AC 4349 PAD17 Metropolitan Borough of Paddington. Annual Report of the Council FOR THE YEAR 1912. APPENDIX. REPORT OF THE Medical Officer of Health. LONDON: HENDERSON & SPALDING, Ltd., Printers, SYLVAN GROVE, OLD KENT ROAD, S.E. PAD 17 Metropolitan Borough of Paddington. report ON The Vital Statistics AND Sanitary Work For the Year 1912. BY REGINALD DUDFIELD, M.A.. M.B., D.P.H.. F.S.S. Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. CONTENTS. Page Acute Poliomyelitis 27 Administrative Work 68 Alcoholism, Mortality from 49 Animal Diseases 27 Bacteriological Examinations, Results of 75 Bakehouses, Inspection of 82 Births: Natality 8 „ Notification of 11 „ "Hopeless" 55 „ Still-births 11 ,, Transferred 9 Canals, Canal Boats Acts 79 Cancer, Mortality from 49 Census Results, 1911 1 Cerebro-spinal Fever 26 Chickenpox 33 Childbed, Mortality in 25 Childhood, Mortality in 53 Cirencester Street Improvement Scheme 86 Cirrhosis of the Liver, Mortality from 49 "Clarendon Street Area," Vital Statistics of 94 Combined Drainage 77 Common Lodging Houses 100 "Consumption," Mortality from 40 ,, Notification of 37 Consumptives, Occupations of (Table) 48 ,, Segregation of 37 Cream Regulations 106 Dairies and Milkshops 101 Deaths: Mortality 16 Deaths in Institutions—all causes 52 „ „ —pulmonary tuberculosis 40 Diarrhœa, Deaths from 56 ,, Infection and Flies 60 Diphtheria 14, 19 Disinfection 69 Drainage Plans 77 Drains, Private, Re-laid 76 Enteric Fever 23 Erysipelas 25 Factory and Workshop Act, 1901, Work under 81 Food Adulteration, Summary of Samples taken 104 „ Summary of Proceedings 109 Food Supervision 101 Glanders 27 Health Visiting 63 Home Workers (Outworkers) 82 Hospital Accommodation, Measles, Whooping Cough 33 „ „ Puerperal Fever 25 House Refuse 76 Housing, Town Planning, &c., Act 85 Ice Cream, Inspection of places where made 102 Illegitimates, Births of 10 „ Deaths of 66 Infant Consultations 64 Infants, Mortality among 53 ,, ,, in Special Areas 63 „ „ in Wards 54 Influenza, Mortality from 49 Inhabited House Duty, Exemption from 100 Inquests held 51 Institutions, Deaths in, General 52 ,, ,, Pulmonary Tuberculosis 40 Internotification 75 Legal Proceedings, Summary of 107 Leprosy 34 Lime Juice, Lime Juice Cordial 105 Manure, Removal of 76 Measles 30 Page Meat Condemned in Slaughterhouses 101 ,, Seized in Shops. &c. 102 Meteorology 6 Milk Supply 101 Milkshops. Trades carried on at 102 Mortality among Infants 53 „ „ ,, "Hopeless Births" 55 „ at ages 1—5 years 66 „ in Childbed 25 „ (Infantile), in Special Areas 63 Mortuaries 70 Mumps 33 National Insurance Act 43 Notification of Births 11 ,, „ Sickness 14 „ ,, Phthisis (Consumption) 37 Offensive Sewers 78 Office Work 106 Ophthalmia Neonatorum 28 Other Infectious Diseases 33 Other Septic Diseases 26 Other Tuberculous Diseases 45 Outworkers (Homework) 82 Phthisis, Mortality from 40 Poliomyelitis, Polio-encephalitis, Acute 27 Population, Estimated 5 Premature Birth 56 Preservatives in Foods 104 Prevention of Infectious Disease 68 Puerperal Fever 24 Pulmonary Tuberculosis 37 „ „ Institutional Deaths 40 Rents of Tenements 87 Respiratory Diseases, Mortality from 49 Ringworm 33, 73 Scabies 74 Scarlet Fever 13, 21 Schools and Infectious Diseases 70 Segregation of Consumptives 37 Septic Diseases 24 Sewer Connections 77 Sickness (Notification) 13 Slaughterhouses, Inspection of 101 Smallpox 19 Smoke Prevention 78 "Sore Throat" 72 Special Areas, Infantile Mortality in 63 Suicide, Mortality from 49 Tenement Houses, Annual Cleansing 91 „ ,, Vital Statistics 99 Trade Nuisances 76 Trade Refuse 76 Tuberculous Diseases, Deaths from 36 Underground Rooms 87 Unsound Food seized 102 Vaccination 19 Vermin 74 Water Supply, Cutting off of 69 Wharves, Inspection of 79 Whooping Cough 32 Workshop Supervision 81 APPENDIX A. Tables (Local Government Board, Home Office, and London County Council) 111—121 APPENDIX B. Street Distribution of New Cases of Pulmonary Tuberculosis 122 Institutional Treatment of Cases of Pulmonary Tuberculosis 124 to his worship the mayor, the aldermen and councillors of the borough of paddington. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my Report on the health of the Borough—as evidenced by the official statistics—and the work of your Public Health Department during the past year. The census (1911) data relating to the Borough published at the time of preparation of this Report are given in a brief form under population. The information as to the housing of the inhabitants appears to confirm the provisional estimate of the total loss of population (approximately 16,000 persons) which I gave in my last Report. It would also appear from the particulars at present available that the standard of housing, judged by the size (number of rooms) of the individual tenements, has improved since 1901. Not only has the size of the average tenement increased, but the average number of persons per tenement has decreased. The changes, it is true, are but small, but they are in the right direction. The birth-rate again showed a shrinkage, last year's rate being the lowest on record. The subject of the reduction in apparent fertility is one of the first importance to the Nation. It is satisfactory to observe that we are supplying the needs of population in our Dependencies beyond the seas, as otherwise those countries would be occupied by other nations. We need, however, a greater supply of new lives at home to make good the draft of emigrants, to maintain our manufactures, and to defend our shores. It is much to be desired that public opinion should be very definitely directed to the question. Of the infectious diseases, diphtheria was expected to be unusually prevalent during the past year, and there was a considerable increase in the number of notified cases. The number reported is, however, in one sense misleading, as several "carrier" cases were notified. Such cases are not clinical diphtheria, and it is doubtful if the presence of the Klebs-Löffler bacillus is dangerous to the patient. "Carrier" patients are, however, undoubtedly a source of danger to the public. Under "schools" will be found an account of the special work with reference to such cases in the public elementary schools. The account is far from complete, and it is hoped that a more complete history may be published at a later date. Return cases of scarlet fever are of too frequent occurrence. There was a very considerable reduction in the number of cases of enteric fever during the year. Very few cases of puerperal fever are now reported, but evidence is adduced to show that the mortality in childbed does not appear to be decreasing to the extent generally supposed. For the first time all cases of pulmonary tuberculosis—except those in lunatic asylums—were notifiable. A complete list of the streets from which new cases were reported during the year is given in Appendix B. The total mortality recorded in 1912 was the lowest on record, but the figures given in this Report have still to be corrected for the changes in the sex-age constitution of the population. The Registrar-General in his Annual Summary for 1912 gave the nett mortality at 12 33 and the factor corrected rate as 12.26, the nett rate being 1.05 and the corrected l.04 less than the averages for 1907-11. The most striking change in the mortality rates from individual diseases was the decline in the mortality from pulmonary tuberculosis (phthisis), the decline being however, limited to the form which is not described as "acute" in the death certificate. The mortality from "acute phthisis" was higher in 1912 than 1911. Infantile mortality was at a low rate last year, viz., 99, as compared with 129 in 1911 and an average of 109 for the five years 1907-11. By far the greater part of the decrease was observed among females. The mortality from the diarrhœal diseases recorded last year was in striking contrast to that recorded in 1911. Attention should be directed to the very small share in the reduction of mortality recorded at ages under one month. From figures (1891-1910) taken from the Annual Reports of the Registrar-General evidence has been obtained to show that the mortality during the first year of life in England and Wales from prae-natal causes has increased, although the total infantile mortality has decreased. The question of prae-natal causes of mortality demands serious consideration. The proportion of deaths in institutions to all deaths continues to increase. Some of the increase has been due to the Hospitals of the Metropolitan Asylums Board being made available for more diseases. At the same time there has been a fairly large increase in the proportion of deaths in the Poor Law Institutions, which is not a satisfactory feature. It remains to be seen what effect the National Insurance Act will have towards reducing the proportion of deaths in Poor Law Institutions. I have in preparation reports summarising the morbidity and mortality experienced during the ten years 1901-1910 adjusted to the latest census returns. From those data it is my ambition to construct a life-table. A summary of the results of the census is also in preparation, but the date of its completion will be dependent on the publication of the Census Office Returns. The past year was a busy one, mainly on account of the exceptional—judging from past experience—amount of sickness among school children. How far the increases observed last year were due to more careful and systematic reporting by school teachers time only will show. It is believed that last year's increase was largely due to that cause, and that the present high figures may be expected to be maintained. If so, it emphasises the need of more Women Inspectors. There was a considerable increase in the work consequent on the notification of pulmonary tuberculosis—work which experience has convinced me is more efficiently carried out by women. It has to be remembered that it is not a matter of one visit only to each reported case. In some instances several visits are necessary to complete the preliminary inquiries, and in others visits at fairly frequent intervals are required, both for the sake of the patient as well as for the protection of the public. This work will be still further increased by the extension of notification to all forms of tuberculosis, which came into effect in February last. Moreover, additional work is confidently anticipated in connection with the administration of the Sanatorium Benefit of the National Insurance Act. The work in connection with the preservation of infant lives has not received from the Staff that amount of attention which its importance demands. Fortunately, last year the "School for Mothers" was able and willing to make good some of the deficiency, but it has been intimated that the School cannot continue to undertake the amount of visiting hitherto performed. The present Staff (two women) is quite inadequate to cope with the growing demands on the Department. I trust that the Council will take steps at an early date to appoint additional Women Inspectors or Health Visitors, otherwise the most useful part of the Department's activities will be very seriously curtailed. The work connected with the Housing Acts entailed a considerable increase in administration, especially that in connection with the " Cirencester Street Improvement Scheme." It is hoped that the amended series of by-laws with reference to tenement houses will result in improved domestic hygiene, a matter not dealt with in old series, which was limited to landlords' liabilities. Now the tenants are required to take their share in maintaining domestic cleanliness. The inquiries with reference to the rents of tenements have disclosed an unexpected fall in rents during the seven years 1906 to 1912. A perusal of that part of the Report which deals with administration will show that the Staff as a whole has been very fully occupied. All members have discharged their duties to my satisfaction, and, I trust, to that of the Council. I cannot conclude without expressing my deep gratitude to the Council and to the Public Health Committee for the support and consideration I have always received not only during the past year, but ever since I have had the honour to occupy my present position. My thanks are also due to the members of the Medical Profession practising in the Borough for their cordial co-operation in my efforts to promote the health of the inhabitants of the Borough. 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., 1st July, 1913. 1 REPORT. The Borough of Paddington comprises an area of 1,356 statute acres, including 20 of inland water-ways (the Grand Junction and Regent's Canals), parts of Hyde Park and Kensington Gardens (68 acres), the Recreation Ground (27 acres'), the disused Church Yard of St. Mary's Paddington Green (5 acres), and Paddington Green (1½ acres). The Borough is co-terminous with the Registration District "No. 1, Paddington," comprising three SubDistricts, viz., "North,'' "Central," and "South." For municipal purposes the Borough is divided into eight Wards. The grouping of the Wards in the Registration Sub-Districts is set out below : Registration Sub-Districts. Wards. North Paddington Queen's Park. Harrow Road. Maida Vale. Central Paddington Westbourne. Church. South Paddington Lancaster Gate, West. Lancaster Gate, East. Hyde Park. The Borough is situated on the southern side of the range of low hills which culminate in the Hampstead Heights, the slope being (generally) towards the south and west. The subsoil is principally clay, but in places, more particularly in the neighbourhood of the Bayswater Road, pockets of gravel exist, or did exist. In the central parts of the Borough many depressions were filled up years ago with slop and refuse of all descriptions. In the western parts of the Borough the subsoil water lies at a very few feet below the surface of the ground. There are at least two, and possibly more, subterranean watercourses, one of which, running parallel with the Edgware Road, close to the western side thereof, has been found on several occasions, in the course of works of excavation to trace the causes of dampness in cellars. The second, the better known, is the Ranelagh, which now forms the Ranelagh Sewer, one of the main sewers of the Metropolis. POPULATION. At the census of 1901, which took place some five months after the formation of the Borough under the provisions of the London Government Act, 1899, the population of the Borough was found to number 143,976 persons, comprising 61,626 males and 82,350 females. Had the old Parish of Paddington remained unchanged in its boundaries, the population at that census would have been 127,328 persons (53,305 males and 74,023 females), so that the changes in the boundaries resulted in a nett gain of 16,648 persons (7,957 males and 8,327 females). During the ten years April, 1901, to April, 1911, the natural increment of the population of the Borough, being the excess of registered births over the corrected deaths, amounted to 11,959 persons, or an average of 1,196 per annum. The increment during the first five years amounted to 6,421 persons (642 per annum), and during the second, to 5,538 persons (554 per annum). With such rates of increment on record it was thought that an estimate of 152,876 persons as the population of the Borough at the census of 1911 might fairly be regarded as a conservative forecast. The final total obtained at that census was, however, 142,551, showing a decrease of 1,425 persons, instead of an anticipated increase of something like 9,000. Figures were submitted in the Report for 1911 (page 1) to show that the actual loss of population during the ten years was probably upwards of 16,000 persons. B 2 POPULATION. The population enumerated in 1901 comprised 60,415 males and 82,136 females. As the incidence of disease and death is very considerably influenced by the sex-age composition of the population, each sex and age having what may be termed its special liabilities, it will be useful to state some of the changes which have taken place in the composition of the population of the Borough during the last ten years. In the comparisons now to be instituted it has been thought desirable to include the figures for the old Parish of Paddington, which were obtained to supplement the data for the Borough at the census of 1901. Proportions of Males to Females.—In the population of the Borough at 1901 there was an excess of 20,724 females, equal to 14.39 per cent. of the total population. The addition of the new population to the Borough consequent on the extension of its boundaries materially affected the proportion of females to the total population, the excess of females in 1901 within the old Parish having been 20,718 (equal to 16.27 of the total population), the added population importing more males than females. At the last census (1911) the excess of females amounted to 21,721 individuals, and was equal to 15.24 per cent. of the total population. The foregoing facts may be stated in another form, viz., by comparing the number of females enumerated to each (say) 1,000 males. The results of such comparison are set out below. In every 1,000 of the total population. 1901. 1911. Males. Females. Males. Females. Old Parish 419 581 Borough 428 572 424 576 To each 1,000 males, females in the total population. 1901. 1911. Females. Males. Females. Males. 1,389 720 1,336 748 1,359 735 Changes in the Sex-age Grouping.—In Table 1 (page 5) the proportions of individuals (per 1,000 of each sex) as determined in 1901 and 1911 are set out, the figures for the reconstituted old Parish being added to show the changes due to the addition to the population resulting from the extension of the boundaries of the Parish. It will be seen that the added population contained an excess of young persons, the proportions of males in the new Borough at ages under 25 and of females under 15 being higher than in the old Parish. The population determined at the last census was more "elderly" than that of 1901, the proportions at ages under 25 for males and females being less than those determined at the earlier census. The wide age-groups used in that table leave the actual ages at which the changes in the proportions were first observed in doubt. An examination of the figures for fiveyear age-groups shows that in both sexes the proportions below the group 30-35 years were less in 1911 than in 1901, and at the higher ages, above. The alterations in the age-grouping are, perhaps, better shown in the following summary:— Age Composition of 1,000 Individuals. Ages. 1901. 1911. Old Parish. Borough. Borough. Males 0.25 474 483 448 25 and upwards 525 518 551 Females 0.15 205 215 200 15 and upwards 796 784 799 The changes indicated have been produced in part by the fall in the birth-rate and in part by the migration of residents. The birth-rate during the three years 1899-1901 averaged 23.66 per 1,000 persons, that during the three years 1909-1911, 20.13—a decrease of 353 per 1,000, or 13.6 per cent. of the rate of the earlier period. In 1901 the males enumerated at ages 0-10 years formed 194 per 1,000 males, and in 1911, 189, the corresponding figures for females being 147 and 139. In 1901 the persons (both sexes) aged 0-10 years formed 167 of the total population, and in 1911, 160—showing a reduction of 4.2 per cent. only as compared with a reduction of 13.6 in the birth-rate. POPULATION. 3 Ward Populations.—In Table 2 (page 6) the numbers enumerated in 1901 and 1911 at all ages (distinguishing the sexes) are set out. Below will be found a statement of the actual increases and decreases, together with the percentage changes (persons) from 1901. The greatest increase is to be noted in Lancaster Gate, West, Ward (8.16 per cent.), and may reasonably be supposed to be due to the increased number of boarding-houses and private hotels opened in that Ward. The increase in Maida Vale Ward (7.35 per cent.) is attributable to the erection of the numerous blocks of flats in the neighbourhood of Sutherland and Elgin Avenues. The greatest decrease (7.45 per cent.) took place in Hyde Park Ward, and the next (6.22 per cent.), in Queen's Park. Increase (4-) Decrease (-) in Enumerated Populations—Census, 1911. Persons. Males. Females. Totals. Changes Per cent. Queen's Park -523 - 546 -1,069 -6.22 Harrow Road -440 - 206 -646 -2.33 Maida Vale +755 +1,358 +2,113 +7.35 Westbourne —142 —174 —316 —1.32 Church -763 -464 -1,227 -4.66 Lancaster Gate, West +268 +422 +690 +8.16 East + 80 -12 +68 +0.85 Hyde Park -446 -592 -1,038 -7.45 With the comparatively small amount of information at present available, it would be useless to attempt to inquire as to the factors to which the decreases are to be attributed. Density of Population.—This is measured by the number of persons living on an acre of land. On the present occasion only the averages per total area, i.e.. without deducting waterways, open spaces, &c., can be given. It is manifest that such figures are insufficient for any comparisons dealing with the relationship between density and vital statistics of different parts of the Borough, as the population of one part may be uniformly spread over the whole area and in another crowded on a fraction thereof. For some years the density of population in Paddington (measured as described above) has been considerably in excess of that observed in London as a whole and in the districts immediately adjacent to the Borough. Below is a tabular statement showing the densities observed in the old Parish and in the Borough at each census since 1881. It will be seen that the changes in the boundaries made in 1900 increased the density from 101 to 106 persons per acre, and that during the ten years 1901-11 the density of the Borough decreased to the extent of one person per acre. Density of Population. Average Numbers of Persons per Acre. (Unadjusted.) Old Parish. Borough. 1881 85.2 1901 106.1 1891 93.8 (+ 8.6) 1911 105.1 (-10) 1901 101.3 (+ 7.5) The density observed in the Borough in 1911 (105.1) was nearly 45 persons per acre in excess of the average for the whole County of London (60.4). If the density for the County be represented by 100, that for the Borough becomes 174, showing a sufficiently striking contrast. The densities recorded in 1901 and 1911 in the districts immediately adjacent to the Borough are given below. It will be noted that in Hampstead and Willesden only did the density increase during the intercensal period. Density of Population. Average Numbers of Persons per Acre. (Unadjusted.) London. Paddington. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1901 60.6 106.1 77.0 73.1 90.4 36.1 26.1 1911 60.4 (-0.2) 105.1 (-1.0) 75.2 (-1.8) 64.0 (-9.1) 80.2 (-10.2) 37.7 (+1.6) 33.1 (+7.0) 4 POPULATION. The densities in the Wards of the Borough, calculated on the results of the last census, varied from 57 persons per acre in Lancaster Gate, East, Ward to 178 in Harrow Road. (See below.) The greatest increase (7.8) during the ten years 1901-11 took place in Maida Vale Ward, and the greatest decrease (9.5) in Queen's Park. Density of Population. Average Numbers of Persons per Acre. (Unadjusted.) Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. 1901 152.0 182.2 68.5 104.2 130.6 70.4 56.7 108.7 1911 142.5 178.0 76.3 102.8 124.6 76.2 57.1 100.6 (-9.5) (-4.2) ( + 7.8) ( -1.4) ( -6.0) (+5.8) ( +0.4) (-8.1) Housing.—Prior to the last census the numbers of houses have been determined, distinguishing those inhabited, those occupied but not inhabited, those unoccupied, and those building. In addition, the number of separate families or occupiers has been given. It is an open secret that for the purposes of the last census the "house" has been abandoned as a unit, and that the data which have been collected with reference to housing are—the numbers of "dwellings or tenements" (a) inhabited, (b) uninhabited, (c) building, and (d) not used as dwellings. The housing tables will comprise returns of the numbers occupying tenements of so many rooms, not limited to tenements of less than five rooms as on former occasions. Such scheme will give information of much greater value, but renders comparison with former years difficult and uncertain. At the census of 1901 the following numbers were obtained:— Census, 1901. Numbers of houses inhabited 17,684 (a) Occupied, not inhabited 488 (b) Unoccupied 533 (c) Building 32 Number of tenements 33,661 The only data collected at the last census at present available are:— Census, 1911. Numbers of dwellings or tenements inhabited 33,925 (a) Uninhabited 2,276 (b) Not used as dwellings 1,244 (c) Building 5 Apparently (b) in the former (1901) statement is the same as (a) in the latter (1911), and if so, bears testimony to the migration from the Borough. At the census of 1901 the population averaged 8.14 per inhabited house, and that figure applied to 2,276 would represent a loss of 18,527 persons. If, however, the average of 8.14 be applied to 1,743—the increase of (a), 1911, over (b), 1901—the increase in the number of empty properties represented a loss of 14,212 inhabitants. The "occupied, not inhabited" houses of 1901 (488) are apparently the same as the tenements "not used as dwellings" of 1911 (1,244)—showing, therefore, an increase of 711 "lock-up" shops and premises, an increase which may be taken to represent a further loss of some 5,000 inhabitants. The decrease in the number of premises building was to be expected in one way, seeing that almost the entire area of the Borough was covered prior to 1910. Many building leases are now expiring, and new premises are likely to be erected during the current intercensal period. The number of schedules (see Table 2, page 6) increased from 33,661 in 1901 to 33,925 in 1911. Such increase is somewhat remarkable having regard to the actual decrease in the number of persons. The average number of persons per 100 schedules, homes or families, which stood at population. 5 428 in 1901, was 420 in 1911. As may be seen from the appended statement that reduction was not universal throughout the Borough, notable increases being recorded in the two Lancaster Gate Wards. Average Numbers of Persons per 100 Schedules. Tenements (homes). Families. Census. Queen's Park. Harrow Road.Maida Vale. Westbourne. Church. Lancaster Gate, West. East. Hyde 1901 420 372 434 413 402 586 596 503 1911 423 360 382 419 396 628 657 507 Estimated Population.—Although the natural increment of the population during the fifteen months which elapsed between the census of 1911 and the middle of 1912 amounted to 1,390 persons, the population for last year (middle of) has been based on an assumption of a continued decrease. A new method of making the estimate has been adopted, that described in the Annual Report of the Registrar-General for 1910. The method in question was devised by the late Mr. A. C. Waters, of the General Register Office, and has the advantage of giving results for the component parts of the country (or sub-divisions of any area), which add up to agree with totals for the whole country based upon an assumption of a geometrical rate of growth of population—an assumption which fits most closely with theory and practical results. At present no estimates have been made of the numbers of each sex or of those at various ages. The estimated population for the Borough at the middle of the past year was 142,362 persons, the estimates for the individual Wards are given below. Populations of Wards. Persons. Estimated at Middle of 1912. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 15,970 26,972 21,111 23,418 24,888 9,237 8,016 12,750 TABLE 1. Numbers of Each Sex in Sex-age Groups. (Proportions per 1,000 of each sex.) Age Groups. 0- 1- 5- 15- 25- 65- Number. Proportion. Number. Proportion. Number. Proportion. Number. Proportion. Number. Proportion. Number. Proportion. Males. 1901-Parish 1,287 24 4,207 79 9,0,33 169 10,767 202 25,865 485 2,146 40 Borough 1,480 24 4,904 80 10,820 176 12,529 203 29,556 480 2,337 38 1911-Borough 1,298 21 4,730 78 10,152 168 10,945 181 30,397 503 2,893 48 Females. 1901-Parish 1,227 17 4,282 58 9,612 130 16,124 218 38,716 523 4,062 55 Borough 1,415 17 4,973 60 11,389 138 17,753 216 42,428 515 4,392 53 1911-Borough 1,263 15 4,748 58 10,427 127 16,102 196 44,394 540 5,202 63 6 METEOROLOGY. TABLE 2. Enumerated Populations. Ward. Males. Females. Persons. Tenements. 1901. 1911. 1901. 1911. 1901. 1911. 1901. 1911. Queen's Park 8,611 8,088 8,570 8,024 17,181 16,112 4,087 3,811 Harrow Road 13,128 12,688 14,576 14,370 27,704 27,058 7,441 7,520 Maida Vale 7,497 8,252 11,221 12,579 18,718 20,831 4,313 5,450 Westbourne 9,775 9,633 14,001 13,827 23,776 23,460 5,750 5,604 Church 12,486 11,723 13,791 13,327 26,277 25,050 6,528 6,324 Lancaster Gate, West 2,847 3,115 5,609 6,031 8,456 9,146 1,442 1,455 East 2,290 2,370 5,649 5,637 7,939 8,007 1,333 1,219 Hyde Park 4,992 4,546 8,933 8,341 13,925 12,887 2,767 2,542 Borough 61,262 60,415 82,350 82,136 143,976 142,551 33,661 33,925 METEOROLOGY. The customary table of records (Table 3) is based, as in former years, on observations taken at the Royal Botanical Society's Gardens, the results of which are published during the first week of January of each year in The Times. To the table taken from that source has been added the summaries for the preceding five years to afford basis for comparison. Comparisons should, however, be made with averages for a period of not less than thirty-five or, preferably, fifty years. It is probably no exaggeration to write that the reputation of a year is made, or marred, by the weather of the summer holiday season. If that be granted, last year may well be summed up as "cold, wet and miserable"—a complete contrast to the preceding year, which was described as "almost tropical." An examination of Table 3, however, shows that the year as a whole did not differ very notably from any of the preceding five years. The mean (9 a.m.) temperature (50.5°) was the second highest observed during the six years, being exceeded only by that of 1911 (51.5°), and the same remark applies to the maximum (shade and sun) temperatures. The total rainfall (27.76 in.) is the highest in the list, and the total amount of bright sunshine (1,242 hrs.), the lowest. On the other hand, the comparison of the principal elements for the three summer months June-August indicates very markedly the differences between the two seasons, and explains how the year earned its bad reputation. (See below.) "Two Summers." June, July, August, 1911. 1912. 1911. 1912. 1911. 1912. Mean Temperature (9 a.m.) 61.3° 60.0° 69.5° 64.6° 68.0° 57.4° Absolute Maximum 85.0° 81.0° 91.8° 88.0° 96.0° 70.0° ,, Minimum 39.5° 44.5° 47.0° 46.0° 47.0° 44.0° Total Rainfall 2.79" 3.40" 1.80" 1.30" 0.86" 4.98" No. of Days on which Rain was Measured 9 19 4 10 7 22 hrs. mins. hrs. mins. hrs. mins. hrs. mins. hrs. mins. hrs. mins. Amount of Bright Sunshine 212 53 199 22 320 18 156 26 246 1 114 8 No. of Days of Record 27 28 25 30 30 27 Temperature of the Earth 57.0° 57.2° 60.5° 61.8° 64.2° 61.0° meteorology. 7 In 1911 the rainfall for those three months amounted to 5.45 ins., measured on 20 days; last year the total was 9 68 ins., measured on 51 days. The total amount of bright sunshine in the former year was 789 hrs. 12 mins., measured on 82 days, and averaging rather more than 9.5 hrs. per day, while in the latter year the total was 469 hrs. 56 mins., measured on 85 days, averaging 5.5 hrs. per day. The meteorology of these months has a special interest for those engaged in preventive medicine, as the prevalence of infantile, or summer, diarrhœa is intimately associated with temperature and rainfall. TABLE 3. Meteorological Elements. Year. Month. Means at 9 a.m. Extreme Temperatures. Rainfall. Sunshine. Barometer: reduced to sea level. Thermometer Shade. Sun. Max. Grass. Min. Total depth. No. of days of fall. Bright Sunshine registered. No. of days of record. Dry bulb. Wet bulb. Maximum. Minimum. 1912. Inches Deg. Deg. Deg. Date. Deg. Date. Deg. Deg. Inches Hrs. Mins. January 29.95 39.4 38.3 51.0 6th 20.0 29th 78.0 17.5 3.81 15 18 23 8 February 29.67 42.2 40.6 58.0 28th 18.0 3rd 89.0 10.0 1.66 16 24 56 12 March 29.72 46.1 43.4 60.0 26th 34.0 21st 105.5 29.0 2.72 16 88 14 23 April 30.15 50.0 45.1 70.5 21st 29.8 12th 115.0 25.0 no rain 225 19 30 May 29.98 57.7 53.1 80.0 11th 38.5 25th 125.0 32.0 1.16 10 185 20 29 June 29.83 60.0 56.1 81.0 19th 44.5 3rd 128.0 40.0 3.40 19 199 22 28 July 29.92 64.6 60.4 88.0 14th 46.0 19th 130.0 42.0 1.30 10 156 26 25 August 29.74 57.4 54.8 70.0 4th 44.0 14th 117.0 39.8 4.98 22 113 38 27 September 30.14 55.1 52.2 67.8 17th 38.0 27th 113.5 310 2.22 5 114 6 26 October 29.92 45.7 44.9 62.5 1st 310 5th 99.0 27.5 2.09 13 77 30 20 November 29.97 43.2 41.9 55.0 7th 28.0 3rd 79.0 23.0 1.65 14 20 56 13 December 29.92 45.6 44.5 55.0 28th 25.0 1st 75.0 20.0 2.77 18 17 54 10 Totals ... ... ... ... ... ... ... ... ... 27.76 158 1,242 4 251 Means 29.91 50.5 47.9 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 88.0 July ... ... 130.0 ... ... ... ... ... Lowest ... ... ... ... ... 18.0 Feb. ... 10.0 ... ... ... ... 1911. Totals ... ... ... ... ... ... ... ... ... 25.34 143 1,644 4 267 Means 29.99 51.5 49.3 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 96.0 Aug. ... ... 134.0 ... ... ... ... ... Lowest ... ... ... ... ... 22.0 Feb. ... 12.0 ... ... ... ... 1910. Totals ... ... ... ... ... ... ... ... ... 25.92 168 1,249 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 1,460 7 273 Means 29.96 48.7 46.1 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 85.5 Aug. ... ... 124.0 ... ... ... ... ... Lowest ... ... ... ... ... 19.0 Mar. ... 14.0 ... ... ... ... 1908. Totals ... ... ... ... ... ... ... ... ... 24.49 173 1,461 48 285 Means 30.01 50.4 46.5 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 85.0 July ... ... 128.0 ... ... ... ... ... Lowest ... ... ... ... ... 16.5 Dec. ... 11.0 ... ... ... ... 1907. Totals ... ... ... ... ... ... ... ... ... 23.86 177 1,304 7 280 Means 29.96 49.5 46.2 ... ... ... ... ... ... ... ... ... ... Highest ... ... ... 80.0 May ... ... 12.20 ... ... ... ... ... Lowest ... ... ... ... ... 22.0 Jan. ... 17.0 ... ... ... ... 8 BIRTHS. Sunshine*—On an average the sunshine record of the three months June-August forms 45 per cent. of the year's record (at Westminster), and that of the four months May-August, 60 per cent. Last year's record for June-August was only 37.7 per cent. of the year's total, and that for May-August, 52.7 per cent. According to the Kew records, the bright sunshine measured during the year gave a mean daily duration of 3.5 hrs., 0.5 hr. less than the average for the preceding 35 years. In May the mean daily duration was 5.5 hrs. (average, 6.5), in June, 6.4 hrs. (average, 6.6), in July, 4.9 hrs. (average, 6.8), and in August, 3.5 hrs. (average, 6.1). April and October were the only two months of the year in which the mean daily duration exceeded the average, the excess in April amounting to 2.9 hrs. (record, 7.8; average, 4.9), and in October, 0.4 hr. (record, 3.7 hrs.; average, 3.1). The mean daily duration, as observed at Kew, was 1.25 hrs. below the record for 1911. In "England S." and "England S.E." last year was the cloudiest observed since 1889. Rainfall.—At Camden Square the total fall amounted to 27.85 ins., an excess of 2.77 ins. above the average (35 years) and equivalent to 11 per cent. increase. The mean rainfall for England (represented by 27 selected stations) was 42.63 ins., as compared with an average of 35.18 ins., an increase of 21 per cent. In the British Isles last year's total fall was 15 per cent. above the average. In 1903 the excess of rainfall amounted to 26 per cent., in 1882, 18, and in 1877 and 1872, 15—those being the only years comparable with last year. The rainfall associated with the "Norwich Floods" (August 26th) will long be remembered. In spite of the excessive precipitation, there were two periods of absolute drought in London, viz., April 10th-27th (18 days) and September 12th-27th (16 days), and a partial drought lasting from April 1st to May 6th. The longest run of consecutive wet days was thirteen, observed in August. Temperature.—Notwithstanding the unfavourable records just set out, the mean temperature of the year in London (Camden Square) was 0.9° above the average (50 years), and, further, the monthly means were each in excess of the corresponding average, except in August, September, and October. (See below) March and December were both characterised by abnormally high mean temperatures. Variations of Mean Monthly Temperatures (1911) from the Mean Values (50 Years). January + 1.7° April +2.1° July +1.0° October —3.0° February +3.6° May +3.8° August —4.4° November + 0.2° March +4.4° June +0.1° September —3.6° December +6.1° BIRTHS: Natality, Fertility. Crude Figures.—The births registered locally during the fifty-two weeks ended December 28th, taken to represent the year 1912, numbered 2,774 (comprising 1,422 of males and 1,352 of females), and were fewer by 141 than the total for 1911 (2,815). Table I. in Appendix A shows the numbers registered in each of the ten years 1902-11. The annual average number for the five years 1907-11 was 194 in excess of the total for 1912. The uncorrected birth-rate for the year (19.48 per 1,000 persons) was 0.27 less than that for 1911 (19.75) and 1.30 less than the average rate for the quinquennium 1907-11 (20.78). It will be seen further that the crude annual birth-rate has fallen each year, with the exception of 1908, from 22.61 in 1902 to 19.48 last year—a drop of 3.13 per 1,000. The check in the decrease noted in 1908 was, it is believed, due to some acceleration in registration following on the adoption by the Council of the Notification of Births Act, 1907. The Notification Register, first kept in 1908, is regularly *The notes here following are taken from a letter ("A Warm December") published in The Times of January 3rd, from "The Sunshine of 1912," idem of January 6th, and "The Rainfall of 1912," idem of January 15th. Births. 9 examined by the Registrars of Births and Deaths, who "look up" births which they find have not been registered and secure their registration.* The births of 91 children took place in the Workhouse Lying-in Wards, such births constituting 3.2 per cent. of the registered total, as compared with 3.8 in 1911 and 2.8 in 1910. There were 45 multiple births registered (all of twins), as compared with 30 (all twins) in 1911 and 48 (47 twins and 1 triplet) in 1910. The twin births of last year comprised 10 in which both children were males, 19 in which the sexes were mixed, and 16 in which both children were females. One set of twins (both girls) was born to non-resident parents. In Table 4 (page 12) comparisons are made between the births registered and the birth-rates recorded in 1912 and previous years in the whole Metropolis and in the areas immediately adjacent to the Borough. The figures given in that table have been taken from the Quarterly Reports of the Registrar-General, except in the case of St. Marylebone. In that Borough the presence of Queen Charlotte's Lying-in Hospital renders the published numbers of births incomparable with the figures for the other districts, and corrected numbers have been obtained from the Medical Officer of Health of the Borough. It will be seen that while in four of the areas (Kensington, Westminster, St. Marylebone, and Hampstead) the rates for last year were slightly higher than the respective rates for 1911, in all areas those rates were notably below the mean rates for 1907-11. The comparisons made are the only ones possible at present. Rates based on the numbers of women of child-bearing ages form a safer guide as to the relative fertility, whether compared geographically or with reference to secular changes. Such comparisons will be made when the necessary data are obtainable from the census reports. Corrected Figures.—Of the births registered within the Borough the Registrar-General marked 31 (12 males and 19 females) for transfer to other districts, but, according to the local Registrars' returns, the total number of children born within the Borough to non-resident parents was 50 (26 of males and 24 of females). The 50 children included 26 born in the Workhouse Lying-in Wards and 24 others born (for the most part) in nursing homes. The RegistrarGeneral allocated to the Borough 272 births registered outside the Borough, but that total included 5 children born in 1911 whose births were included in the report for that year, so that the inward transfers to be counted this year numbered 267 (137 of males and 130 of females). Complete particulars of these inward transfers have been obtained this year. Below is a statement showing where such children were born. Births: Inward Transfers. 1912. Total. Illegitimate. Born in Lying-in Hospital Males. Females. Males. Females. 129 116 25 22 Male. Female. Male. Female. Queen Charlotte's . 115 106 24 20 British 6 6 — — City of London 1 2 — 1 General 2 1 — — Salvation Army 2 1 1 1 Clapham Maternity 3 —- — — Other Hospitals 6 9 1 3 Poor Law Institutions 2 5 1 4 Totals 137 130 27 29 The above included four multiple births (all twins), viz.:— Children of same sex 3 (males, 2; females, 1) ,, mixed sexes 1 *Provision is made in the Register for the entry of the week of registration of each live birth notified. Last year eight notified births were not registered, at least not within the Borough where they should have been. Enquiries were made at the addresses given in the notifications and it was ascertained that the families had gone away without leaving any addresses. The facts were communicated to the Registrar-General. c 10 BIRTHS. The allocation of the inward transfers to the Wards of the Borough is given below. In certain instances the proportions of illegitimate births are surprisingly high. Births: Inward Transfers, 1912. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, West. East. Hyde Park. 27(8) 58(8) 44(8) 38(6) 66(17) 11(2) — 23(7) The figures in parenthesis indicate the numbers of births of illegitimate children included in the totals. The corrected total number of births, based on the local registration and the outward and inward transfers furnished by the Registrar-General, was 3,015 (1,548 males and 1,467 females), equal to a birth-rate of 21.18 per 1,000 persons. After much consideration, however, it has been decided to adopt the correction for outward transfers deduced from the local Registrars' returns and to include only 267 of the inward transfers received from the Registrar-General, thus arriving at a corrected total of 2,991 births (1,533 of males and 1,458 of females), equal to a birthrate of 21.01 per 1,000. The arithmetic of the two corrections is given below. According to The Registrar-General. The Department. Males. Females. Males. Females. Births registered locally 1,422 1,352 1,422 1,352 Outward transfers 12 19 26 24 1,410 1,333 1,396 1,328 Inward transfers 138 134 137 130 1,548 1,467 1,533 1,458 3,015 2,991 The corrected number of multiple births last year was 48, all of twins, comprising 12 of males, 16 of females, and 20 of mixed sexes, so that 96 children (3.2 per cent. of the total number) were born in multiple births, 44 (2.8 per cent.) being boys, and 52 (3.5 per cent.) girls. The proportion of female to male births (corrected numbers) was somewhat less last year than in either of the preceding two years, the figures being:— No. of Births of Femai.es to 1,000 Births of Males. 1912, 951. 1911, 995. 1910, 978. For the first time it has been possible to make a complete tabulation of inward transfers according to the residences of the parents, and in consequence the numbers of births allocated to the Wards during 1912 are not strictly comparable with those given for earlier years (see Table II., Appendix A), when the distribution of such transfers was incomplete. The numbers of births entered to each Ward during the six years 1907-12 will be found in the table just mentioned. Last year's birth-rates are given in Table 5 (page 12). The rates in the following Wards—Queen's Park, Maida Vale, Westbourne, Lancaster Gate, West, and Hyde Park, were higher last year than in 1911, and last year's rates exceeded the mean rates in Maida Vale, Westbourne, and Lancaster Gate, East, Wards. Illegitimacy.—The 2,774 births registered locally included 159 of illegitimate children, equal to 5.7 per cent. of the total, as compared with 6.0 per cent. in 1911. The proportions of illegitimate to total births registered in the three Registration Sub-districts were—North, 2.0 per cent. (3.1, 1911), Central, 10.8 (10.3, 1911), and South, 2.8 (2.5,1911). The excess noted in the Central Sub-district is due to the fact that that Sub-district includes the Workhouse, where 64 illegitimate births occurred (70.3 per cent. of all births in the Institution, as compared with (66.3 in 1911). The local Registrars' returns showed that 29 of the 159 children were born to non-resident mothers, or 7 more than the number of outward transfers furnished by the Registrar-General. The inward transfers numbered 56. The corrected total has been put at 186 Births. 11 (97 males and 89 females), equal to 6.2 per cent. of the corrected total number of births, as compared with 5.7 in 1911 and 4.8 in 1910. The proportion of female to male births was as 917:1,000, as compared with 810:1,000 in 1911. Information as to the numbers of illegitimate births belonging to the individual Wards and the proportions of such births to all births will be found in Table 5. Notification of Births.—The certificates received in pursuance of the Notification of Births Act, 1907 (adopted by the Council in May, 1908), numbered 3,128, relating to 2,861 births. In 1911,2,910 certificates were received, relating to 2,782 births, the corresponding figures for 1910 being 2,793 and 2,707. The foregoing figures show a satisfactory increase in the practice of notification. The certificates received from medical practitioners during the year (1,137) constituted 36.3 per cent. of the total number, as compared with 23.3 per cent. in 1911 and 18.9 per cent. in 1910. The certificates received from midwives (1,080) formed 34.5 per cent. of the total (34.6 and 36 per cent. in 1911 and 1910 respectively), and those from parents (715), 22.7 per cent. (36.3 in 1911 and 39 7 in 1910). The 2,861 births notified included 76 of illegitimate children (2.6 of the total, as compared with 3.4 in 1911 and 2.6 in 1910). Among the children whose births were notified from the Workhouse Lying-in Wards the illegitimates constituted 51.3 per cent. (57 out of 111), and among those notified from nursing homes 14.3 per cent. (2 out of 14). Of the 2,774 births registered during the year only 99 (3.5 per cent.) had not been previously notified. The improvement in notification is clearly shown by the appended figures. Total Births. Proportions (per cent.) Registered after Notification. Quarters. 1. 2. 3. 4. 1909. 1910. 1911. 1912. 1910 760 81.0 92.1 84.4 North Paddington 79.1 87.8 96.1 97.2 1911 92.3 95.0 96.7 93.2 Central „ 71.6 81.7 95.5 97.2 1912 95.5 97.1 96.4 93.6 South „ 49.0 78.3 79.5 85.8 Borough 78.2 84.4 94.4 96.4 Of Illegitimate Births—Borough. Percentages Registered after Notification. 1909, 71.3. 1910, 74.5. 1911, 93.5. 1912, 94.9. Still-Births.—Although the registration laws take no cognisance of children not born alive, and allow the bodies of children alleged to have been born dead to be buried, or otherwise disposed of, on very informal evidence, yet the Notification of Births Act requires the birth of every dead child, born after twenty-eight weeks' gestation, to be notified. Last year 75 stillbirths were reported, equal to 2.6 per cent. of all the births notified. The corresponding proportions in 1911 and 1910 were 3.1 and 2.6 respectively. In the Metropolis the proportions of stillbirths (per cent. of the total births notified) were 2.2 in 1910, 2.3 in 1911, and 2.4 last year. Among the 2,785 legitimate births notified during the past year there were 70 still-births, equal to 2.5 per cent. of the whole, and among the 76 illegitimate births 5, equal to 6.5 per cent. Ten of the still-births occurred among children born at multiple births, 8 being the second children of twins and 2 the produce of a single twin-birth. Altogether 54 twin births were notified, in 45 of which both children were alive, 8 one dead, and 1 both dead. An analysis of the twin births is given below. Among the children born in multiple births, the still-births formed 9.2 per cent. of the whole; among males 11.1 and among females 7.4. All Births. Illegitimate. Twin Births— (Totals) M.M. M.F. F.F. (Totals) M.M. M.F. F.F. Both children alive (45) 12 17 16 — — — — One child dead (8) 4 3 1 (2) 1 1 — Both dead (1) 1 — — — — — — 12 BIRTHS. There is little room for doubt as to the incompleteness of the notification of still-births. Comparison with the returns issued by other European countries, where registration of still-births is practically universal, is not reliable as a measure of the incompleteness of the present returns, as no legal definitions of "still-birth" or "still-born" have been up to the present formulated and office regulations vary considerably. Nevertheless, a comparison with the records of cities such as Vienna and Munich (3.7 per cent. of still-births), Dresden (3.9), Antwerp (4.4), and many others—whatever their imperfections—confirms the opinion as to the incompleteness of the figures submitted in the preceding paragraphs. A study of the causes producing still-births cannot fail to be useful both by indicating the measures requisite to prevent such occurrences and by furnishing suggestions for the prevention of that part of post-natal infantile mortality which, at present, appears to be beyond human control—such causes of mortality as premature birth, congenital defects, and the like are referred to. In July of last year a report was published by the Royal Statistical Society giving the results of an inquiry conducted by a Special Committee of the Society into the laws governing the registration of births and deaths in force throughout the civilised world. That report gives a full account of the diverse practices with regard to the registration of still-births, and points TABLE 4. Births, Birth-rates. London. Paddington. Kensington. Westminster. St. Marylebone. Hampstead. Willesden. Births, 1912 111,512 2,774 3,079 2,132 2,246 1,224 3,914 1911 112,810 2,815 3,040 2,109 2,375 1,198 3,864 Birth-rates, 1912 24.67 19.48 17.92 13.56 19.30 14.24 24.55 1911 24.95 19.75 17.76 13.21 20.17 14.00 24.88 1907-11 26.09 20.69 18.29 15.00 20.77 15.10 27.12 The sources of the data in this Table are described in the text. TABLE 5. Births, Birth-rates.* Corrected Numbers. Birth-rates. Percentage of Illegitimate to Total Births, 1912. Total. Illegitimates. 1912. 1911. Mean 1907-11. Males. Females. Males. Females. Borough. 1,533 1,458 97 89 21.01 21.46 21.78 6.2 Wards. Queen's Park 205 194 8 10 24.98 23.81 25.17 4.5 Harrow Road 364 336 9 8 25.95 26.85 28.12 2.4 Maida Vale 234 203 20 12 20.69 19.39 20.03 7.3 Westbourne 240 236 20 13 20.32 19.53 20.06 6.9 Church 349 342 30 35 27.36 29.02 29.24 9.5 Lancaster Gate, West 33 31 2 2 6.93 5.46 7.05 6.2 East 32 32 1 — 7.98 8.61 7.60 1.5 Hyde Park 76 84 7 9 13.33 12.44 13.46 9.4 * Per 1,000 persons of all ages. Sickness. 13 out, among other matters, the complete absence of any legal definition of the term. In various countries such terms as "born dead," "born without signs of life," &c., have been enacted by the registration laws, but in none of them is there anything approaching a "definition.'' The report contains a suggested reasoned definition. This country and such of its dependencies as have based their registration laws on the English model stand apart in the absence of legal requirement for the registration of still-births. It is much to be hoped that that defect will be remedied at no distant date.* SICKNESS: Morbidity. The diseases scheduled by Section 55 of the Public Health (London) Act, 1891, for notification were small-pox, diphtheria, membranous croup, erysipelas, cholera, and the fevers known as scarlet, enteric (typhoid), typhus, relapsing, continued, and puerperal. To that list there have been added from time to time, by Orders made under Section 56 of the Act, the following— bubonic plague, cerebro-spinal fever, acute poliomyelitis, hydrophobia, glanders, anthrax, and ophthalmia neonatorum. Varicella (chickenpox) has been temporarily on the list at times when smallpox has been prevalent. In certain parts of the Metropolis the following diseases have been, and some still are, notifiable—epidemic (zymotic) enteritis, measles, and whooping cough. The notification of pulmonary tuberculosis, and more recently of tuberculosis generally, being enacted by Orders under an Act other than the Public Health (London) Act, will be dealt with separately. Only the diseases which occur practically every year have been included in the tables given in this section. Other diseases will be dealt with under their appropriate headings. The returns for the Borough (Table 6, page 14) relate to the number of cases certified, irrespective of corrections for ultimate diagnosis, but corrected for repeated notifications of the same case. Compared with the previous year, there were increases in the notified cases of diphtheria (increase, 81 cases, or 49 6 of the total for 1911), scarlet fever (increase, 46, or 20.3 per cent.), and puerperal fever (increase, 4 cases, or 57.1 per cent.). There was a notable dccline in the reported number of cases of enteric fever (decrease, 22 cases, or 59.4 per cent.). The difference between the estimated numbers of the population for the two years is so slight that what has been said of the actual numbers applies equally to the rates for the two years. As compared with the quinquennial averages the rates for last year show notable decreases with regard to scarlet fever (rate, 1912, 1.91; mean, 3.32) and enteric fever (rate, 1912, 0.10; mean, 0.24). Increases have to be reported in all the other diseases for which quinquennial means can be determined. Charts showing the equivalent annual morbidity rates based on the numbers of cases of scarlet fever and of diphtheria reported in each week in the Borough and the Metropolis will be found opposite page 16. Two curves are given in each case, viz., one of rates for the past year —hard black line—and one of average rates (1902-11)—broken line. Scarlet Fever.—The London curve for 1912 was well below that of the averages throughout the year. The dip in the curve associated with the summer holidays is well shown in the curve of averages, but does not appear in that for 1912 until the last week of those holidays. The autumnal rise is very apparent in the curve of averages, but not so in that for the last year. There is not so much distance between the Paddington curves as was noted in the London, and in several weeks last year's curve rose above that of the averages. The dip during the summer holidays is very marked in the curve of averages, but last year there was a considerable ascent in the curve in the earlier weeks of the holidays followed by an unusually deep dip, and for some weeks after the holidays the curve ran at a much lower level. Except in the 44th and 45th weeks the autumnal increase was very slight. *The report referred to above, entitled "Report of the Special Committee on Infantile Mortality," was issued by the Society as a separate document in August of last year. It has been reprinted, together with a discussion on the contents thereof, in the Journal of the Society for December, 1912. 14 Sickness. Diphtheria.—The London curve for 1912 followed that of the averages very closely. The dip during the summer holidays is marked in both curves. The high levels seen in the Paddington curve of 1912 in the first and second quarters were due to the notification of "carrier" cases. In the third and fourth quarters the two curves are fairly in agreement. The dips associated with the summer holidays can be seen in both curves. Table 7 affords a comparison between the morbidity rates for last year and the mean (1907-11) rates in the Metropolis and the districts immediately adjacent to the Borough and between the local rates and those for the other districts. As the data on which the rates for the Borough have been calculated have been extracted from tables in the Registrar-General's Quarterly Reports, differences will be noted from the rates given in Table 6. In the whole Metropolis puerperal fever was the only disease with a morbidity rate (342 per 1,000 births registered) in excess of the mean (2.31). Similar excesses are to be noted in Paddington, Kensington, Westminster, and St. Marylebone. The 1912 rates from diphtheria were in excess of the mean rates in Paddington, St. Marylebone, and Hampstead, and those from erysipelas in Paddington, Westminster, Hampstead, and Willesden. Below is given a summary showing the rates recorded in the districts included in the table which were above the local rates. Local Rate (1912). Exceeded by Rates Recorded in Diphtheria (1.78) Hampstead (l.88). Erysipelas (0.82) London (0.91). Scarlet Fever (1.89) London (2.50); St. Marylebone (2.23); Willesden (2.69). Enteric Fever (0.10) London (0.15); Westminster (0.11); St. Marylebone (0.15); Hampstead (0.12). Puerperal Fever (3.96) Westminster (8.96). In Table 8 the numbers of cases notified from the individual Wards of the Borough during the six years 1907 to 1912 are set out, and in Table 9 the notifications of diphtheria and scarlet fever received during each quarter of the past year are compared with the averages (1907-11). These tables belong properly to this section of the report, but the discussion of their contents can be postponed with advantage to the sections dealing with the epidemiological characters of each disease. TABLE 6. Notifications: Notification Rates. (Corrected for duplicate certificates only.) Paddington. Diphtheria. Membranous Croup. Fever. Puerperal. Cerebrospinal Meningitis. Acute Poliomylitis. Ophthalmia Neonatorum Erysipelas. Scarlet. Enteric. Continued. Cases— 1912 244 4 117 272 15 - 11 7 6 31 1911 163 5 117 226 37 1 7 2 1(a) 21(a) Morbidity*— 1912 1.71 0.03 0.82 1.91 0.10 - 3.96 0.05 0.04 11.17 1911 1.14 0.03 0.82 1.58 0.27 0.01 2.49 0.01 ? ? 1907-11 1.05 0.02 0.77 3.32 0.24 0.01 2.09 ? ? ? (a) Notification in force for part of the year only. * Rates per 1,000 persons of all ages, except puerperal fever and ophthalmia neonatorum, per 1,000 births registered locally. SICKNESS. 15 TABLE 7. Notification Rates. Disease. London. Paddington. Kensington. Westminster. St. Marylebone. Hampstead. Willesden. 1912. 19071911. 1912. 19071911. 1912. 19071911. 1912. 19071911. 1912. 19071911. 1912. 19071911. 1912. 19071911. Diphtheria (incl. Mem. Croup) 1.57 1.60 1.78 1.10 1.05 1.19 1.02 1.03 1.28 1.02 1.88 1.11 1.40 1.41 Erysipelas 0.91 0.96 0.82 0.77 0.67 0.76 0.58 0.52 0.77 1.02 0.51 0.47 0.61 0.59 Scarlet Fever 2.50 3.79 1.89 3.03 1.77 216 1.51 2.58 2.23 3.02 1.26 2.66 2.69 3.64 Enteric Fever (incl. Cntd. Fever) 0.15 0.27 0.10 0.24 0.09 0.23 0.11 0.23 0.15 0.21 0.12 0.23 0.08 0.20 Puerperal Fever 3.42 2.31 3.96 2.10 2.60 2.34 8.91 2.14 2.23 2.05 2.45 3.43 2.55 2.82 * Rates per 1,000 persons, except in case of puerperal fever, per 1,000 registered births. TABLE 8. Disease. Diphtheria, including Membranous Croup. Erysipelas. Scarlet Fever. Enteric Fever, including Continued Fever. Puerperal Fever. Year. 1912 1911 1910 1909 1908 1907 1912 1911 1910 1909 1908 1907 1912 1911 1910 1909 1908 1907 1912 1911 1910 1909 1908 1907 1912 1911 1910 1909 1908 1907 Queen's Park 53 27 19 21 11 17 14 7 13 9 9 16 47 25 36 61 86 81 1 2 9 3 5 3 2 ... ... ... 2 2 Harrow Road 60 42 24 43 44 48 37 29 27 23 14 25 44 80 75 166 215 172 2 9 7 2 6 8 2 2 2 ... 1 1 Maida Vale 22 24 12 22 21 19 12 17 12 16 11 11 36 34 33 45 74 76 2 9 7 5 4 4 3 3 1 ... 1 2 Westbourne 48 33 13 27 27 27 15 20 20 22 23 17 45 14 27 107 104 87 3 2 3 2 1 6 3 ... 4 1 1 ... Church 43 31 28 45 24 32 25 35 19 29 43 36 71 47 61 171 152 100 3 7 13 10 6 7 ... 1 2 2 1 1 Lancaster Gate, West 9 9 6 2 8 6 1 2 1 1 ... 4 11 3 11 19 16 13 2 3 2 ... 4 2 1 ... ... ... ... ... „ „ East 2 7 8 6 6 6 3 2 3 1 3 3 4 4 1 12 9 12 1 3 1 2 1 1 ... ... ... ... ... ... Hyde Park 11 5 6 9 5 5 10 5 5 5 2 12 14 19 14 48 25 38 1 3 5 5 5 4 ... 1 ... ... ... ... TABLE 9. Notifications. Wards Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Year 1912. 190711. 1912. 190711. 1912. 190711. 1912. 190711. 1912. 190711. 1912. 190711. 1912. 190711. 1912. 190711. Diphtheria. Quarters 1 31 4 19 11 4 6 19 6 9 8 5 1 - 3 3 1 2 11 3 24 7 5 4 19 6 14 4 2 2 — 1 1 1 3 2 4 7 9 6 4 6 5 7 9 2 1 — 1 2 1 4 9 8 10 13 7 6 4 6 13 11 - 2 2 2 5 3 Year 53 19 60 40 22 20 48 23 43 32 9 6 2 7 11 6 Scarlet Fever. Quarters 1 7 14 11 36 4 12 15 16 9 24 - 4 — 2 4 7 2 12 14 8 37 9 15 8 15 20 23 — 1 1 2 2 11 3 14 16 14 37 9 9 10 18 21 24 2 3 — 2 4 5 4 14 14 11 32 14 16 12 19 21 35 9 4 3 2 4 6 Year 47 58 44 142 36 52 45 68 71 106 11 12 4 8 14 29 16 DEATHS. Table 10 gives the recorded numbers of notifications in the Extra-Metropolitan Areas of England and Wales during 1911 and 1912, with the corresponding morbidity rates. The Port notifications represent almost entirely cases of infectious disease contracted abroad, and therefore indicate the frequency of introduction of infection into this country—or more exactly, the numbers of cases stopped at the ports of entry and thus prevented from spreading disease within the country. Scarlet fever, enteric fever, and puerperal fever all appear to have been more prevalent in Extra-Metropolitan England and Wales during 1912 than in 1911. TABLE 10. Notifications. England and Wales, excluding London. Ports. Cases Reported. Morbidity Rates.* Cases Reported. 1912. 1911. 1912. 1911. 1912. 1911. Smallpox 109 193 0.00 0.01 12 30 Diphtheria† 37,575 40,343 1.17 1.28 66 55 Scarlet Fever 96,012 94,117 3.00 2.98 30 34 Enteric Fever‡ 7,639 12,859 0.24 0.21 132 125 Puerperal Fever 1,805 1,724 2.37 2.24 — — Typhus Fever 28 64 0.00 0.00 — — Cerebro-Spinal Meningitis 168 0.00 Acute Poliomyelitis 688 0.02 Pulmonary Tuberculosis 77,159 2.42 155 * Rates per 1,000 persons of all ages, except puerperal fever, per 1,000 births registered, † Including membranous croup. ‡Including continued fever. DEATHS : Mortality. Crude Figures.—The deaths registered within the Borough during the year numbered 1,889 (947 of males and 942 of females), and were equal to a crude* mortality rate of 13.27 per 1,000 of the estimated population. Last year's total was 185 below that of 1911 (2,074) and 204 below the average for 1907-11 (2,093). Reference to Table I., Appendix A, will show that last year's total was the lowest recorded since 1902 and is believed to be the lowest on record. The crude mortality (13.27) recorded last year was 2.54 less than the rate for 1902 (15.81). As will be seen from the statement given below, the crude rate recorded in each quarter of the year was below the corresponding rate for 1911 and the average for 1907-11, except in the fourth quarter. Mortality Rates: Crude. Per 1,000 Persons. Quarter— 1st. 2nd. 3rd. 4th. 1912 16.09 12.57 9.65 14.82 1911 16.95 13.78 14.03 13.44 1907.11 17.96 13.96 12.04 14.44 *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. NOTIFICATION CHART. Rates per 1000 persons 1912 Average during 10 years ending 1911 Duration of School Holidays DEATHS. 17 Corrected Figures.— I he death returns received by the Department undergo a double correction. 1 he first is made weekly, and consists in deducting the deaths of non-residents recorded in the Borough and adding, from returns received each week from Somerset House, the deaths of residents of the Borough dying in other parts of London and certain of the districts lying immediately outside thereof. Such corrections have been made for many years. During the last two years the Registrar-General has forwarded at the close of each quarter particulars of the deaths of residents recorded in other parts of England and Wales. Such deaths have been included in the annual total, but not in the corrected figures for each week and quarter. The new arrangement has involved a slight increase in the mortality for the whole year as compared with the rates prior to 1911, but the matter will adjust itself in the course of three or four years. In any case, the change is an improvement and to be welcomed. The appended statement of corrected quarterly rates should be considered in connection with what has been written in the last paragraph. The rates are as strictly comparable as they can be made. It will be seen that in each of the four quarters of last year the mortality rate was less than the corresponding rate for 1911, and also than the average for 1907-11. Mortality Rates: Partally Corrected. Quarter— 1st. 2nd. 3rd. 4th. 1912 14.96 11.25 9.42 11.81 1911 15.94 12.49 12.57 12.35 1907-11 16.65 12.67 10.80 13.21 In referring to the corrected mortality rate for the year, it will be well for the moment to ignore the transferred deaths received from the Registrar-General. Without such transfers, the total number of deaths of residents was 1,737, equivalent to a mortality rate of 12.20 per 1,000. That total was 58 less than the lowest previously recorded (1,790 in 1910), 148 less than the total for 1911 (1,885), and 174 less than the annual average for 1907-11. (See Table I., Appendix A.) The mortality rate, which was 14.72 in 1902, has fallen to the extent of 2.52 per 1,000 during the eleven years. When the "transferred deaths" are included, the total for last year becomes 1,771 and the mortality rate 12.44, the deaths being fewer by 155 than in 1911 and the mortality 1.07 lower. In Table II., Appendix A, the corrected numbers of deaths belonging to the individual Wards will be found. It will be seen that the totals for last year were below the averages for 1907-11 in all the Wards except Lancaster Gate (West and East). In Table 11 (page 18) the mortality rates (persons all ages) for the Wards will be found, and the numbers of deaths of each sex recorded during the three years 1910-12. Last year's mortality exceeded that for 1911 in the following Wards—Church (1912, 16.83; 1911, 16.35), Lancaster Gate, West (1912, 8.12; 1911, 6.98), and Hyde Park (1912, 10.51; 1911, 9.95). In comparison with the mean rates excesses have to be recorded in Lancaster Gate, West (1912, 8.12; mean, 7T4) and Lancaster Gate, East, Ward (1912, 7.98; mean, 740). Table 12 (page 18) gives the numbers of deaths in each of six age-groups during the past six years, distinguishing the sexes. The deaths of males were in each age-group fewer last year than in 1911, and, with the exception of the age-group 0-1, last year's figures compare very favourably with any for the preceding five years. The deaths of females in the three first age-groups (0-1, 1-5, and 5-15) were all lower than in any of the preceding five years, while those at the higher ages compare very favourably. It appears from the rates given in Table 13 (page 18) that the local mortality rate was 1.22 per 1,000 below that for the Metropolis, and that the rates recorded in Hampstead (9.79) and Willesden (10.03) were the only two below it. In Hampstead only was last years rate (9.79) above the mean rate for 1907-11 (9.63). D 18 DEATHS. TABLE 11. Deaths: Mortality Rates, Paddington. Mortality (per 1,000 of estimated population). Deaths—Corrected. Males. Females. 1912. 1911. 1907.11. 1912. 1911. 1910. 1912. 1911. 1910. Borough 12.44 13.51 13.51 880 927 868 891 958 927 Queen.s Park 11.58 13.74 13.18 98 119 97 87 102 101 Harrow Road 13.52 13.76 14.08 191 173 195 174 199 197 Maida Vale 11.32 12.92 12.96 114 136 115 125 135 130 Westbourne 12.38 15.22 14.01 126 186 144 164 171 149 Church 16.83 16.35 17.75 232 197 219 187 211 221 Lancaster Gate, West 8.12 6.98 7.14 37 26 20 38 38 34 Do. East 7.98 7.99 7.40 20 32 19 44 32 35 Hyde Park 10.51 9.95 10.71 62 58 59 72 70 60 TABLE 12. Deaths. Sex-age Distribution. Ages. Males. Females. 1912 1911 1910 1909 1908 1907 1912 1911 1910 1909 1908 1907 0— 181 209 164 165 198 219 114 178 130 146 150 135 1 — 71 83 97 69 86 113 53 65 71 76 69 87 5— 25 35 34 24 18 32 19 24 35 29 28 25 15— 22 23 27 30 32 36 31 39 28 27 20 33 25— 359 373 319 399 376 384 332 331 335 367 354 348 65 and upwards 222 228 227 236 225 236 342 338 328 396 340 366 TABLE 13. Mortality Rates.* London. Paddington. Kensington. Westminster. St. Marylebone. Hampstead. Willesden. 1912 1907.11 1912 1907.11 1912 1907.11 1912 1907.11 1912 1907.11 1912 1907.11 1912 1907.11 All Causes 13.52 14.70 12.30 13.33 12.96 13.65 12 35 12.74 13.79 14.74 9.79 9.63 10 03 11.35 Smallpox 0.00 0.00 - - - - - 0.00 - - - - - - Measles 0.40 0.45 0.25 0.31 0.16 0.31 0.23 0.13 0.34 0.28 0.13 0.14 0.21 0.30 Scarlet Fever 0.03 0.09 0 02 0.07 0.03 0.03 0.02 0.05 0.09 0.09 0.01 0.04 0.01 0.08 Diphtheria 0.10 0.14 0.04 0.09 0.03 0.12 0.07 0.09 0.07 0.08 0.20 0.09 0.06 0.15 Whooping Cough 0.21 0.28 0.17 0.24 0.14 0.24 0.10 0.12 0.16 0.26 0.05 0.11 017 0.33 Enteric Fever 0.02 0.04 0.01 0.03 0.02 0.03 0.02 0.04 0 04 0.03 0.01 0.04 0.02 0.03 Diarrhoea 12.42 ? 14.23 ? 11.12 ? 16.18 ? 11.59 ? 0.78 ? — — Phthisis 1 .34 1.34 1.23 1.09 1.06 0.97 1.16 1.27 1.26 1.34 0.64 0.71 0.93 0.86 Other Tuberculous Diseases 0.31 0.48 0.32 0.33 0.28 0.36 0.25 0.32 0.09 0.24 0.15 0.23 0.25 0.34 Cancer 1.11 1.10 1.23 1.19 1.33 1.11 1.38 1.13 1.18 1.27 1.19 0.97 0.96 0.83 Infantile Mortality— Nett 90 113 106 114 98 127 93 105 93 103 64 75 84 102 Corrected 91 114 98 107 91 120 84 97 93 103 62 70 ? ? * Per 1,000 estimated persons of all ages except Diarrhœa and Infantile Mortality (per 1,000 births). diphtheria. 19 SMALLPOX. Neglecting the case erroneously diagnosed in 1911, there has been no notification of this disease in the Borough since 1906. In the whole Metropolis 5 cases were reported last year, as compared with 72 in 1911. In the Extra-Metropolitan parts of England and Wales 109 cases were reported during the year, or 84 fewer than in the preceding year. (See Table 10, page 16.) The cases dealt with at the Ports numbered 12, against 30 in 1911.* The disease appears to have been generally low in prevalence during the past year, contrary to what might have been expected with the occurrence of the two campaigns, viz., that in Tripoli and that in the Balkan Peninsula. Vaccination.—From the returns furnished annually by the Vaccination Officer, Table 14 (page 28) has been constructed. Compared with the preceding year, the proportion of children fully accounted for—either by vaccination, death, or insusceptibility to vaccination—was practically unchanged, while the number exempted by certificates during 1911 constituted 13 0 per of the children born, or 0.8 per more than in 1910. The increasing neglect of vaccination was somewhat fully dealt with in the Report for 1911 (pages 12 and 13). DIPHTHERIA. (Including Membranous Croup.) Last year 288 cases were reported (see Table 6), viz., 244† of diphtheria and 4 of membranous croup, or 80 in excess of the number reported in 1911. The morbidity rate (1.74 per 1,000 persons of all ages) was 0.57 above the rate for 1911 (117), and 0.67 above the mean for 1907-11. In Hampstead alone was the rate recorded last year (1.88) in excess of that recorded in the Borough. (See Table 7.) It will be seen from Table 8 that the largest numbers of cases were reported from Harrow Road (60 cases), Queen.s Park (53), Westbourne (18), and Church (43) Wards, and from Table 9 that the disease was most prevalent in the first and second quarters of the year. The latter table also shows that in comparison with the averages for 1907-11 the incidence of the cases was far heavier in Queen.s Park Ward (last year.s record, 53 cases, being nearly three times the average, 19). The morbidity rates in the Wards were as follow:— DIPHTHERIA. (Including Membranous Croup.) Morbidity Rates Der 1.000 nersons of all ages. Queen.s Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1912 3.32 2.22 1.04 2.05 1.72 0.97 0.25 0.86 1911 1.68 1.55 1.15 0.98 1.24 0.98 0.87 0.39 1907-11 1.17 1.48 0.96 0.99 1.27 0.69 0.82 0.46 The morbidity rates recorded last year were below the corresponding rates for 1911 in Maida Vale, Lancaster Gate, East and West, Wards, but that of Lancaster Gate, East, Ward was the only one below the average for 1907-11. The 248 cases reported included 15 in which the original diagnosis was not confirmed in hospital. Such cases, for brevity.s sake termed "errors," were equal to 6.0 per of the total cases, the lowest proportion noted since 1902, when records of these cases were first kept. In 1911 the "errors" formed 11.3 per of the reported cases, the average for the five years 1907.11 being 129. * The figures given above were obtained by a weekly compilation of the returns received from the Local Government Board. According to the Annual Return of the " Incidence of Notifiable Diseases" during 1912, published since writing the above paragraph, there were 4 cases of smallpox in London, and 107 in the rest of England and Wales, 72 of the latter cases occurring in towns connected with ports. The Returns contain an account of the prevalence of the disease in other countries. † The cases of clinical diphtheria numbered 205 last year, the reported total being swollen by the large number of "carrier" cases reported as a result of a systematic search in connection with certain of the public elementary schools and the Children.s Hospital. 20 DIPHTHERIA. The 233 cases regarded as correctly diagnosed included 6 in which the disease was contracted in hospital, 6 which were imported, i.e., the infection was apparently contracted outside the Borough, but not in any institution, and 6 "return." In 43 other cases the symptoms were so trifling at the time of notification that the cases were marked as "carriers," 1.4 of those cases being reported among the patients and staff of the Children.s Hospital and 18 among children specially examined in school. To obtain a correct impression of the house distribution of the reported cases, it is necessary to pass over 15 cases which occurred among the staffs of local hospitals and that of an important business house (living.in). The remaining 233 certificates were received from 198 houses. The secondary cases (uncorrected for errors) formed 15 per of that total, as compared with 131 per of the reported cases in 1911. The house distribution is given below. 1912. 1911. 1910. 1909. 1908. 1907. Houses with 2 cases 20 9 2 10 8 13 3 4 5 — 1 3 3 4 1 1 — 1 1 — 5 „ 1 - - - - In one house whence 2 cases were reported the second case was an "error," and in another the 2 cases occurred in 2 families. In 2 houses both cases were reported together, and in each of 2 others the second case was a "return." In 13 instances the second case was due to direct personal infection from the first, an independent source of infection being suspected in one instance only. In the 4 houses from which 3 cases were reported, direct personal infection was apparently traced in 3 instances, the second and third cases in the fourth house being "return" cases. The circumstances attaching to the houses with 4 and 5 cases were of some interest, and brief notes of those cases are appended. I. G. T., f., aet. 8; sickened 10 iii.; to hospital 12 iii.; discharged 19 iv. H. T., f., set. 5; ., 10 iii.; „ 13 iii.; „ 26 iv. Fre. T., m., aet. 1; „ 11 iii.; „ 14 iii.; „ 1 xi. Fra. T., m., aet. 4; „ 25 iv.; „ 26 iv.; „ 20 vi. Fra. T..s case commenced 6 days after the return home of G. T., H. and Fre. being then still in hospital. G. and H. were brought to the Town Hall on April 29th (10 days after the discharge of G. T., and 3 days after that of H. T.), and swabs were taken from the nose and throat of each child. G. T. had nasal discharge and enlarged tonsils. H. T. presented no abnormality in nose or throat. The swabs from both throats yielded cultures of the Klebs.Loffler bacillus, and the Hoffman.s bacillus was obtained from the nose of H. T. Both children were re.admitted to hospital on the next day. They were detained in hospital until May 31st. The Medical Superintendent of the hospital from which G. and H. T. were discharged wrote that cultures taken from the nose and throat of G. T. on April 16th (8 days before her first discharge from hospital) showed no diphtheria bacilli, cultures from H. T. on the same day showing no diphtheria bacilli in the throat, but some "organisms resembling D. B." in the nose. Cultures taken from the latter child on April 22nd (again 3 days before discharge) "showed no D. B." All the other members of the family, except the baby, aged 5 months, were swabbfd on April 30th, viz., father (" negative "), mother (" negative"), W. T., m., æ. 11 (" negative "), R. T., m., æ. 10 (" Hoffman " nose and throat), and A. T., m., æt. 5 (throat "negative," nose " Hoffman..). II. H. P., m., æt 2; sickened 20 iv.; to hospital 23 iv.; discharged 1 vi. M. P., æt . 7; „ 26 iv.; „ 27 iv.; „ 1 vi. S. P., f., æt 11; „ 9 v.; „ 9 v.; „ 18 v. E. S., f., æt 17; „ 10 v.; „ 11 v.; 18 v. S. A. P., æt,. 31; „ 24 v.: „ 25 v.; „ 1 vi. The first two cases were certified without preliminary bacteriological examination. S. P. and E. S. were swabbed on May 22nd and the cultures yielded Klebs.Loffler bacilli. Both patients were re admitted to hospital on the 23rd, and discharged on June 1st. The three elder females. illnesses appeared to be cases of " bacteriological diphtheria" only, without clinical symptoms. The bacteriological test was known to have been used in 104 cases last year, but was probably resorted to privately in other instances. In 1911 the test was recorded in 60 instances. SCARLET FEVER. 21 Two hundred and twenty-seven patients were removed to the hospital last year, or including the 4 re-admitted after discharge, as recounted above, 231. (Table 15, page 29.) The proportion of cases treated in hospital last year was 931 per of the notified cases, 1.5 per higher than in 1911, and 2.6 per above the average for 1907-11. (Table 16, page 29.) The deaths among the patients removed to hospital numbered 9 (including 2 "errors"), and there was one death among the 17 patients treated at home. The total fatality (Table 16) of the disease was at the rate of 3.4 per 100 cases, as compared with 8.0 per in 1911 and an average of 9.7 per during 1907-11. Corrections for "errors" have been made in each case. The fatality in hospital was 5.8 per (8.3 in 1911 and 14.2 during 1907-11), and that among patients treated at home 3.2 per (8.0 in 1911 and 9 2 during 1907-11). The 6 deaths recorded during the year occurred among the residents of the four northern Wards of the Borough. (See Table 17, page 29.) Last year.s mortality rate in Maida Vale Ward (0.09) was the only one in excess of the rate for the previous year, but that recorded in Queen.s Park (0.12) was equal to the 1911 rate. In the latter Ward only was the rate for 1912 in excess of the average for 1907.11. According to the figures published by the Registrar-General, the mortality rate in the Borough was 0.04 per 1,000, less than half the mean rate (0.09) for 1907.11. (See Table 13.) The local rate, was less than half the rate (010) for the Metropolis. The rate recorded last year in Kensington (0.03) was the only one below that of the Borough. In Hampstead the 1912 rate (0 20) was above the mean for 1907.11 (0 09), that being the only instance in which last year.s mortality was in excess of the average. SCARLET FEVER. Last year.s reported cases numbered 272, an increase cf 46 above the total for 1911 (Table 6), and the morbidity rate was 1.91 per 1,000 persons, as compared with 1.58 in the previous year, and 332 the average for the five years 1907-11. The numbers of cases reported in each of the last six years are given below. Scarlet Fever. 1907. 1908. 1909. 1910. 1911. 1912. Cases 579 681 629 258 226 272 Morbidity Rates per 1,000 persons 4.05 4.6 4.40 1.81 1.58 1.91 In London, as a whole, the morbidity rate was 2.50 per 1,000, 1.29 less than the mean (3.79) for the years 1907-11 (Table 7), and 0.50 less than the rate (3.00) for the rest of England and Wales (Table 10). From the figures given in Table 7 it appears that the rates recorded last year in St. Marylebone (2.23) and Willesden (2.69) were in excess of the Borough rate (189,). In all the districts included in that table last year.s rates were considerably below the corresponding means. In Table 8 the numbers of cases reported in each of the Wards during the six years 1907-12 are shown, and in Table 9 the totals for each quarter of last year are contrasted with the average totals for the preceding five years. The morbidity rates (see below) were highest in Queen.s Park (2.94) and Church (2.85) Wards. The disease was at a low level of prevalence throughout the year in all parts of the Borough. Some anxiety was caused by the occurrence of cases in three schools, viz., Campbell Street, St. Matthew.s, and St. Saviour.s, but there was no SDread from those schools. Scarlet fever. Morbidity Rates per 1,000 Persons. Queen.s Park. Harrow Road. Maida Vale. Westbourne. Church Lancaster Gate, Hyde Park. West. East. 1912 2. 94 1.63 1.70 1.92 2.85 1.19 0.50 1.10 1911 1.55 2.96 1.63 0.30 1.38 0.33 0.50 1.48 1907-11. 3.53 5.21 2.38 2.36 4.18 1.38 0.95 2.20 22 SCARLET FEVER. Among the 272 reported cases were 12 in which the diagnosis was not confirmed by the progress of the disease. Such "errors" formed 4 4 per of the total number of cases reported, a proportion differing notably from that recorded in 1911 (14.1 per ), and nearly 35 per below the average proportion (6.8 per ) for the five years 1907-11. Among the 260 remaining ("definite") cases were 18 in which the infection was believed to have been acquired outside the Borough, 6 in which it was contracted in hospitals where the patients were under treatment for other complaints, and 14 cases which followed the return home from "fever" hospitals of previous cases. Three patients were certified to have diphtheria and scarlet fever at the same time, but in one case only was the mixed infection confirmed at hospital, although in one of the other two cases the Klebs-Loffler bacillus had been demonstrated bacteriologically before admission. One patient, who had a definite attack of the disease in April, 1909, had a second definite attack in November of last year. The 272 notifications were received from 224 houses, 32 returning two and 8 three. The house distribution of the notifications during the past year compared favourably with that observed in the preceding four years. (See beloiv.) Scarlet Fever. (Notifications.) 1912. 1911. 1910. 1909. 1908. Houses with 2 each 32 16 23 62 57 3 „ 8 3 9 26 30 4 „ — 2 3 3 13 „ 5 „ . 1 1 1 5 ,, 6 — . — - .1 „ 7 „ - 1 - - 2 In three instances both the cases reported from the same house proved to have been erroneously diagnosed, and in two houses whence two notifications were received two families were infected. The distribution of multiple cases, after correcting for errors, &c., was as given below, where the corresponding corrected figures for the three preceding years are also set out. Scarlet Fever. ( Cases.) 1912. 1911. 1910. 1909. Houses with 2 each 29. 14 21 59 3 „ 8 2 7 22 4 - 1 2 3 5 „ 1 1 1 Families with 2 each 27. 14 22 51 3 „ 8 2 6 14 4 „ 1 1 4 5 „ - 1 1 - An examination of the particulars relating to the families with two cases show that in 2 instances the second case was a "return case"; in 7 both cases were reported on the same day; in 5 the second case occurred whilst the first was being treated at home, and in one instance the second case was apparently due to a relative visiting the hospital where the first was in isolation. In three families the intervals between the two cases were so long that independent infections were more than suspected, the intervals being as here indicated:— 28. i.—24. xii.; 14. v.—6. xii.; and 29. viii.—1. iii. In 9 families the shortness of the intervals pointed to direct personal infection:—18—21. iv.; 30. xi.—6. xii.; 3—4. xi.; 29. xi.—11. xii.; 1—9. vii.; 29.x.—1. xi.; 19—21. xi.; 25—27. ix.; 19—20. x. The intervals elapsing between the first and second cases in the 5 families keeping their patients at home were as follow: . 1 day an J 5 days in one instance each; 6 days in two; and 24 days in the fifth. enteric fever. 23 In the 8 families with three cases, all three were reported together in one instance; in two, the second and third cases were reported together shortly after the first; and in one, all three were reported separately at intervals. In two families both the second and third cases were "return," and in another the third only, the second being due to direct infection from the first. The cases removed to institutions for isolation numbered 251 last year (Table 15), and formed 92.2 per of the total notified, as compared with 96.4 per in 1911 and an average of 94.9 during the five years 1907-11. (See Table 16.) In Lancaster Gate, West, Ward only were all the notified cases removed. There were four deaths among the patients sent to hospital and none among those kept at home, the total fatality (Table 16) being equal to 1.5 per 100 "definite " cases, as compared with an average of 2.2 per for the preceding five years. The mortality was 0 02 per 1,000 persons last year, the same as in 1911, and less than one. third of the average (0.07) for the five years 1907-11. (Table 17.) From the figures given in Table 13 it appears that the highest mortality (0 09) was recorded in St. Marylebone, and the lowest (0 01) in Hampstead and Willesden. Except in St. Marylebone, where last year.s rate was equal to the mean, all rates recorded in 1912 were notably below the respective means. ENTERIC FEVER. (Including Continued Fever.) The cases reported during the year numbered 15 only, as compared with 38 in 1911, and an annual average of 35 during the five years 1907-11. Last year.s total (15) was approximately one.half the smallest total previously recorded since 1901, viz., 29 in 1909, but in that year there were 4 cases erroneously diagnosed as enteric fever, while last year there were none— the first occasion since 1902 (when "errors" were first systematically recorded). The morbidity rate last year was equal to 010 per 1,000 persons, 018 less than the rate for 1911 (0.28), and 0.15 less than the mean rate (0.25) for 1907-11 (Table 6). According to the data published by the Registrar.General (Table 7), lower rates were recorded last year in Kensington (0.09) and Willesden (0.08). All the rates recorded last year were notably below the mean rates. The numbers of cases reported in each of the Wards during the past year are given below. The numbers are so small that comment appears to be superfluous, save to remark that they indicate a progressive improvement in the healthiness of the Borough so far as this disease is concerned. Enteric Ff.ver. Queen.s Harrow Maida Lancaster Gate, Hyde Park. Road. Vale. Westbourne. Church. West. East. Park. Cases, 1912 1 2 2 3 3 2 1 1 „ 1911 2 9 9 2 7 3 3 3 „ 1907-11 3 6 6 3 922 4 Morbidity—per 1,000 persons— 1912 0.06 0.07 0.09 0.13 0.12 0.22 0.12 0.08 1907-11 0.18 0.23 0.28 012 0.34 0.24 0.20 0.33 As already stated, no case of erroneous diagnosis was reported to the Department, the average percentage of " errors " having been 212 per of reported cases during the five years 1907-11. From information collected by the Department, it appeared that 4 out of the 15 cases were due to infection contracted outside the Borough, and that in 3 cases there were histories of the consumption of oysters (in one case in France) within the normal incubation period of the disease. One patient, an infant aged one year, was apparently infected by his mother, who was 24 SEPTIC DISEASES. found to be a "carrier." She had had an attack of enteric fever some eighteen months previously while in India. So far as the Department had information, the Widal reaction was resorted to on four occasions only. In no house or family was a second case recorded during the year. Eight patients (533 per of the reported cases) were removed to institutions for treatment, the proportions of removals to institutions showing decreases when compared both with the preceding year and with the period 1907.11 (Table 16). The numbers of cases removed from each Ward are given in Table 15. The total fatality of the disease (Table 16) was notably less last year (6.6 per ) than in 1911 (18.5 per ) and than the average for the preceding five years (14.6). The mortality (0 01 per 1,000 persons) was just one-third the rate recorded in 1911 and the like proportion of the mean for 1907-11. In Hampstead only was so low a rate as 0.01 recorded during the year (Table 13). The excessive rainfall of the summer and early autumn roused some fears of an abnormal prevalence of enteric fever during the late autumn, such fears being based on the theories of the association of the disease with a high level of ground water and a flooded Thames. Happily such fears proved groundless, the morbidity rate recorded in the whole County (Table 7) being only 0.15 per 1,000, 0.09 less than the average for the preceding five years. In England and Wales, outside London (Table 10), the morbidity rate was 0.24 last year, or 0.03 above that for 1911. SEPTIC DISEASES. Puerperal Fever.—The number of reported cases of this disease increased from 7 in 1911 to 11 last year, the annual average for the five years 1907-11 being 5. Last year 3 eases were reported in each of two Wards (Maida Vale and Westbourne), and 2 in each of two (Queen.s Park and Harrow Road), the remaining case being reported from Lancaster Gate, West, Ward, the first case to be reported from that Ward since 1901. For the first time within that same period no case was reported during the year from Church Ward. No case has been reported from Lancaster Gate, East, Ward since 1902. Of the 11 cases reported last year 5 were in the persons of primiparae, 2 following miscarriages, and the remaining 6 (or rather 5, since 1 case was not confirmed at the Infirmary, whither the patient was removed for treatment) of multipara;. There was only one case reported in an unmarried woman. In 5 instances the confinements were attended by medical men, in 2 by students, and 3 by midwives, one patient being unattended (a miscarriage). In 6 instances unqualified persons were reported as assisting at the confinements and subsequently. At 4 of the confinements no instruments were used; at 3 it was known that they were used; while at the remaining 4 (including the 2 miscarriages) there was no record. One woman, suffering from a "sloughing umbilicus," apparently infected herself. In previous reports various data have been used for calculating morbidity and other rates due to this disease, but, after considerable search for data which would be both reliable and always available, it has been decided to use on this (and future) occasions the numbers of births recorded in the Borough for the purpose. The estimated numbers of women aged 15-45 years (married and/or unmarried) are most commonly taken as the basis for these calculations, but a considerable proportion of such women are not " at risk " in any year, as they are neither pregnant nor giving birth to children. The number of births expresses accomplished facts, and although an element of error is introduced by the occurrence of puerperal fever after miscarriages and abortions (which are not counted among the births), and by the number of multiple births (twins, &c.), it is thought that that figure affords a better test of the frequency of the disease, especially as the ratio of confinements to women living is decreasing, as evidenced by the decreasing birth.rate. Last year the notified cases (11) were equivalent to a morbidity rate of 3.96 per 1,000 births registered in the Borough (see Table 6), as compared with one of SEPTIC DISEASES. 25 2.49 in 1911, and an average of 2.09 during 1907-11. In Table 18 (page 150) the corresponding figures for the Metropolis and the districts immediately adjacent to the Borough are set out. The highest rate observed last year was 8 91 per 1,000 births in Westminster, and the lowest, 2.22, in St. Marylebone. In Hampstead and Willesden last years rates were below those of 1911; in all the others above Again, with the exception of those two districts, all the rates recorded last year were in excess of the averages, the greatest excess being recorded in Westminster. Four deaths were recorded in the Borough from puerperal fever, equivalent to a fatality of 36 36 per 100 reported cases, as compared with 2871 in 1911 and an average of 3871 during 1907.11. Lower fatalities (Table 18) were recorded in Westminster (31.57) and Willesden (30). The mortality (per 1,000 births) was 1.44 in the Borough, as compared with 071 in 1911, and an average of 0.80 during 1907-11. The mortality in the Metropolis as a whole was 1.42, and lower rates were recorded in St. Marylebone (0.88) and Willesden (0.76). Last year.s rates were in excess of those recorded in 1911, except in Hampstead and Willesden, and the corresponding averages, except in those two districts and St. Marylebone. Puerperal fever is not the only danger to which parturient women are exposed, and last year 6 women died of various causes included under the general title of " Accidents and Diseases of Parturition," just double the number recorded in 1911. The mortality from these causes (calculated per 1,000 births) was 2.16 last year, as compared with l.06 in 1911 and an average of 3.03 during the years 1907-11. Lower rates were recorded last year in London (1.57) and Westminster (1.87) and higher in all the other districts. In Westminster and Willesden only were last year.s rates below those recorded in 1911 or the averages for 1907.11. Mortality in Childbed.—The total mortality in childbed is the sum of the mortalities due to puerperal fever and to accidents and diseases of parturition. The total mortality (again per 1,000 births) was 3.60 last year, as compared with 177 in 1911 and an average of 3.84 during 1907.11. Lower rates were recorded last year in London (3.00) and in Willesden (3.06), but last year.s rates were below those of 1911 in Hampstead and Willesden. In Paddington and Willesden the rates recorded in 1912 were less than the average; in all the other districts, above. An examination of the rates given in Table 18 does not lend support to any suggestion that the mortality in childbed is really decreasing, that is when the mortality is measured by the number of children born into the world. It is quite possible that were the mortality measured by the number of women of fecund ages (15.45 years), there would be evidence of a considerable reduction, but such a comparison would be fallacious, as it takes no count of the smaller number of women really at risk having regard to the reduction in the births. It has long been urged that the Hospitals of the Metropolitan Asylums Board ought to be available for the treatment of cases of puerperal fever. On August 20th last the Local Government Board issued an Order authorising the Asylums Board to receive such patients. In the case of women who are not paupers, the special recommendation of the Medical Officer of Health is required before any patient can be admitted. Last year no patients were removed to the Board.s Hospitals, but 6 were admitted to the Poor Law Infirmary, including the case in which the original diagnosis was not confirmed. ERYSIPELAS.—One hundred and seventeen (117) cases were reported during the year, the same as in 1911, and 7 in excess of the average for 1907-11. Below will be found a tabular statement of the cases reported during 1912 and 1911 in each of the Wards, together with the annual averages for 1907.11. Erysipelas. Reported Cases. Queen.s Harrow Maida West. Church, Lancaster Gate, Hyde Park. Road. Vale. bourne. West. East. Park. 1912 14 37 12 15 25 1 3 10 1911 7 29 17 20 35 2 2 5 1907-11 11 24 13 20 32 2 2 6 E 26 CEREBROSPINAL FEVER. The morbidity rate in each of the last two years was 0.82 per 1,000 persons, and the annual average rate for the five years 1907-11, 0.77. The local rate (Table 7) was higher than any of the rates recorded in the adjacent districts, but below that for the Metropolis. An analysis of the parts of the body reported to be affected shows that in 86 instances the disease was in the head and face, in 18 in the lower extremity, in 8 in the upper, and in one in the trunk. In 4 instances no note was made on this point. Three men had two attacks during the year, and in one family the mother and a daughter were affected at the same time. Nineteen (19) patients (16.2 per ; 18.9 in 1911) were treated in institutions, viz., 15 at the Infirmary, 3 at St. Mary.s Hospital (including one who apparently contracted the disease there), and one at the London Fever Hospital. There were three deaths from the disease (all at the Infirmary), two of the patients residing in Church Ward and one in Queen.s Park. The fatality of the disease was 26 per of the reported cases last year, as compared with 7.6 in in 1911 and 3.0 in 1910. Other Septic Diseases.—Three deaths were scheduled under this heading last year, as compared with 11 in the preceding year. The tabular statement here appended shows the actual causes of death coming under this heading in each of the last six years. Septic Diseases. Deaths Recorded. 1912. 1911. 1910. 1909. 1908. 1907. Erysipelas 3 9 3 4 5 7 Pyasmia 1 1 3 2 4 1 Infective endocarditis 1 6 4 3 2 3 Noma. 1 — — — — — Carbuncle — — 1 1 — — Cellulitis — — 4 3 — 1 Angina Ludovici — 3 — — — — Septic pneumonia — — — — 1 — Cancrum oris — 1 1 — 1 — An analysis of the deaths from erysipelas and the other septic diseases, according to the sex and ages of the deceased, is given below. The total mortality was 0.04 per 1,000 persons, equally divided between the two divisions of the group. In 1911 the mortality from erysipelas was 0.06 per 1,000, and that from the other septic diseases 0.07. Deaths 0— 1— 5— 15— 25— 65— All Ages. during M. F. M. F. M. F. M. F. M. F. M. F. M. F. Ersipelas 1912 — 1 11 — — 12 1911 — 1 — — — — — — 2 5 1 — 36 11907-11 1 1 ------ 1 2 1 0 3 3 Other Septic Diseases1912 - — — — — — 2 — — 1 21 1911 1 - - - - - 2 5 3 - - 6 5 1907-11 0 - 0 1 0 0 0 1 4 2 0 1 5 4 CEREBRO-SPINAL FEVER. By an Order of the County Council, made on March 9th, 1912, and subsequently confirmed by the Local Government Board, "Cerebro-spinal Fever (Cerebro-spinal Meningitis) " was permanently added to the list of diseases to be notified. Last year 7 cases were reported, one after death, as compared with two during life and two after death in 1911. Last years cases comprised 5 in females and 2 in males, but two cases—one in a male and in a female—were subsequently held to have been erroneously diagnosed in the first instance, they being the only cases removed to the hospitals of the Asylums Board. All the 5 correctly diagnosed cases terminated fatally, equal to a fatality of 100 per acute poliomyelitis. 27 The five "definite" cases comprised 4 in females, aged respectively one year (2 cases), 16 and 19 years, and one male, aged 8 years. One case, that of a female aged 1 year, was reported (after death) as "Posterior basic meningitis," all the others as " Cerebro-spinal meningitis." Vermin were reported to be present in two out of the five homes, and one patient had been reported verminous by the School Authority shortly before the occurrence of his illness. The duration of the attacks was in each instance very short, as appears from the appended summary, which also served to indicate the time of year when the cases occurred. (C. W.) P. E., f., æt. 16, sickn.d 30. xii. .11, died 3. i. .12 (inquest held). (C. W.) B. G., m., æt. 8, sickn.d 1. i. .12, died 2. i. (W. W.) D. A., f., æt. 1, sickn.d 8. i., died 11. i. (W. W.) H. E., f., æt. 19, sickn.d 18. vi., died26.vi. (VV. W.) A. E., f., æt. 1, sickn.d 30.x., died 3. xi. (not related to the preceding). Two of the cases occurred in Church Ward (" C. W." above) and the remainder in Westbourne Ward (" W. W."), but no connection, such as might have been suggested by the sequence of the earlier cases, could be traced, nor, so far as was ascertained, was there any spread of infection from the reported cases. ACUTE POLIOMYELITIS. This disease, also known as "Acute Polio.encephalitis," first made notifiable in July, 1911, was last year, by Order dated March 9th, permanently placed on the list of notified diseases. During the past year 6 cases were reported, one case each from Queen.s Park, Harrow Road, Maida Vale, and Lancaster Gate, West, Wards, and two from Church. Special inquiries were addressed to the certifying practitioners at the beginning of the current year, and in each case no doubt was entertained as to the correctness of the original diagnosis, paralysis being observed in every instance. Two patients were treated at St. Mary.s Hospital, one each at the Children.s Hospital (Great Ormond Street) and Asylums Board.s Hospital, one at a nursing home in Marylebone, and one at home. None of the cases ended fatally. The patient reported in the previous Annual Report (1911) as alive at the end of the year died during 1912 of intercurrent pulmonary tuberculosis. The appended brief statement shows how the cases were distributed with regard to sex and age of the patient and the time of year. (Q. P. W.) B. G., m., æt. 1, sickn.d 29. iii., adm.d S. M. H. 1. iv., dis. 27. iv. (C. W.) P. P., f., æt. 11, sickn.d 7. v., adm.d M. A. B. 10. v., dis. 19. vii. (L. G. W. W.) S. H., m., æt. 22, sickn.d 4. v., went to nursing home 11. v. (C. VV.) W. B., {., æt. 3, sickn.d 25. vi., adm.d S. M. H. 29. vi., dis. 25. vii. (M. V. W.) M. C., m., æt. 8, sickn.d 7. vii., treated at home. (H. R. W.) H. W.,f., æt. 4, sickn.d 3. viii., adm.d C. H., G. O. S. 8. vii., dis. (?) 8. x. The last case was one of some interest. It came to the knowledge of the Department through a communication received from the Medical Officer of Health of the County of Essex reporting the death of two children, residents of the Borough, from acute poliomyelitis while on a visit to a village in that County. Inquiries at the address given led to the discovery of the child H. W. being in the Great Ormond Street Hospital suffering from " paralysis," to which institution she had been removed some fifteen days before the inquiries were made. The report was confirmed by the House Physician at the Hospital, who gave the date of onset of the disease as August 3rd, the day after the two children mentioned above left London. The children had been visiting H. W. before going away. ANIMAL DISEASES. No cases of anthrax or hydrophobia were reported during the year. Two outbreaks of glanders among horses stabled in the Borough were reported, but no illness was traced among the stable hands. 28 OPHTHALMIA NEONATORUM. OPHTHALMIA NEONATORUM. During 1912, the first complete year of notification, 31 cases of this disease were reported, equal to 11.17 per 1,000 births registered in the Borough. There was also one known case which was not notified. Of the notified cases 14 were in male infants (equal to 9.84 per 1,000 male births) and 17 in female (or 12 57 per 1,000 female births), showing a slightly heavier incidence on the latter sex. The cases reported in the four quarters of the year were 9, 7, 9, and 0, so that there is not much evidence of any seasonal variation in incidence. The 31 infants included 9 illegitimate, the incidence on that class being 5.7 per 1,000 of such births, as compared with 8 4 among legitimate children. The cases reported from the individual Wards were: Queen.s Park, 2; Harrow Road, 5; Maida Vale, 3; Westbourne, 10 (including 5 in the Workhouse and 1 in the Lock Hospital) Church, 8; Lancaster Gate, West and East, 0; and Hyde Park, 3. Gonorrhæal infection was definitely diagnosed in 7 cases (6 in illegitimate children) and suspected in 4 others (1 illegitimate). The births of 22 of the 31 infants had been conducted by midwives, the others by medical practitioners. Gonorrheal Cases (6)—The onset of the disease was noted as—on day of birth 1 case, the day after birth 4 cases, and on the fifth and sixth day 1 case each. Two of the patients were treated at hospitals, and the other 5 by the Medical Superintendent of the Infirmary. Seven of the children recovered without damage to the eyes, 2 died of intercurrent disorders, and 2 had slight (superficial) damage to the eyes on discharge from the Infirmary. Doubtful Gonorrhceal Cases (4).—The attacks began on the first, fourth, fifth, and eighth days of life (1 each). Three of the patients were treated at hospitals, and the fourth by a private practitioner. One child removed from the Borough before recovery, the others all recovered with the eyes apparently uninjured. Non-gonorrhceal Cases (22)—The dates of incidence of the disease showed a wider range than in either of the foregoing groups. In 4 cases the eye(s) was (were) affected on the day of birth; in 9 at dates between the second and eighth day after birth, and in 4 during the second week of life, the longest interval being 12 days from birth. In 3 instances no note was made of the date of onset. Ten of the children were treated at hospitals, 4 entirely by private practitioners, 4 at the beginning by private practitioners and later at hospital, while in 2 no note was made on the matter. Two children left the Borough before recovery, the remainder made good recoveries without damage. TABLE 14. Vaccination Returns. Children Born. Successfully Vaccinated. Insusceptible to Vaccination. Died Unvaccinated. Per of Children Born. (Cols. 2, 3, & 4.) Vaccination Postponed. Exempt under the Act. Rest.* Per of Children Born. (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 2,821 2,014 10 228 79.8 31 367 171 20.2 1912† Jan-June 1,437 1,021 3 99 78.1 53 170 91 21.9 * Including " gone away," " false addresses," &c. † Provisional return only. ophthalmia neonatorum. 29 In the case which was not formally notified the attack commenced on the second day of life, and the child recovered without damage to the eyes. The routine established for watching over this disease was fully described in the report for 1911. Free use was made last year of the services of the Victoria Nursing Association. TABLE 15. Wards, &c. 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. Queens Park 53 (5) 47 (5) - 2 47 46 - - 1 - 1 - Harrow Road 60 (4) 58 (4) - 1 44 (1) 40 - - 2 1 - - Maida Vale 22 (1) 21 (1) 1 1 36 (2) 30 - 2 2 1 - - Westbourne 48 (1) 47 (1) - 1 45 42 - 1 3 3 - - Church 43 (4) 42 (4) - 3 (2) 71 (7) 70 (7) - - 3 1 - - Lancaster Gate West 9 4 - - 11 11 - - 2 1 - - East 2 2 - - 4 1 - - 1 - - - Hyde Park 11 10 - 1 14 (2) 11 (2) - 1 1 1 — — Borough 1912 248 (15) 231 (15) 1 9 (2) 272 (12) 251 (9) - 4 (-) 15 8 1 - 1911 168 (19) 154 (17) 1 12 (1) 226 (32) 218 (32) - 4(1) 38 (11) 33 (9) — 6(1) TABLE 16. Diphtheria. Scarlet Fever. Enteric Fever. 1912. 1911. 1907-11. 1912. 1911. 1907-11. 1912. 1911. 1907-11. Removed to Hospital (1) 93. 91.6 90.5 92.2 96.4 94.9 53.3 87. 78.7 Fatality (2)—Total 3.4 8.0 9.7 1.5 1.5 2.2 6.6 18.5 14.6 At Home 5.8 8.3 14.2 — — 0.8 14.2 — 21.2 In Hospital 3.2 8.0 9.2 1.6 1.6 2.2 — 20.8 12.5 Mortality (3) 0.04 0.08 0.09 0.02 0.02 0.07 0.01 0.03 0.03 (1) Per 100 cases reported. (2) Per 100 cases corrected for " errors." (3) Per 1,000 persons of all ages. TABLE 17. Mortality Rates.* Diphtheria. Scarlet Fever. Enteric Fever. 1912. 1911. 1907-11. 1912. 1911. 1907-11. 1912. 1911. 1907-11. Queens Park 0.12 0.12 0.08 - 006 0.06 0.06 - 0.01 Harrow Road 0.04 0.07 0.11 - — 0.10 - 0.07 0.05 Maida Vale 0.09 0.05 0.10 0.05 - 0.04 - 0.09 0.02 Westbourne 0.04 0.13 0.12 0.04 — 0.07 - — 0.02 Church - 0.04 0.10 — 0.08 0.16 - 0.04 0.03 Lancaster Gate, West - 0.11 0.07 — — 0.02 - — 0.02 Do. East - 0.12 0.10 — — — - — . Hyde Park - - 0.01 0.08 . . — 0.04 * Per 1,000 estimated population. 30 MEASLES. TABLE 18. Puerperal Fever: Mortality in Childbed.* London. Paddington. Kensington Westminster. 1912. 1911. 190711. 1912. 1911. 109711. 1912. 1911. 190711. 1912. 1911. 190711. Puerperal Fever— Morbidity 3.41 2.68 2.30 3.96 2.48 2.08 2.59 2.30 2.33 8.91 2.84 2.09 Fatality † 41.73 46.86 56.44 36.36 28.71 38.71 7.5 57.12 51.35 31.57 100 57.69 Mortality * 1.42 1.25 1.30 1.44 0.71 0.80 1.94 1.31 1.19 2.81 1.89 1.20 Accidents and Diseases of Parturition— Mortality * 1.57 1.34 1.42 2.16 1.06 3.03 2.92 2.30 2.26 1.87 1.89 2.33 Total Mortality in Children* 3.00 2.60 2.73 3.60 1.77 3.84 4.87 3.61 3.46 4.69 3.79 3.55  St. Marylebone. Hampstead. Willesden. 1912. 1911. 190711. 1912. 1911. 190711. 1912. 1911. 190711. Puerperal Fever— Morbidity* 2.22 1.68 2.06 2.45 5.01 3.42 2.55 4.14 2.80 Fatality † 40 — 50 66.66 50 50 30 50 48.21 Mortality* 0.88 — 1.03 1.63 2.50 1.71 0.76 2.07 1.35 Accidents and Diseases of Parturition— Mortality* 4.89 2.94 3.01 3.26 2.50 2.95 2.29 2.58 2.55 Total Mortality in Childbed * 5.78 2.94 4.04 4.89 5.01 4.66 3.06 4.65 3.91 * Rates per 1,000 births. † Per 100 cases reported. MEASLES. The cases of measles coming to the knowledge of the Department during the year numbered 1,368, according to the weekly tabulation, but after correction at the end of the year the number was increased to 1,374 (males 656, females 718), that total not including 24 cases of German measles provisionally included under measles in the weekly returns. The numbers of cases heard of—the disease is not notified—in each of the six years (1907-12) are set out below. There can be little doubt that some part of the increase in numbers known during the last three years has been due to more careful reporting by the staffs of the public elementary schools, the principal source of information, and to the public applying in increasing numbers for disinfection after the occurrence of the disease, the existence of which would be unknown to the Department but for such applications. Quarters 1. 2. 3. 4. Year. Uncorrected. Corrected. 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 1912 326 423 181 438 1,368 1,374 measles. 31 The 1,374 cases of measles occurred in 759 houses, averaging 1.8 cases per house, as compared with 1.7, 19, and 1.8 in the years 1911, 1910, and 1909 respectively. There were in all 615 secondary attacks, equal to 44 7 per of the total known cases, as compared with 43.7 per in 1911, 46.8 in 1910, and 44.9 in 1909. The house distribution of the known attacks in each of the past six years is shown below :— 1907. 1908. 1909. 1910. 1911. 1912. Houses with 2 cases 194 130 104 290 196 191 3 „ 97 55 55 164 97 108 4 „ 30 15 21 55 36 36 5 „ 19 6 9 22 13 15 „ 6 „ 7 — — 7 2 3 7 ,, 2 — 1 6 — 3 „ 8 „ 1 — — 1 — 1 9 „ — 1 — 1 The deaths entered as due to this disease, including a number certified as due to bronchitis broncho-pneumonia, &c., but allocated to measles after special inquiry, number 32, 16 of each sex. The fatality observed last year was at the rate of 2.3 per of known cases (24 for males and 2.2 for females). Such fatalities are the lowest recorded during the six years. (Seebelow.) Average, 1907. 1908. 1909. 1910. 1911. 1907-11. 1912- Males 3.3 5.3 5.3 3.5 4.4 4.4 2.4 Females 2.5 4.1 4.8 3.6 3.4 3.8 2.2 Persons 2.8 4.6 5.0 3.6 3.8 4.0 2.3 In Table 19 (page 34) will be found the Ward distribution of known cases and deaths,, together with the equivalent fatalities. That table should be considered with the first part of Table 23 (page 35), and as regards cases, the numbers should be accepted with some reservation, as it is practically certain that known cases are not in the same ratios to actual occurrences in all the Wards. Taking the figures given in Table 19 as they stand, it will be noted that the fatalities recorded last year were generally less than the averages for 1907-11, except in Westbourne and Hyde Park Wards. Last years fatalities were higher than in 1911 in four out of the eight Wards. The sex-age-group fatalities (Table 20) were, with two exceptions (females, 1-2 and 3-4), lower last year than in 1911, and in every case less than the averages. The 32 deaths recorded during the year were equivalent to a mortality of 022 per 1,000 persons of all ages, as compared with a rate of 0.5 in 1911 and an average of 0.3. (See below!) The mortality, according to the data published in the Quarterly Reports of the RegistrarGeneral (Table 13), was 0 25 per 1,000 and the mean mortality 0 31. In the County as a whole the mortality was 040, and in St. Marylebone 0 34, the only rates in excess of the local. In Westminster and St. Marylebone the rates recorded last year exceeded the averages, but in all the other instances they were below. Average, 1907. 1908. 1909. 1910. 1911. 1907-11. 1912. Deaths 37 36 36 75 50 47 32 Mortality 0.6 0.25 0.25 0.52 0.35 0.33 0.22 The mortality rates recorded in the Wards (Table 23) suggest that the disease was unduly prevalent in certain parts of the Borough, last years rates being in excess of the averages in Queens Park and Westbourne Wards. Last years rates were notably above those of 1911 in Queens Park, Harrow Road, and Hyde Park Wards.. 32 WHOOPING COUGH. WHOOPING COUGH. Cases of this disease come to the knowledge of the Department in the same way as do those of measles, but it is believed, and the figures about to be given support that view, that the information thus obtained is much less complete. Last year the weekly compilation of cases reported amounted to a total of 404 cases in the year, the principal incidence of the disease falling on the second and fourth quarters. The corrected total for the year was 377 cases (185 in males and 192 in females), a smaller total than any recorded in the past six years, except 1908. The quarterly (uncorrected) and annual numbers recorded in each of the last six years are appended. Year. Quarters 1. 2. 3. 4. Uncorrected. Corrected. 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 1912 87 126 49 142 404 377 The 377 cases were reported in 203 houses, giving an average of 18 cases per house, the same as in 1911, but higher than in 1910 and 1909 (17). The secondary cases numbered 174, equal to 462 per of the total known cases, a higher proportion than that recorded in 1911 (455) and the two earlier years (42.0). Below the house distribution recorded in the past six years is given. 1907. 1908. 1909. 1910. 1911. 1912. Houses with 2 cases 99 22 98 95 102 61 3 „ 49 16 41 38 51 24 4 „ 12 5 12 11 15 9 5 „ 4 — 2 1 7 7 „ 6 „ 1 - 1 2 1 2 7 „ — — — — 1 8 „ - — 1 — — — Twenty-one deaths (11 of males and 10 of females) v/ere recorded during the year, the total fatility being 55 per 100 cases, as compared with 7"0 for the years 1907-11 and 7*1 in 1911. Lower fatalities among females were recorded in 1908 (4-3) and 1910 (46), otherwise last years rates are the lowest for the six years. Average, 1907. 1908. 1909. 1910. 1911. 1907-11. 1912. Males 9.2 8.8 6.4 9.4 7.2 8.2 5.9 Females 7.8 4.3 6.3 4.6 7.0 6.0 5.2 Persons 8.4 6.5 6.4 6.7 7.1 7.0 5.5 The Ward distribution of attacks and deaths given in Table 21 (page 35) is the basis on which is founded the belief of the incompleteness of the information as to attacks. Fatalities such as 129 for Maida Vale and 42.8 for Hyde Park Wards, containing a large proportion of well-to-do inhabitants, are manifestly not based on data comparable with those used, say, in the case of Church Ward, where the fatality works out at 30 per only. The fatalities in all three southern Wards and in Maida Vale cannot be regarded as tests of actual results, but those noted in the other Wards are probably very close approximations to the truth. In those Wards it will be observed that last years fatalities were below the averages, except in Harrow Road, the decrease in Church Ward being particularly noteworthy. The sex-age-group fatalities (Table 22, page 35) were below the averages, except in the cases of females 1-2 and 2-3. The 21 deaths were equivalent to a mortality of 0.15 per 1,000 persons of all ages, as compared with a rate of 0.31 in 1911 and an average of 024. (See below) The rate obtained from the Registrar-Generals figures (Table 13) was 0.17, 004 less than that for London as a whole OTHER INFECTIOUS DISEASES. 33 and equal to that for Willesden. The rates recorded in all the other districts were below that of the Borough. The mortality rates for the Wards are given in Table 23. Average, 1907. 1908. 1909. 1910. 1911. 1907-11. 1912. Deaths 50 11 36 35 45 35 21 Mortality 0.35 0.07 0.25 0.24 0.31 0.24 015 Hospital Accommodation.—Under Orders of the Local Government Board, made in 1910 and 1911, cases of measles and whooping cough are now admitted to the Hospitals of the Metropolitan Asylums Board, either through the Poor Law or through the Public Health Department. The latter class of case (the non-pauper) can only be received so long as there is a surplusage of accommodation above that required for Poor Law patients, and the Medical Officer of Health has to recommend each case for admission. Under the terms of the 1911 Order, the Asylums Board require to be furnished with certain particulars in addition to that usually supplied for other diseases, and a special " Application for Admission Form " has been prescribed. During the past year 74 patients suffering from measles and 32 from whooping cough were admitted to the Boards Hospitals. Those figures were equivalent to 5.4 per of the known cases of measles and 85 of whooping cough. In 1911 the proportions were 54 and 44 respectively. The deaths in the Boards Hospitals during the year from measles numbered 2, and from whooping cough 6. In 1911 the deaths in those institutions were 9 and 4 respectively. The fatalities among patients treated at home and in the Hospitals during the two years are compared in the tabulation given below, but it should be noted that the figures on which the Hospital rates were based are small, the "probable errors," therefore, being possibly large. Moreover, the patients admitted to Hospital were in many cases seriously ill when removed and most of them drawn from unsatisfactory homes. Fatalities per 100 attacks. Measles. Whooping Cough. Patients treated 1911. 1912. 1911. 1912. at Home 3.3 2.3 6.7 4.2 in Hospital 12.8 2.7 14.2 21.4 OTHER INFECTIOUS DISEASES. In addition to the diseases already mentioned, the staffs of the public elementary schools regularly report cases of chickenpox, mumps, and ringworm, the returns of which are systematically tabulated each week in the Department, as well as of "blight" (ophthalmia), skin diseases, &c., which are not so tabulated. Certain of these cases will be dealt with in detail under School attendance, but the actual numbers of cases reported during the year should be recorded at this stage. There were no fatal cases. Chickenpox.—There was no notification of the disease during the year, there having been no prevalence of smallpox. The cases reported by the school teachers during the year numbered 469 (see over), or, after correction, 459, as compared with 494 (corrected total) in 1911. The corrected numbers reported from the different Wards during the last two years are given below. Chickenpox. Queens Harrow Maida Lancaster Gate, Hyde Park. Road. Vale. Westbourne. Church. West. East. Park. 1912 53 128 61 62 105 14 6 30 1911 106 128 84 52 85 21 9 9 Mumps.—The 341 cases reported last year show a considerable increase above the number reported in 1911 (223). The disease was most prevalent during the first quarter of the year. Ringworm.—The cases reported during the year (267) were considerably in excess of the number reported in any year since 1909. F 34 OTHER INFECTIOUS DISEASES. Uncorrected Figures (From weekly tabulations.) Quarters. 1. 2. 3. 4. Year.[/##] Chickenpox 1900 100 73 43 128 344 1910 222 103 55 140 520 1911 129 147 100 131 507 1912 192 135 52 90 469 Mumps 1909 211 114 30 65 420 1910 31 23 3 12 69 1911 40 39 10 134 223 1912 159 71 39 72 341 Ringworm 1909 45 49 40 42 176 1910 41 24 13 24 102 1911 37 43 31 54 165 1912 69 71 45 82 267 Leprosy.—A death from this disease was reported last year. The deceased, a Jewish female, aged 31, had been an actress, and the disease appeared to have been contracted in South Africa, where she had lived as a child for some years. She was known to have been under treatment for the disease as early as 1900. The notification of leprosy was urged by the Borough Council of Greenwich in a letter dated February, 1912. It was stated in a letter issued by the Medical Officer of Health of that Borough that between 20 and 30 persons suffering from the disease were known to be residing in different places within the Metropolis. A letter approving the proposal was sent from the Council of this Borough to the County Council, who were asked to make the necessary Order. No action appears to have been taken in the matter. TABLE 19. Measles. Queens Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1912. Cases 291 382 141 195 259 39 12 55 Deaths 6 6 1 10 7 - - 2 Fatality. 1912 20 1.5 0.7 5.1 2.7 - - 3.6 1911 1.3 0.2 2.8 7.1 9.4 7.1 - 1.7 Average— 1907-11 2. 2.0 2.6 4.9 6.9 3.5 1.5 3.0 TABLE 20. Measles. 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. 1912—Cases 52 41 81 85 83 69 82 91 110 112 241 301 1 4 6 15 Deaths 6 5 5 7 3 3 1 1 1 - - - - - - - Fatality. 1912 11.5 12.1 6.1 8.2 3.6 4.3 1.2 1.1 0. 9 - - - - - - - 1911 23.6 22.7 12.6 8.0 4.2 9.3 2.5 . 1.1 - 0.8 0.3 - - - - Average— 1907-11 18.3 16.6 16.8 12.7 4.9 5.1 1.6 1.2 1.3 0.8 0.3 0.4 - - - 3.8 OTHER INFECTIOUS DISEASES. 35 TABLE 21. Whooping Cough. Queens Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1912. Cases 75 60 31 47 130 18 9 7 Deaths 2 5 4 2 4 1 . 3 Fatality. 1912 2. 6 8. 3 12.9 4.2 3.0 5.5 — 42.8 1911 9.7 7.8 10.4 5.5 5.1 . . 12.1 Average— 1907-11 5.4 6.6 10.5 7.6 9.2 1.7 - 5.6 TABLE 22. Whooping Cough. 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. 1912—Cases 27 22 18 26 16 15 25 25 25 32 73 69 - l 1 2 Deaths 8 3 2 4 1 1 - 2 - - - - - - - - Fatality 1912 29 .6 13.6 11.1 15.3 6.2 6.6 - 8.0 - - - - - - - - 1911 32.2 26.1 14.2 13.5 - 2.7 3.3 11.9 3.8 2.0 2.5 - - - - - Average— 1907-11 32.0 30.0 28.4 10.6 6.8 3.3 5.6 8.5 1.2 2.0 1.1 0.7 . . . . TABLE 23. Mortality Rates.* Measles. Whooping Cough. 1912. 1911. 1907-11. 1912. 1911. 1907-11. Queens Park 0.37 0.12 0.24 0.12 0.68 0.32 Harrow Road 0.22 0.04 0.24 0.18 0.44 0.37 Maida Vale 0.05 0.24 0.21 0.19 0.24 0.25 Westbourne 0.43 0.47 0.33 0.08 0.21 0.18 Church 0.28 1.08 0.82 0.16 0.32 0.36 Lancaster Gate, West - 0.33 0.11 0.11 — 0.02 Do. East - - 0.05 — — — Hyde Park 0.16 0.08 0.17 0.23 0.31 0.09 * Per 1,000 estimated population. 36 tuberculosis. TUBERCULOSIS. The deaths from all forms of tuberculosis numbered 163 in 1912 (94 of males and 69 of females), as contrasted with 212 in 1911 (122 of males and 90 of females). During the five years 1907-11 the deaths from these causes averaged 199 per annum, and during the preceding quinquennium (1902-06), 234 In the quinquennium 1891-95 the annual average was 270. The decrease in the number of deaths (equal to 39. per cent. of the average for 1891-95) is noteworthy, but a complete examination of the numbers of deaths from causes other than tuberculosis requires to be made before any definite opinions can be expressed. The smaller numbers returned under " tuberculosis " may be due simply to transference to other causes. Deaths from tuberculosis during the past ten years have shown a curious tendency tobiennial increases and decreases, as is shown by the following figures:— Deaths from Tuberculosis. All forms. 1902 213 1907 219 ( + 3) 1903 231 (-MS) 1908 190 (-29) 1904 218 (-13) 1909 204 (+14) 1905 292 ( + 74) 1910 170 (-34) 1906 216 (- 76) 1911 212 (+42) The sex-age distribution of the deaths recorded last year is given below, together with a comparison of the totals (persons) from each form and at each age. The forms of the disease which caused more deaths in 1912 than in 1911 were: acute miliary, 10 deaths (males 4, females 6),. compared with 5 in 1911 (males 3, females 2); meningeal, 17 deaths (males 8, females 9), as against 15 (males 10, females 5); and tabes mesenterica, 5 deaths (males 3, females 2), compared with 3 in 1911 (males 1, females 2). The ages at which more deaths were recorded were: 5-10, 8 deaths (males 2, females 6), as compared with 6 in 1911 (3 of each sex); 30-35, 27 deaths (males 16, females 11), against 20 in 1911 (males 13, females 7); and 60-65, 9 deaths (males 7, females 2), or 3 more than in 1911 (3 of each sex). Tuberculosis. Deaths of Residents: Borough. 1912. Variety- Site. Ages. All Ages. Persons. 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 1912. 1911. Pulmonary: Chronic M. ... ... ... 1 5 3 9 11 7 6 2 4 5 1 2 ... ... 56 95 145 F. ... ... ... 1 5 2 8 1 8 5 4 2 2 1 ... ... ... 39 Acute M. ... ... 1 ... ... 1 5 3 2 2 1 ... 2 ... ... ... ... 17 22 18 F. ... ... ... ... ... 1 3 ... ... 1 ... ... ... ... ... ... ... 5 Acute Miliary M. 3 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 4 10 5 F. 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Meningeal M. 5 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 8 17 15 F. 7 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Abdominal : Tabes Mesenterica M. 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 8 5 3 F. 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Other forms M. 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 10 F. ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Spine M. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 F. ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 Joints M. ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 6 F. ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 3 Kidney M. ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 2 ••• F. ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 General M. 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 8 F. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Totals M. 14 2 2 2 5 4 16 14 9 8 4 4 7 1 2 ... ... 94 163 212* F. 12 6 ... 2 5 4 11 1 9 7 4 4 2 1 1 ... ... 69 Persons 1912 26 8 2 4 9 8 27 15 18 15 8 8 9 2 3 ... ... ... ... ... 1911 31 6 5 16 12 16 20 25 22 17 17 10 6 4 3 2 ... ... ... ... * Including 1 death (m., set. 60) from Senile Tuberculosis. TUBERCULOSIS. 37 In Table 24 (page 44) the Ward distribution of deaths is set out. The Wards in which more deaths were recorded last year than in 1911 were Church (increase 1 death) and Lancaster Gate, West (increase of 3). The mortality from all forms of tuberculosis was at the rate of 114 per 1,000 persons, as compared with 148 in 1911 and an average of 139 during 1907-11. The rates recorded in the Wards are given below. In Church and Lancaster Gate, West, Wards only were last years rates in excess of either the rates for 1911 or the means for 1907-11. Tuberculosis : All Forms. Mortality Rates. Queens Harrow Maida Lancaster Gate, Hyde Park. Road. Vale. Westbourne. Church. West. East. Park. 1912 1.00 1.26 1.04 1.15 1.92 0.32 0.27 0.79 1911 2.11 1.66 1.19 1.74 1.88 — 0.50 1.24 1907-11 1.84 1.54 1.22 1.59 1.91 0.26 0.38 0.85 According to the data published in the Registrar-Generals quarterly reports, the mortality rate in the Borough from all forms of tuberculosis was 120 per 1,000 last year, or 022 below the mean (142). (See below!) In Willesden (118) and Hampstead (0.79) the rates were below that recorded in the Borough. In Kensington last years rate (134) was just above the quinquennial mean (1.33), that being the only exception to the general reduction in the rate. Tuberculosis: All Forms. Mortality Rates. St. London. Paddington. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1912 1.65 1.20 1.34 1.41 1.35 0.79 1.18 1907-11 1.82 1.42 1.33 1.59 1.58 0.94 1.20 Pulmonary Tuberculosis. By the Order ["The Public Health (Tuberculosis) Regulations, 1911"] of November 15th„ 1911, the Local Government Board extended the system of notification of pulmonary tuberculosis (consumption) to patients attended privately. Poor Law cases were first notified in 1909, under the Order of December, 1908, and "institutional " cases in 1911 (beginning in May) under the Order of March, 1911. During 1912, therefore, all cases of pulmonary tuberculosis except those in lunatic asylums were subject to notification. The certificates received during the year numbered 2,143, of which 781 related to patients not residing in the Borough. Such certificates were forwarded to the medical officers of health of the proper districts. The certificates belonging to the Borough numbered 1,362, 320 being sent in under the Order of 1908 (" Poor Law"), 663 under that of March, 1911 (" Institutions "), and 364 under that of December, 1911 ("Private Practice "). The numbers of certificates received in each of the four quarters of the year are shown in Table 25 (page 45). Five hundred and twenty-four certificates were received with reference to cases which had been previously reported. The new cases reported numbered 838 (including 57 already on the Register as "suspect").. The distribution of the new cases according to the addresses given in the certificates is shown in the lower half of Table 25. Seven patients had no real addresses in the Borough. The numbers of cases reported from each of the eight Wards—with tentative case rates—are given below. This is the first occasion that any estimate of the morbidity from pulmonary tuberculosis has been possible, and even now there is room for doubt as to whether the figures do not understate the truth. It will be shown later that deaths from pulmonary tuberculosis were registered last year without the cases being previously notified. Pulmonary Tuberculosis, 1912. Queens Harrow Maida Lancaster Gate,. Hyde Park. Road. Vale. Westbourne. Church. West. East. Park. New Cases 102 190 95 173 215 12 14 30 Morbidity* 6.38 7.04 4.50 7.38 8.63 1.29 1.74 2.36 * Per 1,000 estimated population. 38 TUBERCULOSIS. The frequency of "repeat" notifications of the same case makes it very difficult to arrive at the exact number of new cases reported in the course of the year, and hence the apparent discrepancies between Tables 25 and 26 (page 46). The former table is made up from the analyses of notifications made at the close of each week, the latter from the " Register Cards " at the end of the year, after careful scrutiny of all notifications and the verification resulting from the visits of the Staff. The result of such work is to reduce the number of new cases obtained from the weekly tabulation (838) to 778—the latter figure not including the 57 old "suspect" cases already referred to.* In addition to the 778 patients medically certified for the first time as having pulmonary tuberculosis, 239 others came to the knowledge of the Department as suspected cases. The total number of new names added to the Register was 1,017. Although pulmonary tuberculosis was not notifiable in the Borough prior to 1909, records of cases have been kept since 1903. The histories of the cases recorded prior to last year are shown in tabular form below. 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 1911. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 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 1 - 2 12 11 1907 84 14 12 6 - 1 - 8 20 23 1908 173 25 11 7 4 3 31 24 68 1909 629 65 25 12 - 4 61 462 1910 610 42 34 1 2 13 518 1911 671 69 - 1 19 582 At the close of 1911 there were 1,665 survivors (including 797 "suspects") on the Register. Adding to that figure the 1,017 (including 239 "suspects") reported during the year and 9 cases traced after being lost sight of, the total number of consumptive patients known to the Department to be living in the Borough during the year (for longer or shorter periods according to dates of death) was 1,712,† and of " suspects," 979, making a total of 2,691. The sexes of the 778 patients whose cases were first reported during the year were in the ratio of 3: 4, viz., 334 males and 444 females. Dividing the cases into three main groups (Table "27, page 47), it will be seen that among the Poor Law patients, the males (52) outnumbered the females (34). The disparity between males (127) and females (220) among the patients attending the Tuberculosis Dispensary is remarkable. For the purpose of examining the age-distribution—more fully set out in Table 27—the following grouping has been adopted. New Cases. Per of all Cases. Ages. Males. Females. Males. Females. Infancy 0— 5 5 7 1.5 1.6 School Period 5—15 85 100 25.4 22.5 Working Period 15—65 235 328 70.3 73.9 Rest Period. 65 and over 9 9 2.7 2.0 At all periods the notified cases among females—save in the Rest Period—exceeded those among males. The age-distribution of deaths is just the reverse. *The difference (3 cases) between the total of 838 given in Table 25 and that of 835 (778 + 57) is probably due to cases transferred to other districts at dates subsequent to the making of the weekly analyses. †It was until recently usual to estimate the number of living consumptives at something varying from three to five times the number cf deaths recorded during the year. Such estimates would give numbers ranging from 351 to 585 consumptives as living in the Borough during the past year. The known number (the mean of the survivors at the beginning of the years 1912 and 1913) was 1,144, which is equal to rather more than ten times the number of deaths recorded. Even then no account is taken of the " suspect" cases. TUBERCULOSIS. 39 In Table I., Appendix B, will be found the street distribution of the cases first reported last year, the "suspect" cases being included in the total number of cases entered against each street and shown separately by the figures in parentheses.* As the mere numbers of cases in the streets would by themselves have little or no value, the approximate number of inhabitants (Census, 1911) in each street has been taken out, and also the number of houses invaded. It is not recommended that any rates should be based on the numbers given, nor that the figures for the one year should be used to form any conclusions as to the special incidence of the disease. Patients change their addresses fairly frequently, and until tables such as that now submitted have been compiled for a fairly long series of years, conclusions as to the relative (locality) frequency of the disease are to be deprecated. Each case reported during the year, except 32 reported on by the medical attendants, was visited once at least by the Women Inspectors. Subsequent visits depended upon the need for further advice (and help) of the patients and the pressure of work in the Department. The occupations of the patients on the Register during the year are set out in Table 29 (page 48). It has been found impossible to attempt any further analysis of the information collected in the course of the visits. In the course of the year 295 of the cases known prior to 1912 (Table 28, page 47) were removed from the Register, and 148 of those reported during the year (Table 27). The causes of such removals were :— Cases reported prior to 1912. during 1912. Death 55 76 Removal, &c. 199 60 Reported "arrested" 37 — Diagnosis reviewed 4 12 The relatively large number of " removals " recorded among the old cases is due to special inquiries made for the purpose of purging the Register. Some of the patients struck off the Register for this cause, and by reason of reported "arrest" of the disease, may be expected to be replaced at a later date. Among the 131 deaths included in the above statement there were 25 of which the primary (and in some the only) certified cause of death was a disease other than pulmonary tuberculosis. The statement given below indicates that the diagnosis of pulmonary tuberculosis is far from easy. The sex-age distribution is very different from that observed among the deaths from pulmonary tuberculosis. Certified Cases of Pulmonary Tuberculosis dying during 1912 from C auses other than Pulmonary Tuberculosis. Year Certified. Sex. Age at Death. Cause of Death. Year Certified. Sex. Age at Death. Cause of Death. 1909 m. 39 Street accident. 1911 m. 41 Chronic bronchitis. f. 35 Bronchitis (P.M.). 1912 f. 48 Carcinoma of stomach. m. 10 Heart disease. m. 35 Encephalitis. m. 40 Abdominal carcinoma. m. 58 Cirrhosis of liver. 1910 m. 77 Chronic bronchitis. f. 52 Carcinoma of stomach. f. 54 Heart disease. m. 27 Heart disease. 1911 f. 41 (S) Capillary bronchitis. f. 27 Heart disease. m. 71 (S) Heart disease. f. 54 Abdominal carcinoma (Op.). m. 65 (S) Bronchitis. m. 7 (S) Rheumatism of the heart. m. 3 Broncho-pneumonia and' pleurisy, accelerated by scald. m. 47 Carcinoma of oesophagus. m. 47 Sarcoma of lung. m. 45 Lymphosarcoma of mediastinum. m. 11 Acute poliomyelitis : pulmonary tuberculosis. f. 8 (S) Endocarditis. f. 39 Heart disease. (S) These cases were reported as " suspected pulmonary tuberculosis" only. * A complete street distribution of survivors at the end of 1912 will, it is hoped, be included in the next report. 40 TUBERCULOSIS. Sex-Age Distribution. 0— 10— 15— 25— 35— 45— 55- 65— 75— Totals. Males 2 2 — 1 4 3 1 2 1 16 Females 1 — — 1 3 4 — — — 9 The total number of deaths scheduled under pulmonary tuberculosis during the year was 117*, 95 from "chronic pulmonary tuberculosis" and 22 from "acute phthisis." In 1911 there were 145 deaths from the chronic form and 18 from the acute, or 163 in all. The foregoing figures show a decrease of over 28 per † in 1912 as compared with 1911. The mortality due to the two forms during the year was at the rate of 0.82 per 1,000 persons, as compared with 1.14 in 1911 and an average of 106 during 1907-11. Last year's rate was the lowest observed since 1891, and probably the lowest on record. In Hampstead alone (Table 13) was a lower rate (0.64) recorded. In the Metropolis as a whole the mortality was equal to the average for 1907-11 (1.34). Last year's rates were in excess of the respective averages in Kensington (1911, 1.06; 1907-11, 0.97) and Willesden (1911, 0.93; 1907-11, 0.86), but below the averages in the others. The mortality rates from pulmonary tuberculosis recorded in the individual Wards of the Borough (see below) were less than the averages, except in Lancaster Gate, West, Ward (1911, 0.32; 1907-11, 0.32). The fall in the mortality in Queen's Park Ward (1907-11, 1.47; 1911, 0.69—decrease 53 per ) was very striking. Moreover, the mortality recorded in that Ward last year was fourth in order of magnitude (lower rates being recorded in the three southern Wards only), whereas it has been for some years one of the highest. Pulmonary Tuberculosis. Mortality Rates. Wards. Queen's Harrow Maida Lancaster Gate, Hyde Park. Road. Vale. Westbourne. Church. West. East. Park. 1912 0.69 1.04 0.71 0.81 1.24 0.32 0.25 0.63 1911 1.68 1.29 0.86 1.49 1.32 — 0.50 0.85 1907-11 1.47 1.14 0.93 1.29 1.36 0.22 0.33 0.64 Deaths in Institutions.—Some observers lay great stress on the influence of " segregation " on the prevalence of pulmonary tuberculosis, considering that the isolation of the patients in the last stages of the disease—when such patients are very generally incapable of observing the necessary precautions—will result in a notable decline in the mortality from the disease. It is noteworthy that in Paddington there has been during the past four years—the only period during which the data have been taken out—a notable increase in the proportion of deaths in institutions to total deaths from pulmonary tuberculosis. (See below!) In 1909 45.9 per of the deaths occurred in institutions—more than half of them in the Infirmary—which proportion has steadily increased to 53.8 per last year. The proportion of male deaths in institutions increased from 47.4 per to 63 0 ; that of females decreased to 38 6. Pulmonary Tuberculosis. Proportions (per ) of Deaths in Institutions. 1912. 1911. 1910. 1909. Males 630 54.4 46.6 47.4 Females 386 42.4 42.6 43.5 Persons 53.8 49.0 44.8 45.9 The appended table shows the classes of institutions in which the deaths occurred. The proportion of deaths in the Infirmary has steadily increased during the three years from * The Registrar-General made the total 124. + The deaths in 1912 from chronic pulmonary tuberculosis were 34.5 per fewer than in 1911, while those from the acute form were 22 2 per more. The deaths of males in 1912 (from the two forms) were 18 9 per fewer than in 1911, those of females 39.8 per tuberculosis. 41 275 per in 1910 to 39.3 in 1912. There has also been an increase (per ) in the deaths from this disease in lunatic asylums. Pulmonary Tuberculosis. Numbers of Deaths. Proportions (per ). 1912. 1911. 1910. 1912. 1911. 1910. Poor Law Institutions 46 56 35 39 3 34 3 27 5 " Homes for the Dying" 5 6 8 43 3 6 6'2 General Hospitals 4 6 7 3 4 3 6 5'5 Special Hospitals 3 5 3 2 5 3 0 2-3 Lunatic Asylums 5 7 3 4 3 4-2 2 3 It has already been pointed out that the proportion of deaths of males in institutions has increased and that of females decreased. The records (four years only) are too scanty for any conclusions to be drawn, but it may be observed that, although the total mortality from pulmonary tuberculosis has fallen from 113 to 0'82 during the four years (a decrease of 27 5 per ), the deaths of males have decreased by 26 per (from 99 in 1907 to 73 in 1912), and those of females by 29 per (from 62 to 44). The proportion of institutional deaths among males has increased (from 474 to 63 0 per ), and that of females decreased (from 43'5 to 38'6 per ). There does not appear to be much connection between the Ward mortality rates and the proportions of deaths in institutions, as will be seen on comparing the statement below with that of Ward mortalities already given (page 40). Pulmonary Tuberculosis. Proportions (per ) of Deaths in Institutions. Queen's Harrow Maida Lancaster Gate, Hyde Park. Road. Vale. Westbourne. Church. West. East. Park. 1912 272 464 466 684 677 333 — 627 1911 44.4 37.1 50.0 60.0 696 — 50 545 In previous reports analyses of the duration of institutional treatment have been limited to the deaths of patients in the Paddington Poor Law Infirmary. On this occasion the analysis covers all deaths properly belonging to the Borough which occurred during the year both within and beyond the Borough. The results of the analysis are embodied in Tables II., 111.A, and III.B in Appendix B, which contain other details which appear to be of some interest. Table II. is limited to deaths occurring at the patients' homes. Table III.A includes deaths in the local Infirmary, and Table III.B those in outlying institutions other than lunatic asylums. Of the 54 deceased persons included in Table II., 30 received in-patient institutional treatment during their lives, but in 11 instances the total duration of such treatment could not be obtained. In the remaining 19 instances the length of such treatment varied from one year 9 months as a maximum to one week as a minimum. Analysing the class of institution at which such treatment was received, it appears that 30 patients were treated in hospitals (both general and special), 9 in sanatoria, and 11 in Poor Law Infirmaries. Several of the patients were treated at more than one institution. The dates (years) are indicated in each case, but not the individual periods of treatment. Table III.A (deaths in Paddington Infirmary) relates to 44 deaths. In 36 instances the duration of in-patient institutional treatment was definitely ascertained. The maximum stay was 4 years and the minimum one day. The analysis of institutions shows that only 2 patients had treatment in hospital and one each at sanatorium and "Home for Rest" in addition to that in Poor Law institutions. In addition to the 14 deaths included in Table III.B there were 5 deaths in lunatic asylums. As regards 13 of the 14 patients listed, the amount of institutional (in-patient) treatment was known, and it varied from a maximum of 5 years and 7 months to a minimum of 3 weeks. The treatment was obtained at all four classes of institutions by 4 patients (each) at hospitals and sanatoria, and 5 each at " Homes of Rest" and Poor Law institutions. Inquiries were made with reference to the deaths in lunatic asylums, and it was ascertained that in each instance the g 42 TUBERCULOSIS. disease was known not to be present on admission. Diagnosis is frequently particularly difficult in lunatics, and in all the patients the disease was only known for very short periods before death. Duration of the Disease.—The information as to the lengths of institutional treatment requires to be collated with that as to the duration of the disease, a question to which a good deal of uncertainty attaches owing to the usually insidious character of the onset. In the tables the approximate duration of the disease is given for 84 of the 112 cases tabulated. The maximum durations recorded were 26 years for patients in Table II., and 21 and 15 years in Tables III. A and B, and the minimum 2 months, 3 months, and 6 months respectively. Tables 27 and 28 show when the cases ending fatally during 1912 were reported in summary form, the individual dates of the first reports (and the numbers of certificates received during the lives of the patients) being given in Appendix Tables. Family Histories.—The Staff are required to make inquiries as to known cases of or deaths from tuberculosis in the patients. families, but many patients know little or nothing of the medical histories of their relatives. In only 36 (out of 112) instances was any definite family history of tubercle reported, and in 44 others the disease was definitely stated not to have been present. Civil Status.—The condition of 6 of the deceased persons could not be entered. Of the other 106 persons, 36 were unmarried, 62 married (for periods ranging from 1 year to 39 years— among the " home" and "infirmary" patients), and 8 were widowed. The age at death naturally influences the proportions in each of these classes. Removals.—Admitting the infectivity of pulmonary tuberculosis, the removal of a patient from one house to another—in most cases tenement houses—means the transfer of a centre of infection to a new milieu. Moreover, such removal only too often means that the patient is lost for a longer or shorter period to the Department. Of the patients who died at their homes, 10 (18 5 per ) changed their homes after their cases had been reported; of those dying at the Infirmary, 12 (27.2 per ); and of those dying in outlying institutions, 6 (42 8 per ). In this connection the following analysis of the lengths of residence at the addresses given when the patients were first notified is of some interest. The facts were taken out for the patients dying at home and those dying in the Infirmary. The differences in the distributions for the two classes are so small that it has not been thought necessary to show the results separately. Length of residence. Patients. Length of residence. Patients. Under 1 year 27 5—10 years 9 1—2 years 9 10—15 ,, 3 2—3 6 15—20 „ 4 3—4 „ 2 20 years and over 7 4—5 ,, 5 No permanent address 9 One other analysis of the housing of these patients has been made, viz., that to show on what floor the patients in tenement houses were living at the time of the first inquiries. Where the patient occupied two floors, he has been taken as occupying the upper, e.g., if occupying rooms in the basement and the ground floor, his case has been placed among the occupants of the ground floor. The appended analysis (see below) shows the housing of the patients dying at home separately from that of patients dying in the Infirmary. Part of House Patient Dying occupied. At Home. In Infirmary. Whole House 6 1 Basement 3 9 Ground Floor 13 7 First Floor 14 14 Higher Floors 15 6 Not Specified 3 7 TUBERCULOSIS. 43 Of the 83 patients whose "housing" was noted, 12 (13.6 per cent.) were found in basement homes, and 49 (55.6 per cent.) on the first or higher floors. It would be desirable, were it possible, to trace back the housing histories of the patients to determine the frequency of basement homes among cases of tuberculosis. It is, however, possible to hazard the surmise that as many of the patients were at the time of the inquiries not "so well off" by reason of their illness, they were probably better housed in the past, and therefore less likely to have occupied basements. In the examination of the records of removals (which have not been kept in the past with as much detail as could be wished), it has been noted that many of the patients moved upstairs and not down. Failures to notify.-A strict compliance with the Regulations of 1911 should have resulted in the Department knowing all the cases ending fatally during the year in the lives of the patients, the only exception allowed by the Regulations then in force being cases in lunatic asylums. In addition to the 5 unreported fatal cases in lunatic asylums, there were 6 others during the year, viz., 2 among those dying at their homes, 1 at the Infirmary, and 3 in outlying institutions-facts which may fairly be regarded as evidence of the satisfactory working of the Regulations. National Insurance Act, 1911.-The "Sanatorium Benefit" provisions of the Act came into operation on July 15th of last year, but so far as was known to the Department, no application was sent in from any insured person residing in the Borough until October. Every effort was made to keep in touch with this part of the work of the County Insurance Committee, but it is certain that a number of applications were sent in to the Insurance Committee which did not come to the knowledge of the Department. Supplies of application forms-"Med. 1" and "Med. 2"-were received for distribution, and, whenever possible, the forms were sent to the Insurance Committee through the Department and records kept of the dates of transmission of the forms and of the subsequent progress of each case. During the last quarter of the year nearly all the local work of administering the benefit was carried on through the Department. A "Local Sub.Committee" was appointed and met for the first time on September 16th. A provisional scheme for "domiciliary treatment" was drawn up by the Medical Officer of Health (who was an ex officio member of the Committee) and adopted by the Sub.Committee on November 25th. The scheme remained in operation until January 15th of this year. It should be explained that "Sanatorium Benefit" may be given in one of the following four forms, viz.-Residence in a sanatorium, treatment at a hospital (in. or out.patient), treatment at a dispensary for tuberculosis, and treatment at the patient's home ("domiciliary treatment"). Each patient has to make application for the benefit, and to send in a medical certificate from his own medical attendant, who is subsequently asked to report at length on the case. Each patient has to be seen by the Committee's Referee, who submits his report on the case and makes his recommendation as to the form of benefit which the case needs. Up to the end of the year no attempt appears to have been made to take the patient's home surroundings into consideration when settling the form of benefit to be granted. The applications known to have been sent in from the Borough up to December 31st last numbered 31. Two patients withdrew their applications, and 4 were found to be ineligible, as they were not suffering from pulmonary tuberculosis-the only form of the disease for which any provision was being made by the Insurance Committee. One patient left the Borough before his application was dealt with, and another was sent away privately after a somewhat lengthy wait for the " benefit." Of the remaining 23 patients, 13 were granted treatment in sanatoria ; 4 in hospitals ; 2 at dispensaries, and 4 at home. At the request of the Insurance Committee the Medical Officer of Health made the necessary arrangements for treatment at home, and at the Paddington and Kensington Dispensary, both of patients to whom dispensary 44 tuberculosis. TABLE 24. Deaths from Tuberculosis. Ward Distribution.  Ages Variety of Disease. 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. 1912 Pulmonary ... ... ... ... 1 ... 1 2 4 2 1 ... 7 4 3 ... Meningeal ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... 1 Abdominal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other 1 ... ... ... 1 ... ... ... ... ... ... 1 2 1 1 l All forms 1 ... ... l 2 l 1 2 4 2 1 1 9 7 4 2 1911 ,, ... ... 1 2 2 ... 1 3 16 9 ... ... 20 14 11 5 Harrow Road. 1912 Pulmonary ... ... ... ... ... ... 3 2 14 8 ... 1 17 11 10 3 Meningeal ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... Abdominal 1 ... l ... ... ... ... ... ... ... ... ... 2 ... ... ... Other ... ... ... ... ... 1 ... ... 1 1 ... ... 1 2 1 2 All forms l ... l ... ... l 4 2 15 9 ... 1 21 13 12 5 1911 ” l 1 5 ... 1 l 3 4 17 10 1 1 28 17 11 6 Maida Vale. 1912 Pulmonary ... ... ... ... ... ... ... 1 9 4 1 ... 10 5 4 3 Meningeal ... ... 1 1 ... ... ... 1 ... ... ... ... 1 2 ... ... Abdominal ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... 1 ... Other ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 ... 1 All forms ... ... 3 l ... l ... 2 9 5 1 ... 13 9 5 4 1911 ” ... ... 2 2 1 2 ... 1 11 5 ... 1 14 11 9 4 Westbourne. 1912 Pulmonary ... ... ... ... ... ... ... ... 12 7 ... ... 12 7 10 3 Meningeal ... 1 ... 1 1 ... ... ... ... ... ... ... 2 2 1 ... Abdominal ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 ... 1 Other ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... ...1 All forms l l ... 3 ... 1 ... ... 12 8 ... ... 14 13 11 5 1911 ” 2 ... ... 1 l 1 1 5 17 11 ... 1 22 19 8 9 Church. 1912 Pulmonary ... ... ... ... ... ... 2 1 15 13 ... ... 17 14 14 7 Meningeal ... 1 3 1 1 ... ... ... ... ... ... ... 4 2 4 ... Abdominal ... ... ... l ... ... ... ... ... ... ... ... ... 1 ... ... Other 2 2 2 ... ... 2 ... ... ... 2 ... ... 4 6 2 6 All forms 2 3 5 2 l 2 2 1 15 15 ... ... 25 23 20 13 1911 ” 2 2 5 2 2 ... 2 4 13 12 2 l 26 21 22 9 Lancaster Gate, West. 1912 Pulmonary ... ... ... ... ... ... ... ... 2 1 ... ... 2 1 1 ... Meningeal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All forms ... ... ... ... ... ... ... ... 2 1 ... ... 2 1 1 ... 1911 ” ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lancaster Gate, East. 1912 Pulmonary ... ... ... ... ... ... ... ... 1 l ... ... 1 1 ... ... Meningeal ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Abdominal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All forms ... l ... ... ... ... ... ... 1 1 ... ... 1 2 ... ... 1911 ” ... ... ... ... ... ... ... ... 2 2 ... ... 2 2 1 1 Hyde Park. 1912 Pulmonary ... ... ... ... ... ... ... ... 6 1 1 ... 7 1 4 l Meningeal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... Other ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... l All forms ... ... ... ... ... ... ... ... 8 1 1 ... 9 1 5 l 1911 ” ... 2 1 ... ... ... 3 1 6 2 ... 1 10 6 7 3 tuberculosis. 45 treatment had been granted and of those who had to wait for vacancies in hospitals or sanatoria. Of the 13 patients who were to go to sanatoria only 5 were known to have been admitted before the end of the year, and one of the 4 who were to go to hospital. TABLE 25. Pulmonary Tuberculosis. Summary of Weekly Analysis of Certificates received. 1912. Quarters. Year. 1. 2. 3. 4. Total Certificates received 450 323 242 347 1,362 „ New Cases certified 309 194 135 200 838† Total Numbers * of Certificates received under Order No. District Medical Officers 42 (26) 31 (26) 23 (19) 45 (23) 141 (94) I. Medical Superintendent- Admissions 30 (24) 26 (21) 36 (27) 31 (23) 123 (95) Discharges 7 (6) 15 (12) 14 (13) 15 (14) 51 (45) Relieving Officers - 3 (3) 2 (2) - 5 (5) II. Hospitals and Institutions 208 (68) 168 (61) 117 (40) 170 (69) 663 (238) III. Private Practitioners 157 (17) 75 (5) 50 (6) 82 (17) 364 (45) Other Medical Sources 6 (-) 5 (1) - 4 (1) 15(2) Allocation of New Cases. M. F. M. F. M. F. M. F. M. F. Queen's Park 23 24 8 15 4 11 7 10 42 60 Harrow Road 33 39 20 31 15 9 21 22 89 101 Maida Vale 19 18 9 13 9 4 11 12 48 47 Westbourne 22 37 11 25 17 21 19 21 69 104 Church 30 40 17 31 12 22 19 44 78 137 Lancaster Gate, West 1 3 1 2 - 3 1 1 3 9 „ „ East 5 1 1 - 1 - 4 2 11 3 Hyde Park 5 7 2 6 4 3 - 3 11 19 Common Lodging Houses 1 - - 1 - - 1 - 2 1 No fixed homes - 1 1 - - - 2 - 3 1 *The numbers of certificates relating to cases previously reported are shown in parentheses, † This figure includes 57 cases previously on register as " Suspects." OTHER TUBERCULOUS DISEASES. The deaths from the "Other Tuberculous Diseases" (see tabular statement, page 36) numbered 46 last year, or 3 less than in 1911. The mortality was at the rate of 0 32 per 1,000 persons, as compared with 0 34 in 1911 and an average of 0 33 during 1907.11. The minimum 46 TUBERCULOSIS. mortality recorded since 1891 was 0.28 (in 1908). Last year's rate was the highest of those from this cause included in Table 13. The Ward rates for the past year varied from zero (Lancaster Gate, West, Ward) to 0 68 in Church Ward. In Maida Vale, Westbourne, and Church Wards last year's rates were in excess of the averages. (See below.) Other Tuberculous Diseases. Mortality Rates.-Wards. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1912 0.31 0.22 0.33 0.34 0.68 - 0.12 9.16 1911 0.43 0.37 0.33 0.25 0.56 - - 0.39 1907.11 0.37 0.40 0.29 0.30 0.55 0.04 0.05 0.21 TABLE 26. Pulmonary Tuberculosis. Analysis of Reported Cases. 1912. Medically Certified. Not Medically Certified. From Dispensary " S." Grand Totals. Under Poor Law Order. Under Public Institutions Order from Under Private Practitioners Order. Other Sources. Totals. Dispensary. Other Institutions. First Certificates received 159 469 163 357 16 1,162 239 1,403 Less (repeat notifications) Survivors, 1911 46 122 38 39 3 248 - 248 Certified by Dispensary 23 - 24 43 5 95 - 95 ,, Poor Law - - 13 12 - 25 - 25 ,, Other Institutions - - - 18 - 18 - 18 Totals 69 122 75 112 8 386 - 386 New Cases reported 90 347 88 245 8 778 239 1,017* New Cases terminated during year: Died from Phthisis 27 10 5 24 - 66 - 66 „ other causes 1 2 2 5 - 10 - 10 Totals 28 12 7 29 - 76 - 76 Lost sight of (removals) 7 25 8 13 2 55 5 60 Diagnosis reviewed 6 1 - 5 - 12 - 12 Reported ''arrested " - - - - - - - - Totals 41 38 15 47 2 143 5 148 Survivors, 1913 49 309 73 198 6 635 234 869 *This figure does not include 57 "Suspect" cases reported as definite during 1912. 47 TUBERCULOSIS. TABLE 27. Pulmonary Tuberculosis. New Cases Reported and Deaths among same. (Sex-Age Distribution.) 1912. 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 - - - 3 38 33 20 20 16 37 19 69 19 34 11 15 3 7 1 2 - - 127 220 347 Poor Law - - 2 - 1 3 3 4 1 2 9 8 12 10 11 9 10 1 3 - - 1 52 38 90 Other Medical - 1 3 3 11 23 12 17 27 33 46 42 32 27 12 24 7 10 4 5 1 1 155 186 341 Totals - 1 5 6 50 59 35 41 44 72 74 119 63 71 34 48 20 18 8 7 1 2 334 444 778 Deaths- Phthisis - - - - - - 1 - 3 3 8 10 14 6 6 4 5 3 8 - - - 40 26 66 Other Causes - - 1 - - - 1 - - - 1 1 1 1 - 3 1 - - - - - 5 5 10 Not Medically Certified Cases. Cases- Dispensary - - 20 17 27 43 25 19 10 17 6 26 2 16 2 5 - 3 - 1 - - 92 147 239 Deaths- Phthisis - - - - - - - - - - - - - - - - - - - - - - - - - Other Causes - - - - - - - - - - - - - - - - - - - - - - - TABLE 28. Pulmonary Tuberculosis. (Consumption.) Histories of Cases reported prior to 1912. Known Survivors end of 1911. During 1912. Known Survivors, 1913. 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." Dispensary Patients. "Definite." "Suspect." 1904 1 - - - - - 1 1 - - - 1905 - - - - - - - - - - - 1906 11 - - 3 - 1 7 6 1 3 - 1907 23 - 3 10 - 1 9 8 1 7 - 1908 68 3 9 22 1* 4 35 29 6 19 3 1909 462 2 11 95 7† 5 346 181 165 142 164 1910 518 3 10 59 2* 13 437 246 191 194 190 1911 582 1 4 10 9‡ 16 544 315 229 224 226 Totals ... 1,665 9 37 199 19 40 1,379 786 593 589 583 * Deaths from other causes. † Including 3 deaths from other causes. ‡ All deaths from other causes. 48 TUBERCULOSIS. * Including 9 old cases traced and re-entered during 1912. TABLE 29. Pulmonary Tuberculosis. Occupations of all Reported Cases to end of 1912. Survivors, 1912. New Cases Reported, 1912. Not Medically Certified. Struck off Register. Survivors, 1913. Medically Certified. Poor Law. Dispensary. Other Institutions. Private Practitioners. Other Medical Sources. Dispensary "S." Totals. By Death. By Removal, &c. Medically Certified. Not Madically Certified. Columns 1 2 3 4 5 6 7 8 9 10 11 12 Total Cases 1,674* 90 346 83 245 8 239 2,690 130 312 1,421 827 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 - 342 - 14 - 89 - 13 - 38 - - - 42 - 538 - 29 - 49 - 324 136 Servants 5 75 1 2 - 13 3 4 2 11 - - - 9 11 114 1 3 - 11 8 63 2 37 Charwomen - 25 - 4 - 3 - 1 - 1 - - - 2 - 36 - 1 - 8 - 21 - 6 Laundry Workers 1 21 - 1 1 2 1 1 - 2 - 1 1 2 4 30 - 1 1 4 2 16 1 9 Clerks 21 3 - - 8 1 8 1 9 2 - - - 3 48 10 5 - 5 - 33 6 5 4 Shop Ass'ts, Keepers 10 13 1 - 5 6 - 1 5 3 - - 2 - 23 23 5 1 3 3 10 16 0 3 Dressmakers, Tailors 8 50 - 4 2 16 - 7 3 7 - - - 6 13 90 2 6 2 6 9 60 - 18 Bootmakers 2 - l - - - 1 - - - - - - - 4 - - 1 - 3 - - - Skilled Artizans 39 - 2 - 5 - 4 - 4 - - - 2 - 56 - 10 - 2 - 33 - 11 - Bottle Washers 1 - 1 - - - - - - - - - - - 2 - 1 - - - 1 - - - Waitresses, Barmen, &c. 7 3 - 1 1 2 - - 2 - - - - 1 10 7 1 1 2 - 5 5 2 1 Caretakers 3 3 - - - - - - - - - - - - 3 3 - - - - 2 3 1 - Bakers 2 - 2 - 2 - - - 2 - - - - - 8 - 2 - 3 - 3 - - - Others 6 8 1 - - 2 1 - 3 3 - - 2 1 13 14 2 - - - 7 12 4 2 Outdoor. Building Trades 6 - 1 - 2 - 2 - - - - - 1 - 12 - 1 - 1 - 8 - 2 - Painters 18 - 5 - 6 - 1 - 2 - - - - - 32 - 6 - 1 - 16 - 9 - Labourers 31 - - - 1 - - - - - - - - - 32 - 7 - 5 - 14 - 6 - Road Traffic 29 - 6 - 6 - 3 - 6 - - - 2 - 52 - 10 - 2 - 30 - 10 - Stable Workers 6 - 1 - 1 - - - 3 - - - - - 11 - 3 - - - 6 - 2 - Railway Traffic 11 - - - 3 - 2 - 6 - - - 1 - 23 - 3 - 2 - 17 - 1 - Postmen 9 - - - 9 - 1 - 2 - - - - - 14 - 1 - 1 - 11 - 1 - Gardeners 2 - - - 1 - 2 - 1 - - - 1 - 7 - - - - - 6 - 1 - Street Merchants 6 1 1 1 - - - - 1 - - - - - 8 2 1 - 2 - 5 2 - Lightermen 1 - 1 - - - - - - - - - - - 2 - 1 - - - - - 1 - Road Workers 2 - - - - - - - - - - - - - 2 - - - 1 - - - 1 - Miscellaneous. School Life 354 325 4 6 59 51 1 4 22 32 1 4 54 57 495 479 5 2 57 53 221 218 212 206 Church Officers - 1 - - 1 - - - 1 - - - - - 2 1 1 - - 1 1 - - - Stage, Music 1 -1 - - - 1 1 - - - - - - - 2 2 - - 1 - 1 2 - - Sick Attendants 1 1 - - - 1 - - - - - - - - 1 2 - - 1 - - 2 - - Soldiers and Sailors 2 - - - 1 - - - 1 - 1 - - - 5 - - - - - 5 - - - Butchers, Fishmongers 5 - - - 1 - 2 - 2 - - - - - 10 - - - 1 - 7 - 2 - Dairy Trade 3 - - - - - - - - - - - - - 3 - - - 1 - 1 - 1 - Woodyard Workers 3 3 - - - 3 - - - 1 - - - - 3 7 - - - 2 2 4 1 1 Shop Porters, Messengers 29 2 1 - 5 - 2 - 5 - - - 4 - 46 2 2 - 6 1 22 1 16 - Odd Jobs 5 - 1 - 1 - - - - - - - - - 7 - 3 - 2 - 1 - 1 - Others 4 - 1 - 4 - 1 - 5 1 - - - - 15 1 2 - - - 13 1 - - No occupation or occupation not stated 85 79 19 5 9 30 9 11 21 36 - 1 22 24 165 186 8 4 39 32 68 94 50 56 718 956 52 38 127 220 45 43 108 137 2 6 92 147 1144 1547 83 48 142 170 571 850 348 479 OTHER DISEASES. 49 CANCER. The deaths included under this loose but convenient heading attained a maximum of 185 in 1908, fell to 156 in 1909, and since that year have increased to 165 in 1911 and 175 in 1912. The mortality last year was 1.23 per 1,000, as compared with 1.17 in 1911 and an average of 119 during 1907.11, within which period fell the years with the two highest mortalities on record, viz., l.27 in 1908 and 1.24 in 1907. During the five years 1891.95 the mortality averaged 0.86 per 1,000, and during the last five years (1908.12), 1 18-an increase of nearly 37 per cent. The rates (Table 13) recorded in Kensington (133) and Westminster (1.38) exceeded that of the Borough, while all the rates of the individual Metropolitan districts in that Table exceeded that of the County (1.ll). In Marylebone only was last year's rate (118) less than the average (1.27), the Metropolitan rate (1.ll) being, however, very little more than the average (1.10). The Ward rates recorded last year ranged from 012 in Lancaster Gate, East, to 1.56 in Harrow Road. In about half the Wards last year's rate exceeded the average. "Cancer." Mortality Rates.-Wards. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1912 0.94 1.56 1.33 1.28 1.32 1.30 0.12 1.10 1911 0.99 1.33 1.48 1.11 1.20 0.87 0.75 1.09 1907.11 1.03 1.22 1.53 1.14 1.15 102 1.07 1.08 Table 31 (next page) gives full information as to sex and age, and the parts affected. OTHER DISEASES. Epidemic Influenza.-The mortality (Table 31, page 51) from this cause (0.16 per 1,000) was less than half the average for the preceding five years (0.34). The highest mortality last year (0.22) was recorded in Harrow Road and Lancaster Gate, West, Wards. Respiratory Diseases.-The mortality under this heading is based on the number of deaths from bronchitis and pneumonia (all forms). Last year's mortality (2.28) was practically equal to the average (2.26), but 0 40 above that recorded in 1911. The highest mortality recorded last year (3.54) was observed in Church Ward, where the mortality is always in excess. Alcoholism.- This includes both acute alcoholism (delirium tremens) and chronic forms, but not cirrhosis of the liver or alcoholic neuritis. Owing to changes in classification, the mortality rates recorded in 1911 and 1912 are not strictly comparable with the rates obtained in earlier years. Cirrhosis of the Liver.-The mortality from this cause (013) was slightly in excess of the average (0.11). The highest mortality last year (0.25) was recorded in Queen's Park and Lancaster Gate, East, Wards. Cirrhosis of the liver may be due to causes other than alcoholism. Of the 19 deaths entered under this heading, 16 (8 of each sex) were definitely ascribed to excessive drinking. The total number of deaths from alcoholism recorded during the year was 28, comprising 9 (3 males, 6 females), 1 from "alcoholism," 3 (1 male, 2 females) from "alcoholic neuritis," and 16 (8 of each sex) from "alcoholic cirrhosis of the liver." In 1911 the total number of deaths was 2512 from "alcoholism" and 13 from "alcoholic cirrhosis of the liver." The numbers given cannot, however, be accepted as the full tale of deaths due to drink. Suicides.-The mortality ascribed to this cause was 0.09 per 1,000, as compared with 0 08 in 1911 and an average of 010 during 1907.11. The rates given in Table 31 indicate that the number of deaths from suicide in the individual Wards fluctuate widely and irregularly. h 50 other diseases. (a) Glio.sarcoma. (b) Lympho.sarcoma. (c) Rodent Ulcer. (ci) Generalised Lympho.sarcoma. TABLE 30. 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 - - - - - - - - 2(a) - - - - - 2 - II. Organs of Special Sense. (a) Ear - - - - - 1 - - - - - - - - - 1 (b) Eye - 1 - - - - - - - - - - - - - 1 III. Respiratory System. (a) Larynx 2 1 1 - - - - - - - - - - - 3 1 (b) Lung - - - - - - - - - - - - - - 1 - IV. Circulatory System V. Digestive System. (a) Mouth. (i.) Tongue 2 - 1 - 1 - - - - - - - - - 4 - (ii.) Glands, &c. - - 1 - 1 - - - - - - - - - 2 - (b) Throat. (ii.) (Esophagus 8 4 3 - - - - - - - 1 1 - - 12 5 (c)Intestines. (i.) Stomach 7 13 2 - - - - - - - - 3 - - 11 16 (ii.) Bowel 7 6 1 2 - - - - - - 1 9 - - 9 10 (iii.) Rectum 7 4 2 - - - - - - - - - - - 10 4 (d) Organs. (i.) Liver 6 1 - d - - - - - - - - - - 6 4 (ii.) Pancreas 5 - - - - - - - - - - - - - 5 - (iii.) Spleen 1 - - - - - - - - - - - - - 1 - VI. Lymphatic System. (a) Head and Neck. (i.) Thyroid - 1 - - - - - - - - - 1 - - - 2 (b) Thorax. (i) Mediastinal Glands - - - - - - - - 1(b) - - - - - 1 - VII. Urinary System. (a) Kidney - 2 - - - - - - 2 - - - - - 2 2 (b) Bladder 2 - 1 1 - - - - - - - - - - 4 1 (c) Prostate 1 - - - - - - - - - - - - - 1 - VIII. Generative System. (a) Testicle, Ovary - 3 - - - - - - - - - - - - - 4 (b) Uterus - 12 - 2 - - - - - - - - - - - 14 (c) External Genitals - 1 - - - 1 - - - - - - - - - 2 (d) Breast 1 12 - 5 - - - 7 - - - 1 - - 1 25 IX. Osseous and Muscular System. (a) Head and ISeck - - - - - - - - - - 1 - - - 1 - (c) Thorax - - - - - - - - - - - 1 - - - 1 (d) Extremities (i.) Upper - 1 - - - - - - - - - - - - - 1 (ii.) Lower - - - - - - - - - 1 - - - - - 1 X. Cutaneous System (a) Head and Neck - - - - - - - - - - - 1(c) - 1 - XI. Insufficiently described 1 1 - - - - - - 1(d) - - - - - 2 1 Totals 50 63 12 13 9 2 - 7 7 1 7 10 1 - 79 96 Ages at Death. 0- - - - - - - - - 2 - - - - - 2 - 10- - - - - - - - - - - - - - - - - 15- - - - - - - - - 1 - - - - - 1 - 20- - - - - - - - - - - - - - - - - 25- - 1 - - - - - - - - - - - - - 1 35- 6 6 2 1 - 1 - 1 1 - - - - - 9 9 45- 12 11 - 3 1 - - - 3 1 3 1 - - 19 16 55- 18 18 7 3 1 - - 1 - - 1 4 - - 27 26 65 10 90 2 3 - 1 - 4 - - 3 3 - - 15 31 75- 4 7 1 3 - - - 1 - - - 2 1 - 6 13 INQUESTS. 51 TABLE 31. Disease. Year. Borough Queen's Park. Harrow Road. Maida Vale. West. bourne. Church. Lancaster Gate, Hyde Park. West. East. Epidemic Influenza 1912 0.16 0.19 0.22 0.14 0.17 0.12 0.22 - 0.16 1911 0.17 0.06 0.07 0.24 0.17 0.16 0.22 0.62 0.15 1907.11 0.34 0.25 0.34 0.35 0.32 0.33 0.28 0.42 0.41 Respiratory Diseases 1912 2.28 2.25 2.86 1.75 2.05 3.54 1.07 1.37 1.33 1911 1.88 1.86 1.85 1.58 2.17 2.76 1.30 0.50 1.48 1907.11 2.26 2.77 2.26 1.90 2.27 3.24 1.21 0.90 1.85 Alcoholism 1912 0.06 - 0.15 0.05 - 0.04 0.11 0.25 - 1911 0.08 - 0.07 0.24 0.04 0.12 0.1l - - 1907.11 0.07 0.05 0.03 0.11 0.09 0.10 0.04 0.10 0.04 Cirrhosis of the Liver 1912 0.13 0.25 0.04 0.24 0.08 0.12 0.11 0 .25 - 1911 0.10 0.06 0.11 0.14 0.21 0.12 - - - 1907.11 0.1l 0.08 0.13 0.12 0.18 0.09 0.04 0.05 0.07 Suicides ... 1912 0.09 0.25 - 0.05 0.04 0.12 0.22 0.12 0.31 1911 0.08 - 0.04 0.10 0.08 - - - 0.15 1907.11 0.10 008 0.06 0.12 0.11 0.09 0.13 0.07 0.12 INQUESTS. During the past year 215 inquests were held in the Borough, an increase of 31 above the total for 1911. Of last year's inquests 81 related to deaths of non-residents (68 in 1911), while 17 inquests were held outside the Borough with reference to deaths of residents (22 in 1911). TABLE 32. Inquests. Findings of Juries. 1912. 1911. 1907.11. m. f. M. f. m. f. Natural Causes 39 28 37 23 39 39 By Misadventure 4 4 6 5 6 3 Accidental Causes 26 21 25 19 27 21 Murder 1 2 1 - 1 0 Suicide 7 6 8 3 10 4 Neglect 3 3 1 3 1 2 "Open" 6 2 3 4 2 2 Totals 86 66 81 57 87 71 The corrected total number of deaths of residents registered after inquest was 152 last year, as compared with 138 in 1911 and 157 in 1910. Such deaths formed 8 6 per cent. of the corrected total number of deaths recorded in the year, or 1.5 per cent. more than in 1911 (7.1) and 0.4 per cent. above the average for 1907.11 (8.2). Table 32 shows the numbers returned under the different "findings" of the juries. A summary of the various accidents, &c., inquired into is given below. Deaths by Misadventure (8). Injury at birth, 1. Poisoning, 2 (trional, f., 43 ; strychnine, m., 28). Asphyxia while drunk, 1 (m., 54). Overlaid in bed, 2. Operations, 2 (m., 36., " fright " ; m., 34, anaesthesia). 52 DEATHS IN INSTITUTIONS. Deaths by Accident (47). Drowning, 7 (5 males, 2 females). Overlaid in bed, 4. Falls (various), 17. Road traffic, 13 (9 males, 4 females). Burns and scalds, 3 (1 male, 2 females). Other accidents, 3. Suicide (13). Poison, 4 (oxalic acid, 2 females : spirits of salts, 2 males). Drowning, 3 (1 male, 2 females). Coal.gas, 2 (1 each sex). Cut throat, 2 (males). Under train, 1 (female). Murder (3). Stabbing (f., 29), Strangulation (f., new.born), Not stated (f., 44)-one each. Neglect (6). Induced by alcoholism, 4 (2 males, 2 females). "Exposure" (m., 77), Self.neglect (f., 60)-one each. Open (8). Injuries to children, 3 (males; 2 new.born, 1 aged one week). Drowning, 5 (3 males, 2 females). DEATHS IN INSTITUTIONS. Among the 1,889 deaths registered within the Borough during the year there were 798 (42.2 per cent.) which occurred in local public institutions. Those 798 deaths included 349 (43.7 percent.) of non.residents. In 1911, 41.1 per cent. of the deaths in the Borough occurred in public institutions, 45.0 per cent. of the deceased persons being non.residents. Particulars as to the numbers dying in each local institution are given in Tables VII. and VIII., Appendix A, while the same details relating to deaths in outlying institutions will be found in Table IX. The corrected number of deaths of residents in institutions was 677 last year, as compared with 665 in 1911. The 677 deaths (equivalent to 38.2 per cent. of the corrected total) included 367 of males (417 per cent. of all deaths of males) and 310 of females (34'7 per cent.). In 1911 the percentage of deaths in institutions was 35 8, and the average for 1907.11, 347. Below will be found a tabular statement of the proportions (percentages) of deaths (fully corrected) in each ward of the Borough. 1912 38.9 33.1 34. 7 37.6 52 .2 28. 0 10.8 35 .5 1911 38.2 33.4 33 4 32.8 46.8 23.0 12.1 35.0 1907-11 35.3 31.9 29.6 33.3 45.2 20.7 21.5 28.6 The proportion of institutional deaths was slightly lower last year (10.8 per cent.) in Lancaster Gate, East, Ward than in 1911 (121 per cent.), and in Harrow Road (331 in 1912, 334 in 1911). In Lancaster Gate, East, Ward only was last year's figure (10.8) below the average for 1907.11 (21.5). The proportion observed in Church Ward last year (52.2 per cent.) was much the highest in the series and shows notable increase above the quinquennial average (45 2 per cent). Grouping the institutions into two classes, viz., rate.supported and voluntary, it is found that the deaths in the former formed 26'2 per cent. of all deaths, and in the latter 11 .7. The annual averages for 1907.11 were 23.4 and 10.8 per cent. respectively. From the analysis given below it will be seen that the proportion of deaths in lunatic asylums (2.5) was the only one below the average (2 6). The proportion (16) recorded in the hospitals of the Metropolitan Asylums Board is not strictly comparable with the proportion recorded during 1907.11, as admission now extends to several diseases not previously received. Rate-supported. Voluntary Poor Metropolitan Lunatic (excluding Nursing Law. Asylums Board. Asylums. Homes). 1912 221 16 2.5 117 1911 20.5 2.3 3 0 97 1907.11 19.4 1.4 2.6 10.8 Queen's Harrow Maida Park. Road Vale. Westbourne. Church. Lancaster Gate, Hyde West. East. Park. MORTALITY IN CHILDHOOD. 53 MORTALITY IN CHILDHOOD. At Ages under One Year. The deaths registered in the Borough during the past year included 326 of infants under one year of age, 57 of those infants being non.residents. The crude. mortality for the year was at the rate of 117 per 1,000 births registered within the Borough, as compared with 141 for 1911, and an annual average of 126 during the five years 1907.11. The figures for the four quarters are given below. The contrast between the rates recorded in the third quarters of 1911 and 1912 is striking, the difference being due to the very low mortality in the latter year from summer diarrhoea. Infantile Mortality Rates. Crude. Quarters. 1. 2. 3. 4. 1912 124 110 79 158 1911 137 109 199 118 1907.11 132 106 130 135 The nett mortality is calculated quarterly. It is the rate which has been used for many years past. Last year this rate varied from 80 per 1,000 births (registered within the Borough) in the third quarter of the year to 138 in the fourth. Last year's rate for the third quarter was the lowest summer rate on record. The rates given below-which cover the twenty.two years 1891.1912-are as strictly comparable as mortality rates can be expected to be. The only source of error in the comparison arises from the more complete reporting of outlying deaths (in the County) which has been secured of recent years. Last year's rates were notably lower than those recorded in 1911, except in the fourth quarter. The 1912 rates were slightly in excess of the quarterly averages for the five years 1906.10, except in the third quarter. The only unsatisfactory feature of the comparison between the 1912 rates and those recorded prior to 1906 is the high mortality (138) recorded in the fourth quarter. Infantile Mortality Rates. Nett. 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 1912 115 92 80 138 Since 1904 copies of the entries in the local Registers of Births have been received weekly,, and it has been possible to correct the numbers of births registered in the Borough by the exclusion of births of children to non.resident parents. Quarterly infantile mortality rates-for convenience designated "corrected" rates-have been taken out for the Borough and each of the Wards . By crude mortality is meant the ratio of deaths to births as registered in the Borough in each case, without any correction for births or deaths of non.residents in the Borough, or of residents in outlying districts. The nett mortality is obtained by correcting the deaths, but not the births, such corrections being based on the weekly returns, both those received from the local Registrars and those from Somerset House (confined to deaths in London and the immediate suburbs thereof). The corrected mortality is given by the use of the deaths-corrected as in the last case-and of the births of residents recorded locally. The fully corrected mortality is the rate based on the numbers of births and deaths of residents of the Borough, as determined by the use of the "transferred" births and deaths received at the end of the year from t Somerset House. The calculation of the four rates is necessary to preserve the continuity of the records. 54 MORTALITY IN CHILDHOOD. since 1905. In Table 33 the corrected rates for 1912 are compared with the average rates for 1907.11. In each of the first three quarters of the year the 1912 rate was below the average, notably so in the third quarter (rate 1912, 82; average 116-reduction 293 per cent.). In the fourth quarter last year's rate (141) exceeded the average (126) by 11 per cent. The Ward rates varied in an irregular manner, but too much significance should not be attached to the rates recorded in the Lancaster Gate Wards, where, owing to the very small numbers of births recorded, unit changes in the numbers of deaths at ages under one produce violent changes in the mortality. In the third quarter the mortality in Church Ward (198; average, 138) was the only exception to the general rule of reduced mortality. The fully corrected rate cannot be determined except at the close of the year, when the "transfers," births and deaths, are received from the Registrar-General. Such "transfers" were first received at the end of 1911. Previous to that year the Department made inquiries in outlying institutions with reference to births belonging to the Borough. Such inquiries were, of course, limited to the Metropolis, whereas the "transferred" births and deaths forwarded by the Registrar-General are drawn from all parts of England and Wales. Complete particulars of the transferred births were obtained last year for the first time. The fully corrected number of births recorded last year was 2,991, and of deaths under one year, 295, which figures give a mortality rate of 99, as compared with one of 129 in 1911, and an average of 109. It will be seen from Table 33 that the reduction in mortality (compared with the average for 1907.11) was considerably greater among females (rate, 1912, 78; average, 97-reduction, 19'5 per cent.) than among males (rate, 1912, 118; average, 120-reduction, 17 per cent.). In comparison with 1911 the reductions in mortality were, for males from 140 to 118 (a fall of 15.7 per cent.), and for females from 119 to 78 (a fall of 34 5 per cent.). In Lancaster Gate, West, Ward the mortality (persons) exceeded the average, while the male mortality recorded last year exceeded the averages in five Wards, and the females in one (Lancaster Gate, East). In Table 13 two infantile mortality rates for London and the districts adjacent to the Borough are given, the one the "nett" rate being obtained in the Department from the numbers of births and deaths published in the Quarterly Reports of the Registrar-General, the other the "corrected," from the Annual Summary issued by that Officer, advance proofs of some of the tables therefrom having been circulated while this report was in preparation. The corrected rates are believed to be the lowest on record, certainly so in the case of the Metropolis. The Paddington rate for last year exceeded all the other 1912 rates given in the Table. TABLE 33. Infantile Mortality. Quarters. . Year.† 1. 2. 3. 4. Males. Females. Persons. 1912. 1907-11 1912. 1907-11 1912. 1907-11 1912. 1907-11 1912. 1907-11 1912. 1907-11 1912. 1907-11 Borough 117 123 93 99 82 116 141 126 118 120 78 97 99 109 Queen's Park 115 110 69 73 64 99 160 127 112 105 72 88 93 97 Harrow Road 94 109 103 99 52 95 101 105 104 114 55 79 80 97 Maida Vale 140 125 111 77 51 110 134 103 120 108 74 88 98 98 Westbourne 116 131 75 96 54 159 150 105 83 121 102 108 92 114 Church 135 146 86 140 198 138 177 189 166 151 96 126 134 139 Lancaster Gate, West 158 90 143 98 - 28 62 81 121 70 32 69 78 69 East - 115 118 44 - 42 83 104 - 67 94 71 47 66 Hyde Park 105 104 129 100 91 130 143 122 131 109 71 88 94 100 * Calculated on corrected numbers of deaths (weekly returns) and births corrected by exclusion of non-residents only. † Calculated on fully corrected births and deaths. MORTALITY IN CHILDHOOD. 55 Hopeless Births.-This term is applied to children whose deaths are registered prior to, or simultaneously with, their deaths. The designation "hopeless" must be received with much reservation, as a consideration of the ages at and causes of death affords sufficient evidence that a fair proportion at least of such births are really far from "hopeless"; that is to say, that the deaths were due to causes usually regarded as preventable. The fact that no fewer than 92 such instances (at ages up to two months) were noted last year (101 in 1911) demonstrates the weakness of the present Registration Law, which allows so long an interval as six weeks in which to register a birth. The 92 "hopeless births" recorded last year included 53 of males and 39 of females, 4 of the deceased infants (1 male and 3 females) being non.resident. Six of the infants were illegitimate. Fourteen of the 92 deaths occurred in institutions, and inquests were held with respect to 3 others. An examination of Table 34 (page 58) shows that 67 of the 88 deaths of Borough children (37 of males, 30 of females) were directly associated with development and birth, 50 deaths (26 of males and 24 of females) occurring during the first week of life, 27 (13 of males and 14 of females) in the course of the first twenty.four hours. There were, on the other hand,. 21 deaths (15 of males and 6 of females) from causes which were apparently more or less independent of birth and development. Of these 21 deaths, 3 occurred in the first week of life. The difference in the age distribution of the two groups of causes is illustrated by expressing the numbers of deaths in these age.groups as percentages of the total deaths in each group of causes. Age. Under 1 week. 1-4 weeks. 4-8 weeks. Premature Birth, &c. 75 19 6 Diarrhœal Dis., &c. 14 81 5 The 88 deaths included in this tabulation formed 29.8 per cent. of the corrected total number of deaths under one year of age, the average proportion for the five years 1907.11 having been 31.3 per cent. Age.Group Mortalities.-In Table X., Appendix A, the numbers of deaths recorded at various ages during the past year are compared with the average annual numbers for the years 1907.11. The deaths during the first twenty.four hours of independent life numbered 37, and were equal to the average, there being, however, slight differences in the numbers of deaths of each sex. In the first week of life 69 infants died, one more than the average; in the first month. 113. or one less than the average. Corrected Mortality Rates. Males. Females. 1912. 1907.11. 1912. 1907.11. Under one month 45 66 42.90 2949 30.22 Aged 1-.3 months 2348 24.61 1303 23.65 Under three months 6914 67.51 42.52 53.87 Aged 3-6 „ 1826 22.08 15.08 16.42 " 6-9 " 17.61 17.66 8.23 13.79 " 9-12 " 13.04 13.24 12.34 13.14 The foregoing rates, derived from the fully corrected births and deaths (0.1 year), show considerable differences in the incidence of mortality during the past year upon the two sexes, that among males being always the higher. The mortality among males last year at ages under 3 months was above the average, owing to the heavier mortality at ages under one month. At other ages the mortality of males in 1912 was less than the average, but not much so On the other hand, the mortality among females at each age was below the average, and at some ages notably so, e.g., at ages 6.9 months. Causes of Death.-An examination of the figures in the same Table X. shows that there were fewer deaths of males last year from the "Diarrhœal" and "Tuberculous" Diseases 56 MORTALITY IN CHILDHOOD. (Groups II. and III.) than the annual averages for 1907.11, but more from the others. The most notable increase last year was in the number of deaths from bronchitis and pneumonia (40 deaths, average 30). The deaths of females included in each group were all below the averages. The mortality rates (see below) are to the same effect. For males, the greatest difference from the average is in the " Other Causes " (Group V.). Corrected Mortality Rates. Males. Females. 1912. 1907-11. 1912. 1907-11. I. " Common Infectious Diseases " 9.13 8.20 5.48 8.54 II. " Diarrhœal Diseases " 13.69 22.08 11.65 19.71 III. " Tuberculous Diseases " 3.26 4.41 342 3.94 IV. "Developmental Diseases" 4761 47.31 31.55 32.85 V. " Other Causes " 35.22 29.33 21.26 24.96 All other Causes 9.13 8.20 5.48 7.22 Premature Birth-The deaths returned as due to this cause numbered last year 58 (35 of males and 23 of females), or one more than the average. Ten of the infants (9 males and 1 female) were illegitimate children. Nine of these deaths occurred in twin-births (5 males and 4 females). At two of such births both infants died. In 23 instances the duration of gestation was recorded in the certificates, an analysis of such records being as follows:- Duration of Gestation. Males. Females. 6-7 months 3 1 7-8 , 8 6 8-9 „ 5 - Diarrhœa.-Last year 54 deaths at all ages were entered as due to "diarrhœa and enteritis," as compared with 151 in 1911, 52 in 1910, and 38 in 1909. The average annual number of deaths during the five years 1906.10 was 66. The mortality rate-per 1,000 persons of all ages-was 0.38 in 1912, 1.05 in 1911, and 0.36 in 1910, the average rate for 1906.10 having been 0.46. The following tabulation of quinquennial averages points to a lowering of the mortality from "diarrhœa," independent of the influence of the cooler summers of later years. Rates per 1,000 Persons of All Ages. Quinquennial Average. Maximum. Minimum. 1891-95 0.83 1.26 0.53 1896-1900 1.25 1.53 (1899) 0.89 1901-05 0.71 0.98 0.51 1906-10 0.46 0.92 0.27 (1909) That conclusion is not vitiated by the experience of 1911, as the mortality recorded in that year-quite an abnormal year as regards temperature and rainfall-was 105, against 1.53 recorded in 1899, when the meteorological data approximated to those of 1911. The mortality rates at all ages recorded last year in the Wards (see below) were in every case below the rates recorded in 1911, and, except in Church, Lancaster Gate, West and East, Wards, below the averages for 1906.10. "Diarrhœa." Mortality at all Ages. Queen's Park. Harrow Road. Maida Vale. West. bourne. Church. Lancaster Gate, Hyde Park. West. East. 1912 0.31 0.22 0.28 0.38 1.00 0.11 0.12 0.08 1911 1.18 1.07 0.67 1.41 1.72 0.33 0.37 0.54 1906-10 0.42 0.49 0.34 0.45 0.79 0.04 0.07 0.19 The chief interest in the ''diarrhœal diseases" lies in their incidence on children under 2 years of age, especially during the summer months. Of the 54 deaths recorded last year, 46 deaths occurred at ages under 2 years, 15 (5 of males and 10 of females) from "epidemic MORTALITY IN CHILDHOOD. 57 diarrhœa," and 31 (20 of males and 11 of females) from "zymotic enteritis." The deaths from the causes recorded in the Wards are tabulated below in comparison with the numbers for 1911 and the averages for 1906.10. The Ward mortality rates for the ages 0.2 cannot be given on this occasion. "Diakrhœa." Deaths at ages under 2 years. Queen's Park. Harrow Road. Maida Vale. West. bourne. Church. Lancaster Gate, Hyde Park. West. East. 1912 4 3 4 9 24 1 - 1 1911 15 26 12 28 42 2 2 7 1906-10 . 8 14 10 11 29 0 1 3 In Table 13 (page 18) the rates for diarrhoea (i.e., diarrhoea and enteritis) are based on the births, although the ages at death ranged from 0.2 years. The figures have been taken from the Annual Supplement of the Registrar-General. In Table 35 (page 59) the rates are based on the estimated numbers living at ages 0.2 years, which rates are to be preferred, as giving more exact measures of the local mortality from the disease. If the ratios of births to population and of deaths under one to births were constant, mortality rates for children aged under 2 years, calculated on the numbers of births, would be as useful as rates calculated on the estimated numbers living at those ages. Rates based on the births involve no preliminary work, which is distinctly a gain. The mortality recorded during the year was in each of the Cities and Boroughs-except the City of London itself-less than the rate for 1911 and the annual average for 1907.11. In the whole County last year's rate (7.34) was little more than one-quarter of the 1911 rate (28.57), and just over half the average (14.57). In the Western Districts last year's rate (6.75) was considerably less than one-quarter of the 1911 rate (28.36), and less than half the average (15.94). In Paddington the rate for 1911 (8.86) was the second highest of the rates recorded in the Western Districts, being exceeded only by that of Westminster (10 00). The local rate (8.86) was under one-third of the 1911 rate (27.56), but more than half the average (14.52). In the districts immediately adjacent to the Borough the lowest recorded rate (1912) was that of Hampstead (0.45), less than one.twentieth of the 1911 rate (9 70). The highest rate was that of Westminster (10.00), as compared with 16.53 in 1911 and an average of 10.78. In his Report for the third ("summer") quarter of last year the Registrar-General included a table (Table XVI., page 36) giving the mortality in London from "diarrhoea and enteritis" at all ages, whereby comparison can be made with previous years. Prior to 1907 the annual mortality determined from the deaths registered during the summer had never fallen below 1.43 per 1,000 persons of all ages (1879), and had risen as high as 5.43 (1899). In 1911 it was 4.29, and last year it fell to 0.66, the minimum. In 1907 and 1910 the mortality was also exceptionally low, viz., 073 and 0.84. The prevalence of "diarrhœa" depends (for some reason not definitely determined) so closely on weather conditions that the appended tabulation of "diarrhœal " mortality and certain meteorological elements will he of interest. Rainfall. Year. Mortality from "Diarrhœa" Earth Temperature, Mean (at 3. 2"). Amount. (Inches.) Days of. Years of Minimal Mortality. 1879 1.43 59.4 11.7 53 1907 0.73 59.2 35 32 1910 0.84 59.4 6.7 38 1912 0.66 60.1 7.6 42 Years of Maximal Mortality. 1897 4.66 62.2 6.3 43 1898 4.75 620 2.5 25 1899 5.43 64.0 4.3 29 1911 4.29 64.0 3.0 22 I 58 TABLE 34. Hopeless Births. 1912. Cause of Death. Days. Weeks. Months. Totals. 0- 1- 2- 3- 4- 5- 6- 1- 2 - 3- 1-2 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Premature Birth 9 9 4 4 2 3 - - 1 - - - - - 1 2 2 - - - 1 1 20 19 Congenital Defects 1 2 1 1 1 - 1 - - 1 - - - - - 1 - - - - 1 - 5 5 Atelectasis 1 2 1 - - - - - - - - - - - - - - - - - - - 3 2 Injury at Birth - 1 - - - - - - - - - - - - 1 - - - - - - - 2 2 Debility at Birth 2 - - - - - - - - 1 - - - - 1 - 1 1 - -• - - 4 2 Atrophy, Debility - - - - - - - - 1 - - - - - 1 - - - - - 1 - 3 - 13 14 6 5 3 3 1 - 3 2 - - - - 4 3 3 2 1 - 3 1 37 30 Diarrhœal Diseases - - - - - - - - - - - - - - - 1 2 - - 1 - 1 2 3 Respiratory Diseases - - - - - - - - - - - - - - 2 1 4 - 1 - - - 7 1 Convulsions - - - - - - - - - - 1 1 - - - - - - - - - - 1 1 Other Causes - 1 - - - - - - - - - - - - - - - - - - - - 5 1 Totals 13 15 6 5 3 3 1 - 3 2 1 1 - - 9 5 10 2 3 1 3 2 52 36 mortality in childhood. TABLE 35. Diarrhœa and Enteritis. Mortality Rates per 1,000 children aged 0-2 years. Cities and Boroughs. "Summer." Year. Cities and Boroughs. "Summer." Year. Cities and Boroughs. "Summer." Year. 1912. 1911. 190610.* 1912. 1911. 190610. 1912 1911. 190610. 1912. 1911. 190610. 1912. 1911. 190610. 1912. 1911. 190610. Paddington 18.12 50.44 51.78 8.86 27 .56 14.52 Holborn 8.17 74.51 39.05 5.42 22.55 13.78 Southwark 24.56 109.58 65.38 1129 32.50 18.15 Kensington 10.10 85.00 59.59 7.17 28.33 16 21 Finsbury 13.83 117.45 60.84 10.87 34.68 20 31 Bermondsey 28.52 104.27 61.70 10.54 32.81 17.50 Hammersmith 9 .85 113.10 58 17 5.94 37.04 15 50 City 22.53 86.31 24.76 1126 27.37 8.16 Lambeth 15.72 90.30 56.39 8.03 28.11 10.27 Fulham 33.5 131.39 76.67 4.61 30.22 20.15 Central Districts Battersea 11.64 90.24 52.21 6.61 29.49 12.28 12.98 104.96 52.69 9.56 31.07 1417 Chelsea 3.76 78.09 46.22 3.76 25.62 15.54 Wandsworth 10.20 68.27 43.87 5.90 24.10 10.49 Westminster 13.68 49.59 31.72 10.00 16.53 10.78 Camberwell 10.67 81.60 47.50 5.77 24.65 12.57 Wesiern Districts 9.77 88.01 56.63 6.75 28.36 15.94 Shoreditch 33.79 128.19 80.83 17.44 40.57 22.70 Depford 12.74 112.20 55.21 5.77 34.20 15.57 Greenwich 13.13 115.31 54.50 5.85 35.81 13.64 Bethnal Green 14.10 129.02 56.34 7.35 38.04 16.60 Lewisham 4.29 67.77 37.19 398 20.05 10.92 St. Marylebone 11.28 64.26 45.30 7.34 23.82 12.04 Stepney 23.13 108.62 6.19 11.06 33.67 18.89 Woolwich 2 40 70.10 44.21 2 .20 20.59 10.56 Poplar 18.96 136.93 81.97 8.27 38.31 22.94 Southern Districts 13.71 88.81 51.79 6.88 27.74 13.53 Hampstead 1.72 29.48 16.47 0.45 9.70 5.77 Eastern Districts 22.07 122.27 67.52 10.67 36.58 19.54 St. Pancras 4.07 75.98 40.93 4.19 22.55 10.27 Islington 10.19 85.51 33.71 6.56 26.60 9.69 County of London 13.49 92.25 54.38 7.34 28.57 14.57 Stoke Newington 2.32 57.77 34.85 1.73 16.13 875 Hackney 11.51 71.36 36.64 6.64 21.73 15.14 Northern Districts 83.6 73.51 40.94 5.53 22.60 10.98 mortality in childhood. . The method by which the deaths tabulated under the old system (1906.10) of the Registrar.General have been adjusted to the new (1911) tabulation is described in a paper, Diarrhoea in 1911, read before the Royal Society of Medicine (Epidemiological Section). See Proceedings of the Society, 1912, vol. v. (Epid. Sec.), pp. 99.148. 59 60 MORTALITY IN CHILDHOOD. Infantile mortality during the summer months is a question of high or low diarrhceal mortality. Owing to the exceptionally low mortality from that disorder-a feature which was observed in almost every part of the country-the total infantile mortality fell to a minimum-in England and Wales to 79 per 1,000 births, 61 per 1,000 below the annual average for the quarter (ten years 1902.11), and 122 less than the 1911 (3rd quarter) rate. In the County of London the infantile mortality was only 81 per 1,000 births. The "summer" rate of mortality from diarrhoea per 1,000 persons aged 0.2 years (see Table 35) was 13.49 in the County, just exceeding one.seventh of the 1911 rate (92'25), and less than one.quarter of the average (5438). In the Western Districts last year's rate (977) showed even greater differences, being less than one.ninth of the 1911 rate, and a trifle over one.sixth of the average (56 63). In the Eastern Districts, where the mortality in 1911 was highest, the reductions were notable-rate 1912, 22.07 ; 1911, 122.27; 1906.10, 67.52. The rate observed in the Borough (18T2) was the highest recorded in the Western Districts, the lowest being that of Fulham (3.35), which should be contrasted with the 1911 figure (13139). It would be an interesting study to examine the factors which produced such differences in the relative positions (order of magnitude) of the different cities and boroughs in the two years. Arranged in descending order of magnitude of mortality, the boroughs included in the Western Districts stood thus in 1911 and 1912:- 1911. 1912. Maximum. Fulham (131). Paddington (18). Hammersmith (113). Westminster (14). Kensington (85). Kensington (10). Chelsea (78). Hammersmith (10). Paddington (50). Chelsea (4). Minimum. Westminster (49). Fulham (3). Arrangements were made for obtaining information of attacks of diarrhoea on the lines described in previous reports. The "Diarrhœa Register" was opened on Monday, June 10th, and closed on Monday, November 25th, being open for a period of 24 weeks. During the greater part of that period "fly counts" were made three days a week. The reported cases included 146 in children under 2 years of age-89 being patients at St. Mary's Hospital, and 14 under the care of the District (Poor Law) Medical Officers. Thirty other cases were reported from various sources, both lay and medical, and 13 were traced by search through the admissions to the Infirmary. After making the necessary corrections for repeated reports, wrong addresses, &c., the corrected number of cases was reduced to 129. By including 25 deaths registered during the same period (the attacks not being known during life) as cases, a grand total of 154 attacks is obtained, as compared with 456 in 1911. The weekly distribution of (known) dates of onset and of death is given in Table 36. The contrast between the cases known in 1911 and 1912 is very striking, not merely from a numerical standpoint, but also as regards the distribution of the cases week by week. Last year in the three weeks ended August 10th, 37 attacks were recorded, and in the following three weeks (to August 31st), 11. In the two corresponding periods of 1911 the reported attacks numbered 115 and 147 respectively. The distributions by months of the cases of which the dates of onset were known were as follows:- June July August September October November Diagrams have been prepa 1912. 1911. 18 21 23 25 38 242 18 65 23 17 10 5 d for 1911 and 1912-on the same scale, but with a lower datum line for earth temperature, 45° instead of 55°-showing the weekly variations in 1912. MORTALITY IN CHILDHOOD. 61 earth temperature, rainfall, numbers of flies, cases and deaths. The data used in the construction of the diagrams are given in Table 37. The figures in that table examined in conjunction with the diagrams illustrate very clearly the great differences between the two years. . *"Dying" means cases known during life ending fatally. " Deaths" are attacks known to the Department through the registration of deaths only. Note.-Five of the deaths included in the above table are excluded from the diagram for last year, viz., 1 in week ending July 13th, 3 in that ending September 7th, and 1 in that ending November 16th. The deceased children's attacks did not begin in the Borough, and their deaths occurred in outlying institutions. The 129 reported cases included 65 in males and 64 in females. Among these cases there were 14 deaths, equal to a fatality of 10.8 per cent., as compared with 14.7 in 1911. Of the 65 cases in males 5 ended fatally (fatality 7 6 per cent.; 13.1 in 1911), and of the 64 in females 9 had a like ending (fatality 140 per cent.; 16.5 in 1911). The sex-age distribution of the cases is given in Table 38. Among the known cases there were 59 in children under nine months, and among the cases known after death 20. The distribution of these cases and deaths, according to the method of feeding, was as follows :- Cases reported. Known after death only. Breast 21with2deaths 4 Wholly Artificial27 „ 5 „ 12 Mixed Feeding 7 ,. 0 ,. Method not stated 4 „ 2 ,, 4 TABLE 36. Week ending Dates of Onset of Attack. Dates of Death. 1912. All Cases. All Deaths. 1912. Recovering. Dying.* Deaths. 1912. 1911. 1912. 1911. Cases Dying. Deaths. June 8 1 - - 1 2 - - - - 15 3 1 2 6 7 1 1 - 1 22 3 1 2 6 7 - 2 - - 29 3 2 - 5 5 2 2 - 2 July 6 3 - - 3 7 1 1 - 1 july 6 13 4 2 - 6 12 2 - 1 1 20 4 - - 4 16 - - - - 27 8 - 2 10 20 - 2 - - August 3 11 1 2 14 32 7 6 3 4 10 11 - 2 13 63 3 12 2 1 17 4 - - 4 64 3 16 2 1 24 3 - - 3 58 1 17 - 1 31 4 - - 4 25 1 15 - 1 September 7 4 - 1 5 28 4 6 1 3 14 1 1 1 3 16 - 12 - - 21 5 - - 5 13 3 8 2 1 28 3 1 1 5 8 1 5 - 1 October 5 8 - 1 9 3 - 9 - - 12 5 - 1 6 4 1 2 1 - 19 4 - - 4 5 1 3 - 1 26 3 - 1 4 5 2 2 - 2 November 2 4 - - 4 2 1 1 - 1 9 3 - - 3 1 2 3 1 1 16 2 - - 2 2 2 - 1 1 23 - - 1 1 - 1 - - 1 Not known 11 5 8 24 51 - - - - 1912 115 14 25 154 39 14 25 1911 330 57 69 456 126 57 69 62 MORTALITY IN CHILDHOOD. TABLE 37. Week of Inquiry. Cases. Deaths. Flies. Average per "Cemetery." Earth Temp. Weekly Mean at 4 ft. Air Temp. Weekly Mean. Total Rainfall. Inches. 1912. 1911. 1912. 1911. 1912. 1911. 1912. 1911. 1912. 1911. 1912. 1911. 1 1 2 6 º 56.17 º 58.73 º 5.42 62.3 0.99 0.00 2 6 7 1 1 11 19 56.73 58.76 5.81 5.70 0.39 0.66 3 6 7 - 2 15 28 58.11 68.98 61.7 59.2 0.65 0.94 4 5 5 2 2 20 26 59.95 58.72 60.2 57.5 0.30 0.50 5 3 7 1 1 18 38 59.73 59.80 58.7 65.6 0.36 - 6 6 12 1 - 30 54 60.75 62.16 67.0 65.2 0.20 - 7 4 16 - - 36 74 63.65 63.31 65.8 69.5 0.04 - 8 10 20 - 2 34 103 63.22 65.17 64.8 7.10 0.16 0.26 9 14 32 7 6 44 86 63.09 66.11 5.78 68.0 0.54 0.06 10 13 63 3 12 34 121 61.57 66.43 57.6 72.5 1.26 0.00 11 4 64 3 16 36 153 60.48 67.06 56.2 69.4 0.23 0.58 12 3 58 1 17 44 141 60.22 66.39 57.2 63.9 1.27 0.29 13 4 25 1 15 44 194 59.74 65.36 56.9 65.3 1.33 0.41 14 5 28 1 6 24 148 59.08 64.63 54.8 66.9 0.21 0.01 15 3 16 - 12 9 104 58.01 64.19 52.4 60.3 0.02 0.41 16 5 13 3 8 12 77 57.38 61.74 53.6 54.3 0.00 0.48 17 5 8 1 5 10 44 56.20 59.94 51.5 55.0 0.02 0.44 18 9 3 - 9 6 45 55.11 57.63 48.8 48.2 2.30 0.27 19 6 4 1 2 4 25 52.62 55.99 46.0 51.9 0.00 0.29 20 4 5 1 3 8 15 51.93 55.92 49.8 54.5 0.13 0.37 21 4 5 2 2 5 10 51.55 55.42 45.4 48.5 0.88 1.98 22 4 2 1 1 4 51.17 52.78 49.1 48.4 0.55 0.63 23 3 1 2 3 2 49.54 51.75 47.2 44.5 0.18 1.16 24 2 2 1 - 1 49.31 50.15 43.3 49.0 0.17 1.70 Correspondence of Weeks. 1912. 1911. 1912. 1911. Week 1 June 8th. June 10th. Week 14 Sept. 7th. Sept 9th. „ 5 July'6th. July 8th. „ 18 Oct. 5th. Oct. 7th. „ 9 Aug. 3rd. Aug. 5th. „ 22 Nov. 2nd. Nov. 4th. TABLE 38. "Diarrhœa" Ages. Known Cases. Deaths. Recovering. Dying. Total. 1912. 1911. 1912. 1911. 1912. 1911. 1912. 1911. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Months. 0—3 11 4 10 9 - 1 10 4 11 5 20 13 3 3 9 15 3—6 4 5 21 17 2 3 12 13 6 8 33 30 5 3 7 7 6—9 13 13 31 24 2 1 2 4 15 14 33 28 5 1 10 4 9—12 9 7 29 25 1 3 3 4 10 10 32 29 - - 1 9 Under 1 year 37 29 91 75 5 8 27 25 42 37 118 100 13 7 27 35 1—2 years 23 26 94 70 - 1 1 4 23 27 95 74 2 3 2 5 60 55 185 145 5 9 28 29 65 64 213 174 15 10 29 40 115 330 14 57 129 387 25 69 MORTALITY IN CHILDHOOD. 63 Mortality in Special Areas.-The mortality rates in the "Special Areas" recorded in 1912 arc given in Table 39 (page 05). Last year's rates were in excess of those recorded in 1911-and the annual averages-in "Hall Park," "Clarendon Street," and "Queen's Park" (the Estate). The reductions noted in "Amberley Road" and "Alfred Road" were considerable-23 and 24 per cent. respectively below the annual averages. The changes in the Ward rates of infantile mortality produced by excluding the rates observed in the "Special Areas" is shown in the appended statement. (See below.) It is rather remarkable that the mortality in the "Rest of Ward" in Queen's Park Ward should be so much lower than that on "the Estate." The " Rest" is, generally speaking, much below the "Estate" in the standard of general sanitation. The mortality in the "Special Areas" included in Church Ward plays an important part in raising the total mortality of the Ward. Infantile Mortality. Wards. I.- Queen's Park. III.-Maida Vale. IV.-Westbourne. V.-Church. 1912 . 1911. 1906.10. 1912. 1911. 1 906.10. 1912. 1911. 1906.10. 1912. 1911. 1906.10. Whole Ward 92 125 90 98 109 98 92 155 108 134 155 134 Special Areas 102 92 85 99 181 124 99 171 119 153 161 152 Rest of Ward 71 195 102 98 90 93 89 148 103 88 140 101 Reference to Table 39 will show which Areas are included in the different Wards. In Table 40 the combined mortality rates recorded in the six "Areas" from selected diseases are compared with those in the remainder of the Borough. The figures present two or three peculiarities. The low rate from whooping cough (101) in the "Combined Areas" as compared with one of 4.94 in the "Rest of Borough" suggests that some deaths in the "Combined Areas" from that disease were registered as due to other causes. Such view receives some support from the rates due to the respiratory diseases (24.21 in the "Combined Areas, 15.81 in the "Rest of Borough"). On the other hand, it should be stated that inquiries as to the presence of measles or whooping cough were made in connection with almost all deaths of young children certified as due to bronchitis, broncho-pneumonia, or pneumonia. The mortality from the "diarrhœal diseases" in the "Combined Areas" (25.22) was nearly four times as great as that in the " Rest of Borough." There was also a very great difference in the rates from the tuberculous diseases-more than 3 to 1. Among the deaths arising from premature births and developmental diseases, the only cause giving rise to a notably higher mortality in the "Combined Areas" was "atrophy and debility" (rate 4 03; "Rest of Borough" 2 96). The total mortality from these causes (premature birth and developmental diseases) was 3529 in the " Combined Areas" and 4098 in " Rest of Borough." The mortalities in the "Combined Areas" from convulsions (6.65) and suffocation, overlaid in bed (5.04), were much in excess of the rates recorded in the " Rest of Borough." It is noteworthy that the mortality from all causes at ages under one month in the "Combined Areas" (36.32) was below that of the "Rest of Borough" (38.04). At ages 3.6 and 6.9 months the "Area" rates were more than double those recorded in the "Rest." The opinion has been expressed before that the children in the "Areas" are not, on the whole, born less healthy than in the "Rest of Borough," but that they are the victims of their environment, and hence fail to survive the first year of life to the same extent as do the children in the other parts of the Borough. It is highly probable that maternal ignorance and habits are the most important factors of environment. It is thought that the figures here adduced support those views. Health Visiting.-The staff of Women Inspectors had very little time for the visiting of new.born infants, and only 332 infants were visited by them during the year for the special purpose of tendering advice and help to the mothers in the management of their infants. Much work was, doubtless, accomplished in that direction when visiting homes for other purposes, but no records of such work were kept. The recorded visits were much too late after the births of the children, a fact which accounts for the proportion reported to be breast.fed being so low as 64 MORTALITY IN CHILDHOOD. 68.6 per cent Fortunately, the School for Mothers" was able to supply some of the deficiency of the Department, 1,041 babies being seen by the Visitors attached to the "School." Among those babies the proportion being breast-fed at the first visit was 88 per cent. The total number of children visited was 1,373, as compared with 1,732 in 1911 (a decrease of nearly 21 per cent.), and 1,988 in 1910 (a decrease of 31 per cent.). From the information supplied by 253 mothers it appeared that they had had altogether 1,092 pregnancies, with 30 miscarriages and 40 still births. The average number of pregnancies was 4.3 (most of the families were "incomplete"), the maximum for any woman being 15, with 3 miscarriages and one still birth. The miscarriages averaged 27.4 per 1,000 pregnancies, and the still births 36 6. The children born alive numbered 1,042, of whom 143 (137 2 per 1,000) were dead at the time of the visit, such deaths occurring in 90 families, 35.5 per cent. of the whole number. From the information supplied the causes of death have been analysed as here given:- Measles, 8; whooping cough, 16; scarlet fever, 1; diphtheria, 8. Diarrhoeal diseases, 11. Premature birth, 9 ; congenital defects, 3; atrophy and debility, 23. Convulsions, 17 ; dentition, 4. Bronchitis and pneumonia, 16. Other (less defined) diseases, 14 ; cause not known, 13. Making every allowance for the mistakes by mothers, the preponderance of preventable mortality is very evident. The ages at death of the children ranged from 16 years down to a few months. Among the 1,373 children visited there were 98 deaths during the year, equal to a mortality of 71 per 1,000. The deaths among the unvisited children included-in addition to those born to parents to whom any visiting appeared to be unnecessary-in addition to 76 of children aged under ten days, 22 of children whose births had taken place beyond the Borough and not been reported; 10 not traced (wrong addresses); 26 "hopeless births," being births not known until the registration of death. Infant Consultations.-The "School for Mothers" maintained two centres throughout the year, each having its own medical staff. During the past year 2,903 attendances were made by 470 babies, as compared with 2,667 attendances by 452 babies in 1911. (See below.) Attendances at the Consultation centres:- No. of babies attending Total Consultations. Attendances. South Centre. Born in 1910 2 Do. 1911 124 Do. 1912 175 301 1,813 North Centre. Do. 1911 85 Do. 1912 84 169 1,090 The "School" provides dinners for expectant and nursing mothers, at very low rates (a few free). Last year 169 mothers attending the consultations had meals, and 77 others were sent by the Queen Charlotte's Lying.in Hospital. Milk is also supplied both for mothers and babies in the same way. Last year 1,170 milk rations were issued. The "School" also undertook the provision of the special preparations of milk for children ill with diarrhoea. The cooler summer rendered the demand for such preparations very small, and only 72 patients were supplied. (See below.) Patients attending- St. Marys Hospital 38 Children's Hospital (Paddington Green) 7 Paddington Provident Dispensary 1 Board of Guardians 19 Consultation Cases 7 mortality in childhood. 65 . Corrected rates. TABLE 40. Causes of Death and Mortality Rates. 1912. Cause of Death. Deaths. Infantile Mortality.* Combined Areas. Rest of Borough. Combined Areas. Rest of Borough. Not Certified - - - - Measles 4 7 4.03 3.45 Whooping Cough 1 10 1.01 4.94 Diarrhœa 8 3 8.07 1.48 Enteritis 17 10 17.15 4.94 Premature Birth 19 39 19.17 19.26 Congenital Defects 7 13 7.06 6 42 Injury at Birth 1 5 1.01 2.47 Want of Breast Milk - 3 - 1.48 Atrophy, Debility 4 6 4.03 2 96 Atelectasis 2 5 2.01 2.47 Debility at Birth 2 12 2.01 5.92 Tuberculous Diseases 6 4 6.05 1.97 Syphilis 3 3.02 Meningitis 3 2 3.02 0.98 Convulsions 6 5 6.05 2.47 Respiratory Diseases 24 32 24.21 15.81 Suffocation (Overlaid) 5 1 5.04 0.48 Other Causes 13 13 13.11 6.42 All Causes 125 170 126.13 83.99 Under 1 month 36 77 36 .32 38.04 Aged 1-3 months 25 30 25.22 14.82 Under 3 months 61 107 61.55 52.37 Aged 3- „ 29 21 29.26 10.37 6- „ 20 19 20.18 9.39 9. 15 23 1513 11.36 * Corrected rates. k TABLE 39. Infantile Mortality. Special Areas. Special Areas. 1912. Infantile Mortality.* Births. Deaths. 1912. 1911. 1907.11. Ward. V. " Hall Park " 115 13 113 104 105 "North Wharf" 105 15 142 213 147 " Clarendon Street " 256 45 175 168 172 IV. "Alfred Road" 151 15 99 171 131 III. " Amberley Road" 91 9 99 180 129 I. "Queen's Park" 273 28 102 92 89 66 MORTALITY IN CHILDHOOD. Mortality at Ages 1-5 Years. For some years records have been kept of the numbers of children surviving to each age from 1 to 5 years, such figures being obtained by deducting in each year the numbers dying at each age 0 to 4 years from the numbers born or surviving at those ages. By such method it was estimated that the survivors aged 1-5 years numbered 10,637 last year, and the deaths at those ages numbered 124. The mortality deduced from those figures was at the rate of 11.65 per 1,000, as compared with 13"56 in 1911, and an annual average for the five years 1907-11 of 14.52. Similar calculations—distinguishing the sexes—have been made, at each year of age for each Ward of the Borough, but those at ages 3 and 4 years do not go farther back than 1908 and 1909 respectively. The figures for the whole Borough are given below, and those for the Wards will be found in Table 41. Mortality Rates. Per 1,000 Estimated Living. Ages 1— 2— 3— 4—5 M. F. M. F. M. F. M. F. 1912 243 230 15 9 98 83 47 57 28 1907-11 36.4 27 6 12.5 12.4 67 7.6 6.4 6.0† * 1908-11. † 1909-11. It will be seen from the above figures that the last year's mortality rates of both sexes at ages 1-2 and 4-5 were below the averages, and that at ages 2-3 and 3-4 the mortality for 1912 in males was in excess of the average, that for females, below. The causes for the increases in the mortality among males appear to be (see Table 42) :—Age 2-3 years, respiratory diseases (rate 1912, 7.6; 1907-11, 3.5) ; age 3-4 years, other causes (rate 1912, 4.5; 1907-11, 11). Table 41. Mortality among Young Children. Age (Years) 1— 2— 3— 4—5 Sex Males. Females. Males. Females. Males. Females. Males. Females. Period 1912. 1907-11. 1912. 1907-11. 1912. 1907-11. 1912. 1907-11. 1912. 1908-11. 1912. 1908-11. 1912. 1909-11. 1912. 1909-11. Queen's Park 27.8 31.7 32.0 29.3 17.6 10.1 10.8 10.2 - 3.9 6.5 2.5 10.4 8.7 5.6 Harrow Road 12.3 23.7 15.7 17.5 26.8 8.4 6.6 9.4 6.6 4.-1 — 5.0 5.0 5.6 7.4 Maida Vale 28.7 46.3 - 19.8 5.9 11.1 5.1 9.7 5.9 8.1 11.6 14.9 — — 5 .5 1./ Westbourne 53.7 37.1 34.8 26.0 4.6 14.1 15.5 8.7 4. 6 7.0 5.0 9.5 — 8.5 4.5 3./ Church 23.6 54.0 31.5 50.1 24.3 18.0 12.7 25.0 13.1 13.6 3.7 9.5 10.4 7.2 6.8 9.2 Lancaster Gate, West — 18.3 43'.5 5.9 — — - 7.4 — — — — — 11.4 — — ,, ,, East 28.2 38.4 7.1 — 10.7 37.1 33.3 — — 7.6 58.4 — — 7.8 Hyde Park — 17.7 12.6 17.8 — 13.6 — 7.5 22.4 - 12.7 6.1 - 12.4 - 3.7 Illegitimate Children.—The deaths of 43 illegitimate children were registered in the Borough during the year, of whom 6 were the offspring of non-resident mothers. Seven deaths of these children were transferred from outlying districts. The corrected number of deaths was 44, 32 of males and 12 of females, 3 of the children (2 males and 1 female) dying at ages 1-2 years. The 41 deaths at ages under one year comprised 30 of males and 21 of females. In 1911 58 deaths occurred in the first year of life, the annual average for the five years 1907-11 being 37. The infantile mortality among these children was at the rate of 220 per 1,000 illegitimate births mortality in childhood. 67 in 1912, as compared with one of 337 in 1911 and an annual average (1907-11) of 243. The mortality among males was higher than in 1911 and than the quinquennial average ; that among females, lower than both. (See below.) The mortality rate among legitimate children was 90 last year—about 41 per cent, of that among the illegitimate. Mortality Rates. Per 1,000 births, corrected. Legitimate. Illegitimate. Males. Females. Persons. Males. Females. Persons. 1912 105 75 90 309 124 220 1911 131 103 117 273 415 337 1907-11 113 90 102 250 232 243 TABLE 42. Mortality among Young Children. Age 1— 2— 3— 4—5 Sex Males. Females. Males. Females. Males. Females. Males. Females. Period 1912. 1907-11. 1912. 1907-11. 1912. 1907-11. 1912. 1907-11. 1912. 1908-11. 1912. 1908-11. 1912. 1909-11. 1912. 1909-11. Measles 3.9 8.0 5.4 6.4 2.3 3.1 0.8 2.8 0.8 0.8 0.8 0.8 0.7 0.7 0.9 Scarlet Fever 0.8 - 0.1 — 0.3 0.8 0.6 0.8 1.0 — 0.7 — 0.5 0.7 Whooping Cough 1.6 4.9 3.1 2.2 0.8 1.0 0.8 0.7 — 0.3 1.6 2.0 — 0.7 0.9 Diphtheria 0.8 0.4 — 0.4 — 0.6 — 1.0 — 1.1 — 1.1 — 0.7 0.7 0.2 Diarrhoea 8.1 2. 9 3.1 2.7 — 0.1 — 0.3 — — — 0.2 0.7 — — — Enteritis - 0.3 - 0.7 0.2 — 0.2 — — — 0.3 — — — — Congenital Malformations 0.8 o.1 0.8 0.8 0.2 — — — — — 0.2 — — — — Atrophy and Debility 0.1 — — — — — — — — — — — Tuberculous Diseases 4.7 4.2 0.8 1.9 1.5 1.8 2.3 1.8 0.8 1.6 1.6 0.4 — 1.4 0.7 0.7 Syphilis - - - o.1 - - - - - - - - - - - - Rickets 0.8 0.4 0.6 — — — — — — — — — — — — Convulsions - 0.8 - 0.7 - — — 0.4 — — — 0.2 — 0.2 — — Dentition - 0.1 0.3 0.8 0.3 — o.1 — — — — — — — — Respiratory Diseases 5.5 9.6 6.9 7.9 7.6 3.5 — 2.6 0.8 1.1 0.8 0.4 1.4 0.7 1.4 0.7 Accidents and Yiolence - 0.5 1.5 o.1 0.8 0.3 0.8 0.4 — 0.2 — 0.7 1.4 — — — Other Causes 3.1 3.1 1.5 3.2 1.5 1.0 — 1.0 45 11 — 0.8 — 1.4 — 1.4 All Causes 24.3 36.4 23.0 27.6 15.9 12.5 9.8 12.4 8.3 6.7 4.7 7.6 5.7 6.4 2.8 6.0 The causes of death and the occupations of the mothers of the 44 dead illegitimate children are set out below. Causes of Death. 0— 1—2 M. F. M. F. Measles 1 1 Whooping Cough 1 1 Syphilis 1 Convulsions 1 Bronchitis 1 1 Pneumonia 3 Gastritis 2 Diarrhœa 5 4 Premature Birth 9 1 Developmental Diseases 5 3 1 Congenital Defects 1 Injury at Birth 1 Accident and Violence 1 Totals 30 11 2 1 Inquests held, 3. Occupations of Mothers. Servants— 26 " Domestic General Servant 2 Servant" 8 Kitchen Maid 2 Housemaid 4 Chambermaid 2 Cook 3 Lady's Maid 1 Nurse, N. Housekeeper 1 Governess 3 Others— 15 Charwoman 5 Shop Assistant 2 Dressmaker 3 Waitress 2 Laundress 2 Factory Worker 1 Not Stated— 3 68 ADMINISTRATIVE WORK. ADMINISTRATIVE WORK. The usual summary of the principal items of work accomplished by the District Inspectors during the year is given in Table 43 (page 80). Further summaries will be found in the Appendix A, Tables XI. (Food, Housing and Miscellaneous Matters) and XII. (Workshop Supervision). Prevention of Infectious Disease.—The District Inspectors made 1,976 calls last year in connection with the notified diseases, other than puerperal fever and pulmonary tuberculosis, as compared with 1,812 in 1911, 2,098 in 1910, and 3,010 in 1909. The total number of patients removed to hospital was 523 last year, 435 in 1911, 406 in 1910, and 797 in 1909. The number of patients treated at home increased from 24 in 1911 to 53 last year, the greater part of the increase being due to the number of " carrier cases " of diphtheria certified as "diphtheria " but not removed to hospital. In connection with puerperal fever and pulmonary tuberculosis, both of which are scheduled for notification, and the non-notified infectious diseases, the Women Inspectors made 4,441 calls during the year, as compared with 5,520 in 1911, 5,181 in 1910, and 3,315 in 1909. The reduction in the number of calls recorded last year was mainly due to diminished prevalence of diarrhoea, mpasles, and whooping cough. There was a very large increase in the number of visits for pulmonary tuberculosis (consumption). A tabular statement of the calls made during the past four years in connection with the more important diseases is given below. 1912. 1911. 1910. 1909. 1912. 1911. 1910. 1909. Measles 1,425 1,846 3,051 1,005 Chickenpox 557 545 461 285 Whooping Cough 395 793 430 479 Diarrhoea 433 1,369 410 546 Consumption 1,608 959 807 991 Puerperal Fever 23 8 22 9 The total number of calls made annually by the Women Inspectors has increased from 6,325 in 1909 to 7,279 in 1910, 7,332 in 1911, and 10,627 last year. The differences between the numbers given in this and the preceding paragraph represent work in connection with ringworm, scabies, "sore throats," and other illnesses for which no satisfactory explanation is forthcoming, and dirty and verminous conditions in school children. The demand for such visitation stands at a fairly uniformly high level throughout the year, as appears from the figures given below. Quarters. 1. 2. 3. 4. 1912 2,644 2,837 2,322 2,824 1911 2,028 1,863 2,133 1,308 1910 1,878 2,425 1,493 1,483 1909 1,539 1,905 1,488 1,393 Preventive work which deals with the health of school children offers the best prospect of permanent good, and such work is steadily increasing in amount. The extension of notification to all forms of tuberculosis will involve a great increase in the amount of administrative work of the Department, work which it is believed can be best done by the Women Inspectors. The demands on the time of the present staff of two women in connection with disease has necessitated the abandonment by them of other work, such as the supervision of workshops where women are employed and the visiting of the mothers of new-born children, the former being carried out by the Workshop Inspector (male) and the latter by the School for Mothers. During the year 107 patients suffering from measles (74), whooping cough (32), and chicken-pox (1) were removed to the Hospitals of the Metropolitan Asylums Board, being 5 in excess of the number admitted in 1911, the first year that the Hospitals received such cases. The "warning letters" sent to midwives and others having the care of patients suffering from puerperal fever numbered 6 last year, as compared with 4 in 1911 and 1910 and 1 in 1909. ADMINISTRATIVE WORK. 69 Disinfection.—No changes have to be recorded. Rooms are sprayed with formalin by the Staff of the Department, and bedding, &c., dealt with by the Council's contractors, Messrs. Armfield & Sons, Limited. Last year 2,274 rooms were sprayed, a smaller number than in 1911 (2,857) or 1910 (2,941), but over 16 per cent, more than in 1909 (2,351). Disinfection was effected privately in 25 instances last year, as compared with 10 in 1911 and 25 in 1910. In each instance a certificate as to the efficiency of the processes adopted is required from the medical attendant. Disinfection of rooms occupied by persons suffering from pulmonary tuberculosis is becoming more frequent, the rooms so treated numbering 171 in 1910, 226 in 1911, and 318 last year. The bedding, clothes, &c., treated by the contractors weighed just over 50 tons last year, practically the same as in the previous year, while the expenditure on the work amounted to £1,092, as compared with £1,013 in 1911. The fact that only 7 complaints were received during the year may be taken as evidence of the general public being satisfied with the manner m which the contractors do their work. No evidence has been forthcoming indicative of any failure of the processes of disinfection. Water Supply.—The number of notices of discontinuance of supply received from the Metropolitan Water Board in pursuance of Section 48 of the Public Health (London) Act, 1891, fluctuates from year to year in an irregular manner which it is difficult to understand. In 1909, 84 notices were received ; in 1910, 74 ; in 1911, 41 ; and last year, 62. The causes for the discontinuance of supply during the past year were reported to have been— Premises vacated 33 (30) Demolition of premises 1 (0) Defective water fittings 1 (1) Error made in order 1 (I) Non-payment of rates 26 (3). The italic figures in parentheses are the corresponding numbers for 1911. The inhabited houses from which the supply was cut off numbered 28, one house being vacated in consequence of the discontinuance of supply, while to 15 others the supply was restored at once without notice being served by the Department. In the remaining 12 instances notices had to be served requiring the restoration of the supply, summonses being necessary in 3 cases to secure compliance with the notices. The most unsatisfactory feature of the records of the past year is the increase in the practice of cutting off the water supply for the non-payment of the water rate. In 1909, 5 such cases were recorded; in 1910, 10; in 1911, 3; and last year the number rose to 26. Attention has been called to the undesirableness of this practice in previous reports, and it is much to be desired that the Water Board should exercise its alternative powers of recovery of unpaid rates by civil process in preference to taking a step which results in the creation of a "nuisance" and renders an inhabited house "unfit for human habitation." The increase in the annual totals just quoted points to a reversion by the Board to a practice which the old water companies were abandoning at the time that they were abolished. The attention of the Water Board was specially called (through the Council's Representative on the Board) to three cases of houses occupied by more than one family where the water had been cut off for non-payment of rates—apparently in contravention of Section 4 of the Water Companies (Regulation of Powers) Act, 1887. That section prohibits the cutting off of water for non-payment of the water rate from a house when the "owner" and not the occupier of the house is responsible for the rate. In each of the cases here referred to the person who was liable for the rate was the "owner" within the meaning of the Public Health (London) Act, 1891. Unfortunately the Act of 1887 does not give any definition of the term "owner." The Board contended that in none of the cases mentioned had there been any infringement of the Act of 1887. 70 ADMINISTRATIVE WORK. Mortuaries.—During the year 287 bodies were deposited at the Mortuaries, being 5 more than in 1911. (See below.) Paddington Kensal Green. Road. Number of bodies deposited 283 (277) 4 (5) Coroners' cases 227 (188) 4 (5) Awaiting burial:— Infectious 3 (2) (—) Non-infectious 53 (87) (—) P.M. examinations 99 (76) 2 (4) The italic figures in parentheses are the numbers for 1911. The re-arrangement of the Coroners' districts, alluded to in the last report, was effected on July 4th of last year, since which date all inquests within the Borough have been held at the Coroner's Court, Manor Place, and all bodies taken to the Paddington Green Mortuary. Schools.—On the receipt of information, whether by notification or otherwise, of the occurrence of a case of an infectious disease, a notice is left with each family residing in the house prohibiting the attendance at school of children residing in the house, the date at which attendance may be resumed being included in the notice. Notices of a somewhat similar character are sent to head teachers of the schools concerned. Last year 562 such notices were sent to the schools in connection with the notified diseases, and 2,116 with reference to other diseases—measles, whooping cough, and chickenpox. In 1911 the notices numbered 451 and 2,595, and in 1910, 789 and 1,893. No account has been kept of notices and letters sent with reference to ringworm, scabies, &c. Table 44 (page 81) shows the distribution of cases and contacts (non-attending patients) in the schools within the Borough. Scarlet fever was not unduly prevalent in any of the schools, but some temporary anxiety was caused by the sequence of cases at Campbell Street, St. Matthew's, and St. Saviour's Schools. There was an excessive prevalence of diphtheria at Beethoven Street, Droop Street, Harrow Road, Kilburn Lane, and St. Saviour's Schools. The numbers at three of those schools, viz., Beethoven Street, Droop Street, and Kilburn Lane, were swollen by the " carrier " cases which were certified as diphtheria. Taking the two groups of schools, viz., Provided and Non-provided, scarlet fever was slightly more prevalent in the latter last year, and diphtheria considerably so in the former. Whooping cough was more prevalent in the Provided than in the Non-provided schools, but doubts exist as to the disease being so regularly reported in the latter schools as in the former. The exclusions and closures which were required during the year are set out below. "Unprotected" Children Excluded: Measles. Exclusion, School Class-room. Date of. Duration of. (.Infants' Department). Destorough St. (R.C.) All <5 Jan. 18 15 days ,, ,, ,, June 27 8 „ St. Stephen „ Jan. 18 15 „ Feb. 8 21 „ Bayswater Jewish E Jan. 25 8 „ „ „ Feb. 9 21 „ Wilberforce C Jan. 7 14 „ A Feb. 21 9 „ ,, B „ ,, 16 ,, AH „ 26 11 „ C F July 1 11 „ St. Paul J Feb. 12 11 „ „ ,, Mar. 1 14 „ ,, ,, Nov. 29 15 „ „ H Dec. 2 11 „ Exclusion, School Class-room. Date of. Duration of. (Infants' Department). Droop Street E, F and G Feb. 15 14 days „ D Mar. 7 15 „ „ G „ 22 Until Easter Holidays ,, E „ 25 „ D May 9 Until Whitsun Holidays „ C „ 20 11 days E „ 23 22 „ „ G June 14 7 „ „ Nov. 12 17 „ „ E „ ,, 17 ,, F „ 21 8 „ ADMINISTRATIVE WORK. 71 "Unprotected" Children Excluded: Measles. Exclusion, School Class-room. Date of. Duration of. (Infants' Department). Droop Street D & Hall Dec. 3 10 days „ A and B „ 9 Until Christmas Holidays ,, G ,, St. Augustine F Mar. 4 18 „ „ All < 5 May 29 9 „ „ E June 7 7 „ .1 „ ,, 26 16 „ F „ '28 14 „ „ All < 5 July 5 Until Summer Holidays ,, ,, D m 8 ,, „ E Dec. 2 4 days „ F „ 12 Until Christmas Holidays ,, B „ 16 „ Kilburn Lane E Mar. 12 14 days D May 8 2 „ ,, E June 27 8 „ „ C July 8 Until Summer Holidays F1 „ 18 „ F Dec. 2 11 days Beethoven Street D Mar. 29 6 „ „ B Apr. 29 4 „ „ All < 5 May 2 29 „ D „ 13 Until Whitsun Holidays „ „ June 6 13 days C „ 17 4 „ „ „ July 5 7 „ All <5 „ 1 11 „ Harrow Road D Mar. 29 6 „ „ E Apr. 29 4 „ D May 6 22 „ „ E „ 23 Until Whitsun Holidays „ E „ 31 14 days „ F June 7 14 „ Exclusion, A School Class-room. Date of. Duration of. (Infants' Department). Harrow Road G June 13 8 days St. Peter D May 7 Until Whitsun Holidays " All „ 9 „ A and D June 17 4 days St. Luke G May 8 16 „ ,, H ,, 9 Until Whitsun Holidays „ G June 5 13 days St. Matthew C „ 11 10 „ „ B and C „ 21 14 „ ,, B July 9 Until Summer Holidays ,, All < 5 Dec. 16 Until Christmas Holidays Essendine Road A June 17 4 days „ C Oct. 28 11 „ „ B Nov. 8 14 „ F „ 18 11 „ „ D, E & H „ 22 7 „ C, E & I Dec. 3 10 „ G „ 2 4 „ B „ 12 Until Christmas Holidays A „ 16 St. Michael C June 17 4 days „ B July 1 11 „ „ A and C Dec. 5 8 „ Westmoreland Road C July 1 11 „ (R.C.) Campbell Street C „ 19 Until Summer Holidays „ B and D Oct. 18 14 days „ C „ 17 15 „ All „ 21 18 „ St. Saviour C Dec. 2 4 „ „ All „ 6 Until Christmas Holidays There were no closures of classes or departments on account of diphtheria or scarlet fever. "M.O. 38"—prohibiting the re-admission of children excluded or absent from school owing to "sore throats"—was issued in connection with cases of diphtheria with respect to Beethoven Street Mixed Department on January 9th. Droop Street Girls' ,, ,, „ 23rd. St. Luke's Infants' ,, „ May 10th. St. Stephen's „ „ „ June 1st. "M.O. 117"—reporting exclusions by the School Medical Officer on account of symptoms suspicious of scarlet fever—was issued with respect to Kilburn Lane Infants On September 30th 2 children. ,, ,, „ October 8th 1 child. ,, Girls ,, h 1 ,, ,, Infants „ „ 14th 2 children. St. Matthew's Girls „ November 13th 1 child. Kilburn Lane Infants „ „ 21st 1 „ 72 ADMINISTRATIVE WORK. In addition to the scholars ("P.A.") included in Table 44, as excluded from school onaccount of the infectious diseases specified in that Table, 1,085 other children were reported to the Department during the year as either absent or excluded from school for various reasons. (See Table 45, page 83.) In 1911 only 329 absentees from such causes were reported. Each child so excluded being visited, some many times, the addition to the work of the Department following on the increase from 329 to 1,085 was very considerable. " Sore Throaty*—This term is used in school reports in a very loose way and undoubtedly includes a variety of disorders. Hence cases of "sore throat" are regarded by the Department with more or less suspicion, depending on the amount and character of the recognised infectious disease for the time being prevailing in the Borough. Last year 377 children were reported by the schools as absent or excluded for "sore throat," and 21 other cases were discovered by the Staff of the Department. In 1911 only 82 cases came to the knowledge of the Department. The distribution of the 398 known cases, quâ time, shows, as might be expected, a heavy incidence between January and April, but throughout the year the cases were considerably more numerous than in 1911. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. 82 90 98 30 10 18 14 3 6 18 23 6 - (2) (6) (1) (1) (18) (6) (-) (12) (13) (13) (10) The italic figures in parentheses are the numbers reported in 1911. The figures in Table 45 show the cases reported by the school teachers were principally among the children in the Girls' and Infants' Departments of the Provided Schools. The Nonprovided Schools appear to have been singularly free. From Beethoven Street, Droop Street, and Kilburn Lane Schools the largest numbers were reported—numbers far in excess of the records of any other schools. Droop Street School.—On January 11th a letter was received from the Head Teacher of the Girls' Department calling attention to a number of obscure cases of "sore throat" which had occurred in Room "F" just before the end of the previous school term, but of which no report had been sent at the time to the Department. A list of 14 children was received a day or two later, and among the children included in that list were three from whose throats and/or noses the Klebs-Loffler bacillus (the true diphtheria bacillus) was obtained, and one, the Hoffman (pseudo-diphtheria bacillus). The School Medical Officer of the County was informed of the correspondence, and he caused special inspections of the School to be made on January 17th (Girls' Department), February 7th (Girls' and Infants'), and March 11th (all Departments). On each occasion a number of children were selected for swabbing owing to the unhealthy state of their noses and/or throats. The children "swabbed" totalled 44, "positive" † cultures being obtained from 6, and "suspicious "J from 10. In addition, 16 children were swabbed out of school, most of them at the Town Hall, 10 yielding "positive" and 6 "suspicious" cultures. Beethoven Street School.—In the same week as the preceding School, numerous cases were reported from this School. Special inspections were made on January 21st and February 7th (Mixed Department), February 26th (Infants'), and March 19th (Mixed). Swabs were taken from 57 children at those inspections, 5 "positive" and 12 "suspicious" cultures being obtained. Further, 10 swabs were taken outside the school, 6 yielding "positive" and 4 "suspicious" results. * It has been found impossible to make room for the whole of the information collected relating to the cases of "sore throat." Sufficient material is available for a statement running to many pages. † A " positive" culture is one in which the Klebs-LÖffler bacillus is identified. † A "suspicious" culture is one in which the Hoffman (pseudo-diphtheria) bacillus is found. ADMINISTRATIVE WORK. 73 Kilburn Lane School.—At the end of January cases began to be reported somewhat freely, but a special inspection was not thought necessary until March 4th, when the Girls' and Infants' Departments were inspected and 16 children swabbed, 1 yielding a "positive" and 11 "suspicious" cultures. Fourteen children were swabbed out of school, equal numbers of "positive " and "suspicious" cultures being obtained. The routine followed was to exclude all children from whom either " positive" or "suspicious" cultures were obtained and all members of their families. No child absent from school on account of "sore throat" between January and April was allowed to return without a medical certificate based on bacteriological examination. All the children yielding "suspicious" cultures remained at home, and their parents were urged to obtain medical treatment for them. Where "positive" cultures were obtained a letter was addressed to the medical attendant informing him of the bacteriological examination. A good many of these children were sent to the Asylums Board's hospitals, some of the children having definite attacks of clinical diphtheria while there. The total number of school children swabbed* during the year on account of "sore throat" was— In Schools130, yielding 13 "positive" and 36 "suspicious" cultures. Out of School 49, „ 26 „ „ 23 „ „ In all, 212 swabs were taken from children attending at the Town Hall. The proportions (per cent, of children examined) of "positive" and "suspicious" results obtained from swabs taken in and out of school were strikingly different. Of the swabs taken at school inspections— 10 per cent, gave "positive" cultures, and 27.6 „ „ "suspicious" ,, Of the swabs taken out of school— 53.0 per cent, gave "positive" cultures, and 46.9 „ ,, "suspicious" „ Of the total 212 swabs taken at the Town Hall during the year— 15 0 per cent, gave "positive" cultures, and 23.2 „ „ "suspicious" „ The swabs taken at school inspections were obtained by the use of a platinum loop, which was used to stroke the tonsils and nostrils, inoculation of the nutrient medium following at once. In the swabbing done out of school swabs of sterilised cotton-wool were used to mop over the tonsils, throat, and nose. Ringworm.— During the year 287 reports were received, the actual cases numbering 290. In 1911 the known cases numbered 188. Of the cases known last year 71 were still under observation at the end of the year. The largest number of cases from any individual school was reported from Essendine Road (62), but, in proportion to the number of children, more cases were found in St. Luke. Of the 219 cases reported and completed during the year, 135 were attenders at Provided Schools (equal to approximately 13 per 1,000 children in such schools), 79 at Non-Provided (under 1 per 1,000). It is somewhat difficult to explain so striking a difference. Twenty-five of the children resided outside the Borough. There was very little difference in the distribution according to sex—112 boys, 107 girls. Taking 8 years as the usual age for transfer from the infants' to one of the senior departments, it would appear that in the junior departments—or at the younger ages of life—boys are more subject to the disease than * A special inspection, with swabbing, was made of the children in the Infants' Department of St. Saviour's School on October 23rd. All the cultures proved "negative," but as the numbers of children inspected and swabbed are not known the figures have not been included in the totals given above. l 74 ADMINISTRATIVE WORK. girls, and that in the senior departments girls are more frequently attacked than boys. The figures for last year (completed cases) were— Infants' Departments. Boys' and Girls' Departments. Ages 4—8 years. Ages 8—14 years. Boys 72 35 Girls 51 49 The seasonal distribution is apt to be disturbed by the varying activities of school nurses and others—by varying zealousness in searching out the cases. Of the 219 completed cases, 100 were reported in the first four months of the year (January-April), 75 in the second (May-August — the summer holidays prevent the discovery of cases), and 115 in the last four (SeptemberDecember). In 47 cases the presence of the microsporon was determined by the School Medical Officer. Specimens were taken from 53 children for microscopical examinations during the year by the Medical Officer of Health of the Borough. Ringworm, from an educational point of view, is almost the most worrying of all the ailments to which children are subject. Parents as a rule refuse to regard the treatment of the disease seriously, and waste much time in trying all sorts of quaint remedies and nostrums. It is not infrequent for a child to be out of school—to the detriment of education, manners, and morals—for upwards of a year. Among the 73 cases carried over to 1913, there were 2 reported in 1911 and 16 of over six months' duration (including 2 of nine months' and 1 of eleven). The only treatment which can be absolutely relied upon is that by the X-rays when properly applied, and the best method of use is that which produces complete depilation at one sitting. Even with that treatment the child is likely to be out of school for something over three months, as although cured of the ringworm as soon as depilation commences—usually within three weeks of the application of the X-rays—there is a natural inclination to keep the child from school until the head is covered with hair. Scabies.—The schools reported 46 cases last year—30 in 1911—and 3 other cases were known to the Department. The largest number of cases reported from any school was 12 (Campbell Street), all in the girls' department. An analysis based on the dates on which the cases were reported and the class rooms indicates that the disease was introduced into the school on two separate occasions, and spread from child to child. Six of the 46 children resided outside the Borough. The distribution of the cases during the year was fairly uniform, and as regards sex, equal. Boys in the junior departments seem to be more prone to the disease, while the opposite may be noted in the senior. Infants' Departments. Boys' and Girls' Departments. Ages 4—8 years. Ages 8—14 years. Boys 13 9 Girls 7 20 The patients' beds and personal clothing were stoved whenever consent could be obtained. Vermin.—Last year was the first occasion of systematic reporting throughout the year of children found in schools in a dirty and/or verminous condition. During the year 319 children were reported, of whom 13 could not be traced through wrong addresses being given, and 16 resided outside the Borough. The total number of children visited for this trouble was 365 in 231 families. In three streets, viz., Cirencester, Clarendon, and Woodchester, 165 children in 95 families came under supervision. Thirty-nine children in 33 families were reported on two occasions during 1912, 13 children in 10 families on three, and 7 children in 4 families on four. With the lack of accommodation for personal cleanliness in the children's homes, and the absence of any "cleansing station," very little can be done by the Department in the direction of stamping out verminous conditions, except when the tenements are found to be infested or the beds in the like condition. To deal with the latter the consent of the owner has to be obtained, but that is usually not very difficult. Furniture, such as stuffed chairs, sofas, &c., ADMINISTRATIVE WORK. 75 present greater difficulties, as they cannot be stoved, and are rarely worth re-making—a somewhat expensive process. A very considerable number of the children reported during the year were sent by the School Authority to the Marylebone Cleansing Station. The provision of a similar station in this Borough will be a great benefit, and will do much to get rid of verminous conditions, as all members of the children's families will be able to go to a local station. Where, as last year, special arrangements are made by the Education Authority, only school children are dealt with. Usually, if the school children are dirty and/or verminous, other members of the family will be found in the like condition. Internotification.—Information with reference to cases of infectious disease is constantly being exchanged between the Departments of this and adjacent Boroughs, principally with reference to non-resident school attcnders. The "inward" exchanges as regards this Borough related to 010 cases last year, as compared with 384 in 1911 and 180 in 1910. The increase in the number of cases is sufficient proof of the utility of the system. An analysis of the cases thus reported during the last two years follows here. Disease. Scarlet Fever Diphtheria Enteric Fever Measles Whooping Cough Chickenpox Other Sickness Vermin Kensington. 45 (15) 15 (14) (-) 26 (19) 8 (5) 8 (7) 23 (34) (-) 125 (94) wli.t.esdkn. 61 (20) 46 (29) (-) 148 (91) 15 (32) 45 (22) 145 (67) 3 (7) 463 (268) Hampstead. 3 (1) 1(2) (-) (-) (-) (-) (-) 4(3) Marylebone. 9 (16) 5(-) (-) l(-) l(-) 2 (3) (-) 18 (19) The figures in parentheses are the numbers for 1911. With a view to reducing the amount of clerical work the "outward" exchanges to Willesdcn have been made by using "inquiry cards" supplied by the Medical Officer of Health of that District.* No records were kept of the exchanges forwarded to that District, while to the other Districts mentioned above 267 exchanges were forwarded. Bacteriological Wokk.—The specimens received last year numbered 656, and were more than double the number dealt with in 1911 (316). In 1909, 177 specimens were received, and in 1910, 200. The great increase in the number received last year was due to the large number of diphtheria swabs (530, as compared with 210 in 1911) and of specimens of sputum (112 ; 51 in 1911). Full particulars of the specimens received will be found below. Bacteriological Work. Diphtheria. Enteric Fever. Tuberculosis. Cerebro-spinal Meningitis. Other. Pos. Neg. Hoffman. Pos. Neg. ? Pos. Neg. Pos. Neg. Pos. Neg. Primary 73 304 45 3 7 1 30 78 - 2 - - Repeats 21 58 29 — 1 — 2 2 — — — — Totals 94 362 74 3 8 1 32 80 — 2 — — 1912 530 12 112 2 - 1911 210 34 51 1 20 1910 114 26 54 1 5 1909 122 27 26 2 - * This year that system has been agreed upon with the Medical Officer of Health of Kensington. 76 ADMINISTRATIVE WORK. The results of the examinations were "positive" (i.e., the suspected micro-organism was demonstrated) in 129 instances, equal to 19-6 per cent, of the specimens examined. The proportions of "positive" results obtained in previous years were 322 per cent, in 1911, and 245 in 1910. The proportion of "positive" results was smaller in the case of each of the three principal diseases. (See below.) Proportion (per cent.) of "Positive" Results. Diphtheria. Enteric Fever. Tuberculosis. 1912 17.7 47.0 28.4 1911 28.5 25.0 31.3 Two hundred and forty-six swabs were taken by the Medical Officer of Health at the Town Hall, 212 from school children (15.0 percent, "positive") and 34 from milk carriers and their families (11.7 "positive"). The following comparison is of some interest:— Of 284 swabs sent to the Town Hall, 20.4 per cent, were "positive" and 5.9 per cent. "suspicious." Of 246 swabs taken at the Town Hall, 14 6 per cent, were "positive" and 23.l per cent. "suspicious." Hair specimens were taken at the Town Hall from 53 children last year for microscopical examination, the examinations being made by the Medical Officer of Health. In 1911 hair specimens were taken from 39 children. In one child sent to the Children's Hospital by the Medical Officer of Health, the " large spore " variety of microsporon was identified, a rare form in this country. Offensive Refuse.— Trade Refuse.— Much of the refuse produced by fishmongers, greengrocers, and others is removed by the Borough Council, and the extension of such removal to all forms of trade refuse is to be desired. Two complaints were received during the year with reference to refuse in fishmongers' shops, none relating to refuse in the course of removal. Mamire.—The customary notices requiring the removal of manure on three fixed days in each week were posted throughout the Borough during the month of May. Only 2 complaints with reference to accumulations of manure were received last year, as compared with 11 during the preceding year. One complaint was received of rotten green-stuff deposited in a manure receptacle. House Refuse.—One collection from each house each week remains the rule in the Borough, but the Medical Officer of Health is authorised to arrange for more frequent removals when he deems it necesary. (Resolution of the Works Committee of October 27th, 1908.) Acting under that authority, a second collection was made each week from 59 premises last year (93 in 1911). Moreover, the Council arranges for two collections in each week being made from boarding houses and flat properties during the summer months. Last year a similar arrangement was sanctioned for the whole of the Clarendon Street Area. The complaints relating to irregularity or infrequency of removal of house refuse which came to the Department last year numbered 112 (144 in 1911), of which 38 had been addressed to the Department direct, the remainder being forwarded by the Borough Surveyor. Trade Nuisatices.—In addition to the two relating to fishmongers' shops which have been mentioned above, one other complaint relating to feathers escaping from a bedding factory was received. Drainage Work.—The number of house drains relaid during the year decreases annually, having fallen from 605 in 1908 to 554, 287, 227, and 223 in each successive year. The patent process for making defective drains watertight was used on 98 drains last year, as compared with 50 in the preceding. At 66 houses the drains when tested in the course of preliminary inspections were found to be watertight. In 1911 the number so tested (with a like result) was 64 ; in 1910, 70 ; and in 1909, 97. An important Report on "Intercepting Traps" was issued during the autumn by the Departmental Committee appointed by the President of the Local Government Board in ADMINISTRATIVE WORK. 77 1908. The Committee came to the conclusion that intercepting traps could be dispensed with, with advantage, as a rule, but the Committee were not prepared to recommend the complete abolition of all such traps. So long as the existing drainage by-laws are in force the question does not call for consideration. Deposit of Drainage Plans, &c.—The reduction in the number of drains relaid during the year did not involve any decrease in the number of plans and specifications received, which numbered 302 last year, as compared with 348 in 1911, and 303 in 1910. The correspondence in connection with the deposit of plans involved the despatch of 705 letters (708 in 1911). There were no summonses issued with reference to plans during 1912, three being taken out in 1911, and one in 1910. By the by-law made by the County Council on July 11th, 1911, the builder who carries out the work of reconstructing drainage, &c., is made liable for the deposit of the required plans, but without affecting the liability of the owner to submit the same. Sewer Connections.—In consequence of complaints of rats gaining access to the houses in Westbourne Park Road, a complete inspection of the house connections to the sewers in Porchester Road and Westbourne Park Road was made by direction of the Public Health Committee. The examination included all the connections in Porchester Road and those of the premises in Westbourne Park Road falling into the sewer which discharges into the Porchester Road sewer. Fifty-three connections were found to be defective, 12 from roadside gullies and 41 from houses. In addition, 9 unused or abandoned "sewer eyes " were found. Such defects as could be dealt with by the Council were referred to the Works Committee. In other instances Orders were made by the Council under Section 85 of the Metropolis Management Act, 1855, requiring owners to make good the defects discovered. The required works were all but completed at the close of the year. Combined Drainage.—Eleven systems examined last year were found to be defective and were reconstructed by the Council, viz.:— 30, Bishop's Road. 440, Harrow Road and 56, Chippenham Mews. 20 and 22, Connaught Street. 98 and 100, Ledbury Road. 3, 4 and 5, Green Street. 68, 70 and 72, Porchester Terrace. 114, Great Western Road. 82 and 84, Richmond Road. Yard in rear of 108 and 114, Great Western 20 and 21, Sunderland Terrace. Road and 19, Aldridge Road Villas. 36 and 38, Westbourne Park Road. A combined system of drainage at 37, Cambridge Terrace was reconstructed by the owner, but was afterwards acknowledged to be a "sewer" repairable by the Council, and the cost of the work refunded. New systems were sanctioned (by Order under Sec. 74 of the Metropolis Management Act, 1855) at— 13, 14 and 15, Blomfield Place. 93 and 95, Herries Street. 1 to 6, Goldney Place. 2 and 3, Salem Road. Queen's Park Estate.—The whole of the combined drainage on the estate has been relaid since 1901, as well as the single drains of all premises, except the unoccupied shops on the south side of the Harrow Road. Complaints of rats were received during the past year from two houses in Droop Street and four in Third Avenue. In the former case the rats had made their way through unused sewer eyes, and in the latter rat burrows and nests were found under the footway. The sewer eyes were bricked up and the nests destroyed, and since those works were executed no rats have been seen on the premises. A further complaint of rats was received from a house in Oliphant Street, the animals having made their way through a defective roadside gully. After the completion of the necessary repairs, the nuisance was stopped. 78 ADMINISTRATIVE WORK. Settlements in the back additions of eight houses made works of underpinning necessary, such works involving the reconstruction of parts of the house drains. At 24 houses damp-proof courses were inserted in the main walls to meet complaints of dampness. Inspections of 31 houses were required after infectious illnesses, the drains being chemically tested—the only test which can be used by reason of the design of the drains—at 38 houses, but no defects were disclosed by the tests. Offensive Sewers.— In July last reports were submitted to the Public Health Committee with reference to complaints received as to smells from sewers in Bravington Road and in the railway tunnel between Bishop's Road and Edgware Road Stations. In the former case the smells appeared to come from the "sand pits" at the roadside, the ventilators in the middle of the roadway, and the covers to the side entrances and manholes. The Committee were advised that properly trapped gully pots should be substituted for the "sand pits," that the covers to the side entrances and manholes should be effectively jointed, and that the road ventilators should be closed during the hot weather. The recommendations were forwarded to the Borough Surveyor by the Committee. In the early part of July there was a temporary blockage of the Praed Street sewer owing to a landslip in the course of some work to the sewer. The diversion of the sewage into the sewer in South Wharf Road (under the railway tunnel) caused a great nuisance in the tunnels and stations. It was ascertained that the manholes to the sewer in the permanent way were covered with loose boards and shingle. The Metropolitan Railway Co. were communicated with and proper covers were subsequently fixed to all the manholes. Near the end of the same month it became necessary to run off the water in the Canal Basin owing to its putrid condition, alleged to have been caused by the taking in of water from the Hendon storage ponds. It was currently reported, but denied by the Regent's Canal Co., that that water was polluted with sewage. The more probable cause of the pollution was the decomposition of fresh-water algae. The "stop" was put down at 6 p.m., and up to 9 o'clock no smell was noticed in the neighbourhood of the canal. After that hour up to midnight—and probably later—there was an overpowering sewage smell in South Wharf Road, Praed Street, Edgware Road and Harrow Road, to the eastward of the Basin, and in the railway tunnels and stations. In the course of nineteen years no such occurrence has been previously observed. In the hottest summers, when the water in the Basin has been putrid, no smells such as those experienced in July last have been reported. It is believed that the cause of the numerous wellfounded and (in some cases) strongly worded complaints was not the water from the canal, but the sediment in the South Wharf Road sewer, a conclusion which appears to be supported by the occurrences in the earlier part of the month just recorded. Smoke Prevention.—Twenty (20) premises were kept under special observation last year (see list), the total time given to this work amounting to 821/3 hours, 29 being so watched in 1911 and 20 in 1910. The total time during which "black smoke" was observed last year was 32 minutes, as compared with 22, 40, and 50 minutes in the three preceding years. Other shades (degrees of density) of smoke were observed during 471/3 hours, as compared with 1135/8, 38, and 81¼ in 1911, 1910, and 1909. 1912. " Black Smoke" 32 minutes "Smoke" 471/3 hours. No Smoke 34½ hours. Five complaints of smoke, not necessarily "black smoke," were received during the year, with reference to factories (2), fried fish shops (1), and bakehouses (2). ADMINISTRATIVE WORK. 79 Smoke Observations. Address. Business. Chimney Shaft of 29, Beethoven Street Factory Laundry Steam Boiler — Bishop's Road Bridge G.W.R. Refreshment Rooms — 8, Bristol Gardens Bakehouse Bakers' Ovens 17, Clifton Road ,, ,, ,, 8, Eastbourne Terrace Dining Club Steam Boiler and Stove 189, Edgware Road Bakehouse Bakers' Ovens 347 51, „ „ ,, ,, ,, 401, „ ,, ,, ,, Goods Yard Hydraulic Works Steam Boilers 163, Harrow Road Dairy *> >» 78-80, Kensal Road ,, ,, ,, 5-10, North Wharf Refuse Destroying Destructor — Praed Street G.W.R. Hotel Kitchen Stove 25, Queen's Road Restaurant ,, ,, 29-33, St. Petersburgh Place Dairy Steam Boilers — Saltram Crescent Technical School ,, ,, 120, Sliirland Road Dairy ,, ,, 195, „ „ Bakehouse Bakers' Ovens 3, Spring Street ,, ,, ,, 33, Westbourne Grove General Stores Steam Boilers Canals, Wharves.—The wharves were regularly inspected at least once each week throughout the year. Two complaints were received during the past year—one of smells near the Edgware Road tunnel and the other of dead dogs floating on the water. The Basin was emptied at Easter, the bottom cleaned out (some 500 tons of mud and refuse being collected and barged away), and upwards of 600 square yards of new concrete laid down. The greatest amount of deposit was found alongside the Council's wharves in North Wharf Road. In July the water in the Basin became very green and offensive, and the Basin was emptied and swept out at the end of the month. Canal Boats.—The annual report of the Examining Officer for the year 1912 was submitted to the Council in February of this year, and subsequently forwarded to the Local Government Board. Forty-nine (49) breaches of the Acts were discovered during the year in the course of 237 inspections. At the end of 1911 there were 158 boats on the Register; six new boats were added, and one old one removed during 1912. Of the 163 boats on the Register at the close of the year only some 60 are seen from time to time in the Borough. Summonses were issued last year (against the master and owner) with reference to a certificate of registration which referred to a boat called "Edith," but was produced by the master of a boat called "Lily and Emily." It appeared that the boat's name had been changed, but inasmuch as the Inspector could not adduce evidence connecting the name of " Lily and Emily" with that of" Edith," the Magistrate dismissed the summons against the owner, without costs, that against the master being thereupon withdrawn. The boat was subsequently re-registered under the new name. Of the two summonses taken out in 1911, and reported as pending at the end of that year, one was not served, as the infringement of the Acts was remedied by the time the boat could be found, and the other resulted in the defendant being fined 5s. with 2s. costs, or in default one day's imprisonment. Defendant elected to undergo the imprisonment, which meant sitting in the Court until its rising at the end of the day's work. Two cases of infectious illnesses (1 each of erysipelas and membranous croup) were reported last year among the occupiers of the boats and 5 deaths, viz.:— 3 males -aged 45 (cancer), 6 (drowning), and 8/12 (improper feeding), and 2 females—aged 84 (old age) and 46 (drowning). 80 TABLE 43. Report of the Work of the District Inspectors during the Year 1912. 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, &c. Soil-pipes, New Provided. Soil-pipes Repaired. Soil-pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New Provided. Cisterns, Cleansed, Repaired, &c. New Provided. Repaired, &c. Drains Cleared, Flushed, &c. HousesorRooms 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. administrative work. First 136 5 471 — 3,746 35 36 21 68 35 106 26 8 19 9 6 1 25 6 2 10 52 1 1 18 13 — 1 Second 149 13 474 — 3,974 50 19 30 41 25 86 27 6 10 10 1 — 17 14 1 11 17 — 1 10 12 — 1 - Third 183 1 474 — 3,358 16 20 £0 17 12 53 9 5 3 9 2 2 8 11 2 18 13 — 1 11 3 — 2 - Fourth 117 16 435 — 3,906 29 18 27 45 10 123 26 4 5 14 1 3 4 15 6 20 14 13 — 16 11 — 4 — Year 585 35 1,854 — 14,984 130 93 98 171 82 368 88 23 37 42 10 6 54 46 11 59 96 14 3 55 39 — 8 — workshop supervision. 81 TABLE 44. Places Provided. 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 7 1 2 6 11 40 20 22 21 15 Beethoven Street 1,161 L3 4 27 (1) 4 89 46 17 3 12 5 Campbell Street 972 11 (1) 12 (1) 4 3 50 56 14 8 17 15 Droop Street 1,100 13 4 20 (2) 2 113 64 23 7 35 23 Essendine Road 1,821 5 3 4 (1) 7 100 60 (3) 68 (2) 24 (1) 12 11 Harrow Road (Moberly) 1,586 10 (2) 5 13 (2) 4 56 (2) 52 (1) 21 9 5 7 Kilburn Lane 1,323 9 (2) 4(1) 16 (6) 4 23 (4) 10 (2) 6 (1) 3 (1) 6 (1) 2(1) Royal Oak (Temporary) 270 - - - - - 11 4 - 2 - Kensal Wo. (Tuberculosis) 90 - — 1 — 1 2 — - — — Totals 9,933 68 (5) 33 (2) 87 (12) 30 443 (6) 341 (6) 173 (3) 76 (2) 110 (1) 78 (1) Ratios per 1,000 6.8 3.3 8.7 3.0 44.5 34.3 17.4 7.6 6 11.0 0 78.1 Non-Provided— Bayswater Jewish 396 3 (1) 3(2) — 1(1) 15 (6) 5 2 - 12 (4) 3 Desborough St. (R C.) 523 1 3 4 1 21 (1) 25 9 4 — 2 Holy Trinity 410 5 4 3 1 — 2 38 14 14 7 St. Augustine 1,171 5 (5) 5(4) 5 (5) 1(1) 78 (59) 22 (6) 24 (19) 1 2 (2) 2(2) St. James 332 4 1 — — 1 1 3 2 - St. John, Kilburn Lane 190 1 — 1 (1) 4(3) 2 (1) 1 9 (4) 1 1 (1) — St. John, Titchborne St. 474 3 (1) 2 2 2 5 3 14 3 2 - St. Luke 424 8 (4) 2 5 (2) 4(1) 35 (17) 9 (2) — 2 (2) 5 (3) 2 St. Mary, Paddington Green 170 - 1 — — — 2 1 1 — 1 St. MaryandSt. Michael (R.C.) 246 1 (1) 1 — 1 1 (1) — — — St. Mary Magdalene 490 1 - 1 — — 9 1 6 4 St. Matthew 410 4 2 3 1 21 8 11 (1) 8 10 2 St. Michael, Star Street 460 4 (1) 1 — — 41 27 8 5 3 2 St. Paul 405 1 — 4 — 30 27 7 2 2 7 St. Peter 545 7 (1) 5 3 1 51 (2) 33 10 4 3 6 St. Saviour 512 8 4 10 1 32 13 7 5 4 3 St. Stephen 791 8 (2) 4 (1) 6 4 22 (1) 16 7 5 — 5 Wilberforce 842 7 (2) 1 3 (2) 1 39 (12) 23 (2) 4 (2) 3 (1) 5 (2) 3 Totals 8,791 71 (18) 39 (7) 50 (10) 23 (6) 394 (100) 226 10) 155 (26) 64 (3) 65 (12) 49 (2) Ratios per 1,000 8.0 4.4 5.6 2.6 44.8 25 .7 17 .6 7 .2 7.3 6.5 " p.A."—Patient attending school —"Scholars." "P.n.A."—Patient not attending school—"Contacts." Non-resident cases shown in parentheses and are included in the figures preceding them. WORKSHOP SUPERVISION. Registration.—At the close of 1911 there were 1,508 workshop premises on the Registers of the Department. Last year 194 premises were removed from and 200 added to the Registers, the effective entries at the close of the year numbering 1,514. The premises on the Registers included 123 factories, 32 of them being laundries, 1,024 workshops, 20 domestic workshops, 40 workplaces, and 307 premises in the occupation of "single workers," 263 of whom are on the Registers 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 46, the numbers of outworkers being shown by the figures in parentheses. Notices relating to 65 new workshops were received from the Home Office during the year, 53 of which were already on the Registers of the Department. 82 WORKSHOP SUPERVISION. Home Work.—Employers of outworkers (home workers) forwarded 63 lists in February of last year and 54 in August, or a total of 117 lists, as compared with 125 in 1911, 154 in 1910, and 177 in 1909. The addresses included in those lists numbered 544, of which 350 were forwarded to other districts, where the home workers resided, in accordance with the Act. From other districts 386 addresses (in 61 lists) of home workers residing in the Borough were received, the number in 1911 having been 297 in 44 lists. The numbers of lists received from other districts last year are shown below. City of London 9 (10) Acton 2 (0) Ealing 1 (0) City of Westminster 9 (4) Battersea 2 (0) Greenwich 1 (0) Kensington 7 (9) Bethnal Green 2 (2) Hammersmith 1 (3) Hampstead 4 (3) Chelsea 2 (2) Hendon 1 (0) St. Marylebone 4 (4) Holborn 2 (2) St. Pancras 1 (1) Willesden 4 (4) Islington 2 (0) Stepney 1 (0) Finsbury 3 (4) Shoreditch 2 (1) Note.—The italic figures in parentheses relate to 1911. At the close of the year the registers contained 385 effective entries, being 4 more than at the end of the previous year. The 385 entries comprised 125 "homes" which ranked as workshops and 260 "homes" of single workers, the corresponding numbers for 1911 being 108 and 273 respectively. Inspections.—The inspections of all descriptions numbered 3,076 last year (3,043 in 1911), 298 being first inspections (362 in 1911). Ninety-one (91) workrooms were measured, or 29 more than in the previous year. The numbers of nuisances discovered and dealt with in the course of inspection are given in Table 47 (page 85.) Six (6) notices of all kinds were served during the year, as against 15 in 1911. Complaints.—The Home Office forwarded 15 complaints, 8 less than in 1911, the matters complained of being :— Dirty conditions 1 (9) Overcrowding 2 (5) Other matters 12 (9) Deficient Ventilation.—The numbers of workshops reported to be insufficiently ventilated in 1906 and each succeeding year are 3, 4, 6, 0, 0, 0, and 3. The workshop (laundry) specially mentioned in the report for 1911 (page 81) was closed during last year, and the business transferred to Kensington. One underground workshop in Westbourne Grove was closed on account of the deficient ventilation, and special ventilation was provided at a large underground workplace in Queen's Road. Sanitary Conveniences.—These continue to be kept in a fairly satisfactory condition, but the number of defects reported indicates some carelessness in maintenance. Water-closet Accommodation. 1902. 1903. 1908. 1909. 1910. 1911. 1912. Insufficient 9 2 2 - 3 - - Not separately provided 33 4 2 2 2 3 1 Badly placed 18 13 3 1 8 3 1 Un ventilated 8 - - - - - - Defective 29 23 11 13 16 13 39 Bakehouses.—At the end of 1911 70 bakehouses were on the register, 16 of which were "level" and 54 "underground." Last year 4 underground bakehouses went out of use ; at the end of the year there were 66 bakehouses on the register, 16 "level" and 50 "underground." 1 he 66 bakehouses left on the register included 13 factory bakehouses (5 "level" and 8 "underground"). Eighty-four (84) inspections were made during the year of the factory bakehouses, and 430 of the workshop. TABLE 45. Provided— Places Provided. "Sore Throat." Ringworm. Scabies. Other Complaints. Vermin. T. B. (Mx.) G. I. T. B. Mx.) G I. T. B. (Mx. G. I. T. B. (Mx.) G. I. T. B. (Mx.) G. I. Amberley Road 1,610 6 2 3 1 22 5 6 11 5 1 4 — — — - — 138 43 45 50 Beethoven Street 1,161 51 26 25 30 ~13~ 17 5 2 3 — — — 2 — 2 Campbell Street 972 6 2 2 2 16 2 6 8 12 — 11 1 3 — 1 2 5 1 2 2 Droop Street 1,100 79 7 61 11 11 4 — 7 — — — — 1 1 - — — — - — Essendine Road 1,821 23 1 1 21 62 6 14 44 9 1 — 8 1 — - 1 1 — 1 — Harrow Road (Moberly) 1,586 35 33 1 12 9 4 2 3 2 1 — 1 3 1 - 2 2 — 2 — Kilburn Lane 1,323 133 27 52 54 14 2 4 8 — — — — 8 3 2 3 3 — 3 Royal Oak (Temporary) 270 - - - - 1 - - 1 - - - - - - - - 31 - - 31 Kensal House (Tuberculosis) 90 - - - - - - - - - - - - - - - - - A D M I N I S T R A T I V E W O R K Totals 9,933 333 61 (26) 120 126 167 23 (13) 32 99 33 3 (2) 15 13 16 5 (0) 3 8 178 44 (0) 50 88 Ratios per 1,000 Non-provided— 33.5 168 3.3 1.6 179 Bayswater Jewish 396 — — — — 5 — 4 1 — - — — 3 — 2 1 7 2 3 2 Desborough Street (R.C.) 523 — — — — 9 3 3 3 — - — — 1 1 — — 30 9 12 9 Holy Trinity 410 1 1 — — 9 1 1 7 — - — — — — — — 1 1 — St. Augustine 1,171 — — — — 15 2 1 12 - - - - - - - - 14 — 11 3 St. James 332 — — — — 3 — - 3 — - — — — — — — — — - — St. John, Kilburn Lane 190 - - - 2 — 2 — St. John, Titchborne Street 474 — — — — 5 2 3 — - - - - - - — — 4 2 - 2 424 - - - - 17 - 6 11 — - — — 6 1 — 5 — — - — St. Mary, Paddington Green 170 — - — — 4 3 - — 1 1 — — — — — — 15 15 - — 246 - - - - 1 - - 1 - - — — — — — — — — — St. Mary Magdalene 490 3 - 3 — 4 - 4 — — - — — — — — — 35 7 28 — St. Matthew 410 10 - 7 3 7 3 1 3 3 1 1 1 12 V 2 3 2 — 2 St. Michael, Star Street 460 2 1 1 — 2 - 1 1 1 1 — — 1 — 1 — 4 — - 4 St. Paul 405 5 5 7 4 3 1 - 1 1 1 — 8 8 — St. Peter 545 8 — 8 4 3 1 3 - 3 2 — 2 10 4 6 83 St. Saviour 512 - - - - 11 1 8 2 1 - 1 - 2 1 1 9 2 7 — St. Stephen 791 7 — — 7 8 4 3 1 3 - 2 1 2 1 1 — — — - — Wilberforce 842 8 — 6 2 10 4 1 5 1 1 — — 6 2 1 3 — — - — Totals 8,791 44 2 (5) 17 20 120 23 (7) 36 54 13 4 (-) 4 5 36 13 (1) 8 14 141 37 (12) 64 28 Ratios per 1,000 5.0 13.6 1.4 4.1 16.0 84 workshop supervision. TABLE 46. Factories, Workshops, and Workplaces. 1912. Employees. Business. No. of Premises. No. of Rooms. Women. Young Persons. (Males and Females.) Men. Totals. Clothing— Boot-making 117 (55) 126 (55) 7(4) 3(3) 220 (60) 230 (67) Corset-making 9 (1) 9(1) 18(1) - — 18(1) Dressmaking 400 (56) 744 (62) 2,399 (118) 480 (40) 40 2,919(158) Furriers 10 18 30 — 14 44 Mantle-making 7(2) 7 (2) 30 (3) 2(2) - 32(5) Millinery 46 49 190 25 - 215 Millinery and Dressmaking 24 (2) 48 (2) 200 (3) 40 - 240 (3) Outfitting and Plain Needlework 54 (38) 58(38) 160 (60) 10 - 170 (60) Tailoring 208 (144) 248 (144) 210 (60) 20 (4) 430 (135) 660 (199) „ Ladies' 28 (9) 40(9) 70 (5) - 120 190 (5) Various 18 (8) 20 (10) 25 (4) - 10 35 (4) Fancy Work— Embroidery and Art Needlework 15 (12) 18 (13) 65 (23) 9(5) — 74 (28) Cleansing— Dyers and Cleaners' Receiving Offices 17 24 44 - - 44 Laundries 101 (9) 268 (9) 850 (9) — 80 930 (9) ,, —Receiving Offices 33 38 44 — — 44 Mangling 11 11 11 — — 11 Other Businesses— Blind-making.. 6 14 23 — 50 73 Bookbinding and Printing 29 48 75 20 300 395 Carpentry and Joinery 15 36 - - 320 320 Chaff-cutting 14 20 - — 35 35 Coach Building 10 23 - - 40 40 Cycle and Motor Works 67 100 - - 400 400 Farriers and General Smiths 27 35 - - 90 90 Florists 16 22 60 - - 60 Jewellery and Clock-repairing 12 16 — 30 30 Metal-working 19 34 — — 96 96 Saddlery 10 11 - - 30 30 Sign and Ticket Writing 6 8 - - 20 20 O O Trunk-making 11 12 - - 26 26 Umbrella-making 7 (1) 7 (1) 11 — — 11 Undertaking 11 (2) 18 (3) 1(1) 50 51 (1) Upholstery 51 (27) 83 (27) 99 (30) — 86 185 (30) Wig-making and Hair-work 15 15 - — 40 40 Various 90 (9) 114 200 (9) 30 620 (7) 850 (16) 1,514 (385) 2,342 (376) 4,822 (330) 639 (54) 3,147 (202) 8,608 (586) Women were employed in 988 workshops, including 246 where men and women were employed. The total number of female workers therein was 5,409, viz., 4,822 women and 587 young persons. Women were employed at 265 outworkers' premises, including 23 where men and women were employed. The total number of female workers employed therein was 384, viz., 330 women and 54 young persons. HOUSING. 85 TABLE 47. Inspections of Workshops, &c. 1912. 1911. Workshops — On register end of previous year 1,508 1,508 added during year 200 176 removed „ 194 176 On register end of year 1,514 1,508 Inspections 298 362 Re-inspections and miscellaneous calls 2,778 2,681 Rooms measured 91 82 Workrooms used as bedrooms 89 86 Workrooms without Abstracts 57 46 Notices served, Totals 6 - Written intimations 6 Under Sec. 4 Public Health — 37 (London) — — 38 Act, 189 By-laws, under same Act — — Nuisances dealt with— Discovered Abated. Discovered. Abated. Overcrowding 23 23 5 5 Dirty conditions 58 58 18 18 Deficient ventilation 2 2 — — Temperature too low — — 1 1 Sanitary conveniences— Insufficient — — — , — Not separately provided 2 2 3 3 Badly placed 1 1 3 3 Defective 29 29 13 13 Vapour, effluvia not removed— Gas fumes 10 10 1 — Drains — — 1 1 Accumulations of refuse 5 5 — — Other nuisances or offences 2 2 2 2 Totals 132 132 47 46 HOUSING. Housing of the Working Classes Acts. The inspection of Chippenham Mews and Elnathan Mews—the commencement of the survey of which was recorded in the report for 1911—was continued, but that of the former was still incomplete at the end of last year. The following premises were reported upon during the past year:— Chippenham Mews— Nos. 31, 36, 50, 56 and 66. Elnathan Mews—Nos. 45 and 47. No defects were discovered at No. 45, Elnathan Mews, while such defects as were found at the other premises were remediable under the Public Health (London) Act, 1891. The necessary notices were served and the works duly completed. 86 HOUSING. Inspections of premises for the purposes of the Housing Acts were made during the year at— Found to be unfit for habitation:— Bristol Mews, No. 15. Canterbury Road, No. 165a. Premises vacated. Bishop's Mews, No. 16. Requiring works to be carried out:— Pindock Mews, No. 7 Amberley Road, No. 20 r Dealt with by Falconer Mews, No. 1 Dealt with Cirencester Street, Nos. 29, Notices under Harrow Road, No. 75 under the 31, 33, 35, 37 & 39 Sec. 15 of the Randolph Mews, No. 11 Public Health Desboro' Street, Nos. 2,3,4 & 5 Housing, Town Lanark Place, No. 7(London) Act, Planning, &c., Leinster Street, No. 10 Act, 1909. No defects found:— Leinster Street, Nos. 5, 6, 7 & 8. Closing Orders under Section 17 of the Act of 1909 were made during the year with respect to the following premises :— 35, Clarendon Street—Closing Order made January 9th; no appeal; work done; Order determined May 21st. 1-9, St. John's Mews.—Closing Orders made June 4th; no appeal; nothing done; Demolition Orders made November 19th, but operation suspended for six months. 2 & 3, Carlton Mews, Maida Vale.—Closing Orders made June 4th ; no appeal; nothing done ; Demolition Orders made November 19th, but operation suspended for six months. 8, Desboro' Street.—Closing Order made December 17th. No. 1, Desboro' Street was represented as unfit for habitation on November 19th, and a Closing Order was made at the beginning of this year. In the previous report the making of a Closing Order with respect to No. 17, Desboro' Street (on December 19th, 1911) was recorded. An appeal against the Order was lodged with the Local Government Board, but abandoned. Application was made in April of last year for the Order to be determined, the owner claiming that the premises had been put into a habitable condition. The work which had been done was of the most wretched description, several of the original defects had not been remedied, and others had developed. The Council refused to determine the Order at the meeting of May 21st, 1912. No appeal was taken against such refusal, and no further repairs were executed. A Demolition Order was made by the Council on October 1st, and an appeal was lodged against it. The Local Government Board held an inquiry with reference to the Order, and dismissed the appeal with costs against the owner.* The progress of this case brought to knowledge a somewhat serious defect in the machinery of the "Housing Acts." On the Closing Order becoming operative, notices to vacate the premises were served upon the occupying tenants, some of whom complied with the notices after more or less delay. Others did not leave until after proceedings had been taken against them in the Police Court. The owner and/or his agent did their best to persuade the tenants to remain in the house, and when a tenement became vacant another family was put in. There appears to be no power in any of the Housing Acts, 1890-1909, to deal with such action on the part of the owner. The necessary power would have been conferred by a clause in the Housing of the Working Classes Bill, 1912, brought in by Mr. M. Barlow. That Bill, however, failed to find favour with the Government. Cirencester Street Improvement Scheme.—One of the recommendations of the Joint Committee appointed by the Council and the Board of Guardians to report on the steps to be taken * The Board's decision was given under date of March 24th, 1913, and was received by the Council on March 31st, 1913. The owner had three months, expiring on June 24th, 1913, in which to comply with the Order. The premises were burned out some three days after the Board's decision was known. HOUSING. 87 to improve the conditions in the "Clarendon Street Area" was that provision should be made for a playing court for the children residing in the area. At the beginning of December, 1911, a report was submitted by the Medical Officer of Health to the Public Health Committee calling attention to the dilapidated and insanitary condition of Nos. 20 to 30 (even Nos.), Cirencester Street, and urging that the Council should be recommended to direct an "Improvement Scheme" to be prepared for dealing with those houses. The Council adopted on January 9th of last year the recommendation to that effect submitted by the Committee. In March of last year the Committee passed a resolution instructing the Medical Officer of Health to include the adjacent properties known as No. 18, Cirencester Street, and Nos. 1 to 5, Cirencester Place, together with the open space in front of the latter, in the Scheme. The Scheme, prepared in accordance with the instructions of the Committee, was adopted by the Council on May 21st, 1912, and forwarded to the Local Government Board for approval. A Public Inquiry was held by the Inspector of the Board on October 2nd, 1912, and on the 9th of January of this year the Board issued the "Paddington (Housing of the Working Classes) Order, 1913," confirming the Scheme. Cirencester Place and the open space in front of it were purchased by a lady interested in the Scheme, and have been presented to the Council. The land to be acquired will form an open space of a quarter of an acre or thereabouts, open to the south and fairly protected on the north and east sides. It will make a serviceable playground for the many children living in the area, who at present throng the streets. Underground. Rooms.—By direction of the Council draft regulations under Section 17 of the Act of 1909 were prepared by the Medical Officer of Health, provisionally approved by the Council on January 21st, 1913, and submitted to the Local Government Board on February 8th, 1913. Underground rooms at the undermentioned premises were dealt with during the past year under Section 96 of the Public Health (London) Act, 1891 :— 80, Harrow Road. 74, Star Street. 4, Bouverie Street. 70, Harrow Road. 49, Maida Vale. 13, St. Mary's Square. 78, Harrow Road. 19, Cambridge Place. 116, Church Street. 10, Star Street. 43, Woodchester Street. Rents oe Tenements.—In the autumn of 1906 the Board of Trade sought the cooperation of the Department in inquiries as to the rents of tenements in the Borough.* Application was made last year for similar information. The results of the two inquiries as to rents appear to be of sufficient interest to justify their inclusion here. The streets selected as containing typical "working class" dwellings, and the numbers of houses and tenements dealt with in the inquiries, are given in Table 48. In addition to the streets mentioned in that table, particulars were obtained with reference to the Queen's Park Estate, which have been reserved for separate consideration. The total number of houses returned in the streets included in Table 48 (page 93) was 1,579 in 1906 and 1,612 in 1912—an increase of 33 in the latter year. On the other hand, the number of tenements decreased from 4,631 in 1906 to 4,461 in 1912—a fall of 170. The tenements included in the table are those which are let at definite rentals, tenements which were occupied by " landlords," as well as those which were let furnished or in connection with shops, being excluded. It may appear at first sight to be an anomaly that with a larger number of houses under investigation there should be fewer tenements. The anomaly disappears if the numbers of tenements of various sizes be examined. It will be seen at once that reductions were recorded * The results of the Board's inquiries throughout the country were embodied in a Report, "Cost of Living of the Working Classes," published in 1908. [Cd. 3864.] 88 HOUSING. in 1912 in the numbers of tenements of one and two rooms, and of the larger tenements, and a considerable increase in the number of tenements of three rooms. The figures given below will make this point quite clear. Numbers. Ratio per 1,000. Increase (+ ), 1906. 1912. 1900. 1912. Decrease(-) per cent. Houses 1,579 1,612 Tenements Totals 4,637 4,457 1,000 1,000 Containing Rooms 1 1,102 914 239 205 -14-2 „ 2 1,525 1,258 329 282 -142 „ 3 1,606 2,146 346 481 +390 „ 4 221 130 48 29 -38-9 „ 5 108 8 23 2 -92-9 „ 6 63 1 13 0 -98-6 „ 7 6 - 1 - -100 The numbers of tenements containing five or more rooms are too small, especially in 1912, to make any useful comparisons between the two inquiries. Of the tenements of less than five rooms the following changes have to be noted. (See Table 49, page 95.) Tenements of One Room.—Generally speaking, there were fewer tenements in 1912 in the majority of the streets, but increased numbers (10 per cent, increases being taken as significant) were found in— Portnall Road 1906, 17 tenements; 1912, 20—increase, 17 per cent. Brindley Street „ 60 ,, „ 90 ,, 50 „ Tenements of Two Rooms.—Smaller numbers in 1912 were the rule, but significant increases were recorded in— Ashmore Road... ... 1906, 105 tenements; 1912,118—increase, 12 per cent. Bravington Road „ 50 ,, „ 65 ,, 30 „ Portnall Road ,,61 ,, „ 95 „ 55 „ Hetbpool Street „ 41 ,, „ 51 „ 24 ,, Tenements of Three Rooms.—In no case was the number recorded in 1912 less than that of 1906, but the same numbers were recorded on the two occasions in— Brindley Street, Church Place, and Cirencester Street. The increases reported were significant (i.e., exceeded 10 per cent.) in all the other streets except— Bravington Road ... 1906, 527 tenements; 1912, 565—increase, 7 percent. Tenements of Four Rooms.—Smaller numbers were the rule in 1912 ; in fact, in some streets this class of tenement had disappeared. Significant increases were, however, reported in— Lancefield Street ... 1906, 23 tenements; 1912,34—increase, 48 per cent. Waverley Road „ 2 ,, ,,3 „ 50 „ Church Place ,, — ,, ,,3 On the whole the figures here submitted may be considered sufficient evidence as to a real improvement in the housing conditions, judged solely on the average amount of house room per family. It should be remembered that the average family is smaller now than it was in 1906. Table 49 compares the average rentals prevailing in the selected streets in 1906 and 1912. Although the selection of the streets was decided on with a view to obtaining "random samples" of the working-class dwellings in the Borough, there was some "bias" because such choice was affected by previous general knowledge of the streets. Further, in many of the streets the numbers of any particular class of dwelling are so small that the "errors" are probably large. It should be added that until Table 49 had been prepared it was expected that an increase in all average rentals would be demonstrated. HOUSING. 89 Before proceeding to consider that table, it will be useful to give an extract (Table 50, page 96) from a table given in the Report by the Board of Trade already referred to. One-room tenements were at the time of the Board's inquiry (1905-06) dearer in Paddington than in Kensington, but cheaper than in Westminster and St. Marylebone. Two-room tenements were cheapest in Willesden (South), otherwise the same as the one-room tenements. Threeroom tenements were cheapest in Kensington, Paddington coming next. Turning to Table 49, it will be found that the average rental of one-room tenements in 1906 works out at 3 60 shillings (say 3/7), which is lower than the middle point (3/9) between 2/6 and 5/-, the figures given in the Board's Report. Similarly, the average for tworoom tenements was 6'36 shillings (say 6/4½), as compared with 6/6, the middle point of 5/6 and 7/6. The average for three-room tenements was 8 07 shillings (say 8/-), the Board's middle point, 7/9, being lower. The average for four-room tenements (10.20 shillings, say 10/2½) was again above the Board's middle point (9/6). The comparison instituted between the results of the inquiries in 1906 and 1912, set out in Table 49, can be summarised as follow:— Tenements of One Room * Average rental—1906, 3 60 (3/7); 1912, 3 29 (3/3½)—difference -3½d. Maximal average for street—1906, 4.35 (Hethpool Street); 1912, 4.07 (Hethpool Street). Minimal average for street—1906, 2.75 (Lincefield Street); 1912, 2.98 (Cirencester Street). Range of averages—1906, 1.60; 1912, l-09. rents—1912 [1/- (1); 1/6 (3)] 2/- to 5/- [5/6 (3); 6/6 (1)]. Tenements of Two Rooms. Average rental—1906, 6.36 (6/4½); 1912, 5.79 (5/9)—difference -7½d. Maximal average for street—1906, 7.5 (Ashmore Road); 1912, 6.82 (Hethpool Street). Minimal average for street—1906, 5 81 (Lancefield Street); 1912, 5.31 (Clarendon Street). Range of averages—1906, 1.69 ; 1912, 1.51. Range of rents—1912 [3/- (5); 3/6 (5)] 4/- to 7/- [7/6 (1).] Tenements of Three Rooms. Average rental—1906, 8.07 (8/1) ; 1912, 7.66 (7/8)—difference -5d. Maximal average for street—1906, 8.47 (Ashmore Road); 1912, 8.84 (Hethpool Street). Minimal average for street—1906, 7.31 (Brindley Street); 1912, 6.55 (Herries Street). Range of averages—1906, 1.16; 1912, 2-29. Range of rents—1912 [5/- (7); 5/6 (5)] 6/- to 9/6 [10/- (2); 11/- (2)]. Tenements of Four Rooms. Average rental—1906, 10 2 (10/2½); 1912, 8.98 (9/-)—difference —l/2½. Maximal average for street—1906, 12.5 (Hethpool Street); 1912, 11.5 (Church Place). Minimal average for street—1906, 8.62 (Amberley Road); 1912, 8.5 (Lancefield Street). Range of averages—1906, 3.88; 1912, 3.0. Range of rents—1912, 8/- to 9/6 [10/- (4); 11/- (4); 11/6 (1); 12/- (1)]. To the foregoing the following information (which cannot be regarded as trustworthy) with regard to tenements of five rooms and over may be added. Tenements of Five Rooms. (108 in 1906; 8 in 1912.) Average rental on 68 tenements in 1906, 12.58. 8 tenements in 1912, 11.5—difference —1.08. Tenements of Six Rooms. (63 in 1906; 1 in 1912.) Average rental on 37 tenements in 1906, 16 04. 1 tenement in 1912, 16.0. Tenements of Seven Rooms. (6 in 1906 ; 0 in 1912.) Average rental on 6 tenements in 1906, 18.66. It is singular that Hethpool Street should appear so frequently with maximal averages. Minimal averages were recorded three times in Lancefield Street. What is known as the "Clarendon Street Area" is by no means the part of the Borough where rentals are at their lowest. * The averages are given first as decimals of shillings and then to nearest commercial fraction of a penny. n 90 HOUSING. In local comparisons, such as the above, the question of the charges covered by the rent (e.g., rates, water, &c.) are not material, as it is believed that no change has taken place between the inquiries. The average rental for the 4,631 tenements (of all classes) included in the inquiry of 1906 was 6.775 shillings, and that for the 4,461 dealt with in 1912, 6.283, showing a reduction of 0.492 shilling—practically 6d.; so that the increased house accommodation has been secured at an average cost which is just on 6d. a week less than the average paid in 1906. The foregoing changes, supposing every tenement to be let at its appropriate class average, mean that the weekly amount receivable by landlords for rent has been reduced from £1,569 (approximately) in 1906 to £1,042 in 1912, involving an annual depreciation of something like £27,500. Queen's Park Estate.—In 1906 the rents paid on this Estate were exclusive of the rates, but in 1912 inclusive. The following figures, as to numbers of houses and rents, have been furnished by the Artizans and Labourers Dwellings Company, Ltd. Class of Num- Rent Charged Rateable Value House. ber. 1906. 1912. 1906. 1912. £42 \ First 4 and p.a. No change £45 | £22 £22 to £24 203 12/-to 12/6 (a) 15/3 to 17/- Rate. Second 674 10/- to 12- 12/6 to 15/- £16 £18 to £211906 6/7½ Third 727 8/6 to 9/6 10/6 to 12/3 £15(b) £14 to £18 1912 7/8½ Fourth 370 6/6 to 8/- 9/3 to 10/- £13 £13 to £15 Fifth 52 6/6 (c) 8/3 (e) £11 £11 & £12 Flats 70 6/6 to 7/6 7/6 to 8/9 £9 to £ll (d) (a) One at 13/6. (b) "Special" £18. (c) One at 5/- (d) Three-room flat, £9 ; four, £11. Rents charged weekly, except in the first group of " First Class" houses. It would take too much space to set out the changes in rents on the Estate owing to the complexity due to the altered incidence of the rates. One example, that of a " Third Class " house, must suffice. In 1906, with the rate at 6/7½, there had to be added to the rent charged (8/6 to 9/9 per week) a weekly charge of, say, 1/11 for the rate (actually 1.91 shillings), so that the rental together with the rate approximated to 10/5 to 11/8. In 1912 the rate was 7/8½, equivalent to 2/4 per week (taking the rateable value at £15). That amount has to be deducted from the rent charged, 10/6 to 12/3, making the charge for rent only, 8/2 to 9/11. These calculations will be more readily understood in tabular form:— "Third Class" House. (Rateable Value, £15.) Rent plus Rate 1906, 10/5 to 11/81912, 10/6 to 12/3 Rent only 1906, 8/6 to 9/9 ... 1912, 8/2 to 9/11 Bath Rooms.—During last year proposals were submitted for altering and supplementing the sanitary condition of houses, hitherto occupied as private dwelling houses (one family), with a view to their being converted into "flats or "maisonettes." Additional bath rooms were to be provided, such bath rooms being in the middle of the houses, i.e., not against an external wall. No direct light and no ventilation to the external air was provided. The arrangements appeared to be decidedly unsatisfactory, as the bath rooms have been found to be badly ventilated and lighted. The steam from the bath gets into the adjacent rooms, and owing to insufficient natural light it is anticipated that the bath rooms will not be kept in a cleanly condition. The Superintending Architect of the County has advised that there is no provision in the London Building Acts requiring that bath rooms should have direct light or ventilation to the external HOUSING. 91 air. The matter is under the consideration of a Committee of the County Council, who have noted the facts for future use when the amendment of the Building Acts is undertaken. Tenement Houses. This is the new designation given to " houses let in lodgings or occupied by members of more than one family " by the By-laws made by the Council on March 19th, 1912, and confirmed by the Local Government Board on May 6th, 1912. In the old By-laws such houses were referred to as " lodging houses," and considerable confusion and no little irritation prevailed among property owners who thought that their houses were being dealt with as "common lodging houses." Registration.—There were no additions to or removals from the Register during the past year, the number of houses thereon bei ng 1,348. Supervision.—Apart from the inspections required in connection with the "annual cleansing" and the occurrencc of infectious illness, 2,977 inspections of registered houses were made during the year, as compared with 2,856 in 1911 and 2,430 in 1910. A schedule of the matters calling for attention which were discovered in 1911 and 1912 will be found in Table 51 (page 97). Notices to the number of 1,892 (2,023 in 1911) were issued during the year, including 869 (361 in 1911) "written intimations," 78 (71 in 1911) "statutory notices," 663 (1,374 in 1911) By-law notices, and 287 (196 in 1911) under the London County Council (General Powers) Acts, viz., 109 (184 in 1911) for verminous rooms, 48 (21 in 1911) for the provision of additional water taps and supplies, and 40 (12 in 1911) requiring the abolition of disused wood and brick dust-bins. Annual Cleansing.—This work was (and is) required by the By-laws to be carried out "in the month of April in each year." As the old By-law had proved to be inadequate no cleansing notices were served under it, it being thought to be advisable to await the coming into operation of the new series, confirmation of which by the Local Government Board was expected to be given during that month. As, however, the Board's letter forwarding the confirmed By-laws was not received until May 11th, no "cleansing notices" were served under the By-laws, and " intimation notices" were used instead. The result of the procedure—irregular and risky though it was—was practically as good as in 1911, 1,488 rooms being cleansed, as compared with 1,936 in 1911. To obtain that result 4,184 inspections of 1,348 houses were required. In 1911, with 1,358 houses on the Register, 3,730 inspections secured the cleansing of 1,936 rooms, while in 1909, when the By-law had not been disputed, 1,920 rooms were cleansed in 1,254 houses after 4,933 inspections. The new By-laws are more comprehensive than the old, as may be seen from the comparison given below. Old Series. New Series. 15.—Subject to the provisions of these By-laws, 19.—Subject to the provisions of the By-laws, the the landlord of a lodging-house shall, in the month of tenant of a tenement house which is not intended for April in every year, cause every part of the premises the working classes and the landlord of a tenement to be cleansed. house intended for the working classes shall in the He shall, at the same time, cause the walls of month of April in every year cause every part of the every area, the surface of every ceiling and the interior premises to be cleansed. surface of every wall of every room, staircase, and He shall at the same time cause the surface of passage in the lodging-house, and of every water-closet every ceiling, and the internal surface of the walls of belonging to the premises to be thoroughly lime- every room, wash-house, scullery, staircase, and paswashed. sage in such house, and of every water-closet belonging Provided that the foregoing requirement with to the premises to be thoroughly lime-washed ; respect to the lime-washing shall not apply in any case Provided that the foregoing requirements with where the internal surface of any such ceiling or wall respect to the lime-washing shall not apply in any case is painted, or where the material of or with which that where the surface of any such ceiling or wall is painted surface is constructed or covered is such as to render or where the material of or with which such surface is the lime-washing thereof unsuitable or inexpedient, and constructed or covered is such as to render the limewhere the said surface is thoroughly cleansed, and the washing thereof unsuitable or inexpedient, and where 92 HOUSING. Old Series. Ne w Series. paint or other covering is renewed, if the renewal the said surface is thoroughly cleansed, and the paint thereof be necessary for the purpose of keeping the or covering is removed and renewed, if the removal and premises in a cleanly and wholesome condition. renewal thereof be necessary for the purpose of keeping the premises in a cleanly and wholesome condition ; Provided further that where such cleansing or lime-washing or renewal of paint as is hereinbefore prescribed shall have been duly carried out at any time within three calendar months prior to the month of April, this By-law shall not be deemed to require such cleansing, lime-washing or renewal of paint in the month of April, save in so far as the same shall be necessary for the purpose of keeping the premises in a cleanly and wholesome condition. 20.—Subject to the provisions of these By-laws, the tenant of a tenement house which is not intended for the working classes and the landlord of a tenement house intended for the working classes shall once at least in every three years cause the walls of every court, courtyard and area within the curtilage of the premises to be limewashed. Provision is made for the exemption from the operation of the By-law in any year of rooms which have been "cleansed" for any reason within three months prior to April 1st. Under Sub-Section 3 of Section 16 of the Housing, Town Planning, &c., Act, 1909, the Council has the power to carry out the clcansing if the notice served upon the owner of a house intended for the working classes be not duly complied with. An enumeration was made of the inhabitants of the houses in the Registered Streets,* the results of which are given in Table 52 (page 98). That table comprises 5,004 families, containing 18,007 persons. They occupied 10,105 rooms, averaging 1'8 persons per room, whereas the enumeration in 1911 dealt with 18,823 persons (5,404 families) living in 10,440 rooms, the average (to the first place of decimals) being the same. The contents of the Table may be summarised in the following form. The averages noted in 1911, added for the purposes of comparison, show that the differences between the results of the two enumerations are trifling. Averaging Rooms to a Numbers of Inhabited by Per Tenement. Per Room. Tenement. Tenements. (Persons). 1911. 1912. 1911. 1912. 1 1,909 4,093 2.1 2.1 2.1 2.1 2 2,003 8,256 4.0 4.1 2.0 2.0 3 646 3,145 4.8 4.9 1.6 1.6 4 244 1,252 5.2 5.1 1.5 1.3 5 60 351 5.4 5.8 1.1 1.1 6 66 394 5.3 5.9 0.9 1.0 7 40 228 6.4 5.7 0.9 0.8 8 26 193 5.9 7.4 0.7 0.9 9 6 45 8.3 7.5 0.9 0.8 10 1 5 5.0 5.0 0.5 0.5 * Registered Streets, 1912 :— 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 33 registered houses in 18 other streets (one or two in each street). These odd houses, not included in Table 52, were occupied by 423 persons, 315 over ten years of age and 108 under, living in 276 rooms. HOUSING. 93 Overcrowding.—The By-laws prescribe minimum air allowances of 400 cubic feet for persons aged 10 years and upwards, and 200 cubic feet for those under that age, living in rooms which are used day and night, i.e., for "living and sleeping," and allowances of 300 and 1-50 cubic feet (respectively) in rooms which are used for sleeping only. In 255 tenements inspected last year the inhabitants were found to be in excess of the numbers prescribed by the above standards. The results of the enumeration given above indicate a slight improvement in the housing of the inhabitants generally, and the increase in the number of cases of overcrowding is, therefore, somewhat surprising:— Overcrowding in Tenement Houses. Total As found on Inspections made for Registration. Annual Cleansing. Routine Purposes. Tenements 255 (189) -(1) 216 (165) 39 (23) Rooms 285 (199) -(1) 242 (167) 43 (29) Occupants, total 1,340 (919) -(4) 1,142 (774) 198 (141) Under 10 years of age 606 (413) -(2) 508 (349) 98 (62) Aged 10 years and upwards 734 (506) -(2) 634 (425) 100 (79) Overcrowding abated— By voluntary re-arrangement of occupants 65 (58) -(-) 65 (57) -(1) By voluntary removal 26 (51) -(-) 26 (51) -(-) Under notice 130 (46) -(-) 92 (24) 38 (22) Cases held over 34 (34) -(1) 33 (33) l(-) Note.—Figures in parentheses relate to 1911. TABLE 48. Nos. of Tenements containing—Rooms Houses. Tenements. 1 2 3 4 5 6 7 Herries Street 1906 125 186 24 35 72 18 19 12 6 1912 138 179 14 12 152 1 — — — Lancefield Street 1906 142 330 56 110 110 23 7 24 — 1912 146 271 18 87 132 34 — — — Ashmore Road 1906 251 498 9 105 316 12 40 26 — 1912 240 629 9 118 502 — — — — Bravington Road 1906 220 662 51 50 527 16 8 — — 1912 220 652 22 65 565 — — — — Portnall Road 1906 245 631 17 61 401 120 32 — — 1912 245 740 20 95 546 79 — — — Amberley Road 1906 68 269 128 116 18 4 2 1 — 1912 75 271 123 106 36 4 2 — — Alfred Road 1906 60 213 108 81 21 3 — — — 1912 60 124 28 60 33 1 2 — — Brindley Street 1906 63 155 60 78 13 4 — — — 1912 64 186 90 83 13 — — — — Waverley Road 1906 70 186 51 119 14 2 — — — 1912 70 191 42 120 26 3 — — — Church Place 1906 16 66 39 25 2 — — — — 1912 17 63 35 23 2 3 — — — Cirencester Street 1906 82 354 186 140 23 5 — — — 1912 91 291 167 96 23 2 2 1 — Clarendon Street 1906 112 594 202 350 36 6 — — — 1912 116 428 211 165 50 2 — — — Hethpool Street 1906 32 111 62 41 6 2 — — — 1912 48 118 48 51 16 1 2 — — Woodchester Street 1906 93 376 109 214 47 6 — — — 1912 82 318 87 177 50 4 - - - 94 HOUSING. Vital Statistics.—The total morbidity in the " Registered Streets " was 7.97 per 1,000 last year, as compared with 5.21 in 1911 and 6.03 in 1910. The increase in the rate above the figure for 1911 was equal to 5.3 per cent. (approximately), whereas the increase noted in the " Rest of the Borough" (from 3.91 to 4.54) was only 16 per cent. The rates from diphtheria, scarlet fever, and puerperal fever were all in excess of those noted in 1911 (see Table 53, page 99), the increases in the rates in " Registered Streets" being proportionately much greater than those observed in the " Rest of the Borough." The reduction in the rate from enteric fever was relatively greater in the case of the " Registered Streets " than in the " Rest of the Eorough." The total mortality in the " Registered Streets," which was 22.08 in 1910, and rose to 24.67 in 1911, fell to 2359 last year, but was still in excess of the rate recorded in 1910. In the " Rest of the Borough" the total mortality rates have been—in 1910, 11.21; in 1911, ll.89; and in 1912, 10.87. If the rates recorded in each case in 1910 be taken as equal to 100, those recorded in the two later years would be represented by 112 and 107 in the " Registered Streets," and 106 and 97 in the " Rest of the Borough." The most notable differences in the rates recorded last year in the two sections of the Borough are to be observed in the cases of measles (I., 0.85; II., 0T3*) ; diarrhoeal diseases (I., l.53; II., 0.21); pulmonary tuberculosis (I., 2.16; II., 0.63);. other tuberculous diseases (I., 1.19 ; II., 0.29) ; bronchitis and pneumonia (I., 5.36 ; II., 1.84). Clarendon Street Area.—For the purposes of the Local Government Board Inquiry with reference to the Council's " Improvement Scheme" in Cirencester Street certain figures relating to the housing conditions within the area during 1911 were got out. In the appended statement comparisons are instituted between (a) the general housing state found at the " enumeration " specially made in 1901 and that found in 1911 at the time of the inspections for "annual cleansing"; and (b) the amounts of overcrowding discovered on the two occasions. A. General Housing Conditions. 1901. 1911. No. of houses in Area 452 452 „ „ registered 279 413 „ „ not registered 180 39 „ „ empty 3 20 Empty houses : No. of tenements 7 74 Total number of empty rooms 154 647 Occupants of exempt houses not known 380 comprising families (tenements) 85 Occupants of registered houses 6,060 comprising families (tenements) 1,605 Total No. of inhabitants in Area 7,330† 6,440 „ „ families „ 1,930 1,690 Density of population per acre 476 421 Average No. of persons per family 3.7 3.7 Occupants of tenements (registered), total 7,283 6,060 „ „ aged 0—10 years 2,334 2,171 „ „ „ 10- „ 4,949 4,269 B. Overcrowding. 1901. 1911. Total number of tenements† 1,903 1,605 „ „ „ overcrowded 204 26 Percentage overcrowded 10.7 1.5 Tenements of One room total number 662 727 „ „ overcrowded 97 22 „ „ percentage 14.6 3.0 * For brevity's sake, " I." is written for " Registered Streets," and "II." for " Rest of the Borough." † According to the Census, April 1st, the total was 7,796. The enumeration was made in the following August and September. 95 HOUSING. 1901. 1911. Tenements of Two rooms total number 897 691 „ „ overcrowded 92 4 „ „ percentage 10.2 0.5 „ Three rooms total number 217 161 „ „ overcrowded 14 — „ „ percentage 1.8 — „ Four rooms total number 73 26 „ „ overcrowded 1 — „ „ percentage 1.3 — Total population living in overcrowded tenements 1,174 138 „ „ comprising 0—10 years 441 68 „ „ „ 10- „ 733 70 Percentage of population overcrowded, total 16.0 2.1 „ „ in tenements * 16.1 2.8 The 1911 figures may be taken as evidence that no slight improvement has been effected within the area during the ten years that systematic use has been made of the powers of supervision conferred by the By-laws relating to houses let in lodgings, made under Section 94 of the Public Health (London) Act, 1891. According to the data available, the total amount of overcrowding had been reduced from 10.7 to 1.5 per cent., but it is probable that the amount of overcrowding discovered in 1901 understated the case. The enumeration was conducted somewhat hurriedly, and the Inspectors who had charge of the work were specially appointed for that purpose and knew nothing of the area or its inhabitants. They had no means of testing the statements of the occupiers of the tenements. TABLE 49. Tenements containing 1 2 3 4 1906. 1912. 1906. 1912. 1906. 1912. 1906. 1912. T. R. T. R. T. R. T. R. T. R. T. R. T. R. T. R. Herries St. 24 2.83 14 3 35 6.04 12 5.33 72 7.88 152 6.55 18 10.61 1 9 Lancefield St. 56 2.75 18 3.5 110 5.81 87 5.87 110 7.81 132 7.23 23 11.04 34 8.5 Ashmore Rd. 9 3.55 9 3.72 105 7.5 118 6.14 316 8.47 502 7.83 12 10.5 — — Bravington Rd. 51 3.47 22 4 50 6.54 65 6.01 527 8.05 565 7.84 16 10 — — Portnall Rd. 17 3.53 20 3.95 61 6.45 95 6.13 401 8.06 546 7.83 120 10 79 9.01 Amberley Rd. 128 3.77 123 3.41 116 6.22 106 5.63 18 7.75 36 7.47 4 8.62 4 9.75 Alfred Rd. 108 3.52 28 3.23 81 7.26 60 6.26 21 8.14 33 7.68 3 9.30 1 8.5 Brindley St. 60 3.66 90 3.12 78 6.36 83 5.46 13 7.31 13 6.84 4 11 — — Waverley Rd. 51 3.40 42 3.63 119 6.10 120 6.27 14 8.43 26 8.17 2 9.75 3 9.5 Church Pl. 39 3.87 35 3.91 25 6.29 23 6.24 2 8 2 8 — — 3 11.5 Cirencester St. 186 3.45 167 2.98 140 6.04 96 5.28 23 7.37 23 7.10 5 9.5 2 10.25 Clarendon St. 202 3.28 211 3.12 350 6.21 165 5.31 36 7.64 50 6.95 6 11.08 2 8.75 Hethpool St. 62 4.35 48 4.07 41 7.04 51 6.82 6 8.25 16 8.84 2 12.5 1 11 Woodchester St. 109 3.57 87 3.20 214 6.33 177 5.34 47 7.53 50 6.89 6 9.83 4 8.87 Totals 1,102 3.60 914 3.29 1,525 6.36 1,258 5.79 1,606 8.07 2,146 7.66 221 10.20 134 8.98 "T," number of tenements. "R," average rental—in shillings per week. * Included in the enumeration in 1901, registered in 1911. 96 HOUSING. TABLE 50* Predominant Weekly Rents (including rates). 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. 5 Rooms. s. d. s. d. s. d. s. d. s. d. s. d. s. d. s. d. s. d. s. d. Paddington 2 6 to 5 0 5 6 to 7 6 7 0 to 8 6 8 6 to 10 6 — Kensington 2 6 „ 4 6 5 6 „ 7 0 6 6 „ 8 6 — - Westminster 3 6 „ 6 0 5 6 „ 9 0 8 0 „ 11 6 — — St. Marylebone 3 6 „ 6 0 6 0 „ 8 6 8 6 „ 11 0 — — Hampstead — 5 6 „ 7 6 7 6 „ 9 0 8 0 to 11 0 — Willesden— Whole district — — 7 0 „ 9 0 8 0 „ 10 0 9 0 to 12 0 South — 5 0 to 6 6 7 0 „ 9 0 — — North — — 7 0 „ 9 0 8 0 to 10 0 9 0 to 12 0 * Taken from Report [Cd. 3864] of Board of Trade, page 6. During the five years 1896-1900 the total mortality (see below) in the area averaged 28.88 per 1,000 inhabitants, which rate had fallen to 2675 in the five years 1907-11. The greater part of the decrease was noted among children aged 0-10 years, the mortality among them decreasing from 46.87 to 41.55 (a fall of 113 per cent., as compared with one of 2 8 per cent. at ages over 10). The mortality from the diarrhoeal diseases decreased from 2.05 to 192 per 1,000 persons of all ages, and generally lower rates were recorded in the second period from all the developmental diseases, e.g., premature birth, convulsions, atrophy and debility, &c., &c. On the other hand, the mortality from the tuberculous diseases, bronchitis and pneumonia, and the diseases included among "other causes" (mostly adult diseases),showed very little change, and as regards " other causes " a distinct increase. 1896—1900. 1907—1911. Sickness: (Notifications). Totals. Rates. Totals. Rates. Erysipelas 76 2.08 54 1.63 Diphtheria 68 1.86 53 l.60 Scarlet Fever 190 5.21 258 7.79 Enteric Fever 35 0.96 25 0.75 Puerperal Fever 2 0 05 — — Deaths : (All Causes.) All ages 1,052 28 88 886 26.75 0— 1 year 323 — 260 — 0—10 years 547 46 87 439 41.55 10 years and over 505 2040 447 19.83 0—1 year as percentage of 0—10 years — 59.4 — 59.2 (Selected causes.) Measles 58 1.59 72 2.17 Scarlet Fever 8 0.21 11 0.33 Whooping Cough 34 0.93 18 0.54 Diphtheria19 0.52 4 0.12 Enteric Fever 6 0.16 1 0.03 Erysipelas 3 0.08 1 0.03 Diarrhœa 59 1.62 43 1.29 Enteritis 16 0.43 21 0.63 Tubercular Diseases 137 3.76 107 3.23 Premature Birth 33 0.90 28 0.84 Developmental Diseases 17 0.46 20 0.60 Convulsions 30 0.82 7 0.21 Teething 4 0.10 3 0.09 Atrophy and Debility 43 1.18 20 0.60 Bronchitis and Pneumonia 215 5.90 186 5.61 97 HOUSING. 1896—1900. 1907—1911. (Selected causes.) Totals Rates. Totals. Rates. Overlaid in bed 13 0.35 2 0.06 Suicides 5 0.13 4 0.12 Other Causes* 352 9.66 338 10.20 Deaths in Institutions 318 30.2† 481 54.2† *Including:— Alcoholism 9 0.24 2 0.06 Murder 2 0.05 — — †Per 100 deaths. TABLE 51. Sanitary Defects Remedied in Tenement Houses. 1911. 1912. Drain defective 18 18 „ choked 15 19 „ untrapped 4 3 „ unventilated or improperly ventilated 8 4 Manhole cover defective 4 13 Surface inlet improperly trapped 4 — Gully choked 8 17 Ventilating pipe improperly constructed 10 3 Soilpipe defective 3 — „ improperly constructed 3 1 „ unventilated or improperly ventilated 2 — Water-closet choked 32 54 „ defective 63 76 „ flushed from drinking-water cistern — — „ insufficiently flushed 28 51 „ flushing apparatus defective 45 56 „ without water supply 24 7 „ foul 26 52 „ improperly constructed 6 1 „ accommodation insufficient 30 36 „ without door 18 22 „ without external light or ventilation 1 4 Rainwater pipe not disconnected from drain or soilpipe 2 2 „ defective 32 36 „ choked 6 9 Wastepipe not disconnected — — „ defective 10 20 „ choked 6 9 „ not provided 2 6 Other drainage defects 5 10 Cistern defective 4 12 „ dirty 86 78 „ improperly placed — — „ without proper cover 5 12 „ cover defective 23 18 Dustbin defective 80 157 „ not provided 4 18 „ insufficient 11 2 „ disused and not abolished 12 39 Paving defective in area or yard 82 110 „ „ wash-house 74 91 Guttering defective 18 32 Premises damp 7 24 „ dirty 15 88 Rooms verminous 280 387 Roof defective 134 134 Accumulation of refuse 15 12 Animals improperly kept 8 11 Water supply to premises insufficient 3 57 Other defects or nuisances 29 123 O 98 HOUSING The excessive morbidity and mortality which prevail even now in the "Area" are clearly shown by the figures in Table 54 (page 100), where the more important rates for 1911 and 1912 recorded in the " Area " are contrasted with the rates obtaining in the " Rest of the Borough." Last year the morbidity rate from scarlet fever in the " Area " was below that recorded in the " Rest," and for the last two years no cases of puerperal fever have been recorded in the " Area." The rate from erysipelas—a disease significant of dirt—in the "Area" was more than double that in the " Rest " last year. The total mortality rate in the " Area " (26.52) was nearly 2 per 1,000 higher than the rate for 1911, and more than double the rate recorded in the "Rest" (ll.80). Although the total mortality increased, the rate for children aged 0-10 years decreased last year from 3918 to 30-22, such decrease being due to the comparative exemption of the " Area " from diseases such TABLE 52. Numbers of Tenements and Inhabitants therein in Registered Streets. 1912. Rooms to Tenement. Occupants in each Tenement. 1 2 3 4 5 6 7 8 9 10 11 12 T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P 1 633 633 ... 717 1389 45 305 636 279 182 372 356 54 115 155 14 45 39 3 6 15 1 2 6 ... ... ... ... ... ... ... ... ... ... ... ... 2 58 58 ... 325 642 8 401 992 211 412 1103 545 366 1017 813 278 813 855 112 338 446 45 175 185 5 20 25 1 4 6 ... ... ... ... ... ... 3 15 15 ... 65 129 1 99 264 33 106 335 89 119 384 211 100 370 230 81 343 224 38 168 136 18 78 84 4 23 17 1 6 5 ... ... ... 4 3 3 ... 14 27 1 38 106 8 57 200 28 28 101 39 38 183 45 33 165 66 22 113 63 8 38 34 2 11 9 ... ... ... 1 5 7 5 1 1 ... 4 8 ... 4 12 ... 10 39 1 7 35 ... 10 50 10 11 65 12 4 19 13 4 20 16 5 30 20 ... ... ... ... ... ... 6 ... ... ... 10 20 ... 3 9 ... 3 10 2 14 61 9 8 42 6 7 31 18 10 58 22 6 45 9 3 17 13 2 14 8 ... ... ... 7 ... ... ... 2 4 ... 3 9 ... 5 16 4 2 10 ... 4 18 6 2 14 ... 6 34 14 10 30 15 2 15 5 2 18 4 2 9 3 *8 ... ... ... ... ... ... 2 6 ... 1 2 2 1 5 ... 6 34 2 5 30 5 6 28 20 1 4 5 1 7 3 ... ... ... 1 8 4 9 ... ... ... ... ... ... ... ... ... 1 2 2 1 5 ... 1 5 1 ... ... ... 1 6 2 1 6 3 ... ... ... 1 8 5 ... ... ... 10 ... ... ... ... ... ... ... ... ... ... ... ... 1 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... †12 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 ... ... ... ... ... ... ... ... ... ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... T—number of Tenements containing (P/10) Persons over 10 years of age, and (P/10) Persons under 10 years of age. * Also 1 tenement of 8 rooms occupicd by (9P/10) and (10/4P) and 1 occupied by (9P/10) and (10/6P) † 1 tenement of 12 rooms occupied by (11P/10) and (10/6P) HOUSING. 99 TABLE 53. Registered Streets : Morbidity and Mortality Statistics. Disease. Registered Streets. Rest of the Borough. 1912. 1911. 1912. 1911. Morbidity*— Smallpox — — — — Diphtheria and Membranous Croup 2.51 1.33 1.63 1.11 Erysipelas 1.36 1.44 0.74 0.73 Scarlet Fever 3.02 1.88 1.75 1.54 Enteric (and Continued) Fever 0.05 0.27 0.11 0.25 Puerperal Fever 0.11 0.05 0.07 0.04 All Diseases 7.97 5.21 4.54 3.91 Mortality*— Smallpox — — — — Measles 0.85 2.05 0.13 0.18 Scarlet Fever — 0.05 0.02 0.01 Whooping Cough 0.11 0.77 0.15 0.24 Diphtheria — 0.11 0.04 0.07 Enteric Fever — 0.05 0.00 0.03 Diarrhœal Diseases 1.53 3.04 0.21 0.77 Erysipelas 0.05 0.16 0.01 0.02 Puerperal Fever — 0.05 0.03 0.02 Pulmonary Tuberculosis (Phthisis) 2.16 2.49 0.63 0.94 Other Tuberculous Diseases 1.19 0.94 0.20 0.25 Alcoholism 0.11 0.05 0.05 0.08 Cancer 1.59 0.94 1.18 1.20 Premature Birth 0.85 0.49 0.34 0.27 Developmental Diseases 0.85 1.05 0.21 0.52 Bronchitis 3.13 2.16 1.07 0.92 Pneumonia 2.22 1.60 0.76 0.68 Cirrhosis of Liver 0.22 0.22 0.12 0.08 Accidents and Diseases of Parturition 0.05 0.05 0.04 0.03 Suicides 0.17 0.05 0.08 0.08 Other Causes 8.43 8.26 5.52 5.46 All Causes 23.59 24.67 10.87 11.89 * Rates per 1,000 persons. as measles and diarrhoea. (See below.) Infantile mortality, however, remained at practically the same level in the two years. The subjoined figures will serve to show how the more important diseases fluctuate from year to year. Deaths from— 1909. 1910. 1911. 1912. Measles 12 24 19 5 Whooping Cough 8 — 5 1 Diarrhceal Diseases 14 5 21 16 Tuberculous Diseases— Pulmonary 12 10 15 9 Other 9 6 6 10 Bronchitis, Pneumonia 47 38 27 41 Infantile Mortality 220 122 176 175 100 HOUSING. The was a slight reduction in the proportion of institutional to total deaths in the " Area," although there was a considerable increase in the " Rest of the Borough." The proportions recorded in the past five years are set out below. Proportions of Institutional to Total. Deaths. (Per cent.) 1908. 1909. 1910. 1911. 1912. Clarendon Street Area 63.1 48.1 54.3 61.1 60.1 Rest of the Borough 32.3 31.7 33.1 33.5 42 6 Collections of house refuse were made twice a week in this district during the past year, and in future will be the regular custom from June to September. Common Lodging-houses. The number of houses licensed last year remained unchanged at 7, 6 being for men (195 beds) and 1 for women (37 beds). No infectious illness was reported last year. The deaths among the lodgers numbered 9 (12 in 1911), the causes being returned as— Cancer 3 Premature Birth 1 Respiratory Diseases 3 Old Age 1 Cirrhosis of Liver 1 Inhabited House Duty. Nine applications were received for certificates under the Revenue Act, 1903, to obtain abatement or remission of the duty, and three certificates relating to 14 tenements were issued. TABLE 54. Clarendon Street Area. Vital Statistics. "Clarendon Street Area." Rest of Borough. 1911. 1912. 1911. 1912. Morbidity*— Diphtheria 2.00 2.44 1.10 1.71 Erysipelas 1.07 1.62 0.80 0.78 Scarlet Fever 1.54 1.79 1.58 1.91 Enteric Fever 0.77 0.16 0.25 0.10 Puerperal Fever - - 0.06 0.08 Mortality—All Causes— All ages* 24.96 26.52 12.96 11.80 0—10 years 39.18 30.22 ? ? 10—„ 17.69 24.50 ? ? Infantile Mortality† 176 175 125 90 Institution Deaths† 61.1 60.1 33.5 42.6 * Rates per 1,000 persons. †Per 1,000 births, fully corrected. ‡ Per 100 deaths. FOOD SUPERVISION. 101 FOOD SUPERVISION. Slaughterhouses.—Seven slaughterhouses were 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 447 (479) occasions when killing was in progress, and examined the carcases of 64 (104) bullocks, 7 (11) calves, and 4,303 (4,550) sheep. The following organs were destroyed under his supervision— Sheep. Livers, 6—parasitic 2, and abscess 4. Bullocks. Livers, 5—parasitic 4, and abscess 1. Head and tongue, 1—actinomycosis. This is the first occasion on which tuberculosis does not appear among the conditions giving rise to destruction of meat at the slaughterhouses. The slaughterhouses were specially inspected by the Medical Officer of Health in the autumn, after receipt of the notices of " Intention to apply " for renewal of the licences. The premises were found to be clean and well kept, and no objections were offered to the renewals. Food Purveyors. There were 610 places on the Register of Food Purveyors, the numbers of each trade being as here given— Butchers 81 Milkshops, Dairies 120 „ Pork 20 Refreshment houses 112 Fishmongers 31 Fried fish, Sausages 27 Game, Poultry 11 Ice cream makers, vendors 124 Fruiterers, Greengrocers 71 Margarine dealers 13 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 1,034) reported by the Inspector. Butchers'shops (all kinds) 463 Milkshops 168 Greengrocers'shops 13 Restaurants, &c. 206 Fishmongers' shops 12 Ice cream shops and barrows 114 Fried fish shops 58 (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. 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. Dairies and Milkshops.—At the end of 1911 there were 120 names of milk vendors on the Register. Three new milk vendors were added, and 3 removed. One application for registration was refused during the year. Five businesses were transferred to new proprietors. The 102 unsound and diseased food. Register contained 120 effective entries at the close of the year. The businesses carried or» in combination with the sale of milk by the vendors now on the Register are given below— Dairies: milk, butter, and eggs only 85 (87) „ wholesale 4 (4) Grocers' shops 1 (2) General shops 16 (12) Provisions 1 (1) Refreshments 9 (9) Bakers' shops 4 (4) Two cases of scarlet fever occurred at milkshops, and 8 in the homes of milk carriers. There were 14 cases of diphtheria in the houses occupied by milk carriers, 7 of the patients being members of their families. The precautions required by the Regulations were duly observed in each case, and in addition many of the milk carriers attended at the Town Hall to be examined by the Medical Officer of Health. Swabs were taken from the throats and noses of the men who were seen after the occurrence of diphtheria. They were not allowed to resume work when either the Klebs-Loffier or the Hoffman bacillus was found in the cultures. 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 1911 there were 108 names on the Register, 10 were removed during the past year, and 12 added, leaving 110 on the Register at the close of the year. The businesses with which the ice cream trade is combined are indicated below— Sweet shops 44 Newspapers and Tobacco 27 Bakers 8 Confectioners 9 Milk 2 General 11 Restaurants 13 Cycle Dealer 1 Greengrocers 3 In addition to 6 barrow-men residing in the Borough, 3 others have regular pitches in the Borough, the proprietors residing in— Marylebone 2 Willesden 1 UNSOUND AND DISEASED FOOD. In addition to the meat dealt with at the slaughterhouses, 10,109 lbs. (7,639 lbs. in 1911) of foodstuffs were destroyed last year after voluntary surrender. The quantity of potatoes (nearly 3½ tons) was remarkable. (See below.) Possibly the wet season was responsible for such a loss, the tubers being insufficiently dried when packed for carriage. Meat (Butchers' shops) :— Bullock's liver (parasitic), spleen (tuberculous), pigs' plucks (tuberculous), pieces of bacon (decomposed). Fish:—Haddocks, 100 lbs. Plaice, 60 lbs. Herrings, 1,008 lbs. Decomposed. Vegetables and Fruit:—Apples 208 lbs. Potatoes 110 lbs. Tomatoes 86 „ Melons 10 „ Strawberries 112 „ Peaches 5 „ Summary. Meat 174 lbs. Per G.W.R. Co.— Fish 1,168 „ Bullocks' Brains 56 lbs. Vegetables 531 „ Bacon 356 „ Pork 18 „ 1,873 „ Plums 302 „ Potatoes 7,504 „ Grand Total 10,109 lbs. FOOD ADULTERATION. 103 In August last a letter was received from the Borough Council of Stepney relating to the seizure and condemnation of tuberculous meat. The meat had been purchased outside the Metropolis, and the Stepney Council had been advised that inasmuch as the purchase had been completed outside the County of London, Sub-section 3 of Section 47 of the Public Health (London) Act, 1891, could not be applied. The Council stated that they had communicated the facts to the Local Government Board, and had urged the Board to amend the law so as to make the provisions of the Public Health Act, already mentioned, extend to foodstuffs purchased outside the County. There appears to be some question whether the fear that Section 47 (3) of the Act would not apply in a case such as described. The wording of the sub-section is perfectly general—the person " who so sold " is liable—and there is no limitation requiring the sale to take place within the County. Moreover, Section 132 of the Act extends the provisions of the Act (otherwise limited in its operation to the County of London) " to places elsewhere, so far as is necessary for giving effect to any provisions " of the Act. Hence it would seem that for the purpose of any prosecution under Sub-section 3 of Section 47, the provisions of the Act are applicable outside the County. The Public Health Committee of this Borough were advised in that sense, and did not endorse the action of the Borough Council of Stepney. FOOD ADULTERATION. The number of samples submitted to the Public Analyst during the year was 600, the same as in 1911, the number found adulterated being 104, or 54 more than in the previous year. The percentages of adulterated samples in each of the last five years have been, in 1907. 1908. 1909. 1910. 1911. 1912. 9.2 2.6 8.6 9.0 8.3 17.4 The list of samples taken is given in Table 55. Of the 297 samples of milk, 80 were taken at the Paddington Terminus in course of transit, under contract, at the request of the consignees, many of whom had had samples examined previously by their own analysts, and found such samples to be adulterated. Of the samples taken last year, 40 were found to be adulterated. In 1911, 21 out of 110 samples taken in the same way were condemned. Last year's proportion of adulterated "contract samples" (50 per cent.) was considerably higher than that noted in 1911 (191 per cent.). The comparison of the percentage of adulterated samples taken at the station (see below) does not make comforting reading. "Contract Samples" taken at Paddington Terminus. Percentage found to be adulterated. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 30.6 32.3 6.4 24.3 14.9 19.1 50.0 Samples are taken from time to time on Sundays, and also on Bank Holidays. Last year 61 (62 in 1911) samples of milk were taken on Sundays, 4 (1 in 1911) being reported adulterated. All the 10 samples taken on Bank Holidays were found to be genuine. If the samples taken in the Borough—as distinct from those taken at the G.W.R. Terminus— be considered, and the samples of lime juice, sausages, mincemeat, cream, and brawn (all of which were returned as "adulterated" on account of the presence of preservatives) be excluded, the proportion of adulterated samples was 3.7 per cent. last year, as compared with 2.4 per cent. in 1911. 104 FOOD ADULTERATION. TABLE 55. Total. Found Adulterated. Percentage Adulterated. Milk 297* 53 17.8 Lime Juice Cordial 39 28 75.3 Sausages 32 11 34.3 Mincemeat 26 5 19.2 Cream 23 3 13.0 Butter 22 2 9.1 Vinegar 20 - — Cheese 15 - — Coffee 11 - — Cocoa 11 - — Bread 11 - — Lard 9 - — Jams 9 - — Mustard 8 - — Custard Powder 7 - — Borax 6 - — Jelly Crystals 6 - — Marmalade 5 - — Pepper 5 - — Fish Pastes 5 - — Brawn 4 2 50.0 Ginger 3 — — Spirits 3 — — Wines 2 — — Baking Powder 2 — — Margarine 2 — — Ammoniated Tincture of Quinine 1 — — Blanc Mange Powder 1 — — Ginger Wine 1 — — Carbolic Soap 1 — — Glycerine 1 — — Camphorated Oil 1 — — Sweet Spirits of Nitre 1 — — Black Currant Jelly 1 — — Pressed Beef 1 — — Nutmeg 1 — — Mace 1 — — Cloves 1 — — Cinnamon 1 — — Carraway 1 — — Curry Powder 1 — — Mercury Pills 1 — — Iodides 1 - - 600 104 17.4 * Including 80 taken at Paddington (G.W.R.) Terminus in course of delivery : 40 adulterated. Preservatives in Foods.—In foodstuffs, other than milk and butter, the addition of preservatives was the only form of adulteration reported during the year, but it has to be remembered that a declaration of the admixture of other ingredients to any particular food demanded protects the seller from liability under the Acts. The form of declaration is only too frequently very inadequate. Sausages.—Of 32 samples of sausages purchased during December 11 were found to contain boron preservatives. The average amount of preservative was equivalent to 8.81 grains of boric acid per lb., ranging from 4.2 grains to 1525. In 3 samples the amount was less than 5 grains, in one between 5 and 6, in 3 between 7 and 8, in 3 from 14 to 15, and in one over 15. FOOD ADULTERATION. 105 Brawn.—Five samples were obtained in December, 2 being found to contain boron preservatives in amounts equivalent to 6 75 and 105 grains per lb. Mincemeat.—Of 26 samples purchased just before Christmas 5 were found to contain varying amounts of salicylic acid, the average of the 5 being 1.96 grains, the maximum 3.36, and the minimum 1.00. It is difficult to find any justification for the use of preservatives in any of the above foods, which are consumed very soon after manufacture, and the difficulty is increased by the fact that the makers of 45 of the 63 samples (of all kinds) did not consider the use of preservatives necessary. There are two other facts to be considered, viz., the time of the year (December), when food does not undergo decomposition, and the want of uniformity in the amounts of preservatives used. If 4.2 grains of boron preservative to the lb. of sausages is found by one maker to be adequate, why should another use 15.25 ? One maker of brawn used little more than half the quantity used by the other. In the case of mincemeat the amounts of sugar and spices which enter into its composition should be sufficient to prevent any putrefactive changes, provided the materials are sound when used. That proviso is, it is believed, the crucial point. It is feared that the addition of preservatives to such commodities as the above points to the use of materials which have been kept just too long, and that the preservatives are required to inhibit changcs which are already in progress, but not markedly observable. Lime Juice: Lime Juice Cordial.— During the summer recess 3 samples of these preparations were take by the Inspector, 2 being found to contain salicylates in amounts equivalent to 1.75 and 7.75 grains of salicylic acid to the pint—a sufficiently striking difference. Later on, further samples to the number of 37 were procured. So far as could be ascertained, each sample was the product of a different maker, but as many of the bottles bore labels with the vendors', and not the manufacturers', names, and others had labels without any names, there was probably some duplication of samples. Of the 39 samples secured, 11 were found to be free from preservatives. In the others (28 samples) salicylates were found in amounts varying from l.00 to 7.75 grains (calculated as salicylic acid) per pint. The prices of the 11 preservative-free samples ranged from 6½d. to 1s. per pint, and those of the samples with preservatives from 7½d. to 1s. 2d. There were 2 samples at 1s. per pint free from preservative ; 3 at 1s. 1d., containing respectively (the equivalents of) 1 grain, grains, and 5¼ grains of salicylic acid; and one at 1s. 2d. containing 3½ grains. The average amount of salicylates (calculated as salicylic acid) was 4.6 grains per pint. The following scheme of prices and amounts of salicylates indicates that there is no real connection between the two. Price 6½d. 7½d. 8d. 8½d. 9d. l0½d. 1s. 1s. 1d. 1s. 2d. Totals. (per pint). Genuine. 1 2 — 1 2 1 2 — — 9 1-2 grains — 2 — — — — — 1 — 3 2-3 „ — — — 1 — — — — 1 2 3-4 „ — 1 — 2 — — — 1 1 5 4-5 „ — 3 — — — 1 — — — 4 5-6 „ — 1 — 2 2 — — 1 — 6 6-7 „ — 2 1 1 — — — — 4 7-7-5 „ - 1 1 7-5-7-75 grains — — — 2 — — — — — 2 Three samples (2 genuine at 3½d. and 5½d. and 1 with preservative at 5d.) were sold in bottles containing less than one pint. The results of the analyses were reported to the manufacturers concerned, and a good deal of correspondence ensued. Certain firms referred to the first recommendation of the Depart- P 106 OFFICE WORK. mental Committee (1899) on the Use of Preservatives as sanctioning the use of small amounts of salicylates; but apparently the last sentence of that recommendation—" Its (i.e., the preservative's) presence in all cases to be declared"—had been overlooked. In no instance was there any mention of the addition of preservatives on the label. From one firm it was ascertained that " lime juice" is imported in two forms—one mixed with the fruit pulp and the other free from pulp. It was stated that in the latter sulphites might be expected to be found, but that the other required no preservative, the vegetable acids in the pulp having sufficient preservative powers. The Local Government Board is conducting an inquiry into the method of manufacture of lime juice and the cordial. Cream.—Of the 23 samples of cream taken during the year, 8 were of "cream " (i.e., fresh cream), all of which were returned as " genuine," 3 were of cream not sold as " preserved cream "— they were purchased prior to the new Regulations coming into force—and were found to contain boron preservatives in amount equivalent to 4½, 10½, and 17½ grains of boric acid to the lb., and 12 were sold as "preserved cream" or "jug cream " (5 before and 7 after the new Regulations were in force), all being returned as " genuine." In the case of the 5 samples sold prior to August the report meant no more than that the addition of preservative had been declared and that the amount of such preservative was not excessive. On August 1st of last year the " Milk and Cream Regulations" were issued by the Local Government Board. The Regulations have been made under Sec. 1 of the Public Health (Regulations as to Food) Act, 1907. The Regulations prohibit the addition of any form of preservative to any form of milk, but sanction the addition of borax, boric acid, or a mixture of the two, or of hydrogen peroxide to cream containing not less than 35 per cent. of butter fat. Such cream can only be sold as " preserved cream," and every receptacle containing such cream must bear the prescribed label setting out the nature and amount of preservative added. No limits of preservatives to be used are mentioned, although definite limits were recommended in the Report by Dr. Hamill issued in 1899. Moreover, the standard of butter fat which was suggested in that Report was 40 per cent., or 5 per cent. higher than that prescribed by the Regulations. The local authority is required to afford any person contravening the Regulations " an opportunity of furnishing an explanation in writing or otherwise " before instituting proceedings. The penalty for an offence under the Regulations is £100. OFFICE (CLERICAL) WORK. The appended figures suggest the mass of work accomplished by the Clerical Staff, and give but a very imperfect idea of the large amount of writing which is necessary, the bulk of which cannot be set out in the form of statistics. Letters received 5,006 (4,439) „ despatched 4,638 (4,120) Entries in Postage Rook 13,075 (11,700) Cases of infectious disease entered in Register (including consumption) 1,787 (1,151) Notices sent re above and other diseases 5,226 (4,582) Births entered in Register 3,041 (2,845) Complaints received 752 (875) Plans dealt with 352 (348) New openings in Journals 661 (710) Disinfection Orders (duplicate) 2,655 (2,692) Notices to abate nuisances 1,020 (1,291) The figures in parentheses are the returns for 1911. Daily returns of infectious disease notified are sent to the Metropolitan Asylums Board, and weekly to the County Council, giving full particulars of the notifications of births and of pulmonary tuberculosis. LEGAL PROCEEDINGS. 107 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 £29 5s., and the costs awarded to the Council to £28 2s. 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. 1912 15 8 0 41 19 0 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 The averages of fines and costs imposed with respect to "adulteration" cases were the lowest since 1906—by no means a satisfactory feature. Sophistication is too profitable to be checked until substantial penalties become the invariable rule in all convictions. 1912. 1911. 1909. 1908. 1907. Average per Fine £0 8 11 £0 13 0 £13 9 £12 3 £0 17 0 conviction Costs 0 8 11 0 14 3 0 12 2 0 13 9 0 12 8 In June of last year the Council directed letters to be sent to the various Departments of the Government expressing the opinion " that the penalties usually imposed in respect of offences under the Sale of Food and Drugs Acts are not sufficiently heavy to stop the adulteration of food stuffs." On the same occasion the Council reaffirmed their long-held opinion that the " warranty provisions " of the Acts ought to be repealed so far as milk is concerned. Owing to those provisions it is now extremely difficult to secure the fixing of the responsibility for the adulteration on anyone. 108 LEGAL PROCEEDING. LEGAL PROCEEDINGS, 1912. Public Health (London) Act, 1891. Fines. Costs. Section 4. £ s. d. £ s. d. 37, Cirencester Street Drain defective, &c. Work done. Summons withdrawn. 4, Desborough Street No water supply to premises Supply re-instated. Summons withdrawn on payment of 2, Philip Terrace Room in dirty condition Order made. 0 5 0 „ Non-compliance with Order 1 10 0 0 12 6 45, Portnall Road No water supply to premises Supply re-instaled. 0 10 6 121, Praed Street „ „ „ withdrawn. Summons 71, Westbourne Grove Water-closet without proper light and ventilation Order made. 1 3 0 Section 47. L. Johnson,358, Harrow Road Being in possession of unsound bacon Summons dismissed. —Taylor, 5, Chippenham Road Selling unsound bacon „ By-laws. 36, Bark Place Sanitary works executed without notice 0 10 0 0 2 0 37, Cirencester Street Yard paving and dust-bin defective Work done. Summons withdrawn. 9, Clarendon Street Rooms overcrowded 0 5 0 0 2 0 26, „ Dust-bin defective Work done. 0 2 0 1, Hyde Park Place Water-closet constructed in direct communication with bedroom Summons dismissed costs against Council 2 2 0 80, Lancaster Gate „ „ 2 0 0 2 2 0 18, Prince's Mews Sanitary works executed without notice 0 10 0 0 2 0 5c, Warwick Avenue Defective valve-closet 0 5 0 1 3 0 91, Woodchester Street Insufficient water-closet accommodation No. of occupants reduced. 0 3 0 E. Baggs, Bedfont Cottage, Stanwell Removing offensive refuse during prohibited hours and in an improper manner 0 10 0 0 2 0 W. Muncey, 34, Ceylon Street, Battersea „ „ 1 0 0 0 2 0 Canal Boats Acts. £ s. d. £ s. d. C. R. "Ruby" Failing to produce certificate of registration 0 5 0 0 2 0 C. B. "Lily and Emily" Cabin leaky, stove pipe defective : certificate produced did not identify owner with boat Summons dismissed. Notification of Births Act, 1907. 3 Summonses issued against parents- £ s. d £ s. d. 1 Withdrawn — — 2 Convictions (total) 0 10 0 0 4 0 3 Summonses issued against medical practitioners- 1 Withdrawn - - 2 Convictions (total) 0 10 0 0 4 0 Dairies, Cowsheds and Milkshops Orders. £ s. d. £ s. d. W. J. Gibson, 108, Church Street Selling milk without being registered 0 10 0 0 2 0 Housing, Town Planning, &c., Act, 1908. 5 Tenants, 17, Desborough Street Failing to vacate premises after Notice of Closing Order Ordered to leave within 14days. 1 Tenant, „ „ „ „ „ „ 3 „ 1 „ „ „ „ „ „ „ 7 „ 1 „ „ „ „ „ Rooms vacated. Summons withdrawn. 2 Tenants, „ „ Failing to vacate premises within 14 days as ordered by Mag. strate „ „ „ LEGAL PROCEEDING 109 SUMMARY OF LEGAL PROCEEDINGS DURING 1912 Under Sale of Food and Drugs Acts, 1875-1907. Fines. Costs £ s. d. £ s. d. Milk 9% fat abstracted Warranty proved. Summons dismissed. „ 14% „ Do. Do „ 11% „ 0 10 0 0 2 0 „ 11% „ 0 10 0 0 2 0 „ 13% „ 0 5 0 0 2 0 „ 10% „ 0 10 0 0 2 0 „ 16% „ 0 5 0 0 2 0 „ 12% „ 0 10 0 0 2 0 „ 12% „ 0 5 0 0 2 0 „ 13% „ 0 5 0 0 2 0 „ 8% „ 0 10 0 1 17 0 „ 18% „ 0 5 0 0 2 0 „ 10% „ 0 10 0 0 2 0 „ 13% „ 0 5 0 0 2 0 „ 14% „ 0 5 0 0 2 0 „ 15% „ 0 5 0 0 2 0 „ 8% „ 0 10 0 0 2 0 „ 14% „ 0 5 0 0 2 0 „ 11% „ 0 10 0 0 2 0 „ 7% „ 0 10 0 0 12 6 „ 18% „ 0 5 0 0 2 0 „ 26% „ 1 0 0 0 15 6 „ 15% „ 0 10 0 0 12 6 „ 21% „ Summons dismissed. „ 12% „ Warranty proved. Summons dismissed. „ 29% „ Summons dismissed. „ 28% „ Do. „ 7% „ 2 0 0 0 16 6 „ 8% added water „ 12% „ — 0 14 6 „ 22% „ — 0 14 6 „ 7% „ — 0 13 6 „ 5% „ - 0 13 6 „ 8% „ — 0 13 6 „ 8% „ — 0 14 6 „ 13% „ — 0 14 6 „ 7% „ — 0 17 6 „ 31% „ — 0 14 6 „ 19% „ 0 5 0 0 16 6 „ 10% „ 0 5 0 0 12 6 „ 5% „ Warranty proved. Summons dismissed. „ 10% „ 0 10 0 0 16 6 „ 8% „ 0 10 0 0 2 0 „ 8% „ 0 10 0 0 12 6 „ 8% „ 0 10 0 0 2 0 „ 4% „ 0 10 0 0 12 6 „ 6% „ 0 10 0 0 2 0 „ 3¾% „ Warranty produced Summons withdrawn. „ 6% „ Warranty proved. Summons dismissed. „ 7% „ Do. Do. „ 7% „ 1 0 0 0 15 6 „ 8% „ 1 0 0 0 12 6 „ 9% „ Warranty proved. Summons dismissed. Butter 79% foreign fat 2 0 0 0 12 6 Milk-blended butter Sold in an unstamped wrapper 0 10 0 0 12 6 „ Sold from unlabelled bulk 0 10 0 0 2 0 Margarine Sold in an unstamped wrapper Summons withdrawn on payment of 0 2 0 „ Sold in an improper wrapper 0 10 0 0 1'2 6 „ Sold from improperly labelled bulk 1 0 0 0 12 6 Sold from unlabelled bulk 0 10 0 0 2 0 NOTE. Samples purchased from one and the same vendor are bracketed together. VITAL STATISTICS. 111 APPENDIX. A. TABLE I. L.G.B. Estimated Population. Births Registered. Deaths Registered. Deaths. Births. Totals. Rates.* At ages under One Year. At all Ages. In Local Institutions. In Outlying Institutions. Of NonResidents. Nett Totals. Nett Rates.* Transfers. Corrected Totals. Corrected Rates.* Corrected Totals. Corrected Rates.* Totals. Rates.† Totals. Rates.* 1902 143,806 3,305 22.61 474 144 2,311 15.81 735 207 366 2,152 14.72 1903 143,668 3,302 22.98 425 128 2,103 14.64 743 181 366 1,918 13.35 1904 143,528 3,295 22.96 490 148 2,228 15.52 780 173 387 2,014 14.03 1905 143,388 3,184 22.20 441 139 2,210 15.41 806 161 410 1,961 13.68 1906 143,246 3,152 22.00 395 125 2,041 14.25 775 197 395 1,843 12.87 3,286 22.94 1907 143,103 3,074 21.48 396 128 2,154 15.05 770 232 372 2,014 14.07 3,206 22.40 1908 142,958 3,149 21.66 374 118 2,079 14.30 825 217 400 1,896 13.04 3,296 22.68 1909 142,811 2,895 20.27 347 119 2,154 15.08 813 219 409 1,964 13.75 3,031 21.22 1910 142,663 2,909 20.39 353 121 2,004 14.05 808 175 384 1,795 12.58 3,022 21.18 1911 142,513 2,815 19.75 399 141 2,074 14.55 854 218 407 1,885 13.23 41 1,926 13.51 3,059 21.46 Averages 1902-06 143,526 3,248 22.63 445 137 2,179 15.18 768 184 385 1,978 13.78 1907-11 142,808 2,968 20.78 374 126 2,093 14.66 814 212 394 1,911 13.33 3,123 21.87 1902-11 143,159 3,108 21.71 409 132 2,136 14.91 791 198 399 1,944 13.58 1912 142,362 2,774 19.48 326 117 1,889 13.27 798 220 372 1,737 12.20 34 1,771 12.44 3,015 21.18 * These rates per 1,000 estimated population. † These rates per 1,000 births. Area of the Borough (acres) Total 1,356.1 Total Population 1901, 143,976. Land only 1,336 1911, 142,551. 112 BIRTHS AND DEATHS. TABLE II. Wards. Borough. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Populations. 1907 143,103 16,526 27,308 20,013 23,582 25,525 8,879 7,981 13,289 1908 142,958 16,417 27,242 20,228 23,550 25,400 8,950 7,988 13,183 1909 142,811 16,307 27,176 20,445 23,518 25,274 9,020 7,994 13,076 1910 142,663 16,196 27,109 20,665 23,485 25,146 9,092 8,002 12,969 1911 142,513 16,084 27,041 20,886 23,452 25,017 9,164 8,009 12,860 Averages 142,808 16,305 27,174 20,449 23,517 25,271 9,021 7,995 13,074 1912 142,362 15,970 26,972 21,111 23,418 24,888 9,237 8,016 12,750 Births. 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 1911 2,977 383 726 405 458 726 50 69 160 Averages 3,106 412 768 411 474 739 64 61 177 1912 2,991 399 700 437 476 681 64 64 170 Deaths: All Ages. 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 1911 1,926 222 383 277 365 414 65 66 134 Averages 1,919 216 386 267 332 450 66 60 142 1912 1,771 185 365 239 290 419 75 64 134 Deaths: Under One Year. 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 1911 386 48 83 44 70 113 7 3 18 Averages 339 40 74 41 54 104 4 4 18 1912 295 37 56 43 44 91 5 3 16 DEATHS OF RESIDENTS OF THE BOROUGH. 113 TABLE III. Deaths of Residents of the Borough, 1912. 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. F. M. F. M. F. Enteric Fever 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 32 16 16 6 5 10 11 ... ... ... ... ... ... ... ... 3 7 Scarlet Fever 3 2 1 ... ... 1 1 1 ... ... ... ... ... ... ... 2 1 Whooping Cough 21 11 10 8 3 3 7 ... ... ... ... ... ... ... ... 4 4 Diphtheria, Membranous Croup 6 2 4 ... ... 1 1 l 3 ... ... ... ... ... ... 2 3 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 23 9 14 ... 2 1 1 ... 1 ... ... 6 4 2 6 ... 3 Erysipelas 3 1 2 ... ... ... ... ... ... ... 1 1 1 ... ... 1 2 Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 3 2 1 ... ... ... ... ... ... ... ... 2 ... ... 1 2 ... Pulmonary Tuberculosis, A. Phthisis 117 73 44 ... ... ... ... l ... 6 6 63 37 3 1 46 17 Tub. Meningitis, A. Hydrocephalus 17 8 9 1 3 4 4 2 1 1 1 ... ... ... ... 6 1 Other Forms of Tuberculosis 29 13 16 4 2 5 3 1 5 ... ... 3 5 ... 1 6 12 Syphilis 8 7 1 3 ... ... ... ... ... ... ... 3 1 1 1 4 1 Cancer 175 79 96 1 ... 1 ... ... ... 1 ... 55 52 21 44 39 36 Rheumatic Fever 10 5 5 ... ... 1 ... 3 ... ... 1 1 3 ... 1 ... 2 Alcoholism 9 3 6 ... ... ... ... ... ... ... ... 3 5 ... 1 1 1 Inflammation and Softening of Brain 13 4 9 ... ... ... 1 ... ... ... ... 3 1 1 7 3 3 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Meningitis 10 4 6 2 3 1 1 1 ... ... 2 ... ... ... ... ... 2 Cerebral Hæmorrhage 47 19 28 ... ... ... ... ... ... ... ... 13 11 6 17 6 6 Apoplexy 14 4 10 ... ... ... ... ... ... ... ... 2 l 2 9 ... ... Convulsions 11 5 6 5 6 ... ... ... ... ... ... ... ... ... ... ... ... Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart Disease 175 73 102 ... ... ... ... 3 5 2 3 40 52 28 42 27 31 Bronchitis 189 93 96 17 6 2 6 ... ... ... ... 22 18 52 66 37 33 Lobular (Broncho-) Pneumonia 58 35 23 16 7 10 4 ... ... 1 ... 4 6 4 6 11 5 Lobar (Croupous) Pneumonia 17 11 6 ... ... 2 1 ... ... 2 ... 6 5 1 ... 7 2 Pneumonia 60 33 27 7 3 6 4 ... 1 3 1 8 8 9 10 9 8 Other Diseases of Respiratory Organs 29 17 12 ... ... 2 ... 1 ... ... ... 11 6 3 6 10 ... Diseases of Stomach 7 5 2 3 ... 1 ... ... ... ... ... ... ... 1 2 1 ... Diarrhœa and Enteritis 54 29 25 21 17 5 4 ... ... ... ... 1 2 2 2 14 16 Appendicitis 15 8 7 ... ... 2 ... 1 1 ... 1 5 3 ... 2 7 4 Obstruction of Intestines 17 7 10 ... 2 2 ... 1 ••• ... ... 3 3 1 5 5 5 Cirrhosis of Liver 19 8 11 ... ... ... ... ... ... ... ... 8 7 ... 4 4 2 Nephritis and Bright's Disease 61 22 39 ... ... ... ... ... ... ... 2 14 22 8 15 9 15 Tumours (N.-M.), &c., Female Genital Organs 6 ... 6 ... 1 ... ... ... ... ... 1 ... 4 ... ... ... 4 Puerperal Fever 4 ... 4 ... ... ... ... ... ... ... 3 ... 1 ... ... ... 2 Accidents and Diseases of Parturition 6 ... 6 ... ... ... ... ... ... ... ... ... 6 ... ... ... 1 Congenital Defects 23 13 10 11 9 2 1 ... ... ... ... ... ... ... ... 6 1 Premature Birth 58 35 23 35 23 ... ... ... ... ... ... ... ... ... ... 8 3 Developmental Diseases 42 30 12 29 12 1 ... ... ... ... ... ... ... ... ... 7 4 Old Age 92 35 57 ... ... ... ... ... ... ... ... ... ... 35 57 19 21 Suicide 13 7 6 ... ... ... ... ... ... 1 4 5 3 ... 2 1 Overlaid in Bed 6 1 5 1 5 ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 48 29 19 3 2 3 3 5 l 2 2 16 8 ... 3 9 9 Homicide 3 1 2 1 ... ... ... ... ... ... ... ... 2 ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes 2 1 1 ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 All other Causes 215 119 96 7 3 5 ... 4 1 4 6 60 52 39 34 49 41 All Causes 1,771 880 891 181 114 71 53 25 19 22 31 359 332 222 342 367 310 Q 214 DEATHS OF RESIDENTS OF THE BOROUGH. TABLE IV. Deaths of Residents of the Borough, 1912. Numbers (all Ages) in each Ward. Causes of Death. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F.[.###] Enteric Fever 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 3 3 3 ... 1 6 4 2 5 ... ... ... ... 2 ... Scarlet Fever ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 ... Whooping Cough 1 1 3 2 3 1 1 1 3 1 ... 1 ... ... ... 3 Diphtheria, Membranous Croup 2 ... ... 1 ... 2 ... 1 ... ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 1 2 4 2 ... 3 ... 4 2 1 ... 2 ... ... 2 ... Erysipelas ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... Pulmonary Tuberculosis, A. Phthisis 7 4 17 11 10 5 12 7 17 14 2 1 1 1 7 1 Tub. Meningitis, A. Hydrocephalus ... 2 1 ... l 2 2 2 4 2 ... ... ... 1 ... ... Other Forms of Tuberculosis 2 1 3 2 2 2 ... 4 4 7 ... ... ... ... 2 ... Syphilis 1 ... 2 ... ... ... 1 ... 3 1 ... ... ... ... ... ... Cancer 10 5 16 26 16 12 8 22 16 17 7 5 1 ... 5 9 Rheumatic Fever 3 1 ... 1 ... 2 ... ... ... 1 ... ... 1 ... 1 ... Alcoholism ... ... 1 3 ... 1 ... ... 1 ... ... 1 1 1 ... ... Inflammation and Softening of Brain ... 1 2 2 1 1 ... 3 1 ... ... ... ... 1 ... 1 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Meningitis 1 ... ... 1 ... ... 1 3 1 2 ... ... ... ... 1 ... Cerebral Hæmorrhage 2 1 3 3 2 9 2 1 6 6 1 3 ... 2 3 3 Apoplexy ... ... ... 3 1 1 2 1 1 1 ... ... ... 2 ... 2 Convulsions ... 1 3 1 1 1 ... 1 1 2 ... ... ... ... ... ... Acute Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Organic Disease of the Heart 1 9 19 22 6 13 10 21 21 12 3 5 4 5 9 15 Bronchitis 10 14 23 22 8 12 14 12 28 26 2 1 3 4 5 5 Lobular (Broncho-) Pneumonia 4 1 10 4 1 9 4 4 12 1 2 1 ... 1 2 2 Lobar (Croupous) Pneumonia 3 1 2 2 2 1 2 ... 1 1 ... ... ... ... 1 1 Pneumonia 2 1 10 4 2 2 7 5 10 9 2 2 ... 3 ... 1 Other Diseases of Respiratory Organs 1 1 4 2 2 2 5 2 3 1 1 2 1 1 ... 1 Diseases of Stomach ... ... 2 1 ... ... ... 1 2 ... ... ... ... ... 1 ... Diarrhœa and Enteritis 4 1 2 4 6 ... 4 5 12 13 1 ... ... 1 ... 1 Appendicitis ... ... 2 1 ... 1 2 1 2 2 1 ... ... ... 1 2 Obstruction of Intestines 1 1 1 3 ... ... ... 5 3 1 l ... ... ... 1 ... Cirrhosis of Liver 1 3 1 1 2 3 ... 2 1 2 l ... 2 ... ... ... Nephritis and Bright's Disease 4 5 3 6 6 7 5 5 3 9 ... 2 ... 3 1 2 Tumours (N.M.),&c., Fem. Gen. Orgs. ... 1 ... 3 ... ... ... ... ... 2 ... ... ... ... ... ... Puerperal Fever ... 1 ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... Accidents and Diseases of Parturition ... 1 ... 1 ... 1 ... ... ... 1 ... ... ... 2 ... ... Congenital Defects 2 2 3 1 3 ... 1 4 4 1 ... 1 ... 1 ... ... Premature Birth 3 2 4 4 8 3 2 5 12 6 2 ... ... 1 4 2 Developmental Diseases 4 2 7 3 4 1 5 2 7 3 1 ... ... ... 2 1 Old Age 3 6 11 13 6 8 2 11 9 9 2 1 ... 3 2 6 Suicide 1 ... ... ... 1 ... 1 ... 2 1 ... 2 ... 1 2 2 Overlaid in Bed ... 1 ... ... ... ... ... 2 1 2 ... ... ... ... ... ... Other Accidents and Violence 4 ... 4 2 1 3 4 4 14 6 ... ... ... 2 2 2 Homicide ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 All other Causes 16 10 24 13 18 16 22 16 21 18 7 7 6 8 5 8 All Causes 98 87 191 174 114 125 126 164 232 187 37 38 20 44 62 72 TRANSFERRED DEATHS AND DEATHS IN LOCAL INSTITUTIONS. 115 TABLE V. Transferred Deaths. (Included in Table III.) Causes of Death. All Ages. Under 1. 1-5. 5-15. 15-25. 25-65. 65 and Upwards. Institutions. P. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pulmonary Tuberculosis, A. Phthisis 3 2 1 ... ... ... ... ... ... ... ... 2 1 ... ... 2 1 Other Forms of Tuberculosis 2 ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 Cancer, Malignant Disease 8 4 4 ... ... ... ... ... ... ... ... 4 1 ... 3 1 1 Rheumatic Fever 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Cerebral Hæmorrhage 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Heart Disease 4 2 2 ... ... ... ... 1 ... ... ... ... 1 1 1 1 ... Bronchitis 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Lobular (Broncho-) Pneumonia 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Nephritis and Bright's Disease 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... l ... Turn., &c., Fem. Gen. Orgs. 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Congenital Defects 1 1 ... 1 ... ... ... ... ... ... ••• ... ... ... ... ... ... Old Age 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... l ... Accidents and Violence 2 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... All other Causes 7 4 3 ... ... ... ... ... ... ... ... 4 2 ... 1 l 2 All Causes 34 18 16 l ... ... ... 1 ... ... 2 13 8 3 6 7 6 TABLE VI. Transferred Deaths. (Included in Table IV.) Causes of Death. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park West. East. Pulmonary Tuberculosis, A. Phthisis ... ... ... 2 1 ... ... ... Other Forms of Tuberculosis ... 1 1 ... ... ... ... ... Cancer, Malignant Disease ... 1 1 2 2 1 ... 1 Rheumatic Fever ... ... ... ... 1 ... ... ... Cerebral Hæmorrhage ... ... 1 ... ... ... ... ... Heart Disease ... 1 ... ... 1 ... 1 1 Bronchitis ... ... 1 ... ... ... ... ... Lobular (Broncho-) Pneumonia ... ... 1 ... ... ... ... ... Nephritis and Bright's Disease ... ... ... ... 1 ... ... ... Tumour, &c., Fem. Gen. Orgs. ... 1 ... ... ... ... ... ... Congenital Defects ... ... ... 1 ... ... ... ... Old Age ... ... ... ... ... 1 ... ... Accidents and Violence ... 1 1 ... ... ... ... ... All other Causes ... ... 1 2 2 ... 1 1 All Causes — 5 7 7 8 2 2 3 TABLE VII. Deaths in Local Institutions. (Uncorrected.) Workhouse. Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. Home of Compassion. 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 1911 105 293 383 56 9 8 Averages 77 291 348 85 5 (4 years) 9 1912 119 275 304 95 5 Closed 116 DEATHS IN LOCAL PUBLIC INSTITUTIONS. TABLE VIII. Deaths in Local Public Institutions, 1912. Causes of Death. Workhouse. Infirmary. Lock Hospital. Children's Hospital. St. Mary's Hospital. Nursing Homes. Enteric Fever ... ... ... ... ... ... Measles ... 8 ... ... ... ... Scarlet Fever ... ... ... ... ... ... Whooping Cough ... 2 ... ... ... ... Diphtheria, Membranous Croup ... 1 ... 1 2 ... Croup ... ... ... ... ... ... Epidemic Influenza ... ... ... 1 1 ... Erysipelas ... 4 ... ... ... ... Other Septic Diseases ... 1 ... ... 5 ... Pulmonary Tuberculosis, Acute Phthisis 2 45 ... ... 11 ... Tub. Meningitis, A. Hydrocephalus ... 2 ... 6 8 ... Other Forms of Tuberculosis ... 12 ... 5 7 ... Syphilis 1 2 4 2 4 ... Cancer 4 31 ... 2 45 7 Rheumatic Fever ... ... ... 4 2 ... Alcoholism ... 2 ... ... 1 1 Inflammation and Softening of Brain 2 3 ... 1 1 ... Cerebro-spinal Fever ... ... ... ... 1 1 Simple Meningitis ... ... ... 1 1 1 Cerebral Hæmorrhage 7 2 ... ... 8 2 Convulsions ... ... ... ... ... ... Heart Disease 5 27 ... 1 22 1 Bronchitis 42 26 ... 3 1 1 Lobular (Broncho) Pneumonia ... 6 ... 6 3 ... Lobar (Croupous) Pneumonia 1 3 ... 3 3 1 Pneumonia 1 11 ... 5 6 ... Other Diseases of Respiratory Organs 1 1 ... 5 4 ... Diseases of Stomach ... ... ... ... ... ... Diarrhæa and Enteritis ... 17 ... 12 5 1 Appendicitis ... ... ... 4 13 ... Obstruction of Intestines 2 3 ... 2 11 1 Cirrhosis of Liver ... 5 ... ... 2 ... Nephritis and Bright's Disease 6 10 ... ... 11 2 Tumours (N.-M.), &c., Fem. Gen. Orgs ... 1 ... 1 2 ... Puerperal Fever ... 2 ... ... 5 ... Accidents and Diseases of Parturition ... ... ... ... 3 ... Congenital Defects ... 1 ... 9 1 ... Premature Birth 6 4 1 1 ... 1 Developmental Diseases 2 3 ... 4 1 ... Old Age 26 13 ... ... ... 1 Suicide ... 2 ... ... 4 ... Other Accidents and Violence 1 5 ... 3 48 ... Homicide ... ... ... ... 3 ... Ill-defined Causes ... ... ... ... 1 ... All other Causes 10 20 ... 13 59 5 All Causes 119 275 5 95 304 25 Non-residents 8 6 5 72 243 15 117 deaths of residents outside the borough. TABLE IX. Deaths or Residents outside the Borough, 1912. Causes of Death. Hospitals of Metropolitan Asylums Board. General Hospitals. Special Hospitals and Homes. Lunatic Asylums. Poor Law Institutions. Elsewhere. "Transferred Deaths."* Enteric Fever ... ... ... ... ... ... ... Measles 2 ... ... ... ... ... ... Scarlet Fever 3 ... ... ... ... ... ... Whooping Cough 6 ... ... ... ... ... ... Diphtheria, Membranous Croup 3 ... 1 ... ... ... ... Croup ... ... ... ... ... ... Epidemic Influenza ... 2 ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... Other Septic Diseases ... 1 ... ... ... ... ... Pulmonary Tuberculosis, Acute Phthisis ... 1 8 5 2 ... 3 Tub. Mening., A. Hydroceph. ... 1 ... ... ... ... ... Other Forms of Tuberculosis ... 2 ... 1 ... 1 2 Syphilis ... ... 1 1 ... ... ... Cancer ... 28 6 1 2 1 8 Rheumatic Fever ... ... 1 ... ... ... 1 Alcoholism ... ... ... ... ... ... ... Inflammation and Softening of Brain ... ... ... ... 1 1 ... Cerebro-spinal Fever ... ... ... ... ... ... ... Simple Meningitis 1 ... ... ... ... ... ... Cerebral Hemorrhage ... 2 ... ... ... 1 1 Convulsions ... ... ... ... ... ... ... Heart Disease 1 7 5 3 7 4 Bronchitis ... ... ... ... ... 2 1 Lobular (Broncho-) Pneumonia ... 1 ... 4 2 1 1 Lobar (Croupous) Pneumonia 1 ... ... 2 ... ... ... Pneumonia ... 1 ... ... ... 1 ... Other Diseases of Respiratory Organs 2 3 ... 1 ... ... Diseases of Stomach ... ... ... ... 1 ... ... Diarrhoea and Enteritis 5 1 2 1 ... ... Appendicitis ... 4 ... ... ... 1 ... Obstruction of Intestines ... 2 ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... 1 ... Nephritis and Bright's Disease ... 6 ... 1 1 ... 1 Tumours (N.-M.), &c., Fem. Genital Organs ... 2 ... ... ... 1 1 Puerperal Fever ... ... ... ... ... ... ... Accidents and Diseases of Parturition ... ... 1 ... ... ... ... Congenital Defects ... ... 2 ... ... 1 1 Premature Birth ... 1 2 ... ... ... ... Developmental Diseases 3 ... 1 ... 1 1 ... Old Age ... ... 1 1 ... ... l Suicide ... 1 ... ... ... 2 ... Other Accidents and Violence ... 2 ... ... ... 7 2 Homicide ... ... ... ... ... ... ... Ill-defined Causes ... 1 ... 1 ... ... ... All other Causes 2 21 5 23 ... 8 7 All Causes 29 90 34 46 12 43 34 * Included in the preceding columns. 118 deaths of infants under one year. TABLE X. Deaths under One Year. 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— 1912 1907-11 1912 1907-11 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. m. f. m. f. m. f. m. f. I. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 3 ... 2 2 ... 2 6 5 5 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... 1 1 ... ... ... 2 ... ... ... ... ... 2 ... ... 1 8 7 3 8 II. Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 1 1 1 ... 1 ... 1 ... ... 1 ... ... ... 1 ... ... 4 22 7 18 Enteritis ... ... ... ... ... 1 2 ... ... 1 2 2 2 2 ... 1 4 2 1 1 2 ... 1 ... 1 ... 2 ... ... ... 1 1 1 1 17 13 10 12 III. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... 1 4 3 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 Other Forms do. ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 1 ... ... ... ... ... ... ... 1 ... ... 4 2 2 2 IV. Congenital Malformations 1 2 6 4 1 1 ... ... ... ... 7 5 1 ... 1 2 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 11 10 9 7 Premature Birth 13 10 23 17 3 3 2 2 ... ... 28 22 5 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 35 35 23 22 Atrophy and Debility ... ... 1 ... 1 ... ... ... ... ... 2 ... 4 ... ... ... ... ... 1 ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... 9 13 1 7 Debility at Birth 2 ... 2 1 1 1 2 1 1 ... 6 3 2 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 10 9 4 8 Injury at Birth 1 2 1 2 1 ... ... 1 1 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 3 3 Atelectasis 1 2 3 3 ... ... ... ... ... ... 3 3 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 3 3 4 2 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 2 1 1 V. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 ... 4 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 0 1 0 Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 l 2 3 3 2 Convulsions ... ... 1 2 ... ... ... ... ... ... 1 ... 1 1 ... 1 2 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 5 5 6 2 Gastritis ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ? ... ? Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 Bronchitis ... ... ... ... 1 ... 1 1 1 ... 6 2 2 2 1 ... 1 1 1 ... ... 1 1 ... 1 ... 1 1 ... ... 2 ... 1 ... 17 12 6 12 Pneumonia ... ... ... ... 1 ... 2 1 1 ... 4 1 1 1 2 ... 2 3 2 ... 1 ... 3 1 1 ... 4 1 2 ... 1 1 ... 1 23 18 10 14 Suffocation (overlaid) ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 5 3 Other Causes 2 1 2 1 3 ... 1 ... 1 ... 7 1 1 ... 1 1 2 ... ... 1 1 1 1 14 ... 1 ... 1 ... ... ... 1 1 ... 14 13 8 11 All Causes 20 17 39 30 12 6 13 6 6 1 70 43 25 10 11 9 14 13 7 5 7 12 6 7 1 8 5 7 10 9 3 9 181 191 114 148 Uncertified Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Averages 1907-11 21 16 42 26 11 8 8 6 7 6 68 46 24 23 15 13 10 10 11 8 14 7 9 7 10 8 9 6 7 7 6 6 8 7 Corrected Births—Total 1912. 1907-11. m. 1,533 1,585 f. 1,458 1,522 Illegitimate 1912. 1907-11. m. 97 79 f. 89 70 119 proceedings during 1912. TABLE XI. PROCEEDINGS DURING 1912. L.C.C. Premises. Number of Places— Number of Inspections, 1912. Number of Notices, 1912. Number of Prosecutions, 1912. On Register at end of 1911. Added in 1912. Removed in 1912. On Register at end of 1912. Milk premises 120 3 3 120 168 ... ... Cowsheds 1 ... ... 1 4 ... ... Slaughter-houses 7 ... ... 7 447 • • • ... Other offensive trade premises ... ... ... ... ... ... ... Ice cream premises 108 12 10 110 114 ... ... Registered houses let in lodgings 1,348 ... ... 1,348 7,161 (a) 130 (b) 1,892 ((a) (b) 1 (a) For overcrowding. (b) For other conditions (including annual cleansing). Total number of intimation notices served for all purposes 1,176 Overcrowding, 1912 — Number of dwelling rooms overcrowded 299 Number remedied 265* Number of prosecutions 1 Underground rooms— Illegal occupation dealt with during year 11 Number of rooms closed 23 Insanitary houses— Number closed under the Public Health (London) Act, 1891 - Number closed under the Housing Acts 12 Number of premises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 217 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 17 Number of tenements comprised therein 64 (a) granted 14 Number of tenements for which certificates were (b) refused - (c) deferred 27 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 1 (e) In connection with the removal of offensive matter, &c. 2 (/) 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. 3 (i) With respect to sufficiency of water supply to water closets - (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) Mortuaries— Total number of bodies removed 287 Total number of infectious bodies removed 3 * In 34 cases no action was taken, the total deficiency of air space being less than 50 cubic feet. 120 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. TABLE XII. 1.—Inspections. Including Inspections made by Sanitary Inspectors. H.O. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 110 - - Workshops (including Workshop Laundries) 2,926 6 - Workplaces (other than Outworkers' premises included in Part 3 of this Report) 40 - - Total 3,076 6 — 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. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) making, &c. 112 20 484 5 10 - - (2) cleaning and washing - - - - - - - Lace, lace curtains and nets - - 6 - - 3 - Furniture and upholstery - - 40 - - 20 - Electro-plate 2 10 - 1 5 - - Umbrellas, &c. 2 - 4 1 - 2 - Artificial flowers 2 - 6 1 - 3 - Brush making 2 - 2 1 - 1 - Stuffed toys - - 1 - - - - Basket making - - 1 - - - - Total 120 30 544 9 15 29 - 4.—Registered Workshops. Workshops on the Register (S. 131) at the end of the year. Number. Workshops 1,391 Do. Bakehouses 53 Total number of workshops on Register 1,444 121 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H. M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 58 58 - - Want of ventilation 2 2 - - Overcrowding 23 23 - - Want of drainage of floors - - - - Other nuisances - - - - Sanitary accommodation insufficient - - - - unsuitable or defective 30 30 - - not separate for sexes 2 2 - - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) - - - - Breach of special sanitary requirements for bakehouses (S.S. 97 to 100) - - - - Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) 17 17 - - Total 132 132 - - Work. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (SS. 109,110). Failing to keep or permit inspection of lists. Failing to send lists. - - - - - 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 - - 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) 52 Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5) Notified by H. M. Inspector - Reports (of action taken) sent to H.M. Inspector - Other - Underground Bakehouses (S. 111):Certificates granted during the year - In use at the end of the year 54 r 122 pulmonary tuberculosis. APPENDIX B. TABLE I. Pulmonary Tuberculosis, 1912. Street Distribution of New Cases reported. Name of Street. Approx. No. of Inhabits. No. of Cases reported. No. of Houses invaded. Name of Street. Approx. No. of Inhabits. No. of Cases reported. No. of Houses invaded. Adpar Street 186 1 1 Coomassie Road 30 2 1 Albert Street 171 1(1)* 1 Cornwall Road 484 10 (4) 9 Alexander Street 208 3 1 Courtnell Street 305 3(3) 3 Alfred Place 44 2 1 Craven Hill 182 1 1 Alfred Road 653 11(3) 10 Craven Hill Gardens 438 2 2 Amberley Mews 119 2 2 Craven Road 196 1 1 Amberley Road 1,291 27 (4) 18 Craven Terrace 212 1 1 Amberley Wharves 88 1 1 Crompton Street 184 2 2 Artesian Road 355 5 2 Croxley Road 420 1 1 Ashmore Road 2,349 20 (4) 13 Cuthbert Street 313 2 2 Avenue, First 273 3 3 Dartington Terrace 279 6 (2) 5 „ Second 226 3 (1) 2 Delamere Crescent 460 7(1) 6 „ Third 1,093 11 (5) 9 Delamere Mews 41 1 1 „ Fourth 356 1 1 Delamere Street 140 2 2 „ Fifth 1,143 7(2) 7 Delamere Terrace 364 5(1) 4 „ Sixth 729 7(2) 6 Delaware Mansions 333 1 1 Barfett Street 171 2 2 Denholme Road 285 3 3 Bark Place 234 1 1 Desboro' Street 158 1 1 Barnsdale Road 704 5(1) 4 Devonport Street 49 2 1 Bathurst Mews 150 1 1 Droop Street 1,390 7(1) 7 Bathurst Street 52 1 1 Dudley Street 255 2 2 Beethoven Street 386 7(2) 5 Durham Terrace 120 1 1 Blomfield Mews 65 1 1 Eastbourne Mews 125 1 1 Blomfield Street 186 1 1 Edbrooke Road 707 8(4) 5 Braden Street 264 9(4) 4 Edgware Road 1,030 2 2 Bradiston Road 208 1 1 „ Albert Terrace 46 3(1) 2 Braithwaite Place 107 1 1 Elcom Street 260 7(8) 5 Bravington Road 2,732 39 (13 ) 27 Elgin Avenue 1,466 7(1) 6 Brindley Street 760 15 12 Elgin Terrace 799 3 3 Bristol Gardens 301 3 2 Elms Lane Mews 58 2(1) 1 Bristol Mews 107 4(2) 2 Elnathan Mews 242 3(1) 2 Burlington Road 585 11 (4) 8 Enbrook Street 290 1(1) 1 Burwood Place 78 1 1 Essendine Road 323 1 1 Cambridge Place 281 4 3 Farrant Street 356 1 1 Cambridge Terrace 490 1 1 Fermoy Road 641 5(3) 3 Campbell Street 396 5(1) 3 Fernhead Road 2,029 21 (7) 17 Canterbury Terrace 319 1 1 Fordingley Road 469 3(1) 3 Carlton Mews, G.W. Rd. 37 1(1) 1 Formosa Street 443 5(1) 5 M. V. 145 4 1 Fulham Place 243 1 1 Carlton Vale 487 1 1 Gloucester Mews West 116 1 1 Caroline Place 233 1 (1) 1 Gloucester Terrace 1,504 2 2 Chester Place 90 1 1 Goldney Road 837 8(1) 8 Chichester Road 207 2 (1) 2 Great Western Road 739 4 4 Chippenham Mews 368 8 8 Hall Place 1,158 7(2) 6 Chippenham Road 1,423 19 (5) 14 Hampden Street 873 12 (5) 9 Church Place, K. G. 50 4(2) 2 Harrow Road 3,473 38 (6) 30 P. G. 249 1 1 Hasboro' Street 179 5 5 Cirencester Street 1,557 26 (17 ) 17 Hereford Road 731 4(1) 4 Clarendon Gardens 316 4(3) 2 Hermitage Street 124 2 2 Clarendon Street 2,000 36 (7) 28 Herries Street 1,066 12 (5) 7 Conduit Mews 120 1 1 Hethpool Street 564 5 5 Connaught Mews 38 1 1 High Road 30 1 1 Connaught Square 246 2 2 Hormead Road 453 1 1 * The figure in parentheses indicates the numbers of "suspect" cases included in the total. 123 PULMONARY TUBERCULOSIS. 123 Name of Street. Approx. No. of Inhabits. No. of Cases reported. No. of Houses invaded. Name of Street. Approx. No. of Inhabits. No. of Cases reported No, of Houses invaded. Howell Street 203 1 1 Richmond Mews 17 2 1 Howley Place 206 1 1 Richmond Road 512 1 (1) 1 Huxley Street 293 1 1 Rodboro' Mews 85 1 1 Hyde Park Gardens 310 1 1 Rundell Road 149 7 (2) 3 Ilbert Street 976 10 (2) 7 St. John's Terrace 59 6 (2) 2 Inverness Terrace 885 1 1 St. Mary's Terrace 222 4 (1) 3 James Street 78 1 1 St. Mary's Mansions 279 2 2 Jonson Mews 30 1 1 St. Stephen's Road.. 222 4 2 Junction Place 15 1(1) 1 St. Stephen's Square 331 2 2 Kennet Road 353 5(1) 4 Saltram Crescent 1,216 5 (1) 5 Kensal Road 1,086 13(3) 9 Senior Street 577 11 (6) 6 Kensington Gardens Square 974 2 2 Sevington Street 182 2 2 Kilburn Lane 1,161 8(2) 6 Shelden Street 130 1 1 Kilburn Park Road 1,553 17 (5) 11 Shirland Road 3,298 19 (1) 18 Kilravock Street 606 4 4 South Wharf Road 232 3 (1) 3 Ladbroke Grove 122 2 2 Southwick Street 299 1 1 Lancaster Gate 1,183 2 2 Stanhope Place 74 1 1 Lancaster Gate Terrace 188 1 1 Stanlely Street 116 3 2 Lancaster Mews 135 1 1 Star Street 797 5 4 Lancefield Street 1,335 8(4) 7 Sutherland Avenue 1,551 2 2 Lanhill Road 215 2 2 Sutherland Place 273 3 (1) 2 Lauderdale Mansions 580 2 2 Talbot Road 791 1 1 Leamington Road Villas 273 1 1 Talbot Square 145 1 (1) 1 Ledbury Road 291 5 (1) 4 Tavistock Crescent 438 4 3 Leinster Street 174 v-v 1 1 Tavistock Road 228 1 (1) 1 London Street 207 2 2 Thorngate Road 386 /3 3 Lothrop Street 535 3 (1) 3 Titchborne Street 248 1 1 Lydford Road 639 3 3 Torquay Street 448 8 (2) 5 Maida Vale 570 1 1 Union Place 159 1 1 ,, Sandringham Ct. 163 1 1 Upper Brook Mews 40 1 1 Market Street 377 2 2 Upper Westbourne Terrace 79 1 1 Marlboro' Gate Mews 11 1 1 Victoria Mews 24 1 1 Marne Street 475 1 1 Victoria Place 188 1 (1) 1 Marylands Road 715 11 (3) 6 Victoria Street 190 4 4 Modena Street 224 7(2) 4 Walterton Road 1,260 9 (1) 8 Moscow Road 209 1 1 Warlock Road 622 5 (1) 5 Mozart Street 352 10 (5) 4 Warwick Avenue 855 2 2 Netley Street 312 8(2) 6 Waverley Road 911 13 11 Norfolk Square 379 1 1 Waverley Terrace 51 5 (2) 3 North Wharf Road 468 3 3 Wellings Place 181 1 1 Northumberland Place 309 1 (1) 1 Westbourne Gardens 282 2 (1) 2 Nutbourne Street 414 2 2 Westbourne Park Crecent 409 6 (1) 5 Oliphant Street 750 11 (2) 9 Westbourne Park Mews 37 3(3) 3 Orchard Street 54 4(2) 2 Westbourne Park Road 729 5(2) 4 Oxford Terrace 249 1 1 Westbourne Park Villas 312 3(1) 2 Paddington Green 211 1 1 Westbourne Square 308 1 1 Philip Terrace 196 5 5 Westbourne Terrace North 481 7 (1) 6 Porchester Mews 121 1(1) 1 Westbury Road 250 5 5 Porchester Square 276 1 1 Westbury Terrace 131 2 1 Portnall Road 2,649 33 (10) 20 Westmoreland Mews 51 3 (3) 1 Portsdown Road 1,391 5 5 Westmoreland Road 552 7 (5) 5 Praed Street 587 1 1 Windsor Gardens 95 1 1 Pressland Street 163 2(2) 1 Windsor Street 161 1 1 Princes Square 901 1 1 Woodchester Street 1,616 34 (4) 25 Queen's Gardens 527 3 2 Woodfield Crescent 314 7 (3) 4 Queen's Road 921 1 1 Woodfield Place 380 8(1) 7 Ranelagh Road 369 9(3) 5 Woodfield Road 366 8(1) 8 The figure in parentheses indicates the numbers of "suspect" cases included in the total. 124 pulmonary tuberculosis. TABLE II. Notification. Removals. Duration of Disease (Yrs.). Family History of Tuberculosis. In-patient Treatment. Occupation. Single. Duration of Marriage. Widowed. Year of First Certificates received. Present. Absent. Not known. Total. Yr. M. Hospital. Sanatorium. Home of Rest. Poor Law. 09 l - 3½ X 3½ 09* Shunter 20 08 3 2 7 X 9 06:07:08:09 Labourer, casual 12 12 1 - 1 X - S. Postman X 12 1 - 3 X - 10 Draper's Assistant X 12 1 - 4 X - 09:10:11 Governess X 12 1 - X - X Wf. Glass Painter X 12 1 - 20 X - Bookseller X 11 1 1 ½ X - Gen. Labourer X 12 1 - 1½ X 6 X Police Constable X 10 8 1 12 X 4 10:11 Horsekeeper 12 11 2 - X - D. Police Constable X 12 1 - X - Railway Official 2 12 1 - 4 X - Railway Porter X - - - 2 X ½ x Gasfitter X 12 1 - X - X Lace Worker [Disp. X 12 - X - Wf. Soda Fountain 1 (06)‡11 1 1 8 X - 09 Bus Conductor X 12 1 - 7 X - 06 Metallurgic Analyst X 11 3 - 1½ X - Wd. Shoemaker X 12 1 - X - D. Butler X 12 1 - X - Wf. General Dealer X 12 1 - X - Wf. Builder's Lab. X 12 1 - 2/12 X - 12 Wf. Elec. Batt. Mkr. 6 12 2 - 1½ X - Wf. Hairdresser 18 12 2 1 X 1 12 Wf. Motor 'Bus Driv. 6 10 2 - 21 X - Wf. Tailor's Porter 26 11 2 - 2½ X 10 10:11 Waiter X 12 1 - 2½ X - Railway Clerk X 12 1 - X - X Carpenter 30 12 1 - X - Wd. House Painter X {10) 12 1 1 5 X 2 12 Wf. Taxi Driver 5 12 1 - 8 X 3 05 Motor Car Cleaner X 12 4 - X 1 1 12 Political Agent 14 11 5 - 2½ 3 11:12 Carman 13 11 2 - 2½ X - Wf. Police Constable 22 12 4 1 1½ X 2 12 Pawnbroker's Assist. X 12 1 - X - Wd. Journalist X (06) 10 3 1 6 X 8 11 08 10-11 Electrician X 12 3 - 4/12 X ¼ 12 Wf. Electrician 13 11 2 - 1½ X - Wf. Med. Practitioner X 12 2 - 9 X - 12 Wf. Stationer's Storek'r X 12 1 - X - Tailor X 10 4 - X 3 12 Porter, Shop X 12 1 - 1 X - Errand Boy X 12 5 1 1½ X 1 12 Restaurant Waitress X - - - 1½ X - Waiter, Club X 12 1 - 2½ X - Coachman 10 10 4 - 26 X - X Wd. Army Pensioner X 12 1 - X - X X Dressmaker X 12 1 - X - Clerk 18 08 3 2 5 X 3½ 12 Wf. Painter X 08 2 - 12 X - Wf. Labourer 38 12 1 - 11 X 9 08 Greengrocer X 12 5 2½ X ¼ 12 Wf. Painter 12 * Received in 1909. † Duration in years (when known). ‡ Informally known in 1906. certified in 1911. 125 PULMONARY TUBERCULOSIS. TABLE III A. Patients Dying in Local Poor Law Infirmary. Notification. Removals. Duration of Disease (y«ars). Family History of Tuberculosis. In-patient Treatment. Occupation. Single. Duration of Marriage. Widowed. Year of First Certificates received. Present. Absent. Not Known. Total. Yr. M. Hospital. Sanatorium. Home of Rest. Poor Law. 12 2 - 1½ x 7 11-12 Wf. Bricklayer's Lab. x 10 10 2 1½ x 4 10:12 Dressmaker x 12 4 - 2 x 3 12 Wf. Carman 12 12 1 - 3/12 x ½ 12 Carman 19 12 1 - x 1 12 Wf. Cab Driver 39 (09) 12 3 1 6 x 2 11:12 Carman x (09) 11 6 1 2½ x 4 11:12 Wf. Railway Carman 7 11 5 1 2½ x 9 11-12 Turner 11 12 1 - 21 x ¼ 12 Builder's Labourer x 10 2 - 1½ x 16 10-12 Coachman x 12 3 - 6 x 2d. 12 Wf. Blacksmith's Lab. 10 12 5 - x 2¾ 12 12 Lavatory Attendant x 11 6 4½ x 2 11-12 Labourer 12 12 3 - 6/12 x 1¾ 12 Painter 7 12 3 - x 9 12 11-12 Tennis Court G'dm'n. 10 7 2 4 x 1 11 10:12 Cap Dresser x 12 2 - 1½ x ¾ 12 Cellarman 25 11 2 - 2| X 3 11-12 Steward (Ship) 12 3 - x ¾ 12 Clerk 17 12 4 1 8 x 3 11:12 Baker 10 09 1 - 5 x 46 07-12 Carriage Lamp Mkr. x 12 2 - 4 x 2½ 12 Painter 10 12 5 - 4 X 10 12 Flower Seller x 12 3 - 4/12 x 2 12 Carman 4 - - - diagnosis(?) 3 + 09-12 Dressmaker x 09 1 - 4 x 4 08-12 Labourer 12 3 - 11/12 x 2 12 Laundress X 12 1 - X 1 12 Whitesmith 33 11 1 - 5 x 3 11-12 Bacon Curer x 12 1 2 6/12 x ¾ 12 House Porter x 12 2 - X 1d. 12 Dressmaker 10 4 2 16 X 11 10:11:12 Kitchenmaid x 12 2 - 3 X 2 12 Carpet Layer X 11 5 - 7/12 x 2 11:11-12 Telephone Operator 17 10 5 1 4 x 4 11 10:12 Clerk X 12 2 - X 3d. 12 Dressmaker x 12 4 - 9/12 x 2 12 'Bus Conductor 25 12 2 - X l½ 12 Butler 30 12 4 1 2½ x 1¾ 12 Painter 9 12 2 - 1½ x ¼ 12 Horsekeeper x 11 4 1 2 X 1 11:12 Builder's Labourer 12 10 3 - l½ X ¾ 12 Ticket Writer (App.) X 12 5 1 6/12 X 2 12 Barber's Assistant 6 11 3 - X ¾ 12 Potman x TABLE III b. Patients Dying in Out-lying Institutions. 12 1 - 4 X ¾ 12 Park Gardener X - - - X 1½ 12 Wd. Coachman X 11 3 - 1¾ X 10 11-12 Cook: Housekeeper X (07) 09 8 2 5 X 5¾ 12 97:98 00: 09 Wf. Bottlewasher 9 12 2 1 X 1 12 Groom (Domestic) X 10 5 1 X 6 11:12 12 Painter X - - - X 57 07-12 Dressmaker X 12 4 - 1½ X 4 11-12:12 House Painter X (11) 12 1 1 X 10 11:12 12 Clerk X (08) 09 3 1 5 X 1¾ 12 Saddler X 12 1 - 12 X 4 12 Clerk Holy Orders - - - 15 X 2 11-12 Artist 4 2 - 2 X ½ 12 Cricket Bat Maker 20 10 3 1 ? 12 Wf. Carman X See Footnotes to previous table.