AC 4349 Metropolitan Borouob of pabbington. annual report of the council FOR THE YEAR 1911. APPENDIX. REPORT OF THE Medical Officer of Health. LONDON: HENDERSON & SPALDING, Printers, SYLVAN GROVE, OLD KENT ROAD, S.E. MEDICAL RESEARCH COUNCil LIBRARY. No. 18948 7h PAD 16 Metropolitan Borough of Paddington. report ON The Vital Statistics AND Sanitary Work For the Year 1911. BY REGINALD DUDFIELD, M.A., M.B., D.P.H., F.S.S., Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. CONTENTS. PAGE PAGE Alcoholism, Mortality from 46 Leprosy 32 Animal Diseases 23 Manure, Removal of 75 Anthrax 23 Measles 25 Bacteriological Examinations, Results of 75 Meat Condemned in Slaughterhouses 91 Bakehouses, Inspection of 82 „ Seized in Shops, &c. 92 Births and Birth-Rates 6 Meteorology 3 „ Fertility, Natality 5 Milk Supply 91 and 94 „ Notification of 6 Milkshops, Trades carried on at 92 „ Hopeless 50 Mortality among Infants 46 „ Transferred 7 „ „ ,, " Hopeless Births" 50 Canals, Canal Boats Acts 77 „ at ages 1—5 years 63 Cancer, Mortality from 44 „ in Childbed 21 Cerebro-spinal Fever 22 Mortuaries 69 Chickenpox 32 Mumps 32 Child Rearing 61 Notification of Births 6 Childbed, Mortality in 21 „ „ Sickness 8 Childhood, Mortality in 63 „ ,, Phthisis (Consumption) 38 " Clarendon Street Area" 89 Offensive Refuse, Removal of 75 Combined Drainage 76 Office Work 94 Common Lodging Houses 90 Ophthalmia Neonatorum 24 " Consumption" Mortality from 33 Other Infectious Diseases 32 „ Notification of 38 Other Septic Diseases 21 Consumptives, Occupations of (Table) 43 Other Tubercular Diseases 33 ,, Segregation of 35 Outworkers (Homework) 78 Dairies and Milkshops 92 Phthisis, Mortality from 33 Death and Death-Rates 9 Poliomyelitis 23 Deaths in Institutions 66 Population, Estimated „ Transferred 11 Prevention of Infectious Diseases 67 Diarrhoea, Deaths from 55 Puerperal Fever 20 „ Contact Cases 61 Pulmonary Tuberculosis 34 ,, Infection and Flies 61 Respiratory Diseases, Mortality from 46 Diphtheria 13 Ringworm 32 and 74 Disinfection 67 Scabies 74 Drains, Private, Re-laid 76 Scarlet Fever 17 Dysentery 32 School for Mothers 62 Enteric Fever 18 Schools and Infectious Diseases 69 Erysipelas 21 Segregation of Consumptives 35 Factory and Workshop Act, 1901, Work Septic Diseases, Mortality from 20 Under 78 Sickness (Notifications) 8 Food Analysis, Summary of Samples taken 93 Slaughterhouses, Inspection of 91 „ Summary of Proceedings97 Smallpox 12 Food Supervision 91 Smoke Prevention 77 Food Purveyors 91 Sore Throat 73 Glanders 23 Suicide, Mortality from 46 Health Visiting 61 Trade Nuisances 76 HomeWork 78 Trade Refuse 75 House Refuse 75 Tuberculous Diseases, Mortality from 33 Houses Let in Lodgings, Annual Cleansing of 86 Unsound Food seized 92 ,, ,, Registration of 84 Vaccination 13 „ ,, Overcrowding in 88 Vermin 74 ,, „ Vital Statistics 88 Water Supply, Cutting off of 69 Housing, Town Planning, &c., Act 82 Wharves, Inspection of 77 Hydrophobia 23 Whooping Cough 30 Ice Cream, Inspection of places where made 92 Workshops, Overcrowding in 81 Illegitimates, Births of 5 „ Registration of 78 „ Deaths of 64 „ Sickness on premises of 81 Infants, Feeding of 61 „ Mortality among 46 „ ,, in Insula 53 ., „ inWards 48 APPENDIX A. Influenza, Mortality from 46 Tables (Local Government Board, Home Inhabited House Duty, Exemption from 90 Office, and London County Council) 99 Inquests held 65 Institutions, Deaths in 66 APPENDIX B. Internotification 74 Legal Proceedings, Summary of 95 Memorandum on Ophthalmia Neonatorum 110 to his worship the mayor, the aldermen and the councillors of the borough of paddington. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my report of the vital statistics recorded and the work accomplished by your Public Health Department during the past year. The provisional census data so far published disclosed so large a loss of residents that I concluded that it was useless to frame detailed estimates of the sex-age composition of the population. Consequently a good many of the rates usually given in these reports will not be found in the present issue. Owing to the method of publication of the census results which has been decided on by the Registrar-General, it will be some two or three years before the complete census figures for the Borough will be available. The provisional total population points to one lesson with regard to estimates of population, viz., that the national increment of population cannot be relied upon as a check to estimates of populations of individual localities. The "clearing house" system for births and deaths which the Registrar-General has established will ultimately be of great value. For the time being it has caused an interruption in the annual series of figures which has necessitated correction by parallel tabulation. It is very much to be desired that the particulars of transferred births should in future years be as full as those of transferred deaths. There is no sign of any slackening in downward progress of the birth-rate. Last year's rate, that obtained from local registration, was 19 75 per 1,000, 0 63 per 1,000 less than the rate for 1910 and 9'0 less than that for 1871. The shrinkage in the fertility rate is now practically universal among civilised nations. Even in Germany, where a high rate has persisted until quite recently, the latest returns are so unsatisfactory that a special commission has been appointed to examine the question and, if possible, to submit proposals for checking the evil. As regards sickness, there was a marked reduction last year in the amount of scarlet fever and a satisfactory freedom from enteric fever, but the prevalence of diphtheria was somewhat greater. From its behaviour during the year I was led to fear that the last disease would be notably prevalent during the current year. The only other diseases exceptionally rife during the past year were measles, whooping cough and diarrhoea, to which diseases were due the increase in infantile mortality and the slight increase in the total mortality. From the analyses made of the causes of death—more particularly at ages under one year—it may, I think, be anticipated that the increase in the total and infantile mortalities will prove to be transient only. In each of the five or six years preceding 1911 notable reductions in the infantile mortality had been recorded, and in the Reports for 1909 and 1910 questions were raised as to the possible effect of a really hot summer on the apparently improved risk attaching to infantile life. The experiment has been made, with I think very satisfactory results. The mean temperature of the past summer was identical with that of 1899, and the total rainfall less. Prirnd facie the diarrhoea mortality in the third quarter of last year should have been greater than in 1899. Taking the infantile mortality in the third quarter of the year as a test of diarrhoea mortality, the ratio of mortality rates in Paddington in 1899 and 1911 was 100 to 76. In December last the Local Government Board issued a third series of Regulations re Pulmonary Tuberculosis, whereby the notification of that disease is made complete from the beginning of the current year. The records of notification of, and of deaths from, tuberculosis are dealt with fully in the Report. Hitherto there has not been much scope for work by the Department with regard to consumption—the greater proportion of the patients being under the care of either the Dispensary for Consumption or the Poor Law. The extension of notification, and more particularly the operation of the Insurance Act, will make it absolutely necessary to adopt a more active policy. For such work I consider the Women Inspectors are more suited, but at present their time is taken up mainly with sickness among children, and they have little opportunity for any other work, such as workshop inspection and the visiting of cases of consumption or of new-born children. As regards " birth visiting," we have fortunately had the assistance of the Paddington Health Society (now the School for Mothers), but that Association has intimated its inability to visit as much as in the past. The Paddington and Kensington Dispensary for the Prevention of Consumption has taken charge of most of the work in connection with consumption which in other circumstances would have fallen to the Women Inspectors. The time has come when the Council will have to consider the question of making some addition to the staff of Women Inspectors, partly with a view to carrying out more thoroughly work already imposed on them, and partly to meet the exigencies which are to be expected to arise from the operation of the Insurance Act. The preservation of the health of the children is of such vast importance in preventive medicine that I sincerely hope it will not be necessary either to give up any of the work now done or to neglect the call for further work in the direction indicated. All members of the staff of the Department have discharged their duties in a most efficient manner during the year. At times the work which the Women Inspectors have been called on to undertake has been more than those officers ought to be required to do. They have made exceptional efforts to meet the call. The work of the Clerical Staff is increasing steadily and promises to do so at a more rapid rate in the future. In conclusion I desire to convey my sincere thanks to the Chairman and Members of the Public Health Committee for their sympathetic support in my efforts to carry out the duties entrusted to me. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your most obedient servant, m.a., m.b., d.p.h., f.s.s., Medical Officer of Health Public Health Department, Town Hall, Paddington, W., 6th fuly, 1912. 1 REPORT. POPULATION. At the time of writing, the only report dealing with the census of last year which had been published was the " Preliminary" issued in June, 1911. Although the figures given in that report arc described as " subject to revision," it is not anticipated that the few data concerning the Borough which are contained in the report will, in their final form, differ materially from those already published. The data at the moment available are the numbers of "families, or separate occupiers" (33,962) and of inhabitants (142,576 persons). The number of "families" showed a slight increase in comparison with the (final) figure for 1901 (33,661), while the total population showed a reduction of 1,400 persons below the 1901 total (143,976), equivalent to a shrinkage of (approximately) 1 per cent., as against an increase of a little more than 5 per cent, in the ten years 1891-1901. The difference of 1,400 persons represents only a fraction of the total population lost by the Borough during the ten years. The growth of a population between two successive census-takings represents the algebraic sum of three factors, viz., the population at the earlier census, the natural increase of the population, and the balance of migration during the intervening period. Figures relating to the two first factors are available in the census reports and in the registers of births and deaths. Migration statistics are wanting, except as regards the country as a whole, and such statistics as are available cannot be described as altogether satisfactory. Moreover, while the statistics relating to the natural increment (the difference between the numbers of births and deaths) may be taken as accurate, within a small percentage, for the country as a whole, they are, or have been, far from accurate in the case of unit areas, such as is the Borough of Paddington. A certain proportion of births and deaths, strictly belonging to the Borough, occur beyond its boundaries, and have not hitherto been included in the local statistics, the deficiency having been during the past ten years greater in the case of the births than in that of the deaths. It follows, therefore, that any estimate of the natural increment which is based on the births registered within the Borough and the imperfectly corrected numbers of deaths must yield an under-estimate. Such under-estimate, however, furnishes a striking evidence of the loss of population in the Borough between 1901 and 1911. According to the Departmental records, the excess of births (as registered within the Borough) during the ten years which elapsed between April, 1901, and April, 1911, over the deaths (corrected for deaths in the Borough of non-residents and of residents of the Borough occurring in other parts of London only) amounted to 11,959 persons. If that figure be added to the census population of 1901 (143,976), an estimated census (1911) population of 155,935 persons is obtained, whereas the enumerated total was 142,576, showing a loss of at least 13,359 persons, equivalent to 9 3 per cent, of the estimate. There is reason to think that the estimate of the natural increment given above is approximately 20 per cent, too low, such surmise being based on the results of the more complete corrections of the numbers of births and deaths belonging to the Borough introduced last year by the Registrar-General. If that correction be accepted, the estimated population at the date of the last census should have been 158,327 persons, showing a loss of 15,751 persons (11'4 per cent.). Even that amended estimate is probably too low. The emigration from the Borough has not been uniform throughout the ten years, and there was some immigration in the earlier part of the period. It is probable that the actual loss in population approaches 16,500 persons. b 2 population. The estimates of the population used in these reports have fortunately not been based on the natural increment, but have been obtained by the use of geometrical ratios of the changes in the populations of the three Registration Sub-Districts which constitute the Borough. Although the population of the Borough as a whole increased by nearly 5 per cent, during the ten years 1891-1901, the populations of two of the Sub-Districts (those of North-west and South Paddington) showed decreases. In Table 1 a comparison is instituted between the estimates of the population of the Borough for each of the ten years, obtained by the following methods:— (a) By adding the natural increment observed during each year; (b) By the geometrical method just described, based on the records of 1891 and 1901; and (c) By expressing the decrease observed in 1911 as an arithmetical progression. The last method undoubtedly gives the best approximation to the truth, in the absence of more frequent enumerations and of records of migration. It is obvious that ten-yearly intervals are much too long for public health purposes, and that the various rates which have been given in the more recent of these reports understate the actual fertility, mortality, &c. It will be necessary to re-calculate all the rates' for the past ten years, but it seems to be undesirable to do so until the final census results have been published and data for the Registration Sub-Districts and Wards are available. For the purposes of this report the population of the Borough at the middle of 1911 has been estimated at 142,541 persons, that is 35 less than the number found at the census. The census was taken on April 3rd, and the natural increment of the population during the second quarter of the year was between 250 and 300 persons. No attempt has been made to estimate the numbers of males and females at different ages, nor the populations of the Wards. TABLE 1. Population of the Borough. Natural Increment during Estimates of Population at middle of each year. Quarter Year.(1) A. Method (2) 1. 2. 3. 4. B. C. C 1901 — — - 373 373 144,349 144,188 143,941 1902 381 293 95 257 1,026 145,375 145,052 143,801 1903 427 374 296 378 1,475 146,850 145,927 143,661 1904 448 262 262 493 1,465 148,315 146,815 143,521 1905 334 192 296 339 1,134 149,449 147,713 143,381 1906 397 218 333 377 1,325 150,774 148,621 143,241 1907 373 228 152 315 1,068 151,842 149,542 143,101 1908 372 221 224 363 1,180 153,022 150,489 142,961 1909 367 299 107 265 1,038 154,060 151,437 142,821 1910 354 205 235 333 1,127 155,187 152,396 142,681 C 1911 374 172 202 243 991 156,178 153,370 142,541 Notes (1) The population being estimated to the middle of the calendar year, the 4th Quarter in this table is the Spring Quarter (April-June): the approximate date of the census being at the beginning of that Quarter, is indicated by " C." (2) The three methods are described in the text. Method " B " is that which has been used hitherto in these reports. On this occasion the estimate given by Method " C " is used. The estimates of the population at the date of the last census are:— By Method "A," 155,935. By Method " B," 152,876. By Method "C," 142,576. meteorology. 3 METEOROLOGY. The meteorological data in Table 2 are the records obtained at the Botanical Gardens, Regent's Park, which were published in The Times early in January last. The past summer was, however, of an exceptional character—a summer which, judging from past experience, should have produced a very severe epidemic of infantile diarrhoea. It has been thought desirable, therefore, to discuss the year's meteorological records (or rather some of them) in more detail than is usual.* In all the twelve districts into which the United Kingdom is divided for meteorological purposes, the total amounts of bright sunshine {i.e., sunshine sufficiently strong to make a record by burning the paper of a Campbell-Stokes Recorder) registered during the year were in excess of the 25-year averages (1881-1905), the excess ranging from 7 per cent, in the Channel Islands to 21 per cent, in " England, S.E." (including London) and " England, N.W." In London, itself, last year's total sunshine was the largest on record. If a " very fine " week be defined as one in which the amount of bright sunshine exceeds 50 per cent, of the possible {i.e., if the number of hours of record exceeds one-half of the total number of hours during which the sun is above the horizon), then the number of such weeks in London was 15 last year, or three times the average for the previous 30 years. With the exception of the week ending August 26th, each of the 13 weeks of July-September gave a record of bright sunshine of more than 50 per cent, of the possible. In the week ending August 19th the record was 75 per cent, of the possible. As regards temperature, it will be seen from Table 2 that the mean of the dry-bulb thermometer (9 a.m.) readings was the highest of the series for the six years, but not very different (only 0'4° higher) from the mean for 1906. The maximum reading for the year (96a on August 9th) was but 2° above the maximum reading for 1906 (94° on September 1st), but high temperatures, considerably in excess of the average, were the rule throughout JulySeptember, the maximum for July being 918° (on the 22nd) and that for September 92 5° (on the 8th). According to the Report of the Meteorological Office, temperatures of 97° were registered in many parts of London on August 9th, the thermometer reading at 100° that day at Greenwich, 3° higher than the highest reading previously recorded at the Observatory since its foundation in 1841. In September three specially hot spells occurred, one on the 2nd, when the thermometer reached 90°; a second on the 7th and 8th, with readings of 94° (at Greenwich), and a third on the 12th, with a maximum of 89° (at Camden Square). During those three months minimum readings of 65° were common during the night. The average figures for the three months July September in London are of special interest, bearing in mind the connection between meteorological conditions and the prevalence of infantile diarrhcca. The following data are from the Registrar-General's Third Quarterly Report:— Mean temperature 65'6°: difference from average + 4.5° Total sunshine (hours) 777: „ „ ,, +290 Total rainfall (inches) 3.1: „ „ „ - 3.8 Much as the total amount of sunshine exceeded the average, the number of days on which sunshine was recorded at Regent's Park last year was less than that noted in any of the preceding five years. (See Table 2.) As regards rainfall, the year, as a whole, did not depart much from the average, the record (based on 27 stations) amounting to 34.53 ins., or 98 per cent, of average. There were, however, notable deficiencies in the months of July-September, when the amounts measured were 19, 71, and 81 per cent, of the respective averages. Droughts lasting for various periods up to 28 days occurred in the country from and after the beginning of July, and a second drought took place between August 2nd and'20th. It will be seen from Table 2 that during these three months rain was measured on 20 days only, and that the total amount measured was 4-09 ins. At Camden Square, the total rainfall for the year was 24.79 ins., only 0'32 in. less than the average *Those interested in the subject will find much information in two articles published by The Times, viz., "The Rainfall of 1911" (January 16th) and "The Sunshine of 1911" (January 23rd), both of which have been drawn on largely. 4 METEOROLOGY. for the 35 years 1875-1909. In August only 0 49 in. was measured, as compared with an average of 2*33 ins. In July, the thunderstorm of the 28th yielded 0.89 in. of rain, otherwise that month would have been even drier than August. The excessive rainfall of November and December, amounting to 7.84 ins. at Camden Square (3.43 ins. in excess of the average for the two months), brought the year's total fall up to the average. The amount of harm which may be expected to accrue to vegetation, &c., from such brilliant, hot, and dry weather as that of the past summer may be gauged by the fact that the amount of water evaporated during July-September last from a tank having a superficial area of 36 sq. ft. and a depth of 18 ins., was equivalent to a rainfall of 9.75 ins., the measured rainfall during that same period being only 2.97 ins. Rain, it may be added, is generally regarded as a preventive of epidemics of summer diarrhœa. TABLE 2. Meteorology. 1911. Month. Means at 9 a.m. Extreme Temperatures. Rainfall. Sunshine. Barometer reduced to sea level. Thermometer Shade. Max. sun. Min. on grass. Total depth. No. of days. Bright. No. of days. Dry bulb. Wet bulb. Maximum. Minimum. January Inches Deg. Deg. Deg. Date. Deg. Date. Deg. Deg. Inches Hr. Min. 30.32 37.0 36.5 50.5 26th 26.5 16th 72.0 20.8 1.65 13 25.32 11 February 30.14 40.0 38.0 54.2 25th 22.0 1st 84.0 12.0 1.43 13 59.28 16 March 29.91 40.9 39.1 57.8 22nd 29.8 17th 87.0 22.5 1.59 17 75.19 21 April 30.02 44.7 42.7 66.0 21st 25.5 6th 108.7 22.5 1.69 12 150.00 28 May 30.00 56.9 53.1 79.0 29th 37.0 7th 123.0 33.0 1.48 9 204.00 27 June 30.01 61.3 57.7 85.0 5th 39.5 15th 123.0 36.0 2.79 9 212.53 27 July 30.07 69.5 64.9 91.8 22nd 47.0 3rd 131.0 45.0 1.80 4 330.28 31 August 30.03 68.0 65.1 96.0 9th 47.0 31st 134.0 47.0 0.86 7 246.01 30 September 30.08 61.0 58.4 92.5 8th 39.8 22nd 123.0 87.0 1.43 9 205.54 28 October 29.92 50.1 49.4 63.0 19th 29.8 29th 91.0 29.8 2.90 12 73.28 20 November 29.74 44.2 42.1 58.5 5th 28.5 22nd 83.0 24.0 3.54 17 39.17 17 December 29.73 44.8 43.8 53.0 17th 30.0 8th 69.0 24.0 4.18 21 21.44 11 Totals ... ... ... ... ... ... ... ... ... 25.34 143 1644.04 267 Means 29.99 51.5 49.3 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 96.0 Aug. ... ... 134.0 ... ... ... ... ... Lowest ... ... ... ... ... 22.0 Feb. ... 120 ... ... ... ... 1910. Totals ... ... ... ... ... ... ... ... ... 25.92 168 1249.22 277 Means 29.89 49.3 46.6 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 82.0 June ... ... 120.0 ... ... ... ... ... Lowest ... ... ... ... ... 19.5 Jan. ... 17.0 ... ... ... ... 1909. Totals ... ... ... ... ... ... ... ... ... 27.08 192 1460.07 273 Means 29.96 48.7 46.1 ... .... ... ... ... ... ... ... ... ... Highest ... ... ... 85.5 Aug. ... ... 124.0 ... ... ... ... ... Lowest ... ... ... ... ... 190 Mar. ... 14.0 ... ... ... ... 1908. Totals ... ... ... ... ... ... ... ... ... 24.49 173 1461.48 285 Mrans 30.01 50.4 46.5 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 85.0 July 128*0 Lowest 16.5 Dec. ... 11.0 ... ... ... ... 1907. Totals ... ... ... ... ... ... ... ... ... 23.86 177 1304.07 280 Means 29.96 49.5 46.2 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 80.0 May ... ... 122.0 ... ... ... ... ... Lowest ... ... ... ... ... 22.0 Jan. ... 17.0 ... ... ... ... 1906. Totals ... ... ... ... ... ... ... ... ... 24.42 145 1580.12 292 Means 29.99 51.1 47.6 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 94.0 Sept. ... ... 128.0 ... ... ... ... ... Lowest ... ... ... ... ... 20.0 Dec. ... 15.0 ... ... ... ... births. 5 BIRTHS: Fertility: Natality. During the past year* 2,81 5 births were registered within the Borough, giving a crude birthrate of 19.75 per 1,000 persons. The births of males numbered 1,409, and those of females 1,400, showing an unusual proportion of the latter sex. Last year's rate was 2 26 less than the average (22 01) for the ten years 1901-10, and the lowest on record. (See Table I., Appendix A.) During the first half of the decennium the average rate was 22.88, 3.13 in excess of the rate of last year, and during the second half 20.14, or 139 in excess. It should be noted that the rates for the ten years 1901-10 have been re-calculated on the basis of the populations as determined in 1901 and 1911. Of the births registered, 101 occurred in the Lying-in Wards of the Workhouse, equal to 3.8 per cent, of the total births and 1 per cent, more than the proportion noted in 1910 (2.8 per cent.). Thirty (30) multiple births (all of twins) were registered last year, as compared with 48 (47 of twins and 1 of triplets) in the preceding year. Last year's multiple births comprised 7 in which both children were males, 12 in which both were females, and 11 with mixed sexes. From the total of 2,815 births, those of 57 children born to women not residing in the Borough have to be excluded, 27 of such children having been born in the Workhouse and the remainder in nursing homes or private houses. Information was received by the Department from other parts of the Metropolis relating to 230 children born to women giving addresses in Paddington, but the births of 11 children to whom such information related were ultimately rejected as not belonging to the Borough. The 230 births took place in:—Oueen Charlotte's Lying-in Hospital (222 births, 11 of which, all of illegitimate children, were rejected), British Lying-in Hospital (6 births), and other places (12 births). According to the Departmental records, the corrected total number of births during the year was 2,977 (1,492 of males and 1,485 females), equivalent to a rate of 20'88 per 1,000 persons, or 119 less than the corrected mean rate (22*07) for the five years 1906-10, during which years the rates were— 1906,2294; 1907,22-40; 1908,2263; 1909,2122; 1910,2118. The number on which those rates are based will be found in Table II., Appendix A. For the purpose of comparison with the circumjacent districts, the numbers of births published in the Registrar-General's Quarterly Reports have been used, except that in the case of St. Marylebone a figure which allows for the non-resident births in Queen Charlotte's Hospital has been obtained from the Medical Officer of Health of that Borough. The number of births recorded during the last two years and the corresponding rates (all calculated from populations adjusted to the results of the last census) will be found in Table 3. In both years the rates for Kensington, Westminster, and Hampstead were less than the rates for the Borough. With the exception of St. Marylebone (rate, 1911, 20.15; mean, 20.97) all the rates recorded last year were 2 or more per 1,000 less than the corresponding mean rates. As it has not been possible to re-calculate the estimates of the populations of the Wards of the Borough, a table showing the actual numbers of births (of each sex) credited to the Wards (Table 4) during the past two years had been substituted for the usual table of rates and means. That table shows that the numbers varied in a most irregular fashion. (See also Table II, Appendix A). Illegitimate Births.—The 2,815 births registered in the Borough included 171 (6 per cent.) of illegitimate births, the proportions registered in the three Registration Sub-Districts being— North, 3.1, Central, 10.3 (the Workhouse is in this Sub-District), and South, 2.5 per cent. The illegitimate children born in the Workhouse numbered 67 (66.3 per cent, of all births in that Institution). Thirty-eight (38) of the 171 children were born to non-resident women, 20 out * For the purpose of this report, the numbers of births (and deaths) registered in the 52 weeks ended December 30th have been taken as the figures for the calendar year. 6 births. of the 38 being born in the Workhouse. From other parts of the Metropolis 39 such births belonging to the Borough were reported to the Department, making the corrected total of such births 172, 95 of the children being boys and 77 girls. The proportion of such births to the corrected total of births was 5.7 per cent., an increase of 09 per cent, above the proportion for 1910 (4.8). The percentage of illegitimate births to total births in each Ward (Table 4) varied from 10 per cent, in Hyde Park to 2.7 in Harrow Road. The corrected proportions for the Registration Sub-Districts are—North, 4T, Central, 7'2, and South, 8"3 per cent. TABLE 3. Births* and Birth-rates. London. Paddington. Kensington. Westminster. St. Marylebone. Hampstead. Willesden. Registered Births, 1911 112,810 2,815 3,040 2,109 2,375 1,198 3,864 ” 1910 116,227 2,908 3,006 2,364 2,556 1,270 3,808 Birth-rates 1911 24.94 19.74 17.64 13.20 20.15 13.99 24.88 ” 1910 25.69 20.38 17.40 14.59 21.41 14.89 25.16 ” 1906.10 26.64 21.16 18.54 15.60 20.97 15.70 28.22 *The numbers of births have been taken from the Quarterly Reports of the Registrar-General, except in the case of St. Marylebone, the numbers for that Borough being supplied by the Medical Officer of Health. TABLE 4. Births. Corrected Numbers. Borough. Total Births. Illegitimate Births. Percentage of Illegitimate to Total Births. Males. Females. Males. Females. 1911. 1910. 1911. 1910. 1911. 1910. 1911. 1910. 1911. 1910. 1,492 1,528 1,485 1,494 95 73 77 75 5'7 4.8 WardsL Queen's Park 203 198 180 208 13 6 7 11 5.2 4.1 Harrow Road 371 382 355 335 8 13 12 12 2.7 3.4 Maida Vale 204 194 201 213 10 10 13 8 5.6 4.4 Westbourne 234 247 224 221 18 7 12 17 6.5 5.1 Church 346 353 380 367 33 24 22 23 7.6 6.5 Lancaster Gate, West 24 35 26 35 — 5 3 2 6.0 10.0 „ East 42 28 27 30 5 3 — — 7.2 5.1 Hyde Park 68 91 92 85 8 5 8 2 10.0 3. 9 Notification of Births.— Under the Notification of Births Act, 1907, adopted by the Council towards the middle of 1908, the birth of every living child and that of every child born dead after twenty-eight weeks' gestation has to be reported to the Medical Officer of Health within thirty-six hours after the birth has taken place. Last year 2,910 notifications were received relating to 2,782 births. In 1910 2,793 notifications were received covering 2,707 births. From 7 births. medical practitioners 679 certificates were received, forming 233 per cent, of the total, as compared with 18.9 per cent, in 1910. The notifications by parents constituted 36.3 per cent. (39.7 per cent, in 1910), and those from midwivcs, 346 per cent. (36 per cent, in 1910). The 2,782 births notified included 86 (3.1 per cent.) of children born dead, as against 2.6 per cent, in the previous year, and 94 of illegitimate children, equal to 3.4 per cent, of the whole, the proportion in 1910 having been 2.6 per cent. Five of the illegitimate children were notified as still-born, equal to 5.3 per cent, of such children, a slightly smaller proportion than that recorded in the previous year (5.5 per cent.). Among the 132 births notified from the Workhouse there were 4 (3 per cent.) still-born, a lower proportion again than in 1910 (4.8) There were 32 twin births notified, 8 of males and 12 each of females and mixed sexes. One of the children was reported dead in each of two male twin births, and one of each of the other two classes. The proportion of still-born children among those born in multiple births was 6.2 per cent., whereas the corresponding figure in 1910 was only 23 per cent.* Of the 2,810 births registered during the past year 2,660 (94.4 per cent.) had been notified, an increase of 10 per cent, above the proportion recorded in 1910. Below are given certain comparisons for the three years during which notification has been in force, which show that the practice has made a fairly steady progress:— Quarters. 1 2 3 4 1911 92.3 95.0 96.7 93.2 Borough 1910 76.0 81.0 92.0 84.4 1911. 1910. 1909. North 96.1 87.8 79.1 Registration Central 95.5 81.7 71.6 Sub-Districts South 79.5 78.3 49.0 Borough 94.4 84.4 73.2 Transferred Births.—Last year the Registrar-General established a "clearing-house'' system for births. A return was received from him in February of this year showing the numbers of births recorded last year in the Borough which he was transferring elsewhere, and the number of births which took place outside the Borough which he was including in the local statistics. On this occasion bare numbers only have been supplied, but it is hoped that ultimately full particulars will be given of each birth. With the present information it is impossible to allocate the births to the Wards to which they properly belong, and therefore they have been excluded from the figures given in the preceding paragraphs, and in the I ables 4 and II. (Appendix A). The corrections resulting from the use of the figures supplied by the Registrar-General are shown below:— All Births. Males. Females. Persons. Births registered within the Borough 1,409 1,406 2,815 Less outward transfers 17 15 32 Plus inward transfers 132 124 276 Nett totals 1,524 1,515 3,059 I he total of 3,059 births is equivalent to a completely corrected rate of 21.46 per 1,000 persons as compared with one of 20.88 obtained from the corrections made by the Department. The transfers of illegitimate births numbered 26 outwards (12 of males and 14 of females) and 70 inwards (33 of males and 37 of females). The corrected total of such births was 215 (113 of males and 102 of females), equal to 7 per cent. of the finally corrected total of all births. *The births of 7 children born and notified during 1911 had not been registered at the end of April of the current year. Special inquiries made in these cases were fruitless, as the families had gone away, in all except one. In that case the family was traced, and the parents stated that they thought "registration" was not required after " notification." Possibly the other parents thought so too. 8 sickness. SICKNESS: MORBIDITY. During the past few years there have been many additions (temporary and permanent) to the list of diseases to be "notified." In this section of the report only those diseases* which have been on the list from the commencement of notification (in 1889) will be dealt with, the remainder being reserved for consideration under individual headings. Table 5 gives the numbers of cases of the diseases notified last year in comparison with the numbers for the preceding five years. It is to be understood that no cases of the diseases included in the original schedule, but not mentioned in that table, were reported during the past year. In comparison with 1910, the only disease showing any noteworthy increase last year was diphtheria, of which there were 47 more cases (52, if membranous croup be included). The 168 cases of diphtheria and membranous croup were 16 in excess of the average (156) for the five years 1906-10. The cases of erysipelas (117) were 2 in excess of the same average (115), and the 39 cases of enteric and continued fevers, 4 in excess. The 2.26 cases of scarlet fever were 346 below the average (572), and the 7 of puerperal fever equal to the average. The only morbidity rates which have been calculated are those required for comparison with the notification numbers for the circumjacent districts, and are to be found in Table 6. Smallpox can be disregarded, as the disease was practically non-existent in the districts mentioned in the table. As regards diphtheria, lower rates than that recorded in the Borough (1.18) were observed last year in Westminster (0.90) and St. Marylebone (1.14). Last year's rates were below the average in the former district and in Willesden, last year's rate in Hampstead (1.76) being just a little more than double the mean (0.87). Lower rates from scarlet fever than that noted in the Borough last year (1.59) were recorded in Kensington (1.34), Westminster (1.58), and Hampstead (1.50), all of last year's rates being below the respective averages. The local rate from entcric fever (0.25) was the highest of the scries, and the only case where the average (0.24) was exceeded. The rates due to puerperal fever, being calculated on the total populations, are not of much value. Last year's rates were notably in excess of the averages in Hampstead (rate, 1911,0.07; average, 0.03) and Willesden (rate, 1911,0.10; average, 0.06). It should be remembered that the foregoing rates are based on reported cases (corrected for duplicate certificates), and that in all probability considerable differences would be observed were it possible to make adjustments for errors of diagnosis. TABLE 5. Notifications. Corrected for duplicate certificates only. Year. Smallpox. Diphtheria. Membranous Croup. Erysipelas. Scarlet. Fevers. Enteric. Continued. Puerperal. 1911 1 163 5 117 226 37 1 7 1910 - 116 - 100 258 40 - 9 1909 — 173 2 106 629 29 — 3 1908 — 142 4 105 681 31 1 6 1907 — 154 6 124 579 34 1 6 1906 1 182 138 715 34 1 12 *The original list of diseases was smallpox, cholera, diphtheria, membranous croup, erysipelas, and the fevers known as scarlet, enteric (otherwise typhoid), typhus, relapsing, continued, and puerperal. The diseases which have been added from time to time are chickenpox, cerebro-spinal meningitis (including posterior basic meningitis), anthrax, glanders, hydrophobia, poliomyelitis anterior, and ophthalmia neonatorum, all except the first being now permanently on the list. N0TIFICATION CHART Rates per 1000 persons 1911 —*—*—*-Average during 10 years ending 1910 Duration of School Holidays 9 deaths. TABLE 6. Morbidity Rates.* Disease. London. Paddington. Kensington. Westminster. St. Marylebone. Hampstead. Willesden. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. Smallpox 0.01 0.00 0.00 0.00 - - 0.00 0.00 - 0.00 - 0.00 - - Diphtheria 1.63 1.62 1.18 1.11 1.27 1.13 0.90 1.09 1.14 1.02 1.76 0.87 1.23 1.57 Erysipelas 1.07 0.96 0.82 0.80 0.72 0.78 0.51 0.56 0.92 1.07 0.58 0.47 0.76 0.58 Fevers Scarlet 2.31 4.22 1.59 3.98 1.34 2.47 1.58 2.88 2.79 3.09 1.50 3.27 2.09 4.14 Enteric 0.22 0.29 0.25 0.24 0.13 0.24 0.18 0.24 0.15 0.25 0.16 0.33 0.08 0.24 Puerperal 0.06 0.05 0.04 0.04 0.04 0.04 0.03 0.03 0.03 0.04 0.07 0.03 0.10 0.06 *Calculated (per 1,000 persons) from figures published in the Quarterly Reports of the Registrar-General. The numbers are corrected for duplicate certificates. TABLE 7. NOTIFICATIONS: 1906-11. (Corrected for Duplicate Certificates only.) Disease. Diphtheria, including Membranous Croup. Erysipelas. Scarlet Fever. Enteric Fever, including Continued Fever. Puerperal Fever. Year. 1911 1910 1909 1908 1907 1906 1911 1910 1909 1908 1907 1906 1911 1910 1909 1908 1907 1906 1911 1910 1909 1908 1907 1906 1911 1910 1909 1908 1907 1906 Wards of Borough. Queen's Park 27 19 21 11 17 16 7 13 9 9 16 13 25 36 61 86 81 140 2 2 3 5 3 3 ... ... ... 2 2 3 Harrow Road 42 24 48 44 48 87 29 27 28 14 25 34 80 75 166 215 172 161 9 7 2 6 8 11 2 2 ... 1 1 4 Maida Vale 24 12 22 21 19 38 17 12 16 11 11 19 34 33 45 74 76 87 9 7 5 4 4 4 3 1 ... 1 2 2 Westbourne 33 13 27 27 27 28 20 20 22 28 17 15 14 27 107 104 87 82 2 3 2 1 6 2 ... 4 1 1 ... 1 Church 31 28 45 24 32 18 35 19 29 43 36 12 47 61 171 152 100 177 7 13 10 6 7 10 1 2 2 1 1 1 Lancaster Gate, West 9 6 8 6 5 2 1 1 ... 4 3 3 11 19 16 13 15 3 2 ... 4 2 ... ... ... ... ... ... ... ,, ,, East 7 8 6 6 6 6 2 3 1 3 3 5 4 1 12 9 12 18 3 1 2 1 1 2 ... ... ... ... ... ... Hyde Park 5 6 9 5 6 9 5 5 5 2 12 7 19 14 48 25 85 35 3 5 5 5 4 1 1 ... ... ... ... 1 It has not been thought worth while to get out tables showing the sex-age incidence of the notified diseases, no information as to the numbers of individuals in each sex-age group being available. The only other table to be presented this year is Table 7, which shows the numbers of cases of the principal diseases reported during each of the past six years in each of the Wards. The changes shown by that table will be considered in a subsequent part of this report. DEATHS: MORTALITY. During the year 2,074 deaths were registered within the Borough, 1,059 of males and 1,015 of females, equivalent to a crude* mortality rate of 14.55 per 1,000 persons of all ages. A comparison of the crude rates for each of the four quarters of the past three years is given below:— Crude Mortality Rates. Quarters. 1. 2. 3. 4. 1911 16.94 13.77 14.03 13.44 1910 19.71 14.84 11.25 14.17 1909 15.69 14.10 10.68 15.69 *The "crude" rate is that based on the number of deaths registered within the district during the year; the "nett" rate, that based on the number after exclusion of deaths of non-residents within and inclusion of those of residents beyond the district; and the " corrected " rate, the nett rate multiplied by the correction factor necessary for the sex-age constitution of the population to reduce the mortality to that of a population of standard sex-age constitution. On this occasion no corrected rates can be given. 10 deaths. Last year's crude rate was 0.38 per 1,000 less than the corresponding mean (14.93) for the ten years 1901-10 (after re-calculation of the rates for those years to agree with the results of the last census), 0.78 less than that (15.33) for the five years 1901-5, and 0'03 above that (1452) for the years 1906-10. Table I., Appendix A, shows the crude rates recorded during 1901-10. The 2,074 deaths included 407 of non-residents, most of whom died in the various local institutions in the Borough (see Table VI., Appendix A). The deaths of residents beyond the Borough, regularly reported to the Department as in previous years, numbered 218. The nett total of deaths of residents of the Borough, according to the Department's records, was 1,885 persons, comprising 927 males and 958 females, equal to a nett rate of 13.22 per 1,000 persons, lhat rate was 0.43 less than the nett decennial mean (13.65), 0.84 less than the same rate for the first five years (14.06), and 0.03 less than that for the second five (13.25). (For the nett rates during 1901-10, see Table I., Appendix A.) Comparing the nett rates for the four quarters of the past three years— Nett Mortality Rates. Quarters. 1. 2. 3. 4. 1911 15.49 12.48 12.57 12.34 1910 18.56 13.72 9.41 13.51 1909 14.2 11.04 9.19 14.49 it will be seen that in the third quarter only was there any considerable increase in the mortality, but the (approximate) equality of the rates for the three quarters (second-fourth) does suggest. what will hereafter be demonstrated, that the hot summer did not produce that heavy mortality among infants (from summer diarrhoea) which, judging by past experience, was to be expected. TABLE 8. Deaths of Residents. Persons: all Ages. District. Males. Females. 1911. 1910. 1909. 1911. 1910. 1909. Borough 927 868 923 958 927 1,041 Queen's Park 119 97 107 102 101 93 Harrow Road 173 195 182 199 197 194 Maida Vale 136 115 132 135 130 143 Westbourne 186 144 134 171 149 190 Church 197 219 252 211 221 239 Lancaster Gate (West) 26 20 25 38 34 48 Do. (East) 32 19 22 32 35 40 Hyde Park 58 59 69 70 60 94 Owing to the want of the necessary data the usual tables of sex-age group mortalities cannot be submitted. As substitutes, Tables 8 and 9 have been prepared, the former showing the changes in the numbers of deaths among males and females recorded in the Borough and its Wards during the past three years, and the latter, the numbers of deaths at the six ages (groups of ages) in the whole Borough during the same period. Table II., Appendix A., shows the variations in the total numbers of deaths (persons) in the Wards during the six years 1906-11, at all ages and at ages under one year. deaths. 11 TABLE 9. Deaths of Residents. Sex-age Distribution. Age Periods. Males. Females. 1911. 1910. 1909. 1911. 1910. 1909. 0 — 209 164 165 178 130 146 1 — 83 97 69 65 71 76 5 — 35 34 24 24 35 29 15 — 23 27 30 39 28 27 25 — 373 319 399 331 335 367 65 — 228 227 236 338 328 396 Transferred Deaths.—The "clearing-house" system introduced by the RegistrarGeneral, desirable as it is, has resulted in producing a temporary confusion in local statistics, that is if the " transferred " deaths are included in the local statistics without any comment. It has, therefore, been deemed advisable to exclude them from the tables which have been already presented. They are, however, included in the two tables relating to deaths by ages and sex and by causes given in Appendix A. (Tables III. and IV.). To preserve continuity with the corresponding tables in previous reports supplemental tables (Tables III.A and IV.A) have been added. Such tables will be necessary for the next few years. The "transferred" deaths numbered 41, and their inclusion makes the nett total 1,926, 951 of males and 975 of females, and the nett mortality rate 13-51 per 1,000 persons. The numbers of deaths (persons) of residents of the Wards and the numbers in each age-sex group (whole Borough), after inclusion of the "transferred" deaths, are shown below (cf. Tables 8 and 9) :— Queen's Harrow Maida Lancaster Gate. Hyde. Park. Road. Vale. Westbourne. Church. West. East. Park. 1911 222 383 277 365 414 65 66 134 Age group 0— 1— 5— 15— 25— 65— Borough, Persons 387 148 59 52 704 566 In Table 10 the mortality rates recorded last year and the mean rates for the previous five years prevailing in the circumjacent districts are set out. All the rates* given in that table are based on estimates of the populations calculated on the basis of the results of the last census. Last year's rate in the Borough (13 30) was fourth in order of magnitude, lower rates having been observed in Westminster (12.42), Willesden (ll.72), and Hampstead (9.61). In Kensington, Westminster, and Hampstead last year's rates were below the respective mean rates. In none of the districts was the increase in the mortality rate for last year, presumably due to the hot summer, of any magnitude. A further confirmation of the surmise already made as to the absence of any heavy mortality from diarrhoea is afforded by that fact. Causes of Deaths.—The Registrar-General having adopted the " International List of Causes of Death " for use in his Office, it has been necessary to make the same change in the Department's system. Every endeavour has been made by subdivision of the headings in the new List to preserve the continuity of classification used in the Department while following most carefully the Rules as to classification issued by the Registrar-General. It is feared, however, that there have been some unconscious or inevitable changes in the Department's system of classification. Whatever the variations may amount to, the change was desirable, as the Registrar-General has announced his intention to tabulate his statistics by sanitary and not registration areas—a much wished for change. It is hoped that the figures in this report will be in substantial agreement with those hereafter issued by the Registrar-General. *At present properly corrected rates are not available. It should also be noted that the "transferred" deaths are not included in the numbers used for the calculation of the 1911 rates. 12 smallpox. TABLE 10. Mortality Rates.* London. Paddington. Kensington. Westminster. St. Marylebone. Hampstead. Willesden. 1911. 1906-10 1911. 1906-10 1911. 1906-10 1911. 1906-10 1911. 1906-10 1911. 1906-10 1911. 1906-10 All Causes 14.99 14.83 13.30 13.25 13.63 13.78 12.42 12.88 15.03 14.78 9.61 9.71 11.72 11.23 Smallpox o.oo o.oo - - - - 0.00 - - - — — Measles 0.56 0.41 0.33 0.26 0.54 0.28 0.14 0.12 0.56 0.24 0.16 0.12 0.32 0.27 Scarlet Fever 0.03 0.09 0.02 0.08 0.01 0.04 0.01 0.06 0.05 0.09 — 0.05 0.03 0.08 Diphtheria 0.13 0.13 0.07 0.09 0.10 0.11 0.08 0.08 0.04 0.09 0.19 006 0.07 0.08 Whooping Cough 0.22 0.28 0.30 0.19 0.31 0.20 0.16 0.12 0.23 0.22 0.03 0.10 0.56 0.25 Enteric Fever 0.02 0.04 0.02 0.02 0.02 0.02 0.02 0.03 0.01 0.02 0.02 0.03 0.02 0.03 Diarrhœa † 1.17 0.50 0.94 0.41 0.84 0.40 0.39 0.21 0.70 0.30 0.25 0.12 1.27 0.40 Phthisis 1.34 1.39 1.21 1.06 0.92 1.04 1.20 1.30 1.45 1.36 0.60 0.72 0.85 0.89 Other Tuberculous Diseases 0.37 0.51 0.34 0.33 0.16 0.42 0.29 0.33 0.20 0.27 0.16 0.24 0.30 0.35 Cancer 1.04 1.10 117 1.17 1.14 1.07 1.28 1.06 1.36 1.22 1.00 0.98 0.74 0.83 Infantile Mortality— Nett § 128 113 137 109 142 125 115 106 108 104 82 73 127 99 Corrected‡ 129 114 127 103 133 120 103 99 108 105 78 70 ? ? * The majority of the rates are based on figures published in the Quarterly Reports of the Registrar-General, the others on figures supplied by the Medical Officers of Health of the Districts. The rates—except where otherwise indicated—are per 1,000 persons of all ages of the populations, re-estimated from the last census. †The significance of the term " Diarrhoea " was altered at the commencement of 1911. For information on this point and the values of the rates given consult p. 55. § Per 1,000 births registered, as given in the Quarterly Reports, except in the case of St. Marylebone. For that Borough the numbers of births, exclusive of births to non-resident women in Queen Charlotte's Hospital, have been supplied by the Medical Officer of Health. ‡ From the Annual Summary (1911) of the Registrar-General. SMALLPOX. During the year one case of this disease was notified in the Borough in the person of a woman, aged 36 years, but the diagnosis was not verified at hospital. In the whole Metropolis 72 cases were reported during the year, one being a " Port" case (imported from abroad). Of the remaining 71 cases, 58 were reported in the course of the three weeks ended March 11th. Only one case was reported during the third quarter of the year, and none in the fourth. Last year complete returns of the notification of infectious disease in the whole of England and Wales were available for the first time. The cases of smallpox notified during the year numbered 304,* 31 to Port Authorities, occurring among ships' crews and passengers, 202 to the Extra-Metropolitan Sanitary Authorities, and 71 to Metropolitan.t The returns for the four quarters of the year are given below. Quarters, 1911 1 2 3 4 Metropolis 63 7 1 — Extra-Metropolis 102 70 22 8 Ports 5 16 4 6 Excluding the "Port" cases, the notifications represent a morbidity rate of 0.008 per 1,000 persons. * The totals given above have been abstracted from the Weekly Returns issued by the Local Government Board. Since the paragraph was written a Report—"Statistics of the Incidence of Notifiable Infectious Diseases in each Sanitary District in England and Wales during the year 1911"—has been published by the Board. The totals for the year given in that Report are 72 cases of smallpox in London (including Port of London), and 193 in other places in England and Wales. A comparison of the totals of 193 and 233 suggested that 40 cases (17.1 per cent, of the total originally notified as smallpox) were erroneously diagnosed in the first instance. † Of 65 cases admitted to the hospitals of the Metropolitan Asylums Board during the three weeks ended March 11th of last year, 8 (12.3 per cent.) were definitely reported as "not smallpox" and 2 as "doubtful," from which figures some idea can be obtained of the degree of uncertainty attaching to original diagnoses due to the continued freedom of the country from the disease. diphtheria. 13 Vaccination.—The Vaccination Officer has courteously supplied the usual returns of vaccinations during 1910 (Final Return), and the first six months of 1911 (Provisional Return), the figures from which are included in Table 11, which covers a complete decade, 1901-10. It will be seen that the proportion of children remaining " unaccounted for" (included those covered by "exemption certificates") continues to increase in an unsatisfactory manner. As vaccination is intended to secure a population protected against smallpox, the appended statement showing the proportion (per cent.) of children surviving their first birthdays is more instructive. Percentage of children Averages, surviving to age 1 year 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1901-5 1906-10 Protected 87.7 88.5 86.8 85.8 85.2 86.3 82.8 82.2 82.6 78.0 87.7 81.0 Unprotected 12.3 11.5 13.1 14.2 14.8 13.7 17.2 17.8 17.4 22.0 12.3 19.0 (including "exempted" 1.1 0.6 1.0 0.7 1.3 1.3 3.4 7.0 8.2 13.3 0.9 9.7) children The vaccinated children formed 87.7 per cent, of the total survivors in 1901, that proportion falling to 78.0 in 1910. Comparing the first five years (1901-5) with the second (1906-10), the proportion of vaccinated decreased from 87.7 to 81 0 per cent. The proportion of children covered by exemption certificates in the second period was ten times that in the first. TABLE 11. Vaccination Returns. Children Born. SuccessfullyVaccinated. Insusceptible of Vaccination. Died Unvaccinated. Per cent, of Births. Cols. 2, 8, & 4. Vaccination Postponed. Exempted under the Act. Rest* Per cent, of Births, Cols. 6,7, & 8. Cols. 1 2 3 4 5 6 7 8 9 1901 3,364 2,676 5 313 89.0 23 34 313 11.0 1902 3,262 2,629 12 291 89.8 35 19 276 10.1 1903 3,315 2,621 10 296 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 86.4 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† Jan.-June 1,452 1,017 7 112 78.2 51 168 97 21.8 * Including " gone away," " false addresses," &c. t Provisional return only. DIPHTHERIA. (Including Membranous Croup.) Last year 163 cases of "diphtheria" were reported and 5 of "membranous croup," giving a total of 168 cases, as compared with 116 in 1910. The numbers of cases notified under each designation during the past five years are given in Table 5. The distinction between diphtheria and membranous croup is more or less arbitrary, and of recent years there has been a tendency to make less use of the latter term in consequence of some difficulty in securing hospital accommodation.* The morbidity rates for the past six years have been in 1906, 1.27; 1907, 1.ll; 1908, 1.02; 1909, 1.22; 1910, 0.81; and in 1911, 1.17 per 1,000 persons. Last year's * The difficulty referred to was due to the inability of the Asylums Board to receive cases of membranous croup except when they were described as of a diphtheritic nature. Now the Board admit cases without that limitation. 14 diphtheria. rate was 0.08 in excess of the mean rate (1.09) for 1906-10. The following rates (per 1,000 persons) have been abstracted from the Report of the Local Government Board on Notification already referred to:— England 1.33 England, less London 1.22 Aggregate of County Boroughs, excluding London 1.47 The numbers of cases reported in each of the past six years in the individual Wards of the Borough are given in Table 7, and in Table 12 the numbers recorded therein during each quarter of the past year are compared with the average numbers for the like period. Last year's total cases were above the averages in five of the Wards and below in three, viz., Westbourne, Church, and Hyde Park. The increased prevalence of the disease was limited to the last quarter of the year. TABLE 12. Notifications. (Corrected for Duplicate Certificates only.) Wards Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Year 1911. 190610. 1911. 190610. 1911. 190610. 1911. 190610. 1911. 190610. 1911. 190610. 1911. 190610. 1911. 190610. Di phthe ria. Quarters 1 3 5 6 11 5 6 6 6 6 9 - 2 6 2 1 1 2 4 2 10 6 4 3 3 7 5 5 3 1 - 1 2 1 3 4 4 9 9 4 7 5 6 5 11 1 1 - 1 2 1 4 16 6 17 13 11 5 9 6 15 10 5 2 1 2 - 4 Year 27 17 42 39 24 21 23 25 31 35 9 6 7 6 5 7 Scarlet Fever. Quarters 1 6 14 16 35 14 11 6 17 5 24 - 5 1 1 3 7 2 7 20 22 38 8 18 3 18 7 29 1 2 — 3 5 12 3 7 20 15 40 2 15 — 23 18 37 1 4 2 2 4 6 4 5 27 27 45 10 19 5 23 17 42 1 4 1 3 7 8 Year 25 81 80 158 34 63 14 81 47 132 3 15 4 9 19 33 The numbers on which the foregoing observations are based are the totals reported, allowance being made only for duplicate certification. Such totals included 16 cases which were subsequently found to have been erroneously diagnosed.* The "errors" formed 11.3 per cent, of the total cases reported, as compared with an average of 12.5 for the years 1906-10. The proportions of errors noted in the individual Wards varied from zero in Lancaster Gate, East, to 22 2 per cent, in Queen's Park. In Harrow Road the proportion was 11'9. Of the remaining 152 cases which are to be presumed to have been correctly diagnosed, 7 were "contracted in hospital" and followed preceding attacks of scarlet fever, 8 were apparently due to infection contracted outside the Borough, 3 to the return home of patients from isolation *The morbidity rate, after exclusion of "errors," was 1'04 per 1,000 last year, the corresponding average for 1906-10 being 0'95. diphtheria. 15 hospitals, and one followed an operation. Multiple cases were reported from 15 houses, viz., 2 from 9 houses, 3 from 5, and 4 from one. The frequency of multiple attacks after correction for errors of diagnosis was— Houses with 2 cases, 9; with 3 cases, 4; and with 4 cases, 1. The secondary cases numbered 29, or 13.1 per cent, of the correctly diagnosed cases, whereas in 1910 there was only one secondary ease. The disease spread to a second family in the same house on two occasions, the date of the second case suggesting that it was due to the return home of the previous patient, while in the other instance the spread was synchronous with the earlier cases (there were three cases in all in that house). Simultaneous notification of multiple cases was noted in four instances, once from a house with two cases, and three times from houses with three. In the latter, all three cases were reported together twice, and in the other instance two out of the three cases. With regard to the house whence four cases were reported, the facts elicited were of some interest. A young lady arrived at a boarding-house on October 15th, and was certified to have diphtheria on the 24th, being removed to hospital on the same day. Between the 15th and the '24th the patient was nursed by a daughter of the proprietor of the house, the daughter being taken ill on the 23rd, and removed to hospital on the same day as the first patient. Two further cases occurred on November'22nd and 26th, the case on the 2'2nd being in the person of the son of the proprietor, and the other a guest. All the cases were certified after bacteriological verification. The first case of all appears to have sickened at an address in Westminster earlier than October 15th, and to have had medical treatment before moving to Paddington. She had also been to an address in Liverpool. Enquiries were made of the Medical Officers of Health of Westminster and Liverpool, but no history of any known case of diphtheria with which the patient had been in contact could be obtained. On November 30th the medical practitioner in attendance "swabbed'' the throats of every person in the boarding house, and the Klebs-Loffler bacillus was demonstrated in 4 out of the 16 swabs taken (one being from the throat of the family cat). Attention was given to the throats from which the bacillus was recovered (the cat was not infected), and no further case occurred. There was also a small outbreak of diphtheria at the Lock Hospital, presenting very nearly the same characteristics, but as none of the patients belonged to the Borough the cases were not included in the number reported. On August 11th a case (male, aged 3 months) was reported by the House Physician of St. George's Hospital, the address being given as " 283, Harrow Road " On enquiries being made it was ascertained that the child had been an in-patient of the Lock Hospital, and had been transferred to St. George's Hospital for operation to relieve dyspnoea. At the latter hospital a swab had been taken, and the Klebs-Lcffler bacillus had been found. The patient was then transferred to the Asylums Board's Hospital. On October 6th a second case occurred, and a third on the 10th. On the latter date the throats of all the patients in the ward and of the staff attached to it were "swabbed," and the Klebs-Loffler bacillus was found to be present in the throats of three other children. They were removed to the Asylums Board's Hospital, although none of them presented any sign of clinical diphtheria—one had a slight "cold in the nose"—and no further case of the disease occurred. There was a group of cases in one of the class-rooms of Moberly School, particulars of which will be found under school attendance. Sixty-one of the cases of reported diphtheria were notified after bacteriological test, the Klebs-Loffler bacillus being reported GO times (one of the cases being ultimately reported as "not diphtheria"), and the Hoffmann (pseudo-diphtheria) bacillus once. Two of the reported cases were nothing more than "bacteriological diphtheria," that is to say, the patients had the Klebs-Loffler bacillus in their throats (or noses), but presented no clinical signs of the disease. Six of the patients had nasal diphtheria only. In two instances diphtheria followed preceding attacks of measles ; in four the disease was contracted through nursing other patients, and once the family cat (not the one referred to above) fell under suspicion as the source of infection, but no proof of the suspicion was forthcoming. One patient was reported with a second attack of the disease, the diagnosis being confirmed on both occasions. Of the 168 reported cases, 154, including 13 "errors," were removed to hospital. The percentage of patients removed last year was 916, or 3.6 more than the average (87.9) for the years 1906-10. The percentages of cases removed from the individual Wards varied from 100 16 diphtheria. (in Church, Lancaster Gate, West, and Hyde Park) to 28-5 (Lancaster Gate, East). Among the patients sent away there were 12 deaths, 11 from diphtheria and 1 (an "error") from pulmonary tuberculosis (male, aet. 1 year: bacteriological test, Klebs-Loffler present). Among the 14 patients treated at home there was one death. (See Table 13.) TABLE 13. Diphtheria. Scarlet Fever. Enteric Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Total Reported. Removed to Hospital. At Home. In Hospital. Total Reported. Removed to Hospital. At Home. In Hospital. Total Reported. Removed to Hospital. At Home. In Hospital. Queen's Park 27 (6) 24 (5) 1 - 25 (5) 22 (5) - l(-) 2 (1) 2 (1) - Harrow Road 42 (5) 38 (4) - 2(-) 80(16) 79(16) - - 9(4) 7(2) - 3(1) Maida Vale 24 (2) 23 (2) - 2(1) 34(4) 33 (4) - 1(1) 9 (1) 8(1) - 2(-) Westbourne 23 (2) 22 (2) - 4(-) 14 (1) 12(1) - - 2 (1) 2(1) - - Church 31 (2) 31 (2) - 2 (-) 47 (6) 47 (6) - 2(-) 7 (2) 7 (2) - 1(-) Lancaster Gate, West 9 (1) 9 (1) - 1 (-) 3 (-) 3(-) - - 3(1) 2(1) - - „ East 7 (-) 2(-) - 1 (-) 4(-) 4(-) - — 3(1) 3(1) - — Hyde Park 5(1) 5(1) - — 19 (-) 18 (-) - - 3(-) 2(-) - — Figures in parentheses show numbers of " errors " of diagnosis. TABLE 14. Diphtheria. Scarlet Fever. Enteric Fever. 1911. 1906-10. 1911. 1906-10. 1911. 1906-10. Removed to Hospital 91.6 87. 9 96.4 93.0 84.2 76.0 Fatality† —Total 8.0 9.6 1.5 2.3 19.2 14.0 At Home 8.3 12.7 — 1.0 — 25.6 In Hospital 8.0 9.2 1.6 2.4 20.8 9.7 Mortality‡ 0.08 0.09 0.02 0.09 0.03 0.03 * Per cent, of all cases reported. † Per cent. of attacks, after correction for errors of diagnosis. Based on cases and deaths reported during the year. ‡ Per 1,000 persons of all ages. Based on total number of deaths recorded. The 12 deaths represent a fatality of 8.0 per cent, (on the 154 correctly diagnosed cases), as compared with a mean fatality of 9.6 per cent, (also on correctly diagnosed cases) during 1906-10. Last year the fatalities observed in the Wards ranged from zero (Hyde Park) to 19.0 per cent, in Westbourne. In Lancaster Gate, West and East Wards, the fatalities were 12.5 and 14.2 per cent. respectively. It should be remembered that all those fatalities are based on very small numbers, and much importance should not, therefore, be attached to them. The 12 deaths from diphtheria included one from "croup," and were equivalent to a mortality of 0.08 per 1,000, 0.01 less than the mean rate for 1906-10. The numbers of deaths and the mortality rates for the six years are given below:— 1906. 1907. 1908. 1909. 1910. 1911. Deaths 15 20 16 11 9 12 Mortality 0.10 0.13 0.11 0.07 0.06 0.08 The rates for the circumjacent districts will be found in Table 10. 17 scarlet fever. SCARLET FEVER. There were 226 cases of this disease reported during the year, the smallest total since the' formation of the Borough in 1900, and 32 less than the total for 1910, the previous lowest on record. The numbers of cases reported in each cf the six past years and the morbidity rates (per 1,000 persons) due therefrom are given below:— 1906. 1907. 1908. 1909. 1910. 1911. Cases 715 579 681 629 258 226 Morbidity 4.99 4.04 4.76 4.40 1.80 1.58 The average annual number of cases during 1906-10 was 572, and the morbidity rate 4.00. The morbidity rates from this disease in the circumjacent districts are given in Table 6. The following rates (per 1,000 persons) for the past year are taken from the Report of the Local Government Board already referred to:— England 2.84 England, less London 2.71 Aggregate of County Boroughs, less London 3.33 Table 7 shows how the numbers of cases reported during the year in the individual Wards of the Borough compare with the totals for the preceding five years. In Table 12 the numbers recorded in the Wards in each quarter and during the year are compared with the averages for the preceding five years. Throughout the last table the numbers for 1911 are much lower than those for 1906-10, in some instances strikingly so. The 226 reported cases included 32 erroneously diagnosed as scarlet fever.* The proportion of "errors" was no less than 14.1 per cent., as compared with an average of 5'6 per cent, during the preceding five years. A higher proportion of " errors " is more likely to occur when a disease is at a low ebb than when it is exceptionally prevalent as it has been during part of the period 1906-10. The proportion of "errors" was highest last year in Queen's Park and Harrow Road Wards (20 per cent, in each case), while none were recorded in Lancaster Gate, East and West, and Hyde Park Wards. Of the 194 cases correctly diagnosed, 28 were apparently due to infection acquired outside the Borough, 9 to the return home of patients from hospital, and 7 occurred in patients already in hospital, being attacks of scarlet fever supervening on diphtheria. Multiple cases were reported from 23 houses, as compared with 36 in 1910. A comparison of the frequency of multiple infections, not corrected for " errors," during the past five years is given below:— 1911. 1910. 1909. 1908. 1907. Houses with 2 cases 16 23 62 57 63 „ 3 „ 3 9 26 30 21 „ 4 „ 2 3 3 13 7 „ 5 „ 1 1 1 5 2 „ 6 „ — — — 1 2 „ 7 „ 1 — — 2 2 The distribution of multiple cases, after correction for " errors," during the past three years is given below, the numbers of families with multiple cases being given as well as those of houses. Last year in no house was a second family infected. 1911. 1910. 1909. Nos. of houses with 2 cases 14 21 59 „ 3 ,, 2 7 22 „ 4 ,, 1 2 3 ,, 5 ,, 1 1 1 Nos. of families with 2 cases 14 22 51 „ 3 „ 2 6 14 „ 4 ,, 1 1 4 „ 5 „ 1 1 — *The morbidity rate, after exclusion of "errors," was 1.36 per 1,000 last year, the corresponding average for 1906-10 being 3 77. 18 ENTERIC FEVER. The secondary cases (25) last year formed 12'8 per cent, of the total, as compared with 17.8 per cent, in 1910 and 9'5 in 1909. The comparatively high proportion of such eases last year was due to the houses (and families) with 4 and 5 cases which would heavily weight a year with so small a total of cases. From the houses (families) with two cases, both eases were reported on the same day four times, and in four other instances the second case was due to discharge of the previous patient. In the remaining six instances the intervals between the first and second cases were 1 day, 3, 4 (twice), 12, and 45 days. From each of the houses with three cases two cases were reported together. In one instance an interval of 20 days elapsed between the onsets of the first and the remaining two cases, and in the other the second and third cases were not reported, although their illnesses antedated that of the first by some days, until after the first—a diagnosis not being arrived at until after consultation with the Medical Officer of Health. The cases from the house with four infections were reported on the same day, and the intervals between the cases (onsets) in the house with five cases were 2 (twice), 4, and 5 days. Except in the houses with return cases, direct personal contact with the primary case was the cause of the secondary cases in all but one instance, in which the interval (45 days) appeared to point to some other channel of infection. Of the 226 reported cases, 218 were removed to hospital. The proportion of cases removed to all cases was 964 per cent., an increase of 34 above the average for the preceding five years. (Table 13.) From three Wards all the reported cases were removed to hospital, the smallest proportion of the removed being noted in Westbourne Ward (85'7 per cent.). There was no death among the eight cases kept at home, and only four (one an " error") among those removed to hospital. The three fatal cases of scarlet fever were equal to a fatality of 1.5 per cent, of all correctly diagnosed cases, the average for 1906-10 being 2.3. (Table 14.) The fatality among the patients treated in hospital last year was 1.6, as compared with 2'4 for the preceding five years. The deaths occurred among patients removed from Queen's Park (1 death) and Church (2 deaths) Wards. The mortality from this disease last year was at the rate of 0.02 per 1,000 persons, the lowest recorded since 1891, and probably the lowest on record. The rates recorded in each of the six past years were:— 1906. 1907. 1908. 1909. 1910. 1911. Deaths 18 13 15 14 7 3 Mortality 0.12 0.09 0.10 0.09 0.04 0.02 The rates recorded last year in the circumjacent districts are shown in Table 10. Lower rates (0.01) were recorded in Westminster and Kensington. In Hampstead there was no death from this cause. ENTERIC FEVER. (Including Continued Fever.) Thirty-seven (37) cases of enteric fever were reported last year, and one of continued, making a total of 38, or 4 more than the average (34) for the years 1906-10. The numbers of cases reported in the individual Wards (totals for each year) during the past six years are given in Table 7. The numbers recorded quarter by quarter have been too small to allow of satisfactory averages being determined. A comparison of the annual averages for the Wards is given below:— Queen's Harrow Maida Lancaster Gate, Hyde Park. Road. Vale. Westbourne. Church. West. East. Park. Cases, 1911 2 9 9 2 7 3 3 3 Averages, 1906-10 3 7 5 3 9 2 1 4 The 38 " reported " cases were equal to a morbidity of 0.26 per 1,000 persons, 0 02 in excess of 19 ENTERIC FEVER. the five-year average (0.24). The numbers of cases and the morbidity rates recorded during the six years are appended :— 1906. 1907. 1908. 1909. 1910. 1911. Cases 35 35 32 29 40 38 Morbidity 0.24 0.24 0.22 0.20 0.28 0.26 How the local rates compare with those for London and the districts circumjacent to the Borough can be seen from Table G. The favourable position of the Metropolis in comparison with the other parts of England is clearly shown by the following rates (per 1,000 persons) extracted from the Report on Notification Statistics already referred to:— England 0.38 England, less London 0.39 Aggregate of County Boroughs, less London 0.43 London 0.23 The local figures for last year which have been given so far represent reported cases, among which there were 11 "errors,"* equal to 28 9 per cent, of the total, the average for the preceding five years being 169—a considerable difference. The proportions of "errors" noted last year ranged from zero in Hyde Park Ward to 50 percent, in Queen's Park, Westbourne, and Lancaster Gate, East, Wards. Eleven (11) of the remaining 26 cases were thought to have been due to infection acquired outside the Borough, and among the other 15 cases 2 occurred in persons working at fried fish shops and 2 others were due to earlier cases in their households. The Widal reaction was applied for the purpose of diagnosis in 15 instances, 14 with positive results (2 of the cases being, however, subsequently pronounced to be suffering from diseases other than enteric fever, viz., tuberculosis and gastric ulcer), and one with a negative—the case, certified as enteric fever on the symptoms before removal to hospital, ultimately proving to be one of scpticzemia. In one other case, in which a positive reaction was obtained, the diagnosis of enteric fever remained a matter of doubt. In two families secondary cases occurred. In the one the second patient (a mother) sickened some six weeks after her child had been removed to the Infirmary. She had visited the child almost daily. In the other instance the first patient (f., æt. 25) sickened (approximately) on June 29th, and was admitted to the Infirmary on July Pith. She died on July 26th. Her husband was taken ill about July 14th, and admitted to the Infirmary on August 3rd. In both cases a positive Widal reaction was obtained. Of the 38 reported cases, 32 were removed to institutions for treatment, the proportion of removed to total cases being 84.2 per cent., 8.2 above the average (76.0 per cent.). (See Table 14.) The numbers of cases removed from the individual Wards were too small to make it worth while to give the proportions. The figures themselves are given in Table 13. There were G deaths among the reported cases (all in institutions),one of them being an "error." The total fatality was 18.5 per cent. (Table 14), or 52 in excess of the average. The fatality among institutional cases last year was 20.8 per cent., more than double the average (9.7 per cent.). The numbers of deaths and mortality from enteric fever during the past six years is given below. Last year's rate (0-03) was equal to the average for the five preceding years. 1906. 1907. 1908. 1909. 1910. 1911. Deaths 8 5 4 3 4 5 Mortality 0.05 0.03 0.02 0.02 0.02 0.03 The mortality rates for the circumjacent districts are to be found in Table 10. *The morbidity rate, after exclusion of " errors," was 018 per 1,000, the corresponding average for 1906-10 being 0.19. 20 SEPTIC DISEASES. SEPTIC DISEASES. This general heading includes "puerperal fever " and "erysipelas "—forms of septic infection which are scheduled for notification—and diseases such as pyaemia, infective endocarditis, &c., commonly grouped together under the sub-heading " other septic diseases," of which nothing is known save the number of deaths. Puerperal Fever.—Last year 7 cases of this disease were reported, 2 in Harrow Road Ward, 3 in Maida Vale, and one each in Church and Hyde Park. The number of cases reported last year was equal to the average. The morbidity rates (per 1,000 persons) in the Borough and the circumjacent districts are given in Table 6, but having regard to the fact that the disease is limited to women and to the age period 15-45 years, not much value attaches to those rates. In previous reports morbidity rates for the estimated numbers of women at child-bearing ages have been given, but on this occasion the necessary data for making such estimates are wanting. As substitutes for the morbidity rates based on the numbers of women, rates based on the numbers of births registered have been taken out. Strictly speaking the rates ought to be based on the numbers of confinements which, owing to the frequency of multiple births, would be smaller than the numbers of children. Subject to that reservation, which implies that the rates slightly understate the true frequency of the disease, the rates now submitted are, probably, the best available. The rates for last year in the Borough and the circumjacent districts are given in Table 15. The morbidity in Paddington (0.24) during the past year was the lowest but one of the series, that of St. Marylebone (0.16) being the lowest. Last year's rates were generally higher than the average, that for the Borough being, however, only 0.0l in excess. The districts in which last year's rates were below the averages were Kensington and St. Marylebone. Of the seven attacks reported last year, three occurred in primiparie, all unmarried women, two of them being unattended in their labour. Two of the children born to those women were dead at birth, and the third required instrumental assistance (there was some laceration). There was a history suggestive of gonorrhceal infection in one case at least. Of the four married women two had normal labours, a third was delivered with the help of instruments (some laceration), and the fourth was delivered of a dead child, she having chloroform and (presumably) surgical help in labour. One woman was attended by a qualified midwife and the others by medical men assisted (in two instances) by untrained women. Three of the married women died, none of the unmarried. The fatality among the reported cases was, therefore, 42 8 per cent., according to the Department's figures. The Registrar-General placed only two deaths under this heading, giving a fatality of 28-5 per cent. (See Table 15.) TABLE 15. Puerperal Fever and Mortality in Childbed.* Paddington. London. Kensington. Westminster. St. Marylebone. Hampstead. Willesden. 1911 190610 1911 190610 1911 190610 1911 190610 1911 190610 1911 190610 1911 190610 Puerperal Fever— Morbidity † 0.24 0.23 0.26 0.22 0.23 0.26 0.28 0.22 0.16 0.21 0.50 0.26 0.41 0.24 Fatality‡ 28.5 36.1 46.8 69.9 57.1 51.1 66.6 55.1 — 50 50 50 50 48.9 Mortality† 0.07 0.08 0.12 0.13 0.13 0.13 0.18 0.12 - 0.10 0.25 0.13 0.20 0.11 Accidents and Diseases of Parturition— Mortality† 0.10 0.31 0.13 0.14 0.23 0.23 0.18 0.22 0.29 0.30 0.25 0.33 0.25 0.23 Total Mortality† in ( liildbed 0.17 0.40 0.26 0.27 0.36 0.37 0.37 0.34 0.29 0.41 0.50 0.46 0.46 0.34 "Compiled principally from figures published in the Quarterly Reports of the Registrar-General, † Per 100 births registered. ‡Per 100 cases notified. 21 SEPl'IC DISEASES. The total deaths from puerperal fever according to the Department's records was 5, viz., the three just referred to and two unnotified deaths, one the termination of an unreported case dating from 1910, and the other a death belonging to Paddington which occurred in Westminster. Mortality in Childbed.—In addition to the 5 deaths from puerperal fever, there were 5 other deaths from " accidents and diseases of parturition." Below the mortality (or, perhaps, more correctly the fatality) attaching to child-birth last year is compared with the average figures for 1906-10, as deduced from the records kept by the Department. Fatality per 100 Births. 1911. 1906-10. Puerperal Fever 016 0.08 Accidents and Diseases of Parturition 0.16 0.30 Total 0.33 0.38 The foregoing show a slight improvement last year in comparison with the average, but taking the Registrar-General's figures (Table 15), the improvement was really considerable. The total fatality recorded in the Borough was the lowest of the whole series. In Table 16 the changes noted in the fatality, &c., in the individual Wards are set out. The table is more curious than instructive. TABLE 16. Births. Puerperal Fever. 1911. Deaths from Mortality in Childbed. Morbidity. Fatality. Puerperal Fever. Accidents, &c., of Parturition Total. 1911. 1906-10. 1911. 1906-10. 1911. 1906-10. Queen's Park 383 - 0.32 - 42.8 - - - - 0.56 Harrow Road 726 0.27 0.20 50 62.5 1 2 3 0 41 0.22 Maida Vale 405 0.74 0.28 333 33.3 1 — 1 024 0.33 Westbourne 458 - 0.29 — 14.2 — — — - 0.29 Church 726 0.13 0.18 100 28.5 1 1 2 0 27 0.40 Lancaster Gate, West 50 - - - 1 1 2 00 0.59 ” East 69 - — — — — - - — 0.65 Hyde Park 160 0.62 0.13 100 — 2 1 3 187 0.43 Erysipelas.—The reported cases numbered 117 last year, or rather 116, as one patient had two attacks during the year. The figures given in Tables 5 (whole Borough) and 7 (Wards) tell practically all that can be said about the incidence of the disease during the past six years. The morbidity rates are given in Table 6. Last year's cases included 50 of males and 67 of females. Twenty-two of the patients (18 9 per cent.) received institutional treatment, or nearly double the proportion noted in 1910 (10 per cent.). The deaths during the year numbered 9, making the fatality 7'6 per cent. (.3 per cent, in the preceding year). other Septic Diseases.—Eleven deaths were recorded under this heading. A tabulation of the numbers of deaths (including those from erysipelas) registered during the past six years is appended:— Deaths Recorded during 1911. 1910. 1909. 1908. 1907. 1906. Erysipelas 9 3 4 5 7 7 Carbuncle — 1 1 — — — Cellulitis — 4 3 — 1 2 Angina Ludovici 3 — — — — 1 Pyæmia 1 3 2 4 1 3 Septic pneumonia — — — 1 — — Infective endocarditis 6 4 3 2 3 3 Stomatitis — — 1 — 1 — Cancrum oris 1 1 — 1 — 2 22 cerebro-spinal fever. The exemption of children (not infants) and young adults from fatal erysipelas is clearly shown by the following tabulation for sex and age:— Ages. Deaths 0— 1— 5— 15— 25— 65— during M. F. M. F. M. F. M. F. M. F. M. F. Erysipelas 1911 - 1 - - - - - - 2 5 1 — 1906-10 4 3 - - - - - - 5 7 4 3 Other Septic Diseases 1911 1 — — — - — — 2 5 3 — — 1906-10 2 1 3 1 2 1 1 1 18 10 2 6 The mortality from erysipelas last year was just double the average, that from other septic diseases 0.01 above. (See below.) 1911. 1910. 1909. 1908. 1907. 1906. Erysipelas Deaths 9 3 4 5 7 7 Mortality 0.06 0.02 0.02 0.03 0.04 0.04 Other Septic Diseases Deaths 11 13 10 8 6 11 Mortality 0.07 0.09 0.07 0.05 0.04 0.07 CEREBRO-SPINAL FEVER* (Epidemic Cerebro-spinal Meningitis.) The notification of this disease was continued for a further period of twelve months by an Order made by the County Council in February of last year.† Two cases only were reported under the Order during the year, but two other cases came to the knowledge of the Department by registration of the deaths of the patients. One of the cases was notified as " cerebro-spinal meningitis," the other as " posterior basic meningitis," both cases terminating in death. The notes of the four cases were as follow (the two first being those notified):— (1) P. W., f., æ t. 1, residing in Clarendon Street ; father a labourer. The child was taken ill on Feb. 6th, the attack coming on suddenly after sleep. She had a convulsive fit on the 7th, on which day she was taken to St. Mary's Hospital, moribund, and died within an hour. She had a rash ("red circular macules up to J in. in diameter, fading on pressure ") on admission. P.M. Examination.—" Very small patches of quite early meningitis over interpeduncular space and corpora quadrigemina : no sign of tubercle : convolutions flattened : with the exception of congestion, other viscera absolutely normal." Bacteriology.—" A Gram-negative intracellular diplococcus was found in smears from the cerebro-spinal fluid; organisms very minute." No cultivations were made. The patient's family (12 persons, 6 under 10 years of age) occupied the ground floor (three rooms) of the house, the back room being verminous. There was one other family of 7 persons in the house, the third tenement (basement) being empty. The previous occupiers of the basement (S. family) had had their baby ill some three weeks previously, but the family could not be traced. There was no history of any other illness in the house, and the child P. W. had not been away from home. (2) S.W., m., set. 1, residing in Richmond Mews West; father a carman. Taken ill March 1st with vomiting and (?) headache, always drowsy and more or less asleep, but not comatose (15th). Slight retraction of the head. Kernig's sign present. Patient was admitted to St. Mary's Hospital on March 5th and died April 12th. *The Royal College of Physicians has advised the County Council that the term " cerebro-spinal fever" includes, for the purposes of notification, cases of " posterior basic meningitis," but does not include cases of meningitis due to tubercle, syphilis, middle ear disease, or injury. †By an Order made in March of this year, the disease has been permanently added to the list of notifiable diseases. 23 POLIOMYELITIS. P.M. Examination.—Acute inflammation of the cerebral and spinal meninges. Upper convolutions of the brain slightly flattened: turbid fluid under meninges: cerebro-spinal fluid increased in quantity and opaque with flakes of lymph : the other organs of the body indicated an acute toxic inflammation (cloudy swelling and incipient fatty degeneration). Bacteriology.—Smears taken before and after death showed a Gram-negative intracellular diplococcus indistinguishable from the diplococcus meningitidis of VVischelbaum. Cultures after death gave the same organism. The patient's family comprised 8 persons, 3 under 10 years of age, living in three rooms, which were clean and free from vermin. There was no other illness in the family (the only one in the house), and no history of the child being away from home. (3) W. m., æt. 3, residing in EInathan Mews : father unknown (a nurse child). Taken ill March 26th: delirium, 28th: coma, 30th: muscular rigidity, 31st: died April 2nd. No post-mortem examination allowed. The family comprised four persons, one under 10 years of age (the deceased). An attack of varicella in deceased the only illness known. The home comprised three rooms, clean and free from vermin. (4) E. R., f., five months, residing in Bravington Place; father a carman. Attack began August 10th, with sickness, slight coma, and some muscular rigidity. The patient was taken to St. Mary's Hospital on August 12th, and died at home the same day. When seen at the Hospital (patient could not be admitted for want of accommodation) the conditions were coma, much wasting, marked contraction of the head, and of the abdomen. Kernig's sign and tdche ciribrale present. "A typical case of posterior basic meningitis." There was no P.M. examination and no bacteriological test. The family consisted of 7 persons, 3 under 10 years of age. The home contained three rooms, was clean and free from vermin. There was no history of any previous illnesses in the family or any absence from home. POLIOMYELITIS. The diseases known as "acute poliomyelitis" and "acute polio-encephalitis" became notifiable by an Order of the County Council made in July of last year.* The Order came into operation on September 1st. Only one case was notified during the remaining four months of the year. The notes of the case are as follow:— F. F., m. set. 10, residing in Barnsdale Road, a scholar of Essendine Road (Physically Defective) School. The patient had been delicate from birth. The date of onset could not be stated definitely, but he had paralysis at the age of five years and had been a patient at St. Mary's and the Welbeck Street Hospitals during the past two years. He was reported to have lost the use of his limbs in 1910. At the date of the inquiries (October 4th) there was a history of sickness during the last four days, with headache, but no delirium or coma. He had wasting of "all " his muscles, pain in the side only when coughing. The glands of the neck were enlarged. There was no rash, but sweating was reported to occur. The patient's family comprised 5 persons, all aged 10 years and upwards. Two other families lived in the house, all the members thereof being adults. The patient's home (three rooms) was clean and free from vermin. There had been no other illness in the family or house, and the patient had not been away from home. The patient was alive when last heard of. ANIMAL DISEASES. Anthrax, hydrophobia, and glanders—all diseases contracted from infected animals—are scheduled for notification. No cases were reported among human beings during the year, but five outbreaks of glanders (each of one case) were reported among the horses in the Borough. In 1911 there were 10 outbreaks, and in 1910, 11. *By an Order made on March 13th of this year the above were permanently added to the list of diseases to be notified. 24 OPHTHALMIA NEONATORUM. OPHTHALMIA NEONATORUM. On June 9th, 1910, the Public Health Committee considered a letter from the Social Welfare Association for London in which that Association urged the necessity of making this disease notifiable. The letter was referred to the Medical Officer of Health for report. His report* was submitted on the 20th of the following October, and the Committee resolved to recommend the Council to make an Order under the Public Health (London) Act, 1891, requiring the disease to be notified. The recommendation of the Committee was adopted on November 15th, but, in the meantime, the Medical Officer of Health of the County had been instructed to report on the subject. The County Council in February of last year made a similar Order to that adopted by the Borough Council, which was duly confirmed by the Local Government Board, no action being taken by the Board with respect to the Order made by the Borough Council. The Order made by the County Council has this advantage over that made by the Borough Council, viz., that it is applicable to the whole County and not to a limited area thereof. The Order became operative on March 14th of last year. The Order is perfectly general and the disease is, therefore, now a " dangerous infectious disease" to which all the provisions of the Public Health Act relating to compulsory removal to hospital and disinfection, penalties for exposing an infected person in a public place, &c., &c., apply. It is somewhat remarkable that the Order should have been made so general. In the case of measles, which is not, however, a notifiable disease, only certain of the preventive sections (as to disinfection, &c.) have been made applicable. It would seem to be somewhat superfluous to make the whole of the law dealing with "dangerous infectious diseases " apply to ophthalmia, a disease which never kills, is contagious, not infectious, and for which notification was sought solely with a view to seeing that the children attacked should receive proper treatment to obviate that permanent loss of sight which so frequently ensues from neglect. The disease is manifestly one which requires administrative procedure of a special character. The inquiries and general supervision of the cases were delegated to the Women Inspectors, the routine prescribed being set out in a Memorandum of which a copy is given in the Appendix B. The Order was operative for a little more than nine months and during that time 21 cases † were notified, 3 of the patients being in the charge of the Poor Law. The Ward distribution of the remaining 18 cases was— Queen's Park, 1; Harrow Road, 3 ; Maida Vale, 5 ; Westbourne, 2 ; Church, 5 ; and Hyde Park, 2. Eight of the children were males and 13 females, their ages ranging from a few days to one year, the elder children (aged 2, 4 and 12 months) being girls. The ages of the other 18 were— Under 1 week, 8 (3 males, 5 females). 1— weeks, 6 (3 ,, 3 ,, ). 2 ,, 2(1 male, 1 female). 3— „ 1 (female). 4— ,,0. 5—6 „ 1 (male). Seven of the children were illegitimate, the proportion (33*3 per cent.) contrasting badly with the proportion of illegitimate to total births (0 7 per cent.). The period of incubation (i.e., the interval between birth and onset of disease; is of some interest, and the appended analysis of the records of last year suggests that there are two distinct forms of infection—one acting very quickly, the other less so. Intervals to Onset. 0 days (day of birth)- 4 1 day — 0 2 days — 1 3 days — 8 4 „ - 1 5 „ — 0 6 days 7 „ 8 „ 9 „ 1 each. (In 3 cases the intervals were not recorded.,) * The report forms part of the Minutes of the Council (vol. 1909-10, p. 737;. †In the report of 1910, already referred to, estimates of '20 genuine cases and a possible maximum of 60 (of all degrees of eye trouble) were made. 25 MEASLES. Nine of the cases were notified by private practitioners, 4 (each) by the Medical Officers of the County Council and the Poor Law, 2 by the Physicians of the Western Ophthalmic Hospital, and 1 (each) by those of St. Mary's and the Children's (Paddington Green) Hospitals. It is generally recognised that the disease can be prevented in the majority of cases by the adoption of suitable precautions (in the way of " eye toilet ") at the time the child is born. Prima facie one would expect more cases to occur in connection with confinements which are not attended by medical men. Last year, however, the cases were equally divided between midwives and medical men (9 each, information as to the other 3 not being obtainable1!. Three cases were proved to be gonorrhoeal, the gonococcus being found on microscopical examination. It would doubtless save a good proportion of attacks if bacteriological examination were resorted to prior to labour whenever the expectant mother was known to have any discharge. Five patients received treatment in Poor Law Institutions, and 9 in the Out-patients Departments of Hospitals. Four children were attended by the Queen Victoria Nurses, 3 of such children being out-patients of hospitals and one a private patient. In one case only did any permanent damage to the eye (rupture of the globe) ensue, that child succumbing to another disease before the end of the year. Two other children were also known to have died, not of ophthalmia, before the end of the year. There was no known case of spread to any other person, but in one case there was a history suggestive of the reported child having been infected by an elder child (over a year old) in the same house. MEASLES. During the past year 1,281 cases of measles were reported to the Department, a number considerably in excess of that anticipated. In addition there were 148 cases of German measles, which disease is held to be the same as "measles" for administrative purposes. Below are the figures for each quarter of the last six years, as derived from the weekly tabulation of reported cases (German measles being included). The corrected annual totals relate to "measles " only. Quarters 1. 2. 3. 4. Totals Uncorrected . Corrected. 1906 105 204 199 89 597 592 1907 100 303 276 548 1,236 1,284 1908 413 301 32 74 820 779 1909 133 366 76 127 702 709 1910 571 1,066 72 389 2,098 2,085 1911 659 424 91 135 1,309 1,281 The house distribution was not markedly different from that noted in the preceding year, having regard to the smaller number of cases, but there was a smaller proportion of houses with exceptionally large numbers of cases. The 1,281 cases were reported from 721 houses, giving an average of 1.7 cases per house, as compared with averages of 1.9, 1.8, and 1.6 in 1910, 1909, and 1908. There were 561 secondary cases in all, equal to 43.7 per cent, of the total reported, showing a somewhat lower proportion than in 1910 (46.8 per cent.) and in 1909 (44.9), but higher than in 1908 (40.9). On the whole, it may be concluded that the disease had a slightly lower infectivity than in 1910, but if the infectivity was lowered, the disease was, on the other 1906. 1907. 1908. 1909. 1910. 1911. Houses with 2 cases 100 194 130 104 290 196 3 „ 48 97 55 55 164 97 4 „ 15 30 15 21 55 36 5 „ 4 19 6 9 22 13 6 „ — 7 — — 7 2 „ 7 „ 1 2 — 1 6 — „ 8 „ — 1 _ — 1 — 9 „ — - 1 — 1 - 26 measles. hand, somewhat more fatal, especially among males. In 1910 the fatality was 3.6 per 100 cases (both sexes), as compared with 3"8 last year. Among males the fatality was 4.4 last year, or 0-9 above the rate recorded in 1910. The rate among females was slightly lower (see below). Doubtless the season at which the disease was prevalent accounts to a large extent for the increased fatality, 1,048 cases being reported during the six months October to March, 1910-11, as compared with 698 in the same six months of 1909-10. Average 1906. 1907. 1908. 1909. 1910. 1906-10. 1911. Males 3.4 3.3 5.3 5.3 3.5 4.2 4.4 Females 2.0 2.5 4.1 4.8 3.6 3.4 3.4 Persons 2.7 2.8 4.6 5.0 3.6 3.7 3.8 Some uncertainty attaches to the Ward distribution of attacks of the disease, the cases being almost entirely known through the reports of the staffs of the public elementary schools. TABLE 17. Measles. Fatalities in Wards. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1911 Cases 152 391 173 154 286 42 27 56 Deaths 2 1 5 11 27 3 - 1 Fatality. 1911 13 0.2 2.8 7.1 9.4 7.1 - 1.7 Average, 1906-10 2.2 2.6 2.8 4.1 6.3 1.4 1.7 3.0 TABLE 18. Measles. 1911. Cases. * Deaths. Cases. Deaths. Queen's Park. Church. Droop Street 19/9 1/1 Parts of the "Clarendon Street Area." Cirencester Street 39/23 3/3 Kensal Road 2/1 1/1 Clarendon S reet 59/28 6/5 Desboro' Street 5/2 1/1 Harrow Road. Philip Terrace 10/4 3/3 Chippenham Road 35/18 1/1 Westbourne Terrace N. 3/2 1/1 Woodchester Street 41/23 5/5 Maida Vale. Cuthbert Street 1/1 1/1 Delamere Crescent 6/3 2/2 Amberley Road 32/17 2/2 Edgware Road 6/4 1/1 Braden Street 4/2 2/2 Hermitage Street 5/2 2/2 Carlton Mews 6/3 1/1 North Wharf Road 7/3 1/1 Westbourne. Westbury Road 8/4 1/1 Brindley Street 11/5 1/1 Lancaster Gate, West. Burlington Mews West 1/1 1/1 Kensington Gardens Square 4/4 1/1 Elcom Street 12/4 1/1 Poplar Squaie 6/3 1/1 Kensal Road 12/5 2/1 Queen's Road 4/2 1/1 Modena Street 4/2 3/2 Lancaster Gate, East. Torquay Street 8/3 1/1 Waverley Road 16/9 2/2 Hyde Park. York Row 2/1 1/1 * Note.—Figures to be read thus—19 cases in 9 houses, and 1 death in 1 house. 27 MEASLES. I he proportions of children to total population vary within wide limits in the Wards, as also do the proportions of children attending such schools to the total child populations. Hence, in certain Wards (e.g., Maida Vale and the three Southern Wards) the cases known to the Department are probably only fractions of the true totals. To some extent that defect is,remedied by the increasing practice of applying to the Department for disinfection after occurrence of the disease. A fair number of cases are also reported by the parents or householders as soon as they occur. Even when all due allowance is made for any understatement which is likely to have prevailed, the figures in Table 17 suggest (at least) that the distribution of the disease in the Borough was very irregular, while the recorded fatalities are strikingly so. Attention may be specially directed to the very low fatality in Harrow Road Ward (0.2, 1911; 2.6, 1906-10) and to higher fatalities recorded in Westbourne (7.1, 1911; 41, 1906-10) and Church (9.4, 1911; 6'3, 1906-10). In those Wards it is probable that very nearly all the cases are known during life, but the case is different in Lancaster Gate (West) Ward, where, it is thought, many cases do not get reported. In that Ward last year's fatality (7.1) was more than five times the average (14) for the years 1906-10. In Table 18 an attempt has been made to test the association (if any) between fatality of the disease and the character of the people among whom such fatality prevails. With the exceptions of Kensington Gardens Square and Queen's Road, all the streets included in the table are inhabited by the working classes, some of them by persons of the poorest classes. The information contained in Table 18 is set out in a more comprehensive form helow. Queen's Harrow Maida Lancaster Gate, Hyde Park. Road. Vale. Westbourne. Church. West. East. Park. T . e In streets In rest of , , . a where deaths Ward. occurred. cases 21 35 43 64 190 14 — 2 Houses invaded 10 18 22 29 99 9 — 1 Deaths 2 1 5 11 27 3 — 1 Attacks per house 2.1 1.9 l.9 2.2 l.9 1.5 — 2 Fatality per cent 9.5 2.8 11.6 17.1 14.2 21.4 — 50 Cases in other parts of Ward 131 356 130 90 96 28 27 54 Houses invaded 79 196 74 49 57 18 19 41 Attacks per house 1.6 1.8 1.7 1.8 1.6 1.5 1.4 1.3 Without wishing to draw any definite conclusion—the material is insufficient for the purpose —the above figures may be said to suggest an association between multiplicity of attacks in a house and fatality. The highest fatality (17.1 per cent.) is associated with the highest average of attacks per house (2.2), and the lowest fatality (zero) with the lowest but one (14—differing only by 0'1 from the lowest) house average incidence. The Wards showing the highest fatalities (Westbourne, 17.1, and Church, 14.2), include two "areas" of special characteristics, being densely inhabited with a poor class population. In Westbourne Ward there is the " Waverley Road Area," and in Church Ward the " Clarendon Street Area." In the former area occurred all the deaths recorded in the Ward, the house average of cases in the area being 2.2 and the fatality 17.1 per cent. In the Clarendon Street Area the house incidence was 1.9 and the fatality 121 per cent.— figures which lend support to the suggestion made above. On the other hand, in the three streets Ashmore, Bravington, and Portnall Roads (Harrow Road Ward) there were 121 cases in 67 houses (average 1.8) without a known fatal case. The total of 50 deaths entered during the year as due to measles was one-third less than the total for 1910, but 10 in excess of the average annual number (40) during the five years 1906-10. The mortality last year was at the rate of 0.35 per 1,000 persons, 0.17 less than the rate for 1910, and 0.08 above the average (0.27) for 1906-10. The numbers of deaths and corresponding rates for the six past years are given below. 1906. 1907. 1908. 1909. 1910. 1911. Deaths 16 37 36 36 75 50 Mortality 0.11 0.25 0.24 0.25 0.52 0.35 28 MEASLES. The general run of the rates manifested by the above figures does not conform with the usual experience, namely, alternate years of high and low mortality rates, the first year (1906) with a very low rate being followed by three years with equal but comparatively low rates, after which come two years with high rates. A comparison with the rates for the whole of London during the same six years shows that the prevalence of the disease in the Borough does not agree with that in the Metropolis as a whole. 1906. 1907. 1908. 1909. 1910. 1911. Paddington 0.11 0.25 0.24 0.25 0.52 0.35 London 0.42 0.39 0.33 0.51 0.43 0.57 It appears, therefore, that in Paddington the epidemic of measles which was almost inevitable after the low mortalities of the years 1906-09, came in 1910, a year before the disease prevailed in London as a whole to an extent sufficient to excite popular interest. There being no notification of the disease, the only evidence of its prevalence is to be found in the death returns, but an equality in the number of deaths should not be taken to imply an equality in the number of cases either in any comparison of different years or of different districts in the same year. Subject to such reservation, the rates given in Table '20 may be taken as evidence of the irregular distribution of the disease in the Metropolis last year. The high rates recorded in the Eastern Districts represent a very widespread outbreak in those parts, but it would be unsafe to frame any estimate of the numbers of cases from the experience obtained in this Borough. Last year's outbreak in the Metropolis was the worst experienced since 1898. The following statement of the numbers of deaths recorded in weeks when the deaths from measles exceeded 80 is of interest, and shows that last year's epidemic was more severe than that of 1898, but did not last so long. 1897—87, 120, 108, 122, 134, 112, 166. (7 weeks.) 1898—130, 134, 130, 80, 87, 100, 106, 115, 141, 134, 143, 115, 109, 117, 131, 107, S9, 82. (18 weeks.) 1904—86, 81, 86, 83. (4 weeks.) 1909—82, 93, 94, 92, 105, 129, 118, 94. (8 weeks.) 1910—85, 94, 113, 83, 90, 83. (6 weeks.) 1911—86, 82, 82, 95, 86, 103, 132, 136, 175, 197, 182, 153, 131, 110. (14 weeks.) TABLE 19. Measles. Age-Sex-Fatalities. Ages (years) 0— 1— 2— 3— 4— 5— 13— 15— Sex m. F. m. f. m f. m. f. m. f. m. f. m. f. m. f. 1911—Cases 38 44 79 62 71 75 79 60 87 89 237 292 5 11 17 35 Deaths 9 10 10 5 3 7 2 — 1 - 2 1 - - - - Fatality. 1911 23.6 22.7 12.16 8.0 4.2 9.3 2.5 - 1.1 - 0.8 0.3 - - - - 1910 3.6 12.0 15.4 13.1 9.3 3.3 0.7 0.8 1.1 1.7 0.2 0.3 - — — 11.1 1909 31.8 16.6 21.4 18. 8 2.4 7.2 2.1 - — 1.6 — — - — — — 1908 15.3 16.6 26.1 19.0 2.3 - 2.0 5.4 3.2 — — 0.5 - - - 8.0 1907 17.3 15.1 8.7 4.7 6.5 5.7 1.1 - 0.9 0.7 0.4 1.1 - - — — 1906 17.6 7.1 19.4 10.2 - 2.9 - - - - - — - — — — Average— 1906-10 17.1 13.5 18.2 13.2 4.1 3.8 1.2 1.2 1.0 0.8 0.1 0.6 - — - 1.8 29 MEASLES. TABLE 20. Measles. Mortality rates per 1,000 persons of all ages. 19061910. 1911. 19061910. 1911. 19061910. 1911. Paddington 0.24 0.34 Holborn 0.29 0.31 South wark 0.65 0.63 Kensington 0.30 0.55 Finsbury 0.80 0.90 Bermondsey 0.94 0.44 Hammersmith 0.46 0.30 City of London 0.12 0.05 Lambeth 0.34 0.38 Fulham 0.45 0.42 Central Districts 0.55 0.61 Battersea 0.38 0.67 Chelsea 0.45 0.45 Wandsworth 0.23 0.74 Westminster 013 0.14 Camberwell 0.40 0.43 Western Districts 0.32 0.36 Deptford Greenwich 0.51 0.63 0.40 0.43 Shoreditch 0.81 1.15 Lewisham 0.14 0.13 Bethnal Green 0.58 1.02 Woolwich 0.31 0.23 Stepney 0.65 1.09 St. Marylebone 0.25 0.56 Poplar 0.59 1.39 Southern Districts 0.40 0.49 Hampstead 0.13 0.16 Eastern Districts 0.65 1.15 St. Pancras 0.43 0.50 Islington 0.47 0.40 Stoke Newington 0.19 0.55 County of London 0.42 0.57 Hackney 0.29 0.67 Northern Districts 0.35 0.48 In March of last year the Local Government Board convened a conference of the Medical Officers of Health of the Metropolitan Cities and Boroughs to consider what steps should be taken to cope with the epidemic, even then on the wane. The two most important results of the conference were (i.) the decision to extend the use of the hospitals of the Metropolitan Asylums Board to the disease, and (ii.) the issue by the County Council of instructions to School Attendance Officers to report direct to the Medical Officers of Health any cases of measles discovered in the course of visits with reference to absence from school. The Local Government Board issued a " Memorandum on Measles " recommending a course of procedure for coping with the disease, which agreed very closely with the practice of the Department. The desirability of making the disease notifiable was strongly pressed upon the President of the Board at the conference (he was in the Chair), but the suggestion did not meet with approval. However, the Stepney Borough Council made an Order for notification which the Board approved, the Order coming into force in the week ending May 13th. The last week in which returns were made to the Metropolitan Asylums Board was that ending December 2nd. Between May 6th and December 2nd 1,869 cases were notified, but the worst of the epidemic was over before notification came into effect. During that same period 100 deaths were registered as due to measles, but as attacks and deaths do not fall in the same week, something like half the total deaths (10) in the first week ought to be deducted to adjust for such difference. That would leave 95 deaths among 1,869 cases, making the fatality 5'0 per cent.— P2 higher than that recorded last year in the Borough (3.8 per cent.). Proposals to make the disease notifiable have been put forward by the Council of this Borough on more than one occasion (the last was in 1910), but the Board have hitherto declined to entertain such proposals. One argument adduced against the proposals was the undesirability of having the disease notifiable in one metropolitan area only and not in others. Comment on that point appears to be superfluous. 30 whooping cough. WHOOPING COUGH. Last year no fewer than 632 cases of this disease came to the knowledge of the Department, that figure being higher than any recorded since 1904, when the present system of recording attacks was initiated. From the figures given below it will be seen that the disease appears to have been unduly prevalent during the past three years, the alternations of high and low prevalence observed during 1904-09 not being continued after that last year. It is impossible at this juncture to suggest any reason for the change. Totals. Quarters. 1. 2. 3. 4. Uncorrected. Corrected. 1906 57 65 26 26 174 171 1907 189 305 73 48 615 589 1908 34 65 37 35 171 170 1909 234 243 72 26 584 561 1910 137 182 95 134 548 518 1911 403 219 49 15 686 632 The 632 cases were reported from 344 houses, giving an average of l-8 cases per house, a figure in excess of any average recorded since 1908 (average 1908, l.6; 1909 and 1910, l.7). The secondary attacks numbered 288, and formed 45.5 per cent, of the total cases known, as compared with 42.0 in 1910 and 1909, and 40.5 in 1908. The house distribution of multiple cases is given below. 1906. 1907. 1908. 1909. 1910. 1911. Houses with 2 cases 31 99 22 98 95 102 3 „ 17 49 16 41 38 51 4 „ 4 12 5 12 11 15 „ 5 „ 1 4 - 2 1 7 „ 6 „ — 1 - 1 2 1 „ 7 „ - — — — - 1 „ 8 „ — — — 1 — — There were 45 deaths from the disease, so that the total fatality was 71 per cent., 0.4 above the proportion observed in 1910, but equal to the average. From the statement given below it will be seen that the fatality among males last year (7.2) was less than that recorded in 1910 (9.4), and also than the average (6.0); while the fatality among females (7.0) was higher than in 1910 (4.6), and also than the average (6.0). It may be noted that the number of cases reported during the six months October-March, 1909-10, was 163, and that recorded during the corresponding six months of 1910-11, 537. Such seasonal variation explains in part the difference in the total fatality of the disease as recorded in 1910 and 1911, but it does not explain why there should have been such a cross-over in the sex mortalities:— Average, .1906. 1907. 1908. 1909. 1910. 1906-10. 1911. Males 8.3 9.2 8.8 6.4 9.4 8.4 7.2 Females 6.9 7.8 4.3 6.3 4.6 6.0 7.0 Persons 7.6 8.4 6.5 6.4 6.7 7.1 7.1 In Table 21 will be found the fatalities observed in the Wards last year in comparison with the averages for the five years 1906-10. Unfortunately, it is believed that the information of the attacks is even more incomplete than in the case of measles. In Table 22 the sex-age fatalities of last year are compared with those for the preceding decennium. It will be seen that the rates at ages under one year (males, 322; females, 26.1) were considerably higher than the averages (males, 29.2; females, 25.6), while at ages 1.2 and 2.3 years the facts were reversed. At ages above 3 years the rates are too erratic to be relied on. 31 WHOOPING COUGH. TABLE 21. Whooping Cough. Fatalities in Wards. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1911. Cases 113 152 48 90 155 38 3 33 Deaths 11 12 5 5 8 — — 4 Fatality. 1911 97 7.8 10.4 5.5 5.1 — — 12.1 Average, 1906-10 4.1 6.5 10.0 9.0 10.4 3.5 — 4.3 TABLE 22. Whooping Cough. Age-Sex-Fatalities. Age (Years) 0— 1— 2— 3— 4— 5— 13— 15— Sex m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. 1911—Cases 31 42 42 37 32 36 30 42 52 48 116 123 1 - - - Deaths 10 11 6 5 - 1 1 5 2 1 3 - - - - - Fatality. 1911 32.2 26.1 14.2 13.5 - 2.7 3.3 11.9 3.8 2.0 2.5 - - - - - 1910 37.0 19.4 43.4 10.5 4.1 2.8 - - 4.3 1.1 0.8 - - - — 1909 26.9, 25.0 25.0 8.2 11.6 3.5 - 133 2.2 2.2 1.7 1.5 - - - 1908 28.5 42.8 30.0 - 10.0 - 16.6 8.3 - - - - - - - - 1907 36.0 36.6 29.4 20.6 8.3 7.4 8.1 9.0 — 1.6 — 1.4 - — - — 1906 18.1 9.0 28.5 40.0 7.7 8.3 — — - - - - - - - - Averase— 1906.10 29.2 25.6 31.3 15.9 8.3 4.4 4.9 6.1 0.4 1.6 0.6 0.7 - - - — The 45 deaths recorded last year were equal to a mortality of 0-31 per 1,000 persons of all ages, the average for 1906-10 having been 0.19. The deaths and mortalities rates recorded in each of the last six years are given below, the rates for the Metropolis being added for the purpose of comparing the annual variations in mortality in the Borough with those observed in the County as a whole. The figures for the circumjacent Districts are given in Table 10 1906. 1907. 1908. 1909. 1910. 1911. Paddington— Deaths 13 50 11 36 35 45 Mortality 0.09 0.34 0.07 0.25 0.24 0.31 London— Mortality 0.27 0.39 0.21 0.27 0.30 0.22 Towards the end of 1910 the Local Government Board sanctioned the admission of Poor Law patients ill with measles and whooping cough to the hospitals of the Metropolitan Asylums Board. By that arrangement only persons receiving treatment in the Workhouse or Infirmary or under the care of the District Medical Officers could be sent to the Board's hospitals. By an Order dated May 30th of last year the Local Government Board sanctioned the reception of nonpauper patients ill with measles when admission was specially recommended by the Medical 32 other infectious diseases. Officer of Health of the City or Borough. Such patients can, however, only be admitted if the accommodation set aside for Poor Law cases is more than is required for such cases at the time. The recommendation for admission has to be accompanied by " such information respecting the case as the Metropolitan Asylums Board Managers may reasonably require." When the demand for admission of non-pauper cases exceeds the accommodation available. " the Metropolitan Asylums Board Managers shall have regard to each person's need of isolation in the interests of public health" in deciding what cases are to have priority of admission. Last year 70 cases of measles (some having a mixed infection of measles and whooping cough) and 28 of whooping cough were admitted from the Borough. The number of cases was too small and admission was too much limited to the poorest of the population to permit of conclusions as to the value of hospital isolation. OTHER INFECTIOUS DISEASES. In addition to the 1,281 cases tabulated (at the end of the year) as "measles," there were 148 cases of " German measles" reported by the staffs of the public elementary schools. It is only in the final tabulation that any distinction is made by the Department between " measles " and "German measles." In 1910, 77 cases of "German measles" were reported, and 10 in 1909, so that the prevalence of "German measles" during those three years was on lines similar to those of measles. The other diseases reported by the school staffs, of which any account is kept, are chickenpox, mumps, and ringworm. The first was formally notified for a period of three months dating from March 22nd on account of the outbreak of smallpox, to which attention has already been drawn. During that period 121 cases were reported, which have been included with the numbers of cases reported by the school staffs. (See below.) None of these diseases caused any deaths. (See also Schools, p. 69.) Quarters. 1. 2. 3. 4. Year. 1909 100 73 43 128 344 Chickenpox l910 222 103 55 140 520 1911 129 147 100 131 507 1909 211 114 30 65 420 Mumps 1910 31 23 3 12 69 1911 40 39 10 134 223 1909 45 49 40 42 176 Ringworm l910 41 24 13 24 102 1911 37 43 31 54 165 Leprosy.—One death was certified as due to this cause. The deceased was a Jew, aged 44 years, and the disease was stated to have been contracted in Brazil. The true nature of the disease was not discovered until it was too late to make any investigation of the case. Dysentery.—In February of last year there was a group of cases of acute sickness and diarrhoea affecting nine persons in two families, the bacillus dysenteries (Flexner) being demonstrated in the faeces of the patients. The occurrence of that organism in this country is almost unknown, except in the persons of those who have returned from foreign parts. In this instance there was no history of any member of the households having been recently away from England or of any contact with anyone who had recently come to the country. An account of the outbreak and of the results of the bacteriological investigation will be found in the Journal of Hygiene* * Vol. ix., p. 356 (November, 1911). 33 TUBERCULOSIS. TUBERCULOSIS. The deaths from all forms of tuberculosis during the year numbered 212, or 12 in excess of the annual average for the five years (1906-10). It should be noted that there were 5 deaths from all forms of tuberculosis among the " inward transfers," so that the excess for last year —according to the old system of correcting deaths—was 7, not 12. The mortality rate for the year was 1'48 per 1,000 persons, 0'09 in excess of the mean rate (1'39) for 1906-10. The rates for the individual years are given below:— Tuberculosis: Mortality Rates per 1,000 Persons. 1911. 1910. 1909. 1908. 1907. 1906 1.48 1 .19 1.42 1.32 1.53 1.50 A complete tabulation of the various forms of tuberculosis as certified during the year is appended, in which the sexes are distinguished and the ages given in five yearly groups. The classification of the deaths has been in accordance with the " New List" of causes of death, and the rules laid down by the Registrar-General. This is the first occasion on which such a complete tabulation has been attempted. Tuberculosis. Deaths of Residents: Whole Borough. 1911. Age Groups. All Ages. P. 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- Pulmonary Tuberculosis Phthisis M. 2 ... 1 4 3 4 9 11 11 10 12 5 2 2 2 ... ... ... 78 F. 1 ... 1 8 6 8 6 10 7 5 5 3 3 2 1 1 ... ... 67 145 Acute Phthisis M. ... ... ... 1 ... 2 4 2 2 1 ... ... ... ... ... ... ... ... 12 F. ... ... ... 2 1 1 1 1 ... ... ... ... ... ... ... ... ... ... 6 18 Acute Miliary Tuberculosis M. 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 F. 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 5 Tuberculous Meningitis M. 9 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 F. 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 15 Tabes Mesenterica M. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 F. 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 Other forms of Abdominal Tuberculosis M. 2 2 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 6 F. 1 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 4 10 Tuberculous Disease of the Spine M. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 F. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Tuberculosis of other parts of skeleton M. ... ... 2 ... 1 ... ... ... 1 ... ... 1 ... ... • • • ... ... ... 5 F. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... l ... ... 1 6 Senile Tuberculosis M. ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 F. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... 1 General Tuberculosis M. 2 ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... 5 F. 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 8 Totals M. 19 3 4 5 5 6 13 14 15 12 12 7 3 2 2 ... ... ... 122 F. 12 3 1 11 7 10 7 11 7 5 5 3 3 2 1 2 ... ... 90 212 P. 31 6 5 16 12 16 20 25 22 17 17 10 6 4 3 2 ... ... 212 In Table 23 the deaths from tuberculosis (all forms) allocated to the Wards are shown by sex in wider age-groups, and (in smaller type) the numbers of deaths from the four principal forms of tuberculosis. It will be noticed that there was not a single death from any form of tuberculosis during the year in Lancaster Gate, West, Ward. 34 TUBERCULOSIS. TABLE 23. Deaths from Tuberculosis. Ward Distribution, 1911. 0— 1— 5— 15- 25— 65— All Ages. In Institutions. m. f. m. f. m. F. m. f. m. f. m. F. m. f. m. f. Queen's Park ... ... 1 2 2 ... 1 3 16 9 ... ... 20 14 11 5 Pulmonary ... ... ... ... ... ... 1 3 14 9 ... ... 15 12 8 4 Meningeal ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... Abdominal ... ... 1 1 1 ... ... ... 1 ... ... ... 3 1 2 ... All other forms ... ... ... 1 ... ... ... ... l ... ... ... 1 2 1 1 Harrow Road 1 1 5 ... 1 1 3 4 17 10 1 1 28 17 11 6 Pulmonary ... ... ... ... 1 ... 3 4 16 9 1 1 21 14 9 4 Meningeal 1 1 2 ... ... ... ... ... ... ... ... ... 3 1 ... ... Abdominal ... ... 2 ... ... 1 ... ... ... 1 ... ... 2 2 1 2 All other forms ... ... 1 ... ... ... ... ... 1 ... ... ... 2 ... 1 ... Maida Vale ... ... 2 2 1 2 ... 1 11 5 ... 1 14 11 9 4 Pulmonary ... ... 1 ... ... ... ... 1 10 5 ... 1 11 7 6 3 Meningeal ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 1 ... Abdominal ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 1 ... All other forms ... ... ... 1 ... l ... ... 1 ... ... ... 1 2 1 l Westbourne 2 ... ... 1 1 1 1 5 17 11 1 1 22 19 8 9 Pulmonary ... ... ... ... ... l 1 4 16 11 1 1 18 17 6 9 Meningeal 2 ... ... 1 ... ... ... ... ... ... ... ... 2 1 ... ... Abdominal ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... All other forms ... ... ... ... l ... ... ... 1 ... ... ... 2 ... 2 ... Church 2 2 5 2 2 ... 2 4 13 12 2 1 26 21 22 9 Pulmonary ... ... l 1 ... ... 1 4 12 12 2 ... 16 17 15 8 Meningeal 1 ... 2 ... ... ... ... ... ... ... ... ... 3 ... 1 ... Abdominal ... l ... ... ... ... ... ... ... ... ... ... ... 1 ... ... All other forms 1 1 2 1 2 ... 1 ... 1 ... ... 1 7 3 6 1 Lancaster Gate, West ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lancaster Gate, East ... ... ... ... ... ... ... ... 2 2 ... ... 2 2 1 1 Pulmonary ... ... ... ... ... ... ... ... 2 2 ... ... 2 2 1 l Meningeal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All other forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hyde Park ... 2 1 ... ... ... 3 1 6 2 ... 1 10 6 7 3 Pulmonary ... ... ... ... ... ... 2 1 5 2 ... 1 7 4 4 2 Meningeal ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 Abdominal ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... All other forms ... ... l ... ... ... 1 ... ... ... ... ... 2 ... 2 ... Pulmonary Tuberculosis (Consumption).— There were 145 deaths during the year from pulmonary tuberculosis (the form generally known as "consumption") and 18 from acute phthisis (popularly called "galloping consumption"). In previous reports these two forms have been included under the one heading " pulmonary tuberculosis." The 163 deaths (90 of males and 73 of females) were equal to a mortality of 1.14 per 1,000 persons, or 0.09 in excess of the annual average (1.05) for the five years 1906-10. The rates for the six years are given below :—- 1911. 1910. 1909. 1908. 1907. 1906. 114 0.89 1.12 1.04 1.09 1.12 The total number of deaths from pulmonary tuberculosis, according to the RegistrarGeneral's classification (Quarterly Reports), was 173—10 more than the Departmental total. The higher total gives a mortality rate of 1.21 per 1,000 persons, as compared with a mean rate of l-06 for the preceding five years. (See Table 10.) In St. Marylebone only was a higher rate recorded (1.45), that being also the only other district with a rate for last year above the quinquennial mean. The increases in the rates recorded last year in Paddington and St. Marylebone were 14 35 TUBERCULOSIS. and 6 per cent, respectively, the other districts showing decreases amounting to 12 per cent, in Kensington, 8 per cent, in Westminster, 17 per cent. in Hampstead, and 5 per cent, in Willesden In the Metropolis as a whole last year's rate (1.34) showed a decrease of 4 per cent, from the mean (1.39). Last year's rate was the highest of the series, but differed by 0.02 per 1,000 only from the rates recorded in 1909 and 1906. It will be seen from the appended statement that the deaths allocated to four out of the eight Wards were less than the average numbers for those Wards. Pulmonary Tuberculosis. Deaths in Wards. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1911 27 35 18 35 33 — 4 11 1906-10 22 30 20 30 37 2 2 8 1910 11 36 20 27 21 3 1 8 1909 21 35 23 29 40 3 2 8 1908 29 26 12 31 40 2 3 6 1907 29 25 21 30 38 2 3 9 1906 20 27 24 31 46 3 2 8 The most noteworthy decreases were those in Westbourne and Church Wards. Those decreases are so described, not from their dimensions, but from a consideration of the large proportions of the poorer class of inhabitants to be found therein. How far the smaller numbers of deaths have been brought about by shrinkage of populations and not by improved hygienic conditions cannot be determined until the full results of the last census are known. Institutional Treatment.—This is the only point in connection with the mortality from pulmonary tuberculosis selected for comment. Of the 163 deaths recorded last year 80 took place in public institutions. The increase in the proportion of persons " segregated " during the last stages of their disease is clearly shown in the appended tabulation, from which it appears that males take advantage of institutional care to a considerably greater degree than do females, the proportion of the latter having decreased during the years covered by the tabulation :— Pulmonary Tuberculosis : Proportions (per cent.) of Deaths in Institutions. 1911. 1910. 1909. Males 54.4 46.6 47.4 Females 42.4 42.6 43.5 Persons 49.0 44.8 45.9 The proportion of deaths in Poor Law Institutions was nearly 25 per cent, higher last year than in 1910, and over 80 per cent. in the case of Lunatic Asylums. The numbers and proportions (per cent.) recorded in the past two years are set out below. Occurring in Pulmonary Tuberculosis. Numbers of Deaths, Proportions (per cent.), 1911 1910. 1911. 1910. Poor Law Institutions 56 35 34.3 27.5 " Homes for the Dying " 6 8 3.6 6.2 General Hospitals 6 7 3.6 5.5 Special Hospitals 5 3 3.0 2.3 Lunatic Asylums 7 3 4.2 2.3 Some of the excess proportion of male deaths in institutions is explained by the larger number of deaths from acute phthisis (11) among that sex and the very large proportion of such deaths (91.6 per cent.) which occurred in institutions. That fact does not, however, afford a complete explanation of the difference, as a larger proportion of males die in institutions at each 36 TUBERCULOSIS. age. It will be seen from the figures given below that in every age-group save one (15 years) the proportion of institutional deaths was greater among males than among females. 0— 15— 30— 45— 60— 75— Pulmonary Tuberculosis. Males D. I. % 3 11 31 27 6 — 2 4 14 14 4 — 66.6 36.3 45.1 52.9 66.6 — Females D. I. % 2 22 23 13 6 1 1 8 10 5 3 — 50 36.3 43.4 38.4 50 — Acute Phthisis. Males D. I. % — 3 8 1 — — — 2 8 1 — — — 66.6 ... 100 100 — — Females D. I. % — 4 2 — — — — 3 1 — — — — 75 50 — — — 1). - Total deaths. 1.—Deaths in institutions. The same result is obtained by the next tabulation, which is in broader age-groups, the institutions in which the deaths were recorded being shown for each group. Pulmonary Tuberculosis. Males. Females. 78 Deaths—38 in Institutions 67 Deaths—27 in Institutions At ages (43'6 per cent.). (40 3 per cent.). 0— 3 Deaths—2 in Institutions (66.6 per cent.). 2 Deaths—1 in Institution (50 per cent.). North Western Fever Hospital (aet. 1). Queen Mary's Hospital (æt. 1). Children's Hospital (P.G.) (æt. 3). 15— 69 Deaths—32 in Institutions (46.3 per cent.). 58 Deaths—23 in Institutions (39.6 per cent.). Paddington Infirmary 19 Paddington Infirmary 14 Paddington Workhouse 1 Hammersmith Infirmary 1 Brompton Hospital 4 Lunatic Asylums 2 Lunatic Asylums 3 St. Mary's Hospital 1 St. Mary's Hospital 2 German Hospital 1 Middlesex Hospital 1 "Homes" 4 "Homes" 2 60— 6 Deaths—4 in Institutions (66.6 per cent.). 7 Deaths—3 in Institutions (42.8 per cent.). Paddington Infirmary 3 Paddington Infirmary 1 St. George's Hospital 1 Lunatic Asylums 2 Acute Phthisis. Males. Females. 12 Deaths—11 in Institutions 6 Deaths—4 in Institutions (91.6 per cent.). (66.6 per cent.). 0— 15— 12 Deaths—11 in Institutions (91.6 percent.). 6 Deaths—4 in Institutions (66.6 per cent.). Paddington Infirmary 11 Paddington Infirmary 4 60— Approximate dates of onset of the disease could be fixed in 50 cases terminating fatally during the year in institutions, 35 of the deceased persons being males and 15 females. An analysis of the durations of these cases is given below. Duration in Years. 0— 1— 2— 3— 4— 5—10. "Years." Males 14 2 5 — 3 9 2 Females 3 12 2—3 4 37 TUBERCULOSIS. Inquiries have been made as to the duration of institutional treatment of cach case, and the results—so far as they can be reduced to tabular statement—are given below. Poor Law. (Paddington Infirmary.) Cases admitted once only. Approximate duration of illness (years). No. of Cases. Under one week. One week to one month. 1— 1 Months. Years. m. f. 3- 6— 9— 1— 0— 11 1 3(1) 4 3 2 — — — 1— 2 1 - — 3(1) - — — — 2— 2 2 2(1) — 2(1) - — — — 3— - 1 - - - 1(1) — — — 4— 1 — — - — - — 1 — 5—10 4 1 1(1) 1 1 2 - — - " Years " 2 4 2(1) 2(1) 2(2) - - - - Not known 3 6 1(1) 4(4) 3(1) - — — 2 (over 3 yrs.) Cases admitted twice. Approximate duration of case (years). m. f. Stay in Infirmary. Interval. Stay in Infirmary. 1 2 — 1 157 days 9 months 5 days 2—3 2 — 49 „ 3½years 10 „ 64 „ 3 weeks 129 „ 5—10 1 1 (f.) H „ 20 months 179 „ (m.) 25 „ 2¼years 1,023 „ Cases admitted three times. 1—2 m. 65 12. vii. — 16. xi. '95 (nasal polypus). 13. iv. — 9. v. '08 (influenza). 4. x. '10— 5. xi. '11 (phthisis and bronchitis). 4—5 m. 42 (Sanatorium treatment—2 months.) (Inf.) 2. ii.—1. iii. '09: 27. iii.—22. vii. '11: 19. viii.—28. x. '11. m. 44 (1907—6 weeks in St. Marylebone Infirmary.) (Inf.) 8. iii.—4. v. '09: 2. i.—25. iii. '11 : 3. vii.—17. ix. '11 (certified 7 times). 5—10 in. 56 4. i.—27. i. '92 (bronchitis). 21. iv.—9. v. '10 ( do. T.B. negative). 22. iii.—20. viii. '11 (phthisis, T.B. positive). in. 27 9. i.—3. iii. : 5. iv.—27. viii. '10 : 31. ix. '10—10. iv. '11. Cases admitted many times. 2—3 f. 51 4. viii.—12. viii. '09: 26. ii.—9. iv. '10: 28. vi.—9. viii. '10: 11. viii.—22. viii. 10: 6. ix. 10—15. iv. '11: 17. v.—21. ix. '11 (13 certificates). 5—10 m. 42 5. iii.—5. v. '06: 18. xii. '07—29. viii. '08: 5. x. '08—19. i. '09: 24. vi.— 4. ix. '09: 24. ix.—3. xi. '09: 1. xii.—20. xii. '09: 29. xii. '09—3. ix. '10: '21. ix. '10—9. vii. '11 (7 certificates). Hospital Cases (including one Sanatorium case). Duration of Institutional treatment. Approximate duration of case (years). No. of Cases. Under one week. One week to one month. 1— Months. m. f. 8- 6— 9— One admission only. 0—1 2 1 - — 2 1(1) - — 4—5 1 - 1 - - — — Not known 3 2 1 3(1) — — 1() — Two or more admissions. 2—3 1 3. v.—23. v. '11 : 23. v.—3. vii. '11. 5—10 - 1 Mount Vernon, 1906 Brompton, 1909 : Paddington Infirmary, 21. i.— 17. ii. '11 : Hospital of SS. John and Elizabeth, 22. v.—20. viii. 11. Not known 1 31. x.'10—11. i.'11 : 11. ii.—27. iii.'11 : 5. viii.—10. viii.'11 : 10. viii— 7. xii. '11. (Note.—2 males and 2 females (in addition to the above) dying in hospital were persons passing through the Borough only. 1 other male certified as dying of pulmonary tuberculosis was found to have aneurysm of the aorta and no tuberculosis at the I'.M. examination.) 38 TUBERCULOSIS. Lunatic Asylums. Pulmonary tuberculosis present on admission. f. 47— Admitted 21. xii. '08. Died 3. v. '11. m. 50— „ 28. i. '10. „ 1. iii. '11. m. 19— „ 25. ii. '11. „ 17. vii. '11. No signs of pulmonary tuberculosis on admission. .... Dates of diagnosis u Admission. of p.tuberclosis. Death. f. 69 4. i. '07 vi. '09 23. iv. '11 f. 62 30. vii. '06 iv. '09 14. viii. '11 m. 34 27. v. '05 iv. '11 27. vii. '11 f. 22 3. viii. '03 vii. '11 20. viii. '11 Notification.—Cases of pulmonary tuberculosis receiving medical treatment from the Poor Law have been notified since January 1st, 1909, under the Order of the Local Government Board of December 18th, 1908. Last year compulsory notification was extended to patients attending " hospitals " by the Board's Order of March 22nd—" The Public Health (Tuberculosis in Hospitals) Regulations"—a "hospital" being defined by the Order as "any hospital, dispensary or similar institution for the treatment of the sick, which is partially or wholly supported otherwise than by the contributions of the persons treated thereat, or of their relatives or guardians, or otherwise than from rates and taxes." The Order came into force on May 1st last. Medical officers of institutions within the Borough are required to forward certificates relating to patients seen by them to the Medical Officer of Health of the Borough, no matter where the patients' homes may be. Certificates relating to patients residing outside the Borough * are sorted out and sent on to the medical officers of health of the districts in which the patients' homes are situated. With the exception of the "clearing-house" system just referred to, the Order of last year is on all fours with that of 1908. Although " voluntary" notification has never been established in the Borough, cases of consumption (that loose term is used for brevity's sake only) have been reported to the Department in increasing numbers since 1903. Prior to 1909, 356 cases had been so reported, 109 of the patients being alive at the end of 1910. A statement of the numbers of cases reported during the eight years 1903-10 is appended, the statement including the numbers of cases which are known to have terminated fatally and the records of other cases. The histories of those surviving to 1911 during that year is given in Table 24. Last year 730 medical and other certificates were received under the Board's Orders, and, in addition, one certificate from a private practitioner and 27 informal communications from lay persons. Table 25 shows the number of certificates received under the Orders during each quarter of the year distinguishing the numbers of "repeat" certificates. The actual number of new cases reported was 397, the total of 420 given in Table 25, which represents the result of *A record was kept of the total number of certificates received and the number forwarded to other districts. The number received from May 1st to the end of the year was 1,155, and the number sent on, 495, involving 990 separate communications. Pulmonary Tuberculosis. Total Cases Reported. Known to have died during year Reported recovered. Original Report not confirmed. Lost sight of, removed, &c. Living (known) at end of 1910. 1903. 1904. 1905. 190c ». 1907. 1908. 1909. 1910. 1903 4 2 — 2 — — — — — — — — — 1904 20 5 1 1 1 1 — — — — 10 1 1905 18 10 3 1 — 1 — — — 3 — 1906 57 17 5 7 1 1 — 2 12 12 1907 84 14 12 6 — — 8 20 24 1908 173 25 11 7 3 31 24 72 1909 629 65 25 — 4 61 474 1910 610 42 1 2 13 552 39 TUBERCULOSIS. the corrections made day by day, shows that the preliminary search for " repeat" notifications was unsuccessful in 23 instances. Owing to wrong descriptions of the patients and new addresses, the identity of a patient is frequently not discovered until the case has been visited. The allocation of notified cases to the Wards of the Borough, although incomplete by reason of the limited range of the Orders, viz., to Poor Law and institutional cases, is not without interest. The largest number of cases (114) was reported from Harrow Road Ward, and the smallest from Lancaster Gate, East. The variations in the frequencies of cases and deaths in the Wards is shown below. Queen's Harrow Maida West- Lancaster Gate, Hyde Park. Road. Vale, bourne. Church. West. East. Park. Cases 74 114 32 91 81 7 3 12 Deaths 27 35 18 35 33 — 4 11 In Table 26 the numbers of cases certified medically or informally reported by the various agencies, the extent of repeat notification and the actual numbers of new cases reported, are shown in detail. In the lower part of the same table the histories of the cases during the year are given. Of the total of 671 new patients coming to the knowledge of the Department, 582 remained on the register at the end of the year. Among the patients medically certified there were 65 deaths (57 being certified as due to pulmonary tuberculosis), and among those not medically certified, 6 deaths (1 only certified as due to consumption). The sex-age distribution of the new cases and deaths is given in Table 27. Table 28 is a sort of "balance sheet" of the occupations of the reported patients, showing those of the surviving patients from 1910, those of the new (1911) patients, and those of the persons dying during the year. The total number of patients (both those medically and those not medically certified) on the Register during the past year was 1,806 (790 males and 1,016 females). TABLE 24. Pulmonary Tuberculosis. (Consumption.) Histories of Cases reported prior to 1911. Year when first reported. Known Survivors end of 1910. During 1911. Known Survivors, 1912. Old cases traced and re-entered. Reported recovered. (Arrested) Lost sight of. (Removals.) Original report not confirmed. (Errors.) Known to have died during year. (Consumption.) Totals. Medically certified. “Definite.” Not medically certified. “Suspect” Attending Dispensary. "Definite." " Suspect," 1904 1 - - - - - 1 1 - - - 1905 — - - - - — — — — — - 1906 12 - - - - 1 11 7 4 3 - 1907 24 - - - 1 - 23 10 13 9 - 1908 1909 72 474 - - - 1 4 11 68 462 32 228 36 234 23 186 4 215 1910 552 - - - 6 28 518 274 244 218 227 Totals 1,135 - - - 8* 44 1,083 552 531 439 446 * Deaths due to other causes than pulmonary tuberculosis. 40 TUBERCULOSIS. The 1,135 "survivors 1911 " included 572 medically certified cases and 563 others. During the past year there were added 397 cases which had been medically certified and 274 others; so that the total of 1,806 cases on the Register during the year included 969 medically certified cases and 837 others. The cases not medically certified as " consumptive " include a large proportion of patients under treatment at the "Dispensary" as "suspects," of whom, past experience teaches, a great many will ultimately be certified. Conservative estimates of the proportions of "non-consumptives" in each class would give 10 per cent, of "errors" among those already medically certified and 33 per cent, among the others. Making such allowances, the known cases of consumption—excluding patients under private treatment—may be put at 1,430, or 1 per 1,000 of the total population, and 200 less than ten times the total deaths (163) certified during the year as due to pulmonary tuberculosis. The latter estimate was put forward in these reports some two or three years ago. The estimate of 1,430 living cases is almost certainly too low, as a considerable number of consumptive patients were known to be under institutional treatment during the past year, but had not been reported before the end of the year. TABLE 25. Pulmonary Tuberculosis. Summary of Weekly Analysis of Certificates received. 1911. Total Numbers* of Certificates received under Order No. II. I. Quarters. Year. 1 2 3 4 Total Certificates received 68 180 173 310 731 ,, New Cases certified 29 125 107 159 420† District Medical Officers 34(17) 22(10) 34(18) 23 (10) 113(55) Medical Superintendent— Admissions 26(15) 19(13) 31(24) 23(16) 99(68) Discharges 6(6) 14(11) 7(7) 7(5) 34(29) Relieving Officers 1(1) - - 1(1) 2(2) Hospitals and Institutions — 125 (21) 101(17) 256(119) 482(157) Other Medical Practitioners 1(-) — — — l(-) Allocation of New Cases. M. F M. F M. F. M. F. M. F. Queen's Park 3 - 9 9 11 13 13 16 36 38 Harrow Road 5 2 14 19 15 17 15 27 49 65 Maida Vale 1 — 6 4 4 6 3 8 14 18 Westbourne 4 1 8 18 7 13 17 23 36 55 Church 4 4 10 14 12 5 15 17 41 40 Lancaster Gate, West — — 2 3 — 2 — — 2 5 ” ” East — 1 1 — — 1 — — 1 2 Hyde Park 2 1 3 3 1 1 1 7 5 Common Lodging Houses - - 1 - - - 1 — 2 — No fixed homes 1 - 1 - - - 2 - 4 - *The numbers of certificates relating to cases previously reported are shown in parentheses. †This total is 23 in excess of the actual number, the difference representing certificates not traced to previously reported cases when the analysis was made. 41 TUBERCULOSIS. TABLE 26. Pulmonary Tuberculosis. Analysis of Reported Cases. 1911. Medically Certified. Not Medically Certified. Under Poor Law Order. Under Public Institutions Order from F rom Private Practitioners. Totals. From Dispensary “S.” From Other Sources. Grand Totals. Dispensary. Other Institutions. Certificates received 144 331 135 1 611 259 27 897 Less (reDeat notifications) Survivors, 1910 41 113 23 — 177 — 7 184 Certified by Dispensary 8 — 15 — 23 — 5 28 ,, Poor Law — — 14 — 14 — — 14 Totals 49 113 52 - 214 - 12 226 New Cases reported 95 218 83 1 397 259 15 671 New Cases terminated during year: Died from Phthisis 37 4 16 - 57 1 - 58 „ other causes 3 3 — - 6 0 - 11 Totals 40 7 16 - 63 6 - 69 Lost sight of (removals) 6 2 9 - 17 1 1 19 Diagnosis reviewed 1 — — - 1 — - 1 Reported " arrested " — — — - — — - — Totals 47 9 25 - 81 7 1 89 Survivors, 1912 48 209 58 1 316 252 14 582 From inquiries made with respect to 423 cases of pulmonary tuberculosis recorded during the year (including 58 fatal cases), tuberculous family histories were obtained in 183 instances. The histories obtained can be grouped as below. Disease known in one or both parents 83 „ „ parents and brothers, sisters 39 ,, „ brothers, sisters 30 „ „ husbands, wives 18 „ ,, children 15 „ „ grandparents, uncles, aunts 33 Of the 163 persons who died of pulmonary tuberculosis during the year, the Department had notification records of 102 extending back for some years—in one case to 1906. An analysis of the frequency of repeated notification and of the sources of the same is given below. No. of certificates XT r ir . r- j r received for a Mo. of Year when patient was first heard ot. patient. patients. 19Q6 lgog lg09 191Q 1911 1 60 — 4 7 17 32 2 28 — — — 7 21 3 5 — — — 1 4 4 3 — — — 3 — 5 1 — — — — 1 6 2 — — 1 1 — 7 2 1 — 1 — — 13 1 — — 1 Totals 1 4 ~ 10 29 58 Of the 163 persons who died of pulmonary tuberculosis during the year, the Department had notification records of 102 extending back for some years—in one case to 1906. An analysis of the frequency of repeated notification and of the sources of the same is given below. No. of certificates received for a patient. No. of patients. 1906. Year when patient was first heard of. 1908. 1909. 1910. 1911. 1 60 — 4 7 17 32 2 28 — — — 7 21 3 5 — — — 1 4 4 3 — — — 3 — 5 1 — — — — 1 6 2 — — 1 1 — 7 2 1 — 1 — — 13 1 — 1 — — Totals 1 4 10 29 58 42 TUBERCULOSIS. No. of certificates received for a patient. Received from one source. Received from two or more sources. Poor Law (P.L.). Hospitals (Hosp.). Dispensary (P.T.D.). Others. 1 25 18 11 6 1—Hosp.: P.T.D.* 2 24 2 — — 3 — 1 — 3—P.L.2: Hosp.; 1—P.L.2 P.T.D. 4 1 . — — — 1 each P.L.2: Hosp.: P.T.D.; P.L.: Hosp.3 5 — — — — 1—P.L.4: Hosp. 6 2 — — — 7 2 — — — 13 1 — — — * This to be read: 1 patient reported once by a hospital and once by the Dispensary. Of 18 patients who had been reported to the Department as " consumptives " (10 suspected, 8 definite) the deaths from other causes were recorded during the year (6 at home and 10 in institutions). TABLE 27. Pulmonary Tuberculosis. New Cases Reported and Deaths among same. (Sex-Age Distribution.) 1911. 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— Dispensary 1 1 27 14 21 25 6 18 11 24 10 23 9 19 3 3 1 1 — 1 — — 89 129 218 Poor Law — — 3 1 9 3 1 4 1 8 13 8 13 9 15 4 b 2 2 - — 56 39 95 Other Medical — - — — 1 1 2 3 7 4 11 15 9 11 10 6 — 2 — 1 — 1 40 44 84 Totals 1 1 30 15 24 29 9 25 19 36 34 46 31 39 28 13 7 5 2 2 — 1 185 212 397 Deathf— Phthisis — - - - - - — 2 6 10 9 7 5 11 2 3 1 1 — — — 34 23 57 Other Causes - - 1 - - - 1 - 1 1 - 1 - - 1 - - - - - - - 4 2 6 Not Medically Certified Cases. Cafes— Dispensary 1 — 16 20 43 37 29 16 16 15 5 26 7 8 4 8 3 3 2 — — — 126 133 259 Lay Reports - — 1 - 6 3 1 - - 2 1 - - - 1 - - - — - - - 10 5 15 Totals 1 — 17 20 49 40 30 16 16 17 6 26 7 8 5 8 3 3 2 — — — 136 138 274 Deaths— Phthisis - - - - - - - - - 1 - - - - - - - - - - - - - 1 1 Other Causes - - - - 1 - - - - - - - - — 1 1 1 - 1 - — - 4 1 5 43 tuberculosis. TABLE 28. Pulmonary Tuberculosis. Occupations of all Reported Cases to end of 1911. Survivors, 1911. New Cases Reported, 1911. Totals. Struck off Register. Survivors, 1912. Medically Certified. Not Medically Certified. Under Poor Law Order. Dispensary. Other Institutions. Private Practitioners. Dispensary "Sj") Other Sources. By Death. By Removal. Medically Certified. Not Medically Certified. Columns 1 2 3 4 5 6 7 8 9 10 11 12 Total Cases 1,135 95 218 83 1 259 15 1,806 121 20 868 797 Occupations. Indoor. m. f. m. f. m. F. m. f. m. f. m. f. m. f. m. f. m f. m. f. m. f. m. f. Domestic Duties— Housewives - 249 — 15 — 64 8 — - — 38 — — — 374 - 24 - 6 — 225 — 119 Servants 3 56 2 2 - 4 6 - - 2 9 — — 7 77 1 5 - — 4 37 2 35 Charwomen — 21 — - — 1 — — — — — 1 — — — 23 — — — 13 — 10 Laundry Workers — 17 — 1 1 1 — 3 — — — 23 1 1 — 12 — 9 Clerks 9 1 - 3 1 7 — 4 — 23 2 3 - - — 12 — 8 2 Shop Ass'ts, Keepers 7 9 1 - 1 4 2 2 — 11 15 1 — — 5 11 5 4 Dressmakers, Tailors 6 30 — 3 2 6 8 1 — 5 8 53 — 2 — 7 37 1 14 Bootmakers 2 - 1 — — — — — — 3 — 2 — — 1 — — — Skilled Artizans 23 - 3 — 7 — 5 — — — 6 — — 44 — 6 — — 27 11 — BottleWashers 1 - — - — — — — — 1 — 1 — — — — — — Waitresses, Barmen, &c. 2 4 1 - 2 - 3 - — 1 — — - 9 4 2 1 — — 4 3 3 — Caretakers 3 3 1 - - - - — — 1 — 5 3 2 — — 2 3 1 — Others 5 4 1 1 — 2 1 2 1 — 8 9 1 2 — 5 6 2 1 Outdoor. Building Trades 11 1 1 1 — 1 15 9 - - — 2 — 4 — Painters 10 4 — 1 — — 4 — 1 20 — 2 — — 9 — 9 — Labourers 22 3 5 4 1 35 4 — 19 — 12 — Road Traffic 10 - 4 2 — 1 — — - 3 — — — 20 — 5 — 2 — 8 — 5 — Carmen 14 - 2 - 2 — 1 — 1 — 20 — 5 - - — 11 — 4 — Stable Workers 6 1 — — — 1 — — — — 8 — 3 — — — 3 — 2 — Railway Traffic 7 1 — 1 3 — — — — 12 — 1 — — — 10 1 — Postmen 5 — 3 — 2 — — — 10 — — — — — 8 — 2 — Gardeners 3 - - - 1 - - - - - - - - - 4 - 1 - - - 3 - - - Street Merchants 8 1 - - - - - - - - - - - 10 1 4 - - - 4 a Lightermen 1 - - - - - - - - - - - - - 1 - - - - - - - 1 — Road Workers 2 - 1 — — - - - - - - - - 3 - 1 - - - - - 2 - Miscellaneous. School Life 218 220 3 8 50 37 3 4 76 63 8 3 358 335 4 5 2 1 143 121 209 208 Church Officers — 1 — — — — 1 — — — — — 1 1 1 — — — — 1 — — Stage, Music 1 1 - - - - - - - - - - - — 1 1 — - - — 1 1 — — Sick Attendants 1 1 — — — — - - - — — — — 1 1 — — — — — 1 1 — Soldiers 1 — 2 — — — — — — - - — 3 — 1 — — — 2 - — — Butchers, Fishmongers 5 — 2 — — — — 1 — — — 8 — 3 — — — 2 3 — Dairy Trade 3 - - - - - - - - - - - - — 3 - - - - — 1 - 2 — Woodyard Workers 2 2 1 — 1 — — — 1 — — 4 3 1 — — — 2 1 3 Shop Porters, Messengers 21 — 2 — 1 — 3 — 5 — — — 32 — 3 — — — 13 16 — Odd Jobs 5 — — — — — — 5 — — — — — 3 2 — Others 1 — 1 - - - - - - - - - - - - - - - - - - - - - No occupation or occupation not known 52 45 16 9 6 9 6 12 — — 13 14 — 2 93 91 5 8 3 5 45 37 40 41 470 665 56 39 89 129 40 43 — 1 125 134 10 5 790 1,016 73 48 7 13 359 509 351 446 44 cancer. The causes of death of the 10 suspected cases— Heart disease—5 Bronchitis—3 Mastoid disease—1 Tub. meningitis—1 of the 8 definite cases— Heart disease—2 Bronchitis, puerperal fever, empyema, 1each Acute ulcerative endocarditis, gastric carcinoma, miliary 1 tuberculosis, With regard to the death from puerperal fever the certifying practitioner reported that on post-mortem examination not a trace of tuberculous disease could be found, and the same observation applies to many of the others. CANCER. The deaths from the various forms of malignant disease included under this popular heading numbered 167 last year, 70 of males and 97 of females. In 1910 the total was 165, but the difference between the two years does not afford grounds for thinking that the mortality from the malignant neoplasmata is stationary or tending to decrease. Indeed, the records kept in the Department point to just the opposite. Bearing in mind the fact that both the population of the Borough and the total mortality have decreased during the past ten years, the subjoined figures (total numbers of deaths from " cancer") must be acccpted as showing that the mortality from this cause is still increasing. 1901-05. 1906-10. 1911. Males 59 67 70 Females 95 103 97 Total 154 170 167 Very careful analyses have been made of the deaths from this cause for the last twenty years, but the present occasion is not opportune for entering on a discussion of the records. It is hoped that it may be possible to submit at a later date a special report dealing with the mortality from the various forms of malignant new growths. The mortality last year was 1.17 per 1,000, as compared with a mean rate of 118. The numbers of deaths and rates for the past six years are given below:— 1906. 1907. 1908. 1909. 1910. 1911. Deaths 164 178 185 156 165 167 Mortality 1.14 1.24 1.29 1.09 1.15 1.17 In Table 10 the rates from "cancer" during the past year and the mean rates for 1906-10 in the circumjacent districts are given. Before proceeding to say anything about those figures, it should be pointed out that the rates are " nett," not " corrected " rates,* and that the rates recorded in the different districts would be altered considerably by correction for variations in sex and age constitutions of the populations. As the figures stand, it will be seen that the Paddington rate for last year (1.17) was exceeded only by those of Westminster (1.28) and St. Marylebone (1.36), and that all the rates recorded last year were in excess of the means, except in the case of Willesden (rate, 1911, 0.74; mean, 0.83). The rate for the Metropolis last year (1.04) was 0 06 less than the mean (1.10). The usual analysis of the deaths according to sex and seat of the disease, and sex and age, is given in Table 29. Reference should also be made to Tables III. and IV., Appendix A. * See footnote p. 9. 45 cancer. TABLE 29. CANCER. 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 - II. Organs of Special Sense. - - - - - - - - - - - - - - - - (a) Ear - - - 1 - - - - - - - - - - - 1 III. Respiratory System. (a) Larynx 4 3 - - - - - - - - - - - 7 (b) Lung 2 - - 1 - - - - - - - - - - 2 1 IV. Circulatory System V. Digestive System. (a) Mouth. (i.) Tongue 5 - 1 2 1 — — 1 — — — 9 1 (ii.) Palate - - - - 2 - - - - - - - - - 2 (b) "Throat." (ii.) Œsophagus 5 1 - - - - - - - 1 1 — — — 6 2 (c) "Intestines." (i.) Stomach 6 6 3 1 - - - - - - - 3 - - 9 10 (ii.) Bowels 3 6 — 2 - - — — — - — 3 — — 3 12 (iii.) Rectum 3 2 — 1 - - - - - - - - - - 3 3 (d) " Organs." (i.) Liver 8 5 1 3 1 — — 1 1 1 — — 11 10 (ii.) Pancreas 1 1 — 1 — - — — 1 — 1 — - - 3 2 (e) Peritoneum — 1 - - - - - - - - - - - - - 1 (f) Omentum - - - - - - - - - - - - - - - 1 VI. Lymphatic System. (a) Head and Neck. (ii.) Cervical Glands 2 — 1 — — - — 2 - — — 5 — (b) Thorax. (i) Mediastinal Glands - - - - - - - - - - - - - - 2 — (ii.) Bronchial Glands - - - - - - - - 1 - - - - - 1 — (d) Extremities. (ii.) Lower — 1 - - - - - - - - - - - - - 1 VII. Urinary System. (a) Kidneys - - - 1 - - - - - 1 - - - - - 2 (b) Bladder 2 1 1 1 - - - - - - 1 - - - 4 2 VIII. Generative System. (a) Ovaries — 5 — — — — — — — 3 — - — 8 (b) Uterus — 10 — 3 — — 1 — — 1 — — — 15 (c) External Genitalia — 1 - - - - - - - - - - - - - 2 (d) Breast — 9 - 2 — — 4 - 2 — — — — 17 IX. Osseous and Muscular Systems. (a) Head and Neck 1 - 1 1 - - 1 - 1(a) 1 4 (c) Abdomen 1 1 - - - - - - - - - - - 1 1 (d) Extremities (ii.) Lower - - - - - - - - - - - - - - - 1 X. Cutaneous System XI. Not sufficiently described Totals 41 51 11 17 6 2 1 5 8 9 3 12 — 1 70 97 Ages at Death. _ A_. 0— - - - - - - - - 1 1 1 1 10— — — — — - — — — — — — — — — — — 15— — — — — - — — - - - - - - - - - 20— — — — — — — — - — — — — — - - 25— 1 3 - - - - - - - - - - - - 1 3 35— 3 6 1 1 — — — — 4 7 45— 7 11 2 5 - 1 3 4 2 2 — 13 24 55— 12 10 4 4 3 1 1 1 1 2 5 — — 23 21 65— 14 9 5 3 2 1 — 1 1 3 — 3 — — 22 20 75— 4 12 — 4 1 — — — — 2 1 2 — 1 6 21 (a) Rodent Ulcer. Note.—Two cases of Glioma (m., 19; f., 35) not included. 46 mortality in childhood. OTHER DISEASES. Less than usual can be written about these diseases, as detailed information is wanting as to the populations. Influenza.—There were 25 deaths ascribed to this cause (14 of males and 11 of females), being 6 less than the number (31) recorded in 1910 and 47 less than that (72) of 1909. The mortality rate was 0.17 per 1,000 persons, the average annual rate for 1906-10 having been 0.35. Respiratory Diseases.—The deaths from bronchitis numbered 154 (80 of males, 74 of females), and were 12 less than the number (168) recorded in 1910; those from the pneumonias, 114 (61 males, 53 females), or 28 less than in the previous year; and those from "other respiratory diseases," 18 (10 males, 8 females). The total mortality from all forms of respiratory disease was 1.99, but for the purpose of comparison with other years the total mortality from bronchitis and the pneumonias is used. The mortality from those forms was 1.7 (average, 2'25) last year, 1'08 from bronchitis (average, 1'23) and 0 79 from the pneumonias (average, l.02). Alcoholism.--There were 12 deaths from acute and chronic alcoholism (no longer distinguished in the schedules), 5 of males and 7 of females, equal to a mortality of 0.08 per 1,000 (average, 1906-10, 0.07), and 15 from cirrhosis of the liver, 8 males and 7 females, equal to a mortality of 0.10 (average, 1906-10, 0.12). Of the 15 deaths from cirrhosis, 13 (males 7, females 6) were known to be due to alcoholic excess. As, however, in previous reports all cases of cirrhosis have been included in calculations of the total mortality from alcoholism, that practice will be adhered to. The total number of deaths from such excess was, therefore, 27, 13 of males and 14 of females, and the mortality 0.18, the average for the preceding five years having been 0.19. Suicide.—Eleven (11) deaths were due to this cause, 8 of males and 3 of females. The mortality was 0.07, or 0.03 less than the average (0.10). MORTALITY IN CHILDHOOD. This subject will be dealt with in two sections, viz., Mortality at ages under one year (Infantile Mortality), and that at ages 1—5 years (Mortality in Young Children). The former section will include some account of the work done in connection with "Health Visiting." Infantile Mortality. Owing to the manner in which the records of births and deaths are received from out-lying areas, four values are obtained for the rate of infantile mortality, all except one being used for comparative purposes. Unless some definite name be given to each value, it will be hopeless to attempt to deal intelligibly with so many rates. They will, therefore, be considered with the following designations:— Crude rate.—That obtained from the births and deaths registered in the Borough without any corrections for non-residents or out-lying returns. Nett rate.—The deaths are corrected for non-residents and for out-lying deaths of residents, the births are uncorrected. Corrected rate. — The births and deaths are corrected for non-residents and out-lying births and deaths belonging to the Borough (Departmental corrections). Fully corrected rate.—The corrections of births and deaths are those obtained by the use of the " transfer returns " issued annually by the Registrar-General. This rate can be obtained for the Borough as a whole only. 47 mortality in childhood. During the past year 399 deaths of children under one year of age were registered in the Borough, giving a crude rate of 141 per 1,000 births. In 1910 the deaths registered numbered 353, and the crude rate was 121. Below are given the crude rates for each quarter of last year in comparison with those for the previous year and the averages for 1906-10. Mortality. Rates: crude. Quarters. 1. 2. 3. 4. 1911 137 109 199 118 1910 112 110 106 158 1906-10 125 102 127 136 The most notable feature is the decrease in the rate for the fourth quarter of last year in contrast with the increases seen in all the other three. The rates for each of the years 1901-10 will be found in Table I., Appendix A. The deaths registered within the Borough included 48 of children who were non-residents, and 35 deaths of resident children were included in the weekly returns from out-lying districts, so that the nett number of deaths of residents was 386, the corresponding numbers for 1910 and 1909 having been 294 and 311 respectively. (See Table II., Appendix A.) The nett mortality last year was 137 per 1,000 births registered in the Borough, an increase of 36 per 1,000 above the rate (101) recorded in 1910 and of 28 above the mean (109) for the five years 1906-10. The corresponding rates for the quarters of the past year are compared below with the mean rates recorded in the four quinquennial periods of the preceding twenty years (1891-1910). Quarters. 1. 2. 3. 4. 1891-95 133 124 201 133 1896-1900 130 120 238 137 1901-05 130 101 156 127 1906-10 113 91 108 124 1911 125 112 197 111 The rates given above have all been calculated on the same system, but since 1901 the returns of deaths in out-lying places have been, on the whole, more complete than they were before that date. To that extent, therefore, the rates for the first decennium understate the mortality in comparison with the later periods. The comparison between last year's rates and those of the first three quinquennia cannot be described as other than most satisfactory, while the increases noted last year (except in the fourth quarter of the year) may be ascribed to the exceptional meteorological conditions of the year. The comparison affords further proof of the conclusion already hazarded, that the diarrhoeal mortality in the third quarter of last year was not commensurate with the excessive temperature, when judged by the experience of preceding hot summers. In previous years this has been the only rate which could be used in comparison with other districts. In Table 10 (last line but one) will be found the nett rates and the corresponding mean rates for the circumjacent districts, all the rates for the past year being in excess of the means. In Kensington only (rate, 142 ; mean, 125) were the figures higher than in the Borough. The fully corrected rates (last line of the same table) are to the same effect.* As no particulars of the home addresses are given with the " transferred births," they cannot be considered when dealing with the infantile mortality rates recorded in the Wards of the Borough, and recourse has, therefore, been had to the "corrected " rates, which overstate the facts to some extent.† * The fully corrected rate for Willesden is not included in the tables from the Annual Summary which have been received (in proof) from the Registrar-General. †The inclusion of the " transferred births " lowered the " corrected" rate in the Borough as a whole by some 4 per 1,000. In some of the Wards the reduction would be considerably greater, in others less. 48 mortality in childhood. The "corrected" rate in the Borough was 129 per 1,000 births, after deduction of those of non-resident and inclusion of those in out-lying parts traced by the Department. The numbers of births and deaths (0—1 year) used in the calculations of the " corrected " rates are given in Table II., Appendix A. In Table 30 comparisons are made for the Borough and each of the Wards between — (a) the nett rates recorded in the four quarters of the past year ; and (b) the corrected rates for the whole year, and the corresponding mean rates for the five years 1906-10. TABLE 30. Infantile Mortality. Quarters.* Year.† 1. 2. 3. 4. Males. Females. Persons. 1911. 1906-10 1911. 1906-10 1911. 1906-10 1911. 1906-10 1911. 1906-10 1911. 1906-10 1911. 1906-10 Borough 128 115 114 93 202 109 114 127 140 115 119 93 129 104 Queen's Park 128 104 104 66 139 97 164 111 118 100 133 78 125 90 Harrow Road 101 100 98 91 203 75 68 111 124 108 107 69 115 89 Maida Vale 97 122 78 82 193 94 90 117 147 107 69 88 108 98 Westbourne 175 110 118 94 257 143 109 112 205 104 98 112 152 108 Church 169 139 147 129 207 150 160 184 144 150 166 124 155 137 Lancaster Gate— West - 10.3 444 9 142 20 83 64 166 49 115 51 140 50 East 143 101 52 47 — 72 — 114 47 75 37 80 43 74 Hyde Park 81 101 87 95 310 128 100 127 73 115 141 91 112 103 * Calculated on births corrected for non residents only. t Calculated on births corrected for non-residents and out-lying institutions (Departmental returns). The nett rates exhibit wide fluctuations from quarter to quarter and in various Wards in the same quarter. Rates of zero were recorded in Lancaster Gate, West, Ward (first quarter) and East (third and fourth quarters). The maximum and minimum Ward rates in each quarter were— Maximum. Average. Minimum. Average. Quarters. 1911. 1906-10. 1911. 1906-10. 1st 175—Westbourne 110 0—Lancaster Gate, West 103 2nd *147—Church 129 52— „ East 47 3rd 257—-Westbourne 143 0— ,, ,, 72 4th 164—Queen's Park 111 0— ,, ,, 114 The corrected rate for the year in the Borough was 129 per 1,000 children of both sexes, 25 (24 per cent.) in excess of the average (104), the rate among males (140) being 25 per 1,000 above the average (115), and that for females (119) 26 in excess of the average (93). The greatest departure from the average in the rates recorded in the Wards was observed in Lancaster Gate, West, and amounted to an increase of 180 per cent., last year's rate of 140 being 90 per 1,000 in excess of the average (50). In Maida Vale the increase in the rate was only 10 per cent. and that in Church Ward 13 per cent. The rate for Lancaster Gate, East, Ward (43) was 42 per cent. below the average. The greatest mortality among males (205) was recorded in Westbourne Ward, and the lowest (47) in Lancaster Gate, East; while among females the maximum rate (166) was recorded in Church, and the minimum (37) in Lancaster Gate, East. The mortality among females was particularly low in Maida Vale (69) and Westbourne (98) Wards. It is remarkable that that last Ward should have so low a rate for females, having regard to the high rate for males already mentioned. * The rate of 444 recorded in Lancaster Gate, West, Ward being based on 9 births and 4 deaths, is too unreliable to be taken note of. 49 mortality in childhood. Hopeless Births.—This term is given in these reports to the births of children whose deaths are registered before or at the same time as their births. The time allowed for the registration of births being limited to six weeks, all children coming within this category should be less than six weeks old at death. It will, however, be seen (Table 31) that last year two deaths were registered during the fifth month of life (at ages 4—5 months) and it is evident that such cases scarcely constitute hopeless births, i.e., children born without a hope of surviving. Further, when the causes of death are examined, it is apparent that certain of them are preventable, so that, whatever the age at death, such cases are outside the definition. Last year 101 deaths were registered before or at the time of registration of birth, 58 of the children being males and 43 females. Such deaths formed 26 per cent. of the total number (corrected) recorded at ages under one year. The appended statement shows that the proportion of these deaths to all under one year tends to decrease, the average for the six years 1905-10 having been 30'5 per cent., or 4.5 per cent. higher than last year. Per cent. of all Total. Males. Females. deaths, 0—1 year. 1905 107 53 54 27.3 1906 89 42 47 25.2 1907 124 79 45 35.0 1908 104 58 46 29.8 1909 103 58 45 33.1 1910 97 56 41 32.4 1911 101 58 43 26.0 The subject of "hopeless births" is of interest in connection with questions of mortality due to ante-natal causes and those relating to efforts (municipal and other) to check preventable mortality. With reference to ante-natal causes, the ratio of such deaths to births appears to afford the best measure of the effects of such causes. In the report for 1909 (p. 41) two methods of obtaining such a ratio were proposed, viz.— Method A.—For use when full returns of registration of births are available—in which the number of deaths registered before or synchronously with registration of births are taken out; and Method B. -For use when the dates of birth registration are not known—in which the deaths at ages under one month are taken out, deaths due to overlying being omitted, and those due to premature birth and congenital defects at ages 1—12 months included. Method A can only be used locally, and it was suggested that the ratio to be calculated should be based on the births registered in the district. The alternative method can be applied to any tabulated statistics, and a ratio to the corrected births was therefore proposed. Below are given the ratios (percentages) obtained from the Borough records from 1905 to the end of last year. Combining the sexes, it appears that the average of hopeless births to all births was, by Method A, 3.5 per cent. in 1911, as compared with an average (six years) of 3.3, and by Method B 3 9, the same as the average. Births Hopeless Percentage Bjrths Hopeless Percentage Births. of Births. of (uncorrected). (Method A ) Births. (corrected). (Method B) Births. m. f. m. f. m. f. m. f. m. f. m. f. 1905 1,628 1,556 53 54 3,2 2,8 1,687 1,618 62 59 36 3,6 1906 1,633 1,519 42 47 2.5 3.0 1,719 1,567 56 56 3.2 2.5 1907 1,586 1,488 79 45 49 3.0 1,665 1,541 88 48 5.2 3.1 1908 1,609 1,540 53 46 3.2 2.9 1,678 1,618 75 64 4.3 3.9 1909 1,481 1,414 58 45 3.9 3.1 1,558 1,473 73 50 4.6 3.4 1910 1,462 1,447 56 41 3.4 2.8 1,455 1,419 73 43 5.0 3.0 1911 1,411 1,405 58 43 41 3.0 1,492 1,485 68 48 4.5 3.2 Mean percentages, 1905-10 3.6 3.1 4.3 3.4 h 50 mortality in childhood. TABLE 31. i Hopeless Births. Cause of Death. Days. Weeks. Months. Totals. 0— 1— 2— 3— 4— 5- 6— 1- 2- 3— 1— 2— 3— 4—5 1911. 1910. 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. Not Certified - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 Premature Birth 7 5 4 1 2 - 1 - 1 1 - - - 1 1 1 3 2 1 - - 1 - - - - - - 20 12 28 19 Injury at Birth — 5 1 - - - - - - - - - 1 - 1 - - - - - - - - - - - - - 3 5 3 2 Debility at Birth 3 1 1 1 1 3 4 — — 1 — 7 8 5 — Congenital Defects 1 - 1 — 1 1 - - - — — — — 1 — — 1 1 — 1 — — — — — — — 6 2 5 6 Atelectasis 2 - - - 2 - - - - - - - - - - - - - - - - - - - - - - - 4 — 2 3 Icterus Neonatorum — - — — — — - - - — — — 1 1 — 1 — 1 — — — — — — — — — — 1 3 — — Want of Breast Milk - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - - Atrophy, Debility, Marasmus - - - - - - - - - - - - - - 1 1 1 1 — — — 1 — — — — — — 2 3 1 2 Venereal Diseases - - - 1 - - - - - - - - - - - 1 - - - - - - - - - - - - - 2 7 2 Septic Diseases - - - - - - - - - - - - - - - - 1 - 1 - - 1 - - - - - - 2 1 1 — Diarrhœal Diseases — — — 1 — - - - — — — — — 1 — 1 1 — — 1 3 — — — — 1 — 5 4 2 2 Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - - - Respiratory Diseases. - - - - - - - - - - - - - - - 1 - - - - 1 - - - - - - - 1 1 2 3 Meningitis, Convulsions - - - - - - 1 - 1 - - - - - I - - - - - - - - - - - - - - - - - Overlaid in Bed - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 Other Causes - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - All Causes—1911 12 10 7 2 6 2 2 - 2 1 1 - 3 2 7 8 7 6 3 4 5 8 - - - - 2 - 58 43 56 41 1910 23 12 4 1 3 12 1 — 2 — — — 4 10 9 6 3 5 5 3 3 - — - - - - 56 41 - - 51 mortality in childhood. The figures suggest that there has not been much change in the amount of infantile mortality due to ante-natal causes. Particulars as to causes of and ages at death during each of the last five years—according to the selection proposed by Method A—are given in Table 32. Of the 22 deaths included under this heading which were recorded last year as taking place during the first day of life, 6 (3 of each sex) occurred within the first hour, 17 (11 males, 6 females) within the first twelve hours, and 5 (1 male, 4 females) within the second. The 101 deaths included those of four sets of twins, and with respect to 6 of the total deaths inquests were held. Fourteen of the children were illegitimate, the proportion of such deaths to the total number being 13 8 per cent., the proportion of illegitimate to total births being 5 7 per cent. The elimination of the 101 deaths (Method A) would reduce the infantile mortality to 96 per 1,000, and of the 116 deaths (Method B) to 91. TABLE 32. Hopeless Births. Causes of Death. Causes of Death. Males. Females. 1907. 1908. 1909. 1910. 1911. 1907. 1908. 1909. 1910. 1911. Premature Birth 39 23 25 28 20 22 16 23 19 12 Congenital Defects 6 5 5 5 6 6 5 3 6 2 Atelectasis 2 3 2 4 4 2 3 Injury at Birth 2 3 2 3 3 - 1 2 5 Debility at Birth 6 9 5 7 6 2 - 8 Atrophy, Debility 11 1 4 1 2 7 1 1 2 3 Want of Breast Milk 1 — — — — - - 1 Diarrhœal Diseases 4 4 2 2 5 - 2 1 2 4 Septic Diseases 1 - - 1 2 - - — 1 Venereal Diseases - 1 1 7 2 1 1 2 2 Respiratory Diseases 4 4 3 2 1 6 1 5 3 1 Meningitis, Convulsions 6 4 3 — 5 1 2 2 — - Overlaid in Bed 2 — 1 - - 2 2 1 - Other Causes 3 1 — - 3 1 2 1 — 4 Not Certified 1 3 - - - - 3 1 1 - Ages at death— 0- 18 16 17 23 12 14 12 17 12 10 1- 5 5 7 4 7 3 6 3 1 2 Days 2— 6 3 4 3 6 3 1 1 1 2 3— 3 3 8 2 2 — 4 3 1 - 4— 3 2 2 — 2 3 1 — 2 1 5— 2 2 1 — 1 1 1 — - 6— 3 1 1 - 3 — 1 1 4 2 Weeks 1 12 8 7 10 7 5 5 7 9 8 2— 9 9 2 6 7 6 5 4 3 6 Months 3— 6 4 3 5 3 3 5 3 5 4 1—2 12 5 6 3 5* 7 5 6 3 8 * 2 other deaths aged 4—5 months. Table VIII., Appendix A, contains an analysis of the deaths at ages under one year by causes, sex and ages, in the form prescribed by the Local Government Board, to which have been added the averages for the preceding quinquennium. 52 mortality in childhood. Age-Group Mortality.—The 387 deaths recorded last year were 53 in excess of the average —unadjusted for the smaller number of births recorded during the past year. Below are given the mortality rates for the principal age-group periods, from which it appears that the whole of the increased mortality among males occurred at ages over three months and that among females at ages exceeding one month. Nett Mortality Rates. Males. Females. 1911. 1906-10. 1911. 1906-10. Under one month 40 88 43-45 28.28 31.71 Aged 1—3 months 22 11 25.94 27.60 22.26 Under three months 63 00 69.39 55.89 53.98 Aged 3—6 „ 33.51 22.69 20.87 18.90 „ 6—9 „ 24.12 16.21 18.18 12.82 „ 9—12 „ 19.43 14.26 24.91 10.79 Mortality by Causes.—An examination of the mortality rates (see below) from the groups of causes of death shows at once that the increased mortality of last year was almost entirely due to the "Common Infectious Diseases" (Group I. of Table VIII.) and the " Diarrhceal Diseases" (Group II. of the same table). Nett Mortality Rates. Males. Females. 1911. 1906-10. 1911. 1906-10. I. "Common Infectious Diseases" 12.73 7.13 14.14 6.74 II. " Diarrhœal Diseases" 38.87 23.34 57.23 19.56 III. "Tuberculous Diseases" 3.35 5.18 3.36 4.04 IV. "Developmental Diseases" 44.90 48.63 34.34 33.06 V. "Other Diseases" 29.49 29.18 14.14 26.99 All other Causes 10.72 8.43 10.10 6.74 The deaths from measles (19) were 11 in excess of the average, those from whooping cough (21) 9 in excess, and those from the diarrhœal diseases (143) 80. The total excess of deaths {100) from those three causes was equivalent to a mortality of 33 per 1,000, whereas the difference between the total mortality recorded last year (129) and the average (104) was 25. The excess of deaths from those diseases among males was equivalent to a mortality of 22, the total excess of the average (see Table 30) being 25, and among females to a mortality of 45, the total excess (same table) being 26. Excluding those three diseases altogether, the total mortality was 68 per 1,000 last year, or 14 less than the average (82), the mortality among males 88 (average, 94), and that among females 48 (average, 70). TABLE 33. Infantile Mortality. Special Areas. Special Areas. Insulæ. 1911. Infantile Mortality.* Births. Deaths. 1911. 1910. 1906-10. Ward. "Hall Park" 115 12 104 80 128 V. "North Wharf" 89 19 213 175 135 "Clarendon Street" 315 53 168 122 169 IV. "Alfred Road " 152 26 171 102 119 III.. "Amberley Road" 83 15 180 125 124 I. "Queen's Park 260 24 92 109 86 * Corrected rates. 53 mortality in childhood. Mortality in Special Areas.—In 1901 tv/o special reports on the housing conditions, &c., of certain parts of the Borough were submitted to the Council, the first giving brief accounts of six areas or insula and the second very full details with reference to the largest of the areas, that known as the "Clarendon Street Area." Since 1905, when the returns relating to the registration of births were first received, particulars have been taken out annually of the infantile mortality rates of the six areas. An examination of the figures will throw further light on the causes of the increased mortality among infants recorded in the Borough last year. In Table 33 will be found the numbers of births and deaths at ages under one allocated to each of the six areas, together with the mortality rates for the past and previous years. It will be seen that with the exception of that recorded in "Queen's Park" (92) the rate recorded last TABLE 34. Causes of Death and Mortality Rates. 1911. Deaths. Infantile Mortality.* Combined Insulæ. Rest of Borough. Combined Insulæ. Rest of Borough. Not Certified — 1 - - Measles 10 9 9.86 4.58 Whooping Cough 8 13 7.89 6.62 Diarrhœa 25 31 24.65 15.79 Enteritis 28 39 27.61 19.86 Premature Birth 11 32 10.84 16.30 Congenital Defects 3 11 2.95 560 Injury at Birth 2 7 1.97 3.56 Want of Breast Milk - 2 — 1.01 Atrophy, Debility 7 16 6.90 8.15 Atelectasis 2 2 1.97 1.01 Debility at Birth 8 15 7.89 7.64 Tuberculous Diseases 4 6 3.94 3.05 Syphilis 3 1 2.95 0.51 Meningitis 3 3 2.95 1.52 Convulsions 3 3 2.95 1.52 Respiratory Diseases 12 28 11.83 14.26 Suffocation (Overlaid) 2 3 1.97 1.52 Other Causes 18 17 17.75 8.65 All Causes 149 238 146.94 121.24 Under 1 month 30 73 29.58 37.18 Aged 1—3 months 26 48 25.64 24.45 Under 3 months 56 121 55.22 61.64 Aged 3— „ 38 43 37.47 21.90 6— „ 20 43 19.72 21.90 9- 35 31 34.51 15.79 * Corrected rates. 54 mortality in childhood. year in each of the areas was in excess of that recorded in 1910, the rate for "North Wharf" (213) being the highest of the series. In one only of the six areas was last year's rate below the the average for 1906-10 (Table 33), viz., in "Clarendon Street" (rate, 1911, 168; average, 169). As that area is the poorest and most densely inhabited part of the Borough the difference, small though it is, is satisfactory, and the more so having regard to the great amount of time and attention devoted to improving the general conditions of the inhabitants. The area in past years has been remarkable for having the highest infantile mortality of any part of the Borough. The extent to which the mortality rates prevalent in these areas influence the rates of the Wards in which they are situated is shown by the figures given below. The "Queen's Park" mortality lowered last year's rate for Queen's Park Ward to the extent of some 70 per 1,000 births, while the rates for the other areas increased the Ward rates, the difference amounting to 19 per 1,000 in Maida Vale. I.—Queen's Park. III.—Maida Vale. IV.—Westbourne. V.—Church. 1911. 1906-10. 1911. 1906-10. 1911. 1906-10. 1911. 1906-10. Whole Ward 125 90 109 98 155 108 155 134 Insulae 92 85 181 124 171 119 161 152 Rest of Ward 195 102 90 93 148 103 140 101 Table 34 has been constructed to compare the total mortality recorded last year in the six areas with that for the " Rest of the Borough." Some rather remarkable differences are disclosed. The mortality from diarrhceal diseases in the areas (over 52 per 1,000 births) was just on 46 per cent. higher than that recorded in the " Rest of the Borough " (close on 36 per 1,000 births), while that from measles and whooping cough (17.75) was over 58 per cent. higher. On the other hand, most of the mortalities from the developmental diseases (premature birth .... debility at birth) were lower in the areas than in the other parts of the Borough; and of the other diseases, syphilis is the only one with a rate in the areas much in excess of that recorded in the remainder of the Borough. The age-group mortalities also show some striking differences, only two of those recorded in the areas (viz., 3—6 and 9—12 months) being higher than those of the " Rest of the Borough." The figures confirm the view enunciated in a previous report, that the high mortality at ages under one observed in the areas is due to maternal ignorance and close aggregation of living, and not to feebleness of the children at birth. The records of infantile mortality in the areas have been examined to find out if last year's high mortality was due to anything more than climatic conditions or other exceptional factor. Below will be found a comparison of the mortalities from the more important diseases of infancy recorded last year, in 1910 and during 1906-10 (averages). Special Areas : Infantile Mortality Rates. 1911. 1910. 1906-10. 1911. 1910. 1906-10. Measles 9.9 1.9 3.2 Tuberculous Diseases 3.9 3.9 5.8 Whooping Cough 7.9 9.7 5.4 Syphilis 2.9 3.9 4.1 Diarrhceal Diseases 52.3 18.4 27.4 Convulsions 2.9 — 3.2 Premature Birth 10.8 20.3 16.7 Respiratory Diseases 11.8 26.1 24.3 Congenital Malformations 4.9 13.5 6.0 Overlaid 2.0 1.9 3.8 Atrophy and Debility 14.8 7.1 14.3 All Diseases 146.9 115.1 127.7 1911 1910. 1906-10. Under 1 month 29.6 40.6 35.5 1—3 months 25.6 26.1 30.1 Under 3 months 55.2 66.7 65.6 3— „ 37.5 17.4 25.4 6- „ 19.7 17.4 20.9 9—12 „ 34.5 13.5 15.8 The rates from the two " Common Infectious Diseases," measles and whooping cough, and those due to the " Diarrhœal Diseases " and " Atrophy and Debility" are in excess of the rates given for comparison, all the other rates recorded last year being below both the rates for 1910 55 mortality in childhood. and the averages for 1906-10. Deaths from "Atrophy and Debility" are subject to seasonal variations closely corresponding to those observed in connection with " Diarrhceal Diseases." The age-group mortalities are to the same effect, the only rates for last year showing increases being those for the age-groups 3—6 and 9—12 months, ages at which diarrhoea specially prevails. It may therefore be concluded that the high rate of infantile mortality observed last year was due to the coincident prevalence of summer diarrhoea, measles, and whooping cough, and, further, that there has been no real check in that fall in the mortality from other causes which has been recorded during the past four or five years. Diarrhœa.—The changes in the system of classification, following on the adoption by the Registrar-General of the " International List of Causes of Death," have made it not a little difficult to adjust the new heading " Diarrhoea and Enteritis," to the old headings " Diarrhoea " and " Epidemic, Zymotic Enteritis," which have hitherto been used in calculating the mortality from " summer diarrhoea " of infants. There was, also, formerly a third heading, " Enteritis," but any deaths under that heading (usually they were comparatively few in number) were not included in the mortality from "diarrhoea." Now such deaths are included under the general heading " Diarrhoea and Enteritis." That general heading is subdivided by the Registrar-General under eight sub-heads, and as there is a slight difference between the subdivision used by him and that used in the Department, a comparative statement of the two divisions is appended. Nos. 104 & 105. Diarrhœa and Enteritis. Registrar-General's Sub-heads. Departments Sub heads. A. Infective enteritis. (a) Epidemic diarrhoea ; diarrhoea and vomiting; B. Diarrhoea—not returned as infective. diarrhea; chronic diarrhcea of infants; C. Enteritis „ „ dysentery in asylums. . . " " (b) Enteritis; epidemic, zymotic enteritis; gastro- D. (Gastro-enteritis ,, „ enteritis; gastro-intestinal catarrh; intestinal E. Dyspepsia, under 2 years. enteric catarrh. F. Colic. (c) Diarrhoea due to food. G. Ulceration of intestines. (d) Dyspepsia (infants); athrepsia ; food atrophy ; H. Duodenal ulcer. dilatation of stomach (infants). (e) Intestinal ulceration ; duodenal ulcer ; ulcerative colitis. (/) Colic (infants). (g) Chronic enteritis. Attention should be directed to the fact that last year the figures for diarrhoea (heading "Diarrhcea and Enteritis") given in the Registrar-General's Quarterly Reports are the numbers of deaths at ages under two years, not at all ages as in previous reports, but the mortality rates (based on those figures) are calculated per 1,000 persons of all ages. The deaths from " diarrhoea and enteritis " at all ages recorded in the Borough last year, according to the Department's tabulation, numbered 160, 75 of males and 85 of females. The numbers falling under each of the sub-headings were— (a) Epidemic diarrhcea 68 males, 33 ; females, 35 (b) Enteritis, Epidemic enteritis 82 „ 36 „ 46 (c) Diarrhcea due to food 1 „ 0 ,, 1 (The above correspond, as nearly as possible, with the old headings, " Diarrhœa " and " Epidemic, Zymotic Enteritis.") (d) Dyspepsia 2 males, 1; females, 1 (e) Duodenal ulcer 5 ,,4 „ 1 (g) Chronic enteritis 2 „ 1 „ 1 (The last represents the old heading, " Enteritis.") The deaths due to causes corresponding to the two old headings numbered 151 (at all ages), viz., 69 males and 82 females. (See Tables III. and IV., Appendix A.) Such deaths were 56 mortality in childhood. equal to a mortality rate of 1.05 per 1,000 persons of all ages, as compared with a rate of 0.36 recorded in 1910, and a mean rate of 0'45 for the years 1906-10. The only comparison of a similar character which can be made for the Wards is that of numbers, as set out below. Diarrhœa and Enteritis. Deaths at all ages. Queen's Harrow Maida West- , Lancaster Gate, Hyde Borough. park Road Va]e bourne Church. Wgst £ast Pa'rk 1911 151 19 29 14 33 43 3 3 7 1910 52 3 9 11 10 16 1 — 2 1906-10 66 7 13 7 11 24 0 1 3 As already mentioned, the Registrar-General limited the tabulation of deaths from diarrhoea* in his Quarterly Reports for the past year to those of children under two years of ageThe number of deaths at those ages in the Borough was 135 last year, as compared with 45 in 1910 and an annual average of 61 during the five years 1906-10. (See below.) Diarrhœa and Enteritis. Deaths at ages 0—2 years. Queen's Harrow Maida West- , Lancaster Gate, Hyde Borough. Road Va]e boume Church. East.' Pa'rk. 1911 135 15 27 12 28 42 2 2 7 1910 45 3 9 9 7 16 1 1906-10 61 7 12 7 10 23 0 0 2 The 135 deaths were equivalent to a mortality of 0.94 per 1,000 persons of all ages, the mean rate for the five years 1906-10 (based on the old system of classification, but recalculated to a population estimated from the last census return) being 0 41, less than half the rate obtained for the past year. In Table 10 the corresponding rates for the Metropolis and the districts circumjacent to the Borough are set out, but considerable uncertainty attaches to the comparisons. In the first place the proportions of children 0—2 years of age to total populations vary in the different districts, and, in the second, the tabulation at present in use (the International List) places more deaths under the heading of " Diarrhoea and Enteritis" than did the old. Relatively to previous years the rates for the past year are overstated. With a view to obtaining a more correct idea of the prevalence of diarrhcea during the past year (and summer) an attempt has been made to adjust the old classification to the new, and to calculate mean rates based on the estimated numbers of children aged 0—2 years for the period 1906-10. The method adopted is too long for description here, but it will be found outlined in a paper entitled "Diarrhoea in 1911 " read before the Epidemiological Section of the Royal Society of Medicine in February of this year.† The results obtained for each Metropolitan City and Borough, and the five groups thereof, are given in Table 35. It will be seen from that table that the diarrhoea deaths in the County during the year were equal to a mortality of 28.57 per 1,000 children aged 0—2 years, as compared with a mean rate of 14.57, a difference of 14 per 1,000. In the third quarter of the year (the "summer") the mortality was at the rate of 92.25 per 1,000 per annum, as compared with a mean rate of 54.38. The difference between those rates—37.87—represents an increase of 69.6 per cent., which, large as it, compares very favourably with the difference between the mean rate for 1906-10 and the rate (1104) for the "summer" of 1899, the last year previous to 1911 characterized by an exceptionally high diarrhoea mortality. The rate for 1899 was 102.9 per cent. higher than the mean for 1906-10. The two meteorological elements which are held to influence the prevalence of summer diarrhoea are earth temperature and rainfall, the former favouring the latter checking excessive mortality. As regards earth temperature, the same maximum (64° at a depth of 4 ft.) was recorded in the two years 1899 and 1911, while, as regards rainfall, the former year was slightly the wetter, 4.3 inches being measured during the third quarter, against 2.9 in the * It is to be understood that " diarrhoea " is used simply as an abbreviation of " diarrhcea and enteritis." + Proceedings of the Royal Society of Medicine, 1912, Vol. V. (Epidemiological Section), p. 99. 57 mortality in childhood. latter. Prima facie, therefore, the mortality during the "summer" of 1911 ought to have been higher than that of 1899. Actually the ratio was 100 :113.8, a difference of just on 14 in favour of the last year, affording further confirmation of the view that the excess of diarrhcea was not commensurate with the excess of heat of the summer. TABLE 35. Diarrhœa. Mortality Rates per 1,000 children aged 0—2 years. Year. "Summer." Year. "Summer." Year. "Summer." 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. 1911. 19061910. Paddington 27.56 14.52 50.44 51.78 Holborn 22.55 13.78 74.51 39.05 Southwark 32.50 18.15 109.58 65.38 Kensington 28.33 16.21 85.00 59.59 Finsbury 34.68 20.31 117.45 60.84 Bermondsey 32.81 17.50 104.27 61.70 Hammersmith 37.04 15.50 113.10 58.17 City 27.37 8.16 86.31 24.76 Lambeth 28.11 10.27 90.30 56.39 Fulham 30.22 20.15 131.39 76.67 Battersea 29.49 12.28 90.24 52.21 Chelsea 25.62 15.54 78.09 46.22 Central Districts Wandsworth 24 10 10-49 68'27 43 87 Westminster 16 53 10-78 49 59 31-72 31.07 14.17 104.96 52.69 Camberwell 24.65 12.57 81.63 47.50 Deptford 34 20 15-57 1 i 112.20 55.21 Western Greenwich 35.81 13.64 115.31 54.50 Districts 28.36 15.94 88.01 56.63 Shoreditch 40.57 22.70 128.19 80.83 Lewisham 20 05 10.92 67.77 37.19 Bethnal Green 38.04 16.60 129.02 56.34 Woolwich 20.59 10.56 70.10 44.21 Stepney 33.67 18.89 108.62 60.19 St. Marylebone 2382 12.04 64.26 45.30 Poplar 38.31 22.94 136.93 81.97 Southern Districts 27.74 13.53 88.81 51.79 Hampstead 9.70 5.77 29.48 16.47 St. Pancras 22.55 10.27 75.98 40.93 Eastern Districts 36.58 19.54 122.27 67.52 Islington 26.60 9.69 85.51 33.71 County of London 28.57 14.57 92.25 54.38 Stoke Newington 16.13 8.75 57.77 34.85 Hackney 21.73 15.14 71.36 36.64 Northern Districts 22.60 10.98 73.51 40.94 According to the results included in Table 35 the mortality experienced in the Borough during the year was 27.56, 13 04 above the mean rate. The annual rate based on the deaths during the " summer " (50.44) was the only one in the whole County which was less than the mean rate, but lower rates obtained in Westminster (49 59) and Hampstead (29 48). Such rates are in striking contrast with those of 136.93 and 128.19 recorded in Poplar and Shoreditch respectively. As in previous years, arrangements were made for securing information of cases of diarrhœa treated in the out-patients' departments of the local hospitals and by the Poor Law Medical Officers. All cases so reported during life were visited by the Women Inspectors. A search through the case papers at the Infirmary was also made at the end of the year and notes taken of all cases treated there during the summer months. The "Diarrhoea Register" was opened on June 12th and closed on November 25th, thus including a period of twenty-four weeks. During that time 359 cases of diarrhoea in children under two years of age were recorded. The examination of the case papers at the Infirmary brought to light 28 other cases, making the total number of known attacks 387. At ages over two years there were 34 known cases outside the Infirmary and 10 inside. During the twentyfour weeks there were 69 deaths from diarrhœa in patients whose cases were not brought to the knowledge of the Department, and in addition thereto there were 57 deaths (not all, however, being certified as due to diarrhoea) among the known cases. The largest numbers of cases were reported during the four weeks ending August 12th (32), 19th (53), 26th (80), and September 2nd (31). When the dates of onset are considered (Table 36), the highest numbers fall in the weeks ended August 12th (63) and 19th (64). The disease was acutely epidemic for a period of (approximately) eight weeks—from the week ending August 5th to that ending September 23rd. Fifty-four of the children had relapses (or second attacks), the greater proportion of the cases with relapses occurring after August 5th. i 58 mortality in childhood. TABLE 36. Week ending Dates of Onset of Attack. Dates of Death. Recovering. Dying.* Deaths. Cases and Deaths. All Deaths. Dying. Deaths. June 10 2 - - 2 17 5 1 1 7 1 — 1 24 6 1 — 7 2 2 — July 1 4 1 — 5 2 1 1 8 5 2 — 7 1 — 1 15 12 — — 12 — — — 22 12 3 1 16 — — — 29 16 3 1 20 2 1 1 August 5 22 4 6 32 6 1 5 12 43 9 11 63 12 4 8 19 47 5 12 64 16 7 9 26 44 6 8 58 17 4 13 September 2 21 2 2 25 15 3 12 9 21 2 5 28 6 3 3 16 14 2 — 16 12 6 6 23 12 1 — 13 8 5 3 30 5 2 1 8 5 3 2 October 7 2 1 — 3 9 7 2 14 4 — — 4 2 2 — 21 4 1 — 5 3 3 — 28 5 — — 5 2 1 1 November 4 1 1 — 2 1 1 — 11 1 — — 1 3 2 1 18 2 — — 2 — — — 25 - - - - - - - December 2 1 1 Not known ... 20 10 21 51 — — —— Totals ... 330 57 69 456 126 57 69 * By " Dying " is meant the reported cases which terminated fatally, irrespective of the certified cause of death. The sex-age distribution of known attacks and deaths registered is given in Table 37. More cases were known among boys than among girls, that sex distribution prevailing at all ages, but in the case of the deaths the excess was among girls. Data are not available for calculating attack rates for the age periods, but the appended comparison of proportional age distribution of cases, as noted last year in the Borough and as recorded in an investigation conducted in Islington during 1857-62, is of some interest. Percentage of Total Attacks (Persons). At Ages. Paddington. Islington. Months. (1911.) (1857-62.) 0— 8.5 6.3 3— 16.2 14.6 6— 15.7 14.5 9— 15.7 11.5 12—24 43.6 55.0 The differences in age incidence exhibited by the above figures can probably be explained by the change which has undoubtedly taken place in the method of feeding. At the present time a larger proportion of young children are artificially fed, whereas breast feeding was almost universal in the earlier period. 59 mortality in childhood. TABLE 37. "Diarrhœa," 1911. Ages. (Months.) Known Cases. Deaths. Total. Recovering. Dying.* Males. Females. Males. Females. Males. Females. Males. Females. 0—1 1 - - - 1 - 2 1 1—3 19 13 10 9 9 4 7 14 0—3 20 13 10 9 10 4 9 15 3—6 33 30 21 17 12 13 7 7 6—9 33 28 31 24 2 4 10 4 9—12 32 29 29 25 3 4 1 9 12—18 47 40 47 37 — 3 1 4 18—24 48 34 47 33 1 1 1 1 Grand Totals 213 174 185 145 28 29 29 40 Under 1 year 118 100 91 75 27 25 27 35 Aged 1—2 years 95 74 94 70 1 4 2 5 * See footnote to Table 36. TABLE 38. "Diarrhœa," 1911 Methods of Feeding: Children under One Year Method of Feeding. Ages (Months). Totals under One Year. 0— 1— 2— 3— 4— 5— 6— 7— 8— 9— 10— 11— 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. Known Cases. Recovering. Breast - - 1 2 5 5 3 - 2 4 2 3 1 3 5 6 5 2 1 3 - 2 3 1 28 31 Artificial — 2 — 1 2 2 1 4 1 2 5 4 3 8 1 4 5 7 4 7 4 3 8 44 34 Mixed — — — 1 — — 1 — - 2 2 1 1 — - 3 3 1 1 — 1 5 — 13 9 Not stated - - - - - - 2 - - - 2 - - - - - - - - - 2 1 - - 6 1 Dying. , Artificial 1 - 3 - 4 4 2 - 4 3 3 7 - 3 1 - 1 1 3 - - 2 - 2 22 22 Mixed - - 1 - - - 1 1 - 1 1 - - - - - - - — - — — - — 3 2 Not stated - - - - 1 - - - 1 - - 1 - - - - - - - - - - - - 2 1 Breaths Breast - - - 1 2 - - - - - - - - - - - - - - 1 - 1 - - 2 3 Artificial 2 1 — 10 3 3 1 3 1 2 4 1 2 1 4 1 2 2 — 2 — 1 1 2 20 29 Mixed - - 2 - - - - - - - - - - - - - 1 - - 1 - - — 1 3 2 Not stated - - - - - - - - - - - - - - - - - - - - - - - - 2 1 In children under one year of age the method of feeding is of prime importance with reference to risks of diarrhœa. In Table 38 an analysis is given of the methods of feeding both among the children whose cases were known in life and those not so known. From the information obtained by visiting new-born children it is possible to group such children according to the methods of their feeding. A comparison of proportions (the 60 mortality in childhood. centages) of all visited children on each diet with the diet-distribution of cases of diarrhœa (see below) affords evidence of the importance of the method of rearing of such children as a factor in the prevalence of the disease. Ages. Breast. Artificial. Mixed. Not stated. Months. B. D. B. D. B. D. B. D. 0— 82.7 — 9.1 100 6.5 — 1.5 — 1— 78.6 33.3 12.2 55.5 9.1 11.1 — — 2—3 71.6 43.4 13.5 47.8 10.4 4.3 93 4.3 " B."—as found on Birth Visiting (1st visits)—1,732 observations. " D."—as recorded on Diarrhœa Inquiries—33 observations. Taking the 57 deaths among the children under 2 years of age reported to have diarrhœa as fatal endings of their disease (in 6 instances death was due to causes other than diarrhœa), the fatality among known attacks was 1472 per cent., 1314 among males and 16.66 among females. It will be seen from Table 38 that there was not a death at ages under one month among children who were being fed at the breast. The fatality rates during the first year of life were— breast fed, nil ; artificially fed, 84.6; on a mixed diet (i.e., having the breast and other foods), 96; and among the children whose method of feeding was not stated, 57. If the last group be transferred to the first, the rates are 28 3, 58.6, and 12.9 respectively. Below is given a statement of the fatality rates and ages under three months, distinguishing the methods of feeding, obtained by combining the numbers of unreported deaths (as cases and deaths) with the cases known before death. The conclusion to be drawn from the figures is that the natural method of feeding infants not only prevents attacks, but is also a powerful factor in preventing a fatal issue to attacks among children so reared. Ages. Months. Breast. Artificial. Mixed. Not stated. 0— nil 100 nil nil 1— 25.0 86.6 100 nil 2—3 16.6 82.3 nil 100 There were 54 relapses among the 387 known cases, equal to a frequency of 13.9 per 100 cases, 38 of the patients being under one year old (frequency 17.4 per cent.), and 16 aged one to two years (frequency 9.4). Females appear to be more liable to relapses than males, the frequency in the former sex being 16.6 per 100 cases as compared with 11.7 in the latter. Among the cases with relapses there were 9 deaths, equal to a fatality among such cases of 16.6 per cent. As, however, all the deaths occurred at ages under one the fatality would be more correctly stated at 23.6 per cent., as compared with 23.8 per cent. among cases without relapses. Inquiries were made by the Inspectors when visiting infected houses for unreported cases of diarrhcea. By the inquiries made in connection with the 359 reported cases and 69 deaths (attacks not reported), 132 other attacks of diarrhoea were traced, making the total number of known attacks (reported and unreported) 560, occurring in 419 houses and 4 canal boats. It should be mentioned that at 3 houses all information was refused, and that inquiries were not made at all the homes of the infirmary patients. Multiple attacks were known to have occurred at 84 houses. The results of the inquiries made at 412 houses are summarised below. Of the houses invaded and visited, 412 in all, In 84 houses with 2 or more cases, 2 cases occurred in 59 houses ; 1 family was infected in 41 houses. 3 ,, ,, 13 „ ; 2 families were „ 38 „ 4 ,, ,, 11 i, , and 3 ,, ,, 7 ,, 7 1 house. 4 3 „ The age-distribution of 556 cases and 130 deaths was— Ages. Cases. Deaths. 0—1 year 288 116 1—2 years .,. 180 11 2—5 „ 48 3 5— „ 40 — 61 mortality in childhood. In Fig. 1 the duration of infection in each house in the three main streets in the " Clarendon Street Area " is indicated by hard lines thus X — X. A diagrammatic study of the dates of individual attacks in any given house suggests very strongly a transference of infection direct from person to person, and the general disposition of the lines in Fig. 1 does the same with regard to houses in the same street. In the latter case some vehicle for the conveyance of infection is necessary, and for that purpose the house-fly seems particularly apt. Last year fly counts were taken three days a week at houses or premises in different parts of the Borough. In Fig. 2 the " curve " of the average number of flies counted per cemetery during each week is contrasted with the " curves" of attacks and deaths due to diarrhcea and those of earth temperature and rainfall. The general agreement of the " curves " is very striking, and so is the coincidence of a high fly count with the incidence of the disease as shown in Fig. 1. The facts set out here and illustrated in the diagrams may be taken to afford good reason for suspecting that flies have a large share in the spread of the disease. There are, however, many points which require to be cleared up before that hypothesis can be accepted unreservedly. One practical conclusion can be based on the suggestion and applied without hesitation, viz., the absolute necessity of keeping houses and localities free from accumulations of putrefying refuse, both vegetable and animal, such accumulations being the breeding places of flies of all descriptions. Infant Rearing (Birth Visiting).—In January of last year the " Paddington School for Mothers" (also known as the "Mothers' and Babies' Welcome") was founded to carry on, on extended lines, the work of the Infant Committee of the Paddington Health Society. Later in the year the Institution known as "St. Mary's Kitchen" became amalgamated with the " School," which now undertakes the provision of dinners and other forms of assistance for expectant and nursing mothers, in addition to maintaining two consultation centres. The School" has a full-time Nurse-Matron, who does a large amount.of home visiting, and a staff of voluntary visitors. The " School " has its own house (232, Harrow Road), where various classes are held and much work done to help, but not to pauperise, women of the poorer classes. The cards issued on notification of births numbered 2,954 last year, of which 1,380 were passed on to the School for Mothers. There were also a number of cards issued in 1910 which remained over for visits during the past year. The reports received showed that of the total number of cards issued, 409 related to children of parents above the class requiring visits, and that 280 other children could not be visited by reason of wrong addresses being given or removals. In 47 instances (2.5 per cent. of calls made) the offer of advice was refused. The proportion of refusals last year was slightly higher than in 1910, when it was 18 per cent. The actual number of children visited was 1,732 last year, or 256 fewer than in the previous year. The ages of the children on the occasions of the first visits and the methods of feeding are indicated in the appended statement. Method of Feeding. Breast. Artificial. Mixed. Not stated. Age at Percent- Percent- No Percent- Percent- Totals. Visit. age. age. age. (0— 12 800 — — 2 13.3 1 66 15 1 1— 148 89-7 7 4.2 8 4.8 2 1.2 165 £ 1 2— 382 81.8 46 9.8 32 6.8 7 1.5 467 ? (3— 200 80 0 29 11 6 17 6.8 4 1.6 250 (0— 742 82.7 "82 9.l 59 fro 14 1.5 897 1— 283 78.6 44 12.2 33 9.1 — — 360 2— 116 71.6 22 13.5 17 10.4 7 4.3 162 3— 154 68.7 40 17.8 22 9.8 8 3.5 224 Age not stated 50 56.1 26 29.2 10 11.2 3 3.3 89 Totals 1,345 77.6 214 123 141 8.1 32 1.8 1,732 According to the figures given above, the proportion of children reported to be breast-fed on the occasion of the first visit was 77.6 per cent., as compared with 81.9 in the previous year. 62 mortality in childhood. Such a comparison is, however, of little use without taking into consideration the ages of the children at the first visit. The statement given below shows that there was little difference Percentages of Children Visited at ages of Weeks. Months. Not 0— 1— 2— 3— 0— 1— 2— 3— Stated. 1911 0.9 9.5 27.0 14.4 51.8 20.8 9.3 12.9 5.1 1910 0.9 7.1 25.3 18.2 51.4 24.0 8.8 11.0 4.7 between the age distributions of the two years, so that it is to be concluded that methods of feeding other than that from the breast were more common among the children visited last year. Confirmation of that conclusion is afforded by the fact that the proportion of children under one month old who were being breast-fed was 82.7 per cent. last year, as against 88.6 in the previous year. The total proportion of children being fed artificially, that is, by bottle alone, was 141 per cent., as compared with 11.1 in 1910, and those on a mixed diet, i.e., breast supplemented by the bottle, 81 per cent. (0 8,1910). At ages under one month, 9.1 per cent. were being fed artificially (7.3 in 1910) and 6.5 per cent. (41 in 1910) were on a mixed diet. In view of the above figures it is unsatisfactory to find that 559 children were not visited during the past year owing to pressure of other work. In the course of the inquiries information was obtained of the total numbers of children born to the families visited and the number dead. Such information related to 1,659 families and 5,957 children, among whom there had been 972 deaths, equal to a mortality of 163 per 1,000. In 1910 the ratio of deaths to children born alive was 162, and in 1909, 185. Of the children who were born and visited during the year 81 died before the close of the year, equal to a mortality of 47 per 1,000, the mortality among the unvisited children being approximately 114 per 1,000. The deaths included 38 of breast-fed children (28 per 1,000), 30 of artificially fed (140 per 1,000), and 13 on a mixed diet (92 per 1,000). Below is a tabulation of the causes of death of children who died before and after visit. It has to be remembered that one death among the latter has the same relative weight as 2'4 deaths among the former. Causes of Death of Children Dying Before After Visit. Visit. Total Deaths 140 81 Including— Premature Birth 37 5 Congenital Defects (including Atelectasis) 13 2 Debility (including Debility at Birth) 22 10 Injury at Birth 7 — Diarrhœal Diseases 29 46 Measles — — Whooping Cough 1 — Syphilis 1 1 Convulsions 5 1 Respiratory Diseases 5 5 Overlaid 4 — Work by the " School for Mothers."—The following extracts from the Annual Report of the School will be of interest:— Visiting.—The proportions of children on each class of diet were— Breast-fed 80 per cent. Bottle-fed 11 „ Mixed feeding 7 „ Feeding not stated 2 63 mortality in childhood. Infant Consultations.—"At the Consultations each infant is examined and weighed; inquiry is made as to health and method of feeding, and advice of a general character is given. The mother is recommended to obtain treatment from her own doctor or a hospital if it is required. Records are kept of the weights and progress of each child. " The year's work at the Consultations is here summarised. No. of babies attending Total . Consultations. Attendances. South Centre. Born in 1910 28 Do. 1911 246 - 276 1,561 North Centre. Do. 1910 35 Do. 1911 141 - 176 1,106 Totals 452 2,667 Dinners and Milk.—" Dinners have been supplied by St. Mary's Kitchen to expectant and nursing mothers on the recommendation of the physicians at the charge of a penny a meal. Grants of free meals were made when it was evident that the mother or child would suffer without such assistance, but these grants are reserved for cases of emergency and exceptional distress, which cases are referred to the Charity Organisation Society for investigation and report. Grants of free milk have been made on the same conditions. " Half-cream dried milk has been tried for the first time. It was used successfully in several cases during the hot weather, the mothers, when able, paying cost price. The preparation called 'The Marylebone Cream for Infants' is also provided at the School, the mothers paying a penny for 3 ozs., which is about cost price. It is sold only to those for whom the physicians order it. " During the year sixty-three free grants of milk, twenty-six of dinners, and six of dried milk were made. In eighty-seven cases dinners or milk were granted to mothers paying as above." Mortality among Young Children. At ages between 1 and 5 years the mortality last year was generally less than the mean rates for 1906-10, as also were the rates for the second and fifth years of life in comparison with the rates for 1910. (See below.) The rates here quoted have been obtained from the numbers of survivors at each age at the end of 1910, and the numbers dying during 1911. Whole Borough. Ages (Years). 1— 2— 3— 4—5 1911 3005 1109 774 5 49 1910 39.33 10.79 4.38 6.48 1906-10 31.22 11.98 7.06 5.44 The rates at each age recorded in the Wards of the Borough will be found in Table 39, and those due to the principal causes of death (whole Borough) in Table 40. TABLE 39. Mortality among Young Children. Age (Years). 1— 2— 3— 4—5 Period. 1911. 1906-10. 1911. 1907-10. 1911. 1908-10. 1911. 1909-10.  Sex. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. Wards. Queen's Park 50.2 26.3 25.0 31.3 - 12.9 15.1 9.5 5.2 4.7 3.4 1.8 4.9 5.9 10.6 5.4 Harrow Road 17.5 13.0 23.6 21.0 6.5 5.5 8.8 10.4 2.5 4.6 4.6 5.8 6.0 2.7 5.4 8.7 Maida Vale 39.7 15.2 45.0 17.8 5.8 5.8 14.9 10.7 21.5 16.4 3.7 11.4 — — — 2.5 Westbourne 44.8 15.3 33.3 24.8 19.3 19.7 12.8 5.9 — 9.0 9.4 9.7 20.5 — 2.5 5.5 Church 46.5 51.2 54.2 48.9 9.7 25.6 20.1 24.8 23.8 3.3 10.2 11.5 6.1 6.6 7.8 10.5 Lancaster Gate, West — 29.4 18.3 — — 37.1 — — — — - — — — 17.2 — ,, East 37.1 35.7 25.0 — 32.2 — 5.4 — — — - 10.1 — — — 15.6 Hyde Park - 12.3 20.1 17.5 11.1 - 14.2 9.4 — 13.7 - 3.6 26.6 — 5.3 5.5 64 mortality in childhood. TABLE 40. Mortality among Young Children. Age 1- 2 3— 4-5 Period 1911. 1906-10. 1911. 1907-10. 1911. 1908-10. 1911. 1909-10. Sex M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Cause of Death. Measles 7.3 3.7 6.9 6.2 2.2 5.5 3.3 2.1 1.4 - 0.7 1.0 0.7 - 0.7 1.5 Scarlet Fever - - 1.2 0.1 - - 0.3 0.7 0.7 — 1.0 1.0 - — 0.7 1.1 Whooping Cough 4.4 3.7 4.4 1.8 — 0.8 1.2 0.7 0.7 3.5 0.2 1.5 1.4 0.7 0.3 1.1 Diphtheria — 0.7 0.5 0.4 — — 0.7 1.0 0.7 0.7 1.3 1.2 — 0.7 1.1 — Diarrhœa 2.2 2.9 3.3 3.4 — 0.8 0.2 0.2 — — — 0.2 — — — — Enteritis 0.7 2.9 0.4 0.1 0.8 0.8 — — — 0.7 -— 0'2 — — — — Congenital Malformations - - 0.1 — 0.8 - — — - — — 0.2 — - — — Atrophy and Debility — — — 0.3 — — — — — — — — — — — — Tuberculous Diseases 5.1 1.5 3.4 2.1 0.7 3.1 2.1 1.4 2.1 0.7 1.4 0.2 2.2 — 1.1 1.1 Syphilis - - - 0.1 - - - - - - - - - - - - Rickets - — 0.7 0.7 - - - - — — — — — — - — Convulsions 2.2 - 0.4 0.7 — — — 0.5 - — — 0.2 - — 0.3 - Dentition — - 0.1 0.7 - - 0.3 0.2 - — - — - — — — Respiratory Diseases 5.1 4.4 9.8 8.0 3.0 1.6 3.6 2.9 1.4 0.7 0.9 0.2 0.7 — 0.7 1.1 Accidents and Violence — — 0.7 0.3 — — 0.3 0.5 — — 0.2 1.0 — — — — Other Causes 7.3 5.9 2.5 2.3 1.5 0.8 0.9 1.1 2.1 - 0.8 1.0 2.9 1.5 0.7 1.5 All Causes 34.4 25.7 34.8 27.5 9.0 13.3 13.4 12.2 9.2 6.3 5.9 8.0 7.9 3.0 5.7 7. 4 Corresponding rates (all causes) recorded in the six Special Areas at each age are given below. Sufficient material has not yet been obtained to justify the inclusion of any figures relating to the causes of death at each age in those areas. Special Areas. 1— 2— 3— 4—5 1907.1908.1909.1910.1911. 1908.1909.1910.1911. 1909.1910.1911. 1910.1911Males 52 35 53 67 70 21 14 26 11 9 8 20 6 6 Females 24 28 39 58 41 6 29 6 29 13 11 11 4 5 Persons 38 31 46 63 55 14 21 16 19 11 10 15 5 5 Mortality among Illegitimate Children.—There were 64 deaths of such children recorded in the Borough during the year, 14 of them being non-residents. Prom outlying districts 8 deaths were returned, so that the corrected number of deaths was 58, 26 of the children being males and 32 females. In 1910 the corrected number of deaths was 50, 24 of males and 26 of females. The 58 deaths included 49 of children under one year, 15 more than the number recorded in the previous year. The infantile mortality rate among such children was 337 per 1,000 births, 121 in excess of the rate observed in 1910 and 110 in excess of the annual average for 1906-10. Last year's rate was 220 per 1,000 in excess of the rate for legitimate children, but the greatest difference between the two rates was exhibited in the case of females. (See below.) 1911. (Corrected.) Infantile Mortality. Ages (yrs.). Males. Females. Persons. Illegitimate. Legitimate. 0— 20 29 49 1911. 1906-10. 1911. 1906-10. 1—5 6 3 9 Males 273 243 131 109 — — — Females 415 208 103 88 Totals 26 32 58 Persons 337 227 117 99 65 inquests. The usual tabulation of causes of death and occupations of the mothers is appended. The 13 deaths from the diarrhœal diseases were equal to a mortality of 76 per 1,000, as compared with one of 46 among legitimate children. Inquests were held with reference to 8 out of the 58 deaths, or 13 8 per cent. of such deaths, as compared with 6.9 per cent. for all other deaths. Causes of and Ages at Death. 0-1 1—5 Occupations of Mothers. Total. m. f. m. f. Measles' 5 2 1 2 — Domestic Service— 28 Whooping Cough 2 — 1 — 1 Servant 17 General 6 Diarrhœal Diseases 14 4 9 1 — Housemaid 2 Nurse 1 Erysipelas 1 — 1 — — Cook 2 Syphilis 2 — 2 — — Laundry Workers— 4 Premature Birth 7 4 3 — — "Laundress" 3 Ironer 1 Injury at Birth 4 4 Miscellaneous— 21 Congenital Defects 1 — 1 Charwoman 11 Dressmaker 1 Debility at Birth 4 2 2 — — Waitress 4 Tie Maker 1 Atrophy and Debility 3 1 2 — — Barmaid 1 Shop Assistant 1 Respiratory Diseases 6 3 2 1 — Chambermaid 2 Overlaid 22 — — — , Other Diseases 7 2 2 2 1 Idependent- 1 No occupation, or occupation not stated— 4 Totals 58 20 29 6 3 ; Inquests were held touching 8 deaths. INQUESTS. During the year 184 inquests were held in the Borough, 68 of which related to deaths of nonresidents. In 1910 203 inquests were held, 60 relating to deaths of non-residents. In out-lying districts 22 inquests were held last year with reference to deaths of residents of the Borough, so that the corrected number of deaths of which the causes were certified after inquest was 138 last year, as compared with 157 in 1910. Such deaths formed 7.1 per cent. of all deaths last year, as compared with 8.7 in 1910 and 8.5 during 1906-10. In Table 41 the numbers of inquests are arranged according to the findings of the juries, the figures for the past year being compared with the averages for 1906-10. Below is given a statement of the principal causes of accidents, &c. Accidents, Misadventure, Open, Neglect. Road Traffic m. 11. f. 5. Chloroform nar- Choked by food " Falls" m. 8. f. 10. cosis m. 1. f. 1. or vomit m. 1. f. 2. Struck by falling " Blood poison- " Drinking too bodies m. 2. f. — ing" m. — f. 1. much beer" m. 1. Drowning m. 4. f. 2. Alcoholism Heat m. 1. Burns m. 2. f. 2. (" neglect") m. — f. 2. Overlaid in bed m. 3. f. 1. Accidentsatbirth m. 1. f. 3. Illegal operation f. 1. Injury (undefined) f. 1. Suicides. Cut throat m. 4. f. — Hanging m. 2. f. — Drowning m. 1. f. — Poison... ... m. 1. f. 2. Throwing from height m. — f. 1. Murder. Suffocation m. 1. (new-born). K 66 DEATHS IN INSTITUTIONS. TABLE 41. Inquests. Finding of Jury. 1911. 1910. 1906-10. m. f. m. f. m. f. Natural Causes 37 23 38 44 38 42 Misadventure 6 5 6 3 6 3 Accidental Causes 25 19 27 24 29 22 Murder 1 — — — 1 0 Suicide 8 3 10 3 10 4 "Open" 3 4 — — 2 1 "Neglect," &c. 1 3 — 2 2 2 Execution - - - - 0 - Totals 81 57 81 76 88 74 DEATHS IN INSTITUTIONS. The deaths in local institutions numbered 854 last year, or 51 more than the average (803), but 385 of the deceased persons were non-residents. Tables V. and VI., Appendix A, give the numbers and causes of death in cach institution. In out-lying institutions (Table VII., Appendix A) 196 deaths of residents took place, so that the corrected total of deaths of residents in institutions was 665, equal to 35'8 per cent, of all deaths of residents, as compared with 35'2 per cent, in 1910, and an average of 34T during 1906-10. In comparison with the average for 1906-10 the greatest increase per cent, was observed in Hyde Park Ward (increase 8.0 per cent.), Maida Vale having the next largest (4.6). In Church Ward the increase was only 2.8 per cent., but that Ward had the highest percentage (46.8) in the whole series. In Lancaster Gate, East, Ward, last year's proportion of institutional deaths (12T) was only 0.1 in excess of half the average (24'0). (See below!) 1911. 1910. 190610. 1911. 1910. 1906-10. Queen's Park 38.2 36.8 34.3 Church 46.8 45.7 44.0 Harrow Road 33.4 33.6 31.3 Lancaster Gate, West 23.0 16.6 19.2 Maida Vale 33.4 28.5 28.8 „ East 12.1 27.7 24.0 Westbourne 32.8 33.7 32.6 Hyde Park 35 0 27.7 27. 0 The deaths in the hospitals of the Metropolitan Asylums Board were equal to 23 per cent, of all deaths, showing an increase of 1*5 above the proportion recorded in 1910 and one of 10 above the annual average of 1906-10. It should be remembered that during the past year those hospitals have been open to patients suffering from measles and whooping cough. If the deaths (13) from those diseases be deducted from the total deaths (45) in those hospitals, last year's proportion is reduced to 1.6 per cent., which is double the proportion noted in 1910. An examination of the causes of death (Table VII., Appendix A) points to the number of deaths among the children in the hospitals reserved for them (e.g., Queen Mary's Hospital) as the cause of the increase. There were also increases in the proportions of deaths in Poor Law Institutions and in Lunatic Asylums. (See below.) Some of those increases arc doubtless due to the larger number of deaths returned from out-lying institutions arising from the wider area covered by the " transferred " deaths. Rate-supported Institutions— 1911. 1910. 1906-10. Hospitals of the Metropolitan Asylums Board 2.3 0.8 1.3 Poor Law Institutions 20.5 20.7 18.6 Lunatic Asylums 3.0 2.2 2.5 Voluntary Institutions— Hospitals and Homes (excluding Nursing Homes) 9.7 11.3 11.1 67 ADMINISTRATIVE WORK. ADMINISTRATIVE WORK. A general summary of the work of the District Inspectors in relation to nuisances, &c., of the ordinary type will be found in Table 42. A second summary will be found in Appendix A, Table IX. Prevention of Infectious Disease.—The number of visits required in connection with infectious diseases shows no signs of reduction, the visits having increased from 6,325 in 1909 to 7,279 in 1910 and 7,332 last year. There has, however, been a decrease in the number of inquiries (made by the District Inspectors) after notified diseases. The visits numbered 3,010 in 1909, but decreased to 2,098 in 1910 and 1,812 in 1911. The work of the Women Inspectors—mostly with reference to illnesses among school children reported by the staffs of the public elementary schools—has notably increased, their visits having risen from 3,315 in 1909 to 5,181 in 1910 and 5,520 last year. Below are some of the figures relating to this part of the work of the Women Inspectors. 1909. 1910. 1911. 1909. 1910. 1911. Measles 1,005 3,051 1,846 Chickenpox 285 461 545 Whooping Cough 479 430 793 Diarrhoea 546 410 1,369 Consumption 991 807 959 Puerperal Fever 9 22 8 The distribution of their work throughout the year is shown by the following statement of the quarterly totals of visits. Quarters. 1. 2. 3. 4. 1909 1,539 1,905 1,488 1,393 1910 1,878 2,425 1,493 1,483 1911 2,028 1,863 2,133 1,308 There is practically no slack time at any part of the year, and the present staff (two women) is not sufficient to meet the increasing demands for departmental supervision. The extended scope of notification of pulmonary tuberculosis will entail a very considerable increase in the amount of visiting to be done. School work—visits with reference to reported illnesses— is also steadily increasing. It is only by sacrificing less pressing work that the necessary visits in connection with infectious disease have been accomplished. The hospitals of the Metropolitan Asylums Board are now open to cases of measles and whooping cough under conditions which have already been detailed [see p. 31). Last year 72 cases of measles and 30 of whooping cough were admitted. The admissions of cases of notified diseases numbered 435 last year, as compared with 797 in 1909 and 406 in 1910. The number of patients treated at home (suffering from diseases for which hospital treatment is provided) was 24, as compared with 26 in 1910 and 41 in 1909. Four (4) warning letters were sent to midwives and others after cases of puerperal fever, the same number as in 1910. Only one letter was issued in 1909. disinfection.—This is effected by the spraying of rooms by the staff of the Department, a solution of formaldehyde being used. Last ^ear 2,857 rooms were so treated, the numbers for 1910 and 1909 having been 2,941 and 2,351 respectively. Private disinfection was resorted to in 10 instances only (25 in 1910), the efficiency of the process being certified by the medical attendants. The number of rooms disinfected after use by patients suffering from pulmonary tuberculosis increased from 171 in 1910 to 226 last year. The disinfection of bedding, &c., is performed by the contractors, Messrs. Armfield & Sons, Ltd. The goods removed weighed 50½ tons last year, the cost of the work being £1,013, against £1,067 in 1910 (58 tons) and £1,106 in 1909 (54¼ tons). That the work is done satisfactorily is evidenced by the fact that only 13 complaints were received from the public during the year, the complaints being of no real importance and readily remedied by the contractors. There was no evidence of any want of efficiency in the processes used. 68 administrative work. TABLE 42. Report of the Work of the District Inspectors during the Year 1911. Quarters. 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. Rainwater-pipes Disconnected. W.C., New Provided, Repaired, Sec. 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. Housesor 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. First 116 72 421 — 3,474 32 19 8 49 17 80 17 2 11 18 2 — 18 14 5 8 19 1 — 8 10 1 2 — Second 149 87 439 - 3,582 35 20 6 51 13 67 13 8 5 14 6 1 15 23 8 9 27 2 — 7 8 — 13 — Third 198 5 564 — 3,235 35 22 13 47 18 76 18 1 5 1 6 1 24 31 3 9 43 3 1 14 13 1 10 — Fourth 115 1 426 — 3,591 44 17 23 50 14 81 17 10 10 6 4 — 27 12 5 8 55 2 — 9 15 — 1 1 Year 578 165 1,850 — 13,882 146 78 50 197 62 304 65 21 31 39 18 2 84 80 21 34 144 8 1 38 46 2 26 1 69 ADMINISTRATIVE WORK. Water supply.—The notices of discontinuance of supply received from the Metropolitan Water Board have decreased in number during the last two years, falling from 84 in 1909 to 74 in 1910 and 41 last year. The cases in which the supply was cut off for non-payment of the water rates numbered 5 in 1909, 10 in 1910, and 3 last year. The other causes of discontinuance were— Empty Premises 30 (59). Defective Fittings 7 (6). Mistaken Order 1. Of the 11 occupied houses, one was vacated after discontinuance of the supply, and the supply restored, after service of notices, to the remainder, two summonses being issued. The practice of cutting off the water supply for non-payment of rates is much to be deprecated. The Water Board is afforded by law the alternatives of cutting off the supply or suing for the water rate. Moreover, by the Act of 1887 (Water Companies (Regulation of Powers) Act) the cutting off for arrears is prohibited (Sec. 4) in the case of a house of which the owner and not the occupier is responsible for the payment of the water rate. That provision should prevent discontinuance of supply to tenement houses. Unfortunately it does not. From inquiries made by the Medical Officer of Health of Wandsworth last year it appears that in 20 metropolitan cities and boroughs, where the reasons for cutting off the supply were noted, 553 notices of discontinuance were received, 262 (47 per cent.) being for arrears of water rate. The Water Companies during their last years of work resorted largely to civil process for recovery of the rates, and it is much to be desired that the Board should do the same. Mortuaries.—Last year 282 bodies were received at the Mortuaries, 6 more than in the previous year. (See below) Paddington Kensal Green. Road. Number of bodies deposited 277 (263) 5 (13) Coroners' cases 188 (191) 5 (13) Awaiting burial:— Infectious 2 (3) — Non-infectious 87 (60) — P.M. examinations made 76 (92) 4 (13) The figures in parentheses are those for 1910. A re-arrangement of the Coroners' Districts has been agreed to, whereby the Borough will be in one District only, instead of two as at present. The change will enable all bodies of persons awaiting inquest to be taken to the Paddington Green Mortuary, and that in Kensal Road will then be no longer required for that purpose. There was a considerable increase in the use of the Mortuary Chapel, 87 bodies being deposited pending burial, as compared with 60 in the previous year. Bodies of non-residents are received on payment of a small fee, those of residents, gratis. schools.— In consequence of the new Regulations—"Infectious Diseases: Rules and Regulations"—issued by the Education Committee of the County Council in August, 1910, the work of the Department with reference to all forms of infectious disease in connection with schools was re-modelled at the commencement of last year. Notices are now left with all parents of children attending school who reside in a house where an infectious disease exists, directing such children to be kept at home for the period prescribed by the Regulations already mentioned. By that method " re-admission " notices to the teachers are not required, as the original " exclusion " notices sent to them state when the children are to be re-admitted. Last year 451 notices were issued after notified diseases (789 in 1910) and 2,595 after nonnotified (1,893 in 1910). The school distribution of cases of infectious disease is given in Table 43, that table including cases in children residing outside the Borough, but attending— or having " contacts " attending—schools in the Borough. 70 ADMINISTRATIVE WORK. On three occasions the prevalence of scarlet fever and diphtheria caused some anxiety, viz., scarlet fever twice—at Essendine Road (in January) and Campbell Street (in September), and diphtheria once—at Harrow Road (Moberly), in June. "Caution letters" (M.O. 38) after the occurrence of cases of diphtheria were issued by the School Medical Officer to three schools, viz., Moberly ("Class Room D," May 31st), Essendine Road ("all infected classes," October 11th), and Beethoven Street ("Class Room C," December 5th). After the issue of such letters, no scholar who has been excluded on account of " sore throat" can be re-admitted until certified free from infection, such certificate to be based upon bacteriological examination. The firstnamed school was the only one in which "carrier" children (5 definite and 11 suspicious) were found. At Essendine Road School there were 4 cases of scarlet fever in the girls' school, viz., in E room 2, G and K rooms 1 each. Of the two cases in E room, the first was in school on January 13th, and sickened on the 16th (she gave rise to 4 other cases at home), the second was in school on the 25th, and sickened that day. The cases in G and K rooms were at school on the 30th and 27th, and sickened on the 31st and 29th respectively. No further cases followed. At Campbell Street School there were 11 cases of scarlet fever during September and October in the boys' and infants' schools, 6 in the former and 5 in the latter. The sequence of cases can be appreciated from the following statement. Boys' School. Infants' School. „ _ last attendance. _ „ last attendance. Room Dates of —: : Room Dates of . sickening. sickening. 21, ix. 22, ix. 25, ix. 25, ix. 29, ix. 23, x. 22, ix. 23, ix. 25, ix. 25, ix. 28, ix. 21, x. F 25,ix („) 2,7, ix. 5, x. B A 3, x. lb, x. B 20,X 21, x. (a) Brother and sister. This school was visited by the School Medical Officer and the Medical Officer of Health from time to time, and all children appearing in any way ill were excluded, and not re-admitted until certified by the Medical Officer of Health to be fit to do so. Scarlet fever was very prevalent at the time in St. Marylebonc. At Moberly School there were 8 cases of diphtheria in the infants' school, 7 in room D and 1 in room B\ The dates of ^ast attendance ^ cases jn former room were— sickening 18, v. 22, v. 26, v. 2, vi. 2, vi. (a) 9, vi. (a) 15, vi. (b) 19, v. 24, v. 28, v. 2, vi. 5, vi. 9, vi. — vi. The children (a) lived in the same house, as also did the child in room Ba The child (b) was a "carrier," but not traced until June 15th, on a swab being taken. He was removed to hospital on July 7th. The school was visited by the School Medical Officer, and several children's throats swabbed. The commencement of the summer holidays was doubtless a fortunate intervention. In spite of the widespread prevalence of measles during 1910, that disease demanded active supervision almost continuously last year, as will be seen from the appended statement of " closures " and " exclusions." 71 ADMINISTRATIVE WORK. TABLE 43. Places. Notified Diseases. Non-notified Diseases. 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. Provided— Amberley Road 1,610 3 2 2 2 98 90 15 5 26 41 Beethoven Street 1,205 7 4 8 5 41 23 (1) 20 9 28 21 Campbell Street 972 14 (1) 6(2) — — 4 12 29 13 10 12 Droop Street 1,102 4 2 2(1) 2(1) 62 (1) 27 17 15 37 25 Essendine Road 1,695 30 14 19 4 170 75 40 12 45 38 Harrow Road (Moberly) 1,594 6 5 13 (1) 1 50 42 11 15 19 14 Kilburn Lane 1,539 7(1) 2(1) 9 (4, 3(1) 43(1) 17(2) 30 13 10 6 Royal Oak (Temporary) 230 - - - - - 2 1 — — — Kensal House 95 — 1 — — 2 — — — — — Non-Provided— Bayswater Jewish 396 4(3) 4(4) — 2 14 (4) 8 — - 4(1) 3 Desborough St. (R.C.) 523 1 1 2 - 7 16 10 3 12 11 Holy Trinity 404 2 2 2 2 26 10 3 2 11 13 St. Augustine 1,171 4(3) 1(1) 6(4) 1(1) 36 (11) 15 (1) 9 1 24 (3) 7(1) St. James 322 - - 1 - 46 (1) 9 — — 2 1 St. John, Kilburn Lane 190 - - 1 — 2 1 — 2 2 1 St. John, Titchborne St. 482 5 (1) 1 - - 16(1) 9 2 1 2 4 St. Luke 424 3 2 (2) 2 - 56 (4) 17 (1) 15 (1) 7 4 4 St. Mary 170 1(1) - — - 2 3 1 — — 3 St. Mary and St. Michael of the Angels (.R.C.) 246 1(1) 2(1| - - 13(4) 2(1) - - 2(1) 3 St. Mary Magdalene 474 - 1 — - 1 1 1 1 - — St. Matthew 422 — - 2 - 42 (2) 8 8 2 34 (2) 16 St. Michael, Star Street 466 4 2 — - 12 7 1 1 12 5 St. Paul 444 — — — 1 6 17 5 4 17 13 St. Peter 545 4 4 1 - 9 6 24 10 (1) 11 10 St. Saviour 520 St. Stephen 791 2 3(1) 1 2 2 2 2 27 12 21 9 31 6 13 2 7(1) 3 3 Wilberforce 862 4 2(1) 3 4 7(1) 8 4 5 8 Non-residents are shown in parentheses. " p.a."—Scholar Patient. " p.n.a."—Non-scholar Patient. School Closures : Measles. Closure, School ■ A 1 (.Infant£ Department). Date of. Duration of. St. Augustine Feb. 28th 17 days. Amberley Road April 10th Until Easter Holidays. Beethoven Street „ „ „ Kilburn Lane „ „ „ St. James March 20th 15 days. 72 ADMINISTRATIVE WORK. "Unprotected" Children Excluded: Measles. Exclusion, Exclusion, School Class-room. Date of. Duration of. School Class-room. Date of. Duration of (.Infants' Department). (Infants' Department). Beethoven Street A and F Jan. 19 5 days Kilburn Lane FandF1 Mar. 16 16 days „ B Mar. 28 4 „ „ D 17 15 „ „ A Apr. 6 18 „ „ E „ 31 24 „ St. Augustine E Jan. 27 15 „ „ F June 12 5 „ „ F Feb. 7 17 „ Desborough St. (R.C.) All < 5 Mar. 16 16 „ „ E Nov. 10 6 „ St. Mary of the Angels C „ 20 16 „ St. Luke B Jan. 26 6 „ „ C May 18 8 „ „ C May 17 6 „ Bayswater Jewish F Mar. 24 14 „ Droop Street All < 5* Feb. 7 18 „ „ E „ 29 26 „ „ A May 4 5 „ „ E May 16 4 „ „ C and E „ 9 4 „ St. James H „ 30 10 „ „ D „ 18 15 „ „ G June 19 2 „ St. Michael, Star Street C Feb. 10 8 „ Holy Trinity All < 5 Apr. 3 21 „ Essendine Road E „ 20 5 „ ,, M „ 10 14 „ „ I ,, 21 4 ,, ,, A „ 24 2 ,, „ G Mar. 15 17 „ „ L May 19 7 „ „ A „ 20 12 „ „ K June 9 18 „ „ D „ 28 28 „ St. Peter's All < 5 Apr. 10 14 „ „ All < 5 Apr. 3 21 „ „ C May 15 5 „ B May 1 12 „ „ A „ 18 5 „ ,, ••• D „ 5 7 „ „ D Sep. 22 7 „ „ EandC „ 8 5 „ St. Matthew'sAll < 5 May 3 16 „ „ J June 1 2 „ Harrow Road Ba „ 5 7 „ „ A and D ,,12 5 „ „ B Sept. 20 14 „ F „ 19 6 „ „ All < 5 „ 27 17 „ „ F Sept. 7 5 „ „ E Nov. 23 16 „ „ All < 5 Oct. 5 16 ., „ F Dec. 5 Until „ D Nov. 13 12 „ Christmas St. John, Titchborne St. B Feb. 17 8 „ Holidays St. Stephen B Mar. 1 18 „ St. Saviour'sAll < 5 June 8 21 days St. John, Kilburn Lane A „ 6 12 „ „ C „ 8 6 „ Amberley Road E Feb. 27 4 „ „ B „ 19 2 „ „ All < 5 Mar. 31 24 „ „ A July 6 Until „ „ Nov. 8 17 „ Summer „ I Dec. 6 Until Holidays Christmas Holidays * To be read: "All under 5 years of age." The aim of " exclusions " is to secure the absence from school of possibly infected children at the time when the disease may be expected to develop. The success of the practice depends on the promptness with which parents inform the school teacher of the illness and the school teacher reports to the School Medical Officer and the Department. When the first case in a class is known within (say) a week of its onset, exclusion from school of the unprotected children from the ninth to the fourteenth or fifteenth day after last attendance at school of the patient should serve to prevent such unprotected children who have been infected from attending school in the early days (when the disease is most infectious) of their own attacks. Unfortunately there are two difficulties militating against success—apart from the too frequent delay on the part of the parents in declaring the disease. The first is that the " O.M. Register " (children who have not had the disease) is not absolutely reliable, and the second, the frequent occurrence of second attacks in the same child. An attack of measles does not apparently confer anything like complete immunity against subsequent infection. Judging by the experience of the past four or five years, exclusion of the " O.M." children is not sufficient to check the spread of the disease. The best course, it is believed, is to close the whole class from about the tenth to the fifteenth day after the last attendance of the first patient. 73 ADMINISTRATIVE WORK. Table 44 gives the numbers of children excluded from school during the year on account of sore throat, ringworm, &c. In addition to the numbers set out in the table there were 4 cases of sore throat reported from outlying schools, 15 of ringworm, 2 of scabies, and 14 of "vermin." There were also 14 other cases of "vermin" in which the schools attended were either not known or not noted. The total number of children coming under the supervision of the Department was 392, viz., sore throat, 82 ; ringworm, 188 ; scabies, 30 ; "vermin," 97. Sore Throat.—Each case has been visited and medical advice urged. If there had been any cases of diphtheria in the school re-admission was not sanctioned until the child had been certified free from infection—as demonstrated by bacteriological test. The distribution of cases throughout the year is of some interest. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. — 2 6 1 1 18 6 — 12 13 13 10 The comparatively larger numbers of June and July were due to the inquiries at Moberly School after an outbreak of diphtheria already referred to, while those noted in the last four months of the year were divided fairly equally among Moberly, Essendine, St. Peter's, and Campbell Street. Just over half the children (45) were in infants' schools. The total of 82 children included 51 boys and 31 girls. Twenty-eight (28) children and 5 adults were seen at the Town Hall by the Medical Officer of Health, swabs (38, including repeats) being taken from them for bacteriological examination. In 6 swabs the Klebs-Loffler bacillus was present, and in 5 the Hoffmann. TABLE 44. School. Sore Throat. Ringworm. Scabies. Vermin. Provided— Amberley Road 1 10 6 14 Beethoven Street 1 32 — - Campbell Street 6 13 1 12 Droop Street 1 15 4 — Essendine Road 17 16 1 4 Harrow Road (Moberly) 36 11 2 — Kilburn Lane 1 15 — — Royal Oak (Temporary) — 1 — 1 Kensal House — — — — Non-provided— Bayswater Jewish — 2 — 4 Desborough Street (R.C.) — 6 — 5 Holy Trinity — 2 — — St. Augustine — 1 — — St. James — 10 4 — St John, Kilburn Lane — — — — , St. John, Titchborne Street — 6 1 — St. Luke — 7 — — St. Mary — — — 18 St. Mary of the Angels and St. Michael (R.C.) - 1 - - St. Mary Magdalene — — 1 3 St. Matthew — 7 — — St. Michael, Star Street — 6 2 — St. Paul 3 2 3 •— St. Peter 11 3 — 2 St. Saviour — — — 6 St. Stephen — 3 1 — Wilberforce 1 4 2 l 74 ADMINISTRATIVE WORK. Ringworm.— Each case is visited periodically to urge medical treatment and to see that proper attention is given to the child. Too many of the children get no more than lotions ordered by chemists, and some of the cases drag on for a most unnecessary time." While not wishing to say that " X-ray" treatment should be used indiscriminately in every case, experience does indicate that such treatment deserves to be and should be much more freely resorted to.† Up to about the middle of last year the County Council had an agreement with St. Mary's Hospital for children to be seen twice a week. For some reason, hard to understand, the second day was abandoned. It is always difficult to secure the "red cards" necessary to obtain treatment at the Hospital, and during the latter half of the year exceptionally difficult. Delays of a month or six weeks after application were far too common. The 188 children comprised 110 in Infants' Schools, 97 in Boys', and 91 in Girls'. In 18 families there were 2 children affected, and in 2, 3. The sex distribution was equal. Twenty-nine (29) children came to the Town Hall for examination, the total number of examinations (microscopical) being 39. Scabies.—The 30 cases comprised 11 in boys and 19 in girls, 8 of the children being under 7 years of age. Two families had 2 cases each and 1 family, 3. Disinfection of the patients' clothes and bedding was carried out—In a few instances, not all, as should have been done—when requested by the medical attendant. Vermin.—During the last quarter of the year the Education Authority began to systematically send in reports of children found at school to be dirty, verminous, or in need of cleansing. Unfortunately, the form of report used was most unsatisfactory, giving no information except the children's names (often only the family name) and their addresses (frequently wrong).‡ The 97 children reported were members of 65 families, boys numbering 55 and girls 42—19 of the 97 being under 7 years of age. As there is no " Cleansing Station " provided in this Borough, all the Department can do is to see whether the homes are verminous or in need of cleansing, and stimulate the parents to greater efforts. A good many of the children found at school to be in need of cleansing are sent by the Education Committee to the St. Marylebone Station, the Committee having an arrangement with the Council of that Borough. So long as "cleansing" is carried out under the supervision of the Education Authority it must be incomplete, as that authority can deal only with children attending school. To achieve a complete scheme a municipal station is necessary, where persons of all ages can be dealt with. Persuasion is practically the only means of getting persons to attend for cleansing except in the case of children, with respect to whom the Education Authority has special powers. § internotification.—Information relating to non-resident children attending school and to the members of their families is exchanged between the Medical Officers of Health of this and the circumjacent Districts. Last year information relating to 384 (180 in 1910) cases in connection with local schools was received from outside, the particulars of which are given below. Disease. Kensington. Willesden. Hampstead. Marylebone. Scarlet Fever 15 20 1 16 Diphtheria 14 29 2 Enteric Fever — — — Measles 19 91 — Whooping Cough 5 32 — Chickenpox 7 22 — Other Sickness 34 67 — 3 Vermin — 7 — 94 (31) 268 (137) 3 (1) 19 (11) * Children reported at the end ot 1910 were still under observation at the close of 1911. + A discussion on the use of X-rays for the treatment of ringworm is to be found in the British Mediial Journal of October 14th, 1911 (vol. ii., 1911, p. 890). ‡A new form, based on a draft prepared in this Department, has been adopted by the Education Committee, but has not yet been brought into use (May, 1912). § A special report on the question (desirableness, cost, &c.) of providing a Cleansing Station for the Borough was presented to the Council in July, 1910. 75 ADMINISTRATIVE WORK. To the Medical Officers of Health of the adjacent Boroughs 556 communications were sent from the Department giving extracts from reports (" Form 84 ") by school teachers, in addition to 77 notices relating to cases of infectious disease in the Borough in the homes of children attending schools in the adjacent Boroughs. Bacteriological Work.—The number of specimens taken for bacteriological examination continues to increase. In 1909 177 specimens were examined, in 1910 200, and last year 316. The greater part of the increase in the number of "diphtheria" specimens has been due to the number of children who have been brought to the Department for examination after exclusion from school—"swabbing" being the general rule. An analysis of the specimens received and the results of the examinations are given below. Bacteriological Work. 1911. Diphtheria. Enteric Fever. Phthisis. Cerebro-spina! Meningitis. Dysentery. Others. Pos. Neg. Hoffmn. Pos. Neg. ? Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg.*  Repeats 56 4 134 5 11 - 15 1 8 3 7 - 16 - 35 - — 1 - 9 - 8 - 1 - 2 - Totals 60 139 11 16 11 7 16 35 — 1 9 8 1 2 210 34 51 1 17 3 1910 114 26 54 1 5 1909 122 27 26 2 - In addition to the above work, 39 specimens were examined in the Department for ringworm. Of the specimens mentioned in the above statement, 102 (32.2 per cent.) gave "positive" results—i.e., the organism associated with the suspected disease was found—and 207 (65.5 per cent.) "negative." In 1910 the "positive" specimens constituted 245 per cent. of the total examined. Offensive Refuse: Trade Refuse.—Under this sub-heading are included the offal and other refuse produced by fishmongers, poulterers, greengrocers, &c. A good deal of such refuse is removed by the Council, and it would, it is believed, be advantageous if the whole of such work were done by the Council. Only one complaint was received during the year, of nuisance from offal in the course of removal. Manure.—The usual notices calling attention to the obligation to remove all manure at least three times a week (viz., either on Mondays, Wednesdays, and Fridays, or the other three weekdays) were posted throughout the Borough during the month of May. Eleven (11) complaints touching manure were received during the year, and dealt with by periodical inspection of the stables in connection with which the complaints arose. One summons was issued. House Refuse.—The rule is to remove all refuse once a week, but during the warmer weather removal is effected twice a week where recommended by the Medical Officer of Health. Last year 144 complaints were received by the Department relating to irregularity or infrequency of removal, 40 of the complaints being addressed to the Department direct, and the remainder being forwarded by the Borough Surveyor. A second collection each week, at the cost of the Council, was recommended in 93 cases, after investigation by the Inspectors, in accordance with the resolution of the Works Committee of October 27th, 1908. 76 ADMINISTRATIVE WORK. Trade Nuisance.—Seven (7) complaints of an ordinary character were received with reference to marine stores (one complaint), fishcuring (4), and smell from yards attached to fish and fruit shop premises (2). In September of last year the Kensington Borough Council wrote to the Council of this Borough suggesting that the time allowed for the removal of offensive refuse should be altered from the present hours (4 to 10 a.m. during March-October and 6 a.m. to noon during NovemberFebruary) to 10 p.m. to 10 a.m. all the year round. The Council of this Borough declined to endorse the suggestion. The principal argument in favour of the suggested change appears to be the long interval between 10 a.m. (or noon) on Saturday and 4 or 6 a.m. on the following Monday. The by-laws do not prohibit removal of refuse on Sundays, should the temperature of the air render such removal necessary. The great objection to the suggestion is the impossibility of effective supervision. Drainage Work.—The drainage systems of 227 houses were wholly or partially reconstructed during the year, as compared with 287 in 1910, 554 in 1909, and 605 in 1908. In addition, the drains of 50 houses were made water-tight by means of the patent process. The drains of 64 other houses were tested for various reasons and found to be sound. In 1909, 97 drains were found on first test to be water-tight. Queen's Park Estate.—The reconstruction of the combined drainage systems on this Estate, commenced in 1900, has now been completed. In the course of the work certain short lengths of combined drains (main drains close to the sewer connections) were found to be under large masses of concrete. Such short lengths were not disturbed, but the right to require their reconstruction, if found later to be necessary, was insisted on. During the past year rats were found to have made their way from certain of those old drains, which were then reconstructed. Unused house connections were found on the main drains. At 8 houses settlements in the back additions made underpinning necessary, such work involving disturbance and partial reconstruction of the drains. At 14 houses damp-proof courses were put in the main walls to remedy dampness. Thirty-three (33) houses were inspected after the occurrence of infectious disease, and the drains chemically tested after cases of diphtheria and enteric fever. All drains so tested were found to be sound. Deposit of Drainage Plans, &c.—Last year 348 sets of plans and notices were received, as compared with 303 in the previous year, involving the dispatch of 708 letters (674 in 1910). Three summonses were issued during the year for non-compliance with the by-laws dealing with this matter, as compared with 1 in 1910 and 11 in 1908. Combined Drainage.—Four systems examined last year were found to be defective and were reconstructed by the Council, viz. :— 49, 51 and 53, Queen's Road. 9 and 11, Kildare Gardens. 17, 18 and 19, Warwick Crescent. 55 and 57, Harrow Road. A new system of combined drainage was sanctioned (by Order under Sec. 74 of the Metropolis Management Act, 1855), at— 40 and 41, Market Street. The decision given in the case of Douse Property and Investment Company, Ltd., v. Grice (79 J.P., 395) is likely to have some influence on future cases dealing with combined drainage. Practically the decision amounts to this : that if it can be proved that a combined system of drainage was approved by, or constructed with the knowledge of, a responsible officer of the local authority, acting within the powers conferred upon him by law or the local authority, that system of drainage is a "drain," and not a "sewer." Hitherto it had been necessary to prove the making of an Order either by the Commissioners of Sewers or the local authority before a combined system could be held to be a " drain." 77 ADMINISTRATIVE WORK. Smoke Prevention.—Twenty-nine (29) premises were kept under special observation last year (see list), the total time given to this work amounting to 114 hours, 20 being so watched in 1910 and 28 in 1909. The total time during which "black smoke" was observed last year was 22 minutes, as compared with 40, 50, and 59 minutes in the three preceding years. Other shades (degrees of density) of smoke were observed during 113f hours, as compared with 38f, 81 j, and 110£ hours in 1910, 1909, and 1908. The improvement in the air of the Borough, qua smoke, is shown by the following figures (percentages):— In 100 hours' observations. 1911. 1910. 1909. 1908. 1907. 1906. " Black Smoke" 0.3 0.9 0.5 0.6 1.2 1.7 "Smoke" 68 46 69 74 65 67 No Smoke 31 7 53 1 30 5 25 3 33 3 313 Eleven complaints of smoke, not necessarily " black smoke," were received during the year, with reference to factories (5), fried fish shops (4), and bakehouses (2). 1911. Smoke Observations. Address. Business. Chimney Shaft of 27, Beethoven Street Laundry Steam Boiler 29, ,, ,, ,, ,, ,, — Bishop's Road Bridge G.W.R. Refreshment Rooms Kitchen Stove 42a, Bravington Road Contractors Traction Engine 8, Bristol Gardens Bakehouse Bakers' Ovens 99, Chippenham Road „ ,, ,, 17, Clifton Road ,, ,, ,, — Eastbourne Terrace Dining Club Steam Boiler and Stove 75-77, Edgware Road Restaurant ,, ,, ,, 189, „ Bakehouse and Restaurant ,, „ „ Goods Yard Hydraulic Works Steam Boilers 223-5, Harrow Road Bedding Factory ,, ,, 282, „ „ Fried Fish Shop Kitchen Stove 360, „ ,, Bakehouse Bakers' Ovens 436 126-8, Kensal Road Saw Mills Steam Boiler 122, Lancefield Street Laundry ,, „ 5-10, North Wharf Refuse Destructor ,, „ 15-19, „ ,, Iron Foundry „ „ 134, Praed Street Refreshment Rooms Kitchen Stove 136 " " — „ ,, G.W.R. Hotel ,, ,, — ,, „ St. Mary's Hospital Steam Boiler 29-33, St. Petersburgh Place .. Dairy Steam Boilers 120, Shirland Road „ ,, „ 8, South Wharf Builders' Merchant Travelling Crane 3, Spring Street Bakehouse Bakers' Ovens 33, Westbourne Grove General Stores Steam Boilers 23, Westbourne Terrace, North Bakehouse Bakers'Ovens Canals, Wharves.—The wharves on the Canal were regularly inspected at least once a week. Three complaints were received last year, viz., smells from passing barges and near the (Edgware Road) tunnel, and a dead dog in the water. The Basin was emptied and cleansed at Easter, when approximately 600 tons of mud and refuse were removed and some necessary repairs to the bottom of the Canal and the retaining walls executed. No complaint was received with reference to the canal boats tied up outside the Basin when it was being emptied. 78 WORKSHOPS SUPERVISION. Canal Boats.—The annual report of the Examining Officer was submitted to the Council and forwarded to the Local Government Board in February last. Forty-nine (49) breaches of the Acts were discovered last year. Two summonses were issued, but at the end of the year the cases had not been disposed of. There are 158 boats on the Register (none added during the past year), but actually only 39 boats are known to be working in and out of the Borough. No cases of infectious disease were reported on the boats during the year, but 4 cases of diarrhoea are known to have occurred among the children, one ending fatally. The deaths among the boat population, registered in Paddington, numbered 5, viz.: — Male 8 months, of diarrhoea (in Park Hospital). Male 69 years, of cancer (in Infirmary). Male 48 years, of asthma (in St. Mary's Hospital). Female 11 years, of measles (in Convent Hospital, Shoreditch). Female 39 years, drowned, accidental. WORKSHOPS SUPERVISION. This part of the report is compiled in pursuance of Section 132 of the Factory and Workshop Act, 1901, which requires a medical officer of health to "report specifically" on the administration of the Act within his district. The information here given is in the form prescribed by Memorandum of the Home Office, that Office also requiring a special table, Table X., Appendix A. Registration.—At the close of 1910 there were 1,508 workshop premises on the Register of the Department. Last year 176 premises were removed from the Register and 176 added to it, leaving 1,508 effective entries at the close of the year. The premises then on the Register included 127 factories, 32 of them being laundries, 1,023 workshops, 29 domestic workshops, 60 workplaces, and 269 premises in the occupation of " single workers," 273 of whom were on the Register of Outworkers. An analysis of the occupations carried on at the premises (of all descriptions), with the latest known numbers of persons working therein, will be found in Table 45, the numbers of outworkers being shown by the figures in parentheses. Women were employed in 1,031 workshops, including 212 where men and women were employed. The total number of female workers therein was 5,883, including 761 young persons. Women were employed at 295 outworkers' premises, including 23 where men and women were employed. The total number of female workers employed therein was 442, including 73 young persons. Notices relating to 60 new workshops were received from the Home Office during the year, 52 of which were already on the Registers of the Department. Home Work.—Employers of outworkers (home workers) forwarded 67 lists in February of last year and 58 in August, or a total of 125 lists, as compared with 154 in 1910, 177 in 1909, and 150 in 1908. The addresses included in those lists numbered 541, of which 354 were forwarded to other districts, where the homeworkers resided, in accordance with the Act. From other districts 297 addresses (in 51 lists) of homeworkers residing in the Borough were received, the number received in 1910 having been 28 in 44 lists. The numbers of lists received from other districts last year are shown below. Kensington 9 (7) City of London 10 (4) Chelsea 2 (2) Hampstead 3 (4) Bethnal Green 2 (J) Lambeth 1 (3) Westminster 4 (5) Willesden 3 (4) Hammersmith 3 (0) Finsbury 4 (4) Marylebone 4 (4) Shoreditch 1 (0) Uxbridge 2 (0 Holborn 2 (2) St. Pancras 1 (0) Note.—Figures in parentheses are the numbers for 1910. 79 WORKSHOPS SUPERVISION. TABLE 45. Factories, Workshops, and Workplaces. 1911. Business. No. of Premises. No. of Rooms. Women. Employees. Young Persons. Men. Totals.  Clothing— Boot-making 119 (54) 125 (54) 8(6) 2(1) 189 (54) 199 (61) Corset-making 8(1) 8(1) 17(1) - — 17(1) Dressmaking 425 (72) 769 (76) 2,487 (140) 552 (45) 39 (6) 3,078 (191) Furriers 7 12 26 — 6 32 Mantle-making 7(2) 7 (2)' 30(3) -(2) — 30 (5) Millinery 40(1) 46(1) 244 (1) 20 — 264 (1) Millinery and Dressmaking 22 (2) 47 (2) 380 (3) 52 432 (3) Outfitting and Plain Needlework 45 (30) 50(31) 164 (60) 10 174 (60) Tailoring 201 (148) 242 (158) 205 (69) 23 (20) 405 (167) 633 (256) ,, Ladies' 29 (9) 45 (9) 80 (9) 3 62 145 (9) Various 16(8) 18 (8) 25 (5) — 4 29 (5) Fancy Work— Embroidery and Art Needlework 13 (10) 15 (11) 59 (21) 9(5) 9(1) 77 (27) Cleansing— Dyers and Cleaners' Receiving Offices 17 24 44 — — 44 Laundries 101 (10) 268(10) 821 (10) 12 80 913(10) „ —Receiving Offices 33 33 44 — — 44 Mangling 15(1) 15 (1) 21 (1) — — 21(1) Other Businesses— Blind-making 6 11 23 — 20 43 Bookbinding and Printing 26 40 66 20 280 366 Carpentry and Joinery 19 39 — — 289 289 Chaff-cutting 16 20 — — 56 56 Coach Building 12 25 — — 59 59 Cycle and Motor Works 63 95 — — 309 309 Farriers and General Smiths 31 38 — — 92 92 Florists 15 21 58 — — 58 Jewellery and Clock-repairing 12 16 — — 45 45 Metal-working 20 33 — — 87 87 Saddlery 9 11 — 24 24 Sign and Ticket Writing 9 10 — 6 28 34 Trunk-making 12 12 — — 20 20 Umbrella-making 7 8 11 2 3 16 Undertaking 11 (2) 18 (3) 1(1) — 50 51 (1) Upholstery 54 (26) 86 (27) 112 (32) — 160 272 (32) Wig-making and Hair-work 9 11 14 — 17 31 Various 79 (5) 101 (5) 182 (7) 50 576 (7) 808 (14) 1,508 (381) 2,319 (399) 5,122 (369) 761 (73) 2,909 (235) 8,792 (677) 80 WORKSHOPS SUPERVISION. TABLE 46. Inspections of Workshops, &c. 1911. 1910. Workshops — On register end of previous year 1,508 1,688 added during year 176 158 removed „ 176 338 On register end of year 1,508 1,508 Inspections 362 306 Re-inspections and miscellaneous calls 2,681 2,647 Rooms measured 82 73 Workrooms used as bedrooms 86 78 Workrooms without Abstracts 46 49 Notices served, Totals 15 20 Written intimations - . 15 16 Under Sec. 4 Public Health — — 37 (London) — — 38 Act, 1891 — 3 By-laws, under same Act - 1 Nuisances dealt with— Discovered. Abated. Discovered. Abated. Overcrowding 5 5 1 1 Dirty conditions 18 18 12 12 Deficient ventilation — — — — Temperature too high — — — Temperature too low 1 1 — — Sanitary conveniences— Insufficient — — 3 3 Not separately provided 3 3 2 2 Badly placed 3 3 8 8 Un ventilated — — — — Defective 13 13 16 16 Vapour, effluvia not removed— Steam in wash-houses — — 1 1 Gas fumes 1 —- 2 2 Drains 1 1 o 2 Wet floors, laundries — — 1 1 Accumulations of refuse — — — — Other nuisances or offences 2 2 2 2 Totals 34 33 50 50 See also Table X., Appendix A. In 1910 4 lists were received from the London County Council, none last year. At the close of last year the Register contained 381 effective entries, or 57 less than at the end of the previous year. The 381 entries comprised 108 " homes " which ranked as workshops and 273 "homes" of single workers, the corresponding numbers for 1910 being 120 and 265 respectively. Inspections.—The inspections of all descriptions numbered 3,043 last year (2,951 in 1910), 362 being first inspections (306 in 1910). Eighty-two (82) workrooms were measured, or 9 81 WORKSHOPS SUPERVISION. more than in the previous year. The numbers of nuisances discovered and dealt with in the course of inspection are given in Table 46. Fifteen (15) notices of all kinds were served during the year, as against twenty (20) in 1910. Complaints.—The Home Office forwarded 23 complaints, 1 less than in 1910, the matters complained of being— Dirty conditions 9 (10) Overcrowding 5 (1) Other matters 9 (13) No complaints were received from any other sources. Overcrowding.—No case of overcrowding was discovered by the Staff during the year, but 5 cases were reported by the Home Office. In 1908 9 cases were reported by the Staff and 4 reported by the Home Office, the corresponding figures for 1909 being 0 and 2 respectively and for 1910, 0 and 1. Deficient Ventilation.—The numbers of workshops reported to be insufficiently ventilated in 1906 and each succeeding year are 3, 4, 6, 0, 0, and 0. It seems justifiable to conclude that a real improvement has been effected in this direction. In one instance, a workshop laundry, the special arrangements provided by direction of this Department to secure efficient ventilation were completely destroyed under an Order issued against fire risks. The case was still under consideration at the end of the year. Warming.—Although the maintenance of a proper temperature is intimately connected with ventilation, yet the former is under the jurisdiction of the Home Office exclusively. The Staff of the Department are, nevertheless, instructed to report any workshop which may be either too hot or too cold, with a view to the case being brought to the notice of the Home Office. No infraction of this enactment was reported last year. Sanitary Conveniences.—The following figures .show the improvement which has taken place in this matter. Water-closet Accommodation. 1902. 1903. 1908. 1909. 1910. 1911. Insufficient 9 2 2 — 3 — Not separately provided 33 4 2 2 2 3 Badly placed 18 13 3 1 8 3 Unventilated 8 — — — — — Defective 29 23 11 13 16 13 Sickness.—One hundred and forty-three (143) cases of infectious disease occurred on workshop premises, 4 less than in the previous year. Of last year's cases 45 were on outworkers' premises. The number of each disease are shown below. Scarlet Fever .. 9 (2) Erysipelas 13 (2) Chickenpox 22 (5) Diphtheria 15 (3) Measles 46 (25) Whooping Cough 31 (7) Enteric Fever 3 (-) Puerperal Fever 1 (-) Ophthalmia Neonatorum 3 (1) Note.—The figures in parentheses refer to out-workers' premises. The deaths from the above diseases numbered 5 (2) last year (as compared with 11 in 1910), 2 having been due to measles and 3 to whooping cough. In addition, 7 deaths from pulmonary tuberculosis occurred on workshop premises, 2 being premises occupied by home workers. In 1910 the corresponding numbers were 11 and 1. A careful scrutiny is made of the addresses whence cases of all forms of infectious disease are reported, and if any case occur on workshop premises, the necessary steps are taken to prevent any work becoming the vehicle of infection. The majority of patients suffering from the diseases mentioned in the Act are removed to hospital, and the subsequent disinfection includes that of any work or work material which has been exposed to infection. No difficulty has been experienced in securing the observance of all necessary precautions, and neither notices nor summonses have been required. m 82 HOUSING. Bakehouses.—At the end of 1910 71 bakehouses were on the Register, 17 of which were " level" and 54 "underground." Last year 2 bakehouses (1 level, 1 underground) went out of use, and 1 underground was re-opened. At the end of the year there were 70 bakehouses on the Register, 16 level and 54 underground. The 70 bakehouses left on the Register included 10 factory bakehouses, 3 level and 7 underground. Fifty-four (54) inspections were made during the year of the factory bakehouses and 377 of the workshop. HOUSING. Housing, Town Planning, &c., Act, 1909. In Metropolitan Sanitary Districts obligatory work under the " Housing Acts" is practically limited to (a) Cases of dilapidations in inhabited houses let at rentals not exceeding £40 per annum the occupation of which began not earlier than December 3rd, 1909 (Sections 14 and 15 of the Act of 1909) ; (b) Houses unfit for human habitation (Sees. 17 and 18 of the same Act) ; (c) Improvement schemes applying to not more than 10 houses (Sees. 39 and 72 of the Act of 1890) ; and (d) Underground rooms used as sleeping places (Sees. 17 (7) of the Act, 1909). Existing legislation which is not "housing law" within the usual limited use of the phrase, is modified by the Act of 1909 in respect of (i.) The making of by-laws for houses let in lodgings, when such houses are intended for the working classes (Sec. 16 of the Act), and (ii.) The exemption of common lodging-houses from Inhabited House Duty (Sec. 35 of the Act). The Local Government Board issued Regulations under Sec. 17 (1) of the Act of 1909 in September, 1910, requiring the Local Sanitary Authority to see that the following programme is duly carried out:— (i.) Periodical " thorough inspection " of dwelling-houses " according to the varying needs or circumstances of the dwelling-houses or localities in the district." (ii.) Periodical preparation of lists showing what dwelling-houses require to be inspected at an early date. (iii.) Inspection of dwelling-houses with reference to (a) Arrangements for preventing contamination of the water supply ; (b) Closet accommodation ; (c) Drainage; (d) Condition of the house qua light, air, dampness, and cleanliness; (e) Paving and drainage of yard and outhouses ; (f) Storage of house refuse; (g) Underground rooms used for sleeping; and (h) Generally any defects in other matters tending to render the house dangerous or injurious to the health of the occupants. (iv.) The keeping of records of inspection giving information as to— (a) Description of premises—street and number ; (b) Name of officer making the inspection ; (c) Date of inspection ; (d) References to previous inspections ; (e) Records of results of inspection under heads set out above (Sec. iii.); and (f) Records of action taken and results of such action. 83 HOUSING. In anticipation of the requirements, a special form was drawn up for use by the Inspectors— known in the Department as "Form R.I.E. (T.H.)"—-embodying all the points (and others) set out under (iii.). The forms are designed for binding, and they provide for the necessary referencing and cross-referencing to the Journals, Complaint Book, Notices, &c. At the beginning of last year house-to-house inspection was commenced, on the advice of the Medical Officer of Health, in— Carlton Mews, Great Western Road, Elnathan Mews, and Carlton Mews, Maida Vale, Richmond Mews. Chippenham Mews, The inspections had been completed in Carlton Mews, Great Western Road, and Richmond Mews by the end of the year, but in the others several premises remained to be inspected at that date. In addition to the above, special inspections were made for the purposes of the Acts of the following premises :— Bristol Mews, Nos. 14 and 15. Leinster Street, No. 3. Burwood Mews, No. 18. Oliver Mews (the whole Mews). Canterbury Road, No. 165a. Rodborough Mews, Nos. 7 and 10. Cellbridge Mews, Nos. 6 and 9. Shelden Street, No. 19. Cirencester Street, Nos. 20-30 (even). Shirland Mews, Nos. 1, 8, and 17. Clarendon Street, Nos. 31, 35, 36, 38, 63. Shirland Road, Nos. 171-183 (odd). Desborough Street, No. 19 St. John's Terrace, No. 3. Elms Mews, No. 6. Woodfield Crescent, No. 11. Falconer Mews, No. 1. The total number of premises inspected for the purposes of the Acts was 154, and in the majority of instances the conditions found were remediable under the Public Health (London) Act, 1891. The necessary notices were served, and the required works carried out. In the cases of the following houses, Closing Orders were made by the Council under Sec. 17, with the results as set out. 63, Clarendon Street—Closing Order made February 7th, 1911; Appeal lodged but abandoned ; work done (indifferently well); Order determined May 16th, 1911. 34, 36 and 38, Clarendon Street—Closing Orders made April 4th, 1911; no Appeal lodged; property changed hands ; work done (fairly) ; Orders determined October 3rd, 1911. 17, Desborough Street—Closing Order made December 19th, 1911; Appeal lodged, but abandoned; work put in hand but not completed at end of the year.* No. 165a, Canterbury Road, and No. 6, Elms Mews, were abandoned as dwelling-houses. In these cases the owners were informed that the premises would be reported as unfit for habitation ; that, if Closing Orders were made, they would be obliged to place the premises in a condition fit for habitation ; and that if they failed to do so the premises would be demolished. The owners preferred to voluntarily close the premises rather than incur expense. It is to be desired that it should be possible to avoid demolition of buildings after closure when they are not put in a condition fit for habitation. The Local Government Board of Scotland has ruled that any premises closed under Sec. 17 of the Act, which are not rendered fit for habitation, can be used for any purpose except human habitation, t Regulations for underground rooms have not yet been made by the Council, but the Medical Officer of Health has been instructed to draft a series. The following underground rooms were " closed " during the year under Sec. 96 of the Public Health (London) Act, 1891— 19, Shelden Street; 22, Cambridge Place; 235, Maida Vale; 21, 23, 71, 80 and 83, Cirencester Street, and 76, Harrow Road. * Determination of the Order was refused by the Council on May 21st, 1912. t Letter of the Board dated January 12th, 1912—published in The Sanitary Record, February 16th, 1912. 84 HOUSING. By-laws for houses let in lodgings, incorporating the provisions of Sec. 16 of the Act of 1909, were adopted by the Council last year, and were awaiting confirmation by the Local Government Board at the end of the year.* No action was taken last year under Sections 14 and 15 of the Act of 1909, owing to the failure attaching to an attempt to enforce the provisions in 1910. Houses Let in Lodgings. Registration.—At the beginning of last year 1,326 houses were on the Register, and during the year 32 were added and 10 removed, so that at the close of the year 1,348 houses were registered. The registration of the 32 houses involved 359 visits (inspections). All the houses registered during the year were situated in Star Street. The housing conditions found to prevail at the time of registration are given below :— No. of Houses visited and registered 32 No. of Rooms registered 167 Inhabitants in registered rooms 247 For living only 11 Persons under 10 years of age 29 For sleeping 93 „ over „ „ 218 For living and sleeping 63 Inhabitants in other rooms 49 Other Rooms 87 Persons under 10 years of age 9 Occupied by landlords 48 „ 10 years and over 40 Exempt by rent — Occupied, not inhabited 9 Empty 30 Total Inhabitants 296 Total Rooms 254 Housing. Nos. of Occupants of a Tenement. Totals. — 1 1 2 3 4 5 6 ( P 10 i P 10 P 10 P 10 P 10 P 10 P 10 T— — T I — I— T — — T — — T — — T — — T — — 10 P 10 P 10 P 10 P 10 P 10 P 10 P 1 118 163 17 71 71 71 35 67 3 9 19 8 3 6 6 _ 2 23 52 12 3 3 8 16 6 j 15 8 j 4 14 2 1 | 2 3 1 2 4 P/10 10/p T—number of Tenements containing I — I Persons over 10 years of age, and I — 1 Persons under 10 years of age. J Judged by the theoretical standard of the Registrar-General, about one-tenth of the tenements registered (14 out of 142) were overcrowded ; that is to say, the inhabitants of such tenements averaged more than two persons, irrespective of their ages, per room, but there was only one tenement overcrowded according to the legal standards, this tenement (a single room) being occupied by 4 persons. In each class of home the average numbers of occupants per room was lower than that recorded at the 1901 census, there being 1.5 per room in one-room tenements (census (1901), 1.8), 1.4 in two-room (census, 1.7), 1.0 in three-room (census, 1.3). * The By-laws were confirmed early in May of this year. 85 HOUSING. Supervision.—Apart from registration, annual cleansing, and sickness, 2,856 inspections were made of registered houses during the past year, as compared with 2,430 in 1910. The nuisances and infringements of by-laws discovered and dealt with in the course of all inspections are set out in Table 47. A total of 2,023 notices of all descriptions (excluding cleansing notices) were served last year (1,177 in 1910), including 361 "written intimations," 71 "statutory notices," 1,374 notices under the various by-laws, and 196 under the London County Council (General Powers) Acts, viz., 184 for verminous rooms (179 in 1910), 21 for additional water supply, and 12 with reference to dustbins. TABLE 47. Sanitary Defects Remedied in Registered Houses. 1910 1911 Drain defective 9 18 „ choked 16 15 „ untrapped 26 4 „ unventilated or improperly ventilated 3 8 Manhole cover defective 5 4 Surface inlet improperly trapped 1 4 Gully choked 8 8 Ventilating pipe improperly constructed - 10 Soilpipe defective 1 3 „ improperly constructed - 3 „ unventilated or improperly ventilated - 2 Water-closet choked 42 32 „ defective 95 63 „ flushed from drinking-water cistern 1 „ insufficiently flushed 35 28 ,, flushing apparatus defective 42 45 „ without water supply 16 24 ,, foul 16 26 „ improperly constructed 1 6 ,, accommodation insufficient 33 30 „ without door 6 18 „ without external light or ventilation 1 1 Rainwater pipe not disconnected from drain or soilpipe 2 2 ,, defective 35 32 ,, choked 5 6 Wastepipe not disconnected ,, defective 14 10 ,, choked 3 6 ,, not provided 6 2 Other drainage defects 5 5 Cistern defective 3 4 ,, dirty 58 86 „ improperly placed 1 ,, without proper cover 14 5 „ cover defective 10 23 Dustbin defective 59 80 „ not provided 3 4 „ insufficient 1 11 „ disused and not abolished 6 12 Paving defective in area or yard 82 82 " " wash-house 55 74 Guttering defective 17 18 Premises damp 24 7 dirty 6 15 Rooms verminous 284 280 Roof defective 144 134 Accumulation of refuse 33 15 Animals improperly kept 6 8 Water supply to premises insufficient 4 3 Other defects or nuisances 17 29 86 HOUSING. Annual Cleansing.—The annual cleansing was carried out last year with considerable difficulty. Having in mind the decision given in Arlidge v. Islington Borough Council, and the course adopted by the magistrate at the Marylebone Police Court after that case had been decided, it was felt that no summonses could be issued. New By-laws relating to Houses Let in Lodgings were adopted by the Council on the 19th March, 1912. The new By-laws have been framed to take advantage of the provisions of Sec. 16 of the Housing, Town Planning, &c., Act, 1909, so that the difficulties created by the case of Arlidge v. Islington Borough Council, and by decisions at the Marylebone Police Court as to right of entry, should be met. The term " tenement houses" has been substituted for " houses let in lodgings," to which strong objection has been frequently expressed by property owners. Under the old By-laws the " landlord " was the only person liable for the keeping of lodgings in a proper condition. Under the new series the lodgers are made to a considerable extent responsible, more particularly with reference to details which may be described as included under the term " domestic hygiene," e.g., cleanliness of rooms and beds, proper ventilation of rooms, &c. The By-laws also aim at securing for lodgers adequate means for cleanliness in their persons and clothing. The re-letting of a tenement without adequate cleansing after removal of the previous tenant is prohibited, but, as a set-off, certain relaxations in connection with " annual cleansing " are provided. The new series is a dual one, intended to deal with tenements " intended for the working classes" and those to be occupied by persons of other classes. The wording of Sec. 16 of the Housing, Town Planning, &c., Act, 1909, has been strictly adhered to, but unfortunately no definition of the persons who form the " working classes " has been enacted. The 1,358 (1,340 in 1910) houses on the Register at the end of March were inspected in connection with this work, 3,730 inspections in all being required to secure its completion. The rooms reported as in need of cleansing numbered 1,936 (2,006 in 1910), and the notices served 2,880 (3,088 in 1909), comprising 2,165 cleansing notices, 172 for verminous rooms, and 543 for sanitary defects, &c. Thirty cases were referred to the Solicitor, but no summonses were taken out. Following the practice of recent years, an enumeration was made of the occupants of the houses, but a departure was initiated in tabulating the results. Hitherto only the "housing" conditions in registered tenements have been recorded. This year the table (Table 48) includes all the homes in what are known as " Registered Streets,"* and the tabulation has been extended to cover all homes and not limited to homes of less than five rooms. The change has been made in consequence of information received as to the intention of the Registrar-General to include a full tabulation in the forthcoming census reports. The table gives particulars relating to 5,404 families, comprising 18,823 persons living in 10,444 rooms, average 1.8 persons per room. * Registered Streets, 1911:— Albert Street. Cuthbert Street. Howell Street. South Wharf Road. Alfred Place. Dartington Terrace. Kensal Road. Stalham Street. Alfred Road. Desborough Street. Kent's Place. Torquay Street. Amberley Road. Dudley Street. Modena Street. Victoria Street. Braden Street. Elcom Street. Netley Street. Waverley Road. Braithwaite Place. Emily Street. North Wharf Road. Waverley Terrace. Brindley Street. Green Street. Oliver Mews. Wellings Place. Campbell Street. Hall Place. Orchard Street. Westbourne Terrace Carlton Mews. Hall Place West. Philip Terrace. North. Church Place. Hampden Street. Pressland Street. Woodchester Street. Cirencester Street. Hasborough Street. Ranelagh Road. Woodfield Place. Clarendon Street. Hermitage Street. Senior Street. Crompton Street. Hethpool Street. Southam Street. There are also 34 registered houses in 18 other streets (one or two in each street). These odd houses are occupied by 445 persons, 333 over ten years of age and 112 under, living in 285 rooms. 87 HOUSING. The total numbers of persons in each class of tenement and the corresponding averages are given below. Persons per per tenement. room. In 2,198 tenements of one room 4,705 persons, averaging 2.1 2.1 „ 2,098 „ two rooms 8,511 ,, ,, 4.0 2.0 „ 695 „ three „ 3,387 „ ,, 4.8 1.6 „ 256 „ four „ 1,329 „ „ 5.2 1.3 ,, 83 „ five „ 454 „ „ 5.4 1.1 38 „ six „ 201 „ „ 5.3 0.9 „ 9 „ seven „ 58 „ „ 6.4 0.9 " 19 ,, eight „ 112 „ ,, 5.9 0.7 „ 7 ,, nine ,, 58 ,, ,, 8.3 0.9 „ 1 tenement of ten „ 5 ,, ,, 5.0 0.5 In 1907 no enumeration was made, and a comparison (see below) of the percentages of the different sizes of tenements in 1906, and in each of the years 1908.10, shows that that omission had a distinct effect in lowering the standard of housing. Such view is confirmed by the changes which have taken place in the percentages recorded in the last three years, and may be taken as evidence of the desirability of making such enumerations systematically each year. Percentages of all tenements enumerated. Rooms in tenement 1 2 3 456789 10 1906 43.6 45.0 10.0 1.2 0.04 1908 44.0 45.4 9.7 0.6 0.04 Not previously 1909 47.2 41.2 10.8 0.6 0.09 taken out. 1910 45.3 41.7 11.9 0.9 0.07 1911 40.6 38.8 12.8 4.7 1.6 0.7 0.1 0.4 0.1 0.02 Last year's proportions are not strictly comparable with those of the earlier years, owing to the alterations in the tabulation mentioned above. TABLE 48. Numbers of Tenements and Inhabitants therein in Registered Streets. 1911. Rooms to Tenement. Occupants in cach Tenement. 1 2 3 4 6 7 8 9 10 11 12 T P 10 T P 10 T P 10 T P 10 T P 10 t P 10 T P 10 P T P 10 T P 10 T p 10 T P 10 T P 10 10 p 10 P 10 P 10 P 10 p 10 P 10 "12 10 P 10 P 10 P 10 P 10 p 1 772 772 788 1508 68 331 680313212 437 411 62 134 176 27 58 104 4 16 2 6 10 2 65 65 366 727 5 4121030 206447 1229 559 380 1048 852 264 732 852 115 369 436 42 147 189 5 19 26 2 7 13 3 4 8 8 — 62 23 123 1 106 275 43 118 366 106 139 469 99fi 138 481 347 6S 253 188 50 221 179 9 37 44 2 16 4 _ 2 2 43 3 34 94 8 47 158 30 39 159 36 48 216 72 28 159 41 18 88 56 9 54 27 5 26 * 3 11 9,9, 5 ... ... ... 8 16 ... 7 19 ... 15 51 9 13 56 9 15 74 16 10 57 13 10 7 3 42 14 5 23 22 2 15 5 2 6 5 6 ... ... ... 4 8 4 11 7 26 ... 5 22 3 4 20 ... 8 46 22 2 3 15 12 ... ... ... ... ... ... ... ... ... 7 ... ... ... ... ... ... ... ... 3 8 ... ... ... ... 1 ... ... 1 11 2 3 20 4 1 5 4 8 ... ... ... 1 2 ... 1 3 ... 4 16 3 1 15 ... 3 18 5 ... 2 11 3 2 9 7 ... 17 1 1 9 1 ... ... ... ... 8 4 9 ... — ... ... ... ... ... ... ... ... ... 5 ... 1 1 ... ... ... 1 8 ... 3 21 6 ... ... ... ... ... ... 1 10 ... ... ... ... ... ... ... ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... P/10 10 T—number of Tenements containing — Persons over 10 years of age, and — Persons under 10 years of age. 10 P 88 HOUSING. Overcrowding.—If the limit of reasonable occupation be fixed at two persons per room, and any excess thereof be deemed to be "crowding," then 1,589 tenements were crowded last year, as also the 8,176 occupants of those tenements. The test is not one of overcrowding, but of density of occupation, as no count is taken of the size of the room or the ages (or sexes) of the occupants. It is quite possible that a room with two occupants may be overcrowded according to the rules of hygiene and of law, and one with 7 or 8 occupants not. As a test of " overcrowding " the standard cannot be justified, but it is useful as a rough index of density of occupation. Appended are the proportions (percentages) of the populations, enumerated at the annual cleansings, living in tenements where the average number of occupants exceeded two per room. The figures show some improvement, even if those for last year be left out of consideration, as they ought, perhaps, to be, on account of the changes made in the system of tabulation. "Crowding" in Tenement Houses. 1906. 1908. 1909. 1910. 1911. Percentage of all tenements 33.6 37.l 33.9 33.3 29.4 Percentage of all inhabitants 50.6 49.3 50.2 49.8 43.4 Percentage of children under 10 years 74.6 72.5 73.0 73.2 66.4 Legal overcrowding—i.e., infringement of the by-laws which prescribe minimum air spaces of 400 cubic feet for adults and 200 cubic feet for children under 10 years of age, "living and sleeping " in the same room, or 300 and 150 cubic feet respectively if the room be used for sleeping only—was discovered in 189 instances last year, as compared with 412, 344, 300, 432, and 282 in each of years 1906-10. In 34 of the 189 cases the degree of overcrowding amounted to total deficiencies of air space of less than 50 cubic feet, and the families have been noted for observation. Such relaxation of the by-laws is not sanctioned in the Clarendon Street Area. Particulars of the cases discovered and of the manner in which they were dealt with will be found below. Overcrowding in Tenement Houses. As found on inspections made for Annual Routine Total. Registration. c|eansing. Purp0ses. Tenements 189 (282) 1 (9) 165 (234) 23 (39) Rooms 199 (307) 1 (9) 167 (255) 29 (43) Occupants, total 919 (1,338) 4 (41) 774 (1,072) 141 (225) Under 10 years of age 413 (568) 2 (19) 349 (431) 62 (118) Aged 10 years and upwards 506 (770) 2 (22) 425 (641) 79 (107) Overcrowding abated (rooms)— By re-arrangement of occupants 58 (62) —(6) 57 (56) 1 (—) By voluntary removal 51 (62) — (1) 51 (61) — (—) Under notice 46 (102) —(2) 24 (63) 22 (37) Cases held over 34 (56) 1 (—) 33 (54) — (2) Note.—Figures in parentheses relate to 1910. Vital Statistics.—The total morbidity rate (see Table 49) in the "Registered Streets" was 521 per 1,000 persons last year, 0.82 less than the rate (6 03) recorded in 1910, and 5.42 less than that of 1909 (14.62). In the " Rest of the Borough "—i.e., the Borough less the " Registered Streets"—the morbidity rate was 3.91 last year, 3.32 in 1910,and 5.06 in 1909, so that there was an increase in last year's rate in comparison with that of 1910. The only disease in the " Registered Streets" showing an increase last year was diphtheria (rate 1911, 1.33; 1910, 0.89), the increase amounting to 49.4 per cent. That was also the only disease with any real increase in the " Rest of the Borough," the increase there amounting to 38.7 per cent. The total mortality in the " Registered Streets" was 24.67 per 1,000, as compared with 22.08 in 1910 and 26.32 in 1909. The increase in last year's rate was equal to 11.7 per cent. of the 1910 rate, the increase noted in the " Rest of the Borough " being equal to 6 0 per cent. only. The most important increases were those in the rates from " diarrhceal diseases" (rates, 1911, 89 HOUSING. 3.04; 1910, 1.00; increase 204 per cent.), and "pulmonary tuberculosis" (rates, 1911, 249; 1910, l.50; increase 66 per cent.). In the " Rest of the Borough " increases were noted in both the diseases, 79.0 per cent. from " diarrhœal diseases," and 275 from " pulmonary tuberculosis." In both divisions of the Borough there were higher rates from the "other tuberculous diseases." Although more cases of diphtheria were reported in the " Registered Streets " last year, the mortality from that cause was reduced from 0.33 to 0.11 per 1,000. In the "Rest of the Borough " the mortality was higher last year, rising from 0.02 to 0.07 per 1,000. TABLE 49. Registered Streets : Morbidity and Mortality Statistics. Disease. Registered Streets. Rest of Borough. 1911. 1910. 1911. 1910. Morbidity*— Smallpox — — — Diphtheria and Membranous Croup 1.33 0.89 1.11 0.80 Erysipelas 1.44 1.68 0.73 0.56 Scarlet Fever 1.88 2.74 1.54 1.67 Enteric (and Continued) Fever 0.27 0.50 0.25 0.24 Puerperal Fever 0.05 0.17 0.04 0.04 All Diseases 5.21 6.03 3.91 3.32 Mortality*— Smallpox — — — — Measles 2.05 2.01 0.18 0.31 Scarlet Fever 0.05 0.01 0.01 0.04 Whooping Cough 0.77 0.44 0.24 0.21 Diphtheria 0.11 0.33 0.07 0.02 Enteric Fever , 0.05 — 0.03 0.03 Diarrhœal Diseases 3.04 1.00 0.77 0.43 Erysipelas 0.16 0.05 0.02 0.01 Puerperal Fever 0.05 — 0.02 0.01 Pulmonary Tuberculosis (Phthisis) 2.49 1.50 0.94 0.80 Other Tuberculous Diseases 0.94 0.83 0.25 0.22 Alcoholism 0.05 — 0.08 0.07 Cancer 0.94 0.94 1.20 1.18 Premature Birth 0.49 0.66 0.27 0.38 Developmental Diseases 1.05 1.34 0.52 0.34 Bronchitis 2.16 2.29 0.92 1.01 Pneumonia 1.60 2.46 0.68 0.78 Cirrhosis of Liver 0.22 — 0.08 0.09 Accidents and Diseases of Parturition 0.05 0.16 0.03 0.05 Suicides 0.05 0.05 0.08 0.09 Other Causes 8.26 7.82 5.46 5.06 All Causes 24.67 22.08 11.89 11.21 * Rates per 1,000 persons. Clarendon Street Area.—Ten years having elapsed since the presentation of the Special Report (August, 1901) on the housing conditions, &c., in this area, it is proposed to submit in the early autumn a further report contrasting the conditions found at the enumeration of 1911 with those noted in 1901. The proposed report will also give comparative vital statistics for the periods 1896-1901 and 1906-11. For the sake of continuity the figures usually given in n 90 HOUSING. TABLE 50. Clarendon Street Area. Vital Statistics. " Clarendon Street Area." Rest of Borough. 1911. 1910. 1911. 1910. Morbidity*— Diphtheria 2.00 1.ll 1.10 0.78 Erysipelas 1.07 0.95 0.80 0.68 Scarlet Fever 1.54 3.83 1.58 0.71 Enteric Fever 0.77 1.27 0.25 0.23 Puerperal Fever - - 0.06 0.06 Mortality—All Causes— All ages* 24.96. 27.65 12.96 11.88 0—10 years 39.18 40.44 ? ? 10- 17.69 21.39 ? ? Infantile Mortality† 176 122 125 95 Institution Deaths‡ 61.1 54.3 33.5 33.1 *Rates per 1,000 persons. †Per 1,000 births, fully corrected. ‡Per 100 deaths. this part of the report are inserted (see Table 50). Below are the actual number of deaths from certain diseases recorded during the last three years. The population of the area is so nearly stationary that numbers are almost as instructive as mortality rates. Clarendon Street Area. Deaths from— 1909. 1910. 1911. Measles 12 24 19 Whooping Cough 8 0 5 Diarrhœal Diseases 14 5 21 Tuberculous Diseases 21 16 21 Bronchitis, Pneumonia 47 38 27 The deaths from pulmonary tuberculosis (consumption) included among " tuberculous diseases " in above statement, numbered 12, 10 and 15 in the successive years (1909-11). The infantile mortality was 176 per 1.000 births belonging to the area last year, as compared with 122 in 1910, 220 in 1909, and 173 in 1908. The proportions (percentages) of deaths of residents in the area in public institutions during the past four years are given below. 1908. 1909. 1910. 1911. Clarendon Street Area 63.1 48.1 54.3 61.1 Rest of the Borough 32.3 31.7 33.1 33.5 Common Lodging-houses. The number of houses licensed last year remained unchanged at 7, 6 being for men (195 beds) and 1 for women (40 beds). One case of infectious illness was reported last year (erysipelas, m. 36). The deaths among the lodgers numbered 12 (12 in 1910), the causes being returned as— Cancer 1 Phthisis 5 Respiratory Diseases 3 Old Age 1 Nephritis 2 Inhabited House Duty. Four applications were received for certificates under the Revenue Act, 1903, to obtain abatement or remission of the duty, and five certificates relating to 46 tenements and a common lodging-house were issued. 91 FOOD SUPERVISION. FOOD SUPERVISION. Slaughterhouses.— There were seven slaughterhouses in use during the year, situate as described below. Bishop's Mews, No. 1. Chippenham Mews, No. 18. Edgware Road, No. 275. Harrow Road, No. 125. Portsdown Mews (No. 249, Maida Vale). Southwick Mews, No. 15. Upper Brook Mews, No. 6. The Inspector was present at the slaughterhouses on 479 (404) occasions when killing was in progress, and examined the carcases of 104 (87) bullocks, 11 (—) calves, and 4,550 (4,865) sheep. The following organs were destroyed under his supervision— Sheep. Livers, 9—parasitic 4, abscess 3, and cirrhotic 2. Lungs, 2—pneumonic. Bullocks. Livers, 22—parasitic 14, tuberculous 4, and abscess 4. Lungs, 9— ,, 5, ,, 3, and pneumonic 1. Heart, 1—tuberculous. Heads and tongues, 2—tuberculous. Fore quarter of mutton—pleurisy. The premises were specially inspected by the Medical Officer of Health during the autumn, after receipt of the customary notices of intention to apply for renewal of licences, all but two being found clean and well kept. The works required at the two slaughterhouses were at once carried out. Food Purveyors. There were 616 places on the Register of Food Purveyors, the numbers of each trade being as here given— Butchers 80 Milkshops, Dairies 120 ,, Pork 22 Refreshment houses 117 Fishmongers 29 Fried fish, Sausages 28 Game, Poultry 12 Ice cream makers, vendors 112 Fruiterers, Greengrocers 84 Margarine dealers 12 In addition there are 7 places where fish-curing is carried on, 8 where sausages and saveloys are made, and 2 (factories) where artificial ice is produced. The costermongers' stalls in the Borough are inspected at least twice each Saturday, and such as take pitches on other days in the week, daily. Below is given a tabulated statement of the numbers of inspections (total 1,012) reported by the Inspector. Butchers'shops (all kinds) 451 Milkshops 210 Greengrocers'shops 20 Restaurants, &c. 200 Fishmongers' shops 14 Ice cream shops and Barrows 67 Fried fish shops 50 (Note.—Inspections of coster barrows are not included in the above figures.) Besides inspections for the purposes of the Public Health (London) Act (including discovery of unsound food) all the above premises are subject to special provisions of the London County Council (General Powers) Acts. Inspections made under the latter Acts are not included in the above figures, but are given below. Coffee and dining rooms 2 Provisions 1 Milk Supply. There is only one cowshed in the Borough, that at— Star Street, No. 39, is licensed for 10 cows (usual number, 5). The shed is visited periodically by the Inspector, but the effective control is vested in the County Council. The shed is always clean and in good condition when visited. 92 unsound and diseased food. Dairies and Milkshops.—At the end of 1910 there were 114 names of milk vendors on the Register. Seven new milk vendors were added, 6 old businesses changed hands, and 1 removed. The Register contained 120 effective entries at the close of the year. The businesses carried on in combination with the sale of milk by the vendors now on the Register are given below— Dairies: milk, butter, and eggs only 87 (84) ,, wholesale 4 (4) Grocers' shops 1 (1) General shops 12 (9) Sweet-stuff, Confectionery 2 (2) Provisions 1 (1) Refreshments 9 (9) Bakers' shops 4 (4) Two cases of diphtheria occurred at milkshop premises, and 10 cases of scarlet fever and 3 of diphtheria in the families of milk carriers. Suitable precautions were taken in each case, and there was no conveyance of infection therefrom by the milk. Ice Cream Making. For the purpose of duly enforcing the provisions of Part VIII. of the London County Council (General Powers) Act, 1902, a special Register of all makers and vendors of this commodity is kept. At the end of 1910 there were 116 names on the Register, 10 were removed during the past year, and 2 added, leaving 108 on the Register at the close of the year. The businesses with which the ice cream trade is combined are indicated below— Sweet shops 54 Newspapers and Tobacco 3 Bakers 22 Confectioners 5 Milk 3 Cook 1 Restaurants 12 General 8 In addition to 4 barrow-men residing in the Borough, 10 others have regular pitches in the Borough, the proprietors residing in— Kensington 5 Marylebone 3 Willesden 2 UNSOUND AND DISEASED FOOD. The appended statement, including 7,639 lbs. of foodstuffs destroyed, is additional to the amount dealt with in the slaughterhouses. Meat (Butchers' shops):— Pieces of beef (decomposed), mutton (pleurisy), pork (abscess). Bullocks'liver and lungs, pigs'lungs Parasitic. Fish.:— Haddocks, 336 lbs. Kippers, 370 lbs. Mackerel, 56 lbs. Decomposed Hake, 140 „ Soles, 112 ,, Skate, 70 ,, Vegetables and Fruit:—Apples 132 lbs. Onions 212 lbs. Tomatoes 188 „ Oranges 8 „ Strawberries 15 ,, Summary. Meat 570 lbs. Per G.W.R. Co.— Fish 1,084 „ Pickled Herrings 308 lbs. Vegetables 555 ,, Plums 2,240 ,, Peas 1,008 „ 2,209 „ Asparagus 1,232 „ Fowls 152 „ Ducks 112 „ Pigs' heads 280 „ Venison 56 „ Tripe 42 „ Grand Total 7,639 lbs. 93 food adulteration. FOOD ADULTERATION. The number of samples submitted to the Public Analyst during the year was 600, the same as in 1910, the number found adulterated being 50, or 4 fewer than in the previous year. The percentages of adulterated samples in each of the last five years have been, in 1906. 1907. 1908. 1909. 1910. 1911. 10.2 9.2 2.6 8.6 9.0 8.3 The list of samples taken is given in Table 51. Of the 341 samples of milk 110 were taken at the Paddington Terminus in course of transit, under contract, at the request of the consignees. Such request being based on previous dissatisfaction (for one or another reason) with the milk delivered, it is not surprising to find that 21 (19T per cent.) of the samples were found to be TABLE 51. Total. Found Adulterated. Percentage Adulterated. Milk 341* 30 8.8 Butter 47 2 4.2 Cream 31 9 29.0 Tinned Foods 21 - — Jam 20 — . — Flour 17 - - Coffee 15 - — Cocoa 14 - - Lard 11 - - Cheese 11 — Spirits 7 — — British Wines 7 7 100.0 Rice 6 - - Mincemeat 5 2 40.0 Vinegar 4 — — Golden Syrup 3 — — Glycerine 3 — — Mustard 3 — — Pepper 3 — — Dripping 3 — — Sausages 3 — — Sal Volatile 2 — — Spirit of Camphor 2 — — Spirit of Nitre 2 — — Camphorated Oil 2 — Ammoniated Tincture of Quinine 2 - — Blanc Mange Powder 2 - — Port Wine 2 - — Olive Oil 2 - — Honey 1 - — Tincture of Rhubarb 1 - — Oil of Juniper 1 - — Margarine 1 - — Ground Ginger 1 - — Sago 1 - — Tapioca 1 - — Arrowroot 1 - — Cornflour 1 - - 600 50 8.3 * Including 110 taken at Paddington (G.W.R.) Terminus in course of delivery: 21 adulterated. 94 office work. adulterated. The proportion of such samples proving to be adulterated is always high, as appears from the following figures— 1906. 1907. 1908. 1909. 1910. 1911. 30.6 32.3 6.4 24.3 14.9 19.1 Of 62 samples of milk purchased in the streets on Sundays only one was found to be adulterated. In 1910 4 out of 77 samples of milk obtained in like circumstances proved to be adulterated. An analysis of the forms of sophistication found in the 20 samples other than milk reported to be adulterated shows that except in the last-named commodity adulteration—as generally understood—was practically not found existent in the Borough last year. The 20 samples referred to comprised— Butter, 2.—In each case l.3 per cent. excess of water above the 16 per cent. allowed. Cream, 9.—All containing undeclared amounts of preservative. Mincemeat, 2.— ,, ,, ,, British Wines, 7.—Six with amounts of alcohol ranging from 17.75 to 23.0 per cent, of alcohol, and one with 1 per cent, alcohol and 5 grs. of salicylic acid to the pint. Milk.—An effort is being made to remove milk from the scope of the Sale of Food and Drugs Acts altogether. The position of the law with regard to milk is very unsatisfactory, and much difficulty is experienced in securing convictions for the sale of adulterated milk. A nominal standard composition has been set up by the Board of Agriculture, but it is now established that the sale of milk falling far below that standard—if it be proved that the milk was sold as taken from the cow—is no offence. There is, therefore, no real inducement to farmers to do anything to improve the breed of milch cows as regards the quality of their milk. It is more to their advantage to put quantity before quality. The fact of the morning milk being so frequently below the standard, instead of being used as an argument for the abolition or reduction of the standard, ought to be regarded as a strong argument to making the intervals between milking more equal. Milk is of such importance in the diets of infants and sick people—who together form a large proportion of the total population—that no effort should be spared to improve its quality. In Denmark, where dairy farms are principally concerned in butter making, great success has been achieved in improving the breed of cows both in the direction of quality and quantity of milk yielded. What the Danes have done, British farmers ought to be able to accomplish, if not to surpass. Legislation on the milk question has been promised for some years. It is to be hoped that strenuous efforts will be made to so frame the new law that the public will secure a really good quality of milk with a high nutritive value. OFFICE (CLERICAL) WORK. The appended figures suggest the mass of work which has to be performed by the Clerical Staff, and give but a very imperfect idea of the very large amount of writing which is necessary, the bulk of which cannot be set out in the form of statistics. Letters received 4,439 (4,300) Births entered in Register 2,845 (2,750) ,, despatched 4,120 (3,591) Complaints received 875 (662) Entries in Postage Book 11,700 (12,125) Plans dealt with 348 (303) Cases of infectious disease entered New openings in Journals 710 ( 750) in Register (including consump- Disinfection Orders (duplicate) 2,692 (3,173) tion) 1,151 (1,209) Notices to abate nuisances 1,291 (1,251) Notices sent re above and other diseases 4,582 (6,225) The figures in parentheses are the returns for 1910. Daily returns are sent to the Metropolitan Asylums Board, giving full particulars of cases of infectious disease notified, and weekly to the County Council, giving particulars of births notified. 95 legal proceedings. LEGAL PROCEEDINGS. The results of the cases in which Police Court proceedings were taken are appended. The work of the Department is not to be judged by the number of summonses issued and heard, as by far the greater bulk of the matters requiring departmental intervention are attended to on informal documents—" written intimations," which are not " notices " at law, or letters—or on verbal request. The fines imposed on convictions amounted to £31 16s., and the costs awarded to the Council to £37 18s. 6d. The Police receive fines under the Notification of Births Act, the remainder are paid into the Council's account. The variations in the total amounts of fines and costs imposed during the past six years are shown below. " Health " Cases. " Adulteration " Cases. £ s. d. £ s. d. 1911 19 5 6 50 9 0 1910 13 15 0 125 8 6 1909 52 6 6 86 6 6 1908 43 10 0 55 17 6 1907 69 19 0 31 16 6 1906 34 15 0 63 1 0 There was a very considerable fall in the averages of fines and costs imposed with respect to "adulteration "cases—by no means a satisfactory feature, or one likely to discourage sophistication. 1911. 1909. 1908. 1907. 1906. Average per Fine £0 13 0 £13 9 £12 3 £0 17 0 £0 16 6 conviction Costs 0 14 3 0 12 2 0 13 9 0 12 8 0 15 0 96 LEGAL PROCEEDINGS. LEGAL PROCEEDINGS, 1911. Public Health (London) Act, 1891. j Fines. Costs. Section 4. £ s. d. £ s d. 9 and 11, Chippenham Mews Drain, &c., defective Order made. 0 2 0 37, Clarendon Street No water supply to premises Supply re-instated. Summons withdrawn on pay ment of 0 3 0 51, „ „ Order made. — 41, Elgin Terrace Drain, &c., defective Summons withdraw n on payment of 0 10 6 24, Elnathan Mews „ Order made. „ Non-compliance with Order Summons adjourned sine die (premises vacated). 10, Hasborough Street No water supply to premises Supply re-instated. 0 3 0 9, Kildare Gardens Drain and soil pipe defective Work done. 110 31, Oxford Terrace „ Order made. 0 10 0 2, Philip Terrace Rooms in a dirty condition „ „ Non-compliance with Order 0 17 6 0 2 0 13, Polygon Mews South Drain, &c., defective Work done. Sum mons withdrawn. Section 36 (2). Searcy, Tansley & Co., Ltd. Failing to remove manure periodically from Summons withdraw n on pay- 8, Portsea Mews. ment of 0 10 0 Section 38. 20, Spring Street Workplace without proper sanitary accom- 1 0 0 0 2 0 modation. By-laws. 11, Hall Place Paving defective Work done. Sum mons drawn on payment of 0 10 0 35, ,, „ Summons dismissed. 7, Howell Street „ Work done. 0 10 6 1, Hyde Park Place W.C. constructed in direct communication 1 0 0 2 2 0 with bedroom. 7, Woodfield Place W.C. without water supply Work done. 0 10 0 S. Ford, 3, South Square, Gray's Failing to give notice before commencing Summons dismisse d,21s.costs Inn. sanitary works at 1, Connaught Square. against Council. W. Hale, 17, Upper Westbourne Failing to give notice before commencing Summons dismissed. Terrace. sanitary works at 6, Blomfield Place. — Russell, 84, Chancery Lane Failing to give notice before commencing Summons dismissed. sanitary works at Blomfield House, Upper Westbourne Terrace. J. W. Richards, Market Place, Fixing new w.c. at 9, Shirland Mews without — 110 Canterbury Road. giving notice, and executing the work in an improper manner (2 summonses). Sheppey Glue & Chemical Works, Removing offensive refuse during prohibited 0 10 0 0 2 0 Ltd., 34, Mark Lane. hours. R. Waddington, 57, Geere Road, Removing offensive refuse in an improper 2 0 0 0 2 0 West Ham. manner. Metropolis Management Act, 1855. By-laws pursuant to Section 202. £ s. d. £ s. d. J. Lovell Peters, 2a, Guildhall Neglecting to submit plans of drainage — 0 10 0 Chambers, E.C. works. Mrs. Kelland, 123, Malvern Road „ „ „ 0 5 0 0 2 0 Mrs. Goitein, 21, Portsdown Road „ „ „ — 0 10 0 London County Council (General Powers) Act, 1901. Section 20. \ £ s. d. 41, Elgin Terrace Room verminous — 0 10 6 22, Senior Street „ „ — 0 5 6 97 summary of legal proceedings. LEGAL PROCEEDINGS, 1911. Notification of Births Act, 1907. Failing to notify birth of child. £ s. d. £ s. d. 6 Summonses issued against parents— 1 Withdrawn — — 5 Convictions(total) 116 0 13 0 6 Summonses issued against medical practitioners— 1 Withdrawn — 2 „ (total) — 0 10 6 3 Convictions(total) 1 0 0 0 6 0 Dairies, Cowsheds and Milkshops Orders, 1885 and 1880. £ s. d. £ s. d. F. Rooke, 99, Granville Road Selling milk without being registered 0 1 0 0 2 0 SUMMARY OF LEGAL PROCEEDINGS DURING 1911 Under Sale of Food and Drugs Acts, 1875-1907. Fines. Costs. £ s. d. £ s. d. (1) Milk 27% fat abstracted 5 0 0 or 1 month. 110 22% „ 10 0 or 14 days. 0 12 6 20% „ 2 0 0 0 12 6 4% 0 10 0 0 16 6 1 „ 10% „ 0 10 0 0 12 6 „ 44% „ 5 0 0 or 21 days. 0 12 6 " Summonses withdrawn " " " " on payment of 110 „ 15% „ Summons dismissed. „ 6% „ ,, 6% „ ,, 19% „ „ 16% „ 10 0 0 16 6 20% „ 1 0 0 0 2 0 f „ 17% „ 10 0 0 17 6 I „ 11% „ 1 0 0 0 2 0 „ 8% added water Warranty proved. Summons dismissed. 4% „ - 0 17 6 "41/2 „ - 0 2 0 „ 5% „ 0 2 0 , ., 10% „ 0 10 0 0 16 6 " 5% „ 0 10 0 0 12 6 4% „ 0 10 0 0 12 6 8% „ 0 10 0 0 12 6 „ 44% „ 2 0 0 or 21 days. 0 12 6 Skimmed Milk 62/3% „ 0 10 0 0 12 6 „ 291/2% „ 0 10 0 0 12 6 „ 12% „ 0 10 0 0 12 6 1 „ 53/4% „ 0 10 0 0 12 6 (Draught Cream 0-23% boric acid Summons withdrawn. 110 0-23% „ „ 110 033% „ „ 110 0.3% „ 110 0.23% „ „ 110 045% „ „ 110 0.25% „ „ 110 0.2% „ „ 1 1 0 02% „ „ 110 ("Jam 15% apple pulp 15% „ 2 2 0 „ 12% „ Margarine Sold in an improper wrapper " 0 10 6 Name and address not inscribed on hand-can 0 1 0 0 2 0 NOTES. Samples purchased from one and the same vendor are bracketed together. (1) Defendant served term of imprisonment. (2) Imprisoned for 7 days in default of paying fines and costs. O 99 vital statistics. APPENDIX A. TABLE I. Vital Statistics of Whole Borough during 1911 and Preceding Ten Years. L.G.B. Estimated Population. Births Registered. Deaths Registered. Deaths. Totals. Rates. * At ages under One Year. At all Ages. In Local Institutions. In Outlying Institutions, &c. Of NonResidents. Nett Totals.§ (a) Nett Rates. * Transferred Deaths. Corrected Totals.§ (B) Corrected Rates.* Totals. Rates, t Totals. Rates. * 1901 143,941 3,359 23.33 484 144 2,163 15.02 652 218 324 2,057 14.29 1902 143,801 3,305 22.98 474 144 2,311 16.07 735 207 366 2,152 14.96 1903 143,661 3,302 22.98 425 128 2,103 14.63 743 181 366 1,918 13.35 1904 143,521 3,295 22.95 490 148 2,228 15.52 780 173 387 2,014 14.03 1905 143,381 3,184 22.20 441 139 2,210 15.41 806 161 410 1,961 13.67 1906 143,241 3,152 22.00 395 125 2,041 14.24 775 197 395 1,843 12.86 1907 143,101 3,074 21.48 396 128 2,154 15.05 770 232 372 2,014 14.07 1908 142,961 3,149 21.60 374 118 2,079 14.26 825 217 400 1,896 13.00 1909 142,821 2,895 20.27 347 119 2,154 15.08 813 219 409 1,964 13.75 1910 142,681 2,909 20.38 353 121 2,004 14.04 808 175 384 1,795 12.58 Averages. 1901-05 143,661 3,289 22.88 463 140 2,203 15.33 743 188 371 2,020 14.06 1906-10 142,961 3,036 21.14 373 122 2,086 14.52 798 208 392 1,902 13.25 1901-10 143,311 3,162 22.01 418 132 2,145 14.93 771 198 381 1,962 13.65 1911 142,541 2,815 1975 399 141 2,074 1455 854 218 407 1,885 1322 41 1,926 13.51 * These rates per 1,000 persons. t These rates per 1,000 births registered. § See p. 11 of Report. Area of Borough (exclusive of land covered by water), 1,336 acres. Total Population, 1901, 143,976. Do. 1911, 142,576 (provisional). 100 BIRTHS AND DEATHS. TABLE II. Births and Deaths. Corrected Numbers. (Departmental figures.) L.G.B. Year. Borough. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. Births. 1906 3.286 458 844 430 453 769 63 71 198 1907 3,206 436 797 424 468 768 72 65 176 1908 3,296 455 858 427 505 739 68 65 179 1909 3,031 382 741 392 470 743 63 48 192 1910 3,022 406 717 407 468 720 70 58 176 Averages 3,168 427 792 416 473 748 67 61 184 1911 2,977 383 726 405 458 726 50 69 160 Deaths:All Ages. 1906 1,843 206 319 250 297 487 58 57 169 1907 2,014 235 398 292 337 470 72 64 146 1908 1,896 225 381 249 343 434 64 53 147 1909 1,964 202 377 272 324 491 73 62 163 1910 1,795 198 391 246 293 440 54 54 119 Averages 1,902 213 373 262 319 464 64 58 149 1911 1,885 221 372 270 357 409 64 64 128 Deaths: Under One Year. 1906 353 42 63 46 55 113 3 6 25 1907 354 46 85 46 47 99 6 6 19 1908 348 41 79 43 55 102 2 4 22 1909 311 28 55 36 50 116 4 4 18 1910 294 37 70 34 49 87 2 3 12 Averages 332 39 70 41 51 104 3 5 19 1911 386 48 83 44 70 113 7 3 18 101 DEATHS OF RESIDENTS OF THE BOROUGH. TABLE III. Deaths of Residents of the Borough, 1911. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Under 1. 1-5. 5-15. 15-25. 25-65. 65 and Upwards. In Public Institutions. P. m. F m. f. m. f. m. f. m. f. m. r m. f. m. f. Enteric Fever 5 4 1 ... ... ... ... 1 ... 1 ... 2 1 ... ... 4 1 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 50 27 23 9 10 16 12 2 1 ... ... ... ... ... ... 7 5 Scarlet Fever 3 2 1 ... ... 1 ... 1 1 ... ... ... ... ... ... 2 1 Whooping Cough 45 22 23 10 11 9 12 3 ... ... ... ... ... ... ... 1 5 Diphtheria, Membranous Croup 11 3 8 ... ... 1 2 2 4 ... 2 ... ... ... ... 3 7 Croup 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Epidemic Influenza 25 14 11 ... ... 3 ... ... ... ... ... 5 2 6 9 ... ... Erysipelas 9 3 6 ... 1 ... ... ... ... ... ... 2 5 1 ... 1 4 Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 11 6 5 1 ... ... ... ... ... ... 2 5 3 ... ... 8 5 Pulmonary Tuberculosis, A. Phthisis 163 90 73 ... ... 2 1 1 1 8 17 75 50 4 4 49 31 Tub. Meningitis, A. Hydrocephalus 15 10 5 4 3 5 2 1 ... ... ... ... ... ... ... 2 1 Other Forms of Tuberculosis 34 22 12 1 2 7 4 5 3 ... 1 7 1 ... 1 18 5 Syphilis 10 5 5 2 2 ... ... ... 1 ... 1 2 ... 1 ... 4 3 Cancer 167 70 97 ... ... 1 1 ... ... ... ... 41 55 28 41 30 39 Rheumatic Fever 7 1 6 ... ... ... ... ... 4 ... 1 1 1 ... ... ... 2 Alcoholism 12 5 7 ... ... ... ... ... ... ... ... 5 7 ... ... 2 2 Inflammation and Softening of Brain 16 4 12 ... ... ... ... ... ... ... ... 2 4 2 8 3 11 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Meningitis 16 9 7 4 2 3 1 ... ... ... 1 1 3 1 ... 4 1 Cerebral Hemorrhage 62 26 36 ... ... ... ... ... ... ... ... 13 12 13 24 9 7 Apoplexy 11 7 4 ... ... ... ... ... ... ... ... 4 2 3 2 ... ... Convulsions 9 8 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Endocarditis 5 ... 5 ... ... ... ... ... 1 ... ... ... 4 ... ... ... 1 Heart Disease 169 82 87 ... ... ... 1 4 ... ... 1 48 44 28 41 27 18 Bronchitis 154 80 74 9 6 4 1 ... 2 ... ... 24 16 43 49 23 20 Lobular (Broncho-) Pneumonia 40 21 19 9 7 7 5 ... ... 2 ... 2 4 1 3 8 4 Lobar (Croupous) Pneumonia 25 13 12 1 ... ... ... 2 1 ... ... 9 9 1 2 9 7 Pneumonia 49 27 22 7 1 6 3 ... 1 ... 2 9 8 4 7 7 4 Other Diseases of Respiratory Organs 18 10 8 ... 1 1 1 ... ... ... ... 7 3 2 3 5 1 Diseases of Stomach 6 3 3 3 ... ... ... ... ... ... ... ... 1 ... 2 2 ... Diarrhoea and Enteritis 151 69 82 58 65 5 11 1 ... ... ... 3 3 2 3 26 25 Appendicitis 10 7 3 ... ... 1 ... 3 1 ... ... 3 1 ... 1 6 1 Obstruction of Intestines 13 9 4 1 ... 1 ... 1 ... ... ... 4 1 2 3 5 2 Cirrhosis of Liver 15 8 7 ... ... ... ... ... ... ... ... 7 5 1 2 1 3 Nephritis and Bright's Disease 59 27 32 ... ... 1 ... ... ... 1 1 19 18 6 13 13 17 Tumours (N.-M.), &c., Female Genital Organs 5 ... 5 ... ... ... ... ... ... ... 1 ... 2 ... 2 ... 3 Puerperal Fever 5 ... 5 ... ... ... ... ... ... ... 1 ... 4 ... ... ... 2 Accidents and Diseases of Parturition 5 ... 5 ... ... ... ... ... ... ... 1 ... 4 ... ... ... 3 Congenital Defects 15 11 4 10 4 1 ... ... ... ... ... ... ... ... ... 4 ... Premature Birth 43 25 18 25 18 ... ... ... ... ... ... ... ... ... ... 3 3 Developmental Diseases 69 35 34 33 34 2 ... ... ... ... ... ... ... ... ... 6 6 Old Age 91 36 55 ... ... ... ... ... ... ... ... 1 ... 35 55 16 19 Suicide 11 8 3 ... ... ... ... ... ... 1 1 7 2 ... ... 2 ... Overlaid in Bed 5 4 1 4 1 ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 50 27 23 ... 1 3 ... 7 1 3 2 7 11 7 8 15 8 Homicide 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes 4 1 3 ... ... ... 3 ... ... ... ... 1 ... ... ... ... 1 All other Causes 226 109 117 9 8 3 4 1 2 3 4 57 45 36 54 50 50 All Causes 1,926 951 975 209 178 83 65 35 24 23 39 373 331 228 338 370 320 See p. 11 of the text as to correction of numbers and method of classification. 102 deaths of residents of the borough. TABLE IV. Deaths of Residents of the Borough, 1911. Numbers (Persons) in each Ward. Causes of Death. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. Enteric Fever ... 2 2 ... 1 ... ... ... Smallpox ... ... ... ... ... ... ... ... Measles 2 1 5 11 27 3 ... 1 Scarlet Fever 1 ... ... ... 2 ... ... ... Whooping Cough 11 12 5 5 8 ... ... 4 Diphtheria, Membranous Croup 2 2 1 3 1 1 1 ... Croup ... ... ... ... ... 1 ••• ... Epidemic Influenza 1 2 5 4 4 2 5 2 1 Erysipelas ... 2 2 4 ... ... ... 1 Other Epidemic Diseases '... ... ... ... ... ... ... ... Other Septic Diseases 1 2 1 3 3 ... ... 1 Pulmonary Tuberculosis, A. Phthisis 27 35 18 35 33 ... 4 11 o Tub. Meningitis, A. Hydrocephalus 1 4 2 3 3 ... ... 2 Other Forms of Tuberculosis 6 6 5 3 11 ... ... 3 Syphilis ... 1 ... 1 6 ... ... 2 Cancer. 16 36 31 26 30 8 6 14 Rheumatic Fever 1 4 1 ... 1 ... ... ... Alcoholism ... 2 5 1 3 1 ... ... Inflammation and Softening of Brain 1 2 5 2 4 ... ... 2 Cerebro-spinal Fever ... ... ... ... ... ... ... ••• Simple Meningitis 2 4 ... 1 2 ... ... 2 a Cerebral Hemorrhage 10 12 8 12 11 3 2 4 Apoplexy 1 5 1 l ... l 1 1 Convulsions 1 3 1 3 ... 1 ... ... Endocarditis 1 4 ... ... ... ... ... ... Heart Disease 17 38 25 42 18 7 4 Bronchitis 11 31 19 36 38 6 4 9 Lobular (Broncho-) Pneumonia 8 7 3 6 13 2 ... 1 Lobar (Croupous) Pneumonia 6 4 4 2 7 1 ... 1 Pneumonia 5 8 7 7 11 3 ... 8 Other Diseases of Respiratory Organs 4 2 1 2 7 ... 1 1 Diseases of Stomach ... 29 1 2 3 ... ... ... Diarrhoea and Enteritis 19 14 33 43 3 3 7 Appendicitis 1 1 ... 2 3 1 1 1 Obstruction of Intestines 1 1 3 2 6 ... ... ... Cirrhosis of Liver 1 3 3 5 3 ... ... ... Nephritis and Bright's Disease 9 13 10 8 10 1 4 4 Tumours (N.-M.),&c., Fem. Gen. Orgs. 1 2 1 ... 1 ... ... ... Puerperal Fever ... 1 1 ... 1 ... ... 2 Accidents and Diseases of Parturition ... 2 ... ... 1 1 ... 1 Congenital Defects 2 4 3 2 3 ... 1 ... Premature Birth 4 11 12 7 7 ... 1 1 Developmental Diseases 14 17 4 14 18 1 ... 1 Old Age 7 15 17 23 14 4 4 7 Suicide 4 1 2 2 ... ... ... 2 Overlaid in Bed 1 1 1 1 1 ... ... ... Other Accidents and Violence 8 13 8 9 12 3 ... 2 Homicide ... ... ... ... ... 1 ... ... Execution ... ... ... ... ... ... ... ... Ill-defined Causes ... ... ... 1 2 ... ... 1 All other Causes 19 38 35 41 42 10 24 17 All Causes 222 383 277 365 414 65 66 134 See p. 11 of the text as to correction of numbers and method of classification. 103 "inward transfers," and deaths in local institutions. TABLE III A. "Inward Transfers." 1911. Causes of Death. All Ages. Under 1. 1-5. 5-15. 15-25. 25-65. 65 and Upwards. P. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Whooping Cough 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... Epidemic Influenza 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis, A. Phthisis... 3 2 1 ... ... ... ... ... ... ... ... 2 1 ... ... Other Forms of Tuberculosis 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... Cerebral Hemorrhage 3 2 1 ... ... ... ... ... ... ... ... 2 ... ... 1 Heart Disease 3 2 1 ... ... ... ... ... ... ... ... 2 ... ... 1 Bronchitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Lobar (Croupous) Pneumonia 1 ... l ... ... ... ... ... ... ... ... ... 1 ... ... Diarrhœa and Enteritis 2 ... 2 ... 1 ... ... ... ... ... ... ... ... ... 1 Obstruction of Intestines 4 2 2 ... ... ... ... 1 ... ... ... 1 1 ... 1 Cirrhosis of Liver 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... Nephritis and Bright's Disease 2 1 1 ... ... ... ... ... ... ... ... 1 l ... ... Old Age 2 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Accidents and Violence 4 1 3 ... ... ... ... 2 ... ... ... ... 1 1 ... All other Causes 10 7 3 ... ... ... ... 1 ... ... ... 3 2 3 1 All Causes 41 24 17 ... 1 1 1 5 ... 1 ... 12 9 5 6 TABLE IVa. " Inward Transfers." 1911. Causes of Death. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. Whooping Cough ... 1 ... ... ... ... ... ... Epidemic Influenza ... ... ... ... ... ... ... ... Pulmonary Tuberculosis, A. Phthisis ... 1 ... 2 ... ... ... ... Other Forms of Tuberculosis ... ... ... ... 1 ... ... 1 Cancer ... 1 ... ... ... ... ... ... Cerebral Hæmorrhage ... ... ... 1 1 ... ... 1 Heart Disease ... 1 ... 1 ... ... ... 1 Bronchitis ... ... ... 1 ... ... ... ... Lobar (Croupous) Pneumonia ... ... 1 ... ... ... ... ... Diarrhœa and Enteritis 1 ... ... 1 ... ... ... ... Obstruction of Intestines ... 1 1 ... 2 ... ... ... Cirrhosis of Liver ... ... 1 ... ... ... ... ... Nephritis and Bright's Disease ... ... 1 1 ... ... ... ... Old Age ... 1 ... ... ... ... ... ... Other Accidents and Violence ... 2 ... 2 ... ... ... ... All other Causes ... 2 ... ... 2 ... 1 4 All Causes 1 10 5 9 6 1 2 7 TABLE V. Deaths in Local Institutions. (Uncorrected.) Workhouse. Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. Home of Compassion. 1906 48 266 356 98* 7 ... 1907 22 325 332 88 3 ... 1908 57 316 351 91 ... 10 1909 96 253 362 88 5 9 1910 105 270 310 104 8 11 Averages 1906-10 66 286 342 94 5 (3 years) 10 1911 105 293 383 56* 9 8 * Closed part of the year for re-building or enlargement. 104 deaths in local public institutions. TABLE VI. Deaths in Local Public Institutions, 1911. Causes of Death. Workhouse. Infirmary. Lock Hospital. Children's Hospital. St. Mary's Hospital. Home of Compassion. Nursing Homes. Enteric Fever ... 1 ... 1 1 ... ... Measles ... 3 ... ... 1 ... ... Scarlet Fever ... ... ... ... ... ... ... Whooping Cough ... 2 ... ... ... ... ... Diphtheria, Membranous Croup ... ... ... 1 3 ... ... Croup ... ... ... ... 2 ... ... Epidemic Influenza ... ... ... ... 1 ... 1 Erysipelas ... 6 ... ... ... ... ... Other Septic Diseases ... 3 ... ... 5 ... ... Pulmonary Tuberculosis, Acute Phthisis 1 52 ... 4 11 2 2 Tub. Mening., A. Hydroceph. ... 1 ... 4 8 ... ... Other Forms of Tuberculosis 1 12 ... 4 10 ... 1 Syphilis 1 ... 6 1 1 ... ... Cancer 7 29 ... 1 46 4 8 Rheumatic Fever ... ... ... 1 3 ... ... Alcoholism 2 1 ... ... ... ... 1 Inflammation and Softening of Brain 10 4 ... ... 1 ... ... Cerebro-spinal Fever ... ... ... ... 1 ... ... Simple Meningitis ... 2 ... 2 5 ... ... Cerebral Hæmorrhage 4 6 ... ... 8 ... ... Convulsions ... ... ... 1 ... ... ... Heart Disease 5 19 ... 1 21 ... 2 Bronchitis 22 17 ... 1 10 ... 2 Lobular (Broncho-) Pneumonia ... 5 1 4 6 ... ... Lobar (Croupous) Pneumonia ... 7 ... 2 6 ... ... Pneumonia 1 8 ... 2 8 ... ... Other Diseases of Respiratory Organs 1 2 ... 1 6 ... ... Diseases of Stomach ... 1 ... ... ... ... ... Diarrhœa and Enteritis ... 38 ... 4 9 ... ... Appendicitis ... 1 ... 1 23 ... 2 Obstruction of Intestines ... 2 ... ... 13 ... 1 Cirrhosis of Liver ... 3 ... ... 2 ... 1 Nephritis and Bright's Disease 7 17 ... 1 18 ... 1 Tumours (N.-M.), &c., Fem. Genital Organs ... 1 ... ... 4 ... 3 Puerperal Fever ... 1 ... ... 4 ... ... Accidents and Diseases of Parturition 1 2 ... ... ... ... ... Congenital Defects ... 2 ... 4 2 ... ... Premature Birth 4 1 ... ... 1 ... ... Developmental Diseases 2 2 1 2 2 ... ... Old Age 17 13 ... ... ... ... ... Suicide ... ... ... ... 5 ... ... Other Accidents and Violence ... 5 1 3 57 ... 2 Homicide ... ... ... ... 1 ... ... Ill-defined Causes ... ... ... ... ... ... ... All other Causes 19 24 ... 10 78 1 12 All Causes 105 293 9 56 383 8 39 Non-residents 5 10 9 46 285 8 22 105 deaths of residents outside the borough. TABLE VII. Deaths of Residents outside the Borough, 1911. Causes of Death. Hospitals of Metropolitan Asylums Board. General Hospitals. Special Hospitals and Homes. Lunatic Asylums. Poor Law Institutions. Elsewhere. "Transferred Deaths."* Enteric Fever 2 1 ... ... ... ... ... Measles 9 ... ... ... ... 1 ... Scarlet Fever 3 ... ... ... ... ... ... Whooping Cough 4 ... ... ... ... 1 1 Diphtheria, Membranous Croup 10 ... ... ... ... ... ... Croup ... ... ... ... ... ... ... Epidemic Influenza ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... ... ... ... Pulmonary Tuberculosis, Acute Phthisis 2 3 10 7 1 3 3 Tub. Mening., A. Hydroceph. ... 1 ... ... ... ... ... Other Forms of Tuberculosis 1 1 2 2 ... ... 2 Syphilis 1 ... 1 2 1 ... ... Cancer ... 8 8 ... 1 6 1 Rheumatic Fever ... 1 ... ... ... ... ... Alcoholism ... ... ... ... 1 1 ... Inflammation and Softening of Brain ... ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... Simple Meningitis ... 1 ... ... ... 1 ... Cerebral Hemorrhage ... 2 1 1 1 2 3 Convulsions ... ... ... ... ... ... ... Heart Disease ... 3 1 6 4 6 3 Bronchitis ... 1 ... 1 1 1 1 Lobular (Broncho-) Pneumonia 3 1 ... 1 ... ... 1 Lobar (Croupous) Pneumonia ... 1 ... 4 1 ... ... Pneumonia ... ... ... ... ... 2 ... Other Diseases of Respiratory Organs ... ... ... 1 ... ... ... Diseases of Stomach ... ... ... ... ... ... ... Diarrhœa and Enteritis 4 3 ... 2 ... 6 2 Appendicitis ... 2 ... ... ... ... ... Obstruction of Intestines 1 2 ... 1 ... 3 4 Cirrhosis of Liver ... ... ... 1 ... ... 1 Nephritis and Bright's Disease ... 1 1 ... ... 2 1 Tumours (N.-M.), &c., Fern. Genital Organs ... 2 ... ... ... ... ... Puerperal Fever ... ... ... ... ... 1 ... Accidents and Diseases of Parturition ... ... ... ... ... ... ... Congenital Defects ... 1 ... ... ... ... ... Premature Birth ... ... 1 ... ... ... ... Developmental Diseases 4 1 1 ... ... 1 ... Old Age ... ... ... 3 1 2 2 Suicide ... 2 ... ... ... ... ... Other Accidents and Violence ... 2 ... ... ... 9 4 Homicide ... ... ... ... ... ... ... Ill-defined Causes 1 ... ... 2 ... ... ... All other Causes ... 11 3 27 ... 14 11 All Causes 45 51 29 59 12 63 41 * Included in the preceding columns. p 106 DEATHS OF INFANTS UNDER ONE YEAR. TABLE VIII. Deaths of Infants under One Year. L.G.B. Group. Causes of Death. Days. Weeks. Months. Totals under One Year. Males. Females. 0— 0— 1- 2- 3— 0— 1 - 2— 3— 4— 5— 6— 7— 8- 9— 10- 11— 1911 1906-10 1911 1906-10 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 ... 1 4 3 ... 1 3 1 9 4 10 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... 2 1 ... 1 2 ... ... 2 1 ... ... 3 1 1 1 3 10 6 11 6 II. Diarrhœa ... ... ... ... ... ... ... 1 1 ... 1 1 3 3 3 5 3 2 2 3 4 2 3 3 3 1 2 2 2 1 ... 4 l 2 27 28 29 24 Enteritis ... ... ... ... 1 ... 1 ... ... 1 2 1 2 7 5 5 2 4 3 6 4 1 4 2 ... 3 1 1 3 1 ... 2 3 31 8 56 5 III. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 1 4 4 3 2 Abdominal Tuberculosis- ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... . . ... ... . . • . . . ... ... 2 1 2 Other Forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 1 2 Congential Malformations ... ... 2 1 1 ... ... 2 1 ... 4 3 2 ... ... ... ... ... 1 ... ... ... ... 1 2 ... ... ... 1 ... ... ... ... ... 10 9 4 8 IV. Premature Birth 8 6 16 10 1 1 4 2 1 ... 22 13 2 3 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 25 34 18 23 Atrophy and Debility ... ... 1 ... 1 2 1 1 ... ... 3 3 ... 3 2 ... 3 ... 1 ... ... ... ... 1 ... 1 1 1 1 ... ... ... ... ... 13 13 10 6 Debility at Birth 3 1 5 2 1 3 ... ... ... 4 7 9 ... 3 ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 11 9 12 6 Injury at Birth ... 5 2 6 1 ... ... 1 ... ... 3 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 6 2 Atelectasis 2 ... 4 ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 ... 1 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 1 2 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 Syphilis 1 ... 1 ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 5 2 4 Rickets ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 V. Meningitis ... ... ... ... 1 ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 1 ... ... ... ... ... ... ... ... 4 2 2 2 Convulsions ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 5 5 1 2 Gastritis ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ? ... ? Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 Bronchitis ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 1 ... 2 ... 1 ... 2 ... ... ... ... ... ... ... ... 1 ... 1 9 11 6 13 Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... 2 1 ... 1 1 1 ... 3 1 ... ... 4 1 3 ... ... ... 3 2 17 17 8 14 Suffocation (overlying) ... ... 1 ... 1 ... ... ... ... ... 2 ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 1 4 Other Causes 1 ... 4 1 ... 2 2 ... 1 1 7 4 1 4 1 ... 3 1 ... ... 4 1 ... ... ... ... ... 1 ... 3 ... ... ... 1 16 12 15 9 All Causes 15 12 39 19 8 9 10 7 4 7 61 42 18 27 15 1417 11 15 12 18 8 12 11 11 9 13 7 13 14 3 813 15 209 189 178 144 Uncertified Deaths ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 Averages 1906-10 21 15 41 28 11 7 8 6 8 5 67 47 24 21 16 1211 11 10 9 14 8 8 6 10 8 7 6 8 6 7 6 7 4 189 144 Averages, 1911. 1906-10. Births registered M. 1,409 1,542 within Borough F. 1 406 1,482 107 proceedings during 1911. TABLE IX. PROCEEDINGS DURING 1911. L.C.C. Premises. Number of Places— Number of Inspections, 1911. Number of Notices, 1911. Number of Prosecutions, 1911. On Register at end of 1910. Added in 1911. Removed in 1911. On Register at end of 1911. Milk premises 114 7 1 120 210 ... ... Cowsheds 1 ... ... 1 4 ... ... Slaughter-houses ... Other offensive trade 7 ... ... 7 479 ... ... premises ... ... ... ... ... ... ... Ice cream premises 116 2 10 108 67 . . . ... Registered houses let in lodgings 1,326 32 10 1,348 6,945 (a) 46 (b) 4,142 (a) - (b) 8 (a) For overcrowding. (b) For other conditions (including annual cleansing). Total number of intimation notices served for all purposes 672 Overcrowding, 1911— Number of dwelling rooms overcrowded 207 Number remedied 173* Number of prosecutions Underground rooms— Illegal occupation dealt with during year 10 Number of rooms closed 16 Insanitary houses— Number closed under the Public Health (London) Act, 1891 — Number closed under the Housing Acts 5 Number of premises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 202 Shelters provided under Sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year Revenue Acts— Number of houses for which applications were received during year 6 Number of tenements comprised therein 37 (a) granted 35 Number of tenements for which certificates were (b) refused (c) deferred 2 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. (b) For prevention of nuisance arising from offensive matter running out of any manufactory, &c. (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, &c., of dwelling houses 3 (e) In connection with the removal of offensive matter, &c. 2 (f) As to cesspools and privies, removal and disposal of refuse, &c. (g) For securing the cleanliness of tanks, cisterns, &c— (h) With respect to water closets, earth closets, &c. 5 (i) With respect to sufficiency of water supply to water closets 1 (j') With respect to drainage, &c. (Metropolitan Management Act, Sec. 202) — (k) With respect to deposit of plans as to drainage, &c. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 3 Mortuaries— Total number of bodies removed 282 Total number of infectious bodies removed 2 * In 34 cases no action was taken, the total deficiency of air space being less than 50 cubic feet. 108 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. TABLE X. 1.—Inspections. Including Inspections made by Sanitary Inspectors. H.O. Premises. Number of Inspections. Written Notices s Prosecutions. Factories (including Factory Laundries) 130 - - Workshops (including Workshop Laundries) 2,313 15 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 40 — — Total 2,483 15 - 3.—Home Nature of Work. Outworkers' Lists, Section 107. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Twice in the year. Once in the year. Outworkers. Outworkers. Lists. Contractors. Workmen. Lists. Contractors. Workmen. Wearing Apparel— (1) making, &c. 13 456 — 7 - (2) cleaning and washing - 11 - - 2 - Lace, lace curtains and nets 1 3 - 1 3 - Furniture and upholstery — 21 - — 4 - Electro-plate 116 2 — 9 2 - - Umbrellas, &c. — 1 - - 1 - Artificial flowers — 5 - - — - Brush making — 1 - - 1 - Stuffed toys — 1 - - 1 - Basket making — 2 - - 2 - Total 116 16 501 9 3 21 — 4.—Registered Workshops. Workshops on the Register (S 131) at the end of the year. Number. Workshops ... ... ... ... ... ... 1,381 Do. Bakehouses ... ... ... ... ... ... 60 Total number of workshops on Register ... ... 1,441 109 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 2.—Defects Found. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. Nuisances under the Public Health Acts:- Want of cleanliness 18 18 — — Want of ventilation - — — — Overcrowding 5 5 — — Want of drainage of floors — — — — Other nuisances 5 4 — — insufficient — - — - Sanitary accommodation unsuitable or defective 16 16 — — not separate for sexes 3 3 — - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — - — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - - - - Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 47 46 - — Work. Prosecutions. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (SS. 109,110). - - - - - - - - - - - - - - — — - - - - - - — — - - - - - - — — - - - - - - - - - - - - - - - — - - - - — - - — - - - - - - - — - - - - - - - — - - - - - - - - - - - - — - - - 5.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Factory and Workshop Act (S. 133) 46 Action taken in matters referred by H.M. Inspector Notified by H.M. Inspector 23 as remediable under the Public Health Acts, but Reports (of action taken) sent to H.M. not under the Factory and Workshop Act (S. 5) ( Inspector 19 Other - Underground Bakehouses(S. 111):— Certificates granted during the year — In use at the end of the year 55 110 ophthalmia neonatorum. APPENDIX B. OPHTHALMIA NEONATORUM. Memorandum to Inspectors. ACTION TO BE TAKEN. (A.)—WHEN PATIENT IS UNDER MEDICAL CARE AT HOME. 1. Find out the doctor's orders—seeing him, if necessary, for that purpose. 2. Satisfy yourself that the orders are being regularly and intelligently carried out. 3. If skilled nursing is evidently wanted, report the case specially to the Medical Officer of Health (B.)—WHEN PATIENT IS NOT UNDER MEDICAL CARE. 1. Insist—first by persuasion, and, if that fails, by threats—on medical advice being taken, and see that a promise to do so is carried out. (Note.—Neglect to seek advice can be dealt with by prosecution under the ''Children Act"). '2. If poverty be pleaded, press for removal to hospital. Advice is to be given on the following lines: Ophthalmia is always contagious, the degree of contagiousness depending on the organism causing the disease. If proper care be taken, the risk of the eyes of other persons in the family being affected is slight. Kissing the patient's face is dangerous, as the kisser's eyes are brought too near the affected eyes. Any person attending to the child's eyes should wash her hands carefully immediately afterwards. The child's eyes should not be wiped with handkerchiefs or anything else, except small pieces of clean linen or pledgets of cotton wool—a separate piece being used for each eye—wetted with antiseptic solution (boric acid is the best). Whatever be used should be thrown into the fire at once. Except in very virulent cases, the child's eyes can be saved with a good prospect of undamaged vision. Everything will depend on prompt treatment and an intelligent carrying out of the orders given by the doctor. No line of treatment is to be indicated. That must be left entirely to the doctor. The question of legitimacy is of importance, and will best be settled by indirect method, rather than by direct question, except as a last resource. Enquiry as to mother's health during pregnancy is to be directed to elicit information as to presence of vaginal discharges, especially those due to venereal disease. Ophthalmia caused by such discharges is the gravest form observed and oftenest leads to loss of sight. A married woman is less likely to suffer from such discharges, while in general terms the possibility of infection in an unmarried mother should always be kept in mind. The relationship of date of attack of eye to date of birth will often afford useful suggestion of the presence of vaginal discharge before confinement. Eye trouble coming on very early after birth should be regarded with suspicion, and the enquiry as to discharges pushed as much home as possible. Eye precautions at birth refer to cleansing of the eyes. That should be done with clean pledgets of cotton wool or lint, a separate piece to each eye. Many midwives drop in a weak solution of silver nitrate— a proceeding which does not appear to be necessary and may itself give rise to inflammation of the eye. The note as to state of the eye must be limited to what can be observed without touching or opening the eyes. It is very undesirable to run any risk of getting any discharge on the fingers, as the enquirer may thereby infect her own eyes. End of case. At last visit of home-treated case note is to be taken as to the state of the eyes and record made of what doctor has told parent. Cases treated at hospital will be dealt with by letter from the Office. In making enquiries a sympathetic attitude should be adopted at the outset, but a severe officialism may become necessary to secure the proper treatment of the case. It will be well to use the oblique method of enquiry—not to let it be seen what it is that is wanted, or the importance attaching to replies. Arrangements will be made for— (a) Bacteriological examination of the eye secretions ; (b) Providing nursing where necessary ; and (c) Removal to institutions. Instructions will be issued later on the first two points. Removal to hospital will in the case of new-born children necessitate the mother going with the child. The M.A.B. ambulances will be used. In the early stages of the case a daily visit not at the same hour) will be necessary, and, maybe, more than one visit a day.