STMARY 15 AC 4353 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1910, Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.RC.P. (Ed.) Of the Middle Temple, Barrister-at-Law. London: Geo. Pulman & Sons, Ltd., Printers. 1911. Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1910, Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.RC.P. (Ed.) Of the Middle Temple, Barrister-at-Law. London: Geo. Pulman & Sons, Ltd., Printers. 1911. Public Health Office, 24, Somerset Street, London, W., 9th June, 1911. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor and Gentlemen, In accordance with the instructions of the Local Government Board, I beg to submit the following Report for the year 1910 on the public health and sanitary condition of the Borough of St. Marylebone. From the public health point of view the year was a most satisfactory one. In many respects also it was a noteworthy one, the additions to the staff of inspectors having permitted of a greater amount of work being carried out than in any previous year. Statistical and other evidence is brought forward in the following pages to show that what was done was to the immediate advantage of the public health, and as time goes on it will doubtless be possible to show that a lasting effect also has been produced. The Public Health Committee, with Councillor the Rev. J. A. Beaumont, M.A., for the fourth year in succession in the chair, and Mr. Alderman J. Lea-Smith again Chairman of the Dust Sub-Committee, took the keenest interest in the work and on all occasions gave me the greatest assistance and encouragement, and I take this opportunity of thanking them most sincerely and also of recording my high appreciation of the loyal manner in which all the members of the staff of the department, new as well old, have worked throughout the year. I am, Mr. Mayor and Gentlemen, Your obedient servant, CHARLES PORTER, Medical Officer of Health. TABLE OF CONTENTS. Part I. Statistical. page Infectious Disease Chart facing 7 Population 7 Births (a), Registration (b), Notifications 7, 8 Deaths and Death Rates 8, 9 District Births and Deaths 10 Institution Deaths 10,11 Causes of, and Ages at, Death 11 Deaths in relation to age 11, 12 Infantile Mortality 12, 13, 14 Prevention of Infantile Mortality 14, 15, 16, 17, 18, 19 Deaths in relation to Disease 20 Diarrhœal Diseases 20 Zymotic, Diseases, Phthisis, &c., and Respiratory Diseases 20 Zymotic Diseases 20 Phthisis and other Tubercular Diseases 21 Respiratory Diseases 21 Cancer and Malignant Disease 22 Alcoholism 22 Accident, Suicide and Manslaughter 23 page Records of Diseases 23 Notifications 23 Discharge Notices 24 Diphtheria and Membranous Croup 24, 25 Diphtheria Anti-toxin (London) Order, 1910 25 Scarlet Fever 25 Enteric Fever 26 Cerebro-Spinal Fever 26 Erysipelas 26 Puerperal Fever 26 Measles 26, 27, 28 ,, Deaths 28 ,, Prevention of 28, 29 Whooping Cough 29,30 Glanders 30 Phthisis 30 ,, Notifications 30 ,, Deaths 31 ,, Preventive Measure against 32, 33 ,, Bacteriological diagnosis 34 ,, Distribution of 34 Disinfection 34, 35, 36 Bacteriological Examinations 36 Part II. Departmental. page Protection of Food Supply 39 Inspection 39, 40 Surrenders 40 Seizures 40 Prosecutions 41, 42, 43 Slaughterhouses 43 Milk Supply 43 Cowhouses 43, 44 Milkshops, etc. 44, 45 Examination of Milk 45 Ice Cream Premises 46 Butter, Margarine, etc. 46 Restaurants, Food Stalls, etc. 46 Offensive Trades 47 Bakehouses 47 Sale of Food and Drugs Acts 47, 48 Public Analyst's Reports 49-54, 55, 56, 57 Bacteriological Examination of Food 58 Water Supply 58, 59 Housing 59 Housing, Town Planning, etc. Act, 1909 59,60, 61, 64 Houses Let in Lodgings 61, 62 Common Lodging Houses 62, 63 House to House Inspection 63, 64, 65 page Overcrowding 65 Underground Rooms 65, 66, 67, 68 Customs and Inland Revenue Acts 68 Nuisances 69 Work of Sanitary Inspectors 69, 70 Legal Proceedings 71, 72 Drain Plans and Drainage 73 Combined Drainage 73 Black Smoke Nuisances 73 Removal of House Refuse 74, 75, 76 Verminous Persons Baths 76, 77 Cleansing of Persons Act, 1897 77, 78 The Shelter 78 Public Mortuary 78, 79 Public Sanitary Conveniences 79, 80 Factories and Workshops 80-85 Underground Workrooms 82 Inspection 83 Defects Found 83 Home Work 84 Registered Workshops 85 Sanitary Inspection (Summary) 85, 86, 87 Statistics—Comparative Statement 88 Local Government Board Tables I.-V. 89-93 Vaccination Returns 94, 95 Part I. STATISTICAL. Curve showing the number of cases of Scarlet Fever, Diphtheria and Typhoid Fever, notified week by week during the year 1910. 7 POPULATION. At the middle of 1910 the population of St. Marylebone, estimated by the Registrar-General's method, was 125,195, the population of the Sub-registration districts being:— 1909. 1910. All Souls 33,460 33,239 St. Mary 35,878 35,641 Christ Church 37.379 37,133 St. John 19,310 19,182 126,027 125,195 The estimated decrease since 1909, when the population was estimated at 126,027, is 832, and the decrease since the census 8,106. Whether or not this decrease has actually taken place will be determined in 1911, the report for which year will be based upon an enumerated, not an estimated, population. If the population is decreasing annually by something like 1,000, the main reason is that offered in the report for 1909, viz.:— emigration of persons tempted by improved means of transit to remove to the suburbs, or displaced by the demolition of small houses which are being replaced by flats. BIRTHS. (a) Registration. The number of births registered during 1910 was 2,556,* being 22 above the number for 1909. Male births numbered 1,283, and female 1,273. The birth rate per 1,000 was 20.4. The accompanying table compares the rates in the several registration sub-districts with those of 1909:— 1909. 1910. All Souls 20.1 21.5 St. Mary 13.9 12.1 Christ Church 27.8 27.3 St. John 16.4 20.4 The rate for the Borough in 1909 was 20.0 per 1,000, and though there is a slight increase for 1910, the rate is still below that of the average of the previous 10 years, viz.: 21.2. In the district of All Souls it may be noted that in 1910 as in 1909 the rate has increased. In Christchurch, which showed an increase of 3 per 1,000 in 1908, there is a further decrease of. *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein. 8 (b) Notifications. The Notification of Births Act, 1907, which came into force in the Borough on the 15th June, 1908, has continued to work smoothly during 1910. The total number of notifications received was 4,052. All persons failing to notify, whose names and addresses were revealed by the returns of the district registrars, were either visited or written to and requested to give an explanation of the failure to comply with the requirements of the Act. In practically all cases the reason given was ignorance of the existence of the Act and of the fact of its adoption by the Borough Council. It is believed that as a result of the work during 1910, the visits by women inspectors and the reminder letters sent out, great improvement will be noted in the future in connection with notifications under the Act, large numbers of persons having been made aware of the requirement to notify. No prosecutions were instituted during the year against persons failing to comply with the provisions of the Act. The following are the sources of the notifications received during the year:— 1909. 1910. From Parents 386 or 11.28 per cent. 768 or 1893 percent. „ Doctors 400 or 11.69 „ 387 or 9.54 „ „ Midwives 696 or 20.34 „ 854 or 21.06 „ „ Other persons 35 or 1.02 „ 27 or .66 „ „ Hospitals, etc. 1,904 or 55.68 „ 1,970 or 48.58 „ Of the total births notified, 68 referred to still-births (46 males and 22 females); 1,710 took place at Queen Charlotte's Hospital; 362 at the Middlesex Hospital and 2,052 were born at home. Of those notified as having occurred in St. Marylebone, 1,668 belonged to other Boroughs. DEATHS AND DEATH RATES. Deaths to the number of 1,607 were registered during the year. This figure is inclusive of persons who, though usually resident in the Borough, died in institutions, etc., outside, but exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other districts. The death rate calculated with this figure and the estimated population to the middle of 1910 and corrected for age and sex distribution by multiplying by the RegistrarGeneral's factor 10652, works out at 13.3 per 1,000. As was explained in the report for 1909, the necessity for this "correction" results from the fact that differences in death rates in various areas are not entirely dependent upon the sanitary conditions existing in these areas, but also on the constitution (age and sex) of the population. A population consisting of 9 aged persons would show more deaths than one consisting entirely of young and vigorous adults: a population made up of a large number of males and a small number of females has more deaths and a higher death rate than one in which the females outnumber the males. The death rates of such populations are not comparable the one with the other nor with those of populations differently constituted. The Registrar-General's factors do away with all difficulty in comparing death rates, and all which have been corrected by his method may be safely examined side by side. The corrected death rates of other London Boroughs are given in the accompanying table, compiled from information supplied by the Medical Officer of Health of each District, and may be compared with that for St. Marylebone. Borough. Corrected Birth Rate. Corrected Death Rate. Death Rates from Infant Mortality per 1,000 Registered Births. Seven chief Zymotic Diseases. Phthisis. Pulmonalis. Battersea 23.70 11.30 1.11 1.03 96 Bermondsey 31.20 17.60 1.70 1.70 127 Bethnal Green — — — — — Camberwell — — — — — Chelsea 18.30 l2.70 0.92 1.18 102 Deptford 24.70 14.60 1.71 1.26 123 Finsbury 29.90 17.29 1.94 1.75 121 Fulham 27.20 12.10 1.28 1.07 107 Greenwich 21.41 11.15 1.38 0.96 108 Hackney — — — — — Hammersmith 22.8 12.1 — — 104 Hampstead 14.00 8.60 0.47 0.60 60 Holborn 19.10 14.50 0.81 1.84 101 Islington 23.21 12.80 1.21 1.10 95 Kensington 17.50 13.00 0.74 0.76 108 Lambeth 25.60 12.50 1.01 1.10 82 Lewisham 20.75 9.67 0.50 0.55 80 London (City) 15.30 12.10 0.17 1.05 53 Paddington 19.84 11.77 1.19 0.83 101 Poplar 29.69 15.29 1.39 1.50 119 St. Marylebone 20.10 13.30 1.20 1.10 99 St. Pancras 22.70 13.80 0.96 1.25 108 Shoreditch 31.60 17.60 1.90 1.50 147 Southwark 26.60 15.80 2.06 1.84 120 Stepney 28.90 13.50 1.23 1.29 113 Stoke Newington 17.50 11.40 0.50 0.92 66 Wandsworth 20.26 9.03 0.54 0.76 78 Westminster (City) 15.00 11.00 0.41 1.08 82 Woolwich 22.10 11.80 0.63 1.04 84 The average death rate for the preceding 10 years was 16.5. The rates in the several registration sub-districts for the last three years were as under:— 1908. 1909. 1910. All Souls 13.2 12.6 10.7 St. Mary 14.9 12.8 11.7 Christ Church 19.0 18.2 15.6 St. John 13.4 14.6 13.1 10 District births and deaths for the fifty-two weeks ending 31st December, are given in the following table (Table I.) while vital statistics of separate localities for 1910, and the ten preceding years will be found in Table II. of the Local Government Board series on page 90. TABLE I. District Births and Deaths for the fifty-two weeks ended 31st December, 1910. Sub District. Population estimated to middle of year 1910. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 33.239 354 362 716 188 167 355 St. Mary 35,641 211 221 432 201 216 417 Christ Church 37.133 513 503 1,016 312 270 582 St John 19,182 206 186 392 116 137 253 Totals 125.195 12,284 1,272 2,556 817 790 1,607 Institution Deaths.—Very many of the deaths of St. Marylebone residents occur in institutions either within or without the Borough, and the accompanying table which shows where deaths occurred during 1910 is of interest. Attention may be directed to the large number of nursing and surgical homes in which deaths are recorded as having taken place. The number shown is, of course, only a fraction of the total number in existence in the Borough. Institution within the District veceiving sick and infirm persons from outside the district. Institutions outside the District receiving sick and infirm persons form the District Nussing and Surgical Home within the District, in which deaths of residents and non-residents have occurred. Christian Union Almshouses,John Street Banstead Asylum 3, Beaumont Street Hospital for Epilepsy and Paralysis, Maida Vale Cane Hill Asylum 5, do. Hospital for Invalid Gentlewomen, Lisson Grove Charing Cross Hospital 12, do. Hospital of St. John and St. Elizabeth Children's Hospital, Gt. Ormond 12a, do. London Throat Hospital, 204, Great Portland Street Street 13, do. Middlesex Hospital Children's Hospital, Paddington 14, do. Queen Charlotte's Hospital Green 16, do. Royal National Orthopaedic Children's Infirmary Carshalton 17, do. Hospital, Gt. Portland Street Clayhury Asylum 18, do. St. Marylebone Almshouses Colney Hatch Asylum 20, do. St. Marylebone Workhouse consumption Hospital, Brompton 21, do. St. Peter's Harbour, Greville Place Dartford Heath Asylum 33, do. Samaritan Free Hospital Fastern Hospital 37, do. West End Hospital, 73, Welbeck Freidenheim Hospital 40, do. Western Ophthalmic Hospital Hampstead 47, do. French Hospital Shaftesbury 49, do. Avenue 50, do. General Hospital, Birmingham 52, do. General Hospital, Hampstead 54, do. General Hospital 55, do. Gordon Hospital 57, do. Hanwell Asylum 5, Bentinck Street Heart Hospital, Soho 22, do. Homoeopathic Hospital 14, Bulstrode Street Home Hospital, St. Pancras 15, do. Horton Asylum 12, Devonshire Street, Portland Hostel of God, Clapham Place King's College Hospital 22a, do. 11 nstitutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District Nursing and Surgical Homes with in the District, in which deaths of residents and non-residents have occurred. Leavesden Asylum 23, Devonshire Street, Portland Place London Hospital 24, do. Long Grove Asylum 29, do. London Temperance Hospital 30, do. Lying-in Hospital, Endell Street 32, do. Manor Asylum, Epsom 36, do. Metropolitan Hospital 45, do. North-Western Fever Hospital 25, Dorset Square New Hospital for Women 11, Duchess Street Paddington Infirmary 12, do. Queen's Hospital 90, Harley Street Royal Free Hospital 146, do. St. Bartholomew's Hospital 7, Henrietta Street St. George's Infirmary 14, do. St. Joseph's Home, Kensington 15, do. St. Joseph's Hospice, Mare 25, do. Street 12, Hinde Street St. Luke's House, Kensington 12, Holies Street St. Marylebone Infirmary 18, Manchester Street St. Mary's Hospital 19, do. St. Pancras Infirmary 3, Mandeville Place St. Peter's Home, Lambeth 7, do. St. Peter's Hospital, Covent 9, do. Garden St. Elizabeth's Home, Sick Asylum, Cleveland Street 59, Mortimer Street St. Thomas' Hospital 2, Nottingham Place Tooting Bee Asylum 3, do. University College Hospital 11, do. Western Hospital 24, do. Westminster Hospital 7, Queen Anne Street Westminster Union Workhouse 4, Upper Wimpole Street 6, Upper Montagu Street 8, Welbeck Street 15, do. 51, do. 50, Weymouth Street 51, do. 29, Wimpole Street Causes of and Ages at Death.—The Local Government Board Table IV. (page 92), which appears for the last time in this form, a different classification having now been adopted, gives the details as to the deaths of residents in the Borough during 1910. In it will be found a considerable amount of information regarding the causes of death and the numbers which occurred in various age groups. Some of the points brought out are deserving of fuller consideration than is given to them there, however, and it is proposed to say a few words with regard to the question of age periods at which death occurred and certain of the diseases and conditions certified to be the cause of death. Deaths in Relation to Age. The total number of deaths to be analysed is 1,607, as against 1,849 in 1909. The numbers which occurred at certain age periods are shown in the accompanying table, and it will be noted that infants under 1 and adults in the later years of life contributed most largely to the total. Age Periods. Under 1 year. 1-5 5-15 15-25 25-65 65andover At allages. No. of Deaths 253 115 40 52 665 482 1,607 12 The extent to which each of the four divisions of the Borough shared in the deaths of those aged over 65 in 1909 and 1910 is shown below. The total for the former year was 616 as against 482 for the latter. 1909. 1910. All Souls 146 101 St. Mary 166 147 Christ Church 190 141 St. John 114 93 Of the total, 141 at death were aged 65-70; 224,70-80; 107,80-90; and 10, 90-100. The outstanding causes of death, apart from old age, were chronic bronchitis, 55; nephritis and Bright's disease, 24; cancer, 50; heart disease, 42. In 13 the cause was stated to be tuberculosis of the lungs. The figures for 1909 were: chronic bronchitis, 103; nephritis and Bright's disease, 27; cancer, 50; and heart disease, 23. A comparison of the deaths that took place under 1 and those over 65 years of age is given below; the numbers occurring in each quarter of the year are also shown. The effect of the trying weather conditions of the first and last quarters, at the extremes of life, is well brought out. January- April- July- October- Total. March. June. September. December. Infants under 1 year 87 53 46 67 253 Persons of 65 years and upwards 147 119 72 144 482 Infantile Mortality. The infantile mortality rate of a district is regarded as indicating more distinctly than any other whether or not the sanitary measures adopted are being attended with success. It is calculated from the total number of deaths of infants under 1 year of age, and the number of births occurring in the same year. In 1910, there were 253 such deaths, while the births (corrected) numbered 2,556. The infantile mortality rate is therefore 98.9 per 1,000, which is absolutely the lowest recorded in the Borough, the next lowest being 102.2 in 1907. In 1909 the rate was 102.3, only one point higher than in 1907. The average for the preceding 10 years was 132.8. The number of deaths of infants in 1907 was 264, and in 1909, 259. For the purpose of comparison, a table (page 9) has been prepared from information very kindly provided by the Medical Officers of Health, showing, amongst other things, the infantile mortality rates in each of the Metropolitan Boroughs. It will be noted that though there has been a reduction all over, St. Marylebone has improved her position, standing tenth in the list, as against 11th in 1908 and 9th in 1909. Causes of Infantile Mortality and Ages at Death. The information under this head is arranged in tables similar in construction to those introduced into the Annual Report for 1909. These tables show, 13 for each registration sub-district, the ages at which death occurred amongst the 253 infants who died, and the causes to which death was attributable. TABLE II. Sub-District, Months. 0 1 2 3 4 5 6 7 8 9 10 11 Total All Souls 26 3 6 5 3 2 2 4 1 2 1 4 59 St. Mary 20 2 1 5 6 3 2 1 — 2 3 3 48 Christ Church 48 9 8 11 8 3 3 4 7 8 4 2 115 St. John 8 5 1 4 1 1 3 — 1 1 4 2 31 Totals 102 19 16 25 18 9 10 9 9 13 12 11 253 TABLE III. Cause of Death. Diarrhœa. Prematurity. Marasmus, Atrophy and Debility Bronchitis. Pneumonia. Convulsions. Suffocation. Measles. Whooping Cough. Tuberculosis. Meningitis including Tuberculous. Miscellaneous. Totals. All Souls 1 14 8 4 1 1 4 — 4 1 1 20 59 St. Mary 1 11 3 4 2 5 — — 3 — 1 18 48 Christ Church 6 26 9 10 5 1 4 4 5 2 3 40 115 St. John 1 3 2 4 — 2 — 2 3 — 2 12 31 Totals 9 54 22 22 8 9 8 6 15 3 7 90 253 TABLE IV. Certified cause of Death. Months. 0-3 Months. 3-6 Months. 6-12. Totals. Diarrhœa 2 6 1 9 Prematurity 52 2 — 54 Marasmus, Atrophy and Debility 15 7 — 22 Bronchitis 7 6 9 22 Pneumonia 2 3 3 8 Convulsions 3 5 1 9 Suffocation 6 — 2 8 Measles 1 — 5 6 Whooping Cough 2 3 10 15 Tuberculosis — 2 1 3 Meningitis (including Tuberculous) — — 7 7 Miscellaneous 47 19 24 90 Totals 137 53 63 253 14 In Table IV., the third of the set, the deaths occurring in the age groups, 0-3 months, 3-6 months, and 6-12 months are classified under the various causes set forth in Table III. Table V. of the Local Government Board series, which will be found at page 93, also contains information regarding this important subject. In commenting upon the tables in the report for 1909, it was pointed out that the bulk of the deaths were of children under three months of age. The state of affairs in 1910 is exactly similar, 137 (54 per cent.) of the 253 infants having died before the end of the first quarter. The percentage for 1909 was 59. The number of children who died before attaining the age of one month—102, nearly half of the total—is much higher than in 1909, when the figure was 96 out of 259. Apart from infectious diseases which caused 21 deaths—measles 6, whooping cough 15—the chief causes of mortality amongst infants in 1910 were immaturity (prematurity, wasting and developmental diseases) which accounted for 76, and affections of the respiratory organs (bronchitis 22, and pneumonia 8) which were certified as responsible for 30 deaths. To these two causes alone, therefore, 106 deaths, nearly one half of the total, were traceable. The actual percentages were immaturity 30 per cent., respiratory diseases 11.5 per cent. The proportion due to infectious diseases was 9 8 per cent. Further comment will be made regarding these affections under the heading Records of Diseases (p. 27). In the majority of reports regarding infantile mortality the trio of causes to which the bulk of infant deaths are shown to be traceable are immaturity, respiratory affections and diarrhœa. In the report for 1909 this was the case— diarrhoea being responsible for close on 14 per cent. of the total deaths. In 1910 only 9 deaths were classed as being due to diarrhoea, which made it one of the less important instead of one of the outstanding causes of death. Other causes contributing in about the same proportion as diarrhoea were convulsions 9, suffocation 8, and meningitis—all forms—7. Of the 8 infants certified as having been suffocated (overlaid), 6 were less than three months old, 4 of them less than one week. Prevention of Infantile Mortality. As is now generally recognized, the great bulk of the deaths of infants under one year of age occur from causes almost entirely preventable. Their prevention, and this has been proved over and over again, is to a great extent in the hands of the mothers who bear the children. Many of those who died because prematurely born or because of the diseases classed as developmental, did so because their mothers were in bad health or careless of themselves. Many of 15 those who died from respiratory affections met their death because they were not sufficiently protected and cared for. The difficulty is to convince mothers that carelessness, ignorance and fecklessness on their part are the causes. It can only be done by getting into direct contact with the women soon after the children are born, in the hope of being able to instruct and help them. During 1910, a vast amount of work of this kind was done by the Council through the women inspectors, Miss Baker, Miss Johnson, and Miss Wienholt and her successor, Miss Stokes. The fact that there is a fall in the number of deaths seems to show that the efforts put forth in the past are beginning to produce results and that these efforts should be maintained. The great assistance received by the department in carrying out this work, from the Health Visitors of the St. Marylebone Health Society, must again be gratefully acknowledged. There is very close co-operation between these voluntary visitors and the Medical Officer of Health and the women inspectors, and, as a result, a great deal more work is done and much better results obtained than would otherwise be the case. The chief result of the work of the Society is undoubtedly the getting into close touch with the mothers and with the babies, and this is brought about by holding infant consultations presided over by members of the medical profession specialising in diseases of children and by carrying on clubs for the mothers. The functions of the consultations were described in the Annual Report for 1909, and during 1910, Drs. Murrell and Murray, who preside over that in Bell Street, and Dr. Eric Pritchard, who conducts that at the Welbeck Dispensary, continued their valuable work. The number of infants seen at the former was 230 and at the latter 170, the total number of attendances being 1,330 at Bell Street and at Welbeck Street 946. The work carried out at the clubs is partly social and partly provident. At the social meetings of the mothers tea is served, and simple talks and lectures on domestic subjects and hygiene generally are given. The Provident clubs are largely for the purpose of encouraging expectant mothers to make preparations for the birth of the babies. Both clubs perform most useful functions, and have been highly successful. The total number of babies visited by the women inspectors was 2,065. The number visited by the voluntary workers of the Society was 934. The information elicited as a result of these visits is tabulated on page 16 (Table V.). TABLE V. BIRTHS INVESTIGATIONS, 1910. Method of Feeding Condition of Child Mother's Work Mother's Health Condition of Tenement No. of Rooms totals Age at Visit Breast only Breast, etc. Cow's milk Artificial or Condensed Not fed Well nourished Fairly nourished Badly nourished None Away from home Ditto intermittent Some home work Good Indifferent Bad Clean Fairly clean Dirty One Two Three Four or more First-born Twins Illegitimate Weeks 128 0 to 1 122 2 3 — 1 115 8 5 125 — 2 1 108 13 7 110 15 3 45 76 7 — 19 1 1 493 1 to 2 438 18 31 6 — 451 28 14 463 1 22 7 423 49 21 442 41 10 114 , 264 93 22 98 4 9 458 2 to 3 399 24 33 2 — 412 39 7 437 1 11 9 375 49 34 421 29 8 130 260 59 9 95 5 5 261 3 to 4 223 15 18 5 — 237 15 9 245 1 7 8 210 37 14 239 18 4 72 143 35 11 61 3 6 137 4 to 5 121 9 5 2 — 118 13 6 117 3 13 4 109 15 13 122 11 4 36 81 17 3 29 1 4 111 5 to 6 73 8 18 12 — 90 17 4 97 3 8 3 92 12 7 98 12 1 26 64 '7 4 21 1 5 107 6 to 7 78 11 13 5 — 97 10 — 96 1 8 2 90 9 8 101 5 1 33 59 21 4 30 — 1 29 7 to 8 23 1 4 1 — 25 4 — 27 1 1 — 21 7 1 28 1 — 7 16 5 1 8 — — 341 8 to 12 & over 248 30 48 15 — 279 45 17 304 4 22 11 262 45 34 311 23 7 91 184 57 9 72 6 8 16 17 Births Investigations.—The greater part of the first visits it will be noted were paid to mothers when the babies were aged less than one month old, this being the time when advice as to feeding, etc., is most urgently needed. With regard to the feeding it is satisfactory to note that in a large proportion of the cases only breast milk was given, even amongst children aged 2-3 months, a period at which it is not at all unusual to find that recourse, for one reason or another, is had by mothers to artificial foods. The fact mentioned in the Annual Report for 1909 that the number of mothers going out to work is comparatively small is well brought out. The columns headed "Condition of Tenement" are interesting, and it is encouraging to find that the numbers which had to be classed as dirty are so low. Infant Deaths.—The women inspectors, in addition to visiting homes in which there are babies, visit also those in which a death of an infant under one year has been registered as having occurred. These visits are paid as soon as possible after information as to the death has been received. Special enquiries are made as to the method of feeding, health of the mother, etc. The information obtained in the 84 cases enquired into is given in the accompanying tables. Table VI. relates chiefly to feeding, while Table VII. gives the age at death and particulars of feeding, etc., in relation to the cause of death. TABLE VI. ENQUIRIES INTO INFANT DEATHS, 1910. Method of Feeding Reasons for Weaning Cause of Death Weeks. Totals Breast only Breast, etc. Cows' milk Artificial or condensed Not fed Insufficiency or loss of milk Illness of mother or child Mother's work Mother's death Diarrhœa Prematurity Marasmus Atrophy, etc. Bronchitis Pneumonia Convulsions Suffocation Measles Whooping cough Tuberculosis Meningitis Miscellaneous First-born Twins Illegitimate M. C. 0 52 3 ... 2 ... 47 ... 1 ... ... ... 1 28 ... 11 ... 1 1 4 ... ... ... ... 6 22 5 4 1 8 4 ... 3 ... 1 ... ... ... 2 ... 2 2 ... 1 ... 1 ... ... ... ... ... ... 2 4 1 ... 2 17 11 1 4 ... 1 ... ... 1 ... 1 ... 5 1 3 ... ... 2 1 ... 1 2 ... 2 3 1 1 3 4 2 ... ... 2 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 2 1 1 ... 4 10 6 2 1 1 ... 1 ... 1 ... ... ... ... 2 5 ... ... ... ... ... ... ... 1 2 4 1 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 8 and over 84 56 9 12 5 2 10 1 2 2 1 6 4 4 3 7 10 7 4 5 10 3 2 19 9 5 ... 18 TABLE VII. ENQUIRIES INTO INFANT DEATHS, 1910. Totals First-born Twins Cause of Death. Method of Feeding. Mother's Health Mother's Work Condition of Tenement No. of Rooms in Tenement Age in Months. Breast only Breast, etc. Cows' milk Artificial and condensed Not fed Good Indifferent Bad None Away from home Ditto intermittently Some home work Clean Fair Dirty One Two Three Four or more 0 1 2 3 4 5 6 7 8 9 10 11 9 3 ... Diarrhœa 5 ... 3 ... 1 6 2 I 7 1 I ... 7 2 ... ... 7 ... 2 3 ... ... 1 2 1 ... ... 1 ... ... 1 40 11 6 Prematurity 7 1 3 1 28 26 6 2* 40 ... ... ... 38 2 ... 15 22 2 1 36 2 ... 1 1 ... ... ... ... ... ... ... 6 7 3 ... Marasmus 4 1 1 1 ... 4 2 1 6 ... 1 ... 6 1 ... 2 5 ... ... 1 2 1 2 ... 1 ... ... ... ... ... ... 24 6 2 Atrophy and developmental 5 2 4 1 12 18 3 3 21 ... 2 1 23 ... 1 9 10 4 1 16 3 2 ... 2 1 ... ... ... ... ... ... 7 ... ... Bronchitis 6 ... 1 ... ... 4 ... 3 6 ... ... 1 6 1 ... 4 3 ... ... ... ... ... 1 1 ... 1 2 1 1 ... ... 12 2 ... Pneumonia 5 3 3 ... 1 11 ... 1 8 1 I 2 11 1 ... 5 5 2 ... 2 ... 3 ... ... 1 1 1 3 ... ... 1 11 4 1 Convulsions 6 ... 4 ... 1 7 3 1 10 ... ... 1 9 2 ... 3 7 1 ... 3 3 ... 1 2 ... 1 ... 1 ... ... ... 9 2 ... Suffocation 5 ... ... 1 3 8 ... 9 8 ... 1 ... 7 2 ... 5 4 ... ... 5 2 ... ... 1 ... ... ... ... ... 1 ... 5 ... ... Measles 5 ... ... ... ... 5 ... ... 5 ... ... ... 3 1 1 2 2 ... 1 ... ... 2 ... 1 ... ... ... ... 1 ... 1 11 1 ... Whooping Cough 8 ... 2 1 ... 11 ... ... 10 ... 1 ... 11 ... ... 2 7 2 ... 1 ... ... 1 1 ... 1 3 ... 1 2 1 5 1 ... Tuberculosis 4 1 ... ... ... 3 1 1 4 ... ... 1 4 1 ... ... 5 ... ... 2 ... 1 ... ... 1 ... ... ... ... ... 1 3 2 ... Meningitis including Tuberculous 2 ... ... 1 ... 2 1 ... 3 ... ... ... 3 ... ... 1 ... 2 ... ... 1 ... ... ... ... 1 ... ... 1 ... ... 33 9 5 Miscellaneous 20 4 2 2 5 23 6 1* 32 ... 1 ... 29 4 ... 9 17 6 1 12 4 1 5 ... 4 1 3 1 1 1 ... 3 19 *Died. 20 Deaths in Relation to Disease. The Local Government Board Table IV, which contains the complete mortality statistics for the year, will be found at page 92. Some of the causes contributing to the total number have already been commented upon; others regarding which something may be said are diarrhœal diseases, the zymotic diseases, phthisis and tubercular diseases, respiratory diseases, cancer, alcoholism and accidents and suicide. Diarrhceal Diseases. Like 1909, the year under review was not what may be called a "diarrhœa" year, i.e., one in which the summer was very warm and the weather dry. It is not surprising, therefore, to find the total number of deaths from this cause comparatively small—46—and the death rate low, .37 per 1,000. In 1908, when the weather conditions were favourable to the spread of the disease, the deaths numbered 55. The fact that diarrhoea, especially the epidemic type, is more common and more fatal in early life has already been mentioned, and special precautions are taken to protect infants from infection by ensuring as far as possible that young mothers are made acquainted with the manner in which infection takes place and the modes of prevention. This work is done by the women inspectors and the voluntary health visitors and it is believed that their efforts are responsible to some extent for keeping the death-rate from this cause down. Zymotic Diseases, Phthisis, Etc., and Respiratory Diseases. The subjoined table, continued from the report for 1909, shows the mortality from each of these three causes. Total deaths Rate per 1,000 of the estimated population. 1. Zymotic Diseases 150 1.24 2. Phthisis and other Tubercular Diseases 169 1.40 3. Respiratory Diseases 270 2.24 Zymotic Diseases. Included in this group are the following diseases, viz., smallpox, measles, scarlet fever, whooping cough, diphtheria and membranous croup, typhus, enteric and continued fevers, diarrhoea and enteritis. The mortality due to each is sufficiently indicated in Table IV. It will be noted that whooping cough 21 contributed a very large number—41, nearly twice as many as in 1909, when 24 persons were certified as having died from this cause. Enteric fever which caused no deaths in 1909, gave 6 in 1910. Phthisis and other Tubercular Diseases. The deaths due to phthisis and other tubercular diseases (tubercular meningitis, general tuberculosis, tabes mesenterica, etc.) numbered 169. Of these, 133 were certified as from phthisis (consumption of the lungs), the remaining 36 being traceable to tubercular affections of the brain coverings (tubercular meningitis) and of the peritoneum (tubercular peritonitis, tabes mesenteria), etc. As shown in the following table, the number of deaths and the death rates from tuberculosis have fallen steadily since 1905, there being in 1910 seventynine fewer deaths from this cause than in the first named year. Between 1908 and 1909 the difference was 3; between 1909 and 1910 it is 31. TABLE VIII. DEATHS FROM PHTHISIS AND OTHER TUBERCULAR DISEASES. Year. No. of Cases. Population. Rate per 1000 of Population. 1910 169 125,195 1.40 1909 200 126,027 1.58 1908 203 126,867 1.70 1907 229 127,718 1.79 1906 244 127,960 1.90 1905 248 129,453 1.92 Further reference to the matter of deaths from phthisis will be made when dealing with that disease in the part of the report relating to records of disease. It may be said, however, that the chief reduction in the number of deaths from tuberculosis has been in those due to phthisis. In 1909 this disease caused 170 deaths as against 133 in 1910, the figures for the other tubercular conditions being slightly higher in the latter year. Respiratory Diseases. The total number of deaths—270— from the diseases affecting the organs of respiration—bronchitis, pneumonia, pleurisy, etc., was lower by 54 than in 1909, when 324 were registered. The death rate was 2 24 as against 2 57 in 1909. Of the total, 150 resulted from bronchitis and 99 from pneumonia. 22 Cancer or Malignant Disease. The figures for this disease are exactly the same as those for 1909, viz.: total deaths 156, death rate 1.2 per 1,000. The accompanying tables show the ages at which death occurred and the parts of the body which were affected by the growth. Cancer. Ages at Death. Ages. Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals. Males — 1 — 2 10 19 22 11 65 Females — 1 — 3 15 27 30 15 91 Totals — 2 — 5 25 46 52 26 156 Cancer. Situation of the Disease. Parts of the body affected. Males. F emales. Total. Face, Tongue, Jaw 11 — 11 Throat, Neck, Gullet 10 5 15 Stomach 10 12 22 Intestines 16 21 37 Liver 5 12 17 Breast — 16 16 Uterus and Generative Organs — 21 21 Various 13 4 17 65 91 156 Alcoholism. The number of deaths certified as due to alcoholism was 3. The number due to cirrhosis of the liver was 21, and as this disease is generally regarded as being traceable to the abuse of alcohol, for statistical purposes, it is usual to classify it under the heading "alcoholism." In 1909 alcoholism and cirrhosis of the liver together caused 30 deaths, and in 1908, 35. The combined figure for 1910, 24, compares very favourably with these, and it is hoped that the fall which has taken place during the last two years will be maintained. The deaths from other conditions in some cases, at least, due to the irritation produced by chronic alcoholism, e.g., nephritis (inflammation of the kidneys) and Bright's disease of the kidneys, were, it may be mentioned, also lower in 1910, totalling 57 as against 69 in 1909. 23 Accident, Suicide and Manslaughter. Accidental or violent deaths during 1910 numbered 54. Of these one was due to manslaughter and 14 to suicide. Eight babies were suffocated (overlain) in bed. Records of Disease The diseases of which records are kept and which are considered here are mainly the infectious diseases made compulsorily notifiable by the Public Health (London) Act, 1891, Sec. 55, or by order of the London County Council. The diseases named in the section are small-pox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus, typhoid or enteric, relapsing, continued and puerperal fevers. Those notifiable under order of the London County Council are cerebro-spinal fever, glanders, anthrax, and hydrophobia. In the case of phthisis (consumption) by the Public Health (Tuberculosis) Regulations, 1908, Poor Law medical officers must notify to the Medical Officer of Health, persons suffering from the disease and coming under their care. At the same time, however, medical men in non-Poor Law practice are invited by the Council to notify any cases of phthisis seen by them. Reference is also made here to certain diseases which though infectious are not notifiable, viz., measles, whooping cough, and diarrhoea. The records kept of these are based chiefly upon information obtained as a result of investigations made by the women inspectors, but partly upon returns from the schools and the local registrars. In Table III of the Local Government Board series much useful information is given with regard to the notifiable diseases. Here it is proposed to supplement these figures and to submit them to a closer examination. Notifications.—The total number of notifications received during 1910 was 791, a figure considerably lower than that for 1909 when i,c66 notifications came to hand, a large number being of cases of phthisis which were reported in accordance with the requirements of the Public Health (Tuberculosis) Regulations, 1908. The notification rate (proportion to population of notified cases of infectious disease, including phthisis) was 6.3 per 1,000. The number of notified persons removed to one or other of the hospitals for isolation and treatment was as usual large, viz.:— Diphtheria 121 or 95.4 per cent. of the cases notified. Erysipelas 36 or 31.3 11 ,, ,, ,, Scarlet Fever 195 or 94.2 ,, ,, ,, Enteric Fever 15 or 71.4 ,, ,, ,, Cerebro-Spinal Fever 2 or 100.0 ,, ,, ,, Puerperal Fever 2 or 50.0 ,, ,, ,, Phthisis 164 or 52.5 ,, ,, ,, 24 The cost of carrying out the requirements of the section relating to notification of infectious diseases for the year was £74 is. equal to 11s. 10d. per 1,000 of the population. The cost and rate per 1,000 for each year since 1901 are shown in the following Table: Year. Amounts paid to Medical Practitioners. Cost per 1,000 of Population. £ S. d. £ s. d. 1901 98 5 6 0 14 10 1902 152 5 0 1 3 0 1903 85 11 6 0 13 0 19O4 99 1 0 0 15 2 1905 61 5 6 0 9 6 1906 74 14 0 0 11 8 1907 74 0 0 0 11 7 1908 70 6 6 0 11 1 1909 73 5 6 0 11 7 1910 74 1 0 0 11 10 Discharge Notices. The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 199 and referred to 259 cases. Visits were paid to these cases by the District Inspectors, and advice given as to the date of the return of children to school, and the advisability of obtaining treatment for and isolation of any suffering from any sequel of a disease. Diphtheria and Membranous Croup. Diphtheria was slightly more prevalent in 1910 than in 1909, 128 cases, as against 109 in the latter year, having been notified. The form, however, was apparently milder, the number of deaths being fewer, viz.: 8—6.2 per cent. The number of cases per 1,000 of the population was 1.02. Considerable advantage was taken of the arrangements made by the Council for the carrying out of bacteriological examinations, in doubtful cases, the number of swabs submitted being 107. Of these, 27 gave a positive and 80 a negative result. All Souls and Christ Church districts as usual gave the greatest number of cases, the numbers being 37 for the former and 41 for the latter. St. John suffered least, contributing only 4. The number from St. Mary was 26. 25 The age distribution of the disease (see Table III., page 91) was similar to that for most years, the majority of the cases and all the deaths taking place in the age groups 1—5 and 5—15. The inspection of the premises in which cases occurred resulted in the discovery by the inspectors of a certain number of nuisances, including Dirty premises, etc. 50 Defective drainage 22 The Diphtheria Antitoxin (London) Order, 1910.—Towards the end of 1910, the Public Health Committee decided to take advantage of the powers granted by this order of the Local Government Board, and instructed the Medical Officer of Health to make arrangements for the supply of diphtheria antitoxin free of charge, to the poorer inhabitants of the district when required. The arrangements made were approved by the committee and a letter was sent to each medical practitioner in the Borough informing him that if application was made to the Medical Officer of Health an order on a chemist for the free supply of antitoxin would be given, if such was urgently required for the remedial or preventive treatment of an inhabitant of St. Marylebone unable to pay for the serum. Messrs. Allen and Hanbury of 7, Vere Street, W., very kindly undertook to supply the antitoxin at any hour. During the period intervening between the sending out of the letter and the close of the year, no applications were received. Scarlet Fever. The number of cases of Scarlet Fever fell considerably below the number notified in each of the two preceding years, the figures being:—1910, 207; 1909, 458; 1908, 409. The prevalence of the disease and the fatality was as usual most marked in childhood. The number of deaths certified as from this disease was 6 (2.9 per cent.) The chart inserted at the beginning of the report shows the rise and fall of the disease week by week throughout the year. As regards the source of infection, in 162 of the 207 cases, no definite clue could be obtained. In the remaining 45, infection was supposed to have been acquired from another member of the family in 26 instances; from a previous case in the same house (tenement) in 1 instance; at school in 6; and from another case in the neighbourhood in 6 instances. In 6 cases the source was unclassifiable. Visits and inquiries at the homes of the notified cases resulted in the discovery of nuisances and defects in sanitation to the number of 78. In 23 of these the condition discovered was defective drainage, while in 51 the nuisances were want of cleanliness, etc. Notices calling for remedies were served in each instance. 26 Enteric Fever. Typhoid (enteric) fever was less prevalent, but more fatal during 1910 than in either of the two preceding years, 21 persons being notified as suffering, and 6 as having died from this disease. The mortality rate was 28.5 per cent. The cases were distributed as follows:—All Souls, 5; St. Mary, 8; Christ Church, 6; and St. John, 2. Bacteriological examinations were made of blood from 16 suspected cases, 5 proving to be positive and 11 negative. The fullest enquiries were made in each case in order to discover the source of infection if possible. In one-third (7) of the number, infection was believed to have resulted from the consumption of infected food; viz., fish in 4 instances, oysters in 2 and ice cream in 1. The routine examination of the premises resulted in the discovery of nuisances —dirty premises, etc.—in 5. The defects were remedied by the persons responsible after receipt of notices from the department. The number of cases occurring each week is shown graphically in the chart facing page 7. Cerebro-Spinal Fever. Throughout the year this disease remained by order of the London County Council amongst those compulsorily notifiable. In all, two persons were notified as suffering, both being isolated and treated in hospital. Erysipelas. The total number of cases notified reached 116 and there were 3 deaths. As usual most of the notifications came from the Workhouse Infirmary and General Hospitals, and 36 of the patients were treated in one or other of these institutions. Puerperal Fever. Four cases of puerperal fever were notified in 1910 and two of the patients died. Measles. The only accurate information with regard to this disease at present comes from the death returns of the district registrars. A certain number of the entries in the returns made by the school teachers relate to measles, and some cases are also notified by medical officers of health of adjoining boroughs. 27 The following tables show the number of cases of measles and other infectious diseases reported from schools and other boroughs and also the number of class rooms closed in consequence of measles outbreaks during the year. 1910. SCHOOLS. Scarlet Fever. Diphtheria. Enteric Fever. Measles. Chicken-pox. Whooping Cough. All other Diseases. All Souls, Foley Street 1 4 ... 30 30 18 6 Barrett Street 14 6 ... 16 ... 10 21 Barrow Hill Road 8 7 ... 125 13 22 17 Bell Street 12 1 ... 84 18 20 37 Capland Street 1 12 ... 144 23 46 75 Catholic, Richmond Street 14 ... ... ... ... ... ... Christ Church, Lisson Grove 6 5 ... 1 1 2 2 Convent, Little Union Place ... 1 ... ... ... ... ... Council, Grove Road ... ... ... ... ... ... ... Emmanuel, Aberdeen Place 1 ... ... 27 16 8 3 Emmanuel, North Street ... 1 ... 6 2 2 3 Hampden Gurney, Upper Berkeley Street ... ... ... 45 1 2 5 Homer Row, Catholic ... ... ... 20 ... ... ... Portland, Little Titchfield Street 12 6 ... 9 36 21 7 St. Andrew's, Wells Street 1 ... ... 20 6 ... 2 St. Francis, Upper William Street ... ... ... ... ... ... ... St. James, Marylebone Lane ... ... ... ... 4 ... 16 St. Luke's, Nutford Place 3 ... ... 43 4 6 5 St. Mark's, Violet Hill 1 2 ... 16 9 ... 27 St. Mark's, Marylebone Road ... 1 ... ... ... ... 1 St. Marylebone, High Street 34 10 ... 65 25 12 14 St. Mary's, Crawford Street 10 3 ... 70 44 15 23 St. Paul's, East Street 5 ... ... 20 3 13 14 St. Paul's, Broadley Terrace 3 5 ... 2 15 2 8 St. Stephen's Charlbert Street ... ... ... 2 ... ... 2 St. Thomas', Orchard Street 5 5 ... 14 4 16 1 Stephen Street 17 9 ... 12 26 28 58 Trinity, Buckingham Street ... ... ... 11 ... ... ... St. Vincent, Lower Seymour Street ... ... ... ... ... ... ... Schools out of Borough 5 5 ... 19 6 5 4 Other Boroughs 24 16 ... 91 15 10 9 Totals 177 99 ... 892 301 258 360 28 In the under-mentioned Schools the classrooms indicated were closed during the year, on account of Measles, by the Education Department of the London County Council, and the necessary disinfection carried out. Schools. Dept. * Classroom. Closed. Bell Street — E. 26th January to 4th February. St. Luke's, Nutford Place I. A. 18th to the 20th April. Bell Street I. Under the age of 5 18th and 19th May. Barrow Hill Road I. F., G., H. and I. 2nd to the 10th June. Richmond Street, Roman Catholic I. Room II 22nd June to 5th July. High Street I. F 4th to the 8th July. St. Paul's, East Street I. H Ditto. All Souls, Foley Street I. Under the age of 5 17th November to the 2nd December. Emmanuel, North Street I. Ditto 30th Nov. to the 9th January, 1911. St. Edward's, (Catholic,) Little Union Place I. Ditto Ditto. Trinity, Cleveland Street I. Ditto 9th Dec. to the 9th January, 1911. *1Infants. Deaths from Measles.—The number of deaths certified as from measles was 27, and of those who died 6 were less than one year old and 19 less than 5. Of those under one year, 5 had reached the second half of the year before being attacked. This is a very usual experience. Death in the case of measles usually results from one or other of the sequellae of the disease and most commonly of all from affections of the respiratory organs. Especially in childhood and infancy is there a liability to the occurrence of such a sequel, and the children who died of measles in 1910 were killed either by pneumonia or bronchitis following that disease. Prevention of Measles.—Visits are paid to all houses in which measles is reported to exist or to have occurred, and verbally and by means of pamphlets every effort is made to impress upon parents the seriousness of the disease and the risks run by the sufferers. In a considerable number of the cases disinfection of rooms, bedding etc., is carried out. During the year the Public Health Committee and afterwards the Council considered the advisability of approaching the Local Government Board with a view to having measles placed on the list of notifiable infectious diseases. Having regard to the fact that in most places where the experiment of making measles notifiable had been tried, the practice had been discontinued because no limitation of the spread of infection or reduction in the number of the cases had 29 resulted, it was with great reluctance determined to take no action. Notification must in all cases be regarded merely as a preliminary to the taking of preventive measures, such as isolation of the infected during the period of maximum infectivity. In the case of measles it has been clearly demonstrated that the disease is most highly infectious in the earliest stages, even before diagnosis is possible and before notification could be made and isolation become possible. This being so, practically always the damage due to spread of infection has occurred before action for prevention can be taken. Isolation, as a matter of fact, in any one case is rarely carried out, and is almost impossible to carry out, before infection has been passed to other susceptible contacts. Further, with regard to isolation it may be said that, cases of measles being so numerous, to make provision for notified cases in the same proportion as for the other infectious diseases would mean great increase in the existing isolation accommodation. That measles is a disease neglected to a certain extent is undoubtedly true. It is equally true that this neglect is not wilful. The great stumbling-block in the way of progress in connection with its prevention is ignorance of its causation. Till something more is known regarding it than the plain facts with which practically everyone is acquainted, it seems doubtful if there will be much reduction in the number of cases and of epidemics of measles. Towards the end of the year arrangements were made by the Metropolitan Asylums Board to isolate, through the Boards of Guardians, a certain number of suitable cases in their hospitals. The experiment will be watched with great interest and its effect upon the death rate carefully noted. Whooping-cough. Much that has been said with regard to measles, applies to this disease also. Information with regard to cases is received in the same way. Whooping-cough is most common and most fatal in childhood. The number of deaths in 1910 (41), was nearly double that for 1909 (24) which was exactly double the total (12) for 1908. The age period 1—5 is that in which the majority of the deaths occur, the number for 1910 being 24 (58.5 per cent.) The number of children under one who died of whooping-cough last year was 15, the largest number for several years. Of those who died aged less than one year, 2 were under 3 months' old, 3 were more than 3, but less than 6 and 10 more than 6, but less than 12 months' old. As in the case of measles, therefore, whooping-cough increases in fatality with age, the maximum fatality being reached about the age of 5 years. As death in the case of whooping-cough, again as in measles, usually results from respiratory complications, chiefly pneumonia, the explanation of the increasing liability to lung trouble is want of sufficient protection during the 30 course of the disease. As babies grow older, especially if the family is at all numerous, they are less immediately under the supervision of their mothers, and likely to be less thoroughly protected from infection and complications. These facts probably account for the increase in the number of cases and the number of deaths towards the end of the first year and during the first quinquennium. Glanders. No case of glanders in the human being was notified during the year. On two occasions notice with regard to outbreaks in stables in the borough was sent by the London County Council. The first notice referred to a case at Messrs. Thompson, McKay & Co's. premises in Lodge Road; the second to a case at Messrs. Oates, Grove Road. In both instances the officers of the County Council carried out the necessary disinfection and the district inspector examined the premises. Some slight defects were discovered in the stable drains at Grove Road, and were remedied after receipt of a notice from the Department. Phthisis. Notifications.—The form of notification in connection with cases of pulmonary phthisis or consumption is partly compulsory, partly voluntary. The former is called for by the Public Health (Tuberculosis) Regulations, 1908, the voluntary notifications being made by medical practitioners at the invitation of the Council, originally issued in 1906 and repeated each year since then. The total number of notifications received during 1910 was 537. of these 101 were sent in voluntarily, 421 by the Poor Law Officers under the regulations. of the voluntary notifications 86 came from medical men in practice and 15 from general hospitals. The number received in 1909 was 334 and was nearly double the total for 1908, the increase being the result of the compulsion introduced by the regulations. The following table shows the numbers received under each system since its inception. Phthisis Notifications. 1906 Voluntary Compulsory (six months) 206 — 1907 291 — 1908 176 — 1909 98 236 1910 101 436 31 Deaths from Phthisis. The number of deaths certified as from this disease was 133, giving a death rate per 1,000 of the estimated population of 1.05. At no time during the last ten years have the numbers been so low, the only year at all comparable being 1908 when the total fell to 154 and the death rate to 1.21. The figures for each year since 1900 are shown in the accompanying table, which gives also the distribution of the deaths throughout the Borough. As usual Christ Church sub-district contributed most of the deaths. It will be noted as a hopeful sign, however, that this district has shared to a considerable extent with the others in the general fall. Table IX. DEATHS FROM PHTHISIS. Estimated Population. Year. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 125,195 1910 133 28 37 56 12 126,027 1909 170 43 41 66 20 126,867 1908 154 35 33 61 25 127,718 1907 179 42 46 64 27 127,960 1906 197 36 64 73 24 129,453 1905 195 37 56 69 33 131,000 1904 214 43 57 82 32 131,700 1903 241 71 56 78 36 132,650 1902 225 59 59 71 36 133,301 1901 223 71 60 56 36 135,350 1900 275 80 64 68 63 The distribution of the 133 deaths was as follows:—In Poor Law Institutions, 88; general and other hospitals, 10; at home, 35. The accompanying table in which the age and sex distribution of the deaths from phthisis are worked out show the facts to which attention was directed in the report for 1909, viz., that the majority of the deaths occur at the middle periods of life and that more males die of the disease than females. Ages. Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals. Males 3 2 9 16 29 11 12 2 84 Females - 1 6 12 12 8 8 2 49 Totals 3 3 15 28 41 19 20 4 133 The following tables contain an analysis of the deaths in relation to occupation. In the case of the males the fact that the highest mortality from phthisis occurs amongst those employed in work entailing exposure is well brought out. 32 MALES. Work with exposure. Sedentary work. No occupation. Workmen. Foremen, Masters, etc. Workmen. Foremen, Masters, etc. Professional work. Total. 7 52 1 17 5 2 84 FEMALES. No occupation or house work. Work with exposure. Sedentary work. Professional work. Total. 35 2 9 3 49 Prevention of Consumption.—Really active steps to protect the population against the ravages of consumption seem to have been first taken in 1906, when the Council, acting on the recommendation of the Public Health Committee passed a resolution approving the introduction of a system of voluntary notification of cases of phthisis. The fullest possible use was made of the information received in this way and a system of visitation for the purposes of advising and assisting the infected and contacts to prevent spread of infection was commenced. Since then this work has been continued and extended, the utmost assistance being given to the women inspectors, to whom it was entrusted, by the voluntary workers of the St. Marylebone Health Society. The total number of visits paid during 1910 was 434. At these visits, in addition to making enquiries into the possible sources of infection, the duration of the disease, the sanitary condition of the house and so on, advice was given as to the methods to be adopted by the patient for protecting himself and those associated with him, and disinfection of clothing, etc., arranged for if this seemed necessary. The number of cases in which disinfection was carried out on account of consumption was 66, and in the majority of instances it was done after the patient had left the premises for a hospital or had died. In the report for 1909 note was made of the fact that a proposal to establish an Anti-Tuberculosis-Dispensary in the Borough had taken shape. It is a pleasure to be able to report that in November of 1910 the scheme had borne full fruit and that the dispensary was opened at 15, Allsop Place, N.W., and at the end of the year was at work. The provisional committee of the dispensary which 33 included the Mayor, two members of the Public Health Committee (The Chairman, the Rev. J. A. Beaumont and Mr. Councillor Harvey) and the Medical Officer of Health, were successful in obtaining the services of a highly qualified and experienced medical officer, Dr. Halliday Sutherland, and a fully trained nurse, Miss Barry. Both of these officers have entered upon their duties with the utmost enthusiasm and there seems to be no reason whatever to doubt that the Borough will derive an immense amount of benefit from their efforts. The objects of the dispensary as briefly outlined in last year's report are to obtain all possible information with regard to the amount of consumption in the Borough; to examine and treat patients; to act in co-operation with all charitable and other organizations in the Borough for the benefit of the patients; to visit the homes of patients; to introduce the hygienic methods of treatment into the home and to see that they are carried out; to examine all persons intimately in contact with patients, especially members of their families, and to see that they are put under immediate treatment if such should be considered necessary. With regard to the work ot the dispensary Dr. Halliday Sutherland writes as follows: "The St. Marylebone Dispensary for the Prevention of Consumption, 15, Allsop Place, Upper Baker Street, was open to patients on November 22nd, 1910. From that date up to December 31st, 46 patients came to the Dispensary for examination, diagnosis, and treatment, and of these, 30 were notified to the Medical Officer of Health as suffering from active pulmonary tuberculosis. As a result of the supervision of the homes of patients suffering from pulmonary tuberculosis, 66 persons in contact with the patients were examined for signs of active or latent tuberculous disease. The Medical Officer paid 66 visits to patients' homes, and the Dispensary Nurse made 126 domiciliary visits The arrangement whereby the Public Health Department notifies the Dispensary of all admissions of consumptive patients to the Poor Law Infirmary has proved of great value to the efficiency of the dispensary, as homes are supervised and contacts examined, where otherwise no preventive measures could have been taken." Up till the end of the year 30 notifications of undoubted cases of consumption had been received from the dispensary. Of these, 22 were notified for the first time so that it is evident that as a source of information, if in no other way, the dispensary is likely to be of use to the department. As a matter of fact, however, the establishment of the dispensary is regarded as marking a tremendous advance in the crusade against consumption in the Borough. Individual consumptives resorting to the institutions are likely to derive 34 great advantage. Their families, especially those members who are found to be in need of treatment and who are put in the way of getting it with every hope of cure resulting will also benefit, and there should follow limitation of the spread of infection and a diminution in the number of hopeless cases in the future. For all these reasons, but especially the last, the Council and the inhabitants at large must regard the institution with favour. It is a matter of some importance and worthy of note that St. Marylebone was one of the first three London Boroughs to see a dispensary for the prevention of consumption established within its borders. Bacteriological Diagnosis of Consumption.—During the year 112 specimens of expectoration from persons suspected to be suffering from consumption were submitted for examination. Of these, 28 were found to contain the bacillus of tuberculosis and in 84 the result was negative. Distribution of Consumption.—During the year a register of premises throughout the Borough in which deaths from consumption had occurred, or cases were notified as being present, was commenced. This register will prove of the utmost value and will become increasingly useful. At the end of the year also a map of the Borough was prepared to show the distribution of the deaths from consumption which had occurred during the course of five years, 1906-1910. Fins of different colours were employed, one being introduced as near to the address at which the death took place as possible. Unfortunately, it is not easy to obtain a good photograph of a map marked in this way, but such a good idea of the areas mainly involved is given even in the photograph of the "spot map" that it has been considered worth while reproducing it. Other Tubercular Diseases. The figures regarding forms of tuberculosis other than consumption have already been referred to and will be found on page 21. DISINFECTION. During 1910, infectious diseases being less prevalent than in 1909, the amount of disinfection carried out was rather smaller. The figures relating to the work are set forth in the following tables. For the disinfection of infected articles one steam disinfector was used, viz., Goddard, Massey & Warner's machine. Map showing the distribution of deaths from phthisis during the five years 1906-1910. 35 The disinfection of premises was mainly carried out by means of formic aldehyde gas, produced by an Alformant lamp burning 30 formalin tablets per 1,000 cubic feet of space. The total number of rooms disinfected and the reasons for doing so are shown in the table headed "Reasons for Disinfection." In 1909, the number of rooms disinfected was 809 and of articles 11,524. The number and nature of the articles dealt with in 1910 are shown in the following tabular statement:— Compulsorily Notifiable Infectious Diseases. Phthisis. Measles. Vermin. Other causes. Total. Beds 241 17 4 7 18 287 Mattresses 249 12 9 115 120 505 Bolsters 342 19 10 116 157 644 Pillows 574 54 16 13 184 841 Sheets 669 37 19 19 35 779 Blankets 784 47 42 33 183 1,089 Sundries 4,110 422 70 232 696 5,530 Totals 6,969 608 170 535 1,393 9,675 The number of journeys made by the disinfecting vans during the year 1910, was:— January 32 February 24 March 33 April 36 May 27 June 30 July 38 August 31 September 32 October 30 November 26 December 37 376 The vans were used 478 times in 1909. 36 Reasons for Disinfection. Compulsorily Notifiable Infectious Diseases. Phthisis. Measles. Vermin. Other causes. Totals. January 20 6 4 ... 5 35 February 56 9 2 ... ... 67 March 41 ... 2 ... 4 47 April 49 5 7 ... 6 67 May 17 2 8 ... 10 37 June 35 12 8 ... 8 63 July 47 2 ... ... ... 49 August 22 2 5 ... 2 31 September 41 6 ... 2 5 54 October 33 2 ... 1 5 41 November 31 11 ... ... 2 44 December 34 9 ... 1 4 48 426 66 36 4 51 583 Bacteriologal Examinations. These examinations are still carried out by Dr. Eastes at the Laboratory of Pathology and Public Health, 38, New Cavendish Street, in doubtful cases of Typhoid Fever, Diphtheria, and Phthisis, and the following table gives particulars as to the number of cases examined and compares the results obtained with those of the previous year:— 1909. 1910. Positive. Negative. Total. Positive. Negative. Total. Typhoid Fever — 8 8 5 11 16 Diphtheria 16 57 73 27 80 107 Phthisis 26 51 77 28 84 112 Totals 42 116 158 60 175 235 PART II. DEPARTMENTAL 39 Departmental. The outstanding feature of 1910 in connection with the Public Health Department, was the remarkable increase which took place in the amount of work to be done. This increase made itself felt in every direction, and to cope with it the Public Health Committee found it necessary to recommend the Council to make considerable additions to the staff under their control. The officers appointed include one woman sanitary inspector and health visitor, two district inspectors and one office youth. The staff at the end of the year consisted of, in addition to the Medical Officer of Health; a deputy Medical Officer of Health (Dr. J. R. Prior), two drainage inspectors, one outdoor superintendent, one meat and food inspector, six district inspectors (one—Inspector Hodges— acts as house-to-house inspector), three women sanitary inspectors, one dust inspector, one chief and three assistant clerks and an office youth. The keeper of the public mortuary, the matron and staff of the shelter and baths, the two disinfectors, the men and women attendants at the conveniences, and the men employed in flushing the overground conveniences are also under the control of the Public Health Committee. In the construction of this part of the report the method of dealing with the various topics introduced in the report for 1909 will be followed. Full details will be given, as far as possible, of the work done by each individual member of the staff, all of whom have worked loyally and well during the year. Protection of the Food Supply. Early in 1910 the Council appointed Inspector George Smith who had been a member of the inspectorial staff for some years, and who had temporarily acted as Meat and Food Inspector, permanently to serve in this capacity. The duties for which he was made responsible were the examination of food in shops, etc.; the inspection of premises in which food was sold, stored or prepared, such as milkshops, restaurant kitchens, bakehouses, ice cream shops, slaughterhouses, cowhouses etc. He was also appointed to act as inspector under the Sale of Food and Drugs Acts and to take samples as directed by the Medical Officer of Health. Food Inspection.—This part of the work of the department received very careful attention during the year. Regular visits to all food premises were made by the meat inspector, special inspections being carried out on Saturday nights and Sunday mornings by him and certain of the inspectors possessed of qualifications and experience in meat examination. Considerable quantities of unsound food were dealt with, and that traders had begun to recognise the work done by the department was evidenced by the fact, that a considerable number submitted articles, which they themselves considered 40 unsound, to the inspectors for examination and destruction. When such voluntary surrender was made a certificate was granted to the trader stating that the food being unsound had been destroyed at his request. The articles dealt with in this way are set out in the following list. Articles of Food Destroyed as Unsound after Voluntary Surrender. 97 lbs. Apples 20 lbs. Sausage Meat 1 Basket Apples 7 lbs. Sausages 1 Box Apples 3 Pigs (quinsy) 5 lbs. Fish 2 Sets Pigs' Lungs (pneumonia) 1 Box Herrings 77 lbs. Beef 1 Box Cod Quantity of Suet Barrel of Haddocks Quantity of Tripe Box of Whelks 142 Turkeys Barrel of Oysters 2 Rabbits Quantity of Dried Haddocks 10 lbs. Dough 1 Box Oranges Pickles and Tinned Goods 183 lbs. Tomatoes Few Tins Salmon and Soup 3 Boxes Tomatoes ½ Box Lemons 8 Sheeps' Livers 10 lbs. Cherries, Gooseberries, etc. 1 Sheeps' Pluck (pneumonia) 6 Baskets Raspberries 1 Sheeps' Lungs (cysts) 1½ Baskets Strawberries 8 Scrags of Mutton 14 Baskets Plums 1 Hindquarter Sheep (bruised) 6 lbs. Greengages 2 Pairs Bullocks Lungs (tuberculosis) ½Basket Pears 4 Bullocks' Livers 1 Box Cabbages 3 Bullocks' Heads 2 Barrels Liquid Eggs In a number of cases articles which were "unsound or unwholesome or unfit for human food" were discovered "exposed for sale or deposited for the purposes of sale or preparation for sale" and were seized and dealt with as prescribed by section 47 of the Public Health (London) Act, 1891. After the seizure the articles were examined by the Medical Officer of Health, and were then submitted to a magistrate, to whom application for an order for destruction was made. The articles seized under section 47 included: Seizures. 14 lbs. Tomatoes A quantity of Kidneys 13 quarts Pasteurised Skim Milk A quantity of Hake 5 Joints Beef (infected with worms) 3 Ox Kidneys 90 Tins Machine Skimmed 1 Bullock's Tripe (tuberculosis) Condensed Milk 8 Codfish About 9 lbs. Pears 41 In two instances, viz., one seizure involving a quantity of hake found to be infected with worms and another, go tins of unsound condensed milk, the Committee decided that it would be sufficient, the articles having been condemned and destroyed, if a letter of caution were sent to the vendor. In the remainder of the cases, reported instructions to proceed were given. Details with regard to the offences alleged and the result of the prosecutions are given below. Public Health (London) Act, 1891. Section 47. Name of Inspector. Result. Fine. Costs. 28, William Street, Lisson Grove Exposing for sale on a stall outside No. 28, William Street tomatoes which were unsound and unfit for human food G. Smith 0 10 0 0 5 6 Foley Street Exposing for sale milk which was unwholesome and unfit for food of man G. Smith 5 0 0 3 3 0 Aybrook Street (stall in) Exposing and depositing for sale a quantity of tomatoes which were unsound and unfit for human food A. S. Wilson 1 0 0 1 15 6 82, Carlisle Street Exposing and depositing for sale at No. 82, Carlisle St. tomatoes which were unsound and unfit for human food A. S. Wilson 1 1 0 0 4 0 Bell Street (stall in) Exposing for sale on a stall in Bell St. 7 codfish and 7 pieces of codfish G. Smith 0 10 0 0 2 0 Corlett Street (stall in) Exposing for sale on a stall at the corner of Corlett Street tomatoes which were unsound and unfit for human food A. S. Wilson 0 5 0 0 2 0 41, Gt. Titchfield St. Exposing and depositing for sale certain unsound and unwholesome meat to wit, 5 joints of beef and 3 ox kidneys G. Smith 6 0 0 1 10 0 32a, Union Street, M.H. Depositing for the purpose of preparation for sale tripe which was diseased with tuberculosis G. Smith 10 0 0 2 2 0 32, Bendall Street Exposing for sale a quantity of unsound kidneys G. Smith 25 0 0 5 5 0 32a, Union Street, M.H. Depositing for the purpose of sale a diseased ox liver G. Smith 6 0 0 3 3 0 42 The second on the above list is perhaps one of the most interesting and calls for somewhat fuller reference than is made to it there. The seizure in this case was of a quantity of skimmed milk alleged to be "pasteurized" i.e. kept at a temperature some degrees below boiling point for a period sufficiently long to kill such organisms as are likely to cause disease. The milk was brought from South London and sold in the poorer streets in the eastern end of the borough at two-pence or two-pence half-penny per quart. Firms making a speciality of pasteurized milk usually retail it in sealed bottles to prevent all possibility of re-infection after the process of pasteurization has been carried out. In this case, however, the milk was sold from a churn in the open street, any purifying effect produced by the heat being of course lost. On several occasions samples were taken from the churns and submitted to bacteriological examination, the results obtained always being most unsatisfactory. After each examination a letter, drawing his attention to the unfavourable character of the report, was sent to the vendor, but no improvement whatever resulted. Having regard to this fact and to the possibility of injury being done to the infants whom mothers, misled by the word pasteurized, were feeding upon the milk, it was arranged to attempt to proceed in the manner set forth in sec. 47 of the Public Health (London) Act, and seize the milk, if it could be proved to be unsound. The main difficulty in the way was that it was essential that a bacteriological examination should be made and this is a matter requiring usually a considerable amount of time. Thanks, however, to the kindness of Dr. Eastes, the Council's bacteriologist, who undertook to make special examinations, this difficulty was overcome. The next step was to make certain that after the sample had been taken for examination nothing was added to the milk before the condition of the sample taken was determined by the bacteriologist. For several days a close watch was kept upon the vendor and the exact extent of his "walk" discovered. On a day fixed, Dr. Eastes was advised that samples would be sent to him and two inspectors were dispatched to deal with the case. One purchased a sample of the milk and proceeded immediately to Dr. Eastes' laboratory; the other followed the vendor on his rounds. At the end of an hour Dr. Eastes issued a report with regard to the sample, as follows:— "This milk has a high cellular content; a very high proportion of the cells "are polymorphonuclears, evidence of the presence of a trace of pus. There "is also an enormous number of bacteria, amongst which some long "streptococci were seen, and in my opinion this milk is unfit for human "consumption." On the strength of this report the Medical Officer of Health issued instructions that the milk was to be seized. The seizure was carried out by Inspector Smith who first took further samples for examination and then submitted the milk to a magistrate who unhesitatingly condemned it, partly on the report of Dr. Eastes and partly on account of the dirty condition in which he found the milk to be. 43 The further bacteriological reports made after a fuller examination were to the effect that "One of the bottles contained visible dirt. The deposit consists mainly of "extraneous matter (vegetable and mineral debris) and of bacteria, which are "present in enormous numbers. In addition there is a high cell content "mainly composed of polymorphonuclears, evidence of the presence of a trace "of pus. Some long streptococci are present, and in my opinion the milk is "quite unfit for human consumption." The facts were reported to the Public Health Committee and instructions to proceed were given. The result of the proceedings is stated above. It may be added that the sale of pasteurized milk by the vendor has now ceased in the borough. Slaughterhouses. The number of slaughterhouses in St. Marylebone is 8, as against 9 in 1909, no application having been made for the renewal of the licence of 6a, Bolsover Street which had not been used for several years. The licensing authority in respect of slaughterhouses is the London County Council, but notice must be given to the Local Sanitary Authority by the applicant, of his intention to apply. Such notices were received with regard to the following premises and no objections having been raised the licences were renewed for one year. Premises. Conditions. 75, Abbey Road Nil. 178, Edgware Road Nil. 4, Henry Street, St. John's Wood Small cattle only. 50, Henry Street, St. John's Wood Small cattle only. 134, High Street, St. John's Wood On the clear and distinct understanding that the room over the slaughterhouse is not used as a living room. 31, Little Church Street Small cattle only. 32A, Union Street, Middlesex Nil. Hospital Regular and frequent visits have been paid by the Food Inspector during the year. No conditions calling for the service of notices were discovered. Milk Supply. Cowhouses—The number of Cowhouses in the Borough is small—five— most of the milk coming from districts outside. 44 The situation of the premises is as follows: Premises. No. of Cows. 58, Acacia Road (Sheds, Nos. 1, 2 and 3) 44 56, Bell Street 15 *42A, Clipstone Street 10 26, John Street 14 3, Malthouse Mews 22 Total 105 *This licence is granted on the undertaking of the licensee not to keep more than 10 cows on the premises. Application for renewal of these licences is made annually, and the Borough Council having raised no objection the renewals were granted by the licensing authority, the London County Council. Although the above table shows the sheds to be licensed for 105 cows, at the time of the annual inspection only 45 were actually stabled, as follows:— Premises. No. of Cows. 58, Acacia Road 9 56, Bell Street 9 42A, Clipstone Street 10 26, John Street 3 3, Malthouse Mews 14 Total 45 The premises were regularly and frequently visited during the year. In one case only was it found necessary to serve a notice with regard to drainage and cleansing. Milk Shops, &c.—The number of premises upon which milk is sold is 208. The number of applications for registration received was 62 and of these 11 were refused, as provided by the London County Council (General Powers) Act, 1908. on the ground that the premises were unsuitable. Under this Act also, 72 names were removed from the register on account of the unsuitability of the premises and 24 others were taken off, the premises having been demolished or the sale of milk discontinued. The section of the London County County (General Powers) Act, 1908, giving the Council power to remove a name from the register allows of appeal being made to a magistrate against the decision of the Council. Only in one case was advantage taken of this power, the suggestion that the defendant should appeal coming from the magistrate who was asked to convict an unregistered person for selling milk. The case is referred to below; it may be mentioned, however, that the owner in addition to selling milk retailed beer under an off-licence. The premises were dirty, badly ventilated and in other ways unsuitable. 45 The following are the particulars with regard to the case:— Premises. Offence. Result. 41, North Street Selling milk without being registered Summons adjourned sine die. Defendant granted leave to summons Council to show cause why he should not be reinstated upon the register. Application summons dismissed. During the year an important question in connection with the registration of peripatetic milk vendors was decided on an appeal made by the Council against a decision given by one of the magistrates (Mr. Denman) at Great Marlborough Street Police Court. Mr. Denman's decision was to the effect that a vendor summonsed for purveying milk within the borough without being registered by the Council was not guilty of an offence against the Dairies Cowsheds and Milkshops Order, since he was already registered in another district. The Lord Chief Justice (Lord Alverstone) decided that there was no reason to interfere with the judgment of the magistrate and the other learned judges, Channell and Lord Coleridge concurring, the appeal was dismissed. Examination of Milk. The number of samples of milk taken for analysis was 523, greater by over 100 than the total for 1909. In addition a considerable number were taken with special precautions and submitted to bacteriological examination with results stated on page 58. Of the samples analysed by the public analyst fifty (9.5 per cent.), more than double the number for 1909 were found to be adulterated. As usual the vendors, whose milk proved to be genuine, were notified that no further action would be taken, while those whose sample was found to be adulterated were prosecuted if the adulteration was not too trivial or other circumstances did not suggest that a written caution would meet the case. The prosecutions taken numbered forty, the convictions thirty-five. Fines and costs to the amount of £94 9s. were recovered, the amount for 1909 being £30 2s. 6d. The system of taking a number of samples in the evening and on Saturday night, and Sunday morning was continued, and a considerable number was also taken at the railway stations, Marylebone and Baker Street. Of the latter seven were found to be adulterated and proceedings were instituted against the consignors in six cases. In one case proceedings were not taken, the adulteration being so trivial, and the farmer received a caution. 46 The quarterly returns as to milk samples are tabulated below:— Quarter of the Year. No. of Samples Taken. No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. Fines and Costs. f s. d. 1st 138 19 13.7 16 27 18 0 2nd 129 18 13.9 15 48 13 0 3rd 127 6 4.7 5 12 19 0 4 th 129 7 5.4 4 4 19 0 Total for year 523 50 9.5 40 94 9 0 Ice Cream Premises. There are 86 such registered in the Borough in accordance with the London County Council (General Powers) Act of 1902. They have been regularly inspected, and in no case were proceedings instituted in respect of offences against the Act. Butter, Margarine, etc. The number of persons registered as dealers in and manufacturers of margarine under the Margarine Act, 1887, Sec. 9, and the Sale of Food and Drugs Act, 1889, Sec. 7 (4), is nine, and of wholesale dealers in butter and milk blended butter, under the Butter and Margarine Act, 1907, one. No names were added during the year, and the various premises have been regularly inspected. The matter of sampling of butter, margarine, etc., is dealt with under the heading "Sale of Food and Drugs Acts." Restaurants, Food Stalls, Etc. The total number of premises in the Borough in which food is prepared for sale is 169 (restaurants and dining room kitchens 56, hotel kitchens 19, coffee shops, pastry cooks and tea rooms 94). Acting on the instructions of the Medical Officer of Health the Meat and Food Inspector visits a given number of these each week, each premises being visited at least once during the year. As a result of the visits 92 notices were served, chiefly for breaches of Section 8 of the London County Council (General Powers) Act, 1908, which deals with the question of sanitation In one case only was a summons served for failure to comply with the notice, but this, as shown below, was not proceeded with, the work having been carried out. 47 London County Council (General Powers) Act. 1908. Sec. 8. 1a. Tottenham Court Using the basement rooms for Summons adjourned Road the storage and preparation of sine die. Work done. food the sinks and lavatory basin being untrapped and discharging into channels leading to open gullies. The food stalls in the market streets —Bell Street. Great Titchfield Street. &c.—have been regularly inspected. The system of Saturday night and Sunday morning inspections inaugurated in 1909 has been continued. Offensive Trades. There arc two premises within the borough in which an offensive trade. viz. tripe boiling. is carried on. The meat inspector made 40 visits of inspection. but no cause for complaint was found. Bakehouses. The number of bakehouses on the register at the end of 1910 remained the same as in 1909. viz. 78. none having been added and none removed. Of the 78. 70 are below ground. One application for registration of underground premises. used prior to but not at nor since the passing of the Act in 1901. was refused by the Public Health Committee. In order to insure that the requirements of the Public Health (London) Act 1891. and the Factory and Workshop Act. with regard to the twice a year limewashing. etc.. of inside walls and other parts of bakehouses should not be neglected. notices calling the attention of occupiers were sent out in 73 cases and 151 visits were paid by the Meat and Food Inspector. The regulations were complied with in every instance. proceedings being unnecessary. Notices calling for drainage and other work were served in 37 instances and were complied with. SALE OF FOOD AND DRUGS ACTS. The chief point to which attention has to be directed in connection with this subject. is the great increase in the number of samples taken for analysis under the Acts relating to the adulteration of food and drugs. The instructions as to the sampling to be done were issued to the Food Inspector each Saturday throughout the year. and the total number taken and submitted to the Public Analyst was 1.068. which is some 300 in excess of the number taken in 1909. A considerable number were "test" or "informal samples"; many were taken on Saturday nights and Sundays. or in the early hours of the morning. and usually an "agent" was employed. The number found to be adulterated was 78. or 7.3 per cent. The percentage of adulterated samples in 1909 was 5.4. In 70 cases proceedings were instituted against the vendor. and fines and costs to the amount of £146 9s. od. were recovered. In two cases of prosecution for adulteration of milk the defence of warranty was pleaded. and the summonses were dismissed; three for various reasons 48 were withdrawn; and in two the summonses (the defendants having absconded) were not served. At the end of the year two cases still remained to be heard. These relate to samples of jam certified to be adulterated with apple pulp. and are of extreme interest. They will be fully considered in the report for 1911. Two summonses were served for offences against the provisions of the Sale of Food and Drugs Acts. other than food adulteration. viz. : selling milk from unlabelled cans or vehicles. A third summons. charging a vendor with selling skimmed milk from unlabelled cans. was not served. the defendant having absconded. With regard to this point it may be stated. that during the year a decision was given that only separated or skimmed milk of the class condensed need be labelled. so that in all probability the summons. if served. would have been dismissed. Whether or not it was the intention of the legislature to limit the necessity for labelling to "condensed" milks. is difficult to say. The matter is one of some importance to purchasers of milk and an amendment of the law to the extent of requiring all skimmed and separated milks to be labelled is urgently called for. The particulars of the cases referred to above. may be tabulated as follows. Sale of Food and Drugs Acts. Results. Situation. Offence. Fine. Costs. Gt. Titchfield St. Selling skimmed milk in cans not labelled as rerequired by the Statute. Summons — not served. Defendant absconded . Upper Rathbone P1. Selling milk from a barrow and cans without the vendor.s name being inscribed thereon. Convicted 1 0 0 2 2 0 Carlisle Street Selling milk from a barrow and cans without the vendor.s name and address being inscribed thereon. Convicted 1 0 0 0 2 0 Special mention may be made of a sample of chocolates which. on analysis were found to contain the acrid principle of cayenne pepper. and which were certified by the Public Analyst to be "injurious to health." The intention of the vendor of the sweets was. apparently. to provide children and others with the means of perpetrating a practical joke. and the box from which they were sold was marked "Catch of the Season Chocolates." It was felt that the consumption of the chocolates. on account of the irritation which the cayenne pepper was capable of producing. might be attended by risks. and that the public should be warned against purchasing them. A summons was therefore issued under Section 3 of the Sale of Food and Drugs Act. 1875. and at the hearing the vendor. who admitted the offence. and gave an undertaking not to sell the article in future. was fined £1 and £3 3s. costs. 49 The following table and report from the Public Analyst gives full information with regard to the samples submitted to and examined by him:. Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority. under Section 13 of Act. and. if so. the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated. and if Adulterated. what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. FIRST QUARTER ENDING 31st MARCH. 1910. 115 milks Food Inspector Genuine. £500 per ann. for 700 samples. Over that number 7/6 per sample. One contained a trace of formalin 17 milks Do. Adulterated No. 94. 6.8 per cent added water No. 94. Fined £2 and 12/6 costs No. 99. 4.24 percent. do. No. 99. Proceedings not taken. Vendor cautioned No. 118. 16 7 fat abstracted No. 118. Warranty proved. Case dismissed No. 136. 7.4 per cent. added water No. 136. Fined £4 and £1/3 costs No. 139. 8.23 do. No. 139. Fined 5/. and 2/. costs No. 174. 3.75 do. No. 174. Fined £2 and 12/6 costs No. 184. 3.06 do. No. 184. 2/. costs No. 185. 7.53 do. No. 185. Fined 10/. and £1/0/6 costs No. 186. 2.35 do. No. 186. 2/. costs No. 187. 4.94 per cent. added water No. 187. 2/. costs No. 195. 3.53 per cent. added water and 14.0 per cent. fat abstracted No. 195. Fined £1 and 15/6 costs No. 196. 5.88 percent added water No. 196. Fined ^1 and 15/6 costs No. 208. 10.59 per cent. added water and 3.4 per cent. fat abstracted No. 208. Fined £2 and 12/6 costs No. 238. 1.65 per cent. added water No. 238. Proceedings not taken. Vendor cautioned No. 241. 1.65 per cent. added water No. 241. Proceedings not taken. Vendor cautioned No. 259. 6.7 percent. fat abstracted No. 259. Fined £2 and 12/6 costs No. 267. 9.50 percent. added water No. 267. Fined £2 and 12/6 costs 4 skimmed milks Do. Genuine. 2 skimmed milks Do. Adulterated. No . 165. 14.7 per cent. added water No. 165. Fined £3 and 12/6 costs.or one month.s imprisonment No. 243. 4.0 per cent. added water No. 243. Warranty proved. Case dismissed 44 butters Do. Genuine. 2 butters Private purchaser Genuine. 2 butters Food Inspector Adulterated. No. 108. contained 20 per cent. of foreign fat other than butter fat No. 108. Fined £1 and 12/6 costs on 1st summons and 2/. costs on ?nd No. 248. contained 50 per cent. of fat other than butter fat No. 248. Fined £3 and 14/6 costs 1 butter and margarine mixture Do. Genuine butter 12 creams Do. Genuine. 4 cream cheeses Do. Do. 50 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority.under Section 13 of Act.and.if so.the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated.and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 21 margarines Food Inspector Genuine. £500 per annum for 700 samples Over that number 7/6 per sample. No. 30. Fined £1 and 12/6 costs No. 30 Sold unlabelled No. 67 Do. No. 67. Fined 5/- and 12/6 costs No. 163 Do. No. 163. Fined 10/- and 12/6 costs No. 256 Do. No. 256. Fined 5/- and 12/6 costs 1 margarine Do. Adulterated. No. 219,15 per cent of butter fat No. 219. Withdrawn 11 cheeses Do. Genuine. 5 lards Do. Do. 3 coffees Do. Do. 2 coffees Do. Adulterated. No. 9.58.6 per cent. of chicory Test sample No. 133.35 per cent.of chicory Solicitor advised no proceedings 1 coffee and chicory Do. Genuine 1 cocoa Do. Do. 2 jams Do. Do. 1 oatmeal Do. Do. 1 flour Do. Do. 1 bread and butter Do. Do. 2 pickles Do. Do. 2 vinegars Do. Do. 4 peppers Do. Do. 1 mustard Do. Adulterated. No. 272.20 per cent. of wheat starch No. 272. Fined £2 and 12/6 costs 1 Gregory powder Do. Genuine 2 Gregory powders Do. Adulterated. No. 1.deficient in No. 1. Vendor cautioned Adulterated. No. 1.deficient in magnesia 36.6 per cent. No. 85. Vendor cautioned 4 liqourice powders Do. Genuine 3 sweet spirits of nitre Do. Do. 2 ammoniated ture of quinine Do. Do. 1 boracic ointment Do. Do. 2 sulphur ointments Do. Do. 1 spinach Private purchaser Do. Total Number of Samples analysed during the Quarter 278 Number of Sa mples adulterated 27 SECOND QUARTER ENDING 31st JUNE.1910. 106 milks Food Inspector Genuine. Five of the samples had colouring matter added 18 do Do. Adulterated. No. 289. 1.87 per cent.added water No. 289. Vendor cautioned. Summons not applied for. Do. No. 290. 2.35 do. No. 290. Summons not applied for on advice of Solicitor. Do. No. 318. 5.4 do. No. 318. Fined £1 and 12/6 costs. Do. No. 328. 13.4 per cent. deficient in fat. No. 328. Fined 10/- and 12/6 costs. 51 Articles submitted for Analysis State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority. under Section 13 of Act. and. if so. the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated. and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. Do. No. 383. 16.7 do. £500 per ann. for 700 samples. Over that number 7/6 per sample No. 383. Fined 10/. and 12/6 costs 18 milk (<continued) Food Inspector Do. No. 389. 1 .9 per cent. added water No. 389. Vendor cautioned. Summons not applied for. Do. No. 401. 23.4 per cent. deficient in fat. and 3.6 per cent. added water No. 401. Fined £5 and 12/6 costs. Do. No. 397. 23.4 per cent. deficient in fat. and 34 .4 per cent. added water No. 397. Fined £5 and 12/6 costs. Do. No. 435. 6.7 per cent. deficient in fat. and 6.5 per No. 435. Fined £1 and 12/6 costs. cent. added water Do. No. 460. 4.24 per cent. added water. No. 460. Fined £1/10 and 12/6 costs. Do. No. 470. 10 per cent. deficient in fat. No. 470. Proceedings taken against farmer by Pad. dington Borough Council Do. No. 488. 13.3 do. No. 488. Fined £1 and 12/6 costs. Do. No. 625. 13 4 per cent. deficient in fat. and 10.59 per cent. added water. No. 525. Fined £25 and £1 3/. costs. Do. No. 537. 26.7 per cent. deficient in fat. No. 537. Fined £1 and 12/6 costs. Do. No. 539. 6.7 do. No. 539. Vendor cautioned Do. No. 545. 11.5 per cent. added water. No. 645. Fined 10/. and 12/6 costs. Do. No. 554. 10 per cent. deficient in fat. No. 554. No fine. 12/6 costs. Do. No. 555. 4 per cent. added water. No. 555. No fine. 12/6 costs. 1 separated milk Do. Genuine. 4 skimmed milks Do. Genuine. Nos. 458 and 459 were sold from bulk which was not labelled. A summons was issued but could not be served. as Defendant had absconded 48 butters Do. Genuine. 7 do Do. Adulterated. No. 282. 80 per cent. of fat other than butter fat. No. 282. Case not proceeded with as sample was sold in a wrapper marked " Margarine." Do. No. 285. 70 do. No. 285. Fined £2 and 12/6 costs. Do. No. 321. 40 do. No. 321. Fined £1 and 12/6 costs. Do. No. 391. 70 do. No. 391. Fined £3 and 12/6 costs on 1st summons and 2/. costs on 2nd Do. No. 398. 70 do. No. 398. Do. do. Do. No. 407. 70 do. No. 407. Do. do. Do. No. 527. 30 do. No. 527. Fined 10/. and 12/6 costs. 26 margarines Do Genuine. Ten were test samples. Do. No. 303. Sold unlabelled. No. 303. Fined 10/. and 12/6 costs. Do. No. 461. do. No. 461. Fined 10/. and 12/6 costs. Do. No. 517. do. No. 517. Fined £1 and 12/6 costs. 52 Articles submitted for Analysis State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority under Section 13 of Act. and. if so. the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated. and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations 15 creams Food Inspector Genuine £500 per ann. for 700 samples. Over that number 7/6 per sample Two were test samples. 12 cheeses Do. Do. Seven were test samples. 7 lards Do. Do. One was a test sample. 4 bread and butters Do. Three genuine. one adulterated. No 379. 40 per cent. fat other than butter fat. No. 379. Fined £1 and 12/6 costs. 3 flours Do. Genuine. All were test samples. 1 custard powder Do. Do. A test sample. 3 mustards Do. Do. One was a test sample. 1 pepper ... Do. Do. 1 ground ginger ... Do. Do. 2 oatmeals Do. Do. One was a test sample. 1 coffee Do. Adulterated. No. 408 contained about half its weight of chicory. No 408 Fined £3 and £1/3 costs 1 baking powder Do. Genuine. 5 jams Do. Do. One was a test sample. 2 sweets Do. One genuine and 1 adulterated. No. 331. Chocolates contained the acrid principle of cayenne pepper. Certified to be injurious to health. The genuine one was a test sample. No. 331. Fined £1 and £3/3 costs. 3 golden syrups Do. Genuine. 3 lime juice cordials Do. Two genuine and 1 adulterated. No. 489 contained salicylic acid. 8 grains per pint. One was a test sample. No. 446 which was adulterated with 5 grains per pint No. 489. Summons withdrawn on advice of Solicitor. 1 malt vinegar Do. Genuine. 3 liquorice powders Do. Do. 1 Gregory powder Do. Do. 2 sweet spirits of nitre Do. Do. 2 Boracic ointments Do. Do. 1 Dover powder Do. Do. 1 quinine powder Do. Do. 1 ammoniated tincture of quinine Do. Do. 2 gall and opium ointments Do. Do. 1 zinc ointment Do. Do. This was a test sample. 1 paregoric Do. Do. 1 Ipecacuhana wine Do. Do. 1 lemonade powder Do. Do. This was a test sample. Total Number of Samples analysed during the Quarter 203 Number of Samples adulterated 92 THIRD QUARTER ENDING 30TH SEPTEMBER. 1910. 118 milks Food Inspector Genuine. Fourteen were coloured. and 1 had a minute trace of borax. 1 do. Private purchaser Do. A test sample. 1 skim milk Food Inspector Do. 1 separated milk Do. Do. 53 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority under Section 13 of Act. and. if so. the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated. and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations 5 milks Food Inspector Adulterated. No. 574 7.3 per cent. added water. £500 per ann. for 700 samples. Over that number 7/6 per sample No. 574. Fined £2 and 12/6 costs. Do. No. 610. 16.7 fat abstracted. No. 010. Fined 5/. and 12/6 costs. Do. No. 637. 23 do. No. 637. Defendant absconded. Summons not served. Do. No. 703. 6.7 do. No. 703. Fined 2/. and 12/6 costs. Do. No. 761. 3 per cent. added water. No. 761. Fined £1 and £2/2 costs. 1 skim milk Do. Do. No. 756. 7.1 do. No. 756. Fined £5 and 12/6 costs. 51 butters Do. Genuine. Thirty.seven contained borax from a trace up to 34 grains per lb. 1 butter Do. Adulterated. No. 602. Contained 70 per cent. of fat other than butter fat. No. 602. Fined £5 and 12/6 costs. 25 margarines Do. Genuine. Three were test samples. Do. No. 704. Selling margarine in an unstamped wrapper. No. 704. No fine. 2/. costs. Do. No. 685. Exposing margarine for sale without a label indicating its nature. No. 685. Fined 5/. and 2/. costs. 2 cheeses Do. Genuine. 18 creams Do. Do. 1 oatmeal Do. Do. 1 ice cream Do. Do. 8 coffees Do. Do. 2 custard powders Do. Do. Both were test samples. 1 flour Do. Do. 2 Dover powders Do. Do. 1 bread and butter Do. Do. 1 tomatoes Do. Do. Test sample. 3 mustards Do. Do. 1 raspberry jam Do. Do. 1 gall and opium Do. Do. ointment Total Number of Samples analysed during the Q uarter 246 Number of Samples adulterated 7 FOURTH QUARTER ENDING 31ST DECEMBER. 1910. 122 milks Food Inspector Genuine 7 milks Do Adulterated. No. 877. 10.34 per cent. added water No. 877. Fined 10/. and 12/6 costs No. 916. 6.7 per cent. deficient in milk fat No. 916. Vendor cautioned No. 988. 16.7 per cent. deficient No. 988. Fined 5/. and in milk fat and 28.2 per cent. added water 12/6 costs No. 996. 1.42 per cent. added water No. 996. Vendor cautioned No. 1025. 4 per cent. added water No. 1025. Vendor cautioned No. 1058 10.12 per cent. added water No. 1058. Fined £1 and 16/6 costs No. 1059. 4.42 per cent. added water No. 1059. Fined 10/. and 21/6 costs 54 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority. under Section 13 of Act. and. if so. the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated. and if Adulterated. what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 55 butters Food Inspector Genuine £500 per ann. for 700 samples. Over that number 7/6 per sample One was a test sample 4 butters Do. Adulterated. No. 889. 70 per cent. fat other than butter fat No. 889. Fined £1 and 12/6 costs on 1st summons and 2/. costs on 2nd No. 071. 40 per cent. fat other than butter fat No. 791. Fined £1 and 12/6 costs on 1 st summons and 2/. costs on 2nd No. 1007. 50 per cent. fat other than butter fat No. 1007. Fined £1 and 12/6 costs on 1st summons and 2/. costs on 2nd No. 1041. 18 per cent. fat other than butter fat No. 1041. Fined £3 and 12/6 costs on 1st summons and 2/. costs on 2nd 11 margarines Do. Genuine Five were test samples 7 cheeses Do. Genuine Four were test samples 1 gorgonzola cheese Do. Adulterated. No. 826. 71 per cent. barytes in rind coloured with iron oxide No. 826. Proceedings were not taken in this case 8 coffees Do. Genuine 1 coffee and chicory Do. Genuine 1 mustard Do. Genuine 4 olive oils Do. Genuine Two were test samples 9 creams Do. Genuine 5 jams Do. Genuine Three were test samples 2 jams Do. Adulterated. No. 918. 10 per cent. apple pulp No. 918. Pending No. 919. 10 per cent. apple pulp No. 919. 1 apple jelly Do. Genuine A test sample 3 cocoas Do. Genuine 4 peppers Do. Genuine 1 boracic acid Do. Genuine A test sample 2 Gregory powders Do. Genuine 1 Gregory powder Do. Adulterated. No. 984. 10 per cent. deficient in Mg O. Vendor cautioned. Summons not applied for 2 ammoniated tincture of quinines Do. Genuine Total Number of Samples analysed during the Quarter 251 Number of Samples adulterated 15 SUMMARY. Number of Samples Analysed. Number Adulterated. 1st Quarter 278 27 2nd 293 29 3rd 246 7 4th 251 15 1,068 78 55 REPORT OF THE PUBLIC ANALYST. 1910. During the year 1910. the considerable number of 1.068 samples were analysed under the Act; of these 78 were adulterated. Dairy Produce. Milk.— In all districts by far the majority of adulterated samples are those of dairy produce. This is partly due to the ease with which milk may be tampered with. and partly to the number of persons of small means who sell milk. many of them literally living from hand to mouth. and therefore more likely to succumb to temptation than a big firm with large pecuniary interests at stake; of 523 samples of milk. 50 were either diluted with water. or skimmed. or both. The vendors were nearly all prosecuted and fined varying sums. the biggest fine being one of £25 inflicted on a vendor who sold milk deficient in milk fat to the extent of 13 per cent. and diluted with more than 10 per cent. of water. A great deal of London milk still continues to be slightly coloured with an artificial dye. but preservatives of any kind are now quite rare. It is interesting to record the average composition of the St. Marylebone milk analysed in the laboratory during 1910. To do this the adulterated samples. as well as those which were at the time sour must be excluded. Four hundred and fifty.one samples out of the 523 gave an average as follows :— Sp. Gravity 1.031; Milk fat. 3.63 per cent.; Solids not fat. 8 65 per cent.; Total Solids. i2.28 per cent. The mixed milk of the large dairy companies show as a rule higher numbers than these. viz.. about 37 per cent. Milk fat; 8.9 per cent. Solids not fat; 12.6 per cent. Total Solids. Hence the conclusion is that the ordinary commercial milk is poorer than it should be; in other words much of it has been watered down so as to approach the low legal standard of 3 per cent. of Fat. 8 5 per cent. Solids not fat and 11.5 per cent. Total Solids. Butter.— Two hundred and fifteen samples of butter were submitted and 15 of these were either margarines or mixtures of butter and margarine. The majority of the butters contained boric acid but the amount was under 35 grains per lb. Cream.—Most of the cream sold in the Metropolis contains a small quantity of boric acid. All the samples (16 in number) were genuine. 56 Cheese.—Thirty-seven samples of cheese were analysed; they were all genuine but a sample of Gorgonzola cheese was provided with a thick heavy rind or plaster containing tallow. barytes and iron oxide. The cost to the customer. since cheese is sold by weight. of the edible portion. must be very high. That such a thick casing is not necessary is evident from the fact that there arc Gorgonzola cheeses with an ordinary rind. Traders. since the matter has been brought to public notice by reason of a prosecution in another district. as a rule now cut off the thick rind and it becomes a matter of difficulty to obtain a sample of it. Lard.—It was known that samples of lard were on the market containing paraffin wax. and others with which a small quantity of water had been incorporated. Twelve samples of lard were submitted to analysis. but they proved perfectly genuine. Drugs.—Some 36 samples of various drugs were submitted. All of these were fairly well up to the standard of the British Pharmacopoeia. Conclusion.—In St. Marylebone. under the present systematic method of supervision. it is increasingly difficult for adulteration to escape detection; in not a few districts elsewhere sampling occurs in bursts preceded and followed by periods of inactivity. The astute sophisticator by observation ascertains these respective periods. and acts accordingly; in such districts the real amount of adulteration is never known; in St. Marylebone the Inspector is always at work— he moves in an irregular orbit which no one outside can forecast. This. in the writer.s opinion. is the only effectual way of carrying out the Sale of Food and Drugs Acts. A. WYNTER BLYTH. 24th February. 1911. The following short table summarizes the information contained in the table submitted formally by the Public Analyst:— ANALYSES UNDER THE SALE OF FOOD AND DRUGS ACTS DURING 1910. SUMMARY. Article. Genuine. Adulterated. Milk 462 47 Skimmed Milk 11 3 Butter 201 14 Bread and Butter 14 1 57 Article. Genuine. Adulterated. Cream 45 - Cheese 36 1 Margarine 83 I Coffee 19 3 Coffee and Chicory 2 - Cocoa 5 - Pepper 9 - Mustard 7 1 Vinegar 3 - Oatmeal 4 - Flour 5 - Ground Ginger 1 - Baking Powder 1 - Custard Powder 3 - Lemonade Powder 1 - Jam 13 2 Apple Jelly 1 - Golden Syrup 3 - Ice Cream 1 - Sweets 1 1 Lard 12 - Tomatoes 1 - Spinach 1 - Pickles 2 - Lime Juice Cordial 2 1 Ammoniated Tincture of Quinine 5 - Ipecacuanha Wine 1 - Sweet Spirits of Nitre 5 - Paregoric 1 - Olive Oil 4 - Gall and Opium Ointment 3 - Quinine Powder 1 - Gregory Powder 4 3 Compound Liquorice Powder 7 - Boracic Ointment 3 - Boracic Acid 1 - Sulphur Ointment 2 - Zinc Ointment 1 - Dover Powder 3 - Totals 990 78 58 BACTERIOLOGICAL EXAMINATION OF FOOD. The practice of taking samples of various articles of food for bacteriological examination was continued and 24 specimens including 16 of milk were submitted to Dr. Eastes and investigated by him. Five of the milks were adversely reported upon and in each case every effort was made to obtain improvement by calling the attention of the vendor to the conditions found and also by communicating with the Medical Officer of Health of the district from which the milk was stated to have come. As already mentioned (page 42) proceedings were taken against a vendor of pasteurised milk after the bacteriologist had reported unfavourably as to the condition of the article from a bacteriological point of view. WATER SUPPLY. Water Supply to Dwelling Houses.—Under the provisions of Section 48 of the Public Health (London) Act. 1891. certificates have been granted in respect of 27 premises which have been rebuilt. Under Section 78 of the London County Council (General Powers) Act. 1907. which calls for the provision of a supply of water to upper storeys of tenement houses 215 Intimation Notices were served. In 79 of these cases the notice was complied with. without the necessity of serving a Statutory Notice. Of the 136 owners upon whom the latter notice was served. only 4 were prosecuted for failure to comply with the requirements. The particulars of these prosecutions will be found on page 72. Water Supply cut off.—During the year. in 41 cases. the water supply to premises was cut off by the Metropolitan Water Board. notice being given to the Medical Officer of Health as required by Section 49 (i)of the Public Health (London) Act. 1891. in each case. The reasons for discontinuing the supply were:- Premises empty 28 Non.payment of rates 9 Waste of water 2 Supply not required 2 41 59 Mr. Alderman J.Lea.Smith. the Council.s representative on the Metropolitan Water Board. continued to take a great interest in these cases during the year. and when the premises affected were tenement houses always endeavoured to secure that the tenants should suffer no hardship as a result of the supply of water being cut off. Housing. On account of the coming into operation of the Housing. Town Planning etc. Act. 1909. at its commencement. 1910. so far as housing is concerned. was one of considerable importance. To the Public Health Committee the responsibility of exercising the powers and duties of the Council in regard to the greater part of the Act was entrusted. and during the year as a result. a great deal of work was commenced and carried out. The importance of undertaking a complete and systematic house.to.house inspection was thoroughly grasped. and it was determined that one of the inspectors should be entrusted with this work and to ensure that any defective conditions discovered by him should be at once taken in hand. the number of district inspectors was increased to five. each being placed in charge of a district. These districts are visited in turns by the house. to.house inspector. streets urgently in need of attention being given to him for inspection. Defects found by him are immediately reported to the inspector of the district. who at once visits and arranges for the taking of steps for the removal or remedy of the defective conditions. At the end of the year great improvements had been made in connection with housing as a result of this work. the greater part of the action being taken under the Public Health Act or the byelaws. As usual. much improvement was obtained as a result of pressure brought to bear upon owners of property. many of whom agreed either to carry out considerable alterations or to voluntarily close premises found to be unsuitable. The district inspectors in addition to following up the house.to.house inspector. regularly inspected their own districts and took action with regard to any defective conditions they themselves found. The number of premises reported to the Public Health Committee for closure as unfit for human habitation under Section 17 of the Housing. Town Planning. etc.. Act. 1909. was 17. In 13 cases closing orders were made. In the majority of these cases a visit of inspection was paid by a number of the members of the Public Health Committee. who were in a position to supplement the report submitted by the Medical Officer of Health. and to greatly assist the full Committee when the question of whether or not a closing order was to be made was discussed. Full particulars with regard to the premises reported and represented are given in the accompanying table:- 60 Housing. Town Planning &c. Act. 1909. Premises Represented During the Year 1910. Situation. Date of Representation or Report to Local Authority. Result. 8a, Short Street 7th October. 1910. Closing Order not made. Local Authority consented to premises being using as a store provided drains were sealed off and objectionable w.c. removed. Work executed. 1, Cranmore Place 7th October. 1910. Closing Order made 7th October. 1910. Demolition Order made 24th March. 1911. 7, Cranmore Place 7th October. 1910. Closing Order made 7th October. 1910. Demolition Order made 24th March. 1911. 8, Cranmore Place 7th October. 1910. Closing Order made 7th October. 1910. Demolition Order made 24th March. 1911. 23, Burne Street (Cottage rear of) 18th November. 1910. Closing Order made 2nd December. 1910. Matter of Demolition Order pending. 9, Providence Place 18th November. 1910 Closing Orders made 18th November. 1910. but were not served. Local Authority on the 27th January. 1911. decided to go no further with the matter. the premises having been voluntarily closed and the Owner not feeling disposed to expend the necessary funds in view of the shortness of the Lease. 10, Providence Place 11, Providence Place 12, Providence Place 13, Providence Place 14, Providence Place 12, Mitcham Street 18th November. 1910. Order made 18th November. 1910. Plans have been submitted to and approved by the Local Authority 24th February. 1911. showing alterations which will render the premises fit for habitation. 61 Situation. Date of Representation or Report to Local Authority. Result. 6, Harrow Street (Cottage at rear of) 18th November. 1910. Order made 18th November. 1910. Owner has made certain alterations which have not received sanction or approval of Local Authority. Pending. 24, Burne Street (Cottage at rear of) 2nd December. 1910. Order made 2nd December. 1910. Local Authority in default of Owner to make the premises fit for human occupation has fixed 5th May. 1911. to consider as to Demolition Order. 77, Salisbury Street 21st October. 1910. Order not made. Owner rebuilt the back wall of the premises and remedied the nuisances that were existing. 40 & 42, Richmond Street 4th November. 1910. Order not made. Owner provided through ventilation and improved sanitary accommodation. None of the cases in which closing orders were made were ripe for consideration of the question of making demolition orders when the year came to an end. No proceedings were taken under any of the other Housing of the Working Classes Acts during 1910. In one instance an owner of premises asked that a closing order should be made with respect to his own premises under the Public Health (London) Act. 1891. and this the magistrate consented to do. Particulars with regard to this case will be found on page 72. One house was voluntarily closed and in several others great improvements were carried out after the attention of the owners had been directed to their condition. Houses Let in Lodgings. The re.registration of premises which were on the register of houses.let.in odgings when the new by.laws relating to such places came into force in 1907 continued during 1910. The number originally registered was 758. At the end of 1910 the number re.examined and re.registered was 501 and certificates regarding them were issued to owners and occupiers. 62 The number of inspections made in connection with this work was 6.280. In 692 instances intimation notices relating to nuisances were served. 366 of which were promptly complied with. In the remaining 263 it was found necessary to serve a statutory notice. which in all but four cases led to the work being done. The four owners who failed to comply with the statutory notice did so when an order was made by the magistrate. The staff of inspectors having been increased and a special house.to.house inspector appointed the old register should soon be dealt with. The inspectors have also been instructed to make a note of all premises calling for registration and these will be registered as soon as possible. During the year arrangements were made for systematically inspecting places on the register and. beginning with 1911. notices. will be sent to owners of registered houses in March of each year calling their attention to the necessity for cleansing and limewashing of staircases. etc. As soon as possible after the issue of these notices visits will be paid by the inspectors. Common Lodging Houses. All the necessary particulars with regard to houses of this class are contained in the subjoined table. The premises have been visited from time to time throughout the year. Taking advantage of the provision contained in Section 35 of the Housing. Town Planning. etc. Act. 1909. exempting owners of houses letting sleeping accommodation to persons of the working classes at a charge not exceeding sixpence per night. on the production of certificate from the Medical Officer of Health that the sanitary accommodation is sufficient. the owners of the premises marked with an asterisk in the accompanying table. made application for such a certificate. In each case a certificate was granted but not until a full and careful examination had been made of the premises In one instance (3 Little Grove Street). the granting of the certificate was made conditionally on certain alterations to the drainage and sanitary conveniences being carried out. Address. 54, Bell Street 2, Burne Street and Lisson Street 6., Charlotte Place 123a, Church Street *29, Circus Street 3, Gee.s Court 4, Gee.s Court 22, Harrow Street 47, Hereford Street 45, Lisson Street Registered Owner. Alfred Crew William Booth Emma Lawson Colin Fitz.William Campbell William H. G. Richardson Margaretta E. Howell Margaretta E. Howell Archibald Nicoll MacNicoll Alfred Wilson Alfred Wilson Registered number of occupants. 55 men 594 men 7 women 60 men 100 men 39 men 27 men 02 women 19 men 35 men 63 Address. *3, Little Grove Street *12, Molyneux Street *13, Molyneux Street *7, Venables Street *25. Venables Street ... Registered Owner. Thomas Levy Frederick Charles Walters Frederick Charles Walters Arthur James Howell Arthur James Howell Registered number of occupants. 100 men 17 men 129 men 56 men 18 men 1,249 men 109 women Total 1,35 8 * Certificates granted under Section 35 Housing. Town Planning. etc., Act. 1909. House to House Inspection. The duty of carrying out the work of house-to-house inspection. called for by Section 17 of the Housing. Town Planning. etc. Act. 1909. under the Medical Officer of Health,was during the year definitely entrusted to one of the inspectors (Hodges). For his use in carrying out his inspections. special headed slips were prepared and the record of his work kept in two house-to-house inspection books. one relating to North and the other to South Marylebone. the dividing line between the distiicts being Marylebone Road. These books were produced for the inspection of the Public Health Committee at each fortnightly meeting after the work commenced in October. At the end of the year the number of streets examined by Inspector Hodges was 10. The actual number of houses was 494 (separate houses 327 ; tenements in blocks of buildings 167). In all 1.070 inspections—as against 264 in 1909— were made and 521 notices(Intimations. 368; Statutory Notices. 153) were issued. Only in one instance was it necessary to prosecute for failure to carry out the requirements of a notice. In an order (Housing—Inspection of Districts—Regulations. 1910) issued by the Local Government Board. the Medical Officer of Health is required to " include in his annual report information and particulars in tabular form in regard to the number of dwelling.houses inspected under and for the purposes of Section 17 of the Act of 1909. the number of dwelling.houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation. the number of representations made to the Local Authority with a view to the making of closing orders. the number of closing orders made. the number of dwelling.houses the defects in which were remedied without the making of closing orders. the number of dwelling.houses which after 64 the making of closing orders were put into a fit state for human habitation and the general character of the defects found to exist. He shall also include any other information and particulars which he may consider desirable in regard to the work of inspection under the said Section." The following tabular statement is introduced in compliance with that instruction and is believed to contain the information called for. HOUSING. TOWN PLANNING. Etc., ACT. 1909. (Section 17.) No. of houses inspected. No. unfit for habitation No. of Representations or Reports made to Local Authority. No. of Closing Orders. No. of houses in which defects were remedied without Closing Orders. No. of houses made fit after Closing Orders General character of defects found to exist. Remarks. 327, and 167 Tenements in Blocks of Buildings 16 16 13 6 of which were not served (Providence Place 9.14 see Page 60) 4 in respect of which representations were made 238 in respect of which Notices (Intimations and Statutory) were served. 2 one pending In houses represented or reported defects in structure; want of through ventilation; insufficient light; sanitary conveniences improperly lighted and ventilated without the possibility of improvement; defective drainage etc. In other cases overcrowding; vermin; defective sanitation and drainage. etc. Intimation 238 Statutory 123 361 Sanitary Survey. In addition to the formal house.to.house inspection reported upon above. about the middle of December. arrangements were made for the carrying out by each inspector in his own district of what. for want of a better name. has been called a "sanitary survey." Briefly this is really a house. to.house inspection but the particulars are less full. the objects being to get a rough idea of the condition of the houses in each street. to ensure that the whole of each district shall be gone over completely by the inspector. and to discover the streets and houses which require early systematic inspection by the house. to.house inspector. Any conditions discovered at these visits which call for immediate attention are dealt with as soon as possible. Houses calling for immediate representation are represented. tenements calling for registration under the by.laws relating to houses let in lodgings are noted. and memoranda are made of conditions which can wait for treatment till an opportunity arises. 65 The records of this sanitary survey will be carefully kept and are likely to prove of the utmost value later. The plan adopted is for the Medical Officer of Health to issue a sheet to each inspector naming the street to be examined and giving the headings as to the information sought. As soon as the examination is completed the sheet is filled up and returned to the Medical Officer of Health. and a new sheet is issued. An example of a filled up sheet is given below. The number of streets examined between the 17th and 31st December was 10. METROPOLITAN BOROUGH OF ST. MARYLEBONE. public health department. sanitary survey. Date. 20/12/10. The Medical Officer of Health requests Inspector Clay (District No. 2) to inspect and report as to : Street Allsop Street Total No. of houses 29 Numbers of Houses In fair or good condition 1.3. 5.29 Obviously defective nil Calling for Registration 1.4. 4a. 6. 15. 17. 21. 25 Calling for Supervision 4. 4a Calling for Closing Orders nil Observations Factories 16 Workshops II. 28. 29 Motor Works 7. 8. 18. 19. 20 Warehouses 23. 24. 26. 27 General Shops 14 This sheet to be handed to Medical Officer of Health as soon as completed. p.h.o./i2/io. Overcrowding. The number of dwelling rooms found to be overcrowded during 1910 was somewhat smaller than in 1909. being 159. A number of complaints. anonymous and otherwise. were received and duly investigated. Many proved to be unfounded. Notices were served in each of the 159 proved cases and the overcrowding was reduced in all without the necessity for a prosecution arising. Underground Rooms. In all 118 cases of illegal occupation of underground rooms were discovered in 1910 as against 163 in 1909. After the service of notices on owners and 66 occupiers the illegal occupation ceased. In no case was it found necessary to prosecute. During the year. taking advantage of the power given by Section 17 (7) of the Housing. Town Planning. etc.. Act. 1909. regulations were drafted with regard to rooms of this class habitually used as sleeping rooms and submitted by the Council to the Local Government Board for approval. Several minor alterations were suggested by the Board and accepted by the Council. As finally approved by the Board (on 2nd February. 1911) they read as follows: METROPOLJTAN BOROUGH OF ST. MARYLEBONE. REGULATIONS AS TO UNDERGROUND ROOMS HABITUALLY USED AS SLEEPING PLACES. Whereas by Section 17 of the Housing. Town Planning. etc.. Act. 1909. it is enacted as follows: Sub.Section 7. A room habitually used as a sleeping place. the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room. shall for the purposes of this section be deemed to be a dwelling house so dangerous or injurious to health as to be unfit for human habitation. if the room either— (a) is not on an average at least seven feet in height from floor to ceiling; or (3) does not comply with such regulations as the local authority. with the consent of the Local Government Board. may prescribe for securing the proper ventilation and lighting of such rooms. and the protection thereof against dampness. effluvia. or exhalation : Provided that if the local authority. after being required to do so by the Local Government Board. fail to make such regulations or such regulations as the Board approve. the Board may themselves make them. and the regulations so made shall have effect as if they had been made by the local authority with the consent of the Board. Provided that a closing order made in respect of a room to which this subsection applies shall not prevent the room being used for purposes other than those of a sleeping place ; and that. if the occupier of the room after notice of an order has been served upon him fails to comply with the order. an order to comply therewith may. on summary conviction. be made against him : Now therefore we. the Mayor. Aldermen. and Councillors of the Metropolitan Borough of St. Marylebone. being the local authority for the said Metropolitan Borough. hereby prescribe the following regulations with which a room habitually 67 used as a sleeping place. the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room. shall comply namely:- (a) Such room shall in every part thereof have at least three feet of its height above the level of the surface of the street or ground adjoining or nearest to such room : Provided that if the width of the area hereinafter mentioned is not less than the height of the room from the floor to the said surface. or is not less than six feet. the height of the room above such surface may be less than three feet. but not in any case less than one foot. (b) Every wall of such room shall be constructed with a proper damp.proof course. and. if in contact with the soil. shall be effectually protected against dampness from that soil by means of a vertical damp. proof course or otherwise. (c) There shall be outside of and adjoining such room and extending along the entire frontage thereof and open upwards from six inches below the level of the floor thereof an area properly paved and effectually drained and at least four feet wide in every part: Provided that the width of such area may be not less in any part than three feet. if the mean width of the area be not less than four feet: Provided also that in the area there may be placed steps necessary for access to the room. and over and across such area there may be steps necessary for access to any buildings above the room. if the steps are so placed in such case as not to be over or across any external window of the room. (d) The space (if any) beneath the floor of such room shall be provided with adequate means of ventilation. (e) Every drain passing under any such room shall be properly constructed of a gas.tight pipe. (f) Such room shall be effectually protected against the rising of any effluvia or exhalation by means of a layer of good cement concrete at least six inches thick laid upon the soil of the site of the entire room. or in some other equally effective manner. (g) Every such room which is without a fireplace. and a flue properly constructed and properly connected with such fireplace shall be provided with special and adequate means of ventilation by a sufficient aperture or air shaft which shall provide an unobstructed sectional area of 100 square inches at the least. (h) Such room shall have one or more windows opening directly into the external air. with a total area clear of the sash frames equal to at least 68 one-tenth of the floor area of the room, and so constructed that one halt at least of every such window can be opened, and that the opening may in every case extend to the top of the window. The Common Seal of the Council of the Metropolitan Borough of St. Marylebone was affixed hereto on the twenty-third day of December, 1910. 1By Order, J. WILSON, Town Clerk. The Consent of the Local Government Board is hereby given to the foregoing Regulations this second day of February, 1911. H. C. MONRO, Secretary, Acting 011 behalf of the said Board under the authority of their General Order dated the twenty-sixth day of May, 1877. A large number of rooms will undoubtedly be found to be affected by these regulations and it is proposed to send a copy of them with all notices served with regard to illegal occupation of underground rooms in order to draw the attention of owners and occupiers alike to their existence. Should necessity arise a representation will be made to the Public Health Committee for a closing order in accordance with the provisions of the sub-section. Customs and Inland Revenue Acts. The number of certificates granted during 1910 for reduction of or exemption from inhabited house duty, in accordance with these Acts, was the same as in 1909, vis., 6. The number of tenements covered in the certificates was, as is shown below, 64. Premises. No. of Tenements. Lisson House, Lisson Street 17 Hatfield House, 106, 108 and 110 Great Titchfield Street 23 27 and 28 Harcourt Street 7 5, Circus Street 10 24, Molyneux Street 3 33 and 34 Paddington Street 4 64 In all cases a thorough inspection was made of the premises and the certificate withheld till any improvements called for were carried out. 69 NUISANCES. Work of the Sanitary Inspectors. Considerable alterations were made in the inspectorial staff during 1910. In the early months Inspector Smith who had been in the service of the Council as a district inspector for four years. was promoted to the position of Special Meat and Food Inspector. and in May. 1910. Inspector Draper. for several years Sanitary Inspector under the Finsbury Borough Council. was appointed to take his place. Towards the middle of the year in order to cope with the increase of work. resulting mainly from the coming into force of the Housing. Town Planning. etc.. Act. 1909. the Council decided to accept the advice of the Public Health Committee to sub.divide the borough into five districts. to appoint two additional inspectors. and to put the work of house.to.house inspection entirely in the hands of one man. In June. therefore. Inspectors Clay and Cartledge were appointed and Inspector Hodges was made house.to.house inspector. The amount of work done was very considerable. the number of complaints as to nuisance received from all sources being 1.996 as against 1.899 .n 1909. an increase of 97. In respect of nuisances. 658 statutory notices were issued. the number for 1909 being 514. an increase of 144. Of the notices. 136 were served on owners to provide a proper and sufficient supply of water to the upper storeys of tenement houses under the London County Council (General Powers) Act of 1907. as compared with 49 in 1909. an increase of 87. Notices to the number of 70 were served on owners under the London County Council (General Powers) Act. 1904. in respect of 103 verminous rooms. an increase of 46 over the previous year when 24 were sent out. In 1.338 cases the nuisances were abated by the persons responsible on the service of a preliminary (intimation) notice of the existence of the defect. The table immediately following gives the total inspections made by each district inspector. and the number of nuisances of various kinds detected and remedied. In 27 cases only was it found necessary to resort to legal proceedings to enforce compliance with statutory notices. and the table on page 71 gives the details of the cases so dealt with. the Act or By.laws under which proceedings were taken and the results. 70 Insp. Cartledge. Insp. Clay. Insp. Andrews. Insp. Draper. Insp. A. Wilson. Total. Inspections from Journal 1.690* 1,697† 3,710 2.308+ 3,648 13,053 Houses damp. dirty or dilapidated remedied 133 205 150 127 16 631 Doors. windows. floors. ceilings. sash cords. etc.. repaired 39 42 47 6 5 139 Overcrowding abated 45 58 18 36 2 159 Illegal occupation of underground rooms discontinued 1 16 37 53 11 118 Water closet defects remedied 140 215 126 193 32 706 Water closets erected 2 12 4 42 6 66 Urinal defects remedied 4 3 3 2 - 12 Soilpipe and ventilating shaft defects remedied 6 7 4 5 1 23 Soilpipes and ventilating shafts erected 11 13 14 13 - 51 Yard defects remedied 114 156 88 82 8 448 Waste pipe defects remedied 44 46 62 62 10 224 Water cistern defects remedied 33 44 11 13 - 101 Rubbish. manure. etc.. accumulations removed 2 45 27 19 19 112 Dung or dust receptacles repaired or renewed 69 144 121 72 11 417 Drains relaid or amended 153 178 348 363 33 1075 Drains cleared 3 11 23 9 - 46 Rainwater pipes repaired or renewed 25 28 46 30 8 137 Water supply to houses reinstated 3 1 2 - - 6 Roofs and gutters repaired 28 41 25 19 7 120 Area defects remedied 9 34 52 69 3 167 Wash-house defects remedied 85 115 66 58 5 329 Bakehouses cleansed or repaired 4 4 5 3 - 16 Animal nuisances abated 4 16 2 5 1 28 Basement defects remedied 8 27 17 10 2 64 Stables cleansed or repaired 4 4 5 12 1 26 Water supply laid on to upper storeys of house 44 81 33 45 6 209 Miscellaneous nuisances abated 3 2 - - 1 6 Smoke nuisances abated 32 63 38 30 3 166 Verminous rooms cleansed 4 10 10 44 4 72 Workshops damp. dirty or ated remedied 19 35 31 58 9 152 *Inspector Cartledge took up his duties on 1st July. 1910. †Inspector Clay „ .. „ .. ‡Inspector Draper „ .. 2nd May. 1910. 71 Legal Proceedings in connection with Nuisances. The following list contains particulars of the various prosecutions undertaken against persons failing to comply with notices relating to nuisances. In all 21 summonses were issued 12 under sections in the Public Health (London) Act. 1891. relating to nuisances. water supply. &c.—1 under the by.laws of the London County Council. 1 under the London County Council (General Powers) Act. 1904. Section 20 (1). 4 under Section 8. London County Council (General Powers) Act. 1907. and 3 under the Metropolis Management Act. 1855. The particulars with regard to cases under the Unsound Food Sections. the Sale of Food and Drugs Acts. &c.. are given under the appropriate headings in the report. Public Health (London) Act. 1891. Fine. Costs. 12, Orcus Street Failure to comply with a statutory notice to reconstruct the drain ventilation pipe Summons withdrawn. work done. - - 1, Upper Charlton Street Failure to comply with a statutory notice to cleanse the premises Summons withdrawn. work done. - 13/6 8, Towns. hend Cottages Failure to comply with a statutory notice to abate the nuisance caused by defective roof. Summons withdrawn. work done. - £1/3/- 18, Blandford Street Failure to comply with a statutory notice to redrain the premises. Order made for work to be done. - £1/3/. 8, Henry Place Failure to comply with a Statutory notice to redrain the premises. Summons withdrawn. work done. - - 2, William Street L.G. Failure to comply with a statutory notice to trap sink waste pipes and cleanse the verminous room on the second floor. Summons dismissed. Costs against Council £5 5s. od. - - 4, Gray Street Failure to comply with a statutory notice to redrain the premises. Summons withdrawn. work done. - £1/1/. 22, Baker Street Failure to comply with a statutory notice to redrain the premises. Order made for work to be done. - 14/6 3, Charlton Street Failure to comply with a statutory notice to cleanse the premises. Summons withdrawn. work done. - - 72  Fine. Costs. 142, Great Titchfield Street Failure to comply with a statutory notice to redrain the premises to the sewer and provide sufficient and additional W.C. accommodation and cleanse the premises. Closing order made, at request of the owner. - £1/3/- 20, Bolsover Street Failure to comply with a statutory notice to redrain the premises. Adjourned sine die. Premises to be pulled down. - - 32, Rathbone Place Failure to comply with a statutory notice to provide sufficient W.C. and Urinal accommodation to the premises. Summons withdrawn, work done. - £3/3/- London County Council (General Powers) Act, 1904. Section 20 (1). 20, Bolsover Street Failure to comply with a statutory notice to cleanse the top back verminous room Adjourned sine die Premises to be demolished - - London County Council (General Powers) Act, 1907. (Section 78). 10, Upper Charlton Street Failure to comply with a statutory notice to provide water to the upper storeys of the premises Order made for work to be done - 13/6 3, Charlton Street Ditto Ditto - £1/3/- 142, Great Titchfield Street Ditto Closingordermade at request of owner - 3/0 20, Bolsover Street Ditto Adjourned sinedie. Premises to be demolished. - - Metropolis Management Act, 1855. 95, Church Street Failure to comply with a statutory notice to renew the drain between the house and the sewer Summons dismissed. - - 1, Charlton Street Failure to comply with a statutory notice to redrain premises to the sewer Convicted. £ 3 £2/2/- 3, Charlton Street Ditto Summons withdrawn, work having been done. - - 73 DRAIN PLANS AND DRAINAGE. Work of the Drainage Inspectors. The responsibility of supervising drainage work to new as well as old premises continued in the hands of two drainage inspectors, Gorniot and J. C. Wilson, the only alteration made being a change in districts -the former moving to the north, the latter to the south of Marylebone Road. The distribution of the work in relation to the supervision of works for the remedy of nuisances due to defective drainage remained the same as before, the district inspectors transferring anything more than slight alterations to the drainage inspectors. The total number of inspections made by the drainage inspectors was 8,323 as against 6,850 in 1909, The number of plans relating to drainage of new buildings was 52 (north 15, south 37). In the case of old buildings the number of plans received was 570 (south 343, north 227). The total number of plans deposited during 1910 was 622 as against 521 in 1909. Combined Drainage. The number of orders under seal as to combined drainage granted by the Council was 27, the number in 1909 being 23. In 14 cases the liability of the Council for the reconstruction of the combined portions of existing drains was admitted, and the work carried out by the Works Committee at the request of the Public Health Committee. The case referred to in the report for 1909 (in which, though they disputed the claim of the owner that the drain was a combined drain, for the maintenance of which he personally was not liable, the Council carried out the work), was finally settled on the payment by the owner of the greater part of the cost. BLACK SMOKE NUISANCES. The plan of giving each of the five district inspectors, the outdoor superintendent and the dust inspector, at the beginning of each week, a list of premises other than dwelling houses, the chimneys of which were to be observed during the week, was continued. In all, 1,385 observations were made, and 21 nuisances were discovered. Following the discovery of the nuisance a letter calling attention to its existence was sent to the occupier, and the inspector's report and any reply received from the occupier were considered by the Public Health Committee. A Statutory Notice was served with respect to one case but no prosecutions were taken during the year. 74 REMOVAL OF HOUSE REFUSE. The removal of house refuse still continues to be done by contract, the contractors in both districts (North and South) being Messrs. Mead and Co., Ltd., The Wharves, Paddington. The North District contract was accepted for one year, commencing 1st April, 1911, at a cost of £3,550 per annum. That for the South District was let for two years commencing ist April, 1910, at a cost of £6,950 per annum, making a total cost for removal from the whole Borough of £ 10,500. The following tabular statement gives the number of complaints, letters, and refusals received in respect of the removal of house refuse, together with the fines levied and recovered by the Council for contraventions of the terms of the Contracts during the last six years. NORTH DISTRICT. Year. Complaints. Letters. Refusals. . Fines. 1904 49 52 28 . 1905 53 66 227 W. Mead & Co., Ltd., £20 and £26 5s. 1906 49 61 51 W. Mead & Co., Ltd., £15, and E. H. Jackson & Co., Ltd., £5 1907 46 54 83 E. H. Jackson & Co., Ltd., £50 1908 26 63 114 . 1909 18 68 135 . 1910 43 84 117 W. Mead & Co., Ltd., £1 SOUTH DISTRICT. Year. Complaints. Letters. Refusals Fines. 19O4 194 184 63 T. Hobbs, £20 1905 72 170 366 . 1906 69 157 556 T. Hobbs, £15, £1 1s., and £50 I907 106 173 471 . 1908 63 159 228 W. Mead & Co., Ltd., £1 and £2 1909 58 191 316 W. Mead & Co., Ltd., £2, £1 and £1 1910 73 172 338 W. Mead & Co., Ltd., £2 In connection with the North District contract Bell Street, Bendall Street and Church Street were added to the list of streets in which the daily collection 75 of house refuse from the kerb is in force, and in addition arrangements were made in the contract to remove the house refuse from the following streets in Ward 3, three times a week:. Burne Street Little North street Luton street Capland yard Lyons place Capland plate Capland street Malthouse mews Carlisle mews Manning place Carlisle place Milner's mews Carlisle street Mitcham street Cosway street Cranmore place North place North street Devonshire place, L.G. Devonshire street, L.G. Orcus street Duke street, L.G. Portman market Earl street Princess mews Exeter street Princess street Providence place George street, L.G. Grove mews Ranston street Grove road (from Church street Redlands mews to North street) Richmond street Hardington place Salisbury place Hardington street Salisbury street Harrow street Short street Hatton place Shroton street Hatton street Suffolk place Hereford street Sun cottages High worth street Huntsworth terrace Union street, L.G Lisson street Venables street Little Carlisle street Victoria place Little Church street Little Earl street Weston place Little Exeter street Williams place Little Grove street Williams street, L.G. 76 This increasing of the number of collections from one to three per week over a large area is quite a new departure and the effect of the more frequent removal will be watched with the greatest interest. Practically all the streets in which the frequency has been increased consist of houses mainly of the tenement class occupied by more than one family of persons in poor circumstances. Many of the houses are without open spaces, or have only a small yard, so that the dust bin must be kept inside or close to the premises, and is apt to cause nuisance unless frequently emptied. The addition to the price of the contract is exceedingly small (£274) and this fact as well as the results obtained in the experimental area will probably be taken into consideration by the Public Health Committee in deciding what alterations, if any, they should make when the time comes for entering into new contracts. The usual close supervision was exercised over the work of the contractors by the Public Health Committee during the year. The reports of the inspectors and the complaints, letters and refusals received were considered by the Dust Sub.Committee, which is fortunate in having Alderman J. Lea.Smith still as its chairman, at their fortnightly meetings, reports thereon being made to the Public Health Committee. Considerable numbers of dust shoots as well as old brick receptacles were demolished during the year and new metal dust receptacles to the number of 143 were provided. Inspectors Hill and Lumley, the dust inspectors, paid 5,857 visits and served 165 notices regarding defaults in connection with dust removal. Remedies in each case were carried out without the necessity for prosecutions arising. VERMINOUS PERSONS BATHS. During 1910 these Baths were used by 8,484 adults (males 6,433 I females, 2,051). The children bathed numbered 1,372, 513 being boys and 859 girls. The addresses given by the male adults included Salvation Army Shelter 5,021, and lodging houses 582. In 588 instances no address was given, and in 242 the applicants stated they had come from the Church Army. The Portman House was given as an address by 434 females, the Church Army by 8, and addresses in the Borough by 68. So many as 1541 gave no address. The marked falling off in the numbers of school children resorting to the baths-the number in 1909 was 4684-is due largely to the fact that only children 77 producing a card given to them by the school teacher or nurse and entitling them to a course of 3 baths were admitted; partly also it is accounted for by the fact that the Education Committee of the L.C.C. established a cleansing centre at the Fulteney Street School (Soho) at which a certain number of school children were treated. That the children on the whole are cleaner, those who are verminous being fewer, may to a small extent have led to a reduction in the numbers. The most careful supervision of the homes of the children was exercised by the women inspectors and, wherever the necessity arose, disinfection of premises, bed and other clothes was carried out. The number of notices served with regard to verminous rooms has already been mentioned (p. 69). The final decision to pay the Borough Council a fixed sum of 2/. per head for children treated over a fixed period at the baths at the request of their officers, was arrived at by the L.C.C. during the year. The Council of St. Marylebone had not finally decided to accept the offer unconditionally at the end of 1910, The following tables show the number of persons . adults and childrenbathed each month during 1910, and the number of persons treated each year since 1898. The numbers of adults bathed, it will be noted, fell nearly 2,000. For this reduction there seems to be no sufficient reason, as the baths were as open to adults as in previous years and no alteration in the system, such as had been made in the case of the school children, was introduced. CLEANSING OF PERSONS ACT, 1897 Table shewing the number of Adults and School Children using the Baths provided under the above.mentioned Act during the year 1910:. 1910. ADULTS. CHILDREN. Males. Females. Total. Males. Females. Total. January 790 146 936 73 124 197 February 627 117 744 75 178 253 March 610 143 753 16 74 90 April 552 135 687 19 114 133 May 515 167 682 50 62 112 June 518 186 704 64 124 188 July 460 193 653 67 94 161 August 568 227 795 . 6 6 September 511 242 753 12 21 33 October 476 205 681 80 26 106 November 358 130 488 26 4 30 December 448 160 608 31 32 63 Totals 6,433 2,051 8,484 513 859 1,372 78 Table showing the number of persons using the Baths during the past 13 years:. Year. ADULTS. CHILDREN. Males. Females. Total. Males. Females. Total. 1898 3,301 5 3,306 . . . 1899 4,340 . 4,340 . . . 1900 3,431 31 3,462 . . . 1901 4,140 142 4,282 . 1902 4,326 202 4,528 . . . 1903 5,515 655 6,170 . . . 1904 7,089 1,376 8,465 . . . 1905 7,981 1,431 9,412 107. 353 460 1906 6,891 1,974 8,865 1,873 3,311 5,184 1907 6,785 1,807 8,592 2,367 3,404 5,771 1908 8,741 2,563 11,304 2,198 3,046 5,244 1909 8,563 2,551 11,114 2,725 1,959 4,684 1910 6,433 2,051 8,484 513 859 1,372 Totals 77,536 14,788 92,324 9,783 12,932 22,715 .The Children's Baths were opened in June, 1905. THE SHELTER. The number of times the shelter was used and the reasons for such use are shown in the accompanying statement. The longest period of occupation was 28 hours, and the shortest 1 hour. No. of hours Occupied. Reason of Occupation. No. of Persons. February 12th I Diphtheria 1adult. March 3rd, 4th and 5th 28 Diphtheria 2 adults, 1child. March 22nd 2 Measles 1 adult. July 11th 2 Vermin 1 adult. July 18th 3 Vermin 1 adult. October 25th 3 Septic Poisoning 1 adult. November 2nd and 3rd 24 Diphtheria 2 adults, 1 child. November 22nd and 23rd 16 Scarlatina 3 adults. Public Mortuary. The following table gives all the necessary details regarding the use of the mortuary during 1910. The out.door superintendent has regularly visited and inspected the premises throughout the year. A certain number of alterations, including the provision of an additional table for post mortem examinations, were carried out. 79 Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1910. Males. Females. Total. For burial only. For inquests. Total January 22 17 39 20 19 39 February 17 IS 32 16 16 32 March 22 i7 39 20 19 39 April 17 16 33 19 (1 infectious) 14 33 May 15 10 25 13 12 25 June 10 11 21 12 9 21 July 12 8 20 6 14 20 August 9 8 17 8 9 17 September 6 5 11 7 4 11 October 19 8 27 14 13 27 November 21 17 38 25 13 38 December 11 15 26 14 12 26 181 147 328 174 154 328 Number of inquests held from 1st January to 31st December, 1909 - 151. PUBLIC SANITARY CONVENIENCES. The work of supervising these places has been carried out regularly by the out.door superintendent and the women inspectors and reports have been periodically submitted to and considered by the Public Health Committee. A visit was paid by the Conveniences Sub.Committee to a number of the underground conveniences, and instructions were given for the carrying "out of certain alterations in connection with the electric lighting at all the conveniences at a cost of £74 10s. 4.d. An important step was taken by the Committee during the year in connection with the provision of free sanitary accommodation for women, one urinette being installed in place of a water.closet at Oxford Circus (Women's) Convenience. At the end of a year the effect of having made this provision will be considered and whether or not free accommodation of a similar nature is to be introduced at Portland Road and Marylebone Road Conveniences decided. The urinette at Oxford Circus which was introduced in July, has been, it may be mentioned, largely used and has led to little, if any, reduction in the amount of the takings, reports as to which from all the conveniences were submitted to the Public Health Committee regularly during the year. 8o The following statement shows the receipts for use of Public Conveniences for the year ended 31st March, 1911, compared with the previous year:- 1910.11. 1909.10. Increase. Decrease. £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus-Men's Department 1,036 8 1 985 13 4 50 14 9 . ,, Women's ,, 869 10 5 914 3 0 . 44 13 6 Portland Road -Men's „ 285 13 10 282 10 9 3 3 1 ,, Women's „ 184 0 9 199 8 11 . 15 8 2 Marylebone Road-Men's ,, 217 3 5 208 0 10 9 2 7 . „ Women's ,, 151 15 6 153 12 8 . 1 17 2 Foley Street-Men only 125 16 4 113 12 5 12 3 11 St. John's Wood Road-Men only 115 8 6 116 17 8 . 1 9 2 In the report for 1909 the hope was expressed that 1910 would see the Marylebone Lane and Barrett Street overground urinals removed and an underground convenience constructed in their stead. This desire to a large extent has been gratified, the urinals mentioned having been removed and the work of constructing a convenience underground in Barrett Street having the following accommodation, viz., 4 W.Cs., 10 Urinal Stalls and 2 Lavatory basins being well in hand at the end of the year. The overground urinal removed from Marylebone Lane being in good condition was re.fixed in Park Road in place of the old structure which was obsolete in pattern and did not provide sufficient accommodation. Factories and Workshops. This portion of the annual report is made in compliance with the requirements of Section 132 of the Factory and Workshop Act, 1901, which imposes on the Medical Officer of Health the duty of reporting each year on the administration of the Act in workshops and workplaces. A copy of the annual report, or of this portion, is to be sent to the Secretary of State for the Home Department, along with the tables immediately following. In the annual report for 1909, the fact was noted that each district inspector was responsible for the workshops and workplaces in his own district, the women inspectors being specially concerned with the places in which women are employed. It was also pointed out that the greater part of the workshops lay towards the eastern end of the southern half of the borough, taking Marylebone Road as the dividing line, and that the inspector of this district therefore had most of the work. The appointment of additional inspectors and the division of the Borough into 5 districts resulted in the allocation of two inspectors to this area, so that it became possible to exercise a greater amount of supervision over the numerous workshops there. 81 For the first time for several years the register of workshops was completely revised and the trades carried on in the various premises classified. As shown under heading 4 in the Home Office Report form, the total number of places registered was found to be 2,525. The following list shows the trades carried on and the number of premises occupied by each class. FACTORY AND WORKSHOP ACT, 1901. List of trades carried on in registered workshops:. Trades. No. of Workshops. Trades. No. of Workshops. Blouse, Costume and Dressmaking 1234 Tinplate working 8 Corset making 38 Tinning and brazing 2 Embroidery 24 Wire working I Feather cleaning 2 Wrought iron working 5 Flower making 1 Zinc working Fancy belt making 3 Blacksmith 5 Furriers 28 Carriage lamp making 3 Boot and shoe making and repairing 17 Coach building 9 Hat and cap making 22 Coach painting 1 Tailoring (gentlemen) 345 Cooper 2 Do. (ladies) 199 Cycle making and repairing 11 Ladies and children's outfitting 42 Motor engineering 4 Lace goods, making and cleaning 12 Wheelwright 4 Millinery ... 152 Cabinet making 20 Shirt and pyjama making 14 Carving and gilding 8 Theatrical costumier 1 Church furniture 1 Umbrella and shademaking 9 Military furniture 1 Wig making and hairdressing 21 French polishing 5 Dyeing and cleaning 3 Joinery, carpentry, packing case making 10 Laundries 43 Marquetene cutting 6 Blind making 2 Organ building 3 Carpet making and planning 4 Undertaking 1 Church embroidery 4 Wood carving 9 Cloth shrinking 2 Wood chopping 1 Fancy leather goods 7 Wood turning 1 Fancy needlework 1 Artist in furniture painting 1 Florists 4 Pipe case making 3 Lamp shade making 6 Pianoforte repairing 3 Tent and tarpaulin making 1 Dress stand making 2 Upholstery trimmings and buttons 3 Builders' shop 5 Upholstery 40 Artificial marble making 11 Dental mechanics 9 China mending 1 Manufacturing chemists 8 Glass painting 1 Perfumery 4 Monumental mason 3 Spectacle making 2 Modelling in plaster 1 Surgical instrument making 2 Compositor 1 Basket making 5 Fine art printing 1 Saddlery and harness making 3 Photography 7 Saddle tree making 2 Stationery, die and relief stampin 10 Strap making 1 Ticket and sign writing 3 Brass working 2 Rag and bone sorting 3 Electrical fittings 1 Taxidermist 3 Engraving 1 Ivory working Gold and silver smiths, stone setting 12 Tortoise shell working 1 Silverchasing 1 Sheet, iron working 1 2,525 The total number of visits to workshops and work places in 1910 was 3,692, 707 by the women, and 2,958 by the men inspectors. Seventy complaints were received and 246 notices served. 82 Having regard to the agitation which is taking place with reference to the use of premises underground as workrooms, a considerable amount of attention was given to the matter during the year and numerous visits were paid by the inspectors. The following is a list of underground workrooms showing the means of lighting and ventilation in existence in each. Those marked "improved ventilation "are places in which registration was refused until such alterations as would lead to improvement in this respect were made. No premises, it may be mentioned, where the light is so bad that artificial illuminants must be used constantly, are registered. UNDERGROUND WORKROOMS. 3, Baker Street Improved ventilation, windows and fanlight open to yard 72, Baker Street Two windows open to pavement, through ventilation. 11, Dorset Street 46, Dorset Street Wash.house only, fanlights open to pavement. Improved ventilation, fanlights open to pavement. 10, Great Castle Street Windows open to area, through ventilation. 20, Great Portland Street Improved ventilation, fanlights open to street. 28, Great Portland Street Window opens to area. 81, Great Titchfield Street Wash.house, windows open to area, through ventilation. 32, King Street Windows open to area and street. 152, Marylebone Road Window open to area, through ventilation. 8a, New Cavendish Street Fanlights open to area. 7, Nutford Place Window open to area. 6, Old Cavendish Street Window open to area. 20, Old Cavendish Street Fanlights open to pavement. 4/5, Oxford Mansions Windows and fanlights open to street and area. 158, Oxford Street Shaft through to shop. 44, Park Road Wash.house, windows open to area. 10, Queen Street Windows open to area. 7, Ridinghouse Street Windows open to area. 24. Saville Street Wash.house, windows open to area. 33, Seymour Place Windows open to area. 34, Upper Gloucester Place Windows open to area. 43, Wigmore Street Improved ventilation, fanlights open to area. 1, William St., Manchester Sq. Wash.house, fanlights open to area. 71, York Place Wash.house, window open to area. 83 I.-INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 15 10 . (Including Factory Laundries.) Workshops 1,372 141 1 (Including Workshop Laundries.) Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 2,805 95 . Total 3,692 246 1 2-DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Refe ned to H.M. Inspector. (1) (2) (3) (4) (5) Nit nances under the Public Health Acts:- Want of cleanliness 152 94 . 1 Want of ventilation 16 16 . . Overcrowding 4 4 . Want of drainage of floors 19 19 . Other nuisances 98 93 . . Sanitary accommodation insufttcient unsuitable or 6 34 5 34 . . defective not separate for sexes 28 24 . . Offeneet under the Factory and Workshop Act:- Illegal occupation of underground . . . . house (s. 101) Breach of special sanitary requirements 26 26 . . for bakehouses (ss. 97 to 100). Other offences 27 27 . . (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 410 342 . 1 84 3.-HOME WORK. nature Of WORK. OUTWORKERS LISTS, SECTION 107. Inspections of Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES. SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Addresses of Outworkers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. ^Orders made ;(S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Received from other Councils. forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Con tractors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) Wearing Apparel- (1) Making, etc. 128 160 1,736 ... ... ... 871 1,446 ... ... ... 327 ... ... ... ... ... ... (2) Cleaning and washing 2 8 6 ... ... ... ... 10 ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... Umbrellas, etc 2 ... 8 ... ... ... ... 8 ... ... ... ... ... ... ... ... ... ... Paper bags and boxes ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... Total 132 168 1,750 ... ... ... 873 1,464 ... ... ... 329 ... ... ... ... ... ... 85 4.-REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Workshops Dressmaking, Tailoring, Millinery,' Laundry, Wood Carving, &c.) 2,525 Coffee Shops and Restaurants 234 Bakehouses 78 Total number of workshops on Register 2,837 5.-OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:. Failure to affix Abstract of the Factory and Workshop Act (s. 133) 20 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5.) Reports (of action taken) sent to [ H.M. Inspector 33 24 Other - Underground Bakehouses (s 101):. Certificates granted during the year . In use at the end of the year 78 SANITARY INSPECTION. Summary. The following is an amended list of the special premises in the Borough requiring constant supervision:. Milk Premises 208 Cowhouses 5 Slaughterhouses 7 Offensive Trades 2 Ice Cream Premises 86 Bakehouses 78 Restaurant and Dining Room Kitchens 56 Hotel Kitchens 19 Coffee Shops, Pastrycooks and Tea Rooms 94 Houses Let in Lodgings- On old Register 758 Number re.registered 501 501 Workshops, Work.places and Factories 2,525 Total 3,581 86 A statement, with special reference to the list set out above is contained in the following tables:. Number of places Number of inspections, 1910. Number of notices, 1910. Number of prosecutions, 1910. On register at end of 1909. Added in 1910. Removed in 1910. On register at end of 1910. Milk premises 264 51 I07 208 451 8 . Cowsheds 5 . . 5 41 . . Slaughterhouses 8 . 1 7 142 . . Offensive trade premises 2 . . 2 40 . . Ice cream premises 80 10 4 86 126 19 . Houses let in lodgings. 00 . . 758 . . . . These premises are being re.registered, and to the end of 1910, 501 premises on the old register had been examined and duly registered and certificates issued to the owners and occupiers. MORTUARY. Removed by Inspectors. Number of bodies received 328 . Number of Infectious bodies received 1 1 Disinfection. Number of rooms disinfected 583 Number of Articles disinfected 9,675 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 6,433 2,051 513 859 9,856 Bakehouses. Number on register at end of 1910 78 Number above ground 8 Number underground 70 Number of inspections 151 Number of Notices. Intimations, 35, Statutory Notices 2 37 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1910 169 Number of Inspections 389 Number of Notices 4 House to House Inspections. Number of Inspections 1,070 Number of Notices issued Intimations, 368 1 Statutory Notices, 153 Number of Prosecutions 1 87 House Refuse. Number of Inspections 5,857 Number of Old Brick Receptacles abolished 18 Number of New Metal Reccptacles provided 143 Number of Complaints of Non.removal received 116 Number of Letters received re Removal 256 Number of Refusals of Occupiers to have House Refuse removed 455 Number of Notices served-Intimations 130; Statutory Notices 35 165 Number of Prosecutions Nil Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 215 Number of Statutory Notices served 136 Number of Prosecutions 4 Overcrowding. Number of Dwelling Rooms overcrowded 159 Number remedied 159 Number of Prosecutions Nil Underground Rooms. Illegal occupation dealt with 118 Number of rooms closed or let with rooms on other floors 118 Number of prosecutions Nil Insanitary Houses. Number closed under Public Health (London) Act, 1891 Nil Number closed under Part II of the Housing of the Working Classes Act Nil Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (1). Number of premises cleansed (103 Rooms) 70 Number of prosecutions 1 Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year :- 12 adults. 2 children. Revenue Acts. Number of houses for which applications were received 6 Number of tenements comprised therein 64 Number of tenements for which certificates were granted 64 „ „ „ refused Nil „ , „ deferred Nil 88 STATISTICS. COMPARATIVE STATEMENT. 1910. 4 wks. 29th Jan 4 wks. 26th Feb 5 wks. 2nd Apr 4 wks. 30 th Apr 4 wks. 28th May 5 wks 2nd July 4 wks. 30th July 5 wks. 3rd Sept 4 wks. 1st Oct. 4 wks. 29th Oct 5 wks, 3rd Dec 4 wks. 31st Dec 13 wks. 2nd Apr 13 wks. 2nd July 13 wks. 1st Oct. 13 wks. 31st Dec 52 wks. 31st Dec Births Corrected 208 201 245 216 228 264 189 226 167 171 251 190 654 708 582 612 2556 Deaths 133 176 174 148 122 122 101 97 83 105 209 137 483 392 281 451 1607 Birth Rate per 1000 of pop. 21.59 20.86 20.33 22.42 23.56 21.9 19.6 18.7 17.3 17.7 20.8 19.7 20.86 22.5 18.5 19.5 20.1 Death ,, ,, 14.K9 19.44 15.38 16.35 13.48 10.7 11.1 8.5 9.1 11.6 18.4 15.1 16.37 13.2 9.5 15.2 13.3 Zymotic Diseases 6 18 20 15 15 7 8 9 12 10 17 14 44 37 29 43 150 Death Rate per 1000 of pop. •66 1.98 1.76 1.65 1.65 .61 .88 .79 1.32 1.10 1.50 1.5 1.49 1.25 .98 1.4 1 .2 Phthisis and O. T. D. 14 19 12 13 17 12 13 11 8 8 21 19 45 42 32 50 169' Death Rate per 1000 of pop. 1.54 2.09 1.06 1.43 1.87 1.06 1.43 .97 .88 .88 1.85 2.1 1.52 1.42 1.08 1.7 1.4 Respiratory Diseases 26 34 29 29 15 121 11 13 7 23 49 21 89 56 31 93 270 Death Rate per 1000 of pop. 2.87 3.75 2.56 3.20 1.65 1.06 1.21 1.14 .77 2.54 4.33 2.3 3.01 1.89 1.05 31 2.2 Infantile Mortality 29 29 28 24 18 11 13 12 21 17 24 26 86 53 46 67 253 Death Rate per 1000 Reg. Births 100 144 114 111 79 41 68 53 125 99 95 137 131 74 79 109 99 Infectious Disease. Diphtheria 7 14 11 13 6 17 4 7 11 15 9 13 33 36 22 37 128 Erysipelas 6 7 8 15 13 7 8 11 13 10 8 10 21 35 32 28 116 Scarlet Fever 6 20 28 24 9 22 23 14 16 8 13 23 55 35 53 44 207 Enteric Fever - 2 2 2 - 1 3 1 5 2 9 - 4 3 9 5 21 Typhus Fever - - - - - 1 - - - - - - - 1 - - 1 Puerperal Fever - 1 - 1 - - - 1 - - - 1 1 1 1 1 4 Cerebro Spinal Fever - 1 - - - - - - - - 1 - 1 - - 1 2 Phthisis 34 33 29 29 23 36 15 12 16 15 28 42 96 88 43 85 312 Totals 53 78 78 84 51 84 53 46 61 50 61 89 211 219 160 201 791 89 TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MAETLBBONE DURING 1910 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered is the District. Total Deaths in Public Institutions in the District. 9 Deaths of Nonresidents registered in Public Institutions in the District. 10 Deaths of Residents registered in Public Institutions beyond the District. 11 Nett Dkaths at all Ages belonging to the District. No. S Rate. 4 Under 1 Year of Age. At all Ages. No. e Rate per 1,000 Births registered 0 No. 7 *Rate. 8 No. 12 .Rate. 13 1900 134,600 3,125 23.2 589 1830 2,098 15.6 944 285 887 2,700 20.1 1901 133,301 3,042 22.8 449 1476 1,742 130 941 328 797 2,211 16.6 1902 132,010 2,960 22.4 434 146.6 1,961 14.9 1,118 395 892 2,458 18.6 1903 130,900 2,818 21.5 402 142.6 1,683 12 9 1,070 356 853 2,180 16.6 1904 129,970 2,791 21.5 393 139.9 1,716 13.2 1,062 369 825 2,172 16.7 1905 128,960 2,618 20.3 358 138.5 1,625 12.5 895 400 801 2,026 15.7 1906 127,960 2,648 20.7 322 121.6 1,506 11.8 1,240 334 759 1,931 15.1 1907 127,718 2,583 202 264 102.2 1,574 12 3 1,229 433 790 1,931 15.1 1908 126,867 2,559 20.2 267 104.3 1,703 14.3 794 652 794 1,845 15.4 1909 126,027 2,534 200 259 102.3 1,758 14.7 824 678 769 1,849 15.4 Averages for years 1900 to 1309 129,831 2.767 21.2 373 132.8 1,736 13.5 1,011 423 816 2,130 16.5 1910 125,195 2,556 201 253 98.9 1,566 12.9. 783 658 699 1,607 13.3* Total population at all ages 133,301, at Census of 1901. Area of District in acres, 1,427.8 aores. Number of inhabited houses, 13,536 „ Average number of persons per house, 10.6 ,, . The death rates in columns 8 and 13 have been corrected by multiplying the figures by the Registrar.General's factor 1.0652. 90 TABLE II. Vital Statistics of Separate Localities in 1910 and the ten Previous Years. Names of Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1900 135,350 3,125 2,700 569 35,082 642 575 114 37,805 868 762 127 31,201 790 659 154 31,262 825 704 174 1901 133,301 3,042 2,211 449 35,388 583 514 92 37,963 854 607 90 39,527 1,178 704 202 20,423 427 286 65 1902 132,650 2,960 2,458 434 35,219 570 503 74 37,763 777 721 113 39,342 1,182 775 182 20,326 431 459 66 1903 131,700 2,818 2,180 402 34,966 607 479 73 37,493 802 591 114 39,061 1,003 746 172 20,180 406 364 40 1904 131,000 2,791 2,172 393 34,781 598 512 79 37,293 740 560 106 38,853 1,043 753 168 20,073 352 347 42 1905 129,453 2,618 2,026 358 34,370 527 438 81 36,853 696 530 81 38,394 1,048 723 141 19,836 413 335 45 1906* ... 127,960 2,648 1,931 322 33,974 520 408 64 36,428 627 556 72 37,951 1,088 652 131 19,607 388 315 35 1907 127,71s 2,583 1,931 264 33,908 537 415 47 36,358 629 510 51 1,029 683 105 19,571 404 323 35 1908 126,867 2,559 1,845 267 33,683 460 419 55 36,177 588 506 77 37,628 1,107 675 105 19,439 317 245 26 1909 126,027 2,534 1,849 259 33,460 674 424 59 35,878 502 461 49 37,379 1,041 681 123 19,310 283 28 Averages of Years 1900 to 1909 130,202 2,767 2,130 371 34,483 571 468 73 37,001 708 580 88 37,721 1,051 705 153 20,997 435 376 56 1910 125,195 2,556 1,607 252 33,239 716 355 59 35,641 432 417 48 37,133 1,016 582 115 19,182 392 253 31 *The Rectory and St. Mary's Registration Sub-Districts were amalgamated this year. 91 table iii. cases of infectious disease notified during the year ending 31ST december, 1910. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home At all ages. At ages-years. All Souls St. Mary Christ Church St. John Totals. All Souls St. Mary Christ Church St. John Totals Under 1 1 to 5 5 to IS IS to 25 26 to 65 H5 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 128 2 36 61 15 14 15 37 26 41 24 128 36 24 38 23 121 7 Erysipelas 116 2 4 5 8 82 1 10 38 55 13 116 3 24 8 1 36 80 Scarlet Fever 207 3 59 113 22 9 54 73 59 21 207 50 68 59 18 195 12 Typhus Fever 1 ... ... ... 1 ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... Enteric Fever 21 ... ... 1 4 13 3 5 8 6 2 21 3 5 6 1 15 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... ... 1 3 ... 2 2 ... ... 4 1 1 ... ... 2 2 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 2 ... ... 1 ... 1 ... ... 1 1 ... 2 ... 1 1 ... 2 ... Phthisis 312 ... 5 29 28 231 19 31 105 156 20 312 18 74 62 10 164 148 Totals 791 7 104 210 79 353 38 139 253 319 80 791 111 197 175 53 536 255 92 TABLE IV.-Showing deaths from certain specified diseases during the year ending 31st December, 1910. Registered Births and Deaths. Corrected Births and Deaths. Births. Deaths. Births. Deaths. M. F. M. F. M. F. M. F. 2092. 2019. 781. 785. 1283. 1273. 817. 790. 4111. 1566. 2556. 1607. No CAUSE OF DEATH. Deaths in whole district at subjoined ages. Deaths in localities at all ages. Deaths in Public Institutions. All Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. All Souls. St. Mary. Christ Church. St. John. 1 Small-pox - - - - - - - - - - - - 2 Measles 27 6 19 2 - - - - 6 16 5 2 3 Scarlet Fever 6 1 3 2 - - - 2 2 2 - - 4 Whooping-Cough 41 15 24 1 1 - - 5 12 19 5 1 5 Diphtheria and Membranous Croup 8 - 4 3 1 - 2 2 3 1 3 6 Croup - - - - - - - - - - - 1 7 Fever Typhus 6 - - - 2 4 - 2 1 1 2 4 8 Enteric 9 Continued 10 Epidemic Influenza 16 2 1 - - 8 5 4 5 4 3 2 11 Diarrhœa 39 33 4 - - 1 1 7 9 19 4 7 12 Enteritis 7 2 1 - - 3 1 - 2 4 1 2 13 Puerperal Fever 2 - - - - 2 - 2 - - - 3 14 Erysipelas 3 1 - - - 1 1 1 1 1 - - 15 Other Septic Diseases 7 - - 3 1 1 2 1 2 4 - 9 16 Phthisis 133 - 2 1 11 106 13 28 37 56 12 33 17 Tuberculosis of Meninges 12 2 6 3 - 1 - 2 2 7 1 13 18 Other Tubercular Diseases 24 3 5 1 3 8 4 6 7 8 3 29 19 Cancer, Malignant Disease 156 - - 1 2 103 50 42 47 36 31 205 20 Alcoholism 3 - - - 1 2 - - 1 2 - - 21 Cirrhosis of Liver 21 - - - - 15 6 3 5 7 6 9 22 Heart Disease 121 - 2 3 7 67 42 30 32 43 16 33 23 Other Diseases of Circulatory System 45 - - - - 24 21 7 18 28 15 5 24 19 24 Nervous and Cerebral Diseases 124 - 1 1 1 74 47 29 43 40 25 Venereal Diseases 3 - 1 - - 1 1 - 2 1 - 4 26 Bronchitis, Acute 71 20 6 1 - 17 27 14 16 30 11 9 27 Bronchitis, Chronic 79 - - - - 24 55 15 20 31 13 12 28 Pneumonia 99 9 18 1 3 43 25 24 30 36 9 33 29 Pleurisy 4 - - 1 - 2 1 1 - 2 2 80 Other Diseases of Respiratory Organs 17 1 1 1 - 8 6 3 3 11 8 3 12 43 31 Premature Birth 55 55 - - - - - 14 27 3 32 Suffocation, Overlying 8 8 - - - - - 4 1 3 - - 33 Convulsions 10 9 1 - - - - 2 5 1 2 3 1 34 Marasmus 18 16 2 - - - - 4 3 8 8 35 Developmental Diseases 46 44 1 1 - - - 9 7 25 5 14 11 36 Senility 81 - - - - 1 80 11 35 21 5 37 Accidents and Diseases of Parturition 13 5 - - - 8 - 1 4 4 4 8 38 Tumours and other Diseases of Female Organs 4 - - - 1 3 - - - 2 12 39 Inflammation and Softening of Brain 23 - - - - 4 19 6 7 7 3 3 40 Meningitis 7 4 3 - - - - - 2 3 16 3 41 Nephritis and Bright's Disease 57 - 2 - 1 30 24 10 13 18 28 42 Diseases of the Stomach 14 - - - - 8 6 4 2 2 6 24 43 Intestinal Obstruction 18 1 1 - 1 8 7 6 1 7 4 23 44 Accidents 46 - 5 6 5 23 7 13 7 17 9 22 45 Suicides 14 - - - 2 12 - 5 2 6 1 14 46 Manslaughter 1 - - - 1 - - - - 1 23 1 47 All other causes 118 16 2 8 9 62 31 36 27 32 90 Totals 1607 253 115 40 52 665 482 355 417 582 253 783 93 TABLE V.-Infantile Mortality during the Tear 1910. Deaths from stated Causes in Weeks and Months under One Tear of Age. CAUSE Of DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 1 10-11 Months. I 11-12 Months. Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Totals. i. Common Infectious Diseases. Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 .. .. 1 Measles .. .. .. .. .. .. 1 .. .. .. .. .. .. 2 1 2 6 .. .. 4 2 6 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. 1 .. 1 Diphtheria: (including Membranous Croup) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. 1 1 .. 1 2 1 2 2 1 3 1 1 15 4 3 5 3 15 ii. Diarrhceal Diseases. Diarrhoea, all forms .. 1 1 .. 2 .. .. 1 3 2 .. .. .. .. .. 1 9 1 1 6 1 9 Enteritis, enteritis Gastro-enteritis .. 2 .. .. 2 •• 2 5 5 .. 3 .. 2 3 1 2 25 6 6 11 2 25 Gastritis, Gastrointestinal Catarrh .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 1 iii. Wasting Diseases. Premature Birth 38 4 7 2 51 1 1 1 .. .. .. .. .. .. .. 54 14 11 26 3 54 Congenital Defects . 12 6 1 19 5 3 3 1 1 .. 1 1 .. .. .. 34 4 7 20 3 34 Injury at Birth 7 .. .. 7 .. .. .. .. .. .. .. .. .. .. .. 7 1 2 2 .. 7 Want of Breast-milk Starvation 1 .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 2 1 .. 1 .. 2 Atrophy, Debility, Marasmus 1 4 1 1 7 6 2 5 1 1 .. .. .. .. .. .. 22 8 3 9 22 iv. Tuberculous Diseases. 'Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. 3 1 1 1 .. 3 Tuberculous Peritonitis : Tabes Mesenterica .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. 1 .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 2 1 .. 1 .. 2 v. Other Causes. Erysipelas .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 1 Syphilis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. 1 .. 2 .. 1 .. 4 .. .. 2 2 4 Convulsions 2 .. .. 1 3 .. 2 2 1 1 .. .. .. .. .. 9 1 5 1 2 9 Bronchitis 1 2 .. .. 3 1 3 3 1 1 1 3 1 1 3 1 22 4 4 10 4 22 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 .. .. .. 1 Pneumonia .. .. .. .. .. 2 .. 1 2 .. .. 1 .. .. 1 1 8 1 2 5 .. 8 Suffocation,overlying 4 .. 1 .. 5 .. 1 .. .. .. .. .. 1 .. 1 .. 8 4 .. 4 .. 8 Other Causes .. .. .. 1 1 2 2 1 1 2 1 2 .. 1 2 2 17 6 2 5 4 17 66 13 10 7 102 19 1G 25 18 9 10 9 9 13 12 11 253 59 48 115 31 253 Population. Estimated to middle of 1910-125,195. Births in the year, legitimate, 2,442; illegitimate, 114. Deaths in the year of legitimate infants, 224; illegitimate infants, 29. Deaths from all causes at all ages, 1,607. 94 VACCINATION RETURNS Supplemental Return for 1909. return made to the Board of Guardians and Local Government Board on the 8th February, 1911 t, by Mr. Edward A. Frith, Vaccination Officer of the St. Marylebone Parish, respecting the Vaccination of Children whose Births were registered in St. Marylebone, from 1st January to 31st December, 1909, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets " as registered from 1st January to 31st Dec. 1909. Number of these Births duly entered by 31st January, 1909, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1909, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1909, neither duly entered in the "Vaccination Register " (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book" (columns 8, 9, and 10 of this Return). Total Number of Certificates of Successful Primary Vaccination at ALL AGES received during the calendar year 1910. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, Unvac. cinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown, or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had Small. Pox. 1 2 3 4 5 6 7 8 9 10 11 12 1. St. John 296 245 4 ... 23 13 1 1 7 2 2. Christchurch 867 640 8 ... 48 66 14 12 69 10 3324 Born in St. Marylebone 3. St. Mary 2,237 1,863 2 ... 53 133 113 41 29 3 73 Born 4. All Souls 656 436 4 ... 29 56 15 77 33 6 elsewhere Total 4,056 3,184 18 ... 153 268 143 131 138 21 3,397 Dated 8th February, 1911. Signed EDWARD A. FRITH, Vaccination Officer. 95 VACCINATION RETURNS. Return for the Period January-June, 1910. Return made to the Board of Guardians and Local Government Board on the 8th February, 1911, by Mr. Edward A. Frith, Vaccination Officer of the St. Marylebone Parish, respecting the Vaccination of Children whose Births were registered in St. Marylebone, from 1st January to 30th June, 1910, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the " Birth List Sheets " as registered from 1st January to 30th June, 1910. Number of these Births duly entered by 31st January, 1909, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1909, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of N umber of these Births remaining on 31st January, 1909, neither duly entered in the 44 Vaccination Register " (columns 3, 4, 5, 6, and 7 of this Return) nor temporarily accounted for in the " Report Book " (columns 8, 9, and 10 of this Return). Number of Certificates of Conscientious Objection actually received by the Vaccination Officer, irrespective of the dates of birth of the Children to which they relate, during the year 1910. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, Un vaccinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown or which cannot be reached ; and Cases not having been found. Insusceptible of Vaccination. Had Small. Pox. 2 3 4 5 6 7 8 9 10 11 #] 1. St. John 187 151 ... ... 12 6 4 2 9 3 201 2. Christchurch 458 330 ... 36 30 13 7 35 7 3. St. Mary 1,143 935 3 ... 48 53 56 29 17 2 4. All Souls 345 214 ... ... 16 30 7 62 16 Total 2,133 1,630 3 ... 112 119 80 100 77 12 201 Dated 8th February, 1911. Sigtied EDWARD A. FRITH, Vaccination Officer.