment. In addition, 34 cases were admitted to the infirmary. Prevention of Consumption.—During the year the Council's scheme worked satisfactorily, and, despite the fact that a number of institutions and bodies are involved, there was a complete absence of friction. Miss Baker, acting as Tuberculosis Visitor, paid 1,379 visits to the homes of patients, and to 89 suspects. In addition she attended the consultations at Middlesex Hospital 132 times and those at Margaret Street Hospital 96 times. Attendances at Allsop Place were less frequent, 42 in all, for the reason that the tuberculosis nurse attached to the dispensary does all that is required in the way of following up cases. The Tuberculosis Care Committee met every fortnight throughout the year, and at this 25 attendances were made. The total number of patients examined at the various institutions under the scheme was 680. Of these 190 were found to be suffering, and 259 were " suspected." Patients found to be suffering from other forms of tuberculosis than the pulmonary numbered 22. The number of insured patients found to be suffering was 116 out of 276 examined. Of the new patients visited by Miss Baker, 156 were insured and 149 non-insured. Among the patients were included 23 discharged soldiers and sailors. All contacts from the homes of patients were referred to the various institutions included in the scheme. Deaths from Phthisis.—The table given below shows the number of deaths' certified as due to consumption, and compares the figure for 1918 (167) with those of preceding years- of preceding years- The death rate was 1.7 per 1,000. Of those who died 98 were insured and 69 uninsured. DEATHS FROM PHTHISIS. Estimated Population. Year. All Ages. AH Souls. Sub-Districts. St. John. St. Mary. Christ Church. 98,526 1918 167 45 39 60 23 92,796 1917 137 29 30 48 30 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 57 20 116,155 1912 149 26 32 66 2o 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 Disinfection—The total number of rooms disinfected during the year was 1,086, and of articles (beds, bedding, etc.) 20,314. In the majority of instances the reason for disinfection was on account of infectious disease, but in 52 cases it was rendered necessary by reason of the presence of vermin. 11 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. 1918. Positive. Negative. Total. Typhoid Fever 5 24 29 Diphtheria 58 151 201) Phthisis 83 211 294 Wassermann Reaction — 2 2 Totals 146 388 534 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 respect of the protection of the food supply. Proceedings on account of food adulteration were taken in 10 cases. Warranty was pleaded in 2 cases and the summons dismissed. In the remaining 8, fines and costs to the amount of £ 75 3s. Od. were imposed. The Public Analyst reports as follows:—"Owing to war conditions the samples submitted for analysis were fewer than usual. The total number analysed under the Sale of Food and Drugs Acts was 464. Of these 12 or about 2.6 % were returned as adulterated. A complete list is as follows: LIST OF SAMPLES TAKEN DURING THE YEAR 1918. Article. Genuine. Adulterated. Total. Milk 328 11 399 Butter 69 — 69 Tea 1 — 1 Coffee 22 — 22 Condensed Milk 1 — 1 Margarine 24 — 24 Plum Jam — 1 1 Infants' Food 1 — 1 Boric Ointment 2 — 2 Haricot Beans 1 — 1 Grey Powder 1 — 1 Tabloids 1 — 1 Cocoa 1 — 1 Totals 452 12 464 12 Milk.—339 samples of milk were analysed. Of these 11 or a little more than 3 % were adulterated, 7 out of the 11 had been dilated, 4 of the dilutions were excessive, from 24 to 35%; the remainder were samples deprived of milk fat from 6.7 to nearly 27 %. Preservatives were not detected in any of the samples, and colouring is now rare. The mean composition of the genuine samples of milk is shown by the table to be well over the official standard and not dissimilar to that of previous years. Sp. Gr. Milk Fat. Solids, not Fat. Total Solids. 1914 1031.3 3.75 8.77 12.52 1915 1032.0 3.72 8.82 12.54 1916 1031.0 3.63 8.57 12.20 1917 1032.0 3.70 8.80 12.50 1918 1030.2 3.75 8.75 12.50 Butter.—Sixty-nine samples of butter were examined. Only 1 was free from boric acid, the rest contained boric acid up to 26 grains per lb. Margarine.—The 24 samples of margarine, all genuine, contained boric acid up to 28 grains per lb. Cream.—The absence this time of samples of cream is because cream was not allowed to be sold. Miscellaneous Samples.—Among these was a sample of plum jam containing 10 % of apple pulp; a few drugs were also examined all of which conformed to the British Pharmacopoeia." Public Health (Milk and Cream) Regulations, 1912.—The following report is submitted in accordance witn 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 328 — Cream — — 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 — (ii.) Statements incorrect — Total — (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent — (ii.) Below 35 per cent — Total — 13 (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. 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 183 Cowhouses 5 Slaughterhouses 3 Offensive Trades 2 Ice Cream Premises 108 Bakehouses 65 Restaurant, Dining Room and Coffee Shop Kitchens 150 Hotel Kitchens 38 Pastrycooks and Tea Rooms 40 Fried Fish Shops 23 Fish Curers 3 Houses Let in Lodgings 1152 Workshops 2713 Total 4485 A statement with special reference to the list set out above, is contained in the following tables:— Number of places Number of inspections, 1918. Number of notices, 1918. Number of prosecutions, 1918. On register at end of 1917. Added in 1918. Removed in 1918. On register at end of 1918. Milk premises 203 — 20 183 326 — — Cowsheds 5 — —- 5 21 — — Slaughterhouses 4 — — 4 12 — — Offensive trade premises 2 — — 2 8 — — Icc cream premises 117 — 9 118 — — — Houses let in lodgings 1160 — 8 1152 1164 998 — 14 Mortuary. Removed by Inspectors. Number of bodies received 408 10 Number of Infectious bodies received 1 Disinfection. Number of rooms disinfected 1,086 Number of articles disinfected 20,314 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 2,031 1,058 1,249 1.474 5,812 Bakehouses. Number on register at end of 1918 65 Number above ground 10 Number underground 55 Number of inspections 123 Number of Notices Nil Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1918 372 Number of Inspections 356 Number of Notices Nil House to House Inspections. Number of Inspections Houses 49 Number of Notices issued Intimations 42 Statutory Notices Nil Number of Prosecutions Nil House Refuse. Number of Inspections 2,958 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 90 Number of Notices served 90 Number of Prosecutions Nii 15 Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 6 Number of Statutory Notices served 6 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowdeu 29 Number remedied 29 Number of Prosecutions Nil Underground Rooms. Number dealt with 14 Number of Notices served under P. H. (L.) Act, 1891 14 Number of Notices served under H. T. P., &c., Act, 1909 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 13 Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (1). Number of rooms cleansed 53 Number of Prosecutions Nil Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 22 Inland Revenue Act. Number of houses for which applications were received 4 Number of tenements comprised therein 20 Number of tenements for which certificates were granted 19 ,, „ „ „ refused Nil „ „ „ „ deferred 1 Drainage. The total number of inspections made 4,725 The total number of drainage plans deposited 117 The number relating to new buildings 9 „ „ old buildings 108 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. No. I. No. 2. No. 3. No. 4 Total. Total Inspections 472.5 4132 4522 6241 19620 Houses damp, dirty or dilapidated, remedied 80 105 28 60 273 Doors, windows, floors, ceilings, sash cords, etc., repaired 19 29 10 25 83 Overcrowding abated 3 14 12 0 29 Illegal occupation of underground rooms dealt with 0 14 0 0 14 Water closet defects remedied 60 109 49 70 288 Water closets erected 0 0 0 0 0 Urinal defects remedied 2 1 1 1 5 Soilpipe and ventilating shaft repaired or renewed 26 12 2 3 43 Yard defects remedied 25 58 4 34 121 Waste pipe defects remedied 17 5 7 5 34 Water cistern defects remedied 3 13 4 7 27 Rubbish, manure, etc., accumulations removed 2 75 20 10 107 Dung or dust receptacles repaired or renewed 13 37 23 17 90 Drains relaid or amended 23 0 0 9 32 Drains cleared 10 29 3 4 52 Rainwater pipes repaired or renewed 8 9 8 4 29 Water supply to houses reinstated 1 1 0 4 6 Roofs and gutters repaired 41 40 17 25 123 Area defects remedied 2 29 6 8 45 Wash-house defects remedied 24 33 3 34 94 Animal nuisances abated 2 4 1 1 8 Basement defects remedied 1 24 1 0 26 Stables cleansed or repaired 1 1 0 0 2 Water supply laid on to upper storeys of house 1 3 0 2 6 Miscellaneous nuisances abated 12 33 10 4 59 Verminous rooms cleansed 6 22 5 20 53 Workshops, damp, dirty or dilapidated, remedied 1 9 1 0 11 Workshops Ventilated 1 1 0 0 2 Smoke nuisances abated 2 0 0 0 2 Intimations served 124 2 Co 140 78 602 17 FACTORIES AND WORKSHOPS. The total number of visits to factories, workshops and workplaces during the year was 930, 803 by the women and 127 by the men inspectors. The complaints received numbered 13. 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 (Including Factory Laundries.) 15 — — Workshops (Including Workshop Laundries.) 915 27 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) — — — Total 930 27 — 2.—DEFECTS FOUND. Particulars. Number of Defects- Number of Found. Remedied. Referred to H.M. Inspector. Prosecutions. (1) (2) (3) (4) 5) Nuisances under the Public Health Acts:— Want of cleanliness 17 1 17 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 6 6 — — insufficient 2 2 — — Sanitary accommodation unsuitable or defective 2 2 — — not separate for sexes — — — — Offences under the Factory and Workshop Act.- Illegal occupation of underground house (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 28 28 — — 18 3.—HOME WORK; NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PUEMISES, SECTIONS 109, 110. 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) (?) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 110 678 1520 ... ... ... 89 ... ... ... ... ... ... ... .. Umbrellas, etc. 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Total 112 680 1520 ... ... ... 89 ... ... ... ... ... ... ... ... 19 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 2,713 Coffee Shops, &c 372 Bakehouses 65 Total number of workshops on Register 3,150 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 33 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 13 Reports (of action taken) sent to H.M. Inspector 13 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 1918 AND PREVIOUS YEARS. Year. Populatioi 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 Dist ict. of Residents not registered in the District. Under 1 Year of Age. At all Ages. No. Rate per 1,000 Nett Births. No. Rate. No. Rate. No. Rate. 1 2 8 4 5 6 7 8 9 10 11 12 13 1910 125,195 4,111 2,556 20.1 1,566 12.9 658 699 253 98.9 1,607 13.3 1911 117,844 4,130 2,375 20.2 1,578 14.2 600 840 261 109.8 1,818 16.3 1912 116,155 4,111 2,246 19.3 1,652 15.0 769 752 209 93. 0 1,635 14.8 1913 114,532 3,804 2,146 18.6 1,629 14.9 755 753 195 90.0 1,627 14.9 1914 112,892 3,847 2,128 18.7 1,631 15.1 813 787 210 98.6 1,605 14.9 1915 100,260 3,647 1,852 16.2 1,741 17.2 817 773 178 96. 1 1,697 17.8 1916 98,573 3,936 1,814 16.8 1,681 16.9 855 720 188 103.6 1,588 16.0 1917 92,796 3,065 1,506 14.5 1,647 17.6 853 752 182 120.9 1,580 17.0 1918 98,526 3,340 1,375 12.4 1,852 18.7 898 879 152 110.5 1,835 185 Total population at all ages at Census of 1911, 118,221. Area of district in acres (exclusive of area covered by water), 1427.8 acres. 21 TABLE I. (A) Vital Statistics of Separate Localities in 1918 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 1year Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under1year. Population estimated to middle of each year. Births registered. Deaths at all Ages Deaths under1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. 1908 126,867 2,559 1,845 207 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 3(50 265 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 27,342 337 422 35 30,901 801 639 94 17,015 347 295 28 1916* 98,573 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 1917 92,796 1,506 1,580 182 23,089 332 275 28 25,334 248 416 41 28,621 618 614 87 15,752 308 275 26 Averages of Years 1908 to 1917 113,112 2,171 1,685 220 28,808 472 360 40 31,265 421 422 43 34,464 928 633 109 18,575 350 270 28 1918 98,526 1,375 1,835 152 24,528 311 366 30 26,880 257 429 45 30,391 522 708 58 16,727 285 332 19 "'The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sub-District on the 1st April, 1916, but for the purposes of District comparison over previous years the figures have been allocated to the old Sub-Districts. 22 TABLE II. Cases of Infectious Disease Notified during the Year ending 28th December, 1918. Notifiable Disease. Cases 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 At ages—years. All Souls St. Mary Christ Church St. John Totals. All Souls St. Mary Christ Church St. John Totals Under 1 1 to 5 5 to 15 15to 25 25 to 45 45 to 65 65 and upwards Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera Diphtheria, including ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Membranous Croup 157 8 41 69 21 16 2 ... 27 22 73 35 157 26 20 70 34 150 7 Erysipelas 51 1 1 7 5 12 19 6 11 9 27 4 51 ... ... 1 ... 1 50 Scarlet Fever 80 ... 15 47 12 6 ... ... 17 11 43 9 80 16 10 40 8 74 6 Poliomyelitis 3 ... 1 2 ... ... ... ... 1 ... 2 ... 3 1 ... ... ... 1 2 Enteric Fever 9 ... ... 1 4 4 ... ... 4 2 1 2 9 2 2 1 1 6 3 Ophthalmia Neonatorum 28 28 ... ... ... ... ... ... 1 13 12 2 28 ... 1 ... ... 1 27 Puerperal Fever 6 ... ... ... ... 6 ... ... ... 4 ... 2 6 ... ... ... ... ... 6 Chicken Pox 58 7 15 24 6 6 ... ... 11 13 24 10 58 2 ... 2 ... 4 54 Cerebro-Spinal Fever Tuberculosis 4 ... ... 0 1 ... 1 ... 2 ... 2 ... 4 2 ... 2 ... 4 ... Pulmonary 318 ... 5 30 53 154 66 10 88 66 109 55 318 23 26 23 5 77 241 Non-Pulmonary 43 ... 5 19 8 9 2 ... 13 5 12 13 43 2 1 3 3 9 34 Measles 517 22 200 210 47 35 3 ... 75 79 244 119 517 16 5 11 6 38 479 German Measles 166 11 37 64 32 21 1 ... 14 33 81 38 166 3 5 1 ... 9 157 Measles (Notified by Parents and Guardians) 90 3 21 46 9 11 ... ... 11 14 38 27 90 5 6 5 ... 16 74 Totals 1530 80 341 521 198 280 94 16 275 271 668 316 1530 98 76 159 57 390 1140 1530 23. TABLE III.—Causes of, and Ages at Death during the year ending 28th December, 1918. No. CAUSES OF DEATH. 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. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and ; under 45. 45 and under 65. 65 and upwards. 1 Entcric Fever 2 — — — — 1 1 — — 1 — — 1 1 2 2 Small Pox — — — — — — — — — — — — — — — 3 Measles 11 2 3 5 — 1 — — — — 2 1 8 — 11 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Whooping Cough 24 5 13 5 1 — — — — — 3 5 15 1 24 6 Diphtheria and Croup 11 — 2 8 1 — — — — 1 — 2 8 1 11 7 Influenza 266 6 3 6 16 43 117 57 18 90 52 82 96 36 266 S Erysipelas 6 1 — — — 1 — 2 2 1 5 — 1 — 6 9 Phthisis (Pulmonary Tuberculosis) 167 — 1 — 6 15 70 02 13 22 45 39 60 23 167 10 .Tuberculous Meningitis 7 — 1 2 4 — — — — 11 1 — 5 1 7 11 Other Tuberculous Diseases 16 — 2 2 3 1 4 2 2 5 3 6 5 2 16 12 Cancer 143 — — — — — 18 67 58 298 33 33 49 28 143 13 Rheumatic Fever . 9 — — — 2 1 — 6 2 3 2 2 2 9 14 Meningitis 14 2 2 2 2 2 2 2 — 7 1 3 9 1 14 15 Organic Heart Disease 161 2 — — 1 7 18 54 79 92 37 45 52 27 161 16 Bronchitis . 191 13 2 2 2 — 8 46 11* 18 29 38 91 33 191 17 Pneumonia (all forms) 177 IB 24 11 8 12 32 37 37 76 33 25 85 34 177 18 Other Diseases of Respiratory Organs 38 1 1 — 1 1 6 17 11 12 8 6 17 7 38 19 Diarrhoea and Enteritis (under 2 years) 34 28 6 — — — — 30 8 9 14' 3 34 20 Appendicitis and Typhlitis 7 — — — — 1 3 3 — 28 2 1 3 1 7 21 Cirrhosis of Liver ... 4 — — — — 1 3 6 — 1 2 1 4 21a Alcoholism... 2 — — — 1 1 — 1 1 2 22 Nephritis and Bright's Disease ... 50 — — — 1 2 10 21 16 22 14 11 15 10 50 23 Puerperal Fever 3 — — — 1 2 — — a 2 1 — — 3 24 Other accidents and diseases of Pregnancy and Parturition 4 — — — — — 4 — — 6 1 — 2 1 4 25 Congenital Debility and Malformation, including Premature Birth 46 46 56 9 13 19 5 46 26 Violent Deaths, excluding Suicide 66 3 1 3 8 8 19 5 19 56 17 6 24 19 66 27 Suicides 5 — — — 1 4 7 . 1 2 1 1 5 28 Other defined Causes 371 27 2 3 0 7 2K 111 190 201 57 98 123 93 371 29 Diseases ill defined or unknown — — — — — — — — — — — — — — — Totals 1835 152 63 49 59 105 344 494 569 1053 366 429 708 332 1835