AC 4353 STMARY 16 Detropolitan Borough of St. Darylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1911, Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. London: Geo. Pulman & Sons, Ltd., Printers. 1912. Detropolitan Borough of St. Darylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1911, Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple Barrister-at-Law. London : Geo. Pulman & Sons, Ltd., Printers. 1912. London: Geo. Pulman & Sons, Ltd., printers, london and wealdstone. Public Health Office, 24, Somerset Street, London, W. April, 1912. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor and Gentlemen, I have the honour to submit the following Report on the public health and sanitary condition of the Borough of St. Marylebone for the year 1911, which is made in accordance with the instructions of the Local Government Board relating to Annual Reports of Medical Officers of Health. The year 1911 was the census year and some of the results of the enumeration are given in subsequent pages. The fact that the population has decreased considerably since the census of 1901 is already known to you, the diminution being far in excess of estimations. Some of the rates, calculated on the population of 1911, compare unfavourably with those of recent years, but as the population in these years was probably greatly over-estimated considerable allowances must be made. As a matter of fact the year 1911 was far from unsatisfactory. An increased amount of work was done in every branch of the department, and there is every reason to believe that what was done was greatly to the advantage of the public health. I have received the greatest amount of assistance and encouragement in connection with the work of the department from the Public Health Committee. To the chairman of that committee Councillor the Rev. J. A. Beaumont, M.A., who has presided over it now for five years in succession, and the chairman of the Dust Sub-Committee, Mr. Alderman J. Lea-Smith, I am especially grateful for the kindness they have shown and the support they have given me. All the members of the staff have worked exceedingly well together and with me and I desire to place my high appreciation of their efforts on record. 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 8 Deaths and Death Rates 9, 10 District Births and Deaths 10 Causes of, and Ages at, Death 10 Deaths in relation to age 11 Infantile Mortality 12, 13. 14 Prevention of Infantile Mortality 14, 15, 16, 17, 18, 19, 20, 21 Deaths in relation to Disease 22 Diarrhoeal Diseases 22 Zymotic Diseases, Phthisis, &c., and Respiratory Diseases 22 Zymotic Diseases 23 Phthisis and other Tubercular Diseases 23, 24 Respiratory Diseases 24 Cancer and Malignant Disease 24, 25 Alcoholism 25 Accident, Suicide and Manslaughter 25 PAGE Records of Diseases 25 Notifications 26 Discharge Notices 27 Diphtheria and Membranous Croup 27 Scarlet Fever 28 Enteric Fever 28 Cerebro-Spinal Fever 29 Erysipelas 29 Puerperal Fever 29 Measles 29, 30 ,, Deaths 31 ,, Isolation of 31 Whooping Cough 32 Glanders 32 Polio Encephalitis and Myelitis 32 Chicken-pox 33 Ophthalmia Neonatorum 33 Phthisis 34 ,, Notifications 35 ,, Deaths 35 ,, Preventive Measure against 36, 37, 38, 39, 40, 41, 42, 43 ,, Bacteriological diagnosis 43 Disinfection 43, 44, 45 Bacteriological Examinations 45 Part II. Departmental. page Protection of Food Supply 49 Inspection 49 Surrenders 49 Seizures 50 Prosecutions 50. 51 Slaughterhouses 52 Milk Supply 52 Cowhouses 52 Milkshops, etc 52 Examination of Milk 53 Ice Cream Premises 54 Butter, Margarine, etc. 54 Restaurants, Food Stalls, etc. 54 Offensive Trades 54 Bakehouses 55 Sale of Food and Drugs Acts 55, 56 Public Analyst's Reports 57-65 Bacteriological Examination of Food 65 Water Supply 66 Housing 67, 68 Housing, Town Planning, etc. Act, 1909 69 House to House Inspection 70 Sanitary Survey 70 Houses Let in Lodgings 71 page Common Lodging Houses 71 Overcrowding 72 Underground Rooms 72 Customs and Inland Revenue Acts 73 Nuisances 73 Work of Sanitary Inspectors 74 Legal Proceedings 75 Drain Plans and Drainage 76, 77 Combined Drainage 77 Black Smoke Nuisances 78 Removal of House Refuse 78, 79 Verminous Persons Baths 79, 80 Cleansing of Persons Act, 1897 80, 81 The Shelter 81 Public Mortuary 81, 82 Public Sanitary Conveniences 82, 83 Factories and Workshops 83-86 Inspection 84 Defects Found 84 HomeWork 85 Registered Workshops 86 Sanitary Inspection (Summary) 86, 87, 88 Local Government Board Tables I.-V. 89-95 Vaccination Returns 96, 97 Part I. STATISTICAL. Curve showing the number of cases of Scarlet Fever, Diphtheria and Typhoid Fever, notified week by week during the year 1911. Notes:Scarlet Fever Diphtheria. Typhoid Fever. Average of Scarlet Fever during 10 years ending 1911, ,, ,, Diphtheria. ,, ,, „ „ Typhoid Fever. „ „ „ 7 POPULATION. The population of the Borough enumerated on the night of Sunday, 2nd April, 1911, was found to be 118,221, distributed as follows : Census 1911. All Souls 29,485 St. Mary 32,126 Christ Church 36,544 St. John 20,066 Total 118,221 At the Census taken in 1901 the population was enumerated at 133,301. During the 10 years, therefore, there has been a decrease of 15,080. Since the figures of the Census were ascertained the Registrar General has made a further correction and estimates the population to the middle of the year 1911 at 117,844, a further decrease of 377. All calculations are based on this figure. In the Annual Report for 1910 the population at the middle of that year was estimated to be 125,195, and the decrease since the Census of 1901, 8,106. The estimates were out, therefore, by something like 7,000, though the method adopted was that of the Registrar General and is the one usually regarded as the most reliable. The following table gives the population estimated by this method, of the four Sub-Districts for the last three years:— 1909. 1910. 1911. All Souls 33,460 33,239 29,392 St. Mary 35,878 35,641 32,025 Christ Church 37,379 37,133 36,425 St. John 19,310 19,182 20,002 126,027 125,195 117,844 The main cause of the decrease is undoubtedly emigration ; a factor which the method of estimating the population cannot accurately take into account. Numbers of small houses have been demolished within recent years, and in their place have appeared, in most cases, premises intended for workrooms, and in a smaller number of cases, premises for human habitation. The persons displaced by these alterations, unable to find suitable accommodation within the Borough, have gone elsewhere for a home. This process will doubtless continue, and more and more of the district will cease to be residential, the population becoming more and more a day population. 8 BIRTHS. Registration. The number of births registered during 1911 was 2,375,* being 180 under the number for 1910. Male births numbered 1,194, and female 1,181. The birth rate per 1,000 was 20'2. The accompanying table compares the rates in the several registration sub-districts with those of 1910. 1910. 1911. All Souls 21.5 16.0 St. Mary 12*1 14.4 Christ Church 27.3 29.7 St. John 20'4 19.2 Notifications. The total number of notifications received during the year was 4,090. As heretofore,persons failing to make notification within thirty-six hours were communicated with, but, as was expected, as the fact of the adoption of the Act becomes known, the number of failures to notify diminishes. The number of letters sent was quite small, and of the few who failed to notify it was quite clear that none did so wilfully. It was not considered necessary to institute proceedings in any case. The following are the sources of the notifications received during the year, in some instances duplicates coming to hand from different sources :— 1911. 1910. From parents 564 or 14'06 per cent. 768 or 18'93 per cent. „ doctors 491 „ 12'24 „ 387 ,, 9'54 „ „ midwives 774 „ 19'30 „ 854 „ 21'06 „ „ other persons 38 „ 0'95 „ 27 „ '66 „ „ hospitals, etc. 2,223 „ 55'45 „ 1,970 „ 48'58 „ Of the total births notified 58 referred to still-births (33 males and 25 females); 1,746 took place at Queen Charlotte's Hospital ; 384 at the Middlesex Hospital; and 1,723 were born at home. Of those notified as having occurred in St. Marylebone, 1,755 belonged to other Boroughs. Legitimate males 565 „ females 519 Illegitimate males 331 „ females 340 Total 1,755 * This figure is inclusive of births occurring in the Borough to persons usually non-resident therein, but includes 62 births which occurred outside the district and which have been transferred. Males 29 Legitimate Females 17 Males 6 Illegitimate Females 10 Total 62 9 Deaths and Death Rates. The total number of deaths registered during the year was 1818. This figure is inclusive of persons who, though usually resident in the Borough, died in institutions, etc., outside, but exclusive of those, who, though they died in St. Marylebone, were ordinarily resident in other districts. Arrangements for transferring these deaths are made by the Registrar-General who receives a note of all deaths considered to belong to some other district and sends on such deaths as should rightly be included in the returns of the Borough. Deaths of persons usually resident outside England and Wales are not so treated, and must be included in the returns of the district in which they occur. The figure 1818 includes 51 such deaths being mainly of persons who have come to the hospitals and nursing homes, of which there are so many, in the Borough. The death rate calculated with the figures so obtained (1818) and the estimated population to the middle of 1911 and corrected for age and sex distribution by multiplying by the Registrar-General's factor 1.0652, works out at 16.3 per 1,000. As has been explained in previous reports, 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 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 number of deaths in 1910 was 1607, less by 211 than the number for 1911; the death rate for 1910 was 13.3 as against 16.3 for the year under review. For the increase in the total number of deaths the alteration making compulsory the inclusion of the 51 " outside" deaths referred to above is to some extent responsible ; the chief factor, however, as will be shown when the figures are more closely analysed in subsequent pages, is an increase in the number of deaths from certain causes, more especially in the earlier and later age groups. Measles, for example, which caused 27 deaths in 1910, was responsible for no fewer than 64 in 1911; phthisis (consumption) which gave 133 deaths in the previous year, in 1911 gave 172 ; and so with diarrhcea and enteritis, which in 1911 caused 92 deaths, exactly twice as many as in 1910. As to age, whereas in the age group 65 and upwards in 1910, 482 deaths were registered, in 1911 the number was 561. The increase in the death rate per 1,000 of population, from 13.3 to 16.3 is partly due to the increase in the number of deaths, but largely also to the fact that the the population with which we are dealing is smaller, 117,844, as against 125,195. 1O The two rates, as a matter of fact, cannot be compared at all, as the population for 1910 was certainly considerably overestimated and the number of deaths reduced by the exclusion of " foreign " deaths which occurred in the Borough. In any case, however, the year 1910 was an exceedingly favourable one ; the actual number of deaths was the lowest recorded, and the death rate per 1,000 also the lowest. In the year 1911, the number of recorded deaths was nearer the numbers given for previous years. The death rate also was much the same as in more normal years, the average death rate for the previous 10 years being 15'8 per 1,000. This figure, granting even that the population in some years was overestimated, and the number of deaths reduced by the exclusion of some which are now included, is probably fairly correct. The following short table shows the death rates in the several registration subdistricts in 1911, and compares them with those of the three previous years: — 1908. 1909. 1910. 1911. All Souls 13.2 12.6 10.7 12.7 St. Mary 14.9 12.8 11.7 13.1 Christ Church 19.0 18.2 15.6 19.7 St. John 13.4 14.6 13.1 15.9 District Births and Deaths for the 52 weeks ended 31st December are given in the following table (Table I.). A further table giving the vital statistics of separate localities for 1911, and the ten preceding years, will be found amongst the Local Government Board Tables on pages 89-95. TABLE I. Sub-District. Population estimated to Middle of Year, 1911. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 29,392 255 247 502 214 186 400 St. Mary 32,075 246 239 485 219 221 440 Christ Church 36,425 527 514 1,041 362 328 690 St. John 20,002 166 181 347 140 148 288 The Borough 117,844 1,194 1,181 2,375 935 883 1,818 Causes of and ages at Death.—The new Local Government Board Table (Table III, page 92), gives the'details as to the deaths of residents in the Borough during 1911. The analysis of causes of death is somewhat less full than in the old Table IV, but it nevertheless contains a considerable amount of information regarding the causes of death and the numbers which occurred in various age groups. As in previous years, it is proposed to examine some of the figures more fully and to say a few words with regard to the question of the age periods at which death occurred and certain of the diseases and conditions certified to be the cause of death. The number of age groups it may be mentioned has been increased by breaking up the old group, " 1 to 5 years," into the groups " 1 and under 2," and " 2 and under 5," and the group " 25 to 65," into " 25 and under 45," and " 45 and under 65." 11 DEATHS IN RELATION TO AGE. The total number of deaths analysed in the following table is, 1,818 as against 1,607 in 1910. The fact that the bulk of the deaths took place in the earlier and later years of life will be noted. Owing to the fact of the alteration in grouping, the table for 1910 cannot be given for comparison, but it may be mentioned that the deaths under 1 year in 1910 were 253—8 less than in 1911—and the deaths between 25 and 65, 665, fewer by 69 than in 1911, and those at 65 and upwards, 482, 79 less than in 1911. Age Periods. Under 1 year 1 and under 2 year 2 and under 5 years. 5 and under 15 years. 15 and under 25 years 25 and under 45 years. 65 and upwards At all ages No. of Deaths 261 94 71 48 49 248 488 561 1,818 The extent to which each of the four divisions of the Borough shared in the deaths of those aged over 65 in 1909, 1910 and 1911, is shown below :— 1909. 1910. 1911. All Souls 146 101 140 St. Mary 166 147 161 Christ Church 190 141 159 St. John 114 93 101 Totals 616 482 561 Of the total, 155 at death were aged 65-70; 261, 70-80; 125, 80-90; and 20, 90-100. The outstanding causes of death were as follows:— Cause. 1910. 1911. Bronchitis and other respiratory diseases 114 158 Nephritis and Bright's Disease 24 13 Cancer 50 62 Tuberculosis . 13 14 Influenza 5 10 Violent deaths 7 16 A table showing the deaths that took place amongst infants under 1 year and adults of 65 years and upwards in each of the four quarters of the year, is given below. The effect produced by the excessive heat in the third quarter on infants is well brought out; the fact that to the aged the colder quarters are the more trying is also clearly shown. January- April- July- October- March. June. September. December. Total. Infants under 1 year 62 58 85 56 261 Persons of 65 years and upwards 165 138 91 167 561 12 Infantile Mortality. The infantile mortality rate for any year is calculated from the number of deaths of infants under one year of age, and the number of births occurring in that year. In 1911, the deaths numbering 261 and the births (corrected) 2,375, the rate was equal to 109'8 per 1,000. The average rate for the 10 preceding years was 124'4 ; in 1910 it was 98'9, the lowest ever recorded, the next lowest, 102'2, was the rate for 1907. The conditions in both these years were extremely favourable. The reasons for the excess of the rate of 1911 over that of 1910, are, though the heat of the summer of 1911 was particularly trying to infants, partly only climatic. To a considerable extent they are also statistical. Corrections of figures have been all round more carefully carried out, and as a result the number of births, as compared with former years, has been greatly cut down by rigorous exclusion of all occurring in institutions and elsewhere to mothers not actually members of the population of St. Marylebone. At the same time, the number of deaths of infants has been increased by the addition of all, no matter where they occurred in England and Wales, amongst the children of Marylebone people. Taking these facts into consideration, the rate, though apparently high, is not discouraging. It is high only when compared with those of years in which corrections were less thoroughly made, and in which climatic and other accidental circumstances aided the efforts which the Council are and have been making to reduce the death rate amongst young children. Compared with the average rate for the past 10 years (124'4), or better still, with that of 1901, the year of the last census, when it was 147'6, the population being 133,301, the births 3,042, and the infant deaths 449, it is small, and shows how marked an improvement has taken place. Causes of Infantile Mortality—Ages at Death. The three following tables show for each registration sub-district, the ages at which death occurred amongst the infants who died, and the causes to which death was attributable. TABLE II. sub-district, Under I week I and Under 2 weeks 2 and Under 3 weeks 3 and Under 4 weeks 4 weeks and Under 3 m'ths. 3 m'ths and Under 6 m'ths. 6 m'ths and Under 9 m'ths. 9 m'ths and Under 12 m'ths. Total All Souls 8 2 2 — 11 5 11 1 40 St. Mary 11 — 2 2 16 6 4 8 49 Christ Church 17 6 7 5 34 16 24 28 137 St. John 6 2 3 3 9 3 4 6 35 Totals 42 10 14 10 70 30 43 42 261 13 TABLE III. Cause of Death. Diarrhoea. Prematurity. Marasmus, Atrophy and Debility Bronchitis. Pneumonia. Convulsions. Suffocation. Measles. Whooping Cough. T uberculosis. Meningitis including Tuberculous. Miscellaneous. Totals. All Souls 4 5 6 3 2 2 - - 2 1 1 14 40 St. Mary 6 7 9 - 4 1 2 2 - - 1 17 49 Christ Church 35 16 11 4 7 5 4 10 8 2 6 29 137 St. John 4 5 4 1 3 3 1 - 3 1 3 7 35 Totals 49 33 30 8 16 11 7 12 13 4 11 67 261 TABLE IV. Certified cause of Death. Months. 0-3 Months. 3-6 Months. 6-12. Totals. Diarrhoea 20 11 18 49 Prematurity 33 — — 33 Marasmus, Atrophy and Debility 20 5 5 30 Bronchitis 2 1 5 8 Pneumonia 7 1 8 16 Convulsions 7 1 3 11 Suffocation 5 1 1 7 Measles 1 - 11 12 Whooping Cough 3 2 8 13 Tuberculosis - 1 3 4 Meningitis (including Tuberculous) 3 2 6 11 Miscellaneous 43 5 19 67 Totals 144 30 87 261 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 causes set forth in Tables III. and III. (a), Tables IV. and IV. (a); of the Local Government Board series, which will be found at page 92-5, also contain information regarding this important subject. The bulk of the deaths, 144 (55 per cent.) it will be noted are of infants under three months old. In previous years the results have been exactly similar, the percentage in 1910 being 54 and in 1909, 59. The number of children who died before reaching the age of one month was 76, about half of the total. In 1910, the percentage was much the same, 102 out of 137 deaths under three months of age taking place before the end of the first month. 14 As pointed out in previous reports, the causes to which mortality in infancy is chiefly attributable are : immaturity (prematurity, wasting and developmental diseases), respiratory affections and diarrhcea. In 1911, this rule held good, about 50 per cent, of the deaths being due to these causes. The percentages contributed by each were immaturity, 24 (63 deaths); respiratory affections, 9 (bronchitis 8 deaths, pneumonia 16 deaths) ; diarrhcea and enteritis, 25 (66 deaths). Causes other than those referred to above which contributed to an extent worth mentioning are convulsions 11, measles 12, whooping cough 13, suffocation 11 and meningitis—all forms—11. Overlying accounted for 7 deaths ; two of the children were under one week and five less than three months old. Distribution of Infantile Mortality. The distribution of deaths amongst infants is graphically shown in the accompanying photograph of a map of the Borough into which pins have been introduced, one as near as possible to the address at which each death occurred. Differently coloured pins were used for each of the causes of death, but, unfortunately, the colours do not show up on the photograph. What is shown, however, very clearly, is the massing of the deaths in the districts occupied chiefly by the poorer inhabitants of the Borough. The Lisson Grove area, where most of the houses are let out in tenements is clearly shown to have suffered most. This map may be compared with that given in the report for 1910 and showing the distribution of deaths from phthisis. It is interesting to note how alike the photographs are. Prevention of Infantile Mortality. In a circular issued in August last by the Local Government Board with regard to the prevalence of epidemic diarrhcea amongst children it is suggested that in the Annual Report for 1911 the Medical Officer of Health should set out the course of action adopted in the district to prevent diarrhcea and child mortality generally in that year. The lines along which the circular suggested that action should be taken are exactly those followed in the Borough, viz. The giving of exact advice as to feeding and management of children. A great amount of work of this kind is done by the Council, the three women inspectors, Map showing distribution of deaths of infants under one year of age during 1911. 15 Miss Baker, Miss Johnson and Miss Stokes, giving a great part of their time to the visitation of homes from which births have been notified under the Notification of Births Act, 1907. In addition, the St. Marylebone Health Society, by means of its voluntary Health Workers and the Infant Consultations which have been established as a result of the activity of the Society, one in South Marylebone at Welbeck Street Dispensary and another in North Marylebone at the Portman Club, in Church Street, performed similar duties. Large numbers of women attend these consultations with their babies and obtain advice as to feeding, etc. At the Southern Consultation every Tuesday Dr. Eric Pritchard, and every Thursday Dr. Eric Pritchard and Dr. Lane-Claypon, examine, weigh and advise with regard to the babies, and on Wednesdays and Thursdays at the Northern Consultation Dr. Christine Murrell and Dr. Emily Mecredy do similar work. These consultations and the work of the voluntary visitors have been and are of the greatest value in connection with the prevention of infantile mortality and mothers are resorting to the former in increasing numbers every year. Apart from the consultation work, the Society by means of mothers' clubs and provident clubs for expectant mothers carries out a great deal of social work also. The club in the north was established some years ago and through it a much closer touch with mothers has been brought about. In the south the club is now in its second year and is rapidly making headway. These institutions are deserving of the greatest praise and do an incalculable amount of good amongst the women who attend them. The total number of infants seen at Church Street during 1911, was 303, and at Welbeck Street, 232, the total attendances at the former being 1685, and at the latter, 1911. During the diarhoea period much useful work was done at the consultations, and the following facts with regard to 108 cases seen at Church Street, kindly supplied by Mrs. Dobell, the Secretary of the Society, are particularly interesting. The numbers met with in each of the months from June to December were:— * June, 7; July, 11; August, 24; September, 32; October, 11; November, 17; December, 6. Of the 108, 49 were entirely breast fed, 55 bottle fed, and 4 partly breast and partly bottle fed. In 13 instances the same baby suffered twice, and in one case there were three attacks—one in June, a second in October, and a third in December. This baby, which was entirely breast fed till 1 year old, died of bronchitis early in January, 1912. 16 Out of 17 deaths among infants who attended the consultation only 4 were reported as having suffered from diarrhoea and sickness during the summer. At the end of the year, with the exception of those 4, all who had suffered from diarrhcea were reported as doing well. Of the 17 who died, the cause of death in two cases was stated to be wasting after diarrhaea. The number of babies visited by the Women Inspectors was 2,065. The number visited in their own homes by the voluntary workers of the Society was 361. Tables setting forth the information obtained as a result of these visits will be found on page 19. (Table V.) The leaflets used by the women inspectors and the voluntary workers are the same, and so far as babies are concerned cards of instruction as to feeding are widely distributed, and along with them special leaflets of information with regard to diarrhcea as follows:— Metropolitan Borough of St. Marylebone. SUMMER DIARRHCEA. Public Health Department, 24, Somerset Street, W. Every summer, during the warm weather, many hundreds of babies suffer from sickness and diarrhcea, and very many die. This illness is nearly always caused by dirt getting into baby's mouth in some way, from dirty feeding bottles, dirty teats, dirty dummies and dirty hands. Wrong feeding makes it worse, and bottle-fed babies are more likely to suffer than breast-fed babies. With care mothers can keep babies from catching the disease. 1. What to do to keep Sickness and Diarrhcea away. (1.) Feed baby on the breast, and keep the nipples very clean. (2.) Do not wean baby during the hot weather. (3.) If baby must be fed on the bottle, do not use a long tube bottle. (4.) Only use a clean boat-shaped bottle. (5.) Boil baby's milk as soon as it is taken from the milkman, and keep it covered. (6.) Only make one feed at a time. (7.) Do not use old feeds. If baby does not finish all there is in the bottle, the rest may be used for cooking purposes. (8.) Wash out the bottle and teat in hot water directly baby is fed, and keep them in cold water till the next feeding time. 17 (9.) Always have the bottle and teat quite clean before putting in the feed. (10.) Do not use a dummy teat. (11.) Special care should be taken as to the cleanliness of floors and bedding. (12.) Keep all food covered from flies and dust, which spread the disease. 2. What to do if baby catches the disease. (1.) Remember that the illness is serious. Even if baby is teething, send for the doctor at once. (2.) As soon as sickness and diarrhcea begin, stop giving baby milk and food, and give only pure hot water, sweetened with a little sugar, every half-hour. (3.) Keep baby warm. Put on a flannel binder, and put a hot water bottle to the child's feet. (4.) Open all windows at the top. (5.) Remember that the illness is catching. Always wash the hands after changing baby, and disinfect all soiled clothing by boiling. (6.) If the house drains get stopped up, or the supply of water gets low, tell your landlord and write to the Medical Officer of Health, 24, Somerset Street, Portman Square, W. Another card of information with regard to the care of the eyes is also distributed. Prevention of accumulation in, or in the vicinity of houses of decomposing animal and vegetable matter.—The advice given by the women workers both official and voluntary, in addition to referring to feeding and care of infants, relates also to general hygiene and the importance of destruction of refuse liable to decomposition, on the household fires. When undue collections of refuse of any kind or if dirty houses are met with, the fact is reported to the Medical Officer of Health and steps are taken to have the refuse removed and cleansing carried out. In addition, as is mentioned elsewhere, in the districts inhabited by the poorest members of the community, refuse collection is carried out much more frequently than in other parts. In Lisson Grove, for example, most of the main streets are on the daily kerb collection list, and practically all the side streets on the three times a week list. The blocks of dwellings in most cases are subject to a system of daily or at least a thrice a week collection. The quantity of refuse, therefore, in or in the neighbourhod of houses in these parts is kept very low. With regard to manure removal, in most cases this is carried out three times a week, and accumulations of any size are rarely found. For scavenging, the department of the Borough Surveyor is responsible, and the streets are regularly and frequently cleansed. In connection with the cleanliness of the surroundings of houses, the greatest amount of benefit has been obtained from the sanitary surveys carried out by the 18 district inspectors. These surveys are referred to later in this report, but it may be said here that rapid visits were paid to a large number of streets and premises during the summer, and all conditions which called for immediate attention, e.g., dirty yards, collections of refuse, &c., were immediately dealt with. Information as to cases of diarrhoea.—The chief sources of information of cases of diarrhcea in the district are the voluntary and official workers and the consultations. The work at the consultations is closely followed by all the workers who attend regularly, and attention is directed to any case requiring special visits. No opportunity is lost of warning parents as to the seriousness of diarrhœa, and of advising as to what steps should be taken. To sum up with regard to the course of action adopted to prevent diarrhœa and child mortality generally, it may be said that every effort is made by personal visitation of notified births, to instruct mothers as to the causes of infant deaths, and to show them how to counteract these causes ; this work is carried out by the women inspectors, the voluntary workers of the St. Marylebone Health Society and at the consultations; special instructions are given with regard to diarrhcea; by means of sanitary surveys, house to house inspections and other visits, nuisances are sought for and when discovered removed; refuse removal is carried out three times or oftener per week in those districts in which infantile mortality is highest; stable refuse is removed three times per week and street cleansing and watering are regularly and frequently done. The work referred to above has steadily increased in amount year by year for some years, and has undoubtedly played a great part in the marked reduction in the infantile mortality from 147'6 per 1,000 in 1901 to 109'8 in 1911, the summer of which was one of the most inimical to infant life on record. In the following table (V) the information elicited at visits paid to notified births is tabulated. Births Investigations—The enquiries made at the visits paid to homes in which a birth had occurred were similar to those made in former years. The facts elicited were also much the same. The number of infants found to be fed on condensed milks was somewnat higher than in 1910, the reason being that during the excessively hot weather when fresh cows' milk did not keep well many mothers resorted to the tinned varieties. Infant Deaths.—The tables (VI and VII) following contain particulars of the investigations made into cases of deaths of infants under one year of age. The number of such investigations is considerably higher than in 1910, the work in connection with infants in 1911 being more completely organized and receiving more attention than in the previous year. The contents of the tables are similar to those in Tables VI. and VII. in the report for 1910; methods of feeding, health of mothers, nature of mothers' work, and housing being inquired into. BIRTHS INVESTIGATIONS TABLE V. Method of Feeding Condition of Child Mother's Work Mother's Health Condition of Tenement No. of Rooms • Totals 3 S Age at Visit Sf 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 194 0 177 5 1o 1 1 165 18 11 191 3 — — 152 37 5 165 25 4 71 ioi 20 2 37 6 4 629 1 571 24 24 io — 499 102 28 607 4 9 9 575 132 22 535 90 4 234 333 52 10 149 14 18 504 2 423 28 37 l6 — 392 87 25 472 13 10 9 403 77 24 445 52 7 167 256 69 12 98 6 23 319 3 270 13 32 4 — 245 58 16 287 12 12 8 249 55 15 277 33 9 110 170 34 5 81 4 15 154 4 132 9 10 3 — 129 20 5 136 7 6 5 124 26 4 136 16 2 41 90 21 2 42 — 5 101 5 77 8 13 3 — 81 13 7 82 8 5 6 79 15 7 91 10 — 26 54 18 3 26 4 6 81 6 54 8 12 5 — 62 12 7 66 7 6 2 55 25 1 71 8 2 24 41 12 4 21 — 8 71 7 58 5 6 2 — 5° 20 1 62 1 4 4 51 17 3 64 5 2 22 37 12 — 17 2 3 659 over 8 416 71 214 48 — 516 108 35 555 35 37 32 526 97 36 578 62 19 216 351 82 10 150 7 17 19 ENQUIRIES INTO INFANT DEATHS TABLE VI. Method of Feeding Reasons for Weaning Cause of Death Months. Totals Breast only Breast, etc. Cows' milk Artificial or condensed Not fed Loss of milk Illness of mother or child Mother's work Mother's death Diarrhoea Prematurity Marasmus Atrophy, etc. Bronchitis Pneumonia Convulsions Suffocation Measles Whooping cough T uberculosis Meningitis Miscellaneous First-born Twins Illegitimate 0 to 1 49 20 ... 6 6 17 3 9 3 ... 4 17 4 12 1 1 2 1 ... 1 ... 1 5 21 7 4 1 to 2 14 6 1 5 2 ... 5 1 ... ... 5 1 ... 1 2 1 2 1 ... ... ... ... 1 1 ... ... 2 to 3 16 8 I 2 5 ... 4 1 1 ... 4 ... ... 2 ... 4 ... 1 ... ... ... ... 5 2 ... 1 3 to 4 7 4 I ... 2 ... I ... ... ... 2 ... ... 1 1 1 1 ... ... ... ... 1 ... 1 ... ... 4 to 5 8 3 I I 3 ... 3 ... 1 ... 5 ... 1 ... ... ... ... ... ... ... 1 ... 1 1 1 ... 5to 6 7 1 ... 5 1 ... 3 3 ... ... 3 ... ... ... ... 1 ... ... ... 2 ... 1 ... ... 2 ... 6 to 7 7 1 1 4 1 ... 5 ... ... ... 2 1 ... ... ... 1 1 ... ... ... 2 ... ... ... ... ... 7 to 8 8 3 ... 3 2 ... 3 1 1 ... 2 ... 1 ... 1 ... ... ... ... ... ... 3 I 2 2 1 8 to 9 5 2 1 1 1 ... ... 2 ... ... 2 ... 1 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 9 to 10 5 2 ... 2 1 ... 1 1 1 ... 2 ... ... ... ... 1 ... ... 1 ... 1 ... ... 1 ... ... 1O to 11 2 1 ... 1 ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 11 to 12 7 2 I 4 ... ... 1 ... ... ... 2 ... ... ... ... 1 ... ... 1 ... ... 1 2 1 ... ... 135 53 7 34 24 17 30 18 7 34 19 7 18 5 11 6 3 2 3 4 8 15 31 12 7 21 ENQUIRIES INTO INFANT DEATHS TABLE VII. Totals First-born Twins 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 34 5 I Diarrhœa 8 3 12 11 ... 28 3 3 28 ... 5 1 31 1 2 14 I5 3 2 4 5 4 2 5 3 2 2 2 2 1 2 19 8 2 Prematurity 6 ... ... 3 10 16 1 2 16 1 2 ... 19 ... ... 10 6 2 1 17 1 ... ... ... ... 1 ... ... ... ... ... 7 3 1 Marasmus 3 ... 2 2 ... 6 1 ... 6 1 ... ... 7 ... ... 5 2 ... ... 4 ... ... ... 1 ... ... 1 1 ... ... ... 18 6 2 Atrophy and developmental 6 ... 4 2 6 16 1 1 17 ... ... 1 17 ... ... 10 6 2 ... 12 1 2 1 ... ... ... ... 1 ... 1 ... 5 ... ... Bronchitis 5 ... ... ... ... 2 1 2 3 ... 1 1 5 ... ... ... 5 ... ... 1 2 ... 1 ... ... ... 1 ... ... ... ... 11 5 1 Pneumonia 5 1 3 2 ... 9 1 1 10 ... 1 ... 11 ... ... 3 7 1 ... 1 1 4 1 ... 1 1 ... ... 1 ... 1 6 3 ... Convulsions 4 ... 2 ... ... 4 2 ... 6 ... ... ... 6 ... ... 3 3 ... ... 2 2 ... 1 ... ... 1 ... ... ... ... ... 3 ... ... Suffocation 2 ... ... 1 ... 3 ... ... 3 ... ... ... 3 ... ... 1 2 ... ... 1 1 1 ... ... ... ... ... ... ... ... ... 2 ... ... Measles 1 ... 1 ... ... 2 ... ... 2 ... ... ... 2 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 3 ... 3 Whooping Cough 1 ... 2 ... ... 1 2 ... 3 ... ... ... 3 ... ... ... 2 1 ... 1 ... ... ... ... 2 ... ... ... ... ... ... 4 ... 1 Tuberculosis 1 ... 2 1 ... 2 ... 2 4 ... ... ... 4 ... ... ... 3 1 ... ... ... ... ... 1 ... 2 ... ... 1 ... ... 8 ... 1 Meningitis including Tuberculous 3 1 3 1 ... 5 1 2 7 ... 1 ... 8 ... ... 4 4 ... ... 1 ... ... 1 ... 1 ... 3 1 ... ... 1 15 ... 1 Miscellaneous 8 2 3 1 1 15 ... ... 12 ... 2 1 15 ... ... 2 9 4 ... 5 1 5 ... 1 ... ... 1 ... ... ... 2 135 30 12 53 7 34 24 17 109 13 13 117 2 12 4 131 1 3 52 65 14 4 49 14 16 7 8 7 7 8 5 5 2 7 22 DEATHS IN RELATION TO DISEASE. In Table III, of the Local Government Board series of statistical tables, which is given at page 92, full information is given as to the causes of, and ages at death during the year. According to custom, at this point, it is proposed to consider more fully with regard to certain of the causes. Diarrhœal Diseases. For the reason that these contributed more than twice as many deaths than in 1910, special reference should be made to them. The total number of deaths was 92, the death rate being 0'82 per 1,000. The number of deaths in the years 1908, 1909 and 1910 were 55, 45 and 40. For the increase in 1911 climatic conditions alone were responsible. As mentioned in previous reports, diarrhœal affections are much more common in warm dry summers, and it is very many years since a summer so warm and dry as that of 1911 was experienced. It was in fact a typical " diarrhœa " year, and it was expected that there would be a considerable increase in the number of deaths from the epidemic form especially. The increase, however, was less than had been anticipated and this may be placed to the credit of the sanitary administration in the Borough in connection both with educational and practical work. Amongst infants and young children, unfortunately, liability to diarrhœa is very great, and a fatal termination not uncommon. Reference has already been made to the fact that 66 infants died of diarrhœal diseases (49 diarrhœa, 17 enteritis). In the three previous years, the number did not exceed 35. The work undertaken for the prevention of the spread of diarrhœa amongst children has already been described, and details given of the special observations made at the Infant Consultation in the north district. In the course of their work during the hot months of the summer, the women inspectors reported the discovery of a considerable number of cases of diarrhœa amongst children over one year of age, and the conclusion arrived at was that liability to attack was almost greater amongst these than amongst babies under 1. The number of deaths of children of between 1 and 2 was, however, comparatively small, viz., 12. Zymotic Diseases, Phthisis etc. and Respiratory Diseases. These three causes usually contribute very largely to the total number of deaths and in the report of 1909 a table showing the actual number due to each and the rate per 1000 of the population was given. 23 In 1910 the table was again given and for 1911 a similar table has been made as follows:— Total deaths Rate per 1,000 of the estimated population. I. Zymotic Diseases 203 1.72 2. Phthisis and other Tubercular Diseases 213 1.91 3. Respiratory Diseases 338 3.04 Each of these causes will be considered separately. Zymotic Diseases. The diseases included under this heading are; small pox, measles, scarlet fever, whooping cough, diphtheria and membranous croup, typhus, enteric and continued fevers, diarrhœa and enteritis. The number of deaths due to each will be found in Table III, (page 92). With the exception of measles, which caused 37 more deaths (64 to 27) than in 1910 and diarrhœa, which was responsible for twice as many (92 to 46) as in the latter year, the diseases in this list shewed a decrease over the previous year. Phthisis and other Tubercular Diseases. The number of deaths from phthisis and other tubercular diseases (tubercular meningitis, general tuberculosis, tabes mesenterica, etc.) is greater by 44 than in 1910, 213 to 169. For the increase, phthisis is mainly responsible, no fewer than 172 deaths being certified as due to phthisis (pulmonary tuberculosis or consumption of the lungs) as against 133 in 1910. The remaining 41 deaths were traceable to tubercular affections of the brain coverings (tubercular meningitis) and of the peritoneum (tubercular peritonitis, tabes mesenterica), etc. The cause of the increase in the number of the deaths from lung consumption is difficult to explain. It is notorious that phthisical persons bear extreme heat badly, but the bulk of the deaths as a matter of fact occurred in the first and last, the colder quarters of the year. The increase in 1911 interrupts, as is shown in the following table a steady decline in the death rate from these diseases, which began in 1905. Even so, however, the number of deaths is still lower than that registered in the firstnamed year by 35. 24 TABLE VIII. DEATHS FROM PHTHISIS AND OTHER TUBERCULAR DISEASES. Year. No. of Cases. Population. Rate per 1000 of Population. 1911 213 117,844 1.91 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 A special section of the report is given to a consideration of phthisis, but it may be pointed out now that though the number of deaths from this cause is greater by 39 than that for 1910, it only exceeds the total for 1909 by 13. Respiratory Diseases. The conditions placed in this group are bronchitis, broncho-pneumonia, pneumonia, pleurisy and certain other diseases of the organs of respiration. The total number of deaths due to these in 1911—338—was higher by 68 than 1910, when 270 were registered. The death rate was 3'04 as against 2.24 per 1,000 in 1910. Of the total, 185 resulted from bronchitis mainly amongst persons of 65 years of age and over, and 135 from pneumonia and broncho-pneumonia. The heaviest mortality from respiratory diseases was noted in the last quarter of the year. Cancer or Malignant Disease. There is very little difference between the figure for 1911 and that of the two previous years, the total number of deaths being 161, as against 156, and the death rate 1.4, as against 1.2 per 1,000. The following tables are arranged to show the age at which death occurred and the parts of the body affected by the growth. The figures for males and females are shown separately. 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 1 1 6 25 29 20 83 Females — — 1 7 13 17 21 19 78 Totals — 1 2 8 19 42 50 39 161 25 Cancer. Situation of the Disease. Parts of the body affected. Males. Females. Total. Face, Tongue, Jaw 15 3 18 Throat, Neck, Gullet 23 4 27 Stomach 12 6 18 Intestines 15 16 31 Liver 4 8 12 Breast - 14 14 Uterus and Generative Organs 3 15 18 Various 11 12 23 83 78 161 Alcoholism. The number of deaths certified as directly due to this cause was 6, exactly twice as many as in the previous year. The number due to cirrhosis of the liver, in most cases probably resulting from abuse of alcohol, was, however, lower by 4, viz., 17 as against 21. The combined figure for these two diseases is 23, the figures for 1908, 1909 and 1910 being 35, 30 and 24. The deaths from other conditions due to the irritation produced in various organs by chronic alcoholism, e.g., nephritis (inflammation of the kidneys) and Bright's disease of the kidneys, are also fewer than in previous years, numbering 54 (.48 per 1,000), as against 57 in 1910 and 69 in 1909. Accident, Suicide and Manslaughter. Accidental or violent deaths during 1911 numbered 57. Of these, 17 were due to suicide. Deaths of babies certified as resulting from suffocation (overlying) numbered 7. RECORDS OF DISEASE. The diseases of which records are kept, are in addition to those named in Section 55 of the Public Health (London) Act, 1891, as compulsorily notifiable, certain others added by orders made by the London County Council. The first diseases originally notifiable were smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus, typhoid, or enteric, relapsing, continued and puerperal fevers. Those added by the London County are cerebro-spinal fever, glanders, anthrax, hydrophobia, acute polio-encephalitis and myelitis, ophthalmia neonatorum, and chicken pox. 26 Of these, acute polio-encephalitis and myelitis, ophthalmia neonatorum and chicken pox were added during 1911, the last named for a short period only. In the case of phthisis, up till about the middle of the year notification was compulsory only upon Poor Law Medical Officers under the Public Health (Tuberculosis) Regulations, 1908, later, however, the Public Health (Tuberculosis in Hospitals) Regulations, 1911, imposing the duty of notification on hospital physicians were passed. The only class of patient left unaffected by the compulsory system, was that which did not resort either to the poor law or the general hospital, and in order to obtain information regarding it, the Council continued the system of voluntary notification which had existed for several years previously in the Borough. In addition to these diseases, regarding which notification may or must be made, there are certain others, viz., measles, whooping cough and diarrhœa, in respect of which some record is kept. The records in these cases are based, chiefly, upon information obtained as a result of investigations made by the women inspectors, but partly also upon returns from the schools and the local registrars. A certain amount of information with regard to the notifiable diseases will be found in Table II of the Local Government Board series. At present it is proposed to discuss each rather more fully. Notifications.—The total number of notifications received during 1911 was 1272, a figure higher by 481 than that—791—for 1910. The greater part of the increase was due to the large number (536) of notifications received under the Public Health (Tuberculosis) Regulations, 1908 and 1911, although notifications of cases of scarlet fever were high also, 329, as against 207 in 1910. The notification rate (proportion to population of notified cases of infectious disease, including phthisis) was 10'8 per 1000. 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 91.0 per cent. of the cases notified. Erysipelas 40 or 36.7 „ „ „ Scarlet Fever 318 or 96.6 „ „ „ Enteric Fever 11 or 61.1 „ „ „ Cerebro-Spinal Fever 1 or 50.0 „ „ „ Puerperal Fever 3 or 75.0 „ „ „ Phthisis 172 or 32.9 „ „ „ Ophthalmia Neonatorum 2 or 9.5 „ „ „ The cost of carrying out the requirements of the section relating to notification of infectious diseases for the year was £124. 3s. 9d. equal to £l. 14s. 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 :- 27 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 1904 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 1911 124 3 9 1 14 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 269 and referred to 459 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 very little more prevalent in 1911 than in 1910, 133 as against 128 cases in the latter year having been notified. Of the 133, 7 proved fatal, the case mortality rate being 5.2 per cent. The number of cases per 1,000 of the population was 1.19. The number of swabs from doubtful cases submitted for bacteriological examination was 143. A positive result was returned in 32 instances. The greatest number of cases came from All Souls District, viz., 46, the others contributing as follows :—Christ Church 36, St. Mary 31, and St. John 10. As regards age in connection with prevalence of the disease, 52 of those affected were aged 1-5 years, and 42, 5-15. Though it is practically certain that all those who were affected were treated with antitoxin—the 91 per cent. who went to hospital certainly were—as was expected, in no one instance was advantage taken of the arrangements made for the free supply of the remedy, under the Diphtheria Antitoxin (London) Order, 1910. In investigating the notified cases, the following nuisances were detected and dealt with by the Inspectors:— Dirty Premises, etc. 38 Defective Drainage 14 28 Scarlet Fever. The number of cases notified was 329. In 1910 the number was 207, but this was exceptionally low, the figures for the two preceding years being 1909, 458, and 1908, 409. As a matter of fact, as the chart inserted at the beginning of the report shows, the prevalence of the disease was distinctly below the average of the previous ten years till the second week in September, when a sudden rise took place ; thence onward till the end of the year, when the average was again almost reached, the numbers varied tremendously. In type the disease was distinctly mild, the number of deaths certified as due to this cause being 7, the case mortality working out at 2.1 per cent. Of those affected the majority were of school age, and though no one school was specially involved, in the majority of instances the infection seems to have been originally contracted in school. Many cases occurred in blocks of dwellings, the infection spreading as a result of the friendly relations existing between the occupants, adults and children, of the various flats. The actual source of infection in many cases was not definitely made out though, as has been said, in a considerable number the school was suspected. The supposed source in 38 instances was a previous case in the same family; in 9 a previous case in the same house, and in 16 another case in the same neighbourhood. In 13 the source of infection could not be classified. Defects in sanitation to the number of 99 were discovered. Of these 87 were want of cleanliness, etc., and 12 defects in drainage. The nuisances were remedied after the service of notice in each case. Enteric Fever. Though 1911 was a year in which many cases of typhoid (enteric) fever, might reasonably have been expected to occur, the number notified (18) was less than in 1910 (21), which was distinctly a non-enteric year. Most of the cases were, as usual, imported, infection having been contracted abroad, in the country or at the seaside. In 6 instances the infection was believed to have been obtained from cockles or other shell fish consumed at one of the seaside resorts. In some cases, though not in all, the shell fish had been collected on the sea shore and eaten raw, or after partial cooking. The danger of such a proceeding is constantly being impressed upon members of the public, but is regularly disregarded. The chances of contracting the fever in London itself are comparatively remote, and even those who determine to travel beyond the boundaries can, by exercising a 29 reasonable amount of care in connection with their eating and drinking, easily preserve themselves from an attack. One of the first and most important rules is to avoid eating shell fish unless they are known to have been derived from an absolutely clean source, and never under any circumstances to eat those collected indiscriminately from the seashore, especially of a popular and populous seaside holiday place. Of the 18 notified cases, contaminated food was believed to be the source of infection in one-third (6), the food being cockles in 4 instances, oysters in 1, and shrimps also in 1. The number of deaths from enteric fever was returned as 3, giving a mortality rate of 16'6 per cent. The distribution of the cases in the various districts was as follows :—All Souls, 7 ; St. Mary, 1 ; Christ Church, 4 ; and St. John, 6. Examination of the premises resulted in the discovery of nuisances (dirty premises etc.), in 6. The defects were remedied by the persons responsible, after their attention had been directed to them. The number of cases occurring in each week is shown graphically in the chart facing page 7. Cerebro-Spinal Fever. The order of the London County Council making this disease compulsorily notifiable expired in March, but by a further order the period was extended for an additional twelve months up to March 1912. In all, two persons were notified as suffering, and of these one was isolated and treated in hospital. In both cases the termination was fatal. Erysipelas. The total number of cases notified was 109 and there were 6 deaths. As usual most of the notifications came from the Workhouse Infirmary and General Hospitals, and 40 of the patients were treated in one or other of these institutions. Puerperal Fever. Four cases of puerperal fever were notified in 1911. No deaths were certified as from this disease. Measles. The chief sources of information with regard to cases of this disease, apart from the entries in the returns of deaths supplied by the district registrars, are the returns of infectious diseases made by the school teachers. The following tables show the number of cases of measles and other infectious diseases reported from schools, and other boroughs. during the year. No classrooms where closed by the Education Department of the London County Council on account of measles. 30 SCHOOLS. Scarlet Fever. Diphtheria. Typhoid Fever. Measles. Chicken-pox. Whooping Cough. All other Diseases. All Souls, Foley Street 5 12 ... 2 7 ... 16 Barrett Street 2 3 ... 7 3 1 5 Barrow Hill Road 7 1 ... 49 26 13 262 Bell Street 56 3 ... 71 30 34 39 Capland Street 39 ... ... 125 21 17 81 Catholic, Richmond Street 5 5 ... 1 1 ... ... Christ Church, Lisson Grove 24 3 ... 23 6 4 54 Convent, Little Union Place 13 3 ... 1 ... ... ... Council, Grove Road 2 ... ... 1 ... ... 3 Emmanuel, Aberdeen Place 9 2 ... 56 2 8 11 Emmanuel, North Street 7 ... ... 5 1 2 3 Hampden Gurney, Upper Berkeley Street 7 ... ... 13 9 15 3 Homer Row, Catholic 3 ... ... 3 ... ... 1 Portland, Little Titchfield Street 8 6 1 59 1 1 69 St. Andrew's, Wells Street 4 4 ... 8 ... 1 4 St. Francis, Upper William Street ... ... ... ... ... ... ... St. James', Marylebone Lane 1 ... ... 11 ... 3 ... St. Luke's, Nutford Place 11 7 ... 7 1 13 14 St. Mark's, Violet Hill 6 ... ... 17 7 7 13 St. Mark's, Marylebone Road ... ... ... ... 1 ... 2 St. Marylebone, High Street 54 14 ... 35 10 1 109 St. Mary's, Crawford Street 8 2 ... 27 16 8 10 St. Paul's, East Street 11 ... ... 33 9 29 52 St. Paul's, Broadley Terrace 7 ... ... 42 2 2 7 St. Marylebone Grammar, Marylebone Road 3 ... ... 11 ... ... 2 St. Thomas', Orchard Street 6 7 ... ... 17 5 ... Stephen Street 2 2 ... 8 4 1 5 Trinity, Buckingham Street ... ... ... 1 26 ... 5 St. Vincent. Lower Seymour Street ... ... ... ... ... ... ... Schools out of Borough 9 9 ... 10 ... 3 8 Other Boroughs 24 7 ... 41 14 9 16 Totals 333 90 3 667 214 177 794 31 Deaths from Measles.—The year 1911 was a very bad one so far as measles was concerned, and an exceptionally large number of deaths, viz., 64, were certified as from this cause. In 1910 the number was 27. Table III (page 92), in which the deaths are arranged according to age, shows that with the exception of 2, all took place amongst children under 5 years of age, and that more than half of those who died were in the second year of life. Of 12 who died before the end of the first year was reached, 1 only was under 1 month old, 3 were between 6 and 9 months, and 8 between 9 and 12 months of age. As indicated in previous reports this is a common experience and teaches that the ages at which protection from infection is required are those included in the first quinquennium. Death in the majority of cases took place not during the height of the fever but later and resulted from one or the other of the lung complications which are so apt to follow measles. In measles, no less than the other infectious diseases, it is immensely important to protect the patient during the fever and the convalescent stage. The common tendency is to regard measles as a complaint of little or no seriousness, and to permit the infected person all sorts of liberties almost before the rash has disappeared. The parents who allow children to expose themselves at all while suffering from measles have usually only one excuse, and that is ignorance of what the disease really is. A considerable part of the work of the Council's women inspectors consists of visiting houses, in which cases of measles are reported to exist and of trying to dispel the ignorance as to the seriousness of the trouble. Special leaflets have been prepared setting forth various facts with regard to the disease, and these are distributed by the inspectors. In a considerable number of cases disinfection of rooms, bedding, &c., is carried out. Isolation of measles. Measles not being a notifiable disease, no definite arrangements, up till quite recently, were made for the isolation of the infected. One of the reasons for making no provision was undoubtedly the large amount of accommodation which would have to be set aside, having regard to the extent of the outbreaks which usually occur. On May 30th, 1911, however, the Local Government Board, having taken the matter seriously into consideration, issued an order as to the reception of non-pauper cases into the hospitals of the Metropolitan Asylums Board. This made it possible for isolation to be provided otherwise than as a form of relief. The only condition precedent to admission which was made, was, that the Medical Officer of Health 32 should make a recommendation that in his opinion admission was desirable on the grounds of sudden or urgent necessity, or for some other special or exceptional reason. In all 110 cases were removed to hospital for isolation and treatment during the year. Whooping Cough. Information with regard to this disease is received from sources similar to those in the case of measles. Like measles it is most common and most fatal in early childhood. In the year 1911 the total number of deaths due to whooping cough was 30, nearly 25% fewer than in 1910 when 41 deaths occurred. All but 3 of the deaths took place in the age period 1-5, 13 occurring amongst children aged less than 1 year ; of these 13, 3 were 3 months old, 2 more than 3 but less than 6, and 8 between 6 and 12 months of age. Lung complications are the commonest determining cause of death and these can largely be prevented if the patient is sufficiently protected. Isolation and treatment are as much required as in the case of measles and as the result of arrangements made at the Metropolitan Asylums Board hospitals, 22 children suffering from whooping cough were removed to and provided with accommodation in hospital. Glanders. No case of glanders in the human being was notified during the year and no notices of outbreaks of the disease in stables in the borough were received from the London County Council. Polio-Encephalitis and Myelitis. These are diseases of the central nervous system (brain and spinal cord), in which as a result of an affection of the cells making up the tissue of which the brain and cord are composed, certain symptoms of which the chief is paralysis of one or more parts of the body are produced. The paralysis varies in extent; it may be of one muscle or of a group or groups of muscles : it may be slight and pass off almost completely ; it may be marked and permanent, leaving one or more limbs useless. It may be so widespread as to cause death. The disease usually occurs in childhood and the term " infantile paralysis" is commonly applied to it. Formerly paralysis of, for example, a limb occurring suddenly in a child was invariably put down to an accident, such as a fall from the arms of a mother or 33 nurse ; now it is agreed that these cases are quite independent of accidents and that the condition results from an attack on and the destruction of nervous tissue by an organism. Because investigations seemed to show that many children in a certain neighbourhood were affected about the same time and that the disease appeared as outbreaks and in epidemic form, the view was almost generally adopted that the condition was infectious and might, if the source of infection was discovered, be stamped out. Amongst those who adopted this view were the London County Council and chiefly with the object of obtaining information with regard to polio-myelitis and of having full enquiries made into cases, they issued an order making notification to the Medical Officer of Health in each of the boroughs compulsory. This order was issued on 1st September, 1911, and was in force during the remainder of the year. The total number of cases notified was 1. This was investigated and a return with regard to it made to the London County Council. Chicken Pox. During the year cases of small-pox having appeared in one or two of the London Boroughs and there being a certain amount of fear, as the cases were not discovered in some instances till the disease was somewhat advanced, that there might be a spread of infection to other districts, as a precautionary measure chicken-pox was temporarily included in the list of notifiable diseases. The order of the London County Council was issued on 22nd March, 1911, and remained in force for three months. The total number of cases notified was 119. All were visited and examined. Ophthalmia Neonatorum. This is inflammation of the eyes in new-born children. The inflammatory condition occurs as a result of infection of the eyes with an organism, entry being obtained during birth. The inflammation which results may be slight; it may, and very often is, however, exceedingly severe, so severe as to cause considerable damage to the eyeball, resulting in permanent blindness. Those with most experience amongst the blind have found that an alarming proportion of the cases of blindness resorting to institutions established for the benefit of the blind are due to this cause. It has also been found and proved beyond all question that risks of infection with the germ causing the disease can be prevented if the eyes of the new-born baby are cleaned and bathed and treated with a disinfectant (usually a few drops of a 2 per cent. solution of silver nitrate). 34 It has further been shown that if infection has occurred, the terrible effects which the inflammation is capable of producing can be counteracted by treatment chiefly by frequently bathing the eyes with a solution of boric acid. Largely with the object of spreading knowledge with regard to the condition and to direct attention to the necessity of applying prompt treatment, the disease was made notifiable by the London County Council. The order relating to notification was issued on 13th March, 1911. Since then 21 cases have been notified. Inquiries made prior to the coming into force of the requirement indicated that the number of cases occurring in the Borough was comparatively small. The results of the order as to notification have confirmed this view. As a matter of fact, the greatest attention is paid to the eyes of infants by the staffs of the Hospitals in the Borough, and as many of the poorer inhabitants are attended by doctors or nurses from these institutions, it is certain that the babies will be well looked after in this respect. Phthisis. So far as pulmonary tuberculosis—phthisis or consumption—is concerned, 1911 was a most remarkable year. By means of regulations issued by the Local Government Board, two in rapid succession, it was placed finally amongst the diseases as to which notification must be made; powers and duties in connection with its prevention and treatment were placed in the hands of the Council, and, so far as the Borough is concerned, throughout the whole of the year the dispensary system was at work in relation to it. Notifications.—Though, as is stated above, two orders with regard to notification of pulmonary tuberculosis were issued in 1911, viz., the Public Health (Tuberculosis in Hospitals) Regulations, 1911, and the Public Health (Tuberculosis) Regulations, 1911, only the first-named actually came into force during the year, and that not till May. Notifications for part of the year therefore were received under the Public Health (Tuberculosis) Regulations, 1908, and for another part under these and the Public Health (Tuberculosis in Hospitals) Regulations, 1911. In addition, throughout the year, a certain number were made under the voluntary system inaugurated by the Council originally in 1906. The third set of Regulations did not take effect until the 1st January, 1912. They impose the duty of notifying cases of pulmonary tuberculosis on medical practitioners attending cases left unaffected by the Poor Law and Hospitals regulations, and make compulsory notification practically universal. The total number of notifications received from all sources in 1911 was 536, which was exactly one less than the number for 1910, 537, which in turn was nearly double the number received in 1909—334. Of the 536, 56 were sent in voluntarily, 200 by the Poor Law Officers, under the 35 regulations of 1908. Under the 1911 Hospitals Regulations, 280 cases were notified between May and December. All the 56 voluntary notifications received came from medical men in practice who henceforth will notify under the 1911 regulations. The following table shows the number of notifications received under each system since 1906 when voluntary notification was first introduced in the Borough. Phthisis Notifications. Year. Medical Practitioners (Voluntary). Hospital Cases. Poor Law. Totals. 1906 (six months) 206 — — 206 1907 291 — — 291 1908 176 — — 176 1909 98 20 216 334 1910 101 15 421 537 1911 56 280* 200 536 *Made compulsory in May, 1911. Deaths from Phthisis.—The number of deaths certified from this disease was 172, giving a death rate of 1.4 per 1,000. This is the greatest number since 1908, when there was a drop from 179 in 1907 to 154. In 1909 the total was 170, and in 1910, 133, the smallest number on record. The figures for each year since 1900, are given below. The table also shows the distribution of the deaths throughout the Borough. Some slight change in the extent to which districts were involved will be noted. The fact that only in St. Mary has there been a fall, the total there being in fact the lowest recorded may be mentioned. The increase, both in All Souls and St. John is very marked. Christ Church which still heads the list, has unfortunately not continued the promising diminution in numbers noted in 1910. Table IX. DEATHS FROM PHTHISIS. Estimated Population. Year. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 117,844 1911 172 51 30 65 26 125,195 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 172 deaths was as follows :—In Poor Law institutions, 104 ; general and other hospitals, 13 ; at home, 55. 36 The following table relating to sex and age distribution of the deaths from phthisis, brings out the usual facts, 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 7 24 32 21 16 4 109 Females 5 3 12 18 13 4 6 2 63 Totals 8 5 19 42 45 25 22 6 172 The following tables are similar in construction to those included in the reports for 1909 and 1910 and contain information with regard to the occupations followed by those who died of consumption during 1911. The fact that, in the male sex, more deaths occur amongst those who are employed in work entailing exposure is again very definitely shown. MALES. No occupation. Work with exposure. Sedentary work. Professional work. Total. Workmen. Foremen, Masters, etc. Workmen. Foremen, Masters, etc. 3 63 1 27 3 12 109 FEMALES. No occupation or house work. Work with exposure. Sedentary work. Professional work. Total. 54 1 8 — 63 Information with regard to the work carried out by living patients is given in the table at page 40, which has been introduced at the suggestion of the Medical Officer of Health of the London County Council who, believing that conclusions of some importance may be arrived at by an analysis of statistics collected from all over London, has asked the Medical Officer of Health of each of the Boroughs to co-operate with him in getting them together. Prevention of Consumption.—During 1911 the extension in the direct action for the prevention of consumption, which took place at the end of 1910, as a result of the establishment of the Dispensary in the Borough, was continued. 37 In addition there was, as is shown in the portion of the report dealing with Departmental matters, an increase in the amount of work done for the improvement of sanitary conditions generally, which exercises a certain influence in relation to this as other diseases. Regular visits and revisits have been paid to the homes of notified persons by the women inspectors, by the officials of the dispensary, and the voluntary workers of the St. Marylebone Health Society. Work of the Women Inspectors.—The work of the women inspectors in connection with consumption is largely educative. The patients visited are advised as to the methods to be adopted for their own protection and that of those associated with them. If they seem to be in need of medical treatment and are unable to obtain it they are advised to go to the Dispensary where advice and treatment are provided, and, in addition, all the members of their families are examined and if found to be infected put at once under treatment. Patients in need of sanatorium or other institutional treatment are put in the way of getting it through the Health Society, the Dispensary or other bodies. If relief of other kinds seems necessary these and other bodies are appealed to. During the visits to the homes of the patients investigations are made into the source of infection and so on, and special note is made of any factor which may seem to have played a part in the production of the disease. If disinfection of clothing, etc., seems likely to be of use in connection with the prevention of spread of infection, arrangements are made for having it carried out. The actual number of visits and re-visits paid by the inspectors was 566. The patients removed to hospital numbered 162. The number of disinfections carried out was 113. Of the 566 visits, 152 were re-visits, this part of the work being largely done by the Dispensary staff and the voluntary workers of the Health Society, to whom cases notified otherwise than from the Dispensary were handed after the first visit was paid, if further re-visits seemed necessary. Cases notified direct from the Dispensary were not visited unless by special request, all particulars with regard to them being obtained from the records kept at the Dispensary. Phthisis Investigations.—At the request of the Medical Officer of Health of the London County Council, who, as already mentioned, is desirous of obtaining statistical information regarding cases of pulmonary tuberculosis from all the boroughs, the facts elicited at the visits of the inspectors are tabulated below. Unfortunately past records made and kept with regard to the cases do not contain all the information asked for, but as far as possible the various columns have been filled up. If no information was obtained or obtainable the spaces have been marked with a transverse line. The cases referred to number 432—males 228 ; females 204. Figures relating to grandparents are printed in brackets. 38 PHTHISIS. MALES, MARRIED (Including Widowers). No. and Age of Patient. Patient's Relatives Living and Dead. I. Father and Mother. II. Brothers and Sisters. III. Uncles and Aunts. Patient's wife (if re-married give particulars for deceased wife or wives). Patient's Children. No. of Patients Childless. Age No. Whether or not affected. I. II. III. L. D. L. D. L. D. L. D. L. D. 0 — Affected – – – – – – – – – – – Not – – – – – – – – – – – Unknown – – – – – – – – – – – 15 2 Affected – – – – – – – – – – – Not – – – – – – – – – – – Unknown – – – – – – – – – – 2 25 29 Affected 2 9 3 7 – 3 3 – 5 2 Not – — 1 — — — — — 13 — — Unknown 1 1 1 – – – – – 44 — 3 35 64 Affected 1(2) 1 1 3 — 2 7 3 19 1 – Not – – 1 – – – — 1 44 — — Unknown – – – – – – – 3 88 — 6 55 20 Affected 1 3 1 9 — Not – – – – – – – – 1 — — Unknown – – – – – – – – 21 — 4 MALES, UNMARRIED. No. and Age of Patient. Patient's Relatives, living and dead. i. Father and Mother. ii. Brothers and Sisters. iii. Uncles and Aunts. Age. No. Whether affected or not. i. ii. III. Living. Dead. Living. Dead. Living. Dead. 0 39 Affected 12 10 (4) 16 5 — 15 Not 11 – 35 — — — Unknown 35 — 47 — — — 15 26 Affected 4 3 (1) 4 2 — 3 Not 1 – 8 — — — Unknown 32 8 38 5 — — 25 22 Affected 1 4 3 5 — 4 Not 2 — 6 — — — Unknown 13 3 12 — — — 35 23 Affected 2 3 — 1 Not — — — — — — Unknown 6 2 9 — — — 55 3 Affected 1 — — Not — — — — — — Unknown – – 1 – – – 39 FEMALES—MARRIED (including Widows). No. and Age of Patient. Patient's Relatives, living and dead. I. Father and Mother. II. Brothers and Sisters. III. Uncles and Aunts. Patient's Husband (if re-married give particulars for deceased wife). Patient's Children. No. of Patients Childless. Age. No. Whether or not affected. I. II. III. L. D. L. D. L D. L. D. L. D. 0 — Affected – – – – – – – – – – – Not – – – – – – – – – – – Unknown – – – – – – – – – – – 15 8 Affected — 2 — – — — — Not – – – – – – – – – – – Unknown – – – – – – – – 1 — 7 25 30 Affected — 3(1) 1 14 — — 2 1 8 – — Not – – — — — 10 1 3 Unknown — — — – — — —- — 47 – – 35 62 Affected – 4(1) 3 1 6 4 26 6 — Not – – – – – – – – 32 1 — Unknown 1 — 1 — — — — 7 64 — 14 55 14 Affected – 2 1 — — — — 2 3 — Not – – – – – – – – – – – Unknown – 1 — — – — 7 — 22 1 3 FEMALES—UNMARRIED. Patient's Relatives. Age. No. Whether or not affected. Living. Dead. Living. Dead. Living. Dead. 0 34 Affected 22 6 (3) 17 2 1 3 Not 1 – 26 — — — Unknown 35 1 31 1 — — 15 34 Affected 2 13 9 2 — 4 Not 3 — 12 — — — Unknown 28 8 41 — 2 — 25 14 Affected 2 4 3 — — 2 Not — — 2 — — — Unknown 5 1 8 — 1 — 35 7 Affected — — — — Not — — — — — — Unknown — — — — — — 55 1 Affected — — — Not — — — — — — Unknown – — – — – – MALES. Number of Cases 228. AGE DISTRIBUTION. Under 1 year. 1—5. 5—15. 15—25. 25—45. 45—65. 65 & over. All ages. — 8 31 28 98 59 4 228 40 DURATION OF ILLNESS IN YEARS. Under 1 year. 1—2. 2—3. 3—4. 4—5. 5 and upwards. 52 56 51 20 11 38 No. of Living Rooms in Patient's Tenement. Weekly Rent Paid. 1 room. 2. 3. 4. over 4. Under 5/-. 10/-. 15/-. 15/- & over. Total cases. 104 90 24 3 7 80 134 11 3 228 OCCUPATION OF PATIENTS. Outdoor. Indoor. Taxi-cab Drivers, etc. Carmen, Carters, Drivers. Dock Labourers. Milkmen. Ex-soldiers & sailors. Miscellaneous. Clerks. Laundries. Bakehouses. Printers. Railway and Tube hands. Servants. Tailoring, etc. Builder's Labourers. Trades with predisposing influences. Miscellaneous. Public. Private. 5 11 — 4 9 19 9 — — — – 4 9 13 13 13 28 Females. Number of Cases 204. Age Distribution. Under 1 year. 1—5. 5—15. 15—25. 25—45. 45—65. 65. All ages. — — 34 42 80 47 1 204 Duration of Illness in Years. Under 1 year. 1—2. 2—3. 3—4. 4—5. 5 and upwards. 39 46 48 17 8 46 Number of Living Rooms in Patient's Tenement. One. Two. Three. Four. Over Four. 72 93 26 8 5 Weekly Rent Paid. Under 5/- 5/- and under 10/- 10/- and under 15/- 15/- and over. 58 126 15 5 41 Occupation of Patients. Outdoor. Indoor. Miscellaneous. Clerks. Laundries. Bakehouses. Printers Railway and Tube Hands. Servants. Tailoring, etc. Builders' Labourers. Trades with predisposing influences Miscellaneous. Public. Private. 3 — 2 — 2 — 1 29 12 — 3 3 Work of the Dispensary.—A special report with regard to the work of the Dispensary in connection with the prevention of consumption is made by the Medical Officer of that institution. He has been good enough, however, to prepare a short summary regarding the most important points, which is given below. As mentioned in the report for 1910, though the Dispensary is entirely voluntary, the Executive Committee, in which the management of the institution is vested, includes the Mayor, two members of the Public Health Committee (the Chairman, the Rev. J. A. Beaumont, M.A., and Mr. Councillor Harvey), and the Medical Officer of Health. The relations between the Officers of the Dispensary, Dr. Halliday Sutherland, the Medical Officer, and Nurse Barry, and the Staff of the Public Health Department have been most friendly. That the end in view was the benefitting of the consumptives in the Borough, and the prevention of the spread of the disease, has never been lost sight of. So far as possible, between bodies carrying out duties in many respects alike, overlapping has been avoided, and every assistance in the work has been given by one to the other. As a source of information as to early cases of infection, and to the number of infected contacts in a household, the Dispensary has been of the greatest use, no fewer than 173 of the total notifications (190), sent in by Dr. Sutherland, being of cases previously unnotified. The following is the summary kindly supplied by Dr. Sutherland: " From the opening of the Dispensary on November 22nd, 1910, up to December 31st, 1911, 690 new patients have attended for examination and diagnosis, and the subsequent visits of patients under treatment at the Dispensary numbered 3,721; of these patients, 266 or 38'5 per cent. were 'contacts,' under which term are included all those who are related to or have been living in contact with a patient already attending the Dispensary. " In all, 482 cases were found to be suffering from pulmonary or other forms of tuberculosis, and of these 173 were notified to you for the first time. Of special significance is the fact that 312 or 64.5 per cent. of these patients had never previously received any form of medical treatment, and that only 2.4 per cent. had been definitely treated by general practitioners. 42 "Including the 'contacts' examined at home, 723 persons in relation to patients were examined, and of these 420 were found to be healthy, 290 infected with tuberculosis of the lung, and 13 with other forms of the disease. In all 41.9 per cent. were found to be infected. Of considerable interest, however, is the relation of the amount of infection to the actual conditions under which the patients are living. An analysis of the figures indicates that it is exposure to infection plus that lowered general resistance to disease which is the usual concomitant of advanced disease in the working classes to their dependents, which is the determining factor of infection rather than any seeds of disease implanted before birth. Of our original patients, some were infectious, having the tubercle bacillus in the sputum, while others were non-infectious at the time, since no tubercle bacilli were found. In the families of those in an infectious stage of the disease, 60 per cent. were infected with tuberculosis. In the families of non-infectious patients 75.5 per cent. were found to be healthy. " In compliance with your wishes, I have notified you of all cases of the disease, whether they be in an infectious stage or not. In this way alone is it possible to approximate the actual amount of tuberculous infection in this Borough. Moreover, my experience here has led me to believe that many cases may pass to the normal limits of life without knowing they were ill, but having a definite history of periods of infectivity, so that many other persons succumbed to infection. During the present year, I hope to investigate some of these 'carrier cases,' which are of considerable importance to the public health. "During the past year the Medical Officer paid 1,318 visits to the patients in their own homes, and the Nurse paid 2,813 visits. In conclusion I would like to express the appreciation of the staff here, for the very great assistance we have received from the Public Health Department." Work of the Voluntary Health Visitors. The voluntary workers of the St. Marylebone Health Society follow lines practically similar to those of the women inspectors. Several of these ladies in addition to co-operating with the Public Health Department pay a certain number of visits to patients who are under treatment at the Dispensary. The number paid on behalf of this Department was 482 and the work done was greatly to the advantage of the patients, many of whom were put in the way of getting Sanatorium and other treatment and also relief where this was necessary, the co-operation between the Society and Charitable Organizations in the Borough being very close. Sanatorium and hospital accommodation. The following statement is introduced by the directions of the Local Government Board. Up to the present no provision has been made by the Council, entire reliance being placed upon the charitable agencies and the Board of Guardians to supply the needs of patients in this respect. 43 PHTHISIS: SANATORIUM AND HOSPITAL ACCOMMODATION. Classes for which accommodation is provided. By whom provided. Where situated. Total number of Beds. How are Patients selected ? Are Patients under the care of a resident Medical Officer ? What charge, if any, is made for the use of Beds ? Do the Sanitary Authority use— (1) their Isolation Hospital, or (2) their Small-pox Hospital, for cases of Phthisis ? Do the Sanitary Authority reserve Beds in any Phthisis Sanatorium : If so, how many, and in what Sanatorium ? Do the Sanitary Authority provide portable open-air Shelters or Tents ? (a) Early cases. The Borough Co|uncil have made no provision for Phthisis cases. No. No. No. (b) Intermediate cases. (c) Advanced cases. The St. Marylebone Dispensary for the Prevention of Consumption (15, Allsop Place, N.W.), was opened in November, 1910. It is entirely voluntary at present. The Borough Council is represented on the Executive Committee, the Mayor and the Chairman of the Public Health Committee being members. The Medical Officer of Health is Vice-Chairman. A considerable number of cases have been referred by the Medical Officer of Health to the Dispensary for visitation, treatment, etc. That means of isolation, more especially for the advanced cases, is necessary cannot be doubted. Like the other Borough Councils in London, the Council has no isolation hospital of its own and the example set by many provincial authorities of setting aside some part of the accommodation provided for other infectious diseases, for the use of phthisical patients cannot be followed. Amongst the patients in an advanced stage of the disease, many of whom are undoubtedly possible sources of infection, there is a distinct unwillingness to resort to or remain in the special wards provided at the Union Infirmary. For these some provision will probably have to be made and this matter as well as that of providing sanatorium accommodation for early cases will be taken into consideration by the Public Health Committee in 1912. BACTERIOLOGICAL DIAGNOSIS OF CONSUMPTION. During the year 201 specimens of expectoration from persons suspected to be suffering from consumption were submitted for examination. Of these, 53 were found to contain the bacillus ot tuberculosis and in 148 the result was Negative. DISINFECTION. In connection with this part of the work of the Department, the arrangements carried out in previous years were adhered to. Infected articles were disinfected by means of steam in a Goddard Massey and Warner machine and infected rooms chiefly by means of formic aldehyde gas produced by an alformant lamp burning 30 formalin tablets per 1,000 cubic feet of space. 44 The table headed " Reasons for Disinfection" gives the number of rooms disinfected and the reasons for doing so. In 1910, the number of rooms disinfected was 583 and of articles 9,675. The great increase in the number of disinfections, both of rooms and articles, is due mainly to the fact that a greater number of scarlet fever cases were notified during 1911 than in either 1909 or 1910, and that owing to the introduction of the new regulations with regard to the notification of consumption more cases of this disease were made known to the department. The number and nature of articles dealt with in 1911 are shown in the following tabular statement: Compulsorily Notifiable Infectious Diseases. Phthisis. Measles. Vermin. Other causes. Total. Beds 318 27 15 19 14 393 Mattresses 336 25 30 36 176 603 Bolsters 415 37 33 32 86 603 Pillows 828 70 54 42 342 1,336 Sheets 815 64 76 36 51 1,042 Blankets 1,037 81 103 50 735 2,006 Sundries 4,628 269 570 415 2,056 7,938 Totals 8,377 573 881 630 3,460 13,921 The number of journeys made by the disinfecting van during the year 1911, was :— January 36 February 24 March 29 April 31 May 27 June 30 July 28 August 37 September 30 October 38 November 41 December 40 391 The vans were used 376 times in 1910. 45 Reasons for Disinfection. Compulsorily Notifiable Infectious Diseases. Phthisis. Measles. Vermin. Other causes. Totals. January 35 4 16 1 8 64 February 24 7 48 ... 7 86 March 38 20 55 ... 2 115 April 25 3 23 ... 23 74 May 14 11 10 4 7 46 June 28 4 4 2 2 40 July 32 7 8 2 4 53 August 35 16 1 ... ... 52 September 104 3 ... 2 5 114 October 94 15 4 1 ... 114 November 70 11 ... 19 5 105 December 60 12 ... 5 8 85 559 113 169 36 71 948 BACTERIOLOGICAL EXAMINATIONS. The number of specimens from doubtful cases of typhoid fever, diphtheria and phthisis examined for the Council by Dr. Eastes at the Laboratory of Pathology and Public Health, 38, New Cavendish Street, is greater by over 100 than in 1910. The increase is almost entirely, as shown in the following table which gives particulars as to the number of cases examined, and compares the results with those of the previous year, in connection with phthisis. For the increase in the numbers in this disease the greater attention directed to the importance of diagnosis by the new regulations is probably responsible. 1910. 1911. Positive. Negative. Total. Positive. Negative. Total. Typhoid Fever 5 11 16 1 11 121 Diphtheria 27 80 107 32 111 143 Phthisis 28 84 112 53 148 201 Totals 6O 175 235 86 270 356 Part II. Departmental. 49 DEPARTMENTAL. The amount of work carried out by the department continues to increase, and there has been shown a complete justification for the additions made to the staff in 1910. The numbers of the staff remained the same throughout 1911 as at the end of the previous year, the only change being the appointment of Dr. F. W. Bywater, Medical Officer of Health, Finchley, as deputy Medical Officer of Health, in place of Dr. J. R. Prior, who resigned on taking up the post of Medical Officer of Health to the West Berkshire Combined Districts. The Staff under the control of the Public Health Committee at the end of the year consisted of (in addition to the Medical Officer of Health) a deputy Medical Officer of Health (Dr. Bywater), two drainage inspectors, one outdoor superintendent, one meat and food inspector, six district inspectors (one—Inspector Hodges—acting as house to house inspector;, three women sanitary inspectors, one dust inspector, one chief and three assistant clerks and an office youth. In addition, 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 placed under the Committee. All the officers and members of the staff have worked well and satisfactorily throughout the year, and in the pages following details will be found of the work done by each. PROTECTION OF THE FOOD SUPPLY. The important duties under this head were performed by Inspector George Smith who continued to act as inspector under the Sale of Food and Drugs Acts, and to carry out the inspection of premises in which food was sold, stored or prepared, such as milkshops, hotel and restaurant kitchens, bakehouses, ice cream shops, slaughterhouses, cowhouses, etc. Food Inspection.— Regular visits were made by Inspector Smith during the year to all food premises. The special inspections on Saturday nights and Sunday mornings by him and certain of the Inspectors possessed of qualifications and sxperienced in meat examination were regularly continued throughout the year. Of the unsound food dealt with, a considerable quantity was voluntarily surrendered by traders and destroyed at their request and expense, a certificate that this had been done being granted. The following is a list of the articles voluntarily surrendered for destruction :— Articles of Food Destroyed as Unsound after Voluntary Surrender. 681 lbs. beef Quantity of oysters 239 lbs. mutton 1 box roe 70 lbs. bacon 14 boxes kippers 2 pigs (unsound) 666 lbs. fish (haddock, cod, skate, 1 do. (parturient fever) mackerel, hake, plaice, etc.) 1 carcase pork (two sides) 1 case herrings 50 4 bullocks' livers (flukes) 10 bags peas 2 sheep (septicaemia) 249 lbs. tomatoes 3 bullocks' spleens (unsound) 6 boxes pears 1 do (tuberculous) 7 baskets strawberries 3 doz. sheeps' hearts 5 do. cherries 6 sheeps' livers (flukes) 2 do. gooseberries 14 ducks 10 do. apples 16 fowls 20 lbs. pomegranates 28 rabbits 1 bushel Spanish onions Quantity ot sheeps' and ox kidneys 2 tins tomatoes (3 lbs. each) do. tinned tongue 28 1 lb. tins condensed milk 1 basket crabs 4 1 lb. tins apricots 2 bushels winkles The articles seized and dealt with in the manner prescribed by Sec. 47 of the Public Health (London) Act, 1891, were considerably fewer than in 1910, due in all probability to the recognition by traders of the fact that careful inspections were being made and that the Council were determined to carefully protect the public food supply. The fact that so many dealers submitted so large a number of articles for examination and voluntarily surrendered all considered unsound is open to the same explanation. The following is a list of the articles seized:— Seizures. A quantity of pears (unsound). 10 lbs. beef (unsound). Pig's head and fore quarter 2 pigs' heads (tuberculous), (tuberculous). 3 sheeps' heads (unsound). With regard to each of the articles named, a special report was submitted to the Public Health Committee, who, after taking all the facts into consideration, gave instructions as to whether or not proceedings should be instituted against the vendor. In none of the cases reported during the year did the Committee regard the circumstances to be such as to justify them in simply cautioning the offender. Full particulars regarding the prosecutions are contained in the accompanying table. Public Health (London) Act, 1891. Section 47. Name of Result. Inspector.Fine. Costs. 306, Edgware Road Exposing for sale a quan- G. Smith 2 0 0 0 12 6 tity of unsound pears 105, Church Street Exposing for sale a pig's G. Smith 5 0 0 2 4 0 head and a joint of pork, which were diseased Crawford Street Exposing for sale a quan- G. Smith 2 0 0 0 12 6 (stall in) tity of beef which was unsound and unfit for human food 93, Abbey Road Depositing on the premises G.Smith 2 0 0 1 3 0 three unsound sheeps' heads which were unfit for human food 72, North Street Exposing for sale two G. Smith 2 0 0 0 4 0 pigs' heads which were diseased and unfit for 11 human food 51 Amongst the cases referred to above, perhaps that of most interest is the fifth on the list referring to the two tuberculous pigs' heads. In this case the vendor made a statement at the time of seizure to the effect that the articles had been purchased in the Central Meat Market, Smithfield, that he had paid full price for them and that though he had not examined them himself he had no reason to believe them unsound since there was a system of inspection in vogue in the market. He gave the name and address of the wholesale dealer from whom the heads were obtained, and he, on being communicated with, volunteered the information that though there was no regular system of inspection of all the articles on his stall, his employees had instructions to examine everything and call an inspector in case of doubt. The heads, he stated, were exposed on the front of his stall, and he confirmed the statement of the local vendor that full market price had been paid for them. Neither of the parties denied that the articles were tuberculous. After getting into communication with the Medical Officer of Health of the City of London, it was ascertained that no official inspection had been made of the articles in question. The whole of the facts and the results of the subsequent investigations were reported to the Public Health Committee, who, while considering that the person from whom the seizure was made was responsible for not making an examination and that the case was one in which proceedings should be instituted, concluded also that if the methods of inspection followed in the Central Meat Market were such as had been described, the protection afforded to the public was not so perfect as it might be. There were within the recollection of members of the Committee other cases in which vendors had pleaded in extenuation facts similar to those brought forward in this case, and attention was directed to cases which had occurred in other boroughs. These facts influenced the Committee in taking a serious view of the matter, and it was resolved to draw the attention of the Corporation of the City of London to the case and to suggest to them the necessity, in the interests of the inhabitants of this Borough, if not of London generally, of arranging for a more complete system of meat inspection. A reply received from the Corporation to a communication sent by the Town Clerk on the lines mentioned above, gave a description of the methods in use in the market and pointed out the difficulties of arranging for the complete inspection suggested by the Committee. This was not considered satisfactory and believing that if united action were taken by the Councils of all the Metropolitan Cities and Boroughs something more might be done, it was determined to communicate with all of these and ask for their experiences in this connection. At the end of the year all the Councils had not replied, and the further results, if any, will be mentioned in the report for 1912. 52 Slaughterhouses. The situation of the various premises used for the purpose of slaughtering animals for food of man, and the conditions, if any, under which the licences are granted by the licensing authority, the London County Council, are shown below. They have been regularly visited by the Food Inspector at frequent intervals throughout the year. In one case, conditions calling for the service of a notice were discovered. Premises. Canditions. 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 slaughter-house is not used as a living room. 31, Little Church Street Small cattle only. 32a, Union Street, Middlesex Hospital Nil. MILK SUPPLY Cowhouses.—The number of cowhouses remains the same, viz., 5, no objection having been raised to the London County Council renewing the licences. The following table shows the situation of the premises, the number of cows for which each is licensed, and the number actually stalled:— Premises. Licensed for. Cows kept. 58, Acacia Road 44 24 56, Bell Street 15 9 42a, Clipstone Street 10 10 26, John Street 14 4 3, Malthouse Mews 22 16 Totals 105 63 Inspections were regularly and frequently made throughout the year. One notice served related to the personal cleanliness of the milker, and during the year the owners of the several cowsheds provided smocks and suitable washing accommodation for the men employed in milking. Milkshops, etc.—The number of premises upon which milk is sold is 200. The number of applications received was 28. Of these, 3 were refused under the powers granted by the London County Council (General Powers) Act, 1908, the premises being unsuitable. Under this Act also 33 names were removed from the register on account of unsuitability of the premises and for other reasons, e.g., discontinuance of sale of milk, etc. 53 No appeals against refusal to register or removal of a name from the register were made to a magistrate during the vear. In one case, particulars of which are given below, proceedings were instituted against an unregistered milk vendor. Dairies, Cowsheds and Milkshops Orders, 1885-1899. Penalty Address. Offence. Fine. Costs. 39, Broadley Terrace Selling milk on unregistered premises 0 10 0 0 2 0 Examination of Milk.—The number of samples of milk taken for analysis by the Food Inspector was 54, as against 523 in 1910. A considerable number, as shown in the Public Analyst's report were test or informal samples. Several, also, were collected and submitted to bacteriological examination. These are referred to later. Of the samples analysed by Dr. Wynter Blyth 49 (8.9 per cent.) were found to be adulterated. The percentage of adulterated samples in 1910 was 9.5 and in 1909, 5.7. The usual course of notifying vendors whose samples were found to be genuine that no further action would be taken, was followed. In cases in which the departure from the standard was slight or there were extenuating circumstances, the Committee usually gave instructions that a letter of caution should be sent. The number of cases in which proceedings under the Sale of Food and Drugs Act were instituted numbered 30. Fines and costs to the amount of 58 10s. were recovered, the amount for 1910 being £94 9s. Samples were regularly taken in the evening, and on Saturday night and Sunday as in previous years, and many were also obtained on delivery at the Marylebone and Baker Street Stations. Of the station samples, 9 proved to be adulterated, and proceedings were taken in 4 instances. Three of the cases were against one farmer, who absconded; in the other case the Defendant was fined 10s. and 12s. 6d. costs. The remaining 15 cases showed such a slight percentage of added water or deficiency in fat that proceedings were not taken, the farmers in each case being cautioned. The quarterly returns as to milk samples are tabulated below: — Quarter of the No of Year. No of Percentage ,, Fines and Samples Samples , , Prosecutions „ . Taken. Adulterated. Adulterated. Instituted. Costs. £ š d. 1st 130 13 10.0 9 7 7 6 2nd 134 14 10.4 5 7 4 6 3rd 136 6 4.4 4 9 0 0 4th 150 16 10-8 7 34 18 0 Total for year 550 49 8.9 25 58 10 0 54 Ice Cream Premises. The number of such premises in the Borough, registered as required by the London County Council (General Powers) Act, 1902, is 96. Regular inspections have been made during the year, and in eight cases notices were served in respect of uncleanly premises. Two samples of ice cream were examined bacteriologically, one of which was reported to contain a large number of micro-organisms. Butter, Margarine, &c. The registered dealers in and manufacturers of margarine in the Borough number nine. There is one wholesale dealer in butter and milk-blended butter. Registration of the former is carried out under the Margarine Act, 1887, Sec. 19, and the Sale of Food and Drugs Act, 1889, Sec. 7 (4), and of the latter under the Butter and Margarine Act, 1907. No applications for registration under any of the Acts were received during the year. All registered premises were frequently inspected. Information with regard to sampling of butter, margarine, &c., will be found under the heading, " Sale of Food and Drugs Acts." Restaurants, Food Stalls, Etc. Food is prepared for sale in 183 premises in the Borough, as follows: restaurants and dining room kitchens, 60; hotel kitchens, 21; coffee shops, pastry cooks and tea rooms, 102. Every Saturday a list of such premises to be visited in the ensuing week is prepared by the Medical Officer of Health and handed to the food inspector. Each food place is visited at least once during the year. The 445 inspections made in 1911 resulted in the discovery of conditions calling for the service of notices in 52 cases. The requirements of the notices were complied with in every case without the necessity for taking further proceedings. Food stalls in the market streets—Great Titchfield Street, Bell Street, etc.— received the usual careful supervision, visits as heretofore being paid each Saturday night and Sunday morning. Offensive Trades. There are two premises within the borough in which an offensive business, viz:— tripe boiling, is carried on. The food inspector made 28 visits, but no cause for complaint was found. 55 Bakehouses. During the year two buildings in which registered bakehouses were situated were demolished, and the number of such premises on the register was therefore reduced from 78 to 76. Of the 76, 68 are below ground, the two demolished having been certificated underground bakehouses. During the year attention was directed to one premises underground, in which charcoal biscuits are baked, and in respect of which, apparently because of a misunderstanding on the part of a former inspector, no certificate was applied for or granted. After a full inquiry into the matter, it was suggested that an application for a certificate should be made. This, the Public Health Committee consented to grant on condition that certain alterations were carried out. These the owner of the premises agreed to make, but had not completed the work by the end of the year. Sixty-eight notices calling for the limewashing, etc. of the inside walls and other parts of bakehouses, as required by the Factory and Workshop Act, 1901, were sent out, and 108 visits were paid to the various premises 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 10 instances and were complied with, one only requiring a statutory notice. SALE OF FOOD AND DRUGS ACTS. The activity in connection with the administration of these Acts has been maintained throughout the year. The routine practice of giving directions each Saturday as to the sampling to be carried out by the Food Inspector in the ensuing week was continued, and the number of samples taken totalled 1,111, a slight increase in the numbers for the previous year. In the report of the Public Analyst, which is incorporated with that of the Medical Officer of Health, full details are given with regard to the analyses made, but it may be noted here that the number of samples found to be adulterated was 69, or 6.2 per cent., which is an improvement on the figures for 1910, when the percentage was 7.3. The increased activity in connection with the administration of the Acts is almost certainly responsible for this improvement. As recommended by the Local Government Board, a considerable number of informal or "test" samples were taken and much useful information with regard to cases in which it would be advisable to proceed with the formalities required by the Acts was obtained. 56 Sampling on Saturday nights and Sundays and in the evening or early hours of the morning was carried out regularly. In the majority of cases an agent" was employed and gave valuable assistance. The fines and costs recovered in the cases in which proceedings were instituted against the vendors of the adulterated samples amounted to £ 140 7s. The defence of a warranty was raised in five prosecutions for adulteration of milk and the summonses were dismissed. Adulteration of Jam.—During the year the cases relating to adulteration of jam commenced in 1910 were completed and decided in favour of the Council. In all two summonses were issued relating to two samples, one of black currant jam and one of plum jam, each certified by the Public Analyst to be adulterated by the addition of 10 per cent, of apple pulp. One of the summonses was returnable at Great Marlborough Street Police Court; the other at the Marylebone Police Court. The former was taken first. The latter was withdrawn on the payment of costs, the decision of the magistrate in the former case being regarded as sufficient. The chief defences raised by the defendants in the case heard were that the addition of some alien fruit such as apple was essential to produce "jellying" in the case of jams made from black currants, plums, &c.; that it was a trade custom to add juices of other fruits and that a label, advising purchasers that the jam was improved by the addition of other juices appeared on each pot sold. No satisfactory explanation of the presence of the apple pulp was offered. A considerable body of expert evidence was called on behalf of the defendants and the Council were able to bring forward a great deal of valuable information and opinions given by well-known jam manufacturers in London and elsewhere. In the end the magistrate took the view, that as alleged by the prosecution there had been an offence against the Sale of Food and Drugs Act, and decided in favour of the Council. He imposed a penalty of £\2 and allowed costs amounting to £b 6s. He agreed to state a case but the appeal was not proceeded with. The summonses with regard to a sample of plum jam similarly adulterated and purchased from the same defendants were withdrawn on the payment of £ 10 10s. Od. costs. Samples of jam taken since the above decision was given have all been returned by the Public Analyst as genuine. No summonses for offences against the provisions of the Sale of Food and Drugs Acts, other than food adulteration were issued. 57 The following tables and report from the Public Analyst give 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 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 QU ARTER ENDING 31st MARCH, 1911. 115 milks Food Inspector Genuine. £500 per ann.for 19 samples of milk contained colouring matter 12 milks Do. Adulterated 700 samples. Over that number 7/6 per sample. No. 7. Fined 10/- and 12/6 costs No. 7, 14.59 per cent added water No. 18, 9.88 percent, do. No. 18. Dismissed, warranty proved No. 26, 7.06 per cent. do. No. 26. Fined 10/- and 12/6 costs \ Nos. 124, 125, 126 No. 124, 16.67 fat abstracted Station samples. Summonses adjourned sine die, defendant having absconded, Warrant Officer was unable to effect service No. 125, 6.6 do. No. 126,1.65 per cent, added water No. 134, 20.0 per cent, fat abstracted and 7.77 per cent, added water No. 134. Fined £i and 12/6 costs No. 153, 20.0 per cent, fat abstracted No. 153. Fined 5/- and 12/6 costs No. 179, 10.0 do. No. 179. Fined £2 and 12/6 costs No. 183, 10.0 do. No. 183. Dismissed, warranty proved No. 193,26.67 do. and 824 per cent, added water No. 193. Dismissed, warranty proved No. 219, 9.53per cent, added water No. 219. Dismissed, warranty proved 1 skim milk Do. Genuine 1 skim milk Do. Adulterated. No. 151, 2*22 per cent, added water No. 151. Vendor cautioned 1 separated milk Do. Genuine. 67 butters Do. Do. Three were test samples. 62 butters contained borax from a trace to 34 grains per lb. 3 butters Do. Adulterated. No. 9, equal parts butter and margarine No. 9. Fined £1 and 12/6 costs No. 96, 80 per cent, fat other than butter fat No. 96. Fined £25 and £1/2/6 costs No. 272 Do. No. 272. Fined £5 and 14/6 costs 1 bread and butter Do. Adulterated. No. 118, butter contained 80 per cent, fat other than butter fat No. 118. Summons not issued on advice of Solicitor 1 butter and margarine Do. Genuine. 7 margarines Do. Do. One was a test sample 15 creams Do. Do. Two were test samples 9 cheeses Do. Do. Four were test samples 5 coffees Do. Do. Two were test samples 1 coffee Do. Adulterated. No. 188, contained 48 per cent, of chicory No. 188. Vendor cautioned 6 mustards Do. Genuine. 2 Ipecacuanha wine Do. Do. Both were test samples 58 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under 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. 3 cocoas Do. Do. £5°° per annum for 700 samples Over that number 7/6 per sample. 15 jams Do. Do. 14 were test samples 2 ammoniated Do. Do. tures of quinine 4 camphorated oils Do. Do. 1 standard bread Do. Do. 1 pepper Do. Do. 1 rum Private purchaser Adulterated. No. 217, with 1 grain per gallon of lead and a trace of tin No. 217. This sample is stated to have caused temporary but serious dysenteric symptoms. No. 216 was supposed to be of the same brand; the bottles were capped with foil (an alloy of tin and lead) and the bottles were kept on their sides with defective corks. Contamination of tin and lead might take place from this cause 1 rum Food Inspector Adulterated. No. 216, with 023 per cent, grains of tin per gallon and a trace of lead No. 216. Vendor cautioned 1 rum Do. Genuine. 1 whiskey Do. Do. This was a test sample 2 olive oils Do. Do. 1 honey Do. Do. This was a test sample Total Numbe r of Samples analysed during the Q uarter 280 Number of Sa mples adulterated 20 SECOND QUARTER ENDING 30th JUNE , 1911. 120 milks Food Inspector Genuine. Three were informal samples. Eleven contained colouring matter. 14 do. Do. Adulterated. No. 335. 10 per cent, fat abstracted No. 335. Vendor cautioned. Do. No. 353. 2.8 per cent. added water No. 353. Vendor cautioned. Do. No. 398. 12.71 per cent, added water and 3.3 per cent, fat abstracted No. 398. Fined £1 and 12/6 costs. Do. No. 401. 23.3 per cent. fat abstracted No. 401. Fined 10/- and 12/6 costs. Do. No. 445. 1.8 per cent. added water No. 445. Vendor cautioned. Do. No. 447. 3.3 per cent, fat abstracted No. 447. Vendor cautioned. Do. No. 449. 6.6 do. No. 449. Fined 10/- and 14/6 costs. Do. No. 451. 3.3 do. No. 451. Vendor cautioned. Do. No. 452. 3.3 do. No. 452. Vendor cautioned. Do. No. 455. 3.3 do. No. 455. Vendor cautioned. Do. No. 518. 6.7 do. No. 518. Vendor cautioned. Do. No. 532. 2.35 per cent. added water No. 532. Vendor cautioned. 59 Articles submitted for Analysis State whether the sample was submitted to the Analyst by an Officer acting under 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. 534. 16.7 per cent. fat abstracted £500 per ann. for 700 samples. Over that number 7/6 per sample No. 534. Fined £1 and 12/6 costs. Do. No. 545. 10 per cent. fat abstracted No. 545. Fined £1 and 12/6 costs. Of the butters 82 contained borax from a trace to 35 grains per lb. 84 butters Do. Genuine 8 do Do. Adulterated. No. 316. 80 per cent, fat other than butter fat. No. 316. Fned £20 and £19/- costs. Do. No. 330. do. No. 330. Fined £0 and 14/6 costs. Do. No. 331. do. No. 331. Was a test sample Do. No. 348. do. No. 348. Was a test sample Do. No. 355. do. No. 335. Fined £1/12/6 and 14/6 costs. Do. No. 396. do. No. 396. Fined £1 and 14/6 costs. Do. No. 397. do. No. 397. Fined £1 and 14/6 costs. Do. No. 526. do. No, 526. Was a test sample. 2 margarines Food Inspector Genuine 12 creams Do. Do. 2 cheeses Do. Do. Both were test samples. 4 coffees Do. Do. Two were test samples. 1 bread and butter Do. Do. 1 bread and butter Do. Adulterated. No. 363. Butter contained 80 per cent, fat other than butter fat. No. 363. Fined 10/- and 14/6 costs 1 rum Do. Genuine. This was a test sample. 2 cyder Do. Do. Both were test samples. 3 cocoas Do. Do. 2 peppers Do. Do. 4 mustards Do. Do. 2 plum jam Do. Do. One was a test sample. 1 lard Do. Do. 3 baking powders Do. Do. All three were test samples. 2 custard powders Do. Do. 2 cream of tartars Do. Do. Both were test samples. 2 Dover powders Do. Do. Both were test samples. 1 tincture of iodine Do. Do. This was a test sample. 1 turpentine Do. Do. This was a test sample. 2 Gregory powders Do. Do. One was a test sample. 1 quinine Do. Do. This was a test sample. Total Number of Samples analysed duripg the Quarter 277 Number of Sa mples adulterated 23 THIRD QUARTER ENDING 30th SEPTEMBER, 191 1. 129 milks ... Food Inspector Genuine. Note. Of the 136 samples of milk examined six 1 do Private purchaser Do. tained colouring matter. 6 do. Food Inspector Adulterated. No. 612 4-7 per cent, added water and 3'4 per cent, deficient in milk fat No. 612. Fined £3 and 12/6 costs. No. 613. 13"64 per cent, added water, and 23-4 per cent, deficient in milk fat No. 613. Same vendor. 12/6 costs. 6o Articles submitted for Analysis. State whether the sample was submitted to the . Analyst by an Officer acting under 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. No. 615. 12.71 per cent, added water, and 33.4 per cent, deficient in milk fat £500 per annum in respectof 700 samples. Over that number 7/6 per sample No. 615. Fined £3 and 12/6 costs. No. 650. 4.24 per cent, added water No. 650. Vendor cautioned. Vide P. H. No. 717. 13.34 per cent, deficient in milk fat No. 741. 6.7 per cent, deficient in milk fat Mts., 6/10/11. No. 717. Fined 10/- and 12/6 costs. No. 741. Vendor cautioned. Vide P. H. 84 butters Do. Genuine. Mts., 6/10/11. Nine were test samples. 2 butters . Do. Adulterated. No. 653. 70 per cent, other than butter fat. Note. Of the 86 samples of butter examined, 71 contained borax up to 35 grains per lb. No. 653. Fined £10 and 12/6 costs on 1st summons No. 656. 70 per cent, fat other than butter fat. and 2/- costs on 2nd. No. 656. Fined £1 and 12/6 costs on 1st summons 16 creams Do. Genuine. and 2/- costs on 2nd. Two were test samples. 8 coffees Do. Do. One was a test sample. 7 lime waters Do. Do. One was a test sample. 4 jams Do. Do. Three were test samples. 1 bloater paste Do. Do. - All these were test samples. 2 bacons Do. Do. 1 magnesium citrate Do. Do. 2 ammoniated tinctures of quinine Do. Do. 2 ice creams Do. Do. Total Numbe r of Samples analysed during the Q uarter 265 Number of Sa mples adulterated 8 FOURTH QUARTER ENDING 31ST DECEMBER, 1911. 134 milks Food Inspector Genuine 12 were test samples. 16 had artificial colouring matter added. Seven were test samples. 843 (see foot note). 852. Fined £1 and 12/6 costs. 879. Warranty defence. Case dismissed. 1022. Fined £i and 12/6 costs. 16 milks Do Adulterated. No. 843. 36.7 per cent, deficient in milk fat No. 852. 3.76 per cent, added water No. 87ft. 13.4 per cent, fat abstracted No. 1022 6.7 per cent, fat abstracted and 8.46 per cent, added water No. 1029. 63.3 per cent, fat abstracted No. 1030. 63.3 per cent, fat abstracted and 5.88 per cent, added water Nos. 1029, 1030, 1031. Two brothers were summoned in respect of these samples, the first was fined £2 and 12/6 costs in respect of 1029 and £1 and 12/6 costs in respect of 1030. The other defendant was fined £2 and £3 3s. cost in respect of 1029 and £1 and 12/6 costs in respect of 1030. * This sample was taken direct from the cow before milking was finished hence no proceedings were instituted. A further sample taken when milking was finished, upon analysis proved to be genuine. 61 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under 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. No. 1031. 63.3 per cent. fat abstracted and 5.88 per cent. added water A witness summons was issued in the case of the Vendor of sample 1031 as the milk was sold to him by the Vendors of samples 1029 and 1030. No. 1048. 40.0 per cent. fat abstracted and 2.4 per cent. added water Nos. 1048, 1049, 1088, 1089, 1092, 1094 were test samples taken from the Vendors of 1029 and 1030. No. 1049. 44.7 per cent. fat abstracted and 3.3 per cent. added water No. 1088. 43.3 per cent. fat abstracted and 3 0 per cent added water No. 1089. 16.7 per cent. fat abstracted No. 1092. 6.7 per cent. fat abstracted and 3.5 per cent, added water No. 1094. 73 3 per cent. fat abstracted No. 1105. 10.0 per cent. fat abstracted No. 1105. Fined £20 and 12/6 costs. No. 1107. 2.53 per cent. added water No. 1107. This Vendor was cautioned vide p.h. minutes 12/1/12. No. 1111. 46.7 per cent, fat abstracted No. 1111. Test sample from Vendors of 1029 and 1030 102 butters . Do. Genuine Eight were test samples. 1 butter Do. Adulterated. No. 1106. 800 per cent, fat other than butter fat 72 had borax ranging up to 35 grains per lb. No. 1106. Fined £1 and 12/6 costs and 2/- costs for selling margarine in 12 creams. Do. Genuine a plain wrapper. 1 margarine Do. Do. This was a test sample. 4 jams Do. Do. Two were test samples. 4 coffees Do. Do. One was a test sample. 1 coffee Do. Adulterated. No. 1038. 37 9 per cent, of chicory No. 1038. This vendor was cautioned. Vide p.h. 2 mustards Do. Genuine minutes. 15/12/11. Both these were test samples. 2 lards Do. Do. 1 cocoa Do. Do. 2 Gregory powders Do. Do. Both these were test samples. 4 paregoric elixirs Do. Do. All these were test samples. 2 Dover powders Do. Do. Both these were test samples. 1 white precipitate ointment Do. Do. This was a test sample. Total Number of Samples analysed during the Quarter 289 Number of Sa mples adulterated 18 62 SUMMARY. Number of Number Samples Analysed. Adulterated. ist Quarter 280 20 2n ,, 277 23 3rd ,, 265 8 4th ,, 289 18 1,111 69 REPORT OF THE PUBLIC ANALYST, 1911. During the year 1911, no less than 1,111 samples were submitted for analysis; of these 69 were found to be adulterated and certified accordingly. This shows an increase on the figures for 1910—in that year 1,068 were analysed, an increase therefore of 53 samples. The samples comprise dairy produce, condiments, saccharine substances, alcoholic drinks, and a good many drugs; but the first, viz., dairy produce account for over 80 per cent. A summary table is appended. Dairy Produce. Milk.—Of 547 samples taken, 499 were certified to be genuine, that is to say, they attained the statutory limit; and it is to be remembered that by a skilful addition of separated milk to good milk, this limit is easily attained. Nevertheless it is satisfactory that on comparison with 1910, the "average" composition shows an appreciable improvement. Sp.gr. Milk fat. Solids not fat. Total solids. Average of 1910 1,031 3'63% 8'65% 12'28% „ 1911 1,031 37% 8'64% 12'34% Forty-eight of the samples were certified as adulterated; this calculated on the total milk samples taken works out at 8.7 per cent, as compared with 1910 in which the percentage was 9.2 per cent. Hence, taking both facts together, viz., an improvement in the composition and a decrease in the percentage of adulterated samples—it may be fairly claimed that this gain to the community is a result of the continual and methodical sampling by the Council's officers. A list giving details of each case, and of the convictions, is given elsewhere, from which it will be seen that the adulteration mainly consisted in abstracting milk fat, either directly or indirectly. The worst case was that of a "test" sample, in which it was found that no less than 73 per cent, of the milk fat was wanting. 63 Dilution by water is neither so common nor so extensive as it used to be. The worst case did not exceed 14 per cent., whereas in former years occasionally samples have been found to have been diluted so that more than a fourth has been "added water." The Marylebone milks are also seldom preserved either by formalin, boric acid, or other antiseptic—in no single one of the 547 milks, although all were tested specially, was any preservative found; hence the regulation coming into force this year, absolutely prohibiting chemicals added to milk for the purpose of arresting decomposition, will cause no hardship to the trade here. On the other hand, a great proportion of the Marylebone milks contain small, very small quantities of artificial colouring matter, added for the purpose of imparting a hue suggestive of special richness in cream. This is quite unnecessary, and probably will in time be also dealt with by legislative enactment. Butter.—351 samples of butter were analysed; of these 14 were certified to be adulterated. The adulteration mainly consisted in a substitution of margarine for butter. To the butter samples there may be added three samples of bread and butter purchased at tea shops. Two out of the three were margarines. Most of the butters had an addition of boric acid, but never more than 35 grains to the lb. Margarine.—Ten samples of margarine were analysed. Margarines do not contain the same amount of animal fats as when first introduced, but most of them are made with considerable quantities of cocoa-nut oil. Good margarine is far better and more palatable as a food than inferior butter. Jam.—In 1910 a successful prosecution was instituted with regard to apple pulp added to jam. Apple pulp is easy to detect, but the larger manufacturers have given up its use; it is rare now to find any addition of the kind. Spirits.—Few samples of spirits were taken, the general use of "dilution" notices pretty well making the statutory limits of strength a dead letter. Of 4 samples of rum, 2 were found contaminated with lead and tin. The first bottle was brought by a private purchaser who complained of violent intestinal disturbance after taking a single glassful. The bottle was capped by lead foil and had an imperfect cork. The rum contained 1 grain per gallon of lead, with a less quantity of tin. A bottle of rum bought at the same shop gave similar results. The capping of wines and spirits with lead foil is thus shown not to be without some danger. If the cork becomes defective through age, the liquid diffuses on to the lead capsule and in part dissolves it. The alleged symptoms in the above case appeared to have some connection with the rum, but it must be confessed the metallic contamination was so slight, that it is doubtful whether a "single" glass could have produced the violent disturbance described; possibly the patient was already out of order and the metal-containing rum gave the final impetus to start the transient malady. 64 Drugs.—36 samples embracing 13 varieties of drugs were all found genuine. The English pharmacist, like other people, occasionally makes mistakes, e.g.; sometimes he is tempted to buy his drugs at too cheap a rate; sometimes from keeping too long, certain preparations lose their strength; but wilful adulteration is extremely uncommon, and as a class he is above suspicion. This one would expect, because the English chemist is a highly educated man, selected by a severe examination; each year the practice of pharmacy demands more and more scientific knowledge, a large proportion of the drugs now in use, not being extracted from plants or minerals, but synthetised artificially. Conclusion. The brief summary above given will show that the administration of the Sale of Food and Drugs Acts in Marylebone, continues in a systematic manner to protect the consumer from fraud, and that no one who regularly sells an article of food, drink or drugs, in any way sophisticated will long escape detection. A. WYNTER BLYTH. March 1st., 1912. The following table summarizes the information contained in the table submitted formally by the Public Analyst. ANALYSES UNDER THE SALE OF FOOD AND DRUGS ACTS DURING 1911. SUMMARY. Article. Genuine. Adulterated. Milk 499 48 Skimmed Milk 2 1 Butter 337 14 Bread and Butter 1 2 Butter and Margarine 1 — Cream 55 — Cheese 11 — Margarine 10 — Bacon 2 — Coffee 21 2 Cocoa 7 — Pepper 3 — Mustard 12 — Bloater Paste 1 — Standard Bread 1 — Baking Powder 3 — Cream of Tartar 2 — Custard Powder 2 — Jam 25 — Honey 1 — 65 Genuine. Adulterated Ice Cream 2 — Lard 3 — Lime Water 7 — Ammoniated Tincture of Quinine 4 — Tincture of Iodine 1 — Ipecacuanha Wine 2 — Magnesium Citrate 1 — Turpentine 1 — Paregoric Elixir 4 — Olive Oil 2 — Quinine Powder 1 — Gregory Powder 4 — White Precipitate Ointment 1 — Dover Powder 4 — Camphorated Oil 4 — Rum 2 2 Whiskey 1 — Cyder 2 — Totals 1,042 69 BACTERIOLOGICAL EXAMINATION OF FOOD. During 1911, as in the two previous years, a number of samples of food, 20 in all, were taken with proper precautions and submitted to Dr. Eastes for bacteriological examination. Of the 20, 18 were milk, and of these 7 were adversely reported upon. In each case the attention of the vendor was drawn to the fact that the bacteriologist's report was unsatisfactory, and wherever possible the Medical Officer of Health of the district whence the milk came, was put in possession of the facts and asked to take action. Certification of Meat Food Products.— During the year the Council having assented, the Local Government Board designated me certifying officer in connection with the export of meat food products to the United States of America and the Philippine Islands, in view of the requirements of the Food Laws in operation in those countries. The application to the Board for the designation of an officer was sent in the first instance by Messrs. Keevil and Best, of Carlisle Place, who seem to send a certain amount of prepared food, hams, etc., to the Philippines. The object of the certification is to assure the authorities of the countries with whom arrangements have been entered into, that the premises in which the food is prepared are in a good sanitary condition and regularly inspected, and that the food used is sound. 66 If he is not satisfied with the information he has been able to obtain with regard either to the premises or the food the certifying officer is directed to withhold certification and to notify the Local Government Board. Since the date of designation no applications have been made for a certificate. In certain continental countries, e.g., Switzerland, there is a requirement that any foods forwarded shall be examined and certified sound by a Medical Officer of Health. On one or two occasions certificates were granted in respect of small quantities of bacon ordered from one of the shops in the Borough by a customer in Switzerland. WATER SUPPLY. Water Supply in Dwelling Houses.—The certificates granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises numbered 16. Intimation notices to the number of 327 calling for the provision of a supply of water to the upper storeys of tenement houses (London County Council (General Powers.) Act, 1907, Section 78) were served. In 186 cases the supply was provided after receipt of the intimation and in the remaining 141 after service of a statutory notice. In no case was it necessary to issue a summons against the owner. Water Supply cut off.—In 38 cases, a report was received from the Metropolitan Water Board, as required by Sec. 49 (l) of the Public Health (London) Act, 1891, that the water supply of premises had been cut off. The reasons for discontinuing the supply were:— Premises empty 23 Non-payment of Rates 7 Waste of Water 8 38 In connection with these cases the greatest amount of assistance was received from Mr. Alderman J. Lea-Smith, the representative of the Council on the Metropolitan Water Board, who, if the premises affected were a tenement house, took immediate steps to secure that the tenants should suffer no hardship as a result of being deprived of water. Though the summer was exceptionally warm and dry no complaints whatever reached the Department as to the water supply. 67 Housing. During the year the work of house-to-house inspection went steadily forward and became more distinctly established as one of the routine parts of the administration of the Department. The house-to-house inspector received his instructions to examine the houses in a certain street, the "sanitary survey" sheets, prepared by the district inspectors, serving as a guide to the streets calling for attention; houses in which defects were noted by him were referred to the district inspectors; the conditions were further investigated by them, notices served and follow-up visits paid till the defects were remedied and the matter written off. The matter of house-to-house inspection is referred to later in these pages, but it may be stated now that effects of the utmost value in connection with housing have been produced as a result of the work. Numbers of defects have been found which have been remedied under the powers granted by the Public Health Act. Great improvements have also been produced as a result of indirect pressure brought to bear upon owners, who, to avoid the possibility of action being taken in reference to their property under sections of the Housing, Town Planning, &c., Act, 1909, consented to carry out considerable alterations or even to voluntarily close the premises. The following examples may be quoted :— No. 7, Salisbury Street Obstructive buildings removed from back yard, and premises thrown open at back. Additional light and ventilation provided to back ante room. W.C.'s removed from basement and top floor, and reconstructed in suitable position with adequate light and ventilation in back yard. The drainage reconstructed throughout; 2 rooms cleansed. Nos. 37, 39, 41 and 43, Salisbury Street The water closets and branch drains from same (August, 1911) removed from unsuitable position under basement stairs. New water closet apartments constructed on the ground floor, entered from staircase, and with proper external ventilation to back area. Drains and soil - pipes reconstructed. Water provided to upper storeys; various rooms cleansed and repaired; the basements cleansed, and proper light and through ventilation provided to same at the rear. 68 No. 8a, Earl Street Ceilings of stables, and floors of living rooms (April, 1911) reconstructed and rendered air-tight. The stable ventilators (passing through rooms) properly insulated; windows and roofs repaired; drains and water closet reconstructed. The premises cleansed and renovated throughout. No. 15, Little Church Street Obstructive roof, etc., removed from rear of (February, 1911) the premises. The w.c., washing copper, and party wall to staircase reconstructed. The premises renovated and cleansed throughout. Nos. 18 and 20, Huntsworth Mews Premises (in each case) partially reconstructed at back, so as to provide additional light and ventilation. Window area to all back rooms increased. The drains and w.c.'s reconstructed. Premises cleansed and renovated throughout. 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, &c., Act, 1909, was five. In five cases closing orders were made. Of these four were second orders, the first (served in 1910) having been found to be void on account of one or other of the informalities referred to in the circular letter of the Local Government Board of 8th September, 1911. In the case of 22 Burne Street, two closing orders were made during 1911. The informality, viz., the omission to serve the order on one of the owners, not being discovered till the making of the demolition order came up for consideration. In the case of 1, 7 and 8 Cranmore Place, the demolition orders had actually been served before attention was directed to the fact that the existence of another owner had been overlooked. The number of demolition orders served and complied with was two, viz., with regard to the cottages at the rear of 23 and 24 Burne Street. The improvements resulting from the demolition of these structures are, as was expected, most striking. The closing order made on 18th November, 1910, with respect to 12, Mitcham Street, was withdrawn, after certain alterations and improvements had been made. In no case was an appeal made against any order of the Local Authority. The visiting sub-committee of the Public Health Committee visited all premises reported by the Medical Officer of Health, and their advice and assistance in these most difficult cases was of the greatest value. Full particulars with regard to the premises reported and represented are given in the following table:— 69 Housing, Town Planning, &c. Act, 1909. Premises Reported or Represented during 1911. Date of Representation Situation. or Report to Result. Local Authority. 1, Cranmore Place 17th October, 1910. Closing Order made 17th November, 1911. (Second Order). First Order made 17th December, 1910. Demolition Order made 24th March, 1911. Both void from informality. 7, Cranmore Place 17th October, 1910. Ditto. 8, Cranmore Place 17th October, 1910. Ditto. 22, Burne Street (Cottage rear of) 24th February, 1911. Closing Order made 24th February, 1911. Application for withdrawal of Closing Order made 19th May, 1911. (Refused). Demolition Order considered 6th October, 1911. Not made, as Closing Order regarded as void, on account of failure to serve on all owners. Proceedings commenced de novo, and Closing Order made 20th October, 1911. Matter of Demolition Order pending. 22, Huntsworth Mews . 24th February, 1911. Closing Order made 24th February, 1911. Situation of Premises. Demolition Orders. Date of Consideration. Result. 1, Cranmore Place 24th March, 1911. See above. 7, Cranmore Place 24th March, 1911. See above. 8, Cranmore Place 24th March, 1911. See above. 23, Burne Street (Cottage rear of) 5th May, 1911. Order made 14th July, 1911. Premises demolished. 24, Burne Street. (Cottage rear of) 5th May, 1911. Order made 14th July, 1911. Premises demolished. 22, Burne Street. (Cottage rear of) 6th October, 1911. Order not made. Closing order of 24th February, 1911, void. Second closing order made 20th October, 1911. 22, Huntsworth Mews 6th October, 1911. Order not made. Alterations carried out. No premises were closed under any other act and no proceedings were instituted under any Housing of the Working Classes Act other than that of 1909. 7 o House to House Inspection. This work was steadily continued during the year by Inspector Hodges. The total number of streets examined was 12. The actual number of houses was 694 (separate houses 588; tenements in blocks of buildings 106). In all, 1,176 inspections were made and 661 notices (intimations, 495; statutory notices, 166) were served. The figures for 1910 were: inspections, 1,070; intimation notices, 368; statutory notices, 153. Careful records of the work done were kept in the house-to-house inspection books, which were produced for the inspection of the Public Health Committee at each fortnightly meeting. The following tabular statement contains the particulars regarding the work called for by the Local Government Board in The Housing, Inspection of District Regulations, 1910. 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 588, and 106 Tenements in Blocks of Buildings 5 5 5 9 after letters to Owners 495 in respect of which Notices (Intimations and Statutory) were served. Intimation 495 Statutory 166 1 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. .0000 . . 661 * In 4 cases after taking legal advice it was decided that the original closing orders were void owing to informality in complying with the Statute and fresh representations were made and closing orders again served. Sanitary Survey. The results obtained by means of the Sanitary Survey commenced in 1910 were so satisfactory that it was continued, and by the end of 1911 a considerable portion of the Borough had been surveyed, only 42 streets remaining to be visited. 71 When the work is completed, it is proposed to choose from the records of the survey in each district the streets found to be most in need of house-to-house inspection, and to have it carried out by the inspector of the district. Houses Let in Lodgings. During the year the re-registration of houses let in lodgings, rendered necessary by the passing of the new by-laws in 1907, was steadily proceeded with. The number orginally registered was 758. At the end of 1911 all of these had been re-examined and re-registered, and certificates regarding them were issued to the owners. In addition 294 not previously registered were brought in, bringing up the total number on the register to 1,052. The number of inspections made in connection with this work was 7,539. In 1,465 instances intimation notices relating to nuisances were served, all of which were promptly complied with. During the year all premises on the register were systematically inspected. In March, notices calling attention to the necessity for cleansing and lime washing of staircases, &c., were served upon all owners. Follow-up visits were paid by the inspectors in each case to see that the notice had been complied with. It was not found necessary to institute proceedings in any instance for breach of the by-laws. In July a letter was received from the Clerk to the County Council directing attention to the terms of section 16 of The Housing Town Planning, Etc., Act, 1909 (which extends the power of making by-laws as to lodging houses for the working classes so as to impose duties upon the owner of the premises in addition to or in substitution for any other person), and suggesting that if the Council had not already done so, steps should be taken to amend the existing by-laws. Accordingly, a draft of amendments was made and considered by the Public Health Committee and submitted to the Local Government Board for preliminary approval before laying them before the Council. In addition to showing the amendments required by the section referred to above, certain other alterations were made with the object of simplifying the working of the by-laws. At the end of the year the Board's approval had not been received. Common Lodging Houses. All the necessary particulars with regard to these are contained in the following table. A number of visits have been paid to the premises from time to time by the district inspectors. The number of dwelling rooms found to be overcrowded during 1911 was 85. In each case a notice was served, and all were complied with without the necessity for a prosecution arising. Underground Rooms. A considerable amount of work has been done during the year with regard to underground rooms and a number of contraventions both of section 96 of the Public Health (London) Act 1891, which refers to the occupation of rooms underground apart from rooms on an upper floor, and of the Regulations made by the Borough Council prohibiting the habitual use of rooms underground for sleeping purposes, have been dealt with. The total number of cases in which notices were served was 245. In the case of rooms illegally occupied under the Regulations, the procedure described in Section 17, (7) of the Housing, Town Planning, etc. Act, 1909, under which they are made, is that a closing order shall be made and if the occupier of the room after notice of the order has been served upon him, fails to comply with the order, an order to comply may on summary conviction be made against him. Except in 5 cases, occupation of the room for sleeping purposes was discontinued immediately after receipt of a notice calling attention to the contravention of the regulations. The exceptions referred to are basement rooms in one house and closing orders were made respecting them. These have not been obeyed and the further step of making application to a magistrate for an order to comply against the occupiers had not been fully taken at the end of the year. The actual number of notices served under the Regulations was 64. In two instances underground sleeping rooms used by employees were found in connection with bakehouses situated underground. Though it was formerly fairly usual for master bakers to provide sleeping accommodation for some of their employees 72 Registered Address. Registered Owner. number of occupants. 54, Bell Street Alfred Crew 55 men 2, Burne Street and Lisson Street William Booth 499 men 6, Charlotte Place Emma Lawson 7 women 29, Circus Street William H. G. Richardson 100 men 3, Gee's Court Margaretta E. Howell 39 men 4, Gee's Court Margaretta E. Howell 27 men 22, Harrow Street Archibald Nicholl MacNicoll 102 women 47, Hereford Street Alfred Wilson 19 men 45, Lisson Street Alfred Wilson 35 men 3, Little Grove Street Thomas Levy 100 men 12, Molyneux Street Frederick Charles Walters 17 men 13, Molyneux Street Frederick Charles Walters 129 men 7, Venables Street Arthur James Howell 56 men 25, Venables Street Arthur James Howell 18 men 1,094 men 109 women Total 1,203 Overcrowding. 73 close to the bakehouse, 1n order, apparently, to be certa1n of hav1ng some one on hand 1n t1me for the early work, the pract1ce 1s gradually pass1ng away. After attent1on had been d1rected to the 1llegal1ty of the pract1ce 1n the cases referred to above, the use of the rooms for sleep1ng purposes was d1scont1nued. So far as 1s known there are no other s1m1lar examples 1n the Borough. CUSTOMS AND 1NLAND REVENUE ACTS. The number of cert1f1cates granted dur1ng 1911 for reduct1on of or exempt1on from 1nhab1ted house duty under these Acts was 6. The s1tuat1on of the prem1ses and the number of tenements affected are shown 1n the follow1ng statement:— Prem1ses. No. of Tenements. Bachelor. Chambers, B1ckenhall Mans1ons 14 Montagu Mans1ons, Rooms M and N, Block 2 2 Newcastle House, Northumberland Street . 18 84, H1gh Street, W. 5 Moxon House, Parad1se Street 8 57 and 59, Cleveland Street 2 1n all cases a thorough exam1nat1on was made of the prem1ses and the cert1f1cate w1thheld t1ll any 1mprovements called for were carr1ed out. NU1SANCES. Work of 1nspectors of Nu1sances. The arrangements made 1n the m1ddle of 1910, when the Borough was sub.d1v1ded 1nto 5 d1str1cts, and two add1t1onal 1nspectors appo1nted, 1n order that one 1nspector m1ght be placed 1n charge of each d1str1ct were cont1nued throughout 1911. 1n each d1str1ct a great amount of work has been done, partly as the result of the matters brought to l1ght by the 1nvest1gat1ons of the house.to.house 1nspector; partly, also, as a result of the work done on the san1tary surveys, and 1n other d1rect1ons by the d1str1ct 1nspectors themselves. The total number of compla1nts rece1ved from all sources was 1,927, as aga1nst 1,996 1n 1910, and 1,899 1n 1909. The actual number rece1ved from sources outs1de the department was 281. Many of these were made by the workers of the St. Marylebone Health Soc1ety, and members of the Ch1ldren.s Care Comm1ttees. Several were made by ne1ghbours, 1n some cases out of fr1endl1ness, 1n others apparently sp1tefully. The smallness of the number of such outs1de compla1nts 1s taken as ev1dence of the thoroughness of the work of the department, espec1ally as 1n a number of the cases act1on had already been taken before the compla1nt was rece1ved. All compla1nts, 1t may be added, whether anonymous or not, unless the part1culars g1ven are too vague, rece1ve 1mmed1ate attent1on. 1n respect of nu1sances 881 statutory not1ces were 1ssued. The number for 1910 was 658 and for 1909, 514. Of the not1ces 434 related to ord1nary nu1sances (d1rt, dampness, etc.), 7.7 to verm1nous rooms, 154 to dra1ns, 12 to 1nsuff1c1ent w.c. accommodat1on, 73 to underground rooms, under the Publ1c Health Act. The rema1n1ng 141 were served on owners to prov1de a proper and suff1c1ent supply of water to the upper storeys of 74 tenement houses under the London County Counc1l (General Powers) Act, of 1907. The number of such not1ces for 1910 was 136, and 1n 1909, 49. The 77 not1ces respect1ng verm1nous rooms were served under powers granted by the London County Counc1l (General Powers) Act, 1904, and referred to 325 rooms. The number of not1ces for 1910 was 70, and for 1909, 24. 1n 1,593 cases the nu1sances were abated by the persons respons1ble for the1r removal on the serv1ce of a prel1m1nary (1nt1mat1on) not1ce of the ex1stence of the defect. The number of cases 1n wh1ch the necess1ty to resort to legal proceed1ngs to enforce compl1ance w1th statutory not1ces was 10. The table on page 75 g1ves the deta1ls of the cases so dealt w1th, the act or by.laws under wh1ch the proceed1ngs were taken and the results. The total 1nspect1ons made by each 1nspector, and the number of nu1sances of var1ous k1nds detected and remed1ed are set forth 1n the follow1ng table. D1str1cts. Borough. No. 1. No. 2. No. 3. No. 4. No. 5 1nspect1ons from Journal 3350 3390 3831 3256 3249 17076 Houses damp, d1rty or d1lap1dated remed1ed 119 207 181 149 69 725 Doors, w1ndows, floors, ce1l1ngs, sash cords, etc., repa1red 50 54 31 14 6 55 Overcrowd1ng abated 8 35 28 12 2 85 1llegal occupat1on of underground rooms dealt w1th 3 18 59 126 39 245 Water closet defects remed1ed 97 185 113 107 77 579 Water closets erected 2 1 4 16 14 37 Ur1nal defects remed1ed 1 2 5 3 4 15 58 So1lp1pe and vent1lat1ng shaft repa1red or renewed 7 10 23 18 . Yard defects remed1ed 102 119 94 44 35 394 Waste p1pe defects remed1ed 2 11 13 13 9 48 Water c1stern defects remed1ed 23 65 20 24 13 145 Rubb1sh, manure, etc., accumulat1ons removed 4 22 58 20 29 133 Dung or dust receptacles repa1red or renewed 73 54 64 46 17 254 Dra1ns rela1d or amended ... 97 82 135 87 62 463 Dra1ns cleared 11 32 10 15 14 82 Ra1nwater p1pes repa1red or renewed 22 25 18 15 23 103 Water supply to houses re1nstated 1 3 7 2 — 13 Roofs and gutters repa1red 51 84 31 22 22 210 Area defects remed1ed . 30 58 40 36 164 Wash.house defects remed1ed 93 124 87 77 20 401 An1mal nu1sances abated 3 14 3 5 2 27 Basement defects remed1ed 3 26 24 7 6 66 Stables cleansed or repa1red . 3 3 . — 6 Water supply la1d on to upper storeys of house 50 156 57 45 19 327 M1scellaneous nu1sances abated 13 33 — 1 4 51 Verm1nous rooms cleansed 90 90 58 58 29 325 Workshops damp, d1rty or d1lap1dated remed1ed ... 2 14 23 60 39 138 75 LEGAL PROCEED1NGS 1N CONNECT1ON W1TH NU1SANCES. The total number of summonses 1ssued 1n respect of var1ous nu1sances was 10 as aga1nst 21 1n 1910. Hav1ng regard to the fact that more nu1sances were d1scovered, more not1ces served and more work done, th1s reduct1on 1s regarded as most grat1fy1ng. Of the summonses, only one was 1ssued under the Publ1c Health (London) Act, 1891 ; f1ve were under the Metropol1s Management Act, 1855 ; and four under the by.laws of the London County Counc1l relat1ng to the removal of offens1ve refuse. Part1culars w1th regard to cases under the Unsound Food sect1ons of the Publ1c Health Act, the Sale of Food and Drugs Acts, &c., are g1ven under the appropr1ate head1ngs 1n the Report. Publ1c Health (London) Act, 1891. Nu1sances, etc. F1ne. Costs. 166, Great T1tchf1eld Fa1lure to comply Summons w1th. — — Street w1th a statutory drawn. Work not1ce to amend and done vent1late the dra1n Metropol1s Management Act, 1855. 8 and 8A, Earl Street Fa1lure to comply Conv1cted 2 0 0 0 12 6 w1th a statutory not1ce to redra1n the prem1ses to the sewer 52, St. John.s Wood Fa1lure to comply Adjourned s1ne — — Terrace w1th a statutory d1e. Work not1ce to redra1n done the prem1ses to the sewer 68, R1chmond Street Fa1lure to comply Summons w1th. — — w1th a statutory drawn. Work not1ce to redra1n done the prem1ses to the sewer 18, Sal1sbury Street Fa1lure to comply Conv1cted 1 0 0 2 2 0 w1th a statutory not1ce to renew the connect1on to the sewer 19, L1ttle North Fa1lure to comply Summons w1th. Street w1th a statutory drawn. Work not1ce to redra1n done the prem1ses to the sewer 76 By.laws of London County Counc1l made under Publ1c Health (London) Act, 1891, Sect1on 16 (2). Removal of Offens1ve Refuse. F1ne. Costs. Sussex Place Remov1ng offens1ve matter 1n 1mproper 1 10 0 0 4 0 receptacles dur1ng proh1b1ted hours. H1gh Street, Remov1ng offens1ve matter, and fa1l1ng 2 2 6 0 4 0 St. John.s Wood to make proper prov1s1on for the prevent1on of nu1sance therefrom. Oxford Street Remov1ng offens1ve matter 1n 1mproper 3 0 0 1 1 0 receptacles dur1ng proh1b1ted hours. James Street Remov1ng offens1ve matter 1n 1mproper 0 5 0 0 2 0 receptacles dur1ng proh1b1ted hours. DRA1N PLANS AND DRA1NAGE. Dur1ng the year no change was made e1ther 1n the d1str1cts or the work of the two dra1nage 1nspectors, Gorn1ot and J. C. W1lson, the former rema1n1ng 1n the d1str1ct north of Marylebone Road and the latter 1n that to the south. The total number of 1nspect1ons made was 7,819 as aga1nst 8,323 for 1910 and 6,850 for 1909. The number of plans relat1ng to dra1nage of new bu1ld1ngs was 36 (north 9, south 27). 1n the case of old bu1ld1ngs, the number of plans rece1ved was 507 (north 205, south 302). The total number of plans depos1ted dur1ng the year was 543 as aga1nst 622 1n 1910. The by.law set out below was made by the London County Counc1l on account of a dec1s1on g1ven 1n a case 1n wh1ch a bu1lder was summoned for a fa1lure to comply w1th a by.law of the London County Counc1l call1ng for the depos1t of " plans, sect1ons and part1culars " of work to be carr1ed out 1n connect1on w1th the construct1on of a dra1nage system, by " every person xvho 1s about to construct the p1pes, dra1ns, or other means of commun1cat1ng w1th a sewer, or the traps and apparatus connected therew1th." Accord1ng to the usual read1ng of th1s by.law the person regarded " as about to construct, etc.," was the bu1lder, but the v1ew of the mag1strate when the case came before h1m was that the person who 1nstructed the bu1lder—usually the owner of the prem1ses—was the person 1nd1cated. That 1t was unfa1r to throw the respons1b1l1ty on th1s person, who usually was qu1te 1gnorant of the requ1rement, whereas bu1lders generally were qu1te cogn1sant of 1t was man1fest, and the London County Counc1l took an early opportun1ty of mak1ng 1t clear that they never had any 1ntent1on of mak1ng anyone but the bu1lder respons1ble. As 1t may be useful to have a record of the mak1ng of the by.law the full text 1s g1ven below:— 77 LONDON COUNTY COUNC1L DRA1NAGE BY.LAWS. The Metropol1s Management Act, 1855, Sect1on 202, and The Metropol1s Management Acts Amendment (By.Laws) Act, 1899. By.Laws made by the Counc1l def1n1ng. the person respons1ble under the dra1nage by.laws and the by.laws as to depos1t of plans under the above.named Acts. 1. Notw1thstand1ng anyth1ng conta1ned 1n the by.laws made by the London County Counc1l 1n pursuance of the prov1s1ons of Sect1on 202 of the Metropol1s Management Act, 1855, and the Metropol1s Management Acts Amendment (By.Laws) Act, 1899, 1n the case of any work done to or 1n any p1pe, dra1n, or other means of commun1cat1ng w1th sewers and the traps and apparatus connected therew1th, such plans, sect1ons and part1culars relat1ng to such work as are requ1red to be depos1ted by the sa1d by.laws shall be depos1ted by the bu1lder, and he shall be the person l1able to the penalt1es prov1ded 1n the sa1d by.laws for the fa1lure to depos1t such plans, sect1ons and part1culars. Such bu1lder shall 1n carry1ng out any such work as aforesa1d, observe all the requ1rements conta1ned 1n the by.laws made by the London County Counc1l under the prov1s1ons of sect1on 202 of the Metropol1s Management Act, 1855, and he shall be l1able to the penalt1es prov1ded for a breach of the sa1d by.laws. 2. 1n these by.laws " bu1lder " means the bu1lder, contractor or person actually carry1ng out the work, but does not 1nclude a workman 1n the employ of such bu1lder, contractor or person. The forego1ng by.laws were made by the London County Counc1l on the 11th day of July, 1911, and were subm1tted to and conf1rmed at a subsequent meet1ng of the Counc1l, held on the 18th day of July, 1911, and the Common Seal of the Counc1l was hereunto aff1xed on the 19th day of July, 1911. LAURENCE GOMME, Clerk of the Counc1l. Approved by the Local Government Board th1s fourth day of August, 1911. H. C. MONRO, Secretary. Act1ng on behalf of the sa1d Board, under the author1ty of the1r General Order,dated the 26th day of May, 1877. COMB1NED DRA1NAGE. The number of orders under seal as to comb1ned dra1nage granted by the Counc1l was 12, the number 1n 1910 be1ng 27. 1n 4 cases the l1ab1l1ty of the Counc1l for the reconstruct1on of the comb1ned port1ons of ex1st1ng dra1ns was adm1tted, and the work carr1ed out by the Works Comm1ttee at the request of the Publ1c Health Comm1ttee.+ 78 BLACK SMOKE NU1SANCES. The total number of observat1ons of ch1mneys made by the 1nspectors was 1,292, and 11 nu1sances were d1scovered. A report was subm1tted to the Publ1c Health Comm1ttee at each meet1ng w1th regard to the number of observat1ons made and nu1sances d1scovered. 1n each case 1n wh1ch a nu1sance had been detected, the owner was commun1cated w1th and any explanat1on he had to offer was cons1dered by the comm1ttee along w1th the reports of the 1nspector. Act1ng on the 1nstruct1ons of the comm1ttee 8 letters of caut1on were sent and 1 not1ce was served. 1n no 1nstance was 1t found necessary to 1ssue a summons 1n respect of nu1sance from black smoke. REMOVAL OF HOUSE REFUSE. Dur1ng 1911 the removal and destruct1on of house refuse was carr1ed out, as 1n 1910, by Messrs. Mead & Co., Ltd., The Wharves, Padd1ngton, under contract. The total cost for the whole borough was £ 10,500, the f1gure for the North D1str1ct be1ng ,£3,550, and for the South .£6,950. The contract 1n respect of the former commenced 1st Apr1l, 1911, and for the latter was accepted for 2 years from 1st Apr1l, 1910. The follow1ng tabular statement g1ves the number of compla1nts, letters, and refusals rece1ved 1n respect of the removal of house refuse, together w1th the f1nes lev1ed and recovered by the Counc1l for contravent1ons of the terms of the contracts dur1ng the last 8 years. NORTH D1STR1CT. Year. Compla1nts. Letters. Refusals. F1nes. 1904 49 52 28 — r9°5 53 66 227 W. Mead & Co., Ltd., £20 and £2 6 5s. 1906 49 61 51 W. Mead & Co., Ltd., £15, and E. H. Jacksoq & 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 1911 105 111 466 W. Mead & Co., Ltd, £51 SOUTH D1STR1CT. Year. Compla1nts. Letters. Refusals. F1nes. 1904 194 184 63 T. Hobbs, £20 1905 72 170 366 — 1906 69 157 556 T. Hobbs, £15, £ 1 1s.,and^5o 1907 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 1911 91 190 247 — Dur1ng the str1ke of transport workers 1n August, a certa1n amount of 1nterference w1th the work of removal took place, and no refuse was removed after 10 a.m. on Saturday, August 12th, t1ll the morn1ng of Tuesday, August 15th, 1911. 79 Though the Counc1l were 1n recess a certa1n number of the members of the Publ1c Health Comm1ttee, 1nclud1ng the Cha1rman, the Rev. J. A. Beaumont and the Cha1rman of the Dust Sub.Comm1ttee, Alderman J. Lea Sm1th, fortunately happened to be 1n town and at a meet1ng betweeen them and representat1ves of the contractors such pressure was brought to bear as resulted 1n br1ng1ng the deadlock between Messrs. Mead and Co., and the1r employees speed1ly to a conclus1on. Some of the larger producers of refuse such as the hotels and restaurants 1n the Borough, arranged for the removal of the1r own refuse dur1ng the str1ke, but apart from th1s, very l1ttle 1nconven1ence was caused to the 1nhab1tants. The number of compla1nts rece1ved was remarkably small. The greater part of the penalty of £51 1mposed upon Messrs. Mead and Co., dur1ng the year, was 1n respect of fa1lure to completely carry out requ1rements 1n connect1on w1th the da1ly collect1on 1n Church Street and the thr1ce weekly collect1on 1n the area 1n L1sson Grove, referred to 1n the report for 1910. The usual close superv1s1on was exerc1sed over the work of the contractors by the Publ1c Health Comm1ttee dur1ng the year. The reports of the 1nspectors and the compla1nts, letters and refusals rece1ved were cons1dered by the Dust Sub.Comm1ttee, wh1ch 1s fortunate 1n hav1ng Alderman J. Lea.Sm1th st1ll as 1ts cha1rman, at the1r fortn1ghtly meet1ngs, reports thereon be1ng made to the Publ1c Health Comm1ttee. Cons1derable numbers of dust shoots as well as old br1ck receptacles were demol1shed dur1ng the year and new metal dust receptacles to the number of 158 were prov1ded. 1nspectors H1ll and Lumley, the dust 1nspectors, pa1d 5,912 v1s1ts and served 172 not1ces regard1ng defaults 1n connect1on w1th dust removal. Remed1es 1n each case were carr1ed out w1thout the necess1ty for prosecut1ons ar1s1ng. VERM1NOUS PERSONS BATHS. Dur1ng 1911 these Baths were used by 9,085 adults (males 6,510; females, 2,575). The ch1ldren bathed numbered 967, 504 be1ng boys and 463 g1rls. The addresses g1ven by the male adults 1ncluded Salvat1on Army shelter 4,970, and lodg1ng houses 402. 1n 760 1nstances no address was g1ven, and 1n 378 the appl1cants stated they had come from the Church Army. The Portman House was g1ven as an address by 420 females, the Church Army by 6, and addresses 1n the Borough by 40. So many as 2,109 gave no address. The number of ch1ldren bathed 1s sl1ghtly lower than 1910, due probably to the same causes as ment1oned 1n the report for that year. A poss1ble factor 1n the fall1ng off was probably also the 1ndec1s1on ex1st1ng 1n the m1nds of school teachers and nurses as to what was the proper course to follow pend1ng the f1nal settlement of the agreement between the Counc1l and the London County Counc1l as to system of cleans1ng and payment. 8o Th1s bel1ef 1s supported by the fact that as soon as the agreement was settled, and the scheme was 1n work1ng order, the numbers of ch1ldren bathed began to 1ncrease. The date of s1gn1ng the agreement was 7th October, 1911, and the Counc1l undertook to bath any verm1nous ch1ld sent from the Publ1c Elementary Schools 1n the Borough for a sum of 2/., th1s sum to cover any number of attendances by the ch1ld at the baths over a per1od not exceed1ng one calendar month. Boys attend on Mondays, Wednesdays and Fr1days, between 9 and 1, and g1rls on the same days between 1 and 4. The ch1ldren are brought by a school nurse, who rema1ns 1n attendance dur1ng the bath1ng, and s1gns a card when the ch1ld 1s f1nally cleansed. Th1s procedure of the London County Counc1l 1s carr1ed out under sect1on 122 of the Ch1ldren Act, by wh1ch they are empowered to cleanse a ch1ld after the parents have fa1led to do so. At the same t1me as the agreement was entered 1nto w1th regard to the school ch1ldren, a s1m1lar step was taken 1n relat1on to 1nmates of Common Lodg1ng Houses 1n the Borough found to be verm1nous and sent by the London County Counc1l for cleans1ng. 1n respect of each case cleansed a sum of one sh1ll1ng 1s pa1d. The number of persons sent under th1s agreement between the date of s1gn1ng and the end of the year was comparat1vely small. 1n the case of the ch1ldren, 1t may be ment1oned that the home of every ch1ld sent as verm1nous to the baths 1s v1s1ted and exam1ned by the women 1nspectors and arrangements made for d1s1nfect1on of bedd1ng, &c., wherever poss1ble. The usual table show1ng the numbers of adults and ch1ldren bathed each month 1s appended. The number of ch1ldren 1s d1st1nctly lower than 1n 1910 ; the number of adults h1gher by nearly 1,000. A table show1ng the numbers of persons us1ng the baths s1nce they were opened 1s also g1ven. CLEANS1NG OF PERSONS ACT, 1897. Table show1ng the number of Adults and School Ch1ldren us1ng the Baths prov1ded under the above.ment1oned Act dur1ng the year 1911 :— ADULTS. CH1LDREN. 1911. Males. Females. Total. Males. Females. Total. January 502 164 666 21 30 51 February 449 170 619 45 12 57 March 543 191 737 61 24 85 Apr1l 444 135 579 18 14 32 May 548 237 785 24 41 65 Tune 403 206 669 20 23 43 July 682 264 946 34 37 71 August 1584 344 1,028 — 7 7 September 628 298 926 52 37 89 October 570 231 801 72 43 115 November 515 212 727 81 78 159 December 482 120 602 76 117 193 Totals 6,510 2,575 9,085 504 463 967 81 Table show1ng the number of persons us1ng the Baths dur1ng the past 14 years:— ADULTS. CH1LDREN. Year. 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 1911 6,510 2,575 9,085 504 463 967 Totals 84,046 17,363 101,409 10,287 13,395 23,682 *The Ch1ldren.s Baths were opened 1n June, 1905. THE SHELTER. The number of t1mes the Shelter was used dur1ng 1911 and the reasons for such use are shown 1n the accompany1ng statement. The per1ods of occupat1on var1ed from two hours up to 36. No. of hours occup1ed. Reason of occupat1on. No. of persons January 22nd and 23rd 18 D1phther1a 4 adults, 1 ch1ld. March 13th 2 Sept1c Po1son1ng 1 adult. Apr1l 1st 3 Verm1n 1 adult. June 9th 2 Mumps 1 adult. July 26th 2 Sept1c Po1son1ng 1 adult. August 3rd and 4th 16 Scarlet Fever 2 ch1ldren. October 3rd and 4th 16 Verm1n 1 adult, 2 ch1ldren. October 10th and 11th 18 Scarlet Fever 2 adults, 1 ch1ld. November 3rd and 4th 18 Scab1es 3 ch1ldren. November 30th and December 1st 18 Scarlet Fever 2 adults, 1 ch1ld. December 2nd, 3rd and 4th 36 Scarlet Fever 1 adult, 1 ch1ld. December 5th and 6th 18 Scarlet Fever 2 adults, 1 ch1ld. PUBL1C MORTUARY. All the necessary deta1ls regard1ng the use of the Mortuary dur1ng the year are conta1ned 1n the accompany1ng statement prov1ded by the Mortuary Keeper. 82 Regular v1s1ts of 1nspect1on have been made by the outdoor super1ntendent. Arrangements were made for allow1ng the Mortuary Keeper a certa1n number of hours off duty each week. 1n h1s absence, charge 1s taken by one of the members of the conven1ences staff. Certa1n alterat1ons for the 1mprovement of the heat1ng of the Coroner.s court were carr1ed out. Report of Mortuary Keeper. Number of bod1es depos1ted from 1st January to 31st December, 1911. Males. Females. Total. For bur1al only. For 1nquests. Total January 21 10 31 19 12 31 (1 1nfect1ous) February 20 20 40 21 19 40 March l6 12 28 14 14 28 Apr1l 12 13 25 15 10 25 May 11 13 24 17 7 24 June 11 9 20 9 11 20 (1 1nfect1ous) July 11 6 17 10 7 17 August 13 13 26 15 11 26 September 15 10 25 12 13 25 October 15 11 26 13 13 26 November 14 15 29 15 14 29 (1 1nfect1ous) December 16 15 31 18 13 31 (1 1nfect1ous) - - - - - - 175 147 322 178 144 322 Number of 1nquests held from 1st January to 31st December, 1911 —154. PUBL1C SAN1TARY CONVEN1ENCES. The work of superv1s1ng the publ1c san1tary conven1ences was carr1ed out regularly, as 1n former years, by the outdoor super1ntendent and the women 1nspectors. Reports have been per1od1cally subm1tted to and cons1dered by the Publ1c Health Comm1ttee. The Comm1ttee dur1ng the year cons1dered a report from M1ss Baker w1th regard to the free ur1nette 1ntroduced 1n 1910 at Oxford C1rcus (women.s) conven1ence. 1t was clearly shown that the prov1s1on of such free san1tary accommodat1on for women had proved of great advantage and had been greatly apprec1ated, and that the fact of 1ts 1ntroduct1on had produced only a comparat1vely small effect upon the rece1pts. The Comm1ttee therefore determ1ned to make further prov1s1on of th1s k1nd and 1nstruct1ons were g1ven for the 1ntroduct1on of an add1t1onal ur1nette at Oxford C1rcus, and of one 1n each of the other women.s conven1ences, v1z., at Portland Road and Marylebone Road. 83 The conven1ence at Barrett Street, wh1ch takes the place of the overground ur1nal wh1ch formerly stood 1n that street, and also of that removed from Marylebone Lane, was opened on 19th June, 1911. 1t prov1des the follow1ng accommodat1on, v1z., 4 W.c..s, 10 ur1nal stalls, and 2 lavatory bas1ns. Reports and comparat1ve statements as to rece1pts for use of publ1c conven1ences were per1od1cally subm1tted to the Publ1c Health Comm1ttee dur1ng the year. The follow1ng 1s a Statement of Rece1pts for use of Publ1c Conven1ences for year end1ng 31st December, 1911, compared w1th the prev1ous year. Conven1ence. Total, 1911. Total, 1910. £ s. d. £ s. d. £ s. d. Oxford C1rcus—Men.s 1,084 15 4 1,003 6 11 1ncrease 1 81 8 5 ,, Women.s 865 1 9 865 8 7 ( Decrease 1 0 6 10 Portland Road—Men.s 285 15 6 287 9 8 Decrease 1 14 1 ,, Women.s 174 15 11 190 6 4 | Decrease 15 10 5 Marylebone Road—Men.s 216 4 4 217 14 8 Decrease 1 10 4 ,, Women.s 136 4 7 155 3 1 Decrease 18 18 a Foley Street—Men.s 129 11 1 121 15 7 ( 1ncrease 1 4 15 6 St. John.s Wood Road—Men.s 111 14 9 117 12 0 Decrease 1 5 17 3 Barrett Street—Men.s opened 19/6/1911 58 1 6 FACTOR1ES AND WORKSHOPS. Th1s port1on of the annual report 1s made 1n compl1ance w1th the requ1rements of Sect1on 132 of the Factory and Workshop Act, 1901, wh1ch 1mposes on the Med1cal Off1cer of Health the duty of report1ng each year on the adm1n1strat1on of the Act 1n workshops and workplaces. A copy of the annual report, or of th1s port1on, 1s to be sent to the Secretary of State for the Home Department, along w1th the tables 1mmed1ately follow1ng. The arrangements made 1n 1910 were adhered to and 1n each of the f1ve d1str1cts 1nto wh1ch the Borough was d1v1ded, the 1nspector 1n charge cont1nued to be respons1ble for the workshops and workplaces there1n. The three women 1nspectors, as formerly, gave attent1on to places 1n wh1ch women were employed and to the homes of out.workers. Many of the workshops and workplaces share 1n the 1ncreased attent1on g1ven to prem1ses 1n the course of house.to.house 1nspect1ons and san1tary surveys. As a result of the v1s1ts pa1d, a number of prem1ses call1ng for reg1strat1on were d1scovered. The rev1s1on of the reg1ster of workshops made 1n 1910, ass1sted the work done 1n 1911, and as shown 1n the Home Off1ce Report Form the number now on the reg1ster 1s 3,086. 84 The total number of v1s1ts to workshops and workplaces dur1ng the year was 4,773 3,698 by the women and 1,075 by the men 1nspectors. The number of defects found and remed1ed and of not1ces served 1s shown 1n the Home Off1ce return. The compla1nts rece1ved numbered 25. 1.—1NSPECT1ON. Prem1ses. Number of 1nspect1ons. Wr1tten Not1ces. Prosecut1ons. (1) (2) (3) (4) Factor1es (1nclud1ng Factory Laundr1es.) 33 4 . Workshops (1nclud1ng Workshop Laundr1es.) 3,788 141 . Workplaces (Other than Outworkers. prem1ses 1ncluded 1n Part 3 of th1s Report.) 952 80 • Total 4,773 225 — 2.—DEFECTS FOUND. Part1culars. Number of Defects. Number of Prosecut1ons. Found. Kemeched. Kef erred to H.M. 1nspector. (1) (2) (3) (4) (5) Nu1sances under the Publ1c Health Acts Want of cleanl1ness 116 116 - - Want of vent1lat1on 6 6 — — Overcrowd1ng 8 8 — — Want of dra1nage of floors 1 1 — — Other nu1sances — — — — San1tary accommodat1on 1nsuff1c1ent 5 4 — — unsu1table or defect1ve not separate for 20 12 20 12 sexes Oftenets under the Factory and Workshop Act:— 1llegal occupat1on of underground bakehouse (s. 101) — — — — Breach of spec1al san1tary requ1rements for bakehouses (ss. 97 to 100). 8 8 — — Other offences — — - — (Exclud1ng offences relat1ng to outwork wh1ch are 1ncluded 1n Part 3 of th1s Report.) Total 176 175 - — 85 3.—HOME WORK. OUTWORKERS. L1STS, SECT1ON 107. OUTWORK 1N UNWHOLESOME PREM1SES, SECT1ON 108. OUTWORK 1N 1NFECTED PREM1SES, SECT1ONS 109, 110. nature of work. L1sts rece1ved from EmplojTers. Not1ces served on Occup1ers as to keep1ng or send1ng l1sts. Prosecut1ons. 1nstances. Not1ces served. Prosecut1ons. 1nstances. Orders made (S. 110). Prosecut1ons (Sect1ons 109, 110). Send1ng tw1ce 1n the year. Send1ng once 1n the year. Fa1l1ng to keep or perm1t 1nspect1on of l1sts. Fa1l1ng to send l1sts. L1sts. Outworkers. Outworkers. Contrac tors. Workmen. L1sts. Contrac tors. Workmen. (1) (2.) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wear1ng Apparel— (1) Mak1ng, etc. 116 238 1,414 11 8 136 73 . . . . . . . . (2) Clean1ng and wash1ng 2 8 6 . . . . . . . . . . . . Umbrellas, etc. 2 . 6 . . . . . . . . . . . . Total 120 246 1,426 11 8 136 73 . . . . . . . . 86 4.—REG1STERED WORKSHOPS. Workshops on the Reg1ster (s. 131) at the end of the year. (1) Number. (2) Dressmak1ng, M1ll1nery, Laundry, Cab1net Mak1ng, &c 2,827 Coffee Shops, &c 183 Bakehouses 76 Total number of workshops on Reg1ster 3,086 5.—OTHER MATTERS. Class. (1) Number. (2) Matters not1f1ed to H.M. 1nspector of Factor1es :— Fa1lure to aff1x Abstract of the Factory and Workshop Act (s. 133) 29 Act1on taken 1n matters referred by H.M. 1nspector as remed1able under the Publ1c Health Acts, but not under the Factory and Workshop Act (s. 5.) V, Not1f1ed by H.M. 1nspector 25 Reports (of act1on taken) sent to H.M. 1nspector 18 Other — Underground Bakehouses (s 101) :— Cert1f1cates granted dur1ng the year — 1n use at the end of the year 68 Summary. The follow1ng 1s an amended l1st of the spec1al prem1ses 1n the Borough requ1r1ng constant superv1s1on :— M1lk Prem1ses 200 Cowhouses 5 Slaughterhouses 7 Offens1ve Trades 2 1ce Cream Prem1ses 96 Bakehouses 76 Restaurant and D1n1ng Room K1tchens 60 Hotel K1tchens 21 Coffee Shops, Pastrycooks and Tea Rooms 102 Houses Let 1n Lodg1ngs 1052 Workshops and Workplaces 3086 Total 4707 87 A statement, w1th spec1al reference to the l1st set out above, 1s conta1ned 1n the follow1ng tables Number of places. JNumber of 1nspect1ons, 1911. Number of not1ces, 1911. Number of prosecut1ons, 1911. On reg1ster at end of 1910. Added 1n 1911. Re. moved 1n 1911. On reg1ster at end of 1911. M1lk prem1ses 208 25 33 200 506 10 - Cowsheds 5 . . 5 40 1 — Slaughterhouses 7 - - 7 130 1 — Offens1ve trade prem1ses 2 — — 2 28 — — 1ce cream prem1ses 86 10 — 96 121 8 — Houses let 1n lodg1ngs 758 294 — 1052 7539 1465 . MORTUARY. Removed by 1nspectors. Number of bod1es rece1ved 322 — Number of 1nfect1ous bod1es rece1ved — 3 D1s1nfect1on. Number of rooms d1s1nfected 948 Number of Art1cles d1s1nfected 13921 Cleans1ng of Persons Act, 1897. Adults. Ch1ldren. Males. Females. Males. Females. Total. Number of persons cleansed 6,510 2,575 504 463 10,052 Bakehouses. Number on reg1ster at end of 1911 76 Number above ground 8 Number underground 68 Number of 1nspect1ons 108 Number of Not1ces. 1nt1mat1ons, 10, Statutory Not1ces, 1 11 Number of prosecut1ons N1l Places where Food 1s prepared for Sale (exclud1ng Bakehouses). Number on Reg1ster at end of 1911 183 Number of 1nspect1ons 445 Number of Not1ces 52 House to House 1nspect1ons. Number of 1nspect1ons 1166 Number of Not1ces 1ssued { 1nt1mat1ons,495 statutory Not1ces,166 } 661 Number of Prosecut1ons N1l 88 House Refuse. Number of 1nspect1ons 5,912 Number of Old Br1ck Receptacles abol1shed 21 Number of New Metal Receptacles prov1ded 158 Number of Compla1nts of Non.removal rece1ved 196 Number of Letters rece1ved re Removal 301 Number of Refusals of Occup1ers to have House Refuse removed 713 Number of Not1ces served—.1nt1mat1ons, 152 ; Statutory Not1ces, 20 172 Number of Prosecut1ons N1l Water Supply. London County Counc1l (General Powers) Act, 1907. Sect1on 78. Number of Prem1ses where water supply has been prov1ded to Upper Storeys 327 Number of Statutory Not1ces served 141 Number of Prosecut1ons N1l Overcrowd1ng. Number of Dwell1ng Rooms overcrowded 85 Number remed1ed 85 Number of Prosecut1ons N1l Underground Rooms. Number 1llegally occup1ed 245 Number remed1ed 245 Number of Prosecut1ons N1l 1nsan1tary Houses. Number closed under Publ1c Health (London) Act, 1891 N1l Number closed under Part 11 of the Hous1ng of the Work1ng Classes Act N1l Number closed under Sect1on 17 Hous1ng, Town Plann1ng, &c. Act, 1909 5 Verm1nous Rooms. London County Counc1l (General Powers) Act, 1904, Sect1on 20 (l). Number of rooms cleansed 325 Number of Prosecut1ons N1l Shelter prov1ded under Sect1on 60 (4) of the Publ1c Health (London) Act, 1891. N umber of persons accommodated dur1ng the year :— 16 adults. 12 ch1ldren. Revenue Acts. Number of houses for wh1ch appl1cat1ons were rece1ved 6 Number of tenements compr1sed there1n 49 N umber of tenements for wh1ch cert1f1cates were granted 49 „ „ „ » refused N1l „ „ „ „ deferred N1l 89 LOCAL GOVERNMENT BOARD AND OTHER TABLES. TABLE 1. V1TAL STAT1ST1CS OF THE BOROUGH OF ST. MARYLEBONE. DUR1NG 1911 AND PREV1OUS TEARS. Year. 1 Populat1on est1mated to M1ddle of each year. 2 B1rths, Total Deaths Reg1stered 1n the D1str1ct. Transferable Deaths.J Nett Deaths belong1ng to the D1str1ct. Uncorrected No. 3 Nett. of Nonres1dents reg1stered 1n the D1str1ct. + 8 of Res1dents not reg1stered 1n the D1str1ct. + 9 Under 1 Year of Age. At all Ages. No. + 4 Rate. 5 No. * 6 Rate. 7 No. * 10 Rate per 1,000 Nett B1rths. 11 No. * 12 Rate. 13 1906 127,960 4,029 2,648 207 1,506 11.8 334 759 322 121.6 1,931 15.1 1907 127,718 3,936 2,583 20.2 1,574 12.3 433 790 264 102.2 1,931 15.1 1908 126,867 4.146 2,559 20.2 1,703 14.3 652 794 267 104.3 1,845 15.4 1909 126,027 4,041 2,534 200 1,758 147 678 769 259 1023 1,849 15.4 1910 125,195 4,111 2,556 201 1,566 12.9 658 699 253 989 1,607 13.3 1911 117,844 4,130 2,375 20.2 1,578 14.2 600 840 261 109.8 1,818 16.3 Notes.—Th1s Table 1s arranged to show the gross b1rths and deaths 1n the d1str1ct, and the b1rths and deaths properly belong1ng to 1t w1th the correspond1ng rates. For years before 1911 some of the corrected rates probably w1ll not be ava1lable. The rates should be calculated per 1,000 of the est1mated gross populat1on. 1n a d1str1ct 1n wh1ch large Publ1c 1nst1tut1ons for the s1ck or 1nf1rm ser1ously affect the stat1st1cs, the rates 1n Columns 5 and 13 may be calculated on a net populat1on, obta1ned by deduct1ng from the est1mated gross populat1on the average number of 1nmates not belong1ng to the d1str1ct 1n such 1nst1tut1ons. * 1n Column 6 are to be 1ncluded the whole of the deaths reg1stered dur1ng the year as hav1ng actually occurred w1th1n the d1str1ct. 1n Column 12 1s to be entered the number 1n Column 6, corrected by substract1on of the number 1n Column 8 and by add1t1on of the number 1n Column 9. Deaths 1n Column 10 are to be s1m1larly corrected by subtract1on of the deaths under 1, 1ncluded 1n the number g1ven 1n Column 8, and by add1t1on of the deaths under 1 1ncluded 1n the number g1ven 1n Column 9. f The Med1cal Off1cer of Health w1ll be able from the returns made to h1m by the local Reg1strar of Deaths to f1ll 1n Column 8 1n accordance w1th the rule 1n the next paragraph below. The Reg1strar.General, e1ther d1rectly or through the County Med1cal Off1cer of Health, w1ll supply the Med1cal Off1cer of Health w1th the part1culars of deaths to be entered 1n Column 9 ; and all such deaths must be 1ncluded 1n th1s Column, unless an error 1s detected, and 1ts correct1on has been accepted by the Reg1strar.General. For Column 4 the Reg1strar.General w1ll furn1sh to the Med1cal Off1cer of Health, a Statement of the number of b1rths need1ng to be added to or subtracted from the total suppl1ed by the local Reg1strar. ‡ " Transferable Deaths" are deaths of persons who, hav1ng a f1xed or usual res1dence 1n England or Wales, d1e 1n a d1str1ct other than that 1n wh1ch they res1ded. The deaths of persons w1thout f1xed or usual res1dence, e.g., casuals, must not be 1ncluded 1n Columns 8 or 9, except 1n certa1n 1nstances under 3 (6) below. The Med1cal Off1cer of Health w1ll state 1n Column 8 the number of transferable deaths of " non.res1dents " wh1ch are to be deducted, and w1ll state 1n Column 9 the number of deaths of .. res1dents .. reg1stered outs1de the d1str1ct wh1ch are to be added 1n calculat1ng the net death.rate of h1s d1str1ct. The follow1ng spec1al cases ar1se as to Transferable Deaths:— (1) Persons dy1ng 1n 1nst1tut1ons for the s1ck or 1nf1rm, such as hosp1tals, lunat1c asylums, workhouses, and nurs1ng homes (but not almshouses) must be regarded as res1dents of the d1str1ct 1n wh1ch they had a f1xed or usual res1dence at the t1me of adm1ss1on. 1f the person dy1ng 1n an 1nst1tut1on had no f1xed res1dence at the t1me of adm1ss1on, the death 1s not transferable. 1f the pat1ent has been d1rectly transferred from one such 1nst1tat1on to another, the death 1s transferable to the d1str1ct of res1dence at the t1me of adm1ss1on to the f1rst 1nst1tut1on. (2) The deaths of 1nfants born and dy1ng w1th1n a year of b1rth 1n an 1nst1tut1on to wh1ch the mother was adm1tted for her conf1nement should be referred to the d1str1ct of f1xed or usual res1dence of the parent. (3) Deaths from V1olence are to be referred (a) to the d1str1ct of res1dence, under the general rule; (6) 1f th1s d1str1ct 1s unknown, or the deceased had no f1xed abode, to the d1str1ct where the acc1dent occurred, 1f known; (c) fa1l1ng th1s, to the d1str1ct where death occurred, 1f known ; and (d) fa1l1ng th1s, to the d1str1ct where the body was found. Total populat1on at all ages, 118,221, at Census of 1911. Area of d1str1ct 1n acres (exclus1ve of area covered by water), 1427.8 acres. 90 TABLE 1. (A). V1tal Stat1st1cs of Separate Local1t1es 1n 1910 and the ten Prev1ous Years. Names of Local1t1es. The Whole Borough. All Souls. St. Mary. Chr1st Church. St. John. Year. Populat1on est1mated to m1ddle of each year. B1rths reg1stered. Deaths at all Ages. Deaths under 1 year. Populat1on est1mated to m1ddle of each year. B1rths reg1stered. Deaths at all Ages. j Deaths under 1 year. Populat1on est1mated to m1ddle of each year. B1rths reg1stered. Deaths at all Ages Deaths under 1 year. Populat1on est1mated to m1ddle of each year. B1rths reg1stered. Deaths at all Ages. Deaths under 1 year. Populat1on est1mated to m1ddle of each year. B1rths reg1stered. 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. 1901 133,301 3,042 2,211 449 35,388 583 514 92 37,963 854 607 90 39,527 1,178 704 202 20,423 427 386 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 43 1904 131,000 2,791 2,172 393 34,781 598 512 79 37,293 740 560 106 38,853 1,058 753 168 20,073 395 347 40 1905 129,453 2,618 2,026 358 34,370 527 438 81 36,853 696 530 81 38,394 1,043 723 154 19,836 352 335 42 1906* 127,960 2,648 1,931 322 33,974 520 408 64 36,428 627 556 72 37,951 1,088 652 141 19,607 413 315 45 1907 127,718 2,583 1,931 264 33,908 537 415 47 36,358 629 510 51 37,881 1,029 683 131 19,571 388 323 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 19,439 404 245 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 19,310 317 283 28 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 Averages of Years 1901 to/ 1910 129,187 2,710 2,021 340 34,298 579 447 68 36,784 664 546 80 38,314 1,074 697 150 19,794 393 331 41 1911 117,844 2,375 1,818 261 31,287 502 400 40 33,548 485 440 49 34,953 1,041 690 137 18,056 347 288 35 •The Rectory and St. Mary.s Reg1strat1on Sub.D1str1cts were amalgamated th1s year. 91 TABLE 11. Cases of 1nfect1ous D1sease Not1f1ed dur1ng the Year end1ng 31st December, 1911. Not1f1able D1sease. Cases not1f1ed 1n whole D1str1ct. Total cases not1f1ed 1n each local1ty. Number of cases removed to Hosp1tal from each local1ty. Cases 1solated at home At all ages. At ages—years. All Souls St. Mary Chr1st Church St. John Totals. All Souls St. Mary Chr1st Church St. John Totals Under 1 1 to 5 5to 15 15 to 25 25 to 45 45 to 65 65 and upwards Ch1cken.pox 119 7 40 65 4 3 - - 21 22 28 48 119 - - - - - 119 Pol1o Myel1t1s 1 - 1 - - - - - - - - 1 1 - - - - - 1 D1phther1a, 1nclud1ng Membranous Croup 133 - 52 42 14 23 2 - 56 31 36 10 133 53 27 35 6 121 12 Erys1pelas 109 6 4 3 17 28 40 11 17 32 50 10 109 10 17 13 - 40 69 Scarlet Fever 329 4 76 208 23 18 - - 53 84 173 19 329 52 81 170 15 318 11 Typhus Fever - - - - - - - - - - - - - - - - - - Enter1c Fever 18 - - 5 6 4 2 1 7 1 4 6 18 3 1 4 3 11 7 Relaps1ng Fever - - - - - - - - - - - - - - - - - - - Puerperal Fever 4 - - - - 4 - - - - 3 1 4 - - 2 1 3 1 Ophthalm1a Neonatorum 21 21 - - - - - - 3 8 7 3 21 - 1 1 - 2 19 Cerebro.Sp1nal Fever 2 - - 1 - 1 - - - 1 1 - 2 - 1 - - 1 1 Phth1s1s :— Under Tuberculos1s Regulat1ons, 1908. 200 - 3 7 19 81 72 18 35 82 75 8 200 23 59 48 7 137 63 Under Tuberculos1s Regulat1ons, 1911. 280 - 11 60 50 112 41 6 51 68 123 38 280 8 7 14 4 33 247 Others 56 - 3 6 6 31 9 1 13 8 27 8 56 1 - 1 - 2 54 Totals 1272 38 190 397 139 305 166 37 256 337 527 152 1272 150 194 288 36 668 604 92 TABLE 111. Causes of, and Ages at Death dur1ng the year end1ng 31st December, 1911. No CAUSES OF DEATH. Nett deaths at the subjo1ned ages of " Res1dents" whether occurr1ng w1th1n or w1thout the d1str1ct. Deaths whether of Res1dents or Non-Res1dents 1n 1nst1tut1ons 1n the D1str1ct. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 5 and under 45. 15 and under 65. (55 and upwards. 1 Enter1c Fever 3 - - — — 2 1 — — 2 2 Small-pox — — — — — — — - — — 3 Measles 64 12 33 17 2 — - — — 2 4 Scarlet Fever 7 2 1 3 1 — — — — — 5 Whoop1ng-Cough 30 13 8 6 3 — — — — 3 6 D1phther1a and Croup 7 1 — 3 2 1 — — — 2 7 1nfluenza 23 2 — — — — 2 9 10 2 8 Erys1pelas 6 — — — — — 2 4 — — 9 Cerebro-Sp1nal Fever 2 — — — 1 — 1 — — 1 10 Typhus Fever — — — — — — — — — — 11 Cont1nued Fever — — — — — — — — — — 12 Phth1s1s 172 — 2 4 3 12 75 62 14 28 13 Tuberculous Men1ng1t1s 17 5 3 4 5 — — — — 10 14 Other Tuberculous D1seases 24 4 3 4 2 5 3 2 1 18 15 Rheumat1c Fever 2 - — — 1 — — 1 — 1 16 Cancer 161 — — — — 1 16 82 62 193 17 Bronch1t1s 185 4 4 3 1 1 9 40 123 28 1S Broncho-Pneumon1a 57 11 13 6 — 2 6 11 9 14 19 Pneumon1a (all other forms) 78 9 1 7 1 1 19 24 16 23 20 Other D1seases of Resp1ratory Organs 18 — 1 — — — 3 4 10 7 21 D1arrhoea and Enter1t1s 92 66 12 3 3 - 2 3 3 6 22 Append1c1t1s and Typhl1t1s 11 — 1 — 2 - 3 3 2 11 23 Alcohol1sm 6 — — - — — — 5 1 2 24 C1rrhos1s of L1ver 17 — — - — — 4 10 3 9 25 Nephr1t1s and Br1ght's D1sease 54 — — 1 — — 10 30 13 28 26 Puerperal Fever - - - - - - - - - -—- 27 Other acc1dents and d1seases of Pregnancy and Partur1t1on 7 3 — — — 1 3 — — 11 28 Congen1tal Deb1l1ty and Malformat1on, 1nclud1ng Premature B1rth 78 74 3 1 - - - - - 44 29 V1olent Deaths, exclud1ng Su1c1de 57 6 3 6 6 - 6 14 16 24 80 Su1c1des 17 — — — — 4 6 5 2 3 31 Other def1ned Causes 622 48 6 4 15 19 57 179 276 333 32 D1seases 1ll def1ned or unknown 1 1 — — — — — — — — Totals 1818 261 94 71 48 49 246 488 561 805 93 TABLE 111. (a).—Causes of, and ages at death dur1ng the 52 weeks to 31st December, 1911, accord1ng to Sub-D1str1cts. No. CAUSES OF DEATH. All Souls. St. Mary. Chr1st Church St. John. Total. 1 Enter1c Fever — 1 1 1 3 2 Small Pox — — — — — 3 Measles 3 9 51 1 64 4 Scarlet Fever — 2 5 — 7 5 Whoop1ng Cough 2 2 23 3 30 6 D1phther1a and Croup — 4 2 1 7 7 1nfluenza 4 13 4 2 23 8 Erys1pelas 2 1 3 — 6 9 Cerebro-Sp1nal Fever 1 — 1 — 2 10 Typhus Fever — — — — — 11 Cont1nued Fever — — — — — 12 Phth1s1s 51 30 65 26 172 13 Tuberculous Men1ng1t1s — 2 12 3 17 14 Other Tuberculous D1seases 7 2 12 3 24 15 Rheumat1c Fever — — — 2 2 16 Cancer 42 35 44 40 161 17 Bronch1t1s 42 46 64 33 185 18 Broncho-Pneumon1a 11 13 22 11 57 19 Pneumon1a (all other forms) 16 19 35 8 78 20 Other D1seases of Resp1ratory Organs 5 5 4 4 18 21 D1arrhoea and Enter1t1s 13 18 55 6 92 22 Append1c1t1s and Typhl1t1s 4 5 1 1 11 23 Alcohol1sm 1 3 2 — 6 24 C1rrhos1s of L1ver — 4 9 4 17 25 Nephr1t1s and Br1ght's D1sease 12 13 18 11 54 26 Puerperal Fever — — — — — 27 Other acc1dents and d1seases of Pregnancy and Partur1t1on 1 — 5 1 7 28 Congen1tal Deb1l1ty and Malformat1on, 1nclud1ng Premature B1rth 19 20 30 9 78 29 V1olent Deaths, exclud1ng Su1c1de 13 17 21 5 56 30 Su1c1des 5 4 6 3 18 31 Other def1ned Causes 146 171 195 110 622 32 D1seases 1ll def1ned or unknown — 1 — — 1 Totals 400 440 690 288 1818 94 TABLE 1V. 1nfant Mortal1ty. Nett Deaths from Stated Causes at var1ous ages under 1 Year of Age. No. CAUSE OF DEATH. Under 1 Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under\ Weeks. Total under 1 month. 1 and under 3 Months 3 and under6 Months 6 and under 9 Mon.hs 9 and under 12 Months Total Deaths under 1 Year. 1 Small-Pox — — — - — — — - - — 2 Ch1cken-Pox — — — — — — — — — — 3 Measles — 1 — - 1 - — 3 8 12 4 Scarlet Fever — — — — — — — 1 1 2 5 D1phther1a and Croup - - - - - - - - 1 1 6 Whoop1ng Cough - - - - - 3 2 3 5 13 7 D1arrhoea — — 1 2 3 20 11 9 6 49 s1 Enter1t1s — — 2 — 2 7 2 4 2 17 9 Tuberculous Men1ng1t1s - - - - - - 1 2 2 5 10 Abdom1nal Tuberculos1s - - - - - - - - - - 11 Other Tuberculous D1seases — — — - — — 1 2 1 4 12 Congen1tal Malformat1on 4 1 2 - 7 4 — 1 1 13 13- Premature B1rth 16 3 4 4 25 6 — — — 33 14 Atrophy, Deb1l1ty and Marasmus ... 9 1 2 1 13 7 5 2 3 30 15 Atelectas1s — — — — — — 1 — — 1 16 1njury at B1rth 5 — — — 5 — — — — 5 17 Erys1pelas — — — — — — — — — — 18 Syph1l1s — 1 — — 1 1 — — — 2 19 R1ckets — — — — — — — — 1 1 20 Men1ng1t1s (not Tuberculous) — — — 1 1 1 1 2 1 6 21 Convuls1ons 2 — 1 1 4 3 1 3 — 11 22 Gastr1t1s — — — — — 1 — — — 1 23 Laryng1t1s - - - - - - - - - - 24 Bronch1t1s — — — — — 2 1 4 1 8 25 Pneumon1a (all forms) 1 — 2 — 3 4 1 3 5 16 26 Suffocat1on, Overly1ng 2 — — — 2 3 1 1 — 7 27 Other Causes 3 3 — 1 7 8 2 3 4 24 Totals 42 10 14 10 74 70 30 43 42 261 f Leg1t1mate, 2,224 Nett B1rths 1n the Year J (. 1lleg1t1mate, 151 Total 1 2,375 1 Leg1t1mate 1nfants, 239 Nett Deaths 1n the Year < ( 1lleg1t1mate 1nfants, 22 Total 261 95 TABLE 1V. (a). 1nfant mortal1ty. Nett Deaths from Stated Causes at var1ous ages under 1 Year of Age 1n Local1t1es. No. CAUSE OF DEATH. All Souls. St. Mary. Chr1st Church. St. John. Total.  1 Small Pox — — - — — 2 Ch1cken Pox — — — — — 3 Measles — 2 10 — 12 4 Scarlet Fever — 1 1 — 2 5 D1phther1a and Croup — — — 1 1 6 Whoop1ng Cough 2 - 8 3 13 7 D1arrhoea 4 6 35 4 49 8 Enter1t1s 2 5 9 1 17 9 ( Tuberculous Men1ng1t1s — - 4 1 5 1o Abdom1nal Tuberculos1s — - — — — 11 Other Tuberculous D1seases 1 — 2 1 4 12 Congen1tal Malformat1on 4 5 4 — 13 13 Premature B1rth 5 7 16 5 33 14 Atrophy, Deb1l1ty and Marasmus 6 9 11 4 30 1S Atelectas1s 1 — — — 1 16 1njury at B1rth 1 1 3 — 5 17 Erys1pelas - — — — — 18 Syph1l1s — — 1 1 2 19 R1ckets — — 1 — 1 2o Men1ng1t1s (not Tuberculous) 1 1 2 2 6 21 Convuls1ons 2 1 5 3 11 22 Gastr1t1s — — — 1 1 23 Laryng1t1s — — — — — 24 Bronch1t1s 3 — 4 1 8 25 Pneumon1a (allforms) 2 4 7 3 16 26 Suffocat1on, Overly1ng — 2 4 1 7 27 Other Causes 6 5 10 3 24 Totals 40 49 137 35 261 Nett B1rths 1n the Year Legitimate, 2,224 Illegitimate, 151 Total 2,375 Nett Deaths 1n the year Legitimate, 239 Illegitimate, Infants, 22 Total 261 96 VACC1NAT1ON RETURNS. Supplemental Return for 1910. RETURN made to the Board of Guard1ans and Local Government Board on the 8th February, 1912, by Mr. Edward A. Fr1th, Vacc1nat1on Off1cer of the St. Marylebone Par1sh, respect1ng the Vacc1nat1on of Ch1ldren whose B1rths were reg1stered 1n St. Marylebone, from 1st January to 31st December, 1910, 1nclus1ve. Reg1strat1on Sub-D1str1cts compr1sed 1n the Vacc1nat1on Off1cer's D1str1ct. Number of B1rths returned 1n the " B1rth L1st Sheets " as reg1stered from 1st January to 31st Dec. 1910. Number of these B1rths duly entered by 31st January, 1912, 1n Columns 1, 11, 1V and V of the "Vacc1nat1on Reg1ster" (B1rth L1st Sheets), v1z. : Number of these B1rths wh1ch on 31st January, 1912, rema1ned unentered 1n the "Vacc1nat1on Reg1ster " on account (as shown by Report Book) of Number of these B1rths rema1n1ng on 31st January, 1912, ne1ther duly entered 1n the "Vacc1nat1on Reg1ster " (columns 3, 4, S, 6 and 7 of th1s Return) nor temporar1ly accounted for 1n the " Report Book" (columns 8, 9, and 1O of th1s Return). Total Number of Cert1f1cates of Successful Pr1mary Vacc1nat1on at ALL AGES rece1ved dur1ng the calendar year 1911.  Col. 1. Successfully Vacc1nated. Col. 11. Col.' 1V. Number 1n respect of whom Cert1f1cates of Consc1ent1ous Object1on have been rece1ved. Col. v. Dead, Unvacc1nated. Postpone ment by Med1cal Cert1f1cate. Removal to D1st11cts, the Vacc1nat1on Off1cer of wh1ch has been duly appr1sed. Removal to Places unknown, or wh1ch cannot be reached; and Cases not hav1ng been found. 1nsuscept1ble of Vacc1nat1on. Had SmallPox. 1 2 3 4 5 6 7 8 9 10 11 12 1. St. John 355 294 - - 24 11 5 5 13 3 3527 Born 1n St. Marylebone 2. Chr1stchurch 872 643 1 - 77 63 11 10 60 7 3. St. Mary 2,205 1,826 4 - 70 128 89 56 28 4 102 Born elsewhere 4. All Souls 690 429 - - 36 76 13 97 35 4 Total 4,122 3,192 5 - 207 278 118 168 136 18 3,629 Dated 8th February, 1912. (S1gned) EDWARD A. FR1TH, Vacc1nat1on Off1cer. 97 VACC1NAT1ON RETURNS. Return for the Per1od January—June, 191 1. return made to the Board of Guard1ans and Local Government Board on the 8th February, 1912, by Mr. Edward a. Fr1th, Vacc1nat1on Off1cer of the St. Marylebone Par1sh, respect1ng the Vacc1nat1on of Ch1ldren whose B1rths were reg1stered 1n St. Marylebone, from 1st January to 30th June, 1911, 1nclus1ve. Reg1strat1on Sub-D1str1cts compr1sed 1n the Vacc1nat1on Off1cer's D1str1ct. Number of B1rths returned 1n the " B1rth L1st Sheets " as reg1stered from 1st January to 30th June, 1911. Number of these B1rths duly entered by 31st January, 1912, 1n Columns 1, 11, 1V and V of the "Vacc1nat1on Reg1ster" (B1rth L1st Sheets), v1z. : Number of these B1rths wh1ch on 31st January, 1912, rema1ned unentered 1n the "Vacc1nat1on Reg1ster " on account (as shown by Report Book) of Number of these B1rths rema1n1ng on 31st January, 1912, ne1ther duly entered 1n the "Vacc1nat1on Reg1ster " (columns 3, 4, 5, 6, and 7 of th1s Return) nor temporar1ly accounted for 1n the " Report Book " (columns 8, 9, and 1 oof th1s Return). Number of Cert1f1cates of Consc1ent1ous Object1on actually rece1ved by the Vacc1nat1on Off1cer, 1rrespect1ve of the dates of b1rth of the Ch1ldren to wh1ch they relate, dur1ng the year 1911. Col. 1. Successfully Vacc1nated. Col. 11. Col. 1V. Number 1n respect of whom Cert1f1cates of Consc1ent1ous Object1on have been rece1ved. Col. V. Dead, Unvac- c1nated. Postpone ment by Med1cal Cert1f1cate. Removal to D1str1cts, the Vacc1nat1on Off1cer of wh1ch has been duly appr1sed. Removal to Places unknown or wh1ch cannot he reached; and Cases not hav1ng been found. 1nsuscept1ble of Vacc1nat1on. Had SmallPox. 1 2 3 4 5 6 7 8 9 10 11 12 1. St. John 152 117 - - 14 8 3 9 6 2 2. Chr1stchurch 437 307 1 - 37 34 11 8 33 6 3. St. Mary 1,185 950 1 - 47 49 65 50 1S 5 4. All Souls 383 273 3 - 12 23 2 52 15 3 Total 2,157 1,647 5 - 110 114 81 112 72 16 241 Dated 8th February, 1912. (S1gned) EDWARD A. FR1TH, Vacc1nat1on Off1cer.