AC4349 DAD 22 Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEAR 1922. BY REGINALD DUDFIELD, O.B.E., M.A., M.B., D.P.H. Medical Officer of Health. LONDON: WIGHTMAN & Co., Ltd., Printers, REGENCY STREET, WESTMINSTER. S.W.I. Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEAR 1922. BY REGINALD DUDFIELD, O.B.E., M.A., M.B., D.P.H. Medical Officer of Health. LONDON: WIGHTMAN & Co., Ltd., Printers, REGENCY STREET, WESTMINSTER. S.W.I. CONTENTS. page Administrative Work 23 Alcoholism 13 Annual Cleansing 29 Ante.natal Clinics 25 Anthrax 11 Arrested Cases (Tuberculosis)16 Bacteriological Examinations 23 Bakehouses 30 Births 4 ,, Notification of 5 „ Illegitimate 4 „ in Institutions 4 „ Still. 5 Canals, Canal Boats 24 Cancer, Mortality from 17 Care Committee (Tuberculosis) 15 Carrier Clinic 8 Census Returns 1 Cerebral Haemorrhage 13 Cerebro.spinal Meningitis 11 Chicken.pox 22 Child.bearing, Fatality of 10 Childhood, Statistics of 19 Combined Drainage 24 Common Lodging Houses 29 Compulsory Repairs 28 "Conversions" 28 Cream Regulations 31 Day Nurseries 26 Deaths 5 „ in Institutions 18 Diarrhœa, Mortality from 22 Dinners for Mothers 25 Diphtheria 7 Disinfection 23 Dispensary Work (Tuberculosis) 14 Drainage Plans 24 Drains, Private, Re.laid 23 Dressing of Fur Skins, Bye.laws 24 Encephalitis Lethargica 11 Enteric Fever 9 Erysipelas 11 Estimated Population 3 Food Adulteration 31 ,, Supervision 30 Health Visiting 25 Heart Disease 13 Home Workers (Outworkers) 29 House Sanitation 23 Houses Unfit for Habitation. 28 Housing, Census Data 26 Ice Creams 30 Illegitimates, Births of 4 „ Deaths of 19 Increase of Rent 29 Infant Consultation Centres 25 Infants, Mortality of 19 page Infants, Mortality in Special Areas 19 Influenza 12 Inland Revenue Acts 29 Inquests 18 Institutional Treatment, (Tuberculosis) 14 Institutions, Deaths in 18 Legal Proceedings 32 L.C.C. Houses 29 Malaria 11 Measles 20 "Meningitis" 11 Meteorology 1 Milk Grants 25 Mortality, Infantile 19 ,, at ages 1.5 years 20 „ in Childbed 10 Mortuary 24 Multiple Pregnancies 4 Mumps 22 Notification of Births 5 „ Tuberculosis 13 Nursing 23 Office Work 32 Ophthalmia Neonatorum 10 Outworkers (Homework) 29 Overcrowding 29 Population 1 Pneumonia 12 Preservatives in Food 31 Prevention of Infectious Disease 23 Puerperal Fever 9 Rats and Mice Destruction 31 Residential Treatment (Tuberculosis) 15 Respiratory Diseases, Mortality from 12 Ringworm 22 Scarlet Fever 8 Schools and Infectious Diseases 23 Septic Diseases 11 Sewer Connections 24 Slaughterhouses 30 Smallpox 6 Smoke Nuisance 24 Staff 23 Tenement Houses 28 Trade Nuisances 24 Tuberculosis, Institutional Treatment 14 „ Notification 13 „ Mortality from 16 Underground Rooms 28 Unsound Food 30 Vaccination 6 Venereal Diseases 13 Water Supply 24 Welfare Work 25 Whooping Cough 21 Workshop Supervision 29 APPENDIX. Tables I. to XXL TO HIS WORSHIP THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF PADDINGTON. Mr. Mayor, Ladies and Gentlemen, Since my last Report some of the results of the Census of 1921 have been issued. The population of the Borough as reported (144,261 persons) is likely to be questioned by those intimately acquainted with the housing conditions in the Borough. The number of assessments reported vacant in June, 1921, was insignificant in comparison with the number so reported in June, 1911, and a large number of houses, which in 1911 were occupied by one family, were in 1921 occupied by two or more families. It was anticipated that the population of the Borough in 1921 would show an increase over that enumerated in 1911 of more than 1 per cent., which is the amount shown by the published figures. The tables relating to housing conditions show that very important changes have taken place since 1911—actually, of iourse, since 1914. The Census Report gives no information of the conditions prevailing in the individual Wards. It would be instructive to compare the housing data for the Wards for 1901 and 1911—which are in the possession of the Department—with those for 1921. I am particularly desirous of examining the changes which have taken place in Maida Vale and the two Lancaster Gate Wards. In previous Reports I have referred to the indications of a lowered standard of housing in the Lancaster Gate Wards which have been furnished by the rates of morbidity and mortality. If the doubt as to the completeness of the last enumeration be well founded, the birth and death rates given in this Report are overstated. As regards the latter, correction for any overstatement will make the comparison with previous years even more favourable than appears in the Report. Attention may be called to the comparisons instituted between the average numbers and mean rates for the two triennia 1910.12 and 1920.22. In connection therewith I desire to refer to the increase in mortality (from all causes) observed in males during 1920.22 at ages 15.25. That increase is in marked contrast to the reductions recorded at other ages. There was also a slight increase in the mortality of females at the same ages. The causes of such increases ought to be inquired into more closely, but having no knowledge of the sex.age.distribution of the populations of the Wards, I am unable to find out whether such increases are common to all the Wards, or limited to one or more of them. After the Census of 1901 and that of 1911, tables of the sex.age.distribution were obtained for each Ward. Similar tables for the last Census would yield valuable and instructive information when compared with those in the possession of the Department. The infantile mortality recorded last year (69 per 1,000 births) was a very satisfactory one. In part, no doubt, that low rate was due to the absence of fatal summer diarrhoea. I think that that happy incident is not to be attributed to climatic causes alone. The Council can, I am convinced, claim that their Child Welfare Work has been successful in lowering the mortality during the first year of life. It is not sufficient, however, to reduce the number of deaths unless the survivors are reared with a good prospect of a healthy after.lifetime. At present no evidence can be adduced to show definitely that that result has been achieved. The risk of an epidemic of smallpox appears to be increasing, not a cheerful prospect, having regard to the increasing neglect of vaccination. While the vigilance of the health authorities has, up to the present, been successful in circumscribing the spread of the disease, it is to be feared that with the continued occurrence of sporadic cases in widely separated areas a time will come when such vigilance will prove unequal to the task of coping with the danger arising from the presence of unrecognised cases in a population very imperfectly protected by vaccination. The prevalence of both scarlet fever and diphtheria shows signs of abating. We are still in the dark as to the factors producing cyclical outbursts of these diseases. The mere fact of an increase in the numbers of susceptible individuals is insufficient to explain such periodical outbursts. Sydenham postulated an "epidemical constitution" of the atmosphere, by which it may be presumed that he held that the causes of an epidemic outburst were to be found in the meteorological conditions prevailing at, or immediately before the time of the epidemic. The meteorological records do not, however, furnish any evidence in support of that postulate. It may be surmised that the effective cause lies in the life.history of the organism or in the co.incident development of another organism which reacts on the causal organism in such a way as to give it greatly increased infectivity. The absence of cases of enteric fever among adult males continues to be a notable feature of the records of this disease in the Borough. While there was a reduction in the number of cases of tuberculosis notified last year, the mortality last year was slightly higher than that recorded in 1921. At the same time there has been a very notable fall in the mortality during the thirteen years 1910.1922. As regards notification of this disease there is evidence that there are defects in the present system, too many cases being unheard of until after death, and too many patients dying at very short intervals after notification. The proportion of " contacts " examined during the year (78 per cent.) was very satisfactory. The mortality from malignant disease (cancer) during the past year showed an unusual feature in that the mortality among males increased and that among females decreased. The administrative work of the Department continues to increase, and great difficulty has been experienced in relation to housing questions. With the continued shortage of new houses the need of repairs to existing houses, especially of those occupied by more than one family, becomes more urgent. Great expectations were based on the provisions of Section 28 of the Housing Act of 1919 (Repairs of Houses), but the enforcement of those provisions has been found to bristle with difficulties. It is in consequence of those difficulties, which can only be solved by decisions of the Courts, that so little use was made of the Section last year. In consequence of action taken under that Section in 1920, one freeholder initiated successful proceedings in the autumn of last year under Section 30 of the Act, by which he obtained an Order giving him possession of the house. There is no doubt that freeholders could render great assistance to the Council in securing the repair of existing houses if they would resort to proceedings under Section 30. It is to be regretted that more attention has not been given to tenement houses. It is impossible for the two Inspectors detailed for this work to inspect every house on the Register each year. The District Inspectors have so much to do now that they cannot render assistance in this work as they did before 1914. Unless the Bye.laws under Section 26 of the Housing Act of 1919 are brought into operation at an early date, it will be necessary to remodel the Bye.laws made by the Council under Section 94 of the Public Health (London) Act, 1891, to meet the changes in rents. I cannot close without an expression of thanks to the Chairman and Members of the Public Health, Special Housing and Maternity & Child Welfare Committees for their continued co.operation in the work of the Department. My acknowledgments are [due to the Staff of the Department generally who have worked loyally, a special word being due to Mr. Gower, the Chief Clerk, and to Mr. Potter, the Chief Sanitary Inspector. 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. May, 1923. I. METEOROLOGY. The year 1922 was a notable contrast to 1921, being colder and wetter. The mean temperature of the air (9 a.m.) was 49.9°, as compared with 53.6° in the previous year, but was only 0.4° below the average for the ten years, 1912.21 (50.8°). The annual mean of the wet bulb readings was 46.6°, showing a difference from the dry bulb mean of 3.3° against one of 4.1° in 1921, and a decennial mean difference of 2.6°. The maximum air temperature (90°) was recorded in May, a figure which has been exceeded once only since 1912, viz., in July, 1921 (maximum 93°), and the minimum, 24° in January. The maximum solar temperature (135°)—recorded in May and July of last year—has been surpassed twice only since 1912, viz., in 1914 and 1921 (138° in both instances). The minimum grass temperature in 1922 (19°, January) differed notably from the minima recorded in 1920 (7.5°) and 1921 (7°). The total rainfall for the past year amounted to 26.13 inches, the number of days with measurable amounts of rain being 174, contrasting with a total fall of only 14.55 inches in 1921, measured on 116 days. The number of days with measurable rainfall during 1922 exceeded the decennial average (161), but the total amount measured was nearly an inch less than the mean (26.97 inches). Bright sunshine was recorded on 271 days last year, the total duration of sunshine being 1,323½ hours, the corresponding figures for 1921 being 284 days and 1,561¾ hours, and the decennial means, 266 days and 1,279½ hours. The outstanding features of the past year were the hot dry spell experienced in May, and the coldness and raininess of the "summer." In May the maximum temperature of the year (90°) was recorded, and the rainfall (measured on nine days) amounted to no more than 0.94 inches, the smallest total fall for any month during the year. In July and August the maximum temperatures recorded were 77° (July) and 73° (August), while the total rainfall was no less than 3.92 inches in July and 2.24 inches in August, the number of days with measurable falls being 23 and 18. II. POPULATION. Census Returns.—The enumeration made in 1921 showed that 144,261 persons passed the night of June 19th.20th in the Borough. In 1901 the population was found to number 143,976 persons, and in 1911,142,551, so that while the figures quoted show an increase of 1.2 per cent. in the total for 1921, as compared with that for 1911, there is a practical equality between the totals for 1901 and 1921. To those intimately acquainted with the Borough the result of the last census cannot fail to be surprising. Comparison with the earlier enumerations is, however, somewhat misleading, owing to the fact that the census of 1921 was taken near the end of June, instead of the beginning of April, as in 1901 and 1911. Although in June, 1921, railway traffic had not entirely recovered from the effects of the coal strike in the months of April and May, there is little doubt that the annual migration from London had been established at the time the census was taken. It has been found that the 1921 (census) populations of certain seaside resorts show increases since 1911 beyond what are reasonably probable, i.e., that they were inflated by summer visitors. Further evidence of the probability of error in defect in the census population of the Borough will be adduced in the section of this Report dealing with Housing. Whatever the suspected defect may amount to, the census results (the de facto population) have to be accepted at their face value unless the de jure population be given in a later volume of the Census Report. Although there was an increase of 1,710 persons in the enumerated population in 1921, as compared with that of 1911, the residents in three Wards, viz., Queen's Park, Church (new) and Hyde Park, were fewer in 1921 than in 1911, the percentage decreases, varying from 5.7 in Hyde Park to 2.2 in Queen's Park. If the figures for the last census be compared with those for the census 1901, the only Wards showing increases in population are Maida Vale (increase 18 per cent.), Lancaster Gate, West (increase 13 per cent.), and Lancaster Gate, East (increase 3 per cent.). The decreases observed in the other Wards vary from 13 per cent. in Hyde Park to 1 per cent. in Harrow Road. In Queen's Park Ward there has been a fall of 8.3 per cent. in the population during the twenty years. Sex Distribution.—At the first census (1801), when the population of the Old Parish of Padding. ton was 1,881 persons, the ratio of males to females was 100:116. At each successive census the excess of females has been greater, reaching a maximum (100 : 151) in 1861 and 1881. At the census of 1901 the proportion had fallen in the Old Parish to 100 : 139 (approximately), and was 100 : 134 in the Borough as now constituted. Since 1901 the inequality has become greater, the proportion increasing to 100 : 136 in 1911 and 100 : 138 at the last census. The returns for the individual Wards show wide variations in the sex distribution, those found at the last census ranging from a maximum proportion of 100 : 209 (Lancaster Gate, West, Ward) to a minimum of 100 : 108 (Queen's Park). Both in 1901 and in 1911 there was in the latter Ward 2 population. a slight excess of males, the proportions being 100 : 99 on each occasion. The greatest inequalities have been recorded in the Lancaster Gate Wards, where also the widest fluctuations at successive enumerations have occurred. In Lancaster Gate, West, the ratios have been: 1901, 100: 197; 1911,100:194; and 1921, 100 : 209 ; and in Lancaster Gate, East : 1901,100 : 247; 1911,100 : 238; and 1921, 100 : 200. Prior to 1921 the employment of women as domestic servants was probably the dominant factor in producing the sex.distribution inequality in the Borough, and was certainly true of the three southern wards. In these days the force of such factor is considerably diminished, and it certainly has had no part in producing the reversal of the proportion observed in Queen's Park Ward. Age Distribution.—No data are at present available of the numbers enumerated at different ages in the Wards. The following observations apply, therefore, to the Borough as a whole. With a view to determining the changes in age.distribution, the proportions of those enumerated in each of ten age.groups per 1,000 of each sex, at all ages, have been calculated from the data available for each census since 1841, when the ages were first taken. Considerations of space prevent the inclusion of the tables embodying the results of those calculations, but they show very clearly the reductions which have taken place in the proportions of individuals enumerated at ages under 35 years, and the great increases in the proportions at ages over 45. At ages 0.5 years the proportion of males has fallen 38 per cent., that of females, 42 per cent. For each age.group the fall is less up to ages 25.35. At the higher ages the proportion increases rapidly to maxima for the group 75.85, being 140 per cent. for males and 300 per cent. for females. The inequalities in sex.distribution prevail in each of the ten age.groups. They are especially noticeable in the age.groups 15.25 (100 : 157), 25.35 (100 : 156) and 85 and upwards (100 : 298). The contrast between the proportions found in the age.groups 5.15 (100 : 103) and 15.25 (100 : 157) supports the view as to the influence of the employment of female domestic servants in producing sex. distribution inequality. The changes in the age composition of the population referred to above have been further examined, using the census data available for the Borough, viz., those for 1901, 1911 and 1921. For this enquiry five age.groups have been used, viz., 0.5, 5.15, 15.25, 25.65 and 65 and upwards. From the census data the age.sex composition of a (theoretical) constant population of 1,000 persons has been calculated for each of the three census years. The calculations show that the proportion of males at all ages in 1901 was 427 per 1,000 persons, that for females 573, and that those proportions had become, in 1921, 420 and 580 respectively. The proportion of males at ages 0.5 years, which was 44 in 1901, was 35 in 1921, a decrease of 21 per cent. For females of the same ages the proportions are : 1901, 45 ; 1921. 34, a decrease of 25 per cent. At ages 5.15 the proportions show (in 1921) decreases of 8 per cent. for males and 9 per cent. for females, and at ages 15.25, of 22 . for males and 16per cent. for females. At ages 25.65 the proportions for males and females show increases of 9 and 11 per cent. respectively, and in the last age.group (65 years and upwards) of 50 and 40. The population of the Borough in 1921 was notably "older" than was that of the Old Parish in 1841. From a very rough calculation it has been estimated that the mean age of the 1921 population is some 12 to 15 years higher than that of the population in 1841. It would be reasonable, therefore, to expect that the death.rate recorded in these days should be higher than it was at the middle of the last century. The diminution in the proportion of children in the earliest years of life—a time when the mortality is high—and the increase in the proportion of young adult women—among whom the mortality is low—are factors which have been operative against an increase in the total death rate, but when all allowances have been made for those and other similar natural factors favourable to a lower mortality, the actual reduction in the death rate observed during the last half century must be regarded as an achievement of no small notability. Size of Family.—From 1801.31 the Census Reports gave the numbers of families, but from 1841. 91 that information was not taken out. In 1891 and 1901 the "Numbers of Families or Separate Occupiers "were recorded and in 1911 the number of "Families" and of "Private Families." At the last census only the number of "Private Families "has been reported, such families comprising 131,351 individuals out of the total for the Borough amounting to 144,261 persons. The only comparison which can be safely made is that between the average family during the years 1801.31—which varied from 4.1 to 4.5 persons—and the averages for "private" families in 1911 and 1921—which were 3.9 and 3.4 respectively. Occupations.—Owing to the changes introduced in the Report of the last Census, both as to the grouping of occupations and as to the age.distributions under 25 years, comparison with the earlier records is very difficult, in the absence of any explanatory tabulations. Moreover, the lowest age in the tables for 1921 is 12 years instead of 10, as in the earlier Reports. It is only by assuming that no children under the age of 12 years were "gainfully employed" at the time of the last census that the following comparisons are possible. Attempts to trace out the changes in the actual occupations followed by residents of the Borough have had to be abandoned pending the issue of some explanation of the changes which have been made. 3 population. In 1901 the population aged 10 years and upwards was 119,880 persons, of whom 81,642 (68.1 per cent.) returned themselves as "gainfully employed"; in 1911 the corresponding figures were 119,741 and 73,818 (61.6 per cent.), and in 1921, 124,234 and 73,624 (59.2 per cent.). The percentages of employed males were: 1901, 83.8; 1911, 84.2; and 1921, 82.6; and those for females, 1901, 56.9; 1911, 46.0 and 1921, 43.2. Some of the shrinkage in the proportion of "persons" employed has been due to the lessened employment of the very young. At ages 10.15 years the percentage of boys employed was 12.4 in 1901 and 1911, that of girls 6.8 and 6.6. At ages 10.14* the percentages of youths employed was 1.9 in 1911 and 0.2 in 1921, that of girls 1.9 and 0.1. At ages 14.16 the percentages were: Males, 1911, 69.7; 1921, 61.7; females, 1911, 46.6, 1921, 48.0. The corresponding figures for ages 18.20 were: Males, 92.1 and 82.2; and females, 80.9 and 83.2. At the ages 25.45 and 45.65 there were insignificant changes in the percentages of men returned as occupied, but among women there was some increase in 1911, but a slight decrease in 1921, the latest proportions being, however, higher than those recorded in 1901. The percentages of single women (all ages) were : 1901, 68.6; 1911,72.6; and 1921, 67.9; and of the married and widowed (together), 1901, 16.4; 1911, 19.0; and 1921, 18.8. The only occupation of which the figures from the successive enumerations can at present be safely compared, is that of indoor domestic service—the most numerous of all occupations in the Borough. The totals returned were, 1901, 17,752 (males, 2,048, females, 15,704); 1911, 14,854 (males, 1,023, females, 13,831) ; and in 1921, 12,989 (males, 1,049, females 11,940). During the thirty years the number of male indoor servants has decreased by 48.8 per cent., and that of female by 24 per cent. Foreigners.—At the last census the population of the Borough included 5,344 persons born outside the United Kingdom, of whom 1,393 were British by birth (706) or naturalisation (687), the foreigners (aliens) numbering 3,951. Of the total (5,344) 4,838 described themselves as "residents"— 1,350 British, 3,488 aliens—and 506 (British 43, aliens 463) as "visitors." No information as to their nationality was given by 433 aliens, and of the remaining 3,518, 2,984 were of European nationality, 109 Asiatic, 2 African and 423 American (North and South). The two sexes were practically equally represented, there being 1,781 males and 1,737 females. In 1901, 2,822 aliens were enumerated (equal to 1.9 per cent. of the population of the Borough), and in 1911, 4,484 (3.1 per cent.). At the last Census the percentage was 2.7. The proportion of aliens of European nationality was 84.8 per cent. of the total aliens in 1921, as compared with 87.4 in 1901. The proportion of those of Asiatic nationality increased from 0.9 in 1901 to 3.1, and of those of American (North and South) from 11.0 to 12.1. Estimated Population.—The estimate of the population of the Borough at the middle of 1922, furnished by the Registrar.General, was 145,300 persons. The population increased by 1,710 persons during the intercensal period 1911.21, equivalent to an annual increase of 167, after adjusting for the extended interval between the two Censuses, 10¼ years. The interval for which adjustment had to be made when estimating the population in 1922, was practically twelve months, so that, following the usual assumption of a continued equal (proportional) increase, the estimated population for last year would be 144,428 persons, 872 less than the total furnished by the Registrar.General. In his covering Memorandum, the Registrar.General observes that his estimate has " been based on the adjusted 1921 figures, after allowing for the varying " rate of natural increase as evidenced by the births and deaths in each area and of migration as " evidenced from other sources of information, such as the changes in the numbers on the Parliamentary " Register and the Migration Returns obtained by the Board of Trade. " The usual practice has been to distribute the estimated population among the Wards in the same proportions as prevailed in the last Census return. In the present instance such method of obtaining estimates of the populations of the Wards would result in the estimates exceeding the enumerated (1921) populations, in every Ward, whereas in three Wards, viz., Queen's Park, Church (old) and Hyde Park, the populations reported, both in 1911 and 1921, were less than those returned in 1901. Moreover, the difference (increase or decrease) between the population of any Ward in 1911 and that of 1921 is so small that the changes to be made in calculating the intercensal population based on one.tenth of the intercensal change, would be almost insignificant. Rates calculated on the populations as determined at the Census of 1921, would, it is thought, be sufficiently accurate for all immediate uses. It has, in consequence, been decided to use the estimate furnished by the Registrar. General for the Borough and the Census populations for the Wards. * The actual number of children returned as employed was in 1911, 80 (boys 72, girls 8), and in 1921, 4 (boy 1, girls 3). 4 births. III. BIRTHS: NATALITY. (See Tables I. and II. Appendix.) The corrected number of births during 1922 was 2,731, equivalent to a rate of 18.79 per 1,000 persons. That total was 128 (4.5 per cent.) less than that of 1921, and the birth.rate 0.84 lower. For purposes of comparison with earlier years it has been decided to take the figures for the quinquennium, 1909.13, so as to avoid the disturbances due to the war. During that quinquennium the annual average number of births was 3,008, and the mean birth.rate 21.18 per 1,000 persons, so that last year's records show a reduction of 9.3 per cent. in the actual number and one of 2.39 in the rate. The proportions of women at various ages from 15 to 45 years, who were returned as married at the last Census, were all higher than at the Census of 1911 and at that of 1901. By the use of certain standards of fertility obtained from Scottish Registration records, it has been calculated that the birth.rate for 1921 ought to have shown an increase of rather more than 9 per cent. above that of 1911. The calculated rates for 1911 and 1921 are 31.7 and 34.6 per 1,000 persons, while the recorded (fully corrected) rates were 20.8 and 19.8. Instead of an increase of 9 per cent., there has been a decrease of 5—showing a total deficiency equal to 14 per cent. The difference in the actual fertility can be illustrated in another way. The births recorded during 1911 were equivalent to a rate of 185 per 1,000 married women, aged from 15 to 45 years, the corresponding rate for 1921 being 161, or 13 per cent. less. The same rate for 1922 is 154, or 17 per cent. below that for 1911. The distribution of the births by Wards does not show any notable variations from the annual averages for 1917.21. On the other hand, comparison of last year's figures with the averages for 1909.13 shows some unexpected changes. The births during the past year in Queen's Park, Harrow Road and Church Wards were fewer than the corresponding averages for the quinquennium, 1909.13, the differences varying from 13 per cent. (in Church Ward) to 29 (in Queen's Park). In the other Wards last year's totals were higher, the increases ranging between a minimum of 2 per cent. (in Maida Vale) and 56 (in Lancaster Gate, West). The birth.rate was lower last year in four Wards, viz., Queen's Park, Harrow Road, Maida Vale and Church, the smallest decline (4 per cent.) being observed in Maida Vale, and the greatest (39) in Queen's Park. The other Wards had higher rates, the increases varying from 2 per cent. (in Westbourne) to 50 (in Lancaster Gate, West). In the three last Reports attention has been drawn to the (more than suspected) changing conditions in the two Lancaster Gate Wards. Ample confirmation of that suspicion is afforded by the comparison of the birth.rates in 1922 with the mean rates for 1909.13. In the former (West) Ward the rates are: 1922, 10.2; 1909.13, 6.8; and in the latter (East), 9.5 and 7.4 respectively. Further evidence to the same effect is afforded in the numbers of births transferred from outlying areas. Approximately 60 per cent. of these transferred births take place in institutions. During 1909.13 such births formed 8.9 per cent. of the corrected total of births in the whole Borough. In 1922 the proportion increased to 16.9. In Lancaster Gate, West, Ward, the inward transfers in 1922 formed 27 per cent. of the births, and in Lancaster Gate, East, 36—a proportion which was exceeded in Hyde Park Ward only, where it was 50 per cent. The ratio of births of males to those of females was 1,000: 974 last year, as compared with 1,000: 993 in 1921, 1,000: 968 during 1909.13 and 1,000: 959 during 1915.19. Illegitimacy.—The 2,731 births recorded last year included 214 of illegitimate children, equal to 7.8 per cent., the same as in 1921. During the years 1909.13 the proportion averaged 5.5 per cent., and during 1915.19, 8.9, falling to 7.1 in 1920. In Harrow Road Ward only was the proportion recorded last year (5.1 per cent.) above the proportions recorded in either of the years 1919.21. The smallest proportion (4.7 per cent.) was recorded in Queen's Park Ward, in which Ward a minimum proportion is a constant feature. On the other hand the maximum proportion for the year (14.4 per cent.) was recorded in Lancaster Gate, West, Ward, in which Ward the proportion is always excessive. The proportion of males to females among illegitimate births has varied somewhat remarkably. During 1909.13 the proportion was 1,000 : 919, during 1915.19, 1,000 : 939, in 1920, 1,000 : 1,059, in 1921, 1,000 : 1,000, and in 1922, 1,000 : 805. Births in Institutions.—There is no indication of any reduction in the proportion of women entering institutions for their confinements. The proportion of births during 1922 which took place in the various institutions, including nursing homes, rose to 25.6 per cent., having been 25.3 and 19.5 per cent. in 1921 and 1920, while the average for the years 1916.20 was 19.9. Of the legitimate births recorded last year, 21.6 per cent. occurred in institutions, and of the illegitimate, 54.2. In 1922, 12.5 per cent. of the births took place in Maternity Hospitals and Nursing Homes (11.3 in 1921; 12.8 during 1916.20), 8.2 in General Hospitals (9.6 in 1921, 2.7 during 1916.20) and 4.8 in Poor Law Institutions (4.3 in 1921, 4.4 during 1916.20). Multiple Pregnancies.—The 2,371 infants were the result of 2,698 pregnancies, of which 31 were twin pregnancies, and one triple. The proportion of multiple pregnancies remains fairly constant from year to year, varying slightly round 1 per cent. Twenty.two (22) of the twin pregnancies were uni.sexed, both infants being males in 10 instances, and females in 12. The triplets were males 2 and female 1. 5 notification of births. Notification of Births.—There being no system of transferring notifications the figures now to be given refer exclusively to births which take place within the Borough. Last year 2,621 notifications were received, 50 of which were duplicates. In 1921 the effective notifications numbered 2,671, and in 1922, 2,571, so that there was a reduction last year of 4 percent., exactly the same proportion as that which occurred in the births registered within the Borough. The duty of notifying a birth rests primarily on the father, if he be in residence in the house where, and when, the birth takes places. It is remarkable that the proportion of notifications received from parents has not only been very small (5.7 per cent. during the past year), but that the proportion shows every sign of becoming less. During 1914.18 the proportion of such notifications was 12.0 per cent., falling during the succeeding years to 6.6 (1919), 7.0 (1920), 6.1 (1921) and 5.7 in 1922. Parents are liable for the notification of an infectious disease, a liability which is practically ignored, but no one thinks of taking steps for recovery of the prescribed penalties—unless there be some very exceptional circumstance attaching to the case. It appears probable that notification of births by parents will ultimately become practically "dead," as has the notification of infectious disease. Notification by the medical practitioner constituted approximately one.third (37.4 per cent.) of the total notifications last year—33.9 in 1921—those by midwives in the neighbourhood of one.half (43.9 per cent. 1922, 42.7 1921). The most notable change is the increase in the percentage of notifications received from other sources, which was only 5.2 per cent. of all notifications during 1914.18, and was 13.0 per cent. last year, as compared with 17.2 in 1921. On an average notification of a birth precedes its registration by some 4.6 weeks, and the discovery of failure to notify requires careful comparison between the Returns received from the Registrars and the Notification Register. Last year 83 births were registered within the Borough without previous notification, equal to a 3.2 percentage of failure to notify." During 1914.18 the percentage was 3.7, with a maximum of 5.3 (1917) and a minimum of 2.8 (1916), while in 1919 the figure stood at 3.0, in 1920, at 3.3, and in 1921 at 3.8. The percentages of births registered after notification in each of the three Registration Sub.Districts remain fairly constant, being 97 (with slight variations) in "North." and "Central," and 90 to 92 (the figure for 1922) in "South." It is worth noting that letters sent to the persons held in each instance to be responsible for the failure to notify, have brought to light during the past year some evidence of loss of the post.cards (the official form of notification) in the course of transit by post. Still.Births.—The number of infants notified as still.born during the past year was 59 (all legitimate children), as compared with 80 during 1921. The percentage of still.births to all births notified was 2.3, 0.6 less than in 1921. The following percentages have been recorded during the last four years: Legitimate, 1919, 2.26; 1920, 3.00; 1921, 3.00; 1922, 2.32; Illegitimate, 1919, 5.48; 1920, 7.69; 1921, 2.99; 1922, nil. The highest percentage of still.births (2.94) was recorded in Queen's Park Ward last year, and the lowest (nil) in Lancaster Gate, West. During the three years 1919.21 the highest average was recorded in Westbourne Ward (3.49), and the lowest (1.51) in Harrow Road. Comparing the averages with the records for last year, but neglecting the figures for the two Lancaster Gate Wards (where the numbers are so small that the variations cannot be compared with those in other Wards), the greatest increase is noted in Queen's Park Ward (65 per cent.), and the greatest decrease in Maida Yale (33 per cent.). In addition to the still.births notified, 40 infants died before registration of their births was effected, equivalent to 1.5 per cent. of all notifications of live.births, a figure which compares favourably with those recorded in the three previous years (range from 2.6.2.9 per cent.). Among those 40 deaths were 4 of illegitimate infants, or 14.2 . of all notifications of births of this category. The percentages recorded during 1919.21 ranged from 11.6 to 30.0. IV. DEATHS: MORTALITY. (See Tables /., II., VI. and VII. Appendix.) Registered Locally.—Last year 2,557 deaths were registered within the Borough, 145 (8 per cent.) more than in 1921. During the five years, 1909.13, the annual average was 2,038, last year's total showing an increase of 25 per cent. above the average.* Corrected Number.—The finally adjusted total for the year was 1,888 or 130 (7 . increase) above that for 1921 (1,758). The annual average for 1909.13 was 1,887, differing by one only from last year's total. The total mortality was at the rate of 12.99 per 1,000 persons of all ages, 0.92 more than the rate for 1921 (12.07) and 0.20 below the mean (13.19) for 1909.13. The fall in the rate for 1922 was equivalent to 2 . of the mean for 1909.13. * It may be noted here that the deaths in the local institutions during 1922 (903) were 42 . above the annual average (633) for the years 1909.13. 6 VACCINATION. Sex Distribution.—The total of 1,888 deaths comprised 927 deaths of males and 961 of females, the averages for the three years 1919.21 being males 865 and females 928. The mortality rates last year were 15.22 per 1,000 males and 11.37 per 1,000 females. Taking the two periods of 1910.12 and 1920.22, in each of which a census was taken in the central year, the mean mortality rates (per 1,000 of each sex) are : Males, 14.89 and 14.46 (a reduction in the second period of 2.9 per cent.); and females, 11.34 and 10.85 (a reduction of 4.4 per cent.). Age Distribution.—The deaths recorded during the year have been tabulated in 8 age.groups in Table VI., from which Table mortality rates have been calculated for 6 groups for each sex, viz.: Males, aged 0.5 years, 32.9 per 1,000; 5.15, 2.3; 15.25, 2.7; 25.45, 6.3; 45.65, 20.8; 65 and over, 91.7. Females (same groups), 28.5, 1.2, 2.7, 3.3, 11.7, 74.4. On this occasion the only comparison which has been made is that of the rates for the two periods 1910-12 and 1920.22 for six sex age.groups. The actual rates are not included here, but the comparison shows that in the age group 0.5 years, the rates in the second period were 16 and 12* per cent. lower; in the group 5-15, 12 and 13; in the group 15.25, 39 and 7 per cent. higher; in the group 25.45, 7 and 11 . lower ; in the group 45.65, 12 and 21 lower; and in the group 65 and over, 3 and 0.5 higher. The most striking fact brought out by the comparison is the great increase in the mortality of males at the ages between 15 and 25 years. Combining the two groups 15.25 and 25.45 the mortality for the whole was 10.92 per 1,000 in 1910.12, and 14.50 in 1920.22, an increase of 33 per cent. Among females of the same ages (15.45 years) the mortalities were 9.99 and 9.36, a decrease in the second period of 6 per cent. There can be little doubt about the great increase in the mortality rates recorded among males aged 15-45 during 1920-22 being a result of the war. Ward Distribution.—In four of the Wards the numbers recorded last year were less than the averages, the reductions varying from 10 per cent. (Queen's Park) to 3 (Maida Vale). In the others the increases ranged from 1 per cent. (Church) to 5 (Hyde Park). The mortality rates, calculated on the populations given in the table, varied from a maximum of 15.6 per 1,000 (Church) to a minimum of 9.7 (Lancaster Gate, West). Comparing the mortality rates for the three years 1910.12 with those for the years 1920.22, lower rates are observed in three Wards, viz., Queen's Park (reduction 7 per cent.), Harrow Road (13) and Church (13), the increases in the other Wards ranging from 3 per cent. (Maida Vale) to 31 (Lancaster Gate, West). The rates for males (all ages) for the same periods show changes varying from an increase of 37 per cent. (Lancaster Gate, East) to a reduction of 18 per cent. (Harrow Road), while among those of females a maximum increase of 36 . is observed in Lancaster Gate, West, and a maximum reduction of 28 . in Church. No information being at present available as to the age composition of the populations of the Wards, no comparison of the sex.age mortalities can be given, although from comparisons which have been made of the average numbers of deaths in the sex.age groups, changes in the mortality rates are suggested, which are worthy of being fully investigated. The increase in the mortality rates among males between the ages of 15 and 45 years, to which attention has already been directed, is indicated in most of the Wards, but not all. Causes of Death.—Table VI. contains information of the sex.age distribution of the deaths recorded last year according to selected causes. Consideration of the changes in mortality from individual diseases is reserved for that part of the Report headed Special Diseases. V. VACCINATION. The neglect of vaccination continued during 1921—the last year for which complete returns are available—the proportion of infants not vaccinated, in accordance with the Act, being 30.2 per cent., after excluding those that died within the first year of life without being vaccinated. In 1919 the proportion was slightly higher, viz., 30.6 per cent., but in 1920 it was 28.3. During the last four years smallpox has shown signs of increasing prevalence in the Country. In 1919, 262 cases were notified in England and Wales, 24 of the cases occurring in London. In 1920 the corresponding numbers were 243 and 18, in 1921, 311 and 2, and in 1922, 985 and 62. Last year's cases, outside the Metropolis, were reported principally in the Northern and Midland Counties, viz., Yorkshire, North Riding (253), West Riding (232), Durham (240), Lancashire (63) and Nottinghamshire (94). In the other counties affected the cases were few, Kent being the only one with a total reaching 10. Of the 985 cases, 176 were reported in the first quarter of the year, 304 in the second, 211 in the third and 294 in the fourth. The first cases reported last year in the Metropolis occurred in the third quarter, when 7 cases were notified. At the beginning of November the outlook in London was sufficiently disturbing to call for special action. * In each instance the rate for males is stated first. 7 diphtheria. On November 13th a Vaccination Station was opened in Woodfield Road, the Public Vaccinator attending twice daily. The station was closed on December 14th. During that period upwards of 6,000 vaccinations and re.vaccinations were performed, in addition to the vaccination of infants, which went on as usual. The majority of the Staff at the Town Hall were re.vaccinated. By direction of the Public Health Committee letters calling attention to the threatening danger of an epidemic were issued to firms employing large staffs, and to the Bayswater Chamber of Commerce. The letter also appeared in the columns of the local papers. A circular letter was sent to the medical practitioners practising within the Borough, informing them of the arrangements made to provide vaccination, and of the facilities for consultation with the Experts appointed by the County Council and with the Medical Officer of Health. Happily no case of the disease occurred within the Borough, but the Medical Officer of Health was called in on several occasions to assist in the diagnosis of doubtful cases. A few contacts with cases in other districts were reported and followed up. VI. SPECIAL DISEASES. (See Tables III., IV., V., VI. and VII. Appendix.) DIPHTHERIA. (Including Membranous Croup.) There has been a notable increase in the prevalence of this disease since 1920, but such increase is not peculiar to the Borough. The cases reported last year (401) were 44 fewer than the total for 1921 and 66 below that for 1920. The annual average for the three years, 1920.22, was 437, as compared with an average of 286 for the years 1913.15, a difference equal to 53 . of the average for the earlier triennium. During the years 1910.12 the notifications of this disease numbered (on an average) 177 a year (males 76, females 101), and the morbidity rate was 1.24 per 1,000 persons—1.26 per 1,000 males and 1.23 per 1,000 females. During 1920.22 the annual average of 437 cases comprised 181 among males and 256 among females, the morbidity rates being 3.03 for persons, 2.99 for males and 3.05 for females. Roughly speaking, the numbers of cases in the second period were two and a half times as numerous as in the first, while the morbidity rates showed increases of 144 . for persons, 137 for males and 148 for females. The seasonal distribution of the cases reported during the past year was not quite normal, the proportion of cases reported in the second and third quarters of the year being higher than is usual. Last year 30 . of cases were reported during the first quarter, 25 during the second, and 23 during the third and 22 during the fourth. The averages for the quarters during the periods 1910.12 and 1920.22 were : 1st, 30 and 33; 2nd, 24 and 20; 3rd, 16 and 18; 4th, 29 and 29. The averages for the quarters in the second period showed the following percentage increases, 146, 89, 77 and 125. The sex-age group morbidity rates during the years 1920-22 show the following increases above the corresponding rates for 1910-12 : 0.5 males, 147; females, 223; 5.15, males 164, females 149; 15.25, males 121, females 171 ; 25 and upwards, males 218, females 318. The increase in prevalence among adults, especially females, is striking. Of the 401 cases reported during the year, 204 were notified after bacteriological examination, the results being "positive" in 195 instances and negative in the others. Thirty.seven (37) of the notified cases were definitely recognised as cases of " bacteriological diphtheria." In 57 instances the original diagnosis of diphtheria was proved to be erroneous, equal to 14.2 . of all notified cases, as compared with an average of 8.2 during 1917.21. The cases removed to institutions numbered 387, equal to 96.5 . of the notifications, the average for 1917.21 being 91.8 per cent. Among the notified cases there were 37 deaths, only one of which took place in the patient's home. The 37 deaths included one occurring in 1923 and 12 deaths certified to have been due to diseases other than diphtheria—the majority of such deaths, other than 4 fatal " errors," being those of patients with bacteriological diphtheria. One death was transferred to the Borough without notification, and one death of a patient notified in the Borough was transferred elsewhere. The total fatality of the disease (. of verified cases) was 7.3, as compared with a mean rate (1917.21) of 5.3. The mortality rates for last year were : Persons, 0.17 : males 0.19 and females 0.29 per 1,000. The rate for persons for the three years 1920.22 was 0.17, and that for the years 1910.12 0.06—showing an increaseof 176 per cent. The rates for males were 1910.12, 0.05, 1920.22, 0.14—increase 180 per cent., and those for females 0.07 and 0.19—increase 171 per cent. The greatest increase in 8 SCARLET FEVER. sex age group mortality was that for females aged 0.5 years, at which ages the mean for 1910.12 was 0.22 per 1,000, and in 1920.22 1.63—an increase of 641 per cent. During 1910.12 the mean mortalities observed in the individual Wards varied from zero (Hyde Park) to 0.10 (Queen's Park) and in the period 1920.22 from 0.01 (Maida Vale) to 0.29 (Harrow Road). The mortality in the second period was lower in Maida Vale (by 75 per cent.), and in Lancaster Gate, East (by 57 per cent.), but higher in all the others. Excluding Hyde Park, where the mortality was zero during 1910.12 and 0.08 during 1920.22, the greatest increase in mortality occurred in Harrow Road (383 per cent.). Of the 25 deaths recorded last year, 24 (96 per cent.) took place in institutions. For the years 1910.12 the percentage was 88.4, and for 1920.22 95.8. The percentage of institutional deaths of males has been consistently above that of females. Carrier Clinic.—Last year 12 persons (5 males and 7 females) were referred by the Department to the Special Clinic at St. Mary's Hospital. One patient failed to return to the Clinic after the first attendance, although the swab taken on that occasion proved to be positive. The treatment of the other 11 patients extended over periods varying from 1 to 13 weeks. Since the Clinic was opened in 1920, 41 patients have been treated, all of whom (with the exception mentioned above) have been successfully treated. SCARLET FEVER. The prevalence of this disease declined from a maximum of 738 cases, in 1914, to a minimum of 124 cases, in 1917, and increased to a second maximum of 827 cases, in 1921. Last year's total (529 cases—males 243, females 286) suggests that a period of low prevalence may be expected. For the years 1920.22 the annual average number of cases was 619 (males 275, females 344), and that during 1910.12, 252 (males 123, females 129). The morbidity rate (per 1,000 persons) was 3.64 last year as compared with a mean rate of 4.28 for 1920-22 and one of 1.77 for 1910.12. The sex rates (per 1,000) for the two periods were : 1910.12, males 2.04, females 1.56; 1920.22, males 4.55, females 4.10. The increases in the rates for the second period (1920.22) were : Persons, 142 per cent.; males, 123, and females 163. Comparing the sex.age.group morbidity rates for 1920.22 with those for 1910.12, the following increases are found : 0.5 years, males 18 per cent., females 139 ; 5.15, males 190, females 209 ; 15.25, males 97, females 160 ; 25 and upwards, males 47, females 133. The seasonal distributions of the disease in the two periods were not identical. The percentages of the annual mean total were in 1910.12: 1st quarter, 22 ; 2nd, 25 ; 3rd, 25 ; and 4th, 28 ; the corresponding proportions for 1920.22 being, 18, 19, 26 and 37. In the first six months of the years 1910.12 the percentage of cases reported was 47, and in the second 53, whereas in 1920.22, the proportions were 37 and 63. In the second period there was an increase of 93 . in the first half of the year, and 192 in the second. The morbidity rates recorded in the Wards during 1910.12 varied from a maximum of 2.45 per 1,000 persons (Harrow Road) to a minimum of 0.37 in Lancaster Gate, East. During 1920.22 the maximum rate was 6.59 (Harrow Road), and the minimum 1.54 (Lancaster Gate, West). The maximum increase noted in the second triennium was 551 per cent. (Lancaster Gate, East), and the minimum 69 (Lancaster Gate, West). Among the 529 notified cases there were 41 " errors," equal to 7.7 . of the notifications, as compared with an average of 5.4 . during 1919.21. Removals to institutions during the year numbered 517, or 97.7 . of all notified cases, as compared with 97.2 in 1921, and an average of 95.2 during 1919.21. There were four deaths during the year among the patients notified, all of the deaths taking place in institutions. Two of the deaths were not certified as due to scarlet fever. After correcting for errors the fatality rate (per 100 verified cases) was 0.41 last year, as compared with 0.12 in 1921, the rate for that year being the lowest on record. For the years 1920.22 the fatality rates* were : Persons 0.36 ; males 0.24, females 0.48, which, on comparison with the rates for 1910.12 (persons 1.71 ; males 2.43, females 1.03) show falls of 79, 90 and 53 . respectively. During 1910.12 no deaths from this disease were recorded in the two Lancaster Gate Wards, and during 1920.22 in Maida Vale, Westbourne and the two Wards just mentioned. The cases notified last year included 18 cases in which the disease appeared to have been contracted in institutions, and the same number from patients recently discharged from hospital. In 14 instances the patients came into the Borough after contracting the disease. In 15 instances two cases were reported simultaneously from the family, and in 2, 3. In the course of the year the disease caused two cases in 58 families, in 9, 3, and two families had 4 and 5 cases each. * Per 100 notified cases. 9 enteric fever. ENTERIC FEVER. (Including Continued Fever.*) Owing to the small number of cases reported in recent years, and the frequency of mistakes in diagnosis, the prevalence of this disease requires to be considered from a different aspect to that adopted in the case of diseases such as diphtheria and scarlet fever. Moreover, since the beginning of the war three clinical entities have been differentiated among attacks which used to be called "enteric fever." While the clinical symptoms may differ but slightly three separate causal organisms can be identified, viz., the bacilli known as "Paratyphoid A," "Paratyphoid B" and the "bacillus typhosus (Eberth)." During 1922,8 cases were notified as "enteric fever"—under which designation all three forms are notified—compared with 13 in 1921, and 19 in 1920. Two of the cases were "para" varieties. For the three years, 1920.22, the cases numbered 40 (males 10, females 30), whereas during 1910-12 the total was 92 (males 39, females 53). The ratio of cases among males to those among females was 1 : 1.4 during the earlier period and 1 : 3 during the later. The morbidity rate in 1922 was 0.05 per 1,000 persons, that for 1920.22, 0.09, and that for 1910.12, 0.21. The morbidity rate for males during 1920.22 was 75 percent. less than that during 1910.12, the rate for females showing a fall of 43 per cent. only. There have been striking changes in the sex age distribution of the notified cases. At ages 0.5 6 cases were reported during 1910-12 (5 males and 1 female), but during 1920-22 not a single case. At ages 5-15 there were 17 cases (8 males, 9 females) in the earlier period, and in the later 3 only (all the cases in males occurring in 1920 and 1921). At ages 15-25 the cases during 1910-12 numbered 19 (males 8, females 11), and during 1920-22, 13 (males 3—during 1920 and 1921—females 10), and at ages 25 and upwards during 1910-12, 50 cases (males 18, females 32), during 1920.22 24 (males 4, females 20). For the first time since 1912 no case was found to have been erroneously diagnosed, the average percentage of errors during 1919.21 being 22.4. During the years 1910.12 the errors averaged 19.5 per cent., and during 1920.22, 17.5. Last year only one death, of a female, was certified as due to this disease, to which cause no deat h of males has been assigned for the past three years. The deaths during 1910-12 numbered 10 (males 7, females 3), and those during 1920.22, 3 (all females). The mortalty rates (all ages) for the two periods are : Males 0.04 per 1,000 and nil; females 0.01 in both. The fatality rates (per 100 cases) for each sex show the following changes: Males, 1910.12, 18; 1920.22, 0; females, 5.6 and 10. All the deaths took place between the ages of 5 and 45, the only sex.age groups showing increases during 1920.22 being those of females at ages 15.25 and 25 and over. Of the 8 cases reported last year 6 were imported (including that of the only male, a " para " case) and one imported case was traced to the eating of shell fish. Bacteriological tests were used in 7 instances, positive results being obtainnd in 6. Six (6) cases (75 per cent.) were treated in institutions, the average percentage for the three preceding years being 78.6. PUERPERAL FEVER. Last year 8 cases were notified, compared with 16 in 1921 and 15 in 1920. The annual average for 1920.22 was 13, and that for 1910.12, 9, showing an increase of 44 . in the later period, Calculating the morbidity rate on the corrected number of births, the rate for 1922 was 2.92 per 1,000. and that for 1921, 5.59. During 1910.12 the mean morbidity rate in the Borough as a whole was 3.00 per 1,000 births, the rates recorded in the individual Wards ranging from zero (Lancaster Gate, East) to 5.60 (Maida Vale). During 1920.22 the rate for the Borough was 4.33—an increase of 44 per cent.—the Ward rates varying from 1.76 (Hyde Park) to 11.90 (Lancaster Gate, East). The rates recorded in the later period were lower in Maida Vale (by 37 per cent.), and in Hyde Park (by 11 per cent.), and higher in the other Wards, the increases ranging from 358 per cent.—Queen's Park, 1910.12, 1.68 per 1,000 ; 1920-22, 7.70—to 8 per cent.—Westbourne, 1910-12, 4.99; 1920.22,5.40. The changes in the rates for the Lancaster Gate Wards can be shown only by combination. During 1910-12 the combined rate was 2.86, and during 1920.22, 11.15—an increase of 319 per cent. It should, however, be noted that the rates are in every instance based on very small numbers and that, in consequence, no great significance attaches to the changes. The seasonal distribution shows dissimilarity when the two periods are compared, approaching that recorded in the case of scarlet fever. During the first half.years of 1910.12, 52 . of the cases were notified, and during the second 48. In the period 1920.22, the proportions were 41 and * The last case of continued fever was reported in 1915. 10 fatality in child.bearing. 59. That fact may be expressed in another form by stating that while there were averages of 5 cases in the first half.years of each of the two periods, there were averages of 4 cases in the second half. years of 1910.12 and of 8 in 1920.22. The deaths due to this disease numbered 2 last year—one being a non.notified case—.equal to a mortality rate of 0.73 per 1,000 births. In 1921 the rate was 1.39 per 1,000. Last year's deaths occurred in Maida Vale and Westbourne Wards, and those (4) occurring in 1921 in Harrow Road, Lancaster Gate, East and West, Wards. During 1910.12 Lancaster Gate, East, Ward was the only one without a death from this cause, whereas during 1920.22 that freedom was enjoyed by Queen's Park, Church and Hyde Park Wards. During 1910.12 the mortality rate ranged from 5.43 (Lancaster Gate, West) to 0.47 (Church), and during 1920.22 from 3.96 (Lancaster Gate, East) to 1.41 (Maida Vale). The fatality rate, being the ratio of deaths to notified cases, was 25 . in the whole Borough, both in 1922 and 1921. During 1910.12 the mean fatality was 40.7 per cent., there being one more death in Hyde Park Ward than notifications, and that during 1920.22, 28.7, equivalent to a fall of 30 per cent. In writing the above paragraphs the records of notifications have been taken at their face value, i.e., no corrections have been made for review of diagnosis after notification. During 1922 such review occurred with respect to 5 of the 8 cases notified, leaving 3 verified cases, only one of which terminated fatally, giving a fatality of 33.3 per cent. instead of 25. The "errors" were equal to 62.5. of the notified cases, compared with 16.2 in 1921, and averages of 8.8 and 10.0 for the periods of 1914-18 and 1919-20. All the notified cases' received hospital treatment, 4 in hospitals of the Metropolitan Asylums Board, 3 in St. Mary's Hospital, and 1 in the Royal Free—a fatal case of coli infection. FATALITY OF CHILD.BEARING. In addition to the 2 deaths from puerperal fever there were 6 from "Accidents and Diseases of Pregnancy and Parturition," making the total number of deaths under this general heading 8 —equal to a fatality of 2.92 per 1,000 births, compared with 4.55 in 1921. Last year Queen's Park, Lancaster Gate, West, and Hyde Park Wards recorded no death under this heading. In the other Wards the fatality ranged from 5.44 (Harrow Road) to 1.58 (Church). During 1910.12 the mean fatality rate for the Borough was 3.56, that during 1920-22, 4.10—an increase of 15 per cent. During the first period the rates recorded in the Wards varied from 10.47 (Lancaster Gate, East) to 1.60 (Maida Vale), and during the later, from 7.92 (Lancaster Gate, East) to 1.10 (Queen's Park). The mean rates recorded during 1920.22 were lower in Queen's Park, Church and the two Lancaster Gate Wards, the reductions ranging from 74 per cent. (Queen's Park) to 24 (Lancaster Gate, East). The increases noted in the other Wards varied from 128 per cent. (Harrow Road) to 18 (Lancaster Gate, West). OPHTHALMIA NEONATORUM. The cases notified during 1922 numbered 15, in addition to which 8 cases (including 2 already known to the Department) were reported by the Officers of the County, and one was discovered by the Health Visitor. The last was a midwife's case, and formed the subject of correspondence with the Medical Officer of Health of the County, but, so far as is known, did not result in any legal proceedings. The notified cases were equivalent to a rate of 5.49 per 1,000 births, the corresponding rate for 1921 being 11.88, and that for 1920, 8.49. It is now 11 years since this disease was scheduled for notification, and the following brief notes on the prevalence of the disease will be found to be not without interest. During the five years, 1912.16, the mean rate (per 1,000 births, as finally corrected) was 10.80, the corresponding rate for 1917.21 being 11.18—showing an increase of 3.5 per cent. The maximum rate recorded in any year during the first period was 17.38 (1914), and the minimum 7.28 (1913), the similar figures for the second period being 12.95 (1919) and 8.49 (1920). Last year's rate compares favourably with any and all of the rates previously recorded. During the years 1912.16 the mean rates recorded in the Wards ranged from 22.93 (Westbourne Ward) to 6.89 (Lancaster Gate, West), and during the following period from 15.01 (Church) to 5.93 (Lancaster Gate, East). In four Wards the mean rates for 1916.21 were less than the means for 1912.16, viz., Maida Vale, decrease 4.4 per cent., Westbourne, 41.4, Lancaster Gate, East, 53.9 and Hyde Park, 35.0. In the other Wards the rates were higher, viz., Queen's Park, 29.2 per cent., Harrow Road, 65.8, Church, 36.4, Lancaster Gate, West, 16.4. Last year the rate was 3.64 in Queen's Park, where the minimum rate recorded during the preceding ten years was 5.01 (1912); in Harrow Road, 9.07, previous minimum 6.59 (1914); Maida Vale, 2.36, zero (1921); Westbourne, 4.08, 4.81 (1921); and Church, 4.73 and 2.39 (1919). In the three other Wards the rates last year were : Lancaster 11 SEPTIC DISEASES. Gate, West, 10.31; Lancaster Gate, East, 25.64 ; and Hyde Park, zero. In these Wards zero rates were recorded on 5, 6 and 4 occasions respectively during the preceding decennium. It is permissible to hope that, notwithstanding the increase in the mean rate for the second quinquennium, a reduction in the prevalence of this disease may be looked for in the near future. Five (5) of last year's cases received institutional treatment, 4 in St. Margaret's Hospital (M.A.B.) and one in the Central London. The District Nurses took charge of 4 of the cases treated at home. One infant died (of premature birth) before the case was "cleared," but the remaining 14 other infants suffered no damage to their eyes. The only case during the year with any damage (ultimately recovered from) was the infant whose attack was reported by the Health Visitor. SEPTIC DISEASES. Erysipelas.—Last year 77 cases (males 25, females 52) were notified, the total for 1921 having been 83. During 1909-13 the annual average was 90, and during 1914-18, 101. Last year's notified cases were equivalent to a rate of 0.53 per 1,000 persons, the rate for males being 0.41 and that for females 0.61. In 1921 the rate (persons) was 0.57. The cases reported last year included at least one of erroneous diagnosis and 4 cases contracted in hospital. One patient was reported with the disease twice during the year, and in 2 instances the patients were known to the Department as having had the disease the one twice and the other 3 times previously. The seat of the disease was reported to be : Head, 44 cases; lower extremity, 20 ; upper, 6; trunk, 3; and not stated, 4. Although it is believed that a "wound" is a sine qua non as the site of infection, in 30 instances only was a history of "trauma" obtained. Including the cases contracted in hospital, 23 received institutional treatment (29.8 per cent. of the notified cases). Four of the 77 patients died after notification, one of the deaths being certified as due to a cause other than erysipelas. Two of the 3 deaths occurred in institutions. The mortality was 0.02 per 1,000 persons. During 1910-12 the mortality was at the rate of 0.03 per 1,000 males, and during 1920.22, 0.04—increase 33 per cent. The mean rates for females for the same periods were : 1910-12, 0.04; 1920.22, 0.02—a fall of 50 per cent. Other Septic Diseases.—In addition to the three deaths from erysipelas, there were 15 from other varieties of septic disease, making a total of 18 deaths from all forms of sepsis, other than puerperal fever, during the year, equivalent to a mortality rate of 0.12 per 1,000 persons. During 1910.12, the mean mortality rate was 0.10 per 1,000, the same rate prevailing during 1920-22. There was, however, some increase in the mortality among males—1910-12, 0.11; 1920-22, 0.12—and a decrease among females—1910-12, 0.09; 1920-22, 0.08. OTHER NOTIFIABLE DISEASES. Anthrax.—.One case was reported last year, the patient being a butcher's assistant working at Edgware, where he received his infection, probably when destroying the carcase of a horse found dead in a field. The interval between that act and the date of sickening precluded demonstration of the infection in the horse. The patient was admitted to hospital, and made a good recovery. Malaria.—Five (5) cases were reported during the year, 2 less than in 1921. All the patients were adult males, and satisfactory evidence was obtained in every instance of the disease having been contracted abroad. "MENINGITIS" GROUP. Cerebro Spinal Meningitis (or Fever).—Last year 2 cases were reported, the same number as in 1921. One of the patients (male, 8 months) resided in Church Ward, the other (female, 49) in Hyde Park. In both cases the diagnosis was verified by bacteriological examination, and both patients were treated in hospital. The infant died, the death being certified as due to "meningococcal posterior basic meningitis." The woman was known to have visited the country shortly before sickening, but no evidence could be obtained of the disease having' been contracted there. Encephalitis Lethargica.—In 1921,7 cases (including 2 errors) were reported, last year 2 only— a male, 46, and a female, 15. One patient resided in Harrow Road Ward, the other in Church. The woman's case was verified bacteriologically, and she was treated in hospital. The man's case was of the "ambulant" type. He attended the out.patient department of a hospital. The diagnosis of this case was more than doubtful. 12 pneumonia. THE PNEUMONIAS. The diseases to be notified under the "Pneumonia, etc., Regulations" of 1919 are the "Acute Influenzal" and "Acute Primary" Pneumonias. The latter term covers "Lobar" and "Lobular (Broncho.) "Pneumonia, but only such attacks as are not secondary to other diseases, e.g., measles, are to be notified. Influenzal pneumonia may be primary or secondary to an attack of epidemic influenza. From the figures about to be submitted, it will be evident that, although there has been a great increase in the number of cases notified, notification is still incomplete. Acute Influenzal Pneumonia.—Last year 72 cases were notified, the totals for the three preceding years being : 1919 (1st year of notification), 87; 1920, 45; and 1921, 27. It is doubtful whether the increase observed last year implies anything more than improvement of notification. Last year's total comprised 35 males and 37 females. The close approximation to a numerical equality of distribution between the sexes is borne out by the total numbers of cases reported since the beginning of 1919, viz., males 117, females 114. Had, however, the incidence of the disease been the same in * the two sexes, the number of cases among females corresponding to the 117 among males would have been 161. Of last year's cases, 2 were subsequent to notification marked "errors." The cases receiving institutional treatment numbered 45 (62.5 per cent.), 38 being admitted to the Paddington Hospital. The deaths among the patients whose cases were notified numbered 26, 15 among hospital patients, of whom 12 were in Paddington Hospital. The fatality among the whole group (72 cases) was at the rate of 36.1 per cent., and among the patients admitted to hospital 57.7. Of the 26 deaths, 22 were certified due to epidemic influenza, 3 to " pneumonia," and 1 to other disease (diphtheria). Acute Primary Pneumonia..—The cases notified during 1922 numbered 254, the totals for the preceding three years being : 1919, 83; 1920, 96; 1921, 105. It is thought that, here again, the increase is largely a matter of more complete notification. The sex.distribution of primary pneumonia is very different to that of the influenzal form. Last year's cases comprised 159 of males and 95 of females. The cases reported during the four years covered by notification comprised 327 of males and 211 of females. If the disease had been equally prevalent among the two sexes, the number of cases last year among females (given 159 cases in males) would have been 451. Of the 254 notified cases, 163 (64.1 percent.) received institutional treatment—131 at the Paddington Hospital. The District Nurses were in charge of 14 of the patients treated at home, and 3 patients entered nursing homes. Among the notified cases 74 ended fatally (29.1 per cent.), 50 of the deaths taking place in hospital and 24 at home. The fatality among the patients treated in institutions was at the rate of 30.6 per cent., and that among patients treated at home 26.3. Five persons were reported twice during the year as suffering from the disease, the second attack in each instance terminating fatally. The cause of death was not always certified as a pneumonia, 62 of the 74 deaths being attributed to various forms of pneumonia, 2 to epidemic influenza and 10 to other causes. Defect in Notification.—Last year 68 deaths of residents of the Borough were due to epidemic influenza, of which 49 represented attacks of which no information was obtained until the deaths were registered. Of the 49 deaths 2 occurred in St. Marylebone and 4 were registered after inquest. The deaths from the various forms of pneumonia numbered 162—excluding those of an influenzal origin— 100 of which were not represented by notified cases. Among those 100 cases were 11 which took place outside the Borough and 7 inquest cases, leaving 82 deaths which, apparently, ought to have been notified. Epidemic Influenza.—The 68 deaths from this cause comprised 33 of males and 35 of females. The disease was most prevalent in January (46 deaths) and February (8 deaths). The mortality rate for the Borough was 0.46 per 1,000 persons, which rate was exceeded in Maida Vale (0.58), Westbourne (0.66) and Lancaster Gate, East (0.98) Wards. During 1910.12 the mean mortality was 0.18 per 1,000, and that during 1920.22, 0.31—an increase of 28 per cent. The mortality among males in 1922 was 0.54, the mean rate for 1910.12 being 0.19, and that during 1920.22, 0.34. The rates among females were : 1922, 0.41; 1910-12, 0.18; and 1920-22, 0.30. Respiratory Diseases.—The total of the deaths during 1922 from these causes was 375—202 of males and 173 of females. The numbers entered under each of the diseases included under this general heading are given inTable VI. The mortality rates in 1922 were: Persons, 2.58, males, 3.31 and females, 2.04. The mean rates for persons was 2.11, both for the years 1910-12 and 1920-22. The rates for males were : 1910-12, 2.58; 1920-22, 2.64 ; those for females : 1910-12, 1.75; 1920-22, 1.72. 13 OTHER DISEASES. OTHER DISEASES. Heart Disease.—There were last year 221 deaths—92 of males and 129 of females—from the various affections of the heart, the mortality rates being : Persons, 1.52 ; males, 1.51 ; and females, 1.52. During 1910.12 the mean mortality rates were: Males, 1.15; females, 1.08; and during 1920-22, males, 1.52; females, 1.41. Cerebral Hemorrhage, Apoplexy.—There were during the past year 109 deaths—.48 males and 61 of females—the mortality rate being 0.75 per 1,000 persons. The mortality rate for males during the year was 0.78, as compared with means of 0.48 (1910-12) and 0.63 (1920-22), those for females being 0.72 in 1922, 0.46 during 1910-12, and 0.60 during 1920-22. Alcoholism.—Acute and Chronic.—The deaths in 1922 numbered 5—.2 of males and 3 of females —being one more than in 1921—3 of males and 1 of a female. The average annual numbers (persons) during the following periods were : 1909-13, 11; 1914-18, 7; 1919-20, 3 ; and 1921-22, 4. During 1910.12 the mean annual mortality was : Males, 0.07 ; females, 0.04, the means for 1920.22 being: Males, 0.07; females, 0.02. Cirrhosis of the Liver.—To this cause 5 deaths—2 of males and 3 of females—were due last year' as compared with 13—8 of males and 5 of females—in 1921. The following are the annual average numbers: 1909-13, 15; 1914-18, 19; 1919-20, 6; and 1921-22, 11. During 1910-12 the mean mortality among males was 0.11, and that among females 0.07, the corresponding means for 1920.22 being males 0.10 and females 0.04. The combined figures given in the two preceding sections may be taken to represent the mortality from alcoholic excess, the deaths from such causes during the year numbering 10—4 of males and 6 of females. The mortality rates were : Persons, 0.07; males, 0.06; and females, 0.07. For the years 1909.13 the annual average was 26, for 1914.18, 26, for 1920.22, 9. During the three years 1910.12 the mean rates were: Persons, 0.17; males, 0.18; females, 0.17; and during 1920-22 : Persons, 0.08 ; males, 0.11 ; females, 0.06. Venereal Disease.—.The attendances at the Venereal Disease Clinic, St. Mary's Hospital, numbered 9,111, 6,256 being made by persons giving addresses within the Metropolis. The number of residents of the Borough attending cannot be given. The mortality rates from syphilis are by no means satisfactory evidence of the real fatality due to the disease. Moreover, the deaths certified due to it are mainly those of very young infants. Many of the diseases treated in lunatic asylums, certain forms of disease of the circulatory and other organs have their origin in venereal disease—but very rarely is that origin mentioned in the death certificate. During 1910.12 the mortality rates from syphilis were : Males, 0.11 per 1,000; females, 0.06, and those during 1920.22 : Males, 0.08; females, 0.03. Last year 3 deaths of males and 5 of females were ascribed to the disease, equivalent to rates of 0.04 and 0.05 per 1,000 of each sex. TUBERCULOSIS. (See Tables III., VI., VII..XI., Appendix.) Notification.—During 1922, 961 certificates were received, including 6 inward transfers and 123 for dispatch to other districts, the nett number of certificates relating to residents of the Borough being 834, of which 526 were " repeats." The final total of newly certified cases was 312—204 of pulmonary and 108 of other forms of the disease. In comparison with 1921 last year's total showed a decrease of 57 cases—40 of pulmonary and 17 of other forms. Ten years have elapsed since notification was applied to all forms of tuberculosis in all ranks of society by the "Tuberculosis Regulations, 1912." The number of cases reported annually fell from 836 in 1913—664 of pulmonary and 172 of other forms—to 502 in 1917—355 of pulmonary and 147 of other forms. For the quinquennium the annual average was 600—446 of pulmonary and 154 of other forms. In the following quinquennium the numbers fell from 451 in 1918—325 pulmonary and 126 of other forms—to 312 in 1922—204 of pulmonary and 108 of other forms, the annual average for the period being 374—267 of pulmonary and 107 of other forms. In comparison with the first period of the average for 1918.22 shows a total fall of 39 per cent., 40 in pulmonary cases and 30 in those of other forms. The figures for 1913 cannot, however, be regarded as other than artificial, as they do not represent cases newly diagnosed during the year, but cases under treatment, many of such cases having been diagnosed in previous years. Tentative adjustment has been made of the records for 1913, based on the numbers recorded during the years 1914.17, such adjustment reducing the annual average for 1913.17 to a total of 540 cases—391 of pulmonary and 149 of other forms. In comparison with those estimated averages, the reductions shown by the averages for 1918-22 become, total cases 31 . less, pulmonary, 32 and other forms 28. 14 TUBERCULOSIS. In 1913, 33 . of the new cases were certified by private practitioners, 20 . by the Poor Law Medical Service and 18 by Tuberculosis Dispensaries. Last year the corresponding percentages were 12, 15 and 23 respectively. In addition to the 312 certified (" definite ") new cases, 115 persons were reported as under observation at the Dispensaries on account of suspected tuberculous disease. That number is 25 in excess of the figure for 1921, but otherwise the lowest for any year since 1909, when " suspects " were first reported to the Department. Of the 312 new cases, tuberculosis was reported to be present in one part of the body in 309 instances, and in 2 in 3—the latter counting as " pulmonary cases." As regards the 108 cases of non. pulmonary tuberculosis, the disease was reported to be in the lymphatic system in 59 cases, osseous, 20, digestive, 14, head and neck, 8, generative and urinary systems, 3 each. In 4 instances of " repeat" notifications of non.pulmonary tuberculosis extension of the disease to the lungs was reported in 4 cases, and to head and neck (following lymphatic infection) in 2. In 2 " repeat " notifications of pulmonary cases extension to the osseous and digestive systems (one each) was reported. An examination of the numbers of cases of pulmonary tuberculosis reported during the triennia 1914.16 and 1920.22 shows that the sex distribution (all ages) has varied to so small an extent as to be insignificant. The percentage distribution of the cases among men shows that there have been in the second period reductions in the age groups 0-1, 1-5, 5-10 and 10-15, and in the 2 highest, viz., 65-75 and 75 and over, the proportions in the age groups lying between 15 and 55 years being higher. In the case of females the only age groups showing higher percentage proportions are those of 15-25 and 25.35 years. A similar examination of the numbers of cases of other forms of the disease shows that at all ages there has been an increase among females by a little more than 5 per cent. The percentage distributions for each sex shows in both sexes declines in the proportions at ages under 5 years, but increases in nearly every age.group above that limit. Each year a few of the notified cases cannot be allocated to any Ward, chiefly among those notified by the Poor Law Medical Service and from Lunatic Asylums, the "home address" being given as "Workhouse" or a Common Lodging House. During 1913.17 such cases averaged 17 per annum— 12 of males and 5 of females—while during 1918.22 the average decreased to 7—5 of males and 2 of females. On examining the averages for the periods 1913-17 and 1918-22 it has been found that the annual average of cases (all forms of tuberculosis) for the second period among males has diminished by 39, and that of cases among females by 35 per cent. The average (persons) recorded in Lancaster Gate, East, Ward during 1918.22 is the only one in excess of the corresponding average for 1913.17, the increase being limited to males (40 per cent.) the average for females showing no change. The reductions observed in the averages in other Wards varied (for persons) from 43 per cent. (Queen's Park) to 8 (Lancaster Gate, West), the range in the averages for males being from 46 per cent. (Queen's Park) to 26 (Lancaster Gate, West), and that among females from 51 per cent. (Church) to zero (Lancaster Gate, West). The mean morbidity rate in the Borough during 1920-22 was 2-38 per 1,000 persons. The mean rates for Westbourne and Church Wards (3.01 in both) were in excess of the rate for the Borough. In the other Wards the means varied from 2.32 (Queen's Park) to 1.22 (Lancaster Gate, West). Institutional Treatment.—Non.Residential: Dispensary.—Excluding 146 persons of all ages under observation at the two Dispensaries at the close of 1921, the patients presenting themselves at those Institutions during the year numbered 839, 52 less than the totals for 1920 and 1921, and the smallest total for any year since the first year for which complete figures are available (1917). The 844 patients comprised 223 adult males (183 being insured males), 272 adult females (108 insured) and 344 children aged 0-15 years. It should be noted here thg,t the age limit for children has been reduced from 16 to 15 years in the pro forma issued by the Minister of Health last year. The total number of patients for diagnosis was 985, comprising 546 adults—males 242, females 304—and 439 children—males 224, females 215. Of that total 8 ceased attendance before a diagnosis was made. Of the remaining 977 persons, 197 (20.1 per cent.) were found to be tuberculous. The percentage of the tuberculous adult males was 31.6, that of adult females, 22.8, and that of children (both sexes), 12.0—all those percentages being notably below the figures hitherto reported. Of the insured males 27.7 were found to be tuberculous—24.7 with the pulmonary form and 3.0 with other—and of the females 28.0—23.2 pulmonary, 4.8 other. Of uninsured males 50 were tuberculous—45.2 pulmonary, 4.7 other—and of females 18.9—13.4 pulmonary, 5.5 other. Of the children 1.6 . were found to have pulmonary tuberculosis and 10.3 other forms of the disease. Last year 416 ""contacts" were examined comprising 202 adults (males 87, females 115) and 214 children, among whom 43 cases of tuberculosis were found, 34 of pulmonary (8.1 per cent.), and 25 of other forms, 42 other individuals being kept under observation pending diagnosis. 15 TUBERCULOSIS. Last year 147 "suspects" were reported as discharged, 12 on diagnosis of tuberculosis, 46 on diagnosis of other diseases and 89 as showing no evidence of disease. Among 162 individuals, referred to the Dispensaries for observation and diagnosis, there were 140 whose cases had not been diagnosed after over two month's supervision. St. Mary's Hospital is affiliated to the Dispensaries for purposes of diagnosis of doubtful cases, etc., 144 patients being referred to that Hospital during the year. Consultations between the Tuberculosis Officers and private practitioners took place with reference to 33 patients, 23 being insured persons and 10 uninsured. The Tuberculosis Officers paid 486 visits to the homes of patients under the Dispensaries, and the Nurses attached to the Dispensaries 3,625. Of 299 specimens of sputum examined, 67 gave " positive" results. In September, 1920, a Dental Clinic was opened at the Dispensary in Talbot Road, sessions being held each Tuesday afternoon. Last year there were 49 sessions, at which 382 attendances were made by tuberculous patients. The work done included 53 teeth stopped, 12 scaled, and 247 extracted. The dentures supplied were 14 for the upper jaw and 13 for the lower. Residential.—"C" Forms, reporting the admission to residential institutions (of all descriptions) of 335 patients—266 with pulmonary tuberculosis and 69 with other forms—were received during the year. Of the cases of pulmonary tuberculosis 30 . were admitted to Poor Law Institutions, 27 to Hospitals of the Metropolitan Asylums Board (under 1 . to Hospitals not reserved for tuberculosis), 21 to Special Hospitals, 15 to Sanatoria and 7 to General Hospitals. Of the non.pulmonary cases 43 . were admitted to Hospitals of the Metropolitan Asylums Board (including 17 . admitted to Hospitals not reserved for tuberculosis), 27 . to General Hospitals, 26 to Poor Law Institutions and 3 to Sanatoria. The records of admissions to institutions kept in the Department show that 258 patients were admitted during the year, of whom 144 (55.8 per cent.) were patients whose cases were first notified last year. The 144 patients formed 46.1 . of the 312 cases, and the remainder (114) 5.1 . of the estimated number of survivors as at the middle of the year.* The 258 patients comprised 141 males and 117 females of all ages, the sex.distribution of the 144 new cases being 77 males and 67 females. No statement can be made as to the proportions of males and females (per 100 cases) among the old cases admitted, but of the new cases 46.5 . of males and 45.2 of females received institutional treatment during the first year after notification of their cases. Of the 258 patients 189 were admitted once during the year, 57 twice, 10 three times and 2 four The frequency of admission of new cases was 1 admission 104, 2 admissions 33, 3, 5 and 4, 2. Considerations of space prevent the inclusion of the tabulations showing the class of institution to which the patients were admitted, but it may be stated that of the patients admitted once during the year, 25 (13.2 per cent.) were admitted to Sanatoria, 58 (30.6 per cent.) to Hospitals of the Metropolitan Asylums Board, 37 (19.5 per cent.) to other Hospitals, 2 (1 per cent.) to Tuberculosis Colonies, 66 (34 per cent.) to Poor Law Institutions and 1 to a Home for the Dying. L.C.C. Scheme.—At the end of 1921, 57 patients were still under treatment, including 2 cases belonging to the previous year. Last year 175 applications for treatment under the Scheme were transmitted to the County Council, 89 being from adult males, 79 from adult females and 7 on behalf of children. For various reasons 40 of those applications did not mature. Of the 131 applications which were completed, 73 resulted in admission to hospital and 58 to sanatoria. Of the 73 patients admitted to hospitals 30 were subsequently transferred to sanatoria, and of the 58 admitted to sanatoria 2 were later on transferred to hospitals, 2 to other sanatoria and 1 to a Home for the Dying. Among the 188 patients treated under the Scheme during the year 17 deaths are known to have occurred (a fatality of 9 per cent.), 124 patients were discharged during the year and 47 remained under treatment at the close of the year. Care Committee.—Within a few weeks of opening the Paddington Dispensary for Prevention of Consumption in 1909, a "Case Committee" was appointed by the Executive Committee of the Dispensary. That Committee was formed largely of voluntary visitors. It was in full work until the autumn of 1914, when its members were required for other work. In April, 1915, the Local Government Board issued a Circular Letter pointing out the need of Care Committees to supplement and complement the scheme for the Treatment of Tuberculosis in operation in the Borough. The letter went on to say that the functions of such Committee being to a considerable extent "outside the powers of local authorities . . . the Committee will be a voluntary Committee . . . will have to rely largely on voluntary contributions . . The Council was asked to submit proposals in accordance with the Board's letter. * The "survivors" on December 31st, 1921, numbered 2,273, among whom there were 82 deaths during the twelve months. The estimate has been obtained by deducting half the number of deaths from the number of survivors. 16 TUBERCULOSIS. In October, 1915, a letter was received from the County Council asking the Council to take into consideration the formation of a Tuberculosis Care Committee for the Borough, the suggested constitution providing for representation of the Dispensaries—the Tuberculosis Officers and "several lay members"—of the Council—the Medical Officer of Health and the Women Sanitary Inspectors— of the County Council—the Divisional Medical Officer and an Organiser attached to the School Care Committee—the Insurance Committee and the Board of Guardians. War conditions made the appointment of a new committee a matter of extreme difficulty and after much correspondence and conference with the County Council the latter Council decided to appoint an "Interim Advisory Committee" with a limited constitution. The Interim Committee for the Borough began work in February, 1916, and was mainly engaged in assessment work in relation to admission to residential institutions under the County Council's Scheme for such treatment. There was then little or no visiting of tuberculous patients by voluntary workers as was practised during 1909.14. In May, 1922, the Minister of Health issued a Circular Letter pressing for the appointment of a Care Committee by the Borough Council to replace the Interim Committee. In the following July, the Council adopted a Scheme for submission to the Minister of Health providing for the re.appoint. ment of the Members of the Interim Committee as members of the Borough Care Committee with additional representatives from organisations formed to deal with conditions arising out of the war, and the appointment of a part.time secretary and social worker. The Care Committee, which will comprise some 30 Members, had not begun work at the close of the year. It is to be regretted that the Scheme relating to the Care Committee does not provide that Committee with any money to carry out the duties—outside the powers of the Council—entrusted to the Committee. In Circular No. 194 (received in April, 1921), the Minister of Health intimated that he was prepared to make contributions in aid (not exceeding 50 per cent.) on expenditure for extra nourishment for tuberculous patients, provided that such expenditure did not exceed £2 per 1,000 of the population—say up to £300 per annum for the Borough. Arrested Cases.—The Department has records of 333 patients whose disease was marked "arrested" prior to the end of 1920, 35 of those patients having left the Borough in the meanwhile. Inquiries were made during 1922 as to the health of those patients. Approximately one.third of the patients—107 including 26 who have left the Borough—could not be traced, and of the remainder— 226 patients including 9 removed—8 (all pulmonary cases) were found to have died, 24—19 with pulmonary and 5 with other forms of tuberculosis—were still under observation, and 164 (including 8 removed) were apparently "cures" as regards tuberculosis, but 23 were reported to be Suffering from other diseases. In other words, 72.3 percent. of the patients who had been notified between 1908 and 1919, but marked "arrested" prior to December 31st, 1920, were found during 1922 to be (apparently) cured of that disease, and 86.4 percent. of those originally suffering from other forms of tuberculosis. Of the 164 patients noted as "cures" 148—133 pulmonary and 15 other forms— were entered on the Register during 1910-13. Mortality.—The deaths from tuberculosis (all forms) during 1922 numbered 143—117 from the pulmonary disease and 26 from other forms—equivalent to rates (per 1,000 persons) of 0.98, 0.80 and 0.17. The deaths of males numbered 77—69 pulmonary, 8 other forms—with rates (per 1,000 males) of 1.26, 1.13 and 0.13 ; and those of females 66—pulmonary 48, other forms 18—with rates (per 1,000 females) of 0.78, 0.56 and 0.21. During the years 1910.12 the rates per 1,000 persons were: all forms, 1.25, pulmonary, 0.99, and other forms, 0.26; and for the years 1920-22, 0.98, 0.73 and 0.25. The rates recorded during the later period show reductions of 22, 27 and 4 . respectively. Adhering to the same order the rates (per 1,000 males) were: 1910-12, 1.71, 1.30 and 0.41 ; 1920.22, 1.29, 0.94 and 0.35—showing reductions of 25, 28 and 15 per cent. For females the figures are : 1910.12, 0.91, 0.76 and 0.15; 1920.22, 0.75, 0.59 and 0.18—showing reductions in the total and pulmonary mortalities of 18 and 23 per cent., and an increase of 20 percent. in the mortality from other forms. The incidence of mortality during 1922 on the residents of the different Wards of the Borough can be briefly summed up as follows : Total mortality, maximum rates (persons, males and females), Church, 1.52, 1.83 and 1.25; minimum, Lancaster Gate, West, 0.20, 0.32 and 0.15. Pulmonary tuberculosis, maximum, Church, 1.36, 1.83 and 1.83; minimum, Lancaster Gate, West, 0.20, 0.32 and 0.15. Other forms, no deaths in Lancaster Gate, West, and Hyde Park, 1 death (a male) in Lancaster Gate, East, and in other Wards, persons, maximum, Harrow Road (0.36), minimum, Maida Vale (0.13); males, maximum, Harrow Road (0.23); minimum, Maida Vale (0.11); females, maximum, Harrow Road (0.47), minimum, Westbourne (0.14). The rates for 8 sex.age groups during the triennia 1910.12 and 1920.22, as well as for 1922, have been calculated. Among males the highest mortality from pulmonary tuberculosis in both periods was observed in the age.group 45.55 years, viz., 2.54, during 1910.12, and 1 .72 in the second period and the lowest mortality (both periods) in the group 5.15, viz., 0.10 and 0.07. In the group 15.25 alone was the mortality during 1920.22 higher than in the earlier period, the increase amounting to 5 per cent. The maximum decrease (73 per cent.) took place at ages 0.5, and the minimum at ages 17 CANCER. 25.35 (17 per cent.). Comparison of single year's rates with means for a period are not satisfactory, but it may be observed that the rates recorded in 1922 were above the means for 1920.22 at all ages, except 5.15 and 45.55. Among females for 1910-12 the maximum rate (1.09) was recorded at ages 35.45, and the minimum (0.06) at ages 5.15. During 1920.22 the maximum (0.94) fell on the group 25.35 and the minimum (0.06) on the group 5.15. The rates were higher in the second period at ages 15.25 (by 50 per cent.) and 25.35 (by 13) and 65 and over (9 per cent.). The reductions noted at other ages varied from 59 per cent. in the group 35.45 to 41 per cent. in the group 0.5. In 1922 the rates in four of the age.groups were higher than the 1920.22 means, by amounts varying from 54 per cent. (0.5) to 12 (45.55), and lower in the others, the falls varying from 100 per cent. (5.15) to 8 (25.35). As regards the rates of mortality from other forms of tuberculosis it will suffice to say that at the ages 0.5 and 5.15—the age.groups of maximum incidence—the rates for 1920.22 are all lower than those recorded during 1910.12, but it has to be noted that there were unexpected increases in some of the higher age.groups. Last year's rates for the two youngest age.groups were below the means among males, but among females there was an increase (of 50 per cent.) at ages 0.5. Deaths in Institutions.—Of the 143 deaths from all forms of tuberculosis recorded last year, 84 (58.7 per cent.) took place in institutions, the mean for the years 1917.21 being 58.9 per cent. The deaths of males in institutions formed 58.4 . of all deaths from tuberculosis in males, the corresponding proportion for females being 59.9 per cent. Of the deaths due to pulmonary tuberculosis, 54.7 per cent. occurred in institutions during the past year, the average (1917.21) being 55.4, while of those due to other forms of the disease the institutional deaths formed 76.9 per cent. in 1922, the average being 74.3. While there has been but slight changes in the proportion of the institutional deaths to all deaths, the distribution of deaths in the various classes of institutions has altered considerably. Taking the deaths from pulmonary tuberculosis first: Last year 54.6 per cent. of the deaths in institutions occurred in Poor Law Institutions, the average (1917.21) being 51.4; 14.0 . in the Hospitals of the Metropolitan Asylums Board set apart for tuberculosis, as compared with an average of 7.3 per cent. ; and 12.5 per cent. in Lunatic Asylums, average 17.4. In the case of other forms of the disease, the proportions were : Poor Law, 1922, 55 per cent., average 48.9; General Hospitals, 1922, 20 per cent., average 33.8; Special Hospitals, 1922, 10, average 3.6. In the other classes of institutions the changes (in both divisions of the disease) were insignificant. Defects in Notification.—Of the 143 fatal cases recorded during the year, 24 were never notified to the Medical Officer of Health during life, 9 of the deaths taking place at the deceased persons' homes within the Borough, 10 in local institutions and 5 in out.lying districts (including institutions). In 12 instances the patients were dead when the notification certificates were received, and 21 patients died within one month after notification. CANCER: MALIGNANT DISEASE. (See Tables VI., VII. and XII., Appendix.) Last year 191 deaths—93 of males and 98 of females—were recorded, the mortality rates being, persons 1.31, males 1.52, and females 1.16. The occurrence of a higher rate among males than among females is unusual. Last year's total was 35 below the figure (226) for 1921, 3 below that for 1920 (194), and 7 below that for the annual average for 1914.18 (198). During 1910.12 the mortality rate (persons) was 1.17 per 1,000, and during 1920.22, 1.41—an increase of 20 per cent. During the periods mentioned the rates among males were 1.20 and 1.48 (increase 23.3 per cent.), and those among females 1.17 and 1.36 (increase 16.2 per cent.). The sex.age.group mortality rates have not been calculated, but it may be observed that last year's figures when compared with the averages for the previous five years, show some unexpected changes in the distribution of the deaths. In every age.group, except that of 65.75 (decrease 28 per cent.) the numbers of deaths of males during the past year exceeded the respective average. Neglecting the group 0.35 years, in which the deaths are so few as to be almost insignificant, it has been found that the deaths at ages 45.55 last year exceeded the quinquennial average by 53 per cent., the increase in the next group (55.65), amounting to 46 per cent. Approximate calculations indicate that in each age.group, except that of 35.45, the mortality among males exceeded that among females. Comparison of the numbers recorded in each Ward with the averages for 1917.21 shows that in every Ward, except Harrow Road (no change), Lancaster Gate, West (fall of 25 per cent.), and Hyde Park (no change) the deaths of males recorded in 1922 were in excess of the averages, the excess varying from 77 per cent. (Westbourne) to 33 (Queen's Park). In the whole Borough the excess amounted to 22 per cent. The deaths of females, on the other hand, were below the averages in the Borough (by 15 per cent.), and in every Ward except Lancaster Gate, West (increase 55 per cent.), the deficiencies varying from 67 per cent. (Queen's Park) to 10 (Westbourne). 18 inquests. Comparing the mean mortality rates in the Wards for the periods 1910.12 and 1920.22 it is found that in Maida Vale Ward alone is any decrease in mortality found—males 18 . less, females, 4. In every other Ward increases have to be recorded in the case of males ranging from 67 per cent. (Westbourne) to 2 (Harrow Road), and in the case of females, from 70 (Lancaster Gate, West) to 2 (Harrow Road). The highest Ward rate for males during 1922 (2.33 per 1,000) was recorded in Westbourne, and the lowest (0.97) in Lancaster Gate, West. The highest rate among females (2.17) was recorded in Lancaster Gate, West, and the lowest (0.72) in Queen's Park. During 1917-21, 20.4 per cent. of the deaths were returned as due to such vague causes as "cancer" and "malignant disease." During 1922 the proportion fell to 7.8, the reduction being particularly large (from 17 to 4 per cent.) in the case of males. Among deaths of females the reduction was from 23 to 11 per cent. VII. INQUESTS. During the past year 188 deaths were registered after Coroner's Inquisition, 104 of the deceased persons being males and 84 females. The annual averages for the years 1909.13 (the last five years before hostilities affected the frequency of inquests) were—Total inquests, 158, on deaths of males, 91, and on those of females, 67. During the quinquennium 8.4 per cent. of the corrected total of deaths were registered after inquest, and in 1922, 9.9 per cent., an increase of 18 per cent. The findings at the inquests held last year were : Natural Causes, 86; Misadventure, 6; Accidental Causes, 52; Suicide, 32; Murder, 1; Open, 10; and Neglect, 1. The average numbers for 1909.13—in the same order—were 74, 10, 46, 15, 2, 5 and 6. It will be seen that there were reductions in the numbers of deaths attributed during the past year to Misadventure and Neglect. The greatest increase was in the number of deaths from Suicide, viz., from an average of 15 to 32. Last year there were 20 deaths of males aged 25.65 years from this cause, as compared with an average of 7 during 1909-13, the deaths of females increasing from an average of 5 to 6 last year. At ages of 65 and upwards there were 3 deaths of males and 2 of females, the averages being 2 and "0." In connexion with deaths by suicide the frequency of the use of coal gas to end life has attracted much attention during the year. Prior to 1919 deaths through the misuse of gas were rare, only 15 such deaths being recorded during the ten years 1909.18. In 1919 suicide by gas was effected by 5 persons, in 1920 by 3, in 1921 by 8 and in 1922 by 14. Last year's total was seven times the annual average (2) for 1909.13. In February of last year a request was received from the Minister of Health for a report on a death due to coal gas, which had formed the subject of inquest in the preceding month. Since then reports have been furnished regularly on all deaths attributed to coal gas. The Coroner sends notice of a pending inquest on such case, and either the Medical Officer of Health or the Chief Inspector attends the Inquest and completes the official form to which are appended a plan of the room in which the death took place and a press report of the inquest. During the past year 13 such reports were forwarded, one copy to the Minister of Health, and a second to the Board of Trade. The deaths from traffic accidents last year numbered 14, one less than the annual average for 1909. 13. The deaths from road traffic numbered 13, average 14, 8 being caused by motor traffic, average 10, and 5 by horse, average 5. One death, of an infant, was found to be due to overlying in bed, the average for 1909.13 being 4. VIII. DEATHS IN INSTITUTIONS. Of the deaths registered within the Borough during the year, 903 (46.8 per cent.) occurred in the local Institutions, viz., 546 in the Paddington Hospital, 273 in St. Mary's Hospital, 69 in the Children's Hospital, 13 in the Hospital for Women and Children (formerly " The Lock ") and 2 in the Roll of Honour Hospital for Children (closed at the end of June last). During 1912.16 the annual average of deaths in those institutions was 852, and that during the following five years 686. The increase in the number of deaths in local institutions has been due to the expansion of the work of the Paddington Hospital in which 275 deaths took place in 1912, compared with 546 last year. The deaths of residents in out.lying institutions numbered 233 (71.9 . of all inward transfers) compared with averages of 253 during 1912-16 and 408 during 1917-21, the increase in the latter figure being due to the transfer of the work of the (late) Paddington Infirmary to that of St. Marylebone, while the former was used as a Military Hospital. The corrected total of deaths during 1922 in all institutions was 845 (430 of males and 415 of females) equivalent to 44.7 per cent. of the corrected total of deaths from all causes. During 1917.21, 19 STATISTICS OF CHILDHOOD. the proportion was 42.4 per cent. The proportion of male deaths last year in institutions was 46.3 per cent., the average (1917.21) being 45.4, and that of females 43.1, average 39.8. The institutional deaths were distributed among the various classes of institutions in the following proportions (percentages): Hospitals of the Metropolitan Asylums Board, 1.9; Poor Law Institutions, 28.0; Lunatic Asylums, 3.1; Voluntary Hospitals (General), 8.8 and Special (including Sanatoria) ,2.8. The average proportions during 1917-21 were 1. 9, 24. 4, 4.1, 8 .9 and 2.4 respectively. In addition to the numbers given above 68 deaths took place during the year in private Nursing Homes in the Borough, 30 of the deceased persons being non.residents. In 1912 the deaths in these Homes numbered 25, including 15 of non.residents, and during 1917.21 the annual average was 56, with 32 non.residents. Among the inward transferred deaths there were 41 in Nursing Homes, making a total of 79 deaths of residents in these places, or 4.1 per cent.—over and above the 44.7 per cent. in the institutions previously mentioned. Nearly 49 per cent. (48.8) of the residents who died during 1922 were treated during their last illnesses away from their homes. IX. STATISTICS OF CHILDHOOD (0.5 Years). (See Tables I., II. and XIII.) Mortality at Ages 0.1 Year.—The deaths at ages under one year registered within the Borough during the year numbered 224—equivalent to a mortality rate of 88 per 1,000 births registered in the Borough. In 1921 that rate was 115, and in 1920, 87. The mean rate during 1909.13 was 124, that recorded during 1917.21 being 118. The rate observed during 1922 was 29 . less than the mean for 1909-13. The finally corrected total of deaths during the first year of life in 1922 was 189—100 of males and 89 of females—and the mortality 69 per 1,000 births, the rate in 1921 having been 92, and in 1920 78. For the years 1909-13 the mean rate was 106, and that for 1917.21, 98, last year's rate being 35 per cent. below the former quinquennial mean and 30 per cent. less than the latter. Those reductions represent a saving of 100 infants' lives on the basis of the mean for 1909.13 and 79 on that of 1917.21. The 189 deaths comprised 158 of legitimate children and 31 of illegitimate, the corresponding rates being 62 and 145 per 1,000 births of each category. The mortality rates among males were: Legitimates, 65; illegitimates, 144; and those among females: Legitimates, 59; illegitimates, 147. The mean rates during 1909-13 among legitimate children were: Persons, 96; males, 108; and females, 84, the rates recorded last year showing percentage decreases of : Persons, 35; males, 40; and females, 30. The mean rates (same period) among illegitimate children were : Persons, 266 ; males, 269 ; and females, 263. Last year's figures showed falls of 45 per cent. in the case of the combined sexes, 46 . in that of males and 44 . in that of females. The foregoing comparisons indicate that while the disparity between the mortality rates among legitimate and illegitimate children remains as great as ever, there was, last year, a greatly reduced mortality in each group, and that the reduction was somewhat greater in the case of illegitimate children than in that of the legitimate. The reduction was also greater in the mortality among males than in that among females. The mortality rates (total) recorded in the Wards are shown in Table II. When compared with the mean rates for 1909-3 and 1917-1 in Lancaster Gate, West, Ward alone is an increased rate recorded—the increase amounting to 15 . of the mean for the former period and 82 of that for the latter. The smallest reduction (18 per cent.) below the mean for 1909-3 is found in Lancaster Gate, East, Ward, and the largest (53 per cent.) in Hyde Park. The reductions to be noted in the other Wards can be regarded as satisfactory. Analysing the deaths of infants of each sex by ages it appears that at ages 0.3 months the mortality rate (per 1,000 births) among males was 31 . less than the mean rate for 1909.13, and that among females, 18. Parenthetically it may be observed that at ages under one day the mortality last year was for each sex 12 . less than the mean. At ages 3.6 months, last year's mortality among males was 61 . less than the mean, and that among females, 44. In the next group (6-9 months) the reductions (per cent. of the mean) were: Males, 51; and females, 21; and in the last (9-12 months), 21 and 64. Comparing the mortalities due to the groups of diseases shown in Table XIII., with the means for 1909.13, the following reductions have to be noted: Group I., males 53 per cent., females 67 ; II., males 42, females 79 ; III., males 78, females (increase) 7 ; IV., males 40, females 17 ; V., males 34, female 1 ; Other Causes, males 21, females 5. Special Areas.—In these the only one with a higher infantile mortality was " Alfred Road " area, where the rate last year was 147 per 1,000 births, or 13 in excess of the rate recorded in 1921 (134). In this Area the infantile mortality has increased almost continuously since 1909, and the Area is by that fact distinguished from all the others. In the " Clarendon Street " Area, hitherto regarded as the 20 DISEASES OF CHILDHOOD. worst part of the Borough, there has been a notable improvement. In the years 1909.13 the mortality averaged 172 per 1,000 births. During 1922 it was 116, and the average for 1918.22 was 144. During 1909.13 the mortality in the Borough averaged 106, that in the combined six Areas, 131, and in the Rest of the Borough, 93. Last year the figures were: Borough, 69; Combined Areas, 96; and Rest of the Borough, 59. For the five years, 1918.22, the figures were: Borough, 89 ; Combined Areas, 103; and Rest of the Borough, 84. In comparison with the mean rates (1909.13) the age.group rates for last year show the following reductions : 0.3 months C.A.,* 15 per cent.; R.B., 29 ; 3.6 months, C.A. and R.B., 50 ; 6.9 months, C.A., 36; R.B., 42; 9.12, C.A., 21 ; R.B., 54. As regards causes of death, increases have to be recorded in the Combined Areas from Premature Birth (mean, 16.67, 1922,22.16), Meningitis (from 1.78 to 2.61) and Respiratory Diseases (from 25.81 to 31.30). In the Rest of the Borough increases took place in the mortalities from Atelectasis (mean 1.79, 1922 2.04), Syphilis (1 .39 to 2.03) and Other Causes (from 7.09 to 8.65). Although there has been a satisfactory reduction in the infantile mortality in these areas the disparities between the rates recorded therein and those recorded in the Rest of the Borough indicate that there is still much room for improvement. Mortality at Ages 1.5 Years.—By a method of survivorship it was estimated that the children aged 1.5 years numbered 8,630 individuals of both sexes in 1921. According to the Census the number was 7,453—a difference of nearly 16 per cent. Such difference is not material as regards local comparisons, but would vitiate comparisons with other districts. Last year the number living at these ages was estimated to be 9,459, the increase being due partly to the large number of children born in 1920 and 1921, and partly to the reduced infantile mortality. The deaths during the year among these children numbered 115, giving a mortality of 12.15 per 1,000, the mean rate for 1917.21 being 15.36, and that for 1909.13, 13.97. The mortality rates at these ages are liable to considerable fluctuations from year to year, in response to the prevalence in epidemic form of such infantile diseases as measles, whooping cough and diarrhoea. The rates (sexes combined) recorded last year were : At ages 1.2 years, 24.26 ; 2.3, 8.73 ; 3.4, 5.35 ; and 4.5, 8.14. And the means for 1917.21, 30.95, 14.69, 9.00 and 6.33. The only age showing an increase above the mean was that of 4.5 years where the increase was 29 per cent. DISEASES OF CHILDHOOD. Measles.—Notification of this disease has been in force in the Borough since March, 1914, at first by an Order made by the Council, pursuant to Section 56 of the Public Health (London) Act, 1891, requiring notification of all cases of measles. In January, 1916, the Order of the Council was replaced by Regulations—applying to England and Wales generally—issued by the (then) Local Government Board under which notification of first cases only of measles and german measles was required. Those regulations were repealed in December, 1919, and the " Paddington Measles Regulations " were issued by the Ministry of Health under which notification of all cases of both diseases was required. The year 1922 was marked by a major epidemic of the disease, 3,049 cases of measles being notified or otherwise reported to the Department. Since 1914 that total has been exceeded twice only, viz., in 1915 (3,628 cases) and in 1917 (3,437 cases). In addition to the cases of measles, 171 of german measles were notified or reported last year. Of the cases notified or reported during the past year, 72 per cent. were notified under the Regulations, 18 . (mostly secondary cases) were reported by the Women Inspectors, and 10 . by School Teachers on " Form 84." The epidemic began in the course of the 7th week of the year (that ending February 18th), and continued until the 27th (ending July 8th). While the weekly average number of cases during the whole year was 62, less than half that number were reported in 29 weeks. In the autumn the weekly totals ranged from 0 to 9. The peak of the epidemic fell somewhere in the four weeks, April 8th to May 6th, during which period 660 cases occurred. Of the 3,049 cases of measles 1,706 (56 per cent.) were in children aged 0.5 years, 1.223 (40 per cent.) in children aged 5.15, and 120 (4 per cent.) in adults. At ages 0.5 there were 874 cases among males and 832 among females, the incidence on the sexes being (approximately) 174.4 and 170.0 per 1,000 (of each sex) respectively. At ages 5.15 years the distribution was 578 cases in males and 645 in females, the corresponding incidences being 57.9 and 62.4 respectively. At higher ages the attacks among males numbered 25, and those among females 95, the incidences being 0.5 and 1.3 respectively. Except in the last group the disease was fairly equally prevalent in the two sexes. Taking the estimates of the number living at each age as calculated in the Department, the following incidences (rates per 1,000 persons) have been obtained: At ages 0.1 year, 63.5; 1.2, 156.7; 2.3, 144.6; 3.4, 170.4; and 4.5, 224.5. * "C.A."—Combined six Areas. " R.B."—Rest of the Borough. 21 DISEASES OF CHILDHOOD. From what has been written in the preceding paragraph it is evident that rates of incidence calculated on the populations at all ages fail to show adequately the real incidence of the disease. Unfortunately no information is to hand as to the sex.age distributions of the populations of the Wards, so that nothing beyond the all.age rates can be given. Last year the cases in Harrow Road Ward numbered 836 and in Church Ward, 745, these two Wards furnishing not far short of half the cases reported during the year. The rates of incidence (measles and german measles, persons, all ages) were : Queen's Park, 20.1 ; Harrow Road, 30.3 ; Maida Vale, 16.7 ; Westbourne, 23.4 ; Church, 29.9; Lancaster Gate, West, 7.4 ; Lancaster Gate, East, 11.6 ; and Hyde Park, 18.1. Last year 198 (6.1 per cent.) patients received treatment in institutions, the average for the preceding quinquennium being 4.9 per cent. In 1915 and 1917—years of major epidemics—the percentages removed to institutions were 2.1 and 3.4 respectively. In 1918 the proportion was 7.9 per cent., and in 1921 7.1. In each of two institutions 18 cases occurred, and of the remaining 3,189 cases 59 . came from houses having one case in each. The deaths from measles during the year numbered 33, equal to a total fatality (all ages) of 1 . 0 per cent., the average fatality during 1917.21 having been 2.3 per cent. In 1915 the fatality was 2.7 per cent., and in 1917, 3.3. The fatality of cases in males (all ages) was 1 .2 . last year, averaged 2.7 during 1917.21, and was 3.1 in 1915 and 3.9 in 1917. Among females the percentages were: 1922, 0.9; 1917.21, 1.9; 1915, 2.3; and 1917, 2.8. The fatality rates last year for the two sexes were at ages 0.5, 1.8 per cent., 5.15, 0.08 and 15 and upwards, 0.6. At ages 0.1 and 1.2 the rate (combined sexes) was 3.7, at ages 2.3 and 3.4, 1.1 and at 4.5, 1 .0. During the months of January and July to December no deaths from this cause were recorded. In February the fatality was at the rate of 0.4 per cent., in March, 0.3, in April, 1.1, in May, 2.3, and in June, 0.8. During the months of March to May (both inclusive) there were 2,302 cases and 29 deaths, equal to a fatality of 1 . 2 per cent. Of the 33 deaths 20 occurred in institutions (5 in hospitals of the Metropolitan Asylums Board and 15 in Paddington Hospital). The fatality among the patients removed to institutions was at the rate of 10.1 per cent., among those remaining at home 0.46. During 1909.13 notification was not required, but every effort was made to discover cases ot measles, and 4,740 cases were placed on record. If it be assumed that the error (deficiency) amounted to one.third, the full total of cases during the three years would be 6,320. In that period 157 deaths were certified as due to the disease, equal to a fatality of 2.48 per cent. The estimated deficiency is believed to err on the side of excess. During 1920.22, 5,118 cases were recorded with 63 deaths, a fatality of 1.19 per cent.—showing a fall of 56 per cent. The deaths during 1909.13 included one (of a female) at ages over 15, and those recorded during 1920.22, 2 (both females). Distributing the remaining deaths into two groups, viz., 0.5 and 5.15, and calculating the mortality rates per 1,000 of each sex enumerated at the Census of the central year of each period, the following results are obtained: 0.5, males, 1909.13, 12.7; 1920.22, 6.3 (a reduction of 50.4 per cent.). Females, 1909.13, 11 .4 ; 1920.22, 4.9 (reduction 57.1 per cent.). At ages 5.15 the rates are : Males, 1909.13, 0.29; 1920.22, 0.20 (reduction 30.6). Females, 1909.13, 0.67; 1920.22, 0.09 (reduction 86.8 per cent.). Whooping Cough.—This disease not being on the list of diseases to be notified, the Department has to rely on reports of cases from the school teachers (" Form 84 "), and other sources. No effort is spared to secure the fullest information. Last year 378 cases were placed on record in the Department, 188 cases in males and 190 in females. In 1921 the cases numbered 613, and in 1920, 355. Of the total for last year 231 (males 111, females 120) were cases in children under 5 years of age, 143 (males 73, females 70) in children aged 5.15 years, and 3 (male 1, females 2) in persons aged 15 years and over. The 378 cases occurred in 220 houses, 117 of which had one case each. More than half the cases (231) occurred in two Wards, viz., Westbourne, 106 cases, and Church, 125. There were 55 cases in Harrow Road Ward and 39 in Queen's Park. The patients receiving institutional treatment numbered 9 (2.3 . of the known cases). In 1921, 2.2 . of the known cases received institutional treatment. The deaths certified to have been due to whooping cough during the year numbered 11 (6 of males and 5 of females), giving a fatality of 2.9 per cent., the rate in 1921 having been 3.4 and in 1920, 3.9. The 5 deaths in institutions constituted 36.3 per cent. of all deaths from this cause, and represent a fatality of 55.5 . of cases receiving institutional treatment. The collection of statistics of this disease was commenced in 1903, so that data for twenty years are now available. The average numbers of cases reported in the four quinquennial periods covered by the twenty years are: 1903.07, 410 cases; 1908.12,451; 1913.17,486; and 1918.22, 439. That of the last period showing an increase of 7 per cent. above that of the first—an increase due, probably, 22 DISEASES OF CHILDHOOD. to more complete reporting of the disease. The average annual number of deaths during the same quinquennia were : 36, 30, 27, and 20, the last average being 44 . below the first. The fatalities were : 8.7 per cent., 6.5, 5.5 and 4.6, showing a fall of 47 . in the course of twenty years. Comparing the records for the three years, 1910.12, with those for 1920.22, it is found that in the former triennium there were 723 cases among males and 804 among females, and in the latter 646 cases among males and 700 among females. The age distributions were : 1910.12, males, 0.5 years, 445 ; 5.15, 277 ; and 15 and over, 1. Females (age.groups in same order), 484, 317 and 3. For 1920.22, the figures are : Males, 376, 268 and 2 ; females, 379, 321 and zero. The deaths during the triennia were : 1910.12, 55 males and 46 females ; 1920.22, males, 22, females 24. The cases and deaths at ages above 15 can be neglected. The morbidity rates, per 1,000 individuals, enumerated at the Census of each central year, were : Ages 0.5 years, males, 1910.12, 24.6 ; 1920.22, 25.1 ; females, 26.8 and 24.8 ; ages 5.15, males, 1910.12, 9.1 ; 1920.22, 8.9 ; females, 10.1 and 10.3. The fatality rates (per 100 cases) were : 0.5, males, 1910.12, 11.4 ; 1920.22, 5.6 ; females, 9.3 and 6.3. Ages 5.15, males, 1 .4 and 0.3 ; females, 0.3 and zero. The mortality rates (per 1,000 individuals) were : Ages 0.5 males, 2.82 and 1.40 ; females, 2.49 and 1.63. Ages 5.15, males, 0.13 and 0.03 ; females, 0*03 and zero. Diarrhcea.—During 1922, 26 deaths (including one from enteritis) were recorded as due to " diarrhcea," compared with a total of 90 (including 3 from enteritis).in 1921. The disease in adults differs so much from that in young children under 2 years of age that the 3 deaths above that age limit recorded in 1921, and the 2 recorded last year will be neglected in the following paragraphs. The 24 deaths at ages under 2 recorded last year comprised 18 of males and 6 of females. There was no death from this cause during the third (summer) quarter of the year, which is regarded as the diarrhceal season. In the first quarter there were 8 deaths, in the second 10, and in the fourth 6. In the third quarter of 1921 there were 37 deaths from this cause, the annual average for the quarter during the ten years 1911.20 being 30. All the Wards shared in the comparative freedom from this disease last year, the totals for the year being : Queen's Park, 2 (6)* ; Harrow Road, 1 (10) ; Maida Vale, 2 (7) ; Westbourne, 9 (14); Church, 7 (24) ; Lancaster Gate, West, 1 (2) ; Lancaster Gate, East, 0 (2) ; and Hyde Park, 2 (2). The low prevalence of this disease was not limited to the Borough, but prevailed throughout the County of London, and (it is believed) the Country generally. In the County the deaths recorded at ages 0.2 years during the year numbered 671, compared with 2,133 in 1921. The following were the quinquennial averages during the twenty years 1901.20 : 1901.05, 3,480 ; 1906.10, 2,293 ; 1911.15, 3,070 ; 1916.20, 1,345. The change is, perhaps, more marked if the numbers recorded in the third quarter be considered. In 1922 the deaths numbered 127, in 1921, 1,261, while the averages for the four quinquennial periods were : 2,614, 1,448, 1,937 and 560. An examination of the serial figures for each quarter of the years 1901.22 does more than suggest that the disease can no longer be regarded as one peculiar to summer. The tabulation cannot be given here, but it can be said that within recent years there has been a tendency to a greater prevalence during the autumn and early months of the year than was observed (say) in 1901.05. As regards last summer three facts may be stated as having some bearing on the freedom of the Borough from this disease. In the first place the temperature of the ground, as measured at a depth of four feet at Greenwich, at no time during the quarter rose to 60° F. The mean of the weekly readings during the quarter was only 56.2°. In 1911, when there was a particularly severe epidemic of the disease, the mean—at a depth of 3 ft. 2 in. below the surface—was 64.2°. The rainfall during the quarter measured 7 • 21 inches, which was above the average for the quarter. Lastly the fly.counts taken in the Borough, showed that the number of those pests was very small in comparison with the figures obtained in earlier years. Chickenpox.—In previous years, when smallpox has threatened to become prevalent, notification has been extended to this disease on account of the similarity of the rash. Last year the County Council decided against adding the disease to the list, and in consequence the Borough Council did so at their meeting of November. The total number of cases known to the Department during the year was 539, including 22 notified cases. In 1921 the cases numbered 253, and in 1920 567. Mumps.—Last year 91 cases of this disease were reported to the Department, the total for 1921 having been 494 and that for 1920, 154. Ringworm.—During 1909.13 172 cases of this affection were reported annually, the average falling to 140 during 1914.18. That decrease was at the time thought to have been largely due to less strict supervision of school children, consequent on the war, but the figures for the years subsequent to 1918 lead to a hope that the disease is becoming less prevalent. In 1919 the cases numbered 189, in 1920, 204, in 1921, 108, and in 1922, 99. * The figures in parentheses are the decennial annual averages for the respective Wards. 23 administration. ADMINISTRATION. GENERAL. Staff of the Department.—Mr. Anthony, a District Sanitary Inspector, retired in February, 1922, owing to ill health, after 26 years' service under the Council. Mr. Binns, who since November, 1921, had carried on the duties in a temporary capacity, was appointed to fill the vacancy in October. Miss Mann, one of the Health Visitors, resigned her position in July, being replaced by Miss Davies, appointed in October. Prevention of Infectious Disease.—(Table XIV.). Visits of inquiry numbered 9,789, as compared with 6,835 in 1921, the increase being solely due to the high prevalence of measles during the first half of the year. There were 2,345 visits made in connection with tuberculosis, a considerable reduction on the annual average for the years 1914-18 (4,157). With the object of avoiding duplication of visits, the Department does not now undertake any routine visiting of cases notified by the Tuberculosis Officers, such visiting being left to the Staffs of the two Dispensaries. Patients receiving treatment in hospital last year numbered 1,354 (excluding cases of tuberculosis), against 1,397 in 1921, and an annual average of 679 for the years 1916-20. The increase has been caused by prevalence of scarlet fever, diphtheria and measles, and the inclusion (since 1919) of the pneumonias, of which diseases hospital statistics were first tabulated in 1919. Since 1916, the Council has had an Agreement with the Paddington and St. Marylebone District Nursing Association for the nursing in their homes of patients suffering from measles, whooping cough, ophthalmia neonatorum and pneumonia. Last year, 129 patients were placed under the care of the Association by the Department, the cases including 103 of measles, 18 of pneumonia and 4 each of whooping cough and ophthalmia. Disinfection.—(Table XIV.) Although the rooms disinfected reached the high total of 4,061, almost doubling the figure for the preceding year, the weight of bedding, etc., removed fell from 51½ to 36 tons, and the cost of disinfection from £2,139 to £1,484. As it is not the practice to remove bedding after the occurrence of measles, thorough spraying of the room and contents being considered sufficient, the epidemic of that disease which prevailed last year affected the work of disinfection only so far as the number of rooms dealt with. Bacteriological Work.—(Table XIV.) The specimens sent to the Lister Institute for examination numbered last year 766, as compared with 977 in 1921, and 1,600 in 1920. The annual average for the years 1912-21 was 874. There has been a notable increase during recent years in the proportion of specimens from cases of suspected tuberculosis; these, which formed 20.5 per cent. of the total examinations during the five years 1909-13, equalled 39.4 per cent. of the examinations made last year. During 1922 no tests were made for the diagnosis of enteric fever. The proportions of positive results obtained for diphtheria and tuberculosis were 18.1 per cent. and 17.5 per cent. respectively. In 1921 the percentages were 14.8 for diphtheria and 17.9 for tuberculosis, and during the quinquennium 1909-13, 20.8 and 21.3. Schools.—(Tables XIV. and XV.) On this occasion the tables giving the numbers of exclusions of patients (P.A.) and contacts (P.N.A.) in each School have been omitted. Table XV. shows the incidence rates in Provided and Non-provided Schools. The only rates showing notable increases last year—in comparison with the averages for 1914-18 or with the records for any of the years 1919-21— are those for measles and chickenpox. As regards the former, the rates for Non-provided Schools were higher than those for Provided, the position being reversed in the case of chickenpox (P.A.). The disparity between the rates for sore throat in the two groups of schools is remarkable, and the only explanation which can be offered is that a closer observation for and more complete reporting of such cases prevails in the Provided Schools. The frequency of scabies and verminous conditions remains much below the averages for 1914-18. In addition to the 5,674 "Exclusion Notices" sent during the year direct to the schools in the Borough, 549 reports relating to infectious disease in schools in out-lying districts were forwarded to the Medical Officers of Health of those districts. House Sanitation.—Table XVI. summarises the principal items of the work carried out by the District Inspectors in connection with premises other than registered tenement houses (houses let in lodgings), the latter being separately dealt with in the section headed " Tenement Houses." The record of sanitary works completed shows that more substantial progress is now being made towards the overtaking of arrears left from the war period. House Drainage.—The amount of drainage work done since 1914 is indicated by the following figures:— Annual Average 1914-18 1919 1920 1921 1922 Existing drains tested and found watertight 93 71 89 88 82 Drains reconstructed 93 68 90 87 110 ,, "made sound"* 27 21 17 8 19 * By "Economic" or other process. 24 administration. Reconstruction Plans.—The plans deposited last year reached a total of 274, an increase of 62 on the figure for 1921. With the lower cost of materials and labour, it is to be expected that more voluntary work will be undertaken, and the pre-war annual average of 304 reconstructions (1911-14) restored, if not exceeded. The following figures show how greatly this class of work has fluctuated since 1914:— Average 1914-18 1919 1920 1921 1922 Plans deposited 191 269 299 208 274 In connection with the 274 plans, 664 letters were sent out. No summonses were issued during the year for failure to comply with the bye-laws. Combined Drainage.—Orders were made under Section 74 of the Metropolis Management Act, 1855, sanctioning the draining by combined systems of the undermentioned groups of premises. Biddulph Road, Nos. 4 to 12 Lancaster Mews, Nos. 26 and 27 Harrow Road, Nos. 374 and 376 Oxford Terrace, Nos. 2 and 3 Harrow Road, Nos. 501, 503 and 505 Porchester Square, Nos. 32 and 33 Harrow Road, Nos. 513, 515 and 517 St. Petersburgh Place, No. 24, and Garage Kensal Road, Workshops at rear of Nos. at rear 156 to 168 Westbourne Grove Terrace, Nos. 10 and 11 No systems of combined drainage were reconstructed at the cost of the Council. Sewer Connections.—In all, 63 sewer connections were either wholly or partially relaid, 29 after Order of the Council and 34 on the initiative of owners. Examinations made in consequence of complaints from householders of the presence of rats have led to the discovery of many defective sewer connections during recent years. Average 1914-18 1919 1920 1921 1922 After Order by the Council 12 36 46 22 29 On initiative of " owners" 18 26 24 38 34 Water Supply. (Table XIV.).—Last year seven certificates were issued with respect to newlybuilt houses, the same number as in 1921. All the houses were situated in Biddulph Road. In 13 instances the water supply was cut off from premises by the Water Board, the reasons being unpaid rates (9), and defective fittings (4). Three of the houses were unoccupied. Before the water supply was restored in the remaining 10 cases the service of six notices and one summons was necessary. Shortage of Supply.—In March of last year the Minister of Health issued a circular letter calling attention to the possibility of a shortage owing to the deficiency of the rainfall during 1921, and indicating the possibilities of supplementing any deficiency. There was no evidence of any deficiency in the Borough. Mortuary. (Table XIV.).—The number of bodies received rose from 220 in 1921 to 258 last year, and of inquests held from 158 to 199. Post-mortem examinations were made on 53 per cent, of the bodies, as compared with an annual average of 39 for the years 1914-18. Trade Nuisances.—Offensive Smells.—The complaints received were fewer than in 1921, or any year since 1914. Vegetable refuse and manure were the chief sources of trouble. Emission of Dust.—For some years frequent complaints have been made of nuisance due to dust and down escaping from a bedding factory. Many attempts have been made to remedy the nuisance by screening, air shafts, etc. Last year a system of exhaust shafts was constructed by which the dust, etc., were extracted from the work-rooms and led into water tanks. The scheme appears to have succeeded, no complaints having been received since its installation. A similar method has been installed at a factory where soap powder is made, with equal success. Offensive Trades.—-Bye-laws made by the County Council under the Public Health (London) Act, 1891, for regulating the business of dressing fur skins came into operation during the year No. such business is known to be carried on within the Borough. Smoke Nuisance. (Table XIV.).—Twelve complaints were received during the year, two more than in 1921, but the duration of emission of "black" smoke was actually less, being 3.6 per 100 hours' observation as against 5.2 the previous year. Seven notices were served, but no further proceedings were necessary. Duration of Black Smoke 1918 1919 1920 1921 1922 per 100 hours' observation 6.6 6.6 4.1 5.2 3.6 Canal: Canal Boats. (Table XIV.).—The annual cleansing and repairing of the Paddington Basin took place as usual during the Easter Holidays. About 415 tons of mud, etc., were removed, 752 square yards of concreting laid, 72 cubic feet of brickwork repaired, and 55 square yards of pointing done by the Canal Company. At Nos. 11, 12 and 13 Wharves, North Side, belonging to the Paddington Borough Council, about 5 square yards of brickwork were refaced, and 100 square feet of pointing done. 25 administration—welfare work. The Annual Report of the Examining Officer was presented to the Council at the end of January. Two cases of infectious disease (one each of diphtheria and measles) were reported last year among the boat population, and two deaths occurred, one from bronchitis (male, aged 80,)and the other from broncho-pneumonia (male, aged one). Only 119 out of the 232 boats on the Register were found using the Paddington Basin. The occupants of the boats inspected included 63 children, of whom 44 were of school age. WELFARE WORK. Ante-natal Clinics.—Weekly Clinics continue to be held at 232 Harrow Road (the Paddington School for Mothers) and at St. Mary's Hospital. At the former 252 new cases attended during the year, the total number of attendances being 577. At St. Mary's Hospital 331 women residing in Paddington made 993 attendances, 109 being afterwards admitted to the Hospital for confinement, and 207 confined in their homes under the care of the Extern Staff of the Hospital. Ante-natal Clinics at Queen Charlotte's and other Hospitals are also attended by women resident in the Borough; the numbers, however, are unknown, owing to the fact that separate records for each Borough are not kept by those institutions. Health Visiting.—Last year 1,883 new-born infants were visited by the Council's Health Visitors, the visits being made as soon as possible after the 10th day. It was found that 1,657 infants were being fed naturally (i.e. from the breast), 142 artificially and that 84 were on a mixed diet. The variations in the percentages of the methods of feeding recorded on first visits during the past four years are shown below. Breast Artificial Mixed 1919 90.5 5.8 3.6 1920 90.2 6.3 3.5 1921 83.7 8.5 7.8 1922 88.0 7.5 4.5 Of the 142 children reported as fed artificially 61 were less than one month old, and of the 84 on a mixed diet 35, or 42.9 per cent. in each case. In 1921 only 25.4 per cent. of the infants artificially fed and 29.5 per cent. of those on a mixed diet were visited under one month from birth. Last year there was a v.ery satisfactory reduction of the interval between the birth of a child and the Health Visitor's first call. Before the close of the year 52 deaths occurred among the 1,883 infants visited, equivalent to a mortality of 28 per 1,000. Of the 52 infants dying 39 (23 per 1,000) were reported as breast fed, 10 (70 per 1,000) as artificially fed, and 3 (35 per 1,000) as on a mixed diet. The death rates per 1,000 infants visited during each of the past four years (see below) indicate a progressive decrease in mortality. Mortality Rates per 1,000 infants visited. 1919 1920 1921 1922 Total 45 41 33 28 Breast fed 40 38 25 23 Artificially fed (all forms) 93 73 75 57 Of the 52 deaths, 25 were due to respiratory and 10 to diarrhceal diseases, 3 to congenital defects, 3 to atrophy, 2 to premature birth, and 9 to other causes. Thirty-nine (39) of the deaths occurred in institutions, including 29 in the Paddington Hospital (Infirmary). In May, 1922, a change was made in the arrangements for visiting. Previously, after a first visit had been paid to a child by one of the Council's Health Visitors, all subsequent visiting, up to admission to school, was done by the Staff of the Paddington School for Mothers. Visiting after a child has attained the age of 18 months and up to school age is now undertaken by the Council's Staff. During last year the Visitors attached to the School made 14,989 visits as compared with 16,831 in 1921, and 11,857 in 1920. The Council's Visitors, in addition to the first visits above recorded, made 3,437 visits to children over the age of 18 months. Consultation Centres.—Six Centres are maintained by the School, at two of which consultations are held twice weekly and at the remainder once. Last year the first attendances (new cases) numbered 1,134, and the total attendances 12,840, the latter including 2,257 attendances by children aged one year and over. Among the children attending the Centres there were 47 deaths during the year, 23 at ages under one year, and 24 between one and five years. There were 17 deaths from respiratory diseases and 4 from diarrhoea. As stated in the previous Report, an unknown number of infants are taken to consultations at Queen Charlotte's Hospital and to Centres in adjacent Boroughs. Milk Grants: Dinners for Mothers.—The Scheme adopted by the Council in May, 1921, and approved by the Ministry of Health continued in operation last year. 26 HOUSING. The Committee considered 142 new applications for milk, etc. In 87 instances grants were made, the remaining 55 applications being rejected, either on account of the family income being above the prescribed scale, or because it was considered that the families ought to be left to the Poor Law Guardians on account of their destitution. Besides the 87 new grants there were 206 renewals of grants to former applicants. In all 345 orders were issued: 310 for milk, 4 for dinners and 33 for milk substitutes. The total quantity of milk supplied was 3,295½ quarts—2,923 quarts being free and 372½ quarts at half cost—at an expenditure of about £95. Dinners (63 in number) cost £3 18s. 9d., and milk substitutes ("Glaxo," etc.), £11 2s. 11d. Purchases of milk substitutes for sale at cost price by the School for Mothers were made by the Council to the value of £1,180, the receipts from the School amounting to £1,187. Taking into consideration the milk substitutes supplied free, the receipts from sales should normally be lower than the amount expended; the fact that the receipts were higher was due to variations in the stocks on hand at the beginning and close of the year. Other Work.—Grants were made by the Council towards the maintenance of seven unmarried mothers admitted to the St. Mary Magdalene's Home, the cost thereby incurred being £85 10s. 0d. Five (5) applications were received for the admission to Convalescent Homes of mothers and their babies. Of these, however, 4 were withdrawn, the mother and child in the remaining case being admitted to the Shooters Hill Home. The total cost was recovered from the family. Owing to financial difficulties it was decided, early in the year, to close the Children's Hotel at Beauchamp Lodge. It was shortly afterwards reopened under private auspices, but is no longer on the list of institutions receiving grants from the Council. Three (3) applications were made for the admission of children to the Toddlers' Home, Maidenhead, but other arrangements being made no grants were required. Day Nurseries.—There were 5,642 attendances at the Paddington Day Nursery, Porchester Houses, children being received on 233 days. The number of new children admitted during the year was 79. The Queen's Park Day Nursery in Lancefield Street was open on 279 occasions, a total of 4,777 attendances being made. Forty-four (44) new children were received. The Council gave a grant of £21 to the last-mentioned Day Nursery. Among the children attending Porchester Houses there were 6 cases of measles and 1 of whooping cough ; and among those attending the Queen's Park Nursery 3 cases of whooping cough, 2 of measles and 1 of scarlet fever. It was not found necessary to close either of the Nurseries on account of infectious illness. HOUSING. Census Data.—Until the census of 1921 the unit was the "house," that is to say, a building contained between two party or external walls, and houses were returned simply as "inhabited," "uninhabited," or "building." In 1901 and 1911 "uninhabited" houses were subdivided into "houses in occupation" and "houses not in occupation." In the Report on the last census the designation "house" has been abandoned, and " building " substituted for it. Buildings are classified as "In course of erection" or "Completed," the latter being subdivided into two groups, viz., those "containing dwellings" and those "not containing dwellings." The Report shows that there were in the Borough 15 buildings in course of erection on the night of the census, 1,138 completed buildings not containing dwellings, and 17,153 containing dwellings. The latter are further subdivided under five headings, to which reference will be made later. It used to be the rule to give the total number of "Schedules" completed for census purposes, and regard each schedule as representing a family. At the census of 1911 the detailed tabulations relating to housing were confined to the population forming the "Private Families," and that practice was followed at the last census. The definition of a Private Family is somewhat involved, and is, therefore, quoted here in extenso:— Private Family.-—Any person or group of persons included in a separate return (i.e., schedule) as being in separate occupation of any premises or part of premises is treated as a separate family for census purposes, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i.) institutions or (ii.) business establishments or boarding houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Of the total population of 144,261 persons enumerated in 1921, 131,351 were members of 38,320 private families, such families occupying 19,433 "Structurally Separate Dwellings" containing 141,959 rooms. The designation "Structurally Separate Dwelling" is new, and is defined in the following terms:— Structurally Separate Dwelling.— . . . any room or set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit ; a private house which has not been structurally subdivided is similarly a single unit whether occupied by one family or by several families. . . . Where an undivided house is used partly for business or professional purposes, it is treated as occupied by a private family unless the portion used for non-domestic purposes consists of at least 3 rooms and is more than one-quarter of the whole. housing. 27 Of the 17,153 buildings containing dwellings 435 were occupied by non-private families (comprising 12,910 persons).* The remaining 16,718 buildings contained 20,371 structurally separate dwellings, with a total of 151,813 rooms. Of those dwellings 938 (containing 5,542 rooms) were vacant on the night of the census, and 153 were occupied by caretakers. Including the latter, there were 19,433 dwellings (146,271 rooms) in occupation, 11,051 of the dwellings being occupied by one family, 2,609 by two families, and 5,773 by three or more families. Classes of Dwellings.—Five classes, or groups, are shown in the Report:— i.—Undivided Private Houses : Total number, 12,797 ; housing 108,012 persons. The 12,579f houses occupied by private families contained 113,087 rooms. ii.—Structurally Divided Private Houses : Total, 442, housing 3,569 persons. The 441 occupied by private families contained 6,394 rooms in 1,349 dwellings. iii.—Blocks of Flats : Total, 322, housing 7,717 persons. The 310 blocks occupied by private families contained 15,254 rooms in 3,055 dwellings. IV.—Shops:Total, 1,887, housing 10,321 persons. The 1,873 occupied by private families contained 11,220 rooms. V.—"Others": Total, 1,705 buildings, housing 14,642 persons. Of this group 1,515 buildings were occupied by private families and contained 5,858 rooms. The last group included (amongst others) 110 "hotels," (3,722 inhabitants) and 29 institutions (2,096 inhabitants). Size of Dwelling. (Table XVII.).—Of the 19,433 separate dwellings occupied by private families, 1,928 (10 per cent.) contained 1-3 rooms, and were occupied by 1,997 families; 4,544 (23 per cent.) contained 4-5 rooms, and were occupied by 5,343 families ; 6,254 (32 per cent.) contained 6-8 rooms, and were occupied by 13,091 families ; and 6,707 (35 per cent.) contained 9 or more rooms, and were occupied by 17,889 families. Examination of the returns of rooms occupied by private families shows that there has been since 1911—comparison with earlier figures are uncertain—a concentration of population in homes with small numbers of rooms. In Table XVII. the percentage distributions of (a) homes of different sizes, and (b) of the population therein as enumerated in 1911 and 1921 are set out. The reductions in the proportions both of homes of 6 and more rooms and of the population therein, are striking. The increases in the cases of homes of one and two rooms are comparatively small. Nearly half the private families and half the population in private families were housed in homes of 3-5 rooms at the last census. The increase, both absolute and proportional, in the occupation of small homes is clearly shown by the figures set out below, which summarise the data published in the last four Census Reports. PARISH OF PADDINGTON. 1891—Inhabited houses, 14,473 ; total homes, 27,201 ; homes of 1-4 rooms, 17,208. Average number of homes per house 1.87 Ratio of homes of less than five rooms to all homes (per cent.) 63.2 BOROUGH OF PADDINGTON. 1901—Inhabited houses, 17,684 ; total homes, 33,661 ; homes of 1-4 rooms, 21,815. Average number of homes per house 1.90 Ratio of homes of less than five rooms to all homes (per cent.) 64.8 1911—Inhabited houses, 16,886; total homes, 33,048; homes 1-4 rooms, 23,224. Average number of homes per house 1.95 Ratio of homes of less than five rooms to all homes (per cent.) 70.2 1921—Inhabited houses, 16,718; total homes, 38,320; homes 1-4 rooms, 29,516. Average number of homes per house 2.29 Ratio of homes of less than five rooms to all homes (per cent.) 77.0 Although there has been an increase in the proportion of small homes, there has been a decrease in the density per room. The reductions in the average numbers of persons per room in homes of less than five rooms—in all homes of each class and in "crowded"‡ homes—are shown in Table XVII. For homes of five or more rooms the data do not exist prior to 1911. The averages for homes of five rooms are: 1911, 0.9 persons, 1921, 0.8; for those of 6-7 rooms, 1911, 0.7, 1921, 0.6; for those of 8-9 rooms, on both occasions, 0.6; and for those of 10 or more rooms, on both occasions, 0.5. The changes are not great in any instance, but they are in the right direction. Institutions.—In the Reports of every census prior to that of 1921 particulars have been included of the number of persons enumerated in each institution. The last Report gives no more than the numbers in certain of the institutions in the Borough, viz., 16 out of the 29 mentioned in the principal table of housing. The 16 institutions specified are:—Casual Wards, 1, total population 58 persons, of whom 53 (males 51, females 2) were inmates; Poor Law Infirmary, 1, total population 551 persons, *It is to be regretted that the numbers of the persons in non-private families occupying the different classcs of buildings are not given, and that the analysis of the last group (" Others ") is incomplete. † The difference between the total number and the number occupied by private families shows the number of each class of dwelling occupied by non-private families. ‡"Crowded" homes are those in which the average number of occupants exceeds 2 persons per room. It has to be remembered that all calculations of averages are irrespective of the sizes of the rooms and afford no reliable estimate of genuine overcrowding. 28 housing. of whom 436 (212 males, females 224) were patients; Hospitals, 4, total population 703 persons, of whom 494 (males 172, females 322) were patients; and "Convalescent and Nursing Homes," 10, with a total population of 154 persons of whom 55 (males 10, females 45) were patients. Canal Boats.—Twenty-seven boats were within the Borough on the night of the census, the population enumerated thereon amounting to 93 persons, males 45 and females 48. Estimated Deficiency in Total Population.—The Rate Books for the quarter ended June 30th, 1921, showed 454 "empties." According to the Report of the Census (June 19th/20th) there were 938 Structurally Separate Dwellings (normally occupied by private families) "vacant" on the night of the census, and 153 others occupied by caretakers, making a total of 1,091 homes from which either no schedules were received or the schedules received showed numbers of occupants which may reasonably be presumed to have been below the normal for the homes. From calculations which have been made it is estimated that the 454 "empties" represent 360 "buildings with dwellings," of which 269 would be, if let, occupied by private families. Proceeding by stages which need not be given here, it has been estimated that it is probable that the occupants of 798 dwellings were absent from home on the night of the census. The 5,400 (possibly more) persons normally living in those 798 dwellings were in all probability enumerated elsewhere. The conclusion which appears to be permissible is that the enumerated population was at least some 4 per cent, too low. Conversions.—The conversion of No. 8, Warrington Crescent, into six flats was completed early in the year. That house and No. 30, Westbourne Square (converted into four flats in 1920) are the only premises which have been acquired by the Council under the powers conferred upon them by the Housing Acts. Through the deposit of plans in connection with alterations to sanitary fittings, etc., 46 conversions by private enterprise came to the knowledge of the Department, as compared with 39 in 1921 and 77 in 1920. The premises dealt with last year were converted into some 139 flats. It is more than probable that a number of other conversions were also carried out, which, not involving interference with existing sanitary arrangements, did not come to the knowledge of the Department. Compulsory Repairs.—In view of the difficulty in ascertaining the interpretation of the law, no attempt was made last year to enforce the provisions of Section 28 of the Housing, Town Planning, etc., Act, 1919, beyond the service of notices with respect to two houses. Notices had been served for both houses two years previously, but in one case the owner had died without leaving any legal heir, and in the other the continued neglect of the premises had so added to the number of defects that a fresh notice was deemed necessary. The freeholder of the first-mentioned house acquired possession under Section 30 of the Act of 1919, and executed the works required by the notice ; the owner of the other house failed to carry out the requirements, and the work was put in hand by the Council towards the close of the year. Repairs at 45 other houses, which were outstanding at the end of 1921, were completed during the year by the owners. On a demand for payment of expenses incurred in respect of No. 233 Portnall Road being served upon the owner by the Council under Sub-sec. 3 of Sec. 28 of the Act of 1919, an Appeal was lodged by the owner with the Minister of Health. The Minister being of opinion that no such appeal was provided by the Section, refused to hear the case. The owner applied for and obtained a Mandamus calling on the Minister to hear the Appeal.* A Public Inquiry was held on May 22nd and the Minister made an Order (dated August 1st) requiring the Appellant to pay the sum of £129 13s. Od. in lieu of the sum of £134 15s. l0d. demanded. Appeals by the same owner against demands made with respect to two other houses formed the subject of a Public Inquiry held on December 14th, 15th and 16th. Arising out of this Inquiry a Case on various points of law has been stated by the Minister of Health. Up to the time of writing the case had not been decided. Houses Unfit for Habitation.—No action was taken under Section 17 (1) of the 1909 Act during the year, for the reason that the prevailing shortage of houses makes it impossible for other accommodation to be found by persons occupying premises for which Closing Orders have been made. Underground Rooms.—Last year no action was taken under Section 17 (7) of the 1909 Act, but notices under Section 96 of the Public Health (London) Act, 1891, were served with respect to two houses where the conditions were especially bad. After considerable delay the rooms were vacated. In one instance it was necessary to issue a summons, the defendant, after several adjournments of the case, being fined £7 8s. 0d. Tenement Houses.—The number of houses on the Register at end of 1922 was 1,404. During 1922, 6,507 inspections were made for all purposes, including Annual Cleansing. A summary of the defects, etc., discovered and remedied is given in Table XVIII. The number of dirty rooms dealt with last year (1,638) was almost exactly half that recorded in 1921 (3,275). On the other hand, the figure *This was the case of Rex v. Minister of Health (ex parte Rush). 86 J.P. (Cases) 51 ; (1922) 2 K.B. 281. workshops. 29 for "other defects or nuisances" showed a great increase over the totals for the preceding years, due to the inclusion for the first time of items liable to be dealt with under the Housing Acts, to which the attention of owners was drawn by special letters. Overcrowding.—Nine (9) tenements, comprising 10 rooms, were reported as overcrowded. In 6 cases the overcrowding was abated after service of notice, and in 2 by voluntary removal. A summons was issued in the remaining case, but after adjourning the hearing five times, in order to give the occupier further opportunity of finding other accommodation, the Magistrate finally adjourned the case sine die. There is reason for thinking that overcrowding is on the increase, but the lack of vacant rooms renders it impossible for families to find better accommodation, and only in very serious cases is action taken by the Department. Annual Cleansing.-—-It being impossible for the two Tenement Houses Inspectors to inspect the whole of the registered houses for this purpose, arrangements were made for those houses to be inspected which had not been dealt with the previous year, as well as others in certain streets in the Clarendon Street, Waverley Road, and Amberley Road Areas. By the adoption of this method an annual inspection of the worst streets and a biennial inspection of all other streets on the Register is ensured. Last year, out of 1,404 registered houses, a complete inspection was made of 915. The defects, etc., discovered, necessitated the service of 3,856 notices, including 406 letters relating to matters liable to be dealt with under the Housing Acts. In 19 instances legal proceedings had to be instituted before compliance with notices could be secured. Common Lodging Houses.—There are 5 houses in Kilburn Lane, accommodating 128 men and 37 women. Inspection is made by the Department once a year on receiving the Notices of Application for renewal of licences, and by the Officers of the County Council at other times. No cases of infectious disease occurred during the year among the users of these houses. Three deaths were registered locally, one each from pulmonary tuberculosis, cancer and kidney disease. Inland Revenue Acts.—Four (4) certificates for exemption or reduction of the Inhabited House Duty—covering 9 flats—were issued during the year. In no case was an application refused. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920.—The applications for certificates under Section 2 (2) of the Act numbered 33. Of these 27 resulted in the issue of certificates, 1 was abandoned, and 5 were deferred until the current year. L.C.C. Houses.—Despite the fact that the lists of applications for premises on the L.C.C. Estates were officially closed, efforts were made by the Department in seventeen (17) instances of particularly unsatisfactory conditions for accommodation on such Estates. It is believed that 3 of the applications were successful. WORKSHOPS. Registration.—In 1913, 200 new premises were added to the Register, and in 1914, 163. The additions during the years 1919 to 1922 were 114, 92, 119 and 93 (in 1922). The removals from the Register numbered 293 in 1913 and 138 in 1914. Since 1919 the numbers have been 35, 174, 247 and 210. The foregoing figures are illustrative of the financial difficulties of the years since the War. At the end of 1913 there were 1,421 premises on the Register, a total which increased to 1,446 at the end of 1914. Since the latter year the total has fallen, and was 1,152 at the end of last year. That total included 193 factories (21 being laundries), 558 workshops (including 7 " domestic "), 37 workplaces, and 343 premises of outworkers in which no employees were working. In comparison with 1913, the factories show an increase of 65—but a diminution of 11 laundries—workshops a decrease of 343 (9 of "domestic"), and an increase of 44 "single workers," with a further change that last year all persons in this category were "outworkers"—a fact not hitherto observed. The Home Office forwarded 19 notices of new workshops during the year, of which 13 had already been placed on the Department's Register when the notices were received. At the end of 1913 the Register showed 8,435 persons employed: 4,184 women, 629 young persons and 3,672 men. At the end of 1922 the total had fallen to 6,239, viz., 2,856 women, 247 young persons, and 3,136 men. The figures for 1922 show a total reduction of 26 per cent, for all workers— 15 per cent. in the case of men, 32 in that of women, and 61 in that of young persons. Outworkers.—Local employers forwarded 41 lists in February of last year and 42 in August. In 1919 and 1920 the lists numbered 39 at both seasons of the year. The addresses included in the 83 lists numbered 461, of which 361 were in outlying districts. The local homeworkers (100) were 35 fewer than the number returned in 1921. From outlying districts 69 lists (433 addresses) were received, 40 of those lists coming from the City of London (18), Westminster (12), and Kensington (10). The total number of outworkers on the Register at the end of the year was 604, an increase of 53 above the total at the end of 1921. At the end of 1919 the total was 675, the highest on record. 30 food supervision. Supervision.—Last year 358 first inspections were made, and 34 workrooms were measured. The re-inspections numbered 2,703. In 1921,415 first inspections were made, and 2,100 re-inspections. At 40 workshops the Abstracts of the Factory Acts were not displayed, and notices thereof were sent to the Home Office. Workrooms were used as bedrooms at 33 premises. The Home Office forwarded 5 complaints during the year, 3 relating to dirty closets, and 1 each to overcrowding and inadequate ventilation in workrooms. The Inspector discovered and dealt with 202 infringements of the Acts, including 160 of dirty premises, 2 each of overcrowding and inadequate ventilation, 8 of defective closet apparatus, and 2 of want of separate accommodation in workshops where women were employed. In comparison with the previous year there was a considerable increase—from 34 to 160—in the number of dirty premises, but a decrease—from 25 to 8—in the number of defective closets. Eight Notices under the Public Health (London) Act, 1891, were served and complied with. Infectious Diseases.—The cases occurring on workshop premises increased from 20 in 1921 to 62 last year, of which 33 were on outworkers' premises. Of the 62 cases, 19 occurred in the workers' families, 8 of the families being outworkers. The increase in frequency was mainly due to the epidemic of measles, 29 cases last year, 1 in 1921. There were 14 cases of scarlet fever (12 in 1921), 8 of whooping cough, 6 of diphtheria (3 in 1921), 3 of chickenpox and one each of German measles and influenzal pneumonia. Bakehouses.—The number of these premises remains unchanged at 65, 38 being factory bakehouses. The underground bakehouses numbered 46, 26 of them being factories. The inspections during the year numbered 591. The employed numbered 317 males, including 17 under 18 years of age. The employment of youths has not hitherto been observed in bakehouses. FOOD SUPERVISION. Slaughterhouses.—One slaughterhouse was closed during the year owing to the licensee neglecting to apply for renewal of the licence, leaving 4 premises in use. Very little slaughtering is done at one of these. Last year 2,087 animals—80 bullocks and 2,007 sheep—were killed. During 1909-13 the annual average was 4,434, a figure which demonstrates the shrinkage in trade of locally killed animals. The Inspector visited the slaughterhouses on 233 occasions during the past year (174 times in 1921). He caused parts of one bullock to be destroyed on account of tuberculosis, and 2 sheeps' livers as parasitic. Food Shops.—At the end of 1921 there were 440 premises on the Register, which total was reduced to 437 during 1922, one butcher's and 2 greengrocers' shops being closed. At 5 places fish curing is carried on, and at 10 sausages are made. The number of milk vendors was reduced by one to 95, as also the description of premises at which milk is sold. The one cowhouse still remains in use. The inspections made during the year totalled 949, including a quarterly inspection of the cowhouse. Milk: Tuberculosis.—During the autumn 20 samples of milk were obtained, 15 from consignments in course of transit, and 5 from retailers' shops, for bacteriological examination. In none of the samples was any evidence of the tubercle bacillus found. In 1900, 39 samples were examined for the same purpose. On that occasion the bacillus was found in two samples. The results of the examinations made last year are the more satisfactory as the Medical Officer of Health of the City of London had a very short time before the work was undertaken in Paddington, reported the discovery of the bacillus in a very large proportion of samples taken on his instructions. Infectious Disease.—One case of scarlet fever occurred at a milk shop. In the families of milk carriers, or in houses where such families resided, 17 cases of infectious disease were reported, viz., scarlet fever 10, diphtheria 4, and measles 3. No difficulty was experienced in securing all necessary precautions being taken—including, if required, the swabbing of the milk carriers—and no spread of infection was discovered. Ice Cream.—Last year 38 new vendors were added to the Register, bringing the total number up to 125, 5 more than in 1914, and the highest total so far recorded. Ice cream made within the Borough is sold from 8 barrows having local pitches and 2 others with pitches outside the Borough. The Inspector made 163 visits during the year to places where the "cream" is made or sold. No case of infectious disease occurred on the premises where the cream was made, or in the families of the vendors. Food destroyed.—There was no seizure of unsound food, but 10,416 lbs. of foodstuffs were surrendered for destruction, including 3,584 lbs. (34.4 per cent.) in course of transit, and 224 lbs. from slaughter houses. There was a slight increase (8 per cent.) in the total amount destroyed, due to the increase in amount (from 140 lbs. to 3,584 lbs.) dealt with in course of transit. sale of food and drugs acts. 31 SALE OF FOOD AND DRUGS ACTS. (See Table XIX., Appendix.) Samples Taken.—The standard number (600) were obtained and submitted to the Public Analyst, that total including 73 of milk purchased on Sundays and Bank Holidays, and 67 (also milk) taken in transit at the G.W.R. Terminus. The table shows that 56 (9.3 per cent.) of the samples were returned as adulterated; but, as a matter of fact, only 29 (4.8 per cent.) were adultered in the popular use of the term. The remaining 27 contained preservatives. Milk.—Of the 272 samples of milk, 132 were purchased at shops or from roundsmen, no case of adulteration being detected. The remaining 140 included 73 bought on Sundays and Bank Holidays, one being adulterated, and 67 taken at the G.W.R. Terminus, 18 adulterated—the percentages of adulteration being 1.3 and 26.9 respectively. In 1919-20 the shop samples showed 1.3 per cent. adulterated, and in 1921, 2.0. Among "Sunday" samples the adulteration was 1.5 per cent. in 1921, 5.1 during 1919-20, and 5.9 during 1914-18. For "station" samples, the percentage was 29.6 during 1909-13, 39.2 during 1914-18, 16.5 in 1919, 4.4 in 1920, and 20.7 in 1921. The percentage is always high in this group of samples, as the services of the Inspector are not sought until the consignee has found by analysis that adulterated milk is being sent to him. It is evident that close supervision over the supplies sent to London is very necessary both to protect the public and the retailers. Cream.—Of 11 samples of cream 3 were "preserved," containing over 35 per cent. of fat, and boric acid varying from 0.012-0.4 per cent. All were correctly labelled. Other Samples.—In 2 samples of lime juice (cordial) it was found that phosphoric acid had been substituted for citric acid, the natural constituent of the juice. Preservatives.—In 27 samples varying amounts of boric or salicylic acid were found, viz.:— 5 of sponge cakes (boric acid, max. 23-min. 12 grains per lb.) ; 5 of mincemeat (salicylic acid, max. 3.5-min. 1.5 grains per lb.); 6 of sausages (boric acid, max. 35-min. 8 grains per lb.); 5 of liquid eggs (boric acid, max. 122.5-min. 52.5 grains per lb.); 2 of "British" wines (salicylic acid, 8 grains and 1 grain per pint); 2 of lime juice (salicylic acid, 2 grains per pint in each); 1 of "lemon squash" (salicylic acid, 3.5 grains per pint), and 1 of fruit syrup (salicylic acid, 3 grains per pint). It was ascertained that the presence of boric acid in sponge cakes was due to the use of liquid eggs, which are of Chinese origin. The attention of the Minister of Health was called to the undesirableness of the presence of any preservative in a commodity largely eaten by invalids and young children. After conference with the trade, an agreement was arrived at that the amount of boric acid in liquid eggs should not exceed one per cent., and that liquid eggs should not be used in the manufacture of certain varieties of sponge cake. Apart from any question as to the necessity of adding preservatives to foodstuffs, the conclusion which can be drawn, even from the limited facts given above, is that legislation is urgently required to control such addition. If one grain per pint or pound is found by one manufacturer to be sufficient, why should another add double that quantity, or more ? Colouring Matter.—In 3 samples of tinned peas, copper sulphate was found in amounts varying from 1½ to 3 grains per lb. In this practice regulation is equally necessary. In certain foreign countries the addition of colouring matter is prohibited entirely in foodstuffs for home consumption, but sanctioned in those for export. RATS AND MICE (DESTRUCTION) ACT, 1919. Complaints of rat infestation of houses increased from 59 in 1921 to 106 last year. In 4 instances enquiry indicated that the complaints arose from the presence of a stray rat in the house, and action by the Department was deemed to be unnecessary. In all other instances examinations of the drains of the premises were made, both from the interior of the sewers into which such drains discharged, and within the curtilages of the premises. The examinations from the sewers extended to the drains from the houses on each side of the infested house. In many instances the flap valves on the house drains were found to be defective or rusted up in an open position; in others minor defects were found in the walls of the (brick) sewers. Such defects were made good by the Sewers Department. Reconstruction or repair of the drain connexions were required at 34 houses, and the same applies to the drains within the curtilages of 26 infested houses. The works carried out were successful in freeing the houses of rats. A "Rat Week" was held in November last (6th-l 1th). As on previous occasions the co-operation of the principal tradesmen concerned with foodstuffs, wharfingers, and others was sought, and the Borough Surveyor freely baited manholes and side entrances on the public sewers, 1,983 baits being put down in 462 places. All the baits disappeared and 9 rats were found dead, that being the first occasion of discovering any dead rats. Practically no information was received of the results obtained on private premises. 32 LEGAL PROCEEDINGS. LEGAL PROCEEDINGS. (See Table XXI.) The tabulated statement shows the legal action taken during the year under the Public Health Acts and bye-laws pursuant to them, and under the Sale of Food and Drugs Acts. The fines and costs under the "Health Acts" amounted to £51 13s. 0d., and those under the "Food Acts" to £34 l1s. 0d., making a total of £86 4s. 0d. For the five years 1917-21 the annual averages were: "Health Acts," £40 5s.; "Food Acts," £102; but the latter average is unduly swollen owing to proceedings under War Regulations, etc. The average fine in "Food Acts" convictions during 1922 was £4 5s. (1917-21 £4 16s. 3d.), and that of costs £1 l1s. l1d. (1917-21 £1 Is. l0d.) CLERICAL WORK. (See Table XX., Appendix.) The work of the Clerical Staff has been largely recorded by implication in the preceding pages of this Report. Special statistical analysis fails to bring out the complexity of that work, but such items as lend themselves to mere statement by numbers are indicated in Table XX. There is no evidence of any reduction of the total amount of this work. On the contrary each year more returns are required and the task of preservation and ordering of records assumes larger proportions. 33 appendix: general summary. APPENDIX. TABLE I. 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. Mortal ity. 1912 142,362 2,774 50 267 2,991 21.18 1,889 13.27 372 254 1,771 12.44 326 117 295 98 1913 142,229 2,832 55 242 3,019 20.87 2,071 14.33 407 315 1,979 13.68 342 121 305 101 1914 142,087 2,708 49 274 2,933 20.64 1,892 13.31 347 350 1,895 13.33 312 115 281 96 1915 131,397 2,506 59 267 2,714 20.65 2,304 17.53 370 352 2,286 17.39 343 137 319 117 1916 T 142,169 2,378 61 372 2,689 18.91 ... ... ... ... ... ... 289 121 253 94 C 136,668 ... ... ... ... ... 1,924 14.72 370 326 1,880 14.38 1917 T 136,561 1,834 77 334 2,091 15.31 ... ... ... ... ... ... 290 158 273 135 C 122,507 ... ... ... ... ... 1,997 16.30 321 374 2,050 16.73 1918 T 131,673 1,798 118 337 2,017 15.31 ... ... ... ... ... ... 266 148 235 116 C 117,517 ... ... ... ... ... 1,999 17.01 345 595 2,249 19.13 1919 T 149,941 2,016 154 454 2,316 15.44 ... ... ... ... ... ... 213 105 212 91 C 143,938 ... ... ... ... ... 1,499 10.41 310 725 1,914 13.29 1920 T 150,128 3,181 251 483 3,413 22.73 ... ... ... ... ... ... 279 87 266 78 C 149,673 ... ... ... ... ... 1,667 11.13 370 410 1,707 11.40 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 1922 145,300 2,557 288 462 2,731 18.79 1,929 13.27 365 324 1,888 12.99 224 88 189 69 " T "—Total; " C "—Civil. Census 1921. Area of Borough (stat. acres), 1,356-1, including waterways, 20.0 acres. Total population, 144,261 persons. Density of population, 106 per acre. Total number of buildings containing dwellings 17,153 (a) Dwellings occupied by non-private families 435 Population inhabiting the same 11,200 (b) Dwellings occupied by private families 38,320 (Including, vacant census night, 938). Population enumerated in occupied dwellings 131,351 Occupying 141,959 rooms averaging 1.08 persons per room, or 0.92 room per person. TABLE II. Wards. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Population. 1911 16,112 27,058 20,831 23,460 25,050 9,146 8,007 12,887 1921 15,754 27,512 22,100 24,102 24,952 9,533 8,161 12,147 Births: Corrected. 1917 250 487 327 335 458 52 46 136 1918 200 501 298 353 454 55 53 103 1919 274 526 345 384 492 78 64 153 1920 341 770 527 623 761 97 95 199 1921 294 562 466 551 632 92 79 183 Average 1917-21 272 569 393 449 559 75 67 155 1922 274 551 423 490 634 97 78 184 Deaths: Persons, all Ages. 1917 225 404 322 355 446 86 72 140 1918 244 434 357 406 465 97 96 150 1919 231 362 285 370 348 87 93 138 1920 185 316 256 328 347 78 77 120 1921 178 343 282 349 314 101 65 126 Average 1917-21 213 372 300 362 384 90 81 135 1922 191 352 291 345 390 93 84 142 Infantile Mortality.* 1917 116 101 104 164 185 58 87 103 1918 70 104 101 122 161 109 75 136 1919 95 84 78 133 102 13 78 52 1920 55 57 85 90 95 51 121 65 1921 68 68 73 114 115 22 121 71 Mean 1917-21 79 79 86 119 126 45 104 81 1922 58 51 68 86 83 82 51 43 * Per 1,000 births. 34 appendix: sickness cases reported. notifications. TABLE III. Sickness: Cases Reported. Borough. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Smallpox ... ... 1* ... ... ... ... ... ... .. Diphtheria 293 286 266 207 227 254 254 461 442 401 Membranous Croup 3 3 7 2 2 4 4 3 3 ... Erysipelas 112 141 137 104 66 56 76 81 83 77 Fevers Scarlet 484 738 436 272 124 150 261 501 827 529 Enteric 25 10 18 23 12 13 10 19 13 8 Continued ... 2 1 ... ... ... ... ... ... ... Puerperal 8 10 7 8 *7 2 15 15 16 8 Cerebro-spinal ... 2 10 9 7 3 7 1 2 2 Posterior Basic Meningitis ... ... 4 ... ... ... ... ... ... ... Acute Poliomyelitis 2 3 1 4 1 ... 5 2 1 ... Ophthalmia Neonatorum 22 51 31 20 27 22 30 29 34 16 Dysentery 3(a) 1 2 ... Encephalitis Lethargica 3(a) 2 7 2 Malaria 64(a) 24 7 5 Pneumonia, Influenzal 87(a) 45 27 72 Pneumonia, Primary 83(a) 96 105 254 Trench Fever 1(a) ... ... ... Tuberculosis—Total 836 545 590 526 502 451 391 383 335 312 Pulmonary 664 397 426 388 355 325 284 277 244 204 Other Forms 172 148 164 138 147 126 107 106 91 108 Measles †—Total 1,240 424 3,721 746 4,245 1,519 1,890 2,034 205 3,220 Reported 1,240 111 801 200 1,544 515 632 607 42 1,103 Notified ... 313(a) 2,920 546 2,701 1,004 1,258 1,427 163 2,117 Chickenpox—Total 599 555 644 468 406 813 261 568 253 539 Reported 399 555 560 468 406 606 261 568 253 517 Notified 84(b) 207 (b) 22 (b) Whooping Cough ‡ 644 558 365 540 325 691 160 357 613 382 Mumps ‡ 203 247 167 180 200 680 150 154 494 91 Ringworm ‡ 148 196 125 152 117 111 189 204 122 99 * 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 IV. Notifications. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. A. Ward Distribution. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria 21 41 45 45 15 25 34 38 37 35 ... 5 6 12 12 10 Enteric Fever ... ... ... ... ... 2 ... 1 ... 3 ... ... 1 ... ... 1 Erysipelas 5 7 9 12 5 8 2 9 3 11 ... ... 1 1 ... 4 Ophthalmia Neonatorum 1 ... 1 4 1 ... 2 ... 2 1 ... 1 1 1 ... ... A. Influenzal Pneumonia 2 5 4 2 7 8 6 6 14 9 2 3 ... 2 ... 2 A. Primary Pneumonia 13 10 31 19 15 10 24 25 62 24 4 3 1 ... 9 4 Puerperal Fever ... 2 ... ... ... 1 ... 2 ... 2 ... ... ... 1 ... ... Scarlet Fever 39 54 62 74 23 23 40 36 52 56 4 5 6 8 17 30 B. Sex-Age Distribution. 0— 1— 5— 15— 25— 35— 45— 55— 65— M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria 8 5 65 66 73 78 13 39 9 24 2 6 ... 7 ... 5 ... 1 Enteric Fever ... ... ... ... ... ... ... 2 ... 2 ... 1 ... 2 1 ... ... ... Erysipelas 1 1 1 1 2 5 5 4 3 8 3 9 6 9 2 6 2 9 A. Influenzal Pneumonia ... 1 2 2 2 3 4 5 5 8 7 7 12 1 1 4 2 6 A. Primary Pneumonia 23 16 29 26 16 10 17 7 18 9 26 5 20 4 6 6 4 12 Scarlet Fever 2 6 73 59 147 177 16 26 2 14 2 2 1 1 — 1 ... ... 35 appendix: notifications. TABLE V. Notifications: Wards. Quarterly and Annual Averages. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Quarter. 1917-21 1922 1917-21 1922 1917-21 1922 1917-21 1922 1917-21 1922 1917-21 1922 1917-21 1922 1917-21 1922 Diphther ia. 1 22 11 21 27 13 13 19 23 19 34 1 3 3 2 5 8 2 10 21 18 25 8 14 10 16 14 23 3 ... 2 1 4 ... 3 7 13 13 20 8 5 11 18 13 14 2 1 2 12 2 8 4 15 17 20 18 14 8 21 15 20 21 4 1 4 3 3 6 Totals 54 62 72 90 43 40 61 72 66 92 10 5 11 18 14 22 Scarlet Fever. 1 12 14 21 29 8 12 7 14 11 15 1 2 3 3 5 7 2 6 18 19 35 10 14 7 16 14 20 3 4 4 6 2 6 3 12 33 24 39 12 11 15 25 20 34 2 1 2 1 2 13 4 28 28 48 33 17 9 20 21 25 39 3 2 4 4 6 21 Totals 58 93 112 136 47 46 49 76 70 108 9 9 13 14 15 47 36 appendix : deaths of residents of the borough. TABLE VI. Deaths of Residents of the Borough, 1922. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Deaths at Ages. In Public Institutions. 0— 1— 2— 5— 15— 25— 45— 65— P. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Enteric Fever 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 33 18 15 4 2 7 8 6 4 1 ... ... ... ... ... ... 1 ... ... 10 10 Scarlet Fever 3 1 2 ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... 1 2 Whooping Cough 11 6 5 1 2 2 1 3 2 ... ... ... ... ... ... ... ... ... ... 2 3 Diphtheria, Membranous Croup 25 12 13 l ... 3 4 3 7 4 1 1 1 ... ... ... ... ... ... 12 12 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 68 33 35 l ... ... 1 ... 1 ... ... 1 3 5 7 13 7 13 16 10 10 Erysipelas 3 1 2 l ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 15 8 7 ... ... ... ... ... ... ... ... ... 2 8 1 ... 1 ... 3 5 4 Pulmonary Tuberculosis A. Phthisis 117 69 48 ... 1 1 ... ... ... ... ... 8 19 33 17 21 10 6 1 39 25 Tub. Meningitis, A. Hydrocephalus 10 3 7 l 2 2 1 ... 4 ... ... ... ... ... ... ... ... ... ... 1 6 Other Forms of Tuberculosis 16 5 11 ... 1 ... 1 ... ... 3 1 1 1 1 2 ... 2 ... 3 5 8 Syphilis 8 3 5 2 2 ... ... ... ... ... ... ... ... 1 3 ... ... ... ... 2 3 Cancer 191 93 98 ... ... ... ... ... ... ... ... 1 ... 4 11 58 40 29 47 54 43 Rheumatic Fever 3 2 1 ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... 1 ... Alcoholism 5 2 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 1 ... ... ... Inflammation & Softening of Brain 3 1 2 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 1 1 Cerebro-spinal Fever 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Simple Meningitis 7 3 4 1 2 ... ... ... ... 1 ... ... 1 1 1 ... ... ... ... 3 3 Cerebral Haemorrhage 101 46 55 ... ... ... ... ... ... ... ... ... ... 1 1 14 17 31 37 21 14 Apoplexy 8 2 6 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 3 ... ... Convulsions 4 3 1 2 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart Disease 221 92 129 ... ... ... ... ... ... ... 3 2 2 11 11 29 36 50 77 20 54 Bronchitis 193 99 94 5 14 ... ... 1 ... ... 1 ... ... 6 2 29 11 58 66 29 29 Lobular (Broncho-) Pneumonia 92 49 43 13 8 14 7 4 1 ... 2 1 ... 2 1 4 5 11 19 28 19 Lobar (Croupous) Pneumonia 34 21 13 1 2 ... 1 1 ... 3 ... ... 1 8 ... 6 6 2 3 11 8 Pneumonia 36 22 14 3 ... 1 2 2 1 ... ... 1 1 6 2 4 3 5 5 11 4 Other Diseases of Respiratory Organs 20 11 9 1 1 ... ... ... ... ... ... 1 ... ... 1 6 4 3 3 5 ... Diseases of Stomach 11 8 3 ... ... ... ... ... ... ... ... ... ... 1 1 5 1 2 1 4 2 Diarrhoea and Enteritis 26 20 6 17 6 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 16 5 Appendicitis 6 4 2 1 ... ... ... ... ... ... ... 1 ... 2 ... ... 1 ... 1 2 1 Obstruction of Intestines 12 6 6 1 ... ... ... ... ... ... ... ... ... ... ... 3 2 2 4 4 3 Cirrhosis of Liver 5 2 3 ... ... ... ... ... ... ... 1 ... ... 1 1 1 ... ... 1 ... 2 Nephritis and Bright's Disease 60 27 33 ... ... ... ... ... 1 ... ... 1 ... 2 4 11 15 13 13 11 13 Tumours (N.-M.), &c., Female Genital Organs 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 3 ... 3 Puerperal Fever 2 ... 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 Accidents and Diseases of Parturition 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... 6 ... ... ... ... ... 5 Congenital Defects 14 6 8 6 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 Premature Birth 41 23 18 23 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 10 Developmental Diseases 25 11 14 10 14 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Old Age 68 13 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 55 6 20 Suicide 32 23 9 ... ... ... ... ... ... ... ... ... 1 10 4 10 2 3 2 4 1 Overlaid in Bed 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 59 39 20 1 2 2 1 3 1 5 ... 3 1 5 3 8 5 12 7 17 12 Homicide 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... All other Causes 282 138 144 3 2 1 ... 3 2 3 3 4 4 13 14 48 37 63 82 81 72 All Causes 1888 927 961 100 89 35 27 28 25 23 13 27 41 123 98 271 212 320 456 430 415 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 appendix i deaths of residents of the borough. TABLE VII. Deaths of Residents of the Borough, 1922. Numbers (All Ages) in Each Ward. Causes of Death. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Enteric Fever ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 2 4 3 1 1 3 3 6 5 1 ... ... 1 1 ... Scarlet Fever ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... Whooping Cough ... 1 ... ... 2 ... 3 1 1 3 ... ... ... ... ... ... Diphtheria, Membranous Croup 2 1 2 4 ... 1 ... 3 5 3 ... ... 2 ... 1 1 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 1 5 6 4 6 6 11 5 4 5 ... 4 5 3 ... 3 Erysipelas ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 1 ... ... 1 2 2 1 ... 2 2 ... ... 2 1 ... 1 Pulm. Tub., Ac. Phthisis 10 6 17 8 8 9 9 5 21 13 1 1 1 2 2 4 Tub. Mening., a. Hydrocephalus ... ... ... 4 ... 1 2 1 ... 1 ... ... 1 ... ... ... Other Forms of Tuberculosis l 3 3 3 1 1 ... 1 ... 3 ... ... ... ... ... ... Syphilis ... ... 1 ... ... ... ... 2 1 2 ... ... ... 1 1 ... Cancer 12 6 13 19 13 16 23 18 18 13 3 14 5 5 6 7 Rheumatic Fever ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... Alcoholism ... ... ... ... ... ... 2 ... ... 1 ... ... ... ... ... 2 Inflammation and Softening of Brain ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Simple Meningitis ... ... 1 ... 1 1 ... 2 1 ... ... 1 2 5 ... ... Cerebral Haemorrhage 6 3 2 12 8 8 10 15 12 6 4 3 ... ... 2 3 Apoplexy 1 ... ... 1 ... 3 1 ... ... 1 ... ... ... ... ... 1 Convulsions ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 1 Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart Disease 10 14 19 29 14 17 13 21 19 25 3 8 4 6 10 9 Bronchitis 10 8 20 24 13 12 26 19 23 20 2 5 ... 3 5 3 Lobular (Broncho-) Pneumonia 2 6 9 5 3 6 10 9 20 8 1 1 1 ... 3 8 Lobar (Croupous) Pneumonia 1 ... 3 2 4 1 1 3 9 4 ... ... ... 1 3 2 Pneumonia 2 1 3 3 3 2 5 2 6 1 1 3 2 ... ... 2 Other Diseases of Respiratory Organs 2 ... 2 1 1 2 1 1 3 3 ... ... 1 ... 1 2 Diseases of Stomach ... ... 1 ... 1 ... 2 2 2 ... 1 1 ... ... 1 ... Diarrhoea and Enteritis 2 ... 2 ... 2 1 6 3 6 1 1 ... ... ... 1 1 Appendicitis ... ... 1 1 1 1 ... ... ... ... 1 ... ... ... 1 ... Obstruction of Intestines 1 1 ... 1 1 2 1 ... 3 1 ... 1 ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... 1 3 ... ... 1 ... ... ... Nephritis and Bright's Disease 5 5 6 10 9 5 1 5 2 2 ... 1 2 1 2 4 Tumours (N.-M.), &c., Fem. Gen. Orgs. ... ... ... 2 ... 2 ... 1 ... 1 ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... Accidents and Diseases of Parturition ... ... ... 3 ... ... ... 1 ... 1 ... ... ... ... ... 1 Congenital Defects 1 1 2 2 1 1 1 1 ... 3 1 ... ... ... ... ... Premature Birth 2 2 5 1 5 3 7 4 1 6 1 ... 1 ... 1 2 Developmental Diseases ... ... ... 3 4 4 2 2 3 3 1 1 1 ... ... 1 Old Age 3 9 4 19 ... 7 1 9 4 4 ... 2 1 1 ...... 4 Suicide 1 1 2 1 5 2 2 1 5 2 1 1 4 ... 3 1 Overlaid in Bed ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Other Accidents and Violence 4 ... 10 2 3 5 6 3 10 6 1 ... 2 ... 3 4 Homicide ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... All other Causes 15 17 20 25 17 36 21 23 31 14 11 9 9 6 14 14 All Causes 97 94 158 194 130 161 176 169 222 168 36 57 47 37 61 81 In Institutions 53 46 65 95 49 56 79 74 139 95 12 10 8 6 25 32 38 appendix: tuberculosis. TABLE VIII. Tuberculosis. Total Cases reported. Known to have died from all causes during Reported "Arrested" Diagnosis Varied. Removed. Restored to Register. Suspects transferred to Definite. On Register at end of 1922 "Survivors" Definite Suspect, All Forms. Year. Definite. Suspect. 1903-12 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 P. O. 1903-12 2,215 1,068 518 71 44 27 16 13 16 5 5 5 6 381 410 1,560 41 10 232 5 — 1913 812 203 105 55 24 15 8 11 5 3 — 3 123 142 412 3 1 78 33 — 1914 531 157 85 46 14 9 8 7 1 2 1 73 89 266 5 — 58 39 — 1915 582 129 105 41 23 8 4 2 3 3 40 110 236 15 4 91 56 — 1916 526 149 107 44 14 2 4 3 5 36 127 210 7 — 84 46 — 1917 502 159 119 32 13 8 6 4 33 129 200 4 2 72 47 — 1918 451 150 102 39 7 3 9 23 144 127 1 — 89 59 — 1919 388 130 53 32 11 8 24 109 114 — 3 95 66 3 1920 378 117 76 34 10 7 108 72 1 1 107 78 3 1921 335 90 55(a) 33 3 81 60 — 4 113 70 6 1922 312 115 57 5 80 21 — — 136 89 39 Totals 7,032 2,467 518 176 184 202 193 216 191 123 138 122 139 748 1,529 3,278 77 25 1,155 588 51 P.—Pulmonary Tuberculosis. O.—Other Forms of Tuberculosis. (a)—Including 1 "Suspect" dying from disease other than Tuberculosis. appendix: tuberculosis new cases. 39 TABLE IX. Tuberculosis: Sex-Age Distribution of New Cases Reported and Deaths. 1922. 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 1 2 1 2 1 17 37 25 29 29 13 20 7 11 2 4 2 — — 111 93 204 Other Forms 2 2 6 9 18 15 10 7 7 9 7 5 1 6 2 1 - - - 1 - - 53 55 108 Totals 2 2 7 10 20 16 12 8 24 46 32 34 30 19 22 8 11 2 4 3 — — 164 148 312 Deaths- Pulmonary - - 1 - - - 1 - 2 9 7 2 7 2 5 2 3 1 2 - - - 28 16 44 Other Forms 1 1 1 5 - - - - — — — 2 — 1 — — — — — 1 - — 2 10 12 Other Causes P - - - - - - - - - - - - - - 1 - - - - - - - 1 - 1 O.F. - - - - - - - - - - - - - - - - - - - - - - - - - Totals 1 1 2 5 — — 1 — 2 9 7 4 7 3 6 2 3 1 2 1 — — 31 26 57 Not Medically Certified Cases. Cases — — 4 6 19 13 3 5 12 11 8 12 3 6 7 4 — 1 — 1 — — 56 59 115 Deaths- Pulmonary - - - - - - - - - - - - - - - - - - - - - - - - - Other Forms - - - - - - - - - - - - - - - - - - - - - - - - - Other Causes - - - - - - - - - - - - - - - - - - - - - - - - - Totals - - - - - - - - - - - - - - - - - - - - - - - - - "P"—Pulmonary. "O"—Other Forms of Tuberculosis. 40 appendix: tuberculosis cases-all forms. TABLE X. Tuberculosis—Cases: All Forms. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. Borough. Not allocated. West. East. Males. 1917 36 56 48 55 73 5 5 13 291 10 1918 27 58 33 34 56 1 8 10 227 7 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 5 171 5 1922 12 33 17 27 41 6 8 11 155 9 Females. 1917 26 39 22 43 51 5 7 5 198 3 1918 21 25 27 60 57 4 7 13 214 3 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 8 158 1 1922 24 22 19 25 37 5 6 9 147 1 Persons. 1917 62 95 70 98 124 10 12 18 489 13 1918 48 83 60 94 113 5 15 23 441 10 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 13 329 6 1922 36 55 36 52 78 11 14 20 302 10 41 appendix: tuberculosis. TABLE XI. Tuberculosis. Occupations—New Cases and Deaths. 1922. Pulmonary. Other Forms. New Cases. Deaths. New Cases. Deaths. Occupations. Indoor. M. F. M. F. M. F. M. F. Domestic Duties— Housewives — 40 — 20 — 7 — 4 „ and other occupation — 2 — — — 1 - - Servants — 5 3 6 - 3 - 1 Charwomen — 1 — — - - - - Laundry Workers — — — 1 — 1 - - Clerks 7 4 9 7 3 3 - - Shop Assistants, Keepers 3 3 2 3 2 1 - - Dressmakers, Tailors 3 5 1 3 — 1 — - Bootmakers 2 — 1 — — — — - Skilled Artizan 11 — 9 — 1 - - - Waitresses, Barmen, etc — 1 — 1 — — - - Others 8 5 2 1 1 - - 1 Outdoor. Building Trades 4 - 7 — — — — — Painters 2 1 2 - - - - - Labourers - - - - - - - - Road Traffic 5 - 1 — 1 — — — Railway Traffic 5 - 3 — — — 1 — Postmen 2 - - - - - - - Gardeners 1 - 1 — 1 — — - Street Merchants 2 - - - - - - - Others 3 - - - - - 1 - Food Trades. Bakers 1 - - - - - - - Butchers, Fishmongers — - 1 - - - - - Dairymen 1 - - - - - - - Others — - 1 - - - - - Miscellaneous. School Life 4 3 - — 28 20 3 1 Unskilled Workers 9 — 13 — — — — — Professional Workers 4 1 3 — — — — - Other „ 10 2 3 — 1 — — — Commercial Travellers, etc 1 — — — — — — — Infants 1 1 — 1 8 11 3 9 No occupation, or occupation not stated ... 22 19 7 5 7 7 — 2 111 93 69 48 53 55 8 18 42 appendix: cancer—malignant disease. TABLE XII. Cancer: Malignant Disease. 1922. Borough. Site of Disease. Carcinoma. Cancer. Epithelioma. Scirrhus Sarcoma. Malignant Disease. Other Forms. All Forms. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. I. Nervous System— (a) Brain - - - - - - - - - - - - - - - 1 II. Organs of Special Sense— (b) Eye - - - - - - - - - - - - - - - 1 III. Respiratory System— (a) Larynx 4 — 1 — 1 - - - - - - - - - 6 — (b) Lung - - - - - - - - - - - - - - 2 - IV. Circulatory System— (a) Heart - - - - - - - - - 1 - - - - - 1 V. Digestive System — (a) Mouth — — — — ' — — — — — — — — — — — — (i.) Tongue 2 — — — 3 1 — — — — — — — — 5 1 (ii.) Glands, Secretory 1 2 — — 2 — — — — — — — — — 3 2 (6) Throat— (i.) Pharynx 1 - - - 1 - - - - - - - - - 2 — (ii.) Œsophagus 10 2 - - 2 - - - 1 - - - - - 13 2 (c) Intestines— (i.) Stomach, Pylorus 16 11 1 1 - - - - - - - - - - 17 12 (ii.) Intestine 10 10 — 3 - - - - - - - - — — 10 13 (iii.) Rectum 8 12 — 1 - - - - - - - - - - 8 13 (d) Organs- (i.) Liver 2 3 — 2 - - - - - - - - - - 2 5 (ii.) Pancreas 3 1 - - - - - - - - - - - - 3 1 (e) Peritoneum - - - - - - - - - - - - - - - 1 VI. Lymphatic System— (a) Head & Neck - - - - - - - - - - - - - - - - (ii.) Cervical Lymphatics 2 1 - - - - - - - - - - - — 2 1 (b) Thorax— (i.) Mediastinal Glands 1 - - - - - - - 2 - - - - - 3 — (d) Extremities— (i.) Upper - - - - - - - - - 1 - - - - - 1 (ii.) Lower — - - - - - - - - - - - - - 2 - VII. Urinary System— (b) Bladder 2 - - 1 - - - - - - 1 - - - 3 1 (c) Prostate 4 — 1 - - - - - - - - - - - 5 - VIII. Generative System— (a) Ovary — - - - - - - - - - - - - - - 3 (b) Uterus - 13 - 2 - - - - - - - - - - - 15 (c) External Genitals — — — — 1 1 — — - — — — — — 1 1 (d) Breast — 15 — 1 — — - 1 - - - - - - - 17 IX. Osseous & Muscular System— (a) Head & Neck 3 — — — 1 — - — 1 3 - — — — 5 3 (b) Thorax - - - - - - - - - - - - - - 1 - X. Cutaneous System— (a) Head & Neck - - - - - 1 - - - 1 - - - 1* - 3 Totals 71 72 3 11 11 3 — 1 7 10 1 — — 1 93 98 Ages at Death. 0- - - - - - - - - 1 - - - - - 1 - 20- - - - - - - - - 1 - - - - - 1 — 25- 1 2 - - - - - - - - - - — — 1 2 35- 3 6 - - - - - — — 3 - — — — 3 9 45- 18 14 1 2 2 — - — 2 3 - — — — 23 19 55- 26 15 — 2 7 1 - 1 2 2 - — — —- 35 21 65- 14 23 - 4 2 1 - — 1 2 1 — — 1 18 31 175- 9 12 2 3 — 1 - - - - - - - - 11 16 * Rodent Ulcer. APPENDIX: DEATHS UNDER ONE YEAR. 43 1922. 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- 1922. Averages 1917-21 1922. Averages 1917-21 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chicken pox — — — — — - — — — - — - — - — — - — - — — - — - — — - — — — — — — — — — — - Measles - - - 1 - - - - - - - 1 - - - - - - - - - - - - 1 - 1 - 1 1 - - 1 — 4 4 2 2 Scarlet Fever — — - — — - — — — - — - — - — — - — - — — - — - — — - — — — — — — — — — — - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 — 1 Whooping Cough - - - - - - - - - - - - - - - 2 - - - - - - - - - - - - - - - - 1 — 1 3 2 4 II. Diarrhœa - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - 1 5 - 3 Enteritis — — — — 1 — 1 — — 1 2 1 1 — 5 2 2 1 3 i 1 - 1 — — — - 1 1 — — — — — 16 23 6 15 III. Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 - - - - - - - - - 1 1 2 1 Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 0 - 1 Other Forms „ - - - - - - - - - - - - - - - - - - - - - - - - - 2 - - - - - - - - -— 1 2 2 IV. Congenital Malformations - 1 - 3 1 - 1 2 - - 2 5 - - 4 1 - 1 - - - - - - - - - - - 1 - - - - 6 10 8 6 Premature Birth 13 8 18 14 3 1 2 1 — — 23 16 — 2 — — — — — — — — — — — — - — — — — — — — 23 29 18 23 Atrophy and Debility - - - - - - 2 - - - 2 - - - - 3 - - - - 1 - - - - - - - - 1 - - - - 3 7 4 3 Debility at Birth — 1 1 4 - - - - - - 1 4 - - - - 1 - - - - - - - - - - - - - - - - - 2 6 4 3 Injury at Birth — 1 1 2 - - - - - - 1 2 - - - - - - - - - - - - - - - - - - - - - - 1 3 2 1 Atelectasis 3 1 3 2 - - - - - - 3 2 - - - - - - - - - - - - - - - - - - - - - - 3 3 2 1 Want of Breast Milk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 0 — — V. Erysipelas - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - 1 0 - - Syphilis — — — — 1 — — — 1 — 2 — — — — — — — — 1 — — — 1 — — - — — — — — — — 2 5 2 4 Rickets - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 0 - — Meningitis - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - 1 - - - - 1 1 1 2 1 Convulsions - - 2 - - - - - - - 2 - - 1 - - - - - - - - - - - - - - - - - - - - 2 2 1 2 Gastritis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 0 - 0 Laryngitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 0 — 1 Bronchitis — — - 1 1 — - 1 1 — 2 2 1 3 — — — — - 3 — 1 2 1 — 1 - — — 2 — — — 1 5 8 14 7 Pneumonia — — - — — — 1 — 1 — 2 — 1 2 2 1 — 2 1 — 1 1 2 3 — 1 1 — 2 — 3 — 2 — 17 20 10 10 Suffocation (overlaid) - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - — 1 1 0 Other Causes 1 1 2 2 1 2 — — — — 3 4 — — — — — 1 — 1 1 1 — 2 — 1 1 1 — 1 — — — 10 12 7 11 All Causes 17 13 27 29 8 3 7 4 3 1 45 37 3 8 13 10 3 5 4 6 4 3 6 7 4 4 3 2 6 5 5 — 4 2 100 — 89 — Uncertified Deaths - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 0 Averages, 1917-1921 19 15 37 28 11 6 6 4 4 2 58 40 15 10 13 9 12 8 7 5 5 4 7 5 6 5 7 4 4 5 5 3 6 4 — 145 — 102 Corrected Births:—M. 1,383, F. 1,348. 44 APPENDIX: PREVENTION OF INFECTIOUS DISEASE. SCHOOL EXCLUSION RATIOS. TABLE XIV. Prevention of Infectious Disease. Annual Averages. 1914-18. Totals. Annual Averages. Totals. All Diseases, Enquiries by— 1914-18. 1921. 1922. 1921. 1922. District Inspectors 3,704 1,931 1,675 Mortuary. Women Inspectors and Health Visitors 7,172 4,904 8,114 Tuberculosis—Included in above— Bodies deposited, total 321 220 258 Women Inspectors 4,157 2,755 2,345 „ „ for inquests 258 158 199 Patients removed to Hospital—All Diseases (excluding Tuberculosis) 618 1,397 1,354 „ „ pending burial, infectious 2 1 2 ,, ,, „ ,, other 61 61 59 Rooms disinfected after— P.M. examinations made 125 102 137 Tuberculosis 316 229 216 Trade Nuisances. Other Diseases 3,300 2,074 3,845 Weight of Bedding, etc., Disinfected (tons) 54 51½ 36 Offensive Smells—Complaints 9(7)* 12 (12) 9(8) Cost of same £1,156 £2,139 £1,484 Accumulations of Manure 17(11) 22 (18) 9(8) School Notices issued— Smoke—Complaints 8 10 12 Measles, Whooping Cough, Chickenpox... 3,377 1,212 4,457 „ Premises watched 16 19 17 Other Diseases 796 1,650 1,217 „ „ Hours of observation 106 345½ 286 Bacteriological Examinations for— Duration of smoke (hours), including 67¾ 108¼ 83 5/6 Diphtheria 540 754 462 „ black smoke 2¾ 18¼ 10⅓ Enteric Fever 9 13 — Canal Boats. Cerebro-Spinal Meningitis 9 — — Tuberculosis 215 206 302 (1918.) Sanitary Work. Cutting — off of water supplies. On Register at end of year 204 (Averages.) 226 232 Notices received 29 20 13 Known to be using Canal Basin 73 113 119 Referring to Inhabited Premises 15 13 10 Inspections made 135 61 72 Empty ,, 10 6 3 Infringements of Acts discovered 15 18 42 Other „ 3 1 — Notices served 12 9 20 Reasons for—Rates unpaid 10 13 9 Children found on boats 122 76 63 Defective fittings 8 7 4 * 9 Complaints relating to 7 premises. TABLE XV. School Exclusion Ratios. Per 1,000 Places Provided. Notified Diseases. Non-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 11.1 3.8 5.5 2.4 36.2 29.6 20.0 7.6 13.0 10.3 8.0 8.5 5.8 20.0 6.4 1919 7.4 2.4 4.4 2.2 51.1 27.8 9.9 2.8 4.4 1.7 4.0 13.8 8.9 14.2 0.1 1920 17.0 3.0 14.3 1.9 47.5 27.1 23.4 5.6 11.4 6.6 16.3 13.0 7.9 24.8 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 6.7 2.1 38.5 0.1 1922 17.1 2.4 8.3 1.5 63.9 3.0 22.3 0.1 10.3 0.3 15.6 10.3 2.6 18.3 0.3 Non-Provided Schools. Averages 1914-18 9.0 2.9 6.7 2.5 41.8 27.2 19.4 7.4 13.8 7.9 2.1 7.8 6.9 19.9 7.8 1919 5.2 1.6 6.6 1.9 41.5 20.3 7.3 2.6 5.4 2.6 1.8 7.8 5.9 21.5 0.6 1920 11.8 2.0 10.4 0.8 35.8 26.3 19.6 6.8 8.7 6.0 2.0 6.8 5.7 11.8 0.9 1921 29.3 6.2 8.6 3.0 1.3 1.9 9.6 3.2 20.5 13.1 6.1 7.6 1.0 24.8 0.3 1922 19.3 2.6 6.0 1.0 80.3 4.9 19.2 1.3 10.0 1.5 5.5 10.6 3.8 24.1 0.4 appendix: report of the work of the district inspectors, 1917-1922. 45 TABLE XVI. Report of the Work of the District Inspectors, 1917—1922. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, &c. Water Supply. Dust Receptacles. Miscellaneous. YEARS. No. of Complaints received. "House-to-House." On Complaint or after Illness. Cellar Dwellings. Re-Inspection of all kinds. Entire Reconstruction. Drains Relaid, Trapped, or Ventilated. Drains Repaired and made Sound. Waste Pipes Disconnected. New Waste Pipes Provided. Rain-water Pipes Disconnected. W.C.'s, New, Provided, Repaired, &c. Soil Pipes, New, Provided. Soil Pipes Repaired. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New, Provided. Cisterns, Cleansed, Repaired, &c. New, Provided Repaired, &c. Drains Cleared, Flushed, &c. Houses or Rooms Cleansed, Whitewashed, &c. Cases of Overcrowding Abated. Cellar Dwellings Closed. Yards and Areas Paved and Drained. Roofs Repaired. Manure Receptacles Reconstructed, &c. Accumulations Removed. Improperly kept. Removed. 1917 958 18 1,931 - 12,998 22 23 25 36 78 20 154 19 13 8 5 29 - 14 11 7 68 72 1 - 13 53 - 17 1 1918 663 — 1,730 — 12,436 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 — 1,984 3 11,920 22 46 34 33 361 23 275 11 15 42 10 14 — 13 22 2 80 114 4 1 18 91 — 30 — 1920 1,328 — 2,243 15 10,035 35 55 26 38 363 31 360 8 11 48 9 5 — 21 54 12 66 136 5 4 21 107 3 19 2 1921 1,401 — 2,332 — 10,467 36 51 28 40 450 37 350 7 13 38 6 19 2 17 74 6 86 265 3 1 19 137 2 11 — 1922 1,139 — 2,020 — 10,875 58 52 49 11 410 52 449 66 26 28 8 9 — 36 111 5 90 619 1 2 34 180 1 12 3 46 appendix: housing. TABLE XVII. Number of Rooms in each Home. 1. 2. 3. 4. 5. 6-7. 8-9. 10 and over. Homes —Per Cent . of all Homes. 1911 15.6 20.0 21.9 12.7 7.6 8.4 3.6 10.1 1921 16.4 21.6 24.7 14.3 7.5 7.5 2.5 5.4 Inhabitants—Per Cent. Total Population. 1911 7.2 17.3 21.5 13.7 8.8 9.7 4.7 17.0 1921 7.7 19.8 25.4 16.0 9.0 8.9 3.4 9.7 Homes of less than Five Rooms. Average Number of Persons per Room. Rooms to a Home. 1. 2. 3. 4. Total. 1. 2. 3. 4. Total. A11 Homes . "Crowded" Homes. 1901 1.83 1.69 1.27 1.15 1.40 3.56 2.98 2.57 2.45 2.90 1911 1.79 1.68 1.28 1.05 1.35 3.62 2.96 2.60 2.43 2.89 1921 1.60 1.57 1.17 0.95 1.23 3.43 2.96 2.61 2.43 2.86 TABLE XVIII. Sanitary Defects Remedied in Tenement Houses. 1921. 1922. 1921. 1922. Drain defective 3 3 Cistern defective 4 1 „ choked 24 18 „ dirty 17 13 „ untrapped — — „ without proper cover 12 2 ,, unventilated or improperly ventilated 9 - „ cover defective 23 15 Dustbin defective 228 147 Manhole cover defective 22 17 „ not provided 36 10 Surface inlet improperly trapped - - „ insufficient 5 31 „ disused and not abolished 3 4 Gullev choked 12 9 Ventilating pipe improperly constructed 1 1 Paving defective in area or yard 192 220 Soilpipe defective — 9 „ „ wash- house 138 110 „ improperly constructed - - Guttering defective 39 50 „ unventilated or improperly ventilated 1 - Premises damp 41 62 Rooms dirty 3,275 1,638 „ verminous 344 204 Water-closet choked 50 33 Roof defective 251 387 „ defective 272 271 Accumulation of refuse 5 5 „ insufficiently flushed 13 8 Animals improperly kept 32 16 Water supply to premises insufficient 5 18 „ flushing apparatus defective 76 78 Other defects or nuisances 957 1,531 Overcrowding. „ without water supply 32 29 Tenements overcrowded 2 8 „ foul 41 45 Rooms overcrowded 2 8 „ improperly constructed - - Occupants, total 12 43 Under 10 7 23 „ accommodation insufficient 2 9 10 and upwards 5 20 Overcrowding abated— ,, without door 1 — Byre-arrangement 1 — „ without external light or ventilation - 1 By voluntary removal — 2 Under notice 1 5 Cases held over — 1* Rainwater pipe not disconnected from drain or soilpipe 1 - Notices Issued. Written Intimations 518 735 Statutory Notices 142 240 „ ,, defective 55 50 Bye-law ,, 2,369 2,309 „ „ choked 5 14 Notices under L.C.C. (G.P.) Acts— Wastepipe defective 21 21 „ choked 7 11 Verminous rooms 204 244 „ not provided — 1 Additional taps 4 18 Other drainage defects 10 34 Abolition of old dustbins 5 4 * This case resulted in a summons, which was adjourned five times, finally sine diei appendix: samples taken under the sale of food and drugs acts, etc. 47 office (clerical) work. TABLE XIX. Samples taken under the Sale of Food and Drugs Acts, &c. 1922. Total. Found adulterated. Percentage adulterated. Milk 272 19 6.9 Butter 49 3 6.1 Lard 11 - - Bread 10 — - Dried Milk 7 - - Condensed Milk 1 - — Cream 11 - — Margarine 27 1 3.7 Cocoa 17 — — Chicory 2 — — Flour 14 — - Sponge Cake 20 5 25.0 Ground Rice 3 — — Rice 4 - - Sago 3 — — Pepper 2 — — Mustard 4 - - Vinegar 20 1 5.0 Tapioca 3 — — Arrowroot 4 — - Cheese 3 - - Mincemeat 12 5 41.6 Sausage 23 6 26.0 Liquid Egg 5 5 100.0 Olive Oil 5 - - Camphorated Oil 5 — — Ammoniated Tincture of Quinine 2 - - Glycerine 5 — — Turkey Rhubarb 2 — — Tea Dust 2 - - Asparagus 1 — — Prawns 1 — - Pears 2 - - British Wine 3 2 66.6 Lime Juice 8 4 50.0 Jam 12 - - Lemon Squash 2 1 50.0 Fruit Syrup 3 1 33.3 Table Jelly 6 — - Coffee 11 - - Tinned Peas 3 3 100.0 600 56 9.3 TABLE XX. Office (Clerical) Work. Letters Received 5,634 (6,419) Entries in Birth Register 2,689 (2,828) „ Despatched 7,595 (7,456) Complaints Received 1,403 (1,564) Entries in Postage Book 16,526 (20,735) Plans dealt with 274 (208) Certificates dealt with relating to Infectious Disease (including Consumption) 5,595 (2,703) New Openings in Journals 317 (502) Disinfection Orders 3,857 (2,156) Notices sent re above 9,125 (6,671) Notices to abate Nuisance 2,004 (1,547) Figures in parentheses are those of 1921. 48 appendix: legal proceedings. TABLE XXL Legal Proceedings—1922. PUBLIC HEALTH (LONDON) ACT, 1891. Section 4. Fines. Costs. £ s. d. £ s. d. 144 & 146, Church Street Roof defective, rooms, &c., dirty and dilapidated Order made. 1 1 0 46, Cirencester Street Room overcrowded Summons adjourned sine die. 80, „ Roof defective Work done. 1 1 0 9, Clarendon Street Failing to re-instate water supply Re-instated 1 1 0 2, Courtnell Street Drain defective Summons dismissed. 114, Harrow Road Basement room damp, walls dilapidated Work done. 1 1 0 13, Northumberland Place Rooms dirty, roof, &c., defective Order made. 0 6 0 221 Portnall Road Drain and soil pipe leaky „ 0 6 0 1, Saltram Crescent Failing to comply with Magistrate's Order to amend drain, cleanse rooms, &c. 10 0 0 3 3 0 1, Westbury Road Roof defective, rooms, &c., dirty and dilapidated Summons withdrawn. Section 96. 162, Church Street Failing to vacate underground rooms 7 8 0 - By-Laws. 80, Cirencester Street Failing to cleanse rooms, &c. Work done. 3 3 0 47, Clarendon Street ,, ,, „ 3 3 0 93, Woodchester Street Staircase, passage, area, wash-house, and watercloset dirty (2 summonses) 4 0 0 - 91 „ Areas, wash-house, &c., dirty. Paving, copper, &c., defective (7 summonses) 14 0 0 — LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1904. Section 20. 91, Woodchester Street Room verminous 2 0 0 SUMMARY OF LEGAL PROCEEDINGS UNDER SALE OF FOOD AND DRUGS ACTS. 1875-1907, &c. Fines. Costs. £ s. d. £ s d. "Milk 11½% deficient in fat Summons withdrawn ,, 6 % ,, „ „ „ „ 11 % „ „ „ „ „ 6 % „ „ „ „ „ 20 % „ „ „ „ „ 22 % „ „ „ „ „ 10% „ „ „ „ „ 4 % „ „ — 1 0 0 „ 10 % „ „ — 1 0 0 „ 7 % „ „ — 1 0 0 „ 10 % „ „ — 1 1 0 „ 16 % „ „ — 1 1 0 „ 36½% „ „ 5 0 0 1 0 0 „ 7 % „ „ 5 0 0 1 0 0 „ 5% added water 5 0 0 1 0 0 „ 6 % deficient in fat - 2 2 0 „ 16 % „ „ - „ 8 % „ „ — 2 2 0 Sausages 35 grs. boric acid per lb. 2 0 0 5 5 0 Lime Juice Cordial 40 grs. phosphoric acid per pint Summons dismissed. £5 5s 0d. costs against Council. The braces indicate that the summonses with respect to the samples within each brace were taken against one vendor appendix: housing conditions—statistics. 49 HOUSING. (MINISTRY OF HEALTH). Unfit Dwelling Houses. I. Inspection. 1919. 1920. 1921. 1922. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910— (a) Houses inspected on complaint or after illness 1,984 2,243 2,332 2,020 (b) Registered tenement houses inspected 1,176 240 997 915 (c) Houses inspected under Housing Acts 12 143 63 2 (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* 8* - (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 2 * 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 which notices were served requiring repairs 6 135 55 2 (2) Number of dwelling-houses which were rendered fit— (a) by owners — 27 87 45 (b) 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 of which notices were served requiring defects to be remedied— (a) Number of notices under Public Health (London) Act, 1891, and London County Council (General Powers) Acts 1,497 1,176 1,892 2,198 (b) Number of bye-law notices served 1,057 373 2,570 2,572 (2) Number of dwelling-houses in which defects were remedied— (a) by owners Not available. (b) by Local Authority in default of owners — 1 — — (C) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909— (1) Number of representations made with a view to the making of Closing Orders 6 15 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 - -