Metropolitan Borough of Paddington. * REPORT ON The Vital Statistics AND THE Work of The Public Health Department FOR THE YEAR 1923. 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 1923. 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. 1. CONTENTS. page page Acute Poliomyelitis 10 Institutional Treatment (Tuberculosis) 16 Administrative Work 31 Institutions, Deaths in 23 Alcoholism 21 Legal Proceedings 41 Annual Cleansing 36 L.C.C. Houses 36 Ante-natal Clinics 34 Malaria 21 Arsenic in Borax 40 Measles 27 Bacteriological Examinations 31 "Meningitis" 10 Bakehouses 37 Meteorology 1 Births 3 Milk, Condensed 38 ,, Notification 3 ,, Dried 38 „ Illegitimate 3 „ Grants 34 „ in Institutions 3 ,, (Special Designations) 39 „ Still- 4 ,, Trade 38 Canals, Canal Boats 33 Mortality, Infantile 23 Cancer, Mortality from 20 „ at ages 1-5 years 24 Care Committee (Tuberculosis) 17 „ in Childbed 9 Carrier Clinic 7 ,, of Infants in Special Areas 26 Cerebro-spinal Meningitis 10 Mortuary 33 Chicken-pox 30 Multiple Pregnancies 3 Child-bearing, Fatality of 9 Mumps 30 Childhood, Statistics of 23 Notification of Births 3 Clerical Work 42 „ Tuberculosis 15 Combined Drainage 32 Nursing 31 Common Lodging Houses 36 Offensive Trades 33 Compulsory Repairs 35 Office Work 42 "Conversions" 35 Old Age, Deaths from 22 Cream Regulations 40 Ophthalmia Neonatorum 9 Day Nurseries 5, 62 Outworkers (Homework) 37 Deaths 4 Overcrowding 36 „ in Institutions 23 Population 1 Dental Clinic (Tuberculosis) 17 Pneumonia 10 Diarrhœa, Mortality from 29 Preservatives in Food 40 Dinners for Mothers 34 Prevention of Infectious Disease 31 Diphtheria 5 Puerperal Fever 8 „ Carrier Clinic 7 Rag and Bone Dealers, Bye-laws 33 Disinfection 31 Rats and Mice Destruction 40 Dispensary Work (Tuberculosis) 16 Residential Treatment (Tuberculosis) 17 Drainage Plans 32 Ringworm 30 Drains, Private, Re-laid 32 Scarlet Fever 7 „ Dead 32 Schools and Infectious Diseases 31 Dysentery 21 Septic Diseases 9 Encephalitis Lethargica 10 Sewer Connections 32 Enteric Fever 8 Slaughterhouses 38 Erysipelas 9 Smallpox 5 Estimated Population 2 Smoke Nuisance 33 Food Adulteration 39 Staff 31,62 ,, Supervision 38 Tenement Houses 36 Health Visiting 34 Trade Nuisances 33 Homeless Persons 37 Tuberculosis, Care Committee 17 Home Workers (Outworkers) 37 „ Dispensaries 16, 62 House Sanitation 31 „ Institutional Treatment 16 Houses Unfit for Habitation 36 „ Mortality from 18 Housing 35 „ Notification 15 Ice Creams 39 „ Scheme 16 Illegitimates, Births of 3 Underground Rooms 36 „ Deaths of 26 Unsound Food 39 Increase of Rent, &c., Acts 36 Vaccination 5 Infant Consultation Centres 34, 62 Venereal Diseases 22, 62 Infants, Mortality of 23 Verminous Conditions 41 Infants, Mortality in Special Areas 26 Water Supply 33 Influenza 10 Welfare Work 34 Inland Revenue Acts 36 Whooping Cough 28 Inquests 22 Workshop Supervision 37 APPENDIX. Tables 1—22: Housing: Clinics and Treatment Centres: Public Health Staff. TO HIS WORSHIP THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF PADDINGTON. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Report for the year 1923 as required by Section 106 of the Public Health (London) Act, 1891, and Article 14 (3) of the Sanitary Officers (London) Order, 1922. I have in general followed the plan of earlier Reports, omitting many tables formerly included. Such omission has been made for the sake of economy, but I cannot help feeling that it has involved a sacrifice of clarity. Perusal of the proofs has convinced me that many paragraphs of the Report would be more easily understood had the tables on which such paragraphs were based, been included in the Report. The birth-rate was again lower, being 5.81 per 1,000 less than the rate for 1920. For the three years 1921-23 the mean rate was 18.78 per 1.000, as compared with a mean of 21.17 for 1911-13. The latter period has been chosen for the comparison as it was for 1911 that the first complete return of births belonging to the Borough but taking place in out-lying districts, was received from the Registrar-General. In looking up the data for that comparison, I have been struck by the changes which have taken place in the numbers of births transferred both outwards and inwards. During 1911-13 162 births registered within the Borough were marked for transfer to other districts, which total increased to 859 during 1921-23. In the former period the inward transfers numbered 739, and in the latter 1,449. The inward balance for 1911-13 was 577 births, that for 1921-23, 590, an insignificant variation. In the Report (p.3) I call attention to the increased proportion of births which take place away from the mothers' homes, and to that fact, in part at least, must be attributed the increases in numbers of transfers. The death-rate (11.77 per 1,000) was below the rates for the two preceding years but above that (11.40) for 1920—the minimum rate on record. The mean rate for 1911-13 was 13.21 and that for 1921-23/' 12-28—a difference of 1.93 per 1,000, while the difference between the mean birth rates for the two periods was 2.39 indicating that the decline in the death-rate did not keep pace with the decline in the birth-rate. To express that fact in another way, in the earlier three years the natural increment in the population amounted to 3,311 persons, and that in the later, to 2,942— representing a deficiency of 369 new lives. The infantile mortality (69 per 1,000 births) was the same as in 1922 and the lowest on record. All rates recorded before 1911 were overstatements, as the corrections for births in outlying districts were incomplete. Since that year rates in excess of 100 per 1,000 births have been recorded on five occasions, viz., in 1911 (126), 1913 (101), 1915 (117), 1917 (135) and 1918 (116). Years with hot dry summers have in the past been characterised by an excessive infantile mortality. The two periods used above for the purposes of comparison were both signalised by summers of exceptional heat and drought. For 1911-13 the mean rate was 110 per 1,000 births, and that for 1921-23, 71— a reduction of nearly 35 per cent. I think that the whole of that reduction may be claimed to have been brought about by the combined operations of the Council's Public Health Department and of the Welfare Organisations. On page 29 of the Report, under Diarrhœa, I call attention to the altered seasonal distribution of the mortality from diarrhoea at ages under 2 years. With the exception of whooping cough and chickenpox, all infectious diseases showed lessened prevalence. Although there was a considerable epidemic of the former disease, the fatality, as determined from the data in the possession of the Department, was not excessive (see p. 28). The decision of the Board of the Children's Hospital, Paddington Green, to discontinue the special clinic for this disease, is a matter for much regret. Although there was an increase in the number of cases of tuberculosis notified during the year (p.15), the records for that disease were satisfactory. The mortality has declined to below pre-war level (see p. 18). The Borough Tuberculosis Care Committee began their work in the spring of last year, and the note on their activities (p. 18) will, I venture to say, be found to promise useful results. The mortality from cancer (p. 20) continues to increase. Some increase appears to be inevitable with a larger proportion of the population surviving to high ages, unless future research brings to light not only means of curing the disease but also of preventing its occurrence. At present the outlook cannot be described as hopeful, our only practical treatment at present available being early surgical interference. As regards administrative work, attention may be invited to the serious difficulties attaching to endeavours to improve the housing conditions. The Borough may be described as "full to the brim" and until more houses in the districts immediately adjacent to Paddington are available, there is no hope of making any progress towards improvement. The opportunity for a housing scheme by the County Council on a large scale on the N.W. boundaries of the County is rapidly passing away. The discontinuance of the contract for disinfection marks a notable change. Messrs. Armfield have done the work for the Vestry and Council for over fifty years. In future such work will be done by the Council of the Royal Borough of Kensington. In this connection it may be noted that an advance has been made to provide more complete machinery for dealing with verminous conditions (p. 41), by the Agreement with Kensington for the use of the Medicinal Baths provided by the Council of that Borough. Body vermin are more than suspected to be active propagators of certain of the infectious diseases, a fact which makes the provision of disinfestation the more necessary. It is satisfactory to record that Regulations (p. 38) have been made prescribing the compositions of dried and condensed milks. After full inquiry the Public Health Committee decided that an additional Sanitary Inspector was required to cope with the work of the Department, a decision which was endorsed by the Council. Up to the time of writing the Minister of Health had not signified his approval of the appointment. It will be necessary for the Council at no distant date to take the question of accommodation of the Staff of the Department into consideration. The space at present available is badly congested. All the Staff have discharged their duties loyally and efficiently. Mr. Potter, the Chief Sanitary Inspector, and Messrs. Gower and Dunning, of the Clerical Staff, have materially lightened my work. Prior to the war the work of the Department was controlled by one Committee; now there are three Committees and two Sub-Committees (each very largely autonomous). That change indicates the growth of the work of the Department. I have to express my acknowledgments to the Chairmen and Members of the Committees and Sub-Committees for the generous support afforded to me in my efforts to discharge the multifarious duties attaching to my office. 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. June 30, 1924. I. METEOROLOGY. The general impression left by the weather of 1923 was not a favourable one, low temperatures and heavy rain being, on the whole, the most outstanding characteristics. Comparison of the meteorological records does not, however, furnish unreserved confirmation of that pessimistic impression. The mean temperature for the year (9.0 a.m. observations) was nearly one degree above that for 1922, but was 2-9° below the mean for 1921. The maximum temperature recorded during the past year (95-0° on July 13th) was the highest observed since 1911, when a maximum of 96° was recorded on August 9. The monthly morning (9.0 a.m.) readings were very close to the averages for the preceding year except those of May (6° below the average) June (4° below) July (6° above), November (3° below) and December (4° below). The minimum temperature in November (23-5°) and that in December (29-9°) were the lowest recorded since 1911, the earliest record available at the moment for comparison—fitting preparation for the cold spell with which 1924 opened. It is probable that the amount of bright sunshine with which the year is favoured weighs more with the public than any other of the meteorological elements. If that be so, last year's record (1,200 hours) was largely responsible for the unfavourable impression left by the year. In spite of the fact that bright sunshine was recorded on 5 more days last year than in 1922 (276 days in 1923, compared with 271 in 1922), the year's total (1,200 hours) was 123 hours —nearly 10 per cent.—less than the total (1,323 hours) for 1922. In comparison with the amounts recorded during the years 1918-22, there were deficiencies of 50 hours during the months January to March, and of 200 hours during April to June. During July to September there was an excess of 171 hours and during October to December, one of 8 hours. In May there was a deficiency of 87 hours and in June of 99. During the year no bright sunshine was recorded on 70 days and on 45 days the record exceeded 9 hours per day. According to the records kept at Camden Square the rainfall measured during the past year amounted to 27.03 inches, 2.56 inches in excess of the average for the years 1881-1915. Measurable quantities fell on 182 days, 19 in excess of the average, the duration of the fall being 779.2 hours, or 42.3 in excess of the average. The largest number of rainy days (24) occurred in February (11 more than the average) and the smallest (9) in June (3 days below the average) and October (9 below the average). The thunderstorms which passed over the Metropolis during the night of 9/10 July and the afternoon of the 10th were of exceptional severity, the latter being the worse, its centre lying over the Thames near Windsor. During the storm of the 9th-10th, no fewer than 6,924 flashes of lightning were counted in a space of 6 hours by an observer in Chelsea. In the course of the early hours of the 19th, over 2 inches of rain fell in Hampstead, but no complaints were received of any sewer flooding in the Borough. II. POPULATION. It was anticipated that the unfortunate postponement of the Census of 1921 to the middle of June would introduce errors of deficiency in the London results, an anticipation which has been shown to have been realised by the publication of Part III. (Supplementary) of the Census Report for the County of London. That volume deals with " Workplaces in London and Five Home Counties." It is incomplete to the extent that it does not cover the whole country. The Preface to the Report contains a statement showing the areas and towns in Essex, Herts, Kent and Surrey in which the enumerated population (1921) was more than 3 per cent, in excess of the estimated resident population. The excess was greater than 15 per cent, in the following districts : Margate 40.3 Walton-on-the-Naze 33.1 Frinton-on-Sea 34.0 Clacton 31.1 Broadstairs 28.0 Ramsgate 17.7 The facts given above must be regarded as provisional pending the completion of the tabulation of the Census results. It is hoped that a full analysis of the areas of domicile of visitors to holiday resorts and elsewhere will be given in a later Report on the Census. Such analysis would enable the de jure population of the Borough to be compared with the de facto population recorded by the Census. Workplaces.—At the Census, 41,879 males aged 12 years and upwards (including students over 18) and 32,266 females were enumerated in the Borough "as gainfully employed." Of those individuals 25,055 males and 11,855 females gave addresses of workplaces which were outside the Borough. The numbers reporting themselves as employed within the Borough were—males, 12,765 and females, 17,989—the differences representing failure to state workplace or giving incomplete information with reference thereto. Expressed as percentages, the proportions of occupied persons working outside the Borough were males, 59.8 and females, 36.7. 2 POPULATION. The numbers of those living outside the Borough who gave addresses of workplaces within the Borough were—males, 16,421 ; females, 6,660, the excess employment outside Paddington being— males 8,634; females, 5,195, or a total of 13,829 persons equal to 9-6 per cent, of the total population (144,261) persons. Of the total of 36,910 persons enumerated as residing in the Borough but definitely reported as working outside, 31,297 were employed within the County of London, 3,733 in Middlesex, 200 in Surrey, 173 in Essex, 875 in other parts of England and Wales and 632 outside the United Kingdom. Paddington residents employed in the City of London numbered 5,000 persons. The daily exchange of workers between this Borough and the districts immediately adjacent thereto was as follows:— With reference to Paddington. Outwards. Inwards. Kensington 2,844 4,459 Hammersmith 1,038 1,452 Willesden 2,083 3,930 Hampstead 983 541 St. Marylebone 7,245 1,863 Westminster 7,667 314 Note.—To be read thus 2,844 go to Kensington and 4,459 come from that Borough. The foregoing figures indicate that 21,860 persons go into the adjacent districts for their daily work and 12,559 come thence into the Borough, the outward movement being nearly 75 per cent. greater than the inward. The "day" population, as determined by the excess of workers entering daily for purposes of work over those going beyond the boundaries for that purpose, exceeded the night (census) population in each of 13 of the 29 cities and boroughs within the County of London. The most notable excesses were found in the City of London, where the day population was 2,935 per cent, of that of the night, Holborn (128 per cent.), and Westminster (164). It is somewhat surprising to find that there was an excess of the daily inward migration over the outward in Kensington, the excess being equivalent to 3-9 per cent, of the enumerated population. Estimated Population.—The Registrar-General's estimate of the population at the middle of 1921 was 145,600 persons—the Census total being 144,261—that for 1922, 145,300, and that for 1923, 146,200. During the decennium 1911-21 the population increased by 1,710 persons, equivalent to 1.2 per cent, of the 1911 total, whereas the latest estimate shows an increase of 1,939 persons above the total for the 1921 Census, equivalent to an increase of 1.3 per cent. Assuming that the composition of the population has remained unchanged since the last Census, the estimated numbers of males and females (all ages) at the middle of 1923 are: Males, 61,404 (an increase of 913); females, 84,796 (an increase of 1,026). The estimated increases in the populations of the Wards are comparatively insignificant, ranging from 26 in Lancaster Gate East, to 412 in Harrow Road. With such small changes it has not been thought necessary to calculate any estimates of the numbers of individuals in the usual sex-age groups. For the purposes of this Report the actual changes in the numbers of births, deaths, etc., recorded adequately fulfil the function of mortality and other rates, and will do so so long as the population remains practically stationary. It is difficult to understand why the estimate for 1922 should show a decrease of 300 from that for 1921, and be followed by an increase of 900 in the succeeding 12 months. The Registrar-General states that his estimates are "based on the adjusted figures for 1921, after allowance for the varying rate of natural increase as evidenced by the births and deaths in each area and of migration as indicated from other sources such as the changes in the numbers on the Parliamentary Register and the migration returns obtained from the Board of Trade. . No information is available locally on the last point, there being no data of internal migration (i.e., within the United Kingdom), but the following figures relating to natural increase and the numbers on the local Parliamentary Register are of interest. Between July 1st, 1921, and June 30th, 1922, the births registered numbered 2,915 and the deaths 1,936—after making all necessary corrections. For the corresponding period of 1922-23 the figures were 2,664 and 1,709 respectively. Thus the natural increment for 1921-22 was 979 persons, and that for 1922-23, 955. Comparing the local Parliamentary Registers (Autumn Lists) for 1921 and 1922, an increase of 237 persons (106 males, 131 females) is disclosed, similar comparison for 1922 and 1923 showing an increase of 1,195 persons (males, 459; females, 736). The total natural increase for the two years 1921-23 was 1.3 per cent. and that in the total number on the Parliamentary Register 1.9—very good approximations to the growth indicated by the last estimate calculated by the Registrar-General. One other figure may be mentioned in this connection, viz., the increase in the number of "effective" assessments, i.e., the number on which rates are paid. That number, as returned at June 30th, 1923, was 21,339, as compared with 21,180 on the same date in 1921, showing an increase of 0.7 per cent. births. 3 III. BIRTHS : NATALITY. (See Tables 1 and 2.)* In 1920 the corrected number of births was 3,413, equal to a rate of 22-73 per 1,000 persons—the maximum both as regards number and rate for the Borough. Since that year there has been a fairly steady fall in the number of births, the total for last year (2,620—males, 1,347 ; females, 1,273) being equivalent to a reduction of 23 per cent, in the annual output of children. In comparison with the annual average for the years 1918-22 last year's total shows a fall of 57 only and the rate no change. In comparison with 1922 smaller totals were recorded in 5 out of the 8 Wards, viz., Queen's Park (fall 11 per cent.), Harrow Road (8 per cent.), Lancaster Gate West (14), Lancaster Gate East (40), and Hvde Park (9). When comparison is made with the quinquennial averages (Table 2), last year's totals were above the averages in Maida Vale, Westbourne, Church and Hyde Park Wards. The greatest increase (9 per cent.) was in Church Ward and the smallest (3 per cent.) in Hyde Park. Of the 485 inward transferred births (18-5 per cent, of the corrected total) 92 belonged to the southern Wards, viz., Lancaster Gate, West and East, and Hyde Park. In those Wards the inward transfers formed just on 31 per cent, of the total of 300 births, the highest proportion, 34 per cent., belonging to Lancaster Gate, West. The ratio of births of males to those of females was 1,000 : 944 last vear, as compared with 1,000 : 974 in 1922 and 1,000 : 993 in 1921. Illegitimacy.—The 2,620 births included 212 of illegitimate children, equal to 8-1 per cent., 0-3 above the proportion recorded both in 1921 and 1922. In Harrow Road Ward the proportion was the smallest (3-7 per cent.) and in Lancaster Gate, East the highest (19-1 per cent.). In the three southern Wards, with a total of 300 births there were 52 of illegitimates, 17-3 per cent., while in the remainder of the Borough the proportion was only 6 • 8 per cent. The ratio of male to female births among these children was 1,000 : 812 last year, as compared with 1,000 : 805 in 1922 and 1,000 : 1,000 in 1921. Births in Institutions.—Of the 2,620 children whose births were registered during the year, 729 (27-8 per cent.) were born in institutions or nursing homes. The total of 729 comprised 455 children (17-3 per cent.) born in maternity hospitals, nursing homes and rescue homes; 109 (4 • 1 per cent.) born in general hospitals, and 165 (6-3 per cent.) born in Poor Law Institutions. The children born in local institutions numbered 230 (31-5 per cent, of all births in institutions), the remainder (499) being born in out-lying institutions, including 260 (35-7 per cent, of all institutional births) in Queen Charlotte's Lying-in Hospital. Of the legitimate births recorded during the year 27-1 per cent, took place in institutions, and of the illegitimate 35-3. In 1922 the corresponding percentages were: Legitimate, 21 -6, and illegitimate, 54-2. It was in 1913 that the first complete return of out-lying births (for 1912) was received from the Registrar-General, and the compilation of statistics of births in institutions thereby made possible. In that year (1912) the proportion of births in institutions—meaning any place, not being a private dwelling, other than the home of the parents of the child—was 11-5 per cent., less than half the proportion (27-8 per cent.) recorded last year. During the following quinquennium the proportion rose to 13-7 per cent., and during the years 1918-22 to 21 -5 per cent. Multiple Pregnancies.—The 2,620 births registered were the results of 2,591 pregnancies, there being 29 pairs of twins. Of the twin births 20 were unisexual, 13 of males and 7 of females. The other 9 pairs were bi-sexual. The births registered during the two quinquennial periods of 1913-17 and 1918-22 were practically equal. In the former period there were 165 sets of twins and 1 of triplets, while in the second the twin • births numbered 153 and the triplets 2. The unisexed twins in the first period numbered 102 and in the second 96. The number of boys born at twin-births during the 10 years was the same as the number of girls, but among the triplets the proportion of boys was very different, 8 of the 9 children so born (3 triple births) being males. Notification of Births.—Excluding duplicates (47) 2,449 births were notified during the year, 122 fewer than in 1922, equal to a shrinkage of 5 per cent.—1 per cent, greater than the decrease in the number of births registered. Although the father of the child, if resident in the house at the time of birth, is primarily responsible for notification, only 5-8 per cent, of the notifications were received from fathers. The proportion of notifications received from medical practitioners increased from 33.9 per cent, in 1921 to 37.4 * The principal tables will be found at the end of the Report (p. 43 et seq.). 4 DEATHS. in 1922 and to 42.5 in 1923. The notifications sent by midwives formed 42.7 per cent, of the total in 1921 and 43.9 in 1922, but fell to 37.7 in 1923. The percentage of notifications received from other sources was 13.8 last year, as compared with 17.2 in 1921 and 13.0 in 1922. For the years 1914-18 the proportion was as low as 5.2 per cent. Comparison of the cases notified with the Returns of Registration disclosed the fact that during the year 97.1 per cent. of the births were registered after notification, only 69 being non-notified births. As the births registered in the Borough numbered 2,410, the non-notified births represent a degree of neglect to notify amounting to 2.8 per cent, of those births. There being no system of transfer of notifications of birth, it is impossible to give the total measure of failure, nothing being known of the frequency of notification of births (belonging to the Borough) in out-lying districts. The percentages of non-notified births in the quarters of the year varied from 1.9 in the third quarter to 2.9 in the fourth. In the Registration Sub-district "North" the percentage of failure to notify was 1.8, in "Central" 2.8, and "South" 7.4, all showing improvement in the practice of notification. The failure in notification of illegitimate births was 4.4 per cent., as contrasted with 2.7 per cent, in the case of legitimate births. Such difference is to be much regretted as illegitimate children are, on the whole, more in need of welfare care than are legitimate. Still-births.—Of the 2,449 notifications received 68 (2.7 per cent.) referred to infants born dead, the number so reported in 1921 having been 80, and that reported in 1922, 59. The following percentages of still-births have been recorded during the past three years: Legitimate, 1921, 3.0; 1922, 2.32; 1923, 2.8; illegitimate: 1921, 2.9; 1922, 0; 1923, 10. The percentages of still-births notified from the Wards varied from 7.1 in Lancaster Gate, East, to 1.8 in Lancaster Gate, West. In Church Ward the percentage was 3.1. IV. DEATHS: MORTALITY. (See Tables 2, 6 and 7.) Registered Locally.—The deaths registered within the Borough during the year numbered 1,743, 186 less than in 1922 and 32 less than the annual average for the five years 1918-22. Last year's total included 850 in institutions, viz., 523 in the Paddington Hospital, 253 in St. Mary's Hospital, 55 in the Children's Hospital, Paddington Green, and 19 in the Lock Hospital, or 48.7 per cent, of all the deaths registered in the Borough—311 of the deaths (36.5 per cent.) falling for transfer to out-lying districts. The total number of deaths of non-residents was 338 last year, 33 less than the annual average (352) for 1918-22, and the deaths of residents in out-lying districts, 317, 163 less than the average (480). Corrected Figures.—After making due allowance for transferred deaths, both outward and inward, a corrected total of 1,722 deaths of persons of all ages is obtained, 166 less than the figure for 1922 and 181 less than the annual average for 1918-22. The corrected mortality rate for the past year was 11.77 per 1,000 persons, 1.22 less than the rate for 1922, but 0.37 above that for 1920—the lowest rate (11.40) on record. The mean rate for 1918-22 was 13.77, last year's rate showing a reduction of approximately 15 per cent. The mean rate for 1911 -13 was 13.21, and that for 1921 -23,12.28, showing a reduction of 8 per cent. In the adjacent districts the following are the death-rates for 1923: Kensington, 12.3; Hammersmith ; 11.0 ; Willesden, 9.3 ; Hampstead, 10.3 ; St. Marylebone, 11.7 ; and Westminster 10.6. Sex Distribution.— The deaths of males numbered 820 and those of females 902, the corresponding figures for 1922 being 927 and 961, the deaths of males showing a reduction during the year of 12 per cent, below the figure for 1922, and those of females one of 7 per cent. The annual averages for 1919-21 were : Males 865, females 928, last year's numbers showing falls of 6 and 3 per cent, below the respective averages. Ward Distribution.—The numbers of deaths assigned to each Ward are shown in Table 2. In comparison with the numbers for 1922 and with the averages, smaller numbers were recorded last year for each Ward except Lancaster Gate, West, in which Ward last year's deaths were the same in number as in 1922 and 2 above the average. In the other Wards the reductions in comparison with the records for 1922 vary from 18 per cent. in the case of Church Ward to 3 per cent. in Maida Vale, while those in comparison with the averages vary from 17 per cent. in Queen's Park to 4 in Maida Vale. Causes of Death.—The Registrar-General, in tabulating the causes of death during 1921, used the amended International Schedule of Causes of Death, which will be in use until such time as further amendments are introduced. It being thought desirable to follow the lead given by the RegistrarGeneral, the change was made during the past year. The records for 1921 and 1922 will be retabulated to secure uniformity during the current decennium. The changes introduced are comparatively small, and are indicated in footnotes to Table 6. vaccination. 5 V. VACCINATION. The latest return available, viz., that for the year 1922, shows an insignificant improvement in the vaccination condition of the Borough, the proportion of infants surviving to their first birthday and remaining unvaccinated falling from 30.2 per cent, in 1921 to 29.9 in 1922. The proportion observed in 1922 was, however, the highest on record except that for 1921. In 1921, 602 certificates of exemption were taken out locally representing 22.5 per cent. of the children whose births were registered during that year. For the whole country the proportion was 45 per cent. In 1922, 22.6 per cent. of the children born in the Borough were exempted under the Act. Having regard to the fact that smallpox has shown since 1919 an increasing tendency to epidemic prevalence, the continued neglect of vaccination cannot be regarded as otherwise than perturbing. In 1919, 262 cases of the disease were notified in England and Wales, the total rising to 243 in 1920, to 311 in 1921, to 985 in 1922, and to 2,473 in 1923. In London the figures for the same five years have been 24, 18, 2, 62, and 11. Last year rather more than 90 per cent. of the notified cases occurred in five counties, viz. Gloucestershire (945 cases), Derbyshire (463), Nottinghamshire (435, 94 in 1922), Yorkshire West Riding (289, 232 in 1922), and Yorkshire, North Riding (109, 253 in 1922). Last year 14.1 per cent. of the notified cases occurred in rural sanitary areas, the numbers of cases notified exceeding 50 in each of 5 areas. In the first quarter of last year 519 cases were notified, in the second 737, in the third 662, and in the fourth 585. Expressed as percentages of the year's total, the cases in the first quarter formed 21 per cent. (18 in 1922), those in the second 28 (31 in 1922), those in the third 27 (21 in 1922), and those in the fourth 24 (30 in 1922). VI. SPECIAL DISEASES. (See Tables 3, 4 and 5.) SMALLPOX. For the first time since 1902 a case of this disease occurred in the Borough in September last. Cases have been notified at intervals between 1902 and 1922, but the diagnosis has in each instance been found to have been erroneous. Last year's case was in the person of a man aged 47, who was taken ill on August 31st, the rash appearing on September 2nd. He had been vaccinated in infancy only. Although direct contact with another case of the disease was not demonstrated there was every reason to believe that his case formed one of the series of cases which occurred in London during September and October. Limited as was that outbreak, it was of sufficient interest to justify a brief account being included here :— A Mrs. X arrived in London from Spain on August 7th, remaining in town until the 11th, when she went to the seaside for three days. She was back in London on the 13th, on which day she felt unwell, but not seriously so. She was then staying at an hotel in the Strand, where she remained until the 19th—going about as usual—when she left London for Willesden. On August 29th a female, aged 30, living in Westminster, and employed at the hotel, was taken ill, the illness being diagnosed as smallpox on September 8th. On August 31st the man residing in this Borough, but employed in the Strand at an office opposite to the hotel, sickened, a similar diagnosis being made on September 7th. On September 2nd another member of the hotel staff, living in Camberwell, fell ill, the case being diagnosed on the 7th. On September 10th the Medical Officer of Health for Willesden, in consequence of information received, visited the house in his district where Mrs. X was staying, and came to the conclusion that Mrs. X and her husband (probably) and child had had attacks of the disease. Mrs. X's sister-in-law had sickened with the disease on September 5th, her case terminating fatally on the 21st. All four patients were removed to the M.A.B. Hospital. At later dates cases of the disease occurred in Lewisham, Hackney and Ickford, which were traced direct to the hotel, and other cases in Harrow, Battersea (fatal) and Richmond directly connected with the case in this Borough, and a case in Carshalton, which, in all probability, had the same origin. Concurrently with the above cases the disease was found in Finsbury (one case) and in Greenwich (four cases, one family), the origins of which were not traced. The foregoing paragraphs show that to the case of Mrs. X. 14 other cases were traced, in most instances definitely so traced, including 4 cases in which the infection was acquired secondarily through the case in this Borough. Two cases terminated fatally, one in an unvaccinated female and the other in a male aged 53 who had been vaccinated in infancy only. DIPHTHERIA. (Including Membranous Croup.) Last year 220 cases (including one of membranous croup) were notified, or 181 less than the total (401) for 1922. For the five years 1913-17 the annual average was 260, and for years 1918-22, 365. In 1916 the notifications numbered 211, that being the only year since 1913 in which a total less than that of last year was recorded. The maximum figure for the same period was that of 1920 (464 cases, 6 diphtheria. including 3 of membranous croup). Distributing the cases by Wards, it is found (Table 5) that last year in Lancaster Gate, East, Ward only was the record in excess of averages for the two preceding quinquennia. From that Ward 15 cases were notified during the year, as compared with quinquennial averages of 7 (1913-17) and 13 (1918-22). Last year's cases comprised 88 in males and 132 in females. The age-distribution is given in Table 4. The 88 cases in males were 42 per cent. less than the average (153) for 1918-22 and 23 per cent. less than that (115) for 1913-17. The total of 131 cases in females represents corresponding reductions of 38 and 10 per cent. respectively. On an assumption of equal susceptibility to the disease, 88 cases among males would imply 119 among females. If, however, account be taken of the numbers of cases notified but not subsequently confirmed—"errors," males 18, females 28—the corrected total of 70 cases among males would be equivalent to 95 among females, whereas the actual record was 104. The age-distribution of cases in males last year shows reductions in all groups except that of 15-25, which group furnished 9 cases last year as compared with annual averages of 4 during 1913-17 and 10 during 1918-22. Among females the 3 cases reported last year at ages under one year were the same as the annual averages for the two quinquennia and at ages 15-25 last year's figure of 32 cases was in excess of the average (18) for 1913-17, and only 1 less than that (33) for 1918-22. In those comparisons no account has been taken of the "errors," the age distribution of which is peculiar. Of 4 cases recorded during the year among males aged 0-1 year none were erroneously diagnosed, but of the 3 cases among females of those ages, all. Of the 9 cases among males aged 15-25 there were 4 errors, and among the 32 in females, 8. The analysis of errors by sex and age has not been made hitherto, so no comparison with earlier years is possible. The numbers of cases reported in each quarter of the past year from each Ward are shown in comparison with the quiniquennial averages in Table 5. In 107 instances bacteriological examination of swabs from the throat, etc., preceded notification, positive results being obtained in 100 instances. In 13 patients there were practically no clinical symptoms, and the patients were considered to be carriers, 11 of them having, however, been removed to hospital before such decision was made. Apart from those 13 cases there were 40 in which the original diagnosis was not confirmed by the subsequent course of the disease, such "errors" constituting 20.9 per cent, of the notified cases. During 1918-22 the average percentage of errors was 9.9, the percentage of errors last year being more than double the average for the preceding quinquennium. After excluding errors the records show that 2 cases of the disease occurred in each of 11 families during the year, and 3 cases in each of 2. If the house be taken as the unit and not the family, there were 2 cases in each of 12 houses, 3 in 2 and 4 in 1. In 12 instances it has been possible to fix the intervals between the primary and secondary cases. The intervals between the dates of sickening were : Under 7 days, 3; 7-14 days, 4; 14-21 days, 2; and 21-28 days, 3; and those between the last contact of the secondary case with the primary: Under 7 days, 5; 7-14 days, 1; 14-21 days, 4; and 21-28 days, 2. In 2 instances two patients were reported on the same day from 2 families. One patient (f., set. 25) reported with diphtheria during the past year, had two definite attacks of the disease, the first in February and the second in May. In 11 instances the disease was contracted in institutions where the patients were under treatment for other diseases, in 6 the disease was apparently contracted in out-lying districts, and in 1 it followed the return from hospital of a previous patient. Of the 220 notified cases 211 (95.9 per cent.) were removed to hospital, the mean percentage of removals during 1918-22 being 92.1. Of the patients whose cases were notified during the year 14 died, including 1 "error," 13 of the deaths taking place in institutions. After correcting for errors, the total fatality was 7.3 per cent, last year, or 0.6 above the mean fatality (6.7 per cent.) during 1918-22. The 1 death, which occurred in the patient's home, represents a fatality of 14.2 per cent, of cases treated in their homes, the average fatality among such cases during 1918-22 being 7.0 per cent. The fatality among cases receiving institutional treatment was 7.1 per cent., the quinquennial average being 6.5. The total number of deaths from diphtheria during the year was 15, the 2 deaths additional to those mentioned in the preceding paragraph being those of patients whose cases were notified in 1922. The death rate from this disease was at the rate of 0.09 per 1,000 persons. During 1918-22 the annual average number of deaths was 22, showing a reduction last year of 36 per cent, of the average. The 14 deaths comprised 6 of males and 8 of females, giving (approximately) mortality rates (per 1,000) of 0.09 in each case. Those rates were considerably in excess of the means for the years 1910-12 —males 0.05, females 0.07—but below the means for 1920-22—males 0.14, females 0.19. SCARLET FEVER. 7 Carrier Clinic.—Seven (7) "carriers" were referred by the Department to the Special Clinic at St. Mary's Hospital. One did not go to the Clinic at all, and one went once only, although the bacteriological specimen taken at the Clinic was found to be " positive." The duration of attendance for the remaining 5 varied from 3 to 7 weeks. Since the Clinic was opened in 1920, 48 "carriers " have been dealt with. SCARLET FEVER. In 1917, 124 cases of this disease were reported, the number increasing each year to a maximum of 827 in 1921, since which year the annual totals have decreased to 529 in 1922 and 323. last year. Last year's total was made up of 150 cases among males and 173 among females, with an equal sexincidence the figures should have been 150 and 204.* In comparison with the annual average (411) for 1913-17, last year's total shows a fall of 29 per cent., and as compared with that (454) for 1918-22 a fall of 21 per cent. Except in Church and Hyde Park Wards the numbers recorded in each of the Wards during the past year were satisfactorily below the averages for the two preceding quinquennia. In Church Ward 79 cases were recorded in 1923, as compared with averages of 80 during 1913-17 and 88 during 1918-22, the corresponding figures for Hyde Park Ward being 19, 16 and 23. As regards age-distribution, at ages under 15 years decreases were observed in each age-group of both sexes, but there was an equal, if not greater prevalence between the ages 22-45 in both sexes. Among males aged 25-45, 10 cases occurred last year, the quinquennial averages being 6 (1913-17) and 6 (1918-22), the corresponding figures for females being 16, 16 and 15. The 150 cases among males represent a reduction of 17 per cent. below the annual average (181) for 1913-17, and 1 of 23 per cent, below that (196) for 1922. The 173 cases among females were equivalent to falls of 25 per cent, below the average (230) for 1913-17, and of 33 below that (258) for 1918-22. Of the 323 notified cases, 39 (12 per cent.) were later on marked as "errors," an increase of 114 percent, above the average percentage (5-6) for 1918-22. The percentages of errors noted in the Wards ranged from nil (Lancaster Gate, West, and Hyde Park) to 20.2 in Church. In 4 instances the cases notified last year were secondary to attacks notified in 1922; in 11 the disease was contracted in institutions; in 12 the disease followed the return of previous cases from hospital; and in 3 the disease was contracted outside the Borough. Two patients were reported twice during the year, the second "attacks" being probably relapses. After eliminating the cases marked "errors," it has been found that in 26 houses there were 2 cases during the year; in 6, 3; and in 1, 5. If the family be considered instead of the house, 19 had 2 cases each during the year, 5, 3, and 1,5. In 7 instances the secondary cases in the families were due to the return home from hospital of the primary cases. On 2 occasions 2 cases were reported simultaneously, and on another 2, 3. In 4 instances there was some delay in arriving at a diagnosis, and to that cause 6 secondary cases were apparently due. Of the 323 notified cases 315 (97.5 per cent.) were removed to hospital, the percentage of removal during the years 1918-22 having been 91.5. All the notified cases in the two Lancaster Gate and Hyde Park Wards were removed to hospital. Three of the notified cases terminated fatally, including one "error." The corrected fatality was 0.7 per cent., nearly double the mean fatality (0.4) during 191822. All the deaths occurred in institutions. The 2 deaths were equivalent to a mortality of 0.01 per 1,000 persons of all ages, half the rate for 1922, when there were 3 deaths. The annual average number of deaths during 1918-22 was 3. The deaths last year were equally divided among the sexes, the mortality per 1,000 of all ages being 0.01. For the years 1910-12 the mortality among males was 0.05 and that for the years 1920-22, 0.01. The corresponding figures for females were : 1910-12, 0.02 and 1920-22, 0.02. Multiple Infections.—This designation has been adopted to describe the occurrence of diphtheria and scarlet fever in the same house (or family) during the year under observation. Did time permit the survey should cover all the notified diseases. Last year cases of diphtheria and scarlet fever were notified as having occurred in each of 14 houses, but after allowing for errors of diagnosis that number is reduced to 9. In 4 instances the first case was one of scarlet fever, in 3 of diphtheria, and in 2 the diseases were concurrent, that is to say, that the same patient was notified as having diphtheria and scarlet fever in combination. Maida Vale and Lancaster Gate, West, Wards were the only two in which there was no instance of multiple infection. Of the 4 instances in which diphtheria was reported after scarlet fever the case of diphtheria occurred in a different family in 3 instances, and in the fourth diphtheria supervened, while the patient * Correcting for "errors "—males 15, females 24—the confirmed cases were males 135, females 149, whereas on an assumption of an equal sex-incidence the latter figure should have been 184. 8 enteric fever. was in hospital or the scarlet fever. The intervals in the 3 cases first mentioned were 12 days, 6 and 7 months. Of the 3 cases of scarlet fever following diphtheria, 1 was contracted by the patient after admission to hospital for diphtheria, and of the other 2 the attack of scarlet fever was in one instance in a second family—three months after the case of diphtheria—and in the other—in the same family—six weeks after the case of diphtheria. ENTERIC FEVER. (Including Continued Fever.*) Last year the notified cases numbered 13, 5 more than the total for 1922, but equal to that for 1921. During 1913-17 the annual average number of notified cases was 18, that for the years 1918-22, 13. The only Ward from which no cases were reported during the year was Lancaster Gate, East, the quinquennial averages for that Ward being, 1913-17, 1, and 1918-22, 3. From Maida Vale Ward 1 case was reported in 1923, the averages being 1913-17, 3, and 1918-22, 2. From Westbourne Ward there were 4 notifications last year as compared with annual averages of 3 and 2 and from Church Ward 2 cases, averages 5 and 1. The 13 cases comprised 3 in males and 10 in females. In recent Reports attention has been called to the (approximate) disappearance of the disease among male residents of the Borough. The 3 notifications of the past year show a marked contrast with the 11 recorded during 1913-17. During 1918-22 the notifications averaged 4 each year. On the other hand the 10 notifications among females were in excess of both the average for 1913-17 (8) and that for 1918-22 (9). At ages under 25 the notifications of cases in males last year numbered 2, the annual average for 1913-17 having been between 4 and 5, and that for 1918-22, 3. At ages 25-45, 1 case was notified in 1923, compared with annual averages of 5 during 1913-17, and none during 1918-22. Among females in the same age-groups the comparison is markedly different. At ages under 25, 1923, 3 cases; averages, 1913-17, 4; 1918-22, between 3 and 4; at ages 25-45, 1923, 5; averages, 2 and 4. Among the 13 notified cases there were 3 subsequently marked "errors," equal to 23 per cent. of the notifications, the average percentage for the years 1918-22 being 19. Last year's errors came from two Wards, viz., Westbourne, 2 (with 4 notifications), and Church, 1 (with 2 notifications). Bacteriological tests were reported relating to 9 of the 13 notified cases, positive reactions with respect to the three groups (enteric, paratyphoid A and B) being obtained in 2 instances, with respect to paratyphoid B only in 3, and not stated, 4. The inquiries following notification were particularly barren last year, no information being elicited beyond evidence that in 4 instances the disease had been contracted outside the Borough. Among the notified cases 3 ended fatally, including 1 error. Of the 2 deaths due to enteric fever 1 belonged to another district. Last year was the first occasion of a death occurring among cases notified locally since 1916. The corrected fatality was at the rate of 20 per cent., the average for 1918-22 being zero. The death referred to above (a female aged 29) was the only one allocated to the Borough, the annual average for 1913-17 being 4 (both sexes), and that for 1918-22, 1. No male has died from this disease since 1917. PUERPERAL FEVER. During the past year 5 cases were notified as compared with 8 in 1922, 16 in 1921 and 15 in each of the years 1920 and 1919. During 1913-17, the annual average was 8 and that during 1918-22, 11. Last year's total may, therefore, be regarded as satisfactory, but it is doubtful whether much significance attaches to the reduction. A reference to Table 3 will show that there is a suggestion that the number of cases of puerperal fever notified varies from year to year with the numbers of cases of scarlet fever and/or erysipelas. The suggestion offers attraction for mathematical analysis to measure the connection (if any) between the prevalences of the diseases mentioned. Last year's cases were reported from two Wards, viz., Harrow Road (4 cases, one fatal) and Maida Vale (1 case, fatal). As regards the ages of the patients—one was under 25 years of age, the averages for the age-group 15-25 being 1913-17, 2; 1918-22, 3; the remaining 4 were aged between 25 and 35, for which group the similar averages were 5 and 6. In 1922, 5 of the 8 notified cases were marked errors. Last year no similar correction had to be made. The percentage of errors in 1922 was 62.5, in 1921 16.2, and the mean percentages for 1914-18 and 1919-20, 8.8 and 10.0. The fact that correction for errors was not required last year somewhat discounts the apparently satisfactory reduction in the number of reported cases. * The last case of Continued Fever was reported in 1915. ophthalmia neonatorum. 9 Three of the cases reported during the year occurred in primiparœ, one in a woman pregnant for the second time and the fifth in a woman pregnant for the third. One case (primipara, aged 24) followed (so far as could be ascertained) a normal labour, one (primip., aged 27) after a breech presentation, one (primip., aged 32) after instrumental delivery, one (3-parous) had some laceration and the fifth (2-parous, aged 31) had a miscarriage (not free from suspicion of mechanical interference). The fatal cases were the first and last mentioned. Three of the patients were removed to M.A.B. Hospitals, one to the Paddington Hospital and one to a Nursing Home. The 2 deaths recorded last year were equivalent to a fatality of 40 per cent. of cases, 15 per cent. above the rates recorded in 1921 and 1922. The mean fatality during 1910-12 was 40.7 per cent. and that during 1920-22, 28-7. The annual average number of deaths in the quinquennium 1913-17 was 5, and that during 1918-22, 3. Fatality of Childbearing.—To measure this, the deaths from the various "Accidents and Diseases of Pregnancy and Parturition"—here referred to as "other causes"—have to be added to those from puerperal fever. Last year, for the first time since 1901, when the Borough was constituted, there was no death falling under this headiing, so that the total deaths were 2 (due to puerperal fever). During 1913-17 the deaths of pregnant and parturient women averaged 10 a year, 5 from puerperal fever and 5 from "other causes." During the years 1918-22, the deaths averaged 9 a year, 3 from puerperal fever and 6 from "other causes." The 2 deaths recorded last year were equivalent to a fatality rate of 0.76 per 1,000 births (corrected total), due to the fatality from puerperal fever. The mean rate for the years 1913-17 was 3.56 per 1,000 puerperal fever and "other causes" contributing equally. During 1918-22 the mean was 3.66 per 1,000, 1.34 per 1,000 being due to puerperal fever and 2.32 to "other causes." OPHTHALMIA NEONATORUM. The notified cases numbered 22 last year, as compared with 15 in 1922, and 34 in 1921. The 22 cases (equivalent to 8.3 per 1,000 births) comprised 12 in male infants (8.9 per 1,000) and 10 in female (7.7 per 1,000). Attacks in legitimate infants numbered 20, equal to 9.4 per 1,000 legitimate births, and those in illegitimate infants, 2 (9.4 per 1,000). The incidence on males in the two categories was practically equal but that on illegitimate females was 15.2 per 1,000—there was only one case—as compared with 7.6 per 1,000 for legitimate females. No cases were reported from the two Lancaster Gate Wards. In Hyde Park Ward the attack rate (2 cases only) was 11.8 per 1,000, and that in Queen's Park Ward (3 cases) 12.2. During the five years 1913-17, 151 cases were reported, giving a mean attack rate of 11.2 per 1,000 per annum. During 1918-22 130 cases were reported, the mean rate being 9.7. These figures taken in conjunction with the general run of the annual numbers (Table 3) encourage a hope that a diminution in prevalence has set in. In addition to the 22 cases notified during the year, information was received from the County Council of 6 cases of the disease in slight forms, such cases, although requiring supervision, were, apparently not severe enough to be notified. In 1922 a similar number of such cases were reported by the County Officials. Eight of the notified cases were removed to hospital, 6 going to St. Margaret's (M.A.B.). Many of the infants kept at home attended ophthalmic and other hospitals as out-patients. The District Nurses visited 3 cases. As regards the termination of the cases, one infant died in St. Margaret's a few days after admission and one removed from the Borough before the termination of the attack. Of the remainder, in one instance only was any injury of the eye reported, and that was said to be slight only. Histories of venereal infection were obtained in 3 instances only. SEPTIC DISEASES. Erysipelas.—The cases notified numbered 54—23 in males and 31 in females, a proportion agreeing with the sex-distribution of the estimated population. In 1922 the cases numbered 77. During 1913-17, the annual average was 112, and that during 1918-22, 73, showing a reduction of one-third. The attack rate last year was 0.37 per 1,000 persons, the rates for each of the sexes being the same. In 1921 the rate was 0.57, and in 1922, 0.53. Two of the cases notified during the year were marked errors, and in 3 instances the disease was contracted in institutions. The site of the disease was returned as—Head, 37 cases; Lower extremity, 11; Upper, 5; and Trunk, 1. A definite history of trauma (injury) was obtained in 9 instances only, but there is little doubt that that figure very inadequately represents the truth. 10 "MENINGITIS" GROUP. One patient (f.,æt 46), reported during the year with erysipelas in the head, following the bite of an insect, had been previously notified with the disease on three occasions, viz., once in 1921 and twice in 1922. Fourteen patients (26 per cent. of the notified cases) were treated in the Paddington Hospital. One death from erysipelas (a female aged 75) was recorded, compared with 3 (male, 1; females, 2) in 1922. The mortality rate was 0.006 last year, that in 1922, 0.02. For the years 1910-12 the mean rates were—Males, 0.03; Females, 0.04; and those for 1920-22—Males, 0.04; Females, 0.02. Last year the rates were—Males, nil; Females, 0.01. Other Septic Diseases.—This group heading has a new meaning in consequence of the adoption of the new International Schedule of Causes of Death. Formerly, infective endocarditis was included, but that disease now falls under Diseases of the Heart. The figures for 1918-22 about to be quoted, have been adjusted to agree with the new tabulation. There were 10 deaths classed to this heading last year, all due to septicaemia, 2 of males and 8 of females. That total shows a notable increase above the annual average for 1918-22, viz., 4. Further comparison on this occasion appears to be undesirable. "MENINGITIS" GROUP. Cerebro-Spinal Meningitis (Fever).—One case (f.,œt. 10) was notified last year, as compared with 2 in 1922. The annual average for 1913-17 was 6, and that for 1918-22, 3. The patient was treated in a nursing home and made a good recovery. Encephalitis Lethargica.—Three cases were notified, one in February and 2 in March. One patient was a lad aged 14 whose case was subsequently marked as error. The other two were females aged 40 (ended fatally) and 33. The latter case was apparently contracted in Bristol. Two residents of the Borough had attacks of the disease in the country, one (male aged 51) died of the disease in Bournemouth and the other (female, aged 44) had an attack which was not diagnosed until after her recovery and return to Town. This disease has been on the list for notification since 1919, the cases reported prior to 1923 having been—1919, 3; 1920, 2; 1921, 7; and 1922, 2. Acute Poliomyelitis.—Two cases were notified, one in a male and one in a female, both aged 2 years. The patients received hospital treatment, recovering, with slight muscular weakness in the one case and some paralysis in the other. The annual average number of cases of this disease in each of the quinquennia, 1913-17 and 1918-22, was 2. THE PNEUMONIAS. Acute Influenzal.—This disease has been notifiable since 1919, the cases reported in each year since then having been: 1919, 87; 1920, 45; 1921, 27; 1922, 72; and 1923, 33. Last year's cases comprised 17 in males and 16 in females, with an equal sex-incidence the figures would be : Males, 17; females, 23. There were 11 (males, 5; females, 6) cases in the first quarter of the year, 12 (males, 5; females, 7) in the second, 4 (males, 3; female, 1) in the third, and 6 (males, 4; females, 2) in the fourth. No case was reported from Hyde Park Ward, 10 from Church, 7 each from Maida Vale and Westbourne, 4 from Harrow Road, 3 from Queen's Park, and 1 from each of the two Lancaster Gate. Four cases (males, 3; female, 1) were reported at ages under 5 years; 2 (one of each sex) at ages 5-15, 2 (one of each sex) at ages 15-25, 6 (males, 2; females, 4) at ages 25-35, 9 (males, 5; females, 4) at 35-45, 4 (male, 1; females, 3) at 45-55, 4 (2 of each sex) at 55-65, and 2 (both males) at ages over 65. Of the 33 patients, 15 received treatment in hospital, 14 going to the Paddington Hospital. Two patients were visited in their homes by the District Nurses. Of the 33 cases, 5 ended fatally, all being certified as due to influenza with pneumonic complications. Deaths from Epidemic Influenza.—There were in all 32 deaths from influenza, 17 being certified as complicated with pneumonia, 8 as having other pulmonary complications, and 7 without stated complications. Of the 25 cases in which the lungs were involved, only 5 were notified during life. 11 pneumonia. In the tabulation given below the number of cases of influenzal pneumonia notified from each Ward is compared with the number of deaths from influenza, distinction being made between deaths with and without pulmonary complications. Of the 25 deaths due to influenza with pulmonary complications, all of which it is assumed should have been notified during life, 2 have to be excluded as the deceased persons were not in residence in the Borough at the time of their fatal illness. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancas West. ter Gate East. Hyde Park. Borough. N. Influenzal Pneumonia 3 4 7 7 10 1 1 33 D. Influenza— (a) - 4 (1) 4 (1) 3 (2) 2 1 2 (1) 1 17 (5) (b) - 1 3 (x) 1 1 - 1 1 8 (c) 1 1 2 2 — - - 1 7 (x) 2 died in Eastbourne. Figures in parentheses, fatal notified cases. N, Notified cases. D, Deaths, (a) With pneumonic complications. (b) With other pulmonary complications. (c) Without stated complications. In the following table the seasonal distributions of notified cases and of deaths are compared in connection with the sexes and ages of the patients. Of 11 deaths in males only 1 was notified, and of 14 in females, 4. The occurrence of 8 cases of influenzal pneumonia in persons under 25 without a single fatal termination is remarkable, and an observation which requires to be followed up in future years before it can be unreservedly accepted. ACUTE INFLUENZAL PNEUMONIA: EPIDEMIC INFLUENZA. Borough. Ages. Jan. Feb. Mar. Apr. May. J une. July. Aug. Sept. Or.t. Nov. Dec. Year. N. D. N. D. N. D. N. D. N. D. N. D. N. D. N. D. N. D. N. D. N. D. N. D. N. D. 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 M F M F M F M F M F M f|m F M F M F 0- 1- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ - - - - - - - - - - - - - - - 1 - - — — - - - - —1 - — 1 — — — — 1 - - - - — - - - - - - - - — — — - — 1 - - — 3 1 — — 5- - - - - - - - - - - - - - - - - - - - - 1 - - — - - — - - - — - - - — - - - - — — — - — - - — — 1 — — — 10- - - - - - 1 - - - - - - - - - - - - - — - - - — — - — - - - — — - - - — — - - — - — — - - — — — — 1 — — 15- - - - - - - - - - - - — - - - - - 1 - — - - - — - - — — -- - - - - - — - - - - — - - - — - — — — — 1 — - 20- - - - - - - - - - - - - 1 - - - - - - - - - - - - - — - - - - - - - - - - - - - - - - - - - - - - - - - 25- - - - - - - - - - 1 - 2(1) - 1 - - - - - - - - - - 1 - - - 1 - - - - - - - - 1 - - - - - - - - - - 2 4 — 2(1) 35- — 3 - - - - - - 2 - - - 1 - 1 - - - - - - 1 - 1(1) - - 1 - - - - - - - 1 - 1 - - - - - - - - - - 1 5 4 3 2(1) 45- — - - - - - - 1 - 1 - - - - - - 1 - - 1(1) - - - - - - 1(1) - - - - - - - - - - - - - - - - - - - - - 1 3 1(1) 2(1) 55- - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 1 - - - - - 2 - - - - - - 1(1) - - 1 - - 1 -- 1 2 2 3 2(1) 65- — — — 1 - - - - - - - 1 - - 2 -- 1 - — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 -- 2 2 75All ages 1 — — — - - - - - - 1 2 - - - 1 — - - - - - - - - - — - - - - - - - - - - - - - - - - 1 - - 1 -- 1 - 2 4 1 3 1 i 2 - 1 3 2 1 5(1) 2 2 4 1 2 2 — 1(1) 2 2 - 1(1) 1 1 3(1) — 1 — - — 2 — 1 — 1 1 - 1(1) - — 1 1 1 1 1 2 17 16 11(1) 14(4) N—Notified Cases. D—Deaths certified due to Epidemic Influenza with pneumonic or pulmonary symptoms (11a and l1b). Figures in parentheses, numbers of deaths after notification. Acute Primary*.—As will be seen from Table 3, there has been a continuous increase in the number of cases reported in each of the years since 1919, when the disease was first made notifiable. Evidence will be adduced to more than suggest that notification of this disease or diseases is still incomplete, but it is undoubtedly much better than it was even a year ago. Last year's cases (302) comprised 185 in males and 117 in females. If the 185 cases in males represented the full number of cases in that sex, on an assumption of equal sex-incidence, the cases in females should have been 252, or 135 more than the number recorded. From each of the two Lancaster Gate Wards 4 cases were reported, the maximum from any Ward being 83 from Church. From Harrow Road Ward 65 cases were reported, and from Westbourne 62. More than half the reported cases were in individuals under 15 years of age, infants under 1 furnishing 37 cases (males, 23; females, 14), children aged 1-5 years, 91 (males, 51; females, 40), and those aged 5-15, 52 (males, 32; females, 20). At ages over 45 there were 62 cases, 41 in males and 21 in females. * " Acute primary pneumonia " includes both broncho-pneumonia and lobar pneumonia when not secondary to other disease. 12 pneumonia. From inquiries made it was ascertained that 3 of the patients were in institutions when they sickened, and that 1 was attacked when away from the Borough. In 7 instances the cases were marked "errors." Four patients were reported as having the disease twice during the year. From each of 17 houses 2 cases were reported, but in 11 instances the second case was in a second familyleaving 6 families in which 2 cases occurred during the year. Of the 302 cases notified 193 were removed to institutions, equal to 63.7 per cent. of the total cases, 164 of the patients being admitted to the Paddington Hospital. Fatal terminations were recorded in 73 instances, equal to a fatality of 24.1 per cent. of the reported cases, as compared with 29.1 per cent, in 1922. Among the 193 patients treated at home 24 deaths occurred, 22.0 per cent. of those cases, the corresponding figure for 1922 being 26.3. Of the cases removed to institutions, 49 ended in death, 25.3 per cent., as compared with 30.6 in 1922. It is more than probable that the improvement in notification has been sufficient to account for the apparent reduction in fatality. In 18 instances notification of the case was received after the death of the patient. Mortality from Pneumonia.—There were in all 154 deaths from all forms of pneumonia during the year, 89 (44 of males, 45 of females) from broncho-pneumonia, 35 (males, 26; females, 9) from lobar pneumonia, and 30 (males, 16; females, 14) from "pneumonia." The 154 deaths represent a total mortality of 1.05 per 1,000 persons, the mortality for males being 1.40 and that for females 0.80. The sex-rates recorded last year were slightly higher than the mean rates for 1910-12 (males, 1.17; females, 0.72), and 1920-22 (males, 1.32 ; females, 0.70). Incompleteness of Notification.—Notification of the pneumonias was introduced immediately after the epidemic of influenza in the autumn and winter of 1918-19, one (if not the principal) of the objects of notification being to provide (if possible) some indication of a return of an epidemic of that disease. Such indication will not be forthcoming unless notification be as nearly complete as is humanly possible. In this Borough there is no room for doubt as to the improvement in notification which has taken place in the course of the last (say) three years. The annual increase in the number of cases notified, shown in Table 3, confirms that statement. An examination of the annual totals of notifications (all forms of pneumonia) obtained from a summation of the returns issued weekly by the M.A.B., discloses the fact that the cases notified in the Borough during last year numbered 338, the fifth highest in the County, higher totals being returned from Poplar (460), Wandsworth (432), Stepney (352) and Battersea (342). The differences between the total for Paddington (338) and those for the areas immediately adjacent thereto are remarkable. For Kensington the total for the year is 125, that for Hammersmith 83, that for Willesden 131, that for Hampstead 48, that for St. Marylebone 52, and that for Westminster 59. While recognising the improvement which has taken place in the Borough it is impossible to ignore the fact that there is room for further improvement. Indications in that direction are to be found in the tabular statements included in the paragraphs dealing with Influenzal Pneumonia. In the annexed table the Ward distribution of notifications of and deaths from pneumonias other than influenzal is given. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancas West. ter Gate East. Hyde Park. Borough. N. Primary Pneumonia 43 (11) 65 (14) 30 (6) 62 (17) (a) 83 (22) (a) 4 (1) 4 (-) 11 (2) 302 (73) D. Pneumonia— Broncho 12 (5) 16 (4) 11 (4) 18 (8) 22 (8) 4 (-) 1(-) 5 (1) 89 (30) Lobar 7 (6) 12 (10) 11 (2) 13 (7) 16 (12) 4 (1) 1(-) 1 (1) 65 (39) N. Notified cases. Figures in parentheses, numbers of cases terminating fatally. D. Deaths certified due to pneumonia. Figures in parentheses, numbers of cases notified during life, (a) Two deaths certified due to causes other than pneumonia. As an example attention may be specially directed to the figures for Church Ward. In that Ward 83 cases of acute primary pneumonia were reported, 22 (including 2 in which the deaths were certified to have been due to causes other than one of the pneumonias) ended fatally. On the other hand,there were 22 deaths assigned to broncho-pneumonia, of which only 8 represented cases notified during the lives of the patients. There were also 16 deaths from lobar (and undefined) pneumonia, of which 12 followed notified cases of the disease. pneumonia. 13 In the whole Borough of the 154 deaths assigned to all forms of pneumonia, 69 represented fatal terminations to notified cases, in other words, over 55 per cent, of the deaths followed attacks of the diseases which were not known to the Department during the lives of the deceased persons. Of those 85 deaths, 18 having taken place outside the Borough, the question of notification cannot be raised with respect to those deaths. Of the 67 deaths which took place in the Borough, 4 were registered after inquest, so that notification was not to be expected. There remain, therefore, 63 deaths in respect of which notification was not made, although apparently due. Of those deaths 44 occurred in the homes of the deceased, and 19 in local institutions. It would be going too far to say that there was failure to notify in each and all the 63 instances. Opinions may differ as to whether a given attack of pneumonia be a primary or secondary one. Experience, however, does clearly indicate that a fairly large proportion of those 63 deaths do represent cases which ought to have been notified. It appears to be not unreasonable to conclude that notification of all forms of pneumonia without limitation to "primary" is necessary if the notification of the disease is to furnish any indication of an impending epidemic of influenza. The following table, the age-sex-time distribution of notified cases and deaths, shows curious variations in the proportions of deaths not preceded by notification. For the whole year it will be seen that 50 per cent, of the deaths of males of all ages were fatal notified cases, the proportion of such deaths of females being only 38 per cent. Similar anomalies will be found in the individual sex-age groups. The percentages recorded in the different months cannot be satisfactorily explained, except on the assumption that there has been forgetfulness or neglect of notification. 14 pneumonia. PNEUMONIA—ACUTE PRIMARY (BRONCHO-, LOBAR). Borough. Ages. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. December. Year. N. d. N. D. N. D. N. D. N. d. N. D. N. d. N. D. N. d. N. d. N. D. N. d. N. d. 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 M F M F M F M F M F M F M F M F M F 0- 3 1 3(1) — 4 1 2(1) — 2 3 3(3) 2(1) 1 — 1(1) 1(1) - 1 — 1 5 1 1 1 1 2 1 1(1) 1 1 - — 1 1 1(1) — 1 1 1(1) 1(1) 1 1 2(1) 1 3 1 3 (2) 2 23 14 18 (11) 10 (4) 1- 7 5 2(2) 3(3) 2 2 1(1) 1(1) 5 5 2(1) 1(1) 4 3 1(1) — 2 3 — 1(1) 6 3 — 1 7 4 1(1) — 6 3 1 1(1) 4 1 2 1 3 3 — — 1 2 — — 4 6 — 2 (2) 51 40 10 (6) 11 (9) 5- - - — — - 1 — — 1 4 — — 3 1 — — 7 1 — — 3 1 — — 1 — — — 2 2 — — 2 2 — — 2 — — — 3 1 — — 1 2 2 (1) - 25 15 2 (1) — 10- 1 — 1(1) — 1 1 -r — 1 1 - — — — — — — 1 — — 1 — — — — 1 — — — — — — 1 — — - - - — — 2 1 — — — — — — 7 5 1 (1) — 15- 2 — — — — — 1 — 2 1 — — 1 1 — 1 - 1 — — 1 1 — — — — — — — 1 — — - - — - — - — — — 2 — — 1 — — - 7 7 1 1 20- - - — — — — - — 2 — — — — 1 — — — — — — — — — — 2 — 1(1) — 1 1 1(1) — 1 — — - - - — — — — — — 2 — — - 8 2 2 (2) — 25- 1 - - - - 1 - - 2 - - - 2 1 - - 2 1 - - 1 - - - - - - - - 1 - - 1 - - - 1 - 1 - 3 1 - - 3 — — 1 (1) 16 5 1 1 (1) 35- 3 - 1(1) — — 1 1(1) — — 1 — 1(1) 1 1 1(1) - 1 1 — — 1 - — 1(1) — 1 1(1) — — — — — — — — - — - 1 1 1 3 — 1(1) — — 2 1 7 8 7 (4) 5 (3) 45- 3 1 1(1) 2 2 - - - - - 1 — 2 1 2(1) 1(1) 1 — 3(1) 1 — — — 1(1) 2 — 3(1) — — — 2 — 1 — 1(1) — — 1 1 — 2 2 1 — 5 — 2 (2) — 19 5 17 (7) 5 (2) 55- 3 — 3(3) — — 2 1 1(1) 1 1 — — 1 1 — — 2 — — 1 — 1 1(1) — - - — 1 — — 1 1 — 2 — 1 — — — 2 3 — 2(2) — 1 1 1 1 11 8 9(6) 8 (1) 65- - — — 1 1 - 1(1) 1 1 1 — 1(1) — — 1(1) 2 1 - — 2 2 1 1(1) 1(1) 1 - - - - - - - - 2 - - 1 - 1(1) 2(1) 2 1 — — 1 — 5 2 10 5 9(4) 12 (3) 75- - 2 — 3(2) — 1 - 1(1) — — — 2 — — — 1 1 - 4(1) 1 — — — 2 — — 1 — — — — — — — — - - - 2 2 - - 1 1 — — 1 2 1 3 9(1) 15 (3) All ages 23 9 11(9) 9(5) 10 10 7(4) 4(3) 17 17 6(4) 7(4) 15 10 6(5) 6(2) 18 9 7(2) 7(1) 20 8 3(2) 7(3) 14 8 8(4) 2(1) 10 9 5(1) 2(1) 11 8 4(2) 2 8 5 7(2) 8(2) 18 14 6(3) 3(1) 21 10 16 (5) 11 (3) 185 117 86 (43) 68 (26) N—Cases notified. D—Deaths certified due to broncho-, lobar and undefined pneumonia. Figures in parentheses, numbers of deaths after notification, including 3 notified in 1922 dying in 1923. TUBERCULOSIS. 15 TUBERCULOSIS. (See Tables 3 and 8-11.) Notification.—Last year 1,093 notification certificates were received, of which 138 were passed to other districts, leaving a nett total of 955, as compared with 834 in 1922. At the beginning of August last the Minister of Health appealed to the medical profession to assist him in his efforts to control tuberculosis, pointing out that complete notification of the disease was essential to the success of his efforts in that direction. It is probable that some part, at least, of the increase in the number of certificates received has been due to the Minister's appeal. The 955 certificates represented 338 new cases (312 in 1922) and 617 (526 in 1922) repeat notifications, 442 of the latter being notifications of admission to, or discharge from, approved institutions. From private practitioners 130 certificates were received, including 22 repeat notifications. These certificates formed 13.6 percent. of the year's total. The Tuberculosis Officers sent in 212 certificates (109 repeat notifications), 22.1 per cent. of the total; the Medical Officers of the local Poor Law Infirmary, 188 (142 repeats) or 19.6 per cent. of the total and those of General Hospitals, 146 (86 repeats) or 15.2 per cent. There are four forms of certificates in use, viz., "Form A"—of which 546 were received, 219 relating to cases previously notified; "Form B"—of which 5 were received; "Form C" (admission to approved institutions)—of which 220 were received, including 196 from sanatoria; and "Form D" (discharge from such institutions)—of which 178 were received. In addition, 8 cases notified in other districts were transferred to the local Register. The 338 new cases comprised 222 of pulmonary tuberculosis (104 in males and 118 in females) and 116 of other forms of the disease (61 in males, 55 in females). In 1922 204 cases of pulmonary tuberculosis were notified, 111 in males and 93 in females, and 108 of other forms of the disease, 53 in males and 55 in females. Last year's total (338) represents an increase of rather more than 8 per cent, above the figure (312) for 1922, but while the cases (all forms of the disease) in males (165 in 1923, 164 in 1922) show an increase of less than 1 per cent., the cases in females (173 in 1923, 148 in 1922) show an increase of 17 per cent. The new cases of pulmonary tuberculosis in males (104 in 1923, 111 in 1922) show a fall of more than 6 per cent., while those in females (118 in 1923, 93 in 1922) show an increase nearly of 27 per cent. The new cases of other forms of tuberculosis in males show an increase of 15 per cent. (53 in 1922, 61 in 1923), but those in females, no change (55 cases in both years). The 338 new cases (all forms) represent a fall of 10 per cent, when compared with the annual average (374) for the years 1918-22. Last year 12 cases could not be allocated to any of the Wards, the patients having no fixed addresses. The average annual number (1918-22) of such cases has been 7. The numbers of cases notified from the Wards last year (Table 8) were below the average, except in Queen's Park (1923, 49; average, 40), Lancaster Gate, West, 11 in 1923 (the same as the average) and Hyde Park (1923, 24; average, 19). The increase above the the average (26 per cent.) in the last-named Ward was the greatest observed. In Lancaster Gate, East, the fall in the record for last year was 62 per cent. of the average and in Church 26. The sex-age distribution of the cases first reported during the past year will be found in Table 9. In comparison with the annual average for 1918-22 the cases of pulmonary tuberculosis in males show a fall of nearly 27 per cent. (1923, 104 cases; Average, 142), smaller numbers being recorded last year in each age-group except those of 55-65 (1923, 10; Average, 9) and 65-75 (1923, 3; Average, 2). Among females the shrinkage was less than 6 per cent. (1923, 118; Average, 125), increases being recorded during the year in age-groups 25-35 (1923, 45; Average, 38), 45-55 (1923, 13; Average, 11) and 55-65 (1923, 9 ; Average, 6). The cases of other forms of tuberculosis in males (61) were 15 per cent, in excess of the average (53), the age-groups showing higher numbers, last year being 0-1 (excess 1 case), 1-5 (excess, 3), 10-15 (excess, 6), 25-35 (excess, 1) and 35-45 (excess, 1). The 55 cases in females were the same as the average, but the cases at the following ages were in excess of their respective averages—5-10 (excess, 4), 10-15 (excess, 3), 45-55 (excess, 1) and 65-75 (excess, 2). Among the 338 new cases notified there were 331 in which the disease was reported to be present in one part of the body only, in 219 of such cases the disease was in the respiratory tract, in 68 in the lymphatic system, and in 21 in the osseous system. In 4 instances the disease was reported to be in 2 systems of the body, and in 3 instances in 3. In 4 of the repeat notifications spread of the disease was reported, the original seat of the disease being stated to be in all 4 patients the cervical glands, the extension having taken place to the peritoneum (2 cases) and the osseous system (2 cases, spine, 1; hip, 1). The occupations of the patients whose cases were reported during the year are set out in Table 10. Suspected Tuberculosis.—In addition to the 338 persons who were certified during the year to be suffering from tuberculosis (all forms) 166 others were reported by the Tuberculosis Officers to be under observation as possibly suffering from that disease, 103 of the cases being of pulmonary and 63 of other forms of the disease. During 1922 115 persons (all forms) were similarly reported. 16 TUBERCULOSIS. At the end of 1922 there were 51 suspect cases on the Register and during the year 189 of this class of case were "discharged"—32 by transfer to the notified list, 36 by diagnosis of diseases other than tuberculosis and 128 by clearance, removal, etc.—leaving 28 cases on the Register at the end of 1923. Institutional Treatment.—According to the weekly tabulation of admissions to institutions, based on the Forms "C" received, 386 patients were admitted to institutions during the year, 314 of the patients having pulmonary and 72 non-pulmonary tuberculosis. Of the 386 admissions reported 127 (32.9 per cent.) were to Poor Law Institutions, 127 (32.9 per cent.) to sanatoria, including M.A.B. Hospitals with special accommodation for tuberculosis, 70 (18.1 per cent.) to special hospitals, 43 (11.0 per cent.) to general hospitals, and 19 (4.9 per cent.) to M.A.B. Hospitals other than those above mentioned. The complete analysis of the Department's records made at the end of the year shows that 316 patients (155 males; 161 females) suffering from tuberculosis in all its forms entered institutions during the year, of whom 230 (117 males; 113 females) were admitted once, 68 (30 males; 38 females) were admitted twice, 16 (7 males; 9 females), thrice, and 2 (one of each sex) four times within the twelve months. The foregoing numbers represent admissions drawn from the total number of tuberculous patients on the Register of the Department, numbering 1,743 on January 1st and 1,850 on December 31st. The percentage of those persons receiving institutional treatment during the year was 17.5. Of the 338 patients placed on the Register during the year, 183 (54.1 per cent.) entered institutions, 80 being males (48.8 per cent.) and 103 females (59.5 per cent.). Of the 183 patients in this category, 127 entered institutions once, 43 twice, 12 thrice and one four times. Limits of space prevent the inclusion of the tables showing the class of institutions to which the patients went. Action under the Tuberculosis Scheme.—The Scheme provides for treatment (a) in the patients' homes—Domiciliary—(b) by attendance at the Tuberculosis Dispensaries under the care of the Tuberculosis Officers—Dispensary—and (c) in residential institutions provided by the County Council—Institutional. The line dividing (a) from (b) is not very rigid as many patients receiving domiciliary treatment are seen from time to time by the Tuberculosis Officers either at the Dispensaries or in the patients' homes. The effective distinction is, that the dispensary group regularly visit the Dispensaries and are treated there and not by private practitioners. Dispensary Work.—At the end of 1922 there were 154 patients under observation pending diagnosis, of whom 32 were adult males (26 insured) and 37 adult females (16 insured). The total of 154 also included 13 adult contacts (6 males, 7 females), but how many of those contacts were insured persons cannot be stated. The total also included 85 children under 15 years of age, viz., 37 boys (including 15 contacts) and 48 girls (17 contacts). The patients attending the Dispensaries for the first time during the year numbered 1,031—comprising 216 adult males (169 insured); 350 adult females (128 insured); and 465 children under 15 (males, 233; females, 232). The total dispensary "population" of last year numbered 1,185 persons of all ages, among whom 228 cases of tuberculosis were found, 132 being pulmonary, and 95 other forms of tuberculosis. The percentages of the "population" found to be tuberculous were—total (all forms), 19-1; pulmonary, 11-1; and other forms, 8.0, percentages which compare favourably with the means (percentages) for the five years 1918-22, viz.—total, 23.9; pulmonary, 14.8; and other forms, 9.1. The percentages of adult males found tuberculous were—all forms, 31.4; pulmonary, 26.2; and other forms, 5.2; and of adult females—all forms, 20.4; pulmonary, 16.7; and other forms, 3.6. All the percentages just quoted are well below the mean percentages (both sexes) for the preceding quinquennium. Among the adult population, the cases of tuberculosis formed 30.6 in the insured and 17.8 in the uninsured, 25.6 per cent, of the former and 14.5 per cent of the latter suffering from pulmonary tuberculosis and 5.0 and 3.3 per cent. (respectively) from other forms of the disease. Of the insured males examined, 32.8 per cent. were tuberculous, and of the uninsured, 26.4, the proportions among females being, insured, 27.7, and uninsured, 16.0. Pulmonary disease was found in 27.1 per cent. of the insured males and 22.6 of the uninsured, the proportions among females being insured, 23.5 and 12.7. Other forms of tuberculosis were found in 5.6 per cent. of insured males and 3.7 of uninsured, the proportions among females being insured, 4.1; uninsured, 3.2. Except in the case of insured males, all the proportions mentioned were not only below those recorded in 1922 but also well below the average percentages for 1918-22. Among children under 15 years of age, 12.7 per cent, were diagnosed as tuberculous, 0.3 per cent, having pulmonary disease and 12.3 per cent, other forms of the disease. In 1922, the percentages were—all forms, 11.7; pulmonary, 1.5; and other forms, 10.1; the mean percentages for 1918-22 being—all forms, 16.0; pulmonary, 2.3; and other forms, 13.6. It has to be noted, however, that prior to 1922 the ages of "children" extended to 16 years, a fact which implies a risk of a higher percentage of tuberculosis. There was a remarkable increase in the proportion of the Dispensary "population" reported as free from tuberculosis. For the five years 1918-22 the percentage of those examined as new cases TUBERCULOSIS. 17 and found free from tuberculosis was 57.6 per cent., the percentage for 1922 being 63.7. Last year 76.7 per cent. of all examined were found to show no signs of the disease. Among insured adults the percentage was 65.1, and among uninsured, 79.3. Another striking change was in the number of "suspect" cases remaining undiagnosed at the end of the year. During the years 1918-22 this class constituted 15.1 per cent. of the total number examined, the percentage in 1922 being 15.4. Last year the proportion fell to 3.4 per cent, of all examined, 1.6 in the case of adult males, 3.6 in adult females, and 4.1 in children. Among insured persons the percentage was 3.5 in 1923, as compared with a mean (1918-22) of 15.6, and among uninsured persons, 2.0, mean, 16.2. The patients referred to the Dispensaries for diagnosis numbered 205 last year, as compared with 162 in 1922. A smaller proportion of patients were referred by the Tuberculosis Officers to the "linked" hospital, viz., 133 in 1923, 144 in 1922. In 134 instances last year patients were under observation for periods exceeding two months before a diagnosis was made (136 in 1922). Reports on 11 cases were received from medical practitioners (8 in 1922) and 34 consultations were held with them, 22 patients being insured and 12 uninsured. In 1922 the consultations numbered 33 (insured, 23; uninsured, 10). The Tuberculosis Officers made 544 home visits last year (486 in 1922) and the Tuberculosis Nurses, 3,786 (3,625 in 1922). Two hundred and forty-two sputum tests were made last year, of which 40 (16-5 per cent.) were positive. In 1922, 299 specimens were examined, 67 being positive (22.4 per cent.). The examination of "contacts"—being members of the families of patients found to be suffering from tuberculosis—is an important part of the work of the Tuberculosis Officers. The contacts due for examination during the year numbered 462, of whom 338 (73.1 per cent.) were examined. At the close of 1922 there were 45 contacts awaiting examination, the total number examined during the year being, therefore, 383, among whom 19 cases of tuberculosis, 3 pulmonary, and 16 other forms, were found. The total proportion of contacts found to be tuberculous was 4.9 per cent. Two of the cases were found in adults, one pulmonary and one other form, and 16 in children, equally divided between the two forms of the disease. At the close of the past year there were 628 patients under treatment at the Dispensaries (395 in 1922) and 114 under domiciliary treatment (107 in 1922). Dental Clinic.—By agreement with the British Dentists' Hospital a Surgeon Dentist attends at the Dispensary (20, Talbot Road) each Tuesday afternoon. During the year he saw 297 patients (men, 46; women, 123; children, 128). In 51 instances "advice and inspection" were all that were necessary. Two cases of pyorrhæa (women) were treated. The following surgical treatment was given—scalings, 4; fillings, 33 ; and extractions, 109 (208 teeth)—all with anæsthetic (local or general) except one. Eight upper and 7 lower dentures were supplied, grants towards the cost of the same being made by the Council to 8 patients. The total amount of the grants was £14 14s. Od. Institutional.—This designation covers treatment in residential institutions provided by the County Council. At the end of 1922, 47 patients were under treatment in these institutions. During the past year 198 applications for treatment were received, 89 from men, 86 from women, and 23 on behalf of children. Of the total applications, 162 were carried through, 36 not so maturing, 19 on account of refusal by the County Council, 9 by refusal of the applicants of the form of treatment offered by that Council and 8 by the death of the applicants. In 86 instances the applicants were given treatment in hospital, of whom 36 were transferred to sanatoria; 73 were admitted to sanatoria, 1 being subsequently transferred to a "colony," and 3 to training colonies. Among the 209 patients who were treated in residential institutions during the year there were 15 deaths and 116 discharges, leaving 78 under treatment at the end of the year, including 9 who had been admitted in 1922. Although not a residential institution it may be noted here that 36 children, other than those mentioned above, were admitted to Kensal House School during the year. Tuberculosis Care Committee.—In the Report for 1922 the history of the formation of the Interim Care Committee was briefly set out and the decision of the Council to appoint a Borough Care Committee recorded. The latter Committee was duly appointed by the Council on February 27th of last year. The Committee comprises representatives of the Council, the Guardians, War Pensions Committee, Charity Organisation Society, the Executive Committees of the Dispensaries, three specially selected members who were not representatives of any societies or organisations, and the Officers of the Public Health Department and the Dispensaries (as ex-officio members), there being altogether upwards of 30 members. Miss Dorothy Warren was appointed to be part-time Secretary to the Committee on February 27th, 1923, and whole-time from 30th October, 1923. The Committee 18 TUBERCULOSIS. met for the first time on March 2nd, 1923, and decided to meet on the Friday of each week except in holiday times. The work of the Committee is intended to be complementary to that of the tuberculosis medical services. Whereas the medical treatment aims at curing the sick body, the Care Committee seeks to deal with (what may be briefly described as) the "sick" social conditions of the patient's family. The Committee's aims are (among others) to obviate, if possible, the harm accruing from impoverished finance, to point out and assist in remedying undesirable conditions of the home, to advise, so far as the patient will allow, as to the method of getting the best results from earnings, and generally to act as his guide, philosopher and friend. Apart from the work here sketched, the County Council refers to the Committee all questions relating to assessments towards the cost of maintenance in residential institutions to which patients may be admitted under that Council's scheme. The County Council has also appointed the whole Committee as the School Care Committee for Kensal House School The Committee has no funds at their disposal for distribution in cases of necessity, and therefore patients requiring financial assistance are referred to the Charity Organisation Society, the Red Cross Society, etc., according to the needs of the case. The Committee is in very close touch with all the organisations concerned with ex-service men, with the Labour Exchange and with Mutual Registration. Unfortunately, the present position of the housing question and the large amount of unemployment very seriously restrict two of the most import ant functions of the Committee, namely, assisting the tuberculous to secure employment suited to their condition and the improvement of the housing conditions of the families when undue crowding—quite distinct from overcrowding—is found to exist. The work of the Committee cannot be adequately described by statistical methods. The following summary of the work done is a very imperfect account of the Committee's activities, and altogether fails to convey any idea of the personal element, which is of the greatest importance in social work. On the recommendation of the Tuberculosis Officers 31 persons were referred by the Care Committee to local charities for general help, convalescence or nourishment, 19 to the C.O.S., who gave the required help in 16 cases and arranged for the other 3, and 12 to the Red Cross and United Services Fund, who assisted in every case. In 4 cases where sleeping accommodation was found to be unsatisfactory, beds and bedding were lent by the Public Health Committee. The cases of 7 patients requiring dental treatment were reported to the Committee, and in 5 instances grants towards the cost were obtained from the Public Health Committee. The total sum granted from the Public Health Committee amounted to £14 14s. Od. In 3 instances patients had been unable to obtain the payment of sick benefit. The cases were reported to the Ministry of Health's Insurance Inspectors, who arranged for the amounts due to be paid. In 8 instances the question of finding work for patients or members of their families came before the Committee. One patient was found to be incapacitated, 4 obtained work through the Committee's efforts, and 3 by their own. One baby was placed, through the Committee, in Beauchamp Lodge while the mother underwent treatment, and a grant of 7s. 6d. a week towards the maintenance made by the Public Health Committee. The attention of the Medical Officer of Health was directed to 5 houses where sanitary defects existed, who arranged for their investigation and remedy. Mortality.—(Tables 6 and 7). The total number of deaths from tuberculosis during the year was 127, 97 from pulmonary forms and 30 from other forms. The annual averages for 1918-22 were— all forms, 146; pulmonary, 115; other forms, 31. In comparison with those averages last year's figures show the following reductions—total, 13 per cent.—pulmonary 16, other forms, 3. The 97 deaths from pulmonary tuberculosis comprised 53 of males and 44 of females. The following statement shows the steady fall in the number of deaths since the quinquennium 1906-10. Pulmonary Tuberculosis. Annual Averages. Males. Females. Males. Females. 1901-05 88 64 1911-15 87 65 1906-10 93 58 1916-20 79 66 Males. Females. 1921-23 59 44 Comparing the averages for 1921-23 with the maximal figures—males, 93 (1906-10); females, 66 (1916-20)—reductions of 37 and 33 per cent, will be noted. The deaths from all other forms of the disease (30) comprised 14 of males and 16 of females, numbers not very different from the averages (males, 15; females, 17) for 1918-22. The fall in the number of deaths since 1901 is shown in the following statement. tuberculosis. 19 Other Forms of Tuberculosis. Annual Averages. Males. Females. Males. Females. 1901-05 28 31 1911-15 23 17 1906-10 26 23 1916-20 18 18 Males. Females. 1921-23 13 16 Comparing the averages for 1921-23 with the maxima—males, 28 (1901-05); females, 31 (1901-05) —the former show falls of 54 and 48 per cent. respectively. The deaths from tuberculosis allocated to the Wards are shown in Table 6. Below is a comparison of the deaths recorded last year with the annual averages for 1918-22. The returns last year from Westbourne and Church Wards are eminently satisfactory as regards pulmonary tuberculosis. Tuberculosis. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate. East. Hyde Park. PULMO NARY. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1918-22 9 6 12 9 7 9 11 13 16 10 2 2 1 1 3 3 1923 9 5 16 12 6 9 9 8 6 6 3 1 1 1 3 2 Other Forms. 1918-22 3 2 3 5 2 3 2 3 3 3 0 0 1 0 1 0 1923 1 - 7 2 - 2 1 7 4 3 - - - 1 1 1 " 0 " = average less than 1. " — " = nil. The consideration of the changes in the sex-age distribution of deaths from this disease and of the changes in the numbers recorded in the Wards since 1901 must be reserved for another occasion. It must suffice to say that the average numbers for 1921-23 show notable reductions in comparison with the averages (quinquennial) for the preceding twenty years. The occupations of the deceased persons—as recorded on registration of death—are shown in Table 10. Mortality Rates.—The rates from all forms of the disease for last year were: Persons, 0.87; males, 1.06; females, 0.69. These rates compare favourably with the mean rates for 1910-12. Persons, 1.27; males, 1.71; females, 0.95—and with those for 1920-22—Persons, 0.96; males, 1.24; females, 0.75. The rates for 1923 from pulmonary tuberculosis were: Persons, 0.66; males, 0.86; females, 0.51; those for 1910-12: Persons 0.95; males 1.30, females 0.69—and those for 1920-22: Persons 0.76, males 1.03, females 0.57. From all other forms of the disease the rates were: in 1923, persons 0.20, males O.22, females O.18—in 1910-12: persons O.32, males O.41, females O.25—1920-22: persons 0.19, males 0.21, females 0.18. Deaths in Institutions.—Of the 127 deaths from all forms of tuberculosis 70 took place in institutions, 44 in Poor Law infirmaries, 15 in hospitals, 7 in hospitals of the M.A.B. and 4 in lunatic asylums. Analysis of the data shows that 55.1 per cent. of these deaths took place in institutions as compared with 58.7 in 1922. Of the deaths due to pulmonary tuberculosis 53.8 per cent. were institutional (54.7 in 1922), and of the deaths due to other forms, 60 (76.9 in 1922). The deaths in Poor Law institutions formed 34.6 per cent. of all deaths due to tuberculosis, 36.0 of those due to pulmonary and 30 of those due to other forms. Records of the deaths in the different classes of institutions have been kept since 1914. In that year 27.9 per cent. of all deaths due to tuberculosis took place in Poor Law institutions, 28.4 of those due to pulmonary and 25.7 of those due to other forms of the disease. In 1914, 6.9 per cent. of all deaths from tuberculosis took place in lunatic asylums, the proportion observed last year being 3.1 (6.2 in 1922). During the year the Department had knowledge of 105 deaths from pulmonary tuberculosis, 8 of the deaths belonging to other districts. That total included the 4 deaths in lunatic asylums, which together with 3 others of which the Department had incomplete information only, can for the present purpose be ignored. Of the remaining 90, 16 received, so far as could be ascertained, no institutional treatment. Of the 74 persons concerning whom the records were believed to be complete, 46 entered institutions on one occasion only, 15 on 2 occasions, 8 on 3, 4 on 4 and 1 on 6. The average duration of treatment for the 74 persons was 5¼ months. Duration of the Disease.—With respect to 86 of the 105 fatal cases of pulmonary tuberculosis known to the Department, it was possible to fix the approximate duration of the disease. In 25 20 CANCER. instances the duration was under 12 months, in 18 between one and two years, in 29 between two and five, in 11 between five and 8, and in 3 over eight. Completeness of Notification.—Of the 127 deaths assigned to the Borough, 6 took place before the notification certificates were received, 15 within one month of notification, and 15 between 1 and 3 months. With respect to 23 deaths no notifications were received by the Medical Officer of Health of the Borough. Of those 23 deaths 6 took place in the deceased persons' homes, 10 in local institutions and 7 in out-lying. The 6 deaths in the patients' homes included 2 from pulmonary disease, one being an inquest case (the disease was unsuspected during the deceased's life), and in the other instance the practitioner certifying the death thought that another practitioner had notified the case. The 4 other cases included 3 meningeal and 1 "gland" cases. The last ought, undoubtedly to have been notified as there had been an operation for tuberculous glands in 1920. The 10 deaths in local institutions included 7 of pulmonary and 3 of other forms of the disease. In 9 instances it was stated that the diagnosis was made at post-mortem examination only—in the majority of the instances the duration of treatment at the institution had been very short—and in the remaining instance death ensued within a few hours of admission. The 7 non-notified deaths in out-lying districts included one in prison (cases in prisoners are not notifiable), 2 which had been notified in the districts where the deaths took place, one an inquest case, another diagnosed at post-mortem examination only, and 2 not satisfactorily explained. The 23 non-notified deaths were equal to 18.1 per cent. of all deaths from tuberculosis as compared with a mean percentage of 22.6 during 1918-22. On the whole the reasons for absence of notification to the Medical Officer of Health of the Borough were more acceptable last year than in previous years. Survivors.—The Department began to keep records of cases—as distinct from deaths of tuberculosis in 1903, in which year 4 cases were reported. At the end of 1908 356 cases had come to the knowledge of the Department, but the records were recognised as being very incomplete. Notification was inaugurated at the commencement of 1909, and the Paddington Dispensary was opened at the same date. Since then the Department has had much more complete information of all cases of the disease. During the 21 years 7,370 cases of diagnosed tuberculosis (all forms) have been placed on the Register and (since January, 1909) 2,633 "suspect" cases. Of the total 10,003 cases 1,731 have been taken off the Register on account of change of diagnosis, and 27 "suspect" cases have been transferred to the "definite" group. Of the 7,370 "definite" cases 760 have been marked "arrested." Removals numbered 3,360 during the whole period, but 85 patients were subsequently restored to the Register. The deaths among the persons on the Register which have come to the knowledge of the Department numbered 2,332. At the end of 1922 there were 1,743 names of persons certified as having tuberculosis, and 51 of those reported as suspected to have the disease. At the end of 1923 the entries comprised 1,850 for certified cases—1,186 with pulmonary disease, 664 with other forms—and 28 for suspect cases— equally divided between pulmonary and other forms. Five cases of definite pulmonary disease placed on the Register before 1909 are included among the survivors at the end of 1923. CANCER: MALIGNANT DISEASE. (See Tables 6, 7 and 12.) The deaths from the malignant neoplasmata numbered 206, 80 in males and 126 in females. In 1922 these deaths numbered 191—93 of males and 98 of females, the figures for 1921 being—Persons, 226; males, 93; females, 133. The annual average (persons) for 1918-22 was 189, the total for last year being 9 per cent. in excess of that average. The statement given below shows the number of deaths last year in each Ward and the annual averages for the preceding quinquennium. It will be noted that last year's numbers were higher in each of the Wards except Westbourne and Lancaster Gate, West, the reduction in each case being 14 per cent. of the average. In the other Wards the increase varied from 6 per cent. (Harrow Road) to 50 (Hyde Park). Cancer. Deaths Recorded. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate. East. Hyde Park. 1923 24 37 37 30 34 12 11 21 1918-22* 19 35 32 35 31 14 9 14 * Annual Averages. OTHER DISEASES. 21 Analysing the deaths according to the variety of neoplasma certified, it appears that 76.4 of the total deaths (persons) were due to carcinoma, 5.1 to epithelioma, 0.1 to scirrhus, 6.1 to sarcoma and 12.2 to other and indefinite varieties. (Table 12.) The foregoing percentages differ greatly from those observed during the quinquennium 1901-05 when the records were—carcinoma, 48.5; epithelioma, 4.4; scirrhus, 3.4; sarcoma, 7.3; and other and indefinite forms, 36.4. The fall in the proportion certified as due to "other and indefinite forms" can be explained by more careful certification on the one hand and by the enquiries which are made by the Department when the certified cause is vague. No explanation can be offered of the falls in the proportions certified due to scirrhus and sarcoma, except, possibly, a change in fashion. On distributing the deaths according to the site of the disease it is found that the increased incidence has been mainly in the digestive, urinary and generative systems. The averages for the last three years and for the two previous decennia, of deaths due to disease in the systems mentioned are set out below. The change in the population has been so slight that the figures quoted are practically as good as mortality rates for purposes of the present comparison. Cancer. ANNUAL AVERAGES: ALL FORMS. 1901-10. 1911-20. 1921-23. M. F. M. F. M. F. Digestive System 44 43 52 51 62 54 Tongue 6 o 5 0 5 1 Throat 7 1 9 2 13 2 Stomach 10 10 13 13 16 14 Rectum 6 8 6 8 9 15 Liver 6 10 6 11 6 6 Urinary System 4 2 7 3 8 4 Bladder 2 1 3 1 3 2 Generative System 1 44 1 50 2 52 Uterus — 20 — 20 — 20 Breast — 21 — 23 — 22 "0" Average less than unity. Mortality Rates.—The deaths recorded last year were equivalent to a rate of 1.40 per 1,000 persons, the mean rates for 1910-12 and 1920-22 being 1.18 and 1.44. The mortality rates for males were— 1913,1.30; 1910-12,1.20; 1920-22,1.48; and those for females (same order)—1-48, 1.17, and 1.36. Deaths in Institutions.—Of the 206 deaths 87 (42.4 per cent.) took place in institutions, the percentage of deaths of males being 52.5 and that of females, 35.7. In 1922 the percentages were— Persons, 50.8; males, 58.0; females, 43.8, and in 1921 (same order)—49.5, 53.7 and 46.6. By far the larger proportion of institutional deaths were in Poor Law infirmaries. OTHER DISEASES. Dysentery.—Two cases were notified during the year both in females, one aged 7 years and the other 40. The former was an inmate of the Children's Hospital, Paddington Green, whence she was removed to one of the M.A.B. Hospitals. The Flexner bacillus had been found in the child's faeces before the case was notified, but was hot found after admission to the M.A.B. Hospital. There had been a case of the disease from another area under treatment in the ward of the Children's Hospital in which the Paddington child was lying. The second patient's attack was a recurrence of the disease of which the first attack took place while she was residing in China some three years previously. The amœba histologica was identified in this case. Malaria.—Two cases both in adult males were reported. The disease had been originally contracted by both men while abroad on service. Alcoholism.—Two deaths, one of each sex, were assigned last year to "Alcoholism, acute and chronic" as compared with 5 (males, 2; females, 3) in 1922. On the other hand there were 11 deaths (males, 6; females, 5) from alcoholic cirrhosis of the liver last year as compared with 5 (males, 2; females, 3) in 1922. The 13 deaths (males, 7; females, 6) recorded under these two heads must, in the absence of further information, be taken as the measure of the mortality caused by the excessive consumption of alcohol. They represent a mortality of 0.08 per 1,000 persons, the mortality among males being 0.11 and that among females, 0.07. During the three years 1910-12 the mean mortalities were: males, 0.19; females, 0.17; the corresponding rates for 1920-22 being 0.10 and 0.07. 22 INQUESTS. Old Age.—The deaths placed under this head during the year numbered 54 (males, 11; females, 43), and in 1922, 68 (males, 13; females, 55). During 1910-12 the deaths of males assigned to "Old Age" numbered 37 and those of females 67, the corresponding figures for 1920-22 being: males, 22; females, 57. Within the past few years there has been a change of practice in certifying the deaths of very old people who die without signs or symptoms of active disease. A considerable proportion of such deaths are now certified as due to "arterio-sclerosis without other lesion" instead of "old age." Last year, 4 of the deaths certified due to age occurred at ages under 70 years, while those dying at higher ages numbered 51 (males, 11; females, 40). At ages exceeding 70 years the deaths due to arterio-sclerosis were: males, 21; females, 47. It is probable that the combined figures, viz.: males, 31; females, 87, more nearly correspond with the numbers given above for the years 1910-12, but they may not fit with those for 1920-22. Venereal Disease.—Last year 10 deaths were ascribed to syphilis, 7 of males and 3 of females, the numbers for 1922 being: Persons, 8: males, 3; females, 5. Four of the deaths recorded last year were those of infants under one (males, 3; females, 1). In 1922 there were 4 deaths at those ages, equally divided between the two sexes. The mortality among males last year was 0.11, that among females, 0.03. During 1910-12 the mean mortality rates were 0.11 and 0 06 and those during 1920-22, 0.07 and 0.03. As in the case of alcoholism the mortality from this cause fell during the war period but shows signs of returning to its former level. V.D. Clinic.—This Clinic at St. Mary's Hospital receives patients from all parts of the Metropolis and certain of the Home Counties. Last year 654 persons attended for the first time—263 of whom were infected with syphilis, 3 had soft chancre, and 248 gonorrhoea, the remainder (140) being found free from venereal disease. The total attendances (old and new cases) during the year numbered 9,616. The discharges, i.e., after proved freedom from infection, numbered 165, while 181 others gave up attendance before treatment was complete. Inability to enforce attendance until freedom from infection has been demonstrated is one of the weaknesses of the present method of dealing with venereal diseases. VII. INQUESTS. Last year 201 inquests were held in the Borough, 50 of the deceased persons being non-residents. Those figures show a slight reduction below the average for the preceding quinquennium, viz.: 209 inquests, including 62 re deaths of non-residents. The corrected number of inquests on residents of the Borough was 196, an increase of 17 above the annual average (179) for 1918-22. The inquests on males numbered 117 (average 101), and those on females 79 (average 78). The deaths registered after inquest last year constituted 11.3 per cent. of all deaths as compared with 9.4 during 1918-22. On distributing the inquests according to the residences of the deceased persons, it has been found that the percentages of such deaths to all deaths were higher last year than the averages in all Wards except Maida Vale. The most notable increase occurred in Lancaster Gate, West, Ward where the percentage was 18.2 last year as compared with an average of 8.8. Last year the percentages in Queen's Park (8.1) and Maida Vale (8.7) Wards were the only two below that noted in the Borough (11.3). The findings at the inquests held last year were: Natural Causes, 101 (Average, 1918-22, 81). Misadventure, 10 (6); Accidental Causes, 49 (57); Suicide, 23 (22); Murder, 2 (2); Open, 10 (8); Neglect, 1 (3). Expressing the numbers of the various findings as percentages of the total number of inquests, it is found that last year the proportions for Natural Causes was 51.1 (Average 1918-22 being 45.2); that for Misadventure, 5.1 (Average, 3.3); and that for Open, 5.1 (Average, 4.4). The proportions for the other findings were all less last year than the respective averages. Traffic Accidents.—Including 2 found to have been due to misadventure, there were 17 deaths attributable to various forms of traffic, the average for the preceding quinquennium being 15. Included in the 17 deaths were 11 from motor traffic (average, 9).; 2 from rail services (average, 1); and 1 from aeroplane—the first on record in the Borough. Gas fatalities.—Last year there were 5 deaths by coal gas, the annual average of gas fatalities being 7. The fatalities of last year were all suicides, 2 by men (average, 3); and 3 by women (average, 3). Special reports (with plans) on all the cases were forwarded to the Ministry of Health and the Board of Trade. DEATHS IN INSTITUTIONS. 23 VIII. DEATHS IN INSTITUTIONS. Of the 1,743 deaths registered within the Borough, 850 (48.7 per cent.) occurred in public institutions, 285 of those deaths belonging to other districts. During 1918-22 (the Poor Law Infirmary was not receiving civilian patients in 1918 and 1919) the deaths in local institutions averaged 704 a year, 39.6 per cent. of the deaths registered locally, the average of non-residents in those institutions being 283. In addition 64 deaths took place in nursing homes last year, 26 of the deceased persons being non-residents. The annual average (1918-22) of deaths in nursing homes was 63, including 35 of non-residents. The deaths of 222 residents of the Borough in out-lying public institutions were reported during the past year, as compared with an annual average (1918-22) of 397, but it should be noted that during 1918 and 1919 many Poor Law patients were received by St. Marylebone owing to the use of the local infirmary for military purposes. There were also 34 deaths in nursing homes in out-lying areas during 1923. The corrected number of deaths of residents in public institutions during the past year was 787, or 45.7 per cent. of the total deaths. Of the deaths of males, 47.8 per cent. occurred in institutions, and of those of females, 43.7. The percentages for 1918-22 were: Persons, 43.0; males, 45.6; females, 40.5. The percentages of deaths in the Wards which took place in institutions were (the averages for 1918-22 being given in parentheses)—Queen's Park, 49.1 (45.2); Harrow Road, 49.2 (45.2); Maida Vale, 37.8 (35.6); Westbourne, 44.1 (42.8); Church, 60.7 (54.6); Lancaster Gate, West, 24.7 (24.2); East, 16.0 (29.5); Hyde Park, 52.8 (40.2). The only significant changes were the fall in Lancaster Gate, East, and the increase in Hyde Park. Of the total deaths in institutions during 1923 1.5 per cent. took place in Hospitals of the M.A.B., 29.2 in Poor Law Institutions, 4.3 in Lunatic Asylums, and 19.6 in Voluntary Hospitals, including 2.5 in hospitals for special diseases. The corresponding mean percentages for 1918-22 were: M.A.B., 1.9; Poor Law, 25.2; Lunatic Asylums, 3.9; Voluntary Hospitals, 11.6 (including 2.5 in Special Hospitals). The deaths in rate-maintained institutions were 35.0 per cent. of all deaths, those in institutions maintained by voluntary effort 10.6, while the percentages for 1918-22 (same order) were: 31.0 and 11.6. IX. STATISTICS OF CHILDHOOD (0-5 Years). Mortality at Ages 0-1 Year.—(Tables 1, 2 and 13)—Among the 1,743 deaths registered last year within the Borough were 207 of infants under the age of one year, equivalent to an infant mortality rate of 86 per 1,000 births registered locally (2,410). The mean rate for 1918-22 (obtained in a similar manner) was 106, that rate having been much reduced by the low figure (87) for 1920. Full correction for the large number of births belonging to the Borough which take place in outlying districts cannot be made until after the end of the year, hence the rates for the four quarters of the year are only partially corrected, i.e., deaths of non-resident infants have been excluded, and those of residents in out-lying districts included, but not the births. The partially corrected rate for the year was 74 per 1,000 births, as compared with a mean (1918-22) of 98. The rate for the first quarter was 96, for the second 63, for the third 45 and for the fourth 91. Attention should be specially called to the fact that the rate for the third quarter was the lowest for the year. In the past that quarter's rate used to be the highest. The mean rates for the preceding quinquennium were : 1st quarter, 114; 2nd, 88; 3rd, 88 ; and 4th, 100. The fully corrected rate for the year was 69, as compared with a mean of 87 for the years 1918-22. The rate for males was 81 (mean 99), and that for females 56 (mean 75). In comparison with their respective means the rates recorded last year show the following approximate percentage reductions : Males, 19; females, 28; persons, 23. The subjoined tabular statement of the Index Numbers, read in conjunction with the annual rates given in Table 2, shows clearly the changes in the rates recorded in each of the Wards. Infantile Mortality. Index Numbers for 1923. Mean Rates 1918-22 = 100. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Males 115 79 127 57 67 23 45 96 Females 108 67 64 90 57 90 — 45 Persons 111 74 104 71 64 47 23 79 24 STATISTICS OF CHILDHOOD. The reduction in the rate (36 per cent. for persons) prevailing in Church Ward is particularly satisfactory, that Ward having been in the past the worst in the Borough as regards infantile mortality. It will be of interest to add that as regards the rates recorded last year those for males were above the rate for the Borough (81) in Maida Vale (121) and Queen's Park (91), while the lowest rate (24) was recorded in Lancaster Gate, West. The rates for females in the following Wards were in excess of that for the Borough (56): Westbourne, 84; Queen's Park, 65; and Church, 61—the minimum rate (zero) being recorded in Lancaster Gate, East. Of the total (Persons) rates, which for the Borough was 69, those observed in Maida Vale (83), Queen's Park (78), Westbourne (78) and Church (71) were above that standard, while the minimum rate (21) was that for Lancaster Gate, East. Ages at Death.—The numbers dying at the various ages used in examining infantile mortality are set out in Table 13, together with the annual averages for 1918-22. Having regard to the decrease in the number of births during the year in comparison with the average for 1918-22, smaller numbers of deaths are to be expected for last year, but the numbers actually recorded are, in almost every instance, less than would be expected from a consideration of the shrinkage in the yield of births. To test the saving (if any) in infantile lives which has been effected during recent years, comparisons have been made between the annual average numbers of deaths (of males and females) at each age during the two quinquennia, 1909-13 and 1919-23. The results are shown in the annexed table. The "calculated numbers "—lines "C"—have been obtained by reducing the averages for 1909-13 in the same proportions as the reductions in the average numbers of births. Deaths of Infants: Sex, Age Distribution. Annual Averages. Weeks. Months. Under One Year. 0 1 2 3 0 1 2 3 4 5 6 7 8 9 10 11 Males A 40 9 8 6 63 21 14 11 9 11 10 10 9 7 8 6 179 B 38 11 6 3 58 11 12 10 6 6 7 5 5 5 3 4 132 C 37 8 8 6 59 20 13 10 8 10 9 9 8 7 7 6 166 Females A 26 7 6 4 43 18 12 10 9 8 6 5 7 8 7 6 139 B 27 5 4 1 37 10 8 7 5 4 3 3 4 1 3 90 C 24 7 5 4 40 17 11 9 8 7 6 5 6 7 6 6 128 M. F. A. 1909-13 Annual average births 1,530 1,478 B. 1919-23 „ „ 1,426 1,362 C. Calculated numbers for 1919-23, on assumption that the mortality rates for 1909-13 remained unchanged. The table shows that the average number of deaths of males at ages under one year during 1919-23 was 34 less than the "expected," that of females 38.* It will be observed that at ages under one month the changes are insignificant, 1 less for males and 3 for females. At ages under six months the annual "savings" in the case of males amounted to 17 lives, in the case of females to 21. Between the ages of 6 and 12 months, the savings were same (17 lives) in both cases. Deaths at Ages 1-5 Years.—(Table 14)—It is estimated that the number of children surviving to the ages 1-2 years at the end of 1922 was 2,542; to ages 2-3, 2,533; to ages 3-4, 3,064; to 4-5 years, 2,042; and that the total for the ages 1-5 years was 10,181. It would have been preferable to estimate the numbers to the middle of 1923, but owing to the fact that the births cannot be corrected to that date, such estimates cannot be arrived at. During 1923 the deaths at those ages were: 1-2 years, 37 (males 18, females 19); 2-3, 17 (males 8, females 9); 3-4, 13 (males 8; females 5); 4-5, 5 (males 2, females 3); and 1-5, 72 (males 36, females 36). The mortality rates (per 1,000) were in the same order—14.55, 6.71, 4.24, 2.44 and (1-5) 7.07. In 1922 the rates were: 24.26, 8.73, 5.35, 8.14 and (1-5), 12.15—all considerably above those observed last year. In the table given below the mortality rates for 1909-13 are compared with those for 1919-23. To indicate the reductions in the rates for the latter quinquennium, Index Numbers have been calculated, taking the rates for 1909-13 as 100 in each sex-age group. * The total saving of lives during the quinquennium was, for males 170, for females 190, and the combined Sexes (persons) 360. 25 causes of death. Mortality (1-5 Years). Mean Rates. Index Numbers. Ages (years). 1909-13. 1919-23. 1919-23. (1909-13=100.) m. f. p. M. f. P. M. f. P. 1- 3.90 29.07 31.50 18.90 18.72 18.81 54 64 60 2- 11.96 11.80 11.88 8.65 8.91 8.78 72 75 74 3- 6.56 6.40 6.48 4.55 5.43 4.99 69 85 77 4-5 5.79 5.94 5.86 5.76 5.47 5.62 99 92 96 1-5 14.55 13.36 13.96 9.83 9.98 9.90 68 75 71 CAUSES OF DEATH. At Ages under One Year.—The deaths distributed according to cause are exhibited in Table 13, together with the averages for 1918-22. The births recorded during the past year (males 1,347, females 1,273) were so nearly equal to the annual averages (males 1,373, females 1,294) that it has been thought unnecessary to calculate the rates for the several causes, but the following rates for the groups of causes—See Roman numerals in Table 13—sufficiently indicate the changes. Mortality Rates. At Ages Under One Year. Group of Causes. Males. Females. 1923. 1918-22. 1923. 1918-22. i. 6.6 2.9 7.8 3.8 ii. 5.9 18.9 6.2 11.5 iii. 2.9 2.1 0.7 1.5 iv. 37.8 40.7 22.7 30.1 v. 21.5 24.7 14.8 19.3 Other Causes 5.9 8.7 3.1 8.5 All Causes 80.9 98.3 55.7 74.9 The only rates showing increases last year are those for Group I. (Common Infectious Diseases), in which there was an increase of 127 per cent. in the mortality among males, and 1 of 105 in that among females and Group III. (Tuberculous Diseases), in which there was an increase of 38 per cent. in the mortality among males. If the deaths from Whooping Cough during 1923 had not exceeded the average the mortality rate for males in Group I. would have been the same as the mean, and that for females 19 per cent. less. The epidemic of that disease increased the mortality among males by 3.8 per 1,000, and that among females by 6.3. Below is shown a statement of the annual averages for 1909-13 and 1919-23 for the groups of diseases used in the preceding paragraph. As before the expected averages for the second quinquennium have been calculated—See " C." Deaths: Annual Averages. At Ages Under One Year. Group of Diseases. Males. Females. A. B. C. A. B. #] i. 14 5 13 14 5 13 ii. 32 25 30 30 16 28 iii. 5 2 4 4 2 4 iv. 68 56 63 49 35 45 v. 45 33 42 33 23 30 Other Causes 14 10 13 8 9 7 A—Averages 1909-13. B—Averages 1919-23. C—Expected Averages 1919-23. 26 CAUSES OF DEATH. The greatest reduction from the expected averages occurred in Group I., amounting for each sex to 62 per cent. The differences in the case of Group III. are for each sex 50 per cent. There is a notable contrast in the differences in Group II. (Diarrhœal Diseases), that for males being only 17 per cent., while that for females is 43 per cent. In one instance only, Other Causes, Females, is the observed average (9 deaths) in excess of the expected (7), the difference being equal to an increase of 28 per cent. At Ages 1-5 Years.—In Table 14 (a modified form of Table 13), the deaths at each of the four years forming the group 1-5 during 1923 are compared with the corresponding annual averages for 1918-22. Although the "populations"—meaning the survivors—are greater at each age in 1923 than the mean populations for 1918-22 the deaths recorded last year were fewer than the averages, except those due to diphtheria and accidents. The table here annexed continues the comparison of the averages for 1909-13 and 1919-23, the "C" columns indicating the expected averages for the second quinquennium based on the experience of the first, the differences between the "B" and the "C" columns showing the "savings" in life, on an average, during each year of the second period. Deaths: Annual Averages. Borough. 1-2. 2-3. 3-4. 4-5. 1-5. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females. A. B. C. A. B. C. A. B. C. A. B. C. A. B. C. A. B. C. A. B. C. A. B. C. A. B. C. A. B. C. Measles 11 3 10 11 3 10 4 2 3 4 1 3 1 0 1 1 – 1 1 1 1 1 0 1 17 6 14 15 4 15 Scarlet Fever 1 – 1 0 0 0 0 – 0 1 0 1 1 0 1 0 – 0 0 0 0 1 0 1 3 1 2 2 1 2 Diphtheria 0 2 0 0 1 0 0 1 0 0 2 0 1 0 1 1 2 1 1 1 1 1 2 1 3 3 2 3 7 2 Whooping Cough 6 3 5 5 2 4 1 0 1 2 1 2 0 0 0 2 0 1 1 1 1 1 0 1 8 4 6 10 3 8 Diarrhoea, Enteritis 6 2 5 4 3 3 0 0 0 1 0 1 – 0 – 0 – 0 0 0 0 – – – 6 4 5 6 3 5 Tuberculous Diseases 5 1 4 2 2 2 2 – 2 3 1 2 2 0 2 1 1 1 1 0 1 1 1 1 10 2 8 7 5 6 Respiratory Diseases 11 8 10 10 8 9 6 5 5 3 3 2 2 1 2 1 1 1 1 – 1 1 1 1 19 15 15 15 12 12 Accident, Violence – 1 – 1 1 1 0 1 0 – 1 – 0 1 0 0 0 0 1 1 1 – – – 1 4 1 1 2 1 Other Causes 7 3 6 6 o 5 3 1 2 2 1 2 2 2 2 2 2 1 2 2 1 2 1 1 13 5 10 12 1 10 All Causes 47 23 42 40 22 35 16 10 13 16 10 13 9 5 9 9 6 7 8 6 8 8 5 7 80 44 63 72 44 61 A—Averages 1909-13. B—Averages 1919-23. C—Expected averages 1919-23. Mortality in Special Areas.—(Tables 15 and 16).—Of the 6 Areas selected for special examination of the changes in infantile mortality, increased rates were recorded last year in 3, and they were also in excess of the means for 1918-22. The Areas with increased rates were: "North Wharf," 95 in 1923, 41 in 1922, Mean 87; "Amberley Road," 115 in 1923, 91 in 1922, Mean 89; and "Queen's Park," 94 in 1923, 60 in 1922, Mean 66. Special attention should be directed to the reductions in rates in "Clarendon Street" and "Alfred Road." If the data from the Special Areas be excluded from the records of the Wards in which such Areas are situated, last year's rates for the "Rest of the Wards" are found to be higher than those for 1922 in 3 of the 4 Wards (Table 15). If the 6 Areas be excluded from the figures for the Borough, the rate for "Rest of the Borough" is 67, as compared with 58 in 1922, the total rate for the six Areas (74) being below that for 1922 (96). The rates of mortality at ages under 3 months (Table 16) in the 6 Areas were less than the rates in the "Rest of the Borough," both in 1923 and during 1918-22. On the other hand, the rates at 3-6, 6-9 and 9-12 months during the past year in the 6 Areas were all above the rates for the "Rest of the Borough," as also were the means. Of the mortality rates from the diseases mentioned in Table 16 those observed in the Areas from whooping cough, diarrhoea and the respiratory diseases are notably in excess of the corresponding rates in the "Rest of the Borough," while those due to causes of ante-natal and natal origins (premature birth, etc.) are in defect. Without labouring the question, it may be said that the general trend of the comparisons of the rates in the two sub-divisions of the Borough, suggests that infants born in the Special Areas are quite as vigorous as those born in other parts of the Borough, but such infants succumb, after the third month of life, from the effects of their environment. It is, therefore, satisfactory to note that the total rate for 1923 (73.56) was nearly 27 per cent. less than the mean (100.3), the rate in the "Rest of the Borough" (66.78) being 19 per cent. less than the mean (82.46). Mortality of Illegitimate Children.—The corrected number of deaths during the year was 33, 25 (males 15, females 10) at ages under one year and 8 (males 5, females 3) at ages 1-5 years. The infantile mortality rate (per 1,000 illegitimate births) was : Total, 118; males, 128; females, 105; DISEASES OF CHILDHOOD. 27 which contrasts unfavourably with the rates among legitimate children, viz.: Total, 64; males, 76; females, 52. The mean rates (1918-22) for illegitimates are: Total, 177; males, 204; females, 147; and the corresponding rates for legitimates: Total, 79; males, 89; females, 69. In comparison with the means last year's rates for illegitimates show greater reductions than do those for legitimates the fall in the total illegitimate rate amounting to 33 per cent. of the mean, that in the legitimate, 19. The reductions in the rates for males were, illegitimates 37 per cent., legitimates 15, and those in the rates for females, illegitimates 29, legitimates 25. The ratio of the total legitimate mortality to the illegitimate was 1: 2.2 during 1918-22 and 1:1.8 last year. The illegitimate infantile mortality was zero in Queen's Park and Lancaster Gate, East Wards, and varied from a maximum of 210 per 1,000 in Harrow Road Ward (4 deaths), to a minimum of 91 in Lancaster Gate, West Ward (1 death only). Occupations of Mothers.—Attention has been directed frequently to the large proportion of mothers of deceased illegitimate children who have described themselves as domestic servants. During the war the proportion fell, but it now shows signs of increasing again. During 1909-13 241 deaths of illegitimate children were recorded, the mothers of 143 (59.3 per cent.) being returned as domestic servants. During 1914-18 (340 deaths) the proportion fell to 44.6 per cent., while in the following quinquennium (1919-23), when there were 220 deaths, the proportion increased to 50.9. DISEASES OF CHILDHOOD. Measles.—For administrative purposes no difference is made between "measles (morbilli)" and "german measles (roiheln)." Last year 324 persons (all ages) were certified to be suffering from measles and 48 from german measles. The weekly tabulation of the records indicates that 80 other cases (of the two diseases) came to the knowledge of the Department through various channels, bringing the uncorrected total of cases to 452, giving an average for the year of 8.7 cases per week. Notification has been in force since the early months of 1914. In that year the weekly average of known cases was 8.2, but it is practically certain that notification was incomplete. If the records of 1914 be passed over, last year's average is the lowest on record, save that for 1921, when 208 cases (both diseases) were known to the Department giving a weekly average of 4 cases. The difficulty of instituting reliable comparisons between the records of successive years will be understood when it is stated that in three years since 1914, viz., 1917 (4,444 cases), 1915 (3,826 cases) and 1922 (3,241 cases) the averages exceeded 50 cases per week, being for the years mentioned, 85.4, 73.5 and 62.3. The fatality (ratio of fatal cases to all cases) tends to vary in an irregular manner with the intensity of the disease, but there does not appear to be any clear indication that fatality is directly connected with the seasonal distribution of the cases. For present purposes the returns for last year will be compared with those for 1917, the year of maximal incidence and 1921, that of minimum. Of the 452 cases 128 came on record during the first quarter of the year, 103 during the second, 92 during the third and 129 during the fourth, in which quarter there was a sudden increase of cases in the last three weeks (80 out of the total of 129 for the quarter) which were the forerunners of the epidemic of the current year. On checking the returns at the close of the year, the total number of cases (both diseases) was reduced to 449, comprising 396 of measles and 53 of german measles. Of the former disease 207 cases occurred in males and 242 in females (of all ages), and of the latter 20 and 23 respectively. Both diseases being of limited age incidence, it seems undesirable to submit morbidity rates based on the total population or the population of each sex. In the appended statement the sex-age distribution of both cases and deaths is well shown. As so many children now enter school at the age of 3, the school-age has been taken as 3-15 years. In the same statement a comparison is instituted between the records for the past year and the years 1917 and 1921. Measles: Borough. 1923. 1917. 1921. Ages. M. F. M. F. M. F. 0-3 58(2) 48(1) 555(56) 548(40) 28(2) 28 3-15 124 121 1,173(9) 1,217(11) 56 58 15- 5 40 98 654 9 26(1) All Ages 187(2) 209(1) 1,826(65) 2,419(51) 93(2) 112(1) Figures in parentheses indicate fatal cases. The fatality of the disease last year was at the rate of 0.7 per 100 cases, as compared with 2.7 in 1917 and 1.5 in 1921, a comparison which may be regarded as satisfactory. The rate for males was 1.1 per cent. last year, 3.5 in 1917 and 2.1 in 1921, those for females (in the same order) 0.5, 28 DISEASES OF CHILDHOOD. 2.1 and 0.9. The only age-group for which material for comparison can be drawn from the above statement is that of 0-3 years. For males at those ages the rates were: 1923, 3.4 per cent.; 1917, 10.1; and 1921, 7.8, while the rates for females were: 2.1, 7.3 and zero. The distribution of cases and deaths (figures in parentheses) by Wards in the three years is given below. Measles: Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. Borough. West. East. 1923 58 81 36(1) 67 81(2) 21 23 29 396(3) 1917 552(16) 997(28) 590(10) 654(13) 774(46) 210(1) 190(1) 278(1) 4,245(116) 1921 35(1) 68 31(1) 13 32(1) 9 8 9 205(3) Of the 396 cases of measles, 86 (21.7 per cent.) were removed to hospital, as compared with 2.8 per cent. in 1917 and 4.3 in 1921. The mortality rates last year were 0.02 per 1,000 persons, 0.02 per 1,000 males, and 0.01 per 1,000 females of all ages. Whooping Cough.—This disease is not on the schedule for notification, but the Department has kept records of known cases, after diligent search for the same, for over 20 years. The material available is not free from suspicion that while the search, having been more successful during recent years, has resulted in, what may be called, a spurious increase in the number of cases, the records of fatal cases have been approximately accurate throughout the period. Fatality rates, based on such data, will give an impression that the fatality of the disease has declined in recent years. The records do show a lower fatality, but, as will appear presently, the differences are so remarkable that they can scarcely be put down to the source of error indicated. It is permissible to assume that some part, at least, of the diminution has been due to the activities of the Department. Last year the Department noted 1,018 attacks, an average of 19.4 per week for the whole year, the highest figure since 1914, to go no further back. Prior to last year the highest weekly average noted was 13.5 in 1918 (705 cases), and the lowest 3.2 in 1919 (170 cases). Those years have, therefore, been selected for comparison with last year. The final scrutiny of the year's records reduced the cases to 1,013, 484 in males and 529 in females. Similarly the corrected figures for 1918 were: Total cases 691, males 313, females 378; and those for 1919 : Total 160, males 81, females 79. The appended statement shows the differences in the numbers in each sex-age group, the numbers of fatal cases being shown in parentheses. Whooping Cough : Borough. 1923. 1918. 1919. M. F. M. F. M. F. 0-3 202(8) 208(13) 102(19) 114(27) 20(1) 18 3-15 281(1) 319(2) 211(3) 254(5) 61 60 15- 1 2 – – – 1 All ages 484(9) 529(15) 313(22) 378(32) 81(1) 79 The fatality rates last year were (at all ages): Total 2.36, males 1.85, females 2.83, which contrast very favourably with the rates for 1918, viz.: Total 7.81, males 7.02, females 8.46. The rates for 1919, on the other hand, were notably below those quoted, viz.: Total 0.62, males 1.23, females zero. At ages under 3 the rates were: 1923, Males, 3.9, females 6.2; 1918, Males 18.6, females 23.6; 1919, Males 5, females zero. The greatest fatility is among infants under one year old, which rates show striking variations in the three years. In 1923 the rates were: Males 10.1, females 19.6; in 1918, Males 38.8, females 28.5; and in 1919, males 16.6 and females zero. The disparity between the fatalities in the two sexes is remarkable. While no explanation can be put forward to account for the very great differences in the fatalities of 1923 and 1918, it may be observed that in the former year rather more than 40 per cent. of the attacks were reported in the second and third quarters of the year, as compared with over 50 per cent. in 1918. On a priori grounds it might be expected that the quarters mentioned would, as regards weather, be more favourable than the first quarter during which over 55 per cent. of the attacks were reported in 1923 as compared with 44 in 1918. In 1919 over 78 per cent. of the attacks were reported during the second half of the year—30 during the third quarter and 48-2 during the fourth. The following table shows how the cases and deaths were distributed among the Wards, and indicates the variations in the fatalities observed in the different Wards in each of the three years. The differences in the fatalities recorded in 1923 and 1918 can only be described as remarkable. / DISEASES OF CHILDHOOD. 29 Whooping Cough : Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. Borough. West. East. 1923 126(3) 290(2) 109(4) 173(8) 233(6) 16(1) 13 53 1,013(24) 1918 154(7) 204(11) 56(9) 65(7) 150(17) 14 5 43(3) 691(54) 1919 3 46 18 12 48 1 22 10(1) 160(1) Last year 53 cases were admitted to hospital, or 5.2 per cent. of the total. In 1918 5.8 per cent. were admitted, and in 1919, 2.5. The mortality rates for the year were: Persons, 0.16 per 1,000, males 0.14 and females 0.17. Diarrhœa.—The deaths of 21 infants (males, 12; females 9) were assigned to "diarrhœa and enteritis," giving mortality rates per 1,000 births registered of—Persons, 8-01; males, 8.90; females, 7.07. The 21 deaths included 16 at ages under one year (8 of each sex) and 5 at ages 1-2 years (males, 4; female, 1). The mortality rates under one year per 1,000 births were—Persons, 6.1; males, 5.9; females, 6.2, and those at ages 1-2 years, per 1,000 survivors, aged 1-2—Persons, 1.9; males, 3.1; females, 0.7. Last year's total of 21 deaths compares favourably with the annual average of 46 for the years 1918-22. The differences are shown more markedly by comparing the mortality rates calculated on the numbers living at ages 0-2. For 1918-22 the mean rates were—Persons, 9.2; males 10.6; females, 7.8; and those for 1923—Persons, 3.7; males, 45; females, 3.5. The comparison is to some extent vitiated by the fact that the summer of 1921—"diarrhoea" in infants is generally held to be a summer disease—was a particularly hot one. To obviate that objection comparison may be made between the mean rates for 1909-13 and 1919-23, both of which periods include summers of exceptional characters. The mean rates—calculated on the estimated numbers living at ages 0-2 years—were for 1909-13— Persons, 12.5; males, 12.7; females, 12.3; those for 1919-23—Persons, 8.8; males, 10.1; females, 7.4. The 21 deaths in 1923 were confined to the five northern Wards of the Borough. The subjoined statement compares the records of last year with the annual average for 1918-22:— Diarrhœa Deaths: 0-2 Years. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate. East. Hyde Park. 1923 5 5 1 3 7 — — — 1918-22 4 7 4 11 15 1 2 3 Of the 21 deaths 19 took place in institutions, including 14 in the Paddington Hospital, and 2 in the Infants' Hospital. The reduction in the mortality of children from diarrhceal diseases indicated in the preceding paragraphs is not a local phenomenon, as there has been a fall in number of deaths recorded in the whole County. The annual average number of deaths at ages 0-2 years in the County during the decennium 1901-10 was 2,887, that for the decennium 1911-20, 2,209, and that for the three years 1921-23, 1,247. Taking the first average as = 100, the others can be represented as 76 and 43, showing reductions of 24 and 57 per cent. For the third (summer) quarters the averages were—1901-10, 2,031; 1911-20, 1,248; and 1921-23, 591. Putting the first = 100, the others are represented by 61 and 29, showing reductions of 39 and 71 per cent. Those very considerable falls in the numbers of deaths during the summer quarter are in remarkable contrast with the changes in the other quarters of the year. For the first (winter) quarter the annual averages for 1911-20 and 1921-23—taking that for 1901-10 as= 100—were 123 and 106, showing increases of 23 and 6 per cent; those for the second (spring) quarter—1911-20, 99; 1921-23, 71, showing reductions of 1 and 19 per cent.; and those for the fourth (autumn)—1911-20, 113; 1921-23, 67, showing an increase of 13 and a decrease of 33 per cent. The variations in the directions of the changes indicated in the preceding paragraph point to alterations in the seasonal incidents of the diarrhceal diseases. As already stated, diarrhœal disease in young children has been held to be a disease peculiar to the summer quarter, and specially prevalent in hot summers. Considering the second point first, in the hot summer of 1911 there were 97 deaths in the Borough, the total for the whole year being 135. That year nearly 72 per cent. of the deaths occurred in the summer quarter. During 1921, again a phenomenally hot summer, there were 85 deaths, of which 36 (42.3 per cent.) occurred during the summer quarter. The percentages of deaths in the four quarters of those two years and in 1923 are set out below. Quarter 1st 2nd 3rd 4 th 1911 5.9 7.4 71.8 14.8 1921 16.4 17.6 42.3 23.5 1923 19.0 14.3 14.3 52.4 30 DISEASES OF CHILDHOOD. It is evident that the seasonal distributions in 1921 and 1923 were not the same as in 1911. There is evidence that the change has been a progressive one. Below a comparison is made between the annual average percentage seasonal distributions during 1909-13 and 1919-23. Paddington. Quarter 1st 2nd 3rd 4th 1909-13 8.3 11.1 51.4 29.1 1919-23 19.5 19.5 32.6 28.2 The shifting of the seasonal incidence is very clearly indicated by comparing the percentage distributions for the decennia 1901-10, and 1911-20 with those for 1921-23, in the whole County. County of London. Quarter 1st 2nd 3rd 4th 1901-10 6.3 6.9 70.3 16.3 1911-20 10.2 9.0 56.4 24.2 1921-23 15.7 11.4 47.4 25.2 Reverting to what has been written of the changes in the average numbers of deaths in the whole County, while the index numbers of the averages for the whole year are— 1901-10 100 1911-20 76 1921-23 43 those for the third (summer) quarter— 1901-10 100 1911-20 61 1921-23 29 and those for the other three quarters are— 1901-10 100 1911-20 112 1921-23 77 In effect, the greater part of the reduction in the number of deaths from the diarrhœal disease in young children observed in recent years has been due to the lessened prevalence of the disease in the third or summer quarter rather than to a reduction distributed with any uniformity throughout the year. In other words, infantile diarrhcea, which used to be a summer disease, is now more a cold weather disease. Why ? The usual routine of the Department as to obtaining information of cases of diarrhcea treated at institutions and as to fly counts, was carried out last year, but consideration of the data collected must be reserved for another occasion. Chickenpox.—This disease has been on the list of diseases to be notified for short periods on several occasions, at times when smallpox has been, or has threatened to be, prevalent. Such addition has been one of emergency, to meet the difficulty of diagnosis of the two diseases, chickenpox being frequently confused with disastrous results if smallpox be diagnosed as chickenpox. In 1922 the Council added the disease permanently to the list. Last year 753 cases were known to the Department, of which number 465 were formally notified. The maximum number of cases known in any year since 1914 was 813 in 1918, and the minimum 253 in 1921. Looking at the numbers recorded in Table 3 it will be seen that this disease is apparently always prevalent in the Borough, the average annual number for the years 1918-22 having been 487. Except for its resemblance to smallpox, this disease has little interest from a public health point of view. The distribution of the rash on the body of the patient is the best guide to a distinction between the two diseases. Death from chickenpox is exceedingly rare and, as a rule, the disturbance to the patient's health is slight. Mumps.—Last year 96 cases of this disease were known, 5 more than in 1922. During 1917-21 (See Table 3) there were, on the average, 336 cases each year, with a maximum of 680 in 1918, numbers which contrast remarkably with the totals for 1922 (91) and 1923 (96). Ringworm.—This affection of the skin has decreased notably during the last three years. During 1917-21 the annual average number of cases was 149 (See Table 3), whereas in 1922 99 cases were known and last year only 45. ADMINISTRATION. 31 ADMINISTRATION. GENERAL. Staff of the Department.—The appointment of Mr. Binns as District Sanitary Inspector was terminated on December 2nd last owing to incapacity due to an accident in the the execution of his duty, such incapacity dating from April 4th. Mr. R. A. Jones, who was engaged on June 11th as a temporary Inspector to take charge of Mr. Binns' District, was appointed to the Permanent Staff in January, 1924. (See also p. 62.) Prevention of Infectious Disease.—(Table 17.)—The visits of inquiry after notification of infectious disease numbered 7,486 last year, as compared with 9,789 in 1922 and 6,835 in 1921. There were in addition 2,223 visits in connection with tuberculosis by the Officers of the Department, supplementary to the visits by the Tuberculosis Nurses to which reference has been made in the earlier pages of this Report. Last year 928 patients were removed to hospitals and other institutions for various diseases, other than tuberculosis. The Staff of the Paddington and St. Marylebone District Nursing Association had charge (in the patients' homes) of 19 patients referred to the Association by the Department under the Agreement with the Council which has been current since 1916. The figure just mentioned gives the number officially referred by the Department to the Association. Many practitioners send in the Nurses without reference to the Department, and the Nurses do much work (of which the Department has no numerical record) in connection with the Tuberculosis Dispensaries. In 1922, 129 patients were referred to the Association for the following diseases: Measles, 103; pneumonia, 18; whooping cough and ophthalmia neonatorum, 4 each. Last year the 19 cases so referred comprised: Measles 2; pneumonia, 10; whooping cough, 6 ; ophthalmia, 1. Disinfection.—(Table 17.)—In consequence of the lessened prevalence of all forms of infectious disease, except whooping cough, the number of rooms requiring disinfection fell from 4,061 in 1922 to 2,275, 238 after tuberculosis (216 in 1922), and 2,037 (3,845 in 1922) after all other diseases. Similarly the weight of bedding, etc., removed for disinfection and cleansing fell from 36 tons in 1922 to just over 21 tons last year. The cost of this work during the past year was £904, as compared with £1,484 in 1922. Fifty-three library books were disinfected during the year. In October last Messrs. Armfield & Sons, Ltd., intimated that they wished to give up the work of disinfection for the Borough which they had carried out on behalf of the late Vestry and of the Council for over 50 years. For many years Paddington has been the only district in London, and probably in the country, to entrust the work of disinfection and cleansing of infected goods to a private firm. On receiving Messrs. Armfields' notice to terminate the contract proposals were made to the Council of the Royal Borough of Kensington for the use of plant provided by that Council. On December 18th last the Council of this Borough resolved to enter into an Agreement with the Council of Kensington whereby the latter Council would do all necessary disinfection at their Station in Wood Lane for an experimental period of one year, beginning on April 1st of this year. The Council of this Borough will provide the necessary transport to and from the Kensington Station. Bacteriological Examinations.—The number of specimens sent to the Lister Institute increased from 766 in 1922 to 881 last year, the annual average for 1918-22 being 880. The specimens comprised 533 "swabs" for diphtheria, of which 79 (14.8 per cent.) were found to be positive, 5 of blood for enteric tests, of which 1 (20 per cent.) was found positive, and 343 of sputum from suspected cases of tuberculosis, of which 67 (19.5 per cent.) were positive. In 1922 no specimens of blood were submitted, the positive tests for diphtheria forming 18.1 per cent. of the swabs submitted, and those of sputum 17.5. The proportion of positive results in each test appears to be fairly constant, the means for 1918-22 being : Swabs, 14.2 per cent.; bloods, 21.4; and sputa, 17.7. In February of last year proposals were put forward for the establishment of a central (municipal) laboratory for the County. The proposals emanated from the Holborn Borough Council, but after a circular letter from the Metropolitan Boroughs' Standing Joint Committee seeking the opinion of the Council of this Borough had been dealt with no more was heard of the scheme. Schools.—The "Exclusion Notices" sent out by the Department fell from 5,674 in 1922 to 3,309 last year, and the reports relating to cases in outlying schools, sent to the Medical Officers of Health of the Districts concerned, from 549 to 258. The tables showing the distribution of sickness by schools have been prepared as usual but are not included in this Report. House Sanitation.—Summaries of the work of the Inspectors, other than that in connection with tenement houses, during the years 1918-23 will be found in Table 18. The general impression of 32 ADMINISTRATION. the work of the past year is that while something has been accomplished towards clearing off the arrears of improvements which accumulated during the war, much more remains to be done. It is still very difficult to secure prompt compliance with notices, and undoubtedly the cost of the works called for is still too high. House Drainage.—The appended statement of work done requires no explanation. Annual Average 1914-18 1919 1920 1921 1922 1923 Existing drains tested and found watertight 93 71 89 88 82 63 Drains reconstructed 93 68 90 87 110 135 „ made sound by " process " 27 21 17 8 19 12 There can be no doubt about the increasing necessity for the reconstruction of house drains, a number of which were laid many years ago when the principles of drain construction were not fully understood and official supervision less complete. The check upon this class of work which has been imposed by the aftermath of the war is indicated by comparing the total number of reconstructions reported during 1911-14 with that for the years 1920-23. In the former years the total was 800 and in the latter 322. Soilpipes—On 27th March, 1923, the Public Health Committee recommended the Council (and the Council so agreed) to ask the County Council to amend the Bye-law under Sec. 202 of the Metropolis Management Act, 1855, so as to provide for the use of iron soiipipes within as well as outside a building, such provision to be in the form of an alternative, not exclusive. In November last the County Council wrote to say that the Bye-law had been amended as desired, and the amended Byelaw became operative on 2nd January, 1924. Reconstruction Plans.—The plans deposited during the year increased from 274 in 1922 to 337 last year. There has been a continuous increase in the number received each year since the end of 1918, but the annual total has not yet reached the level of pre-war years. During 1912-14, 1,008 plans were deposited as compared with 819 during 1921-23. In connection with this part of the work of the Department 833 letters were sent out during the year, 169 more than in 1922. Some evidence of the difficulties experienced in these days by the Department in carrying on its work is afforded by comparing pre-war and post-war experiences. During 1912-14, 2,085 letters were sent, a total differing but little from the total (2,028) for 1921-23, but in the latter period the plans were 189 fewer. Three summonses were taken out for failure to supply plans during the past year. Combined Drainage.—Orders were made during the year under Section 74 of the Metropolis Management Act, 1855, with respect to new drainage systems to which the following groups of houses were to be connected:— Ashworth Road, Nos. 1 to 15 (odd) Biddulph Road, Nos. 10 and 12 Cambridge Street, Nos. 34, 35 and 35a Chilworth Mews, Nos 14 to 28 (even) Conduit Mews, No. 7 and Spring Street, No. 12 Harrow Road, Nos. 484-488 (even) Harrow Road, Nos. 507-511 (odd) Maida Vale, No. 133 and Garage in rear Porchester Terrace, Nos. 37 and 37a Porchester Terrace, Church House (in rear of No. 36) and Garage (in rear of No. 38a) Queen's Gardens, Nos. 21 to 24 (consecutive) The old combined drain serving No. 22a, Market Street, Nos. 1-4, Junction Place and No. 59, Praed Street, for which no order or approval could be found, was accepted by the owners of the properties as a private drain and reconstructed by them during the year. The Council recognised as sewers and reconstructed combined systems serving— Andover Place, Nos. 13 and 15 Warwick Avenue, Nos. 61 and 63 When a system of combined drainage is found, a letter is addressed to the owners of the properties connected to such system pointing out the rights which will be vested in the Council if such system be taken over as a sewer, and the difficulty which may accrue when re-development of the site is undertaken. It is hoped that such procedure—first adopted last year— will result in owners accepting their liabilities for the maintenance of combined drains, as undoubtedly was the intention of the Legislature. In October last the County Council announced their intention to include in their General Powers Bill of 1924 a clause to extend the protection against liability for the maintenance of unauthorised combined drains, secured by the Woolwich Borough Council by their Act of 1905, to all Metropolitan City and Borough Councils. Sewer Connections.—Last year 110 were reconstructed, either partially or wholly, 49 after Orders under Section 85 of the Metropolis Local Management Act, 1855, and 61 on the initiative of the owners of the properties concerned. In 1922 the figures were : Constructed under Orders, 29; voluntarily, 34. Dead Drains.—In 1922 the County Council decided to promote legislation to penalise the abandonment of drains without securely sealing off such drains from the sewer. The decision was not acted ADMINISTRATION. 33 upon, and in October last a letter was received from the County Council asking for the views on the matter of the Borough Council. A good many dead drains are found and dealt with by the Council, the Works Department sealing off such drains as soon as their non-use has been verified by joint inspection above and below ground by the Sanitary Inspectors and the Sewer Flushers. When an existing (working) drain is given up, the Inspector secures proper sealing off of the sewer eye and filling up or destruction of the drain to the sewer eye. Having regard to the experience of this Department it is difficult to understand how any necessity for special legislation arises. Water Supply.—Certificates under Section 48 of the Public Health (London) Act, 1891, were issued during the year with respect to 11 premises, 4 more than the numbers recorded in each of the years 1921 and 1922. In 3 instances the certificates were issued with respect to reconstructed premises, and in the remaining 8 with respect to new buildings among which were St. Luke's Hospital, Hereford Road and "Clive Court" (part of only), the latter being the biggest building erected in the Borough since the war. The Metropolitan Water Board reported discontinuance of water supply to 12 premises (13 in 1922), 10 in consequence of non-payment of water rate, and 2 on account of defective fittings. In 3 instances the premises were found on inspection to be unoccupied, and with respect to the others, 7 notices for restoration of the supply and 1 summons were required. Mortuary.—There was a slight increase in the number of bodies received at the Mortuary last year, the total being 268, as compared with 258 in 1922. The number received for inquest purposes was a little lower (185-199 in 1922), and a fairly large increase in the number of non-infectious bodies deposited pending burial (83-59 in 1922). An increase in such practice is to be welcomed, having regard to the growing proportion of the population living in flats and made-down houses. Trade Nuisances.—Offensive Smells.—The complaints received relating to smells were only 10 in number, but there was an increase in the number of complaints relating to accumulations of manure from 9 in 1922 to 26 last year. Emission of Dust.—The apparatus provided by the occupiers to prevent the escape of dust and feathers from a bedding factory and of powder from a soap-powder factory have remained in use throughout the year with satisfactory results, except for some trifling defects which were quickly remedied. Offensive Trades.—Bye-laws regulating the businesses of rag and bone dealers were adopted by the County Council in May last, and duly confirmed by the Minister of Health and Secretary of State in September. The Bye-law relating to the structure of premises occupied for trade purposes cannot be fully enforced until September, 1924. Smoke Nuisance.—Twenty-one premises were kept under observation for the detection of black smoke. Those premises were watched on 356 occasions covering 185 hours. Smoke of all descriptions was noted during 62 hours, but the duration of "black" smoke was only 3½ hours. The duration of black smoke, as observed, was equivalent to 2.1 hours in every 100 hours of observation. That proportion is the lowest recorded since 1918, the proportion varying during the five years from 6.6 to 3.6. Nine complaints relating to the emission of smoke were received during the year, 3 arising from factories, 2 each from motor works and club premises, and 1 each from a zinc workshop and a restaurant. The complaints did not in every instance relate to black smoke, the only form of smoke with which the Department can deal. Extension of the provisions relating to smoke, so as to permit of the control of all shades of smoke, is much to be desired and long overdue. Effect has not yet been given to the recommendations contained in the Report (December, 1921) of the Departmental Committee of which Lord Newton, P.C., was Chairman. It is to be hoped, however, that the recommendation to transfer the duty of smoke supervision from the Borough Councils to the County Council will not be put into effect. The detection of smoke offences appears to be essentially a matter with which the officers of the authority controlling the district in which such offences occur are best capable of discharging. In one instance a notice under Sec. 24 of the Public Health (London) Act, 1891, was issued, but proceedings were not required. Canals: Canal Boats.—At the Easter clean-up of the Paddington Basin 414 tons of mud were removed, 637 square yards of concrete put down, 65 cubic feet of brickwork renewed, and 50 square yards re-pointed. In the Annual Report of the Examining Officer, presented to the Council in January last, it was recorded that there had been no case of infectious disease among the boat population during 1923, and only 3 deaths, 1 from drowning (f., aet. 6) and 2 from tuberculosis (m., æt. 41, pulmonary; f., aet. 1, other form). 34 ADMINISTRATION—WELFARE WORK. Although there are 241 boats on the Register, 9 being added during the year, only 128 can be actually accounted for. Several boats are known to have been dismantled, but there have been no applications to remove them from the Register. On the 102 boats inspected during the year 111 children were found, of whom 70 were of school age. In May last the Minister of Health forwarded to the Council a Memorandum calling attention to the Order made by him in July, 1922, under Sec. 10 of the Canal Boats Act, 1882, under which the Canal Boats Acts of 1877 and 1884 are to apply to vessels which, although to all intents and purposes are "canal boats," have been by recent custom registered as "ships," thereby escaping the supervision, etc., prescribed by the Canal Boats Acts. Such vessels are in future to be registered as canal boats. WELFARE WORK. Ante-Natal.—In addition to the Clinics held weekly at St. Mary's Hospital and by the School for Mothers, an unknown number of expectant mothers attend Clinics at Queen Charlotte's Hospital, Middlesex Hospital and elsewhere. At the St. Mary's Hospital Clinic 320 expectant mothers were seen during the past year, and at that of the School for Mothers 297, making a total of 617 for the two Clinics. It has been impossible to obtain any returns for other Clinics. There appears, however, to be no doubt that a considerable proportion of all expectant mothers who cannot afford paid medical advice attend at the various Clinics. The Health Visitors made 657 visits to expectant mothers, and the Visitors attached to the School for Mothers 545. Requests for visits from Clinics at outlying hospitals are frequent. Post-Natal (Health) Visiting.—The Council's Health Visitors have been instructed that the first visit to the mothers of new-born infants is not to be made, as a rule, before the tenth day following labour, by which day the doctor or midwife may be expected to have ceased attendance. So early a visit implies that the birth has been duly notified, otherwise the visit will be delayed until information of the birth is received—it may be as late as the sixth or seventh week when report of the registration of the birth comes to hand. Last year the Health Visitors made "first calls" to 1,752 infants, as compared with 1,883 in 1922 —the fall in the number naturally following the reduction in the number of children born. Of those first visits, 1,412 (rather more than 80 per cent.) were made during the four weeks following the births of the infants. When first visited, 1,610 infants (91.9 per cent.) were being fed at the breast, 62 (3.5 per cent.) were on artificial foods only, and 80 (4.6 per cent.) on a mixed diet of breast and artificial foods. Of the infants visited during the first four weeks of their lives just on 95 per cent. were breast fed, and of those visited at later dates, 80. Of the 1,752 infants visited for the first time, 37 died before the end of 1923, 17 of the deaths taking place in institutions. The 37 deaths were equivalent to a mortality of 21 per 1,000 births, the rate for breast-fed infants being 18, that for infants on a mixed diet 25, and that for those artificially fed 97. After the visit or visits by the Health Visitor, the "Birth Card" is passed to the Paddington School for Mothers, under whose care the infant or child remains until school attendance begins. Neglecting ineffective calls ("out," "gone away"), the Staff of the School made 22,242 visits to the homes of infants, the infants being seen on 13,575 occasions. These figures refer to all infants and children under the care of the School and not to infants born during 1923 only. The School maintains six Consultation Centres (see p. 62) at which eight sessions are held during the week (Saturday being the only day without a session). A Medical Officer attends at each session. During the year 14,702 attendances at the consultations were made by 7,589 infants and children, 2,042 attendances being made by infants (children) over 18 months old. The returns made by the School do not show the numbers of attendances made by individual infants and children. On 7,284 occasions the infants were seen by the Medical Officers. Among the children under the care of the School there were 52 deaths during the year, 29 at ages under 1 year and 23 at ages 1 to 5 years. Respiratory diseases caused 25 of the deaths, and diarrhceal diseases 9. In addition to the infants who attended the Consultation Centres maintained by the School, an unknown number attended consultations at Queen Charlotte's Lying-in Hospital and others in the adjacent districts. The sales of dried milks of various brands at the School Centres realised £1,228 odd, and the sales to infants in receipt of relief £14 odd. The cost of the dried milks purchased by the Council during the year was just over £1,238. Grants of Milk and Dinners.—The Grants Sub-Committee of the Maternity and Child Welfare Committee considered 230 new and 290 renewed applications during the year. Of the new applications, 104 were refused, either as beyond the scale laid down or because the circumstances of the families could only be dealt with adequately by the Poor Law. The orders issued numbered 532-483 HOUSING. 35 for milk (453 free, 30 half price), 42 for dried milks (41 free, 1 half price), and 7 for dinners (all free). The total amount of milk supplied was 3,626 quarts (3,384 free), and the cost thereof £99. The dinners (84) cost £5 5s., and the dried milks £8 13s. Admissions to Institutions.—Three women were in St. Mary Magdalene's Home at the end of 1922, and 1 was admitted during 1923. The Council contribution towards the maintenance of the four women was £11 5s. 0d. No applications were received last year for grants to assist mothers and/or infants to enter convalescent or other homes. Day Nurseries.—The Paddington Nursery was obliged to vacate No. 1 Porchester Houses in March last. Between January 1st and the date of closure the Nursery received children on 64 days, 1,485 attendances being recorded. The children attending for the first time numbered 15. At the beginning of November the Nursery was re-opened at No. 13, Hasborough Street, a very much smaller house. In the last two months of the year 14 new children were admitted, the total attendances being 234 on 39 days. The Queen's Park Nursery was open on 279 days, the attendances numbering 4,863. Twentyseven new children were received during the year. During January to March there were 5 cases of whooping cough among the children attending the Paddington Day Nursery. Among the children attending the Queen's Park Nursery there were 16 cases of chicken pox, 4 cases of scarlet fever, and 1 of whooping cough. Neither Nursery was closed on any day on account of infectious disease. HOUSING. General.—Work under the Housing Acts and the provisions of the Public Health (London) Act relating to housing, rather than nuisances as generally understood, can only be described as disheartening, if not heartbreaking. Condemnation of houses unfit for habitation is impossible owing to the lack of accommodation for the persons who would be displaced by such condemnation. The hopes of being able to compel owners to put their houses into proper repair, which were entertained after the passing of the Housing Act of 1919, have been found to be illusory. The Council have undertaken during the past three years repairs which owners should have carried out, but, owing to the recent judgments given in the Higher Courts it is impossible to advise the Council to undertake further work. It is very doubtful whether the provisions of Section 10 of the Housing Act of last year will straighten out the legal tangle attaching to work under Section 28 of the Act of 1919. It has to be noted that there is no provision for legal proceedings to enforce compliance with Notices under the latter Section. If the work called for be not done, the Council have, practically, no alternative but to do the work themselves. Conversions.—Plans under Section 202 of the Metropolis Management Act, 1855, relating to the conversion of 46 houses (into 145 "flats") were received during the year, the same number as in 1922. Unless the conversion involves alterations to the drainage and/or sanitary fittings, the Department receives no intimation of such conversion. The jurisdiction of the District Surveyor appears to be very limited. It is, therefore, very probable that the 46 houses mentioned represent only a fraction of the total number of houses, originally built to be occupied by one family, which were " converted " during the year for occupation by two or more families. The possibilities of profit attaching to conversions are illustrated by an instance which has come to the knowledge of the Department. The house, containing five floors and a basement, is rated at £138 per annum. The two top floors have been cut off from the rest of the house and let to the occupier of the next house, communication having been made through the party wall with the sanction of the County Council. The basement, ground, first and second floors are let as five "flats," two being in the basement. The gross rentals obtained by the various sub-lettings amount to £592 per annum. In June last an application was made to the County Court under Section 27 of the Housing Act, 1919, for release from restrictive covenants prohibiting the conversion of No. 6, Porchester Gate. The Court made the necessary Order with a condition that the plans for the conversoin were to be approved by the Local Authority, i.e., the Borough Council. That was the second successful case under that Section in the Borough. The two converted houses owned by the Council have been fully occupied during the year, one of them, that in Warrington Crescent, involving no charge on the rates. Compulsory Repairs.—Two notices only were served during the year under Section 28 of the Act of 1919. At one house the required works were completed before the end of the year. As regards the other house, the Housing Committee had not decided what further steps should be taken at the close of the year. The Council executed repairs at one house, called for by notice served in 1922, and the owner has entered into an agreement to repay the cost of such repairs by instalments spread over six years. 36 HOUSING. The case stated by the Minister of Health after the inquiry held in December, 1922, had not been heard at the end of the year. Houses Unfit for Habitation.—No representations were made to the Council under Section 17 of the Act of 1909 during the year, but that cannot be taken to imply that there were no houses which ought not to have been represented. The reasons for not taking action in this direction have been sufficiently stated in the preceding paragraphs. Underground Rooms.—One Order was made during the year under Section 17 of the Act of 1909 with reference to an underground room used as a sleeping place in contravention of the Regulations made by the Council under Sub-section 7 of that Section. The beds were removed from the room. One basement was dealt with under Section 96 of the Public Health (London) Act, 1891, as being totally unfit for habitation. Its use as such was given up before the end of the year. Tenement Houses.—Section 26 of the Housing Act, 1919, authorises the County Council to frame bye-laws for the registration and supervision of houses let in lodgings or occupied by members of more than one family ("Tenement Houses"). Bye-laws were drafted by that Council in 1920, and submitted to the Borough Council for their comments. The draft was later on submitted to the Minister of Health for confirmation, but so far such confirmation has not been given. When the byelaws under Section 26 are made and confirmed, the bye-laws made by the Borough Council will be repealed. The latter bye-laws can only be described as out of date, and it is much to be hoped that the new series under Section 26 will be issued without further delay. They are much needed. Pending the issue of the bye-laws referred to above, no steps have been taken to add any houses to the Register, which contains some 1,400 houses. The inspections of those houses during the year numbered 6,220, including those in connection with the Annual Cleansing, the value of which it would be difficult to over-estimate. The defects, nuisances and infringements of the bye-laws dealt with are set out in Table 19. It will be noticed that the number of dirty rooms increased from 1,638 in 1922 to 3,202 last year, and that the number of "Other defects or nuisances" increased from 1,531 to 2,494. The increase under the latter head is due to the practice, initiated in 1922, of sending letters to landlords after the inspections for the Annual Cleansing directing their attention to defects which cannot be dealt with under the bye-laws or under the Public Health Act. Overcrowding.—For reasons already explained, action is rarely taken with reference to overcrowding unless very much aggravated. Last year only 4 tenements were so reported. Annual Cleansing.—The selection of streets for special inspection in connection with this work was continued last year. Such selection is probably the explanation of the increase in the number of rooms reported to be dirty. Last year 793 out of the 1,400 houses were specially inspected. The delays made in complying with the Notices under the Bye-laws involve a reduction in the number of houses inspected, to which work two Inspectors give their whole time. Common Lodging Houses.—There are 5 houses in Kilburn Lane accommodating 128 men and 37 women. These houses are inspected once a year by the Department on receipt of the Notices of Intention to Apply for Licences. Routine inspection is carried out by the officers of the County Council. No case of infectious disease was reported among the occupants of these houses during the year, and only 2 deaths (one each from influenza and cancer). Inland Revenue Act, 1903.—Applications for Certificates necessary for exemption from, or reduction of, the Inhabited House Duty, were received (and granted after inspection by the Medical Officer of Health) with respect to 54 flats in Clive Court, Maida Vale, and 3 at No. 166, Portnall Road. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-23.—Twenty-eight (28) applications were received during the year as compared with 33 in 1922. Certificates were issued with respect to 23 of the premises, after inspection by the Medical Officer of Health, 2 were refused, and 3 were held over. One certificate was issued under Section 5 (2) of the Act of 1923 after the work called for in the original certificate had been carried out. The Act of 1923 has made the issue of certificates somewhat laborious in that the works to be executed have to be set out in detail in addition to the statement of the defects rendering the premises otherwise than in all respects reasonably fit for human habitation. L.C.C. Houses.—Appeals for help to obtain accommodation in houses erected by the County Council continue to be received. In 7 instances communications in support of applications were addressed to the Housing Department of the Council. In 2 instances the Housing Department refused the original application, in 2 others the accommodation offered was refused by the applicants, and in the remaining 3 the applications were abandoned. Perhaps more success may be expected as the County Council has resumed building, although the principal building site is very inconveniently situated with reference to the Borough. WORKSHOPS. 37 Homeless Persons.—Each winter (at the end of January or beginning of February) the Officers of the County Council take a night census of persons found in the streets. At the census of January, 1904, 168 persons (100 males, 68 females) were found "on staircases or under arches." At the census of February, 1923, only 4 persons (all females) were found in such places. At the former census the total number of "homeless" persons was 1,797, including 50 "young persons" (males, 1,563; females, 184), "in streets, on staircases and under arches." In 1923 the figures had fallen to 141 persons (no "young persons"), males, 126; females, 15. In addition to the 141 referred to, 13,891 persons were in common lodging houses, 400 in casual wards, and some 500 others in shelters and labour homes not registered as common lodging houses. WORKSHOPS. Registration.—At the end of 1922, 1,152 premises were on the Register of the Department as compared with 1,446 at the end of 1914. Last year 101 premises were removed from the Register and 99 added, making the total at the end of the year 1,150. The shrinkage in the number of premises on the Register, to which attention has been called in recent Reports, still persists. The 1,150 premises comprised 202 factories, including 21 laundries, 582 workshops, 6 "domestic" workshops, 33 workplaces, and 327 premises or rooms occupied by outworkers working single-handed. The total number of persons working in the 1,150 premises was 6,403, compared with 6,239 at the end of 1922, so that although there was a reduction in the number of premises on the Register, there was an increase (approximately 3 per cent.) in the number of workers. The workers included : Women, 2,999; young persons, 328; men (adult males), 3,076. The percentage distribution of the workers was: Women, 46.8; young persons, 5.1; men, 48.0, which may be compared with the following percentage distribution at the end of 1913: Women, 49.3; young persons, 7.4; men, 43.2. The reductions (per cent.) in the actual numbers working in 1923 as compared with 1913 are: Women, 29; young persons, 48 ; men, 17. It is somewhat surprising to find that the shrinkages in the less costly forms of labour have been greater than that in the more costly (men). It might have been expected that, with a view to reduction in cost of production, there would have been a greater (proportional) reduction in the adult males working. The Department reported the opening of 43 workshops to the Home Office, and received from that Office notice of 27, 21 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 42 lists in February, and the like number in August, those lists containing 442 names and addresses, of which 360 belonged, and were sent on, to other districts. From other districts 367 addresses within the Borough were received. As usual, the majority of the lists of addresses were received from the City, Kensington and Westminster. At the end of the year there were 765 outworkers on the Register, comprising: Women, 380; young persons, 117; men, 268, working in 425 workrooms. Trades.—Dressmaking is the business in which the largest number of workers (1,660 women and young persons) were employed, laundries coming next (548 individuals, of whom 59 were men), followed by printing and bookbinding (451 persons, including 137 women and 19 young persons). Supervision.—The inspections for all purposes made during the year numbered 2,309, and 33 rooms (new workshops, etc.) were measured. The Inspector found 38 workrooms in use as bedrooms and 43 without the Abstract of the Factory Acts. The Home Office reported 4 new workshops as having insufficient sanitary accommodation and 4 others in which the ventilation to the water closets was insufficient. In addition 1 other workshop was reported to be in a dirty condition. The Inspector reported that he found 245 nuisances on workshop premises, the majority of which were dealt with on his verbal request. He served 30 notices (28 being "Written Intimations") during the year. Of the 245 nuisances discovered 142 were due to dirty conditions, and 29 to defective sanitary conveniences. On 6 occasions action had to be taken to secure the proper removal of gas fumes from workplaces. Infectious Sickness.—There were 42 cases of infectious disease on premises included in the Workshop Register, 20 of them being outworkers' places, but only 10 cases in the families of the workpeople. The diseases were: Chickenpox, 11 cases; measles, 10; scarlet fever and whooping cough, 8 each; diphtheria, 4; and enteric fever, 1. Bakehouses.—During the year 3 bakehouses (1 "level" and 2 "underground") were re-opened and 1 ("level") closed, the total number on the Register at the end of the year being 67, of which 38 were factory bakehouses. The number of "level" bakehouses was 19 (12 being factories), and of "underground" 48 (26 factory). 38 food supervision. The number of persons working in bakehouses was 322, including 11 women and 26 individuals under the age of 18 years. The bakehouses were inspected on 730 occasions during the year. Duplicate certificates under Section 101 of the Factory and Workshop Act, 1901, were issued with respect to the following underground bakehouses, which were found on inspection to comply with the requirements laid down with respect to underground bakehouses : Edgware Road, No. 401; Herries Street, No. 62; London Street, No. 9; and Norfolk Road, No. 3. FOOD SUPERVISION. Slaughterhouses.—There are 4 slaughterhouses in the Borough, but at one of them very little killing is done. The Food Inspector reported that 1,103 animals were slaughtered during the year, 53 being bullocks and 1,050 sheep. During the five years before the war (1909-13) the number of animals killed within the Borough averaged 4,434 per annum, nearly four times the number recorded last year. In 1922 the total was 2,087, nearly double that of 1923. The Inspector visited the slaughterhouses on 163 occasions. The lungs, liver, heart and mesentery of one bullock were destroyed on account of tuberculosis, and the liver of one sheep on account of parasitic infestation. In March of last year the County Council made a Bye-law under Sec. 19 (4) of the Public Health (London) Act, 1891, prohibiting the slaughter of any animal until it had been stunned " with a mechanically operated instrument sufficient and suitable for the purpose." The Bye-law so far as sheep are concerned was not to become operative until three months after the date of confirmation of the Bye-law by the Minister of Health. The Bye-law is not to affect—"if no unnecessary suffering is inflicted"— slaughtering according to the Jewish ritual of animals intended for food of Jews. The Minister of Health confirmed the Bye-law on December 7th. Food Purveyors.—There were 350 shop premises at which foodstuffs other than milk were sold during the year, 6 premises where fish was cured, and 12 where sausages were made. The Inspector visited these premises 776 times during the year, roughly once each half-year. Milk Trade.—There were on the Register 95 premises for the sale of milk, 3 being wholesalers'. There were 8 changes of proprietorship of retail premises. Only 1 cowshed (3 or 4 cows) now exists in the Borough. All the places where milk is sold are visited at least once a quarter, and each year a reprint of the Bye-laws, etc., regulating the sale of milk is left with each registered milk vendor. There was 1 case of scarlet fever at a milkshop, 11 cases of diphtheria, and 6 of scarlet fever in houses where milk roundsmen working in the Borough resided, and 3 of scarlet fever in houses where roundsmen working in other districts lived. Every precaution was taken in each instance and no untoward consequences have to be reported. Condensed Milk.—Regulations for controlling the quality of condensed milk were made in May last by the Minister of Health under Sec. 8 of the Milk & Dairies (Amendment) Act, 1922, which were to come into operation on October 1st, subsequently postponed to January 1st, 1924. The regulations are to be enforced , as regards sale in this country, by the local authorities and, as regards importation, by the Commissioners of Customs & Excise. The regulations recognise two grades of condensed milk, viz., "full cream" and "skimmed (or machine skimmed)" either of which may be "sweetened" or " unsweetened." " Full, cream " condensed milk must contain not less than 9 per cent. of milk fat and 31 per cent. of milk solids (including fat), while for " skimmed milk " the only standard is one of not less than 20 per cent. (26 per cent. if sweetened) of milk solids, including fat. Four forms of label are prescribed as to size of type, wording, etc. The equivalent (in pints) of the milk (of the same grade as the condensed milk), which can be made from the contents of the tin is to be stated on the label. "Skimmed milks " are to be clearly marked—on the prescribed label—"unfit for babies." Dried Milk.—In November last the " Public Health (Dried Milk) Regulations, 1923," were made by the Minister of Health under Sec. 8 of the Milk & Dairies (Amendment) Act, 1922, to come into operation 1st May, 1924. Under those regulations dried milk may be sold as "Dried Full Cream Milk," containing not less than 26 per cent. of milk fat; "Dried Partly Skimmed Milk (-Cream)," either three-quarter cream, not less than 20 per cent. of fat, or half cream, 14 per cent. of fat, or quarter cream, 8 per cent.; or "Dried Machine-skimmed Milk or Dried Skimmed Milk," for which no standard of percentage of fat is laid down. Packets for retail sale are to indicate the equivalent quantity (in pints) of "full" "partly skimmed" or "skimmed" milk which the contents of such packet represent. The label of packets of "Partly Skimmed Milk" to state that such milk "should not be used for babies except under medical advice," and those of "Skimmed Milk" that such milk is "unfit for babies." If sugar and nothing else has been added in the process of manufacture the word "Sweetened" is to be added to the description of the dried milk; if some constituent of milk, "Modified"; if any other substance, "Compound." The size of type and general make-up of the label to be used for each description of dried milk are prescribed by the regulations. Each label is to include the names and addresses of the manufacturer of the dried milk or (in the case of imported milk) the name and address of the dealer or merchant for whom such milk has been manufactured. SALE OF FOOD & DRUGS ACTS. 39 The percentage of milk fat and milk solids of the various standards of milk which can be made from the different dried milks are set out in the Schedule to the Regulations. " Full milk " so made is to contain not less than 3.6 per cent. of milk fat. Milk (Special Designations).—Orders were made by the Minister of Health under Section 3 of the Milk and Dairies (Amendment) Act, 1922, under dates of December 9th and 18th, 1922, both of which were repealed by an Order made on May 25th, 1923. The Orders prescribed the procedure re licences to sell milk under any of the following designations: "Certified," "Grade A (Tuberculin Tested)," "Grade A," and "Pasteurised," the fees to be paid for such licences and the standards of cleanliness to be maintained in each grade of milk. The limits of the bacterial contents permissible are:— "Certified."—Not more than 30,000 bacteria per cubic centimetre; and no coliform bacillus in one-tenth of a cubic centimetre. "Grade A" (both kinds).—Not more than 200,000 bacteria per cubic centimetre; and no coliform bacillus in one-hundredth of a cubic centimetre. " Pasteurised " (during 1923).—Not more than 50,000 bacteria per cubic centimetre; no coliform bacillus in one-hundredth of a cubic centimetre. (After January 1st, 1924).—Not more than 30,000 bacteria per cubic centimetre; and no coliform bacillus in one-tenth of a cubic centimetre. During the year 33 licences were granted to local traders, 25 for the sale of "Certified" only, and 8 for the sale of "Certified" and "Grade A (Tuberculin Tested)" milks. No licences were issued for the sale of "Pasteurised" milk. One of the conditions attaching to the licence is the right to take samples free of cost. Samples of Certified Milk are examined bacteriologically at the expense of the Minister of Health, those of other grades at the expense of the Council. In March a letter was received from the Ministry of Health stating the number of samples to be taken each month and the names of the producers whose milks were to be sampled. During the year 22 samples were taken and submitted to the Clinical Research Association, Ltd., with whom arrangements had been made for the necessary examinations. Seventeen of the samples were "Certified" milk, 4 "Grade A," and 1 an odd sample. In none of the samples of "Certified" milk was the limit of 30,000 bacteria per cubic centimetre reached, the counts ranging from a minimum of 706 (an August sample) to a maximum of 12,576 (a June sample). In two samples coliform bacilli were found, both being September samples. In one the total bacterial count was 2,760 per c.c. and coliform bacilli were found in one-tenth, one-hundredth and one-thousandth of a cubic centimetre. In the other the bacterial count was 2,450, and coliform bacilli were found in 1 c.c., but not detected in smaller quantities. In the four samples of "Grade A" milk the bacterial counts ranged from 2,200 to 67,900 per c.c., and coliform bacilli were found in 2 samples, in one in one-tenth of a cubic centimetre (September sample), and in the other in one-hundredth of c.c. (August sample). On the whole the results of the examinations may be described as satisfactory, but there was evidently room for improvement as regards cleanliness at certain of the producers' dairies. Ice Cream.—At the end of 1922 there were 125 effective entries on the Register, and last year 35 new entries were made. In addition to the 160 shops of various descriptions at which this commodity is sold there are 15 barrow men, 8 with pitches in the Borough and 7 in other districts. The Inspector made 205 inspections of places where the cream is made or sold. No case of infectious disease occurred on the premises or among the makers and vendors. Food Destroyed.—Excluding the meat dealt with at the time of slaughter, the weight of foodstuffs surrendered for destruction was 10,948 lbs., a slight increase above the total (10,416 lbs.) for the previous year. The foodstuffs dealt with in transit weighed 476 lbs. as compared with 3,584 lbs. in the previous year. SALE OF FOOD AND DRUGS ACTS, 1875-1907. (See Table 20). Samples Taken.—Of the 600 samples purchased or taken during the year, 56 (9.3 per cent.) were reported to be not "of the nature, substance and quality demanded," the same proportion as that recorded in 1922. Of the 56 samples which failed to pass the tests only 11 were adulterated in the ordinary use of the word. The other samples were condemned because they contained preservatives or colouring matters. The adulterated samples last year formed 1.8 per cent. of all samples as compared with 4.8 in 1922. Milk.—If the use of preservatives and colouring matters be excluded, this is the only food commodity in which adulteration was found last year, 11 (4.4 per cent.) of the 246 samples being condemned, as compared with 19 (6.9 per cent.) out of 272 samples taken in 1922. Of the 246 samples 93 were taken on Sundays and Bank Holidays, 2 being found adulterated, and 37 at the G.W.R. (Paddington) Terminus, 8 being adulterated. The last samples are taken at the request of consignees who have had their suspicions aroused by private analyses as to the quality of milk consigned to them. The percentages of adulteration in these two groups of samples were last year 2.1 and 21.6 as 40 sale of food & drugs acts. pared with 1.3 and 26.9 respectively in 1922. The samples obtained from retailers (116) included 1 adulterated, less than 1 per cent. In 1922 no adulterated sample was obtained from this source. Cream.—The 13 samples of cream included 6 of "preserved" cream. In each instance the Regulations as to declaration of the amount of preservative added, and as to the proportion of fat contained, were strictly complied with. Preservatives in Foods.—In February, 1923, a Report by the Medical Officer of Health on the use of preservatives in foodstuffs was presented to the Public Health Committee. The Report was based on the results of inquiries addressed to the Medical Officers of Health of County Boroughs, Administrative Counties and of the Metropolitan Cities and Boroughs. Data as to the numbers of samples taken during 1919-21 found to contain preservatives were received from 109 areas, of which 95 contained information which could be used for the Report. In 18 instances the replies were to the effect that no samples had been taken for the detection of preservatives on account of the great uncertainty attaching to proceedings with respect to samples found to be "preserved." The replies gave not only the number of samples of each commodity found to contain preservatives but the variations in the proportions of preservative contained in such samples. To the Report there was appended a recommendation that the Minister of Health should be asked to exercise the powers vested in him by Sec. 1 of the Public Health (Regulations as to Food) Act, 1907, under which he could issue Regulations either prescribing the nature and quantity of preservative permissible in each class of food or absolutely prohibit the use of preservatives. The Report was submitted by the Committee to the Council with a recommendation following that set out in the preceding paragraph and a second recommendation that the Report should be circulated to the Councils of Administrative Counties, County Boroughs and Metropolitan Cities and Boroughs, and that such Councils should be asked to support the application to the Minister of Health. The Committee's recommendations came before the Council on 27th February, but were referred back. They were re-submitted on 27th March and adopted. The Report was freely quoted in the papers, and during the ensuing months 70 replies endorsing the Council's resolution were received from the Councils to whom the Report was circulated. In reply to a question in the House in May, the Minister of Health stated that a Committee was to be appointed to enquire into the subject of the use of preservatives and colouring matters in foods. The Committee was appointed during July, the reference being in the following terms:— To enquire into the use of preservatives and colouring matters in food and to report— (1) Whether the use of such materials or any of them for the preservation and colouring of food is injurious to health ; and, if so, in what quantities does their use become injurious ; and (2) Whether it should be required that the presence of such materials and the quantities present in food offered or exposed for sale should be declared. The Committee did not begin taking evidence until the autumn. The Medical Officer of Health attended for that purpose on November 2nd. Arsenic in Borax.—A sample of commercial borax was found to contain 1½ arts per million of oxide of arsenic (As2O3. The attention of the wholesale vendor was called to the fact, who in turn communicated with the maker's agents. The latter submitted a sample—obtained from the retailer from whom the original sample was purchased—to the City Analyst of Liverpool, who confirmed the presence of arsenic but disagreed as to the proportion present. The makers expressed themselves as unable to explain why " the arsenic test in this case came above what it should be, their own chemist certified it (sic) in conformity with the Pharmacopoeia," the prescribed limit being one of less than 5 parts per million. Steps were being taken to prevent a similar occurrence. RATS AND MICE (DESTRUCTION) ACT, 1919. Complaints of infestation by rats and mice numbered 75 last year, as compared with 106 in 1922, and 59 in 1921. In 2 instances the complaints referred to mice and of the 73 relating to rats 6 were found to relate to "strays" only, and action by the Department was deemed to be unnecessary. In all other instances the drains, including the portions extending from the curtilages of the houses to the sewers, were examined. Similar inspections were made of the houses immediately adjacent to the house whence the complaint came. In 50 instances repair or reconstruction of the "sewer connections" were found to be necessary, and at 18 houses the drains within the curtilages of the houses had to be reconstructed. Two notices under the Act were served during the year. Rat Week.—The Minister of Agriculture and Fisheries fixed the week ending November 11th for the annual intensive campaign. The procedure adopted was that described in previous Reports. At the end of the week the Borough Engineer and Surveyor reported that baits had been laid at 477 places in the public sewers, the total number of baits being 3,528. All the baits were taken and 61 dead rats were collected. The baits laid last year were nearly double the number laid in 1922, viz., 1,938. The dead rats collected that year numbered 9 only. verminous conditions. 41 VERMINOUS CONDITIONS. The Medical Officer of Health of the County has supplied a table showing the frequency of infestation by vermin in children attending the public elementary schools during the past year. The School Nurses made 44,857 examinations of children during the school year, and reported the finding of vermin after 5,779 (12.8 per cent.) of the examinations. The 12.8 per cent. found verminous comprised 3.9 with live vermin in the hair of the heads, 8.4 with nits, and 0.5 with vermin elsewhere than in the head. Of the examinations in the boys' departments, 1.6 per cent. revealed verminous conditions, of those in girls' departments, 7.8, and of those in infants' departments, 3.6. In the Council's Schools, the percentage of reports of vermin was 11.3 of all children examined, including 8.0 per cent. with nits only, the total percentages in the various departments being: Boys', 1.4; girls', 5.7; infants', 2.6. In the Voluntary Schools the total percentage was 14.5, that of nits 8.9, and those (totals) of the departments : Boys', 1.7; girls', 9.9; infants, 5.7. In one Council School the total percentage was 32.4, and in another 26.1, but if nit cases be excluded the percentages are reduced to 5.3 and 12.0 respectively. In 3 Voluntary Schools the total percentages were 29.6, 28.2 and 22.5, or, excluding nit cases, 11.6, 14.5 and 6.5. In spite of the high proportions of verminous conditions disclosed by the foregoing figures only 4 children were reported as absent from school on account of vermin. Verminous school children are dealt with under the provisions of Section 36 of the London County Council (General Powers) Act, 1907, which empower the Council to take children to a cleansing station if parents neglect to comply with Notices requiring cleansing served under that Section. When children are dealt with under that Section, the School Medical Officer informs the Medical Officer of Health of the Borough, and asks for the homes of the children to be inspected and dealt with as required. Last year 57 such forms were received, 49 for vermin and 8 for scabies. Verminous conditions in school children almost invariably imply not only verminous infestation of the homes, but also of some, at least, of the other members of the children's families. Verminous homes, bedding, etc., can be dealt with by the Department under Sections 9-14 of the London County Council (General Powers) Act, 1922, which repealed (and amended) the provisions of the Council's Act of 1904. For dealing with infestation of persons no provision had been made until last year, the Cleansing of Persons Act, 1897, not having been adopted by the late Vestry or the Council. In October last the Council adopted a resolution to enter into an Agreement with the Kensington Borough Council whereby the latter Council will cleanse at the Medicinal Baths, Blechynden Mews, all persons sent there by the Medical Officer of Health of this Borough. The Agreement became operative on January 1st of this year, but was anticipated during the late autumn in that 4 persons were sent to the baths, they making 11 attendances. Although no compulsion can be exercised, it is hoped that infested persons will be gradually persuaded to take advantage of the facilities now provided to enable them to free themselves from vermin. In addition to the tenements dealt with in consequence of information received from the School Medical Officer, the Department served 190 Notices under Section 10 of the Act of 1922. Since 1904, when the Council was first given power to deal with verminous rooms, bedding, etc., the Notices issued have required infested rooms to be stripped, fumigated with sulphur in large quantities, and the blow lamp to be used to all cracks and crannies. In 1921 and 1922 the Department made experimental use of a special vermicidal spray, the results of which led the Medical Officer of Health to suggest to the Public Health Committee in November last that an offer to spray infested rooms (at the owner's cost) should be sent with each Notice. The Committee adopted the suggestion, and since February, 1923, the Department has sprayed 79 rooms in 55 tenements, receiving £29 odd from the owners thereof. LEGAL PROCEEDINGS. The results of the summonses taken out during the year under the Public Health and other "Sanitary" Acts and the Sale of Food and Drugs Acts are summarised in Table 22. The total amount of the fines and costs in "Health" cases was £101 1s. 6d., as compared with an annual average of £39 8s. 6d. during the three years 1920-22. The fines and costs in "Adulteration" cases amounted to £29 2s. 0d., as compared with an average of £40 5s. 4d. for 1920-22. The averages have been based on three years instead of five as hitherto to eliminate the effects of War Regulations re foods. The average fine and costs per conviction in "Adulteration" cases was : Fine, £3 ; costs, £2 17s. 9d., the corresponding figures for the last three years being: 1922, £4 5s. Od. and£l 11s. 11d.; 1921, £3 16s. 3d. and 15s. 5d.; 1920, £7 5s. Od. and £1 14s. 7d. In 1 "Health" case and in 2 "Adulteration" cases the summonses were dismissed, in the "Health" case with costs against the Council, and in the other without any costs being awarded. Attention may also be directed to the fact that none of the persons summoned last year for adulteration had been previously summoned by the Council—an unusual occurrence. 42 clerical work. CLERICAL WORK. Any attempt to reduce to statistical form the clerical work of the Department is bound to be disappointing, not to say misleading. For what they are worth some figures for last year and for 1922 (shown in parentheses) are given in Table 21. They convey no idea of the amount of recording done on the various card indices, of the time spent in preparing papers and records for the Committees under whom the Department work or in the systematic filing of papers, etc., so as to be available for future reference. The records in the Department have increased in bulk and complexity during the recent years to such an extent that it has been necessary during the past year to largely re-organise the principal systems of filing. general summary. 43 TABLE 1. 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 Locally. Nett. Out. In. Totals. Rates. Out. In. Totals. Mortality. Number. Mortality Totals. Mortal ity. 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 1923 146,200 2,410 275 485 2,620 17.92 1,743 11.92 338 317 1,722 11.77 207 86 180 69 "X"—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. Annual. Movement: Natural Increment. July-June, 1921-22 979 persons. 1922-23 955 Parliamentary Voters: Autumn Register. Males. Females. 1921 26,505 30,912 1922 26,611 31,043 1923 27,070 31,779 Rateable Value, £1,551,861. Penny Rate (1923) =£6,137. TABLE 2. Wards. Queen's Park. Harrow Road. Maida Vale Westbourne. Church. Lancaster West. Gate, East. Hyde Park. 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. 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 1922 274 551 423 490 634 97 78 184 Averages 1918-22 276 582 412 480 595 84 74 164 1923 244 512 447 514 653 84 47 169 Deaths: Persons, all Ages. 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 1922 191 352 291 345 390 93 84 142 Averages 1918-22 206 361 294 359 374 91 83 135 1923 171 337 285 317 321 93 75 123 Infantile Mortality.* 1918 70 103 97 121 160 109 75 136 1919 95 81 78 132 101 13 78 59 1920 58 57 85 90 94 51 126 65 1921 68 67 73 114 115 130 126 71 1922 58 50 68 87 83 82 51 43 Means 1918-22 69 72 80 109 111 77 91 75 1923 78 53 83 78 71 36 21 59 * Rates per 1,000 births (corrected). 44 SICKNESS : CASES NOTIFIED: REPORTED. TABLE 3. Sickness : Cases Notified : Reported. Borough. 1914 1915 1916 1917 1918 1919 1920 1921 1922 ###] Anthrax — 1 — — — — — 1 1 — Cerebro-spinal Fever 1 14 9 7 3 7 1 2 2 1 Chickenpox (a) 555 644 468 406 813 261 568 253 539 753 (555) (560) (468) (406) (606) (261) (568) (253) (517) (288) Continued Fever 2 1 — — — — — — — — Diphtheria 286 269 209 227 254 255 461 442 401 219 Dysentery (c) 3 1 2 — 2 Encephalitis Lethargica (c) 3 2 7 2 3 Enteric Fever 10 19 23 12 13 10 19 13 8 13 Erysipelas 141 139 105 66 56 76 81 83 77 54 Malaria (c) 64 24 7 5 2 Measles (a) 424 3,721 746 4,245 1,519 1,890 2,034 205 3,220 452 (111) (801) (200) (1,544) (515) (632) (607) (42) (1,103) (80) Membranous Croup 3 7 2 2 4 4 3 3 — 1 Ophthalmia Neonatorum 51 31 20 27 22 30 29 34 15 22 Pneumonia—Influenzal (c) 87 45 27 72 33 Primary (c) 83 96 105 254 302 Polio-Encephalitis 3 1 4 i — 5 2 1 — 2 Poliomyelitis Puerperal Fever 10 7 8 7 2 15 15 16 8 5 Scarlet Fever 738 437 272 124 150 261 502 827 529 323 Smallpox — (d) 1 — — — — — — — 1 Tuberculosis—Total 545 590 526 502 451 391 383 335 312 338 Pulmonary 397 426 388 355 325 284 277 244 204 222 Other Forms 148 164 138 147 126 107 106 91 108 116 Mumps (b) 247 167 180 200 680 150 154 494 91 96 Ringworm (b) 196 125 152 117 111 189 204 122 99 45 Whooping Cough (b) 558 365 540 325 691 160 357 613 382 1,018 (a) Including notified and reported cases, the latter shown in parentheses. (6) Reported, not notified. (c) First year of notification. (d) An error. TABLE 4. 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 9 18 21 26 15 15 16 23 17 26 2 4 1 14 7 5 Enteric Fever 1 ... ... 2 ... 1 1 3 1 1 ... 1 ... ... ... 2 Erysipelas 7 3 8 11 3 3 1 6 2 4 ... 1 ... 1 2 2 Ophthalmia Neonatorum 2 1 3 2 1 1 2 2 3 3 ... ... ... ... 1 1 Pneumonia—A.Influenzal 3 ... 1 3 2 5 5 2 5 5 ... 1 1 ... ... ... Pneumonia—a. Primary 21 22 38 27 19 11 38 24 60 23 2 2 1 3 6 5 Puerperal Fever ... 4 1 ... ... ... ... ... Scarlet Fever 23 26 43 42 13 18 21 27 34 45 1 3 1 7 14 5 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 4 3 26 32 45 45 9 32 2 11 2 4 ... 2 ... ... ... 2 Enteric Fever • • • ... 1 1 3 4 1 1 ... 1 ... 1 ... ... Erysipelas 1 1 1 1 2 1 4 2 4 4 4 5 2 9 4 2 1 6 Pneumonia—A.Influenzal ... ... 3 1 1 1 1 1 2 4 5 4 1 3 2 2 2 ... Pneumonia—A. Primary 23 14 51 40 32 20 15 9 16 5 7 8 19 5 11 7 11 9 Scarlet Fever ... 2 48 44 84 91 8 19 8 11 2 5 ... 1 ... ... ... ... 45 TABLE 5. Notifications : Wards. Quarterly and Annual Averages, 1918-22. Records for 1923. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Quarter. 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 Diphtheria. 1 23 9 25 21 14 6 20 12 22 18 2 1 3 1 6 4 2 13 8 21 7 10 14 12 7 15 10 2 2 2 4 3 1 3 9 1 15 10 9 7 14 10 12 7 2 1 4 5 3 3 4 17 9 21 10 13 3 23 10 20 8 4 2 4 5 4 4 Totals 62 27 82 48 46 30 69 39 69 43 10 6 13 15 16 12 Scarlet Fever. 1 13 16 23 30 10 8 9 14 13 32 1 1 4 4 6 10 2 10 10 25 21 12 9 10 9 17 16 3 ... 5 2 3 4 3 18 11 31 15 14 9 19 7 26 14 2 1 1 1 4 2 4 33 12 52 19 18 5 23 18 32 17 3 2 4 1 10 3 Totals 74 49 131 85 54 31 61 48 88 79 9 4 14 8 23 19 Notification 46 deaths of residents of the borough. TABLE 6. Deaths of Residents of the Borough, 1923. 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 3 2 1 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 1 Scarlet Fever 2 1 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 Whooping Cough 24 9 15 7 10 1 2 1 3 ... ... ... ... ... ... ... ... ... ... 6 5 Diphtheria, Membranous Croup 14 6 8 1 ... l 1 3 2 1 5 ... ... ... ... ... ... ... ... 4 8 Epidemic Influenza 32 14 18 ... ... ... ... ... ... ... ... ... ... 3 6 5 5 6 7 2 7 Erysipelas 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Septicaemia 10 2 8 ... ... ... ... ... ... ... ... ... 1 ... 3 1 2 1 ... 1 8 Pulmonary Tuberculosis A. Phthisis 97 53 44 ... ... ... ... 1 ... ... ... 6 7 25 24 20 10 1 3 31 21 Tub. Meningitis, a. Hydrocephalus 11 7 4 2 1 ... 1 1 ... 1 1 2 1 1 ... ... ... ... ... 4 1 Other Forms of Tuberculosis 19 7 12 2 ... ... 1 ... ... 1 3 ... 2 2 2 2 2 ... 2 6 7 Syphilis 10 7 3 2 1 ... ... ... ... ... ... ... ... 2 ... 2 1 ... 1 6 3 Cancer 206 80 126 ... ... ... ... ... ... 1 ... ... ... 6 11 34 56 39 59 42 45 Rheumatic Fever 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Alcoholism 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... Inflammation & Softening of Brain 13 5 8 ... ... ... ... ... ... ... ... ... ... 1 1 4 4 ... 3 3 7 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Meningitis 11 5 6 1 2 ... ... ... 2 ... 1 ... ... 2 ... 1 1 ... ... 5 3 Cerebral Haemorrhage 70 25 45 ... ... ... ... ... ... ... ... 1 ... 1 ... 13 12 10 33 11 9 Convulsions 5 3 2 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Endocarditis 9 5 4 ... ... ... ... ... ... ... ... ... 1 1 ... 3 1 1 2 4 3 Heart Disease 189 86 103 ... ... ... ... ... ... 1 ... 1 3 10 7 32 25 42 68 16 29 Bronchitis 157 80 77 5 4 2 1 1 1 1 1 l ... 3 ... 16 14 51 56 35 22 Lobular (Broncho-) Pneumonia 89 44 45 16 9 2 5 3 4 l ... 2 1 4 ... 8 7 8 17 25 23 Lobar (Croupous) Pneumonia 35 26 9 1 1 2 ... 2 ... l ... 1 ... 2 3 12 3 5 2 21 5 Pneumonia 30 16 14 1 ... ... 2 1 ... l ... ... ... 2 1 6 3 5 8 4 3 Other Diseases of Respiratory Organs 14 9 5 2 ... ... ... ... ... ... ... ... ... 2 ... 2 2 3 3 4 ... Diseases of Stomach 17 12 5 ... ... ... ... ... ... ... ... ... ... 2 ... 4 5 6 ... 5 2 Diarrhoea and Enteritis 25 13 12 8 ... ... 1 ... 1 ... 1 ... ... ... 1 ... ... 1 ... 10 11 Appendicitis 11 5 6 ... ... ... ... ... ... ... ... 2 1 3 3 ... 1 ... 1 3 4 Obstruction of Intestines 25 10 15 1 ... ... 1 ... ... 1 ... 1 ... ... 2 2 5 5 6 4 12 Cirrhosis of Liver 15 8 7 ... ... ... ... ... ... ... ... ... ... ... ... 7 4 1 3 1 4 Nephritis and Bright's Disease 39 23 16 ... ... ... ... ... ... ... ... 1 ... 1 1 7 7 14 8 13 6 Tumours (N.-M.), &c., Female Genital Organs 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... Puerperal Fever 2 ... 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 Accidents and Diseases of Parturition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Defects 12 9 3 7 3 ... ... ... ... l ... ... ... ... ... 1 ... ... ... 4 2 Premature Birth 36 27 9 27 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 4 Developmental Diseases 38 19 19 18 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 10 Old Age 54 11 43 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 11 40 4 12 Suicide 23 17 6 ... ... ... ... ... ... ... ... ... ... 4 3 5 3 8 ... 5 2 Overlaid in Bed 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 62 34 28 ... 1 ... 2 4 ... 3 4 1 2 7 4 8 7 10 8 15 18 Homicide 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All other Causes 302 136 166 2 ... 1 2 ... 1 2 3 3 3 10 11 43 41 75 105 74 93 All Causes 1722 820 902 109 71 18 19 18 17 17 21 22 23 95 87 238 227 303 437 392 395 Uncertified 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... In comparing the above table with similar tables for previous years, the following changes in the classification of causes of death should be noted:— " Septicaemia " was formerly included with " Other Septic Diseases." " Cerebral Haemorrhage " now includes " Apoplexy." " Endocarditis " now includes " Infective Endocarditis," formerly included with " Other Septic Diseases." " Diseases of Stomach " now includes " Duodenal Ulcer." 47 deaths of residents of the borough. TABLE 7. Deaths of Residents of the Borough, 1923. 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 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... Scarlet Fever ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Whooping Cough ... 3 1 1 3 1 2 6 3 ... ... 1 ... ... ... ... Diphtheria, Membranous Croup ... ... 3 4 1 1 1 1 ... ... ... 2 ... ... 1 ... Epidemic Influenza 1 ... 3 3 4 5 2 4 2 ... 1 2 1 ... 3 Erysipelas ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Septicaemia 1 2 ... 2 ... 2 ... ... 1 2 ... ... ... ... ... ... Pulm. Tub., Ac. Phthisis 9 5 16 12 6 9 9 8 6 6 3 1 1 1 3 2 Tub. Mening., A. Hydrocephalus 1 ... 3 1 ... ... 1 2 1 ... ... ... ... 1 1 ... Other Forms of Tuberculosis ... ... 4 1 ... 2 ... 5 3 3 ... ... ... ... ... 1 Syphilis ... ... ... 2 2 ... 1 ... 3 ... 1 1 ... ... ... ... Cancer 11 13 16 21 15 22 8 22 13 21 7 5 5 6 5 16 Rheumatic Fever ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Alcoholism ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... Inflammation and Softening of Brain 1 ... ... 1 1 3 ... 1 2 1 ... ... ... 1 1 1 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Meningitis ... ... 2 1 1 ... 2 2 ... 3 ... ... ... ... ... ... Cerebral Haemorrhage 3 4 3 6 3 7 6 7 5 9 2 4 1 ... 2 4 Convulsions ... ... 1 ... ... 1 1 1 1 ... ... ... ... ... ... ... Endocarditis ... ... ... ... 1 ... 1 1 1 1 ... 1 ... 1 2 ... Heart Disease 9 10 15 23 11 14 16 18 16 18 8 9 5 6 6 5 Bronchitis 8 4 17 20 11 11 20 13 18 16 2 5 ... 5 4 3 Lobular (Broncho-) Pneumonia 7 5 5 11 7 4 9 9 11 11 ... 4 1 ... 4 1 Lobar (Croupous) Pneumonia 2 3 5 1 1 2 6 3 11 ... ... ... ... ... 1 ... Pneumonia 1 1 3 3 5 3 1 3 3 2 2 2 1 ... ... ... Other Diseases of Respiratory Organs ... ... 1 1 4 2 2 ... 2 ... ... 1 ... ... ... 1 Diseases of Stomach 2 ... 2 1 1 2 1 1 4 ... 1 1 1 ... ... ... Diarrhoea and Enteritis 3 2 5 ... 1 2 1 4 3 4 ... ... ... ... ... ... Appendicitis ... 1 ... ... 1 3 1 ... 1 ... ... 1 2 ... ... 1 Obstruction of Intestines 2 ... 1 3 2 3 3 4 ... 2 1 1 ... 1 1 1 Cirrhosis of Liver 2 2 2 1 1 ... 2 2 1 ... ... ... ... 1 ... 1 Nephritis and Bright's Disease 2 1 5 3 3 2 3 2 4 2 ... 1 4 2 2 3 Tumours (N.-M.), &c., Fem. Gen. Orgs. ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... Puerperal Fever ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Accidents and Diseases of Parturition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Defects 2 ... 4 1 ... ... ... 2 2 ... ... ... 1 ... ... ... Premature Birth 2 ... ... 1 13 2 4 1 6 3 ... ... ... ... 2 2 Developmental Diseases... 2 2 4 2 5 2 3 5 1 8 ... ... ... ... 4 ... Old Age ... 3 4 7 ... 8 3 10 3 4 ... 5 ... 4 1 2 Suicide 3 ... 4 1 3 ... 1 1 2 2 2 ... 1 ... 1 2 Overlaid in Bed ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Other Accidents and Violence ... 2 5 4 8 4 7 5 7 5 2 2 2 ... 3 6 Homicide ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... All other Causes 11 22 29 34 20 31 27 28 23 28 8 5 4 8 14 10 All Causes 85 86 163 174 135 150 144 173 163 158 39 54 33 42 58 65 In Institutions 37 47 79 81 54 54 71 69 105 90 9 14 5 7 32 33 See foot notes to Table 6. 48 tuberculosis. TABLE 8. Tuberculosis—Cases Notified. All Forms. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. Not allocated. Borough. West. East. Males. 1918 27 58 33 34 56 1 8 10 7 234 1919 27 33 35 43 44 5 5 13 3 208 1920 22 33 21 37 53 3 7 12 3 191 1921 19 44 25 34 33 6 5 5 5 176 1922 12 33 17 27 41 6 8 11 9 164 1923* 35 (15) 27 (10) 15 (9) 38 (14) 22 (7) 4 (-) 2(1) 14(5) 8 (-) 165 (61) Females. 1918 21 25 27 60 57 4 7 13 3 217 1919 15 34 35 39 39 9 4 7 1 183 1920 15 28 21 63 39 7 8 9 2 192 1921 18 31 29 32 24 8 8 8 1 159 1922 24 22 19 25 37 5 6 9 1 148 1923 14(5) 35 (11) 25(10) 34 (14) 41 (13) 7(1) 3 (-) 10(1) 4 (-) 173 (55) Persons. 1918 48 83 60 94 113 5 15 23 10 451 1919 42 67 70 82 83 14 9 20 4 391 1920 37 61 42 100 92 10 15 21 5 383 1921 37 75 54 66 57 14 13 13 6 335 1922 36 55 36 52 78 11 14 20 10 312 1923 49 (24) 62 (21) 40 (19) 72 (28) 63 (20) 11 (1) 5 (1) 24 (6) 12 338(116) * Figures in parentheses indicate cases of "other forms of tuberculosis," to be read thus: 35 cases of tuberculosis (all forms) including 15 of non-pulmonary (other forms of tuberculosis). 49 tuberculosis—new cases. AiI Ages. Males. Females. Persons. Cases— Pulmonary 104 118 222 Other Forms 61 55 116 Totals 165 173 338 Pulmonary 18 18 36 Other Forms 6 6 12 Other Causes r p 1 1 LO.F. Totals ... 24 25 49 •S3SB3 pagupgQ AnBoipapj jofl Pulmonary ... 40 63 103 Other Forms... 34 29 63 Totals 74 92 166 Deaths— Other Forms Other Causes 1 — 1 Totals ... 1 — 1 " P "—Pulmonary. " O "—Other Forms of Tuberculosis, 50 tuberculosis: occupations. TABLE 10. Tuberculosis. Occupations—New Cases and Deaths. 1923. Pulmonary. Other Forms. New Cases. Deaths. New Cases. Deaths.[###/ Occupations. Indoor. m. f. m. f. m. f. m. f. Domestic Duties— Housewives — 41 — 20 — 5 — 6 „ and other occupation — — — — — — — — Servants 1 24 — 7 — 4 — — Charwomen — 2 — — — — — — Laundry Workers — — — — 1 — — — Clerks 17 9 5 3 3 1 3 — Shop Assistants, Keepers 3 3 2 3 1 1 — — Dressmakers, Tailors 2 6 3 2 — 1 — — Bootmakers — — 1 — — — — — Skilled Artizans 6 1 7 — — — — — Waitresses, Barmen, etc. — 4 — 1 — — — — Others 3 3 3 1 1 — 1 — Outdoor. Building Trades 4 — 3 — 1 — — — Painters 4 — — — 1 — — — Labourers — — 1 — — — 1 — Road Traffic 4 — 6 — 2 — 1 — Railway Traffic 3 — 2 — — — — — Postmen — — — — — — — — Gardeners 1 — — — — — — — Street Merchants 1 — — — — — — — Others — — 1 — — — 1 — Commercial Travellers, etc. 3 — — — — — — — Food Trades. Bakers — — — — — — — — Butchers, Fishmongers — — — — — — — — Dairymen — — 1 Others 2 — 3 — — — — — Miscellaneous. School Life 5 7 — — 33 29 2 5 Unskilled Workers 16 1 2 — 1 — — — Professional Workers 2 4 3 1 1 — — — Other ,, 10 2 — — 1 — — — Infants — — 1 — 12 7 5 3 No occupation, or occupation not stated 17 11 9 6 3 7 — 2 104 118 53 44 61 55 14 16 51 tuberculosis : survivors. TABLE 11. Tuberculosis: Survivors. Year. Definite. Suspect. 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 1923 " Survivors " p. O. p. O. Definite Suspect 1903-12 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 P. O. P. O. 1903-12 2,215 1,068 518 71 44 27 16 13 16 5 5 5 6 1 381 411 1,566 41 10 224 5 — — 1913 812 203 105 55 24 15 8 11 5 3 — 3 2 123 142 413 3 1 75 33 — — 1914 531 157 85 46 14 9 8 7 1 2 1 — 74 91 261 5 — 56 38 — — 1915 582 129 105 41 23 8 4 2 3 3 1 42 110 239 15 4 86 55 — — 1916 526 149 107 44 14 2 4 3 5 2 37 128 211 8 — 80 46 — — 1917 502 159 119 32 13 8 6 4 4 33 131 200 5 2 67 47 — — 1918 451 150 102 39 7 3 9 4 24 144 131 2 — 83 57 — — 1919 388 130 53 32 11 8 5 27 110 124 1 2 83 64 — — 1920 378 117 76 34 10 7 7 113 79 1 1 96 73 — — 1921 335 90 55(a) 33 17 4 88 71 1 4 88 66 — — 1922 312 115 57 32 7 119 40 3 3 94 78 — — 1923 222 116 103 63 50(a) 1 144 25 — — 154 102 14 14 Totals 7,370 2,633 518 176 184 202 193 216 191 128 138 122 139 125 760 1,731 3,360 85 27 1,186 664 14 14 (a)—Including 1 " Suspect " dying from disease other than Tuberculosis. P. = Pulmonary Tuberculosis. O. = Other Forms of Tuberculosis. 52 cancer: malignant disease. TABLE 12. Cancer : Malignant Disease. 1923. 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 — — — — — — — — 4 — — — — — 4 — II. Organs of Special Sense — — — — — — — — — — — — — — — — III, Respiratory System— — — — — — — — — — — — — — — — — (a) Larynx 6 — — — 2 — — — — — — — — — 8 — (b) Lung — — — 1 — — — — — — — — — — — 1 (c) Pleura — 1 — — — — — — — — — — — — — 1 IV. Circulatory System-— (a) Heart — 1 — — — — — — — — — — — — — 1 V. Digestive System — (a) Mouth— (i.) Tongue 2 — — — 3 — — — — — — — — — 5 — (ii.) Glands, Secretory — — — — 2 — — — — — — — — — 2 — (6) Throat — (i.) Pharynx 1 — — — — — — — — — — — — — 1 — (ii.) (Esophagus 5 1 3 — 1 — — — — — 1 — — — 10 1 (c) Intestines— (i.) Stomach, Pylorus 11 12 2 — — — — — — — 1 1 — — 14 13 (ii.) Intestine 6 11 2 2 — — — — — — 1 1 — — 9 14 (iii) Rectum 5 14 2 2 — — — — — — — — — — 7 16 (d) Organs— (i.) Liver 9 2 — — — — — — — — — — — — 9 2 {ii.) Pancreas 1 3 — 1 — — — — — — — — — — 1 4 (e) Peritoneum — 1 — — — — — — — 1 — — — — — 2 VI. Lymphatic System— (a) Head & Neck (ii.) Cervical Lymphatics — 1 — — — — — — — — — — — — — 1 (b) Thorax— (i.) Mediastinal Glands 1 — — — — — — — — — — — — — 1 — (c) Abdomen— (iii.) Suprarenal capsules — 1 — — — — — — — — — — — — — 1 VII. Urinary System— (b) Bladder 1 3 2 1 — — — — — — — — — — 3 4 (c) Prostate 2 — 1 — — — — — — — — — — — 3 — VIII. Generative System— (a) Ovary — 9 — 3 — — — — — — — — — — — 12 (b) Uterus — 20 — 2 — — — — — — — — — — — 22 (c) External Genitals — 2 — — — — — — — — — — — — — 2 (d) Breast — 22 — 1 — — — — 1 — — — — — 1 23 IX. Osseous & Muscular System— (6) Shoulder — — — — — — — — 1 — — — — — 1 — (c) Abdomen — — — — — — — — — 2 — — — — — 2 (d) Extremities— (i.) Upper — — — — — — — — — 1 — — — — — 1 (ii.) Lower — 1 — — — — — — — — — — — — — 1 X. Cutaneous System— (a) Head & Neck — — — — 1 — — — — — — — — 1* 1 1 (d) Extremities— (it.) Lower — — — — — 1 — — — — — — — — — 1 Totals 50 105 12 13 9 1 — — 6 4 3 2 — 1 80 126 Ages*at Death. 0- — — — — — — — — 1 — — — — — 1 — 20- — — — — — — — — — — — — — — — — 25- — — — — — — — — 2 — — 1 — — 2 1 35- 3 6 1 3 — — — — — 1 — — — — 4 10 45- 7 21 2 1 — — — — 2 1 — — — — 11 23 55- 14 26 4 4 4 1 — — — 1 1 1 — — 23 33 65- 16 31 4 4 3 — — — 1 1 1 — — 1 25 37 75- 10 21 1 1 2 — — — — — 1 — — — 14 22 * Rodent Ulcer. 53 DEATHS under one year. Deaths under One Year. 1923. 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- 1923. Averages 1918-22 1923. Averages 1918-22 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 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 1 — 0 Whooping Cough — — — — — — — — 1 — 1 — — 1 — 1 — 3 2 — — 2 2 — 1 — — 1 1 1 — — — 1 7 2 10 4 II. Diarrhoea and Enteritis — — — — — — — — 1 — 1 — 1 — — — 1 3 — 2 1 — 2 2 — — 2 — — — — — — 1 8 26 8 15 III. Tuberculous Meningitis — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — 1 — — 1 — 2 1 1 1 Abdominal Tuberculosis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 1 — 0 Other Forms „ — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —1— — 1 IV. Congenital Malformations 1 — 4 1 1 — — 1 1 — 6 2 1 — — — — 1 — — — — — — — — — — — — — — — — 7 9 3 6 Premature Birth 9 4 16 8 4 —— 4 1 — — 24 9 3 — — — — — — — — — — — — — — — — — — — — — 27 29 9 23 Atrophy and Debility — — 1 2 — — — — — — 1 2 1 2 1 — 1 2 — 1 1 1 1 — — — — — — — — — — — 6 7 8 4 Debility at Birth — — 1 1 2 — — — — — 3 1 1 — — — — — — — — — — — — — — — — — — — — — 4 4 1 3 Injury at Birth 2 1 4 4 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4 3 4 1 Atelectasis 3 3 3 3 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 3 4 4 2 Want of Breast Milk — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — V. Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 0 — — Syphilis — — — — — — — — — — — — — — — 1 1 — — — — — — — — — — — — — — — 1 — 2 4 1 3 Rickets — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 0 — — Meningitis — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — — — — — — — 1 2 1 Convulsions — — — 1 1 — — 1 — — 1 2 — — — — — — — — — — 2 — — — — — — — — — — — 3 2 2 1 Gastritis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Laryngitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 0 — — Bronchitis — — 1 — — — — — — — 1 — — — 2 — — 1 2 — — — — 1 — — — — — — — 1 — 1 5 7 4 8 Pneumonia — — — — 4 — — — — — 4 — 2 2 — 1 — 2 1 — 5 2 1 1 1 1 1 — 1 — — — 2 1 18 19 10 88 Suffocation (overlaid) — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — 1 1 — 1 Other Causes 2 1 3 1 1 — — — — — 4 1 — 1 — — 1 1 2 — — — — — — — 1 — — — — — — — 8 12 4 11 All Causes 17 9 34 21 13 — 4 4 3 — 54 25 10 7 3 3 4 13 7 3 7 5 9 5 2 1 4 2 4 2 — 1 5 4 109 71 Uncertified Deaths 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 0 Averages, 1918-1922 19 15 37 28 10 5 6 4 4 2 57 39 11 10 13 10 11 6 7 6 5 4 7 5 6 4 6 4 4 4 4 2 4 3 135 97 " O "—Average less than one. 1923 Corrected Births:—M. 1,347: F. 1,273. 1918-22 (Averages) M. 1,373; F. 1294. 54 deaths: one to five years. Table 14. Mortality Rates at Ages 1-5 Years. Borough. 1-2 Years. 2-3 Years. 3-4 Years. 4-5 Years. 1-5 Years. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females. 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 1923 1918-22 Population 1,283 1,159 1,259 1,130 1,228 1,112 1,305 1,078 1,593 1,013 1,471 996 1,024 1,052 1,018 1,031 5,128 4,336 5,053 4,235 Measles 1 5 — 4 — 3 1 1 — 1 — 0 — 1 — 0 i 10 1 6 Scarlet Fever — — — 0 — — — 0 1 0 — — — 0 1 — 1 1 1 0 Diphtheria 1 2 1 1 2 1 1 1 1 0 1 2 — 1 — 2 4 3 3 7 Whooping Cough 1 4 2 4 — 1 1 2 1 1 1 0 — 1 1 0 2 7 5 7 Diarrhoea, Enteritis 4 1 1 4 — 1 1 0 — 0 — — — 0 — — 4 2 2 4 Tuberculous Diseases — 2 2 2 — 1 — 1 1 1 — 2 1 1 1 1 2 4 3 6 Respiratory Diseases 6 9 8 9 5 5 3 3 2 1 1 1 — 1 — 1 13 15 12 15 Accident, Violence 1 1 2 1 1 0 — 1 2 1 1 — 1 1 — — 5 3 3 1 Other Causes 4 3 3 5 — 3 2 2 — 3 1 3 — 2 — 3 4 13 6 13 All Causes 18 27 19 31 8 15 9 12 8 8 5 9 2 8 3 7 36 58 36 59 " Q " = average less than unity. " — " = nil return, 55 infantile mortality. Table 15. Infantile Mortality. In Special Areas. Areas. 1923 Infantile Mortality. Births. Deaths. 1923. 1922. 1918-22. Church Ward— " Hall Park " 88 4 45 88 66 " North Wharl " 63 6 95 41 87 Clarendon Street " 215 11 51 116 135 Rest of Ward 287 21 73 61 107 Westbourne Ward— " Alfred Road " 130 9 69 147 132 Rest of Ward 384 31 81 66 98 Maida Vale Ward— " Amberley Road " 78 9 115 91 89 Rest of Ward ... 369 28 76 64 78 Queen's Park Ward— " Queen's Park " 160 15 94 60 66 Rest of Ward 84 4 48 56 74 Totals for Six Areas 734 54 74 96 100 Rest of Borough 988 126 67 58 82 Table 16. Infantile Mortality: Special Areas. Causes of Death. Causes of Death. 1923 Infantile Mortality. Six Areas. Rest of Borough. Six Areas. Rest of Borough. 1923 1918-22 1923 1918-22 Measles — 1 — 3.24 0.53 0.62 Diphtheria — 1 — 0.81 0.53 0.41 Whooping Cough 7 10 9.54 2.97 5.30 2.17 Diarrhoea, Enteritis 5 11 6.81 21.11 5.83 14.21 Premature Birth 8 28 10.90 19.21 14.84 19.39 Congenital Defects 1 9 1 .36 4.87 4.77 5.91 Injury at Birth 4 4 5.45 — 2.12 2.07 Atrophy, Debility 5 9 6.81 4.87 4.77 3.31 Atelectasis 1 6 1 .36 2.43 3.18 1 .76 Debility at Birth — 5 — 0.40 2.65 3.11 Tuberculous Diseases 1 4 1.36 3.51 2.12 1 .34 Erysipelas — — — — — 0.20 Syphilis 1 2 1.36 0.81 1.06 3.21 Rickets — — — 0.10 Meningitis 1 1 1 .36 1.62 0.53 0.82 Convulsions 3 2 4.09 1 .62 1 .06 1.55 Respiratory Diseases 12 25 16.35 24.89 13.25 12.75 Overlaid — 1 — 0.20 0.53 0.51 Other Causes 5 7 6.81 6.75 3.71 8.92 All Causes ... 54 126 73.56 100.13 66.78 82.46 Ages at Death. Under 1 month 16 63 21.80 32.20 33.39 37.65 Aged 1.3 months 4 19 5.45 16.23 10.07 16.28 Aged 0.3 months 20 82 27.25 48.44 43.46 53.93 3.6 19 20 25.88 19.48 10.60 12.86 6.9 ,, 11 12 14.98 18.30 6.36 10.16 9.12 ,, 4 12 5.45 14.07 6.36 5.49 56 TABLE 17. Annual Averages. 1914-18. Totals. Annual Averages. 1914-18. Totals. PREVENTION OF INFECTIOUS DISEASE. 1922. 1923. 1922. 1923. Prevention of Infectious Disease. Mortuary. All Diseases, Enquiries by— Bodies deposited, total 321 258 268 District Inspectors 3,704 1,675 1,234 Women Inspectors and Health Visitors 7,172 8,114 6,252 „ for inquests 258 199 185 Tuberculosis—Included in above— „ „ pending burial, infectious 2 2 1 Women Inspectors 4,157 2,345 2,223 ,, ,, ,, ,, other 61 59 83 Patients removed to Hospital—All Diseases (excluding Tuberculosis) 618 1,354 928 P.M. examinations made 125 137 115 Rooms disinfected after— Tuberculosis 316 216 238 Trade Nuisances. Other Diseases 3,300 3,845 2,037 Offensive Smells—Complaints 9(7)* 9(8) 10 (9) Weight of Bedding, etc., Disinfected (tons) 54 36 21 Accumulations of Manure 17(11) 9(8) 26(17) Cost of same £1,156 £1,484 £904 Smoke—Complaints 8 12 9 School Notices issued— „ Premises watched 16 17 21 Measles, Whooping Cough, Chickenpox Other Diseases 3,377 4,457 2,643 „ ,, Hours of observation 106 286 185½ 796 1,217 666 Duration of smoke (hours), including 63/4 835/6 627/12 Bacteriological Examinations for— ,, black smoke 23/4 101/3 31/1 ½ Diphtheria 540 462 533 Enteric Fever 9 — 5 Cerebro-Spinal Meningitis 9 — — Canal Boats. Tuberculosis 215 302 343 (1918.) 241 Sanitary Work. On Register at end of year 204 232 Cutting-off of Water Supplies. (Averages.) Notices received 29 13 12 Known to be using Canal Basin 73 119 128 Referring to Inhabited Premises 15 10 4 Inspections made 135 72 102 Empty „ 10 3 3 Infringements of Acts discovered 15 42 15 Other „ 3 — 5 Notices served 12 20 15 Reasons for—Rates unpaid 10 9 10 Children found on boats 122 63 111 Defective fittings 8 4 2 * To be read—9 Complaints relating to 7 premises. 57 REPORT OF THE WORK OF THE DISTRICT INSPECTORS, 1918-1923. TABLE 18. Report of the Work of the District Inspectors, 1918—1923. 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 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 38 368 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 1923 1,029 — 2,074 — 11,127 35 41 22 13 704 31 465 51 31 22 — 6 4 17 51 2 85 197 — — 15 107 13 51 — 58 HOUSING. TABLE 19. Sanitary Defects Remedied in Tenement Houses. 1921. 1922. 1923. 1921. 1922. 1923 Drain defective 3 3 25 Dustbin not provided 36 10 9 choked 24 18 15 „ insufficient 5 31 15 „ unventilated or improperly ventilated 9 — 1 „ disused and not abolished 3 4 3 Manhole cover defective 22 17 10 Paving defective in area or yard 192 220 113 Gulley choked 12 9 6 Ventilating pipe improperly constructed 1 1 — „ „ wash- house 138 110 77 Soilpipe defective — 9 7 Guttering defective 39 50 12 Water-closet choked 50 33 27 Premises damp 41 62 53 defective 272 271 130 Rooms, etc., dirty 3,275 1,638 3,202 „ insufficiently flushed 13 8 19 „ verminous 344 204 162 Roof defective 251 387 272 „ flushing apparatus defective 76 78 48 Accumulation of refuse 5 5 11 Animals improperly kept Water supply to premises 32 16 10 „ without water supply 32 29 12 sufficient 5 18 10 Other defects or nuisances 957 1,531 2,494 foul 41 45 55 „ accommodation insufficient 2 9 4 Overcrowding. Tenements overcrowded 2 8 4 without door 1 — — Rooms overcrowded 2 8 5 without external light or ventilation Rainwater pipe not disconnected from drain — 1 3 Occupants, total 12 43 24 Under 10 7 23 11 10 and upwards 5 20 13 Overcrowding abated— By re-arrangement 1 — — By voluntary removal — 2 1 or soilpipe 1 — — Under notice 1 5 3 „ „ defective 55 50 34 Cases held over — 1* — „ ,, choked 5 14 6 Wastepipe defective 21 21 22 Notices Issued. „ choked 7 11 2 Written Intimations 518 735 553 „ not provided — 1 — Statutory Notices 142 240 154 Other drainage defects 10 34 10 Bye-law „ 2,369 2,309 1,771 Cistern defective 4 1 3 Notices under L.C.C. (G.P.) „ dirty 17 13 16 Acts— „ without proper cover 12 2 5 Verminous rooms 204 244 125 „ cover defective 23 15 12 Additional taps 4 18 8 Dustbin defective 228 147 86 Abolition of old dustbins 5 4 1 * This case resulted in a summons, which was adjourned five times, finally sine die 59 samples taken under the sale of food and drugs acts, etc. TABLE 20. Samples taken under the Sale of Food and Drugs Acts, &c. 1923. Total. Found adulterated. Percentage adulterated. Milk 246 11 4.4 Dried Milk 6 — — Condensed Milk 5 — — Cream 13 — — Butter 40 — — Margarine 18 — — Lard 16 — — Bread 21 — — Flour 23 — — Cake 6 1 16.6 Mincemeat 9 2 22.2 Lemon Curd 6 2 33.3 Lemon Cheese 6 4 66.6 Cheese 4 — — Jam 5 — — Cocoa 5 — — Coffee 10 — — Rice 5 — — Tapioca 5 — — Sago 5 — — Mustard 5 — — Pepper 5 — — Vinegar 19 — — Spinach 2 — — Beans 1 1 100.0 Peas 3 3 100.0 Sardines 1 — — Brawn 6 — — Minced Beef 3 — t— Bacon 3 2 66.6 Ham 3 3 100.0 Sausages 28 14 50.0 Dripping 3 — '— Honey 7 — — Borax 3 1 33.3 German Sausage 3 — — Meat Paste 2 — — Fish Paste 11 1 9.0 Soda Water 8 4 50.0 British Wine 3 2 66.6 Lemon Squash 1 1 100.0 Fruit Syrup 1 1 100.0 Olive Oil 5 — — Castor Oil 3 — — Camphorated Oil 3 1 33.3 Ammoniated Tincture of Quinine 2 — — Prescription 1 — — Glycerine 7 — — Lime Juice 4 2 50.0 600 56 9.3 TABLE 21. Office (Clerical Work). Letters Received 5,375 (5,634) Entries in Birth Register 2,572 (2,689) „ Despatched 6,740 (7,595) Complaints Received 1,335 (1,403) Entries in Postage Book 12,840 (16,526) Plans dealt with 337 (274) Certificates dealt with relating to Infectious Disease (including Tuberculosis) 3,180 (5,595) New Openings in Journals 336 (317) Disinfection Orders 2,259 (3,857) Notices sent re above 7,105 (9,125) Notices to abate Nuisances 1,260 (2,004) Figures in parentheses are those of 1922. 60 60 appendix : legal proceedings. TABLE 22. Legal Proceedings—1923. Premises. Offence. Fines. Costs. PUBLIC HEALTH (LONDON) ACT, 1891. Section 4. £ s. d. £ s. d. 14, 30, 32,34,Brindley Street Insufficient water supplies (4 summonses) Additional taps provided 2 2 0 5, Chilworth Mews Roof, walls and ceiling of room defective Order made 1 1 0 9, Clarendon Street Burst water pipe causing dampness Work done. 0 10 6 54, „ Roofs, guttering and w.c. defective „ 1 1 0 110, „ Washhouse paving and ventilating pipe defective (2 summonses) „ 2 2 0 6, Dudley Place Cats improperly kept Order made 277, Harrow Road Failing to reinstate water supply Re-instated 1 1 0 59, Hereford Road Drain defective Order made 1 1 0 1, Kildare Gardens Steps over lobby defective, drain and waste stacks foul, fungus in vault „ 1 1 0 1, 2, 3, 4, 5, Lanark Mews... Roofs defective (5 summonses) Dismissed 2 and 5, „ W.C.'s in direct communication with kitchens, soil pipes improperly constructed Order made 4, „ W.C. in direct communication with bedroom, soil pipe improperly constructed „ 18, Netley Street Sink and windows defective (2 summonses) Work done 1 1 0 9 it 10, Pressland Street Walls damp (2 summonses) Order made 2 2 0 42, Torquay Street Room damp „ 0 6 0 16, Walterton Road Failing to amend water closet 4 0 0 1 1 0 23, Woodchester Street Fowls improperly kept Order made Section 37. 72, Cirencester Street Premises without a proper dustbin Provided withdrawn 52, Warrington Crescent „ „ „ „ „ 0 10 6 59, „ „ „ „ „ „ 0 10 6 Section 47. 50, Great Western Road Exposing for sale unsound tomatoes and pieces of apples, oranges and lemons (2 summonses) 20 0 0 2 2 0 By-laws. 7, Albert Street Failing to carry out annual cleansing 2 0 0 21, Campbell Street Area paving and copper defective (2 summonses) Work done 2 2 0 72, Cirencester Street Insufficient water supply to w.c II withdrawn „ W.C. pan foul „ „ „ Manhole cover broken „ „ Rooms dirty 0 10 0 1 1 0 „ W.C. doors defective 0 10 0 1 1 0 „ Copper defective 0 10 0 1 1 0 „ Paving of areas defective 0 10 0 1 1 0 „ Staircase without proper ventilation 0 10 0 1 1 0 „ Failing to remedy contraventions of By-laws with respect to which fines were imposed. (5 summonses) 10 0 0 5 0 0 18, Clarendon Street Failing to abate overcrowding Abated withdrawn 54, „ W.C. door without fastenings Work done „ 69, Cirencester Street Rooms and staircase dirty „ 2 2 0 110, Clarendon Street Rooms dirty, sash cords defective (2 summonses) „ 2 2 0 54, Kensal Road W.C. door without proper fastening „ 1 1 0 176, „ Insufficient w.c. accommodation „ 1 1 0 2, 4, & 5, Lanark Mews Failing to submit plans of new w.c.'s, constructing new w.c.'s in an improper manner (11 summonses) 5 10 0 4 4 0 9, Modena Street Sash cords defective, w.c. door without proper fastenings Work done 2 2 0 „ Copper defective 1 0 0 1 1 0 2, Senior Street Rooms dirty, etc. (2 summonses) Work done 2 2 0 69, Westbourne Terrace: Failing to give notice of construction of new w.c. 2 0 0 2 2 0 „ Executing work in manner contrary to By-laws 1 1 0 2 2 0 — Removing offensive refuse during prohibited hours Dismissed 3 3 0 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1922. Section 10. 28, Campbell Street ... Rooms verminous ... ... ... ... ... Adjourned sine die SUMMARY OF LEGAL PROCEEDINGS UNDER SALE OF FOOD AND DRUGS ACTS, 1875-1907. Fines. Costs. £ s. d. £ s. d. Milk 13%deficient in fat ... 2 0 0 1 1 0 „ ... 8% Dismissed 6% Dismissed 10% 4 0 0 1 1 0 „ ... 19% — 5 5 0 12% „ „ — 3 3 0 19% — 3 3 0 , ... 7% : — 3 3 0 8% — 3 3 0 12% — 3 3 0 No previous convictions. The braces indicate that the summonses with respect to the samples within each brace were taken against one vendor 61 housing conditions—statistics. HOUSING. (MINISTRY OF HEALTH.) Unfit Dwelling Houses. I. Inspection. 1921. 1922. 1923. (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 2,332 2,020 2,074 (6) Registered tenement houses inspected 997 915 793 (c) Houses inspected under Housing Acts 63 2 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 *8 — *1 (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 55 2 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 55 2 2 (2) Number of dwelling-houses;which were rendered fit— (a) by owners 87 45 27 (b) by Local Authority in default of owners 9 — 1 (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 1,892 2,198 1,861 (b) Number of bye-law notices served 2,570 2,572 1,942 (2) Number of dwelling-houses in which defects were remedied— (a) by owners Not available. (b) by Local Authority in default of owners — — — (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 8 — 2 (2) Number of dwelling-houses in respect of which Closing Orders were made 8 — 2 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit 4 (4) Number of dwelling-houses in respect of which Demolition Orders were made — — — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — — — 62 maternity and child welfare. CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare. Address. By whom provided. Ante-natal Consultation Centres 232, Harrow Road Paddington School for Mothers. St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Infant Consultation Centres *232, Harrow Road St. David's Church Hall, St. Mary's Terrace All Saints' Church House, Norfolk Mews South *Congregational Institute, Third Avenue Orphanage of Mercy, Randolph Gardens St. Simon's Hall, Macroom Road * Two sessions weekly. Paddington School for Mothers. Day Nurseries West House, 13, Hasborough Street Paddington Day Nursery. 66, Lancefield Street Queen's Park Day Nursery. Tuberculosis. Dispensaries 20, Talbot Road Paddington Tuberculosis Dispensary. St Mary's Hospital, Cambridge Place St. Mary's Hospital. Venereal Diseases. Clinics Lock Hospital, 283, Harrow Road (Women and Children) St. Mary's Hospital, Cambridge Place (Male and Female) London County Council. PUBLIC HEALTH STAFF. (W.T.=Whole-time appointments. P.T.= Part-time appointments. See footnote for explanation of figures in parentheses.) Medical Officer of Health, Administrative Tuberculosis Officer, W.T. R. Dudfield, O.B.E., M.A., M.B., D.P.H. Assistant Medical Officers of Health, P.T. R. S. Walker, L.R.C.P., L.R.C.S.Ed., L.R.F.P.S.Glas., D.P.H., Tuberculosis Officer, Paddington Tuberculosis Dispensary. A. B. Porteous, M.D., D.P.H., Tuberculosis Officer, St. Mary's Hospital Tuberculosis Dispensary Public Analyst, P.T. A. W. Stokes, Fellow Chemical Society, Institute of Chemistry and Society of Chemical Industry. Chief Sanitary Inspector and Canal Boats Inspector, W.T. E. J. Potter (1), (4). District Sanitary Inspectors, W.T. J. W. Webster (1). T. Mitchell (1), (3), (4), (5). G. J. Miners (1), (4). R. A. Jones (1), (2), (3). Meat and Food Inspector, W.T. E. J. Grivell (1). (3), (4), (5). Women Sanitary Inspectors, W.T. F. M. Nicolas (2), (6), (7). L. M. O'Kell (1), (7). Workshops Inspector, W.T. C. S. Wansbrough (1), (5). Tenement Houses Inspectors, W.T. C. Lawrence (1), (3), (4), (5). H. J. Heeley (2), (3), (4). Health Visitors, W. T. D. A. M. Newhall (1), (2), (8), (9). E. A. S. Davies (8), (9). (1) Sanitary Inspector's Certificate, Royal Sanitary Institute, (2) „ „ „ Sanitary Inspectors' Examination Board. (3) Meat and other Foods Certificate, Royal Sanitary Institute. (4) Building Construction Certificates. (5) Plumbing Certificates. (6) Diploma, National Health Society (7) Tuberculosis Certificate, National Health Society. (8) Central Midwives Board Certificate. (9) Nursing Training Certificates.