AC 4353 STMARY 18 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1913, 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. 1 9 I 4 . Metropolitan Borougb of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1913, 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. 1914. geo. pulman and sons, ltd., london and wealdstone. Public Health Office, 24, Somerset Street, London, W. 13 th May, 1914. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Madam and Gentlemen, In accordance with the instructions of the Local Government Board, I beg to submit the following Report for the year 1913, on the public health and sanitary condition of the Borough of St. Marylebone. In the main it is a satisfactory report. The interest taken in public health work by the Council, is, I believe, very sincere, and at no time since I have been in office could it truthfully have been stated that there had been any desire on their part to neglect the responsibility with which they are entrusted in this connection. That any evidence of such neglect could have been produced it is impossible to believe. The desire to improve the chances of babies born within the Borough has been very real, and it is because the Council themselves have put forth efforts and have seconded the efforts of others anxious to do work which would lead to the saving of infant lives that the infantile mortality rate has been steadily falling for a number of years, and that 1913 saw it reduced to 90.8, the lowest ever recorded. In relation to the prevention of tuberculosis, it may be claimed that the Council have proceeded as rapidly as they have been permitted to proceed, and have chafed at the delays which they have been compelled to suffer. The work in respect of the ordinary infectious diseases is largely routine in character and the amount that can be done with regard to the other diseases is limited, because medical knowledge as to their causation is limited. So much prevention as can be brought about by improving the surroundings and housing of the people, by searching for detects in sanitation and seeing that remedies are carried out, by protecting the food supply and so on, is obtained. Evidence as to the extent of the work done in this connection will be found in the portion of this report headed "Departmental" and a reference to the most recent Annual Report of the Medical Officer of Health of the London County Council, that of 1912, shows how favourably the record of the Borough compares with that of the others in the metropolis. In carrying out the work during 1913, the greatest amount of assistance was obtained from the Public Health Committee. The members, under the chairmanship of Councillor Sir Horatio H. Shephard, took the keenest interest in what was done, and were always ready to sympathetically consider any suggestion brought forward. 4 \ I take this opportunity of thanking the Committee, and particularly the Chairman, and the Chairman of the Dust Sub-Committee, Mr. Alderman Lea-Smith, for the great help and encouragement which they gave me throughout the year. In the work of the Department I was loyally supported by all members of the staff, and my thanks are due to them for the support so cordially given. Though it did not occur until early in January, 1914, I feel that some reference should be made to the death of Dr. F. W. Bywater, who acted as Deputy Medical Officer of Health during 1913. In Dr. Bywater I had a most helpful and most loyal deputy and colleague. He was perhaps less well known to the Council than to the staff of the Public Health Department, but the regret that was expressed by the Public Health Committee at his loss was very sincere. Dr. Bywater was very proud of being associated with the Public Health Department of St. Marylebone, and the liking he had for the members of the staff was very warmly reciprocated. He will be greatly missed by all. I am, Mr. Mayor, Madam and Gentlemen, Your obedient servant, CHARLES PORTER. TABLE OF CONTENTS. Part I. Statistical. page Infectious Disease Chart facing 9 Population 9 Births, Registration, Notifications 9 Deaths and Death Rates 10 District Births and Deaths 11 Deaths in relation to age 11 Causes of, and Ages at, Death 12 Infantile Mortality 12, 17 Prevention of Infantile Mortality 18, 24 Deaths in relation to Disease 24 Diarrhoeal Diseases 24 Zymotic Diseases, Phthisis, &c., and Respiratory Diseases 27 Zymotic Diseases 27 Phthisis and other Tuberculous Diseases 28 Respiratory Diseases 29 Cancer and Malignant Disease 30 Alcoholism 31 Accident, Suicide and Manslaughter 31 PAGE Records of Diseases 31 Notifications 32 Discharge Notices 33 Diphtheria and Membranous Croup 33 Scarlet Fever .. 34 Enteric Fever .. 34 Cerebro-Spinal Fever 35 Erysipelas 35 Puerperal Fever 35 Measles 35, 36 ,, Deaths 35 ,, Isolation of 33 Whooping Cough 37 Glanders 37 Polio Encephalitis and Myelitis 37 Chicken-pox 37 Ophthalmia Neonatorum 37 Tuberculosis 37, 38 „ Notifications 39, 40 ,, Deaths 42, 43 ,, National Insurance Act Sanatorium Benefit 41 ,, Preventive Measures against 44, 53 ,, Bacteriological diagnosis of 55 Disinfection 53, 54 Bacteriological Examinations 55 Part II. Departmental. page Staff Meetings 59 Protection of Food Supply 59 Inspection 59 Suirenders 60 Seizures 60 Prosecutions 60 Slaughterhouses 61 Milk Supply 61 Cowhouses 61 Milkshops, etc. 62 Examination of Milk 62 Ice Cream Premises 63 Butter, Margarine, etc. 63 Restaurants, Food Stalls, etc. 63 Offensive Trades 63 Bakehouses 64 Sale of Food and Drugs Acts 64, 71 Public Analyst's Reports 65-70 Bacteriological Examination of Food 71 Rag Flock 72 Water Supply 72 Housing 73, 80 Housing, Town Planning, etc. Act, 1909 73. 81 House to House Inspection 80 page Houses Let in Lodgings 81 Common Lodging Houses 82 Overcrowding 82 Underground Rooms 82 Customs and Inland Revenue Acts 83 Nuisances 83 Work of Sanitary Inspectors 84 Legal Proceedings 84, 85 Drain Plans and Drainage 86 Combined Drainage 86 Black Smoke Nuisances 8f» Removal of House Refuse 86, 87 Verminous Persons Baths 87, 88 Cleansing of Persons Act, 1897 88 The Shelter 89 Public Mortuary 89 Public Sanitary Conveniences 90 Factories and Workshops 91 Inspection 91 Defects Found 91 Home Work 92 Registered Workshops 93 Sanitary Inspection (Summary) 94, 95, 96 Local Government Board Tables I.-V. 96,100 Vaccination Returns 101, 102 Part I. STATISTICAL. Curve showing the number of cases of Scarlet Fever, Diphtheria and Typhoid Fever, notified week by week during the year 1913. 9 POPULATION. The population of the Borough at the middle of 1913, as estimated by the Registrar-General, was 114,532. The estimated decrease since the middle of 1912 is 1,623, and since the census, taken in 1911, 3,689. The estimated populations of each of the four sub-districts at the middle of 1913 and of each of the two preceeding years, was:— 1911. 1912. 1913. All Souls 29,392 28,971 28,567 St. Mary 32,025 31,566 31,124 Christ Church 36,425 35,903 35,402 St. John 20,002 19,715 19,439 117,844 116,155 114,532 That there has been a steady decline in the numbers will be noted. Whether or not the decrease indicated has actually occurred it is impossible to say, the figures given not being the result of enumeration. The method of obtaining them has more than once been described in previous reports. Their chief value is in connection with calculation of certain of the rates set out in succeeding pages. BIRTHS. Registration. The number of births registered during 1913 was 2,146*, being 100 fewer than in 1912. Of the children born 1,143 were boys and 1,003 girls. The birth rate per 1,000 was 18.7. The accompanying table contains a comparison of the rates in the several registration sub-districts for 1913, with those of the two previous years. 1911. 1912. 1913. All Souls 16.0 15.6 13.6 St. Mary 14.4 14.3 12.8 Christ Church 29.7 27.0 28.2 St. John 19.2 18.8 18.8 Notifications. The total number of notifications received during the year under the Notification of Births Act, 1907, was 4,185. The provisions of the Act are steadily becoming better known and the failures to notify within 36 hours of birth as * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 56 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 21 ,, Females 15 Illegitimate Males 15 ,, Females 5 10 required were comparatively few. In such cases as there was failure a perfectly reasonable explanation was forthcoming and the necessity for taking proceedings did not arise. The main sources of the notifications are set out below and, for purposes of comparison, the figures for the two previous years are also shown. The figures, it may be noted, refer to notifications and not to births. In some cases duplicate notifications, from different sources, were received with regard to the same birth. 1913. 1912. 1911. From parents 783 or 18.7 per cent. 509 or 12.1 per cent. 564 or 13.7 per cent. „ doctors 500 „ 11.9 „ 592 „ 14.1 ,, 491 „ 14.1 „ „ midwives .„ 758 „ 18.1 „ 780 „ 18.6 „ 774 „ 18.6 „ „ other persons 4 „ .09 „ 18 „ .4 „ 38 „ .4 „ „ hospitals, etc. 2,140 „ 51.1 „ 2,286 „ 54.6 „ 2,223 „ 54.6 „ Of the total births notified, 144 referred to still-births (82 males and 62 females); 1,745 took [place at Queen Charlotte's Hospital; 387 at Middlesex Hospital; and 1,672 were born at home. Of those notified as having occurred in St. Marylebone, 1,714 belonged to other Boroughs, as follows:— Legitimate Males 524 „ Females 490 Illegitimate Males 359 „ Females 341 1,714 DEATHS AND DEATH RATES. The number of deaths registered in 1913 was 1,627. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but exclusive of persons, who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. The corrected death-rate* per 1,000 for the year was 14*9. In the previous year, the number of deaths was 1,635 and the death rate 14.8. In 1911 the rate was 16.3 per 1,000. The following short table shows the death rates in the several registration sub-districts in 1913 and compares them with those of the three previous years:— 1910. 1911. 1912. 1913. All Souls 10.7 12.7 13.9 12.0 St. Mary 11.7 13.1 13.8 11.1 Christ Church 15.6 19.7 17.4 18.4 St. John 13.1 15.9 13.8 13.6 A definition of the term ''corrected death-rate" will be found on page 9 of the Report for 1912. 11 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 1913 and the ten preceding years, will be found amongst the Local Government Board Tables on page 96. TABLE I. Sub-District. Population, estimated to Middle of Year 1913. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 28,567 199 189 388 181 162 343 St. Mary 31,124 207 193 400 185 182 367 Christ Church 35,402 553 445 998 378 274 652 St. John 19,439 184 176 360 131 134 265 The Borough 114,532 1,143 1,003 2,146 875 752 1,627 The usual table showing the number of 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. In the case of the latter the only quarter in which the total number of deaths fell below that for the previous year was the last—OctoberDecember. In 1912 just under twice as many infants, 50 as against 29, died in the July-September quarter as in 1913. The most fatal quarter for both groups was the first. Three times as many infants and twice as many adults died between January and March as between July and September. The reason for this will be seen when the causes of death are analysed in subsequent pages. January-March. April-June. July-September. October-December. Total Infants under 1 year 76 43 29 47 195 Persons of 65 years and upwards 189 149 93 124 555 DEATHS IN RELATION TO AGE. The age distribution of the deaths that occurred in 1913 is shown in the following table, which gives also, for the purpose of comparison, the figures for each age group in 1912. It will be noted that, with but few exceptions, the totals in the groups for 1913 are lower than those for 1912. The principal exceptions are the age-groups from 45 upwards, the two last periods contributing between them 35 more deaths to the total than in 1912. Age Periods under 1 year. 1 and under 2 year. 2 and j 5 year 5 and under 15 year 15 and under 25 year 25 and under 45 year 45 and under 65 year 65and upwards. At all ages. No. of 1912 209 69 45 57 51 238 426 540 1635 Deaths 1913 195 66 47 51 36 229 448 555 1627 The percentage relation of each group to the total number of deaths in 1913 was:— 12 Under 1 year 11.9 per cent. 1 and „ 2 years 4.0 „ 2 „ „ 5 „ 2.9 „ 5 „ 15 „ 3.1 „ 15 „ „ 25 „ 2.2 „ 25 „ „ 45 „ 14.0 „ 45 „ „ 65 „ 27.5 „ 65 „ upwards 34.1 „ The extent to which each of the four divisions of the Borough shared in the deaths of those aged over 65 in 1911, 1912 and 1913, is shown below : 1911. 1912. 1913. All Souls 140 123 112 St. Mary 161 156 140 Christ Church 159 161 187 St. John 101 100 116 Totals 561 540 555 Of the total, 143 at death were aged between 65 and 70; 267 between 70 and 80: 127 between 80 and 90, and 18 between 90 and 100. The outstanding causes of death were as follows:— Causes. 1911. 1912. 1913. Bronchitis and other respiratory diseases 158 192 180 Nephritis and Bright's Disease 13 18 22 Cancer 62 57 60 Tuberculosis 14 7 22 Influenza 10 2 6 Violent deaths 16 16 16 Causes of and ages at Death.—General information with regard to the deaths which occurred in the Borough during the year, mainly with regard to causes and the ages at which death takes place, is given in Table III. of the Local Government Board series at page 99. This same table gives the number of deaths from various specified causes which occurred in institutions, in hospitals, nursing homes, etc. In each of the groups all deaths, whether of residents or non-residents, are included, which accounts for the fact that the total comes up to nearly 1,000, viz., 919. As already stated the information given in the table is rather general and fuller consideration and a closer inquiry into the details is called for. This is given in the following pages, in which also will be found a more or less full analysis of the figures relating both to causes of death and the ages at which these causes were operative. INFANTILE MORTALITY. The infantile mortality rate of any district is the number ot 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 year who died in St. Marylebone in 1913, was 195, and the number of births in that year 2,146. The infantile mortality rate is therefore 90'8. This is nearly 3 per 1,000 below the next lowest—93—which was the rate in 1912. The only other year, apart trom 1912 and 1913, in which a rate below 100 was recorded was 1910, when the figure was 98.9. 13 Infantile Mortality Figures. 14 The fact that the rate is so low, the lowest ever recorded, makes 1913, therefore, a noteworthy year. It is further noteworthy in that it is the first year in which the total number of deaths amongst infants has come definitely below 200. The manner in which the decline in the number and the rate has taken place is graphically shown in the chart facing page 12. The causes which have operated to bring about the decline are discussed on this and succeeding pages. One cause upon which it is customary to throw some of the responsibility for infant deaths is the weather or rather the climatic conditions prevailing throughout any one year. Usually it is found that if there has been much dry warm weather during the summer and autumn a considerable number of infants contract and succumb to the diarrhoeal diseases. In years characterized by such weather, the infantile mortality rate is high. If the other extreme is touched and wet and cold weather prevails respiratory diseases are coipmon and tend to keep the rate up, though rarely so high as is the case if the weather is favourable to diarrhoea. The year 1913 was one in which there was weather favourable both to the respiratory diseases and to diarrhœa. In the first half there was not enough warm weather to counteract the possibility ot bronchitis and pneumonia amongst the infants, and in the summer and autumn not enough cold to prevent the occurrence of diarrhœa. If the total number of deaths and the infantile mortality rate be regarded, however, neither respiratory nor diarrhœal diseases succeeded in getting a thorough hold. The conclusion that there must have been something keeping them in check is therefore justified. That something it is believed is to be found amongst the works done by the Council and those who are co-operating with them, the St. Marylebone Health Society chiefly. The works carried out by the Council are partly in the direction of improving sanitation generally, partly educational; the works of the others are almost entirely educational. Further reference will be made to each of these works under the heading "Prevention of Infantile Mortality" and elsewhere in this report. In the meantime the view is unhesitatingly expressed that the continued and marked reduction in the infantile mortality rate that has been taking place in the Borough for some years, and the low figure of 90 per 1000 in 1913 are the fruits of the efforts of those who have been charged with the duty of safeguarding the public health and those who have assisted them. The results in years favourable from the weather point of view have been good because the efforts put forth on behalf of the infants have helped them and the figures in unfavourable years are lower than they would have been if the work had not been done. 15 Though there has been a reduction in the total number of deaths compared with the figures for previous years, as regards distribution and proportion there has been little change. Christ Church, the district which always contributes most largely to the infantile as to most of the other mortality rates, being the most thickly populated area and that in which there is most poverty, most overcrowding and most neglect of ordinary precautions, is again at the head of the list with 110 deaths amongst infants. In 1912 the figure was 108. In connection with distribution: as to age at death and causation of death matters have undergone very little change. The greatest number of deaths occurred in the early weeks of life. Of the babies 81 were less than one month old when they died and 119 less than three months. The figures for 1912 were 82 and 110. The outstanding causes of death and the proportions traceable to them were the same. Prematurity (numbers 12, 13 and 14 in the table) which caused 81 or 38 per cent, of the total in 1912, in 1913 took 69 or 35 per cent: diarrhoea and enteritis (7 and 8) accounted for 20 or 9.5 per cent. in 1912 and for 21 or 10 per cent. in 1913. Respiratory diseases, the third of the main causes, took 35 or 16 per cent. in 1912 and in 1913 27 or 13.8 per cent. Amongst the other causes of death, those which call for mention are the commoner infectious diseases, which together led to fifteen deaths amongst infants (7.6 per cent. of the total). Of the fifteen, nine were due to measles or its sequels, bronchitis, pneumonia, &c. Injury at birth accounted for eight deaths. In 1912, four deaths were ascribed to this, in 1911, five, and in 1910, seven. In 1909 no death was registered as due to this cause, and in each of the years 1908 and 1907 only two. Some form of tuberculosis was given as the cause in six instances, and in five, convulsions. Overlying was stated to be responsible in three cases as against eight in 1912. One of the victims was aged three weeks and two between one and three months at the time of death. 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 1 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 6 3 1 3 5 3 6 3 30 St. Mary 17 1 1 1 9 1 4 - 34 Christ Church 26 8 2 2 18 26 16 12 110 St. John 7 1 1 1 6 — 2 3 21 Totals 56 13 5 7 38 30 28 18 195 16 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. 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year. 1 Small-Pox - - - - - - - - - - 2 Chicken-Pox — — — — - — — — — — 3 Measles — 1 — — 1 — — 4 4 9 4 Scarlet F ever — — — — — — — 1 1 2 5 Diphtheria and Croup - - - - - - - - 1 1 6 Whooping Cough - — — — — 1 — — 2 3 7 Diarrhœa — 1 — — 1 3 8 2 — 14 8 Enteritis — 1 1 — 2 1 2 1 1 7 9 Tuberculous Meningitis - - - - - 1 1 2 — 4 10 Abdominal Tuberculosis - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - 2 - 2 12 Congenital Malformation 7 1 — 1 9 — 1 — — 10 13 Premature Birth 27 3 1 2 33 3 1 — — 37 14 Atrophy, Debility and Marasmus 7 3 1 1 12 6 3 1 - 22 15 Atelectasis — — — — — — — — — — 16 Injury at Birth 8 — — — 8 — — — — 8 17 Erysipelas — — — — — — — — — — 18 Syphilis — — — — — — — — - — 19 Rickets - - - - - - - - - - 20 Meningitis (not Tubereulout) - - - — - — 2 2 1 5 21 Convulsions — 2 — — 2 — 1 2 — 5 22 Gastritis — — — — — — — — — — 23 Laryngitis - - - - - - - - - - 24 Bronchitis — — — 1 1 4 2 2 3 12 25 Pneumonia (all forms) 1 - 1 — 2 1 2 6 4 15 26 Suffocation, Overlying — — — 1 1 2 — — — 3 27 Other Causes 6 1 1 1 9 16 7 3 1 36 Totals 56 13 5 7 81 38 30 28 18 195 Legitimate, 2,014 Legitimate Infants, 168 Nett Births in the Year Nett Deaths in the Year Illegitimate, 132 Illegitimate Infants, 27 Total 2,146 Total 195 17 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 — — 9 — 9 4 Scarlet Fever 1 - 1 — 2 5 Diphtheria and Croup — — 1 — 1 6 Whooping Cough — — 3 — 3 7 Diarrhœa 4 — 9 1 14 8 Enteritis 3 1 3 — 7 9 Tuberculous Meningitis — — 3 1 4 10 Abdominal Tuberculosis — — — - — 11 Other Tuberculous Diseases — — 1 1 2 12 Congenital Malformation 2 — 7 1 10 13 Premature Birth 3 9 20 5 37 14 Atrophy, Debility and Marasmus 3 4 14 1 22 15 Atelectasis — — — — — 16 Injury at Birth 1 2 3 2 8 17 Erysipelas - — — — — 18 Syphilis — — — — - 19 Rickets — — — — — 20 Meningitis (not Tuberculous) — 2 3 — 5 21 Convulsions 1 1 2 1 5 22 Gastritis — — — — — 23 Laryngitis — — — — — 24 Bronchitis 3 1 4 4 12 25 Pneumonia (all forms) 4 2 9 — 15 26 Suffocation, Overlying 1 — 1 1 3 27 Other Causes 4 12 17 3 36 Totals 30 34 110 21 195 Legitimate, 2,014 Legitimate Infants, 168 Nett Births in the Year Nett Deaths in the Year Illegitimate, 132 Illegitimate Infants, 27 Total ... 2,146 Total ...--195 18 PREVENTION OF INFANTILE MORTALITY. Of the preventability of the greater part of the mortality a great deal has been said in previous reports. Here there is nothing to be done but reiterate the view, now generally held, that the vast majority of the babies who die before reaching the age of one, need not die. A glance at the causes of death set out in Table III. is sufficient to confirm that view. Why, for instance, should nine babies die of measles ? If reasonable care is exercised, no baby need be infected with measles and if it does by chance acquire infection, provided it is properly looked after, it should certainly recover. It is pretty safe to say that the infection of all the babies who took measles as well as the death of the nine who succumbed to the disease resulted because there was a failure on somebody's part to take proper precautions. This failure may have been due to carelessness or may have been due to ignorance, but the fact remains that it was the cause of unnecessary suffering to an appreciable number of infants and of nine avoidable deaths. So also with the other infectious diseases, with diarrhoea and enteritis and the respiratory diseases. The three deaths from overlying certainly need never have occurred, and eight deaths from injury at birth seems an almost unnecessarily large proportion. Even the 69 deaths due to prematurity were not all inevitable. Many of these deaths probably resulted from conditions operating during the expectant period and before the child was born. There were others, however, probably just as many, which occurred through want of care at and after birth. Most of them could have been prevented if care had been exercised; care of the mother of herself and of her baby both before and after it was born. Unfortunately this necessity is not always recognized. The size of the figures clearly indicates that an attempt should be made to impress the necessity, and to some extent it is done in the Borough. There are many difficulties in the way, however, and the chief is that the means of getting into touch with expectant mothers are few in number. Practically the only person who can really help the expectant mother, is the doctor or midwife who is to take charge of the confinement. In very many cases practically all that is done is to attempt to arrive at the date when the birth may be expected to take place and possibly, in the case of the poorer class mother at any rate, to give some more or less general advice as to the apparatus and so on that will be required when the confinement takes place. In such cases the patient, as a general rule, is not seen again until the labour has commenced. With expectant mothers who resort to the hospitals, the case is somewhat different. Very much greater care is now exercised than formerly and the woman is required to visit the hospital at stated intervals and there a preparation is made for the occurrence of the birth. 19 That the hospital authorities consider it necessary to call upon her to attend even for some time before her confinement, probably has the effect of causing the mother to regard the event as of some importance and to induce her to exercise some amount of care. But something more than this is necessary if the lesson is to be thoroughly learned. There must be much closer touch with the woman: she should be visited in her own home, should be instructed and helped to understand how important is her health to her offspring during the expectant period and how serious the results of neglect may be to it after birth. In St. Marylebone some attempt has been made mainly on the part of the workers of the Health Society to carry out work somewhat on these lines by the formation of a Provident Club for expectant mothers. This operated mainly in South Marylebone, and was worked in connection with the hospitals, Middlesex chiefly. Lists of names and addresses of women who had applied to the hospital for medical treatment to be provided at the time of confinement, were supplied and visits were paid to the homes and an attempt made to induce the expectant mothers to make preparations against the arrival of the baby. This club met with considerable success, but since the coming into operation of the Insurance Act and the provision of the Maternity Benefit there has been some dropping off. This is unfortunate, as it cannot be doubted but that good was done as a result of the visitations of the health workers. The practice of obtaining names and addresses is still continued, however, and will be extended, and no opportunity of getting into touch with expectant mothers will be lost. This is all part of the educational work which is done in connection with the prevention of infantile mortality in the Borough, to which very full reference has been made in previous reports. In 1913 there was no lessening of the activity in carrying it out. The three Women Inspectors and Health Visitors of the Council, Miss Baker, Miss Johnson and Miss Stokes, gave a great part of their time to baby work, visiting homes after receipt of notifications of births, advising mothers as to the feeding and care of infants, and on hygiene generally. The St. Marylebone Health Society, through its workers and its Schools for Mothers and Infant Consultations, continued to give the Council a vast amount of assistance also. 20 In the work of reducing the infantile mortality rate, the Council have received the greatest amount of assistance from this organization, and to it is certainly due some of the credit of having brought about the steady fall to which reference has already been made. The type of work done by the Society is more or less indicated by the titles of the institutions which have been founded: Schools for Mothers, Infant Consultations, Provident Clubs for Expectant Mothers, and so on; and descriptions of each of these have been given already. All of these continued to grow during 1913. More and more of the women in the Borough are learning of their existence, and are taking advantage of them. This is indicated more or less by the following figures. In North Marylebone the number of attendances at the consultations held at the Portinan Club, Church Street, under Drs. Christine Murrell and Emily Mecredy, was 1,932. The total number of babies seen was 407. The Mothers' Club, at which lectures and demonstrations are given, was attended by 150 women. In South Marylebone 287 babies were seen at the consultations conducted by Dr. Eric Pritchard at the Marylebone General Dispensary, YVelbeck Street. In all there were 1,223 attendances. The Mothers' Club was attended by 46 mothers. The total numbers of visits to homes by the voluntary workers was 2,162— 1,080 in the North District, and 1,082 in the South District. Work of the Women Inspectors:—The visits paid by the Women Inspectors numbered 3,776. The information obtained by them in the course of their inquiries into births notified under the Notification of Births Act is tabulated at page 21. (Table V). The matters inquired into are set out at the head of the columns, and attention may again be directed to the fact that a very considerable proportion of the infants are breast-fed, even after the earlier weeks or months of life. The very common experience is that breast-feeding is discontinued after the second month, resort being had to mixed breast and bottle or artificial feeding entirely at this time. Infant deaths:— Visits were also paid by the Women Inspectors to a number of the addresses at which deaths of infants had occurred. Enquiries in these cases were made with regard to the cause of death, the method of feeding adopted, and a note made as to the sanitary surroundings. The information obtained is summarized in Tables VI and VII. The total number of deaths investigated was 130. 21 BIRTHS INVESTIGATIONS.—TABLE V. Totals Age at Visit Method of Feeding Condition of Child Mother's Work Mother's Health Condition of Tenement No. of Rooms First-bom Twins Illegitimate Breast only Breast, etc. Cows' 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 Weeks 40 0 to 1 39 ... 1 ... ... 30 7 3 35 ... 2 3 31 6 3 33 4 3 16 19 3 2 14 2 2 335 1 to 2 314 10 9 2 ... 287 43 5 296 6 26 7 274 54 7 293 28 14 115 174 43 13 35 8 4 324 2 to 3 288 17 14 5 ... 258 58 8 274 6 32 12 272 43 9 288 26 10 117 150 49 8 74 6 10 347 3 4 294 15 28 10 ... 278 61 8 305 2 27 13 290 39 I dead 19 299 31 17 11 183 44 9 101 8 20 124 4 to 5 102 11 6 5 ... 104 18 2 106 3 8 7 113 7 4 112 7 5 26 68 24 6 32 ... 4 67 5 to 6 55 3 5 4 ... 58 8 1 59 1 4 3 55 9 3 61 5 1 17 35 10 5 16 2 1 61 6 to 7 45 3 9 4 ... 54 4 3 55 ... 1 5 53 8... 57 2 2 13 32 14 2 21 ... ... 58 7 to 8 46 3 6 3 ... 50 7 1 49 1 5 3 52 6 ... 51 6 1 7 31 19 1 6 ... ... 344 1700 over 8 243 30 52 19 ... 301 31 12 289 6 32 7 301 30 13 305 25 14 67 191 72 14 83 4 8 22 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 Diarrhœa Prematurity Marasmus Atrophy, etc. Bronchitis Pneumonia Convulsions Suffocation Measles Whooping cough Tuberculosis . Meningitis Miscellaneous 0 to 1 54 26 ... 2 1 25 1 1 1 ... 2 21 ... 5 3 4 2 1 ... ... ... ... 16 18 3 5 1 to 2 12 8 1 2 1 ... 2 1 ... ... 1 ... 1 1 2 ... 3 1 ... ... ... ... 3 4 ... 1 2 to 3 13 10 1 2 ... ... ... 1 1 ... 1 ... ... 2 2 2 1 2 ... 1 ... ... 2 3 ... 1 3 to 4 5 1 1 2 1 ... ... ... 2 1 1 ... 1 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 4 to 5 4 2 1 1 ... ... 1 ... ... ... 1 ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 5 to 6 5 4 ... ... 1 ... 1 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 6 to 7 12 9 1 2 ... ... 2 ... ... ... 1 ... 1 ... 1 2 ... ... 2 ... 1 2 2 ... 1 ... 7 to 8 2 ... ... ... 2 ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 8 to 9 4 3 ... 1 ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... 2 ... ... ... ... ... ... ... 9 to 10 5 4 1 ... ... ... ... ... 1 ... ... ... ... ... 2 1 ... ... 1 ... ... 1 ... ... ... 1 10 to 11 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... 11 to 12 11 3 2 6 ... ... ... 1 1 ... 3 ... ... ... 1 ... 1 ... 2 ... 1 1 2 ... 1 ... 130 72 9 18 6 25 9 4 6 2 14 21 3 10 12 13 8 4 8 2 2 6 27 26 5 9 23 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 14 3 ... Diarrhœa 7 ... 5 2 ... 11 3 ... 11 3 ... ... 14 ... ... 5 6 3 ... 2 1 1 1 1 3 1 ... 1 ... ... 3 21 8 2 Prematurity 6 ... 2 ... 13 17 2 2 19 1 1 ... 19 1 1 7 14 ... ... 21 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... Marasmus ... ... 3 ... ... ... 1 2 3 ... ... ... 2 1 ... 2 1 ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... 10 2 ... Atrophy & developmental 6 ... 1 ... 3 8 2 ... 9 ... ... 1 10 ... ... 5 3 1 1 5 1 2 1 1 ... ... ... ... ... ... ... 12 3 ... Bronchitis 10 2 ... ... ... 10 1 1 11 ... 1 ... 11 ... 1 5 7 ... ... 3 2 2 ... 1 ... 1 ... ... 2 ... 1 13 1 1 Pneumonia 9 2 ... 1 1 12 1 ... 11 ... 1 1 12 ... 1 5 7 1 ... 4 ... 2 ... 1 ... 1 1 1 1 1 ... 8 3 ... Convulsions 5 ... 1 2 ... 8 ... ... 6 ... 2 ... 6 2 ... 4 4 ... ... 2 3 1 1 ... ... 1 ... ... ... ... 1 4 ... ... Suffocation 4 ... ... ... ... 4 ... ... 3 ... 1 ... 3 1 ... 2 2 ... ... 1 1 2 ... ... ... ... ... ... ... ... ... 8 1 Measles 5 3 ... ... ... 8 ... ... 8 ... ... ... 7 1 ... 1 6 1 ... ... ... ... ... ... ... 2 ... 2 1 1 2 2 ... ... Whooping Cough 2 ... ... ... ... 1 1 ... 2 ... ... ... 2 ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 2 ... ... Tuberculosis 1 ... 1 ... ... 1 ... 1 2 ... ... ... 1 ... 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 6 ... 1 Meningitis including Tuberculous 3 1 1 1 ... 4 1 1 4 ... 2 ... 5 ... 1 ... 4 ... 2 ... ... ... ... ... 1 2 1 ... 1 ... 1 27 5 1 Miscellaneous 14 1 4 ... 8 24 3 ... 22 1 4 ... 25 1 1 8 17 1 1 16 3 2 1 ... 1 2 ... ... ... ... 2 130 26 5 72 9 18 6 25 108 15 7 111 5 12 2 117 7 6 46 73 7 4 54 12 13 5 4 5 12 2 4 5 3 11 24 National Health Week.—As in 1912, during the celebration of the National Health Week in 1913 (April 6th—13th), special attention was directed to the question of infantile mortality and its prevention. The Borough Council was as usual represented on the Committee organizing the work, the representatives being the Mayor (Edward Penton, Esq., J.P.), the Chairman of the Public Health Committee (Sir Horatio H. Shephard) and the Medical Officer of Health. A number of lectures were given throughout the Borough, and demonstrations were arranged at the infant consultations, the Cleansing Station and elsewhere. Great assistance was obtained from the clergy of the various denominations; and all the organizations in the Borough, dealing in any way with Public Health, took an active part. The work done during the week had the effect of bringing more prominently into evidence what is being done in the Borough in relation to health, not only of infants, but generally, and it is certain that in future celebrations, a considerable part will be played by St. Marylebone. DEATHS IN RELATION TO DISEASE. Under this heading it is proposed to consider somewhat fully some of the causes which contributed most largely to the death rate during the year. A list of the causes, with the ages at which death occurred will be found in Table III of the Local Government Board Series on page 99. Table III(a) on the following page shows the distribution of deaths according to cause in the various registration sub-districts. Diarrhœal Diseases. The deaths included in this group are those registered as due to diarrhoea and enteritis (inflammation of the bowels). The total number of these was 33, equal to 2.2 per 1,000 of the total deaths, and 0.30 per 1,000 of the population. In 1912, the deaths numbered 26 and it was taken that the smallness of the figure was the result largely of climatic conditions, the summer being a particularly cold and wet one. The summer of 1913 was on the whole a pleasant one and in comparison with 1912, 1913 was a "diarrhœa" year. Had there been any marked increase in the number of deaths from diarrhœa, as a matter of fact, there would have been no hesitation in placing a large part of the increase to the credit of the weather. The increase being trivial—only by 7—despite the favourableness of the weather, there is every justification for arriving at the conclusion, already stated, that the work which is being done in the Borough is having some effect. Without hesitation, indeed, it may be said that the activity which has been shown in the Borough during the last few years, in improving sanitation and educating the inhabitants, is beginning to produce results. 25 The fruits of the hard work that has been put in are the children who have been prevented from taking diarrhœa: the returns for the money spent on public health are the infants saved from death from this disorder. The most typical diarrhoea year experienced for a long time was 1911. In that year the total number of deaths, registered as due to diarrhœal diseases, was 92. In 1913 there was not the prolonged periods of excessive heat experienced in that year, but there were quite long spells of warm dry weather. There were, in short, conditions favourable to the occurrence and spread of diarrhoea, and a total of between 40 and 50 might have been expected. That the number was so low as 33 is particularly encouraging, and may be taken to show that the work done has been on the right lines. As has been stated in previous reports, educational work is especially valuable in connection with the prevention of this disease. There was a recognition of this in the appointment by the Council of three women health visitors and sanitary inspectors and the imposing upon them of the duty of visiting those houses in which there are babies. There was further recognition of it in the encouragement of co-operation between the official and the voluntary health workers. No less valuable in connection with the prevention of this disease, is the general sanitary works the responsibility for which rests upon the Council. In 1913 as in previous years this was actively carried out. To the fact that there has been no slackening of the effort to obtain a high degree of sanitation in the district must be given a considerable part of the credit for the reduction that has taken place. The latter part of this report deals with general sanitation and it is not necessary to say more here than that the works done with the object of discovering nuisances and having them remedied; the efforts made to improve the milk and food supplies within the borough; the increased activities in relation to the improvement of housing; the increase in the frequency of house refuse collection and so on, have all played a part and will play yet a bigger part in reducing the numbers of cases of the diarrhoeal and other preventable diseases. Flies and Disease. Since the diarrhoeal diseases are amongst those which it is now generally recognised flies are capable of transmitting, reference may be made at this point to an attempt made to spread information with regard to the dangers arising from these insects and the methods of getting rid of them. Acting on the instructions of the Public Health Committee the Medical Officer of Health prepared a leaflet on the subject and during the fly season large numbers of these were distributed by the various inspectors and also through the infant consultations and schools for mothers. At the same time, the management of one of the picture theatres in the Borough 26 (the Marble Arch Electric Theatre), influenced by a member of the Public Health Committee, arranged for the inclusion in their programme during the greater part of one week, of a film dealing with the fly nuisance. This attracted a considerable amount of attention and, as large numbers of people saw the film, doubtless some amount of good was done. During part of the time the film was on exhibition, copies of the leaflet on flies, of which the following is a copy, were distributed:— METROPOLITAN BOROUGH OF ST. MARYLEBONE. PUBLIC HEALTH DEPARTMENT. FLIES ARE DISEASE CARRIERS. (Diarrhcea, Typhoid Fever, Diphtheria, Consumption, etc.) Flies found in houses, on the walls, the ceilings, the food, and the people, are born and bred in manure heaps and dust bins, and collections of dirt and filth. They feed on filth and carry with them filth germs and germs of disease. Everything upon which the fly rests, more especially food, receives some of these germs. The milk into which the fly falls gets the biggest share. In the milk the germs grow and multiply very quickly. Amongst the diseases spread by flies are Diarrhœa, Typhoid (Enteric) Fever, Diphtheria and Consumption. In clean, airy rooms flies are few. To keep flies away. Keep your house clean. Keep your house and your yard free from collections of dirt and refuse. If you see any collection of refuse in a yard or elsewhere, complain to the Medical Officer of Health, 24, Somerset Street, Portman Square, W. To free houses from flies. Keep your house clean and well aired. Open doors and windows as much and as wide as possible. If necessary, open windows may be screened with muslin. For catching flies use sticky or other fly papers. If a house or room is badly infested with flies, complain to the Medical Officer of Health, 24, Somerset Street, Portman Square, W. To protect food from flies. Keep all food—meat, sugar, jam and milk, especially the milk to be used by a baby—covered. Muslin may be used for the purpose. Baby's face during sleep should also be screened with muslin. This leaflet is issued from the St. Marylebone Public Health Department (24, Somerset Street, Portman Square, W.) where advice and assistance in connection with all matters affecting health can always be obtained. 27 Copies of the leaflet in an enlarged form were posted in public conveniences and elsewhere throughout the Borough. Thanks also to the Editors of the local newspapers, the contents were reproduced in the press as well, and so given a very wide publicity. Zymotic Diseases, Phthisis, &c., 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 86 0.79 2. Phthisis and other Tuberculous Diseases 191 1.75 3. Respiratory Diseases 377 3.46 As compared with 1912, the figures for zymotic diseases and respiratory diseases are slightly lower, and that for phthisis slightly higher. Zymotic Diseases. There has been a very marked falling off in the number of deaths from these diseases during the last three years. The diseases included in the group are: smallpox, measles, scarlet fever, whooping cough, diphtheria and membranous croup, typhus, enteric and continued fevers, diarrhoea and enteritis, and whereas in 1911 the deaths due to them numbered 203, in 1912 and 1913 respectively they have fallen to 99 and 86. The death rate, which in 1911 was 1.72, in 1912 was 0.90, and in 1913 0'79. The common experience with these diseases is that if watched over a number of years they are proved to show a more or less regular variation, rising steadily to a maximum through a series of years, and falling as steadily throughout the succeeding series to a minimum. In 1911 apparently a maximum was reached, and apparently also 1912 was the first of the series of years in which a fall was due to occur. That 1913 may represent the end of the fall is just possible, but even if it does not, that so high a figure as that attained in 1911—203—will ever again be reached seems improbable. Year by year so many improvements are taking place in connection with the prevention of infectious diseases, that the chances of any one of them, with the possible exception of small-pox, getting anything like a firm grip, are growing gradually less. 28 The hope that it will not be necessary again to register a number at all approaching 203, is in the light of these improvements fully justified. Further reference will be made to each of the diseases in the group in subsequent pages. It may, however, be pointed out that of the 86 deaths registered in 1913, the largest number was again due to measles, viz., 32. In 1912 the number was 39, and in 1911, 64. Whooping cough caused 11, and scarlet fever 10 deaths. A table (Table III) giving other figures will be found at page 99. Phthisis and Other Tuberculous Diseases. The total deaths due to the diseases dealt with under this heading, viz.: phthisis (pulmonary tuberculosis or consumption of the lungs), tuberculous meningitis, general tuberculosis, tabes mesenterica, and all conditions due to the germ of consumption, numbered 191, a figure greater by seven than that for 1912, when 184 deaths were registered. The smallest number ever registered in the Borough was 169 in 1910. The great bulk of the 191 deaths, viz., 149, was due to phthisis. This figure is exactly the same as that for 1912, and comes close up to that for 1910, the lowest year, when there were 133. Of the total number of deaths registered (1627), the percentage due to phthisis was 9.1 as against 8.5 in 1912. The age periods at which the deaths occurred were: 2-5 years, 1 (0.7 per cent.); 5.15, 7 (4.7 per cent.); 15-25, 9 (6.4 per cent.); 25-45, 71 (47.6 per cent.); 45-65, 43 (28.8 per cent.); 65 and over, 18 (12.7 per cent.). Below the age of two years, 3 deaths were certified as having occurred from this disease. The subject of phthisis is further discussed in connection with the notification and prevention of tuberculosis. The following table gives the figures with regard to each of the years from 1905. It will be noted that though there have been occasional rises the tendency has all the time been downwards. The reasons for this will be discussed later. TABLE VIII. DEATHS FROM PHTHISIS AND OTHER TUBERCULOUS DISEASES. Year. No. of Cases. Population. Rate per 1000 of Population. 1913 1912 191 184 114,532 116,155 1.75 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 29 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 377. This is lower by 17 than the figure (394) for 1912, but higher than that for 1911 by 39. The death rate was 3.46 per 1,000. In 1912 the rate was 3.07: and in 1911, 3.04. The majority of the deaths in this group were traceable to bronchitis. The number certified to be due to this cause was 225, as against 230 in 1912. Of this number 132 were amongst persons aged 65 and upwards, and 59 amongst those in the group 45-65. The deaths traceable to pneumonia numbered 127, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 28 of the deaths occurred amongst children under 2 years of age. At the moment there is some amount of discussion as to the possibility of taking action for the reduction of the respiratory diseases and having regard to the fact that in 1913 they were responsible for about one-fourth of the total number of deaths, it certainly seems desirable that some examination of this possibility should be made. Of the diseases forming the group, that most definitely known to be due to a germ is pneumonia. That it is a communicable, infectious disease is also generally accepted. It is fairly generally believed that the other respiratory diseases are also due to germs, and to some extent, also, particularly the acuter forms, e.g., "cold," and acute bronchitis, communicable. Diseases that are organismal in origin and communicable so often fall within the category of preventable that inevitably the question of preventability must be raised in connection with pneumonia and the other diseases of the respiratory organs. It may be that the only step that can be taken in the direction of prevention is that of making the public aware of the fact that a germ is the factor in the production of the disease, and warning them that there is a possibility of infection being acquired from a person already suffering. This is, however, something, and if there is any justification for it, it should be done. In addition, of course, disinfection can be carried out, and if it does not help directly, by destroying the organism of the disease, will certainly do so indirectly from the educational point of view, by indicating that the local authority have such a belief in the infectious character of the disease that they consider it necessary to take action with the object of preventing spread of infection. Up to the present no routine work of this kind has been done in the Borough in connection with the respiratory diseases. During 1914, however, it is proposed to deal with pneumonia in this way. All premises in which a death from this disease is found to have occurred will be visited: enquiries will be made, advice will be offered and disinfection, if permission is given, carried out. 30 It is true that, as several days usually elapse before information with regard to deaths is received, there may be delay in taking these steps. That a very small amount of good has been done will be sufficient to justify the taking of the action, and it is hoped that this amount will be done. If further justification is required it is to be found in the following facts: that over 3 per 1000 of the population died of the respiratory diseases in 1913; that there were 127 deaths (1.2 per 1000 of the population) from pneumonia, 28 of them in children under 2 years of age and 51 in adults between the ages of 25 and 65, and that on an average 120 persons die in the Borough from this cause each year. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 156 and the death rate 1.36 per 1000 of the population. In 1912 the total was somewhat lower-137; the figure for 1913 is, however, much nearer the average, that for the previous year being exceptionally low. In the report for 1912 this disease was considered at some length. Since that report was written nothing has occurred rendering any alteration or addition to what is written there, necessary. It is not proposed, therefore, to do more now than submit the usual tables. Cancer. Ages at Death. Ages. Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals. Males 1 - 1 2 10 25 16 16 71 Females - - 2 4 14 22 15 28 85 Totals 1 - 3 6 24 47 31 44 156 Cancer. Situation of the Disease. Parts of the body affected. Males. Females. Total. Face, Tongue, Jaw 9 - 9 Throat, Neck, Gullet 15 2 17 Stomach 9 8 17 Intestines 11 12 23 Liver 6 4 10 Breast - 15 15 Uterus and Generative Organs - 25 25 Various 21 19 40 71 85 156 31 The following table, which was included for the first time in the Report for 1912, is repeated, as it lends further support to the view then expressed that cancer was in no sense a class disease, since if those who died at home or in nursing homes are taken to represent the rich or well-to-do, and those who died in hospitals or the infirmary the less favourably circumstanced, the one group suffered equally with the other. At Home In Nursing Homes. In Hospitals. In Infirmary. In Asylums. Total. Males Females Totals 19 34 53 6 11 17 17 19 36 26 20 46 3 1 4 71 85 156 ALCOHOLISM. The number of deaths certified as directly due to alcoholism was 8, two more than in 1912. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 19 deaths as against 15 in the previous year. The combined figure for these two causes is higher by 4 than that for 1912, viz., 27 as against 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 64 (.58 per 1,000). The number in 1912 was 56. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1913 numbered 70. Of these 15 were due to suicide. Deaths of babies certified as resulting from suffocation (overlying) numbered 3. RECORDS OF DISEASE. The diseases considered under this heading are those made compulsorily notifiable by Section 55 of the Public Health (London) Act, 1891; diseases declared to be notifiable under Orders made by the London County Council: tuberculosis notifiable under Regulations of the Local Government Board, and certain other diseases which though not notifiable are infectious, viz., measles, whooping cough, and diarrhoea. The diseases named in the Public Health (London) Act are smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlet lever, typhus, typhoid or enteric, relapsing, continued and puerperal tevers. Those added by the London County Council are Cerebro-spinal fever, glanders, anthrax, hydrophobia, acute polio-encephalitis and myelitis and ophthalmia neonatorum. 32 In the case of tuberculosis further changes in connection with notification took place in 1913, all previous regulations, of which between 1908 and 1911 there had been three issued, being superseded by a set which appeared in December, 1912. These, in addition to consolidating the previous regulations, extended the requirements with regard to notification to include all forms of tuberculosis, and not only the pulmonary form to which the regulations quoted above referred. The new regulations came into force on 1st February, 1913. The effects produced by them are considered further in the section dealing with tuberculosis. The records kept with regard to the non-notifiable diseases referred to above are based on information obtained by the Women Inspectors who investigated all cases coming to the knowledge of the Medical Officer of Health. Attention is directed to the existence of these diseases usually by school teachers, who make special returns with regard to them, or in returns made by the local Registrars. A special table relating to the infectious diseases-Table II of the Local Government Board Series-will be found at page 98. Information additional to that given there is set out below. Notifications. The total number of notifications received during 1913 was 1,956. Especially in the case of tuberculosis many of the notifications were duplicates, and the actual number of cases notified was 1,334. The number notified in 1912 was 1,219, so that there is an increase of 115 over the previous year. This is accounted for by the extension in the case of tuberculosis and a slight increase in the number of cases of scarlet fever. The notification rate (proportion to population of notified cases of infectious diseases) in 1913 was 11.6 per 1,000 as against 10.4 in 1912. Isolation of Cases. The following table shows, with regard to each disease, the percentages of the totals and the actual number of cases removed to hospital during the year: Diphtheria 127 or 96.2 per cent. of the cases notified. Erysipelas 14 „ 18.6 ,, „ „ Scarlet Fever 398 „ 96.8 „ „ Enteric Fever 15 „ 78.9 „ „ „ Cerebro-spinal Meningitis 2 „ 66.6 „ „ „ Ophthalmia Neonatorum - „ - „ ,, „ Puerperal Fever 2 „ 50.0 „ „ „ Polio Myelitis - „ - ,, „ „ Phthisis 166 „ 24.4 „ „ „ The cost of carrying out the requirements of the Public Health (London) Act 1891, and the various regulations with regard to notification was £ 124 3s. 9d. equal to £1 1s. 8d. per 1,000 of the population. 33 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 1913 124 3 9 1 1 8 Discharge Notices. The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 392 and referred to 577 cases. Visits were paid to these cases by the District Inspectors, and advice given as to the date of the return of children to school and the advisability of obtaining treatment for and isolation of any suffering from any sequel of a disease. Diphtheria and Membranous Croup. Diphtheria was somewhat less prevalent in 1913 than in 1912, 132 cases as against 147 in the previous year. Of the cases 6 died, and the case mortality rate was practically the same as in 1912, viz.: 4.5 as compared with 4.8 per cent. The number of cases per 1,000 of the population was 1.31. The number of swabs from doubtful cases submitted for bacteriological examination was 138. A positive result was returned in 33 instances. Of the registration districts that contributing the largest number of cases was Christ Church with 47. All Souls and St. Mary each gave 38, and St. John 9. As usual the age groups 1-5 and 5-15 were those most affected, 52 of the cases falling into the former and 46 into the latter group. One application for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, was received. The nuisances detected during the course of investigating the notified cases were: Dirty Premises, etc., 34; Defective Drainage, 1. These were all remedied after service of notices. 34 Only in a few cases was it possible to determine accurately the source of infection; in 18 it proved to be in the home of the patient, and in four instances from a previous case in his own family. One patient was believed to have obtained his infection at school and another from a previous case in the neighbourhood. Scarlet Fever. The notifications of this disease numbered 411. This is the highest figure for any year since 1909, when 458 were notified. In 1908 the number was 409 and in 1912 259. The chart inserted at the beginning of this report shows the number of cases reported week by week throughout the year and the relation which the figure has to the average of the previous 10 years. The highest number reported in any one week was 18. The total deaths from scarlet fever numbered 10, and the number of deaths per cent. of the cases was 2.4. The districts to suffer most from this disease were Christ Church and St. John. In the former there were 178 cases and in the latter 103. In All Souls there were 69 and in St. Mary 61. As usual, the majority of the patients were children of school age; the age group, 5-15, giving more than half (251) of the total. Of the remainder 97 were aged between 1 and 5 years. The source of infection was believed to be a previous case in the same family in 52 cases. In 9 cases a patient had been previously notified to be suffering in the same house. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 6 instances that a definite connection could be made out. Defects in sanitation to the number of 97 were discovered. Of these, 92 were want of cleanliness, &c., and 5 defects in drainage. The nuisances were remedied after the service of notice in each case. Enteric Fever. There were eight more cases of enteric fever in 1913 than in 1912, the numbers being 19 and 11. The majority of the cases originated outside the Borough, and in one case only was contaminated food-in this instance fish-believed to be the source of infection. The deaths numbered 5 in all, which gives a case mortality of 26.3. The cases were distributed as follows: St. Mary, 8; Christ Church, 6; and All Souls, 5. Two of the deaths occurred in All Souls and 2 in St. Mary. Examination of the premises resulted in the discovery of nuisances in 9 instances. The drainage was found to be defective in 2 of the premises. 35 The defective conditions were attended to by the persons responsible after receipt of notice in each case. cerebro-spinal fever. Three children, one under 5 years of age, and two aged between 5 and 15, were notified as suffering from this disease. Isolation and treatment were carried out in a hospital, but all three patients died. Erysipelas. The notifications of erysipelas numbered 75, and there were 2 deaths. Most of the cases were notified from the Workhouse Infirmary and the General Hospitals and 14 of the patients were treated in one or other of these institutions. Puerperal Fever. The number of cases of this disease notified, viz., 4, was just about the average. The number of deaths registered as due to this cause, viz., 2, was also about the average. In each case a visit was paid by one of the women inspectors and the premises were disinfected. Measles. As already noted most of the information obtainable with regard to this disease comes from the school teachers and during 1913 the returns made referred to 448. This number is less than that for 1912 and much less than that for 1911. The number of deaths was smaller than in either of the two previous years also, 32 as against 39 in 1912 and 64 in 1911. Of the deaths two-thirds occurred amongst patients under 5 years ot age, the majority-13 out of 32-being of babies more than 1 but less than 2 years old. Visits are paid to all homes in which a case of measles is reported to have occurred, and leaflets impressing the necessity for preventing the spread of infection by isolation and the protection of the sufferer from the common sequels of the disease, bronchitis and pneumonia, are explained to and left with those in charge of the patient. At the same time arrangements are made for the carrying out of disinfection after the termination of the disease. Hospital Isolation of Measles. Patients suffering from measles, to the number of 58, were isolated in the hospitals of the Metropolitan Asylums Board, after the issue of a certificate by the Medical Officer of Health to the effect that isolation could not be carried out at home. The following table shows the number of cases ot measles and other infectious diseases reported from schools and other Boroughs during 1913. With regard to schools it may be stated that no classrooms were closed by the Education Department of London County Council on account of measles. With regard to schools it may be stated that no classrooms were closed by the Education Department of London County Council on account of measles. 36 SCHOOLS. Scarlet Fever. Diphtheria. Typhoid Fever. Whooping Cough. Chicken-pox. Measles. All other Dise ases. All Souls, Foley Street 30 5 ... ... 27 ... 1 Barrett Street 2 1 ... ... 3 2 1 Barrow Hill Road 92 5 2 6 62 47 105 Bell Street 21 17 ... 4 65 24 67 Capland Street 21 13 ... 5 16 43 19 Catholic, Richmond Street 12 1 ... ... 2 ... ... Christ Church, Lisson Grove 35 13 ... 2 10 3 36 Convent, Little Union Place 22 1 ... ... 12 3 13 Council, Grove Road 1 1 ... ... ... ... ... Emmanuel, Aberdeen Place 7 3 ... ... 8 8 12 Emmanuel, North Street 18 3 ... ... 3 6 3 Hampden Gurney, Upper Berkeley Street 4 1 ... 4 1 16 1 Homer Row, Catholic 7 ... ... ... 36 23 24 Jewish, Hanway Street 3 ... ... ... ... ... 1 Portland, Little Titchfield Street 15 8 ... ... 22 11 15 St. Andrew's, Wells Street 5 3 ... ... 13 1 1 Francis Holland, Upper Baker Street ... ... ... ... 1 ... ... St. Luke's, Nutford Place 6 3 ... ... 2 18 21 St. Mark's, Violet Hill ... ... ... ... 2 19 ... St. Mark's, Marylebone Road ... ... ... ... 3 2 ... St. Marylebone, High Street 24 7 ... ... 24 32 18 St. Marylebone Grammar, Marylebone Road 3 4 ... ... 3 11 ... St. Mary's, Crawford Street 23 8 ... 2 8 42 12 St. Paul's, East Street 3 1 ... 1 ... 17 i5 St. Paul's, Broadley Terrace 9 3 ... ... 6 38 4 St. Stephen's, Charlbert Street ... ... ... ... ... ... ... St. Thomas', Orchard Street 8 1 ... 1 8 27 1 Polytechnic, Regent Street ... 1 ... ... ... ... ... Trinity, Buckingham Street 9 ... ... 3 6 39 1 St. Vincent, Lower Seymour Street ... ... ... ... ... ... ... Westminster Jewish School 1 1 ... 1 ... ... ... Schools out of Borough 9 1 ... ... 2 16 3 Totals 390 105 2 29 345 448 374 37 Whooping Cough. Practically the only information obtainable with regard to this disease is derived from the death returns, and during 1913 the number of deaths registered as from this cause was 11 as against 15 in 1912 and 30 in 1911. The disease, as is well known, is one of childhood, and all the 11 deaths that occurred were, as a matter of fact, of children under 5 years of age; 3 were less than 1, 5 less than 2 but more than 1, and 2 more than 2 but less than 5 years of age. Isolation in hospital is carried out in the case of whooping cough as in measles, and 8 certificates were granted during the year. 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. The order making the notification of glanders compulsory came into operation on 1st January, 1908, since when, viz., in November, 1908, only 1 case has been notified. Chicken Pox. This disease being no longer notifiable in 1913, 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 36. Polio-Encephalitis and Myelitis. These diseases remained notifiable during the year, only 1 notification was, however, received. The case occurred in All Souls sub-registration district, the patient being a young woman aged 24. She was admitted to hospital, and recovered. 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 1913. The total number of cases notified was 9, as against 19 in 1912. Visits were paid to all notified cases, none of which were particularly serious, by the women inspectors. Tuberculosis. Formerly the only form of tuberculosis dealt with in this section of the report was the pulmonary (consumption of the lungs) and the heading employed was "Phthisis." Notification having now been extended to all forms of the disease and the 38 regulations directing this having been in force throughout 1913 from 1st February, it has been thought advisable to alter the title to "Tuberculosis." That there should have been such an extension as that noted marks a tremendous advance in the effort to deal with this disease. In previous reports reference has been made to the gradual way in which full compulsory notification was reached, the whole process taking something like four years, and advancing step by step from notification of poor law cases, to notification of hospital cases and then to notification of all cases.This last had been in operation something under 12 months when the regulations revoking all previous regulations and consolidating their provisions, and extending the requirement to all forms of tuberculosis appeared. These bear the title Public Health (Tuberculosis) Regulations, 1912, and though they were issued in December, 1912, did not came into operation until 1st February, 1913. During the whole of January the notifications were made under the Regulations of 1911 and were of pulmonary cases only. Under the 1912 Regulations, though there was some slight change in the form of notification, especially as regards Poor Law cases and cases detected by school medical officers, notification of pulmonarv tuberculosis remained unaffected. It is possible, therefore, to take the figures for this form of the disease as those of a complete year. The figures for other forms of tuberculosis relate only to 11 months. The following table, which, slightly altered, is continued from 1912, is rapidly becoming interesting historically. It shows the number of cases notified each year since 1906, when voluntary notification was first introduced; the changes taking place in the extent of the notification, and the effects produced by these changes. This year, for the first time, the figures relating to non-pulmonary forms of tuberculosis are introduced, and the heading of the table is altered from "Phthisis Notifications" to "Tuberculosis Notifications." The total number of pulmonary cases notified it will be seen is considerably less than that for 1912. The large figure for 1912 probably included quite a number of known cases, notification of which was only brought about as a result of the introduction of compulsory notification in that year. For some years, probably, the annual number of cases will continue to get smaller, and the figures to represent more and more newly discovered cases. 39 TUBERCULOSIS NOTIFICATIONS.—A. Year. Medical Practitioners. Hospitals and Dispensaries, etc. Poor Law. Pulmonary. Nonpulmonary. Totals. 1906 (voluntary) 206 (six months) - — 206 — 206 1907 291 — — 291 — 291 1908 176 — — 176 — 176 1909 98 20 *216 334 — 334 1910 101 15 421 537 — 537 1911 56 **280 200 536 — 536 1912 †l07 428 155 690 — 690 1913 Pulmonary Non-pulmonary ‡115 270 141 526 154 680 53 67 34 *Compulsory 1st January, 1909. †niformly compulsory January, 1912. **Compulsory in May, 1911, for Hospital cases. ‡Uniformly compulsory for Tuberculosis 1st February, 1913. A further table with regard to notifications is printed below. This has been prepared for the Local Government Board and shows the numbers of cases notified on each of the different forms prescribed in the Regulations of 1912. Form A is that intended for use only by medical practitioners (including medical officers of poor law institutions and sanatoria) in notifying cases not previously notified. The notifications made on this form are known as primary notifications and it was drafted with the object of preventing duplication of notifications, from which a considerable amount of trouble had arisen under the 1911 Regulations. Form B is that provided for the use of school medical inspectors. It is interesting to note that only 17 cases in all were found amongst the school children examined in the Borough. As no idea is given of the number of children examined, the work of inspection being carried out by inspectors of the London County Council, who work quite independently of the Borough Council's Medical Officer of Health, it is impossible to say what importance, if any, is to be attached to this figure. Form C is used by medical officers of poor law institutions and sanatoria in notifying patients admitted under their care and not already notified on Form A. A further form, D, is provided for the use of poor law and sanatorium medical officers, upon which they are required to notify the medical officer of health of all patients discharged from the institutions. This and Form C are required to be forwarded weekly. Notifications on Form A are to be made within 48 hours after a diagnosis has been made. 40 TUBERCULOSIS NOTIFICATIONS B. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 1st February, 1913, to the end of the week ending on the 3rd january, 1914. Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C Primary Notifications. Total Notifications (i.e. including cases personally notified by other doctors). Primary Notifications. Total Notifications (i.e. including cases personally notified by other doctors. Poor Law Institutions. Sanatoria 0 to 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Under 5 5 to 10 10 to 15 Total Pulmonary Males — 12 33 21 7 19 44 49 35 27 8 255 337 1 — — 1 2 140 13 ,, Females 2 13 28 26 12 26 48 41 23 11 5 235 291 — 1 — 1 1 46 22 Non-pulmonary Males 3 13 24 7 7 4 7 8 3 3 1 80 88 — 3 4 7 7 10 1 ,, Females 2 6 21 5 4 8 4 4 1 1 2 58 63 3 4 8 8 3 — 7 44 106 59 30 57 103 102 62 42 16 628 779 2 7 8 17 18 199 36 41 National Insurance Act. Sanatorium Benefit.—The part played by the Medical Officer of Health in connection with the administration of sanatorium benefit was remarkably small. Little or no use was made by the Insurance Committee of the machinery provided by the Borough Council for the prevention of tuberculosis, and there was no real attempt to arrange for the working together of the two forces—the Insurance Act force and the preventive force of the Council. It is true that an Insurance Sub-Committee for the Borough was appointed, to which the Council were asked to elect certain representatives and to send their Medical Officer of Health. This met once to elect a Chairman and receive an address from a representative of the Insurance Committee on work which the Sub-Committee might perform. An hour for future meetings, which were never held, was also arranged. It is true also that from time to time the Clerk to the Insurance Committee asks for figures with regard to the proportion of insured persons amongst the notified cases and the registered deaths. It is true that reports are received from the Clerk to the Insurance Committee as to patients admitted to and discharged from sanatoria, and that occasionally an insured person writes to the Medical Officer of Health under the impression that he may possibly be able to bring pressure to bear upon the Insurance Committee to favourably consider his claims for admission to a sanatorium. But that is all. Large numbers of persons in the Borough may be receiving sanatorium benefit; there is no evidence to the contrary in the possession of the Medical Officer of Health. Letters written by the Medical Officer of Health pointing out that the home conditions of an insured consumptive person are so bad that it would be well if he were admitted to an institution for treatment may influence the Insurance Committee; there is no evidence that such letters are capable of producing any effect. One piece of definite information the Medical Officer of Health did receive in 1913, and that was a return, or set ot returns, showing that 42 insured persons were admitted to sanatoria. Other pieces of information he got out for himself or for the Insurance Committee, viz., that of the 680 persons notified, 213 were insured persons, and of those who died of consumption (191) 44 were insured. Some information with regard to numbers of insured persons treated for consumption is given in a letter sent by Dr. Halliday Sutherland, of the St. Marylebone Dispensary for the Prevention of Consumption. That letter was written at the request of the Medical Officer of Health, and the statement with regard to insured persons given because it was specially asked for. All these facts distinctly show that there is an absence of proper co-operation 42 between two important bodies, each of them having very definitely the duty of grappling with the problem of tuberculosis imposed upon them. It is a serious matter that in the one report which is supposed to deal with the Public Health of the Borough, it is found impossible to give any idea of the extent of the work which is being done in the case of so important a disease as consumption, or to express an opinion as to the effect produced by what has been done. The Medical Officer of Health is in a position to obtain information with regard to the housing, surroundings, etc., of the consumptive, which, though practically beyond the reach of the Insurance Committee, it is important they should have before them in deciding as to the form of benefit appropriate to the cases under consideration. It is undoubted that nothing but advantage would result to the committee no less than to the insured from proper co-operation between those responsible for the administration of the sanatorium benefit and the Public Health Department of the Borough, and it is unfortunate that arrangements for bringing it about have not yet been made. Deaths from Phthisis.—The deaths from consumption numbered 149—exactly the same as in 1912. The rate per 1,000 was the same, viz., 1.2. In Table IX below the numbers for each of the years 1900 to 1913 are given and the distribution of the deaths throughout the Borough is also shown. With regard to this last, it is interesting to note that Christ Church, though it still heads the list, shows a very distinct reduction on the figures for 1912. Though it is the most thickly populated district and that in which the majority of the inhabitants are of the class most liable to infection and least capable of withstanding the ravages of the disease, it is at the same time, the district in which most preventive work is done. The official and other workers are more closely in touch with the inhabitants of this part of the Borough than with those in any other; more educational work is done in this district, and more frequent inspections are made and greater efforts are put forth to obtain improvements in housing and sanitation. Much of the work is, of course, done because of the character of the neighbourhood and the circumstances of the inhabitants, nevertheless it preventive work is capable of producing any effect, it is in this district that it should be seen. In the last seven years, the work in connection with tuberculosis having been more or less organised in 1906, the number of deaths has come down distinctly to nearer 60 than 70 and even on two occasions to between 50 and 60. In the period referred to the population has greatly thinned and the neighbourhood altered, and these changes have doubtless played a part in the reduction in the numbers. They have not been responsible for all, however. The vast amount of work carried out by the Council and those acting with them has done its share, not so great perhaps as it would have done had conditions amongst the people themselves been more favourable, but still a share sufficiently great to encourage the workers to continue their efforts and even to increase them. 43 Table IX. DEATHS FROM PHTHISIS. Estimated Population. Year. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 114,532 1913 149 32 40 57 20 116,155 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, 87; general and other hospitals, 15; at home, 47. Of those who died 44 were insured and 105 uninsured. As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 149 the notified cases of pulmonary tuberculosis totalled 526. Tables similar to those printed below and showing the age distribution of the deaths and the occupation of the patients have appeared in previous reports. No comment with regard to them is necessary since no fact to which attention has not already been directed is brought out. Deaths from Phthisis—Age and Sex Distribution. Ages. Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals. Males 4 2 12 30 22 10 16 3 99 Females 4 2 9 10 12 4 5 4 50 Totals 8 4 21 40 34 14 21 7 149 Deaths from Phthisis in relation to Occupation. MALES. No occupation. Work with exposure. Sedentary work. Professional work. Total. Workmen. Foremen, Masters, etc. Workmen. Foremen, Masters, etc. 8 60 4 20 4 3 99 44 FEMALES. No occupation or house work. Work with exposure. Sedentary work. Professional work. Total. 40 2 7 1 50 Prevention of Consumption.—The methods followed thoughout 1913 in relation to the prevention of consumption were substantially those in vogue in previous years. The extension of compulsory notification to other forms of tuberculosis led to an increase in the number of visits paid by the women inspectors, but in these cases, apart from advising as to the obtaining of treatment nothing more could be done than in the case of pulmonary tuberculosis. A great part of the work carried out is, of course, educational, and what the patient and those in charge of or in contact with him are taught has frequently been described in previous reports. The practice of insisting upon the importance of early detection of the disease, of encouraging contacts to submit themselves to examination, and ot making arrangements for them to be examined, has been continued. The greatest assistance in this connection was received from the Dispensary in Allsop Place, the Middlesex Hospital, and other institutions in the Borough. The body responsible for the first named continued to assist greatly in the work of preventing consumption, providing special facilities for children, and taking large numbers into the open air school which they have formed in Regent's Park. Apart from such work as is described above there were, of course, what may be described as the ordinary "sanitary" works. Disinfection of premises, clothing, and so on was carried out on request and in any case in which it seemed necessary. Immediate action was taken with regard to conditions calling for attention, whenever such were detected in the course of visits to premises, and the call for many of the improvements in housing, which are described later, arose after receipt of a tuberculosis notification form and the visitation following it. The importance of the part played by such work in relation to the prevention of tuberculosis has already been described and need not again be enlarged upon. Schemes of Prevention.—Not till the end of the year was any progress made with the drafting of a scheme for the prevention of consumption within the Borough, and then only the dispensary portion was considered. The main cause of the delay was an uncertainty as to whether or not the Borough Council was to be the body responsible for the formation of schemes, the announcement having been more or less made by the London County Council that they would draft a scheme applicable to the whole of London and would make arrangements for each of the Boroughs. After these arrangements were made, the administration was to be handed over to the Borough Council. 45 This idea apparently did not commend itself to the Local Government Board, who eventually laid it down that the Borough was in each case the unit and the Council of the Borough the body responsible for forming the scheme, so far, at least, as the dispensary was concerned. This ruling was not communicated to the Council till nearly the end of 1913. As soon as it was received, however, the work of drafting the scheme was put in hand. The work was not completed till after the New Year, and further consideration is deferred until the end of 1914, when it is to be hoped that it will have been in operation for some months, and some idea of how it has worked may also be given. No advance whatever was made in connection with that part of the scheme relating to sanatoria and hospitals. This is a matter with which the London County Council are expected to deal, and they will in time, no doubt, come forward with a scheme for the whole of the Metropolis. Bacteriological Diagnosis of Consumption. There was a very great increase in the number of specimens of expectoration sent by medical men for bacteriological examination, from cases in which there was some doubt as to the diagnosis. The total number was 672 (as against 271 in 1912), of which 120 were found to contain the bacillus of tuberculosis, and the remainder to be free from this organism. This increase is probably due, amongst other causes, to the introduction of compulsory notification and the increase in the number of contacts. Part of it, it is hoped, is due to an increase in the interest taken by the inhabitants in their own health, and the increased facilities for obtaining medical advice provided by the National Insurance Act. The St. Marylebone Dispensary for the Prevention of Consumption. Some reference has already been made to the work done by the Dispensary in Allsop Place. The following short summary of what was done in 1913 has very kindly been sent by Dr. Halliday Sutherland, the Medical Officer. Dr. Sutherland writes:— During the year 1913 419 patients were examined at the Dispensary and 271 were examined in their own homes. Of these, 207 were found to be definitely tuberculous and 40 were suspected cases. Children under 15 numbered 233, and of these 106 were found to be tuberculous, 23 were suspected cases and 106 were non-tuberculous. The Medical Officer paid 1,153 visits to patients in their own homes, and the Dispensary Sister paid 2,219 domiciliary visits. The number of individual attendances of patients at the Dispensary was 8,346. The number of persons insured under the National Insurance Act coming under treatment at the Dispensary for the first time was 59, but the number of those actually under treatment, including insured persons continuing their attendance from previous years, was 99. In all, 418 patients were actually receiving treatment at the Dispensary in 46 1913, and of these 99 were insured persons and 319 were not insured. The total attendance of same, including home visits by the Medical Officer, were as follows:— Insured persons 1,430 Not insured 8,059 Making a total of 9,489 With regard to the sending of insured patients to the State Sanatoriums, 23 patients were sent from this Dispensary since the Act became operative to the end of 1913." Dr. Sutherland's letter is accompanied by a table which contains most interesting information with regard to the after-history of the insured persons sent to sanatoria. The table is rather long to give in full, but the information it contains may be summarized. The average duration of stay in the sanatorium was 80 days; of the 23 patients, 12 remained a longer time than the average, the remainder shorter. The longest stay was 134 days; the shortest 22. Of the 23 at discharge the condition was stated to be worse in 2 cases, arrested in 3, improved in 5 and not improved in 3. That the patient was fit for work was the verdict in 5 cases; the disease was considered to be still active in 3. Two of the patients were discharged at their own request and one was discharged for breach of regulations. Practically all of the patients were seen by Dr. Sutherland after their discharge, and at the time when he constructed his table, 10 were found to be at work, one as late as 12 months after discharge. In the other cases the period was shorter—one or two up to 10 months. Of the remaining 13, one died 6 months after discharge and the others were not working, two, 13 months after discharge, the remainder from 2 up to 12 months afterwards. Practically all the patients after discharge again went under treatment, the majority of them at the dispensary, though one or two went into an infirmary or hospital. Work of the women inspectors:—The total number of cases seen by the women inspectors was 871, 680 of which were new cases. Of the patients seen 166 were removed to hospital, 213 were insured persons, of whom 42 went to a sanatorium. Disinfection of premises was carried out in 116 instances. The following tables constructed from information obtained by the women inspectors in the course of their investigations have been prepared and are printed here at the request of the Medical Officer of Health of the London County Council, who is desirous of obtaining a body of information sufficiently extensive to allow of conclusions of value being arrived at. The information analysed and tabulated relates to 377 males and 414 females. 47 PHTHISIS. FEMALES—-MARRIED (including Widows) 175 cases. No. and Age of Patient. Patient's Relatives, living and dead. I. Father and Mother. II. Brothers and Sisters. III. Uncles and Aunts. Patient's Husband (if re-married, give particulars for deceased wife). Patient's Children. No. of Patients Childless. Age. No. Whether or not affected. I. II. III. Grandparents L. D. L. D. L. D. L. D. L. D. L. D. 0 - Affected - — — - - - - - - - - - - Not - - - - - - - - - - - - - Unknown - - - - - - - - - - - - - 15 10 Aftected - 1 - 3 3 1 - - 1 - - - - Not — — 11 4 11 — — — 8 1 17 — — Unknown — — 2 — — — — — - — — — — 25 61 Aftected - 4 3 17 3 18 - 7 11 3 33 2 11 Not — — 68 32 89 7 8 — 46 1 93 6 — Unknown — — 2 — — — — — — — — — — 35 91 Affected — 1 4 25 12 24 — 13 6 19 56 7 25 Not — — 74 76 66 15 7 — 56 10 113 11 — Unknown — — - 3 — — — — — — — — — 55 13 Aftected — — - 3 1 2 — — — — 3 2 3 Not — — 4 17 5 — — — 10 3 19 — — Unknown — — - 2 — — - — - - - - - PHTHISIS. FEMALES—UNMARRIED (239 cases). No. & 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. Grandparents Living. Dead. Living. Dead. Living. Dead. Living. Dead. 0 150 Affected 1 20 64 34 105 26 20 36 Not — — 195 7 279 4 88 4 Unknown — - - — — — — — 15 54 Affected — 4 14 14 18 8 9 2 Not — 1 68 12 153 5 33 — Unknown — — — — — — — — 25 19 Affected — 4 3 7 5 2 — 10 Not — — 23 5 48 — — — Unknown — — — — — — — — 35 14 Affected — — — 3 4 1 - 3 Not — — 14 11 14 — 9 — Unknown — — — — — — — — 55 2 Affected - — - 2 - 3 - - Not — — — 2 3 — — - Unknown - — - - - — — — 48 FEMALES. Number of Cases 414. AGE DISTRIBUTION. Under 1 year. 1—5. 5—15. 15—25. 25—45. 45—65. 65 & over. All ages. 1 14 135 64 152 47 1 414 DURATION OF ILLNESS IN YEARS. Under 1 year 1—2. 2—3. 3—4. 4—5. 5 and upwards 148 100 82 22 23 39 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. 93 184 86 32 19 69 256 65 24 414 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. Charing. Trades with predisposing influences. Miscellaneous. Public. Private. — — — — — 4 1 5 — 1 — 5 30 32 41 2 14 OTHER FORMS OF TUBERCULOSIS. 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. Number of Patients Childless Age. No. Whether or not affected. I. II. III. L. : D. L. D. L. D. L. D. L. D. 0 0 Aftected - - - - - - - - - - - Not - - - - - - - - - - Unknown - - - - - - - - - - 15 0 Affected - - - - - - - - - - - Not - - - - - - - - - - Unknown - - - - - - - - - - 25 0 Affected - - - - - - - - - - - Not - - - - - - - - - - Unknown - - - - - - - - - - 35 1 Affected - - - - - - - - - - — Not 1 1 - - - - - 1 5 - Unknown - - - - - - - - - - 55 0 Affected - - - - - - - - - - - Not - - - - - - - - - - Unknown - - - - - - - - - - 49 OTHER FORMS OF TUBERCULOSIS. FEMALES—UNMARRIED. PATIENTS' RELATIVES. Age No. Whether:— Living. Dead. Living. Dead. Living. Dead. 0 20 Affected 2 - 4 2 - 5 Not 37 1 60 1 11 - Unknown — — — — — - 15 3 Affected - - - - - - Not 6 — 5 — — - Unknown — — — — — - 25 0 Affected — - - - - - Not — — — — — - Unknown — — — — — - 35 2 Affected - - - - - - Not 2 2 4 — — - Unknown — — — — — — 55 1 Affected - - - - - - Not — 2 — — — - Unknown — — — - — - Females. Number of Cases 27. Age Distribution. Under 1 year. 1—5. 5—15. 15—25. 25—45. 45—65. 65 & over. All ages. — 3 17 3 2 2 — 27 Duration of Illness in Years. Under 1 year. 1—2. 2—3. 3—4. 4—5. 5 and upwards. 10 5 2 3 1 6 No. of Living Rooms in Patient's Tenement. Weekly Rent Paid. One room. Two. Three. Four. Over Four. Under 5/- 10/- 15/- 15/- & over. Total Cases. 3 10 9 5 — 1 16 9 1 27 Occupation of Patients. Outdoor. Indoor. Miscellaneous. Clerks. Laundries. Printers Servants. Tailoring, etc. Charing. Trades with predisposing influences Miscellaneous. Public. Private. — — — — — — 2 — — — 50 PHTHISIS. MALES, MARRIED (Including Widowers) 140 cases. No. and Age of Patient. Patient's Relatives, Living and De?.d. 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. <• II. III. L. D. L. D. L. D. L. D. L. D. L. D. 0 0 Aflected - - - - - - - - - - - - - Not - - - - - - - - - - - - - Unknown - - - - - - - - - - - - - 15 1 Affected — - - - - - - - 1 - - - - Not — — 2 — 2 — — — — — 1 — — Unknown - - - - - - - - - - - - - 25 42 Affected - 1 4 6 6 6 - 1 10 - 21 - 6 Not — 2 56 16 44 - 6 — 32 — 51 2 8 Unknown — — 2 — — — — — — - — - — 35 86 Affected - 1 - 10 3 17 - 3 10 2 33 7 - Not — — 94 66 66 2 — — 71 3 179 3 23 Unknown — — — 2 — — — — — — — — — 55 11 Affected - - 2 2 1 - - - 1 1 4 - - Not — — 9 9 6 4 — — 8 1 21 — 5 Unknown - - - - - - - - - - - - - PHTHISIS. MALES—UNMARRIED, 237 cases. 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 Grandpirents I. II. III Living. Dead. Living. Dead. Living. Dead. Living. Dead. 0 154 Affected — 23 55 29 108 23 22 47 Not — — 214 10 266 7 56 — Unknown - — — — - — — — 15 36 Affected - 2 4 17 9 14 5 4 Not — - 44 7 61 - 10 9 Unknown — — — — — — — — 25 27 Affected - 1 3 9 10 2 - 10 Not — — 27 13 28 — 5 1 Unknown — — — — — — — — 35 19 Affected - - - 5 - 4 - 3 Not — — 17 16 19 2 — — Unknown — — — — - — — — 55 1 Affected - - - - 1 - - - Not — — - 2 2 — — — Unknown — — - - - — — - 51 PHTHISIS. Males. Number of Cases 377. Age Distribution. Under 1 year 1—5 5—15 15—25 25—45 45—65 65 and over All ages 1 19 134 37 136 50 - 377 Duration of Illness in Years. Under 1 year. 1—2 2—3 3—4 4—5 5 and upwards. 163 70 64 15 21 44 Number of living rooms in patient's Tenement. Weekly rent paid. 1 room 2 3 4 Over 4 Under 5/- 10/- 15/- 15/- and over. Total Cases. ' 82 163 78 34 20 59 220 68 30 377 Occupation of Patients. Outdoor. indoor. Taxi-Cab Drivers, etc. Carmen, Carters, Drivers. B. C. Labourers. Milkmen. Ex-Soldiers and Sailors. Miscellaneous. Clerks. Painters. Bakehouses. Printers Railway and Tube hands. Servants. Tailoring, etc. Builder's labourers. Trades with predisposing influence. Miscellaneous Public. Private. 14 5 6 1 9 47 3 5 5 4 — 5 11 15 15 23 48 52 OTHER FORMS OF TUBERCULOSIS. Males—Married (including Widowers). (6 cases). No. and age of Patients. Patient's Relatives, Living and II. Brothers and Sisters Dead. I. Father and Mother. III. Uncles and Aunts. Patient's Wife (if re-married give particulars for deceased wife or wives.) Patient's Children. No. of Patients Childless. Age. No. Whether or not affected. I. II. III L. D. L. D. L. D. L. D. L. D. 0 — Affected - - - - - - - - - - - Not - - - - - - - - - - - Unknown - - - - - - - - - - - 15 — Affected - - - - - - - - - - - Not - - - - - - - - - - - Unknown - - - - - - - - - - - 25 2 Affected 3 _ 1 Not 2 2 — — — — 2 - 1 — — Unknown - - - - - - - - - - - 35 3 Affected - - - - - - - - 1 — 1 Not 1 5 2 — 1 — 3 - 9 — — Unknown - - - - - - - - - - 55 1 Affected. Not 2 — — — — 1 - 4 - — Unknown - - - - - - - - - - - MALES—UNMARRIED. (35 cases). No. and Age of Patient. Patient's Relatives. Living and Dead. I. Father and Mother. III. Uncles and Aunts. II. Brothers and Sisters. Age No. Whether affected or not. I II. III. Grandparents. Living. Dead. Living. Dead. Living. Dead. Living. Dead. 30 Affected - 3 8 3 10 3 8 Not - - 49 - 46 - 18 - Unknown - - - - - - - - 15 4 Affected - - 1 - 2 - - - Not - - 5 2 12 - - - Unknown - - - - - - - - 25 1 Affected 1 - - - - Not - - 1 - 4 - - - Unknown - - - - - - - - 35 Affected - - Not - - - - - - - - Unknown - - - - - - - - 55 - Affected - - - - - - - - Not - - - - - - - - Unknown - - - - - - - - 53 Males. Number of Cases 41. Age Distribution. Under 1 year. 1—5 5—15 15—25 25—45 45—65 65 & over. All Ages. — 7 23 4 5 2 — 41 Duration of Illness in Years. Under 1 year. 1—2 2—3 3—4 4—5 5 & upwards. 17 5 5 2 3 9 No. of living rooms in Patient's Tenement. Weekly Rent Paid. 1 room. 2 3 4 Over4. Under5/- 10/- 15/- 15-and over. Total cases. 2 22 13 4 — 2 28 9 2 41 Occupation of Patients. Outdoor. Indoor. Taxi-Cab Drivers, etc. Carmen, Carters, Drivers. Dock Labourers. Milkmen. Ex-Soldiers and Sailors. Miscellaneous. Clerks. Laundries. Bakehouses. Printers. Railway and Tube Hands. Servants. Tailoring, etc. Builders' Labourers. Trades with predisposing influences. Miscellaneous. Public. Private. — — — — — 3 — — — — — — — 1 — — 3 Non-Pulmonary Tuberculosis. The total number of cases of non-pulmonary tuberculosis notified up to the end of 1913 was 154. The majority of the notifications, as was to be expected, referred to children. In all, there were 58 cases of bone or joint tuberculosis (spine 17, hip 20 and knee 12): and 71 of tuberculosis of lymphatic glands. The great bulk of the notifications came from institutions where the patients were undergoing surgical or other treatment, but visits were paid to all the homes and where necessary, advice with regard to the obtaining of treatment offered. DISINFECTION. So far as disinfection was concerned no changes were made in methods followed in previous years. For infected articles, clothing etc., the Goddard, Massy and Warner Steam Disinfector was employed, and for the disinfection of rooms, formic aldehyde gas produced by burning formalin tablets. The number of tablets used was, as in former years, 30 per 1000 cubic feet of space. 54 The number and nature of the articles disinfected are shown in the following table. Compulsorily Notifiable Infectious Diseases. Phthisis. Measles. Vermin. Other causes. Total. Beds 393 55 13 17 11 489 Mattresses 427 43 39 13 90 612 Bolsters 474 56 29 13 31 603 Pillows 906 110 46 31 205 1,298 Sheets 1,011 79 72 16 44 1,222 Blankets 1,144 134 101 21 75 1,475 Sundries 5,893 314 695 62 976 7,940 Totals 10,248 791 995 173 1,432 13,639 In 1912, the number of articles disinfected was 11,355 and in 1911, 13,921. The number of journeys made by the disinfecting vans during the year ended December 1913 was as under :— January 33 February 28 March 28 April 39 May 36 June 33 July 65 August 62 September 75 October 74 November 70 December 71 The vans were used 411 times in 1912. 614 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 72 13 21 3 12 121 February 42 7 32 3 5 89 March 30 8 31 1 16 86 April 39 5 11 2 — 57 May 41 9 6 2 10 68 June 30 13 8 6 8 65 July 43 16 — 9 18 86 August 54 7 — — 6 67 September 56 12 — 1 13 82 October 82 8 3 1 3 97 November 82 10 - 2 3 97 December 63 8 1 1 7 80 Totals 634 116 113 31 101 995 The number of rooms disinfected in 1912 was 824. 55 BACTERIOLOGICAL EXAMINATIONS. The number of specimens examined bacteriologically and the diseases in relation to which the examinations were made are shown in the following table. The figures for 1912 are also shown, and it will be noted that whereas there was a reduction in the case of typhoid fever and diphtheria there was a most marked increase in that of phthisis. The reasons for this have already been given. The work of examining the specimens was carried out by Dr. Eastes at the Laboratory of Pathology and Public Health, 35, New Cavendish Street. 1912. 1913 Positive. Negative. Total. Positive. Negative. Total. Typhoid Fever 2 1 18 6 14 17 Diphtheria 31 129 160 33 105 138 Phthisis 80 191 271 120 552 672 Totals 113 336 449 159 671 827 Part II. DEPARTMENTAL. 59 DEPARTMENTAL. The staff of the Public Health Department consists of, in addition to the medical officer of health, a deputy medical officer of health (Dr. Bywater), two drainage inspectors, one outdoor superintendent, one meat and food inspector, one house-to-house inspector, five district inspectors, three women sanitary inspectors, one dust inspector, one chief and four assistant clerks and an office youth. 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 are also attached to the department and immediately responsible to the Public Health Committee. The high standard set for the work in previous years was well maintained during 1913 by the staff. Some details of what was done are given in the following pages. Staff Meetings. The practice of holding staff meetings originated in 1912 was continued throughout the year, and as was anticipated, proved of real value in the working of the department. The total number of meetings held was six. A variety of subjects was discussed, including Housing and Town Planning records, underground room records, overcrowding, phthisis in common lodging houses, water supply (drinking water cisterns), disinfection; food inspection in public-houses, hotels and restaurants, boarding and apartment houses; the use of dirty bottles for milk; examination of drains; back to back houses; gas stoves and ventilation; weight and composition of lead pipes, etc. These were all raised by individual members of the staff, and as a result of the tree and open discussion that followed a number of difficulties which had been experienced were to some extent cleared away. PROTECTION OF THE FOOD SUPPLY. The main duties in relation to this matter were carried out by Inspector Smith, who made inspections of premises in which food is sold, stored or prepared, and acted as inspector under the Sale of Food and Drugs Acts. Food Inspection.—There was no change in the method of carrying out the work of food inspection during the year. The special Saturday night and Sunday inspections in market streets, etc., were continued, and in carrying them out Inspector Smith received the assistance of other members of the staff having the necessary qualifications and experience. On a great many occasions the inspector was called by vendors to examine articles of food under Section 47(8) of the Public Health (London) Act, 1891, and to accept surrender of such as were unsound, or unwholesome or unfit for food. 60 The articles dealt with in this way included:— 450 lbs. of tomatoes. 2 baskets of cherries. 2 „ pears. 1 „ peaches. 1 „ strawberries. 1 „ oranges. 1 „ apples. Sack of peas. Bag of broad beans. Trunk of cod. Barrel of conger eels. Trunk of hake. Quantity of oysters. 30 lbs of whiting. 3 trunks of roe. 1 cwt. of beef. 1 „ mutton. 28 lbs. of pork. 3 geese. 2 turkeys. 3 pigs heads (tuberculosis). 1 ox liver (fatty degeneration). 1 ox liver (flukes). Bunch bullock's lights (echinococci). 2 sheep's livers (echinococci). 1 sheep's liver (flukes). With the object of preventing the distribution of unsound food amongst the members of Christmas Clubs, a number of visits were paid to such places just before Christmas, and all joints and poultry examined. The actual number of premises visited was 9, and the number of birds and joints examined 3,000. All were found to be sound. For the first time tor a number of years no seizures were made under Section 47 of the Act of 1891 of articles unfit for human consumption, and no proceedings were instituted against any vendor under its provisions. It was in 1908 that the Council determined to take active measures to protect the food supply of the ratepayers, and at the end of that year appointed a special officer to act as inspector of meat and foods. Arrangements were made for the carrying out of a systematic inspection of premises and examination of food, and it was made perfectly clear to all vendors within the Borough that while every assistance would be given to them to carry out an intention of purveying only articles that were sound and wholesome, there would be no hesitation in taking action in any case in which there appeared to have been a neglect of proper precaution. In 1909 and ever since, this work has been carried on most actively. That the vendors have shown a desire to accept the assistance offered and to co-operate with the department, is indicated by the increasing frequency with which the inspector iscalled in to give an opinion with regard to foods, and to accept surrender of such as are stated by him to be unfit for consumption. The fact, that in 1909 there were no fewer than 11 prosecutions after seizure of articles of food, clearly shows that there was at that time a distinct necessity for the taking of active measures, and indicates that it was quite time that the Council should put forth a special effort. 61 Further that, though in connection with this work the activities of the department have increased rather than decreased, seizures have become fewer year by year, is evidence enough that the work has had an effect. That there was justification for the determination of the Council was never doubted: it is interesting, however, to be able to produce such evidence as is given here to show how great that justification was. SLAUGHTERHOUSES. There is no call for any special comment with regard to the work done in relation to the slaughterhouses in the Borough during 1913. A complete list of the premises used for the purpose of slaughtering animals for food of man and the conditions under which the licences are granted by the London County Council is given below. Each was regularly and frequently visited and no condition calling for the service of notice was discovered. Premises. Condition. 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.—No objection was offered to the renewal in 1913 of any of the licenses granted by the London County Council with regard to cowhouses, the number—5—therefore remains the same as in 1912. These premises are situated as shown below. The number of cows for which each is licensed and the number actually stalled is also shown. Premises. Licensed for. Cows kept. 58, Acacia Road 44 26 56, Bell Street 15 9 42a, Clipstone Street 10 10 26, John Street 14 1 3, Malthouse Mews 22 16 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. 62 Mitkshops, etc.—The number of premises upon which milk is sold is 229. The number of applications received was 15. Under the powers granted by the London County Council (General Powers) Act, 1908, 2 were refused on the ground that the premises were unsuitable. Under this same Act 12 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 refusals 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 which did not bear his name and address was detected and prosecuted under the Sale of Food and Drugs Act. Further reference is made to this case later. Examination of Milk.—The usual amount of supervision was exercised over the milk traffic in the Borough during 1913, and for the detection of adulteration 536 samples were taken either formally or informally and submitted to the public analyst for examination. A number were also submitted to bacteriological examination and to these reference will be made later. Of the 536 examined chemically 37 (6.9 per cent.) were found to be adulterated. This is a somewhat higher figure than for 1912, when 21 out of 550 (3.8 per cent.) were proved on analysis to be below standard. The percentage in 1911 was 8.9 and in 1910 9.5. As heretofore vendors whose samples were found to be up to standard received a notification to the effect that the dealings with the samples were at an end. When the samples were found to be only slightly below the standard a special report was made to the Public Health Committee, and in the majority of instances a letter of caution was sent to the vendor. In the case of samples that were definitely adulterated proceedings were instituted. The number with regard to which action was taken in 1913 was 22. In respect of these, fines and costs to the amount of £27 16s. 0d. were recovered. The amount in 1912, when the prosecutions numbered 16, was £26 8s. 6d. The practice of occasionally sampling on Saturday evening and on Sundays was continued. 84 samples were obtained on delivery at the Marylebone Station of the Great Central Railway. Of the station samples, 7 proved to be adulterated, and proceedings were taken in 3 instances. In the remaining cases the deficiency in fat was very small and the 63 farmers were 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 145 8 5.5 5 4 17 6 2nd 146 16 10.9 12 14 18 6 3rd 133 7 5.2 2 5 5 0 4th 112 6 5.3 3 2 15 0 Total for year 536 37 6.9 22 27 16 0 Ice Cream Premises. The number of such premises in the Borough on the register is 105. Regular inspections were made throughout 1913, and in 7 cases notices were served in respect of uncleanly conditions. Butter, Margarine, &c. Information with regard to the sampling of these substances will be found under the heading " Sale of Food and Drugs Acts." At the end of the year there were on the registers nine dealers in and manufacturers of margarine, one wholesale dealer in butter and milk-blended butter, and two butter manufacturers. All the registered premises were frequently visited. Restaurants, Food Stalls, &c. The number of premises in which food is prepared for sale is 262, made up as follows:—Restaurant, dining room and coffee shop kitchens, 152; tea rooms and pastrycooks, 44: hotel kitchens, 42; fried fish shops, 24. 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 522, and as a result of these, various conditions calling for attention were discovered. In all 67 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. 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 38 visits, but no cause of complaint was found. 64 Bakehouses. At the end of 1913 the number of bakehouses on the register was 75, 65 being underground bakehouses. In all, 158 visits were paid to these and 4 notices with regard to defects were served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, etc., of the inside walls and other parts of the bakehouses were served. It was not necessary to institute proceedings to enforce compliance with any notice. SALE OF FOOD AND DRUGS ACTS. The usual careful attention was given to this important part of the work of the department during 1913. The total number of samples taken was 1061, which is about the average for the last three years. Of this number 45 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 4.2 per cent., which is slightly higher than that for 1912, when the percentage was only 2.9. In 1911 it was 6.2, and in 1910, 73. The method adopted in connection with the taking of samples was similar to that followed in previous years and described in former reports. The inspector is given instructions each Saturday with regard to the sampling to be done in the next ensuing week. The number and kind of samples to be taken is indicated, and if any are to be taken "informally," that is without complying with the formalities laid down in the Act, special instructions are given. The majority of the samples in 1913 were "formal" samples, and in carrying out the sampling, the inspector was almost invariably assisted by an agent. The bulk of the samples taken were of milk and dairy produce. The Public Analyst's Report, which is included in this report, contains a considerable amount of information with regard to the materials sampled, and there is little necessity for much to be said here. It may be mentioned, however, that the prosecutions in respect of adulteration of food numbered 27, and that the fines and costs recovered amounted to £64 6s. 0d. In one case, relating to a sample of raspberry jam certified by the Public Analyst to contain 10 per cent. of apple pulp, in which a penalty of £2 was imposed with costs £15 15s. 0d., an appeal, which at the end of the year was still pending, was lodged. The warranty defence was raised in 4 prosecutions for adulteration of milk, and was successful in all cases, the summonses being dismissed. In one case proceedings were instituted for an offence against the Acts other than selling adulterated articles, as follows:— Sale of Food and Drugs Act, 1899, Section 9. Fine. Costs. Selling milk from a vehicle without having name and address inscribed thereon 5 0 2 0 65 The following tables and report from the Public Analyst give full information with regard to 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, 1913. 137 milks Food Inspector St. Marylebone Borough Council Genuine. £500 per ann for 700 samples. Over that number 7/6 per sample. Nine were coloured, all were free from preservatives. One was a test sample 8 milks Adulterated. No. 40, 10.0 per cent. deficient in milk fat No. 40. Vendor cautioned vide P.H. Mts. 7/2/13 No. 145, 13.3 do. No. 145. Fined 10/- and 12/6 costs No. 181,13.3 do. No. 181. Fined 10/- and 12/6 costs No. 220, 10.0 do. No. 220. Summons dismissed. Warranty defence No. 223, 6.7 do. No. 223. Vendor cautioned vide P.H. Mts. 4/4/13. No. 247, 13.3 do. No. 247. Summons dismissed. Warranty defence No. 248, 10.0 do. No. 248. Fined £2 and 12/6 costs No. 271, 3.3 do. No. 271. Vendor cautioned vide P. H. Mts. 18/4/13. 105 butters Genuine. 70 were test samples. 92 butters contained borax viz.: 2 up to 10 grains per lb. 40, 10-20 grains per lb. 38, 20-30 grains per lb. 12, 30-35 grains per lb. The largest amount 1 butter Adulterated. No. 58 contained 90.0 per cent. fat other than butter fat found—34 grains per lb. No. 58. Fined £5 and 12/6 costs on 1st summons and £1 and 2/- costs on 2nd summons 9 creams Genuine. Two creams contained less than 10 grains per lb. of borax. Two creams contained less than 20 grains per lb. of borax. 1 tea Private purchaser Do. This sample contained minute trace of potassium permanganate. 6 coffees Food inspector Do. One was a test sample. 1 lard Do. This was a test sample. 1 raspberry jam Do. This was a test sample. 2 margarine Do. 1 cocoa Do. 1 chocolate Do. This was a test sample. 1 cake Do. This was a test sample. 1 mustard Do. This was a test sample. 3 Gregory's powder Do. These were test samples. 1 ipecacuanha wine Do. 1 white precipitate ointment Do. This was a test sample. Total Number of Samples analysed during the Quarter 280 Number of Samples adulterated 9 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. SECOND QUARTER ENDING 30TH JUNE, 1913 130 milks Food Inspector St. Marylebone Borough Council Genuine £500 per annum in respect of 700 samples 25 of the milks contained colouring matter. All the milks were free from preservatives. 10 milks Adulterated. No. 313. 6.67 per cent. deficient in milk fat Over that number 7/6 per sample. No. 313. Vendor cautioned vide P.H. Mts. 2/5/13 No. 324, 23.3 do. No.324. Warranty defence. Case dismissed No. 367, 6.67 do. No. 367. See footnote (A) No. 401, 23.3 do. No. 401. Fined 5/- and 12/6 costs No. 421, 12.0 per cent. added water No. 421. Fined 10/- and 12/6 costs No. 435, 3.0 per cent. deficient in milk fat No. 435. Vendor cautioned vide P.H. Mts. 30/5/13 No. 436, 13.3 do. and 23.3 per cent. added water No. 436. Fined £1 and 12/6 costs No. 439, 13.4 do. No. 439. Fined 10/- and 12/6 costs No. 445, 3.3 per cent. deficient in milk fat No. 445. Vendor cautioned vide P.H. Mts. 30/5/13 No. 464, 6.67 do. No. 464. Fined £1 and 12/6 costs No. 478, 16.67 do. No. 478. Fined £2 and 12/6 costs No. 520, 13.3 do. . ( See foot-. note (b) . No. 520. Fined £1 and 14/6 costs No. 521, 3.3 do. No. 521. 14/6 costs No. 523, 3.3 do. No. 523. 14/6 costs No. 528, 16.7 do. No. 528. 14/6 costs. No fine. See footnote (c) No. 545, 6.67 do. No. 545. Fined 10/- and 12/6 costs 106 butters Genuine 42 butters contained 10-20 grains per lb. borax 39 butters contained 20-30 grains per lb. borax 7 butters contained 30-33 grains per lb. borax 61 were test samples 10 creams Do. 2 creams contatned borax, 14 and 21 grains per lb. respectively 2 mustards Do. One was a test sample 3 boric ointment Do. These were test samples 1 mercurial ointment Do. This was a test sample 9 jams Do. 4 were test samples 2 sweet spirits of nitre Do. One was a test sample. 1 ipecacuanha wine Do. This was a test sample 1 coffee Do. 1 pepper Do. 2 Dover's powder Do. These were test samples 1 lemcn squash Do. This was a test sample (A) Solicitor advised no proceedings in view of the fact that the milk was taken on delivery at the Gt. Central Railway and was consigned by Mr. C. H. Calder. for sale at one of his retail branches in London and in these circumstances there was no contract or warranty. (B) Station samples from one farmer. No fine was imposed in respect of Nos. 521 and 523 (C) Warranty defence raised which was not in order on the ground that notice was not given within the specified time The magistrate upheld this view, but having regard to the excellent character of the Defendant and the fact that he held a warranty, although it could not be admitted, he ordered Defendant to pay costs. Total Number of Samples analysed during the Quarter 285 Number of Samples adulterated 16 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. THIRD QUARTER ENDING 30TH SEPTEMBER, 1913. 12G milks Food Inspector, St. Marylebone Borough Council Genuine. £500 per annum in respect of 700 samples. Over that number 7/6 per sample One was a test sample. No sample contained any preservative, but 21 contained artificial colouring matter. Adulterated. No. 586. 6 67 per cent. 7 milks deficient in milk fat. No. 586. Vendors tioned vide P.H. Mts., 25/6/13. No. 614. 10.0 per cent. do. No. 614. No. 625. 6.67 per cent. do. No. 625. No. 633. No. 655. 'These two samples were taken at G.C. Railway Station on delivery, at the request of the Consignee and the farmer was cautioned vide P.H. Com Mts, 3/9/1913. No. 633. 13.3 per cent. do. No. 655. 2.59 per cent. added water. No. 707. 13.3 per cent. deficient in milk fat. No. 707. Fined £3 and 12/6 costs No. 765. 26.67 per cent. do. No. 765. Fined £1 and 12/6 costs 92 butters Genuine 46 contained borax under 20 grains per lb. 34 contained borax under 30 grains per lb. 5 contained borax under 35 grains per lb. 3 butters Adulterated. 10 contained no preservative No. 668. Margarine, not butter. No. 668. This was a test sample No. 703. 50 per cent. fat other than butter fat. No. 703. This was a test sample No. 750. Margarine, not butter. No. 750. Fined £10 and 12/6 costs on 1st summons and 1/- and 2/- costs on 2nd summons. This sample was taken from same vendor as Nos. 668 and 703 14 creams Genuine. 5 contained borax up to 23 grains per lb. 9 contained no preservative 1 cream was a test sample. 1 mustard Do. Mustard was a test sample. 5 jams Do. These were test samples. 2 jams Adulterated. 1 was a test sample. No. 603. Raspberry Jam contains apple pulp. This was a test sample No. 658 Raspberry Jam contains 10% apple pulp. Proceedings pending. 3rd sample sent to Somerset House 4 coffees Genuine. 2 peppers Do. 1 was a test sample. 1 cider Do. This was a test sample. 1 lard Do. This was a test sample 68 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 boracic ointment Food Inspector, Genuine. £500 per annum in respect of 700 samples. Over that number 7/6 per sample This was a test sample 2 Dover's powder St. Marylebone Do. 1 was a test sample. 1 ammonia ted tincture of quinine Borough Council Do. This was a test sample 1 soda water Do. This was a test sample. 1 boracic acid Do. This was a test sample. 2 borax Do. 1 was a test sample. 1 citric acid Do. This was a test sample. 1 sodium citrate Do. This was a test sample Total Number of Samples analysed during the Quarter 268 Number of Samples adulterated 12 FOURTH QUARTER ENDING 31ST DECEMBER, 1913. 105 milks Genuine. Two were test samples. No sample contained any preservative but 21 contained artificial colouring matters. 1 milk Private purchaser Genuine. 6 milks Food Inspector Adulterated. No. 862. 13.3 per cent. deficient in milk fat No. 862. Fined £1 and 12/6 costs. No. 912. 70.0 do. No. 912. Proceedings not taken on advice of Solicitor. No. 929. 30.0 do. No. 929. Fined 10/- and 12/6 costs. No. 946. 6.67 do. No. 946. This was a test sample. No. 1021. 16.6 do. No. 1021. Warranty defence. Case dismissed. No. 1058. 10.0 do. No. 1058. This was a test sample. 82 butters Genuine. 62 were test samples. 11 contained no preservative. 1 contained less than 10 grains borax per lb, 40 contained between 10 and 20 grains per lb., 30 contained between 20 and 30 grains per lb., 2 contained between 30 and 35 grains per lb. 2 butters Adulterated. No. 857. Margarine, not butter No. 857. This was a test sample. No. 978. Contained at least 65.0 per cent. of fat other than butter fat No. 978. Fined 10/- and 12/6 on 1st summons and 2/- costs on 2nd summons 9 creams Genuine. 2 were test samples. 3 contained no preservative. 6 contained between 10.5 and 16.9 grains borax per lb. 2 mustard Do. 1 was a test sample. 2 pepper Do. These were test samples. 69 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. 8 jams Food Inspector, Genuine £500 per annum in respect of 700 ples. Over that ber 7/6 per sample These were test samples. 4 Dover's powder St. Marylebone Do. These were test samples. 1 ammoniated tincture of quinine Borough Council Do. This was a test sample. 1 currants Do. This was a test sample. 1 coffee Do. This was a test sample. 1 flour Do. This was a test sample. 1 lime juice Do. This was a test sample. 1 ipecacuanha wine Do. This was a test sample. 1 bleaching powder for flour Consisted essentially of calcium phosphate Total Number of Samples analysed during the Quarter 228 Number of Samples adulterated 8 SUMMARY. Number of Samples Analysed. Number Adulterated 1st Quarter 280 9 2nd ,, 285 16 3rd ,, 268 12 4th ,, 228 8 Totals 1,061 45 REPORT OF THE PUBLIC ANALYST, 1913. During the year 1913, 1,061 samples were submitted for analysis. Of these 45 were certified to be adulterated—a little over 4 per cent. This is an increase of more than 1 per cent, of adulteration as compared with 1912. The samples comprise dairy produce, condiments, saccharine substances, non-alcoholic beverages, farinaceous foods and various drugs; but with the exception of a sample of cider and one of medicinal wine, no ordinary alcoholic drinks, i.e., beer, spirits or wine. The dairy produce examined accounts for 91.4 per cent. of the total samples. This large proportion amply explains the apparent increase in the percentage of adulteration—the temptation and the facilities are both greater than in other classes of food. Milk.—Out of 536 samples 37 were certified to be adulterated; all of these save three were simply deficient in milk fat, the deficiency being from as little as 3 per cent, up to as much as 70 per cent. milk fat abstracted. Of the remaining three, two contained added water from 12 to 13 per cent., and another sample was watered to the extent of 23 per cent., and was deficient in milk fat 13 per cent. Although most of the samples of milk were artificially coloured, preservatives were absent—indeed it is quite exceptional now to find even in the height of summer any preservative in milk. 70 The average composition of unadulterated samples during the three years, 1911, 1912 and 1913, was as follows: Sp. gr. Milk fat. Solids, not fat. Total solids. 1911 103 l.O 3.70% 8.64% 12.34% 1912 1031.5 3.74% 8.77% 12.51% 1913 1031.7 3.73% 8.80% 12.53% This clearly shows that the general milk supply of the district maintains the high level of 1912, and compares quite favourably with the supply of any of the large towns. Butter.—391 samples of butter were analysed, 6 of these were adulterated, under 2 per cent. The six were mainly substitutions of margarine for butter. Margarine is now so cleverly manufactured, that the best varieties can scarcely by the taste and smell be distinguished from butter. The butters as a rule (over 80 per cent.) contained boric acid, but the quantity of the preservative used is small, in some cases less than 10 grains per lb., and seldom more than 20 grains per lb. Cream.—Under the Public Health (Milk and Cream) Regulations, 1912, it is an offence 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. Inferentially, therefore, cream to be cream has to contain at least 35 per cent. of milk fat, and surely it would have been better to have defined what is cream in express terms. As it stands it would seem that a cream of 34 per cent. milk fat strength can be sold preserved without such label. The mean content of fat in the 42 creams examined was 50 per cent; 30.2 and 66.3 per cent. being the extreme values. A little more than half the samples contained boric acid in small quantities, the highest being 18.9 grains per lb. Jam.—Of 25 jams analysed, two only were returned as adulterated; both of these were raspberry jams and contained apple pulp. The one case was a sample taken unofficially, the other formed a subject of prosecution by the Council, and the magistrate convicted the vendor; but since an appeal has been lodged and the case will again come before the Courts, further comment is not advisable. The remaining samples, as set out in the annexed table, are of a miscellaneous character and were all of fair commercial purity. March 19 th, 1914. A. WYNTER BLYTH, Public Analyst. 71 ANALYSES UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR 1913. The following table summarizes the information submitted formally by the Public Analyst:— No. Article. Genuine. Adulterated. Total. 1 Milk 499 37 536 2 Butter 385 6 391 3 Margarine 2 — 2 4 Cream 42 — 42 5 Lard 2 —- 2 6 Mustard 6 — 6 7 Pepper 5 — 5 8 Flour 1 — 1 9 Tea 1 — 1 10 Coffee 12 — 12 11 Cocoa 1 — 1 12 Chocolate 1 — 1 13 Cake 1 — 1 14 Jam 23 2 25 15 Currants 1 — 1 16 Cider 1 — 1 17 Lime Juice 1 — 1 18 Lemon Squash 1 — 1 19 Soda Water 1 — 1 20 Ammoniated Tincture of Quinine 2 — 2 21 Sweet Spirits of Nitre 2 — 2 22 Ipecacuanha Wine 3 — 3 23 Flour Bleaching Powder 1 — 1 24 Borax 2 — 2 25 Boracic Acid 1 — 1 26 Boracic Ointment 4 — 4 27 Citric Acid 1 — 1 28 Dover's Powder 8 — 8 29 Gregory Powder 3 — 3 30 Sodium Citrate 1 — 1 31 Mercurial Ointment 1 — 1 32 White Precipitate Ointment 1 — 1 1,016 45 1,061 BACTERIOLOGICAL EXAMINATION OF FOOD. During the year 17 samples of milk, 1 of condensed milk, 2 of Bovril, and 4 of ice cream were submitted to the Council's Bacteriologist (Dr. Eastes) for examination. Of the milks, 10 were found to be "good," 2 "doubtful." and 5 "bad." All the other materials were favourably reported upon. 72 All the reports were submitted to the Public Health Committee and warnings with regard to those which were returned as "doubtful" or "bad" were sent to the vendors. In each of these 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. In 1913, as in previous years, this procedure was found to work well, the Medical Officers of Health written to taking up the matter most energetically and making full use of the complaint sent to them in order to induce farmers and others to bring about improvements in connection with the production of milk. RAG FLOCK. A complete inspection of all premises in which bedding is made was carried out during the year, particular attention being given to those, eight in number, in which rag flock is used. Six samples of this material were taken and submitted to the Public Analyst for examination. The report in each case was satisfactory, none of the samples containing chlorine in excess of the amount (30 parts per 100,000) laid down in the Rag Flock Regulations, 1912. 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 21. In 203 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 113 instances. In the remaining 90, it was found necessary to serve a statutory notice. Following the receipt of this, the work was done, and in three cases it was 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 (l) that the water supply had been cut off in 36 premises. The reasons for discontinuing the supply were : Premises empty 23 Non-payment of Rates 9 Waste of Water 4 36 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 73 tenement house, immediately on receiving information from the department he 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. HOUSING. During 1913 the arrangements made in connection with the carrying out of house examinations remained unchanged. House-to-house inspections were carried out by the house-to-house inspector who made and kept records of the results of his inspections and referred premises that were found to be defective to the Medical Officer of Health and the District Inspector to be dealt with as appeared to be necessary. The practice of communicating with owners in all cases in which it seemed necessary to do something more than could be called for by the usual nuisance notices, before making a report or representation to the Public Health Committee, was continued. The results of this procedure were no less satisfactory than in previous years. To repeat a statement made in the report for 1912—"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 of the improvements obtained as a result of such negotiations are shown below: Premises dealt with voluntarily under the Housing, Town Planning, &c. Act, 1909, during 1913. 14, Cochrane Street Direct external light and ventilation provided to middle room on ground floor; water supply provided to upper storeys; several rooms cleansed. 28, Cochrane Street Direct external light and ventilation provided to middle room on ground floor; defective drinking water cistern abolished; supply obtained direct from main. 58, Cochrane Street Dilapidated building at rear demolished. Direct external light and ventilation provided to middle room on ground floor; water supply provided to upper storeys; yard and forecourt paving repaired; sanitary dust-bin provided, washing copper repaired; defective drinking water cistern abolished, supply obtained direct from main; several rooms, staircase and passage cleansed. Drains relaid. 74 62, Cochrane Street Direct external light and ventilation provided to middle room on ground floor; water supply provided to upper storeys; yard paving repaired; fresh air inlet to drain repaired; defective drinking water cistern abolished: supply obtained direct from main; defective sink waste pipe repaired. 86, Cochrane Street Direct external light and ventilation provided to middle room on ground floor and back room 1st floor; defective drinking water cistern abolished; supply obtained direct from main, sanitary dust bin provided; sink and paving in washhouse repaired. Drains relaid. 88, Cochrane Street Direct external light and ventilation provided to middle room on ground floor; water supply laid on to upper storeys; roof of washhouse repaired; defective drinking water cistern abolished: supply obtained direct from main. Drains relaid. 84, Cochrane Street Direct external light and ventilation provided to middle room on ground floor; ventilation shaft to drains repaired; rainwater pipe in washhouse repaired. 96, Cochrane Street Direct external light and ventilation provided to middle room on ground floor; water supply laid on to upper storeys; defective drinking water cistern abolished, supply obtained direct from main. 92, Cochrane Street Additional light and ventilation provided to water closet on ground floor; rooms, staircase and passage cleansed; water supply laid on to upper storeys. 29, Cochrane Street Direct external light and ventilation provided to back room on ground floor. 39, Cochrane Street Additional light and ventilation provided to water closet. 43, Cochrane Street Additional light and ventilation provided to water closet; brick ashpit abolished; sanitary dust bin provided. 75 53, Cochrane Street Direct external light and ventilation provided to water closet; basement rooms cleansed; drinking water cistern abolished; supply obtained direct from main. 55, Cochrane Street Direct external light and ventilation provided to water closet. 90, Salisbury Street Direct external light and ventilation provided to the back room on the ground floor; drains unstopped, water closet flushing apparatus repaired; stair-treads repaired; refuse removed from shed at rear. 8, Frederick Street Direct external light and ventilation provided to middle room on first floor; several rooms cleansed; basement floor repaired; drains relaid. 4, Belgrave Gardens Direct external light and ventilation provided to water closet on ground floor. 5, Belgrave Gardens Ditto 6, Belgrave Gardens Ditto 127, Carlisle Street Direct external light and ventilation provided to middle room on ground floor. 103, Carlisle Street Wooden building at rear demolished; direct external light and ventilation provided to back room on ground floor. 12, Carlisle Place Building at rear demolished; lighting and ventilation of back room on ground floor improved. 50, Exeter Street The obstructive buildings at the rear of these premises demolished; the back yard thus provided properly paved and drained; washhouse and water closet reconstructed in the yard; proper means of external light and ventilation provided to the back room on ground floor; the premises cleansed throughout. 31, Little Grove Street Additional means of external light and ventilation provided to the bed room and water closet on first floor; the premises cleansed and renovated throughout. 7, Malthouse Mews Additional means of external light and ventilation provided to the back living room on ground floor. 76 109a, Princess Street The external and party walls protected from dampness at ground floor level; windows repaired or renewed; the premises cleansed and renovated throughout. 14, Allsop Street Proper means of external light and ventilation provided at the rear of the premises. The water closet lighted and ventilated from external air and disconnected from house by a ventilated lobby; the drinking water arrangements amended. 9, Earl Street The water closet in basement reconstructed in new position, with proper external light and ventilation and disconnected from house by a ventilated lobby. 14, Little Grove Street The attention of the owner was called to the unsatisfactory condition of the cottage at the rear of these premises, which was subsequently closed voluntarily. No works carried out. Lisson Buildings The attention of the owner was called to the unsatisfactory condition of several of the tenements in these buildings. They were subsequently closed voluntarily with a view to reconstruction of the interior. 4, Huntsworth Mews Additional means of external light and ventilation provided to the living and bed rooms, water closet reconstructed in suitable position; the premises renovated throughout. 21, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of these premises which were subsequently reconstructed as a garage with living rooms over. 23, Huntsworth Mews Ditto. 25, Huntsworth Mews The attention of the owner was called to the unsatisfactory condition of these premises, which were closed. They were subsequently renovated and adapted for use as a store. 32, 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 alterations. 77 39, Huntsworth Mews The living rooms disconnected from stables and provided with separate entrance from the mews; water closet reconstructed in suitable position on first floor; additional means of external light and ventilation provided to the three living rooms; proper sink and ventilated food cupboard provided on first floor. The premises cleansed and renovated throughout. 41, Huntsworth Mews The living rooms disconnected from the stables and provided with separate entrance from mews. Additional means of external light and ventilation provided to the rear of these premises. The drainage system reconstructed. 43, Huntsworth Mews The living rooms disconnected from the stable on ground floor and provided with separate entrance from the mews; water closet reconstructed in suitable position. The premises renovated throughout. 45, Huntsworth Mews The living rooms disconnected from the stables and provided with separate entrance from mews; water closet reconstructed in suitable position. additional means of external light and ventilation provided to the bedrooms on first floor. The premises cleansed and renovated throughout. 47, Huntsworth Mews Ditto. 50, Huntsworth Mews Ditto. 53, Huntsworth Mews Ditto. 8, Huntsworth Mews The premises adapted for stores. 6, Circus Street Cottages at rear of premises demolished. 32, Burne Street Cottages at rear of premises demolished. 49, Queen Street Roof and rain-water pipe repaired; additional light and ventilation provided to rooms; rooms cleansed; stair-treads and flooring repaired. 19, Hereford Street Premises repaired and cleansed throughout; drains relaid throughout. 78 101, Cleveland Street Light and ventilation to main building improved by demolition of cottage in rear to level of ground floor; water closet and washhouse re-roofed. 3, Cornwall Terrace Mews The water closet reconstructed in proper position on first floor with external light and ventilation; living rooms cut off from stables; additional light and ventilation provided to bedrooms; soil-pipe reconstructed. Howard House, Cleveland Street Additional light and ventilation provided; two windows introduced into passages. 2, York Mews, South External light and ventilation provided to water closet. 4, York Mews, South Water closet reconstructed in proper position on first floor with external light and ventilation; drains reconstructed. 5, York Mews, South Ditto. 29, Clipstone Street Additional light and ventilation provided to bedroom on ground floor; additional ventilation provided to basement. Representations and Orders.—The accompanying tabular statement gives a list of the premises represented and closed under the Housing, Town Planning, etc., Act, 1909. The total number was 25. In the case of the tenements in Dorset Buildings, the attention of the owner was first directed to the unsatisfactory state of affairs in May, 1912, and it was only after repeated attempts to get works of a remedial character carried out had failed, that the more drastic step of representing the tenements with a view to closure under the statute was taken. Even after the orders were made and had become operative considerable difficulties were encountered, and for some time, in face even of a magistrate's order to vacate certain of the rooms, the closing orders were persistently disobeyed. On several occasions application was made by the owners for withdrawal of the orders, but as the works done or suggested did not appear satisfactory or likely to lead to any improvement, the requests were not granted. Eventually, on 17th October, 1913, the making of demolition orders was taken into consideration, but was adjourned, a surveyor, who attended on behalf of the owner, undertaking to submit a further scheme. This did not meet with the approval of the Public Health Committee and the owner was so informed. Despite the fact, however, the work was carried out and application for withdrawal of the closing orders made. When this was refused, the owner made an appeal to the Local Government Board against the refusal. At the end of the year matters were in abeyance, the date of the hearing of the appeal not having been fixed by the Board. 79 The closing orders in respect of 9-16, Montagu Mews South were made on the ground that the premises had been constructed back-to-back in contravention of the provisions contained in Section 43 of the Housing, Town Planning, etc., Act, 1909. The period between the service of the orders and the date of their becoming operative had not expired when the year closed. The cottages at the rear of 10, 11, and 12, Burne Street, were represented on 13th June, 1913, after several attempts had been made to induce the owner to demolish them because they were dark, damp, and ill-ventilated, and there seemed to be no possibility of so altering them as to produce improvement in these respects. The making of demolition orders had not been considered at the end of the year. Demolition Orders.—Though during the year the Public Health Committee took into consideration the making of demolition orders with regard to 7 premises, only one order, which was complied with, was made. Appeals.—The actual number of appeals made against closing orders was one; none, however, were heard during the year. In one case the Local Government Board refused to allow the appeal, on the ground that the person who made it had not in fact an owner's interest. In the very considerable amount of work carried out under the Act during the year the greatest assistance was received from the Housing Sub-Committee, who visited all premises reported by the Medical Officer of Health, and considered all the conditions prior to the bringing forward of the formal representation. Their advice was of the utmost value to the Public Health Committee, as well as the Medical Officer of Health. The following table contains a summary of the work done to December 31st, 1913, under Sections 17 and 18 of the Act, in relation to closing and demolition orders. HOUSING, TOWN PLANNING, ETC. ACT, 1909. Premises reported or represented during 1913, and the three previous years. Premises. 1910. 1911. 1912. 1913. 8a, Short Street C.O. 7th Oct., 1910, Committee agree to premises being used as a store 21st Oct., 1910, and closing order determined l,Cranmore Place 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. D.O. still 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. 80 Premises. 1910. 1911. 1912. 1913. 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 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. 9, Charlton Street 1, 2, 7, 8, 13-14, Dorset Buildings, New Street News C.O. 29th Nov., 1912 D.O. made 2nd May. 1913. Demolished 7th June, 1913. C.O.'s made 7th March, 1913. Proposals submitted to Committee considered insufficient. Notice of Appeal to L.G.B received 14th Nov., 1913. Appeal to be heard 8th Jan., 1914. 10, Burne Street, cottage rear of C.O. made 13th June, 1913. 11, do. do. Ditto 12, do. do. Dnto 24, Horace Street Ditto 3, Williams Place Ditto 5, do. Ditto 11, do. Ditto 4&4a, Allsop Street Ditto 5, Fairlop Place C.O. 14th Nov., 1913. 6, do. C.O. 14th Nov., 1913. 10, Little Church Street C.O. 14th Nov., 1913. 9, 10. 11. 12, 13, 14,15&16 Montagu Mews South C.O. 28th Nov.. 1913. House-to-House Inspection. The total number of streets examined by the house-to-house inspector (Inspector Hodges), was 36. As in previous years each of the districts into which the borough is divided, was visited in turn in order to give the district inspectors an opportunity of following up and seeing all necessary remedies carried out and completed. 81 The houses inspected numbered 1503 (separate houses, 1058; tenements in blocks 445). In respect of these 767 notices (intimations, 606; statutory notices, 161) were served. 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 preceeding 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. 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. 1058 and 445 Tenements in Blocks of Buildings 25 25 25 55 after letters to Owners 767 in respect of which Notices (Intimations and Statutory) were served. Intimation 606 Statutory 161 767 Nil. In houses represented or reported, defects in structure; want of through ventilation; insufficient light; sanitary conveniences improperly lighted and ventilated without the possibility of improvement; defective drainage, etc. In other cases overcrowding; vermin; defective sanitation and drainage, etc. One Demolition order was made. One house was demolished. One appeal was lodged. No appeals were heard. Houses Let in Lodgings. At the end of 1912 the total number of houses on the register was 1001, a figure which included the 758 originally registered prior to the passing of the new by-laws in 1907, but which were re-examined and registered after these came into force. During the year under review 241 tenement houses discovered in the course of house-to-house examinations were added, and 29 were removed, bringing the actual number on the register at the end of 1913 up to 1213. All of these were systematically inspected and in all 7970 visits were paid; 2030 notices relating to cleansing and other defects were served, all of which were complied with without the necessity for further proceedings arising. In connection with cleansing it should be mentioned that the inclusion in the by-laws of 1912 of a provision calling for such work to be carried out in the month of April proved most useful and considerably simplified the work of administration. 82 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 Overcrowding. The number of dwelling rooms found to be overcrowded during the year was 89 as against 85 in 1912. 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 to those upon whom the notice had been served. As in previous years many of the cases of overcrowding 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 Committee. Some as usual were anonymous and quite clearly spiteful. A number of the complaints proved on investigation to be without foundation. Underground Rooms. The total number of underground rooms dealt with in 1913 was 157. The total number of notices served was 73. Of the rooms to which these related 39 were occupied separately in contravention of Section 96 of the Public Health (London) Act, 1891, the remaining 34 being illegally used as sleeping rooms, as they failed to comply with the regulations made by the Council under Section 17 (7) of the Housing, Town Planning, etc., Act, 1909. 83 Many 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. In a certain number of cases it was found necessary to grant a little latitude after the service of the notice, in order to allow the persons affected to find other accommodation. All the notices were complied with, however, and it was not found necessary either to make closing orders or to institute proceedings. Customs and Inland Revenue Acts. No applications for certificates were made during 1913 for reduction of or exemption from inhabited house duty under these Acts. NUISANCES. No change was made in the staff of inspectors, or in the method of dividing the Borough into districts during the year. The same five inspectors were at work as in 1912, ard each had charge of the same district as previously. The total number of complaints received was 2,070, as against 2,372 in 1912, and 1,927 in 1911. The majority of these complaints were made by the inspectors themselves, the number from outside being 320. These came from voluntary workers of the St. Marylebone Health Society, members of the Children's Care Committee, neighbours and others. In respect of nuisances, 546 statutory notices were issued, as against 551 in 1912, and 881 in 1911. Of these notices, 345 related to ordinary nuisances (dirt, dampness, &c.) 54 to verminous rooms, 44 to drains, 6 to insufficient w.c. accommodation, 5 to underground rooms, and 2 to smoke. The remaining 90 were served on owners to provide a proper or 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 in 1912 was 101, and in 1911, 141. The 54 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1904, and referred to 83 rooms. The number of notices in 1912 was 47, in 1911, 77. In 1,424 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. In six instances there was failure to carry out works after receipt of statutory notice and court proceedings were instituted. Details of these cases will be found under the heading "Legal Proceedings in connection with Nuisances." 84 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. 1. No. 2. No. 3. No. 4. No. 5. Total Inspections 3773 3642 3574 3576 3534 18099 Houses damp, dirty or dilapidated remedied 201 234 117 143 67 762 Doors, windows, floors, ceilings, sash cords, etc., repaired 112 59 19 26 7 223 Overcrowding abated 15 57 10 3 4 89 Illegal occupation of underground rooms dealt with 4 42 32 49 30 157 Water closet defects remedied 191 173 61 118 102 645 Water closets erected 1 10 6 5 18 40 Urinal defects remedied - 5 4 8 6 23 Soilpipe and ventilating shaft repaired or renewed 5 32 5 20 1 63 Yard defects remedied 180 88 64 78 27 437 Waste pipe defects remedied 8 33 19 11 24 95 Water cistern defects remedied 252 147 12 40 17 468 Rubbish, manure, etc., accumulations removed 7 18 17 28 19 89 Dung or dust receptacles repaired or renewed 80 41 21 36 4 182 Drains relaid or amended 65 74 42 38 35 254 Drains cleared 10 24 4 20 15 73 Rainwater pipes repaired or renewed 30 33 19 18 10 no Water supply to houses reinstated 3 5 1 — 2 11 Roofs and gutters repaired 93 51 22 19 13 198 Area defects remedied 13 15 43 69 28 168 Wash-house defects remedied 189 74 32 34 11 340 Animal nuisances abated 4 10 1 1 1 17 Basement defects remedied 4 26 33 51 19 133 Stables cleansed or repaired 1 6 15 1 1 24 Water supply laid on to upper storeys of house 96 46 26 28 7 203 Miscellaneous nuisances abated 36 34 46 3 7 126 Verminous rooms cleansed 144 80 45 14 20 303 Workshops damp, dirty or dilapidated, remedied 8 20 13 23 30 94 Legal Proceedings in Connection with Nuisances. Of 16 summonses issued during the year, 8 were for offences against the nuisance sections of the Public Health (London) Act, 1891; 4 were issued under the Metropolis Management Act, 1855, and the drainage by-laws of the London County Council; 1 under the Housing, Town Planning, &c. Act, 1909, and 3 under the London County Council (General Powers) Act, 1907. Particulars with regard to each of the cases are given below. Proceedings instituted for offences against the Sale of Food and Drugs Acts are referred to elsewhere. 85 Metropolis Management Act, 1855, and London County Council Drainage By-Laws. 147, Great Titchfield Street. Failure to comply with a Statutory Notice to relay the drains Order made to do the work. Fined 1/- and £2 costs. 141, Marylebone Road. Constructing a w.c. and soilpipe without giving notice or depositing plans. Fined £2 0s. 0d. and 2/- costs, Constructing a lavatory basin waste pipe into a hopper head in vention of the by-laws of the London County Council. Fined 1/- and 2/- costs. Cavendish House, Mortimer Street Constructing additional w.c.'s without notice or depositing additional plans in accordance with the by-laws. Fined £1 and £1 3s. costs. 14a, Upper Montagu Street Failure to comply with a Statutory Notice to drain the premises. Order made to do the work £2 2s. costs. Housing Town Planning, Etc. Act, 1909. 2, Dorset Buildings (Tenement) Failing to comply with a notice to quit the tenement Magistrate made Order to quit within 14 days. Public Health (London) Act, 1891. Section 2. 1-7, East Cottages. Failure to comply with Statutory Notices. (7 Summonses) Abatement Or- ders made in each case. £2 2s. costs. 24a, Townshend Cottages. Failure to comply with Statutory Notice. £2 2s. costs. London County Council (General Powers) Act, 1907. Section 78. 66, Henry Street. Failure to provide a supply of water to the 3rd storey in com¬pliance with the Statutory Notice. Order made to execute work within 14 days. 7, Great Chesterfield Street. Failure to comply with a Statutory Notice to provide water to work to be upper storeys and to cleanse executed, the premises. Order made for 2/- costs. 8,Great Chesterfield Street. Failure to comply with a Statutory Notice to provide water to upper storeys. Order made for work to be executed. 2/- costs. 86 DRAIN PLANS AND DRAINAGE. During the whole of 1913, the duties of the drainage inspector in the district south of Marylebone Road were carried out by Inspector Gorniot; those in the northern district being entrusted to Inspector J. C. Wilson. The total number of inspections made was considerably larger than in any previous year, being 10,200 as against 9,826 in 1912 and 7,819 in 1911. The number of plans relating to new buildings was 62 (north 15, south 47). In the case of old buildings, the number of plans received was 395 (north 205, south 190). The total number of plans deposited was 457, the number for 1912 being 594, and that for 1911, 543. Particulars of 4 cases in which proceedings were instituted in respect of drainage are given on page 85. Combined Drainage.—The number of orders under Seal as to combined drainage granted by the Council was 7, the number in 1912 being 8. In 2 cases the liability of the Council for the reconstruction of the combined portions of existing drains was admitted, and the work carried out by the Works Committee at the request of the Public Health Committee. BLACK SMOKE NUISANCES. The total number of observations of chimneys made by the inspectors was 1,191, and 7 nuisances were discovered. A report was submitted to the Public Health Committee at each meeting with regard to the number of observations made and nuisances discovered. In each case in which a nuisance had been detected, the owner was communicated with and any explanation he had to offer was considered by the Committee along with the reports of the inspector. In 5 of the cases the nuisance ceased after the service of intimation notices. In 2 statutory notices were served, but in no case was it found necessary to issue a summons. REMOVAL OF HOUSE REFUSE. During 1913 the removal and destruction of house refuse was, as in former years, in the hands of contractors, the work being carried out by the Western Cartage Co., The Wharves, Paddington. The total cost for the whole Borough during the year was £12,895, the figure for the North District being £4,520 and for the South £8,375. The contract expires March 31st, 1914. The following tabular statement gives the number of complaints, letters and refusals received in respect of the removal of house refuse. There were no contraventions of the terms of the contract calling for the imposition of penalties during 1913. 87 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 VV. Mead & Co., Ltd, £51 1912 43 98 361 G. E. Cloke, £25 1913 34 74 752 — 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 is., 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 1913 54 184 269 — 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 184 were provided. During the year the dust inspectors-Lumley and Hill-made 9,773 visits; the former, 7,264, the latter, who only gives part time to the work, 2,509. For neglect of the provisions with regard to the covering of dust bins, etc., 662 notices were served. Remedies in each case were carried out, legal proceedings only being necessary in one case. VERMINOUS PERSONS' BATHS. During 1913, the total number of adults using the Baths was 8,005 (males, 5,797; females, 2,208). The children bathed numbered 2,076, 771 being boys and 1,305 girls. 88 The addresses given by the adults included Salvation Army Shelter 4,956, and lodging houses 390. In 1,892 instances no address was given, and in 593 (453 males, 140 females) the applicants stated they had come from the Church Army. The Portman House was given as an address by 176 females. The total number of adults bathed is very slightly lower than the figure for 1912, but considerably lower than that for 1911, viz., 9,085. Since 1909 there has been a very marked falling off which it is rather difficult to account for. In the case of the children there is an increase of about 200. The London County Council still continues to send the majority of the children who attend, making payment in each case for the treatment. The payments received amounted to £77 16s. 0d., and there was in addition £1 5s. 0d. paid on account of cleansing of persons sent by the London County Council inspectors from common lodging houses. During the days when school children were being cleansed, one of the school nurses of the London County Council was in attendance, and in any case in which cutting of the hair seemed to be necessary, carried this out. 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:— 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 1913:— 1913. ADULTS. CHILDREN. Males. Females. Total. Males. Females. Total. January 565 188 753 102 54 156 February 362 197 559 43 92 135 March 547 153 700 48 62 110 April 492 178 670 97 157 254 May 495 192 687 66 147 213 June 495 190 685 72 170 242 July 536 219 755 51 126 177 August 446 215 661 9 9 18 September 390 160 550 80 88 168 October 545 186 731 95 184 279 November 448 136 584 57 130 187 December 476 194 670 51 86 137 Totals 5,797 2,208 8,005 771 1,305 2,076 89 Table showing the number of persons using the Baths during the past 15 years:— Y ear. ADULTS. CHILDREN. Males. Females. Total. Males. Females. Total. 1898 3,301 5 3,306 _ 1899 4,340 — 4,340 — — — 1900 3,131 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 5,241 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 1913 5,797 2,208 8,005 771 1,305 2,076 Totals 95,661 21,955 117,616 11,798 15,838 27,636 *The Children's Baths were opened in June, 1905. THE SHELTER. The accompanying statement shows the number of times the Shelter was used during 1913 and the reasons for such use. The periods of occupation varied from 2 up to 36 hours. No. of hours occupied. Reason for occupation. No. of persons, February 3rd and 4th 16 Scarlet Fever 2 adults, 3 children. February 7th and 8th 12 Scarlet Fever 2 adults, 3 children. March 11th and 12th 24 Vermin 1 adult, 3 children. March 18th and 19th 24 Diphtheria 1 adult, 3 children. May 10th 3 Diphtheria 2 adults. June 13th 2 Puerperal Fever 1 adult. August 21st and 22nd 16 Scarlet Fever 1 adult, 1 child. October 29th, 30th and 31st 36 Vermin 3 children. October 31st 12 Vermin 1 adult, 3 children. November 1st and 2nd 12 Vermin 5 children. November 14th, 15th, 16th and 17th 36 Scarlet Fever 2 adults, 2 children. 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. 90 Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1913. Males. Females. Total. For burial only. For inquests. Total. No. of P.M.'s held. No. of courts held. January 12 7 19 5 14 19 10 6 February 21 15 36 19 17 36 9 8 March 21 11 32 15 17 32 9 8 April 14 11 25 15 10 25 9 6 May 8 11 19 13 6 19 7 5 June 13 9 22 7 15 22 9 7 July 17 7 24 9 15 24 11 9 August 12 2 14 12 2 14 2 3 September 15 6 21 9 12 21 6 4 October 11 13 24 9 15 24 9 9 November 14 4 18 9 9 18 7 5 December 14 14 28 16 12 28 8 6 Totals 172 110 282 138 144 282 96 76 PUBLIC SANITARY CONVENIENCES. The usual supervision was exercised over the sanitary conveniences during the year, Inspector Hill the outdoor superintendent, visiting those provided for the males; the women inspectors, especially Miss Baker, supervising those provided for females. 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 1914, and the amount of increase or decrease as compared with the previous year. 1913-14. 1912-13. Increase. Decrease. Oxford Circus-Men's Department £ s. d. £ s. d. £ s. d. £ s. d. 1056 14 7 1050 10 9 6 3 10 — „ Women's „ 838 10 0 824 13 0 13 17 0 — Portland Road-Men's „ 281 0 0 278 4 7 2 15 5 — „ Women's „ 183 9 6 183 2 11 0 6 7 — Marylebone Road-Men's „ 214 11 10 216 17 1 — 2 5 3 „Women's „ 130 11 7 141 17 4 — 11 5 9 Foley Street-Men only 134 13 7 126 4 11 8 8 8 — St. John's Wood Road-Men only 101 6 2 108 5 1 — 6 18 11 Barrett Street-Men only 150 10 5 132 10 3 18 0 2 — During the whole of this period free accommodation was provided for women at Oxford Circus (two urinettes) Portland Road (one urinette) and Marylebone Road (one urinette). 91 This provision though it has led to some falling off in receipts, was exceedingly necessary and has been greatly appreciated. FACTORIES AND WORKSHOPS. The total number of visits to factories, workshops and workplaces during the year was 4,351, 646 by the women and 3,705 by the men inspectors. The complaints received numbered 31. 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. I—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 180 8 — Workshops (Including Workshop Laundries.) 3,009 204 Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1,162 190 Total 4,351 402 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. liemedied. Referred to H.M. Inspector. (i) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 108 108 - - Want of ventilation 26 26 - Overcrowding 9 9 - — Want of drainage of floors 6 6 - Other nuisances 86 86 - Sanitary accommodation insufficient 9 9 — — unsuitable or defective 70 70 - - not separate for sexes 14 14 — — 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) 4 4 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 332 332 -- - 92 3-HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. NATURE OF WORK. 4 Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. 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) (in (12) (IS) (14) (15) (16) Wearing Apparel— (1) Making, etc. 114 726 974 ... ... ... 69 ... ... ... ... ... ... ... ... (2) Cleaning and washing ... ... ... 1 ... 7 ... ... ... ... ... ... ... ... ... Umbrellas, etc. 2 ... 10 ... ... ... ... ... ... ... ... ... ... ... ... Total 116 726 984 1 ... 7 69 ... ... ... ... ... ... ... ... 93 4.-REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, kc 4,206 Coffee Shops, kc 262 Bakehouses 75 Total number of workshops on Register 4,543 5.-OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 10 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 31 Reports (of action taken) sent to H.M. Inspector 25 Other 3 Underground Bakehouses (s 101):— Certificates granted during the year ... In use at the end of the year 75 94 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 105 Bakehouses 75 Restaurant, Dining Room and Coffee Shop Kitchens 152 Hotel Kitchens 42 Pastrycooks and Tea Rooms 44 Fried Fish Shops 24 Houses Let in Lodgings 1213 Workshops and Workplaces 4206 Total 6105 A statement, with special reference to the list set out above, is contained in the following tables:— Number of places Number of inspections, 1913. Number of notices, 1913. Number of prosecutions, I9I3- On register at end of 1912. Added in I9I3. Removed in 1913. On register at end of 1913. Milk premises 230 13 14 229 536 10 Cowsheds 5 5 40 — — Slaughterhouses 7 — i 6 90 — — Offensive trade premises 2 - 2 38 — — Ice cream premises 104 13 12 105 118 7 — Houses let in lodgings 1001 241 29 1213 7970 2030 - Mortuary. Removed by Inspectors. Number of bodies received 282 — Number of Infectious bodies received - Nil. Disinfection. Number of rooms disinfected ... 995 Number of Articles disinfected ... 13,639 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 5,797 2,208 771 1,305 10,081 95 Bakehouses. Number on register at end of 1912 75 N umber above ground 10 Number underground 65 Number of inspections 158 Number of Notices. Intimations, 3, Statutory Notices, 1 4 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1912 262 Number of Inspections 522 Number of Notices 67 House to House Inspections. Number of Inspections J Houses I 1058 ( Tenements in blocks 445 Number of Notices issued f Intimations, 606 767 1 Statutory Notices, 161 Number of Prosecutions . Nil House Refuse. Number of Inspections . 9773 Number of Old Brick Receptacles abolished 14 Number of New Metal Receptacles provided 184 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, 652; Statutory Notices, 10 662 Number of Prosecutions 1 Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 203 Number of Statutory Notices served 90 Number of Prosecutions 3 Overcrowding. Number of Dwelling Rooms overcrowded 89 Number remedied 89 Number of Prosecutions Nil Underground Rooms. Number dealt with 157 Number of Notices served under P. H. (L) Act, 1891 ... 39) 73 Number of Notices served under H. T. P., &c. Act, 1909 34) Number of Prosecutions Nil 96 Insanitary Houses. Number closed under Public Health (London) Act, 1891 Nil Number closed under Part II of the Housing of the Working Classes Act Nil Number closed under Section 17 Housing, Town Planning, &c. Act, 1909 25 Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (l). Number of rooms cleansed 303 Number of Prosecutions Nil Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during: the year:— 13 adults. 26 children. Revenue Acts. Number of houses for which applications were received Nil Number of tenements comprised therein Nil Number of tenements for which certificates were granted Nil „ „ „ „ refused Nil „ „ „ „deferred Nil LOCAL GOVERNMENT BOARD AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING- 1913 AND PREVIOUS YEARS. 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 Dist- ict. 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 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 1913 114,532 3,804 2,146 18.6 1,629 14.9 755 753 195 90.0 1,627 14.9 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. 97 TABLE I. (A). Vital Statistics of Separate Localities in 1913 and the ten Previous Years. Names of Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. a. b. e. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 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 1,02* 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 82,023 485 440 49 36,425 1,041 690 137 20,002 347 288 35 1912 116,135 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 Averages of Years 1903 to 1912 125,991 2,572 1,899 298 33,074 559 422 60 35,571 595 498 67* 37,660 1,039 677 135 19,691 378 301 35 1913 114,532 2,146 1,627 195 28,567 388 343 30 31,124 400 367 34 35,402 998 652 110 19,439 360 265 21 •The Rectory and St. Mary's Registration Sub-Districts were amalgamated this year. 98 TABLE II. Cases of Infectious Disease Notified during the 52 Weeks ending 27th December, 1913. 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 6 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 132 6 52 46 21 7 ... ... 38 38 47 9 132 36 36 47 8 127 5 Erysipelas 75 ... 2 4 11 20 31 7 12 13 41 9 75 3 1 9 1 14 61 Scarlet Fever 411 6 97 251 35 20 2 ... 69 61 178 103 411 66 62 175 95 398 13 Polio-Myelitis 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 Enteric Fever 19 ... ... 1 4 11 3 ... 5 8 6 ... 19 2 7 6 ... 15 4 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... 1 ... 3 ... ... ... 2 2 ... 4 ... 1 1 ... 2 2 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 3 ... 1 2 ... ... ... ... 1 ... 1 1 3 ... ... 1 1 2 1 Pulmonary Tuberculosis 526 2 23 113 67 199 106 16 73 136 236 80 525 13 38 50 9 110 416 Other forms of Tuberculosis 154 5 20 72 23 23 8 3 22 39 71 23 155 14 14 21 7 56 98 Ophthalmia Neonatorum 9 9 ... ... ... ... ... ... 1 2 6 ... 9 ... ... ... ... ... 9 Totals 1334 28 195 490 162 283 150 26 222 299 588 225 1334 134 159 310 121 724 610 1334 99 TABLE III. Causes of, and Ages at Death during the year ending 27th December, 1913 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. l Enteric Fever 5 — — — 1 1 3 — — 2 2 Small-pox — — — — — — — — — 1 3 Measles 32 9 13 8 2 — — — — — 4 Scarlet Fever 10 2 — 3 5 — — — — 1 5 Whooping-Cough 11 3 5 2 — — — 1 — — 6 Diphtheria and Croup 6 1 3 1 1 — — — — — 7 Influenza 20 3 — — — 1 3 7 6 2 8 Erysipelas 2 - - - - - - 1 1 2 9 Phthisis (Pulmonary Tuberculosis) 149 1 2 3 2 9 71 43 18 26 10 Tuberculous Meningitis 21 4 6 4 5 1 1 — — 14 11 Other Tuberculous Diseases 21 1 2 4 4 3 2 1 4 15 12 Cancer 156 — — 1 — 1 15 78 61 315 13 Rheumatic Fever 5 — — 1 1 — — 2 1 — 14 Meningitis 16 5 2 — 2 1 3 2 1 10 16 Organic Heart Disease 142 - — — 5 8 11 53 65 38 16 Bronchitis 225 12 5 3 1 — 13 59 132 30 17 Pneumonia (all forms) 127 15 13 5 5 4 19 32 34 49 18 Other Diseases of Respiratory Organs 25 — 2 2 — — — 7 14 8 19 Diarrhoea and Enteritis (under two years) 33 21 10 1 - — 1 — — 18 20 Appendicitis and Typhlitis 9 — — 1 3 1 1 1 2 21 21 Cirrhosis of Liver 19 — — — — — 2 14 3 11 2 a Alcoholism 8 — — — — - 2 6 — 1 22 Nephritis and Bright's Disease 64 - - - - - 13 29 22 37 23 Puerperal Fever 2 — — - — — 2 — — 3 21 Other accidents and diseases of Pregnancy and Parturition 10 8 — — — — 2 — — 14 25 Congenital Debility and Malformation, including Premature Birth 67 65 - 1 1 - — - - 51 2G Violent Deaths, excluding Suicide 55 2 1 3 5 1 12 15 16 31 27 Suicides 15 — — — — 2 6 6 1 4 28 Other defined Causes 372 43 2 4 8 3 47 91 174 215 29 Diseases ill defined or unknown - - - - - - - - - — Totals 1627 195 66 47 51 36 229 448 555 919 100 TABLE III. (a).—Causes of, and ages at death during the 52 weeks to 27th December, 1913, according to Sub-Districts. No. CAUSES OF DEATH. All Souls. St. Mary. Christ Church St. John. Total. 1 Enteric Fever 2 2 — 1 5 2 Small Pox — — — — — 3 Measles 3 3 24 2 32 4 Scarlet Fever 4 1 3 2 10 5 Whooping Cough — 2 8 1 11 6 Diphtheria and Croup 1 2 2 1 6 7 Influenza 2 4 7 7 20 8 Erysipelas — 1 — 1 2 9 Phthisis (Pulmonary Tuberculosis) 32 40 57 20 149 10 Tuberculous Meningitis 3 3 12 3 21 11 Other Tuberculous Diseases 5 5 8 3 21 12 Cancer 42 36 52 26 156 13 Rheumatic Fever. 2 1 1 1 5 14 Meningitis 3 4 8 1 16 15 Organic Heart Disease 22 25 58 37 142 16 Bronchitis 50 49 90 36 225 17 Pneumonia (all other forms) 32 25 51 19 127 18 Other Diseases of Respiratory Organs 5 4 10 6 25 19 Diarrhœa and Enteritis (under 2 years) 8 2 21 2 33 20 Appendicitis and Typhlitis 2 3 3 1 9 21 Cirrhosis of Liver 3 5 9 2 19 21a Alcoholism — 4 3 1 8 22 Nephritis and Bright's Disease 9 18 29 8 64 23 Puerperal Fever — 1 1 - 2 24 Other accidents and diseases of Pregnancy and Parturition 1 4 3 2 10 25 Congenital Debility and Malformation. including Premature Birth 8 13 40 6 67 26 Violent Deaths, excluding Suicide 10 6 28 11 55 27 Suicides 5 4 4 2 15 28 Other defined Causes 89 100 120 63 372 29 Diseases ill defined or unknown — — — — — Totals 343 367 652 265 1627 101 VACCINATION RETURNS. Supplemental Return for 1912. RETURN made to the Board of Guardians and Local Government Board on the gth February, 1914, 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, 1912, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the " Birth List Sheets " as registered from 151 January to 31st Dec. 1912. Number of these Births duly entered by 31st January, 1914, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1914, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1914, 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 I9I3- 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 Distiicts, 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 321 252 ... ... 38 11 6 1 12 1 3,091 2. Christchurch 807 574 1 ... 101 51 14 5 50 11 3. St. Mary 2,242 1,829 2 ... 111 106 101 60 24 9 4. All Souls 720 503 ... ... 47 56 9 81 23 1 Total 4,090 3,158 3 ... 297 224 130 147 109 22 3,091 Dated 9th February, 1914. (Signed) EDWARD A. FRITH, Vaccination Officer. 102 VACCINATION RETURNS. Return for the Period January—June, 1913. RETURN made to the Board of Guardians and Local Government Board on the 9th February, 1914, 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, 1913, 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, I9I3- Number of these Births duly entered by 31st January, 1914, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1914, remained unentered in the " Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1914, 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 1913. 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 162 123 ... ... 19 8 3 3 1 5 348 2. Christchurch 407 268 ... ... 57 36 9 7 23 7 3. St. Mary 1,093 860 2 ... 59 54 70 38 8 2 4. All Souls 330 236 ... ... 24 21 5 28 10 6 Total 1,992 1,487 2 ... 159 119 87 76 42 20 348 Dated 9th February, 1914. (Signed) EDWARD A. FRITH, Vaccination Officer.