ACU 349 PAD 20 Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEARS 1919 and 1920. BY REGINALD DUDFIELD, O.B.E., M.A. M.B., D.P.H. Medical Officer of Health. SALUS CIVIUM CIVITIS OPES. LONDON: VAIL & Co., Printers, 170, FARRINGDON ROAD, E.C.I. Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEARS 1919 and 1920 BY REGINALD DUDFIELD, O.B.E., M.A., M.B., D.P.H. Medical Officer of Health. SALIJS CIVIUM CIVITATIS OPES. LONDON: VAIL & Co., Printers, 170, FARRINGDON ROAD, E.C.I. CONTENTS page Acute Poliomyelitis 17 Administrative Work 32 Alcoholism25 Analytical Work 45 Anthrax 24 Bacteriological Examinations, Results of 32 Bakehouses, Inspection of 43 Births 2 „ Notification of 4 „ "Hopeless"27 „ Illegitimate3 „ Still-Births5 Canals, Canal Boats Acts 35 Cancer, Mortality from 24 Cerebro-spinal Fever 16 Chickenpox31 Childbed, Fatality in 14 Childhood, Mortality in 26 Combined Drainage 34 Common Lodging Houses 41 Cream Regulations 46 Deaths5 Deaths in Institutions—All causes 26 Diphtheria7 Disinfection 32 Drainage Plans 33 Drains, Private, Re-laid 33 Dysentery18 Enteric Fever 11 Erysipelas13 Factory and Works'.op Act, 1001, Work under 42 Food Adulteration 45 Food Supervision 43 Health Visiting 35 Home Workers (Outworkers) 42 Hospital Isolation 32 House Sanitation 33 Housing 36 Ice Cream Trade 44 Illegitimates, Births of 3 „ Deaths of 28 Increase of Rent and Mortgage Interest (Restrictions) Act - 41 Infant Consultation Centres 36 Infants, Mortality among 26 „ „ in Special areas 28 Influenza, Mortality from 17 Inland Revenue Acts 41 Inquests held 25 Institutions, Deaths in 26 Legal Proceedings, Summary of 46 page Malaria19 Manure, Removal of 34 Measles 29 " Meningitis"16 Milk Grants 36 Milk Trade 44 Mortality among Infants 26 „ „ „ "HopelessBirths" 27 Mortality at ages 1—5 years 29 „ in Childbed 14 Mortuary34 Mumps31 Notification of Births 4 „ „ Tuberculosis 19 Offensive Refuse 34 Office Work 46 Ophthalmia Neonatorum 14 Outworkers (Homework) 42 Overcrowding41 Phthisis, Mortality from 22 Poliomyelitis17 Population 1 Pneumonia 17 Preservatives in Foods 46 Prevention of Infectious Disease 32 Puerperal Fever 13 Pulmonary Tuberculosis 22 Rats and Mice 44 Respiratory Diseases, Mortality 'rom 18 Ringworm31 Scarlet Fever 9 Schools and Infectious Diseases 32 Sewer Connections 34 Slaughterhouses, Inspection of 43 Smoke Nuisance 35 Staff 32 Tenement Houses 40 Tiade Nuisances 34 Trench Fever 18 Tuberculosis: Dispensary Work 21 „ Notification 19 „ Mortality 21 „ Treatment of 20 Underground Rooms 40 Unsound Food 44 Vaccination 6 Venereal Diseases 25 Vital Statistics 1 Water Supply, Cutting off of 34 Welfare Work 35 Whooping Cough. 30 Workshop Supervision 42 APPENDIX Tables I to XXIX. TO HIS WORSHIP THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF PADDINGTON. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Report on the vital statistics and work of your Public Health Department during the years 1919 and 1920. This present is, I hope, the last of the Reports to be prepared without the very essential data relating to population. In the preparation of this Report and that for the years 1914-18 which was presented to you last year, I have felt myself in the position of an accountant who attempts to draw up a balance sheet without knowledge of his income and assets. Before the close of the current year I hope to receive the results of the Census taken in June. In the absence of data as to population by which to measure the rates of natality, mortality, &c., resort has been had to Index Numbers which show the extent of the variations in the records for the years under review when compared with selected standards, either the average for the quinquennium 1909-13 or that of 1914-18. Taken as a whole, I think it may be safely concluded that the records for the two years are exceptionally satisfactory. The evidence adduced in the Report more than suggests that the population of the Borough has increased, though that fact may not be regarded by all as altogether satisfactory having regard to the high density of population found at the Census of 1911. As observed after previous wars, the number of births notably increased after the cessation of hostilities, and the birth rate will probably be found when the new Census data are available to have been exceptionally high. In one respect the records of the past years are notably exceptional in that the (presumably) high birth rate has not been associated with a high rate of infantile mortality, the recorded rates of the latter being the lowest yet observed. Cases of diphtheria and scarlet fever were above the average, but as regards the former disease some of the excess recorded is explained by the frequency of " swabbing." The statistics relating to scarlet fever suggest that the strain of the causal organism had a high infectivity, but, as shown by the small number of deaths, a low virulence. The records relating to tuberculosis show a diminished prevalence of this disease, and more than suggest a reduced mortality. It is too early to decide whether this satisfactory record can be claimed as a sign of success of the " campaign " which may be said to have been initiated some ten or more years ago, or whether the change is merely cyclical. On the other hand, the mortality from the various malignant neoplasmata connoted by the popular designation of "cancer" shows a continued increase. To some extent, I suppose, an increase is almost inevitable owing to the increased proportion of the population at the higher ages of life. As already stated, the rates of infantile mortality observed during the two years are the lowest on record. I think some of the observed reduction in mortality can be safely attributed to the activities forming " Infant Welfare Work," but not all. Low mortality rates have been observed in districts where those activities are practically non-existent. On the other hand, the saving of lives between the ages of three and twelve months suggests that Welfare Work has not been without some influence. One outstanding feature of the two years has been the " Housing Campaign." In this Borough there is no land available for new houses, and the existing premises are practically all occupied. To provide for any notable increase of population, houses built for one family must be either sub-let to two or more families or be " converted " into flats and maisonettes. Conversion of a single house is rarely satisfactory, and I refer in the Report to certain instances which have been brought to my notice. There is no room for doubt about the necessity of more effective control of all " conversions." As regards the work of the Department there is no evidence of any lessening of the demands on the time and energy of the Staff—on the contrary, more duties continue to be imposed—added to which are the arrears of work which accumulated during the War. With the present establishment anything like a systematic survey of the Borough is impossible. All members of the Staff have worked hard, but I can only describe the present state of the work of the Department as greatly in arrear. I desire, in conclusion, to express my acknowledgments to the Chairmen and Members of the Public Health, Special Housing and Maternity and Child Welfare Committees—three Committees doing work which before the war was performed by one—for their sympathetic co-operation in my efforts to discharge the duties of my office, which I have now held for over twenty seven years. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Public Health Department, Paddington, W. 2. August, 1921. O.B.E., M.A., M.B., D.P.H., Medical Officer of Health. 1 A. VITAL STATISTICS. I.—POPULATION. Comment was made in the last Report—that for the five years, 1914-18—on the uncertainty attaching to estimates of population for the years subsequent to 1913. It can only be said that such uncertainty increased during the years now under review. The estimates furnished by the Registrar-General will be found in Table I. Appendix. While recognising that one guess is as good as another, it has been thought worth while to make an attempt to examine what have been the probable changes in the population of the Borough since 1913. Until that year at least all available evidence pointed to a steady but small annual decrease in the number of residents. For the purpose of this examination the necessary calculations have been based on— (1).—The results of the enumerations of 1901 and 1911, on the assumption that the observed rate of growth (decrease) continued unchanged; and (2).—The variations in the number of assessments reported as "empty" on June 30th, of each year. As regards the former method it is unnecessary to offer any explanation, as it was, prior to the war, the recognised basis of all methods of estimating population. The other method is, it is believed, novel and the results obtained must be accepted with some reserve. More extended trial is necessary to test its reliability. Moreover, to derive the full advantage of the method, some changes appear to be necessary in compiling the assessment returns. Briefly stated, the method adopted was— (1).—To take out the total number of assessments, and the number of "empties" on April 1, 1911 and thus obtain the nett number of "occupied" assessments; (2).—To determine the average number of persons per "occupied" assessment, using the total population enumerated at the Census of that year; and (3).—To estimate the population for each year—on June 30—by applying the averages obtained to the number of "occupied" assessments at that date. In actual working the average per assessment was determined for each Ward— Lancaster Gate, West and East Wards being treated as one Ward—the figure for the Borough as a whole being used solely as a check on the other calculations. (The results are set out below). Year 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 Estimates based on— (a) Census data 1901 & 1911 142,513 142,362 142.229 142,087 141,946 141,803 141,582 141,422 141,259 141,095 (b) Occupied Assessments 143,789 145,164 146,691 148,411 147,429 145,655 146,012 146,695 149,823 154,898 (c) Estimates furnished by) 142 513 142,362 142,210 142,193 142,193 142,169 136,561 131,673 149,941 150,128 the Registrar-General Supplemetary information of uncertain value was given by (i) The National Registration in November, 1915—showing a population of 130,041 persons; (ii) The issue of "Sugar Cards" in November 1917—when the cards issued numbered 38,275 representing 121,457 persons; and (iii) The issue of "Ration" Cards and Books—in July, 1918—to 128,123 persons, ,, ,, in November, 1918—to 126,814 persons, and ,, ,, ,, in September, 1919—to 141,830 persons. The differences exhibited by the various estimates are most erratic and impossible to explain at the present time. It can only be observed that there is good reason to believe that the estimates for the later years based on the census data of 1901 and 1911 are not trustworthy and that since (say) 1914 the population of the Borough has increased, whatever may have been the temporary fluctuations occasioned by the War. Not only has there been a decreasing proportion of empty assessments, but many properties formerly rated and assessed as units are now in effect multiple assessments—that is to say the single assessment which formerly represented one family now covers two or more families. That the population of the Borough is at the present time an increasing one is almost beyond dispute. The percentage of "Empties" has fallen from 8.7 at June 30, 1911, to 2.5 at the corresponding date in 1920 (see next page). In addition there has been during the 2 BIRTHS. last two years a growing practice of converting houses—even comparatively small houses— into maisonettes, flats and tenements. In the Southern Wards many houses occupied in 1911 by separate families comprising small numbers of persons, are now inhabited by from two to four or even five families. Consequently the averages calculated on the data obtained in 1911 considerably underestimate the number of inhabitants of those wards at the present time. "Empties" per cent Total Assessments. June 30 of each year. 1911 8.66 1916 751 1912 7.84 1917 751 1913 7.02 1918 749 1914 5.62 1919 566 1915 6.40 1920 2.53 *Decreased to 2.11 at the end of 1920. Confirmation of the opinion expressed as to the increase of population is afforded by the total "natural increment" between April, 1911, and December, 1920, which amounted to 7,287 persons. Two comments have to be made with respect to that total. The first that there is ample evidence that the number of inward transfers of births (see Table I., Appendix) was incomplete during the first half of the period, and the second, that the number of deaths recorded annually during 1914 (last four months) and 1915-20, were civilian deaths only, i.e. deaths "On Service" were excluded. The deficiency of births was probably somewhere about 750, but no estimate of the deaths "On Service" can be framed. Up to the time of writing no method has been evolved for estimating populations of the Wards, or the sex-age composition of any of the populations required for this Report. For that reason, practically no use will be made of mortality and other rates, preference being given to Index Numbers. Such numbers show the percentage differences from a selected standard. As a rule the annual averages for the five years before the war (1909-13) will be used as the standards taken in each case as equal to 100. Where any other standard be employed a special note will be made. II.—BIRTHS. During the eight years 1911-18 the corrected number of births varied irregularly from 2,977 in 1911 to a minimum of 2,017 in 1918. In 1919 the total rose to 2,316, and reached 3,413 in 1920. In other words, the rise in fertility previously observed after great wars, followed on the cessation of the last hostilities. The corrected annual average which was 3,276 during 1904-08, fell to 3,008 during 1909-13 and 2,489 during 1914-18. If the average for 1904-08 be taken as a standard (=100) the Index Numbers for the other two quinquennia are 92 and 76 respectively, and those for 1919 and 1920, 71 and 104—which last figure does not afford much hope of replacing the losses of the war. Tables I. and II., Appendix, contain more detailed information. The Index Numbers for the Wards for last year are of some interest. The three highest Numbers— those for Westbourne (134), Lancaster Gate, West (156) and East (161)—have been recorded when they were least expected. The increases in Queen's Park, Harrow Road and Church Wards are remarkably small having regard to the class of population. Although the use of birth-rates is deemed to be of no practical utility at the present time, the following rates based on the various estimates of populations given above (see page 1) may be of some interest. Birth-rates : paddington. Per 1,000 Persons. "A" "B" "C" "A" "B" ''C" 1915 19.12 18.41 19.08 1918 14.83 13.75 15.32 1916 18.96 18.46 18.91 1919 16.39 15.45 15.44 1917 14.77 14.32 15.31 1920 24.18 22.03 22.73 During the five years 1914-18 the births of males were to those of females as 1,000 :955. In 1916 there was a preponderance of females, the ratio for that year being 1,000: 1,020. In 1919 the ratio was 1,000: 967, and in 1920 1,000: 914. An excess of births of males over females is another phenomenon which has been observed after wars. 3 BIRTHS. Illegitimate Births.—The percentage of illegitimate children born during 1914-18 was 8.2, increasing irregularly from 6.2 per cent in 1914 to 10.4 in 1918. In 1919 the proportion fell to 9.7 per cent. and was even lower (7.1 per cent.) in 1920. In the statement following this paragraph the percentages of illegitimate births to all births recorded in the separate Wards are compared with the averages for 1914-18. The 1919-20 records for two Lancaster Gate Wards alone compare unfavourably with the averages. Illegitimate Births. Percentages of all Births Registered. Queen's Park. Harrow Road. Maida Vale. Westbourne Church. Lancaster West Gate East Hyde Park. Averages, 1914-18 5.04 4.56 10.95 8.31 8.51 19.11 11.41 15.92 1919 5.47 3.61 9.85 11.98 9'.95 21.79 26.56 17.64 1920 3.81 3.63 8.73 7.54 8.15 12.37 12.63 11.55 Somewhat interesting variations have to be recorded in the proportions of male to female births among legitimate and illegitimate children. For every 1,000 births of boys there were— 954 of girls among legitimate children born during 1914-18, and 971 „ „ illegitimate; 974 „ „ legitimate children born during 1919, and 899 „ „ illegitimate; and 901 „ „ legitimate children born during 1920, and 1101 „ „ illegitimate. No explanation can be offered for the proportions here recorded. Births in Institutions.—Of the 11,224 births registered in the Borough during 1914-18, 692 (6T per cent.) took place in various institutions, viz.— 458 in Poor Law Institutions, 201 in Nursing (Maternity) Homes, and 33 in the Lock Hospital. During 1919-20 529 births (101 per cent. of the total, 5,197) occurred in such institutions, viz.— 198 in Nursing (Maternity) Homes, 192 in the Lock Hospital, and 28 in Poor Law Institutions. During 1914-18 the births occurring in outlying areas transferred to the Borough, numbered 1,584, of which 1,426 (90.0 per cent.) were reported as having occurred in institutions, viz.— 1287 in Maternity Hospitals and Homes and Rescue Homes, 64 in General Hospitals, and 75 in Poor Law Institutions. During 1919-20 937 births were similarly transferred, 713 (76'0 per cent.) having occurred in institutions, viz.— 486 in Maternity Hospitals and Homes, and Rescue Homes, 33 in General Hospitals 194 in Poor Law Institutions. The extent to which resort to institutions for confinements has increased in the past seven years is clearly shown by the subjoined tabulation. This form of institutional treatment is believed to be advantageous both to the mothers and their children. With the increase in the number of families living in small flats, maisonettes and tenements, a larger proportion of expectant mothers may be expected to leave their homes for confinements. Proportions (per cent.) of Births in Institutions. Totals Maternity Hospitals. General Hospitals. P. Law Institutions. 1914 13.0 9.6 0.4 3.0 1915 13.1 9.5 0.6 3.2 1916 18.1 13.0 0.5 4.5 1917 20.2 14.7 0.5 4.9 1918 20.6 12.6 2.0 6.0 1919 21.8 14.9 4.1 2.2 1920 19.5 8.6 6.4 4.5 Notes.—The headings have the same meanings as in text. Maternity Wards were opened at the Lock Hospital (1918) and at St. Mary's Hospital (1920). The Lying-in Wards at Paddington Infirmary have been closed since the end of 1918. 4 births. Multiple Births.—The frequency of multiple conceptions maturing to term or nearly thereto, is shown in the following tabulation. Of the 210 such conceptions 134 (63.8 per cent.) were unisexual, viz.—67 males (including 2 sets of triplets) and 67 females. The remainder (76 or 36T per cent.) were bi-sexual. Multiple Conceptions. Twins Triplets m m m f f f m m 1914 14 17 5 — 1915 7 11 11 1 1916 12 9 12 — 1917 7 6 8 — 1918 7 11 5 — 1919 6 10 10 — 1920 12 12 16 — Notification of Births.—The notifications received during 1919 numbered 2,302 (109 being duplicates) and during 1920, 3,372 (including 149 duplicates), making a nett total of 5,416 for the two years, when the births registered in the Borough numbered 5,197. The proportion of notifications received from parents decreased from an average of 12.0 per cent. during 1914-18 to 6 9 during the period under review, those received from medical practitioners increased from 33.0 per cent. to 37.1 and those from "others,'' from 5.2 to 6.2. The proportion received from midwives remained practically unchanged. In the last Report (p. 2) attention was directed to the great increase during 1914-18 of notifications received from midwives. While the figures for the two years show but slight change in the proportion reported by medical practitioners, the figures for the separate years suggest that the preponderance of confinements attended by midwives was a phenomenon of the war and did not indicate a genuine change of practice. (See below). Notification of Births. Percentages of Total (uncorrected) Notifications Averages Received from 1914-18 1919 1920 Medical practitioners 33.01 82.8 34.1 86.6 39.2 87.0 Midwives 49.8| 52.5 47.8 Parents 12.0 17.2 6.6 [ 13.3 7.0 13.0 Others 5.2 6.7 6.0 During 1914-18 the percentage of births within the Borough registered without previous notification was 3'7, ranging from 2.8 per cent. (1916) to 5.3 (1917). During 1919-20, the non-notified births formed 3'2 per cent. of those registered, 3.0 per cent. in 1919 and 3.3 per cent. in 1920. The variations in the percentages of notified births in each quarter of the year and in the three Registration Sub-Districts are given below. Notification of Births. Percentages of Total Births registered after Notification Quarters Registration Sub-District Period 1 2 3 4 North Central South 1914-18 96.0 95.8 96.7 96.9 97.4 97.2 86.2 (Averages) 1919 97.6 97.9 95.5 97.1 98.7 97.0 88.2 1920 97.6 96.9 96.8 95.4 97.7 96.7 92.9 Although no prosecutions for failure to notify have been taken since the end of 1919, the proportion of non-notified births has remained at a satisfactory level. The fall in that proportion observed in South Paddington Sub-District is particularly satisfactory. 5 deaths. It has to be borne in mind that the measure of notification is based throughout on local notification and registration. No information is available as to the proportion of births in outlying areas—being those of children of residents of the Borough—which are notified. It is much to be desired that a complete system of transfer of notifications should be initiated. Such reform cannot be effected until the form of notification includes a statement of the parents' permanent address as well as the address at which the birth took place. In this connexion the figures relating to births in institutions are of some interest. Still-Births. During the years 1914-18 332 children were notified as dead at birth, equal to 3.0 per cent. of the total births (11,146) notified. In 1919 the proportion fell to 2-8 per cent. (2,193 births notified including 52 still-births) but rose to 3T per cent. in 1920 when the total of 3,223 births included 100 still-births. The proportion of still-births among illegitimates has been from two to nearly three times that among legitimates. (See below). Still-Births : Borough. Percentages of all Births Notified. 1914 1915 1916 1917 1918 1914-18 Averages 1919 1920 All Births 2.95 2.60 251 3.10 4.00 2.97 2.82 3.10 Legitimate 2.91 2.46 243 3.11 3.51 2.83 2.26 3.00 Illegitimate 6.06 7.81 3.93 2.97 9.86 6.00 5.48 7.69 The foregoing figures cannot be taken as a complete record of still-births inasmuch as they do not include still-births notified in outlying areas which ought to be, but are not, transferred to the Borough, and, moreover, it is impossible to determine the frequency of failure to notify as still-births are not registered. The latter defect could be cured by requiring undertakers and cemetery authorities to make returns of all burials of still-born children. As regards the variations in the proportions of still-births in the individual Wards, the following statement embodies the observed proportions, but the data on which the percentages are based, are not of a very satisfactory character. Still-Births. Percentages of all Births Notified. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate East. Hyde Park. Averages 1914-18 2.62 2.66 2.92 3.92 2.63 3.88 3.28 2.66 1919 1.96 2.83 2.27 3.83 1.29 2.08 2.71 - 1920 1.56 2.31 3.52 3.49 4.07 1.36 1.20 3.84 During 1914-18, of 10,814 children who were notified as born alive, 316 (or 2.92 per cent.) were dead when their births were registered. In the case of illegitimate children (438 notified born alive) 29 were dead at the time of registration, equal to 9.58 per cent. In 1919 the percentage for all births was 2.94 and in 1920, 2.91—showing a fairly constant mortality. Among illegitimates the percentages were, 1919—11.59; 1920—30. Percentages of Children Notified as Born Alive. Dead at time of Registration of Birth. Averages. 1914-18. 1919. 1920. All Children 2.92 2.94 2.91 Illegitimate Children 9.58 11.59 30.0 III.—DEATHS. During the five years 1914-18 the deaths registered within the Borough averaged 2,032 per annum, with a maximum of 2,304 registered in 1915, a total which exceeded that (1,999) of 1,918—the influenza year—by 305. The difference was mainly due to the fact of the Infirmary being closed in the latter year. In 1919 the total fell to 1,499 but rose to 1,667 in 1920. (See Table I. Appendix). 6 VACCINATION The annual average for 1914-18, after correcting for deaths of non-residents, &c., was. 2,072, or 185 in excess of the corrected average (1,887) for 1909-13. The highest corrected total (2,286) was recorded in 1915 and was 37 in excess of total (2,249) for 1918. In 1919 the corrected total fell to 1,914, 335 below the total for 1918, while in 1920 the total fell to 1,707,. the minimum recorded since 1909. Taking the averages for 1909-13 as standard (=100) the Index Numbers obtained are— for 1914-18 110 ; 1919 101 ; and 1920 90. The corrected totals for the Wards of the Borough for the five years 1916-20, together with the averages 1909-13 and 1914-18 are to be found in Table II., Appendix. That Table also contains the Index Numbers based on the averages for 1909-13. The numbers for 1920 indicate considerable reductions in the mortality experienced in the Wards except Westbourne and Lancaster Gate (West and East). As regards the two latter, it is surmised that the housing conditions in those Wards have materially altered, and that there is at the present time a much more closely aggregated population than before the War. Proof of such surmise may, or may not, be forthcoming when the results of the census now pending are known. Sex-Age Distribution.—In the absence of the data necessary for calculating the sex-agegroup mortality rates, the averages for the two quinquennia 1909-13 and 1914-18 are contrasted with the records for 1919 and 1920 in twelve age-groups for males, females and persons. (See Table III., Appendix.) The Index Numbers point to lower mortality rates in both years (1919 and 1920) than in 1909-13, and still more so in 1914-18. It is noteworthy that six age-groups of males—viz.: 15-. 20-, 25-, and C5-, 75- and 85—do not appear to have shared in the fall noted for males as a whole, while among females only three age-groups— viz.: 20-, 25- and 75—show a similar phenomenon. Cause of Death.—In Tables VIII. and VIIIa., Appendix, will be found analyses of the causes of death of residents of the Borough according to sex and age of the deceased. In Table VIIIb., Appendix, Index Numbers are given for the more important causes of death (persons). Two sets of Numbers have been calculated, the one (based on the averages for 1909-13) comparing the data for 1919 and 1920 with the last pre-war quinquennium, and the other (based on averages for 1914-18) comparing the two years with the experience of the "war quinquennium." As the majority of the diseases will be considered separately later in the Report, it will suffice here to make one observation of a general character. Bearing in mind what has been written as to the probability of a recent increase in the population of the Borough, the Index Numbers indicate—with a few exceptions—a satisfactory decline in the rate of mortality during the past two years. With the (possibly) sole exception of Diphtheria, the numbers of deaths with Index Numbers much in excess of the standards, were insignificantly small. V.—VACCINATION. In submitting the Vaccination Returns (See Table V., Appendix) for 1919—those for 1920 are not yet available—there is little to be written except that the proportion of children remaining unvaccinated increased from 29.5 per cent. in 1918 to 30.6 in 1919. During the five years 1909-13 the proportion was 20.5 per cent., increasing to 282 per cent. during 1914-18. The percentage of children for whom exemption from vaccination was obtained was 12.6 in the first quinquennium and 18.4 in the second, as compared with 20'3 in 1919. The children falling under "Rest"—"postponements," "apprisals," "not found" and "unaccounted for and fined"—formed 6.9 per cent. of all births during 1909-13, 8.1 during 1914-18 and 8.5 in 1919. 7 diphtheria. VI.—SPECIAL DISEASES. Diphtheria* General Prevalence.—It will be seen from Table III., Appendix, that the total number of cases reported in 1920 (464) was the highest for the ten years 1911-20, but, as will be shown later, that total does not mean that diphtheria was (approximately) three times as prevalent in 1920 as it was in 1911. The numbers of cases reported annually show two "peaks," the first in 1913 (296) and the second in 1920. Since 1916 (209 cases) the cases have increased in frequency to the 1920 maximum. During 1911-15 the annual average was 254, that for the remaining five years being 283, an increase of nearly 12 per cent. Comparing the totals for 1919 and 1920 with the average for 1909-13, Index Numbers of 128 and 233 are obtained, as against 125 for 1914-1918. The numbers for the two years with the ayerage for 1914-18 as standard, are 102 and 183 respectively. In the following statement the cases reported in each quarter of the two years are compared with the averages for the corresponding quarters of 1914-18. Diphtheria: Borough. Cases reported Index Numbers Quarters of year 1 2 3 4 1 2 3 4 Averages 1914-18 67 65 57 64 1919 54 46 59 99 80 71 103 155 1920 152 93 67 152 227 143 117 237 The foregoing figures indicate that the "epidemic" began in the summer of 1919 and continued to the end of 1920. An examination of Table IV., Appendix, discloses the fact that the incidence of the "epidemic" was not uniform on the different Wards of the Borough, neither geographically nor as regards time distribution. The Index Numbers for the yearly totals are :— Diphtheria. Index Numbers. (Averages 1914-18 = 100) Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West Gate East Hyde Park 1919 69 93 122 129 82 222 267 81 1920 406 162 118 285 117 460 267 75 See and Age Incidence.—During 1914-18 the attacks among males constituted (on an average) 46 per cent, of the total cases reported. In 1919 the proportion was 38 per cent., and in 1920, 41—showing that during the past two years the increased prevalence fell more heavily on females than on males. This is borne out by the Index Numbers for the two sexes (all ages) which were in 1919—males 99, females 159 ; and in 1920—males 189, females 275— the averages for 1914-18 being taken as the standards. There were, also, some notable variations in the proportion of persons attacked. Below will be found the percentage age-distributions of the persons attacked during each of the years 1919-1920, compared with the averages for 1914-18. Diphtheria: Borough: Persons. Percentage of Total Cases Reported. Ages (years). 0- 3- 5- 13- 15- 25 and upwards Averages 1914-18 16.1 18.9 46.6 3.1 8.1 7.1 1919 12.8 17.4 47.3 2.7 12.0 7.7 1920 9.5 1.05 52.2 5.2 12.1 10.5 In spite of the "epidemic" children under "school-age" (0-3) were proportionately less attacked during the two years than in 1914-18, whilst "adults" (15 years and upwards) were more freely infected. The proportion for the ages 3-15 showed a slight decline. The sex-age incidence can be examined in another way by using Index Numbers, based on the averages for 1914-18. Such numbers bring out the greater incidence on females, and on persons of the elder ages (both sexes). * Unless otherwise stated this designation includes cases certified as "membranous" or "diphtheritic croup." 8 diphtheria. Diphtheria: Borough. Sex-Age Incidence. Males Females Cases reported 0- 3- 5- 13- 15- 25- 0- 3- 5- 13- 15- 25- Averages 1914-18 23 25 56 3 4 6 17 23 62 5 17 12 1919 22 24 43 2 6 2 11 21 79 5 25 18 1920 23 23 107 9 13 14 21 26 135 15 43 35 Index Numbers 1919 96 96 77 67 150 33 65 91 127 100 147 150 1920 100 92 191 300 325 233 123 113 218 300 253 292 House, Family Distribution.—For the consideration of this question the cases have been divided into two groups viz: "Institutional" and "Family" the former comprising cases occurring among the residents (and/or in-patients) of all classes of institutions, the latter, cases occurring in the patients' homes. The '259 cases reported in 1919 included 20 "institutional" cases (7.7 per cent.) and the 464 reported in 1920, 39 (8.4 per cent). The percentage for the two years together was 81 per cent, as compared with a ratio of 8.8 per cent for the five years 1914-18. After excluding "institutional" cases, there remain 239 "family" reported in 1919, occurring in 207 houses and 211 families—giving averages of 1.1 case per house and family. In 1920 425 "family" cases occurred 370 houses and 371 families—averaging the same (1.1 per house and family). Combining the two years, the averages work out at 1T5 cases per house and 1.14 per family, slightly in excess of the corresponding averages (T08 per house and 1.07 per family) for 1914-18. The foregoing figures are based on the cases reported without correction for errors of diagnosis. The secondary cases (in houses) numbered 31 in 1819 and 55 in 1920, the ratios being 13.6 per cent. of all cases (corrected for errors) in 1919 and 13.9 per cent. in 1920. For the two years secondary cases formed 13.8 per cent. of all verified cases, as compared with 9.4 per cent. during 1914-18. The frequency distributions of multiple attacks per house—expressed as percentages of all houses invaded during 1919-20 and 1914-18 are compared below :— Cases per house 1 2 3 4 5 6 1914-18 92.6 5.6 1.3 0.4 — — 1919-20 8.92 7.8 2.1 0.7 — 0.2 Errors of Diagnosis. — In 1919 the reported cases included 12 "errors" (4.6 per cent.) and in 1920, 31 (6.7 per cent). For the two years the proportion was 5.9 per cent., as compared with an average of 8.1 per cent. during 1914-18. Bacteriological Diphtheria.—The certification of diphtheria was, during 1919, based on bacteriological test in 135 instances (52.1 per cent.) and in 1920, in 217 (46.7 per cent). Negative results of such tests do not, however, rule out a diagnosis of diphtheria, and in 1919 the disease was certified in 15 instances in which the test was negative and in 8 during 1920. These tests are of great value but the general use of "swabbing'' as had one result which was not anticipated, namely, an increase in the number of cases of dip theria reported, which gives a misleading impression of increased prevalence of the disease. proportion of cases which are certified as "Diphtheria" as the result of a positive test present no clinical symptoms of the disease. The individuals yielding such positive results are reahy" "carriers" of the disease, either temporary or chronic. The part which carriers play in spreading clinical diphtheria is not definitely known, but such persons must be regarded as dangerous to the community. Much work has still to be done to clear up this important question, and although the subject cannot be discussed here the following figures are given as illustrating how "bacteriological diphtheria"—carrier cases—swell the records of notified diphtheria. In 1918 6,762 cases were, admitted to the Asylums Board's Hospitals as "diphtheria," which total included 381 cases (5.6 per cent.) of "bacteriological diphtheria." The proportions admitted from the Boroughs varied from a maximum of 17.7 per cent. (Holborn) to a minimum of 1.9 (Hammersmith). From Paddington 31 such cases (14.4 per cent.) were admitted. SCARLET FEVER. 9 During 1920, the frequency of these cases called for special enquiry. Unfortunately the "Discharge Notes" from the Board's Hospitals do not distinguish between "clinical" and "bacteriological" diphtheria, many of the latter being reported as "errors" without comment. The duration of treatment of every case admitted during 1920 has been taken out with the result that an average duration of 49.6 days has been obtained. Assuming that cases discharged within 28 days of admission are not cases of "clinical diphtheria," it may be concluded that 73 out of 343 cases admitted and recovering were cases of "bacteriological diphtheria," that is no less than 21'2 per cent. Another estimate based on a scrutiny of all cases reported during the year, gave 55 "carriers" among "family" cases and 39 among "institutional," or 94 in all, that is 20.2 per cent, of all notified cases. f Institutional Treatment. —During 1919 223 of the reported cases, including 11 errors, were removed to hospital and during 192Q, 408 including 30 errors. The percentages of removals to notifications for the two years were 86.1 and 87.9 respectively, showing fairly considerable reduction below the mean rates for 1909-13 (93-5 per cent.) and 1914-18 (95.4). The lower proportion observed in 1919 may, have been due to difficulty in securing accommodation. That difficulty did not recur in 1920 and the smaller proportion of cases sent to hospital was due to many of the cases of "bacteriological diphtheria" being kept at home. With the co-operation of the Inoculation Department of St. Mary's Hospital, a special "Carrier" Out-patient Clinic was opened in the early months of 1920. To that clinic "carriers" were referred during the remainder of the year. Fatality.—There were during 1919 14 deaths among the notified cases, and 25 during 1920. In the former year there was one "error" which ended fatally and in 1920, 2. The fatality—per cent. of the total cases (corrected for "errors" only, and not for "carriers") was 6.0 per cent. in 1919 and 6.2 per cent. in 1920, as compared with mean rates of 5.6 and 6.9 per cent, for the two preceding quinquennia. (See Table VII. Appendix). Mortality.—The total deaths certified due to diphtheria were 17 in 1919 and 25 in 1920, as compared with annual averages of 10 (1909-13) and 16 (1914-18). The Index Numbers average 1909-13=100) 170 and 250 for 1919 and 1920 respectively. Scarlet Fever. General Prevalence. The total of 501 cases reported in 1920 was nearly double of that of 1919 (260). As will be seen from Table III., Appendix, the disease .after attaining a maximum of 738 cases in 1914, declined in prevalence to a minimum of 124 (in 1917) and has increased each year thereafter. The Index Numbers for 1919 and 1920—basis, average 1909-13—are 69 and 134 respectively, and a basis of the average for 1914-18, 75 and 146. In comparison with the returns for the quarterly averages for 1914-18, the cases reported during the eight quarters of 1919 and 1920, show higher Index Numbers in three quarters only. (See below). The high prevalence of the disease in the third quarter of 1920 is an unusual phenomenon. Scarlet Fever: Borough: Persons. 1 Cases reported Index Numbers Averages 1914-18 1 2 3 4 1 2 3 4 90 68 73 114 1919 35 42 51 133 39 62 70 117 1920 88 62 116 235 98 91 159 206 The distribution of the disease—both as to locality and time—throughout the Borough was irregular, certain of the Wards (viz., Westbourne, Church and Lancaster Gate, West) presenting decreases in their yearly totals—See Table IV., Appendix. The differences are well shown in the following statement of the Index Numbers for the two years. Scarlet Fever: Persons. Index Numbers (Averages 1914-18—100). Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West Gate East Hyde Park 1919 79 94 102 64 57 44 50 50 1920 190 192 133 100 95 67 187 156 10 SCARLET FEVER. Sex and Age Incidence.—Females appear to have suffered less from this disease than they did from diphtheria. The percentage of attacks in males (to total attacks) was on an average 44 during 1914-18, 40 in 1919 and 47 in 1920. The Index Numbers (average 1914-18 basis) were Males—1919, 68; 1920, 154. Females—1919, 82; 1920, 138. The proportions at various ages—percentages of total cases reported—are given below. The proportion at ages 3-15 (taken as school ages) in 1920 shows the greatest change from 76.1 per cent to 81.0 Children under three years show a considerably smaller proportion (4.0) in 1920 as compared with 1914-18 (8.9). Scarlet Fever : Borough : Persons. Ages (years). 0- 3- 5- 13- 15- 25 and upwards Averages 1914-18 8.9 15.2 55.8 5.1 9.1 5.8 1919 5.7 16.1 54.8 4.6 11.9 6.9 1920 4.0 112 63.1 6.8 9.0 6.0 A comparison of the cases reported at various ages shows a very heavy incidence at ages 13-15 and 15-25. (See below.) Scarlet Fever: Borough. Sex-Age Distribution. Males Females Cases reported 0- 3- 5- 13- 15- 25- 0- 3- 5- 13- 15- 25 Averages 1914-18 19 27 81 8 12 6 12 25 111 10 10 14 1919 8 14 63 6 5 8 7 28 80 6 26 10 1920 10 28 151 13 25 8 10 28 165 21 20 22 Index Numbers 1919 42 52 78 75 42 133 63 112 72 60 260 71 1920 53 104 186 163 208 133 83 112 149 210 200 157 Errors of Diagnosis.—In 1919 among the 261 cases notified there were 12 in which the original diagnosis was not confirmed by the continued observation of the cases, and in 1920 among a total of 501 notified cases, 20 similar "errors." Such errors formed 4.6 per cent of the reported cases in 1919 and 4.1 per cent in 1920, proportions notably different from those observed during the two preceding quinquennia when the percentages were—for 1909-13, 7 4 and for 1914-18, 7T per cent. House, Family Distribution.—Although the frequency of secondary cases in individual households depends on factors additional to infectivity (i.e. the power of the organism of the disease to overcome the natural resistance of the individual attacked) the variation in frequency of such cases may be taken as a rough test of infectivity. In 1919, there were 39 secondary cases (after correcting for "errors'') and in 1920, 71. After correcting for cases originating in institutions, and for "errors" the secondary cases constituted 15.5 per cent of "family" cases in 1919 and 14.3 per cent. in 1920. During 1914-18 the secondary cases averaged 11.2 per cent.— ranging from 20.2 per cent. in 1914 to 8.8 per cent. in 1917. It may be assumed therefore that the disease had an infectivity during 1919 and 1920 between 30 and 40 per cent. above the slandard for 1914-18. Such increased infectivity is not be confused with increased virulence, evidence will be adduced to show that during the years under review the virulence was notably below the average. The recorded distribution of multiple cases in households cannot be given here as it would occupy too much space. Below will be found the average percentage distributions for 1914-18 and 1919-20. Scarlet Fever: Borough. Houses with—cases. Per cent, of invaded houses. 1 2 3 4 5 6 Cases 1914-18 85.2 10.1 3.9 0.4 0.3 0.1 „ 1919-20 86.9 9.9 2.2 08 01 - With the exception of houses with 4 cases each (5 only in each period) there was a decreased proportion of each category of multiple infections during 1919-20. 11 ENTERIC FEVER. When writing of secondary cases consideration should be given to the frequency with which two or more cases are notified simultaneously. In 1912 two cases were reported together from 12 families and one institution and three cases from one family. In 1920 two cases were reported together from 12 families, three from three families and four from one. A special class of secondary cases is constituted by "return" cases, being attacks in susceptible individuals following the return from hospital of an earlier patient. In 1919 there were 10 such "return" cases and in 1920, 22. Harrow Road Ward suffered more particularly from this mischance, but one or more cases occurred in all the other Wards during 1920 save Lancaster Gate (West) Ward. Institutional Treatment.—During 1919 237 of the notified cases—including 12 "errors"— were removed to hospital and in 1920 473 including 20 "errors." The percentages of notified cases were slightly lower during those years—91.1 per cent. in 1919 and 94.4 in 1920—than the averages for the two preceding quinquennia—95-6 per cent. 1909-13 and 95 8 1914-18. Fatality.—Four deaths (one an "error") were recorded among the reported cases during 1919 and only 2 during 1920. The fatality after excluding "errors" was 1.6 per cent. in 1919 and 0.4 in 1920, as compared with mean rates of 1.9 per cent. during 1909-13 and 1.3 during 1914-18. (See Table VII., Appendix). Mortality.—The total deaths ascribed to this disease were—in 1919, 5 and in 1920, 3, the annual averages for the two preceding quinquennia being—1909-13, 7 and 1914-18, 5. The Index Numbers for 1919 and 1920—average 1909-13 100—71 and 43 respectively, pointing to a low virulence in 1920. The frequency with which scarlet fever has followed diphtheria and vice versa, during the past two years, calls for some comment. Scarlet Fever following Diphtheria. During .1919, in 3 houses, cases of scarlet fever followed those of diphtheria, the cases of the former disease being suspected to be "return cases" in two instances. In the third no association could be ascertained. In 1920 there were 27 houses where the same phenomenon was observed, with 34 cases of scarlet fever. In 10 instances the second disease was reported after the patients had been in hospital for varying periods, in 2 others (with 5 cases of the secondary disease) the discharged diphtheria patient was suspected of bringing home the infection, while in the remaining instances no connection could be traced. Diphtheria following Scarlet Fever. In 1919 there were 11 houses in which this occurred with 14 cases of the secondary disease. In 5 instances the patients had been sent to hospital for the primary disease, in 3 instances (6 cases of diphtheria) the secondary disease followed the discharge of the diphtheria patients, and in the remainder no connection could be traced. At an orphanage in the Borough 8 cases of scarlet fever were reported between July 9 and August 27, and 10 cases of diphtheria between August 29 and December 31. In 1920 there were 10 similar instances with 12 cases of diphtheria. In two of those instances (4 cases of diphtheria) the secondary disease followed the return home of the scarlet fever patient. In the other instances no connection could be traced. Fourteen patients suffered from the two diseases during 1920, 2 having the disease concurrently, 9 scarlet fever after diphtheria and 3 diphtheria after scarlet fever. One patient was reported to have scarlet fever twice during the year. Enteric Fever.* General Prevalence.—During 1909-13 there were on an average 29 reported cases in each year, the average falling to 15 during 1914-18. In 1919 10 cases were notified and in 1920 19. The percentage of "errors" is always so high with respect to this disease that it appears to be desirable to proceed to that subject at once and to compare corrected rather than uncorrected numbers Errors of Diagnosis.—Of the 10 cases notified during 1919 two were found to be errors, and of the 19 reported in 1920, four. The percentages of "errors" were 20 in 1919 and 21.0 in 1920. During the quinquennium of 1909-13 the annual average of 29 cases included six *in previous reports cases of continued fever have been included under this designation. Four cases have been notified as ''continued fever" since 1910, viz.—one in 1913, two in 1914, and one in 1915. In this report "enteric fever" means and includes the fevers known as "enteric," "paratyphoid A" and "paratyphoid B." 12 ENTERIC FEVER. "errors," and in the next quinquennium the annual average (15) included five "errors." Expressed as percentages the "errors" formed 19.7 per cent. of all reported cases during 1909-13 and 19.5 during 1914-18. After adjustment for such errors the cases of enteric fever averaged 23 in the quinquennium 1909-13 and 10 during 1914-18, as compared with eight in 1919 and 15 in 1920. The Index Numbers (average 1909-13 = 100) are 1914-18 43; 1919 35; and 1920 65. If the average for the "war period" be taken as a standard, the Numbers are 1909-13 230 ; 1919 80 ; and 1920 150. Bacteriological Verification.—During 1919 in five instances—out of 10 reported cases— resort was had to bacteriological tests, two of the tests yielding negative results. The negative tests were yielded by patients whose cases were clinically diagnosed as "enteric fever," such cases not constituting "errors.' In 1920, in 11 out of the 19 reported cases use was made of bacteriology, all the tests proving positive. As regards the four "errors'' recorded in that year, in one a positive reaction was obtained, but that patient had an attack of enteric fever in October, 1919. No bacteriological tests were reported in the other errors. Of the three positive tests reported in 1919, in 2 the disease was one of the paratyphoids, and of the 11 positive tests of 1920, 7 were also paratyphoid (6 paratyphoid B). Sex-Age Incidence.—The numbers of cases notified during the years 1914-18 are too few to enable trustworthy sex-age-group averages to be calculated. The returns for the last two years are compared below with the total numbers for 1914-18. Enteric Fever: Borough. Total Cases Notified. 0- 15- 25- 35- 45- 55- All Ages During m f a f m f m f m f m f m f 1914-18 (5 years) 13 12 10 11 7 2 8 5 3 1 2 2 43 33 1919-20 (2 years) 2 1 2 9 — 6 — 5 1 3 — — 5 24 The differences in the incidence, both as regards sex and age, are rather striking. Still more noteworthy is the fact that during 1919 no case was reported among males. Had the decreased prevalence been limited to males at approximately "service ages," say 25-45 it might have been permissible to suggest that the protective inoculation practised during the war was the efficient cause. The reduction, is however, too general to justify such an assumption. Institutional Treatment.—Whereas the proportion of notified cases removed to institutions fell during 1914-18 to 76.6 per cent. as compared with 80.2 per cent. in 1909-1913, in 1919 the proportion rose to 90 per cent. falling in 1920 to 84.2 per cent. Fatality. Among the 29 notified cases—23 definitely diagnosed—there was only one death prior to December 30, 1920, but one patient died at the beginning of the current year. The fatality of the disease—based on verified cases and deaths during the year of occurrence—was .zero both in 1919-1920, the first time that such a fact has been reported. During 1909-13 the average tctal fatality was 16.1 per cent., and during 1914-18, 11.3. Source of Infection.—In 2 instances in 1919 and 4 in 1920 the disease was believed to have been contracted outside the Borough. Histories of consumption of oysters were obtained in 2 instances, but enquiry failed to elicit any evidence ot contamination of the sources of supply of the oysters. In one instance there was a history of consumption of mussels from a source more than suspected to be polluted- One patient was a member of a family in which several cases of enteric fever had occurred over a period of years in various parts of the country. Mention has already been made of the case erroneously diagnosed as enteric fever, reliance being placed mainly on the Widal reaction. The patient had a definite attack of the disease in the autumn of 1919 and was again notified early in 1920. 13 erysipelas. Erysipelas. General Prevalence.—In 1919 76 cases were reported (males 35, females 41), and in 1920, 81 (males 34, females 47). Those totals compare favourably with the annual averages for 1909-13 (90) and 1914-18 (101). The maximum for any year since 1909 is 141 recorded in 1914, and the minimum, 56 recorded in 1918. Institutional Treatment.—Twenty-one cases (27.6 per cent. of the total) received institutional treatment during 1919 and 28 (34.5 per cent.) during 1920, practically all the cases being treated in Infirmaries. Secondary Attacks.—Certain individuals appear to be subject to periodical attacks of this disease. In 1919 4 persons (3 adult females and one boy aged 8) were reported twice, and in 1920, 2 (adult males). The occurrence of two attacks—at four months' interval—in a boy of 8 is believed to be unusual. Fatality.—Of the 72 persons attacked during 1919, 5 died of the disease, and of the 79 attacked during 1920, 3—showing fatality rates of 6.9 and 3.8 per cent. respectively. Mortality.—During the two years 8 deaths were ascribed to this disease—5 (all males) in 1919 and 3 (2 males, 1 female) in 1920. The annual averages (deaths) for the two quinquennia 1909-13 and 1914-18 were 4 and 5 respectively. Puerperal Fever. General Prevalence.— In each of the years 1919 and 1920, 15 cases of this disease—or group of diseases—were notified, as compared with an annual average of 8 during 1909-13 and 7 during 1914-18. The Index Numbers based on experience of 1909-13, are—1914-18, 87; 1919, 187 and 1920, 187. It has to be borne in mind, however, that during the two quinquennin, the annual numbers of births were decreasing somewhat rapidly, whereas in 1919 and 1920 the numbers increased very considerably. Calculating morbidity rates on the births registered within the Borough, it is found that during 1909-13, the rate averaged 2.07 per 1,000, and during 1914-18, 3.02. For 1919 the rate was 7.44, and for 1920, 4.71, the average for the two years being 5.77—figures which compare unfavourably with those for the preceding quinquennia. The cases reported distributed by Wards furnish numbers too small for averaging. Comparisons of the totals for 1914-18, with the records for the last two years are given below : — Puerperal Fever—Notifications. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster Gate Hyde Park West East 1914-18 (Totals) 4 11 5 5 6 — — 3 1919 2 3 2 5 2 1 — — 1920 — 6 3 3 1 1 1 — The occurrence of puerperal fever—as notified cases—is a new phenomenon in the Lancaster Gate Wards. Errors of Diagnosis.—Among the 30 cases notified during the two years were three subsequently diagnosed not puerperal fever and a fourth in which the diagnosis was doubtful. During 1914-18 the percentage of errors was 88, that for the last two years being exactly 10 per cent. Institutional Treatment.—Of the 15 cases notified during 1919, 13 were removed to institutions; and of the 15 reported in 1920, 12. For the two years, the percentage of cases removed to hospital was 83 3 as compared with an average of 8(3.6 per cent. for 1914-18. Fatality.—Of the 30 cases reported during the two years, 10 terminated fatally (4 in 1919 and 6 in 1920), equal to a fatality of 33.3 per cent. as compared with an average of 55 per cent. during 1914-18. Eight of the 10 women dying were primiparæ. There were in addition 2 deaths (one the subject of inquest) of patients whose cases were not notified. FATATALITY IN CHILDBED Accidents and Diseases of Pregnancy.—To a certain extent some increase in the number of deaths from these causes is inevitable when the number of births shows a material increase, as has already been recorded. During 1909-13 the deaths from these causes averaged 8 per annum, the average falling in the war quinquennium to 4. In 1919 there were 4 deaths but in 19.20 the number rose to 11. Taking the average for 1909-13 as the standard ( = 100) the Index Numbers are—for 1914-18, 50 ; 1919, 50 ; and 1920, 137. If the average for 1914-18 be taken as a standard, the following Numbers are obtained—1909-13, 200; 1919, 100; and 1920, 275. Fatality in Childbed.—In the last Report the following observation occurs (p. 9):— "The risks of parturition to the mothers appear to have increased slightly during the second period," i.e., 1914-18. Comparisons between averages for a term of years and the totals for a single year are apt to be misleading, but the figures given below appear to confirm the conclusion above quoted. Fatality in Childbed. Due to Puerperal Fever and Accidents and Diseases of Pregnancy. Rates per 1,000 births. London Paddington Kensington Westminster St. Marylebone Hampstead Willesden 1909-13 2.80 3.51 4.13 4.23 4.86 3.69 2.34 1914-18 2.85 3.83 3.24 4.54 4.72 4 .54 3.36 1919 3.50 4.40 5.57 8.04 2.54 3.66 4.92 1920 3.17 5.04 2.95 4.78 6.76 1.89 5.70 Within the Borough the rates of fatality observed in the Wards varied greatly during the two years, as will be seen from the appended tabulation. The rates for 1919 and 1920 must, however, be received with caution, as all but four of them are derived from records of a single death in the year. Fatality in Childbed due to Puerperal Fever and Accidents and Diseases of Pregnancy. Rates per ] ,000 Births. Queen's Park. Harrow Road. Maida Vale. Westbourne Church Lancaster West Gate East Hyde Park. 1914-18 1.37 3.53 4.44 4.03 3.17 3.67 — 2.79 1919 7.29 5.70 2.89 2.60 2.03 — 15.62 1920 2.93 10.39 3.79 3.60 1.31 10.30 10.25 5.02 Ophthalmia Neonatorum. General Prevalence— In 1919 30 cases were notified and in 1920 29, but in the latter year 5 other cases of "stickiness" of the eyelids—the inflammation not being deemed sufficient to constitute "ophthalmia"—were brought to the notice of the Department. During 1911-13 the annual average was 25, and that during 1914-18 30, figures which indicate that more cases have been reported each year since 1914. The annual totals will be found in Table III., Appendix. Attention may be directed at the exceptionally high total (51) recorded in 1914. There does not appear to be any marked seasonal prevalence of this disease. During the seven years 1914-20 210 cases have been notified, of which 57 were reported during the first quarters of those years, 45 during the second, 60 during the third, and 48 during the fourth. During that period the cases were equally divided between the sexes (105 of each) but as there is always a varying excess of births of males, there was proportionately a slightly greater incidence among females. As will be seen from the appended tabulation the averages for all Wards except Westbourne and Church were practically the same during 1914-18 and 1919-20. When, however, rates are calculated on the births recorded some very striking differences are observed. For the Borough the corresponding rates are— 1914-18, 12.13; 1919-20. 1029. There was, therefore, in the Borough a slightly lower prevalence during the last two years than during the preceding quinquennium. 15 ophthalmia neonatorum Ophthalmia Neonatorum. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West ' Gate East Hyde Park Averages 1914-18 3 5 3 10 6 1 1 1 1919-20 2 6 3 5 12 1 — 1 Rates (per 1000, births) 1914-18 11.01 8.36 944 25.18 9.88 14.71 17.30 6.98 1919-20 650 9.25 6.88 9.93 19.15 5.71 — 5.68 In the course of calculations necessary for the results given above, a question arose as to whether ophthalmia was generally more prevalent now than when notification was initiated in 1911. To answer that question certain limited data which have been collected by the Department have been drawn upon from which it appears that the answer is in the affirmative. The data immediately available consists of quarterly tabulations of births and cases of ophthalmia extracted from the Registrar-General's Quarterly Returns. In the appended tabulation two series of rates are given for St. Marylebone based (a) on the total births as obtained from the Registrar-General's Returns and (b) on totals limited as far as possible, to births actually belonging to the Borough. The additional calculations were made because it was thought that the ophthalmia rates would be understated by the inclusion of births occurring in Queen Charlotte's Lying-in Hospital. Ophthalmia Neonatorum. Rates per 1,000 births. 1911-15 1916-20 1911-13 1914-18 1919-20 London 6.62 8.78 5.95 7.80 9.84 Paddington 11.06 10.77 8.78 12.92 10.52 Kensington 7.48 10.68 6.66 8.36 13.79 Westminster 8.04 18.68 7.38 15.38 16.11 St. Marylebone (a) 4.00 6.81 3.92 4.40 8.69 (b) 7.29 14.97 5.31 10.36 18.21 Hampstead 7.52 7.25 5.70 8.52 7.02 (a)—Including births in Queen Charlotte's Hospital, (b)—Corrected for non-resident births. Comparing the first quinquennium with the second, Paddington and Hampstead are the only two Boroughs showing any reductions in the rates amounting to 2.7 per cent. in the former instance and 3.6 in the latter. In Westminster and St. Marylebone (b) the rates for 1916-20 are more than double those for 1911-15. The rates for 1911-13, 1914-18 and 1919-20 show progressive increases except in Paddington and Hampstead, where the rates for 1919-20 are below those for 1914-18, both boroughs, however, showing higher rates in the last period than the first. The subject is one demanding more extended study, which is beyond the scope of this Report. Whether the increased prevalence be due to the spread of venereal disease or to increasing neglect of precautions at birth, it is impossible at present to say. Prima facie the latter cause would appear to be improbable owing to the stringent rules of the Central Midwives' Board and to the close supervision of midwives exercised by the Officers of the County. Interval to Onset.—In three instances no information was obtained of the date of onset of the inflammation, and in one instance the certificate related to a recurrence of ophthalmia in a •case already reported. The exclusion of those cases left for analysis 28 cases reported in 1919 and 27 in 1920. The results of the analysis are appended. Ophthalmia Neonatorum. 1919 1920 No. Per Cent. No. Per Cent. Intervals (days) 0- 8 28.6 8 29.6 ,, „ 3- 8 28.6 12 44.4 7- 9 32.1 7 25.9 „ 14 and over 3 10.7 — — The distribution for 1920 is very different from that for 1919. In the latter year 572 per cent. of the attacks developed during the first week after birth, as compared with 74'0 per cent. in 1920. It may be added, for what it is worth, that in 1919 3 children were stated to have been born with the eyes in a state of inflammation, the number of such cases in 1920 increasing to 8. 16 OPHTHALMIA NEONATORUM As a general conclusion it may be said that the inquiries made indicate that two forms occur, one in which the inflammation occurs very early after birth and a second with a much later onset. The distribution noted during 1919 resembles more closely the ante-war experience than does that of 1920. Attendance at Birth.—From enquiries made it appears that the births of 19 of the infants suffering from ophthalmia during 1919 were attended by midwives, and 13 during 1920. If it may be assumed that the births notified by midwives receive no attention from medical practitioners, the following comparison suggests a slightly greater prevalence of the disease in 1919 among midwives' cases than that among cases attended by medical practitioners. Too much significance should not be attached to the figures. Ophthalmia Neonatorum. Percentages of births in midwives' practice. cases Births Ophthalmia 1919 ... 52.5 63.3 1920 ... 47.8 44.8 Venereal Disease.—The information obtained as to this cause cannot be regarded as satisfactory. In 1919 bacteriological tests were reported in four cases only, of which one yielded gonococcus. In 1920 vaginal discharges prior to parturition were admitted in 4 instances, one being almost certainly gonorrhceal. Legitimacy.—Only two of the 30 cases reported in 1919 occurred in illegitimate children, and 3 (out of 29) in 1920. Expressed as percentages the proportions of cases among illegitimate children were 6.6 and 10.3 respectively while the proportions of illegitimate children to all children born were 9.7 and 7.1. Order of Birth.—In 1919 just half the cases occurred among first-born children including the 2 illegitimates. In 1920 13 cases (44.8 per cent.) were first borns, including the three illegitimates. Institutional Treatment.—During the two years 22 cases received in-patient institutional treatment, equal to 37.2 per cent. of reported cases. During 1914-18 the proportion was 27.8 per cent. Of the cases reported in 1919, 43.3per cent. were removed and of those reported in 1920, 31 per cent. Of the 22 cases removed 16 went to St. Margaret's (M.A.B.) Hospital, 5 to Poor Law Infirmaries and one to St. Mary's Hospital. For the patients remaining at home the services of the Nurses belonging to the St. Marylebone and Paddington District Nursing Association are available. In 1919 those Nurses attended 11 children and in 1920, 12. Offers of the Nurses' services were refused in 6 instances. Final Result.—It is satisfactory to be able to report that in no instance was any injury to the eyes reported on the termination of the attacks. "Meningitis" Group. This designation has been adopted to include those infectious diseases whose characteristic symptoms are of a nervous origin. Cerebro-Spinal Meningitis—otherwise cerebro-spinal fever—including posterior basic meningitis. During 1914-18 35 cases (including 5 errors) were notified of which 20 ended fatally—fatality 66.6 per cent. In the past two years 8 cases (7 in 1919, 1 in 1920) were reported (males 3, females 5) including one error (in 1919). This disease was therefore about one-half as prevalent during 1919-20 as in 1914-18, but the fatality (7 deaths among 7 verified cases) was higher. Verification of the diagnosis by lumbar puncture was reported in that year. 5 out of the 6 cases in 1919, and contacts were swabbed, with negative results, twice Swabbing of contacts has been practically given up since about the middle of 1919. In addition to the 7 deaths among the notified cases 4 other deaths occurred during the two years (1 in 1919 and 3 in 1920) from this cause without notification to the Department. One of the 3 deaths in 1920 occurred in the country, and had been notified to the local medical officer of health. INFLUENZA. 17 Acute Poliomyelitis.—In contrast with cerebro-spinal meningitis this disease was more prevalent during 1919-20 than during 1914-18—7 cases (one error) being reported in the two years as compared with 9 (no reported errors) in the quinquennium. In one of the cases reported in 1919 the disease began in the country. Five of the 7 cases (1919-20) were males. Six of the patients received institutional treatment and 5 had some paralysis after "recovery." There were no fatal cases during the two years, the fatality during the quinquennium being 22.2 per cent. Encephalitis Lethargica.—Notification of this disease was required from January, 1919. During the years 1919-20 5 cases (3 in 1919 and 2 in 1920) were notified, all the patients being females. Both the 1920 cases were "errors." Four patients received institutional treatment and one died (1919) giving a fatality rate of 33.3 per cent. One death from this disease was "transferred" to the Borough, the case having been notified in the country. The Pneumonias. Since January 1, 1919, notification of pneumonia—both "primary" and "influenzal"—has been required—an aftermath of the epidemics of influenza of 1917 and 1918. Influenzal Pneumonia.—In 1919 87 cases were notified—42 among males and 45 among females—and in 1920, 45—males 28, females 17. The age distribution of the notified cases is given below in four comprehensive groups. Influenzal Pneumonia : Borough Cases. Ages 0- 15- 45- 65- and over M F M F M F M F 1919 6 1 18 27 14 14 4 3 1920 1 - 20 13 6 3 1 1 The numbers reported from each Ward in each year were:— Influenzal Pneumonia : Cases. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West Gate East Hyde Park 1919 6 14 23 14 14 11 — 5 1920 2 7 7 11 9 1 1 7 Institutional treatment.—During the two years 37 of 132 cases—equal to 28.0 per cent.— were removed, 23 to infirmaries (with 11 deaths) and 14 to hospitals (with 7 deaths). In addition, 7 patients were removed to nursing homes, of whom 5 died. Fatality.—Of the 87 cases reported in 1919, 36 proved fatal, and of the 45 reported in 1920, 14. For reasons which will appear later it is useless to calculate any fatality rates from those figures. Of the 36 deaths in 1919, 33 were certified as due to influenza (with or without pneumonia) anri 3 to pneumonias—broncho-pneumonia, 1; "pneumonia," 2. In 1920, 13 out of the 14 deaths were certified as due to influenza and one to broncho-pneumonia. Among the 46 patients removed from their homes there were 23 deaths, showing a fatality of 50 per cent as compared with one of 31.4 per cent, among those (86 patients, 27 deaths) who remained at home. It is somewhat unsatisfactory to record that of the 50 fatal cases, 21 (18 in 1919, 3 in 1920) died before notification was effected. Those figures imply that in 42 per cent, of the fatal cases, no opportunity was afforded of offering any assistance e.g. services of the District Nurses. Epidemic Influenza.—Notification of influenzal pneumonia was introduced to serve as some guide to the prevalence of influenza. In the following figures an attempt has been made to find out to what extent notification has been successful as such guide. The deaths from epidemic influenza during 1919 numbered 164 and during 1920, 28. During 1909-13, the deaths from this cause averaged 37 per annum, the average rising to 102 in the following quinquennium, the maximum for any year since 1909 being 358 (in 1918) and the minimum 23 (in 1912). On page 18 are set out the sex-age-group and Ward distributions of deaths from epidemic influenza, which should be contrasted with the corresponding distributions given under Influenzal Pneumonia (vide supra). 18 INFLUENZA. Epidemic Influenza: Deaths: Borough. Ages 0- 15- 45- 65 and over M F M F M F M F 1919 4 4 25 55 25 20 16 15 1920 — — 5 8 3 3 5 4 Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West Gate East Hyde Park 1919 13 20 35 33 27 13 6 27 1920 3 3 5 5 5 1 2 4 The 25 deaths recorded in 1920 included 2 "Transfers" and may, therefore, be ignored for the moment. Of the remaining 23, 12 occurred after (or simultaneously with) notification as cases of influenzal pneumonia—a fact which suggests that notification was very incomplete. Six of the deaths took place at the Infirmary (all notified cases) and 3 in nursing homes (2 notified). Primary Pneumonia.—During 1919, 83 cases (48 males and 35 females) were reported, and during 1920, 96 (males 56, females 40). Of the cases notified during 1919, 5 were subsequently marked "errors," as also were 2 of those reported during 1920. In 2 instances there was clear history of the disease being contracted outside the Borough. Of the total 179 cases reported during the two years 37 received treatment in hospitals, 31 in infirmaries and 2 in nursing homes, the total of those cases (70) forming 39.1 per cent, of all cases reported. Institutional treatment was given in 1919 to 36.0 (30 cases) of the cases and to 39.5 per cent. (38 cases) in 1920. The District Nurses were called in by the Department to 19 cases, 9 in 1919 and 10 in 1920. There were 25 deaths (males 12, females 13) among the 83 cases reported in 1919, and 32 (males 19, females 13) among the 96 reported in 1920. Those figures would give fatality rates of 30T and 33'3 per cent, respectively, but such rates by no means represent the truth. Some of the fatal cases were certified to have been due to diseases other than pneumonia, and a good many deaths certified due to "pneumonias"—excluding broncho-pneumonia—were not notified. The notification of the "pneumonias" is at present incomplete. Moreover, as in 30 instances death ante-dated notification, there appears to have been some delay in reporting cases. Notification was better in 1920 than in 1919, as the proportion of cases in which death occurred before notification decreased from 72 per cent, in 1919 to 37.6 in 1920. The deaths from the pneumonias*—excluding broncho-pneumonia—numbered 96 in 1919 (48 of each sex) and 54 (33 males, 21 females) in 1920). The Index Numbers (total) are:— 1919, 110; and 1920, 62—the annual average 1909-13 (=100) being the standard. In 1919 37.5 per cent. of the deaths occurred in institutions, the proportion falling to 29.6 per cent, in 1920. Respiratory Diseases.—The deaths from all forms of these diseases numbered 391 in 1919 and 284 in 1920—as compared with annual averages of 346 and 351 in 1909-13 and 1914-18. Taking the average of 1909-13 as the basis (= 100), the Index Numbers are:— 1914-18, 101; 1919, 114; and 1920, 82. The very small increase noted in 1914-18 is remarkable, having regard to the fact that 1918 was the year of the influenza epidemic (358 deaths beiug due that single disease). In that year the total deaths numbered 239, with an Index Number of 69 only. Dysentery.—This disease was made notifiable in January, 1919. During that year 3 cases—all ex-service men—were reported to have the disease, in each instance contracted abroad. During 1920 only one case—an ex-service man— was notified. In April, 1920, there were 10 cases of dysentery at the Children's Hospital, Paddington Green. In four instances bacteriological tests were applied to the fasces, the Flexner bacillus being found in three. Enquiry failed to connect the outbreak with any ex-service man or to throw any light on its origin. None of the cases were notified. Trench Fever.—This disease was made notifiable in January, 1919. Only one case has been notified since that date. The patient had his first attack in France during 1917. There were no signs of vermin in the man's home, and no spread of the disease. * When a death is certified as due to one of the pneumonias following epidemic influenza, such death is classified under epidemic influenza. TUBERCULOSIS. 19 Malaria.—Since January. 1919, when notification was first required, 89 cases Have been reported, all save one (a female aged 35-45) in ex-service men. In every instance the disease was reported to have been contracted abroad. A special card index has been made of these cases. Tuberculosis. Notification.—The number of certificates received annually during the years 1916-20 is shown in Table IX., Appendix, together with information as to the origins of such certificates. The new cases (all forms of tuberculosis) added to the Register in 1919 numbered 391 and in 1920, 383. The number added each year has declined from 835 (all pulmonary tuberculosis) in 1912. During 1914-18 the annual average of new cases (all forms) was 522, the figures for 1919 and 1920 showing reductions of 25 and 27 per cent, respectively. The annual average of new cases of pulmonary tuberculosis for 1914-18 was 378, as compared with a total of 284 in 1919 and of 277 in 1920—equal to decreases of 25 and 27 per cent. The 1914-18 average of of other forms of tuberculosis was 144, and the totals for 1919 and 1920, 107 and 106— equivalent to 26 per cent, reduction. An informal Register of "suspect" cases—all forms—is also kept. To that Register 130 new cases were added in 1919, and 117 in 1920, as compared with an annuul average of 149 for 1914-18, the total for 1919 being 13 per cent., and that for 1920,22 per cent, less than the average. Since the informal commencement of notification in 1903, 6,385 entries have been made in the Register of "definite," i.e. medically certified cases and 2,262 in that of "suspect." After careful scrutiny of the Registers at the end of 1920, the effective entries were found to be— of "definite" cases 1,790 (1,267 pulmonary ; 523 non-pulmonary) and of "suspect," 535 (all forms). Full particulars will be found in Table X., Appendix, of the additions to and removals from, the Registers trom 1903 onwards. Sex Distribution-—Below is a tabular statement of the sex distribution, all ages, of the new cases reported during the past two years. As regards the definite cases on comparing the Tuberculosis: New Cases. Pulmonary Other Forms Suspects Males Females Males Females Males Females Annual Averages 1914-18 206 172 77 67 60 89 1919-20 144 136 56 51 61 62 Totals 1919 153 131 55 52 68 62 1920 135 142 56 50 55 62 averages, greater decreases—30 per cent, of pulmonary and 27 per cent, other forms—are among males than females—21 and 24 per cent. respectively. In the "suspect" group, there was a slight increase (2 per cent.) among males and a decrease (30 per cent.) among females. Ward Distribution.—It will be seen on referring to Table XI., Appendix, that the decrease in the number of new cases was common to all Wards, except Lancaster Gate, East and West. In Lancaster Gate, West, Ward, the average (persons) for 1919-20 was 50 per cent, above that for 1914-18, while in Lancaster Gate, East, the two averages were equal. The 1919-20 average for males equalled that for 1914-18 in Lancaster Gate, West, but was 20 per cent, higher in Lancaster Gate, East, while that for females was double in Lancaster Gate West, and 14 per cent, below in Lancaster Gate, East. Age Distribution. —In comparing the averages for 1919-20 with those for 1914-18 (see Table XII. Appendix), the numbers of cases of pulmonary tuberculosis in all the age-groups save females aged 65 and upwards, have shown reductions. As regards cases of other forms, the comparison shows the same result, but the differences are not so great. Site of Disease.—Of the 391 cases reported in 1919, 379 (nearly 97 per cent, of the total) were stated to be affected in one part of the body only, the lungs being the affected organs in 276 instances (70.5 per cent, of the total). In 1920, 364 patients out of the 383 reported had the disease in one part—-equal to 95.0 per cent, of all cases—the lungs being the affected parts on 266 occasions (69.4 per cent, of ihe total). An analysis of the reported cases with one site of disease has been made (not included here) and a comparison with the averages for 1914-18. General reductions are noted in the numbers of cases for all parts of the body except the generative and cutaneous systems. The numbers of instances in which disease of those parts is reported alone are too small to make the changes significant. 20 TUBERCULOSIS. Both in 1919 and 1920, twelve first notifications were received certifying the disease present in two parts of the body. Three cases of "general" tuberculosis were reported in 1920. Six cases were re-certified in each of the two years with spread of the disease from the focus originally reported. In eight out of the twelve instances the lungs were the primary focus, the disease spreading to the larynx (lease), the lymphatic system (5 cases—all "head and neck") and the osseous and digestive systems (1 case each). In four instances the lymphatics of the head and neck were first affected, the later foci of the disease being located in the osseous system (3 cases), and cutaneous system, "undefined" (1 case). Occupational Distribution.—Table XIV., Appendix, contains a comparison of the average numbers of persons reported during 1914-18 and 1919-20, distributed according to their occupations. Taking the averages for each group for 1914-18 as 100, the following Index Numbers for 1919-20 are obtained. It remains to be seen whether the decline which has taken Tuberculosis: New Cases, Persons. Group Index Numbers. Indoor Outdoor Food Trades Miscellaneous Infants No Occupation Pulmonary 92 64 67 57 36 68 Other Forms 109 67 0 74 46 85 place since the "war period" is an accidental one due to the removal of certain factors specially mimical to those susceptible to tuberculosis, or a genuine diminution in the prevalence of the disease, signalising the approach of effective control. Institutional Treatment: Non-Residential.—The number of new cases presenting themselves for examination or treitment at the two Dispensaries showed slight increases in each of the years .1919 and 1920. The totals of such new cases in each of the five years for which full records are available have been :— 1916 602 1917 861 1918 874 1919 877 1920 891 The annual average for 1919-20 was 884 and that for the preceding three years 779, showing an increase of 13.5 per cent, (approximately). Of the patients admitted during the last two years 55.5 per cent. were declared to be non-tuberculous, as compared wiih 51.0 per cent, for 1916-18. There was an increase of 3.2 per cent, in the cases diagnosed as tuberculous—from 23.9 per cent. 1916-18 to 27.1 in 1919-23—but the percentage found to be suffering from pulmonary tuberculosis decreased from 17.1 per cent. in 1916-18 to 16.4 in 1919-20. The increase in the proportion found to be tuberculous was limited to cases of nonpulmonary disease—the proportion increasing from 6.8 per cent, in 1916-18 to 10.7 per cent. in 1919-20. The proportion of "suspects" was 17.4 per cent, in 1919-20 ; 7.7 per cent. less than in 1916-18. The appended statement contrasts the average proportions for the insured, uninsured and children, according to sex. Tuberculosis: Dispensary Treatment. Insured Uninsured Adult Males Females Males Females Children Annual Averages of New Cases. 1916-18 166 97 44 129 343 1919-20 193 118 34 120 359 Percentages of Above found Tuberculous All Forms 1916-18 37.2 27.8 19.0 19.0 18.9 1919-20 43.8 33.4 27.9 20.4 19.2 Pulmonary• 1916-18 33.7 22.6 16.7 17.2 7.4 1919-20 37.0 24.1 22.1 15.2 2.7 Other Forms 1916-18 3.4 5.1 2.2 1.8 11.4 1919-20 6.7 9.3 5.8 5.2 16.4 TUBERCULOSIS. 21 The unfavourable features of the proportions for 1919-20 are mainly due to the high percentages observed in 1919, which completely conceal the reductions observed in 1920. This is brought out by the following statement:— Tuberculosis: Dispensary Treatment. Insured Uninsured Adult Males Females Males Females Children New Cases 1919 186 111 33 185 362 1920 200 125 35 176 355 Percentages of Above found Tuberculous Pulmonary 1919 40.8 18.9 16.0 18.1 3.5 1920 33.5 28.8 16.5 25.7 1.9 Other Forms 1919 5.9 9.9 5.0 6.0 16.8 1920 7.5 8.8 5.6 5.7 16.0 In connection with the cases of tuberculosis diagnosed, 530 persons were listed as "contacts" in 1919 and 498 in 1920, the numbers of "contacts" medically examined being 329 in 1919 and 307 in 1920—equal to percentages of 62.0 and 61'6 respectively. In 1917 and 1918 the corresponding percentages were 41.5 and 42.5. Of the "contacts" examined in 1920, 102, approximately one-third, were found to be tuberculous. The proportions for the earlier years are not available. The visiting of the patients' homes by the Tuberculosis Officers and Nurses is one of the most important functions of the Dispensaries. In 1919, 4,440 visits were made (740 by the Tuberculosis Officers and 3,700 by the Nurses), and in 1920, 4,337 (925 by the Tuberculosis Officers and 3,412 by the Nurses). In the period 1916-18 the visits averaged 4,757 a year—519 by the Tuberculosis Officers and 3,906 by the Nurses. Residential Treatment.—Since the last report was written changes have been made in the method of recording admissions to the various institutions, but a completely satisfactory method has still to be evolved. The great difficulty lies in the frequency of transfer from one institution to another and of re-admissions after discharge. A very rough idea of the number of patients receiving resident institutional treatment can be obtained from the figures given in the lower part or Table IX., Appendix. During 1920 the admissions of notified cases to institutions were tabulated weekly. The totals for the vear were:— To Poor Law Institutions 103 General Hospitals: Local 18 Outlying 17 Special Hospitals 29 To M.A.B. Hospitals: Receiving Tuberculosis 50 Others 17 Sanatoria 42 Table XIII., Appendix, summarises the applications relating to, and patients received at institutions specially provided by the County Council for the treatment of tuberculosis. Mortality.—The deaths from all forms of tuberculosis numbered 133 in 1919 and 146 in 1920, averaging 139 for the two years as compared with yearly averages of 187 and 207 for the quinquennial periods 1909-13 and 1914-18 respectively. The foregoing figures indicate that, starting from the annual average for 1909-13 (=100), the average for 1914-18 increased by 11 per cent, while that for 1919-20 decreased by 26 per cent. The total recorded in 1919 was 29 per cent, below the average (1909-13) and that for 1920, 21 per cent. (See Table VIII B, Appendix). Three main forms of tubercular disease are recognised for the purpose of these Reports, viz., "pulmonary tuberculosis" (phthisis, consumption), "tuberculosis of the meninges" and "other forms of tuberculosis." Below the numbers of deaths from each of these forms during 1919 and 1920 are compared with the averages. All the figures show reductions save Tuberculosis: Mortality. Persons: All ages. Recorded Annual Averages 1919 1920 1919-20 1914-18 1909-13 Pulmonary Tuberculosis 105 120 113 165 145 Tuberculosis of Meninges 10 13 11 18 16 Other Forms of Tuberculosis 18 13 15 14 26 the average (1919-20) for "other forms" which is one in excess of the war average (1914-18 . In the case of pulmonary tuberculosis, the reduction in,the average for 1919-20 from the 1909-13 22 TUBERCULOSIS. standard amounts to 22 per cent., while those for the meningeal and other forms, amount to 31 and 42 respectively. In comparison with 1909-13 the mortality among males during 1919-20 showed reductions of 32 per cent, in the case of pulmonary tuberculosis, 33 per cent, in that of tuberculosis of the meninges, and 36 per cent, in that of other forms, the corresponding reductions in mortality among females being 9, 29 and 50 percent. The average numbers of deaths in the selected sex-age-groups were, with one exception, lower (some notably so) in 1919-20 than in 1909-13. At ages 15-45 the number of deaths of males in the two last years was 37 per cent, below the average for 1909-13, that of females only 3 per cent. In the age-group 45-65, the reductions were males, 15 per cent., females 31 per cent. (See Table XV. Appendix). In distributing deaths from tuberculosis according to the Wards, only two forms of the disease have been recognised, viz., " pulmonary " and " non-pulmonary." As regards the former (See Table XVI., Appendix) the averages for 1919-20 were below those for 1909-13 in all Wards except Westbourne (increase 11 per cent.) and Lancaster Gate, West, Ward (67 per cent.). The latter increase cannot be regarded as significant. More value attaches to the reductions in Harrow Road (34 per cent.) and Church (33 per cent.) Wards. As regards "non-pulmonary " tuberculosis the most striking change is the reduction in Church Ward—no less than 62 per cent. Other Deaths of the Tuberculous.—In addition to deaths certified as due to tuberculosis there were during 1919-20 32 others certified due to non-tubercular diseases, 16 in each of the two years. Of the 32 deceased persons, 27 had been certified as suffering from pulmonary tuberculosis and 5 from non-pulmonary. The deaths of 6 "suspects" were recorded during the two years, 5 due to non-pulmonary diseases (including 3 from influenza) and 1 to pulmonary (not certified during the deceased's life). Of the 27 pulmonary patients, two had been notified as early as 1909 and in 8 instances the disease had been certified by two or more practitioners. At least 10 of the patients had received special institutional treatment. One patient, originally notified in 1912, was reported as showing no signs of the disease in 1918. She died of bronchitis in 1919. Save in one instance the causes of death of the non-pulmonary patients did not absolutely exclude tubercular infection. In one instance such infection was included as a "secondary" cause of death. The exception was an infant of seven months notified as a case of tubercular meningitis whose death was due to posterior basic meningitis. Occupational Mortality.— In Table XIV., Appendix, the average numbers of deaths from pulmonary and other forms of tuberculosis are tabulated according to the occupations of the deceased persons as given at Registration of Death. The only occupation under "Pulmonary Tuberculosis" showing an actual increase is that entered as "No occupation or occupation not stated," in which the average for males in 1919-20 shows an increase equal to 62 per cent, of the average for 1914-18. The smallest reduction observed is that of "Housewives" whose deaths averaged 32 per annum in 1919-20, as compared with 35 in in 1914-18, a reduction of less than 9 per cent. The averages of deaths from non-pulmonary tuberculosis do not compare so favourably as those from pulmonary. Duration of Disease.—In 143 out of 225 fatal cases of pulmonary tuberculosis, i.e., 63'5 per cent, of the cases, approximations of the duration of disease could be made. The results are set out below in the form hitherto used in these Reports. Death ensued within Pulmonary Tuberculosis. Intervals to Fatal Issue, 1919-20. Under 6 months 19 Under 6 years 4 „ 6-12 „ 36 „ 7 „ 1 „ 1 year 55 „ 8 „ 2 „ 2 years 42 „ 9 „ 2 „ 3 „ 14 „ 10 1 „ 4 „ 8 ,. 11 1 „ 5 „ 8 „ 12 2 Over 12 and under 27 years 3 six months of the reputed onset in 19 instances (13.2 per cent.) and within 12 months in 55 (38.4 per cent.). During 1914-18, 27.0 per cent, of the cases with known (reported) duration succumbed within six months from onset and 43.0 per cent, within twelve. There were 6 deaths after illnesses exceeding 10 years duration in 1919-20, and 19 in 1914-18— representing 4.2 per cent, and 3.4 per cent, of the cases with known (reported) durations. TUBERCULOSIS. 23 Failure of Notification.— During the two years 65 deaths (36 in 1919, 29 in 1920) certified due tu tubercle were not notified to the Department daring the lives of the deceased persons— i.e., 23.3 per cent, of tuberculous deaths were "non-notified." During 1914-18 the percentage of such deaths was 19'8 per cent. Of the non-notified deaths 33—more than half—occurred in institutions outside the Borough, including 11 in lunatic asylums. A small proportion of the cases of patients dying outside the Borough (35 in all) had been notified to the Medical Officers of Health ot the districts in which the patients died. Enquiry is made with reference to every non-notified death, but the results of the enquiries muse be reserved for consideration elsewhere. In 22 instances during 1919-20 the notification certificates were received after the patients died and in 103 other instances death ensued within 6 months after notification. Combining those figures the result is that of 774 cases notified during 1919-20, no fewer than 125 (16.1 per cent.) were dead within 6 months. The corresponding proportion for 1914-18 was 14.7 per cent. Having regard to what has been written on the duration of the disease, the fact of so many deaths at such intervals after notification cannot be regarded as satisfactory and the increase in the proportion noted during the past two years is even more unsatisfactory. Institutional Mortality.—Of the 133 deaths from all forms of tuberculosis recorded in 1919 71 (53.4 per cent.) occurred in institutions of various characters. In 1920, 81 out of 146 such deaths—55.4 per cent.—were institutional deaths. Of the deaths from pulmonary tuberculosis 45.7 per cent, occurred in 1919 and 55 per cent, in 1920, as compared with averages of 48.3 and 54.4 per cent, during the quinquennia 1909-13 and 1914-1918. Of 28 deaths from non-pulmonary tuberculosis 23 (82.1 percent.) took place in institutions and of 26 in 1920, 15 (57.7 per cent.) During 1909-13, the average percentage was 50.2 and that during 1914-18, 69.3. The variations in the proportions of the deaths of the sexes in institutions are shown below. No explanation can be offered of the somewhat erratic changes. Tuberculosis. Percentages of Deaths in Institutions. Pulmonary Non-pulmonary 1909-13 1914-18 1919-20 1919 1920 1909-13 1914-18 1919-20 1919 1920 Males 52.7 57.3 55.1 51.9 57.8 53.9 71.1 60.0 68.7 50.0 Females 42.1 50.8 45.8 39.6 51.7 51.1 67.0 75.0 100 66.6 During 1919-20 records of frequency of admission to institutions were obtained with respect to 105 deaths from pulmonary tuberculosis—77 of the deceased having received such treatment once, 17 twice and 11 on three or more occasions. In comparision with the records for 1914-18, the figures for the last two years show a slightly smaller proportion (26.7 per cent.) than in 1914-18 (29.1 per cent.) The recorded average duration of treatment of the 105 cases was 4.12 months, exactly the same as in 1914-18. The variations in the proportions dying in different classes of institutions are remarkable and except as regards Mental Hospitals, difficult to explain. (See below). Tuberculosis : Deaths in Institutions, Institution Pulmonary Non-pulmonary 1914-18 1919-20 1919 1920 1914-18 1919-20 1919 1920 Poor Law 60.0 25.3 20.0 30.0 48.9 22.2 18.6 26.9 Hospitals—General and Special 12.5 10.6 7.5 13.3 35.8 37.0 46.4 26.9 M.A.B. Hospitals 7.5 4.4 1.9 6.6 8.2 9.2 14.2 3.8 Approved Sanatoria 2.4 3.1 2.8 1.6 2.0 — — — Mental Hospitals 17.3 7.1 13.3 3.3 4.8 1.8 3.6 — 24 CANCER Cancer: Malignant Disease The deaths from the various malignant new growths numbered 156 in 1909 from which figure the annual total increased to 211 in 1914 and then fell to 164 in 1918. In 1919 the total increased to 170 and again in 19.20 to 194. The annual average of deaths during 1909-13 was 170 and that during 1914-18, 198. The average for the two years 1919 and 1920 was 182, showing an increase of 7 per cent, above the average for 1909-13, and a decrease of 8 per cent, below that for 1914-18. (See Table VIII. B, Appendix.) In the absence of the data for calculating mortality rates, the following ratios of deaths from "cancer" to total deaths all causes are submitted— "cancer" Deaths. Per cent, of all Deaths. 1909-13 9.7; 1914-18 9.5; 1919 8 8; 1920 113; 1919-20 10.0. Inasmuch as it can be confidently stated that the total mortality rate has fallen during the past two years—even below the mean rate for 1909-13—it is safe to conclude that there has been a considerable increase in the mortality due to "cancer." Such statement does not of necessity involve an increase in the prevalence of the disease because cancer being a disease of late adult ages it follows that as the proportion of those ages increases an increased proportion of deaths from "cancer ' must be expected. Table XVII., Appendix, gives an analysis by form of "cancer," site of disease and sex-age distribution of the deaths recorded during the two years. Comparing the numbers of deaths certified as due to the various forms of "cancer" with the averages for 1909-13 and 1914-18, it appears that deaths from carcinoma show a continuous increase since 1909-13, the movements of the numbers under the other headings being irregular. The Index Numbers (averages 1909-13=100) for carcinoma are—Persons. 1914-18, 120; 1919-20, 130: Males, 1914-18, 112; 1919-20, 132 : Females, 1914-18, 126; 1919-20, 129. The use of the terms "cancer" and "malignant disease" is objected to on account of their indefiniteness. It is satisfactory, therefore, to be able to record a notable reduction in the proportion of deaths classified under those heads during 1919-20. In 1909-13, deaths so classified formed 25.1 per cent, of all "cancer" deaths, the proportion rising to 25.7 per cent, during 1914-18 but falling to 16.7 during 1919-20. The deaths from "cancer" of the digestive and generative systems form by far the greater proportion of cancer deaths. In the three periods under review, the deaths from disease located in the former system alone shows a continuous increase (see below). " cancer." Average Annual Numbers of Deaths. Location 1909-13 1914-18 1919-20 M F P M F P M F P Digestive System 49 44 93 52 54 106 55 53 108 Generative System 1 44 45 1 57 58 4 42 46 Anthrax. In July, 1915, a solicitor's clerk resident in the Borough died at the West London Hospital,, the death being registered, after inquest, as due to anthrax cf which the evidence available did not show the origin. From enquiries made suspicion fell on a new shaving brush. Parts of the brush were examined bacteriologically but no baccilli or spores of anthrax were found. Spores were, however, found in a brush obtained from the wholesale vendor of the suspected brush. The local vendor's shop was visited and the remaining brushes wilh the incriminating narks were destroyed. The above incomplete case is recalled because in October, 1919, a case of anthrax was reported to the Medical Officer of Health of Hammersmith, verified bacteriologically, and traced to a shaving brush purchased in this Borough. Acting on the information received the vendor's premises were visited and six specimen brushes were taken away and sent to the Lister Institute. The bacillus anthracis was definitely demonstrated in two out of the six brushes. The facts were reported to the Ministry of Health and to the Medical Officer of Health of the City, within whose jurisdiction was located the wholesale vendor of the brushes. 25 INQUESTS A general inquiry as to the cheaper makes of shaving brushes sold in the Borough was made and other brushes were found to be on sale which came from supplies found to be infected. The brushes were all of Japanese manufacture. In the end an Order in Council was made in February, 1920, pursuant to Sec. 1 of the Anthrax Prevention Act, 1919, prohibiting the importation of shaving brushes made in Japan. All suspected shaving brushes found in local shops were either returned to the wholesale vendors or destroyed. Alcoholism. The mortality from alcoholic excess is measured by the deaths from Acute Alcoholism (delirium tremens) and from Cirrhosis of the Liver—the error caused by the inclusion of the few cases of non-alcoholic cirrhosis being ignored. (See Table VIII. B, Appendix.) Acute Alcoholism.—During 1909-13 the deaths averaged 11 each year, which figure fell to 7 during 1914-18. In 1919 there were only 2 deaths from this cause and during 1920, 4. Cirrhosis of the Liver.—The annual average number of deaths rose from 15 during 1909-13 to 19 during 1914-18. In 1919 and 1920, 6 deaths were recorded each year. Combining the above figures it appears that whereas the annual average both for 1909-13 and 1914-18 was 26 deaths, the records for 1919 and 1920 were 8 and 10 respectively—showing reductions of 69.3 and 6T6 per cent. respectively. Venereal Diseases. Prevalence.—No information is available as to the numbers of attacks of the various forms of venereal diseases. A "V.D. Clinic" was opened at St. Mary's Hospital in January, 1917, which was attended by 999 patients in 1919 and 1003 in 1920. Nothing is known as to the areas from which those patients came. Mortality.—The deaths ascribed to syphilis—practically the only form of venereal disease appearing in death certificates—afford but an imperfect measure of the prevalence of the venereal diseases. Stiil-births, prematurity and many other causes of death could be traced to attacks of syphilis or gonorrhoea if full information could be obtained. The deaths from syphilis averaged 11 per annum during 1909-13, rose to 15 during 1914-18 and fell to 7 and 9 respectively in 1919 and 1920—or 36 and 18 per cent, below the average for 1909-13. INQUESTS. During 1909-13, 793 deaths were registered after coroners' inquisitions, equal to 8.4 per cent, of the corrected total number of deaths, the proportion increasing to 10.0 per cent. during 1914-18, when 1039 inquests were held. In 1919 (175 inquests) the proportion was 9.1 per cent. and in 1920 (166 inquests) 9.7. Table XVIII. Appendix contains an analysis of the findings of the juries at inquests held during the past two years. There has been a slight increase in the proportion of male deaths forming subjects ot inquests, the percentages being—1909-13, 57.6; 1914-18, 52.8 and 1919-20, 58.3. As regards the frequency of death from natural causes and violence, there is to be noted an increase of the former, the percentages being—1909-13, 46.4; 1914-18, 42.1 and 1919-20, 504. The proportion of deaths attributed to suicide fell slightly during the war, but has returned to prae-war level, the percentages being—1909-13, 9.8; 1914-18, 7.4 and 1919-20, 9.9. On the other hand, deaths attributed to accidents increased during the war, even after excluding deaths due to enemy bombs, but have fallen below the prae-war level during the past two years. The percentages are—1909-13, 28.7; 1914-18, 33.8 and 1919-20, 27.8. There has been a decrease in the proportion of inquests arising from road traffic. During 1909-13 there were 70 inquests, including 18 on deaths caused by motors ; in 1914-18, 80 (20 due to motors) and during 1919-20, 17 (4 due to motors). The proportions of deaths due to road traffic (percentages of all inquest cases) were 1909-13, 8.8; 1914-18, 7.7 and 1919-20, 4.9, and the proportions of deaths due to motor traffic (percentage of deaths due to road traffic) were 1909-13, 25.7; 1914-18, 25.0 and 1919-20, 23.5. 26 DEATHS IN INSTITUTIONS. The deaths of infants from suffocation in bed (overlying) numbered 23 during 1909-13; fell to 10 during 1914-18 and to 3 during 1919-20. The Index Numbers (average 1909-13 = 100) are—1914-18, 40 and 1919-20, 20. The Index Numbers for alcoholism (all forms) are— 1914-18, 61 and 1919-20, 34. The deaths returned as due to criminal abortion numbered 2 during 1909-13, 3 during 1914-18 and 5 during 1919-20—an unsatisfactory record. DEATHS IN INSTITUTIONS. The proportion of deaths in various institutions shows no real indication of decreasing. During 1904-8 31.6 per cent of all deaths occurred away from home, during 1909-13 39.1 per cent., and during 1914-18 41.1. (See Table XIX., Appendix.) In 1919 the proportion fell to 39.5 per cent., but in 1920 it rose to 43.2. The practice of seeking institutional treatment is increasing in nearly all parts of the Borough, Lancaster Gate, West, Ward being the only one in which lower proportions were observed in 1919 and 1920 than during the two preceding quinquennia. (See below.) The increased percentages recorded in Lancaster Gate, East, Ward are striking and are, it is presumed, due to changes in the housing conditions which are known to be taking place in that Ward. Deaths in Institutions. Percentages of All Deaths, Corrected. Borough Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster Gate Hyde Park West East 1909-13 39.1 39.6 32.9 31.9 35.2 47.7 22.3 20.7 30.2 1914-18 41.1 44.5 39.3 35.1 40.1 57.5 27.9 28.3 39.4 1919-20 41.3 42.5 43.5 35.1 41.6 51.9 21.0 30.1 35.6 1919 39.5 38.9 40.6 34.7 38.6 52.0 21.6 29.3 38.4 1920 43.2 47.0 48.1 35.5 45.1 51.8 20.5 33.9 32.5 Analysing institutional deaths according to the class of institution (see below) it is found that practically no increase has taken place in the proportion of deaths in the "Voluntary Hospitals"—those where the best treatment is usually expected and found. The greatest increases will be found in "Lunatic Asylums" and in "Special Hospitals and Homes," which include Sanatoria and Homes for the Dying. Deaths in Institutions. Percentages of All Deaths, Corrected. M.A.B. Hospitals Poor Law Institutions Lunatic Asylums Voluntary Hospitals Special Hospitals and Homes 1909-13 1.9 22.3 2.9 10.2 1.8 1914-18 1.7 24.1 4.3 7.5 2.0 1919-20 2.0 22.9 4.0 10.0 2.2 1919 1.7 21.1 4.9 9.9 1.6 1920 2.3 24.8 2.9 10.2 2.8 VII. STATISTICS OF CHILDHOOD. 0 to 5 years. Infantile. Mortality.—In 1919 the rate of mortality—fully corrected—was 91 per 1,000 births, and in 1920, 78—the mean for the two years being 83. During 1909-13, the rate averaged 106 per 1,000 births, rising to 109 during 1914-18. The rates recorded during 1919-20 are the lowest on record. (See Table I., Appendix). The variations in the mortality rates of males and females are shown below. In Mortality Rates—per 1,000 births. 1909-13 1914-18 1919-20 1919 1920 Males 117 119 95 109 85 Females 94 98 71 73 70 comparision with 1909-13, the rates for 1919-20 show reductions of—19 per cent, males, and 25 per cent. females. STATISTICS OF CHILDHOOD 27 The changes in the rates observed in the Wards are set out below. In 1919 the highest mortality (132) was recorded in Westbourne Ward and in 1920 in Lancaster Gate, East, Ward (126). The reduction in the rates recorded in Church Ward are noteworthy. The measures of the changes are given as Index Numbers in Table II., Appendix. Mortality Rates : Persons. Per 1,000 Births, Persons. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster Gate Hyde Park West Bast 1909-13 99 87 92 116 141 68 61 91 1914-18 95 89 100 118 150 73 59 93 1919 95 81 78 132 101 13 78 59 1920 58 57 85 90 94 51 126 65 On comparing the mean mortality rates for 1914-18 and 1919-20 in sex-age-groups (see below) it would appear that the reduction in mortality during the second period was effected— as regards males—between the ages of three and twelve months—and as regards females— Mortality Rates. Per 1,000 Births, corrected. Males Females Age at Death. 1914-18 1919-20 1919 1920 1914-18 1919-20 1919 1920 Under 1 day 12.7 13.8 16.9 11.7 9.8 12.3 11.4 12.9 „ 1 week 24.1 27.6 29.6 26.3 20.5 22.0 20.2 23.3 „ 1 month 41.4 40.7 51.6 33.6 32.9 32.5 21.1 34.4 0-3 months 65.8 62.0 75.4 53.1 52.4 46.3 45.7 46.7 3-6 „ 21.2 17.5 20.3 15.7 17.2 9.4 13.2 6.7 6-9 „ 16.6 9.7 8.4 10.6 14.3 9.4 6.1 11.6 9-12 „ 16.1 5.3 5.0 5.6 14.3 6.1 7.9 4.9 even before the third month of life. The rates recorded in the separate ages are two irregular to permit any reliable conclusions. The deaths at ages under one year during the two years are tabulated by causes in Tables XX. and XXa, Appendix. The changes in mortality from the five groups of diseases named in those tables are indicated below. Mortality Rates. Per 1,000 Births, corrected. Males Females 1914-18 1919-20 1919 1920 1914-18 1919-20 1919 1920 Group I. 8.9 2.3 0.8 3.3 9.1 3.6 — 6.1 „ II. 23.2 19.2 22.8 16.7 19.5 13.0 15.8 11.0 „ III. 3.6 1.3 1.6 1.1 3.4 0.7 0.8 0.6 „ IV. 41.8 42.1 50.0 36.9 32.4 28.2 28.1 28.2 „ V. 31.7 23.9 27.1 21.8 25.1 17.0 18.4 15.9 Other Causes 10.6 5.7 6.7 5.0 8.5 8.6 9.6 7.9 Hopeless Births.*—In 1919 64 births (males 34, females 30) were deemed to be of this category, the total rising to 102 (60 males, 42 females) in 1920. For the two years the total was 166, equal to 3.1 per cent, of the births registered within the Borough, as compared with percentages of 3.2 and 2.7 recorded during 1909-13 and 1914-18 respectively. It is curious that the proportion of these births after a fall during the war period should rise again, especially when one considers the great reduction in the total infantile mortality. Of the 166 deaths during 1919-20, 113 (2.1 per cent.) occurred during the first week of life, 36 between the seventh and twenty-eighth days and 17 at ages 4-6 weeks. The comparison with the experience of 1914-18 is given below. Hopeless Isirths. Numbers and Percentages of Births Registered Locally. Under One Day During 1st week Aged 1-4 weeks Aged 4-6 weeks 1914-18 91 (0.8) 184 (1.6) 92 (0.8) 26 (0.2) 1919-20 62 (1.1) 113 (2.1) 36 (0.6) 17 (0.3) *Applied to infants whose deaths are registered before or simultaneously with their births. In some instances the return of the child's death is the first intimation of the fact of its birth. 28 STATISTICS OF CHILDHOOD. The principal causes of death were "premature birth" and "congenital defects," to which were ascribed 104 deaths during 1919-20. Such deaths formed a little more than 2 per cent, of the total births within the Borough, the proportion during 1914-18 having been 1.6 per cent. Special Areas.—The six Areas mentioned in Table XXI., Appendix, possess marked characteristics and have heretofore, with the exception of "Queen's Park," had rates of infantile mortality notably in excess of the rate obtained by the exclusion of the data for those Areas from the data for the Borough as a whole. In five of those Areas notable reductions in mortality have to be recorded during 1919-20, the "Alfred Road" Area alone not sharing that reduction. The differences between the mean rates for the two periods 1914-18 and 1919-20 are clearly shown by the Index Numbers given below. Infantile Mortality. Index Numbers for 1919-20. (Means, 1914-18=100.) Whole Borough "Hall Park" "North Wharf" "Clarendon Street" "Alfred Road" "Amberley Road" "Queen's Park Combined Areas Rest of Borough 77 48 59 41 96 72 71 85 77 The reductions observed in "Hall Park" (52 per cent.) and in "Clarendon Street" (59 per cent.) are very striking and are worthy of a more detailed examination than can be given on this occasion. Complete tabulations by sex-age distribution and causes of death have been prepared which are not given here for economy's sake. From those tabulations the appended short statement has been compiled. Infantile Mortality. At Selected Ages. Ages (Months) 0-1 1-3 0-3 3-6 6-9 9-12 Combined Areas 1914-18 29.7 28.1 57.9 33.1 22.6 16.7 1919-20 32.7 15.8 48.4 13.8 13.8 11.9 Rest of Borough 1914-18 39.4 20.4 59.9 12.8 12.3 10.2 1919-20 38.3 18.8 56.7 13.5 7.9 3. Although there was in the Combined Areas an increased mortality at ages under one month, the mortality for the first three months decreased some 17 per cent, the decrease in the rest of the Borough being rather more than 5 per cent. only. In the second three months the reduction in mortality in the Combined Areas was approximately 59 per cent., while in the rest of the Borough there was an increase of close on 6 per cent. There were notable decreases in the mortality due to diarrhceal diseases, tubercular diseases syphilis and respiratory diseases (see below). Infantile Mortality : Selected Causes. "Diarrhoea" "Developmental" "Tuberculosis" "Syphilis" "Respiratory'' Conbined Areas 1914-18 36.2 34.3 6.5 3.1 32.8 1919-20 17.6 33.5 3.0 0.6 18.8 Rest of Borough 1914-18 32.6 37.5 2.4 3.8 16.8 1919-20 15.6 35.9 0.4 3.1 12.5 Illegitimates.—Of the 224 illegitimate children born during 1919, 35 died in their first year; equivalent to a mortality ot 156 per 1,000 births. In 1920 the mortality rose to 218 per 1,000 births. For the two years the figures are :— Births 467 : Males 236: Females 231 Deaths 88: „ 56: „ 32 the mortality rate being 188. During 1909-13 the rate was 266, and that during 1914-18, 259. There have been, therefore, reductions in this rate since 1909-13 amounting to 3 per cent, in 1914-18, and 39 per cent, during 1919-20. Among legitimate children the mortality rates have MEASLES. 20 faeen—1909-13, 96; 1914-18, 96, and 1919-20, 74, showing a reduction in the last period of 23 per cent. only. The sex mortalities are shown below. Infantile Mortality. Males Females Legit. Illegit. Legit. Illegit. 1909-13 108 269 84 263 1914-18 106 276 85 241 1919-20 82 237 65 139 Comparing the last with the first period, the reductions recorded are equivalent to 25 and 23 per cent, for legitimate males and females respectively, and 12 and 48 for illegitimate males and females. Children, aged 1-5 Years.—The mortality at ages 1-2 years for 1919-20 was notably lower than the rates recorded during 1909-13 and 1914-18, but those at the other ages show irregular variations. (See below.) Mortality Rates. Per 1,000 survivors. Ages 1.2 2.3 3.4 4.5 1909-13 31.5 11.9 6.4 5.8 1914-18 85.2 14.4 10.9 6.2 1919-20 18.7 12.3 5.5 6.8 1919 18.5 12.2 6.1 8.0 1920 19.0 12.5 4.6 5.7 The total mortality for the group 1-5 years was 10.7 per 1,000 survivors in 1919 and 10.5 in 1920—10.6 for the years 1919-20, as compared with 11.8 during 1909-13 and 13.7 during 1914-18. It remains to be seen whether the foregoing changes are more than periodical variations. Measles.—Until the end of 1919, this disease was notified under the Measles Regulations of 1915, which required notification of first cases of "measles" and " German measles." In November, 1919, the Ministry of Health issued an Order whereby the regulations of 1915 were repealed as from January 1st, 1920. On December 23rd, 1919 the Council made an Emergency Order under Sec. 56(5) of the Public Health (London) Act, 1891, to secure continuation of notification, but that Order was not required as the Ministry of Health issued an Interim Order dated December 31st, continuing the Regulations of 1915, within the Borough until the end of March 1920. Under date of March 29th, 1920, the notification of all cases of measles and German measles was made permanent by "The Metropolitan Borough of Paddington (Measles and German Measles) Regulations, 1920." Formal notification by the medical profession is supplemented by reports from the Public Elementary Schools (" Form 84 ") and by enquiries by the Women Inspectors, who visit all notified and reported cases and report secondary cases when no medical practitioner is in attendance. Under the Regulations parents and guardians are required to report cases in their families and households. The finally corrected totals of cases of measles and German measles reported during 1919 and 1920 were— 1919 Measles 1735, German Measles 155 1920 1946, „ „ 88 For the purposes of comparison with the previous records, the two must be combined. The cases reported during 1919-20 give an average of 1,962 as compared with averages of 1,336 during 1909-13 and 2,125 during 1914-18. There is good reason to believe that there was a very considerable deficit (roughly estimated at 40 per cent.) in the numbers reported during 1909-13. (See also Table III., Appendix). 30 measles. Ward Distribution.—Comparing the averages (See below) for the Wards during 1919-20 with those observed during 1914-18, increases are to be observed in two Wards only, viz. Queen's Park (22 per cent.) and Harrow Road (15.7 per cent.). Measles : Ward Distribution. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West Gate East Hyde Park Annual Averages 1914-18 261 471 307 347 416 91 85 147 1919-20 319 545 227 274 374 64 68 91 Recorded 1919 351 590 178 271 267 59 72 102 „ 1920 287 500 276 277 480 69 65 80 Sex-Age Distribution.—Comparing the averages for 1919-20 with those for 1914-18, the incidence of the disease was 1.8 lower on males (all ages) in 1919-20, and 12.4 less on females. At the same time the incidence on the two-age groups (both sexes), 4-5 and 5-13 years, was higher in 1919-20 than in 1914-18. At ages 4-5 the increases were: males 16 per cent., females 31 ; and ages 5-13, males 19 per cent, and females 8. Institutional Treatment.—In 1919, 65 patients (3.4 per cent.) were removed to hospitals and in 1920, 126 (6.1), For the two years the percentage removed was 4.8 as compared with 3.0 during 1914-18, Of the patients removed during 1919-20, 65 went to M.A.B. hospitals, 78 to the Infirmary, 45 to the London Fever Hospital and 3 to other hospitals. Home Nursing.—The patients to whom the District Nurses were sent numbered 89 in 1919 and 77 in 1920. In 1917, no fewer than 411 patients were thus nursed, and in 1918, 85. Fatality.—There were 11 deaths from measles in 1919 and 25 in 1920, giving fatality rates of 0.5 and 1.2 per cent, respectively. The average fatality during 1919-20 was 0.9 as compared with an average of 2.5 during 1914-18. Slightly higher fatality rates were observed during 1919-20 among females at ages 0—1 and 5—13, all other sex-age fatalities being lower. Mortality.—For the two years 1919-20, the average annual number oi deaths was 18, as compared with corresponding averages of 50 and 53 during 1909-13 and 1914-18. The reduction in 1919-20 was 64 per cent, below the average for 1909-13. Institutional Deaths.—Of the 11 deaths in 1919, 2 (18.1 per cent.) took place in institutions, and of the 25 recorded in 1920, 18 (72 per cent). The average proportion for the two years was 55.5 per cent., as compared with 29.3 per cent, in 1909-13 and 31.7 per cent, in 1914-18. Whooping Cough.—This disease is not notified. The Department received, however, reports of 160 cases in 1919 and 355 in 1920. For the years 1919-20 the annual average was 257, as compared with the averages of 546 and 496 in 1909-13 and 1914-18—showing a reduction of 53 per cent, on the 1909-13 average. Ward Distribution.—The averages for 1919-20 compare very favourably with those for 1909-13 and 1914-18 in all the Wards except Lancaster Gate, East. (See below) Whooping Cough : Ward Distribution. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster Gate Hyde Park West Hast Annual Averages 1909-13 102 156 55 60 124 17 12 20 1914-18 90 122 53 67 122 5 8 29 1919-20 37 81 18 31 62 1 17 10 Recorded 1919 3 46 18 12 48 1 22 10 1920 71 115 19 50 75 2 12 11 Sex-Age Distribution.—The cases (persons) reported during the two years were rather more than 48 per cent, below the average for 1914-18, the reduction for males being 47 and that for females rather more than 49. Smaller averages were observed in all sex-age groups. WHOOPING COUGH. 31 Institutional Treatment.—Removal to hospital is comparatively rare. Only 11 cases— 4 in 1919 and 7 in 1920—were admitted to institutions (9 to M.A.B. Hospitals and 2 to Infirmary) as cases of whooping cough, equal to 21 per cent, of the reported cases, as compared with 5.4 per cent, during 1914-18. Home Nursing.—Only one case (in 1920) needed the services of the District Nurses. Fatality.—The total fatality in 1919 was 0.6 per cent., but rose to 3.9 in 1920. For the two years the fatality averaged 2.9 per cent., as compared with 6.1 during 1909-13. The lower fatality was limited to patients aged 2 years and upwards. At younger ages it was considerably higher during 1919-20 than during 1914-18, those for males during 1919-20 being —under 1 year, 22.2 per cent.; 1-2 years, 27.2 ; and tbose for females—under 1 year, 38.4 and 1-2 years, 25.0. The fatalities observed during 1914-18 (in the same order) were 23.1, 165, 30.5 and 17.6 per cent. Mortality.—The deaths recorded were—in 1919, 1, and in 1920, 14. The average for the two years was 8, as compared with averages of 35 and 30 during 1909-13 and 1914-18. Deaths in Institutions.—Although so few cases are removed to hospital the proportion of deaths in Institutions was considerably greater in 1919-20 (53.3 per cent.) than in 1909-13 (27.0 percent, or 1914-18 (34.8 per cent.) These high proportions are doubtless due to inmates succumbing to whooping cough after admission for other diseases. Chicken-pox.—Records are kept of cases of this disease, although very little interest attaches to its prevalence except when small-pox is prevalent or threatens to become so. In 1919, 261 cases were reported and in 1920, 567. The average for the two years was 414, as pompared with 490 during 1909-13 and 572 during 1914-18. In 1919 more than half the cases were reported in the first three months of the year and in 1920 in the last three. Mumps.—During the two years 304 cases were reported—150 in 1919 and 154 in 1920— giving an average of 152, as compared with averages of 251 during 1909-13 and 295 during 1914-18. Nearly all the cases are known through the schools. Ringworm.—As was anticipated a return to (approximately) normal conditions of school medical inspection has resulted in an increase in the number of cases reported, the total for the two years being 393—189 in 1919 and 204 in 1920. The average for the two years—196 — was above the prae-war average (1909-13) of 172 as well as that of the war (1914-18), 140. 32 B. ADMINISTRATION I.—GENERAL. Staff of the Department.—Mr. S. W. Wingfield (one of the Inspectors of Houses let in Lodgings), who joined up in 1914, resigned his appointment under the Council in August, 1919. Miss Durant, the senior Health Visitor, resigned in November, 1920. Neither vacancy had been filled at the close of 1920. Prevention of Infectious Disease. — Table XXII., Appendix, shows very clearly the amount of work accomplished during the past two years and only a few words in amplification are necessary. During 1909-13, the enquiries made by the Inspectors—male and female—averaged 10,662 per annum, rose to 10,876 during 1914-18, and fell to 8,108 in 1919 and 8,280 in 1920. The reduction in the number of enquiries in connection with tuberculosis is due to the opening of the two Dispensaries. The admissions to hospitals—of all descriptions—in 1920, notably exceeded the annual averages for 1909-13 (666) and 1914-18 (618). Disinfection.—The weight of goods removed by the Contractor has been reduced by change in practice, disinfection of beds, etc., after measles and cancer being no longer a matter of routine. The increased charges for the work necessitated by post-war prices have resulted in an increase in expenditure by some 60 per cent., notwithstanding the smaller weight (over 16 per cent, less than the 1914-18 average) dealt with. Bacteriological Work.—The total number of specimens examined annually averaged 471 during 1909-13 and 676 during 1914-18. The total for 1919 (635) was slightly below the latter average, but that for 1920 (1,600) was much in excess. The great increase in 1920 was due to extensive "swabbing" of suspected cases of diphtheria, including carrier cases. Diphtheria.—Of the 1898 "swabs" submitted during 1919-20, 225—11.8 per cent, only—were reported to be positive, i.e. to contain the Klebs-Lofflcr bacillus. Such proportion of positive swabs was much below the proportions recorded during 1909-13 (20.8 per cent.), or during 1914-18 (16.7 percent.). Enteric Fever.—Of the 8 blood specimens examined during 1919-20, 3 (37.5 per cent.) gave Widal reactions,, the corresponding proportions for 1919-13 and 1914-18 being 39.0 and 32.5 respectively. Tuberculosis.-—The number of specimens of sputum received in 1919 (144), was notably less than the annual average (215) for 1914-18, and although the total increased to 173 in 1920, that figure was far below the average. The figures given here cannot be accepted as evidence of neglect of the microscopical examination of sputum as an aid to diagnosis. The Dispensary Medical Officers make use of the test—performed at the Dispensaries—and doubtless many general practitioners do their own microscopical examinations. The proportion of "positive" examinations—58 out of a total of 317—during 1919-20 was 18.2 as compared with 23.3 during 1914-18, and 21.3 during 1909-13. Miscellaneous.—Included among the 12 miscellaneous specimens examined during the two years, were six of Japanese shaving brushes. The anthrax bacillus was found in two of the specimens. Schools.—The ratios given in Table XXIII, Appendix, are based on data derived from "Form 84" received from the schools. The ratios (rates per 1,000 places provided) show how the diseases mentioned have varied from year to year since 1914. The rates for 1919 were in general below the averages for 1914-18, whereas those for 1920 were, with exceptions, higher. The figures show that as a rule the diseases specified are more prevalent in the Provided than in the Non-provided Schools—verminous conditions being, however, an exception. No suggestion can be offered in explanation, unless it is to be found in the fact that the Non-provided are much smaller than the Provided Schools. In the former class (17 schools) just over 8,500 places are provided, averaging 500 per school, while in the latter (8 schools) the average is over 1,300 per school. In the course of the two years over 8,000 "exclusion forms" were sent to the schools within the Borough, 1,719 relating to notified diseases (other than measles) and 6,309 to measles, whooping cough and chickenpox. In addition 537 notices were sent to the Medical Officers of Health of the circumjacent districts relating to children living in Paddington but attending schools in those districts. ADMINISTRATION 33 Ringworm.—It will be noted that the reported cases of this disease in Provided Schools have apparently increased some 50 per cent, above the average, such increase it is believed, however, to be more apparent than real and due to increased inspection. The figures for 1915-18 lend support to such view. It is, however, somewhat remarkable that the rates observed in Non-provided Schools have varied so slightly. Scabies.—The same explanation is believed to apply to the increase of this disease in Provided Schools. From the Non-provided Schools more cases of scabies used to be reported than from the Provided. In the last two years the position is reversed. Vermin.—The rates here more than suggest that changes in the system of reporting cases have been effective since 1917. In this connection mention may be made of two returns specially received from the County Council showing the numbers of school children found to be verminous when examined in the course of the Winter Term 1919 and the Summer Term, 1920. During the Winter Term, 15,681 children were examined, vermin being found on the heads of 2,581, and in the clothes, on the body and head, in 14 instances only. In the Summer Term when 15,721 children were examined, 2,374 had verminous heads, and on 18 others vermin were found there and/or elswhere. Apparently the cases of vermin reported to the Department are those in which vermin are found elsewhere than the head. House Sanitation.—The following paragraphs are limited to houses which are not on the Register of Houses let in Lodgings, which latter are dealt with under "Tenement Houses" (see p. 40). Table XXIV., Appendix, summarises the principal activities of the District Inspectors under this head during the "war period" (1914-18) and the past two years. A comparison of the figures for 1914 with those for 1920 shows that the work of making good defects and abating nuisances is handicapped by the present high level of prices for labour and materials. The increases to be observed under most headings during 1920 are far short of those required to make up the deficiencies for the years 1916-19. The cleansing of premises and the repair of roofs are practically the only two items notably above the 1914 level. House Drainage.—The figures relating to this work contained in Table XXIV. require to be supplemented as they do not include repairs, &c., undertaken voluntarily by house owners and others. The complete returns for the seven years 1914-20 are set out below:— 1914 1915 1916 1917 1918 1919 1920 Existing Drains tested and found watertight 143 89 80 85 68 71 89 Drains reconstructed 175 105 82 45 57 68 90 „ "made sound"* 78 23 17 12 4 21 17 •By "Economic" or similar process. In 1911, 227 drains were reconstructed, and 50 made sound, the corresponding figures for 1912 and 1913 being 223 and 175 and 98 and 73 for each category respectively. The extent to which this work is below what is thought to be the standard of work required to be carried out annually is demonstrated by the fact that during the four years 1911-14 200 drains were entirely reconstructed and 75 mads sound each year, whereas since 1914 the annual averages have been (approximately) 75 reconstructions and 16 repairs by process. Reconstruction Plans.—As may be seen from the following statement there has been: 1914 1915 1916 '1917 1918 1919 1920 Plans deposited 312 269 145 122 109 269 299 an increase in the number deposited, but the totals for the years 1919-20 are still much below the normal. During 1911-14 340 plans were deposited on an average each year, the annual average for the years 1915-20 being only 202. In 1919, 584 letters had to be dispatched with reference to plans received, and in 1920,. 750. Summonses for failure to deposit plans were issued in 3 instances in 1919 and 2 in 1920. 34 ADMINISTRATION Combined Drainage.—Orders under Sec. 74 of the Metropolis Management Act, 1855, with respect to the following new systems were made :— In 7919 Harrow Road, Nos 81 and 83 Pembridge Sq., No. 19 and premises in rear there of Westbourne Gardens, Nos. 2, 4 and 6 In 1920 Ash worth Road, Nos. 6 & 8 Gloucester Terrace, Nos. 187 & 189 Harrow Road, Nos. 489, 491 &493 Lanark Place, Nos. 3 & 4 Lancaster Gate, Nos. 5 & 6 Lancefield Street, Nos. 116 & 118 Porchester Road, Nos. 32 & 34 Westbourne Grove, Nos. 47 & 49 Defective systems of combined drains were discovered at— In 1919 Caroline Place, Nos. 14, 15 & 16 Newlan Row, Nos. 1, 2, 3 and 4 Oxford Mews, No. 14, and premises in rear thereof Westbourne Terrace Rd., No. 14 Warwick Crescent, Nos. 20 & 21 In 1920 Bishops Road, Nos. 26 & 28 Blomfield Mews, Nos. 18 & 19 Burwood Mews, No. 18 Burwood Place, No. 2 Church Street, Nos. 170, 172 & 174 Ranelagh Road, Nos. 1-17 (odd) As no sanctions for the above systems could be traced they were reconstructed as "sewers" by the Council. Sewer Connections.—During 1919, 62 new connections were laid, and during 1920, 70. The increase in the numbers laid in during the past two years is well shown by the appended statement:— 1914 1915 1916 1917 1918 1919 1920 After Order from the Council 13 15 8 10 16 36 46 On initiative of "owners" 23 22 25 11 11 26 24 Water Supply.—It is satisfactory to note the reduction in the numbers of notices of discontinuance of supplies, 11 in 1919 and only 4 in 1920, as compared with an average of 29 per annum during 1914-18. As the act of cutting off the water from an inhabited house renders such house unfit for human habitation under Sec. 48 of the Public Health (London) Act, 1891, the practice is much to be deprecated. Of the 4 notices received during 1920 one only referred to an inhabited house (See also Table XXII., Appendix). Mortuary.—The number of bodies deposited averaged 321 during 1914-18, whereas the totals for 1919 and 1920 were 228 and 224 respectively. The proportion of bodies deposited for inquests fell from 80.3 per cent, during 1914-18 to 74.2. While the number of P.M. examinations made decreased, the proportion of such examinations to inquests increased from 48'4 per cent, during 1914-18 to 57.1 per cent, during 1919-20. In 1919 an enquiry was made as to the number of private mortuaries maintained in the Borough. Three firms of undertakers were found to have mortuaries within the Borough and a fourth one in Kensington. Other firms admitted that bodies were kept on their premises for a night or so, either in the shop or in a hearse. The majority of the firms use the Public Mortuary. . In the course of the enquiries it was ascertained that a yearly average of some 150 bodies of still-born and unbaptised children were disposed of by undertakers. Trade Nuisances.—Offensive Smells.—The complaints of effluvia from manure and decaying refuse were more numerous in 1919 than the average for 1914-18, but decreased in 1920. Manure is too valuable now to allow of neglect of its removal. WELFARE WORK 35 Dust removal.—Removal once a week has been the rule during the two years. Housing conditions are. however, changing so radically that it is more than doubtful whether that rule can be adhered to much longer. The conversion of ordinary dwelling houses into maisonettes and flats in which no kitchen ranges are provided leads to accumulation in the houses of putrescible refuse, added to which undesirable practice is the difficulty of finding suitable (i.e. safe qua health) places in which to keep the sanitary bins. The difficulties of disposal after collection increase each year. It is probable that some system of "manufacturing" will have to be adopted in lieu of dumping in country districts. Smoke Nuisance.—There has been some slight improvement in this respect since 1918, as evidenced by the decreasing amount of total emission of smoke and of black smoke (See Table XXII., Appendix). The proportions of the observed duration of black smoke to the total hours of observation during the last seven years are given below:— Duration of Black Smoke 1914 1915 1916 1917 1918 1919 1920 per 100 hours of observation 0.7 2.7 2.9 3.6 6.6 6.6 4.1 During 1915-18 the proportion was 32 and that during 1919-20, 4*9. Canal Boats.—There does not appear to be any revival of canal traffic. At the end of 1920 of 224 boats on the Register only 111 could be traced. During the two years one case of Diphtheria (male 26) and one death (heart disease, female 41) were reported—both in 1920. In 1919, 61 children (34 of school ages) were counted on the boats using the Basin, the corresponding figures for 1920 being 86 and 47 respectively. The usual cleansing and repairs to the Basin were effected at Easter in each year. II.—WELFARE WORK. This work is carried on under the Notification of Births Acts, the Maternity and Child Welfare Act, 1918, and more especially the Circular issued by the (then) Local Government Board in August of that year. The greater part of the work is performed by the "Paddington School for Mothers," a Voluntary Society subsidised by the Ministry of Health and the Council. The work falls under the following heads. Ante-natal Clinics.—These are maintained by the School for Mothers, but more recently similar clinics have been opened at St. Mary's Hospital, and at Queen Charlotte's Lying-in Hospital. No information is available as to the numbers of expectant mothers attending at the two latter clinics. At the Clinic of the School for Mothers, 232, Harrow Road—the average attendance during 1919 was 9 per week, which figure increased to 14 in 1920. The Staff of the School visited 150 mothers in their homes during 1919 and 193 during 1920—the total number of visits to the homes numbering 207 in the former year and 238 in the latter. Health Visiting.—Some ten days after notification of birth, and immediately after information of registration of a non-notified birth, the infant's home is visited by one of the Health Visitors on the Staff of the Department and such advice tendered as the circumstances of the case indicate to be necessary. A copy of a booklet "Suggestions for the Rearing and Feeding of Infants" drawn up by the Medical Officer of Health is left when accepted—which it is in nearly every instance—and the mother is urged to take the child to the nearest Infant Consultation Centre so that the child's progress can be watched and recorded. In 1919 2,383 such visits were made and in 1920, 2,989. The proportion of infants reported to be breast-fed was just over 90 in each year, the return for 1920 being a little lower than that for 1919. In 1913, 94 per cent, of the infants visited were reported breast-fed. Of the 1,474 children visited in 1919, 66 died before the end of the year, equivalent to a mortality of approximately 45 per 1,000 while of the 1,958 visited in 1920, 81 were dead before December 31st, mortality 41 per 1,000. The superiority of breast feeding is clearly shown by the differences in the mortality rates: MORTALITY RATES. 1919 1920 Breast-fed 40 38 Artificial and mixed 93 73 30 HOUSING The routine is to pass the infant to the School for Mothers after the Health Visitor has made an effective visit, hut a number of infants remain for further visits by the Department's Official for various reasons. The Visitors appointed by the School continue to visit all infants up to one year of age and a good proportion between the ages of 1-5 years, some of the latter, however, coming under the Care Committees on entering the Infant (3 to 5 years) Classes at the Schools. In 1919, the Staff of the School for Mothers made 10,973, and in 1920 11,857 visits. The figures for infants 1-5 years old were not tabulated separately. Consultation Centres.—In 1914 there were three Centres at work. At the end of 1920 the number was 5, consultations being held at 3 once a week, and at 2, twice. The weekly average of attendances at all centres was 191 in 1919 and 268 in 1920. A medical officer attends at each consultation. Fortnightly consultations are held for children aged 1-5 years. In 1919, there were 378 attendances at those consultations. The returns for 1920 are not available. Sewing and Cookery Classes are held for mothers, and "health talks" given periodically in addition to the informal talks which take place at each consultation. Milk Grants.—In March, 1918, the Council referred to the Paddington School for Mothers the administration of the Milk (Mothers and Children) Order, 1918, which Order was superseded by the Milk (Mothers and Children) Order, 1919. The supply of milk free or at less than cost price was at once commenced, but arrangements for the provision of meals to expectant and nursing mothers did not come into operation until after October, 1919. Experience having shown that in a number of instances, persons eligible for grants of milk were not provided for, owing to the fact that for various reasons they were unable to attend the consultations at the Paddington School for Mothers, the Maternity and Child Welfare Committee in December, 1919, directed that such cases should be dealt with by the Medical Officer of Health. The foregoing arrangements continued until the beginning of 1921, when a Special Sub-Committee of the Maternity and Child Welfare Committee, was formed for the purpose of considering all applications for grants. Since then all orders have been issued by the Medical Officer of Health. Between April, 1918 and December, 1920, the amount expended by the Paddington School for Mothers on milk was approximately £516, which may be divided roughly as follows:— During 1918 (April to December), £36; 1919, £89; and 1920. £391. During the same period milk substitutes (comprising "Glaxo," "Cow & Gate," "Virol," "Marylebone Cream,'' Lactogol," etc.) to the value of £2,635 were purchased for distribution at the Consultation Centres, and £2,226 received from the mothers, the difference (£409) representing the value of the foods supplied free or at less than cost price. During 1920 337 applications were dealt with by the Medical Officer of Health. Threehundred-and-two (302) grants were made, 189 being free and 113 at half-price, the cost to the Council approximating £350. Twenty (20) applications were refused as not relating to necessitous cases, 14 others were referred to the School for Mothers and 1 to the Board of Guardians. III—HOUSING.* Legislation.—The following Acts were passed during 1919-20— In 1919—Housing, Town Planning, etc.. Act. Acquisition of Land (Assessment of Compensation) Act, and Housing (Additional Powers) Act. In2 1920—Increase of Rent and Mortgage Interest (Restrictions) Act. "Housing" work is regulated by no fewer than nine Acts, not to mention special provisions in Acts not entitled "Housing Acts." The six Acts prior to those of 1919 are Housing of the Working Classes Acts, 1890, 1893, 1894, 1900 and 1903 and Housing, Town Planning, etc., Act, 1909. 1 See also Table XXIX, Appendix, which has been constructed at the request of the Ministry of Health. 37 HOUSING The number of repeals, minor amendments, cross references, etc., is very great. A "Synopsis" of the provisions of the "Housing Acts 1890—1919" was prepared for the information of the Housing Committee by the Medical Officer of Health at the end of 1919 and printed in 1920. The Ministry of Health issued a "Manual"—two volumes—in the same year. A Bill to codify the "Housing Acts" is much needed. In July 1919, the Ministry of Health appointed a "Housing Board" for London, and, acting under Section 1 of the Housing, Town Planning, etc., Act of the year, called for a survey of the housing conditions of the Borough. Surveys.—Between July and October, 1917, certain information as to housing accommodation in the Borough was compiled at the request of the (then) Local Government Board. The more important facts collated were as follow:— The number of houses rated up to £20 2,971 „ „ „ „ £20.80 1,876 Of the "houses" included in the above categories, 112 were flats separately rated, and a considerable proportion of the first category were tenements over stables. The number of vacant houses suitable for the working classes was 49 No houses of either of the above categories had been erected since 1911. In July, 1919, the Ministry of Health called for a more complete survey in pursuance of Sec. 1 of the Housing, Town Planning, &c., Act, 1919, together with a "Scheme for the provision of new houses." The more important results of the survey are included here. There are 177 factories and 1,204 workshops in the Borough, including 7 factories and 382 workshops occupied by outworkers. The factories included one of margarine and an oil refinery. Of the 1,381 premises (both classes) trades connected with dress (589 )and boots (120) were 51 per cent., laundries (123) and metal workers (104) being also numerous. A street-to-street inspection showed that there were 787 empty premises of which 212 were being got ready for occupation as private dwellings, and 33 were being converted into flats or maisonettes. The remaining 542 houses included 41 which were "derelict"—6 of them being "closed" under the Housing Acts—and 54 in occupation for National Services. An analysis of the data relating to 540 houses - including 160 stable premises—showed that in the three northern Wards, viz.:—Queen's Park, Harrow Road and Maida Vale—there was practically no vacant accommodation. The first-named Ward had only 14 empty rooms (a derelict stable yard) and the last some 186 rooms in 15 houses. In Harrow Road Ward no house was reported to be vacant. Excluding the stable premises there appeared to be some 380 houses, comprising upwards of 4,500 rooms capable of being adapted for habitation by the working classes, but not all suitable for that purpose. It was probable that the foregoing figures underestimated the actual amount of vacant accommodation as parts of houses and a good many flats which were empty were not included in the return. The Rate Collectors reported that there were at the end of the second quarter of 1920 823 dwellings and 46 flats "empty." The rapidity with which the Borough was "filling-up" was evidenced by the fact that at the end of the corresponding quarter of 1919 the "empties" comprised 1143 dwellings and 118 flats. A large amount of information as to the rents of working class houses and flats was collected which cannot be given here. The following eight areas were reported as requiring to be dealt with under the Housing Acts:— "area" acreage number of houses estimated population Church Place, Kensal Green 1 31 230 "Amberley Road" 5 162 2,120 "Clarendon Street" 15 392 6,500 "Hall Park" 11½ 324 3,190 "North Wharf" 16 213 1,870 "Union Place" 1½ 91 630 "Stanley Street" 1 30 220 "Caroline Place" 6½ 155 700 In certain instances the original ground leases had either expired or were on the verge of doing so and some of these "areas" would have been reconstructed privately prior to 1919 had not the war broken out. The insuperable obstacle to any improvement schemes on large scales is the fact that there is no vacant land available in the Borough. The only plot of any size, that between Lauderdale Road and Elgin Avenue, was let on building lease before the war. There is no suitable accommodation within the Borough to house the population displaced by improvement schemes. The directions in which the Council can, it is believed, successfully initiate housing reforms will be indicated later. In connection with the Survey complete tabulations were prepared of the trades and businesses carried on in each Ward, and a classification of the streets in the Borough was compiled based on the class of dwelling and the status of the majority of the residents. 38 HOUSING In 1920 further information was sought by, and furnished to, the "Unhealthy Area Committee" appointed by the Ministry of Health. No report from that Committee had been published at the end of the year. Dilapidated Derelict Houses.—At the date of the Survey of 1919, 448 houses were reported as standing empty—i.e. not in course of preparation for occupation—including 41 apparently "derelict," the latter being more or less dilapidated. For some unknown reasons certain owners of property will neither let nor sell their houses, appearing to prefer to allow their property to deteriorate until it is uninhabitable. When such houses become actually "dangerous structures" the District Surveyor takes action under Sec. 116 of the Building Act of 1894, but until that stage is reached it seems practically impossible to exercise any pressure on the house-owner. It is true that Sec. 115 of the same Act, which is marginally noted "Removal of dilapidated and neglected buildings," appears to have been drafted to meet these cases, but the provisions of that Section have not proved workable, or, any way, are not enforced. The "Ministry of Health (Miscellaneous Provisions) Bill, 1920" proposed to deal with landlords who abstained from keeping their houses occupied by giving local authorities power to take houses which had been empty for more than three months on leases—to end at Christmas 1923—and to make such houses reasonably fit for occupation of the working classes. The authority was to be empowered to force the taking on the owner and, subject to arbitration if no agreement could be reached, to fix the rent to be paid to the owner, such rent to be determined in part by the amount required to be spent to render the house fit for occupation. The Bill was withdrawn by the Government. Conversions.—Under Sec. 16 of the Housing, Town Planning, etc. Act, 1919, the Ministry of Health is empowered to acquire land and/or houses for the erection, enlargement, alteration, etc., of buildings, to render the same suitable for occupation by persons of the working class. The cost of acquisition, alteration, adaptation, etc., is in the first instance borne by H.M. Treasury, but has to be repaid by the local authority (Sec. 3, Housing (Additional Powers) Act, 1919). Sec. 12 of the same Act gives similar powers to the local authority. If there any be restrictive covenants in the ground lease preventing "conversion," the County Court can set such covenants aside if proof be adduced that the premises could not be readily let to a single family owing to changes in the character of the locality—Section 27. The last named Section (Sec. 27) can be used by private owners desiring to convert houses, and under Sec. 22 of the same Act the local authority can advance money on loan to assist such conversions. Sec. 26 provides for Bye-laws for regulating certain details of construction of "tenement houses." A model series of Bye-laws has been issued by the Ministry of Health and draft Bye-laws have been prepared by the County Council—the authority for making Bye-laws for London, to be enforced by the local authority—but the Bye-laws had not been confirmed at the end of 1920. The London Housing Board had a long list of empty properties—well over 300 addresses —submitted to them for consideration as to suitability for conversion and a number of schemes were prepared. In one instance only—viz., No. 30, Westbourne Square—was it found practicable to carry out conversion, the estimated costs of all other schemes being held to be prohibitive. The same has to be reported with regard to proposed conversions by the Borough Council, No. 8, Warrington Crescent being the only premises the conversion of which was found to be financially possible and even in that instance an annual deficit was estimated for. The Department does not receive notice of conversions (as such) from private owners, and the only information available is such as is obtained either by watchfulness of the Staff (i.e. enquiry where unreported work is noted as in hand) or by Notices for Alterations, etc., toSanitary Fittings. Where a house hitherto let to one family is let to many families without any adaptation, the Department may have no knowledge of the "conversions" until one or other of the occupiers complains to the Department. Unfortunately, there is good reason to believe that there have been a good many instances of such "conversions." The Department had knowledge of the conversion during 1920 of 77 houses into maisonettes or flats. The majority —if not all—of those houses were occupied by single families. The conversions provide for 217 families, nearly three times the old-time number. 39 HOUSING In certain instances the "conversion" has been known to be on very undesirable plans, but with which there was found no power to interfere either under the Building, the Public Health or Housing Acts. In two instances the attention of the Ministry of Health was specially directed to the premises which were inspected by Officers of the Ministry. In one instance a large house of four floors above a basement was found—following a complaint—to contain a family on each floor with "caretakers" in the basement. No alterations or adaptations had been made and three of the families were cooking their food in bedrooms. The basement was indescribably filthy. An Officer from the Ministry of Health inspected the premises at the request of the Medical Officer of Health. What may be described as "jerry conversions" are to be deprecated anywhere, but when they are made in high-class residental districts the ill-effects become more notable. The greater density of population on the land and in the houses cannot fail to lower the standard of health of such districts, and the change in the class of residents inevitably results in depreciation of value of the property to be followed by lower rentals and extension of "conversion" on inferior standards. The final result, unless the question be taken up quickly and new legislation enacted to cope with the evil, can only be the degradation into unhealthy areas of blocks of properts' at the present time well known for their healthy surroundings and social amenities. Applications to ground landlords for their assistance by enforcing the covenants of ground leases or regulating conversion, have had, so far, practically no results. Up to the end of 1920 only one owner—a freeholder—had availed himself of the provisions of Sec. 27 of the Act of 1919. After appeal by the applicant to the King's Bench, the Judge -of the County Court made an Order giving relief to certain restrictive covenants between adjacent owners and sanctioned the conversion of the house subject to the approval by the Borough Council of the proposed alterations. Compulsory Repairs.—Under Sec. 75 of the Housing of the Working Classes Act, 1890, a contract to let a house to a person of the working class implied a condition that the house was at the time of letting reasonably fit for human habitation, and Sec. 15 of the Housing, Town Planning, etc. Act, 1909, made such contract include (by implication) an undertaking to keep the house—or part of the house—in all respects reasonably fit for human habitation. The last-mentioned section gave the local authority power to intervene if the house be not so maintained and call upon the owner to execute works deemed to be necessary. In the event of the owner not carrying out the works, the local authority had power to do the same and recover the cost as a civil debt. Section 28 of the Housing, Town Planning, etc. Act, 1919, re-enacts (without repealing) the provisions of Sec, 15 of the Act of 1909, but—Sub Sec. 3—makes the cost of the works a charge upon the house. The effect of this alteration in the manner of recovery of expenses should give much greater security to the local authority, as all persons having an interest in the house—not merely the receiver of the rack rent—are liable to the extent of their respective interests, for repayment of the work. The provisions of Sec. 30 of the Act of 1919, should be of use in securing that this class of property is maintained in good repair, as the Section authorises the "High Court of Justice" (in respect of London houses) to determine the ground lease when satisfactory proof is given of neglect to keep the house in proper repair. At the end of 1920, the administrative details for giving effect to the provisions of Sec. 28 were still in an experimental state but notices had been issued with respect to 141 houses— 6 in 1919 and 135 in 1920—of which 27 had been complied with. In 4 instances work had been undertaken by the Council but the repairs were not completed before the close of the year. There is good reason to believe that the provisions of this Section will be found to be of special utility in the Borough, improvement schemes being almost impracticable at present and likely to remain so for some years. Unfortunately the preparation of the reports required for the drafting of the Notices, takes a very long time and the Staff of the Department, being otherwise fully engaged, cannot give so much time to this work as could be desired. Unhealthy Areas.—Mention has been made of certain areas which are recognised by the Department as in need of action under the Housing Acts. The list given (See p. 37) does not include all considered by the Officers of the County Council as "unhealthy." Certain of the latter are ripe for re-construction and re-planning by reason of the expiry of the ground leases. Had times been normal, reconstruction on a considerable scale would be in progress in the Borough. As things are, re-construction and improvement schemes cannot be undertaken by the Council partly on account of the prohibitive expenditure involved, but mainly because there is no accommodation available for the inhabitants who would be displaced by such schemes. 40 HOUSING During 1919-20, 11 Improvement Schemes were submitted to the Housing Committee, of which one only, that known as the "Desborough Street Scheme," was adopted by the Council. That scheme was rejected by the Ministry of Health on account of the density of population which would ensue and the limited surface of ground available. Houses Unfit for Habitation.—Closing Orders were made in 1919 with respect to the undermentioned premises Dartington Terrace, No. 3 Cirencester Street, No. 51 Desborough Street, Nos. 4, 8 and 9 Gloucester Mews East, No. 68 All the houses except 4, Desborough Street, and 68, Gloucester Mews East were little better than shells, having been stripped by trespassers. Demolition Orders were made in 1919 with respect to:— Cirencester Street, No. 51 Desborough Street, Nos. 4, 8 and 9 Dartington Terrace, No. 3 An Appeal was made to the Ministry of Health with respect to No. 51, Cirencester Street, which was upheld by the Ministry. The premises have since been made fit for habitation. Although every effort was made to induce the owners to make No. 3, Dartington Terrace habitable, nothing could be achieved and the premises were demolished by the Council in 1920. Underground Rooms.—Section 96 of the Public Health (London) Act, 1891, prescribes the conditions to be fulfilled by such rooms if for habitation, and the Regulations made by the Council in 1914, under Section 17 (7) of the Housing, Town Planning, etc. Act, 1909, the conditions required in rooms used as sleeping places. During the two years 1919 and 1920, no action was taken with respect to these rooms under the Public Health Act, but 18 (1919, 3; 1920, 15) Closing Orders were served under the Housing Act, 4 of the Orders having been determined during 1920 after the rooms had been brought into compliance with the Regulations. One Order (made in 1919) was appealed against, the Appeal being dismissed after a Public Inquiry. When it becomes known that a house with a basement is being converted into flats, a letter is sent to the owner of the house calling attention to the Regulations, copy thereof being sent with the letter. In certain instances steps are taken while the work of conversion is in progress to bring any underground room intended to be used as a bedroom, into conformity with the Regulations. There are many basement rooms in use as bedrooms which are known to be unfit for such use. It is, however, recognised that with the present difficulty of securing house accommodation it is advisable to limit action to the worst of the rooms. A number of basements—other than those dealt with by Closing Orders—have been inspected but action with respect to the failure to comply with the Council's Regulations has been deferred. Housing (Additional Powers) Act, 1919.—Section 6 enacts that after December 3rd, 1919, no house reasonably fit or capable of being made fit for occupation should be demolished or used otherwise than as a dwelling house without the consent of the County Council. The Housing Committee of the Borough called the attention of the County Council to the alterations being made at No. 1 Westbourne Gardens to adapt the premises for the printing trade. The attention of the County Council was also called to the demolition of the dwelling houses Nos. 75-93 (odd) Maida Vale, which the Housing Committee held were capable of being rendered fit for habitation and to the alterations in progress at No. 316, Harrow Road, whereby the upper floors would be diverted from use as a habitation. Under Section 5 the County Council prohibited the erection of a new cinema in the Harrow Road, but the prohibition was not upheld by the Appeal Committee (Ministry of Health) on undertakings being given (a) to build a block of new tenements on certain houses in rear of the site and (b) not to use brickwork for the cinema. At the close of 1920 no work had been put in hand. Tenement Houses.—These are houses registered under Sec. 94 of the Public Health (London) Act, 1891, as houses occupied by members of more than one family. Hitherto these houses have been regulated under Bye-laws made by the Borough Council under the Section mentioned. The new Bye-laws drafted by the County Council under Sec. 26 of the Housing, Town Planning, etc., Act, 1919, will replace those made by the Borough Council, the latter Council being, however, responsible for the administration of the new Bye-laws. 41 HOUSING There are 1404 houses on the Register to which no additions have been made for some 8 years. For the supervision of these houses only one Inspector was available during 1919-20, and the work suffered accordingly. Moreover, that Inspector had to devote no small part of his time to the inspection of houses with a view to action under Sec. 28 of the Housing, Town Planning, etc. Act, 1919 (Repair of Premises)—a work demanding much time owing to the number of visits requisite to complete the inspections and supervise work in progress. During 1919, 3,305 inspections were made and in 1920, 2,536. The extent to which the supervision of these houses decreased during the two years is shown conclusively by the fact that whereas the annual number of inspections averaged 7,120 each year during 1909-13 and 4,140 during 1914-18, the average for 1919-20 was only 2,920. The need for supervision is believed to be greater than it was before the war and the return of work done during 1919-20 (See Table XXV. Appendix) by no means represents the actual needs of repairs. Annual Cleansing.—The cleansing required by Bye-law No. 19 was not carried out in either year on the scale required or desired. The demands on the time of the Staff for other duties made that result inevitable. The returns furnished were so incomplete that they are not worth inclusion in this Report. Overcrowding.—Only 11 cases (8 in 1919 and 3 in 1920) of overcrowding were reported, a total which is almost incredible having regard to the deficiencies in houses and the frequency of reception of sub-tenants (lodgers). Common Lodging Houses.—There are 5 of these houses, all in Kilburn Lane, affording accommodation for 128 men and 37 women. The supervision of the houses rests with the officers of the County Council, the Borough Council's powers being limited to objections to renewal of the licences. At the inspections made immediately before the Licensing Meeting of the Public Health (L.C.C.) Committee, the premises were found to be in good condition and no objections were offered to the renewals. Four cases of infectious disease were notified among the occupants of these houses during 1919-20, viz., one of influenzal pneumonia (f. æt. 58) in 1919 and one of influenzal pneumonia (f. æt. 15) and two of measles (f. æt. 1 and 4) in 1920. In 1919 there were 4 deaths (in the second half-year)—all males, and in 1920,10 (males 7 ; females 3). The deaths in 1919 included 1 from pulmonary tuberculosis and 2 from respiratory diseases. In 1920, one death (f. æt. 1 year) was due to measles and one to respiratory diseases (pneumonia, f. 16 years). The other deaths call for no comment. Inland Revenue Acts.—Three certificates were issued during 1919-20 for remission (or reduction) of the Inhabited House Duty with respect to 139, Portnall Road (3 flats): 33, Randolph Crescent (1 flat): 2. Durham Terrace (2 flats). Increase of Rent and Mortgage Interest (Restrictions) Act, 1920.—Some 75 applications were made to the Medical Officer of Health for advice as to Notices to increase rent received under this Act. The demands made for increased rents of tenement properties were checked and the recipients of the Notices advised as to the steps they should take to protect themselves. The applications for certificates for the purpose of appeals under Sec. 2 (2) of the Act, numbered 21, certificates being issued in 16 instances and refused in 2. Three of the applications were abandoned. Inspections by the Medical Officer of Health were made before the granting or refusal of certificates. L.C.C. Houses.—Applications for help to obtain accommodation on the estates belonging to the County Council were received during 1920 from 26 tenement occupiers in the Borough. Prior to August, nothing could be done save to forward the application to the Housing Manager, but since then preferential selection has been given to applications in respect of which the Medical Officer of Health urged special reasons for preference, e.g. tuberculous patients requiring additional accommodation, ejectment not due to fault or misconduct, etc. of applicant, etc. In 7 instances the applications were not pressed owing to other homes being obtained, etc., 3 families left the Borough before a decision was arrived at by the County Officials, 8 families were given new houses and two others were placed on the waiting list for "pre-war" tenements. Decisions were pending at the end of 1920 with respect to the remaining 6 families. 42 workshops TV.—WORKSHOPS. Registration.—The resumption of more efficient supervision has had a first result in reducing the number of effective entries in the Register at the close of 19'20. That fact 1914 1915 1916 1917 1918 1919 1920 On Register, January 1st 1,421 1,446 1,410 1,436 1,416 1,400 1,479 Removed from Register 138 214 51 75 41 35 174 Added to Register 163 178 77 55 25 114 92 On Register, Dec. 31s 1,446 1,410 1,436 1,416 1,400 1,479 1,397 accounts in part for the relatively large number of removals from the Register during 1920, but doubtless a proportion of those removals represent failures to carry on businesses opened in 1919—114 new "workshops" being opened that year. The "fortune of war" of local business concerns during 1914-20 is sufficiently exemplified by the figures given above. Table XXVI. Appendix, contains an analysis of the numbers of premises where different manufactures or trades were carried on at the end of 1920, the corresponding figures (or 1913— the last "normal" year—being given for comparison. The changes which have taken place in the status of "workshops" within the Borough in the past eight years are further illustrated by the subjoined statement. Three trades show notable increases, viz :—bootmaking, cycle and 1913 1920 Factories (Laundries) 128(32) 168(21) Workshops (Domestic) 942(16) 911(9) Workplaces 36 7 "Single Workers" (Outworkers) 299(256) 302(261) motor repairs—both increased—and laundries—decreased. Another striking feature is the increase in the proportion of "outworkers" from 54 per cent. of all employed in 1913 to 12.8 per cent. in 1920. The more detailed analyses on which Table XXVI. is based show the employees grouped as "women," "young persons" and "men." The figures in each category for 1920 are notably below those for 1913, and they show (see below) a very marked diminution in the number of "young persons'' employed in 1920. 1913 1920 Women 4184(259) 2161(309) Young Persons. 629(55) 158(27) Men 3672(152) 2696(311) It will be observed that the number of "outworkers"—shown in parentheses—included in each category has increased. Out-Workers.—The returns of out-workers employed by local firms show some reduction during the last two years, those from firms outside the Borough an increase—(See below). No. of Lists received from Local Employers— 1914 1915 1916 1917 1918 1919 1920 February 58 56 47 44 39 33 39 August 59 49 45 46 40 39 39 Total for year 117 105 92 90 79 72 78 Local Workers 214 286 180 262 155 145 100 Outlying „ 361 273 374 230 328 240 339 Other Authorities 55 66 69 65 68 63 72 Workers listed 379 359 341 356 372 367 461 No. of Out-Workers on Register, December 31 343 386 394 381 373 675 647 Home Office : Complaints.—During 1919 and 1920, the complaints numbered 50 (21 in 1919, 29 in 1920) as compared with 6 in each of the years 1917 and 1918. The principal complaints referred to among other items,[dirty conditions of workplaces (18), overcrowding (1), insufficient ventilation (2), and lavatory accommodation inadequate, apparatus defective, etc. (18). Home Office: Notification.—There were 89 notifications of new workshops during the two years, as compared with 30 during 1918-19. Of the 89 workshops so reported, 71 had already been entered on the Department's Register. Inspections.—In 1919 the Inspector made 2929 inspections, 296 being of new workshops, and in 1920, 2623 inspections including 123 of new shops. In 1919, 36 workrooms were measured up and in 1920, 19. 43 food supervision Nuisances (or Offences) dealt with.—In 1919, 85 infringements of the Acts were discovered and in 1920, 91—all were remedied within the year of discover}'. As will be seen from the appended statement the majority of the cases requiring action were the result of the war— 1919 1920 Workrooms dirty 33 42 „ overcrowded 3 1 „ insufficiently ventilated 2 5 W.C. apparatus defective 43 37 No separate accommodation 2 3 Insufficient accommodation 2 3 The attention of the Ministry of Health has been specially directed to the need of new powers to regulate the use of basements as workshops. At present nothing can be done until a basement is actually in use as a workshop, after which the only course is to serve notices for nuisances, which it may be possible to abate (at a considerable cost) but more often, not. There is no power at present to prohibit the use of a basement as a workshop or workplace, no matter how unsuitable and unhealthy such basement may be. Certain basements have been opened which were damp, dark and insufficiently ventilated in which the provision of lavatory accommodation was impossible except under very unsatisfactory conditions. Sickness.—Although high prevalences of disease have been reported both in 1919 and 1920, the number of cases on workshop premises was small—26 in 1919 and 10 in 1920. In each year the cases reported among outworkers numbered 5, 2 of the cases being in the families of outworkers. The cases reported were— 1919. 1920. Measles 21 6 Chickenpox 1 1 Whooping Cough — 2 Diphtheria 2 1 Scarlet Fever 1 — Erysipelas 1 — Bakehouses.—During 1919, 6 "level" bakehouses were opened and 2 "underground" re-opened. In 1920, 2 "level" bakehouses were opened. At the end of 1920, there were 68 bakehouses on the Register (64 in 1913), 25 being "level" bakehouses (including 10 factories) and 43 "underground" (19 factories). Of the 64 on the Register at the end of 1913, 16 were "level" and 48 "underground." The inspections made of the factory bakehouses numbered 165 in 1919 and 179 in 1920, the corresponding numbers for the workshop bakehouses being 376 and 414. On the whole the bakehouses are well kept and defects discovered dealt with as soon as pointed out. In 1919 the Council adopted a resolution in favour of legislation requiring the "limewashing" of bakehouses in the months of April and October of each year. V.—FOOD SUPERVISION. Slaughterhouses.—The same five slaughterhouses were in use during 1919-20 as at the end of 1918. The inspections made of these premises, almost exclusively during slaughtering, numbered 510 in 1919, and 320 in 1920. During 1909-13 the inspections averaged 458 per annum and during the following five years, 312. The smaller number of inspections connotes a reduction in the animals slaughtered which fell from an annual average of 4,434 during 1909-13 to 2,893 during 1914-18 but rose to 3,559 during 1919-20. Last year, however, the total was 2,482 as compared with one of 4,636 in 1919. The figures given below show the changes in the class of animals slaughtered during the past two years as compared with the pre-war and war periods. The increase in the number of calves seems to have been a short-sighted policy. Annual 1909-13 Averages. 1914-18 Totals. 1919 1920 Bullocks 85 286 1,071 401 Calves 2 — 296 508 Sheep 4,347 2,607 3,222 1,545 In addition to the animals mentioned 14 pigs were slaughtered in 1918, 41 in 1919 and 12 in 1920, and 6 goats in 1919 and 16 in 1920. The killing of any animals other than bullocks, calves and sheep at the ordinary slaughterhouse was forbidden until towards the end of the war. 44 rats and mice Prior to 1918 the discovery of tuberculosis in animals killed in the local slaughterhouses was (at least for some years) rare. Table 19 (page 40) in the Report for 1914-18 shows this fact. During 1919 and 1920 tuberculosis was unduly prevalent. The following statement for the last three years is unsatisfactory. Bullocks—Parts found Tuberculous. Head and Tongue Liver Lungs Spleen Heart Mesentery Tripe 1918 18 48 5 4 10 4 9 1919 29 34 7 12 9 7 13 1920 19 26 5 7 3 — 3 The sheep were fairly free from disease. Food Shops.—The number of these shops fell from 482 in 1913 to 389 in 1918, but rose to 426 in 1919 and 430 in 1920. The increase was mainly due to the opening of fishmongers' shops and refreshment houses. The inspections of these premises had not returned to the prewar standard before the close of 1920. During 1909-13 the inspections numbered 1,031 per annum falling to 846 during 1914-18 and 883 during 1919-20—762 in 1919 and 1,010 in 1920. In all the figures here quoted, the inspections of foodstuffs sold from street stalls are not included. Food Preparation.—Fish-curing was carried on in 1919-20 at 6 premises, sausages and saveloys manufactured at 7 in 1919 and 8 in 1920. The two margarine factories opened during the war continued operations during the past two years. Only one bacon curing factory remained at the end of 1918 and that was closed down during 1919. Milk Trade.—There was one cowshed (3 cows) in occupation during 1919-20. The premises where milk was sold numbered 100 at the end of 1920, one new dairy having been registered in that year. There were 10 transfers of registration in 1919 and 9 in 1920. The inspections of these premises numbered 171 in 1919 and 250 in 1920. There were no cases of infectious disease on milk vendors' premises during 1919 and 4 (including one of scarlet fever) in 1920. The cases in houses where milk carriers lived (or in their families) numbered 8 in 1919 (including 2 cases each of scarlet fever and diphtheria and 1 of enteric fever) and 19 in 1920 (including 11 of scarlet fever and 6 of diphtheria). Appropriate action was taken forthwith in each instance and no spread of infection through milk was discovered. Ice Cream Trade—This was discontinued during the later years of the war and was not resumed until 1919. At the end of 1920, 71 vendors were on the Register, the inspections of the premises where the trade is carried on, numbering 24 in 1919 and 109 in 1920. One case of scarlet fever occurred among the makers' families during 1919 and one of diphtheria in 1920. There were 7 barrowmen, 3 of whom traded outside the borough. Unsound Food.—The total weight of foodstuffs destroyed as unfit for human consumption during 1919, was 28,336 lbs., of which 2,982 lbs. (10'5 per cent.) were dealt with in transit. In 1920, the total weight destroyed was 20,564 lbs., 5,824 lbs. or 27.9 per cent. being in the course of transit. Having regard to prices, such waste is more than regrettable and ought to be preventable. VI.—RATS AND MICE. In August, 1918, the Ministry of Food and the Local Government Board issued Orders requiring local authorities to take such measures as were deemed requisite for the destruction of rats and to call upon owners to remove rubbish, etc. affording harbourage or food for rats. If any owner neglected to comply with the requirements of the local authority, the authority were given power to enter the lands or premises, make the necessary clearance and recover their expenses from the owner. In January, 1919, the Board of Agriculture and Fisheries called the attention of local authorities to the urgent necessity of more active administration of the Order of 1918 and issued circulars as to the methods of extermination which had been found to be effective. In the following May further circular letters were issued again pressing for greater activity and announcing a "Rat Week" of co-operative destruction for the period of 20 to 27 October. 45 SALE OF FOOD AND DRUGS ACTS Circular letters were issued on 4 October to the railway and canal companies, wharfingers, principal shop keepers and others inviting their co-operation. The Borough Surveyor baited the Council's wharves, sewers, etc., very extensively. In November enquiries were addressed as to the results of the campaign but the replies were not encouraging. The Borough Surveyor reported the disappearance of all baits but no dead rats were found. Certain of the larger firms and traders reported that they employed rat-catchers all the year round. In London the sewers are the abodes of rats, which in most instances gain access to the houses through defective drains or sewer connexions. Special instructions were issued to the Staff in July 1919 for dealing with complaints of rat infestation from householders. During that year 36 complaints were received and dealt with by examinations from the sewers of the house connexions, testing of house drains and the tracing out and destruction of all rat burrows and runs. In July, 1919, the "Rat Destruction Bill" (No. 86) was introduced in the House of Lords to replace the Order of 1918. The Bill received Royal Assent under the amended title of Rats and Mice (Destruction) Act, 1919" on 23 December following. The Medical Officer of Health was appointed as "the officer" (Rat Officer) under the Act 15 January, 1920. "Rat Weeks" were held on four occasions, viz.: 29 December, 1919 to 5 January, 1920; 23 February to 1 March ; and 1 to 6 November, the procedure already described being again adopted, with, it may be added, practically the same results. During 1920 eighty complaints from householders were dealt with, in nearly every instance, successfully. "Rat Quit" is kept in stock by the Department for issue to ratepayers. VII.—SALE OF FOOD AND DRUGS ACTS. Sampling.—As usual 600 samples were purchased and analysed in each of the two years. Of the samples examined in 1919, 31 (5T per cent.) were found to be adulterated, while of those dealt with in 1920, only 5 (0'8 per cent.) were so reported. During 1909-13, the average percentage of adulterated samples was 10'6, and in the next five years, 9.3. A complete tabulation of samples and the results of analyses is contained in Table XXVII., Appendix. Milk.—As in former years samples of milk figure largely in the returns, such samples constituting 67.3 per cent. of all samples in 1919 and 55T per cent. in 1920. The percentages of adulterated samples were—in 1919, 7.2 and in 1920, 1.2, as compared with averages of 113 per cent. during 1909-13 and 10.2 during 1914-18. Records have been kept during 1920 of the composition of milks constituting normal samples, viz.: those not returned as adulterated but excluding those which were taken without proper precautions. The "normal" samples number 307—out of a total of 331 for the year. The averages of the determinations of the 307 samples were - fat 3.69 per cent., total solids 12 45 per cent. The proportion of fat ranged from a maximum of 4.70 per cent. to a minimum of 2.97, and that of the total solids from 13.84 to 11.43 per cent. The appended statement of the averages for the four quarters of the year shows the lowering of the quality observed in the spring quarter (April-June). Qr. No. of Samples Average Fat Maximum Minimum Average Total Solids Maximum Minimum 1st 83 3.59 468 3.00 12.32 13.20 11.48 2nd 53 3.50 4.15 2.97 12.24 12.92 11.56 3rd 77 3.59 4.60 2.97 12.34 13.28 11.43 4th 94 3.95 4.70 3.20 12.78 13.84 11.72 The 307 samples included 44 taken at the railway station—22 in each of first and last quarters of the year. The average contents of the 44 samples were—fat 3.38 per cent. (Maximum, 4.42; minimum, 2.97) and total solids, 12.08 (Maximum, 13.20 ; minimum, 11.43). The railway samples are taken only when adulteration is suspected. After excluding such samples, the average composition of milk sampled in the retail trade is better than that already stated. All Year Rail Retail All 1st Quarter Rail Retail All 4th Quarter Rail detail Percentages of Fat 3.69 3.38 3.74 3.59 3.49 3.62 3.95 3.27 4.16 Total Solids 12.45 12.08 12.52 12.32 12.24 12.35 12.78 11.92 13.04 This last tabulation shows that the percentage of fat in milk sold by retailers fell from 3.62 in the first quarter to 3.50 and 3.59 in the second and third quarters and rose to 4.16 in the fourth. 46 clerical work Samples of milk are periodically taken on Sundays and on Bank Holidays. Of 154 Sunday samples (1919-20) 8 were found to be adulterated, equal to 5.1 per cent. of those samples, as compared with 59 per cent. during 1914-18. Fifteen samples were taken during the two years on Bank Holidays, only one (6.6 per cent.) being found to be adulterated. During 1914-18 the percentage was 15.9. The total of these "off day" samples for the two years was 169 with 9 adulterated samples, equal to 5.3 per cent. as compared with 4.2 per cent of all other milk samples. Milk in Transit.—Of 79 samples taken at Paddington Station in 1919, 13 were adulterated, equal to 16.5 per cent. and of 45 taken in 1920, 5 (4.4 per cent.) In the two years the 124 samples yielded 18 adulterated, equal to 14.5 per cent. as compared with 29.6 per cent. during 1909-13 and 39.2 per cent. during 1914-18. After excluding "off day'" and transit samples, the remaining 451 samples of milk taken during 1919-20 yielded 6 adulterated samples, or 1.3 per cent. only—a very satisfactory record. Cream Regulations.—During 1919 there was practically no trade in cream. In 1920, 6 samples were taken, 2 of "fresh" cream and 4 of "preserved." The former were found to be free from preservative and of the latter preservative was found in 3 only, 1 to the amount of 0.3 per cent. boric acid, and the other two "a trace only." All the preserved creams bore the statutory label declaring the presence of 0.5 per cent. of preservative. In all the "preserved" creams the milk fat exceeded 35 per cent. No infringements of the Regulations were discovered. VIII.—CLERICAL WORK. Figures relating to certain items of the work of the Clerical Staff are given in Table XXVIII. In most instances the figures (notably those for 1920) show considerable increases on the averages for the period 1914-18, a fact largely attributable to the additional duties which have fallen to the Department since the war in connection with housing, maternity and child welfare, tuberculosis and other branches of Public Health Administration. It is impossible to show in tabular form the work involved in the preparation of reports for Committees, the making of returns to Government Departments, the London County Council and Metropolitan Asylums Board, and the compilation of statistical data, to mention but a few of the many other details of the Staffs activities, consequently the table must be regarded as nothing more than a very incomplete record. IX.—LEGAL PROCEEDINGS. The fines imposed during 1919 amounted to £214 10s. 0d. and the costs to £75 2s. 6d., the corresponding figures for 1920, being £42 5s. 0d. and £44 8s. 0d. The differences in the amounts for the two years are due to the small number of cases (3) of food adulteration in the second year. In "Health Cases" the total fines and costs amounted to £105 6s. 6d. during the two years and in "Food Cases" to £270 19s. 0d. All fines and costs are received by the Council except under the "Notification of Births Acts"—4 cases in 1919 yielding £5 10s. 0d. in fines and £8 3s. 0d. in costs (paid to the Council) and £5 5s. 0d. costs against the Council. The following statement shows how the totals of fines and costs have varied during the last five years. "Health Cases" £ s. d. "Food Cases" £ s. d. 1920 50 14 6 35 18 6 1919 54 12 0 235 0 6 1918 45 8 0 139 15 6 1917 14 4 6 49 0 0 1916 21 17 0 108 12 6 The averages per conviction in "Food Cases" during the last five years have been: 1920 £ s. d. 1919 £ s. d. 1918 £ s. d. 1917 £ s. d. 1916 £ s. d. Fine 7 5 0 6 8 8 4 14 2 1 16 8 3 7 7 Costs 1 14 7 1 7 1 17 10 14 6 1 15 10 The summaries of cases taken before the Court usually appended, are omitted to save space. 47 appendix : vital statistics. APPENDIX. TABLE I. Year. Estimated Population. Births. Deaths at All Ages. Deaths under One Year Registered Locally. Transfers. Nett. Registered Locally. Gross Mortality. Transfers Nett. Registered. Nett. Out. In. Totals Rates. Out. In. Totals Mortality. Number Mortality Totals Mortality 1911 142,513 2,815 57 230 2,977 21.46 2,074 14.55 407 259 1,926 13.51 399 141 387 126 1912 142,362 2,774 50 267 2,991 21.18 1,889 13.27 372 254 1,771 12.44 326 117 295 98 1913 142,229 2,832 55 242 3,019 20.87 2,071 14.33 407 315 1,979 13.68 342 121 305 101 1914 142,087 2,708 49 274 2,933 20.64 1,892 13.31 347 350 1,895 1333 312 115 281 96 1915 131,397 2,506 59 267 2,714 20.65 2,304 17.53 370 352 2,286 17.39 343 137 319 117 1916 T 142,169 2,378 61 372 2,689 18.91 ... ... ... ... ... ... 289 121 253 94 C 130,668 ... ... ... ... ... 1,924 14.72 370 326 1,880 14.38 1917 T 136,561 1,834 77 334 2,091 15.31 ... ... ... ... ... ... 290 ) 158 273 135 C 122,507 ... ... ... ... ... 1,997 16.30 321 374 2,050 16.73 1918 T 131,673 1,798 118 337 2,017 15.31 ... ... ... ... ... ... 266 148 235 116 C 117,517 ... ... ... ... ... 1,999 17.01 345 595 2,249 19.13 1919 T 149,941 2,016 154 454 2,316 15.44 ... ... ... ... ... ... 1213 105 212 91 C 143,938 ... ... ... ... ... 1,499 10.41 310 725 1,914 13.29 1920 T 150,128 3,181 251 483 3,413 22.73 ... ... ... ... ... ... 279 87 266 78 C 149,673 ... ... ... ... ... 1,667 11.13 370 410 1,707 11.40 "T"—Total; " C "—Civil. Area of Borough (stat. acres) Total 1,356.1. Waterways 20.0. Total Population 142,551 Number of inhabited houses 16,686 Average number of persons per house 8.5 Census, 1911. 48 appendix : BIRTHS and deaths. TABLE II. Births and Deaths. Annual Numbers : Averages. Wards. Borough Queen's Road. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate, East. Hyde Park. Births. 1916 2689 309 681 391 402 600 57 66 183 1917 2091 250 487 327 335 458 52 46 136 1918 2017 200 501 298 353 454 55 53 103 1919 2316 274 526 345 384 492 78 64 153 1920 3413 341 770 527 623 761 97 95 199 Annual Averages— 1909-13 3008 385 727 413 465 726 62 59 171 1914-18 2489 290 622 358 397 567 54 58 143 Index Numbers— 1914-18 83 75 85 87 85 78 88 98 83 1919 77 71 72 83 82 67 126 108 89 1920 113 88 106 127 134 105 156 161 116 Deaths: All Ages. 1916 1880 188 372 280 333 416 73 79 139 1917 2050 225 404 322 355 446 86 72 140 1918 2249 244 434 357 406 465 97 96 150 1919 1914 231 362 285 370 348 87 93 138 1920 1707 185 316 256 328 347 78 77 120 Annual Averages— 1909-13 1887 207 382 261 326 447 68 61 135 1914-18 2072 226 404 319 866 452 78 78 149 Index Numbers-— 1914-18 110 109 106 122 112 101 115 128 110 1919 101 111 94 109 113 78 128 152 102 1920 90 89 83 98 100 78 115 126 89 Deaths : Under One Year. 1916 253 28 59 29 40 73 4 6 14 1917 273 29 49 34 55 85 3 4 14 1918 235 14 52 29 43 73 6 4 14 1919 212 26 43 27 51 50 1 5 9 1920 266 19 44 45 56 72 5 12 13 Annual Averages— 1909-13 318 38 63 38 54 102 4 3 16 1914-18 272 28 56 36 47 85 4 3 13 Index Numbers— 1914-18 85 73 88 95 87 83 95 94 86 1919 66 68 68 71 94 49 25 166 56 1920 83 50 69 118 104 70 125 400 81 Infantile Mortality. Annual Averages— 1909-13 106 99 87 92 116 141 68 61 91 1914-18 109 95 89 100 118 150 73 59 93 Index Numbers— 1914-18 103 97 102 109 102 106 107 97 102 1919 86 96 93 84 114 71 19 128 64 1920 73 58 65 92 77 68 75 206 71 For Index Numbers: Annual Average, 1909-13 = 100. 49 appendix : deaths—all causes. TABLE III. Deaths : All Causes. Borough. Age. 0- 15- 20- 25- 35- 45- 55- 65- 75- 85 & Upw'ds All Ages. M ales. Annual Averages 1909-13 289 11 14 50 77 105 134 131 82 19 912 191-418 273 13 17 51 69 121 142 168 98 24 976 1919 205 18 14 44 57 105 153 171 110 21 898 1920 229 13 16 52 59 92 114 134 93 21 823 Females. Annual Averages 1909-13 238 15 16 50 73 104 115 153 150 61 975 1914-18 232 19 24 67 73 109 136 183 182 71 1096 1919 143 15 31 76 78 109 113 210 180 61 1016 1920 186 11 19 54 58 89 96 146 171 54 884 Persons. Annual Averages 1909-13 527 26 30 100 150 209 249 284 232 80 1887 1914-18 505 32 41 118 142 230 278 351 280 95 2072 1919 348 33 45 120 135 214 266 381 290 82 1914 1920 415 24 35 106 117 181 210 280 264 75 1707 Index Numbers. Males. 1914-18 94 118 121 102 89 115 106 128 119 126 107 1919 71 164 100 88 74 100 114 130 134 110 98 1920 79 118 114 104 77 88 85 102 113 110 90 Females. 1914-18 97 127 150 134 100 105 118 120 121 116 112 1919 60 100 194 152 107 105 98 137 120 100 104 1920 78 73 119 104 79 85 83 95 114 88 91 Persons. 1914-18 96 123 137 118 95 110 112 124 121 119 110 1919 66 127 150 120 90 102 107 134 125 102 101 1920 79 92 117 106 78 87 84 99 114 93 90 50 appendix : sickness—cases reported. vaccination returns. TABLE IV. Sickness: Cases Reported. Borough. 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 Smallpox 1* ... ... ... 1* ... ... ... ... ... Diphtheria 163 244 293 286 266 207 227 254 254 461 Membranous Croup 5 4 3 3 7 2 2 4 4 3 Erysipelas 117 117 112 141 137 104 66 56 76 81 Fevers. Scarlet 226 272 484 738 436 272 124 150 261 501 Enteric 37 15 25 10 18 23 12 13 10 19 Continued 1 ... ... 2 1 ... ... ... ... ... Puerperal 7 11 8 10 7 8 7 2 15 15 Cerebro-spinal 2(a) 7 ... 2 10 9 7 3 7 1 Posterior Basic Meningitis ...(a) ... ... ... 4 ... ... ... ... ... Acute Poliomyelitis 1(a) 6 2 3 1 4 1 ... 5 2 Ophthalmia Neonatorum 21(a) 31 22 51 31 20 27 22 30 29 Dysentery 3(a) 1 Encephalitis Lethargica 3(a) 2 Malaria 64(a) 24 Pneumonia, Influenzal 87(a) 45 Pneumonia, Primary 83(a) 96 Trench Fever 1(a) ... Tuberculosis—Total 397 835 664 545 590 526 502 451 391 383 Pulmonary 397(d) 835 492(e) 397 426 388 355 325 284 277 Other Forms 172(a) 148 164 138 147 126 107 106 Measlest—Total 1429 1398 1240 424 3721 746 4245 1519 1890 2034 Reported 1429 1398 1240 111 801 200 1544 515 632 607 Notified 313(a) 2920 546 2701 1004 1258 1427 Chickenpox—Total 494 459 599 555 644 468 406 813 261 568 Reported 494 459 399 555 560 468 406 606 261 568 Notified 84(b) 207(b) Whooping Cough} 632 377 644 558 365 540 325 691 160 357 Mumps † 223 341 203 247 167 180 200 680 150 154 Ringworm ‡ 165 267 148 196 125 152 117 111 189 204 * Error. † Measles (morbilli) and German Measles (rubeola). ‡ Reported, i.e., not notified. (a) First year of notification, (b) Notified during part of year only, (c) Notification limited to Poor Law cases. (d) Extended to Hospital Patients. (e) Universal. TABLE V. Vaccination Returns. Children Born. Successfully Vaccinated. Insusceptible to Vaccination. Died Unvaccinated. Per cent, of Children Born (Cols. 1-4) Vaccination Postponed. Exempted under Act. " Rest." Per cent, of Children Born (Cols. 6-8) Cols. 1 2 3 4 5 6 7 8 9 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 2,808 1,990 5 185 77.6 34 388 206 22.4 1913 2,794 1,903 3 197 75.2 40 445 206 24.8 1914 2,715 1,744 11 182 71.3 30 551 197 28.7 1915 2,516 1.683 4 163 73.5 43 422 201 26.5 1916 2,388 1,555 9 164 72.3 36 444 180 27.7 1917 1,843 1,152 7 137 70.3 38 354 156 29.7 1918 1,808 1,126 5 143 70.5 41 308 185 29.5 1919 2,025 1,245 7 153 69.4 33 413 174 30.6 51 appendix : notifications. TABLE VI. Notifications: Quarterly and Annual Averages. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. 1914-18 1919 1920 1914 18 1919 1920 1914-18 1919 1920 1914-18 1919 1920 1914-18 1919 1920 1914-18 1919 1920 1914-18 1919 1920 1914-18 1919 1920 Diphtheria 1 9 5 62 14 13 32 10 10 9 11 8 23 16 15 18 1 ... 3 1 ... 4 3 2 6 2 7 4 25 16 10 24 9 5 8 8 6 16 15 12 16 2 1 8 1 4 3 7 4 2 3 7 3 16 14 16 10 10 17 6 7 8 19 15 9 10 0 I 8 1 3 3 3 3 ... 4 9 10 27 15 15 28 9 14 22 9 22 39 16 25 29 2 9 4 2 9 6 3 4 4 Totals 32 22 130 58 54 94 38 46 45 34 44 97 62 51 73 5 11 23 6 16 16 16 13 12 Sc arlet Fev er. 1 16 12 20 21 14 31 15 3 8 10 1 7 20 3 9 3 ... 2 2 3 2 2 8 2 9 8 9 16 11 14 10 8 11 8 2 8 16 11 13 3 ... 1 2 1 5 4 1 1 3 16 5 27 18 8 35 7 14 12 11 14 15 16 8 21 1 ... ... 2 ... 2 2 2 4 4 20 23 60 29 46 82 11 19 26 23 17 23 18 18 24 2 4 3 8 3 5 8 3 12 Totals 61 48 116 84 79 162 43 44 57 53 34 53 70 40 67 9 4 6 8 4 15 16 8 25 .52 appendix:sickness. TABLE VII. Notifications. Sickness: Removals. Deaths. "Errors" indicated thus ( ). nil return. "0" average less than unity. Diphtheria (including Membranous Croup. Scarlet Fever. Enteric Fever. Averages. Averages. Averages. 1919 1920 1909-13 1914-18 1919 1920 1909-13 1914-18 1919 1920 1909-13 1914-18 Cases Reported. Queen's Park 31 (4) 32 (2) 22 (1) 128 (6) 51 (3) 61 (5) 48 (1) 116 (2) 2 (0) 1 (-) 1 (-) 1 (1) Harrow Road 45 (5) 58 (4) 56 (5) 87 (7) 97 (7) 84 (5) 79 (4) 162 (7) 5 (2) 2 (-) 1 (-) 2 (1) Maida Vale 22 (2) 39 (3) 46 (1) 42 (3) 40 (5) 43 (4) 44 (6) 57 (1) 5 (1) 3 (1) 2 (-) 2 (1) Westbourne 37 (41 84 (4) 44 (5) 94 (5) 55 (3) 53 (4) 34 (-) 53 (4) 3 (1) 2 (1) 1 (-) 2 (1) Church 42 (5) 62 (6) 51 (-? 61 (7) 89 (8) 70 (6) 40 (1) 67 (6) 8 (2) 4 (1) - (-) 1 (-) Lancaster Gate West 8 (1) 5 (-) 11 (-) 23 (1) 11 ) 9 (-) 4 (-) 6 (-) 2 (0) 1 (-) 2 (1) 2 (-) East 7 (0) 6 (-) 16 (-) 16 (1) 9 (1) 8 (-) 4 (-) 15 (-) 2 (0) 1 (-) 2 (1) 5 (-) Hyde Park 9 (0) 16 (1) 13 (-) 13 (1) 22 (1) 16 (1) 8 (-) 25 (1) 3 (0) 2 (-) 1 (-) 4 (-) Borough 201(22) 252(20) 259(12) 464(31) 374(28) 344(25) 261(12) 501(21) 29 (6) 15 (5) 10 (2) 19 (4) Cases Removed to Hospital. Queen's Park 28 (4) 31 (2) 18 (1) 112 (6) 48 (3) 59 (5) 44 (1) 109 (2) 2 (0) 1 (-) 1 (-) 1 (1) Harrow Road 43 (5) 54 (4) 52 (4) 75 (7) 93 (6) 81 (4) 69 (4) 152 (6) 3 (1) 1 (-) 1 (-) 2 (1) Maida Vale 22 (2) 36 (3) 40 (-) 29 (3) 37 (5) 39 (3) 43 (6) 54 (1) 4 (1) 2 (1) 2 (2) 2 (1) Westbourne 36 (4) 32 (4) 38 (5) 88 (4) 52 (2) 52 (4) 33 (-) 50 (4) 3 (1) 2 (-) - (-) 2 (1) Church 41 (5) 61 (6) 38 (1) 57 (7) 87 (8) 69 (6) 37 (1) 65 (6) 7 (2) 3 (1) - (-) 1 (-) Lancaster Gate West 6 (1) 5 (-) 10 (-) 22 (1) 11 (-) 9 (-) 2 (-) 5 (-) 1 (0) 1 (-) 2 (1) 2 (-) East 5 (0) 5 (-) 15 (-) 15 (1) 8 (1) 7 (-) 3 (-) 14 (-) 1 (0) 1 (-) 2 (1) 4 (-) Hyde Park 8 (0) 15 (1) 12 (-) 10 (1) 21 (1) 14 (1) 6 (-) 24 (1) 3 (0) 1 (-) 1 (-) 2 (-) Borough 188(22) 240(20) 223(11) 408(30) 357(26) 330(24) 237(12) 473(20) 24 (5) 12 (2) 9 (2) 16(14) Deaths at Home. Queen's Park 0 0 ... 2 ... 0 1 ... ... ... ... Harrow Road ... 1 ... 1 ... ... ... ... ••• 0 ... ... Maida Vale 0 ... ... ... ... ... ... ... ... ... ... ... Westbourne 0 1 ... ... ... ... ... ... ••• 0 ... ... Church ... 0 1 ... ... ... ... ... ... 0 ... ... Lancaster Gate ... ... ... ... ... ... ... ... ... ... West ... ... ... ... ... ... ... ... ... ••• ... ... East ... ... 1 1 ... ... ... ... ... 0 ... ... Hyde Park ... ... ... ... ... ... ... ... ... ... ... ... Borough 1 (-) 2 (-) 2 (-) 4 ... 0 1 ... 1 (0) 1 (0) ... ... Deaths in Hospital. Queen's Park 1 2 3 9 1 0 1 1 0 ... ... 1 (1) Harrow Road 1 4 3 6 1 1 ... 1 0 ... ... ... Maida Vale 1 1 3 (1) 1 0 1 (1) ... 0 ... ... Westbourne 2 I 3 4 1 1 1 ... 0 ... ... ... Church 4 4 1 4 (2) 3 1 1 ... 0 0 ... ... Lancaster Gate West 0 ... ... 1 ... ... ... ... ... East 0 0 1 1 ... 0 ... ... .... ... ... ... Hyde Park 1 1 ... ... ... 1 ... ... ... 0 ... ... Borough 11 (2) 14 (0) 14 (1) 25 (2) 7 (1) 4 (-) 4 (1) 2 31 (1) 1 (0) ... 1 (1) 53 appendix: deaths of residents in the borough, 1919. TABLE VIII. Deaths of Residents of the Borough, 1919. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Deaths at Ages. In Public Institutions. 0— 1— 2— 5 — 15— 25— 45— 65— P. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. 1 m f. m. f. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 11 5 6 ... ... ... 2 2 1 ... 3 ... ... ... ... ... ... ... ... 1 1 Scarlet Fever 5 3 2 ... ... ... ... 2 ... 1 1 ... 1 ... ... ... ... ... ... 2 2 Whooping Cough 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Diphtheria, Membranous Croup 17 0 11 ... ... ... ... 1 7 3 3 ... ... ... 1 ... ... ... ... 3 10 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 164 70 94 ... ... 1 1 2 1 1 11 12 14 43 25 20 16 15 16 26 Erysipelas 5 5 1 ... ... ... ... ... ... ... ... 1 ... 2 ... 1 4 Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 9 6 3 ... ... ... ... ... ... ... ... 1 ... 2 2 3 1 ... ... 2 2 Pulmonary Tuberculosis A. Phthisis 105 52 53 ... ... ... ... ... ... 2 ... 9 9 18 26 21 15 2 3 27 21 Tub. Meningitis, A. Hydrocephalus 10 4 6 1 ... 1 1 3 1 2 ... 1 ... ... ... ... ... ... 2 6 Other Forms of Tuberculosis 18 12 6 1 1 1 1 3 1 2 ... 3 1 2 2 ... ... 9 6 Syphilis 7 3 4 2 4 ... ... ... ... ... ... ... ... 1 ... 2 4 Cancer 170 71 99 ... ... ... ... ... ... ... ... 2 5 6 32 41 34 50 34 34 Rheumatic Fever 5 2 3 ... ... ... ... ... ... 1 ... ... 2 ... 1 ... ... ... ... 1 ... Alcoholism 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Inflammation and Softening of Brain 5 4 1 ... ... ... ... 1 ... ... ... ... ... ... 1 3 ... ... ... 2 1 Cerebro spinal Fever 8 4 4 1 3 ... 1 1 1 ... ... ... ... ... 1 ... ... ... 4 4 Simple Meningitis 1 1 ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Hæmorrhage 65 25 40 ... ... ... ... ... ... 1 ... ... ... ... ... 8 12 16 28 11 10 Apoplexy 8 1 7 ... . . . ... ... ... ... ... ... ... ... ... 1 3 ... 4 ... 2 Convulsions 6 3 3 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Endocarditis 4 2 2 ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 ... 1 1 2 Heart Disease 223 87 136 ... ... ... ... ... ... ... 1 ... ... 8 9 35 34 44 92 26 40 Bronchitis 189 81 108 6 9 2 1 1 1 1 2 ... ... 5 3 18 22 48 70 33 24 Lobular (Bronchopneumonia 76 41 35 15 2 4 4 8 4 2 ... ... ... 4 1 4 10 4 14 13 15 Lobar (Croupous) Pneumonia 26 14 12 ... 2 ... ... ... ... ... ... 1 2 9 4 4 3 ... 1 6 3 Pneumonia 70 34 36 4 1 ... 1 1 1 1 ... 1 2 7 10 10 10 10 11 16 11 Other Diseases of Respiratory Organs 33 17 16 ... 2 ... ... ... 1 2 1 ... ... 4 3 5 2 6 7 6 5 Diseases of Stomach 17 7 10 ... ... ... ... ... ... ... ... ... ... 2 4 2 2 3 4 3 5 Diarrhœa and Enteritis 60 33 27 27 18 2 3 1 ... ... ... ... ... ... ... 1 1 2 5 25 12 Appendicitis 8 5 3 ... ... ... ... ... ... ... 1 2 1 ... ... 2 ... 1 1 3 2 Obstruction of Intestines 13 4 9 ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... 4 2 2 2 8 Cirrhosis of Liver 6 3 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 2 1 Nephritis and Bright's Disease 41 21 20 ... ... ... 1 1 ... ... ... ... 1 2 4 9 8 9 6 9 8 Tumours (N.-M.), &c., Female Genital Organs 6 ... 6 ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... 3 ... 5 Puerperal Fever 5 5 ... ... ... ... ... ... ... ... ... 2 ... 3 ... ... ... ... ... 4 Accidents and Diseases of Parturition 4 ... 4 ... ... ... ... ... ... ... ... ... 1 ... 8 ... ... ... ... ... 3 Congenital Defects 17 11 6 10 6 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 2 Premature Birth 48 29 19 29 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 8 Developmental Diseases 29 20 9 20 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 4 Old Age 123 42 81 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 41 81 26 41 Suicide 18 11 7 ... ... ... . . . ... ... ... 2 2 3 7 2 2 ... 2 ... Overlaid in Bed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 53 33 20 3 1 4 '2 5 1 2 1 3 5 9 4 7 6 13 9 Homicide 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Ill-defined Causes 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 All other Causes 220 124 96 4 3 ... ... 3 3 2 2 1 3 11 18 51 22 52 45 50 31 All Causes 1914 898 1016 129 83 18 15 28 25 30 20 32 46 101 154 258 222 30!} 451 384 373 Uncertified 3 2 1 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 54 appendix: deaths of residents op the borough, 1920. TABLE VIIIa. Deaths of Residents of the Borough, 1920. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Deaths at Ages. In Public Institutions. 0— 1— 2— 5— 15— 25— 45— 65— p. m. F. M. f. M. f. M. f. m. f. m. F. m. F. M. f. m. F. m. f. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Smallpox. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 25 14 11 4 4 5 5 4 1 1 1 ... ... ... ... ... ... ... ... 12 6 Scarlet Fever 3 3 ... • •• ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 3 Whooping Cough 14 6 8 1 5 4 3 ... ... 1 ... ... ... ... ... ... ... ... 4 3 Diphtheria, Membranous Croup 25 9 16 1 1 1 3 8 4 6 .... ... ... 1 ... ... ... ... 7 15 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 28 13 15 ... ... ... ... ... ... 1 ... 4 8 8 3 5 4 2 6 Erysipelas 3 2 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 2 1 Other Epidemic Diseases ... ... • •• ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 8 3 5 ... 1 ... ... ... ... ... 1 2 1 1 1 1 3 3 Pulmonary Tuberculosis A. Phthisis 120 64 56 ... ... ... ... ... 1 2 2 4 11 30 29 26 8 2 5 37 29 Tub. Meningitis, A. Hydrocephalus 13 8 5 2 ... 1 1 ... 2 1 1 2 ... 1 1 1 3 3 Other Forms of Tuber culosis 13 6 7 ... 1 ... ... 1 3 2 ... l 2 ... 1 1 1 4 5 Syphilis 9 7 2 6 2 ... ... ... ... 1 ... ... ... ... ... 6 2 Cancer 194 82 112 ... ... ... ... ... ... ... ... 7 11 45 54 30 47 48 55 Rheumatic Fever 9 5 4 ... ... ... ... 2 2 1 ... 2 1 ... ... ... 1 3 2 Alcoholism 4 2 2 ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... Inflammation and Softening of Brain 4 2 2 ... ... ... ... ... ... ... 2 1 ... 1 2 2 Cerebro-Spinal Fever 3 1 2 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 Simple Meningitis 7 5 2 2 1 .... 1 1 ... ... ... 2 ... ... ... ... 3 Cerebral Haemorrhage 67 29 38 ... ... ... ... ... ... ... l ... ... 13 8 16 29 4 13 Apoplexy. 5 5 ... ... ... ... ... ... ... ... ... 1 ... 4 ... ... Convulsions 4 1 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Endocaditis 3 l 2 ... ... 2 ... ... ... ... 1 ... ... ... ... 1 Heart Disease 207 88 119 ... ... ... ... 3 2 4 3 16 11 20 33 45 70 35 46 Bronchitis 145 66 79 7 10 1 1 1 1 ... ... ... 2 1 15 5 40 61 14 26 Lobular (Broncho-)Pneumonia 66 36 30 20 8 3 5 2 3 3 1 ... ... 1 1 2 4 5 8 15 8 Lobar (Croupous) Pneumonia 16 10 6 ... ... ... ... ... ... ... 1 3 1 2 2 3 1 2 1 5 4 Pneumonia 38 23 15 1 2 1 ... 2 1 ... 6 1 5 5 8 6 5 2 Other Diseases of Respiratory Organs 19 14 5 2 1 ... ... ... ... ... ... 2 ... 3 ... 4 1 3 3 6 ... Diseases of Stomach 9 4 5 ... ... ... ... 1 1 ... 3 3 ... 1 3 1 Diarrhoea and Enteritis 58 34 14 30 18 ... ... 3 ... ... ... 1 1 1 ... 2 23 19 Appendicitis 9 4 5 ... ... ... ... 1 2 ... 1 ... 2 1 ... 2 ... 2 4 Obstruction of Intestines 22 12 10 ... 1 ... 1 1 ... 1 3 ... 1 4 5 5 8 6 Cirrhosis of Liver 6 3 3 ... ... ... ... ... ... ... ... 1 ... 1 2 1 1 1 1 Nephritis and Bright's Disease 46 22 24 ... ... ... ... ... ... 1 1 ... 1 3 4 6 8 12 10 3 5 Tumours (N.M.), &c. Female Genital Organ s 3 3 ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... 2 Puerperal Fever 5 ... 5 ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... 3 Accidents and Diseases of Parturition 11 11 ... ... ... ... ... ... 2 9 ... ... ... ... ... 9 Congenital Defects 15 12 3 11 3 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 3 Premature Birth 64 30 34 30 34 ... ... ... ... ... ... ... ... ... ... ... ... ... 9 10 Developmental Diseases 40 26 14 26 13 ... ... ... ... ... ... ... ... ... ... ... ... 8 5 Old Age 88 23 65 ... ... ... ... ... ... ... 1 ... ... ... 22 65 7 24 Suicide 16 9 7 ... ... ... ... ... ... ... ... ... 1 2 7 5 1 ... 1 ... Overlaid in Bed 3 1 2 1 2 ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 55 38 17 3 3 1 1 3 1 8 3 2 4 1 11 2 5 7 18 9 Homicide 4 ,,, 4 ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... 3 Execution ... ... ... ... ... ... v.. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All other Causes 201 108 93 3 3 ... ... 3 2 6 3 4 2 16 14 33 30 43 39 53 40 All Causes 1707 823 884 152 114 19 21 20 23 38 28 29 30 111 112 206 185 248 371 358 380 Uncertified 4 2 2 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 55 appendix : deaths—persons, all ages. Table VIII Deaths: Persons. All Ages. Index Numbers. Causes of Death. Index Numbers. Causes of Death. Index Numbers. Averages 1909-13. Averages 1914-18. Averages 1909-13. Averages 1914-18. 1919 1920 1919 1920 1919 1920 1919 . 1920 Enteric Fever Bronchitis 104 80 115 89 Measles 22 50 21 47 Pneumonia, Lobular 136 118 105 92 Scarlet Fever 71 43 100 60 „ Lobar 118 73 96 59 Whooping Cough 2 40 3 47 „ Undefined 108 58 103 56 Diphtheria 170 250 106 156 Other diseases of Respiratory Organs 143 83 157 90 Fpid. Influenza 443 76 161 27 Diseases of Stomach 142 75 142 75 Erysipelas 1?5 75 _ 100 60 Diarrhoea and Enteritis 72 70 87 84 Other Septic Diseases 100 100 160 160 Appendicitis 61 70 89 100 Tuberculosis, Pulmonary 73 83 64 73 Obstruction of Intestines 100 170 81 137 „ Meningeal 62 81 55 72 Cirrhosis of Liver 40 40 32 32 „ Other Forms 69 50 75 54 Nephritis, Bright's Disease 63 72 77 87 Syphilis 64 82 47 60 Congenital Defects 89 79 89 79 Cancer 100 114 86 98 Premature Birth 86 114 109 145 Rheumatic Fever 71 128 167 300 Developmental Diseases f-0 69 78 108 Alcoholism 18 36 28 57 Old Age 120 85 113 81 Cerebral Haemorrhage 125 129 110 114 Suicide 112 100 120 107 Apoplexy 53 33 73 45 Overlaid in Bed — 60 — 150 Convulsions 66 44 150 100 Accidents and Violence 106 110 70 71 Heart Diseases 137 126 91 84 Homicide 50 200 50 200 Note—The annual averages for 1909-13 and 1914-18 will be found in Table 4 of the Report for the years 1914-18.—page 4. 56 appendix : tuberculosis—notifications. TABLE IX. Tuberculosis—Notifications. Total Certificates received 1916 1917 1918 1919 1920 1302 1171 1001 942 889 Certificates forwarded 136 139 117 132 67 New cases certified 526 502 451 391 383 Including Inward Transfers 9 5 3 6 5 No. of Certificates received from— Private Practitioners 395 (29) 189 (34) 125 (18) 119 (16) 129 (15) District Medical Officers 47 (16) 33 (14) 31 (13) 9 (2) 13 (3) M.S.Poor Law Institutions 328(241) 228(141) 182(112) 43 (29) 119 (75) Paddington Tuberculosis Dispensary 183 (77) 148 (78) 125 (47) 131 (52) 132 (59) St. Mary's Hospital Dispensary 60 (27) 70 (29) 52 (19) 119 (52) 109 (50) Sanatoria 170(157) 182(159) 150(134) 218(200) 171(157) Local Hospitals 35 (9) 21 (1) 30 (5) 17 (1) 30 (8) Outlying Hospitals 114 (72) 106 (55) 125 (62) 98 (47) 96 (67) Other Institutions 5 (3) 2 (-) 5 (-) 5 (1) 5 (-) School Medical Officers 20 (9) 32 (15) 43 (17) 36 (13) 12 (5) Other Medical Services 11 (4) 13 (6) 9 (6) 1 (-) The figures in ( ) represent "repeat" notifications. 57 APPENDIX : TUBERCULOSIS. TABLE X. Tuberculosis. (See Table IV., ante, for history of notification.) Total cases reported. Known to have died from all causes during the year. Reported " Arrested." Diagnosis varied. Removed. Restored to Register. On Register l at end of \ 1920 "Survivors," Definite. Suspect Year. Definite. Suspect. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 P. O.F. 1903 4 - - - - - - - - - - - - - - - - - - - - - - - - - 1904 20 5 1 1 1 1 - - - - - - - - - - - 1 _ 10 — — — — 1905 18 10 3 1 1 - - - - - - - - - - — — 3 — — — — — 1906 57 — 17 5 7 1 1 1 1 - 1 - - 1 — — — 1 2 17 — 2 — — 1907 84 14 12 6 1 1 - - - 1 - - - - 5 8 34 — 2 — 1908 173 — 25 11 7 .4 5 1 2 3 2 - - — — 13 34 61 — 5 — — 1909 343 286 65 25 12 8 2 1 2 1 2 9 2 1 61 58 327 10 54 19 1910 341 269 42 34 15 5 4 2 3 1 1 1 - 66 55 312 6 56 2 17 1911 397 274 69 25 18 8 6 3 2 3 — — 63 70 319 9 69 1 24 1912 778 239 76 45 28 14 6 7 3 2 3 128 103 452 11 125 2 34 1913 812 203 105 55 24 15 8 11 5 3 98 126 406 2 104 39 18 1914 531 157 85 46 14 9 8 2 1 54 73 256 4 76 54 14 1915 582 129 105 41 23 7 4 2 15 96 224 12 105 68 33 1916 526 149 106 43 14 2 4 18 22 172 6 112 63 125 1917 502 159 119 32 13 8 13 95 167 1 99 63 53 1918 451 150 102 39 7 8 80 104 126 69 66 1919 388 130 53 32 13 55 81 143 76 65 1920 378 117 75 2 43 33 189 86 67 " P."=pulmonary. "o.P."=non-pulmonary. 58 APPENDIX: TUBERCULOSIS CASKS—ALL FORMS. TABLE XI. Tuberculosis—Cases: All Forms. Queen's Park. Harrow Road. Maida Vale Westbourne. Church Lancaster Gate. Hyde Park. Bor'gh Not allocated. West. East. Males. 1914 39 58 45 47 72 6 4 15 286 9 1915 41 70 41 56 63 3 2 18 294 12 1916 21 46 27 75 77 7 6 11 270 13 1917 36 56 48 55 73 5 5 13 291 10 1918 27 58 33 34 56 1 8 10 227 7 Averages, 1914-18 33 58 39 53 69 4 5 13 274 10 1919 27 33 35 43 44 5 6 13 205 3 1920 22 33 21 37 53 3 7 12 188 3 Index Numbers 1919 82 57 90 81 64 125 100 100 75 30 1920 67 57 54 70 77 75 140 92 69 30 Females. 1914 25 50 34 40 70 7 7 9 242 8 1915 34 51 51 50 65 4 9 12 276 8 1916 26 51 26 48 67 2 4 18 242 1 1917 26 39 22 43 51 5 7 5 198 3 1918 21 25 27 60 57 4 7 18 214 8 Averages, 1914-18 36 43 32 49 62 4 7 11 234 5 1919 15 34 85 39 39 9 4 7 182 1 1920 15 28 21 63 39 7 8 9 190 2 Index Numbers 1919 57 79 109 79 63 225 57 64 78 20 1920 57 65 66 128 68 175 114 82 81 40 Persons. 1914 64 108 79 87 142 13 11 24 528 17 1915 75 121 92 106 128 7 11 30 570 20 1916 47 97 53 123 144 9 10 29 512 14 1917 62 95 70 98 124 10 12 18 489 18 1918 48 88 60 94 113 5 15 28 441 10 Averages, 1914-18 59 101 71 102 181 8 12 24 508 15 1919 42 67 70 82 83 14 9 20 387 4 1920 37 61 42 100 92 10 15 21 378 5 Index Numbers 1919 71 66 98 80 63 175 75 83 76 27 1920 63 60 59 98 70 125 125 87 74 33 59 appendix: TUBERCULOSIS—NEW CASES. TABLE XII. Tuberculosis—New Cases. Males. Females. 0- 5- 15- 45- 65- 0- 5- 15- 45- 65- Definite Pulmonary. Annual Averages— 1914-18 8 34 114 43 7 6 28 108 25 5 1919-20 2 16 93 31 2 3 10 100 17 6 Reported— 1919 3 17 99 30 4 1 14 91 19 6 1920 — 15 87 32 1 5 5 109 16 7 Other Forms. Annual Averages— 1914-18 24 37 14 2 0 19 29 27 2 0 1920-21 10 29 13 2 0 7 24 18 2 — Reported— 1919 8 33 11 3 - 11 27 12 2 - 1920 12 26 15 2 1 4 22 22 2 — Suspect. All Forms. Annual Averages— 1914-18 9 33 14 2 0 9 38 38 4 0 1919-20 9 26 24 2 — 7 21 29 4 0 Reported— 1919 11 30 24 3 10 15 31 5 1 1920 8 23 23 1 - 5 28 26 3 —■ TABLE XIII. Tuberculosis.—Residential Treatment. Insured Persons Uninsured Persons 1919 1920 1919 1920 Total Applications 138 171 50 57 „ „ from Men 104 127 7 9 „ „ from Women 34 44 26 34 „ „ from Children — — 17 14 Applications abandoned 7 6 12 8 Applicants unsuitable — 5 — — Application not completed on removal 3 — — — „ „ on death 4 11 1 4 Applications granted 121 145 34 44 „ „ but carried over 3 7 3 1 Treatment provided— Hospital 44 70 8 9 Sanatorium 69 51 26 35 Domiciliary 8 24 (Not provided under Scheme.) Died while under treatment in institutions 5 7 — 4 „ „ at home 1 — In addition treatment was provided for 18 ex-Service men, 7 in hospital and 11 in sanatoria. 60 APPENDIX: TUBERCULOSIS. TABLE XIV. Tuberculosis: Annual Averages. New Cases. Deaths. Pulmonary. Other Forms. Pulmonary. Other Forms. 1914-18 1919-20 1914-18 1919-20 1914-18 1919-20 1914-18 1919-20 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Indoor Domestic Duties Housewives - 54 - 54 - 5 - 5 - 35 - 32 - 2 - 2 „ and other occupation - 5 - 2 - 1 - - - 0 - - - - - - Servants 2 20 1 10 - 5 - 5 1 8 - 6 - 0 - 0 Charwomen - 4 - 3 - 0 - - - 1 - - - - - - Laundry Workers - 1 0 - - 0 - - - 0 - - - 0 - - Clerks 16 5 14 13 2 0 3 1 10 1 5 4 0 - 1 - Shop Assistants, Keepers 12 3 3 4 1 0 1 1 5 2 2 - 0 0 1 - Dressmakers, Tailors 4 10 3 9 0 1 - 3 1 5 1 2 0 0 - - Bootmakers 3 0 3 - - - 0 - 2 - 0 - - - - - Skilled Artizans 12 0 14 1 1 - 0 - 9 - 4 - 0 - 0 - Waitresses, Barmen, etc. 3 2 2 4 1 0 0 - 2 1 0 2 - - - - Others 6 6 8 5 1 1 - 2 5 3 6 2 1 0 1 1 Totals 58 111 49 106 6 15 6 17 36 56 21 48 3 3 4 3 Outdoor. Building Trades 7 0 3 - 0 - - - 4 - 2 - - - - - Painters 2 - 2 - - - 0 - 3 - 1 - - - - - Labourers 1 - 0 - - - - - 3 - 4 - - - - - Road Traffic 12 0 7 - 1 0 2 - 9 0 4 - 0 - 0 - Railway Traffic 4 0 5 - 1 0 - - 3 - 3 - 0 - - - Postmen 1 - 1 - - - - - 1 - 1 - - - - - Gardeners 1 - 1 - - - - - 0 - - - 0 - - - Street Merchants 1 - 1 - 0 0 - - 0 - 0 - - - 0 - Others 3 - - - - - - - 1 - 0 - - - - - Totals 82 1 21 - 3 0 2 - 24 0 17 - 1 - 1 - Food Trades. Bakers 2 0 0 - 0 - - - 1 - 0 - - - - - Butchers, Fishmongers 1 - 0 - - - - - 1 - 0 - - - - - Dairymen 1 - 0 - 0 - - - 1 - - - - - - - Others 2 2 - 0 — 0 - 2 0 1 - 0 - - - Totals 6 0 4 - 1 - 0 - 5 0 2 - 0 - - - Miscellaneous. School Life 32 25 16 10 29 21 26 22 2 3 1 *1 3 4 4 3 Unskilled Workers 9 0 6 0 1 - 1 - 8 0 1 - 0 - - - Professional Workers 3 2 1 2 1 - - - 2 0 1 - - - 0 - Other „ 29 2 23 0 4 3 2 - 5 - 1 - - - - - Commercial Travellers, etc. - - - 0 - -- - - - - - - 0 0 - - Totals 73 30 46 13 35 24 30 22 17 3 5 1 4 4 5 3 Infants 8 6 2 3 26 21 9 8 3 3 - 0 14 10 4 2 No occupation, or occupation not stated 29 24 22 14 6 7 7 4 8 9 13 4 1 1 1 3 Grand Totals 206 172 144 136 77 67 55 51 93 72 58 54 24 18 15 12 "0"=average less than unity. "-"=nil return. 61 APPENDIX: TUBERCULOSIS—DEATHS. TABLE XV. Tuberculosis: Deaths. Sex—Age Distribution. Pulmonary Tuberculosis. Tuberculosis of Meninges. Other Forms of Tuberculosis. 0- 5- 15- 45- 65- 0- 5- 15- 45- 0- 5- 15- 45- 65- 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. Annual Averages. 1909-13 2 1 1 1 49 39 27 16 6 3 6 5 2 1 0 1 - - 7 5 2 2 3 2 2 1 - 1 1914-18 3 2 3 4 50 46 34 16 3 4 6 4 2 3 0 1 - - 7 4 2 1 4 2 1 2 1 0 1919-20 - 0 2 1 31 38 23 11 2 4 3 3 1 1 1 1 0 - 1 2 3 1 3 1 1 1 - 0 Recorded. 1919 - - 2 - 27 35 21 15 2 3 3 3 1 2 - 1 - - 2 2 3 1 5 1 2 2 - - 1920 - 1 2 2 34 40 26 8 2 5 3 3 1 1 3 1 1 - - 2 3 2 2 1 1 1 - 1 TABLE XVI. Tuberculosis: Deaths. Ward Distribution. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church Lancaster Gate. Hyde Park. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church Lancaster Gate. Hyde Park. West. East. West. East. Annual Averages. 1909-18 19 32 19 28 33 3 2 9 6 9 6 6 13 0 0 2 1914-18 23 36 21 29 41 4 2 9 5 9 6 7 10 2 1 2 1919-20 15 21 13 31 22 5 1 5 6 6 5 3 5 0 1 1 Recorded. 1919 19 16 12 33 15 5 2 3 5 6 4 4 7 - 1 1 1920 10 25 15 29 28 4 3 6 6 6 5 3 3 1 1 1 62 APPENDIX: CANCER—MALIGNANT DISEASE. TABLE XVII. CANCER: MALIGNANT DISEASE. 1919-20. Borough. Site of Disease. Carcinoma. Cancer. Epithelioma. Scirrhus Sarcoma. Malignant Disease. Other Forms All Forms. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. I. Nervous System II. Organs of Special Sense— (c) Nose ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 III. Respiratory System— (a) Larynx 5 1 ... ... 1 ... ... ... ... ... ... ... ... ... 6 1 (b) Lung 2 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 2 IV. Circulatory System V. Digestive System— (a) Mouth— (i.) Tongue 6 ... 2 ... ... ... ... ... ... ... ... ... ... ... 8 ... (ii.) Glands 1 ... 1 ... 1 ... ... ... ... ... ... 2 ... ... 3 2 (b) Throat— (i.) Pharynx 1 ... 2 ... ... ... ... ... ... ... ... ... ... 1 8 1 (ii.) (Esophagus 11 1 3 1 1 ... ... ... ... ... 1 ... ... ... 16 2 (c) Intestines— (i.) Stomach 29 16 1 4 ... ... ... 1 1 ... ... 1 ... ... 31 22 (ii.) Intestine 14 24 2 6 ... ... ... ... ... 1 2 2 ... ... 18 33 (iii.) Rectum 9 15 2 2 ... ... ... ... ... ... 1 ... ... ... 12 17 (d) Organs— (i.) Liver 13 15 1 3 ... ... ... ... ... ... 1 3 ... ... 15 21 (ii.) Pancreas 3 5 ... ... ... ... ... ... ... ... ... 1 ... ... 3 6 (e) Peritoneum ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 (f) Omentum ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 VI. Lymphatic System— (a) Head and Neck— (ii.) Cervical Glands ... ... ... ... ... ... ... ... 2 1 ... ... ... ... 2 1 (b) Thorax— (i.) Mediastinal Glands ... 2 ... ... ... ... ... ... 2 1 ... ... ... ... 2 3 (d) Extremities— (i.) Axillary Glands ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 VII. Urinary System— (a) Kidney ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 (b) Bladder 2 3 ... ... ... ... ... ... ... ... 2 ... ... ... 4 3 (c) Prostate 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... VIII. Generative System— (a) Ovary, Testicle ... 6 ... ... ... ... ... ... 1 1 1 1 1 ... 3 8 (b) Uterus ... 28 ... 4 ... ... ... ... 1 ... 1 ... ... ... 34 (c) External Genitals 3 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 (d) Breast 1 34 ... 4 ... 1 ... 2 ... ... ... ... ... ... 1 41 IX. Osseous & Muscular Systems 2 1 1 ... ... ... ... ... 1 2 ... ... ... ... 4 3 X. Cutaneous System— (a) Head and Neck 1 ... ... ... 4 1 ... ... ... ... ... ... 1 ... 6 1 (c) Abdomen ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... (d) Extremities (i.) Upper ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 XI. Not sufficiently described ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... 1 3 Totals 109 158 15 24 9 3 ... 3 8 9 9 13 3 1 158 211 Age as death. 0- ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20- ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 2 25- 2 1 ... ... ... ... ... ... ... 1 ... ... ... 1 2 3 85- 5 10 ... 2 1 ... ... ... 2 2 1 ... 1 ... 10 14 45- 20 34 4 3 3 ... ... 1 2 2 ... 3 ... ... 29 43 55- 36 42 4 5 2 ... ... 1 2 3 2 1 2 48 52 65- 32 42 5 8 1 2 ... 1 1 1 6 3 ... ... 45 57 75- 14 28 2 6 2 1 ... ... 1 ... ... 5 ... ... 19 40 63 APPENDIX: INQUESTS, 1919-20. TABLE XVIII. Inquests, 1919-20. Finding of Jury. 1919. 1920. M. F. M. F. Natural Causes 49 44 48 31 Misadventure 7 3 2 4 Accidents 27 14 39 15 Murder — 2 — 4 Suicide 11 7 9 7 "Neglect" 2 2 2 — "Open" 2 5 1 4 98 77 101 65 64 APPENDIX: DEATHS IN INSTITUTIONS. TABLE XIX. Deaths in Institutions. Local Institutions (Uncorrected). Outlying Institutions. Corrected Totals. Equivalent Percentage of all Deaths. Totals. Workhouse. Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. (a) Home of Compassion. (b) Women's Hospital for Children. Totals. Metropolitan Asylums Board. General Hospitals. Special Hospitals and Homes. Lunatic Asylums. Poor Law Institutions. 1909 813 96 253 362 88 5 9 193 25 49 42 57 20 628 31.97 1910 808 105 270 310 104 8 11 160 16 66 26 41 11 632 35.20 1911 854 105 293 383 56 9 8 196 45 51 29 59 12 665 34.52 1912 793 119 275 304 95 5 211 29 90 34 46 12 677 38.23 1913 890 139 806 339 99 6 1 252 56 93 34 56 13 789 39.86 1914 791 123 301 273 75 8 11 265 39 82 48 75 21 759 40.05 1915 922 155 392 269 90 11 5 286 41 82 53 91 19 894 39.10 1916 857 119 367 236 109 18 8 250 23 53 54 96 24 799 42.50 1917 815 124 378 190 97 17 9 293 39 79 59 97 19 858 41.85 1918 726 104(d) 262 (d) 216 105 29 10 505 37 86 44 135 203 951 42.28 Averages 1909-13 833 113 281 339 88 7 6 - 202 34 70 33 52 13 678 35.93 1914-18 822 125 340 237 95 17 8 320 36 76 52 99 57 852 41.13 1909-18 830 119 310 288 91 12 3 4 261 35 73 42 75 35 765 38.53 1919 342 - - 234 75 28 5 654 34 89 32 94 405 759 39.65 1920 709 - 356 239 89 18 7 324 40 93 48 51 92 734 43.00 (a) Opened in 1908; Closed in 1912. (b) In-Patients first received Autumn, 1913. (c) Including Sanatoria. (d) Taken over by War Office, November, 1918- -Re-opened February 4th, 1920. 65 appendix: deaths under one year. TABLE XX. Deaths under One Year. 1919. 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— 1919 1914-18 1919 1914-18 I. 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. Smallpox ..... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 ... 7 II. Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 3 1 ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 7 8 5 6 Enteritis ... ... ... ... 2 1 1 ... 1 ... 4 1 2 ... 4 1 3 ... 1 3 1 4 2 1 ... ... ... 1 1 2 1 ... 1 ... 20 22 13 18 III. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... 1 Other Forms do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 2 IV. Congenital Malformations 4 2 6 4 2 ... 1 1 ... ... 9 5 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 10 6 7 Premature Birth 12 7 23 15 2 ... 3 2 ... ... 28 17 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 29 24 19 19 Atrophy and Debility ... ... ... ... ... ... ... ... 1 ... 1 ... 1 2 5 1 3 ... 2 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 13 5 4 4 Debility at Birth ... 1 ... 1 2 ... ... ... 1 1 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 8 2 5 Injury at Birth 2 1 2 1 1 ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 1 2 Atelectasis ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... 2 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 0 V. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0 ... 0 Syphilis ... ... ... ... ... ... ... 1 ... ... ... 1 2 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 5 4 4 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 3 1 3 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Bronchitis ... ... ... ... 2 ... 1 ... ... ... 3 ... 1 1 1 6 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 6 11 9 7 Pneumonia ... ... ... ... 3 2 1 ... ... ... 4 2 2 ... 4 ... 2 ... 1 ... 1 ... 1 ... 1 1 3 ... ... 1 ... 1 ... ... 19 21 5 16 Suffocation (overlaid) ... ... ... ... ... ... ... ... ... ... ... 3 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Other Causes 2 2 2 2 ... 1 1 1 ... 1 ... ... 1 1 ... ... 2 1 ... ... 2 ... 1 ... 1 ... ... 1 ... ... 1 8 14 11 10 All Causes 20 13 35 23 15 4 8 5 3 2 61 34 13 8 15 10 14 3 7 6 3 6 3 3 2 2 5 2 1 4 3 3 2 2 129 153 83 120 Uncertified Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Averages 1914-1918 16 12 31 25 8 6 7 5 5 4 51 40 19 11 14 13 11 10 8 6 8 6 7 6 6 6 8 5 6 7 5 8 7 Corrected Births, M. 1180. F. 1136. 66 appendix : deaths under one year. TABLE XXa. Deaths under One Year. 1920. 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— 1920 1914-18 1920 1914-18 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F M. F. M. F. M. F. M F. F. F. M. F. M. F. I. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 2 ... ... ... ... 4 5 4 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 1 1 Whooping Cough ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... 1 ... ... ... ... ... 1 1 5 5 7 II. Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 5 8 1 6 Enteritis ... ... ... 1 ... 1 1 ... ... ... 1 2 4 1 2 3 6 4 3 1 4 2 1 ... 1 2 2 1 1 1 ... ... ... ... 25 22 17 18 III. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... 1 ... 1 Other Forms „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 3 1 2 IV. Congenital Malformations 1 ... 6 1 1 ... 1 ... 1 ... 9 1 ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 11 10 3 7 Premature Birth 10 15 22 25 3 2 ... ... 1 ... 26 31 2 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 24 34 19 Atrophy and Debility ... ... ... ... 1 1 ... ... ... ... 1 2 2 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 3 4 Debility at Birth 1 ... 5 1 1 ... ... ... ... ... 6 2 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 8 3 5 Injury at Birth 1 1 ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 2 Atelectasis 6 3 10 3 ... ... ... ... ... ... 10 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 3 3 2 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 0 V. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... 2 1 2 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 6 5 2 4 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 0 Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 1 1 1 Convulsions ... ... ... 1 ... 1 ... ... ... ... 1 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... .... ... ... ... ... 1 1 3 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . . . . . . . ... ... ... ... ... ... ... ... 0 ... 0 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... ... ... 2 3 3 2 ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... ... 7 11 10 7 Pneumonia ... ... ... ... ... 1 1 ... ... ... 1 1 3 ... 4 ... 2 ... 1 ... 1 ... ... 3 1 2 2 ... ... ... ... ... ... ... 21 21 8 16 Suffocation (overlaid) ... ... ... 1 ... ... ... ... ... 1 ... 2 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 1 Other Causes 2 3 3 5 ... 2 ... ... ... ... 3 7 2 1 ... 2 ... ... 2 ... ... ... ... ... ... ... 1 1 ... 1 1 ... ... 1 9 14 13 10 All Causes 21 21 17 38 7 9 4 6 2 3 60 56 20 12 15 8 14 5 8 3 6 3 5 6 5 7 9 6 5 5 2 3 3 152 153 114 120 Uncertified Deaths ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Averages, 1914-1918 16 12 31 25 8 6 7 5 5 4 51 40 19 11 14 13 11 10 8 6 8 6 7 6 6 6 8 5 6 5 7 5 8 7 Corrected Births—M, 1786. F. 1627, 67 appendix : infantile mortality. TABLE XXI. Infantile Mortality. 1914 1915 Rates Recorded. 1919 1920 Mean Rates. 1916 1917 1918 1914-18 1919-20 Whole Borough 96 117 94 135 116 91 78 109 83 Special Areas. Hall Park 160 71 88 129 65 61 45 106 51 North Wharf 90 164 91 175 76 99 105 116 99 Clarendon Street 187 238 143 252 264 103 76 209 87 Allred Road 117 176 145 170 96 175 116 148 138 Amberlev Road 184 181 99 138 146 81 111 140 101 Queen's Park 76 115 81 150 60 95 49 97 69 Combined Areas 132 160 110 175 128 104 78 140 88 Rest of Borough 78 97 87 111 112 87 78 95 81 68 appendix : prevention of infectious diseases. TABLE XXII. Prevention of Infectious Diseases. Annual Averages. Totals. 1914-18. 1919. 1920- All Diseases, Enquiries by— District Inspectors 3,704 1,797 1,721 Women Inspectors 7,172 6,311 6,559 Tuberculosis—Included in above— Women Inspectors 4,157 2,670 2,186 Rooms Disinfected after— Tuberculosis 816 239 272 Other Diseases 3,300 2,494 3,217 Weight of Bedding, etc., Disinfected (tons) 54 50½ 45½ Cost of above £1,156 £1,588 £1,850 School Notices issued— Measles, Whooping Cough, Chickenpox 3,877 3,096 3,213 Other Diseases 796 559 1,160 Patients removed to Hospital—All Diseases 618 659 1,122 Bacteriological Examination for— Diphtheria 540 479 1,419 Enteric Fever 9 4 4 Cerebro-Spinal Meningitis 9 — — Tuberculosis 215 144 173 Sanitary Work. Cutting-off of Water Supplies— Notices Received 29 11 4 Referring to Inhabited Premises 15 10 1 Empty 10 1 3 Other „ 3 — — Reasons for—Rates unpaid 10 3 3 Defective fittings 8 8 1 Mortuary— Bodies—Deposited 321 288 224 For inquests 258 220 160 Pending burial, after infectious disease 2 2 2 Other Diseases 61 66 62 P.M. examinations made 125 119 98 Trade Nuisances— Offensive Smells 9 (7) 5 (5) 8 (6) Accumulations of Manure 17 (11) 26 (21) 13 (12) Smoke—Complaints received 8 7 7 Premises watched 16 10 17 Hours of observation (total) 106 41¼ 84 Duration of smoke (hours), including 67¾ 26 58¾ „ black smoke 2¾ 2¾ 3½ Canal Boats— (Year 1918) On Register at end of year 204 211 224 (Annual Averages 1914-18) Known to be using Canal Basin 78 103 111 Inspections made 135 57 64 Infringements of Acts discovered 15 20 23 Notices served 12 13 15 Children found on boats 122 61 86 •69 appendix : schools—prevalence of disease. TABLE XXIII. Schools: Prevalence of Disease. Notified Diseases. Not Notified. Scarlet Fever. Diphtheria. Measles. Chickenpox. Whooping Cough. "Sore Throat." Ringworm. Scabies. Other Complaints. Vermin. 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 Schools— 1914 30.1 10.2 7.5 3.0 8.4 4.4 23.8 6.5 10.8 8.1 26.0 13.1 3.1 18.7 19.5 1915 10.1 2 .6 5.9 3.7 73.8 67.0 20.,9 8.2 10.3 7.2 7.1 6.2 3.8 4.0 4.9 1916 7.4 3.6 3.8 1.1 7.1 6.0 16.1 6.4 17.1 13.3 5.0 8.3 6.7 22.9 6.2 1917 2.8 0.8 4.6 2.0 70.5 60.2 17.8 7.3 7.3 5.5 0.9 6.4 7.5 18.9 0.4 1918 5.1 1.6 5.9 2.0 21.0 10.2 21.3 9.7 19.4 17.3 1.2 8.3 7.9 35.7 0.9 Averages— 1914-18 11.1 3.8 5.5 2.4 36.2 29.6 20.0 7.6 13.0 10.3 8.0 8.5 5.8 20.0 6.4 1919 7.4 2.4 4.4 2.2 51.1 27.8 9.9 2.8 4.4 1.7 4.0 13.8 8.9 14.2 0.1 1920 17.0 3.0 14.3 1.9 47.5 27.1 23.4 5.6 11.4 6.6 16.3 13.0 7.9 24.8 02 Non-provided Schools — 1914 16.7 7.2 7.2 2.8 11.7 5.8 19.5 6.0 24.4 11.0 5.1 11.8 4.6 7.9 22.0 1915 13.8 3.5 6..0 2.2 86.3 60.6 23.0 10.8 8.4 5.2 3.7 6.9 5.3 4.7 11.2 1916 8.0 1.6 9.3 2.0 6.3 2.7 19.0 4.7 11.4 7.7 1.3 8.0 8.7 18.5 4.0 1917 2.7 0.9 6.1 2.9 62.1 45.1 8.4 3.6 10.2 6.2 0.0 6.7 7.6 15.4 0.8 1918 3.8 12 5.1 2.4 42.6 22.0 27.3 11.7 14.7 9.5 0.3 5.5 8.1 53.2 1.0 Averages— 1914-18 9.0 2.9 6.7 2.5 41.8 27.2 194 7.4 13.8 7.9 2.1 7.8 6.9 19.9 7.8 1919 5.2 1.6 6.6 1.9 41.5 20.3 7.3 2.6 5.4 2.6 1.8 7.8 5.9 21.5 0.6 1920 11.8 2.0 10.4 0.8 35.8 26.3 19.6 6.8 8.7 6.0 2.0 6.8 5.7 11.8 0.9 Rates per 1,000 places provided. "P.A."—Patient attending school. "P.N.A."—Patient not attending. Accommodation—Provided Schools 1914—9,843; 1915—10,597 Non-provided Schools 1914-17—8,791; 1918—8,621 70 appendix : report of the work of the district inspectors, 1914-1920. TABLE XXIV. Report of the Work of the District Inspectors, 1914-1920. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, &c. Water Supply. Dust Receptacles Miscellaneous. YEARS. No. of Complaints received. "House-to-House." On Complaint or after illness Cellar Dwellings. Re-Inspection of all kinds. Entire Reconstruction. Drains Relaid. Trapped, or Ventilated. Drains Repaired and made Sound. Waste Pipes Disconnected. New Waste Pipes Provided. Rain-water Pipes Disconnected. W.C's, New, Provided, Repaired, &c. Soil Pipes, New, Provided. Soil Pipes Repaired. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New, Provided. Cisterns, Cleansed, Repaired, &c. New, Provided. Repaired, &c. Drains Cleared, Flushed, &c. Houses or Rooms Cleansed, Whitewashed, &c. Cases of Overcrowding Abated. Cellar Dwellings Closed. Yards and Areas Paved and Drained. ! Roofs Repaired. Manure Receptacles Reconstructed, &c. Accumulations Removed. Improperly-kept Removed. 1914 427 43 1852 — 12926 101 74 78 66 129 29 303 80 9 25 33 12 7 44 125 7 38 101 3 4 12 17 1 21 1 1915 581 — 1885 — 10830 55 50 51 47 67 20 153 29 20 20 6 11 2 32 33 8 33 84 4 — 22 34 2 28 — 1916 561 10 1742 — 11980 32 50 51 39 97 23 202 33 12 22 5 9 3 37 29 10 62 108 1 — 14 42 2 16 4 1917 958 18 1931 — 12998 22 23 25 36 78 20 154 19 13 8 5 29 — 14 11 7 68 72 1 — 13 53 — 17 1 1918 663 — 1730 — 12436 16 41 21 46 223 23 221 33 9 9 5 26 — 27 22 7 110 86 1 - 15 66 2 32 5 1919 995 — 1984 3 11920 22 46 34 33 361 23 275 11 15 42 10 14 — 13 22 2 80 114 4 1 18 91 — 30 — 1920 1328 — 2243 15 10035 35 55 26 38 368 31 360 8 11 48 9 5 — 21 54 12 66 136 5 4 21 107 3 19 2 71 appendix : sanitary defects remedied in tenement houses. TABLE XXV. Sanitary Defects Remedied in Tenement Houses. 1919 1920 Drain defective 5 2 „ choked 13 7 „ untrapped 1 8 „ unventilated or improperly ventilated 1 1 Manhole cover defective 12 a Surface inlet improperly trapped — — Gulley choked 13 4 Ventilating pipe improperly constructed — — Soilpipe defective 3 — „ improperly constructed — — „ unventilated or improperly ventilated 1 — Water-closet choked 62 23 „ defective 130 40 „ insufficiently flushed 30 5 „ flushing apparatus defective 42 6 „ without water supply 42 12 „ foul 36 8 „ improperly constructed - — „ accommodation insufficient 2 2 „ without door 8 — „ without external light or ventilation — — Rainwater pipe not disconnected from drain or soilpipe — — „ „ defective 35 6 „ „ choked 6 1 Wastepipe defective 15 7 „ choked 19 2 „ not provided 3 1 Other drainage defects 7 7 Cistern defective 4 — „ dirty 16 6 „ without proper cover 5 1 „ cover defective 7 1 Dustbin defective 71 20 „ not provided 11 5 „ insufficient — 1 „ disused and not abolished — — Paving defective in area or yard 36 14 „ „ wash-house 24 6 Guttering defective 28 8 Premises damp 20 10 Rooms dirty 1465 175 „ verminous 134 32 Roof defective 176 49 Accumulation of refuse 12 1 Animals improperly kept 21 2 Water supply to premises insufficient 9 5 Other defects or nuisances 285 118 Overcrowding. 1919 1920 Tenements overcrowded 8 3 Rooms overcrowded 11 3 Occupants, total 65 15 Under 10 20 5 10 and upwards 45 10 Overcrowding abated— By re-arrangement 4 — By voluntary removal 2 — Under notice 5 3 Cases held over — — Notices Issued. 1919 1920 Written Intimations 314 102 Statutory Notices 146 60 Bye-law „ 706 152 Notices under L.C.C. (G.P.) Acts— Verminous rooms 94 27 Additional taps — 2 Abolition of old dustbins — — 72 appendix: factories, workshops and workplaces. TABLE XXVI. Factories, Workshops and Workplaces. Manufacture, or business. 1913 1920 No. of Premises. No. of Workers. No. of Premises. No. of Workers. Clothing. Boots 99 (39) 243 (55) 117 (109) 238 (109) Corsets 10 (1) 15 (1) 9 (6) 11 (5) Dress 355 (33) 2,456 (105) 294 (97) 1,047 (124) Furs 10 48 7 (2) 30 (2) Mantles 7 (2) 23 (5) 13 (10) 15 (10) Millinery 44 (1) 181 (1) 38 (31) 51 (81) Millinery and Dress 22 (2) 185 (2) 20 (4) 50 (4) Plain Needlework 48 (34) 105 (38) 43 (32) 59 (32) Tailoring 206 (102) 708 (136) 185 (172) 290 (193) Tailoring, Ladies' 34 (10) 189 (10) 35 (27) 74 (32) Various 12 (8) 29 (8) 23 (12) 26 (12) Fancy Work. Embroidery, Art Needlework 15 (12) 58 (45) 10 (9) 20 (9) Cleansing. Dyers', Cleaners' Receiving Offices 18 46 13 (2) 25 (2) Laundries 102 (8) 920 (8) 63 (2) 480 (2) Laundries, Receiving Offices 28 42 26 36 Others. • Blinds 6 72 7 14 Bookbinding, Printing 25 436 26 274 Carpentry, Joinery 14 290 19 170 Chaff Cutting 12 30 9 13 Cycle, Motor Repairs 69 . 668 94 753 Engineering * * 17 166 Farriery, General Smithy 24 76 20 30 Flowers (Natural) 16 105 14 54 Jewellery, Clock Repairs 12 35 10 (2) 20 (2) Metal Working 21 170 31 124 Trunks, Manufacture, Repairs 11 32 10 11 Umbrellas 7 (1) 10 (1) 6 (2) 6 (2) Undertaking 11 (2) 121 (1) 8 (1) 77 (1) Upholstery 58 (29) 224 (33) 60 (56) 159 (56) Wig and Hair Work 19 89 14 15 Wood Chopping * * 23 82 †Various 106 (10) 884 (17) 133 (18) 595 (18) Totals 1,421 (294) 8,485 (466) 1,397 (594) 5,025 (647) Notes.—Figures in parentheses refer to "outworkers" and are included in total. Not separately scheduled in 1913. † Including—Saddlers, 9, employing 28 hands—in 1913. 73 appendix: samples taken under the sale of food and drugs acts, etc. office (clerical) work. TABLE XXVII. Samples taken under the Sale of Food and Drugs Acts, etc. Total. Found Adulterated. Percentage Adulterated. 1919 1920 1919 1920 1919 1920 Milk 404 331 29 4 7.2 1.2 Cream ... 6 ... ... ... ... Butter 11 26 ... 1 ... 3.8 Margarine 40 24 ... ... 2.5 ... Lard 19 37 ... ... ... ... Coffee 8 22 ... ... ... ... Cocoa 11 10 ... ... ... ... Jam ... 6 ... ... ... ... Bice 8 ... ... ... ... ... Arrowroot 11 ... ... ... ... ... Vinegar 21 25 ... ... 4.8 ... Mustard 4 7 ... ... ... ... Pepper 3 8 ... ... ... ... Olive Oil 5 5 ... ... ... ... Brawn ... 1 ... ... ... ... Sausages ... 12 ... ... ... ... Mincemeat ... 2 ... ... ... ... Chocolate 1 ... ... ... ... ... Bread 17 13 ... ... ... ... Cornflour 1 ... ... ... ... ... Flour 12 21 ... ... ... ... Salt ... 1 ... ... ... ... Sugar ... 38 ... ... ... ... Tea ... 1 ... ... ... ... Lime Juice 5 ... ... ... ... ... Camphorated Oil ... 4 ... ... ... ... Glycerine 7 ... ... ... ... ... Castor Oil 4 ... ... ... ... ... Tartaric Acid 5 ... ... ... ... ... Cream of Tartar 3 ... ... ... ... ... 600 600 31 5 5.1 .8 TABLE XXVIII. Office (Clerical) Work. Averages 1914-18. 1919. 1920. Letters Beceived 3,630 4,264 6,166 „ Despatched 3,127 4,323 6,730 Entries in Postage Book 8,656 8,930 12,351 Certificates dealt with relating to cases of Infectious Disease (incl. Consumption) 3,575 2,975 3,239 Notices sent re above and other diseases 6,060 5,455 6,173 Entries in Register of Births 2,490 2,386 3,489 Complaints Received 801 1,071 1,424 Plans dealt with 191 267 297 New Openings in Journal 341 358 353 Disinfection Orders (Duplicate) 3,755 2,891 3,350 Notices to abate Nuisance, etc. 1,118 525 636 74 appendix : housing conditions—statistics. Ministry of Health. ' TABLE XXIX. Housing Conditions—Statistics. 1. GENERAL. 1919. 1920. (1) Estimated population (total) 149,941 150,128 (2) General death rate 13.29 11.40 (3) Death rate from tuberculosis 092 0.97 (4) Infantile mortality 91 78 (5) Number of dwelling houses of all classes 16,686* (6) Number of working-class dwelling-houses 9,443* (7) Number of new working-class houses erected Nil. Nil. At Census. 1911. 2. UNFIT DWELLING HOUSES. I. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910— (a) Houses inspected on complaint or after illness 1,984 2,243 (b) Registered tenement houses inspected 1,176 240 (c) Houses inspected under Housing Acts 12 143 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 15* (4) Number of dwelling-houses (exclusive of those referred Co under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 6 135 * Underground rooms only. II. Remedy of Dejects without Service, of Notice. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers No record. III. Action under Statutary Powers. (A) Proceedings under Section 28 of the Housing, Town Planning, &c., Act. 1919— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 6 135 (2) Number of dwelling houses which were rendered fit— (a) by owners — 27 (b) by Local Authority in default of owners — 4* (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — — * Work in hand at end of year. (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect ol which notices were served requiring defects to be remedied— (a) Number of notices under Public Health (London) Act, 1891, and London County Council (General Powers) Acts 1,497 1,176 (6) Number of bye-law notices served 1,057 373 (2) Number of dwelling-houses in which defects were remedied— (a) by owners Not available. . (b) by Local Authority in default of owners — 1 (C) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909— (1) Number of representations made with a view to the making of Closing Orders 6 15 (2) Number of dwelling-houses in respect of which Closing Orders were made 6 15 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit ... 4 (4) Number of dwelling-houses in respect of which Demolition Orders were made . 4 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — 1 3. UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I. or (6) Part II. of the Act of 1890. (1) Name of area — Desborough St. (2) Acreage — 0211 (3) Number of working-class houses in Area — 11 (4) Number of working-class persons to be displaced — 62 Number of houses not complying with the building bye-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 __ Staff engaged on housing work with, briefly, the duties of each officer No officers are exclusively engaged on housing work.