4344 PAD 21 Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEAR 1921. BY REGINALD DUDFIELD, O.B.E., M.A., M.B., D.P.H. Medical Officer of Health. LONDON: VAIL & Co., Printers, 170, FARRINGDON ROAD, E.C. 1. 68637 Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEAR 1921. BY REGINALD DUDFIELD, O.B.E., M.A., M.B., D.P.H. Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. LONDON: VAIL & Co., Printers, 170, FARRINGDON ROAD, E.C. 1. CONTENTS PAGE Acute Poliomyelitis 15 Administrative Work 28 Alcoholism 21 Annual Cleansing 35 Ante-natal Clinics 31 Anthrax 17 Bacteriological Diphtheria 8 „ Examinations 28 Bakehouses 39 Births 2 „ Notification of 4 ,, "Hopeless" 24 ,, Illegitimate 2 „ in Institutions 3 , Still 4 Canals, Canal Boats 30 Cancer, Mortality from 20 Carrier Clinic 9 Cerebro-spinal Meningitis 15 Chicken pox 27 Childbed, Fatality in 14 Childhood, Mortality of 23 Combined Drainage 29 Common Lodging Houses 37 Compulsory Repairs 34 "Conversions" 33 Cream Regulations 41 Day Nurseries 33 Deaths 5 „ in Institutions 22 Diarrhœa, Mortality from 26 Diphtheria 6 Disinfection 28 Drainage Plans 29 Drains, Private, Re-laid 29 Dysentery 17 Encephalitis Lethargica 15 Enteric Fever 12 Erysipelas 13 Food Adulteration 40 „ Control 40 „ Supervision 39 Health Visiting 31 Home Workers (Outworkers) 38 House Sanitation 29 Houses Unfit for Habitation 34 Housing 33 Ice Creams 40 Illegitimates, Births of 2 „ Deaths of 25 Increase of Rent 37 Infant Consultation Centres 32 Infants, Mortality of 23 Infants, Mortality in Special areas 24 PAGE Influenza 16 Inland Revenue Acts 37 Inquests 22 Institutions, Deaths in 22 Legal Proceedings 41 L.C.C. Houses 37 Malaria 17 Measles 26 "Meningitis" 15 Meteorology 1 Milk Grants 32 Mortality, Infantile 23 „ „ "Hopeless Births" 24 „ at ages 1—5 years 25 „ in Childbed 14 Mortuary 30 Multiple Births 3 Mumps 27 Notification of Births 4 „ „ Tuberculosis 17 Office Work 41 Ophthalmia Neonatorum 14 Outworkers (Homework) 38 Overcrowding 35 Poliomyelitis 15 Population 2 Pneumonia 16 Prevention of Infectious Disease 28 Puerperal Fever 13 Rats and Mice Destruction 40 Respiratory Diseases, Mortality from 21 Ringworm 27 Scarlet Fever 9 „ Second Attacks 12 Schools and Infectious Diseases 28 Sewer Connections 30 „ Flooding 30 Slaughterhouses 39 Smoke Nuisance 30 Staff 28 Tenement Houses 34 Trade Nuisances 30 Tuberculosis: Institutional Treatment 18 „ Notification 17 „ Mortality from 19 Underground Rooms 34 Unsound Food 40 Vaccination 5 Venereal Diseases 22 Water Supply 30 Welfare Work 31 Whooping Cough 27 Workshop Supervision 37 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 submit my Report on the vital statistics of the Borough and the activities of your Public Health Department during the past year. It is to be regretted that no Report of the final results of the Census of last year has been published, although more than twelve months have elapsed since the actual enumeration of the population. Morbidity and other rates are the only sure tests of the sanitary state of the community, but such rates require population data which are not available at present, the upheaval of the late war having rendered the usual methods of estimating the numbers living quite unreliable. For want of better measurements, resort has been had to Index Numbers which give fair indications of the changes in the morbidity, etc., from year to year when, as is believed to be the case in the Borough, the population is approximately stationary. Index Numbers are, however, of little or no use for comparing district with district, and they suffer from a further disadvantage in that it is practically impossible to adequately gauge the variations due to the changes in the sex-age constitution of the population. The increase in fertility which followed the Armistice has passed away. It remains to be seen whether the birth rate will, as it is feared, fall to the low level of the years immediately preceding 1914. The losses incurred during the war have been by no means made good. Scarlet fever and diphtheria were both unduly prevalent during the year, but the fatality rates (per 100 cases) were low, notably that of the former disease. The records of notified diphtheria were swollen by the numerous instances of bacteriological diphtheria. The same fact was observed in 1920, and it is becoming evident that the notification of diphtheria needs modification to provide for the distinction between "bacteriological" and "clinical" diphtheria. I am not prepared to recognise the former as of no importance from a public health point of view, and therefore not worth the cost of notification. At the same time I think that there is no need to send all cases to isolation hospitals. The new cases of tuberculosis reported annually continue to diminish in number, as also do the deaths from that disease. It is too early to say how far the administrative methods recently adopted have helped to reduce the prevalence of this disease. The mortality from pulmonary tuberculosis had begun to decline long before any special administrative measures had been initiated. The deaths ascribed to cancer show no signs of diminution. Until information as to the sex and age constitution of the population be available, it is impossible to say definitely what the actual increase in the mortality has been. Figures will be found in the Report showing the changes in the proportions of the total deaths from cancer and from all other causes of death. Infantile mortality was low—far lower than was to be expected from past experience. In part the low mortality was due to the non-epidemicity of measles, but more to the absence of summer diarrhoea. Looking back over the years, the diminution in the mortality from that cause is striking. The contrast between the diarrhoea mortalities of 1911 and 1921 gives food for much speculation as to the factors which resulted in a high mortality in 1911 and an exceptionally low one in 1921. No small part of the credit for the change must be given to the Infant Welfare Work which has developed within the fifteen years. As regards the work of your Public Health Department, there is room for greater activity which can only be attained by a larger staff. The arrears in improvements and in the work of sanitary repairs accruing from the war, are far from being cleared off. In addition, new duties continue to be placed on the Department which cannot be efficiently dealt with. All members of the Staff do their best to cope with the demands on their energy, but those parts of the Report which deal with the housing conditions show that the Staff is not sufficient to the needs of the Borough. In expressing my acknowledgments of the support and consideration extended to me by the Chairmen and Members of the Public Health, the Housing and the Maternity and Child Welfare Committees, I am not merely complying with an empty formality. I much appreciate their sympathy and cordiality without which the duties of my office would be almost insupportable. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, O.B.E., M.A., M.B., D.P.H., Medical Officer of Health. Public Health Department, Paddington, W. 2. August, 1922. 1 A. METEOROLOGY. From the point of view of the weather, last year was a remarkable one, recalling in a general way that of 1911. In Table I*, will be found the annual means, etc. of the principal meteorological elements for the 11 years 1911-21, as observed at the Royal Botanical Gardens, Regent's Park, together with the averages, etc. for the decennium 1911-20. The means of the morning (9.0 a.m.) temperatures, wet and dry bulb thermometers, were higher last year than in 1911 and in excess of the averages. In comparison with 1911 the means of the past year were 2.1° and 0.2° higher. It will also be noted that the difference between the readings—4.1°—was greater in 1921 than in 1911 or the averages for 1911-20. That difference meant that the air was, on the average, drier during the past year. Last year the highest temperature recorded was 930—a figure which was exceeded by 3° in 1911, while the absolute minimum air temperature—25°—was 8° above the previous minimum —17° in 1920. The maximum sun—black bulb thermometer—was 138°, a record not exceeded during any of the preceding ten years, but equalled in 1914, a year of a different character from last year. The minimum recorded by the grass thermometer was 19.7°, differing notably from the minimum of 1920 (7.0°) and comparing favourably with the records of the other years. The total rainfall measured last year amounted to 14.55 inches, measurable quantities being recorded on 116 days. In 1911 the total measured was 25.34 inches on 143 days, the decennial average (1911-20) being 28.05, with measurable amounts on 164 days. A glance at Table I will make the differences between the records very apparent. As regards the record of bright sunshine, that for the past year is exceptional, the year's total of 1561 hours—on 284 days—having been exceeded only by that of 1911, 1644 hours, on 267 days. In 1914 bright sunshine was recorded on 287 days, but the total number of hours recorded was nearly 110 hours less. While it has to be admitted that the effects on public health of a summer such as that of last year, have not been fully worked out, it is possible to state that past experience has shown that there is (or has been) a somewhat intimate connexion between high temperatures of the air and soil, deficient rainfall, and infantile diarrhœa. At this stage it will suffice to direct attention to the immediate effects of deficient rainfall and high temperature and reserve comparisons of their influence on the prevalence of diarrhœa for the section of this Report dealing with that disease. (See Diarrhœa, p. 26.) The immediate effects just alluded to are— from deficient rainfall— (i.) Insufficiency of supply of water for domestic and municipal cleansing; (ii.) Loss of cooling of the soil; and from continued high temperatures— (iii.) Promotion of decomposition in accumulations of refuse of all descriptions, thereby favouring the breeding of flies and increased danger of spread of infective material by those insects; and (iv.) High temperatures in the upper layers of the soil. Results (ii.)—(iv.) are important factors in the causation of diarrhoea, and while that remark applies to result (i.), a shortage in the supply of water affects the public so generally that a note on the question will be of sufficient interest to be included at this point. As some 90 per cent. of the Metropolitan supply is drawn from the Thames, data are available for a direct estimation of the extent of the deficiency in the quantity of water from that source. During the months of January and September of last year the rainfall measured was in excess of the average.† The deficiencies observed in the other ten months varied from a maximum of 95 per cent. of the average in July to a minimum of 15 per cent. in November. For the whole year the deficiency was equal to 40 per cent. of the average, the year's total fall amounting to 14.59 ins. and the average to 24.47 ins. The immediate effect of the deficiency in rainfall on the river is clearly shown by the shrinkage in the quantity of water measured as flowing over the weir at Teddington. In January the measurements showed an excess equal to 27.7 per cent. of the month's average, the volume of water steadily decreasing thereafter, until in December the flow showed a deficiency equal to 83 per cent. of *All Tables will be found in the Appendix. †The contents of this paragraph are based on records published in The Lancet of January 21st, 1922 (i., 1922, p. 148). The averages here quoted are those for the 35 years 1881-1915. 2 population the month's average. For the whole year the volume of water passing over the weir was (approximately) 49 per cent. below the average. In normal times the Water Board can only take a fixed proportion of water from the river, the amount being regulated by the measurements at Teddington. But for that regulation having been relaxed, the public would have incurred real hardship through shortage of water supply. It is somewhat remarkable that the vital statistics for the past year do not disclose any injury to public health which can be attributed to deficient water supply. B. VITAL STATISTICS. I—POPULATION. According to the Census taken on the night of 19th-20th June, 1921, the population of the Borough was 144,273 persons, of whom 60,540 were males and 83,733 females. That total represents an increase during the ten years 1911-21 of 1,722 persons, equal to 1 per cent. of the population in 1911. The last Census was the first occasion since 1871 that an increase in the population has been recorded. Up to the time of writing the Preliminary Report of the Census is the only document issued. It is not thought desirable to discuss the results of the Census on this occasion. It is, however, permissible to observe that there is reason to think that the total given above understates the actual number of residents of the Borough. No attempt has been made by the Department to frame any estimate of the population at the middle of 1921, and where any rates based on the total population are given, it is to be understood that the estimate of 145,600 persons furnished by the Registrar-General has been used. II.—BIRTHS. The increase in fertility reported in the last Report was not maintained during the past year when the corrected number of births was 2,859 or 554 fewer than in 1920, equal to a decrease of 16.2 per cent. During the quinquennium 1911-15 the annual average was 2,927, that for 1916-20 being 2,505, last year's total showing a decrease of 68 (2.4 per cent.) from the first average and an increase of 354 (14.1 per cent.) above the second. The annual average for the five war years (1915-19) was 2,365—494 (17.2 per cent.) less than the total for last year. (see Table II.) As has already been stated there is reason to think that the population enumerated at the recent census understates the actual number of residents of the Borough. On this occasion there is no alternative but to use the estmate of the population at the middle of year furnished by the Registrar-General, continuing the practice which was adopted during the war. On that basis the birth-rate for the past year was 19.63 per 1,000 persons, 3.10 less than the rate for 1920 but 2'09 above the mean rate for 1919-20. (See Table II.) The arguments in favour of using Index Numbers rather than rates have been sufficiently set out in previous Reports. Taking the average for 1909-13 (3,008) as the standard (=100) the Index Number for the Borough for last year was 90 as compared with 113 and 77 for 1920 and 1919. Table III., gives the Index Numbers for the Wards. The greatest change during last year is that observed in Lancaster Gate, East, Ward (a fall of 27 points.) The 2,859 births comprised 1434 of males and 1,425 of females, equivalent to 993 births of females to 1,000 of males. During 1914-18 the ratio was 955: 1,000; in 1919, 967: 1,000; and in 1920, 914: 1,000. Illegitimate Births.—The 2,859 births included 224 of illegitimate children, 7.8 per cent. of the total, as compared with 7.1 per cent. in 1920 and 9.7 in 1919. Among the births registered last year within the Borough, the births of illegitimate children constituted 7.4 per cent. of the total, the percentage among births transferred from outlying areas being 20.7. The variations in the proportions of illegitimate births recorded in the Wards of the Borough are shown below. 3 illegitimate births Illegitimate Births. Percentages of all Births Registered. Wards. 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 1921 4.08 4.09 7.08 7.80 9.65 13.04 10.12 17.48 Among the illegitimate children the sexes were equally distributed, that is to say that to every 1,000 males born during the year there were 1,000 females, in striking contrast to the ratios for 1919 (1,000:899) and 1920 (1,000:1,101.) Births in Institutions.—Of the 2,365 births registered within the Borough during the year 478 (18.0 per cent.) occurred in institutions, viz.:—91 in the Paddington Hospital (late Paddington Infirmary), 69 in the Hospital for Women and Children (late Lock Hospital), 206 in St. Mary's Hospital and 112 in Private Nursing Homes. During 1919-20 the percentage was 10.1 and during 1914-18, 6.1. Of the 502 births transferred from outlying areas, 320 took place in institutions, equal to 63.7 per cent. of all such births. The births in Poor Law Institutions numbered 46, those in Lying-in Hospitals 245 (including 226 in Queen Charlotte's Hospital) and those in General Hospitals. 29. In the two years 1919-20 the proportion of institutional births, included among the transferred births was 76.0 per cent. and in the 5 years 1914-18, 90.0. The proportion of the total births recorded, i.e., the number registered within the Borough less births to non-resident parents added to the number of inward transfers, was 25.3 per cent., nearly 6 per cent. more than in 1920. The percentages of births in different classes of institutions during the past eight years are shown below. Proportions (per cent.) of Births in Institutions. Totals Maternity Hospitals and Nursing Homes. General Hospitals. Poor 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 21.3 14.9 4.1 2.2 1920 19.5 8.6 6.4 4.5 1921 25.3 11.3 9.6 4.3 Maternity Wards were opened at The Hospital for Women and Children (late The Lock Hospital) in 1918 and at St. Mary's Hospital in 1920. The Lying-in Wards at the Paddington Hospital (late Paddington Infirmary) were re-opened during 1921. Multiple Births.—Thirty-two instances of twin pregnancies were recorded during the year, equal to rather more than 1 per cent. of known pregnancies. Multiple Conceptions. Twins Triplets m m m f f f m 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 1 1921 9 14 9 — 4 notification of births Notification of Births.—The notifications received during the year, limited to children born within the Borough, numbered 2,732, 61 being duplicates. In the analysis given below showing the origins of the certificates, the most striking change is the increase in the number furnished by "Others." That increase has been mainly caused by the notification of births in the local hospitals being effected by the lay staffs. Notification of Births. Percentages of Total (uncorrected) Notifications Received from Averages 1914-18 1919 1920 1921 Medical practitioners 33.0 82.8 *34.1 86.6 39.2 87.0 33.9 76.6 Midwives 49.8 52.5 47.8 42.7 Parents ... ... 12.0 17.2 6.6 13.3 7.0 13.0 6.1 23.3 Others ... 5.2 6.7 6.0 17.2 The proportion of births registered without previous notification was (on an average) 3.7 per cent. during 1914-18, with a maximum of 5.3 in 1917 and a minimum of 2.8 in 1916. In 1919 the proportion of un-notified births was 3.0 per cent., and in 1920, 3.3. Last year while the proportion for the year rose to 3.8 per cent., those for the quarters decreased from 4.8 per cent. in the first to 3.2 per cent. in the last. The greatest amount of neglect of the Notification of Births Act takes place in the Southern Registration Sub-District, Notification of Births. Percentages of Total Births registered after Notification Quarters Registration Sub-District Period 1 2 3 4 North Central South 1914-18 (Averages) 96.0 95.8 96.7 96.9 97.4 97.2 86.2 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 1921 95.2 96.2 96.5 96.8 96.7 97.0 90.3 where it is probable that a minimum of harm accrues from neglect to notify. It appears to be desirable that the registration of births should be hastened and that the notification of births be thereby rendered unnecessary. Such change would necessitate prompt transfer of registration of births effected in outlying districts. Still-Births. The notifications received during the year included 80 of infants born dead, 79 being legitimate and one illegitimate. The percentage of still-births to all births was 2.99 last year, or 0.02 above the average (2.97) for 1914-18, but 0.11 below the percentage for 1920. (See below). There was a notable reduction in the proportion of still-births among illegitimate children—2.99 per cent. as compared with 6.00 per cent. (average) for 1914-18, and 7.69 per cent. for 1920. Still-Births. Percentages of all Births Notified. Averages 1914-18 1919 1920 1921 All Births 2.97 2.82 3.10 2.99 Legitimate 2.83 2.26 3.00 3.00 Illegitimate 6.00 5.48 7.69 2.99 The tabulation given below shows the variations in the proportions of still-births from year to year in the Wards of the Borough. The increases noted during the last two years in Church and Lancaster Gate, West, Wards are exceptional, but in the latter Ward the proportions are based on very small numbers, and, therefore, hardly "significant." 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 1921 1.83 1.28 3.12 3.14 4.43 5.88 — 2.54 births. 5 Of the 2,631 children notified as born alive during the past year, 67 (including 9 illegitimates) were dead when their births were registered. These deaths were equivalent to 2.58 per cent. of all live-birth notifications, and 23.33 per cent. of the live-born illegitimate children. (See below) Percentages of Children Notified as Born Alive Dead at time of Registration of Birth. Averages. 1914-18. 1919. 1920. 1921. All Children 2.92 2.94 2.91 2.58 Illegitimate Children 9.58 11.59 30.0 23.33 III.—DEATHS. The deaths registered within the Borough increased during the past year, the uncorrected total being 1,784 or 117 more than in 1920. That difference is more than accounted for by the increase in the number of deaths in public institutions—838 in 1921 against 709 in 1920. The annual average for 1914-18 was 2,032 and the maximum for any year since 1911, 2,304 (1915). The crude death-rate (gross mortality) was 12.25 per 1,000 persons, which compares favourably with the average for the five years 1911-15 of 14.60 per 1,000, the comparison being even more favourable if, as is believed, the actual population was last year in excess of the total given by the Census. The corrected number of deaths was 1,758 last year, the lowest total for any year since 1911 with the exception of that for 1920 (1,707). The corrected mortality rate for last year was 12.06 per 1,000, as compared with an average of 14.07 for the five years 1911-15 (see Table II). Taking the annual average for 1909-13 (1,887) as the standard (=100) the following Index Numbers are obtained— index numbers. 1914-18 110; 1919 101; 1920 90; and 1921 93. In Table III., the complete series of Index Numbers for the Wards for the years given above, will be found. It will be noted that in three Wards, viz. Westbourne, and the two Lancaster Gates, the Numbers have been consistently in excess of the standard, i.e., the deaths have exceeded the average for 1909-13. Until the final figures obtained at the last Census are published it is not possible to offer any explanation for the higher mortality rates in those Wards which the index Numbers more than suggest. Sex-Age Distribution.—The data required for the calculation of sex-age mortality rates not being at present available, Table IV., is submitted in which the actual numbers of deaths and the Index Numbers derived from them are to be found. The Numbers for males are higher at ages 15-25 and 45 and upwards, those for females showing increases at ages 25-35 and 55-85. It is satisfactory to observe that not only are the Numbers for the ages 0-15 consistently below 100, but also that those for last year did not increase. Cause of Death.—Table IX., shows the numbers of deaths due to various causes of death distinguishing sex and age, and Table IXa. gives two sets of Index Numbers based (a) on the annual averages for the prœ-war quinquennium of 1909-13 and (b) for the war quinquennium, 1914-18. As the majority of the diseases included in those Tables will form subjects of special paragraphs of this Report, comment at this stage appears to be unnecessary. IV.—VACCINATION. Table VI. contains the latest return of the results of the Vaccination Acts bringing the figures down to the end of 1920. The proportion of children not protected by vaccination during the first year of life was 28.3 per cent. in 1920, a proportion which was lower than those recorded during the three years 1917-18. During 1909-13 the unprotected children formed 20.5 per cent., and during 1914-18, 28.2. On the whole there was an improvement in the vaccination of children, but the proportion of the community not protected against smallpox is dangerously large. 6 DIPHTHERIA. V.—MORBIDITY: MORTALITY. Table V. contains full information of the numbers of cases of infectious diseases which have been notified to the Department since 1911. Diphtheria* General Prevalence.—Last year 445 cases were notified, including 3 of croup, being 19 less than the number (464, including 3 of croup) recorded in 1920, As in 1920, last year's total included a fairly large proportion of cases of "bacteriological diphtheria," or "carriers," in which the Klebs-Loffler bacillus was demonstrated, but the patients presented no clinical signs of diphtheria. These cases will be referred to later in this Report. (See Table V.) The annual average for 1909-13 was 201 cases (including 3 of croup), and that for 1914-18, 252 (with 4 cases of croup). Taking the latter figure as the standard (=100), the Index Number for last year was 175 as compared with 184 for 1920. The Index Numbers for the quarters of the past year are shown below. Diphtheria: Persons; All Ages. 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 1921 163 74 73 135 243 113 128 211 The great differences exhibited in the numbers for the first and last quarters of the year are explained by the numbers of instances of "bacteriological diphtheria" which were reported. Ward Distribution.—Table VII. shows the distribution of notified cases according to Wards in each quarter of last year and contrasts those figures with the averages for the years 1916-20. The totals for the year were in excess of the respective averages, except in the case of Lancaster Gate, West Ward (7 cases last year, average 8). The greatest increase above the average was recorded in Westbourne Ward—total 1921, 107, average, 45. Diphtheria : Persons : All Ages. Wards. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West Gate East Hyde Park[/##] Cases Reported Averages 1914-18 32 57 39 34 63 5 6 16 1919 22 56 46 44 51 11 16 13 1920 128 87 42 94 61 23 16 13 1921 68 103 55 107 70 7 14 21 Index Numbers 1919 70 97 118 128 82 229 276 80 1920 405 151 109 273 98 479 276 80 1921 215 179 142 311 112 146 241 130 Sex-Age Incidence.—In comparison with the annual average for 1914-18 the percentage of males notified with diphtheria was lower in 1921, falling from 46 to 41. The percentage was even lower, viz. 38, in 1919. The percentage distribution of cases, both sexes, indicate a greater incidence at ages under and above school ages last year than in 1920. (See below). Diphtheria: Borough. Percentages of Total Cases Reported. (Persons). Ages—years. 0- 3-. 5- 13- 15- 25- Averages 1914-18 161 18'9 46'6 31 8'1 7'1 1919 12'8 17'4 47"3 2'7 12'0 77 1920 9'5 10'5 52*2 52 121 105 1921 15'7 117 474 3'6 11*0 10'5 ' Including, unless otherwise stated, cases notified as "membranous croup" and "diphtheritic croup." diphtheria. 7 Striking changes in the percentages given above are to be observed in ages 15 and 25, the proportions noted during the past three years being considerably in excess of the averages for 1914-18 at those ages. This change is, perhaps, more clearly brought out by the use of Index Numbers based upon the actual numbers of the cases reported at each age. {See below). Diphtheria : Borough. Sex-Age Distribution of Notified Cases. Cases recorded Averages Males Females 0- 3- 5- 13- 15- 25- 0- 3- 5- 13- 15- 25- 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 1921 35 29 91 3 12 13 35 23 120 13 37 34 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 »♦ 1921 ... 150 118 163 94 300 232 203 99 193 282 223 274 Having no information as to the numbers living at the various ages, no explanation can be offered for the changes in incidence indicated by the figures submitted. Errors of Diagnosis.—Last year the "errors" numbered 55, or 123 per cent, of the cases notified, showing a great increase above the proportions recorded in 1920 (6'7 per cent.) and 1919 (4*6 per cent.) During the five years 1914-18 the errors averaged 8T per cent. In addition to the cases marked "errors" there were a fairly large number of cases of "Bacteriological Diphtheria" of which some information is given in a later section of this Report. House, Family Incidence.— During the year 88 cases (including 5 errors) were reported among the "residents" of institutions within the Borough. The 88 cases were distributed as set out below :— Orphanage of Mercy ... ... 10 (all orphans) Victoria Orphanage ... ... 5 „ „ St. John's Taining School ... ... 8 (girls training) Paddington Infirmary ... ... 47 (Staff, 3; Workhouse, 2; others, allocated to home addresses, 40.) St. Mary's Hospital ... ... 18 (Staff, 9; non-parishioners, 7; others allocated as before, 2.) Children's Hospital, Paddington Green ... 5 (all non-parishioners) The majority of the cases in those institutions were "carrier" cases. After excluding the 54 institutional cases not allocated to home addresses in the Borough and correcting for "errors," it is found that during the past year there were 357 cases in which the original diagnosis was not varied which were (apparently) contracted in the homes. The 357 cases were reported from 301 addresses, 259 of the houses having one case each, 32, 2 cases, 6, 3 cases and 4, 4. The secondary cases, numbering 56, were equal to 15*6 per cent, of reported cases in which the original diagnosis was not varied. In 1919 the percentage of secondary cases was 13*6 and in 1920, 13'9. It is, however, thought that little or no importance attaches to the increase in the proportion of secondary cases observed last year on account of the numerous instances of "bacteriological diphtheria." The distribution of secondary cases last year—expressed as percentages of all houses invaded—is compared below with the (average) distributions for 1914-18 and 1919-20. Diphtheria: Borough. Per cent. of all Houses Invaded. Cases per house 1 2 3 4 5 6 1914-18 92.6 5.6 1.3 0.4 - - 1919-20 89.2 7.8 2.1 0.7 — 0.2 1921 86.0 10.6 2.0 1.3 — — Taking the family, and not the house, as the unit, the 357 cases were reported from 306 families, 262 having one case, 39, 2 cases, 3, 3 and 2, 4. The percentage of secondary cases in families, was 14'8. In 4 instances two cases were reported at the same time. 8 DIPHTHERIA. Institutional Treatment.—Of the 445 cases reported during the year 424 (95*2 per cent.) received treatment in hospitals, including the "carrier cases" reported from local institutions which were not sent to a "fever" hospital. The percentage just quoted showed a considerable increase above the percentages for 1918 (86'1) and 1920 (87*9) but is a little below the percentage (95*4) for 1914-18. The proportion for 1909-13 was 93'5 per cent. The proportion of cases removed to hospital last year would have been even higher than that stated above but for the fact that after consultation with the practitioners concerned it was decided to keep certain "carrier'' cases at home and send them to the "Carrier Clinic" at St. Mary's Hospital. That practice was not adopted as freely as was desired as many practitioners sent their patients to the "fever" hospital as soon as the result of the bacteriological test had been received by them and before the Medical Officer of Health could intervene. An analysis has been made showing the duration of treatment at the Hospitals of the Metropolitan Asylums Board during the past year. The analysis related to 318 cases admitted but excluded cases which terminated in death and those which were reported by the Medical Superintendents as "errors." The average duration of treatment for the series of 318 cases was 57'4 days, but on dividing the cases into two groups (a) patients sent to hospital on a diagnosis following a positive bacteriological test (B.E.+cases) and (6) those in which there was no record of such a test (B.E.O cases), results which appear to be somewhat anomalous are obtained. For 120 cases sent to hospital after positive test, the average duration of stay in hospital was 51*7 days, while for 198 other cases without history of such test, the duration was 60-9 days. The distribution of the cases according to length of stay in hospital—when tabulated in weekly periods shows three maxima in the B.E.-|-series in the third, fifth and ninth weeks, whereas the distribution for B.E.O cases shows but two peaks at the fifth and seventh weeks. There can be little doubt about the presence of numerous "bacteriological diphtheria" being included among the cases sent to hospital after bacteriological test. Fatality, Mortality.—The deaths certified due to diphtheria numbered 22, but of that number 2 were after cases certified during 1920, and a third occurred to a patient certified in 1920 to have scarlet fever whose attack of diphtheria was not notified. After making the necessary adjustments it appears that among the 445 cases notified last year (including 56 errors) there were 19 deaths from diphtheria and 10 from other causes among the "errors". The fatality from diphtheria was, therefore, at the rate of 4-8 per cent of the verified cases (389). In 1920 the fatality was 6"2 per cent, and in 1919, 6"0. For the quinquennium 1916-20 the fatality averaged 7*9 per cent. Much of the lowering of the fatality was due to the frequency of "bacteriological diphtheria" but it is surmised that the virulence of true diphtheria was below what has been observed in earlier years. Particulars of the distribution of deaths according to Wards will be found in Table VIII. Table IX. shows the sex-age distribution of the deaths (22) recorded during the year, and Table IXa compares by means of Index Numbers the mortality during the past year with the averages for 1909-13 and 1914-18. Bacteriological Diphtheria.—In the absence of any notification from the Medical Superintendents of the Hospitals of the Metropolitan Asylums Board as to patients sent in for diphtheria having no clinical symptoms i.e. that the cases are no more than instances of "bacteriological diphtheria," it is not possible to do more than guess at the number of such cases sent into the Board's Hospitals. That a considerable number of such cases are so sent, is well known, the fact having been officially brought to the notice of the Minister of Health and certain preliminary inquiries instituted by the Ministry as to possibility of relieving what is at certain times a serious handicap to the Board, beds being occupied by persons who are not "ill"—but at the same time possible sources of infection—which are required for the reception of "sick" patients. Reference has been made already to an analysis of the duration of stay in the Board's Hospitals during the past year. It might be thought that the length of stay would furnish a means of distinguishing between the two classes of cases, but, unfortunately for the present purpose, instances are known of cases which were recognised before being sent to the Board's Hospitals as "bacteriological diphtheria," being kept in hospital for exceptionally long periods. No case of "diphtheria" can be regarded as one of "bacteriological diphtheria" unless there has been a test demonstrating the presence of the Klebs-Loffler bacillus in one or other of the usual sites. During the past year bacteriological tests were made in connexion with 201 of the 445 notified cases, i.e. 45-l per cent, of cases notified. In 5 instances the test was scarlet fever. 9 negative while the 196 positive results were obtained from swabs taken from throat in 195 instances, from the nose in 32, from the nose and throat in 3, from the ear in 11, and from the eye in 1. Nose, eye and ear cases are almost invariably cases of "bacteriological diphtheria." Of the 120 patients sent to the Board's Hospitals after bacteriological test—in which group the average duration of stay was 51*7 days—35 were in hospital for less than 28 days, i.e. 29 per cent, of these patients were kept for less than half the average term for all patients of this category. The average stay for patients sent in without previous test was 60'9 days, and the number of such patients detained for less than half that period (4-5 weeks) was 34, or only 17*1 per cent. As a rough approximation it is probable that some 30 per cent, of the cases sent to the Board's Hospitals during the past year were cases of "bacteriological diphtheria." In 1918 when an analysis of these cases was prepared by the Board 17*7 per cent, of the cases admitted from the Borough were cases of "bacteriological diphtheria." Since that year the practice of swabbing has extended and hence it is more than probable that the proportion of these cases has increased. In addition to the cases of "bacteriological diphtheria" which were included among the 318 cases analysed, there were at least 39 other cases among the 127 cases excluded from the analysis. Of the 47 cases reported among the "residents" in the Infirmary there were in all 25 cases of "bacteriological diphtheria," of which 11 were not sent to the Board's Hospitals. Three of the patients were reported twice within the year and one three times. Among the 18 cases reported from St. Mary's Hospital there were 15 instances of patients being kept at that Hospital. Seven other instances were recognised among patients kept at home, and a like number among the cases reported by the Asylums Board as "errors." These figures, which do not, it is thought, err on the side of excess, show a proportion of 30*7 per cent., thus in a way confirming the estimate, or guess, given above for the cases sent to the Board's Hospitals. Carrier Clinic.—In 1920 a Special Clinic was opened at St, Mary's Hospital for the treatment of "carrier" cases of diphtheria. In that year 8 patients (if the persons, mostly children, can be rightly so described) were referred to the clinic, and last year, 21. The 29 cases were almost equally divided between the two sexes, 15 males and 14 females. Of the 29 patients, 4 ceased attendance before they were "cleared," i.e., that three successive swabs had been taken and found to be "negative." The average length of "treatment" for the remaining 25 "patients" was 22'5 weeks. Three patients (children) attended for 98, 98 and 100 weeks each. If those cases be excluded, the average for the remaining 26 cases was 12 weeks with a minimum of 2 weeks. Scarlet Fever. General Prevalence.—Last year's total of 827 cases was the maximum for any year since compulsory notification was established by the Notification of Diseases Act, 1889. It will be seen from Table V., that this disease has steadily increased in prevalence since 1917, when 124 cases were reported—the minimum for any year since 1890. During the thirty years, 1890-1919, the annual average of notified cases has been 418, the year's total lying between 500-600 and 700-800 four times (each) and 600-700 (twice). Below are shown the years just referred to, with the numbers of deaths due to this disease. Scarlet Fever : Borough. Years of Excessive Prevalence. Cases Notified. 500— 600— 700— 800— C. D. C. D. C. D. C. D. 1892 ... 541 28 1898 ... 681 11 1893 ... 778 35 1921 ... 827 1 1901 ... 503 11 1899 ... 629 6 1896 ... 790 27 1907 ... 579 13 1906 ... 715 18 1920 ... 501 3 1914 ... 738 8 "C"—cases; "D"—deaths. Note.—The one death from scarlet fever included in Table IX. occurred to a Paddington resident, the deceased being an inmate of an outlying institution. The epidemic of 1887—when notification was not in force—is generally regarded as an outstanding one. The late Medical Officer of Health estimated that 568 cases occurred in Paddington (Old Parish) during that year—about two-thirds of the total for last year. The 10 scarlet fever epidemic of 1887 differed notably from that of last year, in that in the former year there were 35 deaths from scarlet fever—equal to a fatality of 6.1 per cent.—and in the latter, one death only from that cause among the 827 cases—fatality 0.1 per cent. The figures quoted above afford evidence of the reduction in fatality from this disease. The tabulation given below shows that the epidemic of last year began in the third quarter of 1920, and the figures shown in the lower half of Table VII., show how the numbers varied from quarter to quarter in the different Wards. Scarlet Fever : Borough : Persons. Cases reported Index Numbers 1 2 3 4 1 2 3 4 Averages 1914-18 90 68 73 114 1919 35 42 51 133 39 62 70 117 1920 88 62 116 235 98 91 159 206 1921 152 174 215 286 169 256 294 251 The Index Numbers for the yearly totals in the Wards (see below) indicate that the increased prevalence varied within fairly wide limits in the Wards. 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 1921 151 293 253 215 257 322 275 169 Sex and Age Incidence.—There was an increased incidence on females of all ages last year, cases among males constituting 42 per cent. of the total, and those among females, 58. Those proportions differ but slightly from the averages for 1914-18 (males 44, females 56), and those for 1919 (males 40, females 60). The distribution by ages, percentages of total (both sexes) is somewhat unexpected, having regard to the remarkably low fatality. It will be seen from the statement given below that the proportion of children under 3 years was 6.3 per cent. last year, as compared with 4.0 per cent. in 1920, but was below the proportion recorded during the years 1914-18 (8.9). Scarlet Fever: Borough: Persons. Percentage Distributions. Ages. 0- 3- 5- 13- 15- 25- 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 11.2 63.1 6.8 9.0 6.0 1921 6.3 10.9 62.0 7.2 8.3 4.9 On comparing the numbers reported for each sex at each age last year with the records for the years 1914-20 (see below), it will be seen that although large increases were recorded at each and every age, the greatest increases are to be found at ages 13 years and upwards. The increases in the numbers of males is, it is believed, unusual. Scarlet Fever: Borough. Sex-Age Distribution. A—Cases Reported. Males Females 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 1921 26 38 219 26 25 14 26 52 294 34 46 27 B—Index Numbers. 1991 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 1921 138 139 271 342 212 250 217 205 264 340 232 196 11 scarlet fever Errors of Diagnosis.—Of the 827 notified cases 43 were subsequently found to have been erroneously diagnosed. These "errors" formed 5.2 per cent. of the reported cases, a higher proportion than that reported in 1919 (4.6) or 1920 (4.1). The proportion recorded last year shows an improvement on the proportions observed during 1909-13 (7.4) and 1914-18 (7.1). House, Family Distribution.—After correcting for errors, it is found that the secondary cases in houses during the past year numbered 111, equal to 14T per cent. of the corrected total. In 1920 these cases numbered 71 (14.3 per cent.) and in 1919, 39 (15.5). The proportions set out below show that on the whole there was less tendency to multiple cases in houses last year than in the earlier periods mentioned. Scarlet Fever: Borough. Percentages of All Invaded Houses. Houses with Multiple Cases. Cases per House. 1 2 3 4 5 6 1914-18 85.2 10.1 3.9 0.4 0.3 0.1 1919-20 86.9 9.9 2.2 0.8 0.1 — 1921 87.5 8.9 2.8 0.4 0.4 — In thinking of multiple attacks in houses, it is necessary to bear in mind the fact that most of the houses where such cases occur are occupied by two or more families. Whereas the 784 "confirmed" cases came from 673 houses, the actual number of families invaded was 695. The secondary cases in those families numbered 89, or 11.3 per cent. of the total. Two cases occurred in each of 56 families, 3 in 15 and 4 in one. On 15 occasions two cases were reported simultaneously and on 3, three. In this connexion mention should be made of the frequency of "return cases," being new attacks in the family (or house) at various (short) intervals after the return of an earlier case from hospital. Last year 43 such cases were noted, there being two other instances of a somewhat doubtful character. Cases occurred in all Wards of the Borough, Harrow Road and Church Wards being most affected with 15 cases each. The patient suspected of giving rise to the "return case(s)" was seen by the Medical Officer of Health, as soon as possible after the occurrence of the return case(s). Institutional Treatment.—Of the total 827 cases reported 804 were removed to hospital, equivalent to 97.2 per cent. of the the total. In 1920 the percentage so removed was 94.4, and in 1919, 91T, the averages for the two quinquennia 1909-13 and 1914-18 being 95.5 and 95.8 respectively. (See Table VIII.). Fatality.—Last year there were three deaths among the 827 persons reported to have scarlet fever, but only one of those deaths was certified as primarily due to the fever. That death occurred in a boy aged 8 years who was under treatment in an outlying institution and contracted scarlet fever there, there being, apparently no connection (qua source of infection) with the Borough. Of the other two deaths, one a girl aged 10 was first reported with diphtheria and removed to hospital where scarlet fever was subsequently diagnosed. The death was attributed to diphtheria. The remaining death, that of a girl aged 5, who was removed to hospital as a case of scarlet fever and succumbed in hospital to an attack of appendicitis, to which disease the death was allocated. The statement given below shows how the fatality of this disease has diminished during the last few years. Scarlet Fevee : Borough. Fatalities—Per cent. Reported Cases. 1909-13 1.9 1919 1.6 1914-18 1.8 1920 0.4 1921 0.1 Mortality.—The deaths from scarlet fever numbered 5 in 1919, 3 in 1920 and 1 last year. Table IXa shows how the Index Numbers for the three years have fallen. 12 enteric fever Second Attacks.—An attack of scarlet fever is usually regarded as conferring immunity against the disease. While more complete knowledge derived from notification has given rise to doubt as to such immunity, second attacks in the same person are sufficiently rarely recorded to justify the placing on record of cases as they become known. Last year four instances of second attacks were recorded, of which the particulars are as follow:— f., æt 12, to hospital with (supposed) diphtheria, 17th February, 1921: scarlet fever diagnosed at hospital; discharged 5th May; sickened with scarlet fever, 12th December, 1921; removed to hospital 13th December, and diagnosis confirmed. m., æt., 7, treated at home in January, 1920, for an attack of scarlet fever: sickened 12th June, 1921, with the same disease; removed to hospital 15th June, and diagnosis confirmed. The practitioner who treated the case in 1920 wrote, in response to an inquiry, confirming the diagnosis of the earlier attack. f., æt. 5, sickened 6th September, 1920: removed to hospital 10th September; home 20th October; sickened 3rd June, 1921; to hospital 5th June. Enquiries addressed to the medical superintendents of the hospitals concerned elicited confirmation of the diagnosis in both instances. m., æt. 4, sickened 11th November, 1920: to hospital 15th October; home 25th November; sickened 22nd April, 1921; to hospital 23rd April. The first attack was apparently a "return case," and the second occurred while the boy was in a general hospital for treatment of a tuberculous gland. The medical superintendents concerned confirmed the diagnosis in both attacks. Hitherto second attacks have been reported only at long intervals after the first. In each of the above cases the interval was considerably less than a year. There is ample evidence of the low virulence of the infecting organism to which scarlet fever has been due during the last two years. It is permissible to surmise that in consequence of that low virulence, the immunity acquired by an attack of the disease is not so complete as when the organism is of high virulence. Enteric Fever. General Prevalence.—Last year 13 cases were notified as compared with 10 in 1919 and 19 in 1920. The annual averages for the two quinquennia 1909-13 and 1914-18 were 29 and 15 respectively. Errors of Diagnosis.—Of the 13 cases notified, 4 were subsequently found to be other diseases, the "errors" forming no less than 30.7 per cent. of the notifications. The increase in the proportion of errors is remarkable. The percentages during 1909-13 averaged 19.7, during 1914-18, 19.5, and were in 1919 and 1920, 20 and 21. After corrections for errors, the average annual numbers for the two quinquennia were— 1909-13, 23; 1914-18,10, and for the two following years—1919,8; 1920,15, the corrected total for 1921 being 9. No case was notified from Queen.s Park Ward, and the elimination of the errors cleared Harrow Road and Maida Vale Wards. Bacteriological Verification.—Resort to bacteriology as an aid to diagnosis was had in 8 instances, the results being negative in 4. Of the 4 positive, 2 showed the presence of the "enteric organism," one each the "Para-A" and "Para-B." Sex-Age Incidence.—The 13 cases notified included 4 among males and 9 among females. Of the cases among males, 2 (ages 6 and 73) have to be ignored as errors, and the other two were "para" cases. Last year attention was called to the freedom of males from this disease, a phenomenon new since the war. As far as men of ages above (say) 26 are concerned, a very large proportion are more or less protected by inoculation. Males at younger ages have not had that advantage, and it remains to be seen how long attacks among males will continue to be rare. The uncorrected numbers reported at the ages mentioned during the years 1914-21 are set out below. 13 enteric fever. Enteric Fever : Borough. Total Cases Notified. 0- 15- 25- 35- 45- 55- ges M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1914-18 13 12 10 11 7 2 8 5 3 1 2 2 43 33 1919-20 2 1 2 9 — 6 — 5 1 3 — — 5 24 1921 1 — 1 1 — 6 — 1 — — 2 1 4 9 Institutional Treatment.—Of the 13 notified cases 8 received institutional treatment, including one case removed to a nursing home. The cases so treated formed 61.5 per cent. of the notifications, a proportion in marked contrast with the records for the preceding two years, viz., 90 per cent. in 1919 and 84.2 per cent. in 1920. Fatality, Mortality.—There was one death among the cases notified, equivalent to a fatality of 11T per cent. of the verified cases, the fatalities observed during 1919 and 1920 being both zero. In addition to the death here referred to there was a second—at a lunatic asylum—but the case was not notified. The Index Number (see Table IXa.) shows a marked fall below the average. Source of Infection.—In one case there was a history of the consumption of oysters, but enquiry as to possible contamination proved that the supply was a "clean" one. Two patients were nurses at a nursing home and had been nursing an enteric patient admitted from an outlying district. One of the nurses died. A third nurse at the same home was notified for the same disease, but the diagnosis was not confirmed at the hospital. After the report of the last case, the entire staff was inoculated against enteric fever. Erysipelas. General Prevalence.—Last year 83 cases (36 males; 47 females) were notified, 2 more than in 1920 and 7 more than in 1919, The annual averages for the quinquennia 1909-13 and 1914-18 were 90 and 101. Institutional Treatment.—Nineteen (19) cases received institutional treatment (mostly in the Infirmary) or 22.8 per cent. of the total, as compared with 34"5 per cent. in 1920 and 27.6 in 1919. Secondary Attacks.—Two patients (one of each sex) were reported for this disease during the year, but it is doubtful whether the woman really had two attacks or whether the second notification was a duplicate only. The man (aged 23) had his first attack in June and was treated at home. The second attack came on in August when he was admitted to the Infirmary. Two men of the same family were attacked during the year, the first in June and the other in October. Both cases were facial and were treated at home. Fatality, Mortality.—There were 6 deaths among the reported cases, 4 in the Infirmary and 2 at home. The fatality was at the rate of 7.2 per cent. as compared with 6.9 in 1919 and 3.8 in 1920. The Index Number (see Table IXa) shows a slight increase above the average. Puerperal Fever. General Prevalence.—Last year 16 cases were notified, one more than the totals recorded in each of the years 1919 and 1920. The totals for each of the years since 1918 are higher than those for any of the years 1911-18 (See Table V.) Last year.s total was equivalent to a rate of 6.03 per 1,000 births registered within the Borough. That rate compares unfavourably with the average rates for the two quinquennia 1909-13 and 1914-18, which were 2.67 and 3-02 respectively. The rates for 1919 and 1920 were 7.44 and 471, averaging 5.77 for the two years. Those figures furnish some evidence of what has been adverted to in the two last Reports, viz, the tendency to increased risks attaching to child-bearing. The numbers of cases reported from the different Wards (see below) show strange differences from year to year, but two features deserve comment. The first is the apparent diminution in frequency of puerperal fever in Church Ward during the last three years, and the appearance of the disease in Lancaster Gate, West, Ward. 14 fatality in childbed. 0 Puerperal Fever—Notifications. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West Gate East Hyde Park 1914-18 (Totals) 4 11 5 5 6 — — 3 1919 2 3 2 5 2 1 — — 1920 — 6 3 3 1 1 1 — 1921 5 1 1 4 1 2 1 1 Errors of Diagnosis.—The signs and symptoms of a case—even one which is not of great severity—are fairly characteristic It is, however, somewhat remarkable that errors are comparatively rare in the notification certificates, a fact which raises a suspicion that notification is not as complete as could be desired. Last year a review of diagnosis followed after one certificate, but in two or three instances puerperal patients admitted to the Infirmary, after labour, (apparently for illnesses other than puerperal fever) were diagnosed after admission to have that disease The single error recorded last year was equal to 16.2 per cent. of the notifications as compared with averages of 8 8 and 10 per cent. for the periods 1914-18 and 1919-20. Institutional Treatment.—All the 16 cases reported last year received institutional treatment, 12 (including the error) in the Infirmary and 4 in the Hospitals of the Metropolitan Asylums Board. The proportion receiving this class of treatment (100 per cent.) was a good deal above the proportions recorded during 1914-18 (80.6) and 1919-20 (83.3). Fatality, Mortality.—Of the 16 women, 5 died, but in 2 instances the deaths were due to other diseases (influenza and pulmonary tuberculosis, one each), and not to puerperal fever. The corrected fatality rate was 20 per cent. last year as compared with rates of 33.3 and 55 per cent. during 1919-20 and 1914-18 respectively. The total number of deaths from puerperal fever recorded last year was 4, one fatal case being un-notified. In that case death followed a surgical operation to remove a partially macerated foetus. During the quinquennia 1909-13 and 1914-18, the deaths from this cause averaged 3 and 5 respectively, which latter number was recorded in each of the years 1919 and 1920. Accidents and Diseases of Pregnancy and Parturition.—The deaths from these causes averaged 8 a year during 1909-13 and 4 during 1914-18. In 1919 there were 4 deaths and in 1920, 11, while the total for last year was 9. The Index Numbers, based on the average for 1909-13 (= 100) are—1914-18, 50,1919, 50,1920,137, and 1921,112. (See Tables IX. and IXa.) Fatality in Childbed.—The total number of deaths in connection with childbearing was 13 last year, as compared with 16 in 1920 and 9 in 1919. The deaths from these causes averaged 11 each year during 1909-13 and 9 during 1914-18. The fatality rates per 1,000 births (corrected) for the quinquennia 1909-13 and 1914-18 were 3.65 and 3.61, those for the last three years being—1919, 3 88; 1920, 4.68; and 1921, 4.54. The average for the two years 1919-20 was 4.32. There is little or no evidence of any decline in the risks attaching to child-bearing since the war. Confirmation of that conclusion is afforded by the fatality rates recorded in the Wards of the Borough. (See below.) Fatality in Childbed due to Puerperal Fever and Accidents and Diseases of Pregnancy. Rates per 1,000 Births (corrected). Queen.s Park. Harrow Road. Maida Vale. Westbourne Church Lancaster Gate Hyde Park. West East 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 1921 3.40 355 6.43 3.63 4.74 10.86 12.65 — Ophthalmia Neonatorum. General Prevalence.—Last year 34 (males, 12; females 22) cases were reported, the highest number for any year since 1915, when 51 cases were reported. The figures given in Table V. do not suggest any indication of a diminution in the prevalence of this disease. This question was dealt with rather fully in the Report for 1919-20 (see p. 15). In addition to the 34 cases which were formally notified, 6 other cases of "stickiness of the eyelids," not severe enough to constitute ophthalmia, were brought to the notice of the Department by the Officers of the County Council. The numbers ot cases notified from the different wards and the morbidity rates are set out below. 15 ophthalmia neonatorum Ophthalmia Neonatorum. Cases Notified. Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster Gate Hyde Park West East Averages 1914-18 3 5 3 10 6 1 1 1 1919 1 5 2 7 12 1 — 2 1920 3 7 4 3 12 — — — 1921 3 8 — 6 13 — 1 3 Rates per 1,000 births. 1914-18 11.01 8.36 9.44 25.18 9.88 14.71 17.30 6.98 1919 3.6 9.5 5.8 18.2 24.4 12.8 — 13.0 1920 8.8 9.1 75 4.8 15.7 — — — 1921 10.2 14.2 — 10.8 20.5 — 12.6 16.4 Last year Maida Vale and Lancaster Gate, West, Wards were the only two with nil returns. For the whole borough, the rate (per 1,000 births, corrected total) was 11.9, as compared with 12.9 in 1919, 8.4 in 1920, and an average of 121 for the quinqennium 1914-18. Attendance at Birth.—Midwives were in charge of the confinements in 13 instances of ophthalmia last year, equal to 38.2 per cent. of all cases notified, as compared with 63.3 per cent. in 1919, and 44.8 in 1920. The percentage of all births attended by midwives during the past year was 42-7, or thereabouts, as compared with 52.5 in 1919, and 47.8 in 1920. Venereal Disease.—In two instances there was satisfactory evidence that the mothers were suffering from venereal disease, and the same was suspected in a third. From one infant a diphtheroid bacillus was recovered, which could not be cultured. Legitimacy.—Of the infants attacked, 5 (and possibly two others) were illegitimate, equal to 15.(5 per cent. of the attacks, whereas the proportion of illegitimate births was 7.8 per cent. of all births. The incidence among illegitimates was, therefore, just twice that among legitimates. Order of Birth.—Of the infants attacked, 13 (38.2 per cent.) were first-borns, 3 second, and 7 third. Institutional Treatment.—Nine (9) of the notified cases received in-patient treatment, 4 (each) in the Infirmary and Hospitals of the Asylums Board and one at St. Mary.s Hospital.. The 9 cases were equal to 26.4 per cent. of the total, as compared with percentages of 27.8 and 37.2 for the periods 1914-18 and 1919-20 respectively. When a case is not removed to an institution for in-patient treatment, the parents of the infant are offered the services of the District Nurses. That offer was accepted in 10 instances during the past year. Final Result.—In four instances the final state of the infants. eyes was not reported, owing to the families removing and being untraced in spite of full enquiries, and in 2 others the infants died before the records were closed. In the remaining 26 instances there was no damage to the eyes. "Meningitis" Group. Cerebro-Spinal Meningitis—There were two cases of this disease—both females, one in Queen.s Park and the other in Westbourne Ward—as compared with one in 1920 and 7 (1 error) in 1919- Of the two cases, one—a woman aged 25, who was admitted to Queen Charlotte.s Hospital on February 2nd and died next day—was found on post mortem examination to have suffered from primary pneumococcal meningitis, and the case was therefore marked as an error. The other case—female aged 3 months—was admitted to St. Mary.s Hospital on October 25th, and discharged on February 4th of this year. Acute Poliomyelitis.—One case—male aged one year—was notified from Westbourne Ward. During 1914-18, 9 cases were reported, and during 1919-20, 7 (including one error.) Last year.s case was admitted to the Children.s Hospital, Paddington Green, on August 22nd, and discharged September 27th with some paralysis of the right arm and leg. Encephalitis Lethargica.—During 1921, 7 cases—4 males and 3 females—were reported, two being found to be errors. In 1919, 3 cases were reported, and in 1920 2 (both errors.) An eighth case was known to have occurred in the Borough during the past year, but the patient—a servant in the Maida Vale Ward—went to her home in Willesden before the case was diagnosed, and she was treated in the Acton Lane Infirmary. It may be mentioned here that 10 of the infants were born in institutions, 5 in St. Mary.s Hospitals, 2 (each) in the Infirmary and Queen Charlotte.s Hospital and one in the Royal Free Hospital. 16 pneumonia The 7 reported cases included two errors, one of which died—of tuberculous meningitis— that being the only death among this group of patients. Five of the 7 patients received hospital treatment, one being admitted to a Hospital of the Metropolitan Asylums Board. The Pneumonias. The above heading includes, for the purposes of this Report, two forms of "pneumonia", viz "primary lobar" and "influenzal" pneumonia. Broncho-pneumonia should also be notified under the Regulations of 1919, but was not pressed until after the end of 1921 in consequence of a letter from the Ministry of Health (received in 1919) which gave a wrong impression of the interpretation of the Regulations which was not corrected until this year (1922.) Influenzal Pneumonia.—In 1919,87 cases were notified, and in 1920, 45. Last year the number fell to 27—12 in males and 15 in females. The ages of the patients are set out below. The greatest diminution appears to have taken place in the age-group 45-65 years. The Influenzal Pneumonia : Borough Cases. Ages 0- 15- 45- 65- 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 1921 2 1 7 10 2 1 1 3 distribution of cases in the Wards is shown below. The figures are too small and do not cover a sufficiently long period to enable any useful comments to be made. Influenzal Pneumonia : Wards : Cases. Queen.s Park Harrow Road Maida Vale Westbourni Church Lancaster Gate Hyde Park West East 1919 6 14 23 14 14 11 — 5 1920 2 7 7 11 9 1 1 7 1921 3 3 8 5 5 2 — 1 Institutional Treatment.—Of the cases notified during the past year, 15 received treatment in institutions, 11 of the patients being admitted to the Infirmary. The proportion receiving institutional treatment was 55.5 per cent. of the total notified, as compared with 28.0 per cent. for the years 1919-20. Fatality.—The deaths among the notified cases numbered 5, 4 taking place in institutions. All five deaths were classified to "epidemic influenza." Epidemic Influenza.—The deaths attributed to this disease numbered 41 last year, as compared with 28 in 1920, 164 in 1919 and 358 in 1918—the epidemic year. The sex-age and Ward distributions of the deaths are set out below. Epidemic Influenza : Deaths : Borough. Ages 0- 15- 45- 65- M. F. M. F. M. F. M. F. 1919 4 4 25 55 25 20 16 15 1920 — — 5 8 3 3 5 4 1921 2 1 4 7 6 10 4 7 Deaths : Wards. Queen.s Park Harrow Road Maida Vale Westbourne Church Lancaster Gate Hyde Park West East 1919 13 20 35 33 27 13 6 27 1920 8 3 5 5 5 1 2 4 1921 5 4 4 11 6 6 1 4 Primary (Lobar) Pneumonia.—The cases notified as "primary pneumonia" during the year numbered 105—64 in males and 41 in females. During 1919 the notified cases numbered 83 (5 subsequently marked errors) and in 1920, 96 (2 errors.) Of the 105 cases reported during the past year, 71 received institutional treatment, 56 being admitted to the Infirmary. The cases so treated formed 67 6 per cent. of the notifications, showing a marked increase above the proportion (39T per cent.) for 1919-20. Of the 105 cases notified, 24 ended fatally, equal to 22.8 per cent., the fatalities among the patients treated in institutions being—all institutions, 18.3; Infirmary 21.4—and among those treated at home, 32.3. Of the 24 deaths, 22 were attributed to either lobar or unqualified pneumonia, and one each to epidemic influenza and miliary tuberculosis. 17 other notifiable diseasbs The total number of deaths ascribed to "lobar pneumonia" and "pneumonia" during the year was 63, 25 (16 males, 9 females) to the former, and 38 (23 males, 15 females) to the latter. In 1919 the deaths entered under these two headings numbered 96, and in 1920, 54, the annual averages for the two preceding quinquennia being—1909-13, 87; 1914-18, 95. Of the 63 deaths recorded during the past year, 41 represented cases not notified during life. In 10 of the notified cases, death preceded notification. It can only be said that the notification of "pneumonia" has been so far very incomplete. Home Nursing.—In 7 instances the services of the District Nurses were sought for notified cases, 20"6 per cent. of the cases treated at home (34.) It is, however, satisfactory to be able to report that there were no fatal cases under the Nurses. care. Other Notifiable Diseases. Malaria.—Seven cases were reported during the past year, all in men between the ages of 23 and 35 years. In every instance the infection had been contracted abroad. 5 of the cases dating from service on the Salonica front during 1915 and 1916. Last year.s total shows a marksd reduction from that recorded during 1919-20 (89 cases). Dysentery.—Two cases were notified last year, one in a girl aged 5 years and the other in a woman aged 33. The latter case arrived from India with the disease, but in the child.s case no history could be obtained throwing any light on the source of infection. In both cases the Flexner bacillus was found in the faeces. Anthrax.—A case of this disease was reported in the autumn, the patient being a hairdresser (male aged 39 years). The history indicated that the anthrax pustule formed within 3 days of taking into use a new shaving brush in the bristles of which the bacillus anthracis was afterwards found to be present. Brushes of the same make were examined on behalf of the Medical Officer of Health of the City but that bacillus was not found in them. The country of origin of the brush was not ascertained. Tuberculosis. Notification.—The records for the years 1912-21 are given in Table V., and more detailed information for the years 1917-21 in Table X. All Forms of Tuberculosis.— The new cases added to the Register during the past year numbered 335, including 3 cases "transferred" on removal into the Borough. During 1914-18 the additions averaged 522 per annum, last year.s additions (335) representing a fall of 35.9 per cent. below that average. Pulmonary Tuberculosis.—The new cases numbered 244, and were 35.5 per cent. below the annual average (378) for 1914-18. Other Forms.—The new cases (91) were 36.8 per cent. below the average (144) for 1914-18 "Suspects."—In addition to the 335 certified "definite" cases, 93 other cases ("suspects") were reported to the Department by the Tuberculosis Officers as suspected to be suffering from the disease, but of these cases separate records are not kept to show the site of the disease. The total number of cases which have been entered in the Register since 1903 is 9,072 of which 1,873 definite and 63 suspect cases were "survivors" at the end of last year. (See Table XI.). Sex Distribution.—In the appended statement the numbers of cases reported during the past year—distinguishing the sexes—are compared with the averages for 1914-18, and the Tuberculosis: New Cases. Definite Suspect Ail Forms Pulmonary Other Forms Males Females Males Females Males Females 1914-18 206 172 77 67 60 89 1919 153 131 55 52 68 62 1920 135 142 56 50 55 62 1921 134 110 42 49 50 43 records for 1919 and 1920. Decreases are to be noted under all the headings. 18 tuberculosis. Ward Distribution.—In Table XII., the returns of new cases (all forms of tuberculosis) for the past eight years have been distributed according to the Wards. In two Wards only, viz., Lancaster Gate, West and East, is any increase in the prevalence of the disease indicated. Age Distribution.—A statement is given below showing the distribution of new cases according to age, distinguishing the categories of cases. The reductions at ages under 15 years are remarkable, and generally the tabulation can be regarded as very satisfactory. Tuberculosis: New Cases. Pulmonary Definite Other Forms Suspect All Forms Males 0- 5- 15- 45- 65- 0- 5- 15- 45- 65- 0- 5- 15- 45- 65 1914-18 8 34 114 43 7 24 37 14 2 0 9 33 14 2 0 1919 3 17 99 30 4 8 33 11 3 — 11 30 24 3 — 1920 — 15 87 32 1 12 26 15 2 1 8 23 23 1 — 1921 — 3 96 33 2 6 24 8 1 3 4 20 25 1 — Females 1914-18 6 28 108 25 5 19 29 27 2 0 9 38 38 4 0 1919 1 14 91 19 6 11 27 12 2 — 10 15 31 5 1 1920 5 5 109 16 7 4 22 22 2 — 5 28 26 3 — 1921 1 8 82 18 1 7 20 19 3 — 4 14 22 3 — "O" Signifies average less than 1. Site of the Disease.—In 324 of the cases reported during the year, the disease was stated to be in one part of the body only, 236 cases being notified as tuberculosis of the lungs, and 44 as of the cervical glands. In 11 the disease was reported to be in two sites, 8 of these cases being pulmonary cases with infection of the lymphatic glands or neighbouring organs. Among the "repeat" notifications were 5 cases in which secondary (apparently new) sites of disease were reported. Occupational Distribution.—The usual information as to the occupations of patients reported during the year, will be found in Table XV. Institutional Treatment : Non-Residential—The number of admissions, i.e. first attendances, at the two Tuberculosis Dispensaries was 891, the same as in 1920, of whom 135 were found to be suffering from pulmonary tuberculosis, 86 from other forms of that disease, and 158 to be "suspects." An analysis of the admissions and of the proportions (percentages) found to be tuberculous and suspect, is given below. Two points deserve notice Tuberculosis: Borough. Dispensary Records. Adults Males Females Total Insured Uninsured Total Insured Uninsured Admitted 253 207 46 279 104 175 Diagnosed— Pulmonary 33.6 (33.4) 31.9 (36.3) 41.3 (20.8) 17.5 (19.3) 22. 1 (33.7) 14.9 (16 4) Other Forms 9.1 (4.2) 8.2 (4.4) 13.0 (3.4) 6.1 (4 .6) 6.7 (6.8) 5.6 (3'2) Suspect 17.0 (18.4) 18.4 (18.4) 10.8 (18.9) 16.9 (21.3) 17.3 (17.7) 16.5 (214) Children Admittted 359 Diagnosed— Pulmonary 1.9 (5.8) Other Forms 12.8 (13.3) Suspect 18.9 (25.1) in that tabulation, viz. the increase in the percentages of "other forms" of tuberculosis diagnosed last year, in comparison with the averages for 1916-20, among all adults, and the very large increase in the proportion of uninsured men—from an average of 20.8 per cent. to one of 41.3 in 1921—but no explanation can be put forward at present for those changes. The percentages reported as "suspect'' are lower in every catagory except "males, insured." The Tuberculosis Officers report that there were 381 "contacts" connected with the cases of tuberculosis seen for the first time during the year, of whom 243 (63.5 per cent.) were examined, 13 (5.3 per cent. of the examined) were found to be suffering with some form of the disease. Those officers also report that 45 "suspects" were discharged during the year from observation, 17 of the 45 being found to be tuberculous, and 20 to be suffering from other diseases. 19 tuberculosis. The specimens of sputum examined at the Dispensaries during the year numbered 197, of which 50 (25 per cent.) were found to contain the tubercle bacillus. The number of visits of the patients. homes made by the Dispensaries. Staffs were slightly fewer last year than in 1920, the total visits in 1921 were 4,116 (844 by the Tuberculosis Officers and 3,272 by the Nurses), as compared with 4,337 in 1920 (925 by the Officers, and 3,412 by the Nurses. Residential Treatment.—Since May, 1921, all residential treatment has been provided by the London County Council. In consequence no distinction is now made in the records of the Department between insured and uninsured persons. At the close of 1920, 16 patients were under treatment. Last year 143 applications for treatment were received, of which 112 were completed by the patients entering tht institutions to which they had been allocated. The appended tabular statement shows the Tuberculosis: Residential Institutions. 1921. Applications received 143 Applications abandoned 6 Applicants not tuberculous 2 Adult Males 77 „ refused 9 Disease arrested 1 „ Females 62 Treatment refused 10 Patient died 1 Children 4 In suspense 1 Applications completed 113 Treatment given: Hospital 84 Sanatorium 28 Dispensary 1 Under Treatment Jan. 1st 1921 16 Admitted during 1921: Died during year 11 Hospital 84 Discharged 60 Sanatorium 28 112 Remaining Dec. 31st 1921 57 128 128 various reasons for non-completion of the remaining applications. Of the 84 patients admitted to hospitals, 39 were subsequently transferred to sanatoria. Among the 71 patients whose treatment was completed before the end of the year there were 11 deaths (in the institutions where the treatment was being given), equivalent to a case fatality of 15.6 per cent. Mortality.—The deaths from all forms of tuberculosis during the past year numbered 125, 70 of males and 55 of females. The appended statement shows the reduction in the Tuberculosis: Mortality: Borough Persons: All ages. Averages Recorded 1909-13 1914-18 1919 1920 1921 Pulmonary Tuberculosis 145 165 105 120 94 Non-Pulmonary 42 32 28 26 31 Tuberculosis of Meninges 16 18 10 13 12 Other Forms 26 14 18 13 19 numbers recorded during the last three years in comparison with the averages for the two preceding quinquennia. Tabic XII.a, Appendix, gives the sex-age distribution of the deaths during the past year. Last year.s total was 23 per cent. less than the average for 1909-13. Tables XIII. and XIV. show the changes in the incidence of mortality as regards sex and age and in the Wards of the Borough. Deaths of the Tuberculous from other Causes.—Last year only two deaths among notified persons came to the knowledge of the Department, as compared with 16 in each of the years 1919 and 1920. Among the "suspects" one death was known to have occurred. (See Table XII.A.) Occupational Mortality.—The usual information of the occupations (as recorded at the registration of death) of persons dying of tuberculosis during the year will be found in Table XV. Duration of the Disease.—Below is given a statement of the duration of disease as obtained from the records of 66 fatal cases of pulmonary tuberculosis. The proportion of 20 TUBERCULOSIS Pulmonary Tuberculosis. Intervals to Fatal Issue. Under 6 months 10 6-12 „ 14 Under 1 year 24 3 years 4 6 years 2 1 — 19 4 — 5 7 — 2 — 8 5 — i 9 — 1 each 10 — deaths within six months of the reputed onset was 10.0 per cent. last year, as compared with 13.2 during 1919-20, and 27.0 during 1914-18. Cases terminating within one year of the onset formed 25.5 per cent. last year against 38.4 during 1919-20 and 43.0 during 1914-18. Failure to Notify.—During the past year 34 cases of tuberculosis—19 of pulmonary and 15 of non-pulmonary—were known after registration of the deaths only. In 9 instances certificates notifying the cases were received after the deaths of the patients, but for the remaining cases no such certificates were received. Of the non-notified deaths 14—9 of pulmonary and 5 of non-pulmonary—occurred within the Borough, and the remainder in outlying districts. The 34 fatal cases, known after death only, formed 27.2 per cent. of the total number of tuberculous deaths during the year, as compared with 23.2 during 1914-18. Institutional Mortality.—Of the 125 deaths from tuberculosis 69 took place in institutions, equal to 55.2 per cent. In 1919 the proportion was 53.4 per cent., and in 1920 55.4. Of the deaths from pulmonary tuberculosis 55.3 per cent. occurred in institutions last year, as compared with 53 in 1920, 45.7 in 1919, and 48.3 and 54.4 during the quinquennia 1909-13 and 1914-18. In the appended statement the percentages of deaths of males and females Tuberculosis : Borough. Percentages of Deaths in Institutions. Pulmonary Non-Pulmonary 1909-13 1914-18 1919 1920 1921 1909-13 1914-18 1919 1920 1921 Males 52.7 57.3 519 57.8 611 539 711 600 687 937 Females 42.1 50.8 396 517 47.5 511 67.0 75.0 100 80 from the two main forms of tuberculosis which took place in institutions during the years 1909-21 are set out. The changes in the distribution of institutional deaths are indicated in the following statement. Tuberculosis: Borough Percentages of all deaths in Institutions. Class of Institution. Pulmonary Non-Pulmonary 1914-18 1919 1920 1921 1914-18 1919 1920 1921 Poor Law 60.0 43.7 54.5 38.4 48.6 26.0 46.6 44.4 Hospitals—General and Special 12.8 18.7 15.1 28.8 34.9 56.5 46.6 37.3 M.A.B. Hospitals 7.5 8.3 24.2 17.3 8.9 13.0 6.6 — Approved Sanatoria 2.0 — — 3.8 2.0 — — 3.7 Mental Hospitals 17.5 29.1 6.0 11.5 5.4 4.3 — 14.4 Cancer : Malignant Disease. The deaths recorded annually from the various neoplasmata which are included under this general heading numbered 156 in 1909 increased to 211 in 1914, and fell to 164 in 1918, since which year the numbers have risen to 170 in 1919, 194 in 1920 and 226 in 1921. During the quinquennium 1909-13 the annual average was 170 and during the following five years (1914-18), 198, an increase of over 16 per cent. In comparison with the average for the first quinquennium last year.s total shows an increase of 32 per cent. (See Table IXa) and of 14 per cent. above the average for the second. The increase in the proportion of deaths to deaths from all causes is clearly shown by the appended figures. A better understanding of the 21 cancer "Cancer" : Borough. Proportions (per cent.) of Deaths from Cancer to All Causes. 1909-13 97; 1914-18 9.5; 1919 8.8; 1920 11.3; 1921 12.8; 1919-21 10.0. Number of Deaths from All Other Causes to each Death from Cancer. 1909-13 10.1; 1914-18 9.4; 1919 10.2; 1920 7.7; 1921 6.7; 1919-21 8.0 increased mortality from these malignant new growths would be obtained from a comparison of the sex-age mortality fates. The necessary data for calculating reliable rates are at present not available. It may be pointed out that the total number of deaths from causes other than cancer has diminished and that the population of the Borough is increasing (but at a very low rate) and that, therefore, the increase in the number of deaths from cancer is one of real significance. There is one other fact which ought to be taken into consideration, namely the possibility that the proportions of persons at the higher—i.e. cancer ages—ages of life may have increased notably during the past few years. At present no evidence can be adduced to support or controvert that possibility. The 226 deaths recorded last year comprised 93 of males and 133 of females. Table IX., gives the sex-age distribution. Table XVI., Appendix, sets out the numbers of deaths during the past year from the different forms of new growths which are included under the designation of cancer, distinguishing the site and sex, also the sexes and ages of the deceased persons. Designations such as "cancer" and "malignant disease" are to be deprecated in death certificates. During 1909-13 deaths certified under such designations formed (on an average) 25.1 per cent. of all deaths from cancer, the proportion increasing to 25.7 during 1914-18. In 1919 the proportion was 22'8 per cent., in 1920, 11.3 with an average of 16.7 for the two years. Last year the proportion was only 11.5 per cent., showing a very considerable improvement in accuracy of diagnosis and certification. The percentage of cancer deaths ascribed to carcinoma has increased from 60'6 per cent. during 1909-13 to 626 during 1914-18, 73.3 during 1919-20 and 78.5 last year. As reported in previous Reports, the greater part of the attacks are located in the digestive and reproductive systems. (See below) "Cancer": Borough Deaths from Averages. Location 1909-13 1914-18 1919-20 1921 M. F. P. M. F. P. M. F. P. M. F. P. Digestive System 49 44 93 52 54 106 53 55 108 60 64 124 Generative System.. 1 44 45 1 57 58 4 42 46 3 60 68 Other Diseases. Respiratory Diseases.—The deaths from this group numbered 326 in all, 169 of males and 157 of females. The sex-age distribution will be found in Table IX. The changes in the Index Numbers for the individual diseases included in this group will be found in Table IXa. The total for the group (326) compares favourably with the annual averages for the two quinquennia 1909-13 (346), and 1914-18 (351), and with that for the years 1919-20 (339). Last year's total shows a reduction of 6 per cent. below the average for 1909-13. Alcoholism.—The deaths from acute (delirium tremens) and chronic alcoholism numbered 4 during the past year—3 of males and 1 of females—as compared with averages of l1 (1909-13), 7 (1914-18), and 3 (1919-20). The deaths from cirrhosis of the liver, in the majority of cases due to alcoholic excess, numbered 13—males 8; females 5—comparing favourably with the annual averages for 1909-13 (15), and 1914-18 (19), but shows an increase of 7 over the average (6) for 1919-20. While the deaths from the above causes do not represent the full tale of the mortality attributable to alcoholic excess, the combined total furnishes the best index of the damage to the health of the nation from such excess at present available. The total number of deaths last year was 17, as compared with annual averages of 26 during each of the quinquennia 1909-13 and 1914-18, and one of 9 for the (two) years 1919-20. While last year's total shows a reduction of 35 per cent. below the annual average for 1909-13, it is 88 per cent. above the average for 1919-20. The greater part of that increase is due to the increase in the deaths from cirrhosis of the liver, the number of which (13) is 116 per cent. above the average (6) for 1919-20. 22 inquests Venereal Diseases.—The only indication of the fatal results of these diseases afforded by the registration of deaths is that furnished by the comparatively few certificates of cause of death in which "Syphilis" is stated to be the primary cause of death. There is no room for doubt that the 6 deaths assigned to this heading during the past year is a most misleading measure of the fatality from venereal diseases, seeing that of the 6 deaths, 5 were of infants one year of age, the remaining death being that of a male aged 25-45 year?. (See Table IX.) If the certification of the cause of death were strictly confidential, many of the deaths now ascribed to general paralysis of the insane, arterio-sclerosis, etc., would fall to be classified under "venereal diseases." The Index Number for "Syphilis" shows a fall of 46 per cent. below the annual average for 1909-13, and one of 60 per cent. below the average for 1914-18 See Table IXa,). Venereal Clinic.—The Clinic at St. Mary.s Hospital for the treatment of all forms of venereal disease is available for sufferers from any part of the Metropolis and the adjacent counties. The number of patients admitted cannot be taken as any indication of the number of attacks in the Borough. During 1921, 756 new cases attended for the first time, 456 of the patients being males and 300, females. In the course of the year the attendances totalled 12,719. Two hundred and seventy-five (275) patients, 180 males and 95 females, ceased attendance before cure was established. There is at present no power to compel persons so discharging themselves to resume attendance at the Clinic, or submit themselves to treatment privately. VI.—INQUESTS. The proportion of deaths registered after inquest during the year—8.8 per cent.—was very nearly that of the quinquennium 1909-13 (8.4 per cent.) The proportion has steadily fallen since 1918, the average for the five years 1914-18 having been 10.0 per cent. Table XVII. shows the findings at the inquests. The sex-distribution was more normal last year, 57.1 of the inquests being held on males, as compared with 52.8 per cent. in 1914-18, and 58.3 during 1919-20. VII.—DEATHS IN INSTITUTIONS. Last year 838 deaths took place in the various institutions within the Borough, as shown in Table XVIII. Of the deceased persons, 303 were non-residents. There were in addition, 66 deaths (35 of non-residents) in private nursing homes. It is a little remarkable that 32 of the 492 persons who died in the Infirmary were non-residents, equal to 6.5 per cent. of all deaths in that Institution. Among the deaths transferred from outlying districts there were 266 which occurred in institutions. The corrected total of deaths of residents of the Borough in institutions was 801, equal to 45.5 per cent. of the corrected total number of deaths. From the statement given below it will be seen that during the quinquennium 1909-13 the Deaths in Institutions. Percentages of All Deaths, Corrected. Borough Queen's Park Harrow Road Maida Vale Westbourne Church Lancaster West Gate East Hyde Park 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 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 1921 45.5 43.2 48.9 36.8 45.8 58.2 29.7 38.4 42.8 1919-21 42.6 42.9 45.7 35.2 43.1 53.5 24.3 32.4 39.0 percentage of institutional deaths was 39T, last year.s percentage representing an increase of 16 per cent. The percentages for the Borough indicate a fairly steady growth in the proportion of deaths which take place in institutions. The figures for the Wards do not show a similar uniformity in change, either when comparison is made between different years or between the different Wards. The percentages for 1921, when compared with those for 1909-13, show varying rates of increase, the maximum increase having taken place in Lancaster Gate, East Ward (85 per cent.) and the minimum (9 per cent.) in Queen.s Park. (See next page). 23 deaths in institutions. Deaths in Institutions. Increases in Proportions compared with Averages 1909-13. Borough: 16 per cent. Per cent. Per cent. Queen.s Park 9 Westbourne 30 Maida Vale 15 Lancaster Gate, West 33 Church 22 Lancaster Gate, East 85 Harrow Road 48 Hyde Park 41 Analysing the deaths by the classes of the institutions (see below), slight reductions are observed in the percentages for M.A.B. Hospitals and Voluntary Hospitals in 1921, when compared with the averages for 1909-13. In the former instance, the proportion of deaths in those hospitals depends on the prevalence of the infectious disease received at those Hospitals, but there is no doubt that the lower fatality of those diseases, to which attention has already been directed, has helped to reduce the proportions of deaths recorded in more recent years in those Hospitals. The shrinkage in the proportion of deaths in Voluntary Hospitals is unexpected, while the great increase (100 per cent.) noted under Special Hospitals and Homes (including sanatoria but not nursing homes) is noteworthy. Deaths in Institutions. Percentages of All Deaths, Corrected. M.A.B. Hospitals Poor LawInstitutions 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 1.7 21.1 4.9 9.9 1.6 1920 2.3 24.8 2.9 10.2 2.8 1921 1.8 27.8 3.4 8.9 3.6 1919-21 1.9 24.6 3.7 9.6 2.7 Private Nursing Homes—The deaths in this class of "institution" within the Borough have—save for a temporary drop in 1917—steadily increased since 1914, in which year 34 deaths were recorded, 20 of the deceased persons being non-residents. Last year the deaths numbered 66, including 35 of non-residents. Hitherto no complete notes have been made of deaths of residents of the Borough in Homes in outlying districts. VIII. STATISTICS OF CHILDHOOD. 0 to 5 years of age. Infantile Mortality.—The corrected rate rose last year to 92 per 1,000 births, having been 78 in 1920, and 91 in 1919. Last year.s rate compares favourably with the mean rates for 1911-15 (108), and 1916-20 (98). The mean for the decennium 1911-20 was 104. (See Table II.). The appended figures show that the increase in the rate for last year was entirely due to excessive mortality among male infants, the mortality among female in 1921 having been less than it was in 1920. Mortality Rates : Borough. Per 1,000 Births. 1909-13 1914-18 1919 1920 1921 Males 117 119 109 85 118 Females 94 98 73 70 65 The mortality rates recorded in the individual Wards—see below and Table III.—were all higher last year than in 1920, except in Maida Vale Ward. The increases to be noted in the rates for the two Lancaster Gate Wards are unsatisfactory, especially that in Lancaster Gate, East. 24 STATISTICS OF CHILDHOOD. Mortality Rates: Persons. Per 1,000 Births. Queen.s Park Harrow Road Maida Vale Westbourne Church Lancaster Gate Hyde Park West East 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 1921 68 68 73 114 116 130 126 71 In the two following tabulations the mortality rates for the two sexes are compared, analysed by ages and causes of death. Mortality Rates: Borough. Per 1,000 Births. Males Females Ages at Death. 1914-18 1919 1920 1921 1914-18 1919 1920 1921 Under 1 day 12.7 16.9 11.7 16.7 9.8 11.4 12.9 9.8 „ 1 week 24.1 29.6 26.3 31.3 20.5 20.2 23.3 16.1 „ 1 month 41.4 51.6 33.6 47.4 32.9 21.1 34.4 23.8 0-3 months 65.8 75.4 53.1 64.8 52.4 45.7 46.7 39.2 3-6 „ 21.2 20.3 15.7 20.2 17.2 13.2 8.7 12.6 6-9 „ 16.6 8.4 10.6 21.6 14.3 6.1 11.6 8.4 9-12 „ 16.1 5.0 5.6 11.8 14.8 7.9 4.9 4.9 Mortality Rates: Borough. Per 1,000 Births. Causes of Death. Males Females 1914-18 1919 1920 1921 1914-18 1919 1920 1921 Group I. 8.9 0.8 3.3 2.0 9.1 — 6.1 2.8 II. 23.2 22.8 16.7 31.3 19.5 15.8 11.0 21.0 „ III. 3.6 1.6 1.1 1.3 3.4 0.8 0.6 — „ IV. 41.8 50.0 36.9 44.6 32.4 28.1 28.2 21.7 „ v. 31.7 27.1 21.8 29.2 25.1 18.4 15.9 12.6 Other Causes 10.6 6.7 5.0 9.7 8.5 9.6 7.9 7.0 *See also Table XIX., for diseases included in these groups. Hopeless Births .—Seventy-seven (77) births fell in this category last year, as compared with 102 in 1920 and 64 in 1919. These infants constituted 2.9 per cent. of all infants born within the Borough during the year, the proportions for the two preceding years being 3.1 per cent. in 1919 and 3.2 in 1920. During 1909-13 the percentage was 3.2, that during 1914-18 2.7. The 77 deaths included 7 of illegitimate children. Premature birth was the assigned cause of death in 42 instances, congenital defects—including 4 of the heart and 1 "monster"—of 6—the full total falling within the category of "Development Diseases being 60, 38 of males and 22 of females. Twenty-nine of the deaths took place in local institutions, and 3 formed the subjects of inquests. Twenty-five of the infants died within 24 hours of birth. Special Areas.—In the six Areas presenting characteristics of housing, etc., which differentiate them markedly from the rest of the Borough, the infantile mortality was at the rate of 109 per 1,000 births, the rate for the Rest of the Borough being 86. During the quinquennium 1914-18 the mortality in those Areas was 140, that in the Rest of the Borough 95. The rates recorded in each of the last five years are set out below. Applied to infants whose deaths are registered before or simultaneously with their births. 35 statistics of childhood Infantile Mortality: Persons. Per 1,000 Births. 1914-18 1917 1918 1919 1920 1921 Whole Borough 109 135 116 91 78 92 Special Areas— Hall Park 106 129 65 61 45 93 North Wharf 116 175 76 99 105 111 Clarendon Street 209 252 264 103 76 163 Alfred Road 143 170 96 175 116 134 Amberley Road 140 138 146 81 111 28 Queen.s Park 97 150 60 95 49 68 Combined Areas 140 175 128 104 78 109 Rest of Borough 95 111 112 87 78 86 The higher rate in the Areas of last year was chiefly due to excessive mortality from diarrhoea—Rate in the Areas, 43; in the Rest of the Borough, 20; and respiratory diseases (mainly pneumonia)—Rate in the Areas, 22; in the Rest of the Borough, 13. On the other hand, the mortality from the developmental diseases was higher (34) in the Rest of the Borough than in the areas (30), that from congenital defects in the Areas (4) being onehalf of the rate recorded in the Rest of the Borough (7). There was no death from injury at birth in the Areas, but 6 (rate 3) in the Rest of the Borough. Speaking generally, the rates at all ages under one year were higher last year in the Areas than in the Rest of the Borough, which is unusual. Illegitimates.-—Last year there were 36 deaths of illegitimate infants at ages under one year (males, 24; females, 12), giving a mortality rate of 160 per ],000 births of these infants. During 1909-13 this rate averaged 266 per 1,000, and in the next quinquennium 259, The rates for 1919 and 1920 being 156 and 218 respectively. These infants have, therefore, shared in the reduction in the mortality rate recorded in recent years. In the tabulation given below the fluctuations recorded in the rates for each sex, both among legitimate and illegitimate infants, are set out. The disparity between the rates for males and those for females has been more accentuated in recent years among illegitimate infants. Infantile Mortality: Borough. Per 1,000 births. Males Females Legit. Illegit. Legit. Illegit. 1909-13 108 269 84 263 1914-18 106 276 85 241 1919 98 212 71 94 1920 72 262 61 176 1921 110 214 61 170 Children, aged 1-5 Years.—The mortality among these is calculated on the number of survivors in each age group, obtained by carrying over the excess of births over deaths recorded each year. The method is unsatisfactory in that the deaths are drawn from a different "population," viz., the numbers living at the ages in question. The rates quoted are, therefore, certainly too high, but that fact does not in all probability affect the comparison of the rates recorded in a short series of years. From the figures given below, it appears that the mortality rates for last year compare very favourably with those of the preceding years. Mortality Rates : Borough. Per 1,000 Survivors. Ages : Years 1-2 2.3 3.4 4-5 1909-13 31.5 11.9 6.4 5.8 1914-18 35.2 14.4 10.9 6.2 1919 18.5 12.2 6.1 8.0 1920 19.0 12.5 4.6 5.7 1921 17.8 5.4 4.6 3.5 36 diarrhcka Mortality from Diarrhceal Diseases.—According to the tabulation made in the Department, the deaths of children under two years of age from these diseases numbered 86 last year, but according to the Quarterly Reports of the Registrar-General such deaths numbered 91, and were 27 in excess of the average (64) for the ten years 1911-20. Mortality from these diseases is usually markedly higher during the hotter months of the year, i.e. during the summer and early autumn. Last year, as will be seen from the appended tabulation, the deaths in the earlier months of the year were in excess of the averages. • Diarrhcea : Borough : Persons. Deaths at Ages 0—2 years. (From Quarterly Reports of Registrar-General.) Averages Averages 1921 1911-20 1921 1911-20 1st Quarter 14 7 3rd Quarter 35 29 2nd „ 13 9 4th „ 19 19 Last summer was one which judging by previous experience should have been characterised by a severe epidemic of "summer diarrhoea" and the contrast between the experience of 1911 and that of 1921 is remarkable—see appended statement. One curious fact is the failure of the earth temperature during the summer of last year to reach a mean of 60° Farh. for the quarter. "Diarrhcea" : Borough : Persons Deaths at Ages 0—2 years during Third Quarter only. (From Quarterly Reports of Registrar-General.) Deaths "Diarrhoea" Temperatures (Mean) Total Rainfall Maximum Air Earth F° F° ins. 1911 97 65. 1 64.0 2.94 1912 22 58.0 60.2 5.64 1913 29 58.7 59.8 5.43 1914 43 60.7 61.5 3.22 1915 37 59.4 60.5 8.37 1916 13 59.7 59.9 5.90 1917 13 60.7 62.6 10.22 1918 5 60.0 61.7 11.80 1919 22 59.6 56.7 5.62 1920 12 57.9 56.0 8.49 1921 35 63.6 57.8 2.65 1911-20 29 60.0 60.2 6.73 Meteorological conditions alone cannot, it is believed, determine the prevalence of epidemic diarrhoea. Of the other more or less obscure factors, mention should be made of the increased use of dried milk, the lessened amounts of horse manure stored in the vicinity of dwelling houses and the high prices of fruits—all of which favour a low prevalence of diarrhoea. As in former years arrangements were made to obtain information of cases of diarrhoea treated at the Hospitals within the Borough and by the Poor Law Medical Officers. Every known case was visited by the Women Inspectors, and parents advised as to treatment being sought and as to the food suitable for the children. Measles.—Last year 123 cases of this disease occurred in the Borough, as compared -with 1,946 in 1920, and 1,785 in 1919. In addition 82 cases of German measles were reported last year, the totals for 1919 and 1920 being 155 and 88 respectively. It is the custom to combine the figures for these two diseases, the combined total for the past year being 205, the lowest on record since 1911. (See Table V.) The annual averages for the quinquennia 1909-13 and 1914-18 were 1,336 and 2,215, last year.s total showing an almost complete immunity from the diseases—a common phenomenon. Ward Distribution.—The usual tabulation is given below. It is not worth while on this occasion to do more than draw attention to the records. 27 measles. Measles. Queen.s Park Harrow Road Maida Vale. Westbourne Church Lancaster Gate Hyde Park West. East 1914-18 261 471 307 347 416 91 85 147 1919 351 590 178 271 267 59 72 102 1920 287 500 126 277 480 69 65 80 1921 35 68 31 13 32 9 8 8 Fatality, Mortality.—There were three deaths during the year, a total which compares remarkably with the annual averages for 1909-13 (50), and 1914-18 (53). The maximum number of deaths in any year since 1909 was 116, recorded in 1917. In 1914 the deaths numbered 4, and in 1916, 3. The fatality of the disease was 2.4 per cent., nearly the same as the average rate (2.5) for 1914-18, and well above the rates recorded in 1919 (0.5), and 1920 (1.2). Treatment Nine cases were removed to hospital, 2 of which terminated fatally. Four cases were referred to the District Nurses for treatment in the patients. homes. Whooping Cough.—Although not a notified disease the Department receives information which gives a fair idea of the prevalence of the disease. Last year 613 cases were known to have occurred, a large increase above the totals recorded in 1919 (169), and 1920 (357). The annual average for the quinquennium 1909-13 was 546, and that for 1914-18, 160. Reference to Table V., Appendix, will show that last year.s total has been exceeded on three occasions only since 1911, viz., in 1911 (632 cases), 1913 (644), and 1918 (691). Ward Distribution.—The appended statement shows that the disease was spread fairly. generally throughout the Borough, two Wards—Harrow Road and Church—furnishing rather more than half the reported cases. It has to be observed, however, that those two Wards send the largest proportions of children to the Public Elementary Schools whence the information of cases is chiefly derived. Whooping Cough Queen.s Park Harrow Road Maida Vale Westbourne Church Lancaster Gate Hyde Part West East 1914.18 90 122 53 67 122 5 8 29 1919 3 46 18 12 48 1 22 10 1920 71 115 19 50 75 2 12 11 1921 86 200 53 86 115 23 11 39 Fatality, Mortality.—There were 21 deaths from this disease, an increase of 7 above the total for 1920 (14), and of 20 above that for 1919 (1). The annual averages for the two preceding quinquennia were—1909-13, 35; 1914-18, 30; so that last year.s total was well below the averages for both periods. The fatality of the disease was 3.4 per cent. of the known cases as compared with 3.9 in 1920, and 0 6 in 1919. Treatment.—Fourteen (14) of the cases were admitted to institutions, most of them to the Infirmary, 3 of the cases (42.8 per cent.) terminating fatally. Chicken-pox.—The cases reported during the year numbered 253, as compared with 567 in 1920, and 261 in 1919. The annual average for 1909-13, was 490; and that for 1914-18, 572. Mumps,—During the year 494 cases were reported, a notable increase above the totals for 1919 (150), and 1920 (154). During 1909-13 the cases averaged 251 each year, and during 1914-18, 295. Ringworm.—During 1919 and 1920 the reported cases of this disease showed increases in comparison with those reported during the war period. Apparently the disease is becoming more nearly normal in its prevalence, only 108 cases being reported last year, as compared with 204 in 1920, and 189 in 1919. The annual average for 1909-13 was 172, and that for 1914-18, 140. 28 C. ADMINISTRATION. I.—GENERAL. Staff of the Department.—Mr. Anthony, one of the District Sanitary Inspectors, was given extended leave of absence, on account of sickness, in October of last year and Miss Whitty, one of the Health Visitors, resigned her appointment in August. Mr. Heeley commenced duty as one of the Inspectors of Houses let in Lodgings, on February 1st., via Mr. Wingfield resigned and Mr. Binns began temporary duty as a District Inspector on November 6th. Miss Mann took up work as Health Visitor (vice Miss Durant) on March 1st and Miss Newhall, on December 30th. Prevention of Infectious Disease.—A numerical record of this work will be found in Table XX. There were fewer visits of inquiry during the year, owing in part to the absence of any epidemic of measles and in part to the larger proportion of cases of tuberculosis visited by the Staffs of the Dispensaries. During 1909-13 these visits averaged 10,662 a year and during 1914-18, 10,876, as compared with 6,835 last year. The admissions to hospital numbered 1,397 last year—cases of tuberculosis not being included—more than double the annual average for 1914-18. Disinfection.—The total number of rooms disinfected during the year, as shown in Table XX, was notably smaller than the totals for the other years mentioned in the Table, but the figures are not strictly comparable owing to changes which have been made in practice. There was a slight increase in the weight of bedding, etc. removed by the Contractor for disinfection—in round figures from 45 to 51 tons—although there has been a careful scrutiny of the orders for disinfection. During 1914-18 the cost of this work averaged £21 4s. per ton, as compared with £41 5s. during the past year, Great as has been the increase, it is more than doubtful whether the Council could do the work, including the remaking of beds, etc., by direct labour at a lower, or even the same, rate. Bacteriological Work.—Last year 977 specimens were sent to the Lister Institute for examination, as compared with 1,600 in 1920, 635 in 1919 and an annual average of 676 during 1914-18. As will be seen from Table XXI, the fall in the total for last year was entirely under diphtheria. The percentages of positive results are set out below. Bacteriological Work. Percentages of Positive Results. Diphtheria Enteric Fever Tuberculosis 1921 14.8 7.7 17.9 1919-20 11.8 37.5 18.2 1914-18 16.7 32.5 23.3 Schools.—Analyses of the reasons for exclusion from the Public Elementary Schools, as disclosed by the "Forms 84" received from the teachers, will be found in Tables XXII and XXIIa, and a comparison of the ratios per 1,000 places provided in the two groups of Provided and Non-provided Schools, will be found in Table XXIII. The most striking changes to be noted in the last Table are those under measles and chickenpox. "Sore Throats."—While this designation may mean anything—often nothing of importance from a public health point of view—it is a great gain as regards the work of prevention of disease that teachers watch for these cases and report them freely. Every child is visited and when deemed necessary the parents are urged to seek medical advice. When such advice is not taken the School Medical Officer is informed with a view to the child being examined by the School Medical Staff before being allowed to resume attendance at school. The ratios given in Table XXIII. suggest that a closer supervision is kept in the Provided Schools. Ringworm.—In the Provided Schools there was a reduction of nearly 50 per cent. last year as compared with 1919-20, last year.s ratio being also some 30 per cent. below the average for 1914-18. In the Non-provided Schools the changes are insignificant, but the disorder appears to be less prevalent in these than in the Provided Schools. 39 ADMINISTRATION Scabies.—This disease was notably less prevalent in 1921 than in 1920 or during the •quinquennium 1914-18. The ratio (TO per 1,000) in Provided Schools last year was just under half the ratio observed in the Non-provided (2.1). Vermin.—The number of exclusions given in Table XXII.a, is no guide to actual prevalence of verminous conditions among school children. The School Medical Officer has furnished a table showing the results of the inspections made by the School Nurses during the past year. The inspections (not the children inspected) numbered 58,841, and verminous conditions were present in 11,905 instances, equal to just over 20 per cent. The records are under three heads: (A) verminous heads (i) living pediculi seen (ii) nits only found and (B) vermin on other parts of the body or in clothes. The last category is a fairly constant proportion for boys, girls and infants—averaging 0.6 per cent. for all inspections. The frequency of verminous heads (A i and ii) was 19.6 per cent. for all children, 6.8 per cent. with vermin and 12 8 per cent. with nits. The liability to verminous conditions in the head is directly proportionate to the length of the hair as the following figures (percentage frequencies of inspections) show. Boys Infants Girls Vermin seen 1.2 5.4 12.3 Nits only found 3.4 13.0 20.1 Notices sent out.—Exclusion Notices to the number of 2,862—1,650 for the notified and 1,212 for other diseases—were sent to the schools during the year. In addition, 216 notices were sent to the Medical Officers of Health of adjacent districts with reference to children attending schools in those districts. House Sanitation.—Table XXIV. is limited to premises other than tenement houses (houses let in lodgings) which are dealt with in the section headed " Tenement Houses." Comparatively slight progress has been made to clear off the works of repair which accumulated during the war. At the present rate of progress it will necessitate many years. effort to reach the conditions prevailing in 1914. House Drainage.—In addition to the works included in Table XXIV. a certain number of reconstructions, See., were carried out on the owners. initiative, the complete returns being given below:— 1914 1915 1916 1917 1918 1919 1920 1921 Existing Drains tested and found watertight 143 89 80 85 68 71 89 88 Drains reconstructed 175 105 82 45 57 68 90 87 „ "made sound" 78 23 17 12 4 21 17 8 By "Economic" or other process. During 1911-14 200 drains were, on an average, reconstructed annually and 75 made sound by "process." From 1915 to the end of last year the average has been 76 reconstructions and 14 making sound per year. There is not the slightest reason to believe that there has been any similar decline in the necessity for the work. Reconstruction Plans.—The number of plans deposited decreased from 299 in 1920 to 208 last year. The figure for last year when compared with that for 1911-14 (304) shows how high prices affect the improvement in the sanitation of houses. The contrast is more marked when it is remembered that in many instances the reconstruction of the drain, etc., now forms part of the conversion of a "private" house into "flats," a procedure which was nearly unknown in 1914. 1914 1915 1916 1917 1918 1919 1920 1921 Plans deposited 312 269 145 122 109 269 299 208 In connexion with these plans 531 letters were sent out requiring the deposit of plans or their amendment. No summonses were issued during the year. Combined Drainage.—Sanction was given under Section 74 of the Metropolis Management Act, 1855, for the drainage by combined systems of the undermentioned groups of houses. Amberley Wharves, Nos. 1 and 2 Garway Road, Nos. 8 and 10 Biddulph Road, Nos. 14-24 Harrow Road, Nos. 495, 497 and 499 Eastbourne Mews, "C" Arch, Nos. la-7a Kilburn Park Road, No. 29 Edgware Road, Nos. 169 and 171 Randolph Gardens, No. 15 Edgware Road, No. 259 Richmond Road, No. 1 Scenery Store and Westbourne Grove, No. 114c "White Lion" Passage Titchborne Street, Nos. 33 and 34 Westbury Road, No. 1 Westbourne Park 1 Crescent Mews, No. 1 80 ADMINISTRATION Defective systems of combined drains, for which no approvals could be traced, were found at:— Cambridge Street, Nos. 15 and 16 Market Street, Nos. 73, 74 and 751 Porchester Place, No. 15 Sale Street, No. 26 Warwick Crescent. Nos. 5, 6 and 7 The above systems were reconstructed by the Council as "sewers". Sewer Connections.—Fewer new connections were put in last year but the appended tabulation shows that there has been considerable activity in this direction since the war. Why the sewer connections should be—one might almost say—so suddenly found defective in 1914 1915 1916 1917 1918 1919 1920 1921 After Order by the Council 13 15 8 10 16 36 46 22 On initiative of "owners" 23 22 25 11 11 26 24 38 large numbers it is not easy to say. It is surmised that the change in vehicular traffic, both as regards weight and speed, is partly responsible. Water Supply.—A newly built house may not be inhabited until a certificate has been issued by the Council to the effect that an adequate water-supply has been provided. List year seven such certificates were issued—five for houses in Biddulph Road and two for houses in Ashworth Road. The Notices of discontinuance of water supply received from the Water Board numbered twenty last year, as compared with four in 1920. In thirteen instances failure to pay the water rates was the reason for the discontinuance of the supply. One summons was issued for failure to restore the supply to an inhabited house—the water had been cut off on account of waste—but the supply had been restored bv the time the summons came on for hearing, Mortuary.—The number of bodies received fell from 224 in 1920 to 220 last year, the latter total being more than 31 percent below the annual average for 1914-18. (See Table XX.) The difference has been caused entirely by the fall in the number of bodies received for inquest purposes. The proportion of postmortem examinations made on bodies received has increased from 39 per cent during 1914-18 to 46 last year. Trade Nuisances.—Offensive Smells.—There was a slight increase in the number of complaints, attributable, it is thought, to the hot summer. (See Table XX.) Smoke Nuisance.—The coal strike of last spring demonstrated what the atmosphere of the Metropolis would be were no soft coal used. As was to be expected the strike caused difficultties in enforcing the Law relating to the emission of " black " smoke, but not to the extent which might have been anticipated. The duration of emission of such smoke was only slightly increased as is apparent from the appended comparison. (See below.) Duration of Black Smoke 1914 1915 1916 1917 1918 1919 1920 1921 per 100 hours of observation 0.7 2.7 2.9 3.6 6.6 6.6 4.1 5.2 The complaints of smoke numbered 10, not all of them relating to black smoke, the only form with which the Public Health Act deals. Nineteen premises were under observation, emission of "smoke" being recorded during 1081/4 hours, including 181/4 hours of "black" smoke. Four Notices were served but no summones issued. Sewer Flooding.—On August 23rd there was some flooding of houses within a limited area of the Borough after a rain-storm which must have been quite local. The total rainfall for August 23rd, as measured at the Botanical Gardens, Regents Park, was 0.92 in. as compared with 0.02 in. measured at Greenwich. Complaints of flooding were received from occupiers of houses in Warrington and Randolph Crescents, Shirland Road, near "The Chippenham" P.H., Saltram Crescent. Cornwall Road and Clarendon Street (one house in each of the two last). Canal : Canal Boats.—Complaints relating to the canal traffic are rare, partly no doubt because that traffic is much reduced in volume and partly on account of the insignificant amount of manure dealt with at the wharves. 31 welfare work The usual clean-up of the Paddington Basin took place at Easter time, some 225 tons of mud being removed from the bottom of the cut, on which 582 sq. yds. of new concrete were laid down in addition to extensive repairs to the retaining walls. The run-off valve at the foot of Harrow Road Bridge was abolished and a new 22-in. valve fixed lower down, connected directly to the sewer in Harrow Road. The Annual Report of the Examining Officer of Canal Boats was presented to the Council at the end of January, the material parts of which are included in Table XX. No case of infectious disease was reported last year among the boat population and only one death (f., aged two, from diarrhœa) was registered locally. Of the 226 boats on the Register only 113 habitually use the Paddington Basin. The population on the boats inspected during the year included 76 children, of whom 47 were of school age. One of the recommendations of the Departmental Committee appointed by the Minister of Health to inquire into the practice of living-in on Canal Boats, was to the effect that children of school age, i.e., between 5 and 14 years old, should be excluded from these boats during term time. II.—WELFARE WORK. Ante-natal Clinics.—Clinics are held once a week at 232, Harrow Road (the School for Mothers) and at St. Mary's Hospital. At the former 330 expectant Mothers attended during the year, the total number of attendances being 633. At St. Mary's Hospital 310 Paddington mothers attended, the total attendances numbering 1,220. Of the women attending the latter Clinic 74 were admitted to the Hospital and 220 were confined in their homes under the care of the Extern Staff of the Hospital. From certain parts of the Borough expectant mothers attend the Ante-Natal Clinic at Queen Charlotte's Hospital. Separate records for the Borough are not kept at the Hospital. Clinics at other Hospitals are also attended by the women from the Borough. It is certain that last year something approaching one-third of the expectant mothers living in the Borough attended these various Clinics, and it is probable that the proportion was nearer one-half. Health Visiting.—The Council's Health Visitors visited 2,041 new-born infants during the year. At the time of the visit—which should be between the 10th and 14th day after birth — 1709 infants were being fed naturally (i.e. from the breast), 173 artificially and 159 were on a mixed diet (see below). Methods of Feeding at First Visit. 1919 1920 1921 Breast 90.5 90.2 83.7 Artificial 5.8 6.3 8.5 Mixed 3.6 3.5 7.8 The number of infants reported as fed otherwise than from the breast are in a sense fallacious as a guide to the method of feeding new-born infants. Of the 173 reported as fed artificially only 44 (25.4 percent.) were less than one month old, and of the 159 on a mixed diet, 47 29.5 per cent.). The delay in making the first visits which these figures indicate while regrettable, has been unavoidable. Of the 2,041 infants visited 68 died before the close of the year, i.e., before December 31st, which death were equivalent to a mortality of 33 per 1,000 visited infants. That proportion has not the same significance as the infantile mortality rate but affords a rough idea of the mortality among these infants. Of the 68 infants dying, 43 (25 per 1,000) were reported as breast fed, 14 (81 per 1,000)as artificially fed and 11 (69 per 1,000) as on a mixed diet—rates which, with all their defects, convincingly demonstrate the risks attaching to methods of feeding other than the natural. Comparison is made below with the corresponding rates for 1999 and 1920. Mortality Rates per 1,000 infants visited. 1919 1920 1921 Total 45 41 33 Breast fed 40 38 25 Artificially (all forms) 93 73 75 32 welfare work Of the 68 deaths 33 were due to diarrhœal diseases and 11 to respiratory, while only 7 were due to what may be termed ante-natal causes, viz.:-2 from atrophy, and 5 from congenital defects. Satisfactory as the trend of the mortality rates quoted above appear, there is evidently still room for improvement. Thirty-nine (39) of the deaths occurred in institutions, including 31 at the Paddington Hospital (Infirmary). After being visited by the Council's Visitors—usually one visit only—the infants' cards are passed to the Paddington School for Mothers, the mothers being advised by the Council's Visitors to take their infants to the Consultation Centres for weighing and to obtain such further advice as to feeding, etc., as may be necessary. Many mothers take their infants on their own initiative having learned by experience that it is to the advantage of their infants to do so. The Visitors attached to the School continue visiting until the infant attains the age of 5 years, except when the babies are sent to school at the age of 3 years. The Visitors attached to the School made 16,831 visits during 1921 as compared with 11,857 in 1920 and 10,973 in 1919. An unknown number of infants ate taken to consultations at Queen. Charlotte's Hospital, and to Centres in adjacent Boroughs. Except the infants taken to Queen Charlotte's Hospital practically no visiting takes place after the first visits by the Council's Visitors. Consultation Centres.—The number of Centres maintained by the School has increased from three in 1914 to six in 1921. At two Centres two consultations are held weekly and the remainder, one. Last year 1,321 first attendances (= new cases) were made, the total attendances numbering 14,935. The attendances of children between one and five years of age (included in the total just given) numbered 3,578. Among the children attending the Centres there were 59 deaths during the year, 48 at ages under one year and 11 at ages one to five years. Deaths from diarrhoea numbered 20 and from respiratory diseases, 19. Milk Grants: Dinners for Mothers.—With the beginning of 1921 the whole of the administration under these heads was taken over by the Maternity and Child Welfare Committee, who appointed a Special Sub-committee to investigate applications and make grants. An Investigation Officer was appointed temporarily on February 16th, who continued in office until December 3rd. In April, 1921, a new scheme for the making of grants of milk, etc., at less than cost price, embodying a graduated scale of earnings according to the size of the family, was formulated by the Maternity and Child Welfare Committee in response to a Circular Letter (No. 185) issued by the Ministry of Health. The Scheme was adopted by the Council in May and duly approved by the Ministry. The applications considered by the Committee during the year numbered 1,017 from 820 families and grants were made with respect to 850 applications. The remaining applications (167) were considered to be outside the Committee's Scheme either because the earnings were above the scale or because the degree of poverty prevailing was such that a grant such as it was permissible to make would afford no adequate benefit to the grantee or the family. Such applicants were advised to apply to the Poor Law Guardians. In all 3,506 orders were issued, 3,354 for milk and/or dinners and 152 for milk substitutes. The expenditure on milk amounted to just over £1,618—£1,472 for free milk (38,166 quarts) and £146 for milk at half-price (7,176 quarts); that for dinners £137—2,189 in number, all free. In addition 836 packets of "Glaxo" and 125 of "Cow and Gate" (Dried Milk) were granted, 124 of the former and 8 of the latter at half-price, and 712 of the former and 117 of the latter free— at a cost of £96, of which the half-price grants represent just over £7. Milk substitutes are sold by the School for Mothers, the necessary stocks being purchased by the Council. The stocks purchased last year cost £1,461 and the receipts from the School amounted to £1,324. No account is here taken of stocks on hand at the beginning or end of the year. Every applicant was required to furnish a signed statement of his family's earnings and expenditure (fixed items only), and was informed that the statements as to earnings were subject to verification, to which assent was necessary. Latterly, as so many applications were made by wives and not husbands, the husband was required to furnish a separate statement of income with name and address of employer, etc. In certain instances verification led to the 33 HOUSING discovery of understatements of income and any grant already made was thereupon stopped. Certain applicants were called upon to refund the cost of milk supplied and all were warned of the liability to prosecution for making false statements. Four cases were laid before the Council's Solicitor, who advised that there was a prima facie case against each applicant. The papers were sent to the Criminal Investigation Department and two summonses were issued, the defendant in one case being sent to prison for 21 days with hard labour. In the other proceedings the defendant was found not guilty. A milkman who sent in an account for milk ordered by the Council but not supplied was fined £20, with the alternative of two months' imprisonment. The milkman refused to deliver the milk as the family was in his debt for earlier supplies. Other Work.—The Maternity Committee in addition to considering grants for milk, etc., assists in making provision for expectant and nursing mothers (unmarried) before and after the births of the children at St. Mary Magdalene's Home and for married and unmarried mothers requiring convalescent treatment. The Committee also contributed to the maintenance of children admitted to the Hostel—Beauchamp Lodge, Warwick Crescent—on account of the parents requiring treatment away from home Four (4) unmarried mothers were admitted to St. Mary Magdalene's Home, the Council's share in their maintenance amounting to £70 11s. Od. Ten (10) children were dealt with at the Hostel at a cost of £23 13s. 6d. Two mothers with their infants were given convalescent treatment at Shooter's Hill for three weeks in each instance, the full cost being met by the Council. Day Nurseries.—There are two of these institutions in the Borough, the "Paddington Day Nursery" at Porchester Houses and the "Queen's Park" in Lancefield Street. At the former some 374 children attended with a total attendance of 4,705. The Nursery was closed on account of infectious disease (chickenpox and whooping cough) on 35 days, the total number of days on which children were received being 208. The Queen's Park Nursery was open on 284 days, and received 316 children who made 4,973 attendances. III.—HOUSING. The "Housing Board" for London appointed by the Minister of Health in July, 1919, ceased to exist as from July 1st, 1921, the functions of the Board being absorbed by the London Section of the Housing Division of the Ministry. Conversions.—No. 30 Westbourne Square was the only house acquired and converted by the Housing Board on behalf of the Council under Sec. 16 of the Housing Act of 1919. No. 8 Warrington Crescent was acquired by the Board and the conversion into flats undertaken by the Council. The conversion of the latter house was very nearly complete at the end of the year. The former was occupied (as 4 flats) in the latter half of 1920. Owners of property are not required to give the Council formal notice of their intention to convert "single" dwelling-houses into flats. Where the conversion provides self-contained flats the work generally involves notice to the District Surveyor and generally alterations to the drains, etc., of which notice has to be given to the Borough Council. While it may be assumed that most conversions into self-contained flats come to the knowledge of the Department, the fact remains that conversions into so called flats—really tenements—without special adaptations are only discovered in the course of inspections at dates subsequent to the conversions. Moreover, there is practically very little control over conversions into selfcontained flats—a practice for which little or no provision is made in the Building Acts—and none over conversion into tenements. Even when the Bye-laws under Sec. 26 of the Act come into operation, they will only regulate conversions of tenements intended for occupation by persons of the working class. There is urgent need of legislation to regulate all conversions. Last year 39 conversions came to the knowledge of the Department, as compared with 77 in 1920. Two of the 39 houses were united to form a "hostel," the other 37 houses being altered to accommodate 115 families. In the course of the two last years 114 houses, previously occupied by one family each, have been made to accommodate 332 families. Assuming that the houses originally held on an average 6 persons each, and that the new "flats," now house 3 each, the conversions result in an increase of population from 684 persons to 966, or over 45 per cent. Even if the increase be no more than 30 per cent.—one-third less than just estimated—it is manifest that very important issues as regards public health are involved. Density of population (persons per acre) and mortality (death rate per 1,000 persons) are intimately correlated, and an increase in the density following a 30 per cent. increase in the population within fixed boundaries, cannot fail to influence the mortality and mørbidity rates. 34 housing Compulsory Repairs.—It was anticipated that the provisions of Section 28 of the Act of 1919 would be found to be of great value. Unfortunately experience, even with the limited amount of use of the Section possible with the existing Staff of Department, shows that there are innumerable doubts as to the interpretation of the Section, much scope for delaying tactics on the part of owners, and difficulties in the way of executing works when owners fail to comply with the Notices. The question of recovering the cost of work done on behalf of defaulting owners was scarcely opened at the end of last year. "Case law" may be expected to clear up some of the difficulties in connection with the administration of the provisions of the Section, but the opinion has been formed already that amendments of the Section are required to secure more prompt execution of repairs. The continuing deficiency in housing accommodation makes the necessity of putting existing premises in decent repair all the greater. For the reasons already set out, and owing to insufficiency of Staff, only 55 Notices under the Section were issued during the past year, as compared with 141 in 1920 (See Table XXV.). During the same period 87 Notices were complied with by the owners, and in 9 instances contracts were obtained by the Council and the works carried out. Since the inception of this work in 1919, 196 houses have been "scheduled," 114 of which have been repaired by the owners and 13 by the Council at the cost of the owners, but, except in one instance when the Council did the work by agreement with the owner, none of the expenditure had been recovered at the end of the year. In March of last year the Medical Officer of Health gave evidence before an Office Committee of the Housing Department of the Ministry of Health on "Minor Questions arising under Parts I. and II. of the Housing Act, 1890." The main questions related to operations under Section 28 of the Act of 1919. Houses unfit for Habitation.—Action under Section 17 (1) of the Act of 1909— representations for Closing Orders—is impossible owing to the lack of accommodation for the families who would be displaced by such Orders. Had housing conditions been more normal certain of the houses dealt with under Section 28 of the Act of 1919 would have been represented for closure. Closing orders with respect to Cirencester Street, No. 51—Closing Order, 1919 : Demolition Order, 1920; and Gloucester Mews East, No 68—Closing Order, 1919 were determined, the houses having been made fit for habitation. No. 68 was greatly improved being almost rebuilt (See also Table XXV.) The Improvement Scheme for Desborough Street having been rejected by the Ministry of Health, the houses mentioned in the last Report as under Demolition Orders, viz., Nos. 4, 8 and 9, remain as before, i.e. little better than carcases. Underground Rooms.—These, if used for sleeping, come within the provisions of Section 96 of the Public Health (London) Act, 1891, and Section 17 (7) of the Housing Act of 1909. For the reasons stated in the preceding section of this Report, very little is being done, only the very worst rooms being taken up. It is known that there are many rooms, particularly those used as bedrooms for the staffs of the smaller hotels, etc., ought to be dealt with. Last year no action was taken under the Public Health Act and only 8 Orders were made under the Housing Act. Five Orders (including one made in 1919) were determined during the year, the underground rooms having been brought into conformity with the Regulations made by the Council under Section 17 (7) of the Housing Act of 1909. The use of the rooms for sleeping was given up at two houses, the tenants leaving, and in two other instances proceedings were in progress at the end of the year to secure compliance with the Orders. (See also Table XXV.). Tenement Houses.—Although the supervision of these houses was much more complete last year than in 1919 or 1920 (see Table XXVI.), this work is still much below the præ-war standard. It requires more time to inspect the property owing to the larger number of defects requiring attention, there is greater delay in attending to Notices which involves more frequent re-inspections and it is more difficult to secure satisfactory work so that closer supervision is necessary. In addition, much of the time of the two Inspectors has been taken up in connection with Notices under Section 28 of the Housing Act, 1919—Compulsory Repairs. The number of houses on the Register has remained unchanged at 1,404, a figure which is believed to represent only a part—a large part—of the houses which should be registered. 35 HOUSING The inspections made during the year for all purposes including Annual Cleansing, numbered 4,382. Table XXVI. shows the defects, etc., requiring attention. The most striking figures are those relating to dirty (3,275) and verminous (344) rooms. Defective roofs (251) also bulk largely. Overcrowding.— The number of cases (2) reported is very small, and form a striking contrast with the number reported in 1913. (See below.) For reasons which have already been stated under Unfit Houses and elsewhere, cases of slight overcrowding were passed over during the past year, but as will appear in the Section headed Annual Cleansing Overcrowding. All cases reported 1913 1919 1920 1921 Tenements 183 8 3 2 Rooms 234 11 3 2 Occupants, total 958 65 15 12 Under 10 years of age 419 20 5 7 Aged 10 years and upwards 539 45 10 5 there is good reason to hold that legal overcrowding was not so prevalent last year as before the war, notwithstanding the deficiency of housing accommodation. Annual Cleansing.— No attempt was made to secure the cleansing of every house on the Register that being more than the two Inspectors could undertake with their other work. Before the War each of the District Inspectors had certain of the "Registered Streets" allotted to him for this work, now owing to the arrears of other work it is impossible to make such allocation. Even with the restriction of the Annual Cleansing, some 6-8 months are required for completion. No particulars have been taken out separately for the Annual Cleasing, the figures in Table XXVI. including defects. etc., found in connection with the work. Summaries were prepared of the population found in the streets dealt with, the analysis of which has disclosed an unexpected improvement in the housing conditions. The streets selected for special cleansing were— Clarendon Street Area— Waverley Road Area— Cirencester Street Philip Terrace Alfred Road Paignton Street Clarendon Street Ranelagh Road Brindley Street Torquay Street Dartington Terrace Senior Street Hampden Street Waverley Road Desborough Street Statham Street Waverley Terrace Hasborough Street Woodchester Street Westbourne Terrace North Amberley Road Area— North Wharf Road Area— Amberley Road Church Place Hermitage Street Braden Street Dudley Street Wellings Place Netley Street Star Street In the above tabulation the streets have been grouped under the headings of the "Special Areas" so frequently referred to in these reports. In the above streets 3,510 tenements were inspected last year, comprising 7,362 rooms occupied by 12,632 persons, of whom 3,496 were children under 10 years of age. Comparing the foregoing with the records of 1913—the last year when the Annual Cleansing included a complete enumeration—it appears that on that occasion 3,550 tenements were inspected comprising 7,404 rooms occupied by 12,599 persons, of whom 3,892 were children under 10 years of age:— Differences 1913 1921 (1921) Tenements 3550 3510 -40 Rooms 7404 7362 -42 Occupants, Total 12599 12632 +33 Aged under 10 years 3892 3496 -396 10 years and upwards 8707 9136 +429 The numbers of tenements and of rooms inspected on both occasions were to all intents the same, as also the total number of occupants. The returns for last year show, however, a decrease of 10.2 per cent. in the number of children under 10 years of age and an increase of 4'9 per cent. in occupants aged 10 years and upwards. The average number of occupants (all ages) per tenement increased from 3.54 in 1913 to 3.60 in 1921, and per room from 1.701 to 1.715, both changes being insignificant. 36 housing The distribution of the occupants in tenements of various sizes is shown in the appended statement:— Percentages of Total Occupants. Tenements comprising 1913 1921 1 Room 22.74 16.46 2 Rooms 49.86 48.90 3 ,, 17.20 19.44 4 ,, 59.7 9.50 5 Rooms and over 4.20 5.67 Single-room tenements decreased from 1,400 to 1,103—a fall of 21*3 per cent.—whereas all other tenements show increases :— Those of 2 rooms from 1480 to 1573 — increase 6.2 per cent. ; 3 „ „ 429 „ 501 „ 16.7„ ; 4 „ „ 146 „ 213 „ 45 9 „ ; and „ 5 and over „ 95 „ 113 „ 18'9 „ ; The averages per tenement and room—taking each category of tenements as a whole— are shown below:— In all Tenements of each Category. No. of Rooms. Total No. Rooms. Total Population. No. of Occupants. Per Tenement. Per Room. 1913 1921 1913 1921 19.13 1921 1913 1921 1 1400 1103 2866 2080 2.04 1.88 2.04 1.88 2 2960 3146 6282 6178 4.24 3.92 2.12 1.96 3 1287 1503 2168 2456 5.05 4.90 1.68 1.63 4 584 852 753 1201 5.15 5.63 1.29 1.41 5 and over 573 758 530 717 5.75 6.34 0.92 0.94 The only categories of tenements in which the average number of occupants exceeded the theoretical standard of "crowding," viz., an excess of 2 persons of all ages per room—were the 1-room and 2-room tenements inspected in 1913. In 1921 the only class tenement notably approaching that limit were the 2-room tenements with an average of 1.96 persons per room. The foregoing calculations indicate a distinct improvement in housing. The figures now to be set out may be regarded as even more satisfactory. In this part of the subject consideration will be limited to tenements containing less than 5 rooms. Examination of the detailed tabulations for the two years—not included in this report— show that at each enumeration there were many tenements with more than two persons (of all ages) per room. The recorded numbers of such tenements are:— 1 room 1913 352 1921 250 — decrease 29.0 per cent. 2 rooms 639 541 — „ 14.7 „ 3 rooms 106 114 — increase 7.5 „ 4 rooms 10 22 — „ 12.0 „ In 1913 47.2 per cent. of the total occupants of all the tenements inspected lived in tenements thus "crowded", the proportion falling to 39.9 in 1921. The changes of the proportions in the various sizes of tenements were— Percentages of Total Occupants of Inspected Tenements. No. of Rooms. 1913 1921 1 10.19 6.71 2 29.64 25.07 3 6.66 7.05 4 0.73 1.05 Children under 10 years of age are more prejudiced by "crowding" than are their seniors. It is satisfactory to observe that the number of children in such tenements fell from 2,821 (74.3 per cent of all children under 10 living in tenements of less than 5 rooms) to 2,257 (66.9 per cent)—equal to a reduction of 20 per cent. In the foregoing paragraphs the theoretical standard of "crowding"—the RegistrarGeneral's test of overcrowding—has been used. That standard is no measure of legal overcrowding as defined in the Bye Laws for Houses let in Lodgings. To convert the theoretical standard to the legal is impossible without knowledge of the actual dimensions of the rooms forming the tenement. From a general knowledge of the houses in which the tenements furnishing the data which have been discussed in the preceding paragraphs, it may be surmised that (on an average) 4 persons per room would not constitute legal overcrowding. 37 workshops Without wishing to be dogmatic, the figures here furnished afford some confirmation of the probability of freedom from overcrowding in the majority of tenements in registered houses. It may be added that the returns of overcrowding for 1913 took cognisance of any deficiency, however small, from the standards of cubic space prescribed by the Bye-laws. Common Lodging Houses.—There are 5 houses in Kilburn Lane with accommodation for 128 men and 37 women. These houses are only inspected once a year on receiving the Notices of Application for renewal of licenses. At other times the inspections are made by the officers of the County Council. No cases of infectious disease were reported during the year among the users of these houses. There were 8 deaths registered locally—including 3 from cancer (male 1, females 2) and 2 from pulmonary tuberculosis (one of each sex). Inland Revenue Acts.—Three (3) certificates for exemption or reduction of the Inhabited House Duty—covering 6 flats—were issued last year, and one was refused after application made in 1920. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920.—The Medical Officer of Health was consulted with reference to 177 notices under the Act, and 107 applications for Certificates under Sec. 2 (2) of the Act were received. In the second half of the year 1920 the corresponding figures were 75 and 21. Of the 107 applications, 82 resulted in the issue of certificates, 9 applications were refused, and in 16 instances the applications were either abandoned or the issue of the certificates deferred to the current year. What action is taken on receiving the certificate is rarely known. Some of the recipients consider that on receipt of the certificates they are entitled to refuse to pay the increase of rent—an error which the Department seeks to correct as soon as known. Very occasionally the officers are subpœned to give evidence either in support of applications to the County Court for a Suspensory Order and still more rarely in support of applications for recission of such Orders. In every instance when the condition of the premises constitutes a nuisance— probably that applies to the majority of the houses—notices are served under the Public Health Act and (or) Bye-laws thereunder. L.C.C. Houses.—During the past year 11 families in need of better housing accommodation were recommended to the Housing Department of the County Council for preferential treatment. In four instances the families withdrew their applications at a later date. Four families had secured houses on the Council's Estates before the end of the year and three others were awaiting " prae-war " tenements, either because the rent was less or the accommodation in the newer houses in excess of their requirements. In the course of the two years 14 families have secured houses on the Council's new Estates. Unfortunately, the County Council intimated that no more names could be accepted for the waiting list, as the supply of new houses was practically exhausted. It is hoped that as other estates are developed it will be possible to resume the recommendations. IV.—WORKSHOPS. Registration.—At the end of 1920 there were 1,397 premises on the Register of which total 247 were closed during the past year. The premises added during 1921 numbered 119 and the total on the Register on December 31st of last year was 1,269, (Table XXVII). As will be seen from the appended tabulation the number of premises under supervision has fluctuated 1913 1914 1915 1916 1917 1918 1919 1920 1921 On Register, January 1 1514 1421 1446 1410 1436 1416 1400 1479 1397 Removed from Register 293 138 214 51 75 41 35 174 247 Added to Register 200 163 178 77 55 25 114 92 119 On Register, December 31 1421 1446 1410 1436 1416 1400 1479 1397 1269 in an irregular manner since 1914, due in part to the circumstances attaching to the war and to the financial difficulties which have ensued since. The Home Office reported the opening of 32 premises, of which 24 were on the Register when the information was received. Below will be found an analysis of the premises on the Register according to their status under Factory Law. The comparison between the figures for "factories" and 38 workshops shops "on the Register in 1913 and 1921, indicate considerable economic changes. While the Factories Workshops (Laundries) (Domestic) Workplaces “Single Workers" (Outworkers) 19131 28(32) 942(16) 36 299(256) 1920 168(21) 911 (9) 7 302(261) 1921 171(32) 741 (9) 45 367(224) total of these two classes in the latter year shows a decrease of nearly 15 per cent—from 1,070 in 1913 to 912 in 1921, the number of factories has increased by rather more than one-third— from 128 in 1913 to 171 in 1921—and that of workshops has decreased by over 20 per cent— from 942 in 1913 to 741 in 1921. The number of "outworkers" has fallen in the same period from 304 to 265, or just on 13 per cent. In Table XXVII. analyses of the trades carried on in the premises on the Register in the two years will be found. Factory legislation recognises three classes of workers viz, “women," “young persons" and "men," The numbers of workers in those categories are shown below. The total number of workers has fallen from 8,485 in 1913 to 6,073 in 1921—a shrinkage of over 28 per cent. There Women. Young Persons. Men. 1913 4184(259) 629(55) 3672(152) 1920 2161(309) 158(27) 2696(311) 1921 2371(241) 252(12) 3450(298) have been, moreover, considerable changes in the proportions of the three classes of workers, the percentage of all workers of women employed falling from 49.3 in 1913 to 39.0 in 1921, that of young persons from 7.4 to 4.l while that of men has increased from 43.2 to 56.8. Outworkers.— The numbers of lists received from local and from other authorities do not show much varation but it is evident that trade and employment have not yet reached normal conditions. 1913 1914 1915 1916 1917 1918 1919 1920 1921 No. of Lists received from Local Employers— February 54 58 56 47 44 39 33 39 39 August 64 59 49 45 46 40 39 39 39 Totals for Year 118 117 105 92 90 79 72 78 78 Local Workers 187 214 286 180 262 155 145 100 135 Outlying „ 359 361 273 374 230 328 240 339 303 Other Authorities 61 55 66 69 65 68 63 72 65 Workers listed 372 379 359 341 356 372 367 461 392 No. of Outworkers on Register, December 31 466 343 386 394 381 373 675 647 551 Inspections.— The Inspections of premises on the Register numbered 2,515 last year, 415 of the inspections being made on adding new premises to the Register. In 1920 the inspections totalled 2,623 and in 1919, 2,929. The number of workrooms measured last year was 17 as compared with 19 in 1920 and 36 in 1919. Home Office Complaints.— The Home Office forwarded 21 complaints last year, as compared with 29 in 1920 and 21 in 1919. Seven (7) of the complaints related to dirty conditions of the workrooms, 6 to defective closet apparatus, 3 to insufficient closet accommodation, and 2 to inadequate ventilation of the workrooms. The complaints were duly attended to and remedied. Nuisances (or Offences) dealt with.— During the year 66 infringements of the Acts were discovered (and dealt with) as compared with 91 in 1920 and 85 in 1919. The principal items dealt with are set out below. 1913 1919 192C 1921 Workrooms dirty 89 33 42 34 „ overcrowded 21 3 1 2 „ insufficiently ventilated 7 2 5 4 W.C. apparatus defective 35 43 37 25 No separate accommodation 1 2 3 2 Insufficient accommodation — 2 3 — Sickness.— The numbers of cases of infectious disease reported in outworkers' homes during the last three years are set out below. 1919 1920 1921 Measles 21 6 1 Chickenpox 1 1 2 Whooping Cough — 2 2 Diphtheria 2 1 3 Scarlet fever 1 — 12 Erysipelas 1 — — 39 Food supervision Bakehouses.— At the end of 1920 there were 68 bakehouses in use—25 “level" and 43 “underground"—including 29 factory bakehouses 10 "level" and 19 "underground". During the past year 7 "level " bakehouses went out of use and 1 was re-opened, in addition to 3 " underground " which were re-opened. At the close of the year there were 65 bakehouses in use—19 "level" and 46 "underground"—including 37 factories—11 "level" and 26 "undergound." The workers in the bakehouses numbered 314. V.— FOOD SUPERVISION. Slaughterhouses.— The number of premises licensed remains unchanged at 5, but at one (Upper Brook Mews) the Department has no record of any slaughtering having taken place for many months. For the quinquennium 1909-13 the annual average number of animals slaughtered was 4,434, falling in the following quinquennium to 2,893. During the last three years the numbers have been—1919, 4,636; 1920, 2,482; and 1921,1,743, including 6 pigs. The killing of pigs at slaughterhouses which were not specially licensed for that purpose, was prohibited until the last months of the war. The appended statement shows Annual Averages. Totals. 1909-18 1914-18 1919 1920 1921 Bullocks 85 286 1,071 401 50 Calves 2 — 296 508 6 Sheep 4,347 2,607 3,222 1,545 1,681 somewhat remarkable changes in proportions of animals slaughtered locally during the last three years. As the inspection of slaughterhouses is almost entirely limited to visits to inspect slaughterings, the great reduction in the amount of that work has resulted in a corresponding reduction in the number of inspections which totalled 174 last year, as compared with 320 in 1920, and 510 in 1919. There was an improvement in the health of the animals slaughtered last year, none being found in a state calling for condemnation, and only five organs being destroyed, viz. 4 livers (bullocks')—2 each on account of abscess and parasites, and one pluck on account of tuberculosis. The diminution in the prevalence of tuberculosis among the bullocks slaughtered is manifest from the following tabulation. Bullocks—Parts found Tuberculous. Liver Lungs Spleen Heart Mesentery Tripe Head and Tongue 1918 18 48 5 4 10 4 9 1919 29 34 7 12 9 7 13 1920 19 26 5 7 3 — 3 1921 — 1 — — — — — Food Shops.— At the end of the year these numbered 440, as compared with 482 in 1913, and 389 in 1918. In the appended tabulation the numbers of the different branches of the food trade are shown. Food Trade. Butchers 77 Fishmongers 29 Fish Friers 32 Refreshments 90 Game and Poultry 15 Greengrocers 85 Margarine 16 Milk Vendors 96 Among the above: Fish Curers 6 Sausage Makers 8 Of the trades shown above, the sale of milk and of margarine are the only two subject to registration. Last year 4 milkshops were closed, and 7 changed hands. The 96 registered vendors comprised at the end of the year— Dairymen, wholesale 6 „ retail 50 Grocers 23 General dealers 9 Refreshment house proprietors 8 There is also one cowshed (3 cows) within the Borough. The inspections of the premises where milk is sold numbered 282, and of all other premises connected with the food trade, 733. There were three cases of scarlet fever at one 40 rats and mice milkshop, and 11 cases of diphtheria, and 27 of scarlet fever in the families of milk roundsmen, or the houses where they lived. Due precautions were taken in every instance and there was no evidence of any spread of infection through the trade. Ice-cream Trade.— This trade appears to have recovered its præ-war vigour. Last year 16 names were added to the Register, making a total of 87 vendors, comprising— Proprietors of Sweet Shops 21 General Dealers 26 Refreshment House Keepers 19 Newagents 6 Greengrocers 1 Confectioners 6 Bakers 8 There are 9 "barrow men" of whom 3 trade outside the Borough. Unsound Food.— While no seizure of unsound food was made during the year, a total of 9,604 lbs. of food stuffs were surrendered for destruction, of which amount 140 lbs. (1.4 per cent.) was in course of transit, the same weight being dealt with at the slaughter houses. In 1919 the total weight of food stuffs destroyed was 28,336 lbs. (10.5 per cent. being in transit), and in 1920, 20,564 lbs. (27.9 per cent. in transit). The saving of food stuffs indicated by the foregoing figures is the more satisfactory when the meteorological conditions of the summer of 1921 are taken into consideration. Other Work.— In addition to the work which may be designated "normal," of which details have been given in the foregoing paragraphs, the Food Inspector made 150 enquiries with reference to profiteering, and 160 on behalf of the Food Controller, whose functions were revived during the coal strike. VI.—RATS AND MICE DESTRUCTION. The Department received 65 complaints during the year, 6 of which referred to mice. In 6 instances the complaints proved to be unfounded. Where there was prima facie evidence of the presence of rats the drainage system of the house and of adjacent premises was examined, such examination including the sewer connexions beyond the curtilages of the premises. New sewer connexions were laid in to 33 houses and complete systems of new drains to 4 houses. Minor defects to house drains were made good and in certain instances new floors—some solid—put down in the basements. Separate records of these works have not been kept. Rat poison was issued free to a large proportion of the occupiers of the houses infested with rats. A "Rat week" was held from 31st October to 5th November. The procedure described in previous Reports was followed, but as to results nothing can be said, except that the baits disappeared. No dead rats were found. VII.—SALE OF FOOD AND DRUGS ACTS. Sampling.—The samples obtained numbered 601, of which 33 (5.4 per cent.) were found to be adulterated. (See Table XXVIII.). In 1919 the proportion of adulterated samples was 5.1, and in 1920, 0.8. The proportions cited are in marked contrast with the averages for the two preceding quinquennia—1909-13, 10.6 per cent.; 1914-18, 9.3. Milk.—More than half the samples—313 in all—were of milk, 16 (5.1 per cent.) being below the prescribed standard. In 1919, the proportion of adulteration was 7.2, and in 1920, 1.2, the quinquennial averages being 1909-13, 1T3, and 1914-18, 10.2. Of 53 samples taken at the Paddington terminus in the second and third quarters of the year, 11 were adulterated—20.7 per cent. as compared with 16.5 per cent. in 1919, and 4.4 in 1920. During 1909-13 the percentage was 29.6, and that during 1914-18, 39.2. Of 64 "Sunday" samples only 1 (1.5 per cent.) was not up to standard, as compared with 5.1 per cent. during 1919-20, and 5.9 during 1914-18. Excluding the 117 railway and "Sunday" samples, there remain 196 "shop" samples, or which 4 were adulterated. The proportion of adulteration, 2.0 per cent., was slightly worse than that recorded for the years 1919-20, viz. 1.3 per cent. Other Samples.—Of the 313 samples of commodities other than milk, 17 were found to be adulterated, equal to 59 per cent. In 1919, of 156 similar samples, 2 (1.2 per cent.) were adulterated, and in 1920 of 269 samples, 1 (0.3 per cent.). Last year's proportion was by no means satisfactory. 41 CLERICAL WORK The adulteration found in the samples of sausages, mincemeat, sponge cake and lime juice was due to the addition (undeclared) of preservatives. The three adulterated samples of sausages which were taken at the middle or December, were found to contain boric acid—2 of 15 grains to the lb. and one of 8. The three samples of mincemeat, also taken in December, contained 12 grains of salicylic acid to the lb. in two samples and 15 grains in the third. The 5 adulterated samples of sponge cake contained boric acid in amounts varying from 5 to 20 grains to the lb. As regards these last, it was ascertained that "liquid eggs" were used in the manufacture of the cakes. Three samples of the "liquid eggs" were obtained, which were found to contain from ¾ to 1¼ per cent. of boric acid, i.e., 52½ to 88½ grains to the lb. By direction of the Public Health Committee the facts were reported to the Ministry of Health. As regards the lime juice, the samples contained from .01—.08 per cent. of benzoic acid. The quantities of preservatives reported in the above paragraphs were individually small—may be even described as insignificant except for those susceptible to the drug named. When, however, it is remembered that the addition of chemical preservative is widespread, it may happen that more than the official dose of any one preservative—if recognised at all for internal administration—may be taken at a single meal. It is full time that the addition of chemicals to articles of food should be very strictly regulated by law. One condition should be a declaration of the nature and amount of chemical used. Cream Regulations.—Included among the 8 samples of cream were 5 of “preserved" cream, all containing more than 35 per cent. of fat. Preservative was found in 4 of the 5 samples, in quantities ranging from 0.30—0.43 per cent. All the “preserved" creams were labelled as required by the Regulations, and no addition of “thickening substances" was detected. VIII.—CLERICAL WORK. A numerical statement of so much of the work of the Clerical Staff as can be reduced to statistics will be found in Table XXIX. It must suffice to say that work continues to grow not only in quantity but in complexity. The administration of the recent Housing Acts and of the Tuberculosis Scheme has involved a very great increase in the dossiers to be kept and in correspondence. The taking over by the Council of the granting of milk, etc., at less than cost price and the purchase of stocks of milk substitutes have taken up no small part of the time of the Clerical Staff already hard pushed to get their work completed in due time. IX.—LEGAL PROCEEDINGS. Summonses were taken out under the Public Health (London) Act, 1891, and Byelaws pursuant thereto in respect of 19 offences, a statement of which will be found at the end of the Appendix. Under the Housing Acts, 6 summonses were taken for failing to enter prescribed particulars (names and addresses of the person receiving the rent and of the Medical Officer of Health) in the Rent Books, and one for obstruction to men sent to do work under contract accepted by the Council under Sec. 28 of the Act of 1919. A summons was also taken out for recovery of expenditure for work done under a similar contract. Under the Sale of Food and Drugs Acts, 16 summonses were taken out against 9 offenders, of whom two had been previously convicted. The total amount of fines imposed was £72 10s., and of costs given by the Court, £13 14s. 6d. The amounts of fines and costs recovered during the last five years have been— “Health Cases" £ s. d. 1921 35 18 0 1920 50 14 6 1919 54 12 0 1918 45 8 0 1917 14 14 6 “Adulteration Cases" £ s. d. 50 6 6 35 18 6 235 0 6 139 15 6 49 0 0 The averages of fines and costs per conviction in “Food Cases" were noticeably lower last year than in any year since 1917. 1921 1920 1919 1918 1917 £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. Fine 3 16 3 7 5 0 6 8 8 4 14 2 1 16 8 Costs 15 5 1 14 7 1 7 1 17 10 14 6 42 appendix: meteorology—general summary. APPENDIX. TABLE I. Meteorology. Mean Temperature (9.0 a.m.) Extreme Temperatures (Shade) Temperatures Rainfall Bright Sunshine Dry Bulb Wet Bulb Maximum Date Minimum Date Max. Sun Min. Grass Total Measurement No. of Days Hours of Record No of Days F° F° F° F° F° F° Inches. Hrs. Mins. 1911 51.5 49.3 96.0 Aug. 9 22.0 Feb. 1 134.0 12.0 25.34 143 1644 04 267 1912 50.5 47.9 88.0 July 14 18.0 ,, 3 130.0 10.0 27.76 158 1242 04 251 1913 51.3 49.3 84.4 June 16,17 27.0 Jan. 13 Feb. 23 Mar. 18 Dec. 31 125.0 19.0 22.52 156 1207 04 278 1914 52.5 50.1 92.0 July 1 20.0 Jan. 24 138.0 18.0 25.89 161 1459 45 287 1915 50.6 48.0 90.5 June 8 25.0 Feb. 25 129.0 20.0 33.13 148 1325 45 269 1916 50.2 47.9 85.0 July 31 25.0 Dec. 17 124.0 22.5 34.61 188 1124 46 259 1917 49.1 46.6 89.0 June 17 19.5 Feb. 7 132.0 11.0 29.80 165 1333 25 276 1918 50.0 48.0 91.0 Aug. 22 18.0 Jan. 9 132.0 11.5 31.91 182 1191 54 254 1919 49.0 46.7 90.0 Sept. 11 17.5 Feb. 9 135.0 7.5 26.58 178 1181 54 250 1920 51.0 48.5 85.0 May 25 17.0 Dec. 13 182.0 7.0 22.96 163 1077 51 256 (Means) Absolute Readings (Means) (Means) 1911-20 50.6 48.2 96.0 1911 17.0 1920 138.0 7.0 28.05 164 1278 51 265 1921 53.6 49.5 93.0 July 11 25.0 Nov. 13 138.0 19.7 14.55 116 1561 46 284 TABLE II General Summary. 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 tality 1911 142,513 2,815 57 230 2,977 21.46 2,074 14.55 407 259 1,926 13.51 399 141 387 126 1912 142,362 2,774 50 267 2,991 21.18 1,889 13.27 372 254 1,771 12.44 326 117 295 98 1913 142,229 2,832 55 242 3,019 20.87 2,071 14.33 407 315 1,979 13.68 342 121 305 101 1914 142,087 2,708 49 274 2,933 20.64 1,892 13.31 347 350 1.895 13.33 312 115 281 96 1915 131,397 2,506 59 267 2,714 20.65 2,304 17.53 370 352 2,286 17.39 343 137 319 117 1916 T,C 142,169 2,378 61 372 2,689 18.91 ... ... ... ... ... ... 289 121 253 94 136,666 ... ... ... ... ... 1,924 14.72 370 326 1,880 14.38 1917 T,C 136,561 1,834 77 334 2,091 15.31 ... ... ... ... ... ... 290 158 273 135 122,507 ... ... ... ... ... 1,997 16.30 321 374 2,050 16.73 1918 T,C 131,673 1,798 118 337 2,017 15.31 ... ... ... ... ... ... 266 148 235 116 117,517 ... ... ... ... ... 1,999 17.01 345 595 2,249 19.13 1919 T,C 149,941 2,016 154 454 2,316 15.44 ... ... ... ... ... ... 213 105 212 91 143,938 ... ... ... ... ... 1,499 10.41 310 725 1,914 13.29 1920 T,C 150,128 3,181 251 483 3,413 22.73 ... ... ... ... ... ... 279 87 266 78 149,673 ... ... ... ... ... 1,667 11.13 370 410 1,707 11.40 1921 145,600 2,653 296 502 2,859 19.63 1,784 12.25 372 346 1,758 12.07 307 115 263 92 "T"—Total; "C "—Civil. Area of Borough (stat. acres) Total Population 142,551 Total 1,356.1 Number of inhabited houses 16,686 16,686 Waterways 20.0. Average number of persons per house 8.5 Census 1911. Total Population—Census, 1921. 144,273. 43 APPENDIX: BIRTHS AND DEATHS. TABLE III. Births and Deaths. Annual Numbers: Averages. Wards. Borough Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde West. East.  Birth 1917 2091 250 487 327 335 458 52 46 136 1918 2017 200 501 298 353 454 55 53 103 1919 2316 274 526 345 884 492 78 64 153 1920 3413 841 770 527 623 761 97 95 199 1921 2859 294 562 466 551 632 92 79 183 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 1921 90 76 77 112 118 87 148 134 107 Deaths: All Ages. 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 1921 1758 178 343 282 349 314 101 65 126 Annual Averages— 1909-13 1887 207 382 261 326 447 68 61 135 1914-18 2072 226 404 319 366 452 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 1921 93 86 89 103 107 70 148 106 88 Deaths: Under One Year. 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 1921 263 20 38 34 63 73 2 10 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 1921 82 52 60 89 116 71 300 333 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 1921 86 68 77 79 98 81 191 206 78 For Index Numbers: Annual Average 1909-13 = 100. 44 APPENDIX: DEATHS—ALL CAUSES. TABLE IV. Deaths: All Causes. (Corrected Numbers) Borough. Age. 0- 15- 20- 25- 35- 45- 55- 65- 75- 85 & Upw'ds All Ages. M ales. Annual 1909-13 289 11 14 50 77 105 134 131 82 19 912 Averages 1914-18 273 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 1921 226 14 18 36 63 108 142 141 104 23 875 Females. Annual (1909-13 238 15 16 50 73 104 115 153 150 61 975 Averages 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 1921 164 14 14 56 51 100 117 162 155 50 883 Persons. Annual 1909-13 527 26 30 100 150 209 249 284 232 80 1887 Averages 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 1921 390 28 32 92 114 208 259 303 259 73 1758 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 1921 78 127 128 72 81 103 106 109 127 121 96 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 1921 68 93 87 112 69 96 101 106 103 82 90 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 1921 74 107 106 92 76 99 104 106 111 91 93 Averages 1909-13 = 100. 45 appendix: sickness—cases reported. vaccination returns. TABLE Y. Sickness: Cases Reported. Borough. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Smallpox ... ... ... 1* ... ... ... ... ... ... Diphtheria 244 293 286 266 207 227 254 255 461 442 Membranous Croup 4 3 3 7 2 2 4 4 3 3 Erysipelas 117 112 141 137 104 66 56 76 81 83 Fevers.Fevers. Scarlet 272 484 738 436 272 124 150 261 501 827 Enteric 15 25 10 18 23 12 13 10 19 13 Continued ... ... 2 1 ... ... ... ... ... ... Puerperal 11 8 10 7 8 7 2 15 15 16 Cerebro-spinal 7 ... 2 10 9 7 3 7 1 2 Posterior Basic Meningitis ... ... ... 4 ... ... ... ... ... ... Acute Poliomyelitis 6 2 3 1 4 1 ... 5 2 1 Ophthalmia Neonatorum 31 22 51 31 20 27 22 30 29 34 Dysentery 3(a) 1 2 Encephalitis Lethargica 3(a) 2 7 Malaria 64(a) 24 7 Pneumonia, Influenzal 87(a) 45 27 Pneumonia, Primary 83(a) 96 105 Trench Fever 1(a) ... ... Tuberculosis—Total 835 664 545 590 526 502 451 391 383 335 Pulmonary 835 492 397 426 388 355 325 284 277 244 Other Forms 172(a) 148 164 138 147 126 107 106 91 Measles†—Total 1398 1240 424 3721 746 4245 1519 1890 2034 205 Reported 1398 1240 111 801 200 1544 515 632 607 42 Notified 313(a) 2920 546 2701 1004 1258 1427 163 Chickenpox— Total 459 599 555 644 468 406 813 261 568 253 Reported 459 399 555 560 468 406 606 261 568 253 Notified 84(b) 207(b) Whooping Cough ‡ 377 644 558 365 540 325 691 160 357 613 Mumps‡ 341 203 247 167 180 200 680 150 154 494 Ringworm‡ 267 148 196 125 152 117 111 189 204 122 * Error. † Measles (morbilli) and German Measles (rubeola). ‡Reported, i.e., not notified. (a) First year of notification. (b) Notified during part of year only. TABLE VI. 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 38 354 155 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 1920 3,196 2,106 12 174 71.7 23 694 187 28.3 46 APPENDIX: NOTIFICATIONS. TABLE VII. Notifications: Wards. Quarterly and Annual Averages. 19141918 Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. 1916-20 1920 1921 1916-20 1920 1921 1916-20 1920 1921 1916-20 1920 1921 1916-20 1920 1921 1916-20 1920 1921 1916-20 1920 1921 1916-20 1920 1921 Diphtheria. 1 9 62 28 14 32 34 10 7 26 11 21 40 16 16 17 1 3 1 1 4 8 3 7 9 2 7 24 7 16 20 24 9 8 6 8 16 15 15 12 11 2 8 2 1 3 4 7 2 5 3 7 16 9 14 8 13 10 6 9 7 18 20 15 8 17 0 8 1 1 3 1 3 ... 3 4 9 26 24 15 27 32 9 21 14 9 39 32 16 25 25 2 4 3 2 6 1 3 4 4 Totals 32 128 68 58 87 103 38 42 55 34 94 107 62 61 70 5 23 7 5 16 14 16 13 21 Scarlet Fever. 1 16 20 18 21 31 38 15 8 25 10 7 20 20 9 29 3 2 2 2 3 10 2 8 10 2 9 9 10 16 14 61 10 11 22 8 8 21 16 13 35 3 1 11 2 5 10 4 1 4 3 16 27 22 18 35 62 7 12 30 11 15 29 16 21 58 1 ... 8 2 2 3 2 4 3 4 20 60 42 29 82 85 11 26 32 23 23 44 18 24 58 2 3 8 3 5 7 8 12 10 Totals 61 116 92 84 162 246 43 57 109 53 53 114 70 67 180 9 6 29 9 15 30 16 25 27 47 APPENDIX: SICKNESS. TABLE VIII. Notifications. Sickness: Removals. Deaths. "Errors" indicated thus ( ). “-"nil return.“0" average less than unity. Diphtheria (including Membranous Croup). Scarlet Fever. Enteric Fever. Averages. 1916-20 1920 1921 Averages. 1916-20 1920 1921 Averages. 1916-20 1920 1921 Cases Reported. Queen's Park 45 (2) 128 (6) 68 (13) 50 (2) 116 (2) 92 (6) 1 (0) 1 (1) ... Harrow Road 63 (4) 87 (7) 103 (10) 74 (4) 162 (7) 246(15) 2 (0) 2 (1) 1 (1) Maida Vale 37 (3) 42 (3) 55 (7) 32 (2) 57 (1) 109 (2) 2 (1) 2 (1) 1 (-) Westbourne 46 (4) 94 (5) 107 (10) 37 (3) 53 (4) 114 (4) 2 (1) 2 (1) 3 (1) Church 59 (5) 61 (7) 70 (10) 45 (4) 67 (6) 180(11) 2 (0) 1 (-) 1 (-) Lancaster Gate West 9 (0) 23 (1) 7 (1) 5 (-) 6 (-) 29 (2) 2 (0) 2 (-) 2 (1) East 10 (0) 16 (1) 14 (1) 8 (0) 15 (-) 30 (1) 3 (0) 5 (-) 2 (-) Hyde Park 16 (1) 13 (1) 21 (3) 11 (1) 25 (1) 27 (2) 2 (-) 4 (-) 3 -) Borough 285 (19) 464 (31) 445 (55) 262 (16) 501 (21) 827 (43) 16 (2) 19 (4) 13 (3) Cases Removed to Hospital. Queen's Park 40 (2) 112 (6) 67(13) 47 (2) 109 (2) 90 (6) 1 (0) 1 (1) Harrow Road 58 (3) 75 (7) 96 (9) 70 (4) 152 (6) 240(15) 1 (0) 2 (1) 1 (1) Maida Vale 32 (2) 29 (3 ) 52 (7) 30 (2) 54 (1) 104 (2) 2 (1) 2 (1) ... Westbourae 43 (4) 88 (4) 103(10) 36 (3) 50 (4) 110 (4) 2 (0) 2 (1) 3 (1) Church 55 (5) 57 (7) 68(10) 44 (4) 65 (6) 179(11) 2 (0) 1 (-) 1 (-) Lancaster Gate West 8 (0) 22 (1) 6 (1) 4 (-) 5 (-) 28 (2) 2 (0) 2 (-) ... East 9 (0) 15 (1) 14 (1) 8 (0) 14 (-) 28 (1) 2 (0) 4 (-) 1 (-) Hyde Park 15 (1) 10 (1) 18 (3) 9 (1) 24 (1) 25 (2) 1 (-) 2 (-) 2 (-) Borough 260(17) 408(30) 424(54) 248(16) 473(20) 804(43) 13 (1) 16 (4) 8 (2) Deaths at Home. Queen's Park 1 2 ... 0 ... ... ... ... ... Harrow Road 1 1 ... ... ... ...... 0 ... ... Maida Vale ... ... ... ... ... ... ... ... ... Westbourne 0 ... 1 ... ... ... ... ... ... Church 0 ... ... ... ... ... 0 ... ... Lancaster Gate West ... ... ... ... ... ... ... ... ... East 0 1 ... ... ... ... ... ... ... Hyde Park ... ... ... ... ... ... ... ... ... Borough 2 4 1 0 ... ... 0 ... ... Deaths in Hospital. Queen's Park 3 9 1 0 1 1 (1) 0 (0) 1 (1) ... Harrow Road 3 6 8 1 1 2 (1) ... ... ... Maida Vale 6 (0) 1 (1) 2 (0) ... ... ... ... ... Westbourne 2 4 9 (4) 1 ... ... ... ... ... Church 3 (0) 4 (2) 5 (4) 0 ... ... ... ... ... Lancaster Gate West 0 1 1 ... ... ... ... ... ... East 1 1 2 (1) 0 ... ... ... ... ... Hyde Park 1 ... 1 ... ... ... 0 ... ... Borough 19 (0) 25 (2) 28 (10) 4 (0) 2 3 (2) 0 (0) 1 (1) ... 48 appendix: deaths op residents of the borough, TABLE IX. Deaths of Residents of the Borough, 1921. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Death 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 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 2 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Scarlet Fever 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Whooping Cough 21 10 11 1 4 7 4 2 3 ... ... ... ... ... ... ... ... ... ... 3 3 Diphtheria, Membranous Croup 22 4 18 2 ... 1 1 ... 3 1 12 ... 1 ... ... ... ... ... 1 4 16 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 41 16 25 1 ... ... 1 1 ... ... ... 1 3 3 4 6 10 4 7 4 7 Erysipelas 6 4 2 ... ... ... 1 ... ... ... ... 1 ... 1 ... 2 1 ... ... 3 1 Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 8 4 4 ... 1 ... ... ... 1 1 ... ... ... 2 1 ... ... 1 1 4 2 Pulmonary Tuberculosis A. Phthisis 94 54 40 ... ... ... ... ... ... ... ... 11 12 23 17 18 8 2 3 33 19 Tub. Meningitis, A. Hydrocephalus 12 4 8 1 ... ... 3 1 1 2 1 ... 1 ... 2 ... ... ... ... 4 8 Other Forms of Tuberculosis 19 12 7 1 ... ... ... ... ... 2 ... 4 3 2 2 2 2 1 11 4 Syphilis 6 4 2 3 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 3 2 Cancer 226 93 133 1 ... ... ... ... ... 1 1 ... ... 2 12 51 73 38 47 50 62 Rheumatic Fever 7 5 2 ... ... ... ... ... ... 2 ... 1 ... 1 2 1 ... ... ... 3 ... Alcoholism 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 2 ... Inflammation and Softening of Brain 3 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 Cerebro-spinal Fever 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Simple Meningitis 10 5 5 3 1 ... 3 ... ... ... 1 ... ... 1 ... 1 ... ... ... 4 4 Cerebral Haemorrhage 78 33 45 ... ... ... ... ... ... ... ... ... ... 1 3 12 20 20 22 12 13 Apoplexy 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... Convulsions 7 4 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Endocarditis 3 1 2 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 Heart Disease 198 95 103 ... ... ... ... ... ... 1 ... 2 4 11 8 33 24 48 67 34 19 Bronchitis 139 74 85 8 2 2 2 ... ... ... ... ... ... 2 4 22 11 40 66 21 22 Lobular (Broncho-)Pneumonia 71 40 31 21 10 6 4 ... 2 ... 3 ... ... 1 2 5 3 7 7 27 15 Lobar (Croupous) Pneumonia 25 16 9 1 ... 1 1 1 ... ... ... ... ... 4 2 7 4 2 2 7 4 Pneumonia 38 23 15 2 ... 1 ... 1 ... ... 2 ... ... 7 5 5 2 7 6 7 2 Other Diseases of Respiratory Organs 23 16 7 3 1 ... 1 ... ... ... ... 3 ... 2 ... 6 2 2 3 4 2 Diseases of Stomach 11 8 3 ... ... ... ... ... ... 1 ... ... ... 2 2 2 ... 3 1 4 2 Diarrhoea and Enteritis 90 50 40 45 30 3 8 ... 1 ... ... ... ... 1 ... 1 ... ... 1 41 33 Appendicitis 7 2 5 ... ... ... ... ... 1 ... 2 ... ... ... 1 1 1 1 ... 2 4 Obstruction of Intestines 18 7 11 ... 2 ... 1 ... ... 1 ... ... 1 1 ... 3 4 2 3 6 8 Cirrhosis of Liver 13 8 5 ... ... ... ... ... ... ... ... ... ... 1 ... 4 3 3 2 4 3 Nephritis and Bright's Disease 48 22 26 ... ... ... ... ... ... ... ... ... ... 3 4 12 6 7 16 8 9 Tumours (N.-M.), &c., Female Genital Organs 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 2 ... 2 Puerperal Fever 4 ... 4 ... ... . .. ... ... ... ... ... ... ... ... 4 ... ... ... ... ... 3 Accidents and Diseases of Parturition 9 ... 9 ... ... ... ... ... ... ... ... ... 1 ... 8 ... ... ... ... ... 6 Congenital Defects 20 13 7 11 6 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... 7 2 Premature Birth 55 37 18 37 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 5 Developmental Diseases 25 18 7 17 7 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 9 2 Old Age 83 31 52 ... ... ... ... ... . . . ... ... ... ... ... ... ... ... 31 52 12 20 Suicide 28 16 12 ... ... ... ... ... ... ... ... 1 ... 5 5 8 5 2 2 4 2 Overlaid in Bed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 48 27 21 4 2 1 1 ... ... 3 ... 6 1 2 ... 8 8 3 9 13 13 Homicide 2 1 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All other Causes 201 110 91 3 2 1 ... 2 2 4 3 2 1 18 13 37 26 43 44 61 40 All Causes 1758 375 883 170 93 26 31 10 14 20 26 32 28 99 107 250 217 268 367 432 369 *Uncertified 3 1 2 ... 2 ... ... ... ... ... ... ... ... ... .... 1 ... ... ... ... ... * Included in above. 49 appendix : deaths—persons, all ages. TABLE IXA. Deaths: Persons, All Ages. Index Numbers. Index Numbers. Index Numbers. Causes of Death. Based on Averages 1909-13. Based on Averages 1914-18. Causes of Death. Based on Averages 1909-13. Based on Averages 1914-18. 1919 1920 1921 1919 1920 1921 1919 1920 1921 1919 1920 ###] Enteric Fever — — 50 — — 66 Bronchitis 104 80 88 115 89 97 Measles 22 50 6 21 47 5 Pneumonia, Lobular 136 118 126 105 92 98 Scarlet Fever 71 43 14 100 60 20 „ Lobar 118 73 113 96 59 92 Whooping Cough 2 40 60 3 47 70 „ Undefined 108 58 58 103 56 56 Diphtheria 170 250 220 106 156 137 Other diseases of Respiratory Fpid. Influenza 443 76 110 161 27 40 Organs 143 83 100 157 90 109 Erysipelas 125 75 150 100 60 120 Diseases of Stomach 142 75 91 142 75 91 Other Septic Diseases 100 100 100 160 160 160 Diarrhœa and Enteritis 72 70 108 87 84 130 Tuberculosis, Pulmonary 73 83 65 64 73 57 Appendicitis 61 70 53 89 100 77 „ Meningeal 62 81 75 55 72 66 Obstruction of Intestines 100 170 138 81 137 112 „ Other Forms 69 50 73 75 54 45 Cirrhosis of Liver 40 40 86 32 32 68 Syphilis 64 82 54 47 60 40 Nephritis, Bright's Disease 63 72 75 77 87 90 Cancer 100 114 133 86 98 114 Congenital Defects 89 79 105 89 79 105 Rheumatic Fever 71 128 100 167 300 233 Premature Birth 86 114 98 109 145 125 Alcoholism 18 36 36 28 57 100 Developmental Diseases 50 69 43 78 108 67 Cerebral Hæmorrhage 125 129 150 110 114 132 Old Age 120 85 80 113 81 76 Apoplexy 53 33 20 73 45 27 Suicide 112 100 175 120 107 186 Convulsions 66 44 77 150 100 175 Overlaid in Bed — 60 — — 150 — Heart Diseases 137 126 119 91 84 79 Accidents and Violence 106 110 96 70 71 62 Homicide 50 200 100 50 200 100 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. 50 appendix: tuberculosis—notifications. TABLE X. Tuberculosis— Notifications. 1917 1918 1919 1920 1921 Total Certificates received 1171 1001 942 889 928 Certificates forwarded 139 117 132 67 114 New cases certified 502 451 391 383 335 Including Inward Transfers 5 3 6 5 3 No. of Certificates received from— Private Practitioners 189 (34) 125 (18) 119 (16) 129 (15) 112 (18) District Medical Officers 33 (14) 31 (13) 9 (2) 13 (3) 4 (—) M.S.Poor Law Institutions 228 (141) 182(112) 43 (29) 119 (75) 135 (84) Paddington Tuberculosis Dispensary 148 (78) 125 (47) 131 (52) 132 (59) 112 (59) St. Mary's Hospital Dispensary 70 (29) 52 (19) 119 (52) 109 (50) 88 (41) Sanatoria 182(159) 150(134) 218(200) 171(157) 140(130) Local Hospitals 21 (1) 30 (5) 17 (1) 30 (8) 24 (6) Outlying Hospitals 106 (55) 125 (62) 98 (47) 96 (67) 182(135) Other Institutions 2 (-) 5 (-) 5 (1) 5 (-) 3 (—) School Medical Officers 32 (15) 43 (17) 36 (13) 12 (5) 10 (5) Other Medical Services 11 (4) 13 (6) 9 (6) 1 (-) 1 (1) The figures in ( ) represent " repeat" notifications. 51 APPENDIX : TUBERCULOSIS. table xi. 1921. Tuberculosis. (see table v., 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. .Suspects. Transferred to .Definite.. On Register at end of 1921 . Survivors,. Definite. Suspect Year. Definite Suspect. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 O.F. 1903 4 — 2 — 2 — — — — — — — — — — — — — — — — — — — — — — — — 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 2 17 — — 2 — — 1907 84 — 14 12 6 — 1 1 — — — 1 — — — — — 6 8 34 — — 1 — — 1908 173 — 25 11 7 4 5 1 2 3 — — — — — — 15 34 6l — — 3 — — 1909 343 286 65 25 12 8 2 1 2 — 2 9 2 1 2 6l 74 324 10 2 46 — — 1910 341 269 42 34 15 5 4 2 3 1 1 1 — — 66 66 817 7 4 53 2 1 1911 397 274 69 25 18 8 6 3 2 3 — — 2 63 90 325 10 — 66 1 — 1912 778 239 76 45 28 14 6 7 3 2 3 1 134 124 462 13 4 119 2 — 1913 812 203 105 55 24 15 8 11 5 3 — 103 140 109 3 1 100 39 — 1914 531 157 85 46 14 9 8 2 1 2 61 87 262 4 65 50 — 1915 582 129 105 41 23 7 4 2 3 30 107 235 14 1 100 64 3 526 149 107 44 14 2 4 3 22 124 200 7 — 103 59 — 159 119 32 13 8 5 21 122 195 2 — 88 56 4 1918 451 150 102 39 7 3 11 131 120 1 — 113 67 9 388 130 53 32 11 15 101 98 — 3 120 76 9 117 75 32 3 94 54 — 1 139 83 14 1921 335 90 54 — 66 26 — — 176 80 23 Totals 6,720 2.352 2 5 13 21 21 45 84 75 121 131 176 184 202 193 210 190 123 137 118 612 1,373 3,149 71 16 1,294 579 63 52 APPENDIX : TUBERCULOSIS CASES—ALL FORMS. TABLE XII. 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 5 13 205 3 1920 22 33 21 37 53 3 7 12 188 3 1921 19 44 25 34 33 6 5 5 176 5 Index Numbers 1919 82 57 90 81 64 125 100 100 75 30 1920 67 57 54 70 77 75 140 92 69 30 1921 57 76 64 64 47 150 100 38 64 50 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 13 214 3 Averages, 1914-18 26 43 32 49 62 4 7 11 234 5 1919 15 34 35 39 39 9 4 7 182 1 1920 15 28 21 63 39 7 8 9 190 2 1921 18 31 29 32 24 8 8 8 159 1 Index Numbers 1919 57 79 109 79 63 225 57 64 78 20 1920 57 65 66 128 63 175 114 82 81 40 1921 69 72 90 65 38 200 114 72 68 20 Persons. 1914 64 108 79 87 142 13 11 24 528 17 1915 75 121 92 106 128 7 11 80 570 20 1916 47 97 53 123 144 9 10 29 512 14 1917 62 95 70 98 124 10 12 18 489 13 1918 48 83 60 94 113 5 15 23 441 10 Averages, 1914-18 59 101 71 102 131 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 1921 37 75 54 66 57 14 13 13 335 6 Index Numbers 1919 71 66 98 80 63 175 75 83 76 27 1920 63 60 59 98 70 125 125 87 74 33 1921 63 74 76 64 43 175 108 54 66 40 Averages for 1914-18 = 100. 53 APPENDIX : TUBERCULOSIS—NEW CASES. TABLE XIIa. Tuberculosis : Sex-Age Distribution of New Cases Reported and Deaths. 1921. Ages (years). All Ages. 0— 1 — 5— 10— 15— 25— 35— 45— 55— 65— 75— Males. Females, Persons. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Medically Certified Cases Cases— Pulmonary — — — 1 2 4 1 4 27 34 39 30 30 18 26 10 7 8 2 1 — — 134 110 244 Other Forms — — 6 7 17 16 7 4 4 10 1 8 3 1 1 1 — 2 2 — 1 — 42 49 91 Totals — — 6 8 19 20 8 8 31 44 40 38 33 19 27 11 7 10 4 1 1 — 176 159 335 Deaths— Pulmonary — — — — — — — — 6 4 3 5 8 1 6 2 3 5 1 — — — 27 17 44 1 1 2 1 — — — — — — — — — — — — — — — 5 2 7 Other Causes P. — — — — — — — — — — — — — — — — — — — — — — 1 — 1 O.F. — — 1 — — — — — — — — — — — — — — — — — — — 1 — 1 Totals — — 2 1 2 — 1 — 6 5 3 5 9 1 7 2 3 5 1 — — — 34 19 53 Not Medically Certified Cases Cases — — 4 4 10 12 8 2 11 6 7 12 7 3 1 1 — 2 — — — — 48 42 90 Deaths— Pulmonary — — — — — — — — — — — — — — — — — — — — — — — — — Other Forms — — — — — — — — — — — — — — — — — — — — — — — — — Other Causes — — — — — — — — — — — — — — — — — — — — — — 1 — 1 Totals — — — — — — — — — — — — — — — — — — — — — — 1 — 1 (a) Broncho-pneumonia. 54 APPENDIX : TUBERCULOSIS—DEATHS. TABLE XIII. 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 a 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 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 1921 . ... - - - - 34 29 18 8 2 3 2 4 2 1 - 3 - - 1 - 2 — 6 5 2 2 1 - TABLE XIV. Tuberculosis: Deaths. Ward Distribution. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Queen.s Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate. East. Hyde Park. Queen.s Park. Harrow Road. Maida Vale. Westbourne. Church Lancast West. er Gate. East. Hyde Park.[/### Annual Averages. 1909-13 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 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 1921 11 20 16 17 20 4 2 4 2 6 7 6 6 1 2 1 55 APPENDIX : TUBERCULOSIS. TABLE XV. Tuberculosis. Occupations—New Cases and Deaths. 1921. Pulmonary. Non-Pulmonary. New Cases. Deaths. New Cases. Deaths. Occupations. Indoor. M. F. M. F. M. F. M. F. Domestic Duties— Housewives - 33 - 13 - 4 - 1 „ and other occupation ... - 1 - 2 - - - Servants 4 16 1 4 - 8 - - , Charwomen - 1 - 1 - - - - Laundry Workers 1 2 2 - - - - - Clerks 9 12 7 3 - 2 1 - Shop Assistants, Keepers 4 - - 3 1 - - - Dressmakers, Tailors 3 4 1 5 - 1 - - Bootmakers - - - - - - - - Skilled Artizan 14 1 9 1 - _ - - Waitresses, Barmen, etc. 1 1 4 - 1 - - - Others 4 2 1 3 - 1 - - Outdoor. Building Trades 1 - - - - - - - Painters 7 - 1 - - _ - Labourers - - - - - - - - Road Traffic 7 - 2 - 2 - - - Railway Traffic 5 - 4 - - - - - Postmen - - - - - - - - Gardeners - - - - - - - - Street Merchants 1 - - - - - - Others - - - - - - - - Food Trades. Bakers 4 - 2 - - - - - Butchers, Fishmongers 1 - - - - - - - Dairymen 1 - - - 1 - - - Others - - - - - - - - Miscellaneous. School Life 3 7 3 - 21 20 2 - Unskilled Workers 8 1 2 - 4 - - - Professional Workers 3 7 1 - - - 1 - Other „ 18 1 6 1 1 1 2 - Commercial Travellers, etc. 7 - 2 - 1 - - - Infants - - - 9 6 4 1 ??? No occupation, or occupation not stated 28 21 10 11 1 6 - - 134 110 58 47 42 49 10 2 56 APPENDIX : CANCER—MALIGNANT DISBASE. TABLE XVI. CANCER: MALIGNANT DISEASE. 1921. 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— (6) Spinal Cord ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 III. Respiratory System— (a) Larynx 5 ... I ... ... ... ... ... ... ... ... ... ... ... 6 .... (b) Lung ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 IV. Circulatory System V. Digestive System— (a) Mouth— (i.) Tongue 3 1 ... ... 2 ... ... ... ... ... ... ... ... ... 5 1 (ii.) Mouth ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... (b) Throat— (i.) Pharynx 2 ... ... ... ... .. . ... ... ... ... ... ... ... ... 2 ... (ii.) (Esophagus 11 ... ... 2 1 ... ... ... ... ... ... ... ... ... 12 2 (c) Intestines— (i.) Stomach 16 12 1 3 ... ... ... ... ... ... ... 1 ... ... 17 16 (ii.) Intestine 5 12 ... ... ... ... ... ... ... ... ... ... ... ... 5 12 (iii.) Rectum 10 13 1 2 ... ... ... ... ... ... ... ... 11 15 (d) Organs— (t.) Liver 4 9 1 1 ... ... ... ... 1 1 ... ... 6 11 (ii.) Pancreas 2 3 1 ... ... ... ... ... ... ... ... ... 3 3 (e) Peritoneum 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... VI. Lymphatic System— (6) Thorax— (i.) Mediastinal Glands ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 1 2 VII. Urinary System— (a) Kidney ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 1 2 (b) Bladder 2 2 1 ... ... ... ... ... ... ... ... ... ... 3 2 (c) Prostate 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... VIII. Generative System— (a) Ovary, Testicle ... 7 ... 2 ... ... ... ... 1 ... ... 1 ... ... 1 10 (b) Uterus ... 20 4 ... ... ... ... ... ... ... ... ... ... ... 24 (c) External Genitals 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... (d) Breast ... 26 ... ... ... ... ... ... ... ... ... ... ... ... ... 26 IX. Osseous & Muscular Systems ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 X. Cutaneous System— (a) Head and Neck ... ... 1 ... 2 1 ... ... ... 1 ... ... 1 1 4 3 XI. Not sufficiently described 1 1 2 ... ... ... ... ... i ... ... ... ... ... 4 1 Totals 70 108 9 14 7 1 ... ... 5 6 1 8 1 1 93 133 Ages at Death. 0- ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... 2 1 20- ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25- ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 2 35- 1 10 ... . . . ... ... ... ... ... ... ... ... 1 10 45- 13 27 4 6 2 ... ... ... 1 2 ... ... ... 1 20 36 55- 23 31 3 3 3 1 ... ... 2 1 ... 1 ... 31 37 65- 27 24 ... 2 1 ... ... ... 1 1 ... ... ... ... 29 27 75- 6 16 2 3 1 ... ... ... ... ... ... 1 ... ... 9 20 57 appendix : inquests, 1919-21. TABLE XVII. Inquests, 1919-21. Finding of Jury. 1919. 1920. 1921. M. F. M. F. V F. Natural Causes 49 44 48 31 39 30 Misadventure 7 3 2 4 3 1 Accidents 27 14 39 15 25 20 Murder — 2 — 4 1 1 Suicide 11 7 9 7 16 12 .Neglect. 2 2 2 — 1 2 .Open. 2 5 1 4 4 1 98 77 101 65 89 67 58 APPENDIX: DEATHS IN INSTITUTIONS. TABLE XVIli. Deaths in Institutions. Local Institutions (Uncorrected). Outlying Institutions. Corrected Totals. Equivalent Percentage of all Deaths. Totals. Workhouse. Infirmary, now Paddington Hospital. St. Mary.s Hospital. children.s Hospital. Lock Hospital. Home of Compassion. . Women.s Hospital for Children. Totals. Metropolitan Asylums Board. General Hospitals. Special Hospitals and Homes. Lunatic Asylums. Poor Law Institutions. (a) (b) (c) 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 890 139 306 339 99 6 1 252 56 93 34 56 13 789 39.86 1914 791 123 301 273 75 8 11 265 39 82 48 75 21 759 40.05 1915 922 155 392 269 90 11 5 286 41 82 53 91 19 894 39.10 1916 857 119 367 236 109 18 8 250 23 53 54 96 24 799 42.50 1917 815 124 378 190 97 17 9 293 39 79 59 97 19 858 41.85 1918 726 104(d) 262(e) 216 105 29 10 505 37 86 44 135 203 951 42.28 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 Averages 1911-15 850 128 313 313 83 8 (6) 242 42 79 39 65 15, 756 38.35 1916 20 689 (d) (d) 223 95 22 8 405 34 80 47 94 158 620 41.85 1911-20 769 (d) id) 268 89 15 (6) 323 38 79 43 80 82 788 40.10 1921 838 492 248 78 13 7 266 31 82 63 61 29 801 45.56 (a) Opened in 1908 ; Closed in 1912. (b) In-Patients first received Autumn, 1913. (c) Including Sanatoria. (d) Taken over for Military Hospital, November, 1918—Not re-opened as a Workhouse. (e) Taken over by War Office, November, 1918--Re-opened February 4th, 1920. 59 APPENDIX: DEATHS UNDER ONE YEAR. Deaths under One Year. 1921. 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— 1921 1916-20 1921 1916-20 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F M. F. M. F. M. F. M F. M. F. M. F. M. F. I. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 1 ... 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 2 ... ... ... ... 1 3 4 5 II. Diarrhoea ... ... ... 1 1 ... • •. ... ... 1 5 4 Enteritis ... ... ... 1 1 1 2 1 1 4 3 3 2 5 8 5 2 3 3 3 2 7 3 6 2 1 2 2 1 2 1 3 1 44 19 30 13 III. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Abdominal Tuberculosis ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Other Forms „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 IV. Congenital Malformations 2 ... 5 2 1 2 1 ... 1 ... 8 4 ... 1 3 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 11 6 6 Premature Birth 18 9 28 10 6 4 1 1 ... 35 15 1 2 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 26 18 23 Atrophy and Debility ... ... ... ... ... ... ... ... 1 ... 1 ... 3 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 8 6 2 4 Debility at Birth ... ... 1 2 ... ... ... 1 ... ... 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 7 3 3 Injury at Birth 1 1 4 1 ... ... ... ... ... ... 5 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 2 1 2 Atelectasis 1 1 2 1 ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 1 1 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 V. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 Syphilis ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 5 2 4 Rickets ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... 0 Meningitis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 1 1 Convulsions 1 ... 3 2 ... ... ... ... ... ... 3 2 ... ... ... ... I ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 3 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... ... Bronchitis ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... 1 ... 1 ... ... 1 8 ... 1 ... ... ... ... ... ... ... ... ... ... 8 9 2 8 Pneumonia ... ... 1 ... ... 1 1 ... ... ... 3 1 1 4 1 ... 3 1 ... 1 1 ... 2 ... 3 ... 2 ... ... ... 2 ... 2 1 24 19 10 11 Suffocation (overlaid) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Other Causes 1 3 1 4 1 1 ... ... ... 3 4 ... ... 3 ... 3 3 ... ... ... ... ... 2 2 ... 2 ... ... ... 1 1 ... ... 14 12 10 12 All Causes 24 14 45 23 13 8 7 2 3 1 68 34 11 12 14 10 16 8 5 7 8 3 14 ... 11 3 6 3 7 3 5 2 5 2 170 140 93 107 Uncertified Deaths ... 2 ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 0 Averages, 1916-1920 17 15 34 28 10 6 6 6 4 3 54 43 18 9 13 10 11 8 8 5 6 5 6 6 5 6 7 4 3 5 4 2 5 4 Corrected Births—M. 1434. F. 1425. 60 appendix : prevention of infectious diseases. TABLE XX. Prevention of Infectious Diseases. Annual Averages. Totals. 1914-18. 1919. 1920. 1921. All Diseases, Enquiries by— District Inspectors 3,704 1,797 1,721 1,931 Women Inspectors 7,172 6,311 6,559 4,904 Tuberculosis—Included in above— Women Inspectors 4,157 2,670 2,186 2,755 Patients removed to Hospital—All Diseases (excluding Tuberculosis) 618 659 1,122 1,397 Booms Disinfected after— Tuberculosis 816 239 272 229 Other Diseases ... 3,300 2,494 3,217 2,074 Weight of Bedding, etc., Disinfected (tons) 54 50. 45. 51½ Cost of same £1,156 £1,588 £1,850 £2,139 School Notices issued— Measles, Whooping Cough, Chickenpox 3,377 3,096 3,213 1,212 Other Diseases 796 559 1,160 1,650 Bacteriological Examinations for— Diphtheria 540 479 1,419 754 Enteric Fever 9 4 4 13 Cerebro-Spinal Meningitis 9 — — — Tuberculosis 215 l44 173 206 Sanitary Work. Cutting-off of Water supplies. Notices Received 29 11 4 20 Referring to Inhabited Premises 15 10 1 13 Empty „ 10 1 3 6 Other „ 3 — — 1 Reasons for—Rates unpaid 10 3 3 13 Defective fittings 8 8 1 7 Mortuary. Bodies Deposited, total 821 288 224 220 „ „ for inquests 258 220 160 158 „ „ pending burial, infectio 2 2 2 1 „ „ other 61 66 62 61 P.M. examinations made 125 119 98 102 Trade Nuisances. Offensive Smells—Complaints 9 (7) 5 (5) 8 (6) 12 (12) Accumulations of Manure 17 (11) 26 (21) 13 (12) 22 (18) Smoke—Complaints 8 7 7 10 „ Premises watched 16 10 17 19 „ „ Hours of observation 106 411/4 84 345½ Duration of smoke (hours), including 673/4 26 583/4 1081/4 „ black smoke 23/4 23/4 3½ 181/4 Canal Boats. (1918) On Register at end of year 204 211 224 226 (Averages) Known to be using Canal Basin 73 103 111 113 Inspections made 135 57 64 61 Infringements of Acts discovered 15 20 23 18 Notices served 12 13 15 9 Children found on boats 122 61 86 76 61 APPENDIX: BACTERIOLOGICAL WORK. TABLE XXI. Bacteriological Work. 19-21. Diphtheria. Enteric Fever. Tuberculosis. Ophthalmia. Cerebro- Spinal Meningitis. Other. Pos. Neg. Hoffman. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Primary 108 571. - 1 11† 37 157 - - - - - 4 Repeats 4 71 - - 1 - 12 - - - - - - 112 642 - 1 12 37 169 _ - - - - 4 1921 754 13 206 - - 4 1920 1,419 4 173 - - 4 1919 479 4 144 - - 2 1918 298 7 159 - 6 - 1917 338 - 197 - 12 - 1916 225 6 214 - 14 - 1915 359 18 245 - 10 - 1914 1,479 12 259 4 2 11 1913 722 29 • 240 6 7 1 † Includes 2 examinations of Urine and Faeces. . Does not include 51 .no growth. swabs. 62 appendix : administrative work. TABLE XXII. Places Provided. Notified Diseases. Non-notified Diseases. Scarlet Fever. Diphtheria. Measles. Chickenpox. Whooping Cough. P.A. P.N.A. V P.N.A. P.A. P.N.A. P.A. P.N.A. P.A. P.N.A. Provided— Amberley Road 1,610 35 9 9 9 3 2 4 8 4 4 Beethoven Street 1,161 9 (3) 5 (2) 17 6 (2) 6 4 24 4 45 (1) 19 Campbell Street 972 25 7 3 1 3 2 7 6 22 17 Droop Street 1,100 10 6 14 (1) 3 7 3 6 5 4 1 Essendine Road *1,821 105 (4) 15 (2) 18 (1) 8 (1) 23 14 (4) 10 6 60 31 Moberly 1,586 28 (1) 8 38 (1) 8 (2) 3 3 15 4 28 10 Kilburn Lane 1,323 10 (1) 7 (2) 15 (5) 8 (2) 13 (2) 10 (1) 16 (4) 2 31 (2) 12 (3) Senior Street 1,024 18 4 7 3 2 2 2 3 7 9 Totals 10,597 240 (9) 61 (6) 121 (8) 46 (7) 60 (2) 40 (5) 84 (4) 38 201 (3) 103 (3) Ratios per 1,000 22.6 5.7 11.4 4.3 5.6 3.7 7.9 3.6 18.9 9.7 Non-Provided— Bayswater Jewish 396 9 (3) 5 (2) 1 2 (1) 1 ... ... ... 2 3 Desborough St. (B.C.) 523 14 1 2 1 ... ... ... ... 3 Holy Trinity 410 26 (1) 10 (2) 1 ... 1 ... 10 7 15 11 St. Augustine 1,171 15 (9) 7 (3) 17 (7) 3 (2) 1 2 (1) 4 (2) 2 25 (9) 14 (7) St. James 332 27 3 5 2 ... ... 5 ... 5 12 St. John, Kilburn Ln, 190 12 (7) 4 (2) 7 (2) 1 (1) ... 2 ... ... 1 ... St. John, Titchborne Street 474 4 ... 2 1 ... ... 1 ... 22 13 St. Luke 424 33 (7) 4 1 ... 1 4 (1) 19 3 23 (1) 9 St. Mary & St. Michael (B.C.) 246 2 (2) 1 (1) 1 1 (1) ... ... ... 4 2 St. Mary Magdalene 490 11 2 6 ... ... 1 4 2 2 3 St. Matthew 410 23 (2) 4 5 2 1 1 10 4 16 14 St. Michael, Star St. 460 11 ... 2 2 2 2 2 1 1 2 St. Paul 405 20 • •• 2 1 1 1 7 2 18 12 St. Peter 545 12 5 (1) 6 3 1 ... 14 1 36 11 St. Saviour 512 6 1 4 3 3 3 3 3 St. Stephen 791 17 5 (1) 11 (2) 4 ... ... 4 2 2 1 Wilberforce 842 11 (7) 2 2 ... — 1 (1) 3 4 (3) 2 (2) ... Totals 8,621 253 (38) 54 (12) 75 (11) 26 (5) 12 17 (3) 83 (2) 28 (3) 177 (12) 113 (7) Ratios per 1,000 29.3 6.2 8.7 3.0 13 1.9 9.6 32 20.5 131 Special— Bravington Road (M.D.) 85 ... ... ... ... ... ... ... 1 ... 1 Ivensal House (Tuberculosis) 90 3 ... 2 ... 1 ... ... ... ... 2 3 ... 2 ... 1 ... ... 1 ... 3 Secondary— Saltram Crescent ... ... ... ... ... ... ... ... ... ... Paddington and Maida Vale High 3 (3) 5 (4) ... 1 (1) ... ... ... ... ... 1 3 (3) 5 (4) ... 1 (1) ... ... ... ... ... 1 . P.A..—Patient attending school—. Scholars.. . p.n.a..—Patient not attending school—. Contacts.. Non-resident cases shown in parentheses are included in the figures preceding them. . Including 176 in Physically Defective Department. 63 administrative work. Places Provided. .Sore Throat.. Ringworm. Scabies. Other Complaints, Vermin. T. B. (Mx.) G. I. T. B. (Mx.) G. I. T. B. (Mx.) G. I. T. B. (Mx.) G. I. T. B. (Mx.) G. I. Provided— Amberley Road 1610 10 ... 10 ... 8 5 3 7 6 ... 1 27 5 22 ... ... ... ... Beethoven Street 1161 23 8 15 12 4 8 1 ... ... 1 52 15 Campbell Street 972 34 1 25 8 19 ... 7 12 ... ... ... 86 8 22 56 2 ... 1 1 Droop Steeet 1100 3 3 ... ... 10 1 2 7 2 ... 1 1 19 5 1 13 ... ... ... ... Essendine Road* 1821 36 ... 24 12 2 1 1 12 5 7 127 13 114 ... ... ... Kilburn Lane 1323 15 4 11 2 1 ... 1 1 1 ... 32 5 ... 27 ... ... ... ... Moberly 1586 20 2 12 6 8 4 ... 4 31 ... 3 28 ... . . ... ... Senior Street 1024 11 8 2 1 ... ... 34 5 3 26 ... ... ... ... Totals 10597 141 10 8 71 52 72 19 4 15 34 23 7 6 10 408 28 15 64 301 2 ... 1 1 Non-provided— Bayswater Jewish 396 ... ... ... . . . 4 4 2 1 1 55 55 ... Holy Trinity 410 10 . . .... 3 7 3 ... ... 3 ... ... ... 7 1 1 5 Our Lady of Dolours (B.C.) 523 2 1 ... 1 1 ... 1 ... ... ... ... 2 ... 2 St. Augustine 1171 1 ... ... 1 8 ... 8 ... ... ... ... 23 ... 23 St. James 332 13 13 ... 6 6 1 ... ... 1 2 2 St. John, Kilburn Lane 190 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. John, Titchborne Street 474 1 ... ... 1 8 4 4 ... ... ... 21 3 18 St. Luke 424 5 ... ... 5 5 ... ... 5 ... ... ... ... 7 ... 2 5 ... ... ... ... St. Mary of the Angels ... ... ... St. Michael (B.C.) 246 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... St. Mary Magdalene 490 4 ... 3 1 2 ... 2 ... 3 ... 3 ... 35 2 3 30 ... ... ... ... St. Matthew 410 ... ... 7 ... ... 7 ... ... ... ... 2 ... ... 2 ... ... ... ... St. Michael, Star Street 460 2 ... 2 ... ... ... ... ... 2 ... 2 ... 26 ... 14 12 ... ... ... ... St. Paul 405 10 10 9 7 2 ... ... 3 1 2 ... ... ... ... St. Peter 545 8 ... ... 8 3 2 1 1 1 ... 4 1 ... 3 ... ... ... ... St. Saviour 512 ... ... ... ... 2 2 ... ... ... ... ... ... 14 14 ... ... ... ... ... ... St. Stephen 791 2 ... 1 1 5 ... 3 2 ... ... ... ... 5 ... 4 1 3 ... 2 1 Wilberforce 842 ... ... ... ... 2 ... 1 1 ... ... ... ... 8 ... 3 5 ... ... ... ... Totals 8621 53 1 23 9 20 66 2 23 7 84 9 ... 2 5 2 214 18 59 27 110 3 ... 2 1 Special— Bravington Road 85 ... ... ... ... 2 2 ... ... 3 3 ... ... 6 1 5 ... 6 5 1 Keusal House 90 9 4 4 1 1 ... 1 ... 2 1 1 ... 1 ... 1 ... ... ... ... ... Totals 175 9 4 4 1 3 2 1 ... 5 4 1 ... 7 1 6 ... 6 5 1 ... * Including 176 in Physically Defective Department. 64 appendix: exclusion ratios. TABLE XXIII. Exclusion Ratios. Per 1,000 Places Provided. Notified Diseases. Not Notified Diseases. 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 Averages 1914-18 ll.l 3.8 5.5 2.4 36.2 29.6 20.0 7.6 13.0 103 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 17 4.0 13.8 8.9 14.2 0.1 1920 17.0 3.0 14.8 19 47.5 27.1 23.4 5.6 11.4 6.6 16.3 13.0 7.9 24.8 0.2 1921 22.6 5.7 11.4 4.3 5.6 3.7 7.9 3.5 18.9 9.7 13.3 67 2.1 38.5 0.1 Non Provided Schools. Averages 1914-18 9.0 2.9 6.7 2.5 41.8 27.2 19.4 74 18.8 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 60 20 6.8 5.7 118 0.9 1921 29.3 6.2 8.6 3.0 1.8 1.9 9.6 3.2 20.5 13.1 6.1 7.6 l.O 24.8 0.3 . P,A.>. based on scholars excluded. .P.N.A.,. patients did not attend schools, contacts excluded. 65 appendix : report of the work of the district inspectors, 1914-1921. TABLE XXIY. Report of the Work op the District Inspectors, 1914-1921. 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 aud Areas Paved and Drained. Roofs Repaired. Manure Receptacles Reconstructed, &c. Accumulations Removed. Improperly-kept Removed. 1915 581 — 1885 — 10830 55 50 51 47 67 20 153 29 20 20 6 11 2 32 33 3 33 84 4 — 22 34 2 28 — 1916 561 10 1742 — 11980 32 50 51 39 97 23 202 33 12 22 5 9 3 37 29 10 62 108 1 — 14 42 2 16 4 1917 958 18 1931 — 12998 22 23 25 36 78 20 154 19 13 8 5 29 — 14 11 7 68 72 1 — 13 53 — 17 1 1918 663 —— 1730 — 12436 16 41 21 46 223 23 221 33 9 9 5 26 — 27 22 7 110 86 1 - 15 66 2 32 5 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 1921 1401 — 23.32 —— 10467 36 51 28 40 450 37 350 7 13 38 6 19 2 17 74 6 86 265 3 1 19 137 2 11 — 66 APPENDIX : HOUSING CONDITIONS—STATISTICS. TABLE XXV. Housing Conditions—Statistics. 1. GENERAL. 1919. 1920. 1921. (1) Estimated population (total) 149,941 150,128 145,600 (2) General death rate 13.29 11.40 12.07 (8) Death rate from tuberculosis 0.92 0.97 0.85 (4) Infantile mortality 91 78 92 (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. Nil. . At Census. 1911. 2. UNFIT DWELLING HOUSES. I. Inspection. (a) 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 (Insnection of District) Regulations, 1910— (a) Houses inspected on complaint or after illness 1,984 2,243 2,332 (b) Registered tenement houses inspected 1,176 240 997 (c) Houses inspected under Housing Acts 12 148 63 (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 to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 6 135 55 Underground rooms only. II. Remedy of Defects 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 Statutory Powers. (A) Proceedings under Section 28 of the Housing, Town Planning, &c., Act. 1919— (1) Number of dwelling-houses in respect of v/hich notices were served requiring repairs 6 135 55 (2) Number of dwelling houses which were rendered fit— (a) by owners — 27 87 (ft) by Local Authority in default of owners 4 9 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — — — (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect ol which notices were served requiring drfects to be remedied — (а) Number of notices under Public Health (London) Act, 1891, and London County Council (General Powers) Acts ... 1,497 1,176 1,892 (b) Number of bye-law notices served 1,057 373 2,570 (2) Number of dwelling-houses in which defects were remedied— (а) 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 8 (2) Number of dwelling-houses in respect of which Closing Orders were made 6 15 8 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — 4 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 — 0.211 — (8) 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 sively engaged on housing work. 67 APPENDIX: SANITARY DEFECTS REMEDIED IN TENEMENT HOUSES. TABLE XXVI. Sanitary Defects Remedied in Tenement Houses.. 1919 1920 1921 Drain defective 5 2 3 „ choked 13 7 24 „ untrapped 1 8 — „ unventilated or improperly ventilated 1 1 9 Manhole cover defective 12 3 22 Surface inlet improperly trapped — — — Gulley choked 13 4 12 Ventilating pipe improperly constructed — — 1 Soilpipe defective 3 — — „ improperly constructed — — — „ unventilated or improperly ventilated 1 . — 1 Water-closet choked 62 2:J 50 „ defective 130 40 272 „ insufficiently flushed 30 5 13 „ flushing apparatus defective 42 6 76 „ without water supply 42 12 32 „ foul 36 8 41 „ improperly constructed — — „ accommodation insufficient 2 2 2 „ without door 8 — 1 „ without external light or ventilation — — — Rainwater pipe not disconnected from drain or soilpip — — 1 „ „ defective 35 6 55 „ „ choked 6 1 5 Wastepipe defective 15 7 21 „ choked 19 2 7 „ not provided 3 1 — Other drainage defects 7 7 10 Cistern defective 4 — 4 „ dirty 16 6 17 „ without proper cover 5 1 12 „ cover defective 7 1 23 Dustbin defective 71 20 228 „ not provided 11 5 36 „ insufficient — 1 5 „ disused and not abolished — — 3 Paving defective in area or yard 36 14 192 „ „ wash-house 24 6 138 Guttering defective 28 8 39 Premises damp 20 10 41 Rooms dirty 1465 175 3275 „ verminous 134 32 344 Roof defective 176 49 251 Accumulation of refuse 12 1 5 Animals improperly kept 21 2 32 Water supply to premises insufficient 9 5 5 Other defects or nuisances 285 113 957 Overcrowding. 1919 1920 1921 Tenements overcrowded 8 3 2 Rooms overcrowded 11 3 2 Occupants, total 65 15 12 Under 10 20 5 7 10 and upwards 45 10 5 Overcrowding abated— By re-arrangement 4 — 1 By voluntary removal 2 — — Under notice 5 3 1 Cases held over — — — Notices Issued. 1919 1920 1921 Written Intimations 314 102 518 Statutory Notices 146 60 142 Bye-law „ 706 152 2369 Notices under L.C.C. (G.P.) Acts— Verminous rooms 94 27 204 Additional taps — 2 4 Abolition of old dustbins — — 5 . Excluding defects dealt with under Housing Acts, 1890-1919. 68 appendix : factories, workshops and workplaces. TABLE XXVII. Factories, Workshops and Workplaces. Manufacture, or business. 1913 1921 No. of Premises. No. of Workers. No. of Premises. No. of Workers. Clothing. Boots 99 (89) 243 (55) 121 (77) 219 (96) Corsets 10 (1) 15 (1) * * Dress 355 (33) 2,456 (105) 259 (84) 1,437 (91) Furs 10 48 * * Mantles 7 (2) 23 (5) 8 (5) 13 (5) Millinery 44 (1) 181 (1) 42 (5) 49 (5) Millinery and Dress 22 (2) 185 (2) 8 48 Plain Needlework 48 (34) 105 (38) 10 (9) 17 (9) Tailoring 206 (102) 708 (136) 151 (108) 253 (125) Tailoring, Ladies. 34 (10) 189 (10) 34 (4) 104 (14) Various 12 (8) 29 (8) 37 (25) 74 (25) Fancy Work. Embroidery, Art Needlework 15 (12) 58 (45) 9 (6) 60 (31) Cleansing. Dyers., Cleaners. Receiving Offices 18 46 15 40 Laundries 102 (8) 920 (8) 46 (1) 393 (11) Laundries, Receiving Offices 28 42 21 30 Others. Blinds 6 72 9 29 Bookbinding, Printing 25 436 23 311 Carpentry, Joinery 14 290 25 372 Chaff Cutting 12 30 9 27 Cycle, Motor Repairs 69 663 90 659 Engineering . * 24 257 Farriery, General Smithy 24 76 19 45 Flowers (Natural) 16 105 13 58 Jewellery, Clock Repairs 12 35 8 (2) 18 (2) Metal Working 21 170 26 (1) 273 (1) Trunks, Manufacture, Repairs 11 32 * * Umbrellas 7 (1) 10 (1) * * Undertaking 11 (2) 121 (1) 9 82 Upholstery 58 (29) 224 (33) 45 (20) 127 (116) Wig and Hair Work 19 89 17 25 Wood Chopping . 14 76 Various 106 (10) 884 (17) 177 (20) 670 (20) Totals 1,421 (294) 8,485 (466) 1,269 (367) 5,766 (551) Notes.—Figures in parentheses refer to . outworkers . and are included in totals. * Trades with fewer than 6 workshops are not separately shown. † Not previously included in this table. Bakehouses—For numbers of premises and workers see Section Bakehouses.. 69 APPENDIX: SAMPLES TAKEN UNDER THE SALE OF FOOD AND DRUGS ACTS, ETC. OFFICE (CLERICAL) WORK. TABLE XXVIII. Samples taken under the Sale of Food and Drugs Acts, etc. 1921. Total. Found Adulterated. Percentage Adulterated. Milk 313 16 5.1 Cream 8 ... ... Butter 15 ... ... Margarine 47 ... ... Lard 25 ... ... Dripping 9 ... ... Coffee 5 ... ... Cocoa 6 ... ... Jam 14 ... ... Bice 9 ... ... Tapioca 3 ... ... Sago ... 2 ... ... Vinegar 27 ... ... Mustard 4 1 25.0 Pepper ... 8 ... ... Olive Oil 7 ... ... Sausages 29 3 10.3 Mincemeat 9 3 333 Tinned Meat 1 ... ... Bread 5 ... ... Sponge Cake 12 5 41.6 Flour 14 ... ... Cornflour 2 ... ... Baking Powder 2 ... ... Lime Juice 13 5 38.4 British Wines 6 ... ... Spirits 2 ... ... Glycerine 3 ... ... Soap Powder 1 ... ... 601 33 5.4 TABLE XXIX. Office (Clerical) Work. 1921. Letters Beceived 6,149 (6,166) Entries in Begister of Births 2,828 (3,489) „ Despatched 7,456 (6,730) Complaints Beceived 1,564 (1,424) Entries in Postage Book 20,735 (12,351) Plans dealt with 208 (297) Certificates dealt with relating to cases of Infectious Disease (including Consumption) 2,703 (3,239) New Openings in Journal 502 (353) Disinfection Orders (Duplicate) 2,156 (3.350) Notices to abate Nuisance, 1,547 (636) Notices sent re above and other diseases 6,671 (6,173) Figures for 1920 in parentheses. 70 appendix : legal proceedings. LEGAL PKOCEEDINGS—1921 PUBLIC HEALTH (LONDON) ACT, 1891. Section 4. Fines. Costs. £ s. d. £ s. d. 358, Ladbroke Grove Premises damp, dirty, dilapidated, etc. Work d one 1 1 0 2, Modena Street Failing to comply with Magistrate.s Order to re-instate water supply 18 0 0 2 2 0 25, Ranelagh Road W.C., washhouse and area dirty, guttering and roof defective Order mado. 1 1 0 1, Saltram Crescen Drain and w.c. defective, rooms dirty and dilapidated do. 1 1 0 17, Sutherland Place Basement rooms damp, etc. do. 16, Walterton Road No water supply Reinstated. 0 6 0 23, Woodchester Street Keeping rabbits in improper manner Rabbits removed. 62, Do. W.C. choked Work done. 1 1 0 BY-LAWS. Removing offensive refuse during prohibited hours and in improper receptacles (8 offences) 9 0 0 2 2 0 14, Walterton Road Drinking water cistern dirty and not properly covered No order. 0 4 0 16, Do. do. do. 40, Woodchester Street W.C. without proper flush Work done. Withdrawn. HOUSING, TOWN PLANNING, Etc., ACT, 1919. 1, Amberley Road Failing to insert prescribed particulars in rent books Summons withdrawn. 1 1 0 15, Elgin Avenue do. do. do. 1 1 0 6, Hasborough Street do. do. do. 1 1 0 7, Hall Place West do. do. do. 1 1 0 8, Waverley Road do. do. do. 1 1 0 23, Do. do. do. do. — 29, Clarendon Street Failing to pay cost of repairing works Order made for payment of £251 2s. 7d. 2 2 0 16, Walterton Road Obstructing the execution of repairing works Summons marked by magistrate. withdrawn SUMMARY OF LEGAL PROCEEDINGS UNDER SALE OF FOOD AND DRUGS ACTS, 1875-1907, Etc. Fines. Costs. £ s. d. £ 8. d. Milk ... 10% added water 5 0 0 0 10 6 1 „ 5% do. Warranty proved. Dis miss ed. f „ 24% do. 3 0 0 1 1 0 1 „ 20% do. 2 0 0 — 2 „ 5% do. Warranty proved. Dis miss ed. 3 „ 11% deficient in fat do. do. „ 45% do. 5 0 0 0 10 6 | „ 22% do. 5 0 0 0 10 6 „ 46% do. 5 0 0 0 10 6 „ 47% do. 5 0 0 0 10 6 „ 45% do. 5 0 0 0 10 6 „ 13% do. Summonses withdrawn. „ 7% do. „ 28% do. „ 13% do. 0 10 0 — „ 31% do. 10 0 0 — Butter 82% foreign fat — 0 12 6 Samples purchased from one and the same vendor are bracketed. PREVIOUS PROCEEDINGS. 1 18th July, 1918 Milk 18% deficient in fat Warranty proved. 2 10th March, 1916 Selling margarine as butter 0 5 0 0 10 6 22nd „ 1918 Milk 12% added water 5 0 0 0 12 6 7th June, 1918 „ 6% deficient in fat Warranty proved. 3 20th „ 1905 „ 12% do. do. 13th „ 1917 „ 46% do. 1 1 0