Ac 4353 Stmary 17 (metropolitan borougb of st. marglebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1912, 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 AND SONS, LTD. 1913. ) • >■,*</■ -■,■-'>.1; "s1 'J i 'V Metropolitan Borough of St. Marglebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1912, 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. 1913. GEO. PULMAN AND SONS, LONDON AND WEALDSTONE Public Health Office, 24, Somerset Street, London, W. May, 1913. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Miss Roberts 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 1912. This report is made in accordance with the instructions of the Local Government Board relating to Annual Reports of Medical Officers of Health, and in it there are included the report of the Public Analyst and the report on Factories and Workshops, giving the details called for by the Secretary of State for the Home Department. The year 1912 in practically every respect compares most favourably with previous years. So far indeed as Infantile Mortality is concerned the rate recorded, 93, is the lowest yet reached. The work done in every branch of the Department was again very large in amount, and there is no doubt that what has been done in 1912 and in previous years must be given credit for some at least of the reduction that has taken place in the Infantile Mortality and other rates. That all the members of the staff of the department did so much is to a very large extent due to the assistance and encouragement given by the Public Health Committee. For the greater part of the year, Councillor the Rev. J. A. Beaumont was in the chair, being succeeded in November by Councillor Sir Horatio H. Shephard, while the chairmanship of the Dust Sub-Committee was entrusted to Mr. Alderman J. LeaSmith. These gentlemen and all the members of the Committee took the keenest interest in the work of the department and I take this opportunity of thanking them for the kindness they have shown and the support they have given me. Mr. Beaumont I wish particularly to thank for the help and encouragement he gave me and the interest he took in the department, not only during 1912, but throughout all the years he acted as Chairman. For the loyal manner in which the members of the staff have acted together and with me, I have to thank them also. Each one has worked well, and I am glad of this opportunity of recording my appreciation of their efforts. I am, Mr. Mayor, Madam 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, Registration, Notifications 8 Deaths and Death Rates 9, 10 District Births and Deaths 10 Causes of, and Ages at, Death 10, 11 Deaths in relation to age 10 Infantile Mortality11, 12, 13. 14, 15 Prevention of Infantile Mortality 15, 16, 17, 18 19, 20, 21, 22, 23, 24 Deaths in relation to Disease 24 Diarrhœal Diseases 24 Zymotic Diseases, Phthisis, &c., and Respiratory Diseases 25 Zymotic Diseases 25 Phthisis and other Tubercular Diseases 26 Respiratory Diseases 27 Cancer and Malignant Disease 27, 28, 29, 30, 31, 32 Alcoholism 32 Accident, Suicide and Manslaughter 32 PAGE Records of Diseases 32 Notifications 33, 34 Discharge Notices 34 Diphtheria and Membranous Croup 34 Scarlet Fever 36 Enteric Fever 35, 36 Cerebro-Spinal Fever 36 Erysipelas 36 Puerperal Fever 36 Measles 37, 38 ,, Deaths 37 ,, Isolation of 37 Whooping Cough 39 Glanders 39 Polio Encephalitis and Myelitis 39 Chicken-pox 39 Ophthalmia Neonatorum 39 Phthisis 39 ,, Notifications 40, 41 ,, Deaths 41, 42 ,, Preventive Measure against 43, 44, 45, 46, 47, 48, 49, 50 ,, Bacteriological diagnosis 45 Disinfection 50, 51 Bacteriological Examinations 51, 52 Part II. Departmental. PAGE Staff Meetings 55 Protection of Food Supply 56 Inspection 56 Surrenders 56, 57 Seizures 57 Prosecutions 58 Slaughterhouses 59 Milk Supply 59 Cowhouses 59 Milkshops, etc. 60 Examination of Milk 60 Ice Cream Premises 61 Butter, Margarine, etc. 61 Restaurants, Food Stalls, etc. 61 Offensive Trades 62 Bakehouses 62 Sale of Food and Drugs Acts 62, 63 Public Analyst's Reports 64-70 Bacteriological Examination of Food 70 Certification of Meat Food Products 71 Water Supply 71 Housing 72 Housing, Town Planning, etc. Act, 1909 72, 73. 74, 76, 76, 77, 78 House to House Inspection 78 Sanitary Survey ,, 79 PAGE Houses Let in Lodgings 79 By-laws 80, 81, 82, 83, 84, 85 Common Lodging Houses 85 Overcrowding 86 Underground Rooms 86 Customs and Inland Revenue Acts 87, 88 Nuisances 88 Work of Sanitary Inspectors 88, 89 Legal Proceedings 90 Drain Plans and Drainage 91 Combined Drainage 92 Black Smoke Nuisances 92 Removal of House Refuse 92, 93 Verminous Persons Baths 94 Cleansing of Persons Act, 1897 95 The Shelter 96 Public Mortuary 96 Public Sanitary Conveniences 96 Factories and Workshops 97 Inspection 98 Defects Found 98 Home Work 99 Registered Workshops 100 Sanitary Inspection (Summary) 101, 102, 103 Local Government Board Tables I.-V. 103-107 Vaccination Returns 108, 109 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 1912. " " Diphtheria " " " " " Typhoid Fever " " " 7 POPULATION. The population of the Borough at the middle of 1912, as estimated by the Registrar General, was 116,155. In 1901, when the census was taken, it was 133,301. The census population of 1911 was 118,221, and the decrease 15,080, or roughly 1,500 a year. In estimating populations, the Registrar General bases his calculations upon the two preceding census populations, and according as there has been an increase or a decrease in the more recent over the one immediately before it, in each succeeding year obtains a figure higher or lower than that resulting at the time of enumeration. There having been a fall in the population of St. Marylebone between 1901 and 1911, between 1911 and 1921, when the next census is due to be taken, there will continue to be shown a falling population each year by the method of estimation adopted by the Registrar General. Since April 2nd, 1911, it is calculated to have been reduced by 2,066. The estimated reduction between the middle of 1911 and the middle of 1912 is 1,689. The populations of the four Sub-Districts for the last four years, estimated by the same method, are:— 1909. 1910. 1911. 1912. All Souls 33,460 33,239 29,392 28,971 St. Mary 35,878 35,641 32,025 31,566 Christ Church 37,379 37,133 36,425 35,903 St. John 19,310 19,182 20,002 19,715 126,027 125,195 117,844 116,155 All of these, as well as the total population of the Borough are, it must be remembered, merely estimated. It is not claimed for the method by which the figures are obtained that it is accurate. For the purposes of a review of the health of the Borough, however, it is necessary to have some figure representing population upon which to work out birth, death, and disease rates, and that calculated by the Registrar General's method is more satisfactory and more nearly correct than any estimated in any other way. As to why there should be a decrease in the population and why it should be regarded as continuing year after year, the explanation given in the Report for 1911, as follows, will serve:— " 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 1912 was 2,246* being 129 under the number for 1911. Male births numbered 1,165, and female 1,081. The birth rate per 1,000 was 19.3. The accompanying table compares the rates in the several registration sub-districts with those of the two previous years. 1910. 1911. 1912. All Souls 21.5 16.0 15.6 St. Mary 12.1 14.4 14.3 Christ Church 27.3 29.7 27.0 St. John 20.4 19.2 18.8 Notifications. The total number of notifications received during the year under the Notification of Births Act, 1907, was 4,083. As in previous years persons failing to make notification within thirty-six hours were communicated with, but the number of letters sent was quite small. In no case did the explanation offered appear to be unreasonable, and it was not considered necessary to institute proceedings. The following are the sources of the notifications received during the year, in some instances duplicates coming to hand from different sources. For purposes of comparison the figures for the two preceding years are also given, and it will be noted that the percentage of notifications by doctors is increasing, while that by parents is diminishing. 1912. 1911. 1910. From parents. 509 or 12.16 per 564 or 14.06 per cent. 768 or 18.93 per cent. cent. „ doctors 592 „ 14.14 „ 491 „ 12.24 „ 387 „ 9.54 „ „ midwives 780 „ 18.64 „ 774 „ 19.30 „ 854 ,, 21.06 „ „ other 1.8 „ 43 „ 38 „ 95 ,, 27 „ 66 „ persons „ hospitals, 2,286 „ 54.63 „ 2,223 „ 55.45 „ 1,970 „ 48.58 „ etc. Of the total births notified, 132 referred to still births (77 males and 55 females); 1,847 took place in Queen Charlotte's Hospital; 404 at the Middlesex Hospital; and 1,832 were born at home. Of those notified as having occurred in St. Marylebone, 1,865 belonged to other Boroughs. Legitimate Males 634 ,, females 579 Illegitimate Males 344 „ Females 308 Total 1,865 *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 58 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone. Legitimate Males 25 „ Females 15 Illegitimate Males 5 „ Females 10 Total 58 9 DEATHS AND DEATH RATES. Deaths to the number of 1,635 were registered during the year. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions, etc., outside, but exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other districts. The death rate (corrected) per 1,000 was 14'8. By a "corrected" death rate is meant one which has been treated in such a way, raised or lowered in a certain ratio, as to be comparable with the death rates, similarly treated, of other districts. That " correction " is necessary is due to 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. To overcome this difficulty each year the Registrar-General issues a " factor for correction " for each district which represents the number of times which the actual death rate of each must be raised in order to permit of its examination side by side with the rates in other districts. The " factor for correction," called shortly the " factor," in the case of St. Marylebone is 1 0652, and the corrected death rate is obtained by multiplying with this figure the number of deaths per 1,000, calculated from the total deaths and the population, estimated to the middle of 1912. The number of deaths in 1911 was 1,818, and the death rate 16.3. As was shown in the report for that year these figures were, for certain reasons, climatic and other, abnormally high. In 1910, the year in which the actual number of deaths was the lowest recorded and the death rate per 1,000 also the lowest, the figures were 1,607 and 13.3. With these, the results obtained in 1912 compare favourably and cannot be regarded as unsatisfactory. The following short table shows the death rates in the several registration subdistricts in 1912, and compares them with those of the three previous years:— 1909. 1910. 1911. 1912. All Souls 12.6 10.7 12.7 13.9 St. Mary 12.8 11.7 13.1 13.8 Christ Church 18.2 15.6 19.7 17.4 St. John 14.6 13.1 15.9 13.8 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 page 104. 1O TABLE I. Sub-District. Population estimated to Middle of Year, 1912. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 28,971 227 225 452 202 177 379 St. Mary 31,566 246 207 453 214 197 411 Christ Church 35.903 489 482 971 321 267 588 St. John 19,715 203 167 370 105 152 257 The Borough 116,155 1,165 1,081 2,246 842 793 1,635 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 fact that to the aged the colder quarters are the more trying is clearly shown. DEATHS IN RELATION TO AGE. The following table contains an analysis of the 1,635 deaths, according to age, and shows the numbers which occurred in each age group. For purposes of comparison the figures for 1911 are printed along with those for the year under review. In every respect it will be noted that 1912 was very much better than 1911, though the difference in some groups is much more marked than in others. The fact that it is at the extremes of life that most deaths occur is well shown in both sets of figures:— Under 1 year 1and under 2years, 2 and 5 years. 5 and under 15 15 and under 25 years 25 and 45 and under 65 65 and upwards. At all ages Age Periods. No. of 1911 261 94 71 48 49 246 488 661 1,818 Deaths l912 209 69 45 57 51 238 426 540 1,635 The percentage relation of each age group to the total number of deaths in 1912 was:— Under 1 year 12.8 per cent. 1 and „ 2 years 4.2 „ 2 „ „ 5 „ 2.8 „ 5 „ 15 „ 3.4 „ 15 „ „ 25 „ 3.1 „ 25 „ „ 45 ,, 14.6 „ 45 „ „ 65 26.0 „ 65 „ upwards 33.1 „ That the summer quarters of the year were comparatively cold and wet probably to a great extent accounts for the smallness of the number of deaths amongst infants in the April-June and July-September periods. JanuaryMarch. AprilJune. JulySeptember. OctoberDecember. Total. Infants under 1 year 66 38 . 50 55 209 Persons of 65 years and upwards 172 139 72 157 540 11 The extent to which each of the four divisions of the Borough shared in the deaths of those aged over 65 in 1910, 1911 and 1912, is shown below:— 1910. 1911. 1912. All Souls 101 140 123 St. Mary 147 161 156 Christ Church 141 159 161 St. John 93 101 100 Totals 482 561 540 Of the total, 138 at death were aged 65-70; 249, 70-80; 131, 80-90; and 22, 90-100. The outstanding causes of death were as follows:— Cause. 1910. 1911. 1912. Bronchitis and other respiratory diseases 114 158 192 Nephritis and Bright's Disease 24 13 18 Cancer 50 62 57 Tuberculosis 13 14 7 Influenza 5 10 2 Violent deaths 7 16 16 Causes of and ages at Death.—In table III of the Local Government Board series, which will be found at page 106, a certain amount of information is given with regard to the deaths which occurred during the year amongst residents in the Borough. The numbers dying from certain specified causes are shown, as well as the numbers dying from these causes between certain ages. In a separate column the total number of deaths which occurred in institutions in the Borough are entered. These are classified only according to cause. That the number was so high as 933, a figure which includes non-residents as well as residents, is due to the fact that, when nursing homes are included, the number of institutions is very considerable. Much of the information contained in the table, interesting as it is, calls for much fuller consideration than is given to it there. Closer enquiry into the causes which contributed to the total number of deaths is required. The figures relating to age at death also should be more fully analysed, and in the hope that some fact which may be of use may emerge this is carried out in the following pages. INFANTILE MORTALITY. The Infantile Mortality rate of any district is the number of deaths of infants under one year of age per 1,000 of the births which occurred in the same year. The number of babies under one who died in St. Marylebone in 1912 was 209 and the number of births in that year 2,246. The infantile mortality rate is therefore 93, and the lowest ever recorded. The only year in which a figure at all approaching this was recorded was 1910; that year the rate was 98'9. Never before had a rate below 100 been recorded, the next lowest to it being 102'2 which was noted in 1907. In their climatic conditions, and as is generally recognized now, these play a considerable part in relation to infantile mortality, these two years closely resembled 1912. 12 Babies born in that year were no better and no worse off so far as climate was concerned than those born in 1907 and 1910. The rates may be quite safely compared and there need be no hesitation whatever in saying that as compared with 1907 the outstanding feature of 1912 was that 10 more babies out of every 1,000 born reached the end of their first year in safety. In 1911 the rate was 109'8 per 1,000. It will be remembered, however, that the summer was an exceptionally hot and dry one, so that comparison of the figures 93 and 109'8 is not quite fair. For the reduction of the rate to 93 there can be no doubt that the efforts put forth by the Council to improve sanitation and by them and others, particularly on behalf of children, are largely responsible. The extent of the responsibility of these efforts is indicated by the difference between 102.2 in 1907 and 93 in 1912. That it can be represented by the figures 109.8 and 93 for 1911 and 1912 cannot be pretended. Part of it is certainly due to differences in the weather, but almost as certainly part of it was due to public health work. Even greater efforts than those which had been put forth in the four or five preceding years were made in 1912, and if they were capable of producing good results in previous years, they may safely be credited with some of the marked improvement shown in that year. The whole of this report is largely a record of what the efforts referred to were, but certain special works were carried out with no other object than the prevention of infantile mortality. These it is proposed to consider separately. Before doing so, however, attention may be directed to the following figures, with regard to distribution of infantile mortality, its causes, and so on. More especially should attention be directed to the accompanying chart (facing p. 12) which shows the marked fall which has taken place not only in the number of deaths amongst infants but in the rate of infantile mortality between the years 1897 and 1912. Causes of Infantile Mortality—Ages at Death. The 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 15 3 1 2 11 6 3 4 45 St. Mary 11 5 — — 2 5 3 4 30 Christ Church 23 1 5 4 10 28 19 18 108 St. John 9 1 1 1 5 3 3 3 26 Totals 58 10 7 7 28 42 28 29 209 Infantile Mortality Figures. Number of deaths of children under one year of age. Rate per 1,000 of registered births. 13 TABLE III. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year of Age. (Local Government Board Table IV.) No. CAUSE OF DEATH. Under 1 Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under 4 Weeks. Total under 1 month. I and under 3 Months 3 and under6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year. 1 Small-Pox — — — — — — 2 Chicken-Pox — — — — — — — — — — 3 Measles — — — - — - 2 2 5 9 4 Scarlet Fever — — — — — — 1 — — 1 5 Diphtheria and Croup - - - - - - - - 1 1 6 Whooping Cough — — — - — 1 2 1 2 6 7 Diarrhoea — — 1 1 2 2 4 4 1 13 8 Enteritis — — 1 — 1 1 5 — — 7 9 Tuberculous Meningitis — — — — — — — 3 1 4 l0 Abdominal Tuberculosis - - - - - - - - - - ll Other Tuberculous Diseases — — 1 1 1 3 12 Congenital Malformation 17 2 2 — 21 2 — 1 — 24 13 Premature Birth 25 2 1 1 29 3 — — — 32 14 Atrophy, Debility and Marasmus 2 2 2 2 8 2 11 2 2 25 15 Atelectasis — — — — — — - — — — 16 Injury at Birth 4 — — — 4 — — — — 4 17 Erysipelas — — — — — 1 — — — 1 18 Syphilis — — — — — 1 — — — ] 19 Rickets — — — — — — — — — — 20 Meningitis (not Tuberculous) — — — — — — — 1 3 4 21 Convulsions 2 — — — 2 — — — — 2 22 Gastritis — — - — — — — 1 — 1 23 Laryngitis — — — — — — — 1 — 1 24 Bronchitis — 2 — 2 4 1 2 3 4 14 25 Pneumonia (all forms) 4 8 4 5 21 26 Suffocation, Overlying 4 — — 1 5 — 2 — 1 8 27 Other Causes 4 2 — — 6 9 5 4 3 27 Totals 58 10 7 7 82 28 42 28 29 209 Legitimate 2,117 Legitimate Infant, 183 Nett Births in the Year Nett Deaths in the Year Illegitimate, 129 ( Illegitimate Infants, 26 Total 2,246 Total 209 14 TABLE IV. Infant mortality. Nett Deaths from Stated Causes at various ages under 1 Year of Age in Localities. (Local Government Board Table IV. (a).) No. CAUSE OF DEATH. All Souls. St. Mary. Christ Church. St. John. Total. 1 Small Pox — — - — — 2 Chicken Pox — — — — — 3 Measles — 1 8 — 9 4 Scarlet Fever — - 1 — 1 5 Diphtheria and Croup — — 1 — 1 6 Whooping Cough 1 1 4 — 6 7 Diarrhoea 4 — 9 — 13 8 Enteritis 2 1 2 2 7 9 Tuberculous Meningitis — — 2 2 4 10 Abdominal Tuberculosis — — — — — 11 Other Tuberculous Diseases 1 1 — 1 3 12 Congenital Malformation 6 4 11 3 24 13 Premature Birth 7 8 11 6 32 14 Atrophy, Debility and Marasmus 4 3 16 2 25 I5 Atelectasis — — — — — 16 Injury at Birth 2 — 1 1 4 17 Erysipelas — — 1 — 1 18 Syphilis 1 — — — 1 19 Rickets — — — — — 20 Meningitis (not Tuberculous) 4 — — — 4 21 Convulsions — — 1 1 2 22 Gastritis — — 1 — 1 23 Laryngitis — — — 1 1 24 Bronchitis 2 2 8 2 14 25 Pneumonia (all forms) 3 2 15 1 21 26 Suffocation, Overlying 3 — 4 1 8 27 Other Causes 5 7 12 3 27 Totals " 45 30 108 26 209 Table III contains the information given in the Local Government Board Table IV, but is introduced here instead of in the appendix, for convenience of reference. 15 The facts revealed by these two differ little, if at all, from those to which attention has been directed in previous years. The distribution of the deaths as regards causes, age periods, and districts is much the same as last; is indeed, much the same year after year. Any variations are largely in relation to the figures, the proportions and percentages remaining practically the same. In 1912, for example, 82 of the babies who died were aged less than one month. For 1911, the figure was 76. The total number of children who died before reaching the age of three months, in 1912, was 110, about half the total number of deaths. In 1911, 144 out of 261 were under three months old at death. In connection with distribution of the deaths it was shown in 1911 that Christ Church was the district to suffer most, because there were to be found conditions inimical to infant life, viz., poverty and overcrowding. Again, in 1912, the same fact is to be noted, 108 of the deaths being credited to that district. As regards causation, too, the same conditions stand out prominently. Prematurity (numbers 12, 13 & 14 in the table) caused 81, or 38 per cent, of the total; diarrhoea and enteritis (7 & 8) 20 or 9.5 per cent., and respiratory diseases (24 & 25 in the list), 35, or 16 per cent. In 1911 the only difference was that the percentage of deaths due to diarrhoea was higher than that for respiratory, the change in position, as compared with 1912, being the result of climatic conditions. Prematurity always heads the list; which of the others shall take second place depends almost entirely upon the weather. The extent to which the other causes contributed is shewn in the table. The commoner infectious diseases (1-6) were responsible for 17 deaths, as against 28 in 1911. The deaths certified to be due to convulsions number 2, as compared with 11 in the previous year. Overlying accounted for 8 deaths, the number in 1911 being 7. Four of the children were less than 1 month old; 4 less than 1 week. PREVENTION OF INFANTILE MORTALITY. The outstanding feature of all these deaths is that they are practically all preventable. Most of the babies who died did so either because they were not properly protected or properly nursed. As has been said over and over again, ignorance and carelessness, mainly on the part of the mothers, are the chief causes of infantile mortality. No baby need catch an infectious disease or a respiratory disease, or die of them if it does by accident catch them, if it is properly looked after. No baby need die of convulsions or be overlain. Even amongst the poorest no baby need die of wasting. The greater part of the prevention is in the hands of the parents of the children, chiefly the mothers. Some part of it is in the hands of the Council. It is the duty of the latter to see that no baby's chance of life is jeopardized because his surroundings are insanitary. It is the duty of the former to care for their children, to guard them and to protect them. It is a hard thing to say that there are mothers who neglect their babies. Yet very many do; not wilfully, but through ignorance or thoughtlessness. 16 Few women realize that it is necessary for them to learn how to feed and look after a baby; how to do the best for it. The general idea is that a knowledge of these things is born in a woman. Unfortunately it is not so, and because it is not, many children have been and are being sacrificed. That ignorance and thoughtlessness are elements in the causation of infantile mortality was recognized by the Council of the Borough some years ago, and in addition to recognizing, their duty in connection with sanitation, as this annual report is designed to show, they considered it also to be their duty to try to combat these. To this end, they appointed three specially trained women inspectors and health visitors, Miss Baker, Miss Johnson and Miss Stokes, and arranged that a considerable part of their time should be given to what is known as " baby work." This means getting into touch with mothers, especially young mothers, as soon as possible after the baby is born; visiting the homes; meeting the mothers; talking to them about babies, encouraging them, advising them, and teaching them. In carrying out this work, the Council and the Public Health Department have received the greatest amount of assistance from the voluntary Health Workers of the Marylebone Health Society and the Infant Consultations, Clubs, and so on, which have been organised by that Society. In previous reports, very full descriptions have been given of the Consultations, the Mothers' Clubs and the Provident Clubs for expectant mothers, and as there is included in this a copy of a special return with regard to them made to the Medical Officer of the Local Government Board (Dr. Newsholme), who is carrying out an enquiry into the whole subject of infantile mortality; it will be sufficient at this point to give some figures indicating the work done in 1912. In the case of the Northern Consultation, held at the Portman Club, Church Street, the number of babies seen by the two doctors, Dr. Christine Murrell and Dr. Emily Mecredy, was 243. The total attendances were 1921. At the Southern Consultation, held at the Marylebone General Dispensary, Welbeck Street (Dr. Eric Pritchard and Dr. Lane Claypon), 177 babies were seen, and there were 1,099 attendances. The Mothers' Club in the North, at which lectures and demonstrations are given, was attended by 148 mothers, that in the South by 50 mothers. So far as visits to the homes of babies are concerned, the number paid by the voluntary workers of the Health Society was 615. The visits by the women inspectors numbered 3519. Births Investigations.—In the following Table V, the information obtained by the women inspectors at their visits to houses in which births have been notified as occurring, under the Notification of Births Act, 1907, is summarized. With regard to this table it may be noted that even after the first and second month, by far the greater number of the babies are fed on breast milk only. This is most encouraging, and though in many cases mothers themselves resort to breast feeding because it is cheaper and less troublesome, in others they do so because they are encouraged thereto by the women inspectors and other health visitors. Infant Deaths.—Tables VI and VII relate to investigations made by the inspectors into cases of deaths of infants under one year old. The total number of deaths inquired into was 97. BIRTHS INVESTIGATIONS.—TABLE V. Totals Age at visit Weeks Method of Feeding Condition of Child Mother's Work Mother's Health Condition of Tenement No. of Rooms First-born Twins Illegitimate Breast only Breast only 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 71 0 to 1 66 ... 4 I ... 59 5 7 65 2 1 3 47 22 2 68 2 1 28 38 4 1 12 ... ... 402 1 to 2 377 4 13 8 ... 335 35 32 341 31 20 10 314 71 17 360 32 10 176 181 34 11 86 4 6 341 2 to 3 313 7 12 9 ... 300 22 19 303 18 15 5 285 43 13 322 16 3 126 174 30 11 98 6 13 318 3 to 4 276 13 20 9 ... 268 24 26 272 l6 29 1 245 42 11 288 24 6 III 161 37 9 70 6 10 152 4 to 5 135 7 6 4 ... 123 15 14 137 6 5 4 128 14 10 142 7 3 57 73 17 5 31 6 5 59 5 to 6 47 ... 10 2 ... 51 7 1 49 6 4 ... 47 8 4 54 5 ... 17 34 6 2 16 ... 4 62 6 to 7 48 4 10 ... ... 55 4 3 56 2 3 1 54 5 3 60 2 ... 19 21 19 3 19 ... 2 55 7 to 8 44 4 7 ... ... 47 2 6 51 3 ... 1 50 3 2 51 4 ... 14 25 12 4 9 ... ... 303 over 8 211 27 45 2o ... 255 27 21 251 8 25 19 241 36 26 277 23 3 82 152 56 13 76 2 6 17 ENQUIRIES INTO INFANT DEATHS.—TABLE VI. Months. Totals Method of Feeding Reasons for Weaning Cause of Death First-born Twins Illegitimate 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 Tuberculosis Meningitis Miscellaneous 0 to 1 36 18 1 5 12 2 5 1 ... 2 13 3 5 I ... 1 1 ... 2 ... ... 8 8 3 1 1 to 2 7 6 ... 1 ... ... 1 ... ... ... ... 1 ... 3 ... 1 ... ... ... 1 ... ... 1 2 ... 2 2 to 3 9 5 3 1 ... 4 ... ... ... 2 ... 2 ... ... 3 ... ... ... ... ... ... 2 ... ... ... 3 to 4 7 3 2 2 ... 1 1 ... 1 2 ... ... ... 1 2 ... ... ... ... ... .. 2 ... ... ... 4 to 5 14 6 1 5 2 ... 1 3 3 ... 1 ... 2 ... 1 5 ... ... 1 1 ... ... 3 ... ... ... 5 to 6 3 1 ... 1 1 ... 2 ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 6 to 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 to 8 4 2 ... 1 1 ... 1 1 ... ... 1 ... ... ... ... 1 ... ... 1 ... ... 1 ... 1 ... ... 8 to 9 2 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 9 to 10 2 ... ... 2 ... ... 1 ... ... 1 ... ... ... ... ... 1 ... 1 ... ... .. ... ... ... ... ... 10 to 11 9 4 ... 5 ... ... 3 2 ... ... ... ... 1 ... ... 1 ... ... 2 1 1 1 2 1 ... ... 11 to 12 4 3 ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... 97 49 4 27 5 12 16 13 5 2 10 14 8 8 5 15 1 2 5 5 2 4 18 12 3 3 18 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 10 I I Diarrhoea 1 ... 8 1 ... 7 2 1 9 ... ... 1 8 2 ... 3 5 2 ... 2 2 2 1 1 ... 1 1 ... ... ... 14 I I Prematurity 5 ... 2 ... 7 7 6 1 10 ... 1 3 13 I ... 6 6 2 ... 13 1 ... ... ... ... ... ... ... ... ... ... 8 I Marasmus 7 ... 1 ... ... 6 2 ... 7 ... ... ... 7 1 ... 4 3 ... 1 3 ... 2 ... 2 ... ... ... ... ... 1 ... 8 Atrophy & developmental Bronchitis 5 1 ... ... 2 6 2 ... 6 1 ... 1 8 ... ... 2 5 1 ... 5 3 ... ... ... ... ... ... ... ... ... ... 5 1 3 ... 2 ... ... 3 1 I 4 1 ... 3 2 ... 1 2 1 1 1 ... ... 1 1 2 ... ... ... ... ... ... 15 I I Pneumonia 9 2 2 2 ... 14 1 ... 10 2 3 ... 11 3 ... 7 6 1 1 ... ... 3 2 5 ... ... 1 1 1 1 1 ... Convulsions ... ... 1 ... ... 1 ... ... 1 ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... Suffocation 2 ... ... ... ... 2 ... ... 1 1 ... ... 2 ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 5 ... Measles 4 ... ... 1 ... 4 1 ... 3 ... ... 2 5 ... ... ... 4 ... 1 ... ... ... ... 1 ... ... 1 ... ... 2 1 5 1 Whooping Cough Tuberculosis 4 ... 1 ... ... 3 2 ... 3 2 ... ... 5 ... ... 1 4 ... ... 2 1 ... ... 1 ... ... ... ... ... 1 ... 2 1 1 1 ... ... ... 1 1 ... ... 1 ... ... 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 4 1 Meningitis 1 ... 2 1 ... 2 2 ... 2 2 ... ... 3 1 ... 1 ... 2 1 ... ... ... ... ... ... ... 1 1 ... ... 1 including Tuberculous 18 5 2 Miscellaneous 7 ... 8 ... 3 13 4 1 13 ... 3 2 18 ... ... 8 6 2 2 8 1 2 2 3 ... ... ... ... ... 2 ... 97 49 4 27 5 12 69 24 4 69 10 8 10 86 10 1 34 45 11 7 36 7 9 7 14 3 ... 4 2 2 9 4 19 20 National Health Week.—The opportunity offered by Health Week, which was first held in 1912, from April 28th till May 4th, was taken advantage of in the Borough, and special efforts were made to direct fuller attention to the question of infantile mortality and its prevention. On the special committee, which was formed by the Marylebone Health Society to organise the work, the Borough Council was represented by the Mayor (Ernest Debenham, Esq., J.P.), the Chairman of the Public Health Committee (the Rev. J. A. Beaumont, M.A.), Sir Horatio Shephard and the Medical Officer of Health. The object of the Week was "to focus public opinion on all matters connected with health, hygiene, sanitation and the prevention of disease, for the space of one week, so as to arouse attention to health among the members of any section of the community." In carrying out this object, large numbers of persons and organisations assisted. The Clergy of the various denominations were particularly active, and the Committee were successful in obtaining a large number of speakers, who gave lectures and demonstrations on various health subjects. The interest in the work being done on behalf of the babies was greatly stimulated, and the enthusiasm which was expended cannot fail to have produced some effect. Local Government Enquiry.—The following table gives the information which was supplied to Dr. Newsholme, Medical Officer to the Local Government Board, in connection with his enquiry into infantile mortality. Much of what is set down has already been noted in this and previous reports, but because it may be useful for reference it is reproduced. PREVENTION OF INFANT AND CHILD MORTALITY. Return for Medical Department, Local Government Board. A. 1. Has the Notification of Births Act Yes. been adopted ? If so, please state (1) Date of its adoption 17th June, 1908. (2) Total No. of Births notified in each 1909. 1910. 1911. 1912. complete year since its adoption... 3224 4052 4090 4031 (a) Attended by doctors 856 811 839 1339 (b) Attended by midwives 696 854 774 780 (3) No. of still-births notified in each 1908. 1909. 1910. 1911. 1912. of the same years 17 39 68 58 131 (4) No. of births registered in each of 2559 2534 2556 2375 2246 the same years 2. As the result of your experience, are Yes, but practically no difficulty ex- you of opinion that Notification of perienced in cases in which it is of Births might without disadvantage importance to have early information (e.g. in failure to secure breast- of birth. feeding) be postponed for a few days? 21 3. If any postponement of notification Adequacy of midwifery arrangements, is suggested, please state whether this but see no necessity for alteration, suggestion is based on local knowledge as to the adequacy of midwifery arrangements in the town, or on other considerations 4. How soon after birth is the first Within three weeks, visit made? 5. In what proportion of the total births 89'32 per cent, are visits made? 6. How many re-visits are made? No systematic re-visiting. Number varies. 7. What proportion of cases are re- 40-50 per cent. Practically all poorer visited, and how often ? cases. Whether there is Notification of Births or Visits and re-visits by three Women not. Inspectors; re-visits by Health Society C. 1. Please state by whom visits and (voluntary), who take about 500 cases re-visits are made ? per annum, and visit monthly. 2. Please fill in the columns in the following table: How is the organization managed. No. and character of staff. Date when established Daily attendance of children. Infant Consultations Two in number, North and South, and held each, twice weekly; organized by Marylebone Health Society, and managed by a local committee responsible to the Executive committee of the society. South (Welbeck Dispensary) 2 doctors. Women inspectors, voluntary workers. North (Portman Club, 8082, Church Street, Edgware Road, N.W.), 2 lady doctors, women inspectors, voluntary workers. 1905 Average attendance 20 Average attendances 14 and 23. School for Mothers. (Mothers' Clubs) One in each of the two districts worked in conjunction with infant consultations Voluntary workers in varying numbers. Women Inspectors attend. North 1909 South 1911 Meet weekly or bi-weekly attendance 35-40 Any form of milk distribution Nil ... ... ... Creches Five in number— (1) 9, Lower Seymour Street, W., Order of St. Vincent de Paul. Sister, nurse, 3 girls over 16. 1869 40 22  How is the organization managed. No. and character of staff. Date when established. Daily attendance of children. Creches (cntd.) (2) 76, East Street, (in connection with St. Paul's Church) Matron, Assistant, 2 girls. 1887 23 (3)Ogle Mews Ragged School Union. Matron, Assistant, 1 girl. 1881 30 (4) 21, Bell Street, (in connection with St. Barnabas Church) Matron. 1889 18 (5) Upper William Street, (in connection with St. Stephen's Church). Superintendent, 2 juniors. 1882 20 Health Society St. Marylebone Health Society, Executive Committee under chairmanship of Medical Officer of Health. Society works through 2 branches each with a committee, organizing secretary and infant superintendent to whom the visitors report. Women Inspectors attend. This Society organizes the Infants' Consultations and Mothers' Clubs. With exception of women inspectors (3), all voluntary workers. Number varies. 1905 ... 3. Is there any arrangement in the Dinners free, or at 1d. or 2d. each, by town for charitable or other Social Service League. In connection help to be given to expectant with the Mothers' Clubs " Paying-in mothers of Clubs " have been organised and are (а) legitimate infants ? proving successful. Names of ex- (б) illegitimate ,, pectant mothers are obtained from hospitals. Health Society works in co-operation with Charity Organisation Society. 4. Is there any system in the town of Arrangements have just been completed visitation to or inspection of whereby a note will be sent to the children after infancy and Medical Officer of Health of the name before the commencement of and address of any child discharged school life? from the Poor Law Infirmary to If so, particulars on this point whom it is advisable visits should be will be especially valuable. paid. On receipt of this information the cases will be distributed for visitation amongst the official and voluntary workers. 23 7. Is any special action taken in House-to-house visits paid to infants respect of Infant Mortality during the months of June, July and during the summer quarter of August, in each year, each year ? 8. To what extent are the staff of the Chief attention given to infants to the Sanitary Department diverted partial exclusion of workshops, verfrom other work for this minous school children, non-notifiable purpose ? infectious diseases, etc. Male Inspectors, during 1911-1912 carried out special house-to-house survey in streets containing tenement houses for detection of nuisances. 9. Has any system been organized See No. 7. for visiting, during the months in which diarrhoea prevails, infants born during the previous six months ? 10. Please state the relative amount All primary visits are paid by official of work done by official and health visitors (3). These carry out a voluntary agencies. number of re-visits, but great bulk of this work done by voluntary workers of the Health Society. The chief and most valuable work of this organization is in connection with Infant Consultations and Mothers' Clubs, at which official visitors also render assistance in weighing babies and addressing mothers. 11. To what extent is co-operation Medical Officer of Health is Chairman between these effected ? of Health Society. Women Inspectors are members of Committees, and assist at the Infant Consultations, and Mothers' Clubs. First visits always paid by officials, and a certain number of infants then visited entirely and systematically by voluntary workers, who also organize clubs and maternity benefits for those mothers visited. Reports of results of re-visitation are made to Medical Officer of Health through women inspectors. 24 12. Have any addresses or courses Lectures and Health Talks are given at ot instruction been given Mothers' Meetings. Also courses of bearing on child hygiene ? instruction at the Mothers' Clubs by official and voluntary visitors. CHARLES PORTER, Medical Officer of Health. Public Health Office, 12th February, 1913. St. Marylebone, W. DEATHS IN RELATION TO DISEASE. As usual under this heading consideration is given to some of the causes which have contributed most largely to the death rate during the year. A list of these will be found in Table III of the Local Government Board series which will be found at page 106. This gives also the ages at which deaths occurred. Table 111(a) shows the distribution of deaths according to cause in the various registration sub-districts. Diarrhceal Diseases. The total number of deaths from these diseases, which include diarrhoea and enteritis (inflammation of the bowel), was 26, 1'5 per 1,000 of the total deaths. The death rate per 1,000 of the population from these causes was 0"22. In 1911, which was noted as a "diarrhoea" year, the total number of deaths was 92, and the death rate 0"82 per 1,000. The marked improvement in 1912 was to a great extent due to the fact that the weather was much more favourable. The summer was notably cool and wet, and when such conditions exist they are always associated with a comparatively small number of deaths from diarrhceal diseases and a low diarrhoea death rate. Of the 26 deaths, 25 occurred amongst children less than two years old. This unfortunately, is a common experience, the diarroehal diseases being notoriously common amongst infants and unfortunately too often the cause of death amongst them. Much of the work which is done by the Women Inspectors and The Health Society and its workers has for its object the prevention of diarrhoea amongst infants. All the year round, but more especially in the early summer months, the disease occurring most commonly in summer, efforts are put forth to impress upon mothers the fact that the disease is an infectious one, that babies are very liable to infection, that infection is carried by dirt of all kinds, and that the best way to protect their babies is by being scrupulously clean themselves, by keeping their babies clean and giving them nothing that is not clean. That the disease is a highly dangerous one, liable to come on suddenly, and not unlikely to cause death in a comparatively short time after it commences, is also impressed upon the mothers. 25 Leaflets setting forth these facts are widely distributed, especially in the poorer districts. The fact that the number of deaths from the diarrhceal diseases in 1912 was so comparatively small, even after allowance is made for the effect of climatic conditions, is no doubt largely traceable to the educational work referred to above. Some part of the credit, and probably a considerable part of being able to show 26 deaths as against 35 in any of the previous 4 years, is due to the general improvement in sanitation which has taken place in the Borough. The activity which the Council has for some time shown, and is continuing to show in connection with public health, has undoubtedly had an effect. Street cleansing and washing, flushing of gullies and sewers, more frequent removal of house refuse, improvements in housing under the Public Health and Housing Acts, all duties seriously taken up and carried out, have all directly tended to improve the chances of every baby born in the Borough to escape infection with the dirt germs of diarrhoea. It is safe to say that they have acted indirectly also, and proof is not wanting that the more active the Public Health Department becomes, the more active property owners also become. The influence exerted, and the example offered by both of these bodies, must, indeed have had an effect upon the occupants of houses, inducing them to give more attention to cleanliness, and to try to keep clean the houses that have been made clean or improved. Zymotic Diseases, Phthisis, etc. and Respiratory Diseases. The following table shows the number of deaths from each of these diseases and the death rate per 1,000 of the estimated population from each. Total deaths Rate per 1,000 of the estimated population. 1. Zymotic Diseases 99 0.90 2. Phthisis and other Tubercular Diseases 184 1.67 3. Respiratory Diseases 394 3.07 In 1911, except in the case of the respiratory diseases, all the figures were much higher. Zymotic Diseases. The decrease in the number of deaths from the diseases included in this group (small pox, measles, scarlet fever, whooping cough, diphtheria and membranous croup, typhus, enteric and and continued fevers, diarrhoea and enteritis) is very marked, from 203 to 99. The death rate fell from 172 in 1911 to 0'90 per 1,000 in 1912. 26 The largest number of deaths was due to measles, to which 39 were ascribed. This figure compares very favourably with that for 1911, viz., 64. Whooping cough was responsible for 15 and scarlet fever for 11. The figures for the other diseases will be found in Table III (p. 106) and in dealing with the individual infectious diseases, some comment will be made with regard to each. Phthisis and Other Tubercular Diseases. The diseases included under this heading are phthisis, tubercular meningitis, general tuberculosis, tabes mesenterica, and all conditions due to the germ of consumption. The total deaths numbered 184, 29 less than in 1911, but 13 more than in 1910, when the total was 169, and the smallest since 1905. Of the 184, no fewer than 149 were due to phthisis (pulmonary tuberculosis or consumption of the lungs). This figure though large is considerably smaller than that for 1911, when 172 deaths were certified to be due to this condition. In 1910, the total was 133. Of the total number of deaths registered (1,635), the percentage due to phthisis was 8'5. The age periods at which the deaths occurred were : 2-5 years, 1 (0'6 per cent.); 5-15, 4 (2'6 per cent.); 15-25, 14 (9"3 per cent.); 25-45, 73 (49 per cent.); 45-65, 50 (33 per cent.); 65 and over, 7 (4'6 per cent.). Below the age of 2 years no deaths were certified as having occurred. The fact that the majority of the deaths occurred between the ages of 25 and 45 is noteworthy. It is largely because of its tendency to destroy men and women when they are in their prime that consumption is regarded so seriously and that such active measures in the direction of prevention are being taken. Further reference is made to this subject in the section relating to phthisis. The following table is interesting as it shows that the steady fall in the number of deaths from tubercular diseases which commenced in 1905 and which was interrupted by a slight rise in 1911, has again been resumed. Having regard to the special measures which have been adopted to combat these diseases, there is every reason to suppose that it will be continued. TABLE VIII. DEATHS FROM PHTHISIS AND OTHER TUBERCULAR DISEASES. Year. No. of Cases. Population. Rate per 1000 of Population. 1912 184 116,155 1.67 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 27 Respiratory Diseases. The number of deaths due to bronchitis, pneumonia and other diseases of the organs of respiration, was higher by 56 than in 1911, viz., 394 against 338. The death rate was 3'07 as compared with 3.04. In 1911 there was an increase of 68 over 1910, the figure for the latter year being 270. Probably the cold wet weather experienced in 1912 to a large extent accounted for the increase in the numbers, and it is to be noted that of the total, 230 were due to bronchitis, to which disease the deaths of no fewer than 152 persons over 65 years of age were ascribed. The number of deaths from pneumonia was 131, 46 occurring amongst children less than two years of age. Cancer or Malignant Disease. The number of deaths due to cancer, 137, is somewhat smaller than for some years past. In 1910, there were 156, in 1911, 161. The death rates were 1.2 and 1.4 per 1,000; that for 1912, was IT. To these slight variations little or no importance is to be attached. The number of deaths year after year is always somewhere in the neighbourhood of 150, and the death rate as indicated between 1 and 1.5 per 1,000. In the year 1911, according to the Medical Officer of Health for London, the death rate per 1,000 for London as a whole was 1 "05. In that year the rate for St. Marylebone was 1.4. In a table in his annual report the County Medical Officer of Health shows the death rates in each of the Boroughs corrected for the purposes of comparison with these figures. He has also worked out a round figure for comparison for each Borough, which can be placed alongside the figures for other Boroughs and for London as a whole. These figures are known as "comparative mortality figures," and they represent the corrected death rate in each Borough compared with the death rate in London as a whole, which for convenience is taken as 1,000. The figure produced for Marylebone is 1,157. This is higher than any of the other Boroughs, except Fulham, the figure for which was 1,205. It was 10 above the next below it, St. Pancras and Chelsea, over and 500 above the City of London. From a table in this same report, showing the corrected death rates from cancer in each of the Sanitary districts, in each of the years 1901 to 1911, that for the Borough, it apppears, though it has varied up and down slightly, has always been high. Reaching as low as .92 in 1901, it has never previously been so high as 1'21, the figure obtained in 1911. 28 This is not by any means the highest figure reached in any other Borough. In Fulham, for example, in 1911, it was 1.26; in Bermondsey, in 1910, it was 1'25, and in St. Pancras, in 1908, 1.24. In all the Boroughs, practically without exception, the rate in 1911 was higher than in 1901, and whereas in the latter year the Boroughs which had rates of over 1 per 1,000 were the exceptions, in 1911 such rates were the rule. Why there should have been this increase, why Marylebone should appear with the second highest rate and show so many deaths from cancer, it is impossible at present to explain. Despite the vast amount of work which has been, and is being done, apart from the fact that a growth sometimes appears when some part of the coverings of the body, internal or external, are subjected to irritation of some sort for a long time, practically nothing is known as to the causation of the disease. From time to time suggestions have been put forward that it is associated with housing, and some houses have been called "cancer houses" as a result, and the disease has been declared to be infectious; sometimes certain districts have been called "cancer districts" and their smokiness, or the manner in which the streets have been arranged, have been blamed. That there is any real definite evidence in favour of these contentions is something more than doubtful. The increase in the number of deaths from cancer, which has been so steadily taking place throughout London and indeed the country generally, for some years has been alleged by a number of observers to be more apparent than real. They state that medical science has advanced, that the medical man of to-day makes amore correct diagnosis than his predecessor, partly because he has better opportunities and better means at his disposal. Some of the increase is almost certainly accounted for in this way. But there are other reasons, and as to what they are we are still ignorant. From statistics, especially statistics of one district, really very little can be learned. In this report, however, in addition to the figures and tables relating to cancer given in previous years others are included. Ages at Death.—The table giving this information also shows the number of deaths amongst males and amongst females at the various ages. That with one exception the deaths all occurred in the early and late adult age groups will be noted. Childhood, youth and early adult life are, as a matter of fact, usually comparatively rarely involved. Though the disease may have originated earlier it is usually about the age of 40 that cancer as a cause of death comes most into evidence. The fact that in 1912 the number of deaths of males was considerably less than that of females, though interesting, is of little consequence. In 1911 the opposite was the case and usually they run very close to one another. 29 Cancer. Ages at Death. Ages. Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 60 50 and under 60 60 and under 70 70 and upwards Totals. Males — — 1 2 7 10 20 15 55 Females 1 — 2 7 12 21 20 19 82 Totals 1 — 3 9 19 31 40 34 137 Situation of disease.—The table indicating the tissues and organs affected in those who died is one generally included in this report. For the fact that in man the face, tongue and jaw are so frequently affected, smoking is said to account. ' It may be noted, however, that in addition to the irritation of the tobacco smoke there is usually something else. The resistance of the tissues has generally been reduced by some other cause and a well-known writer on venereal diseases has recently noted that persons who have suffered from syphilitic lesions of the tongue not infrequently later develop cancer. Decayed and neglected teeth are also important in connection with cancer of the tongue and mouth. Cancer. Situation of the Disease. Parts of the body affected. Males. Females. Total. Face, Tongue, Jaw 13 5 18 Throat, Neck, Gullet 8 2 10 Stomach 14 9 23 Intestines 7 14 21 Liver 5 6 11 Breast — 14 14 Uterus and Generative Organs — 20 20 Various 8 12 20 55 82 137 Occupation and Cancer.—A very careful analysis has been made of the occupations followed by those, both male and female, who died of cancer during 1912. Practically nothing of any note was made out as a result. As is pointed out in connection with the distribution of the disease, cancer may safely be said to be no respecter of persons. Amongst males, the rich and the poor, 30 those serving as soldiers, officers or privates, those following the professions, the skilled workman and the unskilled, those following no occupation at all, or those picking up a precarious livelihood on the street, are all equally affected. Amongst the females, the conditions are the same. The mistress and the maid, the wife or the widow of the peer, and the wife or widow of the labourer, the woman who works for her living and the woman of independent means, all are attacked alike. Any table constructed from the death returns on occupation and cancer would be merely a list of trades, occupations and professions, and is not worth including. General Circumstances.—Information under this head, it was thought, might be obtained by discovering from the death returns where the death occurred in each case. The results are tabulated in the table given below. It is probably safe to say that those who died at home or in nursing homes were rich or well to do, and may so be classed. Those dying in the hospitals or the infirmary may also be grouped together, since though some of them were probably fairly comfortably circumstanced, in the majority of cases, it may be taken, they were if not poor, or very poor, at least not well off". The totals for these two groups it will be noted are practically the same. This may be taken as further evidence that cancer is not a class disease. Cancer: Distribution of Deaths. At Home In Hospitals. In Nursing Homes. In Infirmary. In Asylums Total Males 16 13 5 20 1 55 Females 32 17 16 14 3 82 Totals 48 30 21 34 4 137 With regard to 7 of the deaths referred to in the above and other tables, it should be pointed out that these were of persons, who, though resident normally outside England and Wales, died in Marylebone. The rule that makes it necessary to 'regard such deaths as Marylebone deaths was referred to in the report for last year. The majority of the 7 persons who died, and are included here were colonials and died in nursing homes. 31 Map showing the distribution of Cancer during the four years 1909-1912. No. of deaths. No. of deaths. 1909 156 1911 161 1910 156 1912 137 32 Distribution.—The accompanying map which has been prepared in the same way as those shown in previous reports in connection with infantile mortality and tuberculosis, viz., by introducing a pin into a map of the Borough as nearly as possible at the address given on the death certificate in each case, gives some idea of the distribution of the deaths from cancer which have occurred during the past four years. The whole borough it will be noted is affected, and to all intents and purposes equally. That there are more in Ward 3 means nothing more than that more people reside there. The same remark applies in the case of the most eastern portions of Wards 7 and 8. The large black patch at the northern end of Ward 6 is over the Workhouse, and may be taken to indicate the number of deaths that took place in the Poor Law Infirmary. Of the two other clusters in this same ward, one represents deaths occurring in nursing homes and the other those of persons who, dying of cancer, had for their only address a common lodging house in the district. Practically the only conclusion that can be drawn from the distribution of cases as indicated on the map is that cancer is no respecter of persons, a conclusion already arrived at as a result of analysing the circumstances of the persons who died. Alcoholism. The number of deaths certified as directly due to this cause was 6, exactly the same 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 2, viz., 15 as against 17. The combined figure for these two diseases is the same as in 1911, viz., 23. The fact that there has been a decline, a steady decline in this figure during the last few years may be noted. The figures for 1908, 1909, 1910 and 1911 were 35, 30, 24 and 23. 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, numbered 56 ('48 per 1,000), as against 56 in 1911. Accident, Suicide and Manslaughter. Accidental or violent deaths during 1912 numbered 60. Of these, 16 were due to suicide. Deaths of babies certified as resulting from suffocation (overlying) numbered 4. 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. 33 Those added by the London County Council are cerebro-spinal fever, glanders, anthrax, hydrophobia, acute polio-encephalitis and myelitis and ophthalmia neonatorum. Chicken pox, which was notifiable during part of 1911, was not on the list during 1912. In the case of phthisis, 1912 was the year which saw it made a disease uniformly compulsorily notifiable. In 1911, the notification was only partial, and affected those who resorted to Poor Law or other institutions, in accordance with the terms of the Public Health (Tuberculosis) Regulations, 1908, and the Public Health (Tuberculosis in Hospitals) Regulations, 1911. The Local Goverment Board, which had issued both of these^ superseded them, however, at the end of 1911, and issued a new set, the Public Health (Tuberculosis) Regulations, 1911, which came into operation on the 1st January, 1912. A separate section of the report dealing with phthisis will be found elsewhere, and in it further information with regard to notification and the disease generally is given. Apart from the notifiable diseases, records are kept of some others which are infectious, viz., measles, wbooping cough and diarrhoea. The information with regard to these is obtained chiefly as a result of investigations made by the Women Inspectors, though a certain amount is given in returns sent from the Schools and by the local Registrars. Table II of the Local Government Board Series, which will be found at page 105, contains a certain amount of information with regard to the infectious diseases. Some points call for further consideration, however, and that is given here. Notifications.—The total number of notifications received during 1912 was 1,219. This is lower by 63 than the figure for 1911, but higher than that of 1910 by 428. The cause of the increase in the two previous years was of course the large number of notifications of cases of phthisis received under the various Tuberculosis Regulations. Part of the reduction in 1912, as compared with 1911, is due to a fall in the number of cases of scarlet fever. Other diseases which were slightly less prevalent were enteric fever and erysipelas. In 1912 the notification rate (proportion to population of notified cases of infectious disease) was 10"4 as against 10'8 in 1911. The number of notified persons removed to one or other of the hospitals for isolation and treatment was in practically all cases larger than in the previous year. The percentages of the totals and the actual numbers were as follows:— 34 Diphtheria 142 or 96.6 per cent. of the cases notified. Erysipelas 37 or 44.4 „ „ Scarlet Fever 256 or 98.8 „ „ Enteric Fever 10 or 90.9 „ „ Cerebro-spinal Meningitis 1 or 100.0 „ „ Ophthalmia Neonatorum 5 or 26.3 „ „ Puerperal Fever 4 or 80.0 „ „ Polio Myelitis 1 or 33.3 „ „ Phthisis 147 or 21.3 „ „ The cost of carrying out the requirements of the section relating to notification of infectious diseases for the year was £\ 16 lis. 9d., equal to £l Os. Id. per 1,000 of the population. The cost and rate per 1,000 for each year since 1901, are shown in the following table:— Year. Amounts paid to Medical Practitioners. Cost per 1,000 of Population. £ s. d. £ s. d. 1901 98 5 6 0 14 10 1902 152 5 0 l 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 1912 116 11 9 1 0 1 Discharge Notices. The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 347, and referred to 551 cases. These figures are higher than in 1911, for the reason that amongst the patients returned were a number who had been admitted on account of measles and whooping cough. Visits were paid to all these cases by the 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 1912 than in 1911, 147 as against 133 cases in the latter year having been notified. Of the 147, 7 proved fatal, the case mortality rate being 4'8 per cent. The number of cases per 1,000 of the population was slightly higher than in 1911, 1.26 as against 1.19. 35 The number of swabs from doubtful cases submitted for bacteriological examination was 160. A positive result was returned in 31 instances. The greatest number of cases came from All Souls' District, viz., 48, the others contributing as follows :—Christ Church 45, St. Mary 37, and St. John 17. As regards age in connection with prevalence of the disease, 58 of those affected were aged 1-5 years, and 54 5-15. Though it is practically certain that all those who were affected were treated with antitoxin—the 96 per cent, who went to hospital certainly were—only in one case was application received for a 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. The source of infection so far as could be made out was in 14 cases in the home of the patient, from a previous case in his own family in 9, and in another family in the same house 5. Scarlet Fever. The number of cases notified was 259. This compares very favourably with figure for 1911, viz., 329, as well as with that for 1910 when only 207, the smallest number for several years, were notified. From the chart inserted at the beginning of the report it will be noted that except for two or three weeks in January and March the number of cases weekly was well under the average of the previous 10 years. The highest number reported in any one week was 15. The case mortality of the disease, though the average case was quite mild, was higher than in 1911; the total deaths numbered 11 as against 7 in 1911, and the number of deaths per cent, of the total cases notified 4.2, the figure for 1911 being 2.1. The actual source of infection in the majority of the cases was not made out. Most of the patients were children of school age and attending school, and there seemed to be some reason for believing in certain instances that infection had been contracted there. From inquiries made by the Inspectors in 17 instances infection appeared to be traceable to a previous case in the same family; in 6 to a previous case in the same house, and in 17 to another case in the same neighbourhood. In 13 instances the source of infection could not be classified. Defects in sanitation to the number of 60 were discovered. Of these 51 were want of cleanliness, etc., and 9 defects in drainage. The nuisances were remedied after the service of notice in each case. Enteric Fever. As compared with 1911, 1912 was distinctly a non-enteric year, and the fact that the cases numbered only 11, as against 18 in the former year, rather bears this out. 36 In 1910, which was a year in which few cases might have been expected to cccur, 21 cases were notified, almost twice as many as in 1912. Of the cases, few originated in St. Marylebone, or in London even, the majority coming from outside. Three of the cases were believed to have been infected by contaminated shell fish. In one instance—that of a nurse who took the disease from a patient whom she had been nursing, and who had died of the disease—the infection was the result of direct contact. In hospitals, the risk of infection in this way is considerable, though it is usually held that if proper precautions are taken, and care and cleanliness are exercised, especially in connection with the discharges of the patient, no nurse need be infected. The number of deaths was 5, giving a mortality rate of 45.4 per cent. This is a high rate for the Borough, and compares most unfavourably with that of 1911, when it was 16.6. The distribution of the cases in various districts was as follows :—All Souls, 2; St. Mary, 1; and Christ Church, 2. In St. John no cases were notified as having occurred. Examination of the premises resulted in tin discovery of nuisances (dirty premises, etc.) in 4, and no defects in drainage were discovered. After the attention of the persons responsible had been directed to the conditions found, the cause of complaint was removed. The chart inset at the beginning shows the number of cases notified in each week and gives a comparison of the numbers with the average for the preceding ten years. Cerebro-Spinal Fever. Only one person—a child—was notified as suffering from this disease. Isolation and treatment were carried out in hospital, but the patient died. Erysipelas. The total number of cases notified was 84, and there were 3 deaths. As usual, most of the notifications came from the Workhouse Infirmary and General Hospitals, and 37 of the patients were treated in one or other of these institutions. Puerperal Fever. Of this disease 5 cases were notified during the year and in 2 death certificates puerperal fever was set down as the cause of death. Though much rarer now than formerly, this disease is still exceedingly fatal, and to find almost half the number of women infected dying as a result is not uncommon. Visits are paid to all notified cases by the women inspectors and disinfection of the premises carried out. 37 Measles. So far as can be gathered from the returns provided by the school teachers, the only persons who give any information with regard to persons infected, measles was considerably less prevalent than in 1911, the total number noted being 484 as against 667. The fact that the number of deaths was considerably smaller, 39 as against 64, also lends support to this conclusion. Of the deaths that occurred only 4 were amongst patients more than 5 years of age, the great majority—17 out of 39—being of babies more than 1 but less than 2 years old. In previous reports certain of the characteristics of measles have been referred to and it is not proposed to enter at any length here into a discussion of them. Attention must again, however, be directed to certain facts relating to measles, viz., that it is a disease of early life, that it is a disease exceedingly fatal to young children, and that it is not at the height of the disease that the greatest risk is run, but in the later stages and during convalescence, when complications affecting the lungs are apt to occur. Most important of all, it should be pointed out, measles is not a disease that children must suffer from. If properly protected from infection no child need be attacked by measles and the person who, as too frequently happens, places the healthy child with the infected in order that he or she may get the disease and get it over is guilty almost of a criminal act. By degrees, as a result of visits paid by the women inspectors to homes in which measles is known to exist, information with regard to this and other matters is being disseminated, and the attempt to dispel ignorance as to measles is being pushed on with. Special leaflets embodying the above information with regard to the disease have been prepared and were distributed by the inspectors during the year. Disinfection of premises, bedding, etc., was carried out in a number of instances. Isolation of Measles.— During 1912, under the arrangement made by the Metropolitan Asylums Board, cases to the number of 153 were removed to hospital. These were all non-pauper cases and isolation was provided on the ground that it could not be properly carried out in the patient's own home. In all cases a certificate was granted by the Medical Officer of Health to this effect, and it was on this certificate that the patient was admitted. The accompanying table shows the number of cases of measles and other infectious diseases reported from Schools and other Boroughs during 1912. With regard to Schools it may be stated that no classrooms were closed by the Education Department of the London County Council on account of measles. 38 SCHOOLS. Scarlet Fever. Diphtheria. Typhoid Fever. Whooping Cough. Chicken-pox. Measles. All other Di seases. All Souls, Foley Street 18 20 ... 20 ... 17 6 Barrett Street 1 4 ... 10 9 6 6 Barrow Hill Road 13 4 ... 2 21 39 93 Bell Street 37 6 ... 15 22 48 66 Capland Street 21 ... ... 16 20 43 56 Catholic, Richmond Street ... ... ... ... ... ... 3 Christ Church, Lisson Grove 48 3 ... ... 7 14 33 Convent, Little Union Place 8 1 ... ... 1 19 3 Council, Grove Road ... ... ... ... ... ... ... Emmanuel, Aberdeen Place 3 1 ... 11 1 23 4 Emmanuel, North Street 3 ... ... 3 4 3 10 Hampden Gurney, Upper Berkeley Street 5 ... ... 3 19 23 21 Homer Row, Catholic 34 4 ... 5 ... 2 18 Jewish, Hanway Street 5 5 ... ... ... ... ... Portland, Little Titchfield Street 11 4 1 15 16 12 19 St. Andrew's, Wells Street 18 30 ... 5 9 6 12 St. Francis, Upper William Street ... ... ... ... ... ... ... St. James', Marylebone Lane ... 1 ... 12 10 10 3 St. Luke's, Nutford Place 10 3 ... 13 4 4 30 St. Mark's, Violet Hill 14 4 ... 3 14 23 2 St. Mark's, Marylebone Road 1 ... ... ... 1 4 2 St. Marylebone, High Street 18 7 ... 19 49 94 26 St. Marylebone Grammar, Marylebone Road 1 ... ... ... ... 1 1 St. Mary's, Crawford Street 14 3 ... 28 5 15 16 St. Paul's, East Street ... 5 ... 8 5 17 19 St. Paul's, Broadley Terrace 4 3 ... 9 19 11 3 St. Stephen's, Charlbert Street ... ... ... ... ... ... ... St. Thomas', Orchard Street ... 5 ... 1 3 6 1 Stephen Street ... ... ... ... ... ... ... Trinity, Buckingham Street 4 2 ... 6 ... 18 4 St. Vincent, Lower Seymour Street ... ... ... ... ... ... ... Other Boroughs 24 11 ... 16 11 16 6 Schools out of Borough] 6 14 ... 3 3 10 7 Totals 321 140 1 223 253 484 470 39 Whooping Cough. The number of deaths which occurred from whooping cough during 1912 was exactly half that for 1911—15 as against 30. Epidemics of this disease very commonly run concurrently with those of measles so that it is not surprising to find that there is a diminution in connection with each. In many respects the disease resembles measles. It is, for example, a disease of children, and all the 15 deaths which occurred were of children under 5 years of age. Of the 15, 6 were less than 1 year old, 3 less than 2 but more than 1, and 6 were aged from 2 to 5 years. The arrangements made by the Metropolitan Asylums Board in connection with admission to hospitals of patients suffering from whooping cough are the same as in the case of measles. During 1912 the number admitted was 31. 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. Chicken Pox. This disease being no longer notifiable in 1912, the only information with regard to it came from the schools. The numbers reported and the schools affected are given in the table on page 38. Polio-Encephalitis and Myelitis. These diseases remained notifiable during the year. The total number notified was 3. The patients were all less than 5 years old and all 3 cases occurred in Christ Church sub-registration district. Only 1 was isolated at home, the other 2 being admitted to hospital. All the patients recovered. Special investigations were made in each case, and a return regarding each sent to the London County Council. Ophthalmia Neonatorum. This disease—inflammation of the eyes in newly born children—made notifiable by order of the London County Council in 1911, continued to be so during the whole of 1912. The total number of cases notified was 19, as against 21 in 1911 (9 months only). Visits were paid to all notified cases, none of which were particularly serious, by the women inspectors. In one or two cases it was found necessary to draw the attention of midwives to the fact that cases of eye inflammation had been detected amongst infants attended by them, and to remind them of the necessity of notifying the condition. Phthisis. The outstanding features of 1912, so far as consumption is concerned, were the coming into force of the Public Health (Tuberculosis) Regulations, 1911, which 40 made pulmonary tuberculosis (consumption) universally compulsorily notifiable, and the taking effect of the provisions relating to the Sanatorium benefit under the National Insurance Act, 1911. Notification: The Public Health (Tuberculosis) Regulations, 1911.— These regulations came into operation on the 1st of January, 1912, but as they had been issued towards the end of 1911, time and opportunity had been given for their consideration by the Public Health Committee, and for the making of preparations for carrying them out properly. In December, 1911, all medical men in the Borough had been notified that on January 1st, 1912, every case of consumption met with in practice must be notified. In addition each had been provided with a supply of forms upon which to make notification. So far as the staff of the department were concerned, they were prepared to deal with any additional cases regarding which information might be received, in the same way as when the more limited forms of notification only were in force. Having regard to the fact that the leading up to full notification had been more or less gradual and that since the middle of 1906, when the voluntary form was introduced in the Borough, the scope had been steadily widened by the inclusion first of Poor Law Cases (in 1909) and of Hospital Cases (in May 1911), it was not anticipated that there would be any marked increase in the numbers. The actual increase over 1911 was as a matter of fact 154, total number of new cases notified in 1912 being 690 as against 536 in the previous year. As the following table shows, the increase was entirely in connection with cases seen in private practice or at the hospitals. In the Poor Law Cases there was a distinct falling off, which was not unexpected since notification of these has been compulsory for some time and the great bulk amongst the persons seeking relief had already been discovered and notified. 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 1912 † 107 428 155 690 *Made compulsory in May, 1911. † Do. do. 1st January, 1912. That a similar effect has been produced by the voluntary form of notification is distinctly brought out by the table. It was at the beginning that the medical practitioners made notification, and the numbers dropped off in the later years, not 41 because the members of the profession were less anxious to help, but because they had previously notified the cases with which they were well acquainted, and with regard to which they considered it necessary or were permitted to make a report. The figures with regard to voluntary notification, when compared with those relating to compulsory notification, are evidence of the value of the voluntary form. They are, further, evidence of the wisdom of the Council in agreeing in 1906 to adopt it, and of the loyal way in which the medical profession has assisted the Council. Sanatorium Benefit.—The provisions of the National Insurance Act, 1911, relating to sanatorium benefit, took effect on 14th July, 1912. Despite the fact that the Insurance Committee for London was the body to which the working of this benefit was delegated, a large amount of work had to be done locally, and with the object of getting it done a local sub-committee was created. This was temporary in character and contained amongst others the Chairman of the Public Health Committee, representing the Council, and ex-officio, the Medical Officer of Health. After its formation the Committee met two or three times under the Chairmanship of Mr. Alderman Debenham. At the first meeting it was resolved that the Medical Officer of Health be requested to prepare a report with regard to a certain number of points in connection with the administration of the benefit. The preparation of this report involved a great amount of work and the expenditure of a considerable amount of time. The chief suggestion which it contained was that if convenience was to be regarded the bulk of the administration should be done locally, viz., the first selection of the cases for admission to a sanatorium, and of those for whom other forms of treatment, such as domiciliary and dispensary, would be suitable. In addition, and again if convenience was to be regarded, it was suggested that the exceptional opportunities of the Council's Public Health Department and Medical Officer of Health should be taken advantage of. These suggestions were adopted by the Sanatorium Sub-Committee and sent to the Insurance Committee for London. So far as could be made out, however, they were acted upon only to the extent that the Council was asked to keep a supply of forms to be used by applicants for sanatorium benefit, and that the Medical Officer of Health was given the duty of finding doctors and institutions for those patients recommended for domiciliary or dispensary treatment. So far as can be ascertained the number of persons in the Borough who applied for sanatorium benefit was comparatively small. Up to the end of the year only 29 persons were supplied with forms of application at the Public Health Department, and the records with regard to treatment in the hands of the Medical Officer of Health at the end of 1912 related to only 8 persons. Of these, 3 went to a sanatorium, 1 received domiciliary treatment, and 4 were allowed dispensary treatment. Deaths from Phthisis.—The deaths from consumption numbered 149, a number considerably lower than that for 1911, viz., 172. The rate per 1,000 was 1.2, as against 1.4 in 1911. 42 In the following table, the number of deaths occurring each year since 1900 is shewn, as well as the distribution of deaths throughout the Borough. So far as the total number and the rates per 1,000 for the Borough are concerned, a considerable improvement is to be noted. The difference between 1900 and 1912 is 126, nearly 1 per 1,000, and though this is to some extent due to the clearing away of inferior property and the removal of a certain number of the poorer inhabitants, the credit for some of 't must be given to the work of prevention carried out by the Council and others. So far as the various districts in relation to deaths are concerned, the marked increase which was noted in All Souls, in 1911, proved, as was expected, accidental and temporary, and it is hoped that the fall commenced in 1910 will continue. In Christ Church there seems to be little tendency to reduction in the average number of deaths. Again, as in previous years, it heads the list, giving 50 per cent, more deaths than any other district. With regard to it, it is to be noted, of course, that it is the most thickly populated district, and one in which the majority of the inhabitants are of the class unfortunately most liable to infection, and least capable of withstanding the ravages of the disease. Table IX. DEATHS FROM PHTHISIS. Estimated Population. Year. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 116,155 1912 149 26 32 66 25 117,844 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 149 deaths was as follows In Poor Law institutions, 63; general and other hospitals, 21 ; at home, 65. That the majority of the deaths take place at the middle periods of life and that more males than females die of consumption has been pointed out in previous reports. The table here shown serves to bring out these facts once more. The fact that only one child under 10 died of consumption as against eight in 1911 may be noted. Ages. Under 10 10 and under 20 20 and under 30 30 and 40 and under 40 under 50 50 and under 60 60 and under 70 70 and upwards Totals. Males 1 4 11 22 23 14 12 1 88 Females — 7 10 16 7 12 5 — 57 Totals 1 11 21 38 30 26 17 1 145 43 Tables similar in construction to those given below have been printed in the reports of previous years. They contain information with regard to the occupations followed by those who died of consumption during 1912. 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. 4 56 5 20 1 3 88 FEMALES. No occupation or house work. Work with exposure. Sedentary work. Professional work. Total. 44 5 5 3 57 Prevention of Consumption.—Though the amount of work done in connection with the prevention of consumption during 1912 was considerably greater than in any previous year, the methods remained practically the .same. On receipt of a notification a visit was paid to the home by one or other of the women inspectors. The patient was advised generally as to the measures to be adopted by himself, for his own benefit, and the protection of others. The importance of the detection of the disease in the earlier stages was pointed out, and contacts were strongly urged to submit themselves to examination, and arrangements were made for this to be done in a number of cases. A considerable number of such examinations were carried out at the dispensary in Allsop Place, which throughout the year continued to assist greatly in the work of preventing consumption. In cases in which such treatment as could not be given at home was required, in a sanatorium or a hospital for example, the inspectors assisted in every possible way to obtain this, and referred the patients to the dispensary or other bodies who seemed likely to be able to help. In addition to initial visits in a considerable number of cases, revisits were paid by the Inspectors with the object of keeping the cases under observation and seeing that the advice given had been acted upon and that precautions against spreading of infection were being carried out. 44 In any case in which disinfection seemed to be called for, if the patient were moving and so on, arrangements were made for disinfection of rooms, clothing, etc. If any conditions on the premises calling for attention were found, e.g., defects in sanitation, uncleanliness, defects in ventilation, and so on, steps were taken to have these remedied either by means of persuasion or under the Public Health Act and other appropriate Acts. That works of this kind are done and that they play a very definite part in the prevention of infectious diseases, and this disease more especially, must not be overlooked. There always has been a tendency to belittle the importance of attention to sanitation as a part of the system of prevention. It is unfortunate that such should be the case. It should be grasped that every effort made to improve sanitation is an effort made on behalf of the consumptive and the prevention of consumption. Action taken directly in relation to the patient is not the only kind that produces results. Practically everything done by the Council in connection with the carrying out of their duties and powers in relation to public health—care of the food supply, improvement of housing, removal of nuisances, and the others that mean improved surroundings for the individual—all these play their part and must be credited with a share in any reduction in the amount of consumption that may occur. Of the whole of this report it may be said that it is a record of work done for the prevention of consumption just as it is a record of work done for the prevention of infantile mortality or of enteric fever and any other disease. Under the heading "Departmental" will be found a description of the works of sanitation carried out during the year. The figures and details given show how extensive it has been and how it has increased in amount. It is only because it is inconvenient to do so that all that is written there is not placed under the side-heading "Prevention of consumption." Schemes of Prevention.—During a considerable portion of the year the Public Health Committee were engaged upon the task of drafting a scheme for the prevention of consumption within the borough, and considered a number of reports from a Special Tuberculosis Sub-Committee and the Medical Officer of Health. The necessity for the formation of a special scheme arose largely out of the clauses in the National Insurance Act relating to tuberculosis, and the suggestion that it should be made came from the Local Government Board who issued a number of memoranda dealing with the question during the year. In most of these reference was made to the fact that a complete scheme should consist of three elements, viz.: a dispensary, a sanatorium and accommodation for persons in advanced stages of the disease, all linked up with one another, and with the public health organization of the Borough. That the scheme should contain these elements the Public Health Committee readily agreed, and even before attention had been directed to the matter by the Board, the Committee had recognized the necessity, and had formed very definite opinions with regard to it. 45 So far as the dispensary element is concerned certain steps had indeed been taken prior to 1912. The question of placing the existing voluntary dispensary fully under the control of the Council had been discussed with representatives of the governing body of that institution. In the opinion of the Committee, infinitely more effective work on the tuberculosis problem could be done if the dispensary definitely formed part of the Public Health Organization of the Borough and the officers carrying out that part of the tuberculosis work done at the dispensary, were appointed by and under the control of the Council. With this view, which was adopted by the Council in July, 1912, on a report of the Public Health Committee, those who represented the Dispensary refused to agree, and though there were several meetings and the point was frequently discussed, no definite decision was arrived at. With regard to the other parts of the scheme, the Committee formed the opinion that the Sanatorium provision could most conveniently be made by the Metropolitan Asylums Board, and so reported to the Council and to the London County Council. Accommodation for advanced cases they advised should, if possible, be provided locally, and if necessary for the purpose, combination might be made with the Councils of one or more neighbouring Boroughs. The view expressed with regard to sanatorium provision gained ground during the year, and so far as can be made out at present, the arrangement suggested is that likely eventually to be made. The delay in taking action in this part of the scheme, and that relating to the advanced cases, is largely due to the difficulties that have been experienced in arriving at a settlement of the dispensary question. Until the dispensary part of the scheme is fully organized and working properly, the full necessities of the case, so far as concerns the patient in need of treatment in the sanatorium or the hospital cannot be decided. During the year, all the sanatorium treatment provided, apart from the small amount given by the Insurance Committee was obtained by interesting philanthropic persons in the patients in need of such treatment. The only resort of the patient with advanced consumption was as in previous years the Poor Law Infirmary. That this was so is as much open to objection as the arrangement which compels the patient in poor circumstances in need of sanatorium treatment to depend upon the philanthropist to provide it for him. Bacteriological Diagnosis of Consumption.—The arrangements made by the Council which allow of any medical man in doubt as to diagnosis of a case of consumption submitting a specimen of expectoration to the Council's bacteriologist for examination and report were largely taken advantage of during the year. The total number of specimens submitted was 271, of these 80 were found to contain the bacillus of tuberculosis and in 191 a negative result was obtained. 46 The St. Marylehone Dispensary for the Prevention of Consumption.—The following information with regard to the work of the local anti-tuberculosis dispensary is taken from a short summary kindly supplied by Dr. Sutherland, the Medical Officer. Dr. Sutherland writes:— "During the second year of its existence the work of the tuberculosis dispensary was materially increased. New patients numbered 553, and the total attendances of old and new patients amounted to 8,507, as against 3,637 in 1911. Of the new patients, 293 were diagnosed as suffering from pulmonary tuberculosis, and were notified as such to the Public Health Department. The Public Health Authority is also notified on the death or removal of any patient, or from time to time if the home conditions be very bad, so that disinfection may be carried out. Insanitary conditions and all changes of address are notified to the Medical Officer of Health, as they come to the notice of the Dispensary Officers, while the Sanitary Inspectors and Health Visitors of the Council have the right of inspecting at the dispensary the medical case sheets and the domiciliary schedules. The home treatment of tuberculosis patients involves in many cases a careful consideration of economic conditions, and to deal with this aspect of the work, a Case Committee of voluntary workers, of which Sir Reginald Talbot is chairman, meets every Friday morning. The work of this committee covers such ground as unsatisfactory home conditions, advanced cases, sanatorium and convalescent cases, shelter cases, etc. Under the Insurance Act, cases requiring domiciliary treatment are referred to the Dispensary by the County of London Insurance Committee. The Open Air School, in Regent's Park, which opened in January, 1911, has now passed the experimental stage. Beginning with 11 names on the roll, the high water mark was reached in November, 1912, with 57 names on the roll, and an average daily attendance of 50 pupils. This school is intended for two groups of children (1) the infected children from tuberculous homes; and (2) those who have received previous treatment at sanatoriums and convalescent homes. None of these children are infectious, but are excluded from the ordinary schools by the Dispensary Medical Officer, by arrangement with the School Medical Officer for London, the reason being that while they do not progress well under the ordinary conditions of school life, very remarkable progress is made when they are educated under conditions of pure air. Although the school is open all winter, there are very few cases even of cold in the head, and no cases of infectious fevers." Work of Women Inspectors.—As already pointed out a considerable part of the time of the women inspectors is given to visiting and revisiting cases of consumption, advising and helping those who are affected and trying to obtain protection for those who are still unaffected, 47 The total number of cases of consumption seen by them was 602, and of visits and revisits paid, 1,105. Of the patients seen 147 were removed to hospital, and in 112 instances disinfection of the premises was carried out. Each case visited was most carefully investigated with a view to discovering amongst other things the possible source of infection and the number of contacts. The lines of the investigations made were those uniform throughout London, the object of the uniformity being to obtain a body of information which would be sufficiently extensive to allow of conclusions of value being based upon them. The information which relates to 303 female and 299 male patients has been analysed and is tabulated on the following pages. PHTHISIS. Females. Number of Cases 303. Age Distribution. Under 1 year. 1—5. 5—15. 15—25. 25—45. 45—65. 65. All ages. — 15 86 50 113 36 3 303 Duration of Illness in Years. Under 1 year. 1—2. 2—3. 3—4. 4—5. 5 and upwards. 146 50 35 28 13 31 Number of Living Rooms in Patient's Tenement. One. Two. Three. Four. Over Four. 63 151 50 24 15 Weekly Rent Paid. Under 5/- 5/- and under 10/- 10/- and under 15/- 15/- and over. 37 197 58 11 Occupation of Patients. Outdoor. Indoor. Miscellaneous. Clerks. Laundries. Printers Servants. Tailoring, etc. Trades with predisposing influences Miscellaneous. Public. Private. 2 — 5 — — 36 26 2 11 48 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 aflected. I. II. III. L. D. L. D. L. D. L. D. L. D. 0 — Affected - - - - - - - - - - - Not - - - - - - - - - - - Unknown - - - - - - - - - - - 15 12 Affected 1 4 3 1 1 2 1 - 2 - 1 Not 4 - 3 - - - 10 - 20 - - Unknown 13 2 2 - - - 1 - 2 - - 25 52 Affected 6 11 6 17 - 6 10 1 35 6 8 Not 32 6 26 - 2 - 38 2 98 2 0 Unknown 43 6 3 1 1 - 1 - - - - 35 63 Affected 1 21 10 11 - 5 6 8 50 9 15 Not 23 24 29 - 8 1 43 3 91 - - Unknown 31 26 2 - - - 2 1 - - - 55 10 Affected - 5 - 2 - 1 - - 5 - 3 Not - 7 - - - - 9 1 16 - - Unknown 1 7 - 1 - - - - - - - FEMALES—UN MARRIED. Patient's Relatives. 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. 0 101 Affected 53 21 75 10 15 28 Not 122 5 180 5 45 8 Unknown 1 — — — 1 — 15 39 Affected 10 13 19 10 7 6 Not 38 10 187 4 21 5 Unknown 5 2 — — — — 25 11 Affected 1 9 5 2 — 5 Not 15 — 24 — 4 — Unknown 7 4 — — — — 35 7 Affected - 4 — — — — Not 3 5 2 — — — Unknown 1 1 1 — — — 55 1 Affected — — — 1 — — Not — 2 2 — — — Unknown — — — — — — 49 MALES. Number of Cases 299. AGE DISTRIBUTION. Under 1 year. 1—5. 5—15. 15—25. 25—45. 45—65. 65 & over. All ages. 1 15 92 25 120 40 6 299 DURATION OF ILLNESS IN YEARS. Under 1 year. 1—2. 2—3. 3—4. 4—5. 5 and upwards 145 41 36 16 17 44 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. 73 140 55 19 12 58 183 44 14 299 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. 13 14 — — 2 35 5 — 2 8 1 2 18 15 9 27 40 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. 0 108 Affected 47 24 78 12 8 48 Not 137 6 191 1 58 — Unknown — 2 7 — — 1 15 24 Affected 4 8 3 6 7 2 Not 16 3 50 — 4 1 Unknown — 5 — — 2 — 25 24 Affected 3 11 7 2 — 4 Not 20 9 29 — 3 — Unknown 2 3 7 — 4 — 35 17 Affected — 4 — 3 — 3 Not 9 7 17 2 1 — Unknown 7 7 — — — — 55 3 Affected — — — — — — Not — — 2 — — — Unknown — 6 — — — — 50 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. - - Affected - - - - - - - - - - - Not - - - - - - - - - - - Unknown - - - - - - - - - - - 15 1 Affected - - - - - - - - - - 1 Not 2 - 8 - — — 1 — — — — Unknown - - - - - - - - - - - 25 39 Affected 5 4 5 - - - - - - - - Not 24 9 - - - - - - - - - Unknown 29 7 - - - - - - - - - 35 69 Affected 1 9 3 15 - - 11 4 36 7 14 Not 21 25 30 - 10 4 52 — 142 5 — Unknown 50 32 3 1 - - 2 1 - - - 55 14 Affected - 3 - - 1 - 1 1 2 - 6 Not 1 13 4 4 — — 11 1 18 — — Unknown — 11 - - - - - - - - - DISINFECTION. The methods of disinfection adopted in 1912 remained the same as in previous years. For infected articles, the Goddard, Massey and Warner Steam Disinfector was employed, formic aldehyde gas, pioduced by burning formalin tablets, being depended upon mainly in the disinfection of rooms. The number of tablets used in each case was generally 30 per 1,000 cubic feet of space. Because the amount of infectious disease was somewhat less in 1912 than in 1911, the number of disinfections carried out was rather smaller than in that year. Particulars of the work done are given in the following Tables. The number and nature of articles dealt with in 1912 are shown in the following tabular statement:— Compulsorily Notifiable Infectious Diseases. Phthisis. Measles. Vermin. Other causes. Total. Beds 334 57 35 45 11 482 Mattresses 308 46 17 39 121 531 Bolsters 390 57 39 44 46 576 Pillows 685 133 66 103 269 1,256 Sheets 712 106 65 80 48 1,011 Blankets 843 124 76 113 188 1,344 Sundries 3,733 402 429 611 980 6,155 Totals 7,005 925 727 1,035 1,663 11,355 In 1911, the number of rooms disinfected was 948 and of articles 13,921. 51 The number of journeys made by the disinfecting vans during the year ended December 1912 was as under:— January 41 February 29 March 27 April 34 May 37 June 33 July 43 August 44 September 31 October 35 November 29 December 28 411 The vans were used 391 times in 1911. The number of rooms disinfected and the reasons for carrying out disinfection are stated below:— Reasons for Disinfection. Compulsorily Notifiable Infectious Diseases. Phthisis. Measles. Vermin. Other causes. Totals. January 65 6 6 3 9 89 February 33 6 10 — 7 56 March 68 19 1 8 9 105 April 32 5 8 1 3 49 May 31 9 2 10 7 59 June 44 4 5 4 9 66 July 52 12 7 1 12 84 August 32 10 24 2 3 71 September 44 5 15 2 10 76 October 26 18 9 2 10 65 November 21 9 16 3 1 50 December 27 9 17 1 — 54 Totals 475 112 120 37 80 824 BACTERIOLOGICAL EXAMINATIONS. The accompanying table shows the number of specimens examined bacteriologically, and the diseases in which the assistance of the bacteriologist was called for in making a diagnosis. The figures for 1911, as well as those for 1912, are shown, and indicate that in the latter year increased use was made of the laboratory. The main increase, it will be noted, was in connection with consumption, and for this, doubtless, the coming into operation of the compulsory form of notification was largely responsible. 52 The work of examining specimens from doubtful cases of Typhoid Fever, Diphtheria and Consumption, was, as in former years, carried out by Dr. Eastes, at the Laboratory of Pathology and Public Health, 35, New Cavendish Street. 1911. 1912. Positive. Negative. Total. Positive. Negative. Total. Typhoid Fever 1 11 12 2 16 18 Diphtheria 32 111 143 31 129 160 Phthisis 53 148 201 80 191 271 Totals 86 270 356 113 336 449 Part II. DEPARTMENTAL. 55 DEPARTMENTAL. No change was made either in the numbers or personnel of the staff during 1912, and throughout the year the duties of the Council in relation to public health were carried out by (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, one house-to-house inspector, five district inspectors, three women sanitary inspectors, one dust inspector, one chief and three assistant clerks and an office youth. In addition to these there are immediately responsible to the Public Health Committee, the keeper of the public mortuary, the matron and the one female and two male members of the staff of the shelter and baths, the two disinfectors, the men and women attendants at the underground conveniences, and the men employed in flushing the overground conveniences. By this staff a vast amount of important and valuable work has been done, and all the members have worked well and satisfactorily. The pages that follow contain a record of what has been done. Staff Meetings, During 1912 there was initiated a practice which promises to lead to an improvement in the working of the department and also to be to the advantage of the public health in the Borough, viz., that of holding regular meetings of all the members of the staff. These meetings are held on the first Monday in each month after office hours and are attended by all the inspectors, male and female, and by the deputy Medical Officer of Health, the chief clerk and the Medical Officer of Health. Their object is to give an opportunity for the general discussion of all matters relating to the practical work in connection with public health and to keep each member of the staff in touch with the others and with what is being done generally. The system in vogue being largely one of specialism, and special inspectors being of necessity appointed for special duties, it seemed exceedingly important, if there was to be no overlapping and if, which is just as bad, each officer was not to get shut away in his own specialism and so spoil that unity which is so important in connection with public health work that, there should be exchange of ideas and of experiences. From the Medical Officer of Health's point of view it seemed absolutely essential at times to have the whole staff together, to put before them systems of working and to obtain from them suggestions and ideas as to working, and as to matters calling for combined action, which may have been noted by any Inspector, or set of Inspectors, during the course of inspections. It is the case, of course, that each officer reports each morning to the Medical Officer of Health, and the work done on the preceding day is reviewed, and that to be done is considered. 56 It is the case also that once a week each officer reports fully with regard to progress made with works called for by notices. Nevertheless, there seemed to be occasion for discussing matters with the staff> as a whole, from time to time, drawing their attention to, and hearing from them of improvements made or required in connection with public health work. At the end of the year only a few meetings had been held, but sufficient evidence was obtained from these to show that good results were likely to follow. Each member of the staff felt that he was put on his mettle, and that the work which he was given to do was all the more important because it was not merely his own work, but part of the whole work of the department. All the members of the staff have most loyally co-operated to make the staff meeting a success, and it seems certain that it has become definitely established as part of the routine of the department. PROTECTION OF THE FOOD SUPPLY. The greater part of the important work under this head was again carried out by Inspector George Smith, who in addition to inspecting food in all shops, etc. throughout the Borough, acted as inspector under the Sale of Food and Drugs Act, and inspected premises in which food was sold, stored or prepared, such as milk shops, hotel and restaurant kitchens, bakehouses, tea-rooms, coffee shops, ice-cream shops, slaughterhouses, cowhouses, etc. Food Inspection.—As in the previous year, routine inspections of all food premises and of the food in them were made by Inspector Smith. In making special inspections on Saturday nights and Sundays, and at other times, assistance was rendered by members of the staff of inspectors possessed of the necessary qualifications and experience. At these inspections special attention is directed to the meat and articles of food exposed on stalls in the various market streets. During the year there was every evidence of a desire on the part of meat and food vendors to make use of the knowledge of the food inspector and to take advantage of the provisions of Section 47 (8) of the Public Health (London) Act, 1891, which empowers any person having any unsound article of food in his possession to call upon the sanitary authority to remove it for destruction. On a great many occasions the meat and food inspector was called in to examine articles of food and to accept surrender of such as were unsound or unwholesome, or unfit for food. Amongst the articles thus voluntarily surrendered were the following:— Articles of food destroyed as unsound after voluntary surrender. 215 lbs. beef 14 turkeys 97 lbs. mutton 10 geese 75 legs pork 130 lbs. skate Hind quarter of pork (tuberculous) 126 lbs. mackerel 6 pigs' heads (unsound) 112 lbs. haddock 57 2 Do. (tuberculous) 3,080 lbs. dates 3 pigs' plucks ( do. ) 640 lbs. tomatoes 9 sheep's livers (echinococcus 55 lbs. pears veterinorum) 40 lbs. plums Pair bullock's lights (tuberculous) 1 basket oranges Most of the turkeys and geese and some of the meat and pork were surrendered on Christmas Eve at a Mission Hall in Lisson Grove to which they had been sent for distribution amongst the members of a Xmas Club formed by a number of poor people in the neighbourhood. The fact that the food was not in a condition quite fit for consumption was discovered accidently by one of the district inspectors, and a complete examination was made of the whole consignment. This consisted of a large number of turkeys and geese, and joints of beef and pork, and quite a fair proportion were found to be in an unsatisfactory condition. That they were in this condition seemed to be to some extent due to the fact that they had been delivered at the mission hall on the day preceding the examination and had been improperly stored. Because this seemed to be the explanation it was decided instead of seizing the goods in the manner laid down in Section 47 of the Public Health (London) Act, 1891, to accept surrender of a 1 that appeared to be unfit for food and to destroy them. The vendor was most anxious that this course should be adopted and willingly undertook to bear the whole cost. On the facts being reported to the Public Health Committee, they approved the action that had been taken, and gave instructions that a strong letter of caution should be sent to the vendor concerned. In this case, though those responsible for the formation of the club saw that the contributors, who could not be provided with the food for which they had paid, received their contributions back, it is certain that many were greatly disappointed, and were put to a great deal of inconvenience. There is no doubt that if the unsound articles had been distributed, most of them would have been cooked and eaten, and effects more or less serious would have been produced in those who had shared in them. In order to prevent the possibility of unsound food being distributed in this way in future, it is proposed to make arrangments each Xmas for examinations to be made of all meat and poultry on delivery by the vendors at Xmas Clubs. The number of articles seized and dealt with in the manner described in Section 47 of the Act of 1891, was considerably smaller than in the previous year. This is taken to be the result of the careful work done in the past, and to the recognition by vendors of the fact that the Council are determined to prevent the sale of food which is not in all respects fit for human consumption. The articles seized were :— Seizures. Quantity of Tomatoes (unsound) Do. Brawn ( do. ) 58 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 neither of the cases reported during the year did the Committee regard the circumstances to be such as to justify them in simply issuing a warning. Full particulars of the prosecutions are given below. Public Health (London) Act, 1891, Section 47. Name of Result. Inspector. Fine. Costs. 19, Upper Charlton Exposing for sale a quantity G. Smith 20/- 4/Street of unsound tomatoes 80, Great Titchfield Exposing for sale a quantity G. Smith £5 23/Street of unsound brawn Inspections at Central Meat Market.—In the report for 1911, reference was made to the fact that during that year, on account of certain seizures which had been made within the Borough of tuberculous pork which had been purchased by a local vendor at the Central Meat Market, a communication was sent to the Corporation of the City of London, suggesting that in the interests of the inhabitants of the Borough, if not of London generally, a more complete system of meat inspection should be arranged for. The reply which the Committee received from the Corporation was not considered satisfactory and it was determined to carry the matter further and get into communication with other borough councils and obtain their views on the question. At the end of 1911 all the councils had not replied and nothing definite had been done. During 1912 the matter was before the Committee on several occasions, and eventually it was taken up by the Metropolitan Boroughs Standing Joint Committee who arranged for a meeting between one of their sub-committees and representatives of the City Corporation. This as held and was attended by Mr. Councillor Melluish, a member of the Public Health Committee, and the Medical Officer of Health. A number of points were raised and considered at this meeting, and a number of suggestions made. The City Corporation again took the matter into consideration, and towards the end of the year a letter was sent to the Metropolitan Standing Joint Committee, a copy of which was forwarded to the Public Health Committee. In this, it was pointed out that the examination in detail of the enormous quantity of meat passing through the market, amounting in 1911 to upwards of 435,000 tons, would be impracticable, even with an increased staft of inspectors, inasmuch as the delay it would entail would practically stagnate the business of the market, besides which, disease which cannot be seen when meat is inspected in carcase, may become apparent in cutting up. 59 The Sanitary Committee, it was further stated, had formed the opinion that the inspection in the market was as complete and efficient as possible under existing circumstances, and that the respective responsibilities of Local Authorities and Retail Butchers could not be got rid of by any previous examination. The Committee were, they stated, fully alive to the importance, in the interests of public health, of having a proper and efficient inspection of food, and that only recently additional powers to facilitate prosecutions in regard to diseased and unsound meat had been obtained by the City of London (Various Powers) Act of 1911, Part IX., and it was thought that the best way to minimise, if not to entirely remove, the possibility of diseased meat being exposed for sale was to make compulsory by legislation a general system throughout the country of inspection at the time of slaughter. All this, it will be noted, did not carry matters very much further forward than they had been in 1911. It should be pointed out, however, that no tuberculous pork was seized during 1912, and the necessity of making a complaint with regard to tuberculous or other pork from the Central Market did not once arise during the year. That the action of the Public Health Committee had anything to do with this improvement it is difficult to say. It is noteworthy, however, that there was improvement. 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. Conditions. 75, Abbey Road Nil. 178, Edgware Road Nil. 4, Henry Street, St. John's Wood Small cattle only. 50, Henry Street, St. John's Wood Small cattle only. 134, High Street, St. John's Wood On the clear and distinct understanding that the room over the 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:— 6o Premises. Licensed for. Cows kept. 58, Acacia Road 44 26 56, Bell Street 15 9 42a, Clipstone Street 10 10 26, John Street 14 3 3, Malthouse Mews 22 14 Totals 105 62 Inspections were regularly and frequently made throughout the year. In no case were conditions regarding which it was necessary to serve notices discovered. Milkshops, etc.—The number of premises upon which milk is sold is 230. The number of applications received was 45. None were refused under the powers granted by the London County Council (General Powers) Act, 1908, the premises being unsuitable. Under this Act also 15 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. No appeals against refusal to register or removal of a name from the register were made to a magistrate during the year. One milk vendor who was discovered selling milk from a vehicle and from cans which did not bear his name and address was detected and prosecuted. In another case a vendor who obstructed the inspector in the course of his duties was summoned and fined. Action in both cases was taken under the Sale of Food and Drugs Acts, and further reference will be made to them later. Examination of Milk.—The number of samples of milk taken for analysis by the Food Inspector was 550, as against 547 in 1911. 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 21 (3'8 per cent.) were found to be adulterated. The percentage of adulterated samples in 1911, was 8'9, and in 1910, 9'5. 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 were instituted in respect of adulteration of milk was 16. Fines and costs to the amount of £26 8s. 6d. were recovered, the amount in 1911 being £58 10s. 61 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, 3 proved to be adulterated, and proceedings were taken in 2 instances. In these cases, the defendant, a farmer, denied that there had been any abstraction of milk fat, and asserted that the milk was as given by the cow. In these circumstances the Magistrate dismissed the Summonses, but refused the defendant's application for costs. In the remaining case the deficiency in fat was very small and the farmer was cautioned. The quarterly returns as to milk samples are tabulated below:— Quarter of the Year. No. of Samples Taken. No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. Fines and Costs. £. s. d. 1st 134 10 7.4 8 14 5 6 2nd 144 7 4.8 6 9 7 6 3rd 136 3 2.1 1 1 13 0 4th 136 1 .74 1 1 2 6 Total for year 550 21 3.8 16 26 8 6 Ice Cream Premises. The number of such premises in the Borough registered as required by the London County Council (General Powers) Act, 1902, is 104. Regular inspections were made throughout 1912, and in 20 cases notices were served in respect of uncleanly conditions. Butter, Margarine, etc. At the end of 1912, there were nine registered dealers in and manufacturers of margarine, one wholesale dealer in butter and milk-blended butter, and two butter manufacturers. 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, 1897. One application for registration as a wholesale dealer in margarine and milkblended butter was received during the year and a certificate was granted. All registered premises are frequently inspected. Information with regard to sampling of butter, margarine, etc., will be found under the heading "Sale of Food and Drugs Acts." Restaurants, Food Stalls, etc. The number of premises in the Borough in which food is prepared for sale is 246. This is made up of: restaurants and dining room kitchens 116; hotel kitchens 42 ; coffee shops, pastry cooks and tea rooms, 76 ; and fried fish shops 22, 62 Each one of these was examined at least once during the year, many much more frequently. This work is done by the meat and food inspector, who each Saturday is handed a list by the Medical Officer of Health of the premises he is to visit in the course of the week following. The total number of inspections made was 617, and as a result of these, various conditions calling for attention were discovered. In all 91 notices were served, and in every case the work called for was carried out without the necessity for taking other proceedings. The food stalls in the market streets—Great Titchfield Street, Bell Street, Church Street, Blandford Street, etc., were kept under close observation throughout the year, visits being paid every day, Saturdays and Sundays included. Offensive Trades. These call for no special mention. There are only two premises within the Borough upon which offensive trades are carried on. The business in each case is that of tripe boiling. The Food Inspector made 27 visits, but no cause of complaint was found. Bakehouses. At the end of 1912 the number of bakehouses on the register was 75, as against 76 at the end of 1911. Of the 75, 65 are below ground. The Public Health Committee agreed to register certain premises below ground as a bakehouse, the owner, who carries on the business of a baker of charcoal biscuits, having neglected, on the advice of a former inspector, to make application. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, &c., of the inside walls and other parts cf the bakehouses were duly served. * 4 The Food Inspector paid 109 visits to bakehouses during the year, and saw that the regulations with regard to cleansing were complied with. Notices calling for other works were served in 14 cases, and complied with. In no case did the necessity for taking legal proceedings arise. SALE OF FOOD AND DRUGS ACTS. The usual careful attention was given to this important part of the work of the department during 1912. The routine practice of handing the food inspector each Saturday a list of articles to be sampled and the number to be taken of each was continued. The total number taken was 1,093, which is about the average for the last three years. As the Public Analyst submits a report with regard to the work done under the Acts (see page 64), it is unnecessary to say much here. It should be pointed out, however, that on the whole year's working there has been a most striking reduction in the number of samples found to be adulterated. 63 Out of the 1,093, as a matter of fact, only 31 were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of 2'9 per cent., a figure which compares most favourably with that for 1911 and 1910, when it was 6.2 and 7.3 respectively. For this reduction there is no doubt that the increased activity in connection with the administration of the Acts is largely responsible, and it is to the credit of the Council. that the work they have caused to be done has led to a great improvement in the food supply of the inhabitants of the Borough so far at least as purity is concerned. Sampling of food under the Acts is by no means an easy matter. It must be carried out with the greatest care. There must be nothing slipshod about the method, nor must it be stereotyped or too routine in character. As far as possible, every dealer is visited at least once a year, but if it is considered necessary, more than one visit is paid and more than one sample taken. Some of these are " informal," that is to say, they are taken merely for the purpose of testing as to the purity of the article provided, and exact compliance with the rules of procedure laid down in the Sale of Food and Drugs Acts is omitted. In the majority of cases, however, the formalities of the Act are adhered to, and the announcement made of the purpose for which the sample is taken. In these, the Inspector is usually assisted by an agent, who actually makes the purchase. Such a person is most useful, and in the majority of cases in 1912 was employed. As in previous years, there was no routine time fixed for sampling. Many were taken in the early hours of the morning, and on Saturday nights and Sunday mornings. The bulk of the samples taken, as already mentioned, were of milk. The number of cases in which persons were prosecuted was 18, and the fines and costs recovered amounted to £36 10s. 0d. The warranty defence was raised in six prosecutions for adulteration of milk, and was successful in all cases, the summonses being dismissed. Two prosecutions were instituted against defendants for offences against the Acts other than selling adulterated articles. Particulars of these are given below. Sale of Food & Drugs Act, 1899, Section 9. Fine. Costs. Bolsover Street. Hawking milk in a public street without name and address on vehicle or cans 3 0 2 0 Sale of Food & Drugs Act, 1899, Section 16. Fine. Costs. 16, James Street. Wilfully obstructing an Inspector in the course of his duties under the Sale of Food & Drugs Acts. 10 0 2 0 64 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 QUARTER ENDING 31st MARCH, 1912. 123 milk Food Inspector Genuine. £500 per ann. for 700 samples. Over that number 7/6 per sample. Six were test samples, two contained colouring matter. All were free from preservatives. 1 milk Private purchaser Genuine 10 milk Food inspector Adulterated. No. 1, 60 per cent. fat abstracted No. 1. This was a test sample. Do. No. 19, 46.7 do. No. 19. Fined £5 and £5/5 costs Do. No. 68, 4 per cent, added water No. 68. As vendor had warranty from wholesale dealers, Solicitor advised no prosecution vide P.H. Mts., 9th February, 1912 Do. No. 79, 23.3 per cent, fat abstracted No. 79. Warranty defence. Case dismissed Do. No. 86, 3.3 do. No. 86. Vendor cautioned vide P.H. Mts. 23rd February, 1912 Do. No. 98, 10.0 do. No. 98. Warranty defence. Case dismissed. Do. No. 152, 10.0 do. No. 152. Fined £2 and £1/3 costs Do. No. 160, 6.67 do. No. 160. Warranty defence. Case dismissed Do. No. 210, 30.0 do. 9.2 per cent. added water No. 210. Defendant died 20th March, 1912, summons not served Do. No. 251, 6.67 per cent. fat abstracted No. 251. Fined 5/- and 12/6 costs 5 butter Do. Genuine. 65 contained borax ranging from a trace up to 35 grains per lb., 4 were test samples. The greatest quantities were in the five following:— No. 39. 34.6 grains per lb. No. 97 33.6 do. No. 168. 25.0 do. No. 180. 35.0 do. No. 219. 30.2 do. 1 butter Do. Adulterated. No. 239, 80.0 per cent, foreign fat Fined £3 and 12/6 costs on first summons and 2/costs on second. 6 cream Do. Genuine. No. 252 contained borax to the extent of 30 grains per pint 1 cheese Do. Do. This was a test sample 3 jams Do. Do. These were all test samples 3 lime water Do. Do. Two were test samples 3 mustard Do. Do. Two were test samples 1 Frankfort sausages Do. Do. This was a test sample 65 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. vations. 1 black currant jelly Food Inspector Genuine ,£500 per annum in respect of 700 samples Over that number 7/6 per sample. This was a test sample 1 red currant jelly Do. Do. This was a test sample 3 coffee Do. Do. 2 seidlitz powders Do. Do. These were test samples 3 pepper Do. Do. These were test samples 1 Dover's powder Do. Do. This was a test sample 1 cocoa Do. Do. This was a test sample 1 sweets Do. Do. This was a test sample 1 rice Do. Do. This was a test sample 1 liquorice powder Do. Do. This was a test sample 1 boracic ointment Do. Do. This was a test sample 1 milk chocolate Private Do. Purchaser Total Number of Samples analysed during the Quarter 254 Number of Sa mples adulterated 11 SECOND QUARTER ENDING 30TH JUNE, 1912. 137 milk Food Inspector Genuine Four were test samples Out of 144 samples of milk, one only contained a coal tar colouring matter 7 do. Do. Adulterated. No. 302. 13-3 per cent. deficient in milk fat No. 302. Fined 10/- and 12/6 costs Do. No. 309. 36.7 per cent. deficient in milk fat No. 309. Fined £2 and 12/6 costs Do. No. 354. 43.3 per cent. deficient in milk fat and 14.6 per cent. added water No. 354. Fined £5 and 12/6 costs Do. No. 412. 6.67 per cent. deficient in milk fat No.412. Station samples. No. 413. Defendant farmer stated that milk was as given from cow. Dismissed. No costs allowed Do. No. 413. 6.67 per cent. deficient in milk fat Do. No. 434. 3.3 per cent. deficient in milk fat No.434. Vendor cautioned vide P. H. Mts. 28th June, 1912 Do. No. 499. 16.67 per cent. deficient in milk fat No.499. Warranty defence. Case dismissed 87 butter Do. Genuine Twenty-two were test samples. Out of a total of 88 butters, 72 contained borax as follows: Up to 20 grains per lb., 20; 20-30, 42; over 30 grains per lb., 10. Greatest quantity 32-4 grains per lb. 1 do. Do. Adulterated. No. 482. Not butter but margarine containing over 85 per cent, of fat other than butter fat No. 482. Fined £2 and 12/6 costs on first summons and £1 and 12/6 costs on second summons 10 cream Do. Genuine One was a test sample 2 margarine Do. Do. One was a test sample 1 nutter Do. Do. This was a test sample 4 lard Do. Do. One was a test sample 2 mustard Do. Do. 2 jams Do. Do. One was a test sample 9 coffee Do. Do. Two were test samples 1 coffee and chicory Do. Do. 66 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. 2 lime water Food Inspector Genuine £500 per annum in respect of 700 samples. Over that numper 7/6 per sample These were test samples 1 pepper Do. Do. 1 canned salmon Do. Do. This was a test sample 3 Dover's powder Do. Do. These were test samples 1 boric ointment Do. Do. This was a test sample 1 paregoric elixir Do. Do. This was a test sample 1 turpentine liniment Do. Do. This was a test sample 2 Gregory's powder Do. Do. These were test samples Total Number of Samples analysed during the Quarter 275 Number of Sa mples adulterated 8 THIRD QUARTER ENDING 30TH SEPTEMBER, 1912. 133 milk Food Inspector Genuine. No preservative in any sample; 9 samples contained colouring matter. One was a test sample. 3 do. Do. Adulterated. Do. No. 709. 6.67 per cent. fat abstracted Do. No. 741. 33.3 per cent. fat abstracted Do. No. 787. 26.67 per cent. fat abstracted No. 709. Vendor cautioned. No. 741. This was a test sample. No. 787. Fined 10/- and £1/3/- costs. 89 butter Do. Genuine. 17 were test samples. 20 samples contained borax up to 20 grains per lb. 44 samples contained borax between 20 and 30 grains per lb. 9 samples contained borax over 30 grains per lb. Greatest amount in any one sample 34 grains per lb. 16 samples contained no borax or other preservative. 2 margarine Do. Do. One was a test sample. 2 cream Do. Do. One was a test sample. 1 sample contained 15.9 grains borax per lb. 1 sample contained no preservative. 1 cheese Do. Do. This was a test sample. 1 lard Do. Do. 3 jam Do. Do. Two were test samples. 7 coffee Do. Do. Two were test samples. 1 chicory Do. Do. This was a test sample. 3 pepper Do. Do. One was a test sample. 5 mustard Do. Do. Three were test samples. 1 Dover's powder Do. Do. This was a test sample. 1 liquorice powder Do. Do. 1 boracic ointment Do. Do. This was a test sample. 2 lime water Do. Do. One was a test sample. 1 citrate of magnesia Do. Do. 2 sweet spirits of nitre Do. Do. Both were test samples. Total Number of Samples analysed during the Quarter 258 Number of Samples adulterated 3 67 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. 1 FOURTH QUARTER ENDING 31ST DECEMBER, 1912. 135 milk Food Inspector Genuine. £500 per annum in respect of 700 samples. Over that number 7/6 per sample One was a test sample. 8 contained colouring matter. 1 milk Do. Adulterated. No. 797. 73.3 per cent, fat abstracted. No. 797. Fined 10/- and 12/6 costs. 2 condensed milk Do. Genuine. Both were test samples. 90 were test samples. 107 contained borax, 6 contained 30 grains per lb. or over, 31 contained 20 and under 30 grains per lb., 50 contained 10 and under 20 grains per lb., 20 contained under 10 grains per lb. 116 butter Do. Do. 8 butter Do. Adulterated. No. 869. 40 per cent, fat other than butter fat. Do. No. 880. do. Do. No. 876. do. Do. No. 893. do. Do. No. 901. do. Do. No. 902. do. Do. No. 960. Margarine, not butter. Do. No. 977. do. This was a test sample. (No. 869) This was a test sample. (No. 880) This was a test sample. (No. 876) Fined £1 and 12/6 costs for selling on 1st summons and 10/- and 2/- costs on 2nd summons. (No. 893) This was a test sample. (No. 901) This was a test sample. (No. 902) This was a test sample. (No. 960) This was a test sample. (No. 977) 13 cream Do. Genuine. Three were test samples. 3 creams. Nos. 820, 822 and 1053 contained borax when not so labelled. 7 creams contained borax ranging from 5.6 to 17.5 grains per lb. 1 lard Do. Do. This was a test sample. 8 coffee Do. Do. Six were test samples. 2 pepper Do. Do. One was a test sample. 4 mustard Do. Do. 3 Dover's powder Do. Do. These were test samples. 2 Ipecacuanha wine Do. Do. These were test samples. 1 Gregory's powder Do. Do. This was a test sample. 2 ammoniated tincture of quinine Do. Do. One was a test sample. 1 sweet spirits of nitre Do. Do. This was a test sample. 3 jam Do. Do. Two were test samples. 2 cocoa Do. Do. These were test samples. 1 lime water Do. Do. 1 cream cheese Do. Do. This was a test sample. Total Number of Samples analysed during the Quarter 306 Number of Samples adulterated 9 68 SUMMARY. Number of Samples Analysed. Number Adulterated. 1st Quarter 254 11 2nd „ 275 8 3rd „ 258 3 4th „ 306 9 Total 1,093 31 REPORT OF THE PUBLIC ANALYST, 1912. During the year 1912, 1,093 samples were submitted for analysis, of these, only 31 were certified as adulterated—not quite 2.9 per cent. This shows a remarkable decrease compared with the samples taken in 1911—in that year 69 samples out of 1,111, were found wrong, or 6.2 per cent., and as the same kind of samples were taken in both years, it is fair to say that there was a little more than double the adulteration in 1911, as compared with 1912. The samples comprise: dairy produce, condiments, saccharine substances, canned goods, non-alcoholic beverages, farinaceous foods and drugs, but not a single sample of wine, beer or spirits. Of these dairy produce accounts for 89 per cent. Milk.—Out of 550 samples, 529 were found to attain or exceed the statutory limit, that is 3 per cent. milk fat and 8.5 per cent. solids not fat. The average composition of the unadulterated samples during the three years, 1910,1911 and 1912 was as follows:— Sp. gr. Milk fat. Solids, not fat. Total solids. 1910 1031.0 3.63% 8.65% 12.28% 1911 1031.0 3.70% 8.64% 12.34% 1912 1031.5 3.74% 8.77% 12.51% This clearly shows a progressive improvement—in over 20 per cent. of the samples the milk fat was 4 per cent. or above—hence as a rule excellent milk of far more than the average quality was supplied to the Marylebone residents during 1912. In no case was any preservative detected, but artificial colouring of milk is still prevalent. Twenty-one of the samples of milk, a little under 4 per cent., were certified as adulterated. 69 All of these were deficient in milk fat from 3 up to 73 per cent., in two cases only the milk was also watered, from 9 to nearly 15 per cent. water having been added. Butter.—387 samples of butter were analysed, 10 of these were adulterated, equal to only 2'6 per cent. Over 83 per cent. of these samples contained boric acid, varying from 10 grains per lb. up to the legal limit of 35 grains per lb., the average amount being 22.5 grains per lb. Sixty-three samples of butter (16.6 per cent.) contained no preservatives. If it is not found necessary to add chemicals to some kinds of butter, the question may be asked, what is the reason the dairy farmers and butter manufacturers add it to any class of butter? Butter properly made from clean milk, and slightly salted, keeps quite sufficiently well for most commercial purposes, and such small quantities of boric acid as 10 to 12 grains per lb. can have little, if any, preserving properties. Of the 10 samples of butter certified as adulterated, six were "test" or informal samples. One half of the samples were margarine pure and simple, and therefore substitutions of a cheaper for a dearer article. The remainder were mixtures of over 40 per cent. of fats other than that of butter fat. Cream.—Thirty-one samples of cream were analysed: all of these were genuine, nine were free from preservatives, the remainder contained on an average 16 grains boric acid to the lb., the extremes being 5 and 30 grains to the lb. The Public Health (Milk and Cream) Regulations, 1912, came partly into force in the last quarter of the year, the chief working regulation being that it is an offence now to sell preserved cream containing 35 per cent. or more by weight of milk fat containing any other preservative than boric acid, borax or hydrogen peroxide, and such cream has to be labelled as preserved cream with the name of the preservative (boric acid or peroxide), the maximum quantity of boric acid added has also to be stated on the label. Three vendors of cream, since October, 1912, were found to have infringed the regulations by selling cream containing over 50 per cent. of milk fat, preserved by small quantities of boric acid. Other Samples.—There is little to be said about samples other than dairy samples. A number of jams were examined. In the previous year, 1911, a prosecution was undertaken and conviction obtained with regard to apple pulp added to currant and plum jams, but the 1912 samples were all free from apple pulp. A number of drugs were analysed and found quite up to standard, and the remaining articles call for no special comment. The appended table gives a summary of the work done. A. WYNTER BLYTH. January 22nd, 1913. Public Analyst. 70 ANALYSES UNDER THE SALE OF FOOD AND DRUGS ACTS DURING 1912. The following table summarizes the information submitted formally by the Public Analyst:— No. Article. Genuine. Adulterated. Total. 1 Milk 529 21 550 2 Butter 377 10 387 3 Margarine 4 — 4 4 Cream 31 — 31 5 Cheese 2 — 2 6 Cream Cheese 1 — 1 7 Lard 6 — 6 8 Nutter 1 — 1 9 Mustard 14 — 14 10 Pepper 9 — 9 11 Rice 1 — 1 12 Cocoa 3 — 3 13 Coffee 27 — 27 14 Chicory 1 — 1 15 Coffee and Chicory 1 — 1 16 Jam 11 — 11 17 Black Currant Jelly 1 — 1 18 Red Currant Jelly 1 — 1 19 Condensed Milk 2 — 2 20 Sweets 2 — 2 21 - Frankfort Sausage 1 — 1 22 Canned Salmon 1 — 1 23 Lime Water 8 — 8 24 Seidlitz Powder 2 — 2 25 Dover's Powder 8 — 8 26 Liquorice Powder 2 — 2 27 Gregory's Powder 3 — 3 28 Paregoric Elixir 1 — 1 29 Boracic Ointment 3 — 3 30 Turpentine Liniment 1 — 1 31 Citrate of Magnesia 1 — 1 32 Ammoniated Tincture of Quinine 2 — 2 33 Sweet Spirits of Nitre 3 — 3 34 Ipecacuanha Wine 2 — 2 1,062 31 1,093 BACTERIOLOGICAL EXAMINATION OF FOOD. The practice of taking a certain number of samples of food and submitting them to the Council's bacteriologist (Dr. Eastes) for examination was continued during 1912. In all, 15 were taken, of which were milk. Of the milk samples, some were taken at one or other of the railway stations, others at shops within the Borough. 71 The samples reported against were 5 milks and 1 ice cream. The report in each case was submitted to the Public Health Committee, and warnings with regard to those which were found to be bad were sent to the vendors. In the milk cases also a communication was sent to the Medical Officer of Health of the district from which the milk was stated to have come, and he was asked to take such action as seemed necessary in order to bring about improvement. Certification of Meat Food Products.—During the year six certificates were granted in connection with the export of meat food products to the United States and Philippine Islands, to the effect that the premises were sanitary and regularly inspected. In each case the foods concerned were hams, and would total about 1,500, and the certificates, which were granted by the Medical Officer of Health in his capacity as certifying officer, were issued at the request of Messrs. Peter Keevil and Sons, Ltd., 370, Edgware Road, W. 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 34. In 321 cases, intimation notices were served calling for the provision of a supply of water to the upper storeys of tenement houses, as required by Section 78 of the London County Council (General Powers) Act, 1907. The supply was provided, after the receipt of the intimation notice, in 214 instances. In the remaining 107, it was found necessary to serve a statutory notice. Following the receipt of this, the work was done, and in only one case was it necessary to apply for a summons against the owner. Water Supply Cut Off.—The Metropolitan Water Board reported, in accordance with the requirements of the Public Health (London) Act, 1891, Section 49 (1) that the water supply had been cut oft in 20 premises. The reasons for discontinuing the supply were: Premises empty 9 Non-payment of Rates 9 Waste of Water 2 20 Mr. Alderman J. Lea-Smith, the Council's representative on the Water Board, and a member of the Public Health Committee, as in the past gave a great amount of assistance in connection with these cases. If the premises affected were a tenement house, immediately on receiving information from the department he immediately took steps to secure that the tenants should suffer no hardship as a result of being deprived of water. No complaints with regard to the water supplied were received during the year. 72 HOUSING. During 1912 the routine established in 1910 and perfected in 1911 in connection with house examinations was continued. The sanitary survey was completed by the district inspectors early in the year, and the house to house inspector went steadily forward dealing with street after street, referring those premises that were found defective to the Medical Officer of Health and the district inspectors to be dealt with as appeared to be necessary. The system of communicating always in the first instance with the owners of defective property before submitting representations or complaints to the Public Health Committee was continued, and results probably more satisfactory than could have been expected from the service of formal notice under any of the sections of the Public Health Act, or even the Housing, Town Planning, etc., Act, were obtained. Owners always showed themselves to be willing to meet the Medical Officer of Health or the inspector and discuss matters, and improvements of real value were undoubtedly obtained because the necessity for them and the methods in which they could be brought about were discussed in a friendly way. Some examples of such cases are quoted below:— Premises dealt with voluntarily under the Housing, Town Planning, &c. Act, 1909. 48, Huntsworth Mews Additional external light and ventilation provided to the bedrooms. The premises thoroughly cleansed throughout. 53, Linhope Street The back room on first floor of these premises properly sealed off from the stables below. Additional ventilation provided to the stables. 35, Salisbury Street The premises voluntarily closed to prevent representation being made to Committee under Housing Town Planning etc., Act. 41, Exeter Street Proper means of external light and ventilation provided to the water closet on ground floor. 1, Wilcove Place The two-storey obstructive buildings in back yard demolished. 2, Wilcove Place The obstructive buildings at rear of these premises demolished and proper washhouse constructed. 1, Huntsworth Mews The w.c. removed from under staircase on ground floor. New w.c. constructed in proper position on first floor. Additional light and ventilation provided to the living rooms. Access provided to these rooms direct from the Mews. The stables disconnected from the living rooms. Premises redrained and cleaned throughout. 73 3, Huntsworth Mews The attention of the owners was called to the unsatisfactory condition of these premises which were subsequently closed voluntarily and together with Nos. 5 and 9 reconstructed as a Garage. 7, Huntsworth Mews Ditto. 27, Huntsworth Mews The existing w.c. on the 1st floor properly lighted and ventilated from the external air, and disconnected from the living rooms by a ventilated lobby 29, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of these premises which were subsequently closed voluntarily, and, together with No. 27, reconstructed as a garage. 31, Huntsworth Mews Ditto. 33, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of the living rooms over blacksmith's shop. These premises were subsequently closed voluntarily. No works carried out. 35, Huntsworth Mews The stables properly disconnected from living rooms and separately ventilated to the external air. Additional external light and ventilation provided to the bedroom and water closet. The premises cleansed throughout. 39, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of these premises. They were subsequently closed voluntarily to avoid further action. 41, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of these premises. They were subsequently closed voluntarily with a view to structural alteration. 43, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of these premises. They were subsequently closed voluntarily with a view to structural alteration. 6, Huntsworth Mews The w.c. removed from under staircase on ground floor. New w.c. constructed in proper position on 1st floor. New staircase constructed, additional means of external light and ventilation provided to the living rooms. The premises cleansed throughout. Drains reconstructed. 74 8, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of these premises. They were subsequently closed voluntarily with a view to structural alteration. 10, Huntsworth Mews The w.c. removed from under staircase on ground floor. New w.c. constructed in proper position on 1st floor. New staircase constructed, additional means of external light and ventilation provided to the living rooms. The premises cleansed throughout. Drains reconstructed. 12, Huntsworth Mews The use of lower part of these premises as a stable discontinued. Additional means of external light and ventilation provided to the w.c. on first floor. Premises cleansed and redrained throughout. 14, Huntsworth Mews The w.c. removed from under staircase on ground floor. New w.c. constructed in proper position on 1st floor. New staircase constructed, additional means of external light and ventilation provided to the living rooms. The premises cleansed throughout. Drains reconstructed. 26, Huntsworth Mews The w.c. reconstructed in proper position on ground floor. New staircase constructed, additional means of external light and ventilation provided to living rooms on 1st floor. 28, Huntsworth Mews Additional means of external light and ventilation provided to the bedroom and w.c. on 1st floor. Drains reconstructed. 36, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of these premises. They were subsequently closed voluntarily with a view to conversion to workshops. 38, Huntsworth Mews The w.c. removed from under staircase in workshop on ground floor. New w.c. constructed in proper position on 1st floor. New staircase constructed. 75 44-6, Huntsworth Mews The defective w.c. in No. 44 demolished. The w.c. in No. 46 reconstructed in proper position on ground floor. The stables in both premises properly disconnected from the living rooms. The 1st floor of the two premises converted into a single flat, with separate entrance from the mews. 19, Little Exeter Street Proper means of external light and ventilation provided to the staircase, basement and w.c. Ventilated food cupboard constructed. The basement repaved. Premises cleansed and renovated throughout. 54, Salisbury Street The internal partitions on the ground floor reconstructed so as to provide direct external light and ventilation to the two back rooms. The roof over these rooms entirely reconstructed. 56, Salisbury Street Ditto. 58, Salisbury Street Ditto. 60, Salisbury Street Ditto. 21 Townshend Road External light and ventilation provided to back bedroom on ground floor, fire grate fixed in fire place, inner surface of walls replastered, damp proof course laid in walls, external light and ventilation provided to scullery and yard w.c., supply of water laid on to upper floors, 2nd floor rooms staircase and passage cleansed. 6, 8, 9, 10, 11, 12,13, Venables Street Light and ventilation of ground floor back room improved by demolition of back cottage built over washhouse and water closet entered by covered passage from half landing between ground floor and first floors. Washhouse and water closet re-roofed. 109, Carlisle Street External light and ventilation provided to ground floor middle room by the removal of a portion of the back addition and the building of a doorway to the yard, with a hinged fanlight above. Lighting of 1st floor back room improved by removal of obstructing portion of back addition. Drains reconstructed and supply of water laid on to upper floors. Two rooms cleansed. 76 45, Frederick Street External light and ventilation provided to ground floor back room by the removal of a portion of the back addition built over back window. Yard paving repaired. 31 Frederick Street External light and ventilation provided to ground floor back room by the removal of a portion of the back addition built over window; supply of water laid on to upper floors; three rooms cleansed. Sanitary dust bin provided. Defective and foul drinking water cistern abolished, drinking water supply taken direct from main. 6, Hatton Street Closed voluntarily for structural alterations. 59, Henry Street Bedroom 1st floor back without external light and ventilation,now used for storage purposes. 12, Hatton Street Closed voluntarily. 4, York Terrace Mews Suitable and sufficient external light and ventilation provided to bedroom: light and ventilation provided to w.c. Drain partially reconstructed. 9, York Terrace Mews Ceilings of living room and bedroom raised, additional light and ventilation provided. Premises cleansed throughout. 13, York Terrace Mews Damp, dirty, improperly quired reconstruction throughout. Voluntarily closed. 15, York Terrace Mews Additional external light and ventilation provided to bedrooms. Premises cleansed throughout. 16, York Terrace Mews Additional external light and ventilation provided to bedroom: w.c. cut off from, staircase and light and ventilation provided to same. 18, York Terrace Mews Additional external light and ventilation provided to bedroom, w.c. erected in proper position with external light and ventilation. Drain relaid throughout. 77 10, Williams Mews Additional ventilation provided to two rooms. 27, Paddington Street Basement rooms voluntarily closed. 5, Cornwall Terrace Mews Additional light and ventilation provided to bedrooms; ceilings of rooms removed and height increased. Water closet fitted in suitable position with proper light and ventilation. 8, Cornwall Terrace Mews Water closet removed from living room. Proper light and ventilation provided to w.c. on ground floor. 11, Cornwall Terrace Mews W.C. cut off from premises and staircase cut off from stable and entered from coach house: height of bedroom increased and additional light and ventilation provided by the introduction of skylight. 12 Cornwall Terrace Mews Height of rooms increased; w.c. put in proper position. Skylights introduced to provide adequate light and ventilation to rooms, landing and w.c. 15, Cornwall Terrace Mews Height of rooms increased and w.c. put in proper position: skylights introduced. 20, Cornwall Terrace Mews Window provided in w.c. 21, Cornwall Terrace Mews W.C. placed in proper position; light and ventilation provided. One result of this procedure was certainly to reduce the number of premises reported to the Public Health Committee for closure. The actual number was one, and this was only represented because no improvement seemed possible. In this case a closing order was made. In no case was an appeal made against any order of the Local Authority. The Visiting Sub-Committee is now definitely a Sub-Committee of the Public Health Committee, and visits all premises reported by the Medical Officer of Health. Full particulars of proceedings under the Act will be found in the following table:— 78 HOUSING, TOWN PLANNING, Etc., ACT, 1909. Premises reported or represented during 1912, and the two previous years:— Housing and Town Planning. 1910. 1911. 1912. 8a, Short Street. C.O. 7th Oct., 1910. Committee agree to premises being used as a store 21st Oct., 1910, and closing order determined. 1, Cranmore Street C.O. 7th Oct., 1910. D.O. 24th March, 1911, void for informality. C.O.s again made 17th Nov., 1911 Question of D.O. in abeyance. 7, do. 8, do. 9, Providence Place C.O.s made 18th Nov., 1910, held over 2nd Dec.,1910. C.O.s withdrawn 27th Jan., 1911. Premises voluntarily closed 10th March, 1911 Works executed and completed. Premises again occupied Dec., 1912. 10, do. 11, do. 12, do. 13, do. 14, do. 23, Burne Street, cottage rear of. C.O. 2nd Dec., 1910. D.O. made 14th July, 1911, demolished 17th Nov., 1911 24, Burne Street, cottage rear of. C.O. 2nd Dec., 1910 D.O. made 14th July, 1911, demolished 1st Dec., 1911 6, Harrow Street, cottage rear of. C.O. 18th Nov., 1910 Premises rendered fit. C.O. withdrawn 19th May, 1911 12, Mitcham Street. C.O. 18th Nov., 1910 Premises rendered fit. C.O. withdrawn 6th June, 1911 22, Huntsworth Mews C.O. 24th Feb., 1911 Work executed, C.O. determined 1st April, 1912. 22, Burne Street, cottage rear of C.O. 24th Feb., 1911 (void for informality). Further C.O. 20th Oct., 1911 D.O. 22nd March, 1912. Premises demolished 10th April, 1912. 5, Portman Street, 5 basement rooms C.O. 25th Aug., 1911 5th July, 1912, Magistrate confirmed c.O.s 19th Sept.,1912. Not occupied House-to-House Inspection. As in the previous years this work was carried out in 1912 by Inspector Hodges. The total number of streets examined was 36. The various districts into which the Borough is divided, being visited in turn in order to give the district inspectors an opportunity of following up and seeing all necessary remedies carried out and completed. The actual number of houses inspected was 1,586 (separate houses, 1,559 ; tenements in blocks, 427). The inspections totalled 2,318, and the notices served 914 (intimations 760; statutory notices, 154). Records of all inspections were made in the house-to-house registers, which were produced for the inspection of the Public Health Committee. In addition a note was made on each agenda of the number of inspections made in the preceding fortnight, and the estimated number of first inspections which remained to be made. 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. 79 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. 1159 1 1 2 67 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. and 427 Tenements in Blocks of Buildings after letters to Owners 760 in respect of which Notices (Intimations and Statutory) were served. Intimation 760 In other cases overcrowding; vermin; defective sanitation and drainage, etc. Statutory 154 914 *6th July, 1912. Magistrate confirmed Closing Order on 5 Underground Basement Rooms at No. 5, Portman Street. Sanitary Survey. This survey, commenced in 1910, was completed early in 1912, the 42 streets remaining at the end of 1911 soon being dealt with by the district inspectors. The records obtained have already proved exceedingly useful in assisting the Medical Officer of Health to determine the order in which streets shall be examined by the house-to-house inspector. During the course of the survey also a number of glaring defects were found, and steps to have these removed without delay were immediately taken. Houses Let in Lodgings. At the end of 1911 the total number of houses on the register was 1,052, a figure which included the 758 originally on the register prior to the passing of the new By-laws in 1907, but which were re-examined and registered after these came into force. During 1912, 278 tenement houses, discovered in the course of house-to-house examinations, were added, but in the revision of the register a number of houses which had previously been registered were found to have altered in character and were removed. In the course of clearing of areas for the purpose of rebuilding, a number of registered houses were demolished. These also have been deleted from the register, and as a result of the deletions caused in these two ways, the number of houses actually on the register was reduced by 51, making a total of 1,001 at the end of the year. All premises on the register were systematically inspected during the year, and, in all, 1,159 visits were paid. In 760 instances intimation notices relating to nuisances were served, the majority of which were promptly complied with. In only 154 cases were Statutory Notices necessary. 80 In March notices calling attention to the necessity for cleansing and limewashing of staircases, etc., were served upon all owners of registered houses. 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 August, 1912, the assent of the Local Government Board to the new By-laws drafted by the Council in order to incorporate the alterations rendered necessary by the coming into force of Section 16 of the Housing, Town Planning, etc., Act, 1909, was received. Thereafter all action with regard to houses let in lodgings was taken under these By-laws, a copy of which is reproduced here. Metropolitan Borough of St. Marylebone. Public Health (London) Act, 1891, Section 94. Housing, Town Planning, etc., Act, 1909, Section 16. BY-LAWS. Made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone, with respect to Houses let in Lodgings or occupied by members of more than one family in the Metropolitan Borough of St. Marylebone. Interpretation of Terms. 1. In these By-laws, unless the context otherwise requires, the following words and expressions have the meanings hereinafter respectively assigned to them ; that is to say:— "Council" means the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. "Lodging House" means a house or part of a house intended for the working classes which is let in lodgings or occupied by members of more than one family. "Landlord" in relation to a lodging house means the owner within the meaning of the Public Health (London) Act, 1891. "Tenant" means the person who, whether as owner or otherwise, has an interest in the premises of such nature and extent as to entitle the said person to let the lodging house in lodgings or for occupation by members of more than one family or for the time being to receive the profits arising from the said letting. "Lodger" in relation to a lodging house means a person to whom any room or rooms in the lodging house may have been let as a lodging, or for his use and occupation. Exempted Houses. 2. In either of the following cases a lodging house shall be exempt from the operation of these By-laws; that is to say:— (a) Where the rent or charge payable by each lodger and exclusive of any charge for the use by the lodger of any furniture, is at a rate of not less than 10s. per week; 81 (b) Where the rent or charge payable by each lodger, and inclusive of any charge for the use by the lodger of any furniture, is at the rate of not less than 12s. 6d. per week. (a) For fixing the number of persons who may occupy a house or part of a house which is let in lodgings or occupied by members of more than one family; (b) For the registration of houses so let or occupied; (c) For the inspection of such houses; (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in such houses ; (e) For the cleansing and lime-washing at stated times of the premises: (f) For the taking of precautions in case of any infectious disease. 3. A lodger in a lodging house and (subject to the provisions of these By-laws) the tenant of the lodging house shall not, knowingly, cause or suffer a greater number of persons than will admit of the provision of three hundred cubic feet of free air space for each person of an age exceeding ten years, and of one hundred and fifty cubic feet of such space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is used exclusively for that purpose, and which, in the case of the lodger, has been let to that lodger. 4. A lodger in a lodging house and (subject to the provisions of these By-laws) the tenant of the lodging house shall not, knowingly, cause or suffer a greater number of persons than will admit of the provision of four hundred cubic feet of free air space for each person of an age exceeding ten years, and of two hundred cubic feet of such space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is not used exclusively for that purpose, and which, in the case of the lodger, has been let to that lodger. 5. The tenant of a lodging house within a period of fourteen days after he shall have been required by a notice in writing, signed by the Clerk to the Council, and duly served upon or delivered to such tenant, to supply the information necessary for the registration of such house by the Council, shall, himself, or by his agent duly authorised in that behalf, sign and furnish to the Council a true statement of the following particulars with respect to such house, that is to say:— (a) The total number of rooms in the house; (b) The total number of rooms let in lodgings or occupied by members of more than one family; (c) The manner of use of each room; (d) The number, age and sex of the occupants of each room used for sleeping; (e) The Christian name and surname of the lessee of each room; and (f) The amount of rent or charge per week payable by each lessee. 82 6. Where the tenant of a lodging house resides in any part of the premises, the tenant, and where the tenant of a lodging house does not reside in any part of the premises, every lodger who is entitled to have or to exercise the control of the outer door of the premises, and every other person who being resident in any part of the premises is entitled to have or to exercise the like control, shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, afford any such officer free access to the interior of the premises for the purpose of inspection. 7. Every lodger in a lodging house shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, afford any such officer free access for the purpose of inspection to the interior of any room or rooms which may have been let to the lodger. 8. Where the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf has, for the purpose of inspection, obtained access to the interior of a lodging house or to the interior of any room or rooms in a lodging house, a person shall not wilfully obstruct any such officer in the inspection of any part of the premises, or, without reasonable excuse, neglect or refuse when required by any such officer, to render him such assistance as is reasonably necessary for the purpose of his inspection. 9. Where a lodger in a lodging house is entitled to the exclusive use of any washhouse or outhouse or of any staircase, or passage, or of any court, courtyard, area, or other open space within the curtilage of the premises, such lodger, and where two or more lodgers in a lodging house are entitled to the use in common of any washhouse or outhouse or of any staircase, or passage, or of any court, courtyard, area, or other open space within the curtilage of the premises, the tenant shall, subject to the provisions of these By-laws, cause the washhouse, or outhouse or the staircase, passage, court, courtyard, area, or other open space, to be thoroughly cleansed from time to time as often as may be requisite for the purpose of keeping the same in a cleanly condition. 10. Subject to the provisions of these By-laws, The landlord of a lodging house shall cause every drain or means of drainage with which any water' closet belonging to the lodging house may communicate, to be maintained at all times in good order and efficient action. He shall also cause all such means of ventilation as are provided in or in connection therewith to be maintained at all times in good order. 11. Every lodger in a lodging house shall cause all solid or liquid filth or refuse to be removed at least once in every day from every room which has been let to him, and shall, once at least in every day, cause every vessel, utensil, or other receptacle for the said filth or refuse to be thoroughly cleansed. 83 12. A lodger in a lodging house shall not cause or suffer any animal to be kept in any room which has been let to him, or elsewhere upon the premises, in such a manner as to render the condition of such room or premises filthy. 13. Where a lodger in a lodging house is entitled to the exclusive use of any staircase, landing or passage in the lodging house, the lodger shall cause every part of the staircase, landing or passage, to be thoroughly cleansed from time to time as often as is requisite. 14. Every lodger in a lodging house shall cause all bedclothes and bedding and every bedstead in any room which may have been let to him unfurnished to be thoroughly cleansed as often as shall be necessary for the purpose of keeping such bedclothes, bedding and bedstead in a clean and wholesome condition and free from vermin. 15. Subject to the provisions of these By-laws, the tenant of a lodging house in which rooms are let in furnished lodgings shall cause all bedclothes and bedding and every bedstead in such rooms to be cleansed as often as shall be necessary for the purpose of keeping such bedclothes, bedding and bedstead in a clean and wholesome condition and free from vermin. 16. Where necessary, and subject to the provisions of these By-laws, the landlord of a lodging house shall, not later than the 30th April in every year, cause every part of the premises to be thoroughly cleansed. He shall at the same time (except as is hereinafter specified) cause the walls of every area, the surface of every ceiling, and the interior surface of every wall of every water closet belonging to the premises, and where necessary, the yard walls of such premises and the surface of every ceiling and the interior surface of every wall of every room, staircase, and passage in the house to be thoroughly lime-washed or distempered in every case where lime-washing or distempering is necessary for effective cleansing. Provided that the foregoing requirement with respect to lime-washing or distempering shall not apply in any case where the interior surface of any such wall or ceiling is painted, or where the materials of or with which such suface is constructed or covered are such as to render the lime-washing or distempering thereof unsuitable or inexpedient, and where such surface is thoroughly cleansed, and the paint or other covering is renewed when necessary for the purpose of keeping the premises in a cleanly and wholesome condition. 17. Subject to the provisions of these By-laws, the landlord of a lodging house shall provide and maintain in good order, adequate means of ventilation in, or in connection with, every common passage or staircase in such house. 18. Subject to the provisions of these By-laws, the landlord of a lodging house shall provide and maintain adequate means of ventilation in, or in connection with, any room in such house. 84 19. In every case where two or more lodgers in a lodging house are entitled to the use in common of any passage, landing or staircase, and the tenant of a lodging house resides in any part of the premises, such tenant shall cause every part of such passage, landing or staircase to be ventilated daily. 20. In every case where a lodger in a lodging house is entitled to the exclusive use of any passage, landing or staircase in such house, such lodger shall cause every part of such passage, landing or staircase to be ventilated daily. 21. Every lodger in a lodging house shall cause the floor of every room which has been let to him to be thoroughly swept at least once in every day and to be washed thoroughly once at least in every week, and from time to time as often as may be necessary for the purpose of keeping the same in a clean and wholesome condition and free from vermin. 22. Where, in pursuance of any statutory provision in that behalf, an Order of a Justice has been obtained for the removal from a lodging house to a hospital of a person suffering from any dangerous and infectious disease who is without proper lodging or accommodation the tenant of the lodging house, where the tenant resides in any part of the premises, and the lodger to whom any room whereof such person may be an occupant has been let, shall, on being informed of such Order, forthwith take all such steps as are requisite on the part of such tenant or lodger respectively to secure the prompt removal of such person in compliance with such Order, and shall, in and about such removal, adopt all such precautions as, in accordance with any instructions which such tenant or lodger respectively may receive from the Medical Officer of Health of the Council, are most suitable for the circumstances of the case. 23. Where a duty imposed upon or a prohibition applied to the landlord or the tenant of a lodging house is by any By-law expressly imposed or applied subject to the provisions of these By-laws, proceedings shall not be taken against such landlord or tenant for an offence against the By-law unless and until such landlord or tenant shall have had first served upon him a notice in writing by the Council requiring him within such reasonable time as is specified in the notice to comply with the By-law and shall have failed to comply with the By-law within the time so specified. Penalties. 24. Every person who shall offend against any of the foregoing By-laws shall be liable for every such offence to a penalty of Five Pounds, and in the case of a continuing offence to a further penalty of Forty Shillings for each day after written notice of the offence from the Council. Provided, nevertheless, that the Justices or Court before whom any complaint may be made or any proceedings may be taken in respect of any such offence, may, if they think fit, adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this By-law. 85 Repeal of By-laws. 25. From and after the date of the confirmation of these By-laws with respect to houses let in lodgings or occupied by members of more than one family any By-laws with regard thereto previously in force in the Metropolitan Borough of St. Marylebone shall be repealed. The Seal of the Council of the Metropolitan Borough of St. Marylebone was hereunto affixed on the 31st day of July, 1912. By Order, J. WILSON, Town Clerk. Allowed by the Local Government Board this seventeenth day of August, 1912. H. C. MONRO, Secretary, Acting on behalf of the said Board under the authority of their General Order, dated the twenty-sixth day of May, 1877. Common Lodging Houses. The following table contains all the necessary particulars with regard to these. A number of visits were paid from time to time to the premises by the District Inspectors. Address. Registered Owner. Registered number of Occupants. 54, Bell Street Alfred Crew 55 men 2, Burne Street and Lisson Street W. Bramwell Booth 499 men 6, Charlotte Place Emma Lawson 7 women 29, Circus Street William H. G. Richardson 100 men 47, Hereford Street Alfred Wilson 19 men 45, Lisson Street Alfred Wilson 35 men 3, Little Grove Street Thomas Levy 100 men 12 & 13, Molyneux Street Frederick Charles Walters 146 men "Portman House" (late Shaftesbury Institute), Harrow and Union Streets, Lisson Grove Archibald Nicol Macnicoll 102 women 7, Venables Street Arthur James Howell 56 men 25, Venables Street Arthur James Howell 18 men 1,028 men 109 women Total 1,137 86 Overcrowding. The number of dwelling rooms found to be overcrowded during the year was 85. Because the conditions resulting from overcrowding are so harmful to health generally, more especially in the case of children, every effort is made to get rid of it. Unfortunately, however, it is generally so difficult for those who overcrowd to obtain the only suitable remedy, viz., extra accommodation, that the results are often dishearteningly unsatisfactory. Too often the person who is served with a notice for overcrowding merely moves out of the house occupied at the time into another, which in its turn becomes overcrowded, and no permanent remedy is obtained. Sometimes the remedy provided is to send some of the members of the family to the house of a friend or relative, and though this may produce some improvement in one home it cannot really be regarded as a satisfactory remedy. The family life is broken up, and the conditions in the house in which the additional accommodation is found are rarely improved. In every case discovered a notice was served and in all a remedy was found. In finding a remedy the inspector who discovered the nuisance gave all the assistance possible. Many of the cases of overcrowding, it may be mentioned, were brought to light as a result of complaints, the majority of which were made by the Visitors of the St. Marylebone Health Society or School Care Committees. Some of them, as usual, were anonymous and quite clearly spiteful. A considerable number of complaints of overcrowding proved on investigation to be without foundation. Underground Rooms. The total number of underground rooms dealt with in 1912 was 199. The total number of notices served was 94. Of these 51 were occupied separately in contravention of Section 96 of the Public Health (London) Act, 1891, while the remainder were illegally used as sleeping rooms, not being in accordance with the regulations made by the Council under Section 17 (7) of the Housing, Town Planning, etc., Act, 1909. All were discovered as a result of the work of the house-to-house inspector, and a report with regard to each was submitted to and considered by the Public Health Committee before notices were served. During the year a case in which closing orders were made by the local authority on five underground rooms illegally used as sleeping rooms was taken before a magistrate and an order obtained which directed the defendant to comply with the closing orders and discontinue occupation of the rooms for sleeping purposes. Being the first case of its kind a certain amount of interest attaches to it. All the rooms were situated on the same premises and formed the sleeping apartments of the staff of servants in a large private hotel in a street near the Marble Arch. Many of the rooms were badly lighted and insufficiently ventilated 87 and all of them failed to comply in a number of respects with the regulations as to underground sleeping rooms. The fact that they were illegal was discovered some time before the provisions of Section 17 (7) of the Housing, Town Planning, etc., Act, 1909, and the regulations made thereunder came into force, but apart from advising the owner of the premises to discontinue using them no definite action was taken. A certain number of improvements were made, and the use of certain other rooms in the basement, which were very bad and quite unsuited for sleeping purposes, was discontinued. When the regulations came into operation notices were served upon the owner with regard to the five rooms which were then in use, but all attempts to obtain compliance with these failed. Eventually, therefore, a representation was made to the Public Health Committee with regard to each and closing orders were made calling for discontinuance of the use of the rooms as sleeping apartments. Several appeals were made by the owner for withdrawal of these on the ground that improvements had been made and that it was impossible to find sleeping accommodation elsewhere for the staff of domestics. On each occasion the Committee refused to accede to the owner's request, and eventually, as there seemed to be no intention of complying with the orders or of appealing to the Local Government Board against them, the only other course open to a Local Authority, viz., of applying to a Court of Summary Jurisdiction for an order enforcing the closing orders, was adopted. Before this step was taken the Committee recognising that the section was one presenting a number of curious features from the legal point of view, determined to take Counsel's opinion. This was done, and though, even afterwards, there still remained some points which were far from clear, generally the case to be submitted to the Court appeared to be sound. Summonses were therefore issued, and in order to be quite safe all the parties, the servants as well as the owner, were included as defendants. The fact that the servants were summoned caused a certain amount of delay, since the majority of them being foreigners and not quite certain as to what their position might be, more or less of a stampede took place, and service was not carried out without some difficulty. Finally, however, all summonses were served and the case came up for hearing. Only the owner appeared to answer the summonses, but was unable to show cause why the closing orders should not take effect, and an order directing compliance was made. Very shortly afterwards the use of the rooms as sleeping rooms was discontinued. During 1912 all the underground rooms regarding which notices were served under the regulations were closed voluntarily and no closing orders were made. Customs and Inland Revenue Acts. The number of certificates granted during 1912 for reduction of or exemption from inhabited house duty under these Acts was 17. 88 The situation of the premises and the number of tenements affected are shown in the following statement:— Premises. No. of Tenements. St. Andrews Mansions, Dorset Street 3 Luxborough House, Paddington Street 3 Regent House, 1, Wellington Place 1 Balcomb House, Balcomb Street 17 Boston House, Boston Street 12 Cavendish Mansions, Langham Street 3 Bentinck House, William Street, Marylebone Lane 6 St. Michael's Dwellings, Horace Street 16 St. George's Dwellings, Horace Street 14 St. Mary's Dwellings, Horace Street 14 Oxford and Cambridge Mansions 21 5, Marylebone Street 12 14, Marylebone Street 18 Winsford House, 10 & 11, Northumberland Street 4 De Walden Chambers, 70 & 71, High St., Manchester Sq. 6 Treborough House, 9, Great Woodstock Street, W. 1 Tenby Mansions, Nottingham Street 1 152 In all cases a thorough examination was made of the premises and the certificate withheld till any improvements called for were carried out. NUISANCES. Work of Inspectors of Nuisances. Throughout 1912, the staff of inspectors was the same in numbers as at the end of 1911, viz. 5, each being in charge of a portion of the Borough. The total number of complaints received during the year from all sources, was 2,372, as against 1,927 in 1911 and 1,996 in 1910. The actual number received from sources outside the department was 386 Many of these were made by the workers of the St. Marylebone Health Society, and members of the Children's Care Committees. Several were made by neighbours, in some cases out of friendliness, in others apparently spitefully. The smallness of the number of such outside complaints is taken as evidence of the thoroughness of the work of the department, especially as in a number of the cases action had already been taken before the complaint was received. All complaints, it may be added, whether anonymous or not, unless the particulars given are too vague, receive immediate attention. In respect of nuisances 551 statutory notices were issued. The number for 1911 was 881, and for 1910, 658. Of the notices, 299 related to ordinary nuisances (dirt, dampness, etc.), 47 to verminous rooms, 97 to drains, 6 to insufficient w.c. accommodation, 94 to underground rooms, under the Public Health Act, 1 to smoke. The remaining 101 were served 89 on owners to provide a proper and sufficient supply of water to the upper storeys of tenement houses under the London County Council (General Powers) Act, of 1907). The number of such notices for 1911 was 141, and for 1910, 136. The 47 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1904, and referred to 77 rooms. The number of notices for 1911 was 77, and for 1910, 70. In 1,593 cases the nuisances were abated by the persons responsible for their removal after receipt of a preliminary (intimation) notice advising them of the existence of the defect. The number of cases in which the necessity to resort to legal proceedings to enforce compliance with statutory notices was three. The table on page 90 gives the details of the cases so dealt with, the Acts or By-laws under which the proceedings were taken, and the results. The total inspections made by each inspector, and the number of nuisances of various kinds detected and remedied, are set forth in the following table. Districts. Borough. No. I. No. 2. No. 3. No. 4. No. 5. Total Inspections 3504 3566 3459 3440 3481 17450 Houses damp, dirty or dilapidated remedied 211 206 147 141 80 785 Doors, windows, floors, ceilings, sash cords, etc., repaired 73 62 35 10 11 191 Overcrowding abated 14 36 20 11 4 85 Illegal occupation of underground rooms dealt with 2 30 58 75 34 199 Water closet defects remedied 130 226 103 128 90 677 Water closets erected 1 1 2 16 10 30 Urinal defects remedied 24 12 4 35 58 133 Soilpipe and ventilating shaft repaired or renewed 6 5 13 12 5 41 Yard defects remedied 94 123 85 64 35 401 Waste pipe defects remedied 16 12 13 18 13 72 Water cistern defects remedied 31 70 22 13 1 137 Rubbish, manure, etc., accumulations removed 9 23 47 20 13 112 Dung or dust receptacles repaired or renewed 51 28 53 36 13 l8l Drains relaid or amended 72 84 73 80 48 357 Drains cleared 12 18 5 12 27 74 Rainwater pipes repaired or renewed 21 34 18 33 8 114 Water supply to houses reinstated 1 3 5 1 4 14 Roofs and gutters repaired 70 63 45 12 8 198 Area defects remedied 6 36 40 46 20 148 Wash-house defects remedied 118 144 60 53 24 399 Animal nuisances abated 15 10 7 5 - 37 Basement defects remedied 6 16 26 14 20 82 Stables cleansed or repaired 2 4 — 8 1 15 Water supply laid on to upper storeys of house 77 101 80 42 21 321 Miscellaneous nuisances abated 15 35 9 6 10 75 Verminous rooms cleansed 168 83 47 30 13 341 Workshops damp, dirty or dilapidated, remedied 10 11 13 38 28 100 93 NORTH DISTRICT. Year. Complaints. Letters. Refusals. Fines. 1904 49 52 28 — 1905 53 66 227 W. Mead & Co., Ltd., £20 and £26 5s. 1906 49 61 51 W. Mead & Co., Ltd., £15, and E. H. Jackson & Co., Ltd., £5 1907 46 54 83 E. H. Jackson & Co., Ltd., £50 1908 26 63 114 — 1909 18 68 135 — 1910 43 84 117 W. Mead & Co., Ltd., £1 1911 105 111 466 W. Mead & Co., Ltd, .£51 1912 43 98 361 G. E. Cloke, £25 SOUTH DISTRICT. Year. Complaints. Letters. Refusals. Fines. 1904 194 184 63 T. Hobbs, £20 1905 72 170 366 — 1906 69 157 556 T. Hobbs, £15, £1 1s., and £50 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 — 1912 82 201 140 The Western Cartage Co., Ltd., £8 8s. and £6 The fine of £2,5 was imposed for failing to collect house refuse during strike; that of £8 8s. for failing to remove house refuse from the kerb in 8 cases from Great Portland Street; while the £6 fine was imposed on account of failing to remove refuse from kerb in 2 cases in Marylebone Lane and 10 cases in Newman Street. The usual close supervision was exercised over the work of the contractors by the Public Health Committee during the year. The reports of the inspectors and the complaints, letters and refusals received were considered by the Dust Sub-Committee, which is fortunate in having Alderman J. Lea-Smith still as its chairman, at their fortnightly meetings, reports thereon being made to the Public Health Committee. Considerable numbers of dust shoots as well as old brick receptacles were demolished during the year and new metal dust receptacles to the number of 13 were provided. Towards the end of the year special attention was directed to the fact that in those districts in which a daily collection from the kerb is in force, the practice of using uncovered tins and improper receptacles—wooden and cardboard boxes, etc., had sprung up. In order to meet this special notices were prepared for the use of the dust inspectors, who were instructed to serve one on any person detected using an 94 uncovered or improper receptacle. At the same time special placards were made and affixed to all dust carts warning householders against the practice, and giving full information with regard to hours of collection, etc. As a result of these notices and placards and the work of the inspectors a considerable improvement was soon noticeable, and as the inspectors have instructions to continue the service of notices and to report any failure to comply it is probable that the improvement will continue. During the year the dust inspectors—Lumley and Hill—made 10,699 visits; the former 8,185, and the latter, who only gives part time to this work, 2,514. The great increase in number is due to the additional work imposed in connection with the service of the notices referred to above. Other notices to the number of 124 were served regarding defaults in connection with dust removal. Remedies in each case were carried out without the necessity for prosecutions arising. VERMINOUS PERSONS' BATHS. During 1912 these Baths were used by 8,202 adults (males, 5818: females, 2,384). The children bathed numbered 1,878, 740 being boys and 1,138 girls. The addresses given by the male adults included Salvation Army shelter 5,314, and lodging houses, 542. In 2,159 instances no address was given, and in 145 (142 males, 3 females) the applicants stated they had come from the Church Army. The Portman House was given as an address by 222 females, the Church Army by 3 females. In the case of the adults, the numbers show a slight falling off from those noted in the previous year, viz., 9.085. For this probably the colder weather experienced during the summer months is responsible. The numbers of children bathed were rather more than double those for 1912. This is doubtless due to the fact that during the year the arrangement entered into with the London County Council was fully established and School Nurses and Teachers were closely on the watch for all children in need of cleansing. The nature of the arrangement was fully described in the report for 1911 and nothing further need be said with regard to it here except that the payments received by the Council in respect of baths was £75 12s. The payments made on account of baths given to adults sent from Common Lodging Houses by Inspectors of the London County Council amounted to 15s. The practice of visiting the homes of all children sent for cleansing, and arranging for the bathing of other members of the family and the disinfection of bedding, etc., wherever possible, was continued. The usual tables showing the extent to which the baths have been used year by year since they were opened are given below:— 95 CLEANSING OF PERSONS ACT, 1897. Table showing the number of Adults and School Children using the Baths provided under the above-mentioned Act during the year 1912:— 1912. ADULTS. CHILDREN. Males. Females. Total. Males. Females. Total. January 555 157 712 55 58 113 February 462 150 612 40 132 172 March 478 142 620 87 128 215 April 449 177 626 61 126 187 May 466 214 680 62 158 220 June 445 205 650 95 126 221 July 533 242 775 79 118 197 August 531 261 792 8 15 23 September 440 240 680 69 64 133 October 521 240 761 53 102 155 November 457 190 647 75 79 154 December 481 166 647 56 32 88 Totals 5,818 2,384 8,202 740 1,138 1,878 Table showing the number of persons using the Baths during the past 15 years:— Year. ADULTS. CHILDREN. Males. Females. Total. Males. Females. Total. 1898 3,301 5 3,306 - - - 1899 4,340 — 4,340 - - - 1900 3,431 31 3,462 - - - 1901 4,140 142 4,282 - - - 1902 4,326 202 4,528 - - - 1903 5,515 655 6,170 - - - 1904 7,089 1,376 8,465 - - - 1905 7,981 1,431 9,412 107* 353 460 1906 6,891 1,974 8,865 1,873 3,311 5,184 1907 6,785 1,807 8,592 2,367 3,404 5,771 1908 8,741 2,563 11,304 2,198 3,046 5,244 1909 8,563 2,551 11,114 2,725 1,959 4,684 1910 6,433 2,051 8,484 513 859 1,372 1911 6,510 2,575 9,085 504 463 967 1912 5,818 2,384 8,202 740 1,138 1,878 Totals 89,864 19,747 109,611 11,027 14,533 25,560 *The Children's Baths were opened in June, 1905. 96 THE SHELTER. The number of times the Shelter was used during 1912 and the reasons for such use are shown in the accompanying statement. The periods of occupation varied from two up to 16 hours. No. of hours occupied. Reason of occupation. No. of persons. January 22nd and 23rd 16 Diphtheria 2 adults, 1 child. April 7th 2 Puerperal Fever 1 adult. October 25th and 26th 16 Diphtheria 2 adults. November 25th and 26th 16 Scarlet Fever 2 adults, 1 child. November 26th and 27th 16 Scarlet Fever 2 adults, 1 child. December 12th and 13th 12 Scarlet Fever 2 adults, 1 child. PUBLIC MORTUARY. All the necessary details regarding the use of the Mortuary during the year are contained in the accompanying statement provided by the Mortuary Keeper. Regular visits of inspection have been made by the outdoor superintendent. Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1912. Males. Females. Total. For burial only. For inquests. Total. January 10 6 16 12 4 16 February 14 10 24 13 11 24 March 10 21 31 22 (2 infectious) 9 31 April 11 12 23 10 13 23 May 11 10 21 13 8 21 June 4 7 11 8 3 11 July 14 15 29 20 9 29 August 20 5 25 11 14 25 September 17 13 30 17 13 30 October 13 10 23 11 12 23 November 16 7 23 9 14 23 December 27 9 36 17 19 36 Totals 167 125 292 163 129 292 Number of inquests held from 1st January to 31st December, 1912—144. PUBLIC SANITARY CONVENIENCES. There is nothing of particular note to report with regard to the public sanitary conveniences, either over or underground. The usual supervision was exercised over 97 those provided for males by Inspector Hill, the outdoor superintendent, and over those provided for the use of females, by the women inspectors, especially Miss Baker. Reports, and comparative statements as to receipts for use of the underground conveniences were regularly submitted to and considered by the Public Health Committee. The following is a statement showing the total receipts at each of the conveniences for the year ended March 1913, and the amount of increase or decrease as compared with the previous year. 1912-13. 1911-12. Increase. Decrease. £ s. d. £ s. d. £ s. d. £ s. d. Oxford Street—Men's Department 1050 10 9 1079 18 11 — 29 8 2 „ Women's ,, 824 13 0 828 19 1 — 4 6 1 Portland Road—Men's ,, 278 4 7 299 7 5 — 21 2 10 ,, Women's „ 183 2 11 173 18 5 9 4 6 — Marylebone Road—Men's ,, 216 17 1 217 19 4 — 1 2 3 „ Women's ,, 141 17 4 132 19 11 8 17 5 — Foley Street—Men only 126 4 11 130 19 4 — 4 14 5 St. John's Wood Road—Men only 108 5 1 109 11 2 — 1 6 1 Barrett Street—Men only 132 10 3 *88 6 7 — — *Opened 19th June, 1911. In connection with the receipts at the conveniences for women, it must be borne in mind that throughout the whole year free accommodation was provided at each— Oxford Circus two urinettes, Portland Road and Marylebone Road one each. This free accommodation has been greatly appreciated, and, as the statement shows, led to no falling off in the receipts except in the case of Oxford Circus, where there was a decrease of just over £4. This, it is quite probable, was due to some other cause, such as the proximity of the tube stations and large shops and restaurants where lavatory accommodation for ladies is provided. FACTORIES AND WORKSHOPS. The total number of visits to workshops and workplaces during the year was 4080, 560 by the women and 3,520 by the men inspectors. The complaints received numbered 40. The following report which the Medical Officer of Health is required to make to the Secretary of State for the Home Department in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901, gives in addition to other information the total number of defects found and of notices served. 98 I.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 91 11 — Workshops (Including Workshop Laundries.) 3,330 303 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 659 117 — Total 4,080 431 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Pound. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 218 218 - - Want of ventilation 15 15 — - Overcrowding 6 6 — — Want of drainage of floors 1 1 — — Other nuisances 79 79 1 — Sanitary accommodation insufficient 4 4 — — unsuitable or defective 61 61 — — not separate for sexes 9 9 - - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100). 14 14 — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 407 407 1 — 99 3—HOME WORK. OUTWORKERS LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. NATURE OF WORK. Lists received from Employers. Notices served on Occu piers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 118 454 1,324 ... ... ... 65 ... ... ... ... ... ... ... ... (2) Cleaning and washing 2 8 6 ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc 2 ... 10 ... ... ... ... ... ... ... ... ... ... ... ... Total 122 462 1,340 ... ... ... 65 ... ... ... ... ... ... ... ... 100 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c 4,200 Coffee Shops, &c 234 Bakehouses 75 Total number of workshops on Register 4,509 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 46 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5.) 'Notified by H.M. Inspector 40 Reports (of action taken) sent to H.M. Inspector 35 Other 6 Underground Bakehouses (s 101):— Certificates granted during the year 1 In use at the end of the year 65 101 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 230 Cowhouses 5 Slaughterhouses 7 Offensive Trades 2 Ice Cream Premises 110 Bakehouses 75 Restaurant and Dining Room Kitchens 116 Hotel Kitchens 42 Coffee Shops, Pastrycooks and Tea Rooms 76 Houses Let in Lodgings 1001 Workshops and Workplaces 4509 Total 6173 A statement, with special reference to the list set out above, is contained in the following tables:— Number of places. Number of inspections, 1912. Number of notices, 1912. Number of prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Milk premises 200 45 15 230 615 15 - Cowsheds 5 — — 5 50 — — Slaughterhouses 7 — — 7 129 —I — Offensive trade premises 2 — — 2 27 — — Ice cream premises 96 15 7 104 I20 20 — Houses let in lodgings 1052 278 329 1001 7774 1881 — Mortuary. Removed by Inspectors. Number of bodies received 292 — Number of Infectious bodies received — 2 Disinfection. Number of rooms disinfected 824 Number of Articles disinfected 11355 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 5,818 2,384 740 1,138 10,080 102 Bakehouses. Number on register at end of 1912 75 Number above ground 10 Number underground 65 Number of inspections 109 Number of Notices. Intimations, 13, Statutory Notices, 1 14 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1912 246 Number of Inspections 617 Number of Notices 91 House to House Inspections. Number of Inspections 1159 Number of Notices issued {Intimations,760 Statutory Notices, 154 } 914 Number of Prosecutions Nil House Refuse. Number of Inspections 10,699 Number of Old Brick Receptacles abolished 13 Number of New Metal Receptacles provided 13 Number of Complaints of Non-removal received 125 Number of Letters received re Removal 299 Number of Refusals of Occupiers to have House Refuse removed 501 Number of Notices served—Intimations, 200; Statutory Notices, 26 226 Number of Prosecutions Nil Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 321 Number of Statutory Notices served 107 Number of Prosecutions 1 Overcrowding. Number of Dwelling Rooms overcrowded 85 Number remedied 85 Number of Prosecutions Nil Underground Rooms. Number dealt with 199 Number of Notices served under P. H. (L) Act, 1891 51 94 Number of Notices served under H. T. P., &c. Act, 1909 43 Number of Prosecutions 5 103 Insanitary Houses. Number closed under Public Health (London) Act, 1891 1 Number closed under Part II of the Housing of the Working Classes Act Nil Number closed under Section 17 Housing, Town Planning, &c. Act, 1909 2 Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (l). Number of rooms cleansed 341 Number of Prosecutions Nil Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year:— 9 adults. 6 children. Revenue Acts. Number of houses for which applications were received 17 Number of tenements comprised therein 152 Number of tenements for which certificates were granted 152 „ „ „ „ refused Nil „ „ „ „ deferred Nil LOCAL GOVERNMENT BOARD AND OTHER TABLES. table i. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1912 AND PREVIOUS TEARS. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 nett Births. No. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 20.0 1,758 14.7 678 769 259 102.3 1,849 15.4 1910 125,195 4,111 2,556 20.1 1,566 12.9 658 699 253 98.9 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 1912 116,155 4,111 2,246 19.3 1,652 15.0 769 752 209 93.0 1,635 14.8 Total population at all ages, 118,221, at Census of 1911. Area of district in acres (exclusive of area covered by water), 1427 8 acres. 104 TABLE I. (A). Vital Statistics of Separate Localities in 1912 and the ten Previous Years. Names of Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. a. b. c. d a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 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 1911 117,844 2,375 1,818 261 29,392 502 400 40 32,025 485 440 49 36,425 1,041 690 137 20,002 347 288 35 Averages of Years 1902 to 1911 127,641 2,644 1,981 321 33,697 565 435 62 36,190 630 529 75 38,002 1,064 696 141 19,752 385 321 43 1912 116,155 2,246 1,635 209 28,971 452 379 45 31,566 453 411 30 35,903 971 588 108 19,715 370 257 26 *The Rectory and St. Mary's Registration Sub-Districts were amalgamated this year. 105 TABLE II. Cases of Infectious Disease Notified during the 52 Weeks ending 28th December, 1912. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home At all ages. At ages—years. All Souls St. Mary Christ Church St. John Totals. All Souls St. Mary Christ Church St. John Totals Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 147 7 58 54 14 11 2 1 48 37 45 17 147 47 35 44 16 142 5 Erysipelas 84 ... 2 1 8 26 36 11 18 27 33 6 84 7 15 13 2 37 47 Scarlet Fever 259 3 76 147 21 11 1 ... 44 62 122 31 259 44 62 121 29 256 3 Ophthalmia Neonatorum 19 19 ... ... ... ... ... ... 2 6 11 ... 19 ... 3 2 ... 5 14 Enteric Fever 11 ... ... 3 3 5 ... ... 4 1 5 1 11 3 1 5 1 10 1 Polio-Myelitis 3 ... 3 ... ... ... ... ... ... ... 3 ... 3 ... ... 1 ... 1 2 Puerperal Fever 5 ... ... ... 2 3 ... ... 2 2 1 ... 5 2 1 1 ... 4 1 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 1 ... ... 1 ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... Phthisis: — Under Tuberculosis Regulations, 1908. 155 ... 1 14 13 66 51 10 19 44 84 8 155 16 26 61 6 109 46 Under Tuberculosis Regulations, 1911. 428 1 20 175 70 126 35 1 47 103 182 96 428 7 8 12 8 35 393 Others 107 ... 2 5 14 65 19 2 12 32 41 22 107 1 1 ... 1 3 104 Totals 1219 30 162 400 145 313 144 25 196 314 528 181 1219 127 152 261 63 603 616 106 TABLE III. Causes of, and Ages at Death during the year ending 28th December, 1912. No CAUSES OF DEATH. Nett deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 Enteric Fever 5 — — — — 2 2 1 — 1 2 Small-pox — — — — — — — — — — 3 Measles 39 9 17 9 4 — — — — 1 4 Scarlet Fever 11 1 2 3 4 — 1 — — — 5 Whooping-Cough 15 6 3 6 — — — — — — 6 Diphtheria and Croup 7 1 — 4 2 — — — — 2 7 Influenza 16 5 1 — — — 3 5 2 1 8 Erysipelas 6 — — 1 — — 1 1 3 1 9 Phthisis (Pulmonary Tuberculosis) 149 — — 1 4 14 73 50 7 36 10 Tuberculous Meningitis 24 4 2 10 8 — — — — 13 11 Other Tuberculous Diseases 11 3 — 1 1 1 2 3 — 18 12 Cancer 137 — — — 1 1 17 61 57 307 13 Rheumatic Fever 4 — — — 2 — 1 — 1 4 11 Meningitis 14 4 3 2 1 1 1 2 — 8 15 Organic Heart Disease 126 — — — 4 4 22 46 50 43 16 Bronchitis 230 13 4 1 1 2 8 49 152 26 17 Pneumonia (all forms) 131 21 25 3 3 4 15 30 30 55 18 Other Diseases of Respiratory Organs 33 1 — 2 1 — 5 12 12 4 19 Diarrhoea and Enteritis (under two years) 26 21 4 — — — — — 1 3 20 Appendicitis and Typhlitis 16 — — — 4 1 3 8 — 25 21 Cirrhosis of Liver 15 — — — — — 4 8 3 8 21a Alcoholism 6 — — — — — 3 2 1 1 22 Nephritis and Bright's Disease 56 — — — 3 2 10 23 18 27 23 Puerperal Fever 2 — — — — — 2 — — 4 24 Other accidents and diseases of Pregnancy and Parturition 11 5 — — — 2 4 — — 13 25 Congenital Debility and Malformation, including Premature Birth 73 71 1 — 1 — — — — 69 26 Violent Deaths, excluding Suicide 60 2 2 1 7 6 14 12 16 42 27 Suicides 16 — — — 1 2 4 6 3 7 28 Other defined Causes 391 42 4 1 4 9 43 104 184 213 29 Diseases ill defined or unknown 5 — 1 — 1 — — 3 — 1 Totals 1635 209 69 45 57 51 238 426 540 933 107 TABLE III. (a).—Causes of, and ages at death during the 52 weeks to 28th December, 1912, according to Sub-Districts. No. CAUSES OF DEATH. All Souls. St. Mary. Christ Church St. John. Total. 1 Enteric Fever 2 1 2 — 5 2 Small Pox — — — — — 3 Measles 3 2 28 6 39 4 Scarlet Fever 1 4 5 1 11 5 Whooping Cough 3 6 6 — 15 6 Diphtheria and Croup 1 2 2 2 7 7 Influenza 3 5 4 4 16 8 Erysipelas 3 2 1 — 6 9 Phthisis (Pulmonary Tuberculosis) 26 32 66 25 149 10 Tuberculous Meningitis 6 4 9 5 24 11 Other Tuberculous Diseases 3 3 3 2 11 12 Cancer 35 44 34 24 137 13 Rheumatic Fever — 2 1 1 4 14 Meningitis 6 3 4 1 14 15 Organic Heart Disease 34 30 44 18 126 16 Bronchitis 50 61 85 34 230 17 Pneumonia (all other forms) 25 36 56 14 131 18 Other Diseases of Respiratory Organs 4 9 14 6 33 19 Diarrhoea and Enteritis (under 2 years) 8 2 14 2 26 20 Appendicitis and Typhlitis 3 6 4 3 16 21 Cirrhosis of Liver 7 5 2 1 15 21a Alcoholism — 4 2 — 6 22 Nephritis and Bright's Disease 13 11 25 7 56 23 Puerperal Fever — — 1 1 2 24 Other accidents and diseases of Pregnancy and Parturition 3 — 5 3 11 25 Congenital Debility and Malformation, including Premature Birth 18 13 30 12 73 26 Violent Deaths, excluding Suicide 22 16 20 2 60 27 Suicides 3 5 4 4 16 28 Other defined Causes 97 101 116 77 391 29 Diseases ill defined or unknown — 2 1 2 5 Totals 379 411 588 257 1635 108 VACCINATION RETURNS. Supplemental Return for 1911. RETURN made to the Board of Guardians and Local Government Board on the 8th February, 1913, by Mr. Edward A. Frith, Vaccination Officer of the St. Marylebone Parish, respecting the Vaccination of Children whose Births were registered in St. Marylebone, from 1st January to 31st December, 1911, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st Dec. 1911. Number of these Births duly entered by 31st January, 1913, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. Number of these Births which on 31st January, 1913, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1913, neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9, and 10 of this Return). Total Number of Certificates of Successful Primary Vaccination at ALL AGES received during the calendar year 1912. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, Unvaccinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown, or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had SmallPox. 1 2 3 4 5 6 7 8 9 10 11 12 1. St. John 297 221 2 ... 35 18 5 7 7 2 3333 Born in St. Marylebone 2. Christchurch 824 581 2 ... 76 67 15 9 63 11 3. St. Mary 2,247 1,850 2 ... 89 114 112 60 18 2 70 Born elsewhere 4. All Souls 699 503 6 ... 31 43 7 80 27 2 Total 4,067 3,155 12 ... 231 242 139 156 115 17 3,403 Dated 8th February, 1913. (Signed.) EDWARD A. FRITH, Vaccination Officer. 109 VACCINATION RETURNS. Return for the Period January—June, 1912. RETURN made to the Board of Guardians and Local Government Board on the 8th February, 1913, by Mr. Edward A. Frith, Vaccination Officer of the St. Marylebone Parish, respecting the Vaccination of Children whose Births were registered in St. Marylebone, from 1st January to 30th June, 1912, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 30th June, 1912. Number of these Births duly entered by 31st January, 1913, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. Number of these Births which on 31st January, 1913, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1913, neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6, and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9, and 10 of this Return). Number of Certificates of Conscientious Objection actually received by the Vaccination Officer, irrespective of the dates of birth of the Children to which they relate, during the year 1912. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, Unvac- cinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown or which cannot be reached ; and Cases not having been found. Insusceptible of Vaccination. Had . SmallPox. 1 2 3 4 6 6 7 8 9 10 11 12 1. St. John 176 135 ... ... 21 5 6 1 5 3 272 2. Christchurch 404 282 1 ••• 48 22 11 ... 30 10 3. St. Mary 1,127 908 1 ... 56 45 72 26 14 5 4. All Souls 345 235 ... ... 20 24 5 48 10 3 Total 2,052 1,560 2 ... 145 96 94 75 59 21 272 Dated 8th February, 1913. (Signea) EDWARD A. FRITH, Vaccination Officer.