AC 4349 No. 15442 BAD 19 Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEARS 1914-18 (inclusive). BY REGINALD DUDFIELD, O.B.E., M.A., M.B., D.P.H. Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. LONDON: MORTON & BURT, Ltd., Printers, 187, DGWARE ROAD, W.2. PAD 19 Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEARS 1914-18 (inclusive). BY REGINALD DUDFIELD, O.B.E., M.A., M.B., D.P.H, Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. CONTENTS. page Acute Poliomyelitis 8 Administrative Work 30 Analytical Work 42 Arsenic in Foodstuffs 43 Bacteriological Examinations, Results of 31 Bakehouses, Inspection of .37 Births 1 ,, Notification of 2 ,, "Hopeless" 24 „ Illegitimate 1 „ Still-births 2 Canals, Canal Boats Acts 35 Cancer, Mortality from 21 Cerebro-spinal Fever 8 Chickenpox 30 Childbed, Mortality in 9 Childhood, Mortality in 23 Combined Drainage 33 Dairies ana Milkshops 40 Deaths 3 Deaths in Institutions—All Causes 23 Diphtheria 7 Disinfection 31 Drainage Plans33 Drains,Private,Re-laid 33 Factory and Workshop Act, 1901, Work under 36 Flooding 34 Food Adulteration 42 Food Supervision 39 Home Workers (Outworkers) 36 Hospital Isolation 7 House Sanitation 32 Housing .37 Housing Acts 37 Ice Cream, Inspection of Places where made 41 Illegitimates, Births of 1 „ Deaths of 25 Infants, Mortality among 23 „ „ . in Special Areas 24 Influenza, Mortality from 22 Inquests held 22 Institutions, Deaths in 23 Internotification 32 Legal Proceedings, Summary of 44 Manure, Removal of 35 Measles 26 Meat Condemned in Slaughterhouses 40 „ Seized in Shops, &c. 42 "Meningitis" 8 PAGE Milk Supply 40 Milkshops, Trades carried on at 40 Mortality among Infants 23 „ „ „ " Hopeless Births" 24 „ at ages 1—5 years 25 ,, in Childbed 9 Mortuary 35 Mumps 30 Notification of Births 2 ,, „ Sickness 5 „ ,, Tuberculosis 9 Offensive Refuse 35 Office Work 44 Ophthalmia Neonatorum 9 Outworkers (Homework) 36 Overcrowding 38 Phthisis, Mortality from 17 Pig Keeping 35 Poliomvelitis 8 Population 1 Preservatives in Foods 43 Prevention of Infectious Disease 30 Puerperal Fever 8 Pulmonary Tuberculosis 17 Respiratory Diseases, Mortality from 22 Ringworm 30 Sanatorium Benefit 14 Scarlet Fever 7 Schools and Infectious Diseases 31 Sewer Connections 33 Sickness (Notification) 5 Slaughterhouses, Inspection of 39 Smoke Nuisance 35 Staff 30 Tenement Houses 37 Trade Nuisances 35 Tuberculosis: Dispensary Work 14 ,, Notification 9 „ Mortality 16 ,. Treatment of 12 Unsound Food 42 Vaccination 6 Vital Statistics 1 Water Supply, Cutting off of 35 Whooping Cough 29 Workshop Supervision 36 APPENDIX. Tables I to XIX. TO HIS WORSHIP THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF PADDINGTON. Mr. Mayor, Ladies and Gentlemen, The last Annual Report which I had the honour to submit to you was that for the year 1913. A report for the following year was submitted by the Acting Medical Officer of Health, Dr. Galway Murray. Strictly speaking the duty lay on me to prepare Reports for each year after 1914, but when I looked into the matter I found that a most essential statistical detail, viz., a true estimate of the population for any of those years, was unobtainable. Taking that fact into consideration in conjunction with the excessive cost of publishing a series of Annual Reports, and the interference in the work of the Department—already overloaded with current work—I decided to combine the Reports into two volumes, the first to cover the period of hostilities, the five years 1914-18, and the second to serve for the two years 1919 and 1920. This decision appeared to me to be justified by the fact that no reliable information as to the population of the Borough will be available until the autumn of 1921, when the results of the next Census will be known. In the preparation of this Report I have included tables of the annual figures of the cases of infectious disease, births and deaths belonging to the Borough, so that at a later date the annual rates of natality, morbidity and mortality may be calculated for the period under review and thus preserve the continuity of the Departmental records. I much regret that I am unable to submit any information as to the numbers of residents who took an active part in the war, either by service with H.M. Forces or in works essential to the success of those Forces, nor of the numbers of those who gave their lives and health for the safety of their Country and humanity. It is more than doubtful whether any such information will ever be available. I he Report now submitted is divided into two sections, viz., Vital Statistics and Administrative Work. In the former, the first fact which will attract attention is the decrease in the number of births amounting, for the five years under review, to over 17.0 per cent. less than the total for 1909-13. The corrected total of deaths for 1914-18 was only 10 per cent. above that for 1909-13, but it has to be remembered that the figure for 1914-18 represents (almost exclusively) deaths among the civilian population, while that for 1909-13 the deaths among the total population. In the introductory letter to the Report for 1913, I adduced evidence which I thought indicated that the reduction in the population of the Borough recorded in the most recent Censuses have given place to an increase. If the suggested increase had persisted during 1914-18, a large number of deaths could have been recorded during those years (in comparison with the preceding five years) without any increase in the rate of mortality. As a matter of fact the 1914-18 total was drawn from a population from which were excluded all adults serving with the Forces, a section of the population with a low rate of mortality. The mortality rates given in Table I., Appendix, are, I believe, too high. as I think that the civil population has been underestimated. The mean of the rates, there given for 1914-18, is some 22 per cent. above the mean for 1909-13. After carefully considering the available information, I am inclined to the opinion that the civilian mortality during 1914-18 was approximately 15 per cent, higher than the total mortality during 1909-13. This view is supported to some extent by the fact that the mortality during 1914-18, at ages under 5 years—not dependent on any estimate of the total population--was 16 per cent above that for 1909-13 (See page 26). The general run of the records show that the mortality tended towards an increase with the prolongation of hostilities. That fact is, I think, more particularly observable in the mortality at ages under one year. The records included under IV. Sickness : Notification demonstrate clearly the immunity which the Borough enjoyed during the war period from epidemic diseases. Such immunity was not a local one, but was shared by the Country generally. The contrast between the experience qua epidemics of the War of 1914-18 with that of earlier wars—known historically as "great wars"—was remarkable. The only disease which can be said to have left an outstanding record during the past War is epidemic influenza, which prevailed on an unprecedented scale during the latter half of 1918. I cannot help thinking that the statistics dealing with tuberculosis will give rise to disappointment, and especially so when cognisance is taken of the frequency of cases unknown to your Health Department before death, and of the relatively large proportion of patients dying in Poor Law Institutions. Some consolation may be found in the fact that the war involved great dislocation of the services inaugurated in 1914 for the care of the tuberculous. The Staff of the Department was somewhat depleted and had extra duties imposed upon it in connection with National Registration and Food Control. In spite of that added work, the records of the Staff's activities in the direction of sanitary supervision are, I think you will find, satisfactory. Nevertheless, the figures included in Tables XIII. and XV. (Appendix) and the remarks made on pages 33 and 38 demonstrate the fact that at the end of 1918 there were considerable arrears of work to be cleared off. Such arrears were inevitable, having regard to the time taken for the special war works already mentioned and to the difficulties of obtaining labour and material for sanitary works. Although the Departmental records were carefullv kept up throughout the war—for which an acknowledgment is due to the Chief Clerk (Mr. Gower)—the task of collating the material for this Report has been a heavy one. No one can be more conscious than I am of the deficiencies in the Report, and I shall be more than content when the next Report (that for 1919-20) shall be complete and the series of Annual Reports resumed. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant. O.B.E., M.A., M.B., D.P.H., Medical Officer of Health. Public Health Department, Paddington, W. 2. December, 1920. 1 A. VITAL STATISTICS. I.—POPULATION. In 1914 the mid year population of the Borough, calculated by the usual methods, was estimated to be 142,087 persons (60,021 males and 82,066 females). Following the outbreak of war the withdrawal from civil life first of males of the true "fighting ages" and later on of males of lower and higher ages and of women, rendered useless all estimates of population derived from time-established formulae. For 1915 the Registrar-General furnished an estimate of the population of the Borough, and for the years 1916-18, two, one the "total population" and the other the "civil," the former being supplied for determining birth and marriage rates, the latter for sickness and death-rates. The estimates are included in Table I., Appendix. Considerations of space prevent a discussion of the values of the estimates, but there is reason for thinking that the figures are under-estimates, more particularly in the last year (1918). Estimates of the populations of the Wards, and of the sex-age constitution of populations are dependent on the estimate of the total population. Partly because the estimates of total population are deemed to be vague, and partly because no data are available as to the numbers of persons, normally resident in the different Wards, who were taken for the Services or Munition work, no figures as to the populations of Wards or as to the sex-age composition of the population are included in this Report. The decision to exclude such figures has involved the exclusion of practically all the rates usually included in the Reports, and has made a comparison between the vital statistics of the "war period" with those of years antecedent thereto, a matter of some difficulty. An attempt to meet that difficulty has been made by calculating "Index Numbers." Those numbers show the percentage increase (or decrease) in the numbers of births, &c., recorded during 1914-18, when compared with the numbers recorded in the preceding five years (1909-1913). This method when used for (say) morbidity or mortality rates at all ages takes no account of changes in sex-age composition of the population, and to that extent constitutes an imperfect measure of annual (or other) variations. It may be recalled that up to 1914 the population of the Borough was a slightly decreasing one. II.—BIRTHS. The numbers of births registered locally and the corrections required to obtain the nett totals are given in Table I., Appendix. The corrected total decreased from 3,031 in 1909 to 2,017 in 1918—a fall of 33.5 per cent. In the five years, 1904-08, the births averaged 3,276 per annum, in the next quinquennium (1909-13) the annual average was 3,008 (a shrinkage of 268 per annum or 8.2 per cent.), and in the last (1914-18), 2,489 (a total shrinkage of 788 births per annum or 24T per cent.). The last period in comparison with that immediately preceding it shows an annual reduction of 519 births, or 17.3 per cent. In the first section of Table II., Appendix, the corrected numbers of births have been distributed according to Wards. Index Numbers showing the differences between the annual averages for the two quinquennial periods 1909-13 and 1914-18 are included. The greatest differences (decreases) are recorded in Queen's Park (a reduction of 25 per cent.) and Church (a reduction of 22 per cent.) Wards, and the smallest (2 per cent.) in Lancaster Gate, West, Ward. In the whole period for every 1,000 births of males there were 955 of females. Except in 1916, births of males were in excess of those of females. (See below). Numbers of Births of Females to every 1,000 Births of Males. 1914—951. 1915—935. 1916—1,020. 1917—999. 1918—862. Illegitimate Births.—The proportion of illegitimate births to all births rose during the years 1914-18 from 6.2 per cent, in 1914 to 10.4 in 1918, the average for the period being 8.2. The proportion of illegitimate males to all male births was 8.l, the corresponding figure for females being 8.2—the ratio of males to females among illegitimates being approximately 1,000 to 977, but that ratio varied somewhat widely and irregularly from year to year. The annual percentages are given on the next page. B 2 births. TABLE 1. Illegitimate Births: Percentages. Percentage of Illegitimate to Total Births. 1914 1915 1910 1917 1918 Borough. 6.17 6.26 8.92 10.28 10.41 Words. Queen's Park 5.35 3.84 5.50 6.40 4.00 Harrow Road 3.44 2.92 4.99 3.90 8.58 Maida Vale 6.23 11.02 11.76 12.23 14.76 Westbourne 6.56 7.72 945 10.74 7.65 Church 7.36 6.35 866 10.91 10.57 Lancaster Gate, West 12.28 7.84 21.05 34.61 20.00 „ East 6.25 10.00 13.63 15.21 13.20 Hyde Park 12.42 8.51 17.48 21.32 21.36 Notification of Births.—Of the 11,224 births registered in the Borough during the five years, 10,823 had been previously notified. The percentage of non-notified births for the whole period was 3.6, the annual percentages varying from 2.8 (1916) to 5.3 (1917). The variations in the proportions of births registered after notification are shown below. Percentages of Births Registered after Notification. Total Births. Quarters 1 2 3 4 Registration Areas 1914 1915 1916 1917 1918 1914 97.0 96.7 96.1 95.6 North Paddington 97.2 97.5 98.4 95.9 98.3 1915 96.1 96.3 97.2 96.8 Central „ 97.2 98.0 97.5 95.5 97.2 1916 97.0 96.0 98.2 97.7 South „ 88.2 82.2 89.5 83.2 88.0 1917 93.4 92 .9 96.2 96.7 Borough 96.4 96.6 97.2 94.6 96.9 1918 96.6 97.2 96.0 98.0 The figures given below, showing the proportions of notifications received from medical practitioners and others, indicate great changes in the practice of midwifery, in 1914 rather more than one-third (38 per cent.) of births were reported by midwives—some 4 per cent, more than by medical practitioners—whereas in 1918 the proportion reported by midwives had increased to over 61 per cent., and that reported by medical practitioners fallen to some 27 per cent.—a difference in favour of the former of approximately 34 per cent. The demand for medical practitioners for the Services was undoubtedly largely responsible for this change. It will be interesting to observe whether the change be a temporary one or not. Notification of Births. Percentages of Total Notifications received. 1914 1915 1916 1917 1918 From— Medical Practitioners 33.7 35.79 35.22 33.44 26.96 Midwives 37.8 40.14 48.44 55.06 61.35 Parents 17.9 14.36 13.17 7.57 7.21 Others 10.6 3.70 3.15 3.91 4.18 Included among the .11,224 births registered within the Borough there were 818 births of illegitimates, of which 783 had been previously notified. The percentage of non-notified births of this category for the whole period was 4.3, varying within the limits of 1'6 per cent. (1916) and 6-7 (1915). Still-Births.—The 11,146 births notified during the five years included 332 notifications of still-births, equal to 3.0 per cent, (nearly) of all births notified. I he annual percentages recorded in each year—in the Borough and in each of the Wards—are shown in Table 2. 3 deaths. TABLE 2. Percentages of Still-births to all Births Notified. 1914 1915 1916 1917 1918 Borough 2.95 2.60 2.51 3.10 4.00 Wards. Queen's Park. 2.00 2.96 252 2.79 2.22 Harrow Road 2.73 2.25 2.47 3.43 2.69 Maida Vale. 3.96 3.39 1.24 2.67 3.18 Westbourne . 2.28 3.15 3.67 3.47 6.72 Church 3.55 1.53 2.78 2.04 3.03 Lancaster Gate, West 5.00 2.70 2.70 3.33 5.55 „ „ East 2.00 3.51 2.44 6.06 3.12 Hyde Park . 1.68 2.78 0.83 5.00 5.00 The data on which the foregoing proportions are based cannot be accepted without reservation. As regards notification generally there is no real system of transfer of certificates. As the person notifying is not required to say whether the address at which the birth takes place is or is not the permanent address of the parents, the interchange of notifications can be effected only after systematic enquiry. As regards still-births there is no check upon the numbers reported, such as that furnished by the registration of (live) births. One other comparison is submitted, viz., the differences between the proportions of stillbirths to legitimate and to illegitimate births. (See below.) Still-Births. Percentages of Births Notified. 1914 1915 1916 1917 1918 Legitimate 2.95 2.60 2.51 3.10 4.00 Illegitimate 6.06 7.81 3.93 2.97 9.86 For the whole period the notifications of legitimate births numbered 10,679, including 303 of still-births (2.8 per cent.), and those of illegitimate births, 467, including 29 of stillbirths (6.2 per cent.). Generally speaking the figures given above suggest an increase in frequency of stillbirths, but it would be unwise to accept such suggestion without considerable reservation. In spite of the serious defects in the Notification of Births Act 1907, there is no doubt that notification is becoming more general in the Borough, and to that improvement must be attributed some part at least of the increased proportion of still-births. III.—DEATHS. The total number of deaths registered within the Borough during 1914-18 was 10,116, 0.8 per cent, fewer than the total for 1909-13 (10,192). The annual averages were 2,038 in the first quinquennium and 2,032 in the second. After correcting for deaths of non-residents within the Borough and for those of residents occurring outside, the corrected totals become —for 1909-13, 9,435, and for 1914-18, 10,360, showing an increase of 9.8 per cent. The numbers recorded in each year are shown in Table I., Appendix, where will be found the mortality rates, which, for the years 1916-18, are calculated on the estimated civil—not total—population furnished by the Registrar-General. In Table II., Appendix, the corrected total of deaths in each of the five years has been distributed according to the Wards of residence of the deceased persons. For reasons already fully set out, it has been decided that it is useless to give any Ward mortality rates. Attention maybe directed to the annual averages given in that Table, and to the Index Numbers. While the Index Number for the Borough is 110, lower Numbers were observed in the following Wards:—Church (101), Harrow Road (106) and Queen's Park (109). The reductions are somewhat unexpected, especially that in the first-named Ward. It may be presumed that the drain of men and women was heavier in those Wards than in the others, but at present no proof of that presumption can be offered. b 2 4 deaths. On distributing the deaths from all causes into age-groups (male and female), and striking averages for the two quinquennial periods, the results set out in Table 3 are obtained. While the number of deaths of persons at all ages during 11) 14-18 was 10 per cent. above that for 1909-13, the increase for males was only 7 per cent. and that for females 12. The highest increase in any age-group (persons) was 37 per cent. (group 20-25), and the greatest decrease 6 per cent. (group 35-45). Among males the greatest increase was 29 per cent. (group 65-75), and greatest decrease 11 per cent. (group 35-45). Among females the greatest increase (48 per cent.) occurred at ages 20-25, and the greatest decrease (3 per cent.) at ages 0—15. TABLE 3. Deaths: All Causes. Age Groups. All Ages. 0- 15- 20- 25- 35- 45- 55- 65- 75- 85- Annual Averages. Males: 1909-13 289 11 14 50 77 105 134 131 82 19 912 1914-18 273 13 17 51 69 121 142 168 98 24 976 Females: 1909-13 238 15 16 50 73 104 115 153 150 61 975 1914-18 232 19 24 67 73 109 136 183 182 71 1096 Index Numbers: 1914-18. Males 94 110 125 101 89 116 106 129 120 126 107 Females 97 134 148 132 100 104 118 120 121 117 112 Persons 90 126 137 116 94 110 111 124 120 119 110 A complete analysis of the deaths of residents of the Borough for each of the years 1914-18 by cause, sex and age will be found in Tables V.A-E, Appendix. The annual averages (persons, all ages), together with the Index Numbers for certain selected causes will be found in Table 4. TABLE 4. Deaths : Persons, All Ages. Cause of Death. Annual Averages. Index Numbers * Cause of Death. Annual Averages. Index Numbers.* 1909-13 1914 -18 1914-18 1909-13 1914-18 1914-18 Enteric Fever 4 3 68 Bronchitis 180 163 91 Measles 50 53 104 Pneumonia, Lobular 56 72 128 Scarlet Fever 7 5 74 „ Lobar 22 27 124 Whooping Cough 35 30 87 Pneumonia 65 68 105 Diphtheria 10 16 160 Other Dis. of Respiratory Organs 23 21 93 Epid. Influenza 37 102 277 Disease of Stomach 12 12 100 Erysipelas 4 5 124 Diarrhoea and Enteritis 8.3 69 82 Other Septic Diseases 8 5 89 Appendicitis 13 9 70 Tuberculosis, Pulmonary 145 165 114 Obstruction of Intestines 13 16 123 „ Meningeal 16 18 109 Cirrhosis of Liver 15 19 131 „ Other Forms 26 42 93 Nephritis 64 53 83 Syphilis 11 15 138 Congenital Defects 19 19 100 Cancer 170 198 117 Premature Birth 56 44 78 Rheumatic Fever 7 3 44 Developmental Diseases 58 37 63 Alcoholism 11 7 65 Old Age 103 109 106 Cerebral Haemorrhage 52 59 114 Suicide 16 15 97 Apoplexy 15 11 75 Overlaid in Bed 5 2 43 Convulsions 9 4 44 Accidents and Violence 50 77 155 Heart Diseases 166 249 149 Homicide 2 2 100 * Averages 1909-13 = 100. 5 SICKNESS. IV.—SICKNESS: NOTIFICATION. In Table III , Appendix, the numbers of cases of the infectious diseases recorded in each of the years 1909-18 are set out. The annual averages for the two quinquennia and the Index Numbers for 1914-18 are given in Table 5. The figures in both Tables are corrected for duplicate reports, but not for "errors of diagnosis," &c. Table IV., Appendix, gives the numbers of "errors" for (what are designated) the more important infectious diseases. Of the diseases included in Table 5, diphtheria (and membranous croup—a clinical TABLE 5. Paddington. Annual Averages. Index Numbers.* 1909-13 1914-18 1914 1915 1916 1917 1918 1914-18 Diphtheria 198 248 144 134 105 115 128 125 Membranous Croup 3 4 107 250 71 71 142 125 Erysipelas 110 101 128 124 94 60 50 91 Scarlet Fever 374 344 147 117 73 31 40 92 Enteric Fever 29 15 34 62 72 41 .44 51 Continued Fever 0 0 Puerperal Fever 8 7 132 92 105 92 26 89 * A verages 1909-13 = 100. variation of diphtheria) is the only one with a higher annual average during the "war period" (1914-18). The low prevalence of all the other diseases, and (to a less degree) even of diphtheria during the three years 191G-18), forms a remarkable variation from the experience of previous great wars. In this respect the Borough did not enjoy a special immunity. I he returns for the Metropolis, extra-Metropolitan England and Wales, and for the Ports have been collated—they have not been included in the Report for economy's sake —and they tell the same tale. Smallpox and enteric fever were respectively epidemic on great scales during the Franco-German War of 1870-72 and the South African War of 18991901. The severest epidemic of smallpox of which reliable statistics are on record occurred in this country during 1871-72, and there was a considerable prevalence of enteric at home following the return of troops from South Africa. The relative immunity from these diseases enjoyed by the country during the last war was attributable to the high standard of the preventive medical services in the Army and the vigilance of the Port Sanitary Services. As regards enteric fever the experience in the Services during the last war was a noteworthy one. The conditions of trench warfare were such as to favour the development of an epidemic of devastating proportions. The failure of the disease to overcome preventive measures can be attributed only to the almost universal protection of the troops by inoculation a statement which can be made without in any way minimising the value or efficiency of the methods of conservancy or water purification. The success which attended antityphoid inoculation should be an unanswerable argument to the anti-vaccination propagandist. The success in the past nineteen years of the propagandum against vaccination is clearly shown in cols. 5 and 9 of Table 6. If the proportion of unprotected children continues to increase there can be only one result. At no very distant date the proportion of the unprotected to the total population will become so large that the disease (smallpox) will not be kept in check by the vigilance of health officers, and the experience of 1871-72 will be repeated. Errors of Diagnosis.—Table IV., Appendix, shows the distribution according to Wards of the three diseases—diphtheria including membranous croup), scarlet fever and enteric fever during the years 1914-18, together with the numbers of instances of variation of first diagnosis ("errors"). The data in that Table are summarised in Table 7. The percentages of "errors" to all notifications follow this. 6 SICKNESS. During 1914-18—diphtheria, 8.2; scarlet fever, 71; and enteric fever, 19 5, as compared with During 1909-13—diphtheria, 11.0; scarlet fever, 7.4; and enteric fever, 19.7. TABLE 6. Vaccination Returns. Children Born. Successfully Vaccinated. Insusceptible to Vaccination. Died Unvaccinated. Per cent, of Children Born. (Cols. 1-4.) Vaccination Postponed. Exempted • under Act. " Rest." Per cent. of Children Born. (Cols. 6—8.) Cols. 1 2 3 4 5 6 7 8 9 1901 3,364 2,076 5 313. 89.0 23 34 313 11.0 1902 3,262 2,692 12 291 89.8 35 19 276 101 1903 3,315 2,621 10 290 88.2 48 32 308 11.7 1904 3,311 2,578 8 307 87.4 52 22 344 12.6 1905 3,188 2,495 11 261 86.8 61 40 320 13.2 1906 3,174 2,545 9 224 87.5 36 41 319 12.5 1907 3,092 2,349 7 255 80.4 28 97 356 15.6 1908 3,098 2,346 8 244 83.8 28 201 271 16.1 1909 2,920 2,242 11 207 84.2 27 243 190 15.7 1910 2,916 2,093 6 232 79.9 26 356 203 20.1 1911 2,821 2,014 10 2 28 79.8 31 367 171 20.2 1912 2,808 1,990 5 185 77.6 34 388 206 22.4 1913 2,794 1,903 3 197 75.2 40 445 206 24.8 1914 2,713 1,744 11 182 71.3 30 551 197 28.7 1915 2,516 1,683 4 163 73.5 43 422 201 26.5 1916 2,388 1,555 9 164 72.3 36 444 180 27.7 1917 ] ,843 1,152 7 137 70.3 38 354 155 29.7 1918 1,808 1,120 5 143 70.5 41 308 185 29.5 TABLE 7. Diphtheria (including Memb. Croup). Scarlet Fever. Enteric Fever (including Cont'd Fever). 1909-13 1914-18 1909-13 1914-18 1909-13 1914-18 Total Cases Reported 1003 1258 1869 1720 147 77 Errors included 111 102 139 123 29 15 Total Cases to Hospital 938 1200 1785 1648 118 59 Errors included 108 92 127 118 26 12 Deaths at Home 5 12 ... 2 5 5 Errors included ... ... ... ... ... ... Deaths in Hospital 57 70 37 20 17 4 Errors included 12 2 4 ... 3 1 Percentages. Errors Reported... 11.0 8.1 7.4 7.1 19.7 19.5 „ to Hospital 11.5 7.6 7.1 7.1 22.0 20.3 Total Fatality (corrected) 5.60 6.92 1.90 1.37 16.10 11.29 Fatality in Hospital (corrected) 5.42 6.13 1.99 1.30 15.21 6.38 All reported Cases removed to Hospital 93.5 95.4 95.5 95.8 80.2 76.0 7 sickness. Hospital Isolation.—Although the Metropolitan Asylums Board was called upon to surrender six of its fever hospitals (4,250 beds) to the Services, the proportions of cases removed to hospital for isolation and treatment were actually higher during 1914-18 than during 1909-13, with the exception of enteric fever. (See Table IV., Appendix and Table 7 supra.) The following comparison of the percentages of cases removed to hospital from the County as a whole and from the Borough, indicates that the Borough fared better in this respect than did the County as a whole :— County of London. Borough of Paddington. 1914 1915 1916 1917 1918 1914 1915 1916 1917 1918 Diphtheria 87.6 91.7 95.2 98.4 96.1 93.1 97.0 97.6 96.5 93.4 Scarlet Fever 91.0 92.6 93.8 95.7 94.3 94.1 97.4 97.8 94.4 96.6 Enteric Fever 55.1 64.7 64.2 57.8 62.2 75. 8 9.4 71.4 66.7 77.0 Multiple Cases.—It would occupy too much space and be of doubtful utility after so long an interval to attempt an analysis of the instances (and the causes thereof) of occurrence of two or more cases in a house or family. It must suffice, as an appendage to the figures relating to the proportions of cases removed to hospital to submit the following summary of "multiple cases" of diphtheria and scarlet fever:— Scarlet Fever. (Coses—Corrected.) 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 Houses with 2 Cases 59 21 14 29 42 62 33 26 5 14 „ „ 3 „ 22 7 2 8 16 31 9 6 3 5 „ „ 4 „ 2 1 — 4 4 2 — — — „ „ 5 „ 1 1 1 — — 3 1 — — „ „ 6 „ — — — 1 1 I — — — „ „ 10 „ — — — — 1 — — — — — Families with 2 Cases 51 22 14 27 46 66 31 24 5 14 „ „ 3 „ 14 6 2 8 12 26 5 6 3 4 „ „ 4 „ 4 1 1 — 6 4 — — — — „ „ 5 „ — 1 1 — — 2 1 1 — — „ „ 8 „ — — — — 1 — — — — — The following institutional outbreaks are not included in the above figures. 1915 30 cases at an Orphanage. 3 cases at a Training School. 2 cases at the Workhouse. 1916 7 cases at an Orphanage (referred to above). Institutional cases were excluded from the figures for 1909-13. Diphtheria. (Cases—Uncorrected.) 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 Houses with 2 Cases 10 2 9 20 15 19 11 13 12 12 „ „ 3 „ 1 — 5 4 2 2 7 3 1 3 „ „ 4 „ 1 — 1 1 — 1 — — 3 1 „ „ 5 „ — — — 1 1 — — — — — „ „ 7 „ — — — — 1 — — — — — Diphtheria. (Cases —Corrected.) 1913 1914 1915 1916 1917 1918 Houses with 2 Cases 12 17 11 13 8 10 „ „ 3 „ 1 2 6 2 1 3 „ „ 4 „ — 1 — — 2 1 „ „ 5 „ 1 — — — — — „ „ 7 „ 1 — — — — — Families with 2 Cases 11 15 11 11 7 12 „ „ 3 „ 3 2 4 1 1 — „ „ 4 „ — — 2 — „ „ 5 „ 1 — — — — — 8 SICKNISS. Fatality.—The percentages of deaths to cases (corrected for "errors") *during 1914-18 was higher for diphtheria, but lower for the other two diseases (see Table 7), the total fatalities being— Diphtheria. Scarlet Fever. Enteric Fever. 1914-18 6.92 1.37 11.29 1909-13 5.60 1.90 16.10 The fatalities among cases removed to hospital were lower than those among patients treated at home. Attention may be specially directed to the fatality of enteric fever (Table 7). A comparison of the fatalities observed in M.A.B. Hospitals among patients removed from the County as a whole and from the Borough shows that the latter had a higher recovery rate. (See below). Fatality rates per 100 cases treated in Hospital (M.A.B.). County of London. Borough of Paddington. 1914 1915 1916 1917 1918 1914 1915 1916 1917 1918 Diphtheria 7.9 7.9 6.8 6.7 7.7 5.1 8.8 4.7 5.4 6.5 Scarlet Fever 1.4 2.0 1.8 1.9 1.8 0.9 1.8 1.6 1.9 0.7 Enteric Fever 17.1 16.7 131 17.3 13.4 14.3 7.7 6.7 — — "Meningitis" Group.—This general designation is used to cover notifications of— Cerebro-spinal fever (or meningitis) 31 cases reported during 1914-18. Posterior Basic Meningitis 4 „ „ „ „ Anterior Polio-myelitis 9 „ „ „ „ The numbers of cases reported each year are shown in Table III., Appendix. Five of the reported cases of cerebro-spinal fever were ultimately marked "errors," viz., 3 in 1915 (30 per cent. of the notifications) and one each in 1916 and 1917. The seasonal distribution of the cases—excluding" errors"—based on the reported dates of onset, is shown below. Jan. Feb. Mch. Apr. May. June July Aug. Sept. Oct. Nov. Dec. Cerebro-spinal fever 4 2 2 6 2 2 1 — 1 1 1 4 Posterior Basic Meningitis 1 2 — — — — — — — — — 1 Anterior Polio-myelitis 1 1 — — 1 — — 1 3 2 — — There is no record of any case having been traced to a previous case, nor of any spread of infection from a case reported locallv. The fatalities averaged for the five years, calculated after exclusion of "errors, were— Cerebrospinal fever 26 cases, 17 deaths—73 per cent combined 66.6 per cent. Posterior Basic Meningitis 4 „ 3 „ 75 „ Anterior Polio-myelitis 9 „ 2 „ 22 „ In addition to the 17 deaths among the 20 reported cases of the first disease, there were two other (un-notified) deaths (in 1916) from that cause—one a soldier and the other a civilian. Two cases notified as cerebro-spinal fever—marked "errors"—terminated fatally, the causes of death being tubercular meningitis in one, and cerebral tumour in the other. In April, 1918, attention was called in The Lancet to certain groups of cases with symptoms suggestive of "botulism"—a disease originally traced to the consumption of sausages infected with a special organism. In May the Medical Officer of Health of the County issued a circular letter asking for reports of any cases coming to light in the Borough. Three such cases were reported, viz.:— f. set 2 sickened May 9 or 10 (died of tubercular meningitis), f. „ 7 „ „ 18 recovered, f. „ 26 „ „ 30 recovered. In no instance was there any paralysis of the oculo-motor muscles. Towards the end of the year it was recognised that the proper diagnosis of the cases was Encephalitis Lethargica, and the disease was made notifiable as from January 1, 1919. Puerperal Fever.—During the five years 34 cases were reported (see Table III., Appendix), of which 3 were marked "errors." Institutional treatment was given to 25 cases, or 80.6 per cent, of all cases. The deaths recorded numbered 17, giving a fatality of 55 per cent, (after exclusion of "errors"). The fatality varied from 30 per cent, in 1914 to 100 in 1918. 9 TUBERCULOSIS. Accidents and Diseases of Parturition.—There were 18 casualties from these causes during the five years, viz., 1914, 7; 1916, 8; and 1915, 1917 and 1918, one each. The deaths from puerperal fever and accidents and disease of parturition numbered 41 during 1914-18, or 4 less than the total (55) for 1909-13. The Index Numbers for 1914-18 (averages for 1909-13=100) are — Puerperal fever, 144. Accidents and Diseases of Parturition, 46. Combined, 74. In dealing with this group of diseases, it is possible to present reliable statistics as fatality rates should be calculated on the numbers of births, rather than the numbers of women of any age-group. One reservation is necessary, however. There being no record of still-births, the rates now to be submitted somewhat overstate the fatalities being based on the births of children registered as born alive. According to the Department's records there were 15,040 births (corrected total) during 1909-13, and 41 deaths from this group of diseases, giving a fatality of 3.6 per thousand. During 1914-18 the figures were births, 12,444 and deaths, 41, and the fatality 3.2 per thousand From puerperal fever alone the fatality was IT in the first period and 1.8 in the second. The following comparison is based on data extracted from the Quarterly Reports of the Registrar-General. Puerperal Fever and Accidents and Diseases of Parturition. Fatality per 1,000 Births. Quinquennial Averages. London. Paddington. Kensington. Westminster. Marylebone. Hampstead. Willesden 1909-13 1914-18 2.80 3.51 4.13 4.23 4.86 3.69 2.34 2.85 3.83 3.24 4.54 4.72 4.54 3.36 The risks of parturition to the mothers appear to have increased slightly during the second period. Accommodation for cases of puerperal fever has been provided for some years in the hospitals of the Metropolitan Asylums Board. In 1918 a small special hospital (12 beds) was opened for parturient women suffering from venereal diseases. Admission to this hospital is authorised under Sec. 80 of the Public Health (London) Act, 1891. Ophthalmia Neonatorum.—This disease has been notified since 1911. (See Table III., Appendix.) During 1914-18 the notifications totalled 151, averaging 30 per annum. In the three years 1911-13 the average was 25 per annum. The attack-rate per 1,000 children born was 12.1 per 1,000 during 1914-18, compared with one of 8.2 during the preceding three years. Forty-two of the patients (27.8 per cent.) received institutional treatment, 30 in the Infirmary, 9 in Queen Charlotte's Hospital, 1 in St. Mary's Hospital, and 2 in St. Margaret's (M.A.B.) Hospital—opened in 1918 only. Tuberculosis. Notification.—Informal notification of pulmonary tuberculosis was initiated in the Borough in 1903, but up to 1909, when the Paddington Tuberculosis Dispensary was founded, the numbers of cases reported remained very low. Compulsory notification, limited to cases of pulmonary disease among persons under the care of the Poor Law, was brought into force by the Tuberculosis Regulations, 1909, and the universal notification of all forms of tuberculosis by those of 1912. During the five years, 1914-18,(5,241 certificates were received by the I)epartment, of which 2,832 (45.3 per cent.) referred to patients already on the Department's Registers and 834 (13'3 per cent.) to patients not residing in the Borough. A further 39 certificates were received from outlying areas relating to patients living in the Borough, so that the corrected total of new cases reported during the period amounted to 2,614. A Register of "suspect" cases* is also kept by the Department, to which 744 new names were added during the five vears. At the end of 1918 the Registers contained entries relating to 1,674 "definite" and £541 "suspect" cases. Table 8 shows the numbers of cases reported annually since 1903 and the "wastage" (by death, removal, &c.) in each year. It will be observed that the number reported annually since 1911, i.e., since complete compulsory notification was established, rose to a maximum of 812 in 1913, and that, save for an increase in 1915, the numbers have progressively decreased since that year. Taking the numbers for 1914 as 100 in each case, the following Index Numbers for the last four years are obtained. * These are cases under observation as possibly tuberculous. Cases medically certified are referred to as " definite." c 10 TUBERCULOSIS. Tuberculosis: All forms, Persons. Index Numbers (Totals for 1914 = 100). 1915 1916 1917 1918 " Definite " 108 96 92 83 "Suspect" 82 95 101 95 TABLE 8. Tuberculosis. On Register at end of 1918 "Survivors." Suspect. ... ... ... ... ... ... 25 19 25 33 21 16 53 143 91 115 Definite. ... 1 ... 2 o 6 62 68 73 152 188 155 215 223 233 294 Restored to Register. ... ... ... ... ... 6 16 12 13 29 22 4 12 3 1 3 Removed. ... 10 17 34 66 315 312 325 465 406 246 204 135 128 57 Diagnosis varied. ... ... 3 2 8 34 56 55 70 102 124 71 68 7 64 35 Reported "Arrested" ... ... 1 5 13 60 61 57 116 81 42 7 7 4 1 • Known to have died from all causes during the year. 1918 ... ... ... ... ... ... 9 1 3 2 10 8 7 14 32 102 1917 ... ... ... 1 ... ... 2 1 2 7 8 9 23 43 119 1916 ... ... ... ... 1 o 1 3 3 6 15 14 41 106 1915 ... ... ... ... ... 3 2 2 6 14 24 46 105 1914 ... ... ... 1 . ... 2 1 4 8 28 55 85 : 1913 ... ... ... ... ... 1 2 5 18 45 105 1912 ... ... ... 1 1 5 8 15 25 76 1911 ... ... ... 1 1 4 12 34 69 1910 ... ... ... 1 7 25 42 1909 ... ... 1 1 6 11 65 1908 ... 1 7 12 25 1907 ... 1 1 5 14 1906 ... 1 3 17 1905 2 1 10 1904 ... 5 Total Cases reported. 1903 2 Suspect. ... ... ... ... ... ... 286 269 274 239 203 157 129 149 159 150 Definite. 4 20 18 57 84 173 343 341 397 778 812 531 582 526 502 451 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 11 TUBERCULOSIS. Of the 2,614 new cases, 74 could not be assigned to any of the Wards of the Borough, the Ward distribution of the remainder being as shown below. Tuberculosis: All Forms. 1914-18. (Excluding 74 cases not allocated.) Ward. Total Cases. Percentage. (Borough = 100) Ward. Total Cases. Percentage. (Borough = 100) Queen's Park 296 11.7 Church 651 25.6 Harrow Road 504 19.8 Lancaster Gate, West 44 1.7 Maida Vale 354 13.9 „ „ East 59 2.3 West bourne 508 20. Hyde Park 124 4.9 The definite cases are divided into two main groups, viz., "pulmonary" (popularly called "phthisis") and "other forms." The 2,614 new cases comprised 1,891 (72.3 per cent.) pulmonary cases and 723 (27.7 per cent.) of other forms. A distribution by sex follows here. Tuberculosis: All New Cases. 1914-18. Definite. Suspect. Males. Females. Males. Females. All Forms 1418 (54.2) 1196 (45.8) 298 (40.0) 446 (60.0) Pulmonary 1031 (39.4) 860 (32 9) 336 (12 9) (not taken out) Other Forms 387 (14.8) Note:—The figures in parentheses are percentages of the total definite (or suspect) cases. The higher percentage observed among females in the suspect group is to be explained by the fact that a large proportion of those cases are drawn from the examination of contacts. Considerable difficulty is experienced in persuading working males to present themselves for examination. The 2,540 cases allocated to the Wards comprised 1,368 of males and 1,172 of females— the corresponding percentages being 53.9 and 46.1 respectively. The highest proportion of cases among males (554 per cent.) was observed in Queen's Park Ward, and among females (57.6 per cent.) in Lancaster Gate, East, Ward. In the two Lancaster Gate Wards the general rule of a higher proportion of cases among males was broken, the proportions being equal (50 per cent. each) in the Western and 42.4 for males and 57.6 in the Eastern. Table 9 contains a sex-age distribution of the 2,614 new definite and 744 suspect cases. Taking the total at all ages for each sex as 100, the following are the proportions for five broader age-groups. Tuberculosis: 1914-18. Borough. (Total for each sex = 100). Males. Females. Definite 0- 5- 15- 45- 65- 0- 5- 15- 45- 65- Pulmonary 4.2 16.4 55.3 20.6 3.5 3.2 16.4 62.9 14.8 2.7 Other Forms 30.8 48.3 17.8 2.9 0.2 28.0 42.6 25. 4.2 0.3 Suspect 15.4 55.7 24.2 4.0 0.7 9.7 43.1 42.6 4.4 0.2 On analysing the certificates of the 2,614 new definite cases, in 28 (or 1 per cent.) the site of the disease was either not or insufficiently described. In 33 cases (or 1*3 per cent.) the disease was generalised—including 2 cases with three sites specifically named—and in 63 (or 2.2 per cent.) two sites were named. Analyses of the cases with the disease in one and two sites are given in Tables 10 and 11. A distribution of the new cases by occupation and sex is given in Table VI., Appendix. c 2 12 Institutional Treatment.—Of the 6,241 certificates received during the five vears, no fewer than 2,920 (46'8 per cent.) came from institutions. The numbers for each of the five years were—1914, 620; 1915,617; 1916,652; 1917,539; 1918,492. On analysing the institutions it was found that— 1,308 (4:4-8 per cent.)—including 411 new cases—were from Poor Law Institutions. 743 (25.4 per cent.) „ 351 „ „ Hospitals, general and special. 851 (29.1 per cent.) „ 74 „ „ Sanatoria. 18 (0.6 per cent.) „ 15 „ „ Other Institutions. Inasmuch as many of the institutions are required to report cases on discharge, as well as on admission—a requirement not universally complied with—the foregoing figures cannot he taken as measures of the proportions of cases-treated in each class of institution. tuberculosis. TABLE 9. Tuberculosis. Sex-Age Distribution of New Cases Reported and Deaths. • 1914-18. Ages (years). All Ages. 0- 1- 5- 10- 15- 25- 35- 45- 55- 65- 75 — Males. Females. Persons. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Medically Certified Cases. Cases— Pulmonary 9 5 34 23 114 85 55 56 157 165 206 217 207 159 142 76 71 51 33 20 3 3 1031 860 1891 Other Forms 34 24 85 70 127 94 60 49 32 10 18 26 19 18 7 11 4 3 ... 1 1 ... 387 336 723 Totals 43 29 119 93 241 1791 15 105 189 205 224 243 226 177 149 87 75 54 33 21 4 3 1418 1196 2614 DeathsPulmonary 5 4 7 5 11 4 3 6 29 42 30 23 46 34 41 17 27 14 8 8 2 2 209 159 368 Other Forms 8 10 21 20 4 10 2 2 ... 3 ... 2 6 2 ... 3 2 2 ... ... ... ... 43 54 97 Other Causes P. O.F. ... 1 3 2 1 ... ... ... 2 1 3 1 2 ... 4 4 2 4 ... 2 ... 1 17 16 33 3 2 4 1 2 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 11 4 15 Totals 16 17 35 28 18 15 5 8 33 46 33 26 54 36 45 24 31 20 8 10 2 3 280 233 513 Not Medically Certified Cases. Cases 1 45 43 117 131 49 61 17 46 35 98 20 46 12 17 ... 3 2 ... ... 1 298 446 744 Deaths— Pulmonary ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Forms ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... 1 1 Other Causes ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... 2 1 3 Totals ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... l 1 ... ... ... ... ... ... 2 2 4 " P."—pulmonary. " O.F.''—non-pulmonary (other forms of tuberculosis). 13 TUBERCULOSIS. TABLE 10. Tuberculosis : Persons. 1914-18. One Site only. Site of Disease. Site of Disease. Totals. 1914 1915 1916 1917 1918 1914-18 Head and Neck 10 14 9 20 13 66 Meninges 9 13 8 17 9 56 Special Organs 1 1 1 3 4 10 Digestive System 11 22 22 7 9 71 Intestines 7 18 17 4 4 50 Peritoneum 4 4 5 3 5 21 Generative System 1 ... ... 1 2 4 Lymphatic System 71 95 71 54 55 346 Head and Neck 65 91 71 51 55 333 Axilla 1 ... ... ... ... 1 Mesentery 4 i ... 2 ... 7 Groin 1 3 ... 1 ... 5 Respiratory System 380 405 390 359 330 1864 Lungs 376 404 388 355 325 1848 Larynx 3 1 1 1 5 11 Pleura 1 ... 1 3 ... 5 Urinary System 4 ... 1 3 1 9 Kidney 4 ... ... 2 1 7 Bladder ... ... 1 1 ... 2 Cutaneous System ... 5 l ... 5 11 Head and Neck ... 1 ... ... 1 2 Thorax ... ... 1 ... ... 1 Upper Extremity ... 3 ... ... 4 7 Lower „ ... 1 ... ... ... 1 Osseous System. 29 19 28 30 13 119 Head and Neck 2 ... ... ... ... 2 Thorax 1 1 1 1 i 5 Spine 10 10 15 11 7 53 Upper Extremity 3 . 2 5 ... 10 Lower „ 13 8 10 13 5 49 Totals 506 560 522 474 428 2490 TABLE 11. Tuberculosis: Persons. Two Sites. 1914-18. Primary Site. Secondary Site. Head and Neck Digestive System. Generative System. Lymphatic System. Respiratory System. Urinary System. Cutaneous System. Osseous System. Meninges. Bowel. Peritoneum. Head and Neck. Axilla. Abdominal. Inguinal. " General." Larynx. Pleura. Kidney. Bladder. Head and Neck. Abdomen. Up. Extremity. Low. „ | " General." 1 Spine. \ Up. Extremity. Low. „ 1 "Joints." Totals Digestive System Bowels ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 Peritoneum ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Lymphatic System Head and Neck ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 3 Respiratory System Lung 1 3 1 ... 22 ... ... ... 1 9 2 1 ... ... ... ... ... ... 2 ... ... 1 43 Pleura ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... i Urinary System Kidney ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Cutaneous System Head and Neck ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 Thorax ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 3 Osseous System Head and Neck ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Spine ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... 5 Totals 1 3 2 1 22 2 1 2 1 9 2 1 1 1 4 1 2 1 2 1 2 1 63 14 TUBERCULOSIS. It will be noted that the 2,920 certificates are 306 in excess of the new cases reported in the five years. Actually they dealt with only 851 new cases, the balance referring to cases included among the " survivors " at the end of 1913—1,777 " definites " and 1,002 " suspects"— as well as those coming to light during 1914-18. A further complication involved arises from the fact that reports relating to the same patient have been received from two or more institutions. A special analysis of certificates from institutions has been established recently from which it is hoped to extract better information as to the numbers of cases receiving treatment in institutions. Even after admitting the defects of the foregoing analysis, it cannot be regarded as satisfactory that so large a proportion of cases should have been reported from Poor Law Institutions, having regard to the scheme for sanatorium treatment inaugurated under the National Insurance Act and that provided by the County Council. Insured Persons.—During the five years 499 applications for " Sanatorium Benefit passed through the Department—335 from males and 1154 from females. The total number of applications received each year was—1914, 113; 1915, 111; 1916, 102; 1917,87; 1918, 86. Of the applications received 97 (19'4 per cent.) were not completed owing to Ineligibility of applicant 8 Removal from Borough 5 Death of applicant 28 Withdrawal of application 56— a not very satisfactory record. The 402 grants of benefit took the form of Admission to Sanatoria 298. „ „ Hospital 45 Domiciliary Treatment 45 Dispensary „ 14 The 298 admissions to Sanatoria included 157 to" Downs" and 95 to " Winchmore Hill." During the whole period 25 patients (7*2 per cent.) died while receiving residential institutional treatment. Uninsured Persons.—The applications for treatment under the County Council's scheme numbered 216—115 for adults (males 21, females, 94) and 101 for children under 16 vears of age. The annual numbers of application were—1914, 13; 1915, 57; 1916, 74; 1917-42; 1918, 29. Forty-two (42) applications (19*4 per cent, of the total) were withdrawn, and 3 others not completed owing to removal from the Borough (2 cases) and death (1 case). The 171 completed applications resulted in Admission to Sanatoria 90 cases. „ „ Hospital 81 „ Only one death occurred among the patients while under residential institutional treatment. Dispensary Work.—The Paddington Dispensary for the Prevention of Consumption was opened as a voluntary institution in 1909. It worked in close co-operation with the Public Health Department until 1914, when "Dispensary Treatment " became an integral part of the Tuberculosis Scheme, formulated in that year by the County Council to provide treatment for the tuberculous uninsured population—for the insured, provision already existed under the National Health Insurance Act, 1911. An agreement* was made between the Council and the Executive Committee of the Dispensary under which the Council became largely, but by no means entirely, responsible for the maintenance of the Dispensary, so far as its expenditure related to uninsured persons. In 1915 a second j Dispensary was opened in connection with St. Mary's Hospital which begun work for the County Council's scheme in March, 1916, the Borough being divided into two " Tuberculosis Areas." In 1915 the staff of the Talbot Road Dispensary comprised 2 Tuberculosis Officers, 2 Nurses (one whole time and one part time), and I Dispenser. In 1918 the staff was—1 Tuberculosis Officer (whole time), 4 Nurses (3 whole time and 1 part time), 1 Dispenser (part time) and 1 Secretary. The Staff of St. Mary's Dispensary consists of I Tuberculosis Officer and 1 Nurse, but that Dispensary has the advantage of the services of all members of the Hospital Staff. An Executive Committee is in charge of each Dispensary, to which the Council appoints representatives with .the Medical Officer of Health as an ex-officio member. * The date of the first agreements—which are annual ones—was. October 11th, 1916, but the dates on which the Dispensaries commenced the work under the scheme were - Talbot Road, July 28th, 1914, and St. Mary's, March 1st, 1915. t For convenience, the two Dispensaries will be referred to as " Talbot Road " and " St. Mary's." 15 TUBERCULOSIS. The numbers of persons attending for the first time in each of the five years were— Talbot Road. St. Mary's. 1914 651 — 1915 613 152 (Mch.-Dec.) 1916 679 169 1917 630 230 1918 727 147 The total " admissions " for the five years were 3,300 to Talbot Road and 698 (3f years) to St. Mary's. The total numbers certified as tuberculous (pulmonary and non-pulmonary) were —from Talbot Road, 820, including 354 previously known to the Department and 298 from St. Mary's, of which 117 were already known. In 1916 the Local Government Board prescribed a half-yearly statistical table to be returned bv each Dispensary. The first return was for the second quarter of that year— not the full half-year. Neglecting on this occasion the incomplete figures for 1916, the following information has been extracted for the two years 1917 and 1918 for the whole Borough. The total number of new patients was 1,735, of whom 626 (3(5 1 per cent.) were insured persons and 1,109 (63'9 per cent.) uninsured adults and children under 16 years of age, of whom there were 740 (42*6 per cent, of the total number). Of the 1,735 patients 403 (23*2 per cent) were found to be tuberculous and 417 (24*0 per cent.) suspected to be so. Of the 23*2 per cent, found to be tuberculous, 15*5 per cent, were suffering from pulmonary tuberculosis and 7*7 per cent, from non-pulmonary. Among the 626 insured persons 198 (31*6 per cent.) were found to be tuberculous, and 130 (20*7 per cent.) suspected to be so. The percentage of pulmonary cases was 27T and of non-pulmonary, 4*4. , Among the 1,109 uninsured persons, 205 (18*4 per cent.) cases of tuberculosis were discovered and 287 (25'8 per cent.) of suspected cases. The proportions of the two forms of the disease were—pulmonary, 8*9 per cent, and non-pulmonary, 9*5. The subjoined analysis brings out the following facts :— (a) That the incidence of tuberculosis (all forms) was a good deal heavier on insured males than on insured females, and notably so, in both sexes, on the insured as compared with the uninsured; (b) That the incidence of pulmonary tuberculosis on insured males was more than that of uninsured, that on uninsured females not quite one-quarter greater than that on insured females ; and (c) That whereas the incidence of tuberculosis on children under 16 was 18*6 per cent, of the cases examined, that on adults (males and females) was 26*6 per cent. On the other hand while the incidence of non-pulmonary tuberculosis on children was 13"1 per cent, that on adults was only 3*7. Adult Males. Total examined 509 including 399 (78 3) insured and 110 (21 6) uninsured. Total Tuberculous ... 157 (30.8) „ 139 (34.8) „ 28 (16.3) Pulmonary Cases 138 27.1) „ 123 (30.8) „ 15 (13.6) Non-pulmonary Cases 19 (3.7) „ 16 (4.0) „ 3 (2.7) Suspect Cases 97 (19.0) „ 77 (19.3) „ 20 (18.1) Adult Females. Total examined 486 including 227 (46'7) insured and 259 (53.2) uninsured. Total Tuberculous 108 (22.2) „ 59 (25.9) „ 49 (18.9) „ Pulmonary Cases 90 (78.5) „ 47(20.7) „ 43 (16.6) „ Non-pulmonary Cases 18 (3.7) „ 12 (5.2) „ 6 (2.3) „ Suspect Cases 115 (23.6) „ 53 (23.3) „ 62 (23.9) „ Children under 16: Persons. Total examined 740 Total Tuberculous 138 (18.6) Pulmonary 41 (5.5) Non-pulmonary 97 (73./) Suspect 205 (27.7) Note :—The italic figures in parentheses are the percentages. The average number of attendances of patients during the year at the Dispensaries was (in round numbers) 9 per patient in 1917 and 10 in 1918, and the frequency of "systematic physical examination " was in each year one to every 7 attendances. 16 TUBERCULOSIS. The visits of the Tuberculosis Officers to the homes of the patients (calculated on all patients seen) averaged 2*3 per patient in 1917 and 3'0 in 1918. The Nurses' visits— calculated on the same basis—averaged 18*5 in 1917 and 24T in 1918. The sputum tests, having regard to the numbers of patients, were comparatively few, only 113 in 1917 and 101 in 1918, St. Mary's showing a larger ratio than Talbot Road. Contacts.—The examination of the members of the families of tuberculous patients is deemed to be a factor of high import in the work of a dispensary. From enquiries addressed to the Tuberculosis Officers the following information has been compiled: — Total number of contacts to be examined ... ... 2,545 „ „ „ examined ... ... 1,453* + Percentage examined ... ... 57'4 + The patients at Talbot Road furnished 1,848 contacts, of whom 1,218 were examined, i.e., 65*9 per cent., those at St. Marv's, 697 contacts, of whom 235 (plus an unknown number in 191(1) were examined. 1 he percentages examined annually were— 1914 ... 73-3. 1915 ... 68-0. 1916 ... 397 +. 1917 ... 41-5. 1918 ... 59-9. Undoubtedly the reductions recorded were largely due to the war. Suspects.—During the five years 744 "suspect" cases were reported from the Dispensaries. Of those cases 64 were subsequently certified as tuberculous and in 320 other cases tuberculosis was definitely excluded, thus accounting for 384 (51*6) per cent.) of the " suspects," the proportion up to the end of 1918 certified as tuberculous being 8"6 per cent. Many of the patients are still under observation, while others have been lost sight of for one reason or another. • Deaths.—The corrected number of deaths from all forms of tuberculosis during 1914-18 was 1,035, exactly 100 in excess of the total (935) for 1909-13, very nearly a 10 per cent, increase. The annual average numbers of deaths were—1909-13, 187 ; 1914-18, 207. In these reports deaths from tuberculosis are sub-divided into deaths from— Pulmonary Tuberculosis (phthisis; ... 826 deaths 1914-18 ; 724, 1909-13 Tuberculosis of Meninges .. ... ... 88 „ „ 81 „ Other forms of Tuberculosis 121 „ „ 130 „ The annual average numbers of deaths and the Index Numbers for 1914-18 (averages for 1909-13 = 100) are shown below. Deaths: Tuberculosis. (All Forms: Persons.) Index Numbers. Annual Averages. Category 1909-13 1914 18 1914.18 Pulmonary 145 16 26 165 187 18 24 207 114) 109 1 93 J 110 Meningeal Other Tables V. a—e, Appendix, contain full information of the sex-age distribution of the corrected total number of deaths for each of the five years 1914-18. The following Index Numbers for 1914-18 show the variations during that period in comparison with the preceding five years :— Deaths : Index Numbers 1914-18. (Total in each Category for 1909-13 = 100.) Ages at Death. Category 0- 5- 15- 45- 65- All ages. M. F. M. F. M. F. M. F. M. F. M. F. 120 119 79 Pulmonary 140 240 260 317 102 119 128 97 59 131 110 Meningeal 107 96 78 243 200 71 45 114 )* 47 100 Other 94 88 144 58 127 67 104 * Three deaths 1914-18, none 1909-13. The following tabular statement showing the differences in sex-age incidences of attacks (notified cases) and deaths is of interest. The figures represent the numbers at each age in 100 cases (or deaths) of each sex. * The record for 1916 at St. Mary's is not available. 17 TUBERCULOSIS. Tuberculosis. Sex-Age Distribution. 1914-18. Males. Females. Ages 0- 5- 15- 45- 65- 0- 5- 15- 45- 65 Pulmonary Tuberculosis. Cases 42 1C-4 553 206 35 32 164 629 14-8 2-7 Deaths 3-0 2-8 53-7 36!) 36 33 5-3 63-6 220 5-8 All other Forms. Cases ... 30-8 48-3 17-8 29 0-2 28-0 42-6 25' 4-2 0-3 Deaths ... 55-1 204 18-0 96 4-2 48-3 26-4 14-3 8'8 22 A distribution of the deaths by sex and occupation is given in Table VI., Appendix. Ward Distribution.—In the absence of mortality rates for the Wards, the subjoined statement of the annual average number of deaths in each of the periods 1909-13 and 191418 is given, the Index Numbers for the latter period being shown in ( ). Tuberculosis: Deaths, Persons. Annual Averages. Ward. Pulmonary. Non-Pulmonary. 1909-13. 1914-18. 1909-13. 1914-18. Queen's Park 19 23 (126) 6 5 (89) Harrow Road 32 36 (112) 9 9 (95) Maida Vale 19 21 (107) 6 6 (103) Westbourne 28 29 (106) 6 7 (127) Church .. 33 41 (125) 13 10 (77) Lancaster Gate, West . 3 4 (119) 0 2 (900)(a) „ „ East 2 2 (92) 0 1 (250) (6) Hyde Park 9 9 (102) 2 2 (84) Notes — The averages are the nearest whole numbers and have not been used in calculating the Index Numbers which are bated on the actual number of deaths in each period. (а) One death during 19U9-13 ; 9 during 1914—18. (б) Two deaths „ „ 5 „ „ The annual average numbers of deaths recorded in each Ward are shown in Table 12. Duration of Disease.—The records of the Department of cases of pulmonary tuberculosis show the intervals between onset of the disease and death in 543 instances—out of a total of 826 deaths. According to the histories furnished such intervals varied from something under 6 months to 40 years. In 234 instances (43-0 per cent, of cases with known durations) the disease was said to have run its course in less than 12 months, including 147 (27*0 per cent.) cases of less than six months' duration. A complete tabulation follows this. Pulmonary Tuberculosis. Intervals to fatal issue. 1914-18. Less than 6 months 147 Between 5 and 6 years 15 From 6-12 „ 87 » 6 „ 7 „ 8 Total under 1 year ... 234 7 „ 8 „ 10 Between 1 and 2 years ... 127 8 „ 9 5 » 2-3 ,, 57 9 „ 10 „ 4 » 3-4 ,, 36 „ 10 „ 11 >, 6 „ 4-5 27 „ 11 „ 12 „ 2 Exceeding 12 years ... • 11 The last group included two cases in which the duration was stated to have been 34-35 years and 40-41 years (one of each). The onset of pulmonary tuberculosis is generally so insidious that it is impossible—or only exceptionally possible—to give anything but a rough approximation of the date of onset. If the theory of practically universal infection with d 18 TUBERCULOSIS. tuberculosis in infant life be accepted, then the supposed onset of an attack of pulmonary tuberculosis marks but the lighting-up of an old infection—or the re-infection of an individual imperfectly protected by earlier infection(s)—and the durations on which the above tabulation is founded must be regarded as understatements of the facts. In any case the data given above lend support to the view that an attack of pulmonary tuberculosis ought not to be regarded as an immediate death warrant, and they can be regarded as rebutting the somewhat pessimistic conclusions based on sanatorium work. TABLE 12. Tuberculosis: Deaths. 1914-18. Ward. 0- 1- 5- 15- 25- 65- M. F. M. F. M. F. M. F. M. F. M. F. Pulmonary Tuberculosis. Queen's Park o 1 4 9 12 58 23 4 3 Harrow Road o 1 3 3 10 17 85 52 3 4 Maida Vale 1 2 7 6 47 32 3 5 Westbourne 2 2 G 3 10 15 06 39 1 2 Church 3 5 6 2 6 12 20 81 60 5 4 Lancaster Gate, West 1 2 1 8 5 2 „ „ East 4 6 1 Hyde Park 2 4 21 16 i Tuberculosis of Meninges. Queen's Park 1 1 2 1 4 1 Harrow Road 1 1 4 8 1 1 2 ... Maida Vale o 1 2 2 2 1 2 Westbourne 1 1 3 1 2 2 1 ... Church 5 7 5 3 4 1 Lancaster Gate, West 1 2 1 i „ „ East 1 1 1 Hyde Park 1 1 1 1 Other Forms of Tuberculosis. Queen's Park 3 1 2 1 2 1 2 1 2 ... Harrow Road 2 5 3 1 1 1 4 1 4 3 ... Maida Vale 1 4 1 2 1 2 3 1 2 Westbourne 2 1 5 5 4 3 1 2 1 2 Church 5 4 4 4 1 2 2 3 ... Lancaster Gate, West 1 1 1 1 „ „ East i 1 Hyde Park ' i "i i 1 1 1 1 Deaths not due to Tuberculosis.—The 820 deaths assigned to pulmonary tuberculosis do not represent the complete mortality among the tuberculous. During the five years 95 persons on the Department's Registers were known to have died, the cause of death being ■certified as primarily not due to tuberculosis. One of the deceased persons had been notified as suffering from pulmonary tuberculosis as early as 1908. In addition, the deaths of 20 persons, notified as suffering from non-pulmonary tuberculosis, were recorded during the five years, death being attributed to causes other than tuberculosis. A tabular statement showing the intervals between notification and death observed in these 115 instances is given in Table 13, and in Table 14 an analysis of the certified causes of death. It is almost certain that a number of similar occurrences took place among those marked in the Registers as " removed." There is a great need of a system of exchange of dossiers of cases between Medical Officers of Health. Until patients are more systematically followed up, our knowledge of the life history of the disease and of the duration of life of the tuberculous will be incomplete. Deductions and conclusions based on the present incomplete data are not only misleading but even unnecessarily depressing. 19 TUBERCULOSIS. TABLE 13. Non-Tubercular Deaths among the (notified) Tuberculous. Intervals between Notification and Death. Year of Death. Totals. Year of Notfication. 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 Pulmonary Tuberculosis 1914 20 1 1 2 4 5 7 1915 13 1 4 8 1910 9 2 1 0 1917 19 1 9 4 4 4 1918 34 1 1 3 4 4 2 1 5 1 16 Totals. 95 1 2 2 5 11 13 11 14 15 5 16 Non-Pulmonary Tuberculosis.* 1914 1 1 1915 8 1 1 6 1916 4 4 1917 2 1 i 1918 5 1 1 3 Totals. 20 1 2 8 4 2 3 *Not notified before 1913. TABLE 14. Certified Cause of Death. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Ages at Death. All Ages. Ages at Death. All Ages. 0- 5- 15- 25- 45- 65- M. F. 0- 5- 15- 25- 45- 65- M F. Enteric Fever 1 1 Measles 1 1 4 3 1 Diphtheria 1 1 Whooping Cough 3 1 o 1 1 Epid. Influenza 2 1 3 1 5 3 1 1 Dther Septic Dis 1 1 Cancer i 7 1 4 5 Diseases of Brain. i 3 3 1 1 1 1 3 „ „ Heart & Blood Vessels 5 2 13 2 9 13 Bronchitis 1 1 9 7 8 10 Pneumonia 1 i 1 3 2 2 4 f. 1 ... i Dther Respiratory Dis. I l 4 1 1 7 1 1 1 ... Diseases of Digestive Orgs. 1 1 3 ... ... 2 1 „ „ Urinary „ 1 4 1 3 "3 Premature Birth 1 1 Atrophy, Debility 1 1 . , „ Did Age i ..» 1 ... Suicide 1 1 Accident 1 1 1 i 1 1 0 Totals 8 4 13 17 40 13 49 40 15 3 9 16 4 Notes:— Pulmonary Tuberculosis. Died in Institutions ... 49 Inquests held ... ... 6 P.M. examinations ... 8 Pulmonary T. as " secondary " cause associated with— Epid. Influenza ... 2 Enteric Fever i Cancer ... ... ... 1 Disease of Heart ... 1 Miliary T. as "secondary" cause associated with— Whooping Cough ... 1 Non-Pulmonary Tuberculosis. Died in Institutions ... 12 Inquests held ... ... 2 P.M. examinations ... 2 Tuberculosis (not defined) as " secondary " cause associated with — Measles 1 Accident 1 d 2 20 tuberculosis. Non-notified Deaths.—If the Tuberculosis Regulations 1912 were strictly complied with, the instances of death from tuberculosis being the first report to the Department of the disease should be very few, and should be limited to sudden deaths of persons in whom the disease was not diagnosed during life and of those who succumbed to very acute attacks of the disease. During 1914-18 there were 205 deaths of residents of the Borough due to various forms of tuberculosis, such deaths being the first intimation to the Department of those persons having the disease. In addition 75 persons died from tuberculosis, the notification certificates with reference to which were received after death. The total "non-notified" (fatal) cases amounted, therefore, to 280, equal to 27 per cent. of the total deaths (1,035) ascribed to tuberculosis in all its forms. Of the 280 deaths 9(5 (47 per cent.) occurred within the Borough (64 at the deceased persons' homes and 32 in local institutions), and 109 (53 per cent ) were " transferred " deaths, i.e., took place outside the Borough (in different parts of England and Wales), and were reported to the Department through the General Register Office. Of these 109 deaths, 95 occurred in institutions. A full analysis has been made of the 280 deaths with a view to ascertaining the reasons for "non-notification," but the results of such analysis cannot be included here. So considerable a "leakage " as 27 per cent, (of fatal, not all, cases) cannot be regarded as anything but very unsatisfactory. Deaths in Institutions.—The "segregation," i.e., isolation in institutions of advanced cases of pulmonary tuberculosis, has been urged as a factor of high import in the control of tuberculosis. The proportion of tuberculous patients isolated cannot be given, as the knowledge of the prevalence of the disease is very incomplete. Some evidence of increase in public appreciation of institutional treatment is afforded by a review of the proportions of patients who die in institutions. During 1909-13 350 of the 724 deaths from pulmonary tuberculosis took place in institutions (of all kinds), and during 1914-18, 450 out of 826. In the former period the institutional deaths were equal to 48.3 per cent. and in the latter to 54.4 per cent.—an increase of 12*6 per cent. The total deaths from non-pulmonary tuberculosis during 1909-13 numbered 221, of which 111 (50.2 per cent ) occurred in institutions, the corresponding figures for 1914-18 being 209 and 145 (69.3 per cent.) showing an increase of 38 per cent. in the latter period. Below are shown the percentages of deaths in institutions of males and females in the two periods. Deaths in Institutions. Pulmonary Tuberculosis. Non-Pulmonary. 1909-13. 1914-18. 1909-13. 1914-18. Males 52.7 57.3 53.9 71.1 Females . 421 50.8 51.1 67.0 The increases in the proportions shown above are equal to—in the case of males— pulmonary tuberculosis, 9 per cent., non-pulmonary, 31, and, in the case of females, 21 and 31. The percentages of tuberculous deaths occurring in the various classes of institutions were— Tuberculosis : Deaths in Institutions. Percentage Distribution. 1914-18. Institutions. Pulmonary. Non-Pulmonary. Poor Law 60 48.9 Hospitals— General and Special 12.5 35.8 M.A.B. Hospitals 7.5 8.2 Sanatoria 2.4 2.0 Mental Hospitals 17.3 4.8 No fewer than 260 of the 450 deaths attributed to pulmonary tuberculosis occurred in the Paddington and St. Marylebone Infirmaries. Of the 34 deaths in the Metropolitan Asylums Board's Hospitals, 4 occurred in hospitals not set apart for the treatment of pulmonary tuberculosis. The deaths from tuberculosis (all forms) in mental hospitals (lunatic asylums) numbered 85, and were equal to 17.2 per cent. of all deaths (494) in those institutions—in the rest of the "population " of the Borough the proportion was 9.6 per cent. Fairly complete information was collated relating to 396 deaths from pulmonary tuberculosis in institutions other than mental hospitals. The duration of treatment in such institutions averaged a little over 4 months (4.12). The numbers of times the deceased persons had been in institutions are shown on the next page. 21 cancer. Number of Admissions ro Institutions Recorded for each Patient. Dying during 1 2 No. of Admissions. 5 6 Average duration of stay (months). 3 1 1914 52 10 7 ... ... ... 3.71 1915 52 16 3 1 ... ... 4.18 1916 65 22 6 2 ... 1 4.33 1917 73 21 5 4 ... ... 4.31 1918 39 13 1 3 ... ... 3.85 Totals 281 82 22 10 ... 1 4.12 The decreases observed during 1918 can be ascribed to the war conditions. " CANCER." The deaths from the various forms of malignant new growths during 1914-18 numbered 989, 141 more than the total (848) for 1909-13—equivalent to an increase of 17 per cent. (Index Number, 117). In Table VII., Appendix, a full analysis of the deaths during the last five years is given. The growths have been classified in these Reports for several years in seven varieties. Below are shown the numbers ascribed to each of the seven varieties during the last two quinquennial periods. "Cancer ": Persons. Totals. Carcinoma. Cancer. Epithelioma. Scirrhus. Sarcoma. Malignant Disease. Other Forms. 1909-13 514 136 28 21 63 77 9 1914-18 620 162 41 18 48 93 7 Percentages. (All "Cancer " deaths = 100.) 1909-13 60.6 16.0 3.3 2.5 7.4 9.1 1.1 1914-18 62.7 16.4 4.1 1.8 4.9 9.4 0.7 Index Numbers. 1914-18 121 119 146 86 76 121 78 "Cancer" and" Malignant Disease" are undesirable designations. When either is found in a death certificate enquiry is made to ascertain, if possible, more exact information. The deaths entered under these headings constituted 25T per cent. of all "Cancer" deaths during 1909-13 and 24.7 during 1914-18. The changes in sex (all ages) incidence during the ten years is exhibited below. "Cancer." Variety. 1909-13 Totals. 1914-18. Index Numbers. 1914-18. M. F. M. F. M. F. Carcinoma 207 307 228 392 110 128 Cancer 48 88 57 105 119 119 Epithelioma 21 7 22 19 105 271 Scirrhus 1 20 2 16 200 80 Sarcoma 32 31 26 22 84 71 Malignant Disease 30 47 33 60 110 128 Other Forms 4 5 4 3 100 60 Totals 343 505 372 617 108 122 The total increase in the number of deaths of females (22 per cent.) was 14 per cent. greater than that recorded among males, but too much significance should not be given to the difference owing to the preponderance of males withdrawn for service with H.M. Forces. As regards the high Index Numbers shown for certain varieties, the totals on which those Numbers have been calculated are too small for comment. A comparison of analyses of deaths from all forms of "Cancer" in sex-age groups follows here. "Cancer" Ages. 1909-13. Totals. 1914-18. Index Numbers. 1914-18. M. F. M. F. M. F. 0- 3 8 1 6 ... 3 2 6 0 37 200 100 10- 1 2 3 ... 300 0 15- 3 ... 1 2 67 - 20- 1 3 ... 2 0 67 25- 6 11 7 11 117 100 35- 25 47 21 51 84 108 45- 79 115 68 132 86 115 55- 104 119 111 159 107 134 65- 87 117 122 154 140 132 75- 34 90 40 104 118 115 The last comparative analysis, that of anatomical distribution, is shown on page 22. 2 Z inquests. "Cancer." Locale of New Growth Totals. Index Numbers. 1909-13. 1914-18. 1914-18. M. F. M. F. M. F. P. Nervous System 7 7 5 8 2 4 1 1 28 57 20 12 25 33 Organs of Special Sense ... 3 2 ... 2 0 67 Respiratory System 25 5 15 2 60 40 57 Circulatory System ... ... ... ... ... ... ... Digestive System 242 221 259 270 107 122 114 Lymphatic System 15 5 20 15 133 300 175 Urinary System 25 14 38 14 152 100 133 Generative System 3 221 5 283 167 128 128 Osseous System 17 20 8 14 47 70 59 Cutaneous System 4 2 13 9 325 450 367 Not sufficiently described 5 9 10 9 200 100 136 Note—A more complete analysis is given in Table VII., Appendix. The only parts of the body in which new growths were less frequently reported were the nervous system and organs of special sense—practically one system—when the reduction amounted to 67 per cent (both sexes), 43 per cent, males and 88 per cent. females, the respiratory and osseous systems. Without an examination, for which time is not available, it is impossible to account for the increases noted in the urinarv and cutaneous systems of males. Influenza.—Of the f)09 deaths from this cause during 1914-18, no fewer than 358 occurred during 1918. For the other four years of the quinquennium, the annual average of deaths was 38, but in 1915 52 deaths were ascribed to this cause The 358 deaths—or the excess (318) of (say) 40, the approximate annual average for non-epidemic years—does not represent the complete toll taken by influenza in 1918. The rule of the Department is to place every death in the certificate of cause of which "influenza" (even as a secondary cause) is mentioned under that disease. Consequently it can onlv be surmised which increases in the average numbers of deaths should be attributed to influenza as a primary cause of death not appearing in the certificates. Respiratory Diseases.-The deaths from the three "pneumonia" headings—lobular and lobar pneumonias and "pneumonia " (undefined)—during the last ten years have numbered— 1909, HO; 1910,142; 1911,114; 1912,135; 1913,155. 1914,112; 1915,200; 1916,139; 1917,162; 1918,221. the annual averages being for 1909-13, 139 and for 1914-18, 167. Inquests. Of the 10,360 deaths occurring during 1914-18, 1,039 formed subjects of inquest, equal to 10 per cent. of the total During the five years, 1909-13, the percentage of deaths registered after inquests held was S'4. The numbers of inquests held during each of the last five years, distributed according to sexes and "findings," are shown in Table VIII., Appendix. A comparison of the "findings" during the two quinquennial periods is given below. Findings of Inquests. Totals— Natural Causes. Misadventure. Accidental Causes. Suicide. Murder. Manslaughter. Open. "Neglect." 1909-13 368 52 228 78 9(a) 27 29 1914-18 438 36 371(b) 77 10 64 43 Annual Averages— 1909-13 74 10 46 15 2 5 6 1914-18 88 7 74 15 2 13 9 Index Numbers— 1914-18 111 69 162 99 111 237 148 (а) Including one death by manslaughter. (b) „ 19 deaths from bombs -3, in 1917 ; 16, in 1918. In 1909 there were two deaths by execution. The Index Number (1914-18) for all inquests was 131. Excluding the deaths due to bombs, the annual average (Accidental Causes) for 1914-18 was 70 and the Index Number, 154. The increase in open findings (137 per cent.) is remarkable, while the decrease in deaths by suicide (although only 1 per cent.) is unexpected. 23 deaths in institutions. Table VIII., Appendix, gives an analysis of the sexes and ages of the persons whose deaths were dealt with by Coroner's Inquest. The striking fact brought out by that Table is the increase of deaths from Accidental Causes in every sex-age group except females aged 0-1 year. The Index Numbers (1914-18) at all ages are— All Inquests. Males 120 Females 146 By Misadventure. 69 69 Accidental Causes. 157 171 Suicide. 100 96 Murder. 150 100 Open. 153 437 Neglect. 158 141 Deaths in Institutions. The numbers of deaths recorded in local institutions and of those occurring in institutions outside the Borough which have been included in the corrected totals of deaths, are shown in Table IX., Appendix, the causes of those deaths are shown in Tables X. and XI. The proportion of institutional to all deaths (corrected total) was 29'9 per cent. in 1904 and rose to 42.3 per cent. in 1918. The average percentages during the three quinquennial periods included in Table IX. are—1904-8, 31.6; 1909-13, 35.9; and 1914-18,41.1. Expressed by Index Numbers (average for 1904-8=100) that for the middle period is 114, and that for the last, 130. The percentages of institutional to all deaths (corrected) and the Index Numbers for the last five years are given below. Percentages of Institutional Deaths to all Deaths (corrected). Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate. East. Hyde Park. Average, 1909-13 39.6 32.9 31.9 35.2 47.7 22.3 20.7 30.2 „ 1914-18 44.5 39.3 35.1 40.1 57.5 27.9 28.3 39.4 Index Number, 1914-18 112 119 110 114 120 124 130 115 The proportion of institutional deaths is always highest in Church Ward, but the greatest increase (30 per cent.) in the proportion of those deaths during 1914-18 was observed in Lancaster Gate, East, Ward. In the Borough as a whole the proportion of institutional to all deaths of males during 1914-18 was 43'9 per cent.—that of females, 4T6. Analysis of the institutional deaths shows that the greatest part of the increase during 1914-18 occurred in lunatic asvlums. The figures are set out below. Percentages of Institution Deaths to all Deaths (corrected). Averages. Index Numbers. 1909-13. 1914-18. 1914-18. Rate-supported. Metropolitan Asylums Board Poor Law Infirmaries and Workhouses Lunatic Asylums Voluntary. General and Special Hospitals l.7 20.7 2.7 251 11.1 1.7 24.0 30.4 4.7 10.4 100 116 21 176 93 The voluntary institutions include sanatoria but exclude nursing homes. MORTALITY IN CHILDHOOD. Infantile Mortality.—During the five years 1914-18, 11,224 births were registered within the Borough and 1,500 deaths at ages 0-1 year, which figures give a crude average rate of infantile mortality for the whole period of 133 per 1,000 births. In the preceding five years the births numbered 14,225 and the deaths 1,767, the average (crude) mortality being 124 per 1,000 births. The fully corrected numbers of births and deaths in the two quinquennial periods were— Births. Deaths. 1909-13 15,040 1,592 1914-18 12,444 1,361 and the corresponding infantile mortalities (average for each period) 106 and 109 respectively, showing an increase of (approximately) 3 per cent. Table II., Appendix, contains comparisons of the average rates of mortality in each of the Wards for the two periods from which it appears that the averages were higher in the second period in all Wards except Queen's Park and Lancaster Gate, East. The greatest increase (9 per cent.) was recorded in Maida Vale Ward. The mortality recorded in the Borough in each year is shown in Table I., Appendix. In the course of the ten vears, 1909-18, the highest mortality was 135 (recorded in 1917) and the lowest, 94 (recorded in 1916). 24 mortality in childhood. The average mortality among males during 1909-13 was 117 per 1,000 births, and that during 1914-18, 119—an increase of one per cent. only. Among females the mortalities were 94 and 98—an increase of 4 per cent. in the second period. Among males the mortality recorded in the second five years was lower in Harrow Road and Lancaster Gate, Last, Wards, and that among females in Queen's Park, Westbourne, Lancaster Gate. West, and Hvde Park Wards. The total deaths occurring during 1914-18 at ages under one year are distributed by sex, ages and causes in Table XII., Appendix. From that Table the following summary figures (annual average numbers) have been compiled:- Average Annual Numbers of Deaths Males. Females. At Ages. 1909-13 1914-18 1909-13 1914-18 Under one day 21 16 16 12 „ „ week 40 31 26 25 „ ,, month 63 43 51 40 „ three months 98 84 73 64 Three to six „ 31 27 27 22 Six to nine „ 29 21 18 17 Nine to twelve „ 21 21 21 17 The sex mortality rates per 1,000 births, calculated on the average number of births recorded in each period were— At Ages Under 1 day. Under 1 week. Under 1 month. Under 3 months. 3-6 months. 6-9 months. 9-12 months. 1909-13 14 26 Males. 41 64 20 19 14 1914-18 12 24 34 66 84 21 16 33 16 1909-13 11 18 Females. 34 49 87 18 12 31 14 1914-18 9 20 33 53 68 18 14 26 14 71 28 From the same Table the following average group mortality rates are obtained :— Group. Males. Females. 1909-13 1914-18 1909-13 1914-18 I. 9 9 9 9 II. 21 23 21 20 III. 3 4 3 3 IV. 45 42 34 32 V. 29 31 22 25 Hopeless Births.—This phrase has been adopted to describe those children whose deaths are recorded before or simultaneously with their births. The figures about to be given are not quite complete, inasmuch as the necessary information as regards such cases occurring outside the Borough is not available. During 1914-18 302 instances were noted—179 of male births and 123 of female. In the preceding five years there were 409 similar cases—268 among boys and 201 among girls. The totals for the two periods were equivalent to 3.2 and 2.7 percent. of the births registered locally, showing a reduction of 0.5 per cent. in the later period. The principal causes of death were "premature birth," "congenital malformations" and "atrophy and debility," to which causes 70.3 per cent. of the deaths of boys and 67.4 per cent. of those of girls were due during 1914-18. Special Areas.—For several years the data relating to infantile mortality have been extracted for six groups of streets which form areas with marked characteristics. Of those areas—see Table 15—all but one, viz., Queen's Park—are composed almost exclusively of houses registered under Section 94 of the Public Health (London) Act, 1891—"houses let in lodgings." A discussion of these statistics cannot be included in this Report, but the figures are on record. mortality in childhood. 25 Examining the figures in Table 15 it will be seen that the mortality rates recorded during the five years ranged from a maximum of 264 per 1,000 births (Clarendon Street, 1918) to a minimum of 60 (Queen's Park." 1918). Of the six areas "Clarendon Street" shows the worst record (rather more than one-fifth —209 per 1,000—of the children born during the five years dying at ages under one year) and Queen's Park, the best (not onetenth—97 per 1,000—dying at those ages). The last line of the Table mentioned shows what the total mortality rate would be if the high mortality generally experienced in the special areas were reduced to that of the rest of the Borough. The excessive mortality in these special areas is due to measles, whooping cough, "diarrhœa," tuberculosis and the respiratory diseases—the rates from which are almost always notably higher in the areas than in the rest of the Borough. On the other hand the rates due to "developmental diseases" (premature birth, congenital defects, &c.) are frequently lower in the areas than in the rest of the Borough. One result of the foregoing facts is that the mortality rates at ages under one month are frequently notably lower in the areas than in the rest of the Borough, the reverse being found at higher ages. (See below). Infantile Mortality. Ages at Death. 1914 1915 1916 1917 1918 S.A. R.B. S.A. R.B. S.A. R.B S.A. R.B. S.A. R.B. Under 1 month 29 36 30 31 20 39 41 44 21 52 1-3 months 27 16 35 23 25 20 34 27 17 17 Under 3 months 57 51 65 54 51 59 75 70 38 69 3-6 months 38 12 31 12 35 7 20 19 40 16 6-9 „ 10 8 29 15 12 14 34 11 35 14 9-12 „ 27 7 35 16 11 6 45 10 14 12 " S.A."—Combined Special Areas. " R.B."—Rest of Borough. Illegitimates.—Of 1,016 illegitimate children born during 1914-18,263 died within the first year of life—equivalent to a mortalitv of 258 per 1,000 births, as compared with 96 among legitimate children. During 1909-13 the mortality was at the rate of 266 per 1,000 among illegitimate children and 96 among legitimate. There was, therefore, a reduction of some 3 per cent. in the mortality of illegitimate children, but none among the legitimate. The subjoined figures sufficiently emphasise the differences in the incidence of mortality on the two sexes. (See below.) Infantile Mortality. Males. Females. Legit. Illegit. Legit. Illegit. 1909-13 108 269 84 263 1914-18 106 276 85 241 TABLE 15. Infantile Mortality per 1,000 Births. 1914 1915 1916 1917 1918 Whole Borough 90 117 94 136 116 Special Areas "Hall Park " 100 71 88 129 65 "North Wharf " 90 104 91 175 76 "Clarendon Street " 187 238 143 252 264 "Alfred Road " 117 176 145 170 96 "Amberlev Road " 134 181 99 138 140 "Queen's Park " 70 115 • 81 150 60 Combined Areas 132 160 110 175 128 Rest of Borough 78 97 87 111 112 Children Aged 1-5 Years.—By a method of tabulating annually the survivors at ages 1-4 years, the following mean mortalities have been obtained :— Mortality per 1,000: Both Sexes. Ages at Death 1-2 2-3 3-4 4-5 years. 1909-13 31.5 11.9 0.4 5.8 1914-18 35.2 14.4 10.9 6.2 It is clear that the mortality was higher in the latter period. Taking the rates for each age during 1909-13 as 100, the following Index Numbers are obtained for 1914-18: — 1-2 112; 2-3 121; 3-4 170; 4-5 107 E 26 measles. The mean mortality rates for each sex, together with the Index Numbers for 1914-18 are shown below. Mortality per 1,000. Females. Males. Ages (yrs.) 1909-13 1914-18 I.N. 1909-13 1914-18 I.N. 1-2 33.9 36.7 108 29.0 33.7 116 2-3 12.0 14.4 120 11.8 14.8 125 3-4 6.5 11.8 181 6.4 10.1 156 4-5 5.7 5.8 102 5.9 6.6 112 It is of interest to record that the maximum and minimum rates were recorded during the second period at ages— Males. Females. 1-2 yrs. Max. 54-5 (1917), Min. 19.8 (1914) Max. 65.8 0918), Min. 13.9 (1914) 2-3 „ „ 30.1 (1918), 5.4 (1916) „ 25.2(1917), 6.3(1916) 4-5 „ „ 8.7(1918), 2.3 (1916) „ 10.4 (1918), „ 2.3 (1914) At ages 3-4 years— Maximum rates (.both sexes) were observed in 1918 19.5 males; 19.6 females. Minimum „ „ „ „ „ „ 1910 4.3 „ 4.4 „ Space forbids a more complete discussion of the incidence of mortality which, it may be remarked, shows signs of progressive increase as the war dragged on. tor the same reason the data as to causes of death must be passed over. One additional calculation ought, however, to be mentioned. By totalling the survivors at the four ages—thus obtaining the numbers at risk in each quinquennial period—the mortality rates for the group 1-5 years are found to be—1909-13, 11.8 per 1,000; 1914-18, 13.7. The Index Number for 1914-18 is 116, which confirms to some extent the number for all ages (persons) arrived at by other methods. Measles.—Records of the prevalence of this disease have been collected systematically by the Department since 1898, but, except such as was given by "Form 84," the information was entirely voluntary. In March, 1914, the Council made an Order—subsequently confirmed by the Local Government Board—requiring notification of the disease under Sec. 55 of the Public Health (London) Act, 1891. In November, 1915, the Local Government Board issued the "Measles Regulations"* under the Public Health Act, 1875 and the Public Health Act, 1896, making notification of measles and rubeola (commonh called "German Measles") compulsory throughout England and Wales as from January 1, 1910. As a consequence the Council's Order of 1914 was rescinded in 1916. The issue of those Regulations may be taken to have brought to a successful conclusion the demand for notification which was first urged bv the (late) Vestry of Paddington in 1890. As might be expected the introduction of compulsory notification involved a disturbance in the records of this disease, hitherto mainly of cases among school children attending the Public Elementary Schools. In part, compulsory notification accounts for the great increase in certain Wards, e.g., the two Lancaster Gate Wards, to which attention will be directed later on. Hitherto the records of rubeola have been kept separately from those of measles, the separation being possible as it was based ori the observations of the Women Inspectors without control by medical certification. Such separation is now deemed inadvisable. That fact requires to be kept in mind when considering the increase in the numbers of reported cases observed since 1914. The numbers of cases reported annually are shown in Table III., Appendix. The annual average (as deduced from the weekly records) for 1909-13 is 1,342, and that for 1914-18, 2,157, showing an average increase of 815 (or 60'7 per cent.) cases each year. Comparing the numbers reported in the four quarters of the year, it is found that in the second period of five years there has been a considerable shifting of time distribution—a fact which is also apparent in the weekly records kept in the Department. During 1909-13, the percentages of all cases recorded during the year reported in each quarter were— 1st Quarter 33 9; 2nd Quarter 408; 3rd Quarter 8-9 ; 4th Quarter 16.4 and those recorded during 1914-18— 1st Quarter 42*5; 2nd Quarter 45.7 ; 3rd Quarter 7.3 ; 4th Quarter 4.4 *The Council's Order required the notification of all cases of Measles—excluding Rubeola. The Regulations of 1915 prescribed the notification of first cases only (in families) of both diseases. 27 measles. This observation can be summarised by saying that during 1909-13, on an average nearly 75 per cent, of the cases (uncorrected total) reported during the year, occurred during the first six months of the year, and that during 1914-18 that proportion rose to over 88 per cent. The weekly records show an annually recurrent epidemicitv without that alternation of years of low prevalence which has been observed in the past. If future observation confirms the experience of recent years, i.e., since 1914, when notification became compulsory, one will be obliged to conclude that one effect of efforts to control the spread of the disease has been to modify its epidemicity. After the necessary corrections of the weekly records the totals for the two periods of five years become -1909-13, (3,679; 1914-18, 10,024—an increase of over 59 per cent. The annual averages for the sexes are shown below. Measles. Annual Averages. Index Numbers. Males. Females. Males. Females. 1909-13 646 690 100 100 1914-18 939 1186 142 172 The increased prevalence among females is somewhat surprising, but an examination of the Index Numbers for the usual sex-age groups (see below) reveals the fact that such increase is largely due to the reporting of cases among individuals over 13 years of age, most of whose cases were not recorded under the old regime. Some of the increased prevalence among males is similarly explained. Measles: Annual Averages. Index Numbers, 1914-18. (Averages 1909-13 = 100.) 0- 1- 2 3- 4- 5- 13- 15- Males 123 146 157 130 126 140 277 590 Females 139 131 153 145 103 146 192 1407 To obviate any misconception of the Numbers for the two highest groups, the observed figures are given. Total Cases. Annual Averages. 1909-13 1914-18 1909-13 1914-18 13- 15- 13- 15- 13- 15- 13- 15- Males 26 41 72 242 5 8 14 48 Females 52 91 100 1281 11 18 20 256 The increased prevalence demonstrated by the above figures was not equally distributed throughout the Borough. Analysis of the figures according to Wards gives higher Index Numbers (1914-18) for those Wards whence cases may be assumed to have been least completely reported under a regime which was dependent on returns from the Public Elementary Schools. Measles: Annual Averages, Persons. Index Numbers, 1914-18. (Averages, 1909-13=100.) Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate, East. Hyde Park. 130 141 175 185 132 275 331 233 Fatality.—If the assumption already made that a considerable proportion of the apparent increase in prevalence of the disease during 1914-18, was due to improved methods of reporting cases, it will be at once expected that the fatality during those years will prove to be lower. During 1909-13 the fatalities per 100 cases known to the Department were— Persons 3.7 ; Males 3.8 ; Females 3.7 and those during 1914-18— Persons 2.5* ; Males 3.1 ; Females 1.9 *Assuming a constant fatality of 3'7 per cent., the total cases during 1914-18 would have been 15,723 instead of 10,024—a theoretical increase of 48 per cent. e 2 28 whooping cough. The reduced incidence of fatality was by no means equal in the sex-age groups, those at ages 3-4 and 4-5 being notably higher. (See below.) Measles: Average Fatalities. Index Numbers, 1914-18. (Averages, 1909-13 = 100.) 0- 1- 2- 3- 4- 5- 13- 15- Persons 51 79 59 157 125 80 ? 14 Males 70 88 69 200 100 75 ? ? Females 35 73 47 100 133 80 ... 14 Note :—index Numbers could not be calculated where " ? is shown, as no deaths were recorded at those ages during 1909-13. The fatalities recorded in the Wards are set out below, as they support the view that the apparent high prevalence of measles during 1914-18 was largely a matter of improved records. Measles: Average Fatalities. Persons. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate, East. Hyde Park. 1909-13 2.3 1.9 2.7 5.2 6.8 2.4 2.3 2.5 1914-18 2.3 2.0 1.6 2.6 4.9 0.6 0.7 1.1 Index Numbers 1914 18 100 105 59 50 72 25 30 44 Hospital Isolation.—During the five years 319 patients (3'0 per cent, of all cases) received institutional treatment, 130 in hospitals of the Metropolitan Asylums Board and 189 in the Infirmary. The fatality among the former (20 deaths) was equal to 15*4 per cent, and that among the latter (42 deaths), 22'2. The patients included in this category are "selected," i.e., those who are either seriously ill or in unsatisfactory homes, and higher fatality is, therefore, to be expected. Home Nursing.—In 1917 a contract was made with the Paddington and St. Marylebone District Nursing Association, under which the Association agreed to nurse patients referred to the Association by the Department. During 1917, 411 cases were so referred, and in 1918, 85. Among those patients there were 34 deaths in 1917 and 5 in 1918, the fatalities being 8'2 and 5'8 per cent, respectively. Mortality.—The total number of deaths recorded during 1914-18 was 204, as compared with 252 during the preceding five years, the annual averages for the two periods being 53 and 50 respectively. The annual averages for the two sexes were— Males Females Annual Averages. 1909-13 1914-18 Index Number. 24 26 30 23 121 89 showing that the incidence of death during the second period was greater among males and less among females. During 1909-13 29.3 per cent. of the deaths occurred in institutions, the proportion during 1914-18 rising to 31.7—an increase of 8 per cent. Whooping Cough.—Although this disease is not scheduled for notification 2,479 cases were reported to (mainly bv Form 84) or discovered by the Department during the period 1914-18. In the previous five years the cases totalled 2,732. The annual averages were— for 1909-13, 546, and for 1914-18, 496. The annual numbers are given in Table III., Appendix. The total for 1914-18 was 9 per cent, less than that for 1909-13, the same reduction being observed in the total for males and females (all ages). The Index Numbers for the sex-age groups used for this disease, with five exceptions, show a reduced prevalence. (See below). Index Numbers for 1914-18. Averages, 1909-13=100. Age Groups 0- 1- 2- 3- 4- 5- 13- 15- Males 81 99 117 89 92 85 200 50 Females 69 94 94 100 90 92 150 128 29 WHOOPING COUGH. An examination of the totals for the four quarters of the vear shows that the distribubution in time during the second five years differed from that of the first. Taking the annual averages for each period as 100, the proportions for the four quarters were— Qr 1909 13 1914-18 1 40.2 32.7 2 33.6 39.3 3 13.0 19.4 4 13.2 8.5 If the first and fourth quarters be accepted as the two most unfavourable, qua prognosis, for the disease, the facts that during 1909-13 53'4 per cent, of the cases occurred in those quarters, and that during 1914-18 58'7 per cent, occurred during the second and third quarters, besides indicating an unexplainable change in the time distribution of the disease, give reasons for expecting a lower fatality during the second period. The Index Numbers for 1914-18 (at all ages) are males, 85; females, 108; and persons, 97. The Numbers for the individual age-groups are given below. Index Numbers for 1914-18. Fatalities, 1909-13=100. 0- 1- 2- 3- 4- 5- 13- 15- Males 81 71 114 450 107 64 ... ... Females 144 116 228 26 75 57 ... ... Persons 110 90 171 57 86 55 ... ... Comparison of the distribution of cases by Wards shows that the disease was less prevalent in all the Wards during 1914-18 except Westbourne and Hyde Park. On the other hand the fatalities observed in Maida Vale, Church and Lancaster Gate (East) Wards were the exceptions to the general reduction. Index Numbers for 1914-18. Averages 1909-13=100. Fatalities Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate, East. Hyde Park. Annual Averages 88 78 96 112 98 29 67 145 Fatality 75 72 133 81 101 ... 141 77 During 1909-13 the secondary cases constituted 47"8 per cent, of all known cases, as compared with 39'6 per cent, during 11)14-18. The total numbers of secondary cases are shown below. No. of houses with 2 cases 3 „ 4 „ 5 „ 1909-13 406 195 66 21 1914-18 394 195 56 24 No. of houses with 6 cases 7 „ 8 „ 1909-13 8 2 1 1914-18 6 1 ... Institutional Treatment.—During the five years 1.34 cases (5*4 per cent, of the known cases) were admitted to institutions—79 to hospitals of the Metropolitan Asylums Board and 55 to the Infirmary. The deaths (8) among the former were equivalent to a fatality of 101 per cent. and those among the latter (31) to a fatality of 56'3 per cent. Mortality.—During 1914-18 152 deaths were due to this disease, as compared with 174 during 1909-13. The annual averages and Index Numbers are given below. In 1909-13 27.0 per cent. of the deaths occurred in institutions, the proportion rising to 34-8 in 1914-18. Other Diseases.—The records of the following diseases are based on information other than medical certificates addressed to the Department, being drawn mainly from " Form 84." The annual numbers are given in Table III., Appendix. Whooping Cough. Males Females Persons Annual 1909-13 17 18 95 Averages. 1914-18 13 17 30 Index Numbers. 1914-18 76 98 87 30 ADMINISTRATION. Chickenpox.—Notification was required of this disease for short periods in 1915 and 1918, in consequence of threatened prevalence of smallpox. During 1909-13, 2,448 cases were recorded, as compared with 2,858 during 1914-18. The annual averages were 490 for the former period and 572 for the latter. The Index Numbers for 1914-18 (Averages, 190913=100) are— 1st Quarter 134; 2nd Quarter 153; 3rd Quarter 100; 4th Quarter 72; Year 117 Mumps.—The total cases recorded during the two quinquennial periods were —1909-13, 1,256; 1914-18, 1,474; and the annual averages, 251, 295. The Index Numbers for 1914-18 are— 1st Quarter 109; 2nd Quarter 139; 3rd Quarter 189; 4th Quarter 94; Year 117 Ringworm.—The reported cases are almost exclusively those with the disease in the head (scalp). The numbers will varv with the amount of inspection carried out by School Medical Officers and Nurses. During the war this work was naturally somewhat restricted. The cases during 1909-13 aggregated 858. and during the war (1914-18), 701, the annual averages for the two periods being 172 and 140. The Index Numbers for 1914-18 are— 1st Quarter 97; 2nd Quarter 102; 3rd Quarter 69; 4th Quarter . 54; Year 82 B. ADMINISTRATION. I.—GENERAL. Staff of the Department.—This report on the activities of the Staff being mainly statistical and involving comparisons with the work accomplished during years anterior to 1914, some record of the officers called away to the Forces or munition works and of the special duties imposed on those left behind, is essential to a proper appreciation of such comparisons. Moreover, in addition to the difficulties consequent on the shortage of labour and materials, there was undoubtedly a general loss of capacity for work (not limited to any one section of the population), arising from the air raids and food shortage, which cannot be ignored in comparing the war period with normal years. InspectorsMr. S. W. Wingfield enlisted in the 1st London (City of London) Sanitary Company R.A.M.C. in October, 1914. and was later gazetted as Lieutenant. At the end of 1918 he was a Captain in charge of a Sanitary Section overseas. Mr. Potter was with the Paddington Volunteer Training Corps during parts of 1914 and 1915, and served with the Special Constabulary from June, 1917 Mr. Mitchell was with the Training Corps from September, 1914 to April, 1917 ; Mr. Miners, during parts of 1914 and 1915, and Mr. Wansbrough during 1915. Mr. Wansbrough worked at Woolwich Arsenal (Volunteer Munitions Brigade) from September, 1915, to June, 1916, and after the latter date was in charge of the workshops of the British Red Cross Society. All the Inspectors, except Mr. Grivell, were employed on National Registration from May, 1916, to November, 1918, and all had duties in connection with Food Control subsequent to April, 1917—such work being additional to their routine sanitary work. Clerical Staff.—Mr. F.wings enlisted in the 2/15 London Regiment in August, 1915, and was transferred to the Royal Engineers in November, 1916. Mr. Fisher enlisted in the 6th Seaforth Highlanders in September, 1914, and Mr. A. J. O Sheppard in the 1st London (City of London) Sanitary Company, R.A.M.C., in October, 1914. Mr. Dunning was exempted until May, 1918, when he enlisted in the Royal Garrison Artillery. Mr. Rainger was employed as an engineering turner at the Royal Arsenal, Woolwich from August, 1915. Mr. Gower continued his duties as Chief Clerk, but out of office hours was engaged in ambulance seivice, first with the National Reserve (8th Middlesex) Ambulance Section and later with the 7th Middlesex V.A.D. and Eastern Command Volunteer Ambulance Convoy. Prevention of Infectious Disease.—The number of visits which the Staff makes in connection with infectious diseases naturally depends on the prevalence of those diseases and, as has already been reported, the prevalence of the more important diseases was most fortunatelv low at the time of greatest stress. During the five years 1914-18, 54,382 such visits were made by the Staff—18,523 by the District Inspectors and 35,859 by the Women*— as compared with 53,309—11,154 by the District Inspectors and 42,155 by the Women— during 1909-13. The annual numbers will be found in Table XIV., Appendix. The comparison between the two periods is affected bv two facts, viz., the introduction of compulsory *The Women Inspectors deal with measles, whooping cough, chickenpox and other "minor" infectious diseases, as well as tuberculosis—the District Inspectors, all other diseases. administration. 31 notification of measles in 1914 and the more complete notification of tuberculosis from 1914 onwards. On the other hand the Dispensary Staffs took over a large share of the visiting of cases of tuberculosis after 1915. The total number of patients removed to hospital was 3,091 during 1914-18, as compared with 3,328 during the preceding five years. Bearing in mind the fact that over 4,250 beds in the hospitals of Metropolitan Asylums Board were taken over for the Services, there was very little interference with the isolation service of the Metropolis. Disinfection.—The contractors (Messrs. Armfield & Son) were able to carry out this work without interruption. The number of rooms disinfected by the Council's Staff and the weight of bedding, &c., dealt with by the contractors are shown in Table XIV., Appendix. Bacteriological Work.—The total number of specimens received by the Department for examination was 3,380, or nearly 65 per cent, more than the total (2,354) for 1909-13. The annual numbers of the more important specimens are shown in Table XIV., Appendix. The diphtheria swabs numbered 2,699, an increase of nearly 59 per cent. The positive swabs (451) formed 16.7 per cent. of the total, and those yielding the "Hoffmann" bacillus,* 2.4 per cent. During 1909-13 the " positive " swabs formed 20.8 per cent of the total examined, and the "Hoffmann,"† 5.2. The highest percentage (26'2) of " positive " swabs was recorded in 1916 and the lowest (11'4), in 1914. The enteric specimens—blood —numbered 43, as compared with 128 in 1909-13, showing a reduction of twothirds (663 percent.). Positive results were obtained with 14 specimens (325 per cent.), as compared with 50 (39'0 per cent) in 1909-13 The highest percentage (41*6) was obtained in 1914 and the lowest (27'7) in 1915. The specimens from tuberculous patients - sputum—1,074, as compared with 483 in 1909-13, show an increase of 122"3 per cent. The " bacillus tuberculosis " was found present in 251 specimens, equal to 23 3 per cent, of the total, showing a slight increase (2 0 per cent.) above the proportion observed (21.3 per cent.) in 1909-13. The specimens examined for detection of the organism of cerebrospinal meningitis numbered 44 against 13 in 1909-13, an increase of 238 per cent. Of the 44, 6 (13 0 per cent.) gave " positive " results, whereas 3 (23 0 per cent.) did so during 1909-13. There were 20 miscellaneous specimens examined—with 11 "positive" results—during 1914 18. and 32— with 13 "positive" results during 1909-13, the latter total, including 17 specimens of faeces examined in connection with a small outbreak of dysentery. Certain of the specimens examined for cerebro-spinil meningitis taken from apparently healthy contacts were tested in the laboratories of the County Council and the Ministry of Health, all others at the Lister Institute. Schools.—The annual numbers of notices sent to the head teachers of the Public Elementary Schools following the occurrence of infectious disease in school children's homes are included in Table XIV., Appendix. In Table 15 will be found the prevalence rates—for certain infectious diseases per 1,000 places provided—in the two classes of elementary schools, viz., the Provided (L.C.C.) schools TABLE 15. Places Provided. Ratios per 1000. Scarlet Fever. Diphtheria. Measles. Chickenpox. Whooping Cough. P.A. P.N.A. P.A. P.N.A. P.A. P.N.A. P.A. P.N.A. P.A. P.N.A. 1914 ... 9,343 30" 1 10-2 7-5 30 8'4 44 238 65 108 81 1915 ... 10,867 101 26 5-9 37 738 67 0 209 8'2 103 7-2 1916 ... 10,597 7'4 36 38 1-1 7-1 6-0 161 64 17 1 133 1917 ... 10,597 28 08 4'6 2-0 705 602 17 8 7 3 73 55 1918 ... 10,597 51 1-6 5 9 2-0 21-0 10-2 213 9-7 19-4 173 1914 ... 8,791 16 7 7-2 72 2-8 11-7 5'8 19-5 60 244 11-0 1915 ... 8,791 138 35 60 2'2 863 60-6 230 10-8 8'4 5-2 1916 ... 8,791 8-0 1-6 93 2-0 6-3 2-7 190 47 11'4 7'7 1917 ... 8,791 2'7 0-9 61 29 62 1 45'1 84 36 10-2 6-2 1918 ... 8,621 3'8 1-2 51 2-4 42-6 22-0 27-3 11-7 147 9-5 " P.A."— Patient attending School —" Scholars." " P.N.A."—Patient not attending School—" Contacts." * This bacillus was reported present in the swabs examined during 1914 and 1915 only. | Reported present in swabs examined during 1911-13 only. 32 Administration. and the Non-provided (Church). With but few exceptions the rates are higher in the former class of schools. Table 16 gives similar information with regard to children excluded from school on account of " sore throat," ringworm, scabies, vermin, etc. In this Table it will be observed that the rates for scabies and vermin are higher in the Non-provided schools than in the Provided. As regards vermin, the rates in both classes of schools appear to have been notably lower in the last three years under review, but it is practically certain that the apparent decline is fictitious, and that it was caused by increasing difficulty in the inspection of the children due to the war conditions. Attention may also be directed to the increased proportions of children excluded for "other complaints" during 1916-18, the same years with a reduced prevalence of vermin. No explanation can be offered for the figures after so long an interval. TABLE 10. Places Provided. Ratios per 1000. '' Sore Throat." Ringworm. Scabies. Other Complaints. Vermin. Provided Schools— 1914 9,843 26.0 13.1 3.1 18. 7 19.5 1915 10,807 7.1 6.2 3.8 4.0 4.9 1916 10,597 5.0 8.3 6.7 22.9 6.2 1917 10,597 0.9 6.4 7.5 18.9 0.4 1918 10,597 1.2 8.3 7.9 35.7 0.9 Non-nrovided Schools— 1914 8,791 5.1 11.8 4.6 7.9 22.0 1915 8,791 3.7 6.9 5.3 4.7 11.2 1916 8,791 1.3 8.0 8.7 18.5 4.0 1917 8,791 0.0 6.7 7.6 15.4 0.8 1918 8,621 0.3 5.5 8.1 53.2 1.0 Internotification—There is a free interchange of information between the Departments of the Borough and of the adjacent districts. The numbers of notices received from other districts are shown in Table 17. TABLE 17. Internotification. Disease. Kensington. Willesden. Hampstead. Marylebone. 1914 1915 1916 1917 1918 1914 1915 1916 1917 1918 1914 1915 1916 1917 1918 1914 1915 1916 1917 1918 Scarlet Fever 109 38 32 7 16 108 20 19 4 3 3 2 5 ... ... 57 13 11 1 1 Diphtheria 26 22 9 16 9 34 3 9 11 11 5 1 ... ... ... 17 5 13 1 5 Enteric Fever ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 13 60 6 69 8 5 18 12 51 14 ... 3 ... 1 ... 1 ... 6 10 9 Whooping Cough 2 6 11 1 14 35 1 12 5 32 1 ... ... ... ... ... ... ... ... 5 Chickenpox 10 8 14 5 11 37 4 14 14 9 ... ... ... ... ... ... 6 ... 1 5 Other Sickness 36 1 33 22 50 45 6 13 3 2 ... 1 ... ... ... 3 ... 7 9 6 Vermin ... 1 25 8 11 ... ... ... ... 1 ... ... ... ... ... ... ... ... 4 2 House Sanitation.*—A statistical summary of the complaints received and of the sanitary works carried out under the supervision of the District Inspectors will be found in Table XIII., Appendix. * In houses and premises not registered as " Houses let in Lodgings," which are dealt with under "Tenement Houses." administration. 33 The only headings under which higher totals are shown for the war period are— "complaints" (increase 16*2 per cent.), " drains cleared and flushed" (increase J«6'2 per cent.), " roofs repaired" (increase 76'6 per cent.), and "animals improperly kept, removed" (increase 37*5 per cent.). As regards roofs it will be observed that there was an increase in the number repaired each year, the maximum (66) being reported in 1918. There is little room for doubt as to the association between this work and air-raids. It is probable that attempts to supplement meat deficiencies by rabbit breeding accounts for the increase under the last heading (See also Pig Keeping.) The decrease in the number of inspections and re-inspections from 82,843 in 1909-13 to 70,350 in 1914-18 (a reduction of 15T per cent.) was regrettable but unavoidable, having regard to the time taken for food-rationing, &c. The decreases in the various classes of sanitary work are attributable to shortage of labour and materials rather than to any deficiency of sanitary supervision. The figures permit one verv important conclusion to be drawn, viz., that the need of inspection for the discovery and remedy of sanitary defects was greater at the end of 1918 than it had ever been before. The fact that the majority of the houses in the Borough were constructed anterior to the framing of the existing Bye-laws under the Metropolis Management Act, 1855 and the Public Health (London) Act, 1891— which regulate the construction of drains, waste-pipes, &c.—together with the ageing of the fabrics of the houses, points to the urgent necessity of more careful inspection. During 1909-13 an average of 193 drains were found to need complete re-construction, whereas during the v/ar the re-construction averaged 45 a year—not one-quarter of the preceding average. It does not appear to be necessary to labour the point which "leaps to the eye" if the totals for the two periods—the last two lines of Table XIII.—be examined. Confirmation of what is written above is furnished in the following paragraphs. House Drainage.—The figures relating to drainage works are contained in Table XIII. Tn the subjoined statement the totals for each of the five years are given—such figures including all works whether voluntary or compulsory. 1914 1915 1916 1917 1918 Existing drains found sound 143 89 80 85 68 Drains re-constructed 175 105 82 45 57 „ " made sound "* 78 23 17 12 4 The re-constructions in the three years 1911-13 were—in 1911, 227 ; in 1912, 223 ; and in 1913, 175, and the numbers " made sound "—in 1911, 50; in 1912, 98 ; and in 1913, 73. Re-construction Plans.—In 1911, 348 plans were deposited for re-construction of drains, renewals or alterations to sanitary fittings. In 1912 the number was 352 and in 1913, 344. The reduction in the amount of such work during the war is fully demonstrated by the following statement Plans deposited 1914 312 1915 209 1916 145 1917 122 1918 109 Sewer Connections.—The great changes which have taken place in road traffic during recent years involving the free use of mechanical transport by vehicles of much greater weight and higher speeds, cannot fail to result in damage to house connections, a very large proportion of which are constructed of brickwork without any concrete protection. Even without traffic changes the continued pressure of the superincumbent soil may be expected to lead to the collapse of old brickwork.f Moreover, it is to be anticipated that the vibrations set up by dropped bombs and artillery fire will have produced damage to underground drains. The numbers of new connections put in during the war are set out below. After Order from the Council On initiative of " owners" 1914 13 23 1915 15 22 1916 8 25 1917 10 11 1918 16 11 Combined Drainage.—During the last five years 13 systems of combined drainage were examined and re-constructed, viz., in 1914, 6; in 1916, 5 ; and in 1918, 2. * By " Economic " or similar process. † As mentioned in the Annual Report for 1913, complaints of rats gaining access to houses are becoming moie frequent, defective house connections being the usual mode of access. f 34 administration. Orders sanctioning the construction of combined drains were made bv the Council under Sec. 74 of the Metropolis Management Act, 1855, with respect to the following premises:— In 1914. Ashworth Road, Nos. 10-20. 22-28. Chilworth Stieet, Nos. 18 and 20. Coburg Place, Nos. 5-11. In 1916. Harrow Road, No. 53. Irongate Wharf Road, Nos. 29 and 31. In 1918. Prince's Square. Nos. 75 and 76. Queen's Road, Nos. 76 and 78. Canterbury Terrace, Nos. 36 and 38. Princes Mews, Nos. 15 and 16. Westbourne St. Mews, Nos. 11 and 12. Westbourne Terrace, Nos. 32 and 34.| Craven Road, Nos. 26-30. Moscow Road, Nos. 29 and 31. Bristol Mews, No. 1. Bristol Gardens, No. 30. Flooding.—Two exceptional storms occurred in June, 1917, the first on the 16th and the second on the 28th. On the former occasion 2T7 inches of rain were measured at the Botanical Gardens and 2.55 in Harrow Road, the durations of those falls being 2 hrs. 15 mins. and 2 hrs. 40 mins. respectively. The total rainfall measured on the 28th during the 24 hours was 1.69 inches at the Botanical Gardens and 1.47 inches in Harrow Road, at which station over three-quarters of an inch of rain fell in the course of an hour. The Metropolitan sewers, originally designed to cope with a rainfall of one-quarter of an inch (spread uniformly over 24 hours), can now carry off half-an-inch if the fall be uniform throughout the day. That means that the sewers can carry the rain falling at the rate of 0*02 inch per hour. In the storm of June 16th the fall was at the rate of T04 inches per hour —assuming an equal time distribution—and in that of June 28th about 0'75 inch. In other words the hourly falls were 52 and 37 times the hourly capacity of the sewers. The result need hardly be stated—there was back-flooding on a large scale of rain water and sewage. The danger of flooding is enhanced in these davs by the covering of the roads with impervious materials and of the adjacent grounds with houses. Much rain, hitherto absorbed into the ground, now flows into the sewers. The maximum flooding appears to have been observed in Saltram Crescent (6 ft. approximately above the basement level) and the minimum in Marlborough Gate Mews (some 9 inches above road level). The flooded areas appear to have clustered round the Ranelagh Sewer (from Willesden to Baysvvater Road), the Midlevel Sewer (under Bayswater Road) and the Westbourne Grove Sewer. The railvvav lines in the Borough were all more or less flooded, the "Sakerloo" Tube—the deepest of allsuffering the least. In a Report to the Public Health Committee the Acting Medical Officer of Health remarked— "Apart from a few isolated cases the flooding .... was confined to 6 well"defined areas viz. (1) Kilburn Park Road and the group of houses round about the "junction of that road with Shirland Road; (2) Netley Street, the lower end of "Shirland Road and neighbouring roads . . . . ; (3) Senior Street, Ranelagh Road "and adjacent streets; (4) the lower half of Gloucester Terrace and adjoining "thoroughfares; (5) the Westbourne Grove district ; and (6) Great Western Road ". . . . In Netley Street a uniform depth (of flooding) of 4 feet was measured." Within 10 days 174 complaints were received in the Department from 35 thoroughfares, the full total amounting to 316, to many of which were attached claims for compensation. The conditions found by the Acting Medical Officer of Health were stated bv him to be " especially bad " in Netley Street and Ranelagh Road. At 96 houses the bedding in the basement rooms was found to be "saturated with sewage and rendered quite unfit for further use." With the help of the Scavenging Department all sewage-soaked bedding was removed and new provided by the Council, 158 families receiving 255 mattresses and 85 palliasses at a cost of .£204 (or thereabouts). The time of the Inspectors of the flooded areas was fully taken up for four weeks in dealing with the effects of the storm of the 16th, which must have been aggravated by the second storm (on the 28th), although no special report was made of the latter. On July 18th the Acting Medical Officer of Health was able to report— " All the flooded houses have now been cleansed .... and the rooms are now in a fairlv habitable condition." H.W. the Mayor opened a Relief Fund and a sum of £406 was collected. administration. 35 Water Supply.*—During the five yeais 143 notices of discontinuance of supplies were received from the Water Board, 74 relating to occupied houses and 52 to empty premises. In 91 instances the supply was cut off on account of failure to pay the water rate, in 39 on account of waste arising from defective fittings, and in one instance because the supply was not required. Mortuary.*—During the five years 1,604 bodies were received at the Public Mortuary, Paddington Green, 1,290 (80'4 per cent.) being removed thereto on Coroner's order. The annual average for the period was 301, which compares with 283 in 1912 and 333 in 1913. The bodies deposited to await burial numbered 320, including 9 of persons dying of infectious disease. Post-mortem examinations were made on 625 bodies, equivalent to 48*4 per cent, of the instances of removal on Coroner's order. In 1912 the corresponding percentage was 43'5 and in 1913, 47 4. Pig-Keeping.—Section 17 (4) of the Public Health (London) Act, 1891, enacts that any premises within forty yards of any street or public place are unfit for the keeping of pigs, which implies that the keeping of such animals within the Borough is illegal. In January, 1917, the Local Government Board issued a circular letter which, in effect, advised the Council to ignore the provisions just mentioned and to encourage the keeping of pigs—as also of rabbits and fowls—wherever possible, without causing serious nuisance. The object of the Board's action was to make use of edible house refuse and to make an effort to supplement the threatened shortage of food. Pig-styes were opened at the Paddington Infirmary and at the Dust Wharves belonging to the Councils of this Borough and of the Borough of St. Marylebone. A fair number of householders engaged in rabbit and fowl rearing. Trade Nuisances:* Offensive Smells.—The complaints received numbered 44, arising from 34 premises, including 13 relating to public house urinals, 10 to fishmongers and 9 to poulterer's premises. Manure Nuisances.—There were 86 complaints of smells due to failure to remove manure from 66 premises. Smoke /VMtsatice.j—The taking of skilled stokers for the Services and the demand for smokeless coal for the Navy rendered the enforcement of the law against the emission of smoke not only impracticable but also undesirable. The complaints received in the course of the five years numbered 40 and the time spent in observation amount to 531J hours. Smoke of varying density was recorded during 339 hours (nearly 64 per cent, of the time given to observations), " black " smoke being noted during 13-f hours. The durations of " black " smoke recorded each year are very small, but the percentages of duration (in hours of observation) serve to illustrate the extent to which the difficulty of avoiding the emission of such smoke increased vear bv vear. Duration of black smoke per 100 hours of observation 1914 0.7 1915 2.7 1916 2.9 1917 3.6 1918 6.6 Canal Boats.|—An Annual Report has been presented each year by the Examining Officer, so that a brief summarv only is included here. There was an increase in the volume of traffic during the war, the number of boats using the Basin in any year rising rather more than 33 per cent, from 63 in 1914 to 96 in 1918. In the course of 667 inspections made during the five years 83 infringements of the Acts were discovered, requiring the service of 60 notices. The children found on the boats diminished from 148 (78 of whom were of school age) noted in 1914 to 90 (51 of school age) in 1918. The progressive decline in the numbers is fully brought out by the subjoined figures. Number of boats using Basin Total children found Children of school ages 1914 63 148 78 1915 65 150 91 1916 68 130 80 1917 74 93 63 1918 96 90 51 * See also Table XIV., Appendix † Mr. Wansbrough, the Inspector of Workshops, deals with this matter. See also Table XIV., Appendix. ‡ See also Table XIV., Appendix. The Chief Inspector (Mr. Potter) is the Inspector of Canal Boats. f 2 36 workshops. Sickness.—The cases of infectious disease reported to the Department during the five years numbered 8, viz.— Erysipelas 3 Diphtheria, Chickenpox . , Scarlet Fever 2 Measles 1each. Deaths.—No deaths among the boat population were known to the Department in 1914 and 1918. During the three years, 1915-17, 14 deaths were reported, the causes of death being— Whooping Cough 1 Bronchitis 2 Diarrhoea and Enteritis 1 Pneumonia 5 Heart Disease 1 Drowning 3 Other cause 1 11.—WORKSHOPS. Registration.—There was very little change in the number of factories, workshops, &c., on the Register during the war, the entries at the end of 1918 being only 21 fewer than at the end of 1913—a reduction of 1.5 per cent. The fluctuations from year to year are shown below. 1914 1915 1916 1917 1918 On Register, January 1 1,421 1,446 1,410 1,436 1,416 Removed from Register 138 214 51 75 41 Added to Register 163 178 77 55 25 On Register, December 31 1,446 1,410 1,436 1,416 1,400 The small numbers of new workshops, &c., opened during 1916-18 is striking. Another notable feature is the increase in number of factories in the Borough, which numbered 137 at the end of 1914 and 163 at the end of 1918. The figures for domestic workshops, workplaces and single workers (mostly outworkers) have not been extracted since 1916. The numbers of each of those classes of work-places in 1914 and 1916 are shown below. Domestic Workshops. Work-places. Single Workers. (Outworkers)*. 1914 19 1916 17 32 20 295 (259) 234 (230) There was a corresponding reduction in the number of notices of new workshops received each year from the Home Office, viz., in 1914, 73 (65); in 1915, 52 (49); in 1916, 27 (22); in 1917, 18 (16); and in 1918, 12 (10). The figures in parentheses indicate the number of instances in which registration of the workshops had been effected in the Department before receipt of the notice from the Home Office. Out-Workers.— The number of this class of workers at the end of the year rose from 294 in 1913 to 373 in 1918—an increase of over 26 per cent.—but the out-workers for local employers (i.e., those on Out-workers' Lists received from Paddington employers) showed a reduction of 17*2 per cent. The total number on the Register increased to the end of 1916 and then fell. The annual figures of Lists received, &c., are shown below. OUT-WORKERS. No. of Lists recived from Local Employers- 1914 1915 1916 1917 1918 February 58 56 47 44 39 August 59 49 45 46 40 Total for year 117 105 92 90 79 Local Workers 214 286 180 262 155 Outlying „ 361 273 374 230 328 Other Authorities 55 66 69 65 68 Workers therein 379 359 341 356 372 No. of Out-Workers on Register, Decmber 31 343 386 394 381 373 Home Office Complaints.—As might be expected these decreased as the war continued, owing to the calls on the Department for work other than the inspection of workshops. Whereas in 1914 and 1915 9 and 14 complaints were received, in 1917 and 1918 they numbered only 6 in each year. The total number of complaints received in the five years was 45, dealing with the following defects, &c.:— Workrooms dirty 12 „ overcrowded 4 „ insufficiently ventilated 3 W.C. accommodation inadequate 8 „ apparatus defective 17 „ apartment dirty 1 37 HOUSING. Supervision.—The Inspector made 15,218 inspections during the five years—in 1914, 3,310; in 1915,2,829; in 191(5, 2,834; in 1917, 3,414; and in 1918, 2,831. He found and dealt with 378 nuisances and defects, of which an analysis is here appended. Workrooms dirty 157 „ overcrowded 24 „ insufficiently ventilated 15 W.C. accommodation inadequate 14 „ „ not separate 11 apparatus defective 144 „ apartment unventilated 4 Sickness.—On premises where work was carried on 20(5 cases of infectious disease occurred during the five years, but only 72 of the cases were in the workers' families. Those figures include 81 cases in houses where out-workers lived, 39 of the cases occurring in their families. The cases reported were— Measles 125 Scarlet Fever 41 Diphtheria 12 Chickenpox 17 Whooping Cough 9 Erysipelas 2 Bakehouses.—At the end of 1913 there were 04 bakehouses in use, 16 being "level" (i.e., above the basement) and 48 "underground-" At the end of 1918 the number in use was 58,* 17 being " level " and 41 "underground." During the war 20 underground bakehouses were closed following disuse, but some were re-opened, as is allowed by Law. Of those remaining out of use at the end of 1918, a certain number will not be re-opened. The inspections of bakehouses during the five years numbered 1,797—389 of the factories and 1,408 of the others. Frequent visits were necessary under the "Bread" and " Flour" Orders, and such occasions were used for inspections (in the ordinary sense). III.—HOUSING. Housing Acts.—During the five years 17 Closing Orders were made, 15 of which were determined before the end of 1918. See below. Address of Premises. Closing Order. made. determined. Cirencester Street, No. 40 1914 1915 „ 42 1914 1915 „ 43 1914 1914 „ 44 1914 1915 „ „ 48 1914 1916 ,, 41 1915 1916 Desborough Street, No. 9 1916 1917 Alfred Road, No. 39 1917 1917 ,, ,, 39a 1917 1917 Amberley Road, No. 11 1917 1918 ,, „ 12 1917 1918 ,, „ 15 1917 1918 Cirencester Street, No. 37 1917 1918 ,, 51 1917 † Dartington Terrace, No. 2 1917 1917 Cirencester Street, No. 52 1918 1918 ,, ,, 69 1918 † In addition the following houses were closed by the owners and left derelict, most of them being in ruins at the end of 1918:— Dartington Terrace, No. 3. Desborough Street, Nos. 4, S and 9. Torquay Street, No. 15. Tenement Houses.— I his term is used to describe those houses which, being occupied by two or more families, are registered under the Bye-laws pursuant to Section 94 of the Public Health (London) Act, 1891. The number of such houses, which was 1,350 at the end of 1909, stood at 1,376 at the end of 1913, two Inspectors giving their whole time to the supervision of this class of property. In October, 1914, Mr. Wingfield joined the Army, and the sole charge devolved on Mr. Lawrence. During 1909-13 the two Inspectors made 12,686 inspections, that total falling to 8,798 during 1914-18—representing a deficiency of supervision equal to nearly 31 per cent, of the standard implied by the 1909-13 figures. In Table XV., Appendix, will be found a statistical statement of the nuisances and defects found and dealt with during the last five years. * Of the 58 bakehouses 26 are factories, 18 of them being underground. † Cases not completed at end of 1918. 38 Housing. The matters calling for attention may be described as divisible into "major" and "minor " defects according to the labour and material reuuired to remedv the defects. Premising that the fabrics of the houses are steadily ageing and that no improvement can be observed in the care given to the buildings and their fittings by the tenants and landlords, the following comparisons between the totals for the two quinquennial periods unmistakably indicate the pressing demand which existed at the end of 1918 for increased supervision of this class of property :— "Major" defects. "Minor" defects. 1909-13. 1914-18. 1909-13. 1914-18. Soilpipes defective 6 10 Drains choked 59 58 Water Closets defective 378 530 Gulleys choked 63 69 W. W. P. defective 300 263 Water Closets choked 229 279 Paving defective, area, wash-house 850 374 ,, without water 96 219 „ foul 172 245 Roof defective 783 925 Cisterns dirty 342 286 Dustbin defective 515 251 Rooms dirty 9309 7249 „ verminous 1666 930 In addition to the systematic inspections which were made throughout the vear, there used to be a general "Annual Cleansing"—provided for by the Bye-laws—when two of the District Inspectors were temporarily assigned to assist in tenement house inspection. The work began in April of each year and was generally (approximately) completed by the end of the summer vacation. Great importance was attached to this "cleansing," not only on account of its results as regards cleanliness, and consequently health, but also for the very useful information obtained by the survey made of population and housing conditions. During 1914-18 this work was carried out fairly successfully during the first three years, but no compilations were made of the data obtained from the survey.* Leaving that loss out of consideration, another measure of the need of increased supervision is afforded by comparing the total number of inspections made for "cleansing" purposes in the two quinquennial periods. In 1909-13 such visits numbered 22,912 and in 1914-18, 17,409—a deficiency of just over 24 per cent. The numbers of houses inspected were 1,445 in 1914, 1,389 in 19i5, 1,235 in 1910, and 1,05I in 1917. In 1918 the " cleansing" inspections numbered 563 only, as compared with 4,574 in 1915. Further evidence of the incompleteness of the " cleansing" is afforded by the numbers of cases referred to the Solicitor and of the summonses taken out— Cases referred to the Solicitor Summonses issued 1914 96 3 1915 103 1 1916 54 - 1917 14 4 1918 - - Overcrowding.—In Table 18 the numbers of cases of overcrowding dealt with each year are set out. The figures cannot be accepted as evidence of a real improvement of housing conditions. While the absence of men with the Services undoubtedly effected some reduction of overcrowding the smaller numbers recorded after 1914 are undoubtedly due to the breakdown in the arrangements for the "Annual Cleansing," when most cases of overcrowding have been discovered in the past. Having regard to the (believed) inherent defects in the data comment on the Table appears to be undesirable. TABLE It. Tenement Houses. Overcrowding: 1914-18. 1914 1915 1916 1917 1918 Total. Tenements overcrowded 188 45 69 41 9 352 Rooms „ 194 49 72 43 13 371 Occupants: Total 910 261 363 245 60 1839 ,, Under 10 354 118 161 91 29 753 „ 10 and upwards 556 217 207 154 31 1165 Overcrowding abated— Byre-arrangement 34 22 39 34 2 131 ,, voluntary removal 26 11 14 3 ... 54 Under notice 13 5 4 1 7 30 Cases held over 115 8 12 3 ... 138 *The work was much impaired through inability to obtain the necessary cards, &c., arising from the shortage of paper. food supervision. 39 Dirty and Verminous Rooms.—As already stated 7,240 rooms were reported to be dirty and 930 verminous during 1914-18, as compared with 9,309 and 1,666 (respectively) during 1909-13. The figures for each year shown in Table XV., Appendix, should be compared with those of rooms cleansed* (i.e., disinfested) shown in" Table XVIII., B, Appendix. The conclusion that not only was there a failure to discover verminous conditions, but an even greater failure to get rid of the verminous conditions. Notices Issued.—The following is a summary of the Notices issued with respect to this class of house during the five years. Shortage of paper made it necessary to include in one notice—the written intimation, usually—defects remedial under the Bve-laws for which separate notices are legally required. 1914 1915 1916 1917 1918 Written Intimations 395 484 287 290 363 Statutory Notices 168 108 31 46 124 Bye-law 1749 1040 912 930 127 Notices under L.C.C. (G.P.) Acts : — Verminous Rooms 265 144 93 79 32 Additional Taps 44 6 - 4 - Abolition of old Dustbins 13 6 1 1 — IV.—FOOD SUPERVISION. Slaughterhouses.—In 1913 slaughtering was carried on at the undermentioned premises— Bishop's Mews, No. 1. . Southwick Mews, No. 15. Edgware Road, No. 275. Chippenham Mews, No. 18. Portsdown Mews Harrow Road, No. 125. fat rear of 249 Maida Vale). Upper Brook Mews, No. 6. The slaughterhouse in Southwick Mews was closed during 1915 and that in Bishop's Mews in 1916. The others were in use throughout the war. During 1914-18 the Inspector (Mr. Grivell) was present on 1,561 occasions when animals were being slaughtered, as compared with 2,290 during 1909-13. The animals killed numbered 14,479, or nearly 35 per cent. fewer than the total for 1909-13. The numbers of animals slaughtered in each five vears were— 1909-13. 1914-18. Bullocks 423 1,428 Calves 11 Sheep 21,736 13,037 Pigs - 14 The annual figures for 1914-18 are shown below— Animals slaughtered— 1914 1915 1916 1917 1918 Bullocks 61 91 92 79 1,105 Sheep 2,770 2,094 2,225 2,417 3,531 Pigs — - — — 14 Totals 2,831 2,185 2,317 2,496 4,650 A statement of the diseased parts of the carcases destroyed after inspection in the course of slaughtering is given in Table 19. Food Vendors.—The vendors of food trading in the Borough at the end of 1913 numbered 482, which total fell to 389—a reduction of a little over 19 per cejit. The tabular statement below shows the trades most affected. Trade. 1913 1918 Change per cent. Meat 81 70 —30.7 Pork 20 Fish 31 25 —19.4 Game, Poultry 11 10 — 9.1 Fruit, Greengrocery 69 68 — 1.5 Milk 123 99 —19.6 Refreshments 108 83 —23.2 Margarine 13 15 +15.3 Fried Fish 26 19 —27.0 The inspections of the above premises—for detection of unsound foodstuffs—numbered 4,232 during 1914-18, as compared with 5,157 during 1909-13—a decrease of 18'0 per cent., which shows that the supervision of the sale of foodstuffs was maintained at its usual level. * No records have been kept of the number of rooms cleansed, in the ordinary sense of the word. 0 40 food supervision. The foregoing figures do not include the trades carried on by costers, whose stalls and the foodstuffs exposed for sale are systematically inspected, especially on Saturdays, when two rounds at least are made. TABLE 19. Slaughterhouses. Organs Destroyed 1914-18. 1914 1915 1916 1917 1918 Abscess. T uberculosis. Parasitic. Actinomycosis. Abscess. T uberculosis. Parasitic# Actinomycosis. Abscess. Tuberculosis. Parasitic. Actinomycosis. Abscess. T uberculosis. Parasitic. Actinomycosis. Abscess. T uberculosis. Parasitic. Actinomycosis. Bullocks:- Liver 2 2 2 ... ... 1 3 ... ... ... 5 ... ... ... 4 ... 6 18 24 ... Lungs ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 5 48 ... ... Spleen ... ... ... ... ... ... ... ... ... • • • ... ... ... ... ... ... ... 5 ... ... Heart ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... Mesentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 ... ... Tripe ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... Head & Tongue... ... 2 ... ... ... 1 ... ... ... ... ... ... 3 ... ... ... 9 ... 1 Sheep:- Liver 2 ... 6 ... ... ... 6 ... ... ... 7 ... ... ... 3 ... ... ... 50 ... Lungs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... In 1918 there were destroyed 3 tubercular carcases (and organs) and 4 forequarters of beef. Food Preparation.—In 1913 there were 7 fish-curers, 8 sausage and saveloy makers in the Borough, which figures had fallen to 6 and 7 respectively at the end of 1918. The 2 ice factories established prior to 1913 continued to run without interruption. In 1915 a margarine factory was opened, and in 1916 a second, both of which were in operation at the end of 1918. A butter factory opened and closed during 1915. In that year also bacon-curing was commenced in Newcastle Mews (3 smoke holes). 319, Edgware Road (4 smoke holes). Irongate Wharf (5 „ ). (in rear of) At the above premises the Inspector made 780 inspections. In 1916 73 lbs. of pig's flesh were destroyed as unfit for curing. Between October, 1915, and October, 1916, premises were opened at No. 12 Wharf, South Side, for preparing, salting and smoking horse flesh for human consumption. These premises were visited on 444 occasions. The Inspector reports that the only parts found unfit for consumption were 3 parasitic livers. Between 5 and 10 tons of horse flesh were always found on the premises. Milk Trade.—As already mentioned the number of dairies and milkshops on the Register decreased during the war from 123 (at the end of 1913) to 99 (at the end of 1918). The changes in the class of premises at which milk is sold are indicated in the following statement :— 1913 1918 Wholesale Dairies 5 3 Retail „ 86 70 Refreshnent Houses 9 9 Grocers' Shops 1. 10 General Dealers 17 6 Bakers' Shops 4 1 Provision Dealers 1 — In 1914 a number of shops previously classed as "dairies " were transferred to the class "grocers' shops," in consequence of the occupiers adding groceries to the stock kept at those shops. At "general dealers'" shops wood and paraffin are sold under conditions prescribed FOOD SUPERVISION. 41 by the Council acting under powers conferred by the London County Council (General Powers) Act, 1908. The inspections of premises where milk is sold during the five years numbered 653—every shop being visited at least once in each year and a copy of the Regulations left with the proprietor. Table 20 shows the number of cases of infectious disease reported (1) on premises from which milk is sold, and (2) in the families of milk roundsmen or in houses where such men reside. No spread of infection was traced back to any of the 2 milkshops or roundsmen. TABLE 20. 1914 1915 1916 1917 1918 (1) (2) (1) (2) (1) (2) (1) (2) (1) (2) Scarlet Fever 3 18* 3 11 ... 7 1 3 ... 4 Diphtheria ... 7 ... 3 1 4 ... 5 ... 3 Enteric Fever ... ... 1 ... ... ... ... ... ... ... Erysipelas ... ... ... 1 ... ... ... ... ... ... Measles 1 ... ... 9 2 3 11 4 ... 2 Chickenpox ... ... ... ... ... ... ... ... 1 ... 4 25 4 24 3 14 12 12 1 9 ♦Includes 4 cases of S.F. in the homes of men living in Paddington, but working in other boroughs. (1J At milk shops (2) In the families of roundsmen or in the houses where roundsmen resided. Ice Cream Trade.—Sugar-rationing, following calls to the Service, crippled this trade, which was completely shut up in 1918. The records given in Table 21 tell the story without any need of amplification. TABLE 21. Ice-cream Making: 1914-18. Makers and Vendors of Ice Cream on Register. 1914 1915 1916 1917 1918 Businesses with which the sale of ice cream is combined :- Sweetstuff 55 43 22 12 ... Newspapers and Tobacco 20 15 12 5 ... Restaurants 14 9 11 8 ... General Dealers 12 9 4 4 ... Bakers 7 7 5 2 ... Confectioners 8 11 16 10 ... Greengrocers 2 2 2 2 ... Milkshops 2 ... ... ... ... Totals 120 96 72 43 ... 1914 6 Resident, and 6 non-resident, barrowmen. „ 2 cases of S.F. occurred at premises where ice cream is sold. 1915 Ice Cream sold from 6 barrows in Borough, and 2 outside Borough. „ 2 cases of S.F. occurred at premises where ice cream is sold. 1916 Ice Cream sold from 4 barrows in Borough, and 2 outside Borough. 1917 Ice Cream sold from 4 barrows in Borough, and 3 outside Borough. 1918 The making of ice cream ceased. G 42 SALE OF FOOD AND DRUGS ACTS. Unsound Food.—In addition to the quantities already reported as destroyed at slaughterhouses and elsewhere, 174.103 lbs. of foodstuffs (77*7 tons) were destroyed as unfit for consumption, an increase of 610 per cent, above the quantity destroyed during 1909-13 (10'8 tons). Table 22 gives a classified summary of the foods destroyed. In 1914, 1,312 lbs. of foodstuffs were found at a private house, after the death of the occupier, in a state unfit for human consumption and were destroyed. Comparing the figures for 1914-18 with those for 1909-13, it appears that the annua averages were— Averages (lb.) 1909-13. 1914-18. Total foodstuffs destroyed 4,864 34,821 Including in transit 3,031 32,523 Percentage of total in transit 62.3 934 Almost the whole of the foodstuffs destroyed in transit were so dealt with at the request of the Great Western Railway Company. If the above returns form a fair sample of the foodstuffs lost through causes which should have been obviated, it can only be remarked that such loss was not only regrettable but almost blameworthy. After so long an interval it is impossible to assign any cause for the loss. TABLE 22. Foodstuffs Destroyed. (Weight in lbs.) 1914 1915 1916 1917 1918 On Vendors' request— Flesh (various) 16 112 48 672 336 Fish 280 112 260 1,302 2,674 Fruit. Vegetables 438 378 460 672 1,526 Other Provisions — 224 56 70 1,012 Totals 734 826 824 2,716 5,578 In transit— Flesh (various) 538 913 2,442 7,798 1,456 Fish — — 1,008 -_ Fruit, Vegetables 4,368 87,136 39,928 8,608 9,128 Totals 4,906 88,079 42,370 17,486 10,584 Grand Totals 5,640 88,905 43,194 20,202 16,162 V.—SALE OF FOOD AND DRUGS ACTS. Samples Taken.—The usual number (600) of samples were taken under the Acts in the course of each of the five years, the number of adulterated samples in any year varying from 43 in 1917 to 64 in 1915. The percentages of samples reported to be adulterated in each of the last ten years are shown below. Percentages of Adulteration. 1909 8.6 1914 9.6 1910 9.0 1915 10.6 1911 8.3 1916 9.3 1912 17.3 1917 7.2 1913 10.5 1918 10.0 Averaee 1909-13 10.6 Averaee 1914-18 9.3 The proportion of adulterated samples fell in the second period by 12'5 per cent. A classified summary of the samples taken during 1914-18 will be found in Table XVI., Appendix. Milk.—The samples of milk—i.e., new milk—constituted more than half of the total samples taken, numbering in 1914-18, 1,694 (56'4 per cent.), and in 1909-13, 1,515 (50'5), the adulterated samples numbering 192 (1T3 per cent.) in the former period and 156 (10'2 per cent.) in the latter. The annual numbers and percentages are given below. Milk Adulteration. Total Samples. Adulterated. Total Samples. Adulterated. Number. Percentage. Number. Percentage. 1909 301 20 6.6 1914 281 23 8.2 1910 317 23 7.2 1915 324 46 14.2 1911 341 30 8.7 1916 312 39 12.5 1912 297 53 17.8 1917 349 32 9.2 1913 259 30 11.5 1918 428 52 12.1 SALE OF FOOD AND DRUGS ACTS. 43 Adulteration of this food was on a larger scale during the war period than before the war, Milk is the only food of which samples are taken on Sundays and Bank Holidays. During 1914-18, 396 samples were taken on those days, 352 on Sundays and 44 on Bank Holidays, the number found adulterated among the former being 21 (5'9 per cent.) and those among the latter 7 (15*9 percent.)—the total adulterated samples (28) forming 17'8 per cent.,, or 6"5 per cent, more than the general bulk of milk samples. Milk in Transit.—Samples are taken at the railway stations on request of the consignees, such request being consequent on the unsatisfactory results of private analyses. Having regard to the increase in the higher proportion of samples reported during 1914-18 to be adulterated, it might have been expected that local milk vendors would have made freer use of the check afforded by station sampling. The returns, however, show that there was a decrease of some 12£ per cent, in the number of samples taken in transit, the figures being— 1914-18 265 samples taken, 104 adulterated, equal to 39'2 per cent. 1909-13 337 „ „ 100 29.6 The annual figures are here set out. They again show a larger amount of adulteration during the war period, becoming progressively worse towards the end. Station Samples. Total taken. Adulterated. Total Adulterated. Number. Percentage. taken. Number. Percentage. 1909 41 10 24. 4 1914 66 16 24.2 19l0 67 10 14.9 1915 77 33 42.9 1911 110 21 19.1 1910 60 26 43.3 1912 80 40 50. 1917 22 11 50. 1913 39 19 48.7 1918 48 18 45.0 After deducting the number of samples taken in transit from the totals previously reported, it appears that the proportions of adulterated samples sold in the Borough were 4.3 per cent, during 1909-13 and (3.1 per cent. during 1914-18. Preservatives in Foods.—During the five years 30 samples of foods and beverages were found to contain preservatives, either salicylic acid or boric acid. The samples comprised (see also below) 1 of " fresh " cream containing 21 grains of boric acid to the pound ; 5 of lime juice cordial, containing salicylic acid in amounts varying from 4½ to 11¾ If grains per pint; 6 of brawn containing from 2 to 11 9/16 grains of boric acid to the pound; 8 of sausages containing the same preservative to the extent of from 3½ to 11½ grains per pound; and 10 of German sausages with from 2 1/10 to 21 grains of boric acid to the pound. Even if the use of preservatives be recognised as necessary—a very arguable point—no amount of argument will justify such wide variations in the quantities used. Legal proceedings in cases of this character are notoriously hazardous and costly. It is time that the question was fully gone into and settled by the legislature. Preservatives in Foods. 1914—13 samples. Brawn — 2 samples — boric acid 5½— 119/10 grains per lb. Sausages -3 „ — „ 3½ - 7¾ „ „ German Sausage — 8 „ — „ 4 9/10 - 21 „ „ 1915—7 samples. Lime juice Cordial — 1 sample — salicylic acid 9½ grains per pint. Brawn — 3 samples — boric acid 2 — 5½ grains per lb. Sausage — 1 sample „ 5¼ German Sausage — 2 samples „ 2 1/10 and 4¼ grains per lb. 1916—5 samples. Lime juice Cordial — 1 sample — salicylic acid 4½ grains per pint. Brawn — 1 — boric acid 6 „ per lb. Sausages — 3 samples „ 4 1/3 — 7 grains per lb. 1917—4 samples. Cream (fresh) — 1 sample — boric acid 21 grains per lb. Lime juice Cordial - 2 samples — salicylic acid 9½ and 11¾ grains per pint. Sausages — 1 sample — boric acid 11½ grains per lb. 1918—1 sample. Lime juice Cordial — 1 sample — salicylic acid 6 „ per pint. Arsenic in Foodstuffs.—In October, 1916, a sample of baking powder was found to contain arsenic (in amount equivalent to 9—ten thousandths of a grain per ounce), and in the following month the same poison (87—one hundred thousandth of a grain per ounce) in g2 44 CLERICAL WORK. an " egg powder.". The samples were. obtained from the same shop. The whole of the stocks of both commodities were seized and destroyed by magistrate's order. The samples were taken on receipt of a letter from the Local Government Board, in which the Board stated that a baking powder had been found to contain arsenic in consequence of a contamination of acid phosphate manufactured in Scotland. The above results were communicated to the Board. The Solicitor advised that no proceedings should be taken, as the vendor had sold the articles just as they were received from the makers. VI.—CLERICAL WORK. A full statistical statement of the work of the Clerical Staff would entail much labour and the result would be neither satisfactory nor convincing. The appended statement gives some sort of an idea of the staff's principal activities. It takes no account of the time spent in the preparation of reports and papers for Committee work, nor of returns to the Government Departments and to the County Council and Metropolitan Asylums Board. There was some check in the demands for information arising from the need of economy in the use of paper, but such check cannot be regarded as anything more than temporary. The compilation of the data for this Report has entailed much work, of which a statistical statement is impossible. TABLE 23. Office (Clerical) Work. 1914-1918. 1914 1915 1916 1917 1918 T otals. Letters received 5,321 4,124 3,004 3,146 2,554 18,149 „ despatched 4,981 3,668 2,642 2,412 2,033 15,736 Entries in postage book 14,880 8,320 6,860 7,200 6,020 43,280 Certificates dealt with relating to cases of infectious disease (incl. consumption) 3,023 5,406 2,510 4,197 2,740 17,876 Notices sent re above and other diseases 6,236 7,631 3,802 7,053 5,589 30,311 Entries in Register of Births 3,084 2,723 2,604 2,023 2,018 12,452 Complaints received 791 672 676 1,103 762 4,004 Plans dealt with 312 269 145 122 109 957 New openings in Journal 472 331 281 412 207 1,703 Disinfection orders (duplicate) 2,239 5,827 2,407 4,946 3,358 18,777 Notices to abate nuisance 1,972 1,207 1,107 952 326 5,564 VII.—LEGAL PROCEEDINGS. Annual Tables giving particulars and results of all summonses taken out during 1014-18 have been prepared, but a short Summary Table is only included in this Report. (See Table XVII., Appendix.) The amount of fines inflicted was £430 7s. (id. and that of costs, £205 3s. 0d., making a total of £635 lis 0d., all of which, save the fines imposed under the Notification of Births Act, 1907, are paid to the Council. During 1909-13 the fines and costs amounted to £483 15s. 3d. As will be seen from the statement following this paragraph the increase in the total during 1914-18 was obtained in "Food" cases, viz., those taken under the Sale of Food and Drue's Arts All Cases. Fines. Costs. 1914 £ 66 11 6 £23 1 0 1915 108 6 0 58 5 0 1916 87 0 0 43 9 6 1917 39 10 0 24 4 6 1918 129 0 0 56 3 6 Fines and Costs. " Health " Cases. " Food " Cases. £18 11 0 £ 71 1 6 6 5 6 160 5 6 21 17 0 108 12 6 14 14 6 49 0 0 45 8 0 139 15 6 In "Food cases the average amount of fine and cost in successful prosecutions was £3 18s. 0d., as compared with £1 16s. 8d. during 1909-13. The annual averages (sec below) fluctuated in a somewhat irregular manner. Fines. 1909 £1 3 9 1914 £2 3 4 1910 2 3 8 1915 2 2 8 1911 0 13 0 1916 3 7 7 1912 0 8 11 1917 1 16 8 1913 1 10 11 1918 4 14 2 Costs. 1909 £0 12 2 1914 £0 11 0 1910 0 12 2 1915 1 0 6 1911 0 1 1 3 1916 1 15 10 1912 0 8 11 1917 0 14 6 1913 0 15 9 1918 0 17 10 appendix : vital statistics. 45 APPENDIX. TABLE I. Year. Estimated Population. Births. Registered Locally. Deaths at All Ages. Deaths under One Year. Registered Locally. Transfers Nett. Gross Mortality. Transfers Nett. Registered. Nett. Out. In. Totals ,Rates. Out. In. Totals Mortality. Number Mortality. Totals Mortality. 1909 142,811 2,895 62 198 3,031 21.22 2,154 15.08 409 219 1,964 13.75 347 119 311 102 1910 142,663 2,909 57 170 3,022 21.18 2,004 14.05 384 175 1,795 12.58 353 121 294 97 1911 142,513 2,815 57 230 2,977 21.46 2,074 14.55 407 259 1,926 13.51 399 141 387 126 1912 142,362 2,774 50 267 2,991 21.18 1,889 13.27 372 254 1,771 12.44 326 117 295 98 1913 142,229 2,832 55 242 3,019 20.87 2,071 14.33 407 315 1,979 13.68 342 121 305 101 1914 142,087 2,708 49 274 2,933 20.64 1,892 13.31 347 350 1,895 13.33 312 115 281 96 1915 131,397 2,506 59 267 2,714 20.65 2,304 17.53 370 352 2,286 17.39 343 137 319 117 1916 T 142,169 2,378 61 372 2,689 18.91 ... ... ... .... ... ... 289 121 253 94 C 130,668 ... ... ... ... ... 1,924 14.72 370 326 1,880 14.38 1917 T 136,561 1,834 77 334 2,091 15.31 ... ... ... ... ... ... 290 158 273 135 C 122,507 ... ... ... ... ... 1,997 16.30 321 374 2,050 16.73 1918 T 131,673 1,798 118 337 2,017 15.31 ... ... ... ... ... ... 266 148 235 116 C 117,517 ... ... ... ... ... 1,999 17.01 345 595 2,249 19.13 "T"—Total; "C"—Civil. (See text). Area of Borough (stat. acres) (Total 1,356.1. Waterways 20.0. Total Population 142,551 Number of inhabited houses 10,686 Average number of persons per house 8.5 Census, 1911. 46 appendix : births and deaths. TABLE II. Births and Deaths. Annual Numbers: Averages. Wards. Borough Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate, East. Hyde Park. Births. An. Average 1909-13 3008 385 727 413 465 726 62 59 171 1914 2933 355 755 401 442 706 57 64 153 1915 2714 338 685 372 453 614 51 60 141 1916 2689 309 681 391 402 600 57 66 183 1917 2091 250 487 327 335 458 52 46 136 1918 2017 200 501 298 353 454 55 53 103 An. Average 1914-18 2489 290 622 358 397 567 54 58 143 I.N 83 75 85 87 85 78 88 98 83 Deaths: All Ages. An. Average 1909-13 1887 207 382 261 326 447 68 61 135 1914 1895 224 347 288 330 440 58 63 145 1915 2286 249 464 348 403 493 77 81 171 1916 1880 188 372 280 333 416 73 79 139 1917 2050 225 404 322 355 446 86 72 140 1918 2249 244 434 357 406 465 97 96 150 An. Average 1914-18 2072 226 404 319 366 452 78 78 149 I.N 110 109 106 122 112 101 115 128 110 Deaths: Under One. An. Average 1914-18 318 38 63 38 54 102 4 3 16 1914 281 31 51 39 41 103 5 11 1915 319 37 67 48 56 92 2 3 14 1916 253 28 59 29 40 73 4 6 14 1917 273 29 49 34 55 85 3 4 14 1918 235 14 52 29 43 73 6 4 14 An. Average 1914-18 272 28 56 36 47 85 4 3 13 I.N 85 73 88 95 87 83 95 94 86 Infantile Mortality. An. Average 1909-13 106 99 87 92 116 141 68 61 91 1914-18 109 95 89 100 118 150 73 59 93 I.N 103 97 102 109 102 106 107 97 102 " I.N."—Index Numbers. (Annual Averages 1909-13=100). appendix : sickness. 47 TABLE III. Sickness : Cases Reported. Borough. Smallpox 1909 , 1910 1911 1912 1913 1914 1915 1916 1917 1918 ... ... 1* ... ... ... 1* ... ... ... Diphtheria 173 116 163 244 293 286 260 207 227 254 Membranous Croup 2 ... 5 4 3 3 137 2 2 4 Erysipelas 106 100 117 117 112 141 137 104 66 56 Fevers. Scarlet 629 258 226 272 484 738 436 272 124 150 Enteric 29 40 37 15 25 10 18 21 12 13 Continued ... ... 1 ... ... 2 1 ... ... ... Puerperal 3 9 7 11 8 10 7 8 7 2 Cerebro-spinal 2(a) 7 ... 2 10 9 7 3 Posterior Basic Meningitis ...(a) ... ... ... 4 ... ... ... Acute Poliomyelitis 1(a) 6 2 3 1 4 1 ... Ophthalmia Neonatorum 21(a) 31 22 51 31 20 27 22 Tu berculosis—Total 173 341 397 835 664 545 590 526 502 451 Pulmonary 173(c) 341 397(d) 835 492(e) 397 426 388 355 325 Other Forms 172(a) 148 164 138 147 126 Measles —Total 719 2162 1429 1398 1240 424 3721 746 4245 1519 Reported 719 2162 1429 1398 1240 111 801 200 1544 515 Notified 313(a) 2920 546 2701 1004 Chickenpox—Total 338 520 494 459 599 555 644 468 406 813 Reported 338 520 494 459 399 555 560 468 406 606 Notified 84(b) 207(b) Whooping Cough‡ 589 518 632 377 644 558 365 540 325 691 Mumps‡ 420 69 223 341 203 247 167 180 200 680 Ringworm‡ 176 102 165 267 148 196 125 152 117 111 * Error. † Measles (a) First year of notification. (morbilli) and German Measles (rubeola). (b) Notified during part of year only (d) Extended to Hospital Patients. † Reported, i.e., not notified. (c) Notification limited to Poor Law cases. (e) Universal. 48 appendix : sickness. TABLE IV. ( Notifications Sickness : Removals 1 Deaths. Diphtheria. Scarlet Fever. Enteric Fever. 1914 1915 1916 1917 1918 1914 1915 1916 1917 1918 1914 1915 1916 1917 1918 Cases Reported. Queen's Park 39 (4) 46 (4) 22 (2) 22 (1) 29 (1) 162 (7) 59(10) 50 (5) 17 (1) 18 (1) ... 2(1) ...(-) ...(-) l(-) Harrow Road 60 (-) 56 (7) 50 (2) 43 (3) 73 (7) 173 (6) 114 (8) 58 (4) 40 (3) 33 (2) 1(-) 2(-) 1(-) l(-) 3(1) Maida Vale 56 (4) 42 (-) 22 (2) 33 (2) 41 (5) 87 (5) 70 (8) 37 (4) 7 (-) 15 (1) 2(1) 7(-) ...(-) 3( 1) 2(1) Westbourne 39 (3) 42 (6) 26 (3) 37 (6) 28 (3) 70 (6) 98 (0) 53 (5) 16 (4) 27 (-) 4(1) l(-) 2(1) 2(-) 3(1) Church 62 (3) 66 (9) 40 (5) 71 (5) 73 (9) 165(13) 67 (5) 53 (4) 20 (4) 44 (5) 3(1) 5(2) 7(-) 3(2) ... LancasterGate West 7 (-) 7 (1) 3 (-) 3 (-) 4 (-) 19 (-) 10 (1) 8 (-) 8 (-) 1 (-) ... ... 5(1) l(-) ... East 9 (-) 3 (1) 6 (-) 10 (-) 1 (-) 11 (-) 8 (-) 6 (-) 9 (-) 6 (l) l(-) ... 2(-) l(-) 3(-) Hyde Park 17 (2) 11 (-) 34 (1) 10 (-) 9 (2) 51 (-) 10 (-) 7 (1) 7 (3) 6 (-) 1(-) 2(l) 4(-) l(-) l(-) Borough 289(16) 273(27) 209(15) 229(17) 258(27) 738(37) 436(38) 272(23) 124(15) 150(10) 12(3) 19(4) 21(2) 12(3) 13(3) Cases Removed to Hospital. Queen's Park 39 (4) 46 (4) 22 (2) 22 (1) 27 (1) 153 (6) 58(10) 49 (5) 17 (1) 17 (1) ... 2(1) ... ... 1(-) Harrow Road 56 (-) 53 (7) 56 (2) 41 (3) 65 (7) 166 (6) 110 (7) 57 (4) 38 (3) 33 (2) 1(-) 2(-) ... ... 3(1) Maida Vale 50 (4) 41 (-) 18 (2) 33 (2) 40 (5) 74 (4) 67 (8) 36 (4) 5 (-) 14 (1) 2(1) 6(-) ... 2(1) 2(1) Westbourne 35 (3) 39 (6) 26 (3) 35 (6) 27 (3) 66 (5) 90 (6) 53 (5) 16 (4) 27 (-) 2(-) 1(-) 2(-) 2(-) 3(1) Church 61 (3) 66 (9) 40 (5) 71 (5) 68 (9) 163(12) 66 (5) 53 (4) 20 (4) 43 (5) 3(1) 4(2) 5(-) 3(2) ... LancasterGate West 6 (-) 7 (1) 3 (-) 3 (-) 4 (-) 18 (-) 10 (1) 7 (-) 7 (-) 1 (-) ... ... 4(-) ... ... East 7 (-) 2 (-) 6 (-) 7 (-) 1 (-) 8 (- 8 (-) 6 (-) 9 (-) 6 (1) ... ... 2(-) 1(-) ... Hyde Park 15 (2) 11(-) 33 (1) 9 (-) 9 (2) 47 (-) 10 (-) 5 (1) 5 (3) 4 (-) l(-) 2(1) 2(-) ... 1(-) Borough 269(16) 265(27) 204(15) 221(17) 241(27) 695(33) 425(37) 266(23) 117(15) 145(10) 9(2) 17(4) 15(-) 8(3) 10(3) Deaths at Home. Queen's Park ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... Harrow Road 2 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... Maida Vale ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Westbourne 2 2 ... 1 ... ... ... ... ... ... 1(1) ... ... ... ... Church 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... LancasterGate West ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... East ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Hyde Park ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Borough 6 3 ... 1 2 2 ... ... ... ... 2(1) 1 ... ... ... Deaths in Hospital. Queen's Park 2 6 (1) ... 3 1 1 1 ... ... ... ... ... ... ... ... Harrow Road 8 5 3 1 4 1 2 1 1 ... ... ... ... ... ... Maida Vale ... ... ... 2 ] ... 9 ... 1 1 1 ... ... ... Westbourne 2 (1) 2 ... 1 2 ... 2 2 ... ... ... ... ... ... ... Church 1 7 2 3 6 4 ... 1 ... ... 1(1) ... ... ... ... LancasterGate West ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... East ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... Hyde Park 1 2 3 ... ... ... ... ... ... ... ... ... 1 ... ... Borough 14 (1) 22 (1) 9 11 14 6 7 4 2 1 2(1) 1 1 ... ... Note.—The figures in parentheses indicate the numbers of " errors of diagnosis." appendix i deaths of residents of the borough. 49 Deaths of Residents of the Borough, 1914. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Deaths at Ages. In Public Institutions. 0— 1— 2— 5— 15- 25— 45— 65— P. M. F M. F. M. F. M. F. M. F. M. F. m. F. M. F. M. F. M. F. Enteric Fever 3 1 2 ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 1 2 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 4 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... Scarlet Fever 8 5 3 ... ... 1 1 1 2 3 ... ... ... ... ... ... ... ... ... 4 3 Whooping Cough 26 12 14 8 5 3 4 1 5 ... ... ... ... ... ... ... ... ... ... 5 4 Diphtheria, Membranous Croup 20 11 9 1 ... ... 1 5 6 5 2 ... ... ... ... ... ... ... ... 9 6 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 29 10 19 1 2 ... ... ... ... ... ... ... ... 2 ... 4 3 3 12 1 ... Erysipelas 9 5 4 1 ... ... ... ... ... 1 ... ... ... 1 ... 1 2 1 2 2 3 Other Epidemic Diseases 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Other Septic Diseases 8 2 6 ... 1 ... ... ... ... ... ... 1 ... ... 2 ... 3 1 ... 2 4 Pulmonary Tuberculosis A. Phthisis 151 79 72 1 ... ... ... 1 1 3 4 12 14 28 29 32 21 2 3 45 30 Tub. Meningitis, A. Hydrocephalus 17 8 9 ... 2 ... 2 7 2 1 ... ... 2 ... 1 ... ... ... ... 4 3 Other Forms of Tuberculosis 18 12 6 2 3 4 1 ... ... 2 ... 1 ... 1 ... 2 2 ... ... 8 3 Syphilis 12 7 5 6 3 ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... 3 2 Cancer 211 80 131 ... ... ... ... ... ... 1 1 ... 1 5 13 48 66 26 50 37 51 Rheumatic Fever 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ......... ... ... ... ... ... ... 1 Alcoholism 9 3 6 ... ... ... ... ... ... ... ... ... ... 2 3 1 2 ... 1 1 4 Inflammation and Softening of Brain 11 3 8 ... ... ... ... ... 1 ... ... ... ... 2 ... ... 3 1 4 1 5 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Meningitis 11 7 4 1 2 2 1 1 2 1 ... ... ... 1 ... ... ... 4 1 Cerebral Hæmorrhage 63 28 35 ... ... ... ... 1 ... ... ... ... ... 1 2 7 13 19 20 4 7 Apoplexy 8 3 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 4 1 ... Convulsions 3 ... 3 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Endocarditis 1 1 ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... ... 1 ... Heart Disease 242 103 139 ... ... ... ... 1 1 ... 1 ... 4 13 13 38 40 50 80 39 51 Bronchitis 151 63 88 10 6 3 1 1 ... ... ... ... ... 3 ... 16 17 30 64 28 33 Lobular (Broncho-) Pneumonia 45 30 15 16 6 2 1 4 ... ... ... ... ... 1 ... 4 4 3 4 11 3 Lobar (Croupous) Pneumonia 19 10 9 1 ... ... ... ... ... ... 1 ... 1 3 2 6 2 ... 3 4 6 Pneumonia 48 26 22 5 2 2 ... ... 2 1 1 ... 1 7 3 8 3 3 10 3 2 Other Diseases of,Respiratory Organs 24 12 12 ... 2 1 1 1 ... 1 ... ... 1 ... ... 6 5 3 3 4 6 Diseases of Stomach 11 8 3 1 ... ... ... ... 1 ... ... ... ... ... 2 4 ... 1 ... 4 2 Diarrhoea and Enteritis 83 41 42 34 38 4 2 1 1 1 ... ... ... ... ... 1 ... ... 1 26 24 Appendicitis 10 5 5 ... ... ... ... ... ... 1 ... ... 1 1 1 3 1 ... 2 3 2 Obstruction of Intestines 18 7 11 2 ... ... ... ... ... 1 1 ... ... ... 3 1 6 3 1 3 6 Cirrhosis of Liver 20 10 10 ... ... ... ... ... ... ... ... ... ... 1 3 7 4 2 3 3 3 Nephritis and Bright's Disease 57 3 20 ... ... ... ... ... ... 1 3 ... ... 6 1 20 7 10 9 16 7 Tumours (N.-M.), &c., Female Genital Organs 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... 4 ... 2... ... ... ... 2 Puerperal Fever 5 ... 5 ... ... ... ... ... ... ... ... ... 2 ... 3 ... ... ... ... ... 5 Accidents and Diseases of Parturition 7 ... 7 ... ... ... ... ... ... ... ... ... 3 ... 3 ... 1 ... ... 4 Congenital Defects 12 6 6 5 5 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 3 Premature Birth 44 25 19 25 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 9 Developmental Diseases 40 25 15 25 14 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 4 Old Age 65 19 46 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 18 46 7 14 Suicide 24 18 6 ... ... ... ... ... ... ... ... ... 1 6 3 8 2 2 ... 3 ... Overlaid in Bed 3 2 1 2 l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 70 41 29 4 2 2 1 3 2 2 1 5 1 6 4 13 6 6 12 16 12 Homicide 2 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Execution ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 111-defined Causes 2 ... 2 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 All other Causes 263 152 111 8 4 1 ... 2 3 3 7 4 1 23 13 48 28 63 55 71 43 All Causes 1895 923 972 162 119 27 19 29 29 31 25 28 33 116 113 281 245 249 389 387 372 *Uncertified 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... * Included in above. h 50 appendix : deaths of residents of the borough. TABLE V. B. Deaths of Residents of the Borough, 1915. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Deaths at Ages. In Public Institutions. 0— 1— 2— 5— 15— 25— 45— 65— P. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. f. Enteric Fever 5 4 1 ... ... ... ... ... ... ... ... . ... ... 3 ... 1 1 ... ... 1 1 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 98 55 43 9 8 26 22 19 8 1 5 ... ... ... ... ... ... ... ... 19 5 Scarlet Fever 10 9 8 ... ... 1 ... ... 4 1 3 ... ... ... 1 ... ... ... ... 1 8 Whooping Cough 31 14 17 4 9 4 3 5 4 1 1 ... ... ... ... ... ... ... ... 4 3 Diphtheria, Membranous Croup 20 10 10 1 3 1 1 6 4 1 1 ... ... ... 1 ...1 ... ... ... 9 9 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 52 26 26 1 ... ... ... ... 1 ... ... 2 ... 5 4 10 4 8 17 ... 2 Erysipelas 6 1 5 ... 2 ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 1 3 Other Epidem ic Diseases.. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 5 2 3 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 1 1 2 Pulmonary Tuberculosis, A. Phthisis 173 107 66 1 ... ... 1 1 2 5 4 12 9 44 31 40 11 4 8 52 37 Tub. Meningitis, A. Hydrocephalus 17 12 5 4 ... 1 ... 2 3 3 2 1 ... 1 ... ... ... ... ... 10 4 Other Forms of Tuberculosis 23 18 5 4 ... 3 ... 1 1 3 3 3 ... 2 ... 1 1 1 ... 11 5 Syphilis 8 4 4 2 2 1 1 ... ... ... ... ... ... 1 ... ... ... ... 1 4 2 Cancel- 208 75 133 ... ... ... ... ... ... ... ... ... ... 6 17 35 58 34 58 37 44 Rheumatic Fever 4 1 3 ... ... ... ... ... ... 1 2 ... ... ... 1 ... ... ... ... 1 1 Alcoholism 15 8 7 ... ... ... ... ... ... ... ... ... ... 5 5 3 2 ... ... 4 3 Inflammation and Softening of Brain 13 5 8 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 2 2 6 4 5 Cerebro-spinal Fever 8 4 4 1 ... 1 1 ... ... ... 1 1 ... ... 1 ... 1 1 ... 3 3 Simple Meningitis 4 1 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 1 ... Cerebral Hæmorrhage 70 26 44 ... ... ... ... ... ... ... ... ... ... ... 1 5 13 21 30 11 9 Apoplexy 11 4 7 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 2 6 ... ... Convulsions 3 1 2 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Endocarditis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Heart Disease 258 113 145 ... ... ... ... ... ... 4 4 ... 3 8 10 53 51 48 77 27 48 Bronchitis 209 89 120 12 7 1 2 ... 2 1 ... 2 ... 3 ... 22 21 48 88 23 40 Lobular (Broncho-) Pneumonia 100 49 51 23 21 8 7 7 7 2 2 ... ... 2 2 2 3 5 9 20 19 Lobar (Croupous) Pneumonia 33 16 17 1 ... ... ... ... ... ... ... 1 1 4 4 7 8 3 4 10 11 Pneumonia 67 27 40 5 6 2 5 1 1 1 ... 1 3 7 2 6 7 4 16 3 4 Other Diseases of Respiratory Organs 32 14 18 ... 1 1 1 ... ... ... ... ... ... 2 ... 4 3 7 13 4 2 Diseases of Stomach 16 9 7 ... ... ... ... ... 1 ... ... ... ... 2 1 5 2 2 3 3 2 Diarrhoea and Enteritis 102 58 44 47 36 7 4 1 1 ... ... ... ... ... ... 1 1 2 2 35 28 Appendicitis 11 5 6 ... ... ... ... ... ... 1 2 1 1 1 1 ... 9 ??? ... 3 5 Obstruction of Intestines 9 3 6 ... ... ... ... ... ... ... ... 1 ... ... 2 1 ??? 2 2 1 5 Cirrhosis of Liver 19 9 10 ... ... ... ... ... ... ... ... ... ... 1 2 6 5 2 3 3 4 Nephritis and Bright's Disease 50 27 23 1 ... ... ... ... 1 ... ... 4 ... 1 3 13 11 8 8 8 7 Tumours (N.-M.), &c., Female Genital Organs 8 ... 8 ... ... ... ... ... ... ... ... ... ... ... 3 ... 4 ... 1 ... 2 Puerperal Fever 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 1 Accidents and Diseases of Parturition 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Congenital Defects 24 15 9 13 9 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 9 3 Premature Birth 40 26 14 26 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 4 Developmental Diseases 39 22 17 21 16 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 4 1 Old Age 143 44 99 ... ... ... ... ... ... ... ... ... ... ... ... 5 2 39 97 27 55 Suicide 9 6 3 ... ... ... ... ... ... ... ... ... ... 2 1 3 2 1 ... 3 1 Overlaid in Bed 2 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 80 43 37 1 1 5 ... 2 1 3 1 2 ... 9 5 15 3 6 26 26 16 Homicide 4 ... 4 ... ... ... ... ... ... ... 1 ... ... ... 3 ... ... ... ... ... 1 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes 2 .... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... All other Causes 240 118 122 l 1 2 1 3 1 7 6 4 3 11 10 36 39 54 61 51 49 All Causes 2286 1074 1212 180 139 65 51 49 43 36 38 36 20 122 116 279 264 307 541 439 455 ♦Uncertified 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... * Included in above. appendix: deaths of residents of the borough. 51 TABLE V. C. Deaths of Residents of the Borough, 1916. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Deaths at Ages. In Public Institutions. 0- 1— 2- 5— 15— 25- 45— 65— F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Enteric Fever 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 1 2 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Scarlet Fever 4 4 ... ... ... ... ... 1 ... 3 ... ... ... ... ... ... ... ... ... 4 ... Whooping Cough 22 8 14 3 9 3 3 1 1 1 1 ... ... ... ... ... ... ... ... 3 6 Diphtheria, Membranous Croup 9 4 5 ... ... ... ... 1 2 3 3 ... ... ... ... ... ... ... ... 4 5 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 39 14 25 ... ... ... ... ... ... ... 1 ... ... 1 4 7 5 6 14 2 3 Erysipelas 3 ... 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 Other Epidemic Disaases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 7 3 4 ... ... ... ... ... ... ... 1 ... ... ... 2 3 ... ... ... 3 2 Pulmonary Tuberculosis, A. Phthisis 179 109 70 ... ... ... ... 3 ... 1 3 6 16 60 27 37 19 2 5 58 38 Tub. Meningitis, A. Hydrocephalus 15 8 7 2 ... 2 2 2 1 2 4 ... ... ... ... ... ... ... ... 6 4 Other Forms of Tuberculosis 17 10 7 1 ... ... 1 1 2 ... 1 4 4 1 1 1 ... ... 8 5 Syphilis 15 10 5 5 3 ... ........ ... ... ... ... ... ... 3 ... 2 1 ... 1 9 4 Cancer 205 82 123 ... ... ... ... ... ... 1 ... ... ... 8 12 32 56 41 55 38 46 Rheumatic Fever 4 ... 4 ... ... ... ... ... ... ... ... ... 2 ... 1 ... 1 ... ... ... 1 Alcoholism 8 4 4 ... ... ... ... ... ... ... ... ... ... 3 1 ... 3 1 ... 3 ... Inflammation and Softening of Brain 5 1 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 3 1 2 Cerebro-spinal Fever 5 3 2 ... 1 ... ... ... 1 1 ... ... ... 1 ... ... ... 1 ... 1 2 Simple Meningitis 2 2 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Cerebral Hæmorrhage 56 21 35 ... ... ... ... ... ... ... ... ... ... 1 2 9 10 11 23 8 7 Apoplexy 13 7 6 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 6 5 ... 1 Convulsions 5 4 1 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart Disease 213 107 106 ... ... ... ... 1 ... ... ... 2 3 8 11 39 33 57 59 45 44 Bronchitis 150 64 86 10 6 2 1 ... 3 ... ... ... ... 1 1 9 9 42 66 22 16 Lobula (Broncho-) Pneumonia 65 31 34 17 12 6 6 1 3 ... ... ... ... ... ... 6 5 1 8 16 14 Lobar (Croupous) Pneumonia 19 13 6 ... ... 1 ... ... ... ... ... 1 ... 3 1 6 2 2 3 9 5 Pneumonia 55 26 29 3 3 1 2 2 1 ... 1 ... ... 3 1 9 12 8 9 8 5 Other Diseases of Respiratory Organs 16 7 9 2 ... 1 ... ... ... ... ... ... ... 1 1 1 4 2 4 1 3 Diseases of Stomach 8 6 2 ... ... ... ... ... ... 1 ... ... ... 1 ... 4 ... ... 2 3 ... Diarrhoea and Enteritis 67 38 29 29 19 6 5 1 2 1 ... ... ... ... ... ... ... 1 3 22 18 Appendicitis 12 5 7 ... ... ... ... 1 1 ... ... 2 1 1 4 ... ... 1 1 4 5 Obstruction of Intestines 12 7 5 2 ... ... ... 1 ... ... ... ... ... 1 ... 1 3 2 2 6 3 Cirrhosis of Liver 28 16 12 ... ... ... ... ... ... ... ... ... ... 2 '3 11 4 3 5 5 7 Nephritis and Bright's Disease 56 28 28 ... 1 ... ... ... ... ... ... 1 2 5 4 9 12 13 9 5 12 Tumours (N.-M.), &c., Female Genital Organs 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... 4 ... 1 ... ... ... 3 Puerperal Fever 7 ... 7 ... ... ... ... ... ... ... ... ... 2 ... 5 ... ... ... ... ... 7 Accidents and Diseases of Parturition 8 ... 8 ... ... ... ... ... ... ... ... ... ... ... 7 ... 1 ... ... ... 5 Congenital Defects 24 15 9 15 8 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 6 4 Premature Birth 42 21 21 21 21 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 6 Developmental Diseases 39 20 19 17 19 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 5 Old Age 108 41 67 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 40 67 20 35 Suicide 19 9 10 ... ... ... ... ... ... ... ... ... ... 2 8 5 2 2 ... 5 3 Overlaid in Bed 2 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Accidents and Violence 75 37 38 2 3 1 2 2 2 12 4 4 2 3 6 6 6 7 13 18 16 Homicide 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes l 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... All other Causes 230 122 108 5 4 1 3 ... 1 4 5 2 3 19 15 40 25 51 52 60 40 All Causes 1880 909 971 140 113 27 26 19 20 32 23 20 37 131 124 240 216 300 412 413 386 Uncertified ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... h 2 52 appendix : deaths of residents of the borough. TABLE V. D. Deaths of Residents of the Borough, 1917. Sex-Age Distribution for Whole Borough. Causes of Death All Ages. Deaths at Ages. In Public Institutions. 0— 1— 2— 5— 15— 25— 45— 65— F. M. F. M. F. M. F. M. f. M. F. M. f. M. F. M. F. M. f. M. F. Enteric Fever 2 2 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 116 66 51 13 4 35 26 14 17 3 4 ... ... ... ... ... ... ... ... 14 16 Scarlet Fever 2 1 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 1 Whooping Cough 19 9 10 3 3 3 3 2 4 1 ... ... ... ... ... ... ... ... ... 5 ... Diphtheria, Membranous Croup 13 6 7 1 1 1 ... ... 1 3 4 ... ... ... ... 1 ... ... 1 6 7 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 31 14 17 ... ... ... ... ... ... 2 ... ... 1 ... 3 5 3 7 10 ... ... Erysipelas 6 2 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 2 1 2 Other Epidemic Diseases 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 4 1 3 ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... ... 1 2 Pulmonary Tuberculosis, A. Phthisis 184 99 85 1 2 ... 1 1 3 2 7 9 22 39 34 40 13 7 3 64 44 Tub. Meningitis, A. Hydrocephalus 18 9 9 1 1 3 1 1 ... 4 6 ... 1 ... ... ... ... ... ... 6 7 Other Forms of Tuberculosis 38 22 16 2 6 2 1 6 2 6 3 5 1 ... 1 1 2 ... ... 17 11 Syphilis 17 8 9 5 8 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... 6 8 Cancer 201 89 112 ... ... ... ... ... ... ... ... ... 1 5 10 44 59 40 42 43 43 Rheumatic Fever 4 2 2 ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... 1 Alcoholism 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Inflammation and Softening of Brain 9 4 5 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 2 3 3 2 Cerebro-spinal Fever 5 ... 5 ... 3 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 4 Simple Meningitis 3 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 2 ... Cerebral Hæmorrhage 61 25 36 ... ... ... ... ... ... ... ... ... ... ... ... 9 8 16 28 8 6 Apoplexy 15 2 13 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 10 1 1 Convulsions 6 2 4 2 3 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 2 Endocarditis 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Heart Disease 271 121 150 ... 1 ... ... ... ... 1 ... 1 4 9 11 45 49 65 85 50 59 Bronchitis 175 77 98 12 11 2 1 1 2 ... ... ... ... 2 2 21 12 39 70 18 20 Lobular (Broncho-) Pneumonia 71 37 34 14 7 6 7 1 6 ... ... ... ... 2 1 6 3 8 10 19 11 Lobar (Croupous) monia 33 17 16 1 ... 1 1 ... 1 1 ... 2 3 4 4 4 6 4 1 10 7 Pneumonia 58 32 26 5 6 2 2 3 3 ... 3 ... 1 6 2 10 4 6 5 14 8 Other Diseases of Respiratory Organs 17 13 4 ... ... ... ... ... 1 ... ... ... ... 4 ... 4 ... 5 3 5 ... Diseases of Stomach 13 6 7 ... ... ... ... ... ... ... ... ... 1 1 1 4 3 1 2 4 4 Diarrhœa and Enteritis 63 38 25 30 19 ... ... 1 2 ... ... ... ... ... ... 2 3 2 ... 22 16 Appendicitis 3 1 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... 1 1 Obstruction of Intestines 22 8 14 2 ... ... ... ... ... ... ... ... ... 1 1 2 8 3 4 4 10 Cirrhosis of Liver 15 9 6 3 4 2 5 1 3 3 Nephritis and Bright's Disease 49 30 19 ... ... ... ... 1 ... 1 ... 1 ... ... 3 14 7 13 9 9 2 Tumours (N.-M.), &c., Female Genital Organs 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 ... ... ... 5 Puerperal Fever 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... 6 ... ... ... ... ... 5 Accidents and Diseases of Parturition 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Congenital Defects 20 11 9 10 7 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 7 2 Premature Birth 43 25 18 25 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 4 Developmental Diseases 35 22 13 21 13 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 Old Age 109 30 79 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 79 20 35 Suicide 9 6 3 ... ... ... ... ... ... ... ... ... ... 1 3 4 ... 1 ... 1 ... Overlaid in Bed 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 64 33 31 3 4 ... ... 2 4 5 3 3 ... 8 6 4 7 8 7 18 13 Homicide 2 2 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes 2 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... All other Causes 206 111 95 2 ... 4 1 1 2 2 2 2 6 16 14 35 28 49 42 53 39 All Causes 2050 997 1053 155 118 65 46 37 49 33 36 24 44 101 112 266 230 316 418 452 406 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... appendix : deaths of residents of the borough. 53 TABLE V. E. Deaths of Residents of the Borough, 1918. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Deaths at Ages. In Public Institutions. 0— 1— 2— 5— 15— 25— 45— 65— P. m. F. M. F. M. F. M. F. M. F. M. F. M. f. M. F. M. F. M. F. Enteric Fever 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 43 24 19 1 3 8 5 12 7 2 3 ... 1 1 ... ... ... ... ... 17 8 Scarlet Fever 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Whooping Cough 54 22 32 7 10 9 12 6 10 ... ... ... ... ... ... ... ... ... ... 11 12 Diphtheria, Membranous Croup 20 13 7 3 1 ... 2 6 1 4 3 ... ... ... ... ... ... ... ... 12 6 Croup Epidemic Influenza ... 358 ... 129 ... 229 ... 5 ... 3 ... 2 ... 8 ... 12 ... 16 ... 11 ... 13 ... 11 ... 35 ... 43 ... 96 ... 30 ... 41 ... 15 ... 17 ... 35 ... 51 Erysipelas 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Pulmonary Tuberculosis, A. Phthisis 139 72 67 ... 1 1 ... 4 1 2 1 13 14 27 33 23 15 2 2 48 34 Tub. Meningitis, A. Hydrocephalus 21 7 14 1 2 3 2 2 4 1 5 ... ... ... 1 ... ... ... ... 4 8 Other Forms of Tuberculosis 25 12 13 5 4 1 3 2 ... ... 1 2 1 ... ... ... 2 2 2 10 11 Syphilis 21 11 10 7 4 ... 2 ... ... ... 1 ... ... 2 2 2 1 ... ... 9 10 Cancer 164 46 118 ... ... ... 1 ... ... 1 ... ... 2 4 10 20 52 21 53 22 49 Rheumatic Fever 3 1 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... 1 Alcoholism 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Inflammation and Softening of the Brain 13 6 7 ... ... ... ... ... ... 1 ... ... 1 1 ... 3 4 1 2 5 5 Cerebro spinal Fever 2 1 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Simple Meningitis 8 4 4 1 3 ... ... 1 ... 2 ... ... ... ... 1 ... ... ... ... 1 2 Cerebral Hæmorrhage 47 15 32 ... ... ... ... ... ... ... 1 ... ... ... 1 5 6 10 24 5 4 Apoplexy 10 2 8 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 5 ... 3 Convulsions 3 2 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart Disease 257 113 144 1 ... ... ... ... ... 1 ... ... 7 7 13 41 38 62 86 51 64 Bronchitis 131 53 78 9 4 1 2 ... 2 ... 1 ... ... 4 5 18 16 21 48 18 15 Lobular (Broncho-) Pneumonia 78 39 39 10 11 5 11 4 4 3 2 1 1 3 3 7 3 6 4 24 10 Lobar (Croupous) Pneumonia 30 11 19 ... 1 ... ... ... 2 ... ... ... 3 2 6 6 5 3 2 4 7 Pneumonia 113 52 61 4 4 2 3 5 3 6 2 6 11 10 22 11 6 8 10 30 30 Other Diseases of Respiratorv Organs 18 7 11 1 ... ... ... ... ... ... ... ... ... 2 2 ... 3 4 6 3 2 Diseases of Stomach 14 6 8 1 2 1 2 2 3 2 1 3 2 Diarrhœa and Enteritis . 29 14 15 9 7 ... 6 2 ... ... ... ... ... ... ... 2 1 1 1 10 10 Appendicitis 8 2 6 ... ... ... ... ... ... 1 ... ... 2 1 2 ... 1 ... 1 1 5 Obstruction of Intestines 18 8 10 1 ... ... ... ... ... ... ... ... ... ... 1 4 2 3 7 6 3 Cirrhosis of Liver 14 4 10 ... ... ... ... ... ... ... ... ... ... ... 2 3 4 1 4 2 6 Nephritis and Bright's Disease 54 31 23 ... ... ... ... ... ... 1 ... 1 1 3 4 12 12 14 6 14 10 Tumours (N.-M.), &c., Female Genital Organs 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... ... ... 5 Puerperal Fever 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 Accidents and Diseases of Parturition 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Congenital Defects 16 8 8 8 6 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 Premature Birth 50 25 25 25 25 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 7 Developmental Diseases 31 19 12 18 11 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 6 5 Old Age 122 37 85 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 36 85 25 61 Suicide 16 10 6 ... ... ... ... ... ... ... ... 1 1 1 1 5 4 3 ... 2 3 Overlaid in Bed 2 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 97 61 36 5 4 3 ... 6 2 8 5 5 1 6 9 16 8 12 7 31 11 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... All other Causes 203 105 98 1 2 ... 1 4 2 3 2 1 2 11 10 35 33 50 46 37 32 All Causes 2249 979 1270 126 109 37 61 63 54 47 41 42 84 131 234 247 266 281 421 453 498 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 54 appendix : tuberculosis. TABLE VI. New Cases Tuberculosis: Deaths. Sex and Occupational Distribution. Totals 1914-1918. Pulmonary. Other Forms. New Cases. Deaths. New Cases. Deaths. Males. Females. Males. Females. Males. Females. Males. Females. Indoor— Domestic Duties— Housewives ... 272 ... 173 ... 23 ... 8 „ with occupations ... 24 ... 2 ... 4 ... ... Servants 8 100 7 42 ... 25 ... 3 Charwomen ... 18 ... 4 ... 1 ... ... Laundry Workers ... 7 ... 2 ... 1 ... l Clerks 80 23 48 8 11 2 2 ... Shop Assistants, Keepers 59 17 26 9 4 3 2 1 Dressmakers, Tailors 19 49 5 24 2 6 1 3 Bootmakers 18 1 11 ... ... ... ... ... Skilled Artizans 60 1 47 ... 6 ... 2 ... Waitresses, Barmen, etc. 17 11 10 4 4 3 ... ... Others 29 31 23 13 5 6 7 2 Totals 290 554 177 281 32 74 14 18 Outdoor— Building Trades 36 2 21 ... 2 ... ... ... Painters 8 ... 16 ... ... ... ... ... Labourers 3 ... 15 ... ... ... ... ... Road Traffic 60 2 46 1 8 1 1 ... Rail „ 20 3 16 ... 6 1 2 ... Postmen 5 ... 3 ... ... ... ... ... Gardeners 6 ... 1 ... ... ... 1 ... Street Merchants 7 ... 1 ... 1 1 ... ... Others 16 ... 3 ... ... ... ... ... Totals 161 7 122 1 17 3 4 ... Food Trades— Bakers 7 1 5 ... 1 ... ... ... Butchers, Fishmongers 8 ... 7 ... ... ... ... ... Dairymen 6 ... 6 ... 1 ... ... ... Others 7 ... 9 2 1 ... 1 ... Totals 28 1 27 2 3 ... 1 ... Miscellaneous — School Life 158 124 11 15 145 105 18 20 Unskilled Workers 45 2 43 1 6 ... 2 ... Professional „ 16 12 10 1 4 ... ... ... Other „ 146 12 23 ... 19 15 2 1 Totals 365 150 87 17 174 120 22 21 Infants 41 28 13 14 132 105 70 48 No Occupation 146 120 40 45 29 34 7 4 Occupation not stated Grand Totals 1031 860 466 360 387 336 118 91 appendix : cancer. 55 TABLE VII. . Cancer : Malignant Disease. 1914-18. Borough. Site of Disease. Carcinoma. Cancer. Epithelioma. Scirrhus. Sarcoma. Malignant Disease. Other Forms. All Forms. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. I. Nervous System— (a) Brain ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... 2 1 11. Organs of Special Sense— (a) Ear ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... (c) Nose 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... III. Respiratory System- (a) Larynx 7 ... ... ... 5 ... ... ... ... ... 1 ... ... ... 13 ... (b) Lungs 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 2 IV. Circulatory System V. Digestive System— (a) Mouth— (i.) Tongue 16 1 6 ... 5 2 ... ... ... ... ... ... ... ... 27 3 (ii.) Glands, etc. 9 ... 3 ... 3 2 ... ... 1 ... ... ... ... ... 16 2 (b) Throat— (i.) Pharynx 3 1 3 ... 1 ... ... ... ... ... ... ... ... ... 7 1 (ii.) (Esophagus (c) Intestines— 26 5 7 2 ... 1 ... ... ... ... 6 3 ... 1 39 12 (i.) Stomach 43 46 14 7 1 ... 1 ... 1 1 3 10 ... ... 63 64 (ii.) Intestine 28 48 1 4 ... 1 ... ... ... 1 5 10 ... ... 34 64 (iii.) Rectum 27 37 2 8 2 1 ... ... ... ... 2 2 ... ... 33 48 (d) Organs— (i). Liver 14 34 8 19 ... ... ... ... 1 ... 2 9 ... ... 25 62 (ii.) Pancreas 10 7 2 1 ... ... ... 1 ... ... ... ... ... ... 12 9 (e.) Peritoneum ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 ... (/) Omentum and Mesentery ... 3 ... 1 ... ... ... ... ... ... 1 1 ... ... 1 5 VI. Lymphatic System— (a) Head and Neck— (i.) Thyroid Gland 1 2 ... 1 ... ... ... ... ... ... ... 3 ... ... 1 6 (ii.) Cervical Glands 3 ... 1 ... ... 1 ... ... 8 2 ... ... ... ... 12 3 (b) Thorax— (i.) Mediastinal Glands 1 ... ... ... ... ... ... ... 3 2 1 ... 1 ... 6 2 (c) Abdomen— (i.) Spleen ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (ii.) Mesenteric Glands ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 (d) Extremities— (ii.) Inguinal Glands ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (e) General ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... VII. Urinary System— (a) Kidney 1 2 ... 1 ... ... ... ... 2 3 4 ... ... ... 7 6 (b) Bladder 9 7 2 1 ... ... ... ... ... ... 1 ... 1 ... 13 8 (c) Prostate 13 ... 3 ... ... ... ... ... ... ... 2 ... ... ... 18 ... VIII. Generative System— (a) Testicle Ovary 1 17 ... 2 ... ... ... ... ... 1 1 9 ... 1 2 30 (b) Uterus ... 82 ... 24 ... 1 ... ... ... 1 ... 8 ... ... ... 116 (c) External Genitals 2 3 ... ... 1 5 ... ... ... ... ... ... ... ... 3 8 (d) Breast ... 80 ... 30 ... 1 ... 15 ... ... ... 3 ... ... ... 129 IX. Osseous System— 1 6 1 1 ... ... ... ... 4 6 1 ... 1 1 8 14 X. Cutaneous System— (a) Head and Neck 6 1 1 1 2 1 1 ... ... 2 ... ... 1* ... 11 5 (b) Thorax ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 1 (d) Extremities (ii.) Lower ... ... ... ... 1 2 ... ... ... 1 ... ... ... ... 1 3 XI. Insufficiently described 4 5 1 2 ... ... ... ... 3 1 2 1 ... ... 10 9 Totals 228 392 57 105 22 19 2 16 26 22 33 60 4 3 372 617 Ages at Death. 0- ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 10- ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 ... 15- ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 20- ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 25- 4 8 1 1 ... ... ... ... 1 1 ... ... 1 1 7 11 35- 10 34 3 4 2 2 1 3 2 3 8 ... ... 21 51 45- 48 89 11 24 3 1 ... 3 5 3 1 11 ... 1 68 132 55- 69 97 23 35 5 3 ... 3 5 6 7 15 2 ... 111 159 65- 73 104 12 24 10 7 ... 2 7 3 18 14 ... ... 122 154 75- 24 60 7 16 2 6 ... 7 2 2 4 12 1 1 40 104 *Rodent ulcer of nose. 56 appendix : records of inquests held. TABLE VIII. Records of Inquests held. Finding. 0- 1- 5- 15- 25- 45- 65- 75- M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Totals. By Misadventure 1909-13 7 9 1 3 2 ... ... 2 12 4 5 3 1 ... 1 2 „ „ 1914-18 3 4 ... ... 2 2 2 ... 5 4 6 5 2 ... ... 1 Accidental Causes 1909-13 16 13 13 10 25 7 6 5 28 11 27 18 11 13 8 17 „ „ 1914-18 18 10 27 15 28 12 16 7 31 30 49 24 23 26 18 37 Suicides 1909-13 4 4 15 13 22 11 7 1 1 ... „ 1914-18 3 2 11 16 26 10 7 ... 2 ... Murder, Manslaughter 1909-13 2 2 ... ... ... ... ... ... ... 5 ... ... ... ... ... ... „ „ 1914-18 2 1 ... ... ... 1 ... ... 1 4 ... ... ... ... ... 1 " Open " 1909-13 5 2 ... ... ... ... 2 1 5 1 4 4 1 ... ... ... „ 1914-18 8 11 1 2 1 1 2 1 4 7 10 5 1 5 2 3 "Neglect" 1909-13 1 2 ... ... ... ... ... ... 4 6 5 7 1 2 1 ... „ 1914-18 3 6 ... ... ... 1 ... ... 8 7 5 9 2 1 1 ... Annual Averages. By Misadventure 1909-13 1 2 0 1 0 ... ... 0 2 1 1 1 0 ... 0 0 „ „ 1914-18 1 1 ... ... 0 0 0 ... 1 1 1 1 0 ... ... 0 Accidental Causes 1909-13 3 3 3 2 5 1 1 1 6 2 5 4 2 3 2 3 „ „ 1914-18 4 2 5 3 6 2 3 1 6 6 10 5 5 5 3 8 Suicide 1909-13 1 1 3 3 4 2 1 0 0 ... „ 1914-18 1 1 2 3 5 2 1 ... 0 ... Index Numbers: 1914-18. By Misadventure 43 44 0 0 100 ? ? 0 42 100 120 167 200 ... 0 50 Accidental Causes 112 77 207 150 112 171 267 140 111 273 181 133 209 200 250 218 Suicide 75 50 73 123 118 91 100 0 200 ... TABLE IX. Deaths in Institutions. Persons: All ages. Year. Local Institutions. (Uncorrected.) Outlying Institutions. Corrected Totals. Equal to per cent of Corrected Deaths. Totals. Workhouse. Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. Home of Compassion. Women's Hospital for Children. Totals. M.A.B. Hospitals. General Hospitals. Special Hospitals and Homes. Lunatic Asylums. Poor Law Institutions. • (a) (b) (c) 1904 780 66 261 360 92 1 ... 154 27 43 31 46 7 582 29.89 1905 806 91 233 387 91 4 ... 146 13 48 31 49 5 578 29.47 1906 775 48 266 356 98 7 ... 172 35 45 38 43 11 597 32.39 1907 770 22 325 332 88 3 ... 205 27 60 36 59 23 655 32.52 1908 825 57 316 351 91 ... 10 187 30 59 43 42 13 662 34.91 1909 813 96 253 362 88 5 9 193 25 49 42 57 20 628 31.97 1910 808 105 270 310 104 8 11 160 16 66 26 41 11 632 35.20 1911 854 105 293 383 56 9 8 196 45 51 29 59 12 665 34.52 1912 798 119 275 304 95 5 211 29 90 34 46 12 677 38.23 1913 890 139 306 339 99 6 1 252 56 93 34 56 13 789 39.86 1914 791 123 301 273 75 8 11 265 39 82 48 75 21 759 40.05 1915 922 155 392 269 90 11 5 286 41 82 53 91 19 894 39.10 1916 857 119 367 236 109 18 8 250 23 53 54 96 24 799 42.50 1917 815 124 378 190 97 17 9 293 39 79 59 97 19 858 41.85 1918 726 104(d) 262(d) 216 105 29 10 505 37 86 44 135 203 951 42.28 Averages 1904-8 791 57 280 357 92 3 173 26 51 36 48 12 615 31.60 1909-13 833 113 279 340 88 7 6 202 34 70 33 52 13 678 35. 94 1914-18 822 125 340 237 95 17 8 320 36 76 52 99 57 852 41.13 (а) Opened in 1908; Closed in 1912. (b) In-patients first received Autumn, 1913. (c) Including Sanatoria. (d) Taken over by War Office November, 1918. appendix : deaths in local public institutions. 57 TABLE X. Deaths in Locai. Public Institutions. Persons : All Ages. 1914-18. Causes of Death. Work house. Infirmary. Lock Hosp. Child ren's Hosp. St Mary's Hosp. Women's Hosp. for Children. Nursing Homes. Enteric Fever ... ... ... 1 4 ... ... Measles ... 49 ... 2 2 ... ... Scarlet Fever ... ... ... ... ... ... ... Whooping Cough ... 39 ... 3 ... 1 ... Diphtheria, Membranous Croup ... 9 ... 3 3 ... ... Croup ... ... ... ... ... ... ... Epidemic Influenza 1 10 ... 6 16 2 11 Erysipelas 2 10 ... ... 2 ... ... Other Septic Diseases ... 8 ... 1 18 ... ... Pulmonary Tuberculosis, Acute Phthisis 6 261 ... 6 30 1 1 Tub. Meningitis A. Hydrocephalus ... 21 ... 48 29 7 ... Other Forms of Tuberculosis ... 51 1 37 24 2 1 Syphilis 9 24 62 3 1 1 ... Cancer 30 162 1 2 192 ... 57 Rheumatic Fever ... 4 ... 6 5 ... ... Alcoholism 10 2 ... ... 1 ... 1 Inflammation and Softening of Brain 3 1 ... 3 ... ... 2 Cerebro-spinal Fever ... 6 ... 24 5 1 ... Simple Meningitis ... 5 2 7 9 ... 2 Cerebral Hæmorrhage 24 31 ... ... 20 ... 9 Convlsuions ... 4 1 1 ... ... ... Heart Disease 137 199 ... 6 62 2 12 Bronchitis 100 89 1 9 16 1 4 Lobular (Broncho-) Pneumonia 7 83 2 35 10 3 7 Lobar (Croupous) Pneumonia 4 25 ... 8 8 ... 4 Pneumonia 8 29 2 16 25 2 9 Other Diseases of the Respiratory Organs ... 12 ... 7 8 ... 2 Diseases of the Stomach 1 10 ... ... 36 1 3 Diarrhæa and Enteritis 4 145 1 79 8 2 1 Appendicitis ... 2 ... 8 53 ... 5 Obstruction of Intestines 1 20 ... 11 60 ... 3 Cirrhosis of Liver 4 21 ... 2 13 ... 4 Nephritis and Bright's Disease 7 36 ... 9 61 1 3 Tumours (N.—M.), &c., Fem.Genital Organs ... 5 1 ... 13 ... 7 Puerperal Fever ... 13 ... ... 2 ... 2 Accidents and Diseases of Parturition 2 3 ... ... 4 1 1 Congenital Defects 3 8 ... 36 9 3 ... Premature Birth 11 13 3 10 3 2 8 Developmental Diseases 1 14 2 17 2 4 2 Old Age 178 53 ... ... ... ... 4 Suicide 1 9 ... ... 20 ... ... Other Accidents and Violence 6 84 1 24 207 4 3 Homicide ... 1 ... ... 1 ... 1 Ill-defined Causes ... ... ... 1 ... ... All other Causes 65 129 3 46 201 2 36 All Causes 625 1700 83 476 1184 43 205 Non-Residents 44 69 76 356 888 28 115 i 58 appendix: deaths of residents outside the borough. TABLE XI. Deaths of Residents outside the Borough. Persons: All Ages. 1914-18. Causes of Death. Hospitals of Metropolitan Asylums Board. General Hospitals. Special Hospitals and Homes. Lunatic Asylums. Poor Law Institutions. here. Enteric Fever 3 1 1 2 ... ... Measles 28 1 ... 1 3 2 Scarlet Fever 23 ... ... ... ... ... Whooping Cough 10 1 1 ... 1 2 Diphtheria, Membranous Croup 63 ... ... ... ... ... Croup ... ... ... ... ... ... Epidemic Influenza ... 11 6 13 46 15 Erysipelas ... ... ... 2 ... ... Other Septic Diseases 1 5 ... ... ... Pulmonary Tuberculosis, Acute Phthisis 15 10 71 75 15 28 Tub. Meningitis A. Hydrocephalus 4 8 1 1 1 2 Other Forms of Tuberculosis 8 9 6 6 4 3 Syphilis ... 4 5 3 7 1 Cancer 1 103 46 15 17 48 Rheumatic Fever ... 1 ... ... ... ... Alcoholism ... ... 1 ... ... 2 Inflammation and Softening of Brain ... 2 ... 25 ... 1 Cerebro-spinal Fever 3 3 ... ... ... 2 Simple Meningitis ... 2 ... ... ... 2 Cerebral Hæmorrhage 1 2 ... 10 3 16 Convulsions 1 ... ... ... ... 1 Heart Disease 2 23 9 60 47 36 Bronchitis ... 7 3 10 24 14 Lobular (Broncho-) Pneumonia 2 6 7 12 15 2 Lobar (Croupous) Pneumonia) 1 2 ... 31 1 7 Pneumonia 1 8 4 9 31 12 Other Diseases of Respiratory Organs 1 4 4 2 2 1 Diseases of Stomach ... 7 ... ... 1 2 Diarrhoea and Enteritis 2 12 9 3 11 4 Appendicitis ... 14 1 ... ... 7 Obstruction of Intestines ... 6 ... ... 1 2 Cirrhosis of Liver ... 7 1 1 3 3 Nephritis and Bripht's Disease ... 9 5 21 1 11 Tumours (N.—M.), &c., Fem. Genital Organs ... 10 ... ... ... 3 Puerperal Fever 2 4 1 ... 1 1 Accidents and Diseases of Parturition ... 3 4 ... ... 2 Congenital Defects ... 4 5 ... 2 9 Premature Birth ... 2 27 ... 5 3 Developmental Diseases ... 6 9 ... 6 6 Old Age ... ... 9 67 8 8 Suicide ... 4 ... ... 1 19 Other Accidents and Violence ... 24 1 1 6 46 Homicide ... ... ... ... ... 1 Ill-defined Causes ... ... ... ... ... 2 All other Causes 7 57 25 124 23 82 All Causes 179 382 255 494 286 401 Transferred Deaths* ... 18 40 48 12 167 * Included in the figures given above. appendix . deaths under one year. table xii. Deaths under One Year 1914-18. Group. Causes of Death. Days. Weeks. Months. Annual Averages. Males. Females. 0— 0— 1— 2— 3— 0— 1— 2— 3— 4— 5— 6— 7— 8— 9— 10— 11— 1909-13 1914-18 1909-13 1914-18 m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. I Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 2 ... 2 3 3 ... 4 1 1 2 8 4 4 4 6 5 6 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 ... 1 ... ... 1 ... 2 ... 1 2 0 1 0 1 Whooping Cough ... ... ... ... ... ... 2 ... ... ... 2 ... 2 2 1 ... 1 2 2 1 4 6 2 5 1 6 1 4 6 3 1 2 2 5 8 5 7 7 II. Diarrhœa ... ... ... ... ... ... ... 1 2 2 2 3 11 4 5 6 3 3 6 4 1 1 2 1 3 3 3 1 ... 2 ... 2 2 9 13 8 15 6 Enteritis ... ... ... 1 6 3 2 3 1 1 9 8 15 9 18 18 14 11 10 6 12 5 8 1 4 4 8 7 5 5 1 5 6 8 19 22 16 18 III. Tuberculous Meningitis . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ... ... 2 3 ... 1 ... 1 ... 1 ... ... 1 2 1 2 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 1 1 ... 1 ... ... ... 1 ... 2 ... ... ... ... 1 1 1 1 Other Forms „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... 1 3 2 1 2 3 1 2 ... 3 1 2 3 1 2 IV. Congenital Malformations 3 3 21 11 8 3 2 3 2 ... 33 17 9 4 4 6 1 3 2 ... 1 3 1 ... ... 1 ... ... ... 1 ... ... ... ... 10 10 8 7 Premature Birth 52 27 85 63 12 10 10 10 5 5 112 88 5 3 2 9 5 1 ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... 32 24 24 19 Atrophy and Debility ... ... 1 ... ... ... 1 1 ... 1 2 2 6 4 4 5 4 2 4 2 2 2 ... ... ... ... ... 1 1 ... ... 1 1 ... 9 5 5 4 Debility at Birth 3 6 10 10 5 1 5 2 6 2 26 15 10 2 3 1 1 ... ... 3 ... 9 ... ... ... ... ... ... ... ... ... ... ... ... 10 8 6 5 Injury at Birth 4 7 6 11 1 1 1 ... ... ... 8 12 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 3 2 Atelectasis 8 5 11 9 ... ... 1 ... ... 1 12 10 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 3 2 Want of Breast Milk ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 2 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 1 1 0 V. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 0 0 0 Syphilis 3 ... 4 ... 3 1 1 ... 3 ... 11 1 6 11 2 6 3 1 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 4 0 2 4 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0 0 0 Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 ... ... 1 ... ... ... ... ... 1 2 ... ... ... ... ... ... 3 1 2 1 Convulsions ... ... 1 1 ... 1 9 1 ... ... 3 3 2 9 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 3 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 0 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 Bronchitis ... ... ... 1 1 1 2 2 2 ... 5 4 10 5 9 3 6 5 3 3 1 2 4 3 2 4 2 ... 1 3 4 1 6 1 12 11 10 7 Pneumonia ... ... 3 4 4 3 4 9 ... 5 11 14 12 4 8 5 6 10 8 7 9 3 5 4 6 7 13 4 6 5 11 8 10 8 20 21 14 16 Suffocation (overlaid) ... ... 2 1 ... ... ... ... 1 ... 3 1 2 ... 1 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 9 1 2 1 Other Causes 8 12 10 13 2 4 ... 2 2 3 14 22 5 4 5 2 4 4 2 ... 5 1 6 5 9 4 5 4 4 1 5 3 4 2 14 14 8 10 All Causes 81 60 154 125 42 28 34 27 24 20 254 200 96 57 69 62 53 49 42 28 40 28 34 28 33 32 39 27 29 26 35 26 39 35 179 153 139 120 Uncertified Deaths .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Averages 1909-13 21 10 40 26 9 7 8 6 6 4 63 43 21 18 14 12 11 10 9 9 11 8 10 6 10 5 9 7 7 8 8 7 6 6 Averages 1914-18 16 12 31 25 8 6 7 5 5 4 51 40 19 11 14 13 11 10 8 6 8 6 7 6 6 6 8 5 6 5 7 5 8 7 59 I 2 60 appendix : report of the work of the district inspectors. TABLE XIII. Report of the Work of the District Inspectors, 1914-1918. YEARS. No. of Complaints received. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, &c. Water Supply. Dust Receptacles Miscellaneous. " House-to-House " On Complaint or after Illness Cellar Dwellings. Re-Inspection of all kinds. Entire Reconstruction. Drains Relaid, Trapped, or Ventilated. Drains Repaired and made Sound. Waste Pipes Disconnected. New Waste Pipes Provided. Rain-water Pipes Disconnected. W.C.'s, New, Provided, Repaired, &c. Soil Pipes, New, Provided. Soil Pipes Repaired. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New, Provided. Cisterns, Cleansed, Repaired, &c. New Provided. Repaired, &c. Drains Cleared, Flushed, &c. Houses or Rooms Cleansed, Whitewashed, &c. Cases of Overcrowding Abated. Cellar Dwellings Closed. Yards and Areas Paved and Drained. Roofs Repaired. Manure Receptacles Reconstructed. &c Accumulations Removed. Improperly-kept Removed. 1914 427 43 1852 — 12926 101 74 78 66 129 29 303 80 9 25 33 12 7 44 125 7 38 101 3 4 12 17 1 21 1 1915 581 — 1885 — 10830 55 50 51 47 67 20 153 29 20 20 6 11 2 32 33 3 33 84 4 — 22 34 2 28 — 1916 561 10 1742 — 11980 32 50 51 39 97 23 202 33 12 22 5 9 3 37 29 10 62 108 1 — 14 42 2 16 4 1917 958 18 1931 — 12998 22 23 25 36 78 20 154 19 13 8 5 29 — 14 11 7 68 72 1 — 13 53 — 17 1 1918 663 — 1730 — 12436 16 41 21 46 223 23 221 33 9 9 5 26 — 27 22 7 110 86 1 — 15 66 2 32 5 Totals— 1914-18 3190 71 9140 61210 226 238 226 234 594 115 1033 194 63 84 54 87 12 154 220 34 311 451 10 4 76 212 7 114 11 1909-13 2743 808 9595 — 73248 964 461 221 961 * 367 1842 225 60 324 168 68 15 450 344 118 263 646 48 19 262 120 18 129 8 * Not shown separately prior to 1914. appendix : prevention of infectious disease. 61 TABLE XIV. Prevention of Infectious Disease. 1914 1915 1916 1917 1918 All Diseases, Enquiries by— District Inspectors 4808 5738 3718 2705 1554 Women Inspectors 6384 8119 5627 8317 7412 Tuberculosis (included in above)— Women Inspectors 5758 4902 4064 3119 2941 Rooms Disinfected— All Diseases 2927 4900 2491 4641 3122 Tuberculosis 351 340 374 293 224 Weight of Bedding, &c., Disinfected (Tons) 54 81⅔ 44½ 50½ 38¼ Cost of above £1085 £1648 £932 £1193 £922 School Notices issued— Measles, Whooping Cough, and Chicken Pox 1917 5051 1562 4956 3397 Other Diseases 1407 926 674 437 534 Patients removed to Hospital—All Diseases 999 764 534 390 404 Bacteriological Examinations for— Diphtheria 1479 359 225 338 298 Enteric Fever 12 18 6 — 7 Cerebro-Spinal Meningitis 2 10 14 12 6 Tuberculosis 259 245 214 197 159 Sanitary Work. 1914 1915 1916 1917 1918 cutting-off of water supply— Notices received 29 32 26 38 18 Reasons for action—Rate not paid 14 10 9 12 6 Defective fittings 8 9 4 12 6 Supply not required — — — — 1 Premises Inhabited 20 15 13 17 9 „ Empty 7 13 13 14 5 Mortuary— Bodies Deposited 321 339 332 288 324 Inquest Cases 259 277 262 232 260 Other Cases—Non-Infectious 59 62 70 56 * 64 Infectious 3 3 2 1 — P.M. Examinations made 119 147 120 123 116 Canal Boats— On Register at end of year 176 175 181 182 204 Known using Canal Basin 63 65 68 74 96 Inspections made 206 160 166 68 77 Infringements of Acts discovered 38 18 12 8 7 Notices served 25 12 10 8 5 Cases of Infectious Disease 1 — 1 1 5 Deaths of Occupants — 8 4 2 — Children found on Boats 148 150 130 93 90 Trade Nuisances— Offensive Smells 14(8)* 14(11) 5(5) 6(5) 5(5) Accumulations of Manure 26(12) 15(13) 10(10) 13(12) 22(19) Smoke—Complaints received 6 11 11 8 4 Premises watched 22 21 20 10 7 Total time of observation (hours) 134½ 135¾ 152½ 90 19 Duration of Smoke 80 76½ 95¾ 72¼ 14¼ Including " black " Smoke 1 3¾ 4½ 3¼ 1¼ * To be read thus—" 14 complaints relating to 8 premises." 62 appendix : sanitary defects remedied in tenement houses. TABLE XV. Sanitary Defects Remedied in Tenement Houses. 1914 1915 1915 1917 1918 Drain Defective 13 4 4 2 4 „ choked 10 11 12 14 11 „ untrapped ... 2 2 1 1 „ unventilated or improperly ventilated .. 11 4 6 1 ... Manhole cover defective 9 14 11 8 7 Surface inlet improperly trapped ... ... ... ... ... Gully choked 11 9 16 16 17 Ventilating pipe improperly constructed ... 2 I ... ... Soilpipe defective 1 2 2 2 3 ,, improperly constructed ... ... ... ... ... „ unventilated or improperly ventilated ... ... 4 ... ... Water-closet choked 49 63 60 60 47 „ defective 123 99 80 108 120 ,. insufficiently flushed 30 19 32 24 20 „ flushing apparatus defective 74 69 35 54 31 „ without water supply 41 31 41 63 40 „ foul 34 78 36 41 57 „ improperly constructed 1 ... 1 ... ... „ accommodation insufficient 15 6 4 3 1 „ without door 11 4 8 7 14 „ without external light or ventilation ... ... ... ... ... Rainwater pipe not disconnected from drain or soilpipe ... ... ... ... ... „ „ defective 42 34 43 41 17 „ „ choked 20 9 10 11 4 Wastepipe defective 27 16 10 12 8 „ choked 19 11 2 16 17 „ not provided 2 3 3 ••• 3 Other drainage defects 10 3 3 8 7 Cistern defective 13 5 2 4 5 „ dirty 33 113 74 54 12 „ without proper cover 15 6 ... 6 4 „ cover defective 15 13 1 7 14 Dustbin defective 85 70 35 29 32 „ not provided 10 5 8 5 7 insufficient 12 5 4 ... 2 „ disused and not abolished 12 7 1 3 ... Paving defective in area or yard 78 57 31 11 12 „ „ „ wash-house 90 50 31 6 8 Guttering defective 33 29 41 36 21 Premises damp 18 20 21 27 26 Rooms dirty 2040 1848 1370 1278 713 ,, verminous 360 282 117 105 60 Roof defective 213 254 146 199 113 Accumulation of refuse 14 30 17 8 18 Animals improperly kept 18 14 5 3 4 Water supply to premises insufficient 29 6 2 10 16 Other defects or nuisances 336 201 137 138 142 APPENDIX : SAMPLES TAKEN UNDER SALE OF FOOD AND DRUGS ACTS. 63 TABLE XVI. Samples Taken under Sale of Food and Drugs Acts. 1914 1915 1916 1917 1918 Total. Found Adulterated. Percentage ! Adulterated. Total. Found Adulterated. Percentage Adulterated. Total. Found Adulterated. Percentage Adulterated. Total. Found Adulterated. Percentage Adulterated. Total. Found Adulterated. Percentage Adulterated Milk—Fresh 281 23 8.2 324 46 14.2 312 39 12. 5 349 32 9.2 428 52 12.1 „ —Other 4 1 25.0 ... ... ... 2 ... ... 3 ... ... 7 2 28.9 Cream 13 1 7.7 10 ... ... 9 ... ... 4 1 25.0 ... ... ... Butter 47 10 21.1 39 10 25.6 33 7 21.2 27 1 3.7 22 ... ... Margarine 5 ... ... 12 ... ... 10 ... ... 25 3 12.0 5 ... ... Cheese 23 ... ... ... ... ... 13 ... ... ... ... ... ... ... ... Lard, Dripping, Cooking Oil 23 ... ... 30 ... ... 29 ... ... 25 1 4.0 20 1 5.0 Tea. Coffee, Cocoa 23 ... ... 19 ... ... 17 ... ... 23 ... ... 14 ... ... Sweets, Sugar 1 ... ... ... ... ... 8 ... ... 5 ... ... 5 ... ... Jain, Marmalade, Honey, Syrup 6 ... ... 20 ... ... 16 1 6.2 9 ... ... ... ... ... Bread, Cake 1 ... ... 20 ... ... 20 ... ... 16 ... ... 19 ... ... Flour, Farinaceous Foods 30 ... ... 28 ... ... 18 ... ... 44 ... ... 33 ... ... Baking, Custard Powders ... ... ... ... ... 18 2 16.7 1 ... ... ... ... ... Vinegar, Condiments 33 1 3.0 23 1 4.3 35 ... ... 43 2 4.6 38 3 7.9 Brawn, Pressed Beef, Sausages 37 13 35.1 31 6 19.3 24 4 16.6 13 1 7.7 5 ... ... Meat Pastes, Mincemeats 17 ... ... 14 ... ... 8 ... ... ... ... ... ... ... ... Wine, Spirits, Beer 18 ... ... 3 ... ... 4 ... ... ... ... ... ... ... ... Temperance Beverages 9 9 100.0 12 1 8.3 6 2 33.3 2 2 100.0 4 2 50.0 Fruit 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Drugs 28 ... ... 15 ... ... 17 ... ... 11 ... ... ... ... ... Totals 600 58 9.7 600 64 10.7 599 56 9.3 600 43 7.2 600 60 10.0 64 appendix : summary of summonses. TABLE XVII. Summary of Summonses. 1914-18. Health Cases. Summonses under 1914 1915 1916 1917 1918 Public Health (London) Act, 1891 11 13 8 13 27 Metropolis Management Acts 1 1 ... ... ... L.C.C. (General Powers) Act, 1904 ... ... ... ... 3 Housing Acts 5 1 1 ... ... Notification of Births Act, 1907 3 ... 5 6 Dairies, Cowsheds and Milkshops Reg's 4 2 ... 2 3 Summonses dismissed—3. Under Public Health (London) Act, 1891—1 Notification of Births Act, 1907—2. Food Cases. 1914 1915 1916 1917 1918 Total Summonses 44 77 51 26 51 No. of Defendants 19 37 25 17 39 No. with Previous Convictions 7 10 7 6 11 1 Conviction 1 4 ... 1 8 2 Convictions 4 3 1 1 2 3 „ 1 2 2 3 1 4 „ 1 ... 3 ... ... 5 „ ... ... ... ... ... 6 „ ... 1 ... 1 ... 8 „ ... ... 1 ... ... Analysis of Summonses Taken Out. 1914 1915 1916 1917 1918 Milk 20 49 34 24 46 Butter 4 5 1 ... Butter/Margarine 8 8 3 ... ... Margarine 8 8 4 ... ... Summonses were also taken for— Lime Juice Cordial—1 each 1916 & 1918 Vinegar—4 (1918). Jam—1 (1916). Condensed Milk—1 (1918). Carraway Seeds—1 (1917). Analysis of Summonses Dismissed. 1914 1915 1916 1917 1918 Milk—Warranty 11 14 5 3 17 ,, —Other causes ... ... 5 1 ... Condensed Milk ... ... ... ... 1 Butter ... 1 ... ... ... Margarine 1 ... ... ... ... Summonses Withdrawn. 1916—Milk- 15 (8 against one defendant who was heavily fined on a tenth summons, and 7 against another fined on the eighth summons. In each instance the batch of summonses were heard on the same day). Margarine and Lime Juice Cordial—1 each. 1918--Milk and Lime Juice Cordial—1 each. appendix : proceedings. 65 TABLE XVIII. A. 1914. Premises. On Register at end of 1914. No. of Inspections. No. of Prosecutions. Cowsheds 1 4 ... Milkshops 119 164 4* Houses let in lodgings 1,425 8,781 (a) 1 (b) 2 ... Ice Cream premises 120 114 ♦Three for selling milk without being registered, and one for selling milk from infected premises. (a) For overcrowding. (b) For other conditions (including annual cleansing). 1915. Premises. On Register at end of 1915. No. of Inspections. No. of Prosecutions. Cowsheds 1 4 ... Milkshops 115 171 1* Houses let in lodgings 1,425 6,291 8 Ice Cream premises 96 117 ... *For selling milk without being registered. 1916. Premises. On Registe. at end of 1916 No. of Inspections. No. of Prosecutions. Cowsheds 1 4 ... Milkshops 112 160 ... Houses let in lodgings 1,404 6,513 4 Ice Cream premises 72 80 ... 1917. Premises. On Register at end of 1917. No. of Inspections. No. of Prosecutions. Cowsheds 1 4 ... Milkshops 108 133 1 Houses let in lodgings 1,404 5,308 9 Ice Cream premises 43 76 ... 1918. Premises. On Register at end of 1918. No. of Inspections. No. of Prosecutions. Cowsheds 1 4 ... Milkshops 99 125 ... Houses let in lodgings 1,404 3,616 21 Ice Cream premises ... ... ... K 66 appendix : proceedings. TABLE XVIII. B. 1914 1915 1916 1917 1918 Total. Slaughterhouses — No. of inspections 380 265 261 232 423 1561 „ „ notices ... ... ... ... ... Offensive Trades— No. of inspections 125 114 ... ... 239 „ „ notices ... ... ... ... Smoke Nuisances— No. of observations 134½ hrs. 181 203 119 25 662½ hrs. „ „ nuisances and complaints 6 11 21 13 5 56 „ „ notices ... ... ... ... ... ... „ „ summonses ... ... ... ... ... ... Housing of the Working Classes— No. of houses inspected 232 134 99 63 62 590 „ ,, ,, dealt with under Sec. 15 of Housing Town Planning &c., Act, 1909 1 ... ... ... ... 1 „ „ representations ... 1 1 8 2 12 „ „ closing orders 7 1 1 8 2 19 , „ houses remedied without closing orders ... ... ... ... ... ... „ „ houses remedied after closing orders ... 2 2 4 4 12 „ „ houses demolished ... ... ... ... ... ... Other details ... ... ... ... ... ... Underground Rooms— No. illegally occupied 115 2 ... ... ... 117 „ closed, or illegal occupation discontinued 115 2 ... ... ... 117 Overcrowding— No. of rooms overcrowded 197 60 80 52 13 402 „ „ „ remedied 80 51 68 49 13 261 „ ,, prosecutions 1 ... ... ... 1 Cleansing*— No of adults cleansed ... ... ... ... ... ... ,, „ children „ ... ... ... ... ... ... „ „ rooms or premises cleansed 355 282 117 105 63 922 Water Supply to Tenement Houses— No. of premises supplied ... 9 ... 4 1 14 „ „ prosecutions ... ... ... ... ... ... Inland Revenue Act (applications for certificates)— No. of houses 5 2 1 4 1 13 „ „ tenements therein 17 5 1 8 2 33 „ „ applications granted 2 6 1 3 1 13 „ „ „ refused, deferred or withdrawn 15 ... ... 1 ... 16 Mortuaries- No. of bodies received 321 339 332 288 324 1604 ,, „ infectious bodies 3 3 2 1 ... 9 Sale of Food— No. of premises used other than ice cream premises, milk-shops and cowsheds 585 551 331 302 308 2077 „ „ inspections 1040 739 982 444 776 3981 Disinfection Shelter—(No Shelter) No. of persons accommodated ... ... ... ... ... ... Ophthalmia Neonatorum Regulations— No. of notifications received from certified midwives 2 8 4 3 2 19 * There is no Cleansing Station. appendix : military cases. 67 TABLE XIX. Military Cases. Notifications and Deaths Recorded Locally.* 1914-18. 1914 1915 1916 1917 1918 Notifications of Infectious Disease- Scarlet Fever 1 Diphtheria 3 1 2 1 Cerebro-Spinal Fever 1 Enteric Fever 1 2 Erysipelas 2 1 Total 8 4 2 1 Deaths— Enteric Fever ... 1 1 ... ... Influenza ... ... ... ... 5 Septic Diseases ... ... ... l 1 Tubercular Disease ... ... ... ... 1 Syphilis ... ... ... ... 1 Cancer ... ... 1 ... 2 Alcoholism ... ... 1 1 ... Cerebro-Spinal Fever ... 1 ... ... ... Heart Disease ... 2 ... ... 1 Bronchitis ... ... ... ... 1 Lobular (Broncho) Pneumonia ... ... ... ... 1 Lobar (Croupous) „ ... ... 1 ... 2 Pneumonia ... ... 1 ... 1 Other Respiratory Diseases ... ... 2 ... ... Diarrhœa and Enteritis ... ... ... ... 1 Appendicitis ... ... ... 2 1 Nephritis ... 1 ... 2 1 Suicide ... ... ... 1 3 Accidents and Violence ... ... 1 1 1 Battle Casualties ... ... 4 11 4 Ill-defined Causes ... ... ... ... 1 All Other Causes ... 2 ... 3 5 All Causes ... 7 12 22 33 Non-residents ... 1 4 17 18 ♦These have not been included in the other Tables of this Report.