AC 4353 STMARY 19 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1914, 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 1 5 . Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1914, 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. Pui.man & Sons, Ltd., Printers. 1915. geo. pulman & sons, ltd., london and wealdstone. Public Health Office, 24, Somerset Street, London, W. lst June, 1915. 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 1914, on the public health and sanitary condition of the Borough of St. Marylebone. The method of arrangement is similar to that adopted in previous reports, and in the main it is no less satisfactory than any I have submitted since I was appointed. The war has, of course, made some difference to the work, but apparently has affected the statistics as to diseases and deaths comparatively little. The infantile mortality rate is higher than in 1913, possibly because of the war, but the general death rate, though unfortunately some few of the deaths included were of officers and men who died in hospitals or nursing homes in the Borough, is very little affected. Reference is made in the portion of the Report, headed "Departmental," to changes in the staff that followed the outbreak of war, and mention is also made of additional works undertaken because of the existence of war. In carrying out this and all the other work of the department the greatest amount of assistance and encouragement was given by the Public Health Committee. The keenness of the interest of the members under the chairmanship of Sir Horatio H. Shephard was maintained throughout the whole year, and I take this opportunity of thanking them, and particularly the Chairman, and the Chairman of the Dust Sub-Committee, Mr. Alderman Lea-Smith, for the sympathetic way in which they considered every suggestion brought forward, and for the great help and encouragement which they gave. To the members of the staff, who so loyally supported me during the year, my thanks are also due, and I am glad of this opportunity of tendering them. 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, 10 Deaths and Death Rates 10 District Births and Deaths 11 Deaths in relation to age 12 Causes of, and Ages at, Death 13 Infantile Mortality 13, 18 Prevention of Infantile Mortality 19, 20 Maternity and Infant Welfare 20 Deaths in relation to Disease 21 Diarrhoea Diseases 21 Zymotic Diseases, Phthisis, &c., and Respiratory Diseases 22 Zymotic (Communicable) Diseases 22 Phthisis and other Tuberculous Diseases 23 Respiratory Diseases 24 Cancer and Malignant Disease 24 Alcoholism 25 Accident, Suicide ami Manslaughter 26 page Records of Diseases 26 Notifications 26 Discharge Notices 27 Diphtheria and Membranous Croup 27 Scarlet Fever 28 Enteric Fever 29,32 Cerebro-Spinal Fever 32 Erysipelas 33 Puerperal Fever 33 Measles 33, 34 ,, Deaths 33 ,, Isolation of 33 Whooping Cough 35 Glanders 35 Polio Encephalitis and Myelitis 35 Chicken-pox 35 Ophthalmia Neonatorum 35 Tuberculosis 35 ,, Notifications 36, 38 ,, Deaths 39, 40 ,, National Insurance Act Sanatorium Benefit 41 ,, Preventive Measures against 40, 43 ,, Bacteriological diagnosis of 46 Syphilis 43 Disinfection 44, 45 Bacteriological Examinations 46 Part II. Departmental. Page Staff Meetings 49 Effect of War Conditions 49 Protection of Food Supply 51 Inspection 51 Surrenders 51 Seizures 52 Prosecutions 52 Slaughterhouses 52 Milk Supply 52 Cowhouses 53 Milkshops, etc. 53 Examination of Milk 53 Ice Cream Premises 54 Butter, Margarine, etc. 54 Restaurants, Food Stalls, etc. 54 Offensive Trades 55 Bakehouses 55 Sale of Food and Drugs Acts 55, 59 Public Analyst's Reports 60, 62 Public Health (Milk and Cream) Regulations, 1912 62, 64 Bacteriological Examination of Food 64 Rag Flock 65 Water Supply 65 Housing 65, 73 Housing, Town Planning, etc. Act, 1909 65, 74 House to House Inspection 73 Houses Let in Lodgings 74 Common Lodging Houses 74 Overcrowding 75 Underground Rooms 75 Customs and Inland Revenue Acts 76 Nuisances 76 Work of Sanitary Inspectors 77 Legal Proceedings 77, 78 Drain Plans and Drainage 78 Combined Drainage 79 Black Smoke Nuisances 79 Removal of House Refuse 79, 80 Verminous Persons Baths 81, 82 Cleansing of Persons Act, 1897 81, 82 The Shelter 82 Public Mortuary 82 Public Sanitary Conveniences 83 Factories and Workshops 84 Inspection 84 Defects Found 84 Home Work 85 Registered Workshops 86 Sanitary Inspection (Summary) 87, 89 Local Government Board Tables I.-III. 89, 93 Vaccination Returns 94, 95 Part I. STATISTICAL. Curve showing the number of cases of Scarlet Fever, Diphtheria and Typhoid Fever, notified week by week during the year 1914. 9 POPULATION. The population of the Borough at the middle of 1914 as estimated by the Registrar-General was 112,892, which is lower by 1,640 than the population at the middle of 1913, and 4,952 below that of the census population of 1911. The estimated populations of each of the four sub-districts at the middle of 1914 and of each of the three preceding years, was:— 1911. 1912. 1913. 1914. All Souls 29,392 28,971 28,567 28,158 St. Mary 32,025 31,566 31,124 30,678 Christ Church 36,425 35,903 35,402 34,895 St. John 20,002 19,715 19,439 19,161 117,844 116,155 114,532 112,892 The same reasons that were offered to account for the fall in the population in previous years, viz., migration, demolition of houses and the erection of business premises in their stead, doubtless operated in 1914 as well. That the falling off in numbers was so great as stated is, of course, doubtful. The figure is only an estimated one and arrived at by a special method of calculation devised by the Registrar-General. Having regard to the fact that, as is generally known, large numbers of the male inhabitants of the Borough went on active service after the outbreak of war, it is just possible that towards the end of the year the figure was even lower than that given above. The chief use to which the figures are put, is in connection with the making of calculations of various rates, and these are shown in the succeeding pages. BIRTHS. Registration.—The number of births registered during 1914 was 2,128,* being 18 fewer than in 1913. Of the children born 1,095 were boys and 1,033 girls. The birth rate per 1,000 of the population was 18.7, exactly the same as in the preceding year. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1914, with those of the three previous years. 1911. 1912. 1913. 1914. All Souls 16.0 15.6 13.6 15.4 St. Mary 14.4 14.3 12.8 13.9 Christ Church 29.7 27.0 28.2 26.8 St. John 19.2 18.8 18.8 17.1 The Bojough 20.2 19.3 18.6 18.7 * This figure is exclusive of births occurring in the Borough to persons usually non-residen therein, but includes 78 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males ... ... ... ... ... ... ... 23 ,, Females ... ... ... ... ... ... ... 27 Illegitimate Males ... ... ... ... ... ... ... 15 ,, Females ... ... ... ... ... ... ... 13 10 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,901, which is considerably lower than the number for 1913, viz., 4,185. The provisions of the Act are now very generally known, and the necessity for notifying is not less well recognized than that for registration. Failures to notify within 36 hours of birth, as required, were comparatively few. In such cases as there was failure, a perfectly reasonable explanation was forthcoming, and it was not considered necessary to take proceedings against any of the parties. The main sources of the notifications are set out below and, for purposes of comparison, the figures for the three 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. 1911. 1912. 1913. 1914. From parents 564 or 13.7 per cent. 509 or l2.l per cent. 783 or l8.7 per cent. 405 or l0.7 per cent. „ doctors 491 „ 14.1 „ 592 „ 14.1 „ 500 „ 11.9 „ 589 „ 15.6 „ „ midwives 774 „ 18.6 „ 780 „ 18.6 „ 758 „ 18.1 „ 791 „ 20.7 „ „ other persons 38 „ .4 ,, 18 ,, .4 „ 4 „ .09 „ 13 „ .3 „ ,, hospitals, etc. 2,223 „ 54.6 „ 2,286 ,, 54.6 „ 2,140 ,, 51.1 „ 2,103 ,, 55.7 „ Of the total births notified, 140 referred to still-births (68 males and 72 females); 1,713 took place at Queen Charlotte's Hospital; 388 at Middlesex Hospital; 2 at the Samaritan Hospital; and 1,670 were born at home. Of those notified as having occurred in St. Marylebone, 1,797 belonged to other Boroughs, as follows:— Legitimate Males 575 ,, Females 547 Illegitimate Males 337 „ Females 338 1,797 DEATHS AND DEATH RATES. The number of deaths registered in 1914 was 1,605. 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 rate was exactly the same and the number of deaths 1,627. In 1912 the rate was 14.8 per 1,000, and in 1911, 16.3. *A de6nition of the term ''corrected death-rate" will be found on page 9 of the Report for 1912. 11 The following short table shows the death rates in the several registration sub-districts in 1914 and compares them with those of the three previous years:— 1911. 1912. 1913. 1914. All Souls 12.7 13.9 12.0 11.2 St. Mary 13.1 13.8 11.1 12.6 Christ Church 19.7 17.4 18.4 18.0 St. John 15.9 13.8 13.6 14.0 District births and deaths for the 52 weeks ended 26th December are given in the following table (Table I.). A further table giving the vital statistics of separate localities for 1914 and the ten preceding years, will be found amongst the Local Government Board Tables on page 90. TABLE I. Sub-District. Population. estimated to Middle of Year 1914. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 28,158 230 205 435 174 143 317 St. Mary 30,678 212 206 418 205 183 388 Christ Church 34,895 482 455 937 332 298 630 St. John 19,161 171 167 338 120 150 270 The Borough 112,892 1,095 1,033 2,128 831 774 1,605 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. Generally speaking the year, as compared with its predecessor, was more favourable to the old than to the young. The total number of persons over 65 was lower by 21 than in 1913, whereas 15 more babies died in 1914 than in the previous year. In the case of the babies the only quarter that showed a lower figure on comparison was the first, the last two quarters, particularly that of JulySeptember, being very distinctly higher. Amongst the elderly these two quarters were also slightly more fatal than in 1913. The first quarter was the most fatal for both groups, though the difference between it and the others was more marked in the case of adults than in the infants. For babies, as a matter of fact, as will be shown later, 1914 was an infinitely more trying year than 1913, and as evidence of this there may be taken the fact that differences between the numbers dying in each of the quarters were so comparatively small. In 1913 it was noted that three times as many infants died between January and March as between July and September. In 1914 the difference was only 13 and the figure for the quarter was 20 above that for the corresponding quarter of the year before. January-March. April-June. July-September. October-December. Total. Infants under 1 year 62 45 49 54 210 Persons of 65 years and upwards 185 127 96 126 534 12 DEATHS IN RELATION TO AGE. The age distribution of the deaths that occurred in 1914 is shown in the following table, which gives also, for the purpose of comparison, the figures for each age group in 1912 and 1913. The fall in the number of deaths in the second group and the continued increase in the figures for the group 45-65 may be noted. Age Periods. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years 25 and under 45 years. 45 and under 65 years. 65 and upwards At all ages. No. of Deaths 1912 209 69 45 57 51 238 426 540 1635 1913 195 66 47 51 36 229 448 555 1627 1914 210 38 38 42 54 228 461 534 1605 The percentage relation of each group to the total number of deaths in 1914 is shown below. The plus and minus signs are introduced to show whether there las been a rise or fall since 1913. Under 1 year 13.8 per cent. ( + ) 1 and ,, 2 years 2.3 „ (—) 2 „ 5 „ 2.3 „ (—) 5,, ,, 15 ,, 2.6 „ (—) 15 „ „ 25 „ 3.3 „ ( + ) 25 „ „ 45 14.2 „ ( + ) 45 „ „ 65 „ 28.7 „ ( + ) 65 „ upwards 33.2 „ (—) The extent to which each of the four divisions of the Borough shared in the deaths of those aged over 65 in 1912, 1913 and 1914 is shown below: 1912. 1913. 1914. All Souls 123 112 106 St. Mary 156 140 145 Christ Church 161 187 164 St. John 100 116 119 Totals 540 555 534 Of the total, 139 at death were aged between 65 and 70; 254 between 70 and 80: 122 between 80 and 90, and 19 between 90 and 100. The outstanding causes of death were as follows:— Causes. 1912. 1913. 1914. Bronchitis and other respiratory diseases 192 180 135 Nephritis and Bright's Disease 18 22 24 Cancer 57 60 54 Tuberculosis 7 22 16 Influenza 2 6 8 Violent deaths 16 16 13 13 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 92. 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., 947. Fuller information than is possible in the table is given in the following pages, in which also the figures relating both to causes of death and the ages at which these causes were operative are analysed. INFANTILE MORTALITY. The infantile mortality rate of any district is the number of deaths of infants under one year of age per 1,000 of the births which occurred in the same year. The number of babies under one year who died in St. Marylebone in 1914, was 210, and the number of births in that year 2,128. The infantile mortality rate is therefore 98.6. This is nearly 8 per 1,000 above the figure (90.8) for 1913, which was the lowest on record. It is interesting to note, however, that though there has been a rise, the rate which first fell definitely below 100 in 1912 is still maintained in that position. The variations which have taken place in the infantile mortality rate and the number of deaths amongst infants under 1 year of age in each of the years from 1897 are shown in the accompanying chart. It will be noted that the fall in both was interrupted in 1914, the number of deaths rising once more to above 200, a point below which it fell for the first time in 1913. When in that year an attempt was made to account for the fall, the fact that the splendid efforts made by the official and voluntary workers were only to a slight extent assisted by the climatic conditions was noted. In 1914 climate was even less on the side of the workers. Their efforts made to reduce the number of deaths traceable to respiratory diseases (pneumonia, bronchitis), and intestinal disorders (diarrhoea and enteritis) particularly were counteracted by the occurrence of weather favourable to these conditions. That there is a tendency for the former causes to operate when cold and wet are prevalent, and for the latter when the weather is warm and dry has already been explained more than once. In 1914 pneumonia amongst infants was more common than in 1913, and diarrhoea and enteritis caused 9 more deaths than in the preceding year. As the difference between the total number of deaths in the two years was only 15, and respiratory and intestinal diseases account for 11 of the 14 Infantile Mortality Figures. 15 extra deaths, it is probably unnecessary to go further than has already been done to find an explanation. It may, of course, be that the changed conditions following the outbreak of the war also assisted. So many homes were thrown into more or less disorder at the beginning of August, and continued in this condition for some time afterwards, that it is not at all unlikely that some of the precautions usually taken in respect of the babies were to some extent relaxed. The relaxation, if it came, did so at a time when increased effort was required, viz., during the late summer and early autumn. The babies, therefore, suffered as the figures show; they suffered by contracting and, in some cases, succumbing from diarrhoea and enteritis. One thing is certain, the increase was in no sense due to a diminution in the work done on behalf of the babies. On the contrary, there was all round, by all the parties concerned, as is shown in the following pages, a decided increase in the amount carried out. The Council continued and extended its efforts to improve sanitation, and to get and keep in touch with the mothers of young babies, and to help them in every way possible. In this latter class of work the fullest possible assistance was obtained from the St. Marylebone Health Society and its workers. Doubtless, these efforts, which were responsible for bringing the rate down to 90.8 in 1913, operated in 1914 to prevent a more serious rise than that shown. As regards the distribution and the proportion of deaths due to various causes there is little that is new to be said. Christ Church, being the most thickly populated area and that in which there is most poverty, most overcrowding and most neglect of ordinary precautions, is as usual at the head of the list with 113 deaths amongst infants. In 1913 the figure was 110. 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 66 were less than one month old when they died and 105 less than three months. The figures for 1913 were 81 and 119. The outstanding causes of death and the proportions traceable to them were those usually noted. 16 Prematurity (numbers 12, 13 and 14 in the table) which caused 69 or 35 per cent. of the total in 1913, in 1914 took 69 or 32 per cent.: diarrhoea and enteritis (7 and 8) accounted for 21 or 10 per cent, in 1913 and for 30 or 14 per cent, in 1914. Respiratory diseases, the third of the main causes, took 27 or 13.8 per cent. in 1913 and in 1914, 29 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 13 deaths amongst infants (6 per cent. of the total). Of the 13, 7 were due to whooping cough and 5 to diphtheria. Injury at birth accounted for 7 deaths. In 1913, 8 deaths were ascribed to this ; in 1912, 4; in 1911, 5, and in 1910, 7. Some form of tuberculosis was given as the cause in 3 instances, and in 6 convulsions. Overlaying was stated to be responsible in 2 cases as against 3 in 1913. Both of the victims were aged under one week 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 1 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 8 3 3 3 3 7 8 1 36 St. Mary 12 — 2 — 7 9 3 — 33 Christ Church 16 2 4 3 23 29 23 13 113 St. John 2 3 4 1 6 4 3 5 28 Totals 38 8 13 7 39 49 37 19 210 17 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 I Weeks. Total under 1 month. 1 and under 3 Months 3 and under6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year. 1 Small-Pox — — — — — 2 Chicken-Pox — — — — — — — — — — 3 Measles — — — — — — — — 1 1 4 Scarlet Fever — — — — — — — — — — 5 Diphtheria and Croup — — — — — — 1 4 — 5 6 Whooping Cough — — — — — 1 2 3 1 7 7 Diarrhoea — — — — — 2 — 4 1 7 8 Enteritis — — 1 1 2 5 12 3 1 23 9 Tuberculous Meningitis — — — — — — 2 1 — 3 10 Abdominal T uberculosis — — — — — — — — — — 11 Other Tuberculous Diseases 1 — 1 — 2 12 Congenital Malformation 8 — 2 — 10 2 — 1 — 13 13 Premature Birth 11 3 3 3 20 1 2 1 — 24 14 Atrophy, Debility and Marasmus 4 2 1 1 8 8 7 5 4 32 15 Atelectasis — — — — — — — — — — 16 Injury at Birth 7 — — — 7 — — — — 7 17 Erysipelas — — — — — — 1 — — 1 18 Syphilis — — — — — — — — — — 19 Rickets — — — — — — — 1 — 1 20 Meningitis (not Tuberculous) — — — — — — 2 — — 2 21 Convulsions 2 1 — — 3 1 1 1 — 6 22 Gastritis — — — — — — 1 — — 1 23 Laryngitis — — — — — — — — — — 24 Bronchitis 1 — 2 — 3 2 2 1 2 10 25 Pneumonia (all forms) 1 1 1 1 3 4 5 4 3 19 26 Suffocation, Overlying 2 — — — 2 — — — — 2 27 Other Causes 2 1 4 1 8 12 11 7 6 44 Totals 38 8 13 7 66 39 49 37 19 210 Nett Births in the Year Legitimate, 2,008 Illegitimate 120 Total 2,128 Nett Deaths in the Year Legitimate Infants, 168 Illegitimate Infants, 42 Total 210 18 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. I Small-Pox — — — — — 2 Chicken-Pox — — — — — 3 Measles — — 1 — 1 4 Scarlet Fever — — — — — 5 Diphtheria and Croup 1 — 4 — 5 6 Whooping Cough 2 — 4 1 7 7 Diarrhoea — 2 5 — 7 8 Enteritis 2 3 14 4 23 9 Tuberculous Meningitis 1 — 1 1 3 10 Abdominal Tuberculosis — — — — — 11 Other Tuberculous Diseases — — 1 1 0 12 Congenital Malformation 6 3 4 — 13 13 Premature Birth 4 8 8 4 24 14 Atrophy, Debility and Marasmus 5 5 19 3 32 15 Atelectasis — — — — — 16 Injury at Birth 1 1 4 1 7 17 Erysipelas — 1 — — 1 18 Syphilis — — — — — 19 Rickets 1 — — — 1 20 Meningitis (not Tuberculous) 1 — 1 — 2 21 Convulsions 1 2 3 — 6 22 Gastritis 1 — 1 23 Laryngitis — — — — — 24 Bronchitis 2 1 4 8 10 25 Pneumonia (all forms) 2 — 14 3 1 19 26 Suffocation, Overlying — 1 1 2 27 Other Causes 7 6 24 7 44 Totals 36 33 113 28 210 Nett Births in the Year Legitimate, 2,008 Illegitimate 120 Total 2,128 Nett Deaths in the Year Legitimate Infants, 168 Illegitimate Infants, 42 Total 210 19 PREVENTION OF INFANTILE MORTALITY. If reference be made to reports tor past years it will be found that with regard to infantile mortality the same remarks are regularly made, viz., that the outstanding causes of death are prematurity, diarrhoea, enteritis and respiratory diseases ; that these are largely preventable causes and that the bulk of the babies need not have died. It is pointed out also that the Council and the St. Marylebone Health Society and their workers are all convinced of the preventability of infantile mortality, and have put into operation such methods as are regarded as capable of assisting in prevention. The absolute necessity of impressing upon mothers the importance of their part in prevention is recognised, and in every way possible it is sought to get into touch with them, and to give them such instruction in hygiene and guidance in infant management as they seem to require. The Women Inspectors of the Council give a great part of their time to work of this kind, visiting homes after receipt of notifications of births, advising mothers as to the feeding and care of infants and on hygiene generally. These are the lines upon which the St. Marylebone Health Society operates also. In the infant consultations and the schools for mothers they have established, a great amount of educational work has been done. In them they have placed at the disposal of the mothers medical practitioners who have made a speciality of this branch of medicine. Associated with them there are numbers of workers who are always ready and willing to help and teach the mothers. Year by year the work of the institutions has extended, and in 1914 there was again an increase in the amount done. In North Marylebone the number of attendances at the consultations held at the Portman Club, Church Street, under Drs. Christine Murrell and Emily Mecredy, was 2,098, as against 1,932 in 1913. The total number of babies seen was 240. The Mothers' Club, at which lectures and demonstrations are given, was attended by 94 women. In South Marylebone 275 babies were seen at the consultations conducted by Dr. Eric Pritchard at the Marylebone General Dispensary, Welbeck Street. In all there were 1,880 attendances. The Mothers' Club was attended by 24 mothers. The total number of visits to homes by the voluntary workers was 2,190— 1,400 in the North District, and 790 in the South District. These were supplementary to the visits paid by the Women Inspectors, which numbered 3,889. 20 In addition to these visits the Women Inspectors visited also a number of the addresses at which deaths of infants had occurred, gave such help as seemed to be required, and made arrangements for the giving of attention to defects in sanitation, if any such were detected. With regard to the work of the Health Society, it may be noted that in recognition of the assistance given to the Council a grant was paid during the year by the Board of Education towards the cost of carrying on some of their activities. In the future it seems probable that further grants will be made by the Treasury for this and other work. MATERNITY AND INFANT WELFARE. In the Report for 1913 attention was directed to the necessity of doing something more for the woman who was in expectation of becoming a mother, and it was suggested that if she could be advised and educated as to the care which she should take of her own health and the advantages to the unborn child likely to follow the taking of greater care, many of the deaths now put down to prematurity might be prevented. The idea of carrying out work on these lines was most eagerly accepted by the Health Society and arrangements were made for taking it up. During 1914 considerable advances were made and towards the end of the year there were other indications that a special department, to be known as an "Ante-Natal Clinic," would be established in connection with the infant consultations in North and South Marylebone. About the same time the Local Government Board issued a memorandum with regard to maternity and child welfare, and suggested the lines upon which a scheme might be constructed. This involved the establishment of ante-natal clinics, infant consultations and the provision of hospital accommodation for women during their confinement. In St. Marylebone it was seen that there was already in existence everything necessary for the construction of a complete scheme as suggested by the Board. There were infant consultations and there were or would soon be ante-natal clinics. So far as beds were concerned, there were Queen Charlotte's Hospital and the Maternity Department of the Middlesex Hospital. By linking these one with the other, it was felt that the fullest possible provision could be made both for the mother and the child. The managing bodies of the hospitals and other institutions showed themselves most willing to participate in the scheme, and at the end of the year there seemed every likelihood that in the ensuing year the complete scheme would be in existence. National Health Week: On account of the outbreak of war, it was determined that Health Week should go uncelebrated. A date had been fixed in November for the celebration, and prior to August some preparations were made, 21 These were abandoned, however, to allow the workers to give attention to other matters which seemed to call for it more urgently. DEATHS IN RELATION TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table III. of the Local Government Board series on page 92. Table III. (a), on page 93, shows the distribution of deaths according to cause in the various registration sub-districts. The following are some notes with regard to certain of the causes which contributed most largely to the death rate. DIARRHCEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 36, equal to 18.6 of the total deaths and 0.31 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1914 this was the case also, no fewer than 30 of the 36 being children under 1 year of age. In 1913 the deaths from diarrhoeal diseases numbered 33, and of this number 21 were babies. In 1914, therefore, there was not only an increase in the total, but an increase in the number amongst babies. The reasons for this increase have been more or less indicated in the section dealing particularly with infantile mortality. Deaths from diarrhoeal diseases always vary most markedly with the weather conditions, being higher when the summer is warm and dry, lower when it is cold and wet. The latter part of the summer of 1914 was one very favourable to the occurrence of diarrhoeal diseases, amongst infants especially, and the main part of the increase is traceable to this cause. Diarrhoeal diseases vary very greatly in extent with the sanitary conditions of a district, and are always taken, more or less, as an index in this connection. The number of cases, even though it is larger than in 1913, cannot be taken as an indication that there has been any failure on the part of the Council to maintain a high standard of sanitation. The figure is not indeed a high one at all, and though some disappointment may be felt that the fall noted in 1913 was not continued, it is safe to say that it was not contributed to at all by any neglect or failure on the part of the Council. The efforts that they have put forth not only in relation to sanitation but in other directions, e.g., in the spreading of information amongst the inhabitants, have produced wonderful results in connection with this group of diseases as with others. In these efforts, particularly the last named, the Council have received the greatest assistance from the St. Marylebone Health Society, and part of the credit for the results obtained must undoubtedly be given to this body, 22 In relation to educational work it may be noted that in 1914 the practice of showing films dealing with matters of importance in connection with hygiene was again, as in 1913, adopted. Owing to the kindness of a prominent member of the Public Health Committee it was found possible to make arrangements with the proprietors of the Eldorado Picture Theatre in Lisson Grove and during one week in practically every month a health film found a place in the programme of pictures. Many hundreds of tickets were distributed on each occasion and a corresponding number of persons were thus enabled to see the film. Large quantities of leaflets dealing with such subjects as Flies in Relation to Disease, the Feeding and Care of Infants, and so on, were distributed, and in other ways it was tried to make the attempt at education reach as far as possible. 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. I. Zymotic Diseases 72 0*63 2. Phthisis and other Tuberculous Diseases 183 1.61 3. Respiratory Diseases 307 2.70 All the figures, it may be noted, are lower than those for 1913, the drop in the case of the respiratory diseases from a total of 377 to 307 being most marked. Zymotic (Communicable) 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 1912 the deaths due to them numbered 99, in 1913 and 1914 respectively they have fallen to 86 and 72. The death rate, which in 1912 was 0.90, in 1913 was 0.79, and in 1914 0.63. The common experience with these diseases is that if watched over a number of years they are found 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, with 203 deaths, 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. In the report for 1913 it was suggested that possibly that year might represent the end of the fall. Clearly, however, it has not, but the same prophecy that was 23 made then may be made now, viz., that even if the figure for 1914 does not, it is unlikely that so high a figure as that attained in 1911 will, in face of the improved protective measures taken, ever be reached again. Further reference to each of the diseases in the zymotic group is made in subsequent pages. It may be noted here, however, that of the 72 deaths 17 were due to diphtheria and croup, and 16 to whooping cough. In the case of measles there was a very marked fall from 32 to 3. The table from which these figures are taken will be found on page 92. 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 183, a figure smaller by 8 than that for 1913, when 191 deaths were registered. The smallest number ever registered in the Borough was 169 in 1910. The great bulk of the 183 deaths, viz., 152, was due to phthisis. This figure is greater by 3 than that for 1913. Of the total number of deaths registered (1,605), the percentage due to phthisis was 9.4 as against 9.1 in 1913. The age periods at which the deaths occurred were: 2—5 years, 1 (0.6 per cent.); 5—15, 4 (2.6 per cent.); 15—25, 15 (9.8 per cent.); 25—45, 58 (38.1 per cent.); 45—65, 58 (38.1 per cent.); 65 and over, 14 (9.2 per cent.). Below the age of two years, 2 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 for 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. 1914 183 112,892 1.61 1913 191 114,532 1.75 1912 184 116,155 1.67 1911 213 117,844 1.91 1910 169 125,195 1.40 1909 200 126,027 1.58 1908 203 126,867 1.70 1907 229 127,718 1.79 1906 244 127,960 1.90 1905 248 129,453 1.92 24 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 307. This is lower by 70 than the figure (377) for 1913, and lower than that for 1912 by 84. The death rate was 2.70 per 1,000. In 1913 the rate was 3.46; and in 1912, 3.07. The majority of the deaths in this group were traceable to bronchitis. The number certified to be due to this cause was 181, as against 225 in 1913. Of this number 105 were amongst persons aged 65 and upwards, and 45 amongst those in the group 45-65. The deaths traceable to pneumonia numbered 109, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 23 of the deaths occurred amongst children under 2 years of age. During the year, as was indicated in the report for 1913, some attempts at prevention were made in respect of these diseases and particularly of pneumonia. As far as possible all premises in which a death from this cause was found to have occurred were visited by the district inspectors, enquiries were made as to possible sources of infection, previous cases in the hcuse or family, disinfection was offered, and, if permission was given, carried out. The total number of visits paid in this connection was 109. Very little information of any value as indicating the source of infection was obtained, but in the majority of instances the suggestion that disinfection should be carried out was gladly accepted. In one case disinfection had already been done privately before the inspector visited the house, and the fact that the offer was made was taken by the occupier as evidence not only of his own wisdom, but also of the enterprise and activity of the Council in relation to public health work. As was noted in the report of 1913, it is unfortunate that some time must elapse between the occurrence of the death and the visit to the home, for the reason that the information can only be obtained from the Registrar's returns of deaths which are generally not received until at least one week after the event. Despite the delay, it is believed that some amount of good from the educational point of view at least is done. In time it may be that pneumonia will be made notifiable, and the possibility of getting to closer grips with the disease will come then. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 138 and the death rate 1.21 per 1000 of the population. In 1913 the figures were higher, the total being 156 and the death rate 1.36 per 100. Information with regard to the situation of the disease and the age at which death occurred is given in the following tables: 25 Cancer. Ages at Death. Ages. Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 60 50 and under 60 60 and under 70 70 and upwards Totals Males — — 1 1 9 21 12 19 63 Females 1 — 2 3 7 20 18 21 75 Totals 1 — 3 4 16 41 30 43 138 Cancer. Situation of the Disease. Parts of the body affected. Males. Females. Total. Face, Tongue, Jaw 10 1 11 Throat, Neck, Gullet 15 1 16 Stomach 12 9 21 Intestines 8 8 16 Liver 6 3 9 Breast — 8 8 Uterus and Generative Organs 1 20 21 Various 11 25 36 Totals 63 75 138 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 20 6 13 20 4 63 Females 34 3 16 20 2 75 Totals. 54 9 29 40 6 138 ALCOHOLISM. The number of deaths certified as directly due to alcoholism was 4, 4 less than in 1913. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 18 deaths as against 19 in the previous year. 26 The combined figure for these two causes is lower by 5 than that for 1913, viz., 22 as against 27. 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 68 (.59 per 1,000). The number in 1913 was 64. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1914 numbered 69. Of these 14 were due to suicide. Deaths of babies certified as resulting from suffocation (overlaying) numbered 2. 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 diarrhœa. The diseases named in the Public Health (London) Act are smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus, typhoid or enteric, relapsing, continued and puerperal fevers. Those added by the London County Council are cerebro-spinal fever, glanders anthrax, hydrophobia, acute polio-encephalitis and myelitis and ophthalmia neonatorum. Tuberculosis during the whole of the year was notifiable as to all forms under the Public Health (Tuberculosis) Regulations, 1912, which came into force on 1st February, 1913. The year under review (1914) is, therefore, the first full year in which there has been a full scheme of notification in operation in relation to this disease and full reference is made to the results obtained later. The records as to the infectious but non-notifiable diseases—measles, whooping cough, etc.—are based mainly 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 cases of these diseases 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 91. Information additional to that given there is set out below. Notifications. The total number of notifications received during 1914 was 2,008. Especially in the case of tuberculosis, many of the notifications were duplicates, and the actual number of cases notified was 1,299. The number notified in 1913 was 1,334, so that there is a decrease of 35 from the previous year. 27 The notification rate (proportion to population of notified cases of infectious diseases) in 1914 was 11.5 per 1,000 as against 11.6 in 1913. 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 228 or 99.6 per cent. of the cases notified. Erysipelas 30 „ 46.1 ,, „ „ Scarlet Fever 412 „ 95.3 ,, „ „ Enteric Fever 33 ,, 91.7 ,, „ ,, Cerebro-spinal Meningitis 1 ,, 100.0 „ ,, ,, Ophthalmia Neonatorum 18 „ 72.0 „ „ „ Puerperal Fever 6 „ 66.0 ,, „ ,, Polio Myelitis — ,, — „ ,, „ Phthisis 91 ,, 18.1 ,, „ ,, The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £137 9s. 9d., equal to £1 4s. 4d. per 1,000 of the population. The cost and rate per 1,000 for each of the past 10 years, are shown in the following table:— Year. Amounts paid to Medical Practitioners. Cost per 1,000 of Population. 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 1914 137 9 9 1 4 4 Discharge Notices. The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 439 and referred to 585 cases. Visits were paid to these cases by the District Inspectors, and advice given as to 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 far more prevalent in 1914 than in 1913—229 cases as against 132 in the previous year. Of the cases 17 died, and the case mortality rate was 7.4 as compared with 4.5 per cent., the rate for 1913. The number of cases per 1,000 of the population was 2.01. 28 Of the 229 cases quite a considerable proportion were notified as having occurred in institutions. During the year no fewer than 24 cases were notified from the Workhouse Infirmary, the majority in the last quarter. With the object of discovering the source of infection, which seemed to be one or more carrier or unrecognised cases, a complete examination of all patients in certain of the Wards was made. This resulted in the detection of a number of patients who, apparently unaffected themselves, harboured the organism of the disease. After these persons had been isolated and otherwise dealt with a great diminution in numbers followed. At the Royal National Orthopaedic Hospital, where there were 23 cases during the year, the experience was very similar. Only in a few cases was it possible to determine accurately the source of infection; in 32 it proved to be in the home of the patient, and in ten instances from a previous case in his own family. Three patients were believed to have obtained infection from a previous case in the neighbourhood. The number of swabs from doubtful cases submitted for bacteriological examination, including a large number from the institutions referred to above, was 743. A positive result was returned in 93 instances. Of the registration districts, that contributing the largest number of cases was Christ Church, with 100. All Souls 70, St. Mary 31, and St. John 28. As usual the age groups 1-5 and 5-15 were those most affected, 96 of the cases falling into the former and 85 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., 38; Defective Drainage, 1. These were all remedied after service of notices. Scarlet Fever. The notifications of this disease numbered 432. This is the highest figure for any year since 1909, when 458 were notified. In 1908 the number was 409, in 1912 259, and in 1913 411. 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 26. The total deaths from scarlet fever numbered 9, and the number of deaths per cent. of the cases was 2.08. The districts to suffer most from this disease were Christ Church and All Souls. In the former there were 181 cases and in the latter 100. In St. Mary there were 92 and in St. John 59. 29 As usual, the majority of the patients were children of school age; the age group, 5-15, giving more than half (244) of the total. Of the remainder 115 were aged between 1 and 5 years. The source of infection was believed to be a previous case in the same family in 34 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 18 instances that a definite connection could be made out. Defects in sanitation to the number ot 60 were discovered. Of these, 59 were want of cleanliness, &c., and 1 defects in drainage. The nuisances were remedied after the service of notice in each case. Enteric Fever. There were 17 more cases of enteric fever in 1914 than in 1913, the numbers being 36 and 19. A very close investigation was made into all the cases, with the object of discovering the source of infection and of preventing the occurrence of other cases if possible. Except in one instance, the cases were all single and seemed to be unconnected with any other. In the exceptional instance there seemed to be the makings of a fair-sized outbreak. Largely, however, because precautions were taken, and it was possible to have isolation carried out quickly with those who were infected later, the number of persons attacked did not exceed 10. All these resided in the same neighbourhood, some were members of the same family, or lived in the same house. The following table, in which the cases are shown in the order in which they were notified, indicates the relation of one patient to the other, and the probable source of infection in each case. ENTERIC FEVER. Number. Patient. Sex. Age. Date of Notification Probable Source of Infection. 1 A.J.P. M. 30 16/4/14 Contaminated Food ? 2 M.O. F. 14 17/4/14 Sisters. Both either from A. J. P. or same source 3 E.O. F 11 18/4/14 4 A.T. F. 8 26/5/14 Brother and Sister. Children of J.T. and possibly infected by her 5 C.T. M. 13 6/6/14 6 W.B. M. 17 29/6/14 Related to and infected by A.J.P. 7 E.D. F. 7 1/7/14 Probably from W.B. 8 T.W.M. M. 9 24/7/14 Resided in same house as, and probably infected by J.T. 9 R.N. F. 12 27/7/14 10 J.T. F. 46 27/7/14 Unrecognized case 30 The cases, it will be noted, were spread over a period of something like three months, and occurred to some extent in groups. When the first three came to hand the conclusion arrived at as to source of infection was that A.J.P. had probably contracted the disease as a result of eating contaminated food, the two most likely articles being shellfish or fish bought ready cooked. No history of contact with any other case could be obtained. The girls, M.O. and E.O., were on very friendly terms with the family of A.J.P., and, living close by were frequently in and out of the house during the considerable time that elapsed between the date of his attack and his removal to hospital. The conclusion with regard to them was that they were infected because of their association with A.J.P. The next case (A.T.) did not appear until four or five weeks later. Enquiries made at the home elicited no information of any value in arriving at a conclusion. The mother (J.T.), though enquiries made later revealed the fact that she had actually suffered from the disease, both at this period and later, when the case of C.T. was under investigation, alleged that she was and had been quite well, and could point to no suspicious circumstance in her own or any other family in the house. The conclusion arrived at, therefore, was that A.T. was probably infected from one or the other of the first three cases, and that C.T. contracted the disease from A.T. W.B., who was notified next, was closely related to A.J.P., who was probably the source of his infection. E.D., who came later, it was believed was infected by W.B. and completed the group of cases for which A.J.P., whatever the source of his infection, was responsible, viz.: M.O., E.O., W.B., and E.D. T.W.M., a boy of 9, was ill for some time before he was notified. The notification came from the Workhouse Infirmary, the diagnosis of enteric fever having been made some time after he had been under observation and treatment there. On receipt of this notification further investigations were made. As far as possible every person who had been in contact with any of the cases was questioned, bacteriological examinations were made, death returns were scrutinized, and so on. The result of these investigations was that J.T. was found to have suffered from enteric fever in an unrecognized form, probably about the time when the first cases were notified. Further, it was found possible to link her up with the case R.N., who also had a mild attack, and with A.T. and C.T. (her own children) and T.W.M., who resided in the same house. It was found, in short, that there were two groups of cases in the series: one for which A.J.P. seemed to be responsible and the other which, as already stated, was traceable to J.T. 31 With the discovery of J.T. and R.N. the series ended, but further enquiries were made with the object of deciding where and how J.T. herself acquired the infection. It has been noted above that at the time A.T. and C.T. were notified, J.T. alleged that she had always enjoyed good health, and had not been at all out of sorts. By the time the fuller investigation came to be made, however, she recollected that between Christmas 1913 and April 1914 she had not really been always well. About Christmas time she had suffered from weakness and fainting fits, and had been treated as an out-patient at one of the neighbouring hospitals. At Easter she was confined to bed for a few days with "influenza," one of the outstanding symptoms being diarrhoea. This history was regarded as very suspicious, and when a specimen of her blood was submitted to examination, the suspicion that the attack was enteric fever and not influenza was confirmed. In the case of R.N. the facts elicited were very similar, and it is easy to understand how these two patients managed to infect the remaining three patients, A.T., C.T. and T.W.M. The house in which they all resided is a tenement one, and all the occupants are closely associated. There is, further, only one closet, and all the time the patients were ill and suffering from diarrhoea they used this' convenience. In the common washhouse all the clothing, probably soiled and certainly undisinfected, used by the patients, was washed and afterwards put to dry in the yard and passages, common to all the occupants of the house. Very many opportunities to spread were, therefore, given to the germ. After the unwillingness of J.T. to give information had been overcome, and here it may be noted that distrust and a tendency to conceal information are nearly always met with in these cases, it was easy to account for the majority of the cases. The great difficulty came, however, when the source of infection in J.T.'s case was sought. In all there seemed to be three possibilities: (1) That it was the same as in A.J.P.'s case, i.e., possibly contaminated food; (2) that it had been acquired outside the Borough, and (3) that there had been another unrecognized case. Each of these seemed not unlikely. The facts supporting (1) were that A.T. and A.J. P. were ill more or less about the same time; the families lived fairly close together, and led very much the same kind of life. As regards (2) it was found on enquiry that prior to her attack of "influenza" J.T. had visited the home of a sister in one of the suburbs to see a member of the family, who was ill at the time, and who died soon afterwards. No definite information as to the cause of death was obtainable from the Medical Officer of Health of the district or from J.T, 32 (3) The suspicion that the source of infection was an unrecognized case in the neighbourhood arose after searching the death returns for the period between the beginning of the year and the date of the occurrence of the cases. This revealed the fact that there had been a death in a house adjoining that occupied by J.T., the cause of which seemed somewhat uncertain. Enquiries were at once instituted with regard to this case, and it was found that the deceased, a woman, had been exceedingly friendly with J.T., had indeed, until compelled by illness to take to bed, assisted in looking after her. A description obtained from the physician who attended this woman and who conducted an examination after death, strengthened the opinion that the condition from which she suffered and from which she died was enteric fever. When the enquiries were made the woman had been dead for some months, and it was found impossible to get accurate information with regard to date of sickening and so on. Nevertheless it was taken as highly probable that she had the fever before J.T., and that the attack in this case originated from her. As soon as J.T. and R.N. were found to have been infected, arrangements were made for their isolation, the house in which they resided was thoroughly disinfected, and all other precautions that seemed necessary were taken. Following the taking of these steps no further cases occurred, which seems to suggest that they exerted some influence. Of the remainder of the total 36 cases, the source of infection appeared to have been acquired outside the Borough in four cases. In six cases contaminated food was believed to be the source, the article suspected being shell-fish and fish in three and watercress in three. The deaths numbered seven in all which gives a case mortality of 19.4 per cent. The cases were distributed as follows: St. Mary, 9; Christ Church, 16; All Souls, 7; and St. Johns 4. Four of the deaths occurred in Christ Church, and 1 in each of the three other sub-districts. A complete examination of the premises was made in each case and resulted in the discovery of nuisances in six cases. The defects were remedied by the persons responsible after notice had been served. Cerebro-Spinal Fever. Only one case of this disease, a child 1 year old, was notified. Isolation and treatment were carried out in a hospital, but the patient died. 33 Erysipelas. The notifications of erysipelas numbered 65, and there were 2 deaths. Most of the cases were notified from the Workhouse Infirmary and the General Hospitals and 30 patients were treated in one or other of these institutions. Puerperal Fever. The number of cases of this disease notified, viz., 9, was considerably above the average. The number of deaths registered as due to it, viz., 3, was 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 1914 the returns made referred to 216. This number is less than that for 1913 and much less than that for 1912 and 1911. The number of deaths was smaller than in either of the two previous years also: 3 as against 32 in 1913, 39 in 1912 and 64 in 1911. All the deaths occurred amongst patients under 5 years of age. 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 sequelae 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 11, 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 of measles and other infectious diseases reported from schools and other Boroughs during 1914. With regard to schools it may be stated that no classrooms were closed by the Education Department of the London County Council on account of measles. 34 SCHOOLS. Scarlet Fever. Diphtheria. Typhoid Fever. Whooping Cough. Chickenpox. Measles. All other Diseases. All Souls, Foley Street 26 22 ... 3 2 ... ... Barrett Street ... ... ... ... 1 ... 2 Barrow Hill Road 26 8 1 83 56 7 63 Bell Street 72 26 1 6 22 40 92 Capland Street 27 8 ... 22 28 11 78 Catholic, Richmond Street 5 4 1 ... 1 ... 3 Christ Church, Lisson Grove 4 6 ... ... ... ... 9 Convent, Little Union Place 24 9 1 9 5 2 21 Council, Grove Road 1 ... ... 1 ... ... 3 Cosway Street 69 16 ... 3 3 5 59 Emmanuel, Aberdeen Place 9 3 ... 14 8 15 7 Emmanuel, North Street 13 5 ... ... ... ... 1 Hampden Gurney, Upper Berkeley Street 8 4 ... 10 ... 22 8 Homer Row, Catholic 9 7 ... 5 7 4 12 Jewish, Han way Street 6 3 ... 3 ... 1 3 Portland, Little Titchfield Street 13 19 ... 21 2 12 12 St. Andrew's, Wells Street 16 9 ... 5 5 4 19 St. Francis, Upper William Street 2 ... ... ... ... ... ... St. James', Marylebone Lane 7 ... ... ... 2 3 4 St. Luke's, Nutford Place 61 1 ... 12 18 21 18 St. Mark's, Violet Hill 44 8 ... 41 3 ... 24 St. Mark's, Marylebone Road 7 6 ... 1 ... 1 ... St. Marylebone, High Street 29 2 ... 27 9 7 25 St. Marylebone Grammar, Marylebone Road 7 ... ... 2 1 1 ... St. Mary's, Crawford Street 27 5 ... 14 14 47 51 St. Paul's, East Street 11 5 ... 12 9 4 24 St. Paul's, Broadley Terrace 4 6 ... 5 10 5 23 St. Stephen's, Charlbert Street ... ... ... ... ... ... ... St. Thomas', Orchard Street 1 ... ... 4 19 4 8 Polytechnic, Regent Street ... ... ... ... ... ... ... Trinity, Buckingham Street ... ... ... ... 18 ... 10 St. Vincent, Lower Seymour Street ... ... ... ... ... ... ... Upper Marylebone Stree 30 5 ... ... 5 ... 2 Westminster Jewish School ... ... ... ... ... ... ... Schools out of Borough 19 2 1 2 5 ... 5 Totals 577 189 5 305 253 216 586 35 Whooping Cough. As in measles much of the information obtained with regard to this disease is derived from the death returns, and during 1914 the number of deaths registered as due to whooping cough was 16 as against 11 in 1913, 15 in 1912 and 30 in 1911. All the 16 deaths were of children under 5 years of age; 7 were less than 1, 6 less than 2 but more than 1, and 3 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 13 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 1914, 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 34. Polio-Encephalitis and Myelitis. These diseases remained notifiable during the year; no notification was, however, received. 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 1914. The total number of cases notified was 25, as against 9 in 1913, and 19 in 1912. Visits were paid to all notified cases, none of which were particularly serious, by the women inspectors. Tuberculosis. So far as tuberculosis is concerned 1914 is an interesting year, because it is the first complete year in which there has been full compulsory notification in respect of all cases. 36 In previous reports the manner in which this point was reached has been fully described, and it is not proposed to refer to it again at length here. In the accompanying Table the number of cases notified each year since 1906 is shown, as well as the source of the notifications and the system under which they were made. The non-pulmonary form, it may be noted, was not notifiable until 1913, the table, therefore, shews no reference to cases prior to that year. The fact that the number of pulmonary cases has fallen since 1912 probably means merely that in that year and 1913 cases that had been recognized but not notified under systems previously in force were brought in as a result of the introduction of the compulsory notification. It may mean of course that there is some diminution in the actual number of cases, but though it is possible that there is diminution, it is doubtful if it has been to the extent which the drop in numbers shown in the table would suggest. TUBERCULOSIS NOTIFICATIONS.—A. Year. Medical Practitioners. Hospitals and Dispensaries, etc. Poor Law. Pulmonary. Nonpulmonary. Totats. 1906 (voluntary) 206 (six month) — — 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 ††ll5 270 141 526 154 680 Non-pulmonary 53 67 34 1914 120 244 138 424 78 502 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. A note with regard to each of the forms was made in the report for 1913, and it is unnecessary to add anything to what was said then. The total number of cases found amongst school children, it will be seen, was 4. In 1913 the figure was 17. The exact signification of the figure and of the fall cannot be judged, since no information is given as to the total number of children examined. The fact that the pulmonary form of tuberculosis is believed to be rare in children may, however, be noted, and the statement that these figures seem to support this view may be made. *Compulsory 1st January, 1909. †Uniformly compulsory January, 1912. **Compulsory in May, 1911, for Hospital cases. ††Uniformly compulsory for Tuberculosis 1st February, 1913. TUBERCULOSIS NOTIFICATIONS.—B. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 4th January, 1914, to the 2nd January, 1915. Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Primary Notifications. Total Notifications Form A. Primary Notifications. Total Notifications Form B. Poor Law Institutions. Sanatoria. 0 to 1 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 2 8 20 14 13 15 43 45 56 29 12 257 350 — — — — 1 143 34 ,, Females — 9 19 7 8 21 35 26 27 6 3 161 205 — 1 — 1 1 43 18 Non-pulmonary, Males 1 7 10 4 1 1 3 7 1 1 1 37 45 1 — — 1 1 12 6 ,, Females 1 7 9 7 2 1 3 2 3 1 1 37 45 — — 3 3 4 4 2 4 31 58 32 24 38 84 80 87 37 17 492 645 1 1 3 5 7 202 60 37 TUBERCULOSIS NOTIFICATIONS C. Cases of Tuberculosis notified during the 52 weeks ending 26th December, 1914. Localisation of 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. Chtist Church. St. John. Totals. All Souls. St. Mary. Christ Church. St. John. Totals. Under 1. 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards. Lungs Totals 424 2 20 62 58 152 118 12 75. 91 191 67 424 15 19 35 5 74 350 Spine 5 — — 4 1 — — — 2 1 2 — 5 1 1 — — 2 3 Hip 11 — 3 4 1 2 1 — — 3 8 — 11 — 1 4 — 5 6 Skin 2 — — 1 — 1 — — — 1 1 — 2 — — — — — 2 Brain. 2 1 1 — — — — — — — — — 2 — — — — — 2 Neck 24 1 4 14 1 1 3 — 2 1 20 1 24 — — 1 — 1 23 Ankle 3 — — — — 2 — 1 — — 3 — 3 — — — — — 3 Chest 2 — — — — 1 1 — — — — — — — — — — — 2 Elbow 2 — 1 1 — — — — — — 2 — 2 — — — — — 2 Cervical Glands 3 — 2 1 — — — — 1 — 2 — 3 — — — — — 3 Abdomen 2 — 1 1 — — — — — — 1 1 2 — — 1 — 1 1 Wrist 1 — — 1 — — — — — — 1 — 1 — — — — — 1 Larynx 2 — — — — 1 — 1 — — 2 — 2 — — — — — 2 Eye 1 — — 1 — — — — — 1 — — 1 — — — — — 1 Meninges 1 — — 1 — — — — 1 — — — 1 — — — — — 1 Peritoneum 5 — 2 1 — 2 — — — — 4 1 5 — — 2 1 3 2 Throat 2 — — — 1 1 — — — 1 — 1 2 — — — — — 2 Foot 2 — — 1 1 — — — 1 — 1 — 2 1 — — — 1 1 Hand 1 — — — — 1 — — — — — 1 1 — — — — 1 Knee 3 — — 2 — 1 — — 1 — — 2 3 1 — — 1 2 1 Lymphatic System — — — — — — — — — — — — — — — — — — — Ribs 1 — — — — — 1 — 1 — — — 1 — — — — — 1 Abscess 2 — — — — 2 — — 1 1 — — 2 — 1 — — 1 1 Ear 1 — — — — 1 — — 1 — — — 1 1 — — — 1 — Non-Pulmonary Totals 78 2 14 33 5 16 6 2 11 9 51 7 78 4 3 8 2 17 61 38 39 Table C., page 38, which analyses the notifications and groups the pulmonary and non-pulmonary cases according to age, source, and mode of isolation, is an interesting one. It shows very well that the age-period at which the pulmonary form is most common is that between 25 and 45, the non-pulmonary being more frequent amongst the young. It shows also that Christ Church had the largest proportion of both pulmonary and non-pulmonary cases. The explanation of this fact is to be found very largely in the circumstance that the great bulk of the population is located in that district, and here there is most packing of the inhabitants, most poverty, and most insanitation in the form of overcrowding, lack of house-cleanliness and neglect of hygiene on the part of the individuals. Treatment of Tuberculosis. Sanatorium Benefit.—In previous tables some indication as to where the patients received treatment is to be obtained from the notes given as to the sources of the notifications. As to the numbers receiving sanatorium benefit it is impossible to give any definite information. So far as can be made out, of the 502 persons notified to the Medical Officer of Health, at least 179 were insured and 63 of these applied for the benefit. In a letter from the Medical Officer of the St. Marylebone Dispensary for the Prevention of Consumption, which is set out elsewhere, it is stated that of 365 patients treated, 150 were insured and made 1,893 attendances: 17 of the patients were sent to State Sanatoria. Deaths from Phthisis.—The table given below shows that the number of deaths from consumption increased somewhat in 1914, from 149 to 152. The deaths were 1.3 as against 1.2 per 1,000, in 1913. In Christ Church there was a very marked rise in the number of deaths from 57 to 73, an increase of 16. For some years there has been a tendency to a fall in this district and the greater part of the preventive work, both that carried out by the Council and that undertaken by voluntary agencies, has been done there. There has been no slackening of efforts on the part of any of the bodies concerned and it is difficult to find an explanation of why the rise should have occurred and there should have been a return to the figure for 1906, the year in which preventive measures were really seriously organized. TABLE X.—DEATHS FROM PHTHISIS. Estimated Population. Year. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 112,892 1914 152 18 38 73 23 114,532 1913 149 32 40 57 20 116,155 1912 149 26 32 66 25 117,841 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 40 The distribution of the 152 deaths was as follows:- In Poor Law Institutions 82; general and other hospitals, 17; at home, 53. Of those who died 37 were insured and 115 uninsured. As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 152 the notified cases of pulmonary tuberculosis totalled 424. 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 10 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals. Males 3 1 11 18 19 25 14 5 96 Females 1 4 12 14 10 9 6 — 56 Totals 4 5 23 32 29 34 20 5 152 Deaths from Phthisis in relation to Occupation. MALES. Work with exposure. Sedentary work. No occupation. Workmen. Foremen, Masters, etc. Workmen. Foremen, Masters, etc. Professional work. Total. 7 55 — 27 5 2 96 FEMALES. No occupation or house work. Work with exposure. Sedentary work. Professional work. Total. 41 3 12 — 56 Prevention of Consumption.—So far as prevention is concerned the methods followed in 1914 were largely those in vogue in former years and more than once described in previous reports. 41 Visits were paid to the homes of notified cases by the women inspectors, who, in addition to giving instruction with regard to the preventive measures to be adopted by the patient and the persons associated with him, endeavoured to arrange for the examination of contacts at the institutions co-operating with the Council in this work, viz., the Middlesex Hospital, the Dispensary in Allsop Place and the Margaret Street Dispensary. Very great assistance was given by the staff and the voluntary workers of the Dispensary for the Prevention of Consumption, Allsop Place, in connection with home visitation and educational work. A branch of prevention in which great interest is taken by the Committee of this Institution is that in relation to children, and the open air school which was instituted some years ago is largely attended by children who are suffering or are suspected to be suffering from consumption. In addition to carrying out such works as are referred to above, the Council, during 1914, continued their various activities in relation to housing and what may be called works of sanitation generally. In a large number of cases disinfection was carried out and any defects detected on examination were remedied in the usual way. Schemes of Prevention.—Early in 1914 the scheme of the Council, so far as regards the Dispensary portion—the only part with which the Council is directly concerned—was completed. Draft agreements had been prepared and submitted to and approved by the various bodies willing or desirous of taking part in the scheme, and there remained only to obtain the sanction of the London County Council, the Local Government Board and the London Insurance Committee. The necessity of consulting these bodies arose because the first two, between them, were responsible for the repayment of 75 per cent. of the total cost of the scheme, so far as regards uninsured persons; the Insurance Committee's duty was to make a contribution in respect of the insured. The desire of the Council from the very beginning was, roughly, to make arrangements for the uninsured persons, taking advantage of the facilities offered by the Middlesex Hospital, the Margaret Street Dispensary and the Allsop Place Dispensary, and linking up their own work with these institutions through certain members of the Public Health staff. Having made the arrangements for the uninsured, the Council proposed, and all the institutions agreed, to place these arrangements at the disposal of the Insurance Committee for the insured persons, and leave that body to settle with the Hospital and Dispensary Committees as to terms. The scheme, as proposed by the Council, was approved by the London County Council in a comparatively short time. The Local Government Board approved, so far a's the Middlesex Hospital and the Margaret Street Dispensary were concerned, subject to satisfactory arrangements being made with the Insurance Committee as regards the Dispensary in Allsop Place. 42 At the close of the year no such arrangement had been arrived at, and matters therefore were not very much further forward than at the beginning of the year. The whole trouble seemed to be the amount to be paid to the Dispensary by the Insurance Committee, and whether or not the payment should be made direct by them or through the Council. If the amount could have been decided upon, and it may be noted here that this was no concern of theirs, the Council would probably have been prepared to accept either arrangement. As it apparently was a difficult sum to settle, the Council could do nothing but wait. At the end of the year it seemed likely that there would be some considerable delay. Fortunately the delay means very little more than that the organisation is not quite formally completed. All the elements which will eventually make up the scheme are working together, doing everything possible to deal with the cases and tuberculosis prevention generally. The St. Marylebone Dispensary for the Prevention of Consumption.—This institution particularly, although it is the one with regard to which difficulties are experienced by the Insurance Committee, continued its work actively throughout the year. What that work was is shown in the following note, which has been very kindly provided by Dr. Saner, the Acting Medical Officer:— During the year 1914, 317 patients were examined at the Dispensary. Of these, 157 were found to be definitely tuberculous and 43 were suspected cases. Children under 15 numbered 150, and of these 48 were found to be tuberculous, 22 were suspected cases, and 70 were non-tuberculous. The Medical Officer paid 1,079 visits to patients in their own homes, and the Dispensary Sister paid 1,962 domiciliary visits. The number of individual attendances of patients at the Dispensary was 6,057. The number of persons insured under the National Insurance Act coming under treatment at the Dispensary for the first time was 62, but the number of those actually under treatment, including insured persons continuing their attendance from previous years, was 150. In all, 365 patients were actually receiving treatment at the Dispensary in 1914, and of these 150 were insured persons and 215 were not insured. The total attendance of same, including home visits by the Medical Officer, were as follows:— Insured persons 1,893 Non-insured 4,164 Making a total of 6,057 With regard to the sending of insured patients to the State Sanatoria, 17 patients were sent from this Dispensary during the year 1914. 43 Of the 17, 7 are now working, 2 are improved, in 3 the disease is arrested, 1 is not improved, and 1 is worse. Three have not yet returned. Five of the patients were discharged at their own request, and of these 2 are working, 1 is improved, 1 not improved, and 1 worse. Bacteriological Diagnosis of Consumption.—Again in 1914 as in the previous year an 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, is to be noted. The total number was 859 as against 672 in 1913. Of these, 173 were found to contain the bacillus of consumption, while the remainder were free. Work of the Women Inspectors.—The total number of cases seen by the women inspectors was 1,227, 578 of which were new cases. Fifty-six of the patients seen were removed to hospital, 171 were insured persons and of these 54 went to a sanatorium. Disinfection of premises was carried out in 162 instances. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—78 asagainst 154 in 1913—in the case of this form of tuberculosis came from institutions where the patients were undergoing treatment. Visits were paid to the homes and, where necessary, advice with regard to the obtaining of treatment was offered. Particulars as to the parts affected by the disease will be found in the table on page 38. SYPHILIS. Although no deaths were actually certified as directly due to this disease during the year, the number that resulted indirectly from it must have been considerable. The victims in this group were many of them infants and young children. These died, having inherited the infection. A large percentage died of the sequels of the acquired infection. Many of the sequels appeared because the disease was neglected in the early stages. Considerable numbers of the children who died from inherited syphilis were infected because the parent did not seek proper advice and did not submit to full and proper treatment. Recognizing that not only did this disease contribute largely to the death-rate, but that it was a very serious cause of sickness, the Public Health Committee towards the end of 1913 determined that it was their duty to see if anything could be done in the way of prevention. The conclusion arrived at after discussion at a number of meetings was that the first step was to find out, if possible, the extent of the problem. To do so by means of notification in the ordinary way was regarded as difficult and impracticable, if not impossible, and it was finally decided to adopt in relation to syphilis a method which had given excellent results a number of years ago in connection with consumption. 44 This method involves the provision of assistance to medical men in making a diagnosis of the case, and is applicable of course only in diseases in which laboratory methods can be used in relation to diagnosis. Syphilis has recently been shown to be one of the diseases in which special tests can be applied, viz., to the blood in the form of what is known as Wassermann's test, and it was determined to take advantage of this fact; to offer to carry out the test free of charge for medical men in exchange for certain information with regard to the patient. Before adopting the procedure the medical men in practice in the Borough were circularized and asked whether or not they would be prepared to make use of facilities for the application of the test, and if they would be willing to give information as to the age and sex of the patient and some indication of the part of the Borough in which he resided. Without exception those who were written to agreed to take part in the scheme. The Committee thereupon made arrangements with Dr. Foulerton, at that time bacteriologist at Middlesex Hospital, to carry out the test. Each medical practitioner was provided with a special outfit, and it was arranged that all specimens and information should be addressed to the Medical Officer of Health, and should be sent on by him to Dr. Foulerton. In all 120 specimens were examined. The majority of these came from institutions, chiefly the Workhouse Infirmary. The total number from male patients was 66 and from females 54. Several of the specimens were from children, but the greater number were from adults in the age groups 25-45, and 45-65. The number giving a positive result was 38; of these 20 were males and 18 females. With regard to these proportions it should be noted that the test is applied to a specimen of the patient's blood, and collection of the specimens is not always easy. This fact may be taken to be the reason for the smallness of the number of specimens sent in, but as the scheme is to be continued it is probable that greater use will be made of the facilities, and figures with regard to which comment may be made will be obtained. DISINFECTION. As is shown in the following tables, there was a considerable increase in the amount of work done in this connection during 1914. The methods employed during the greater part of the time were substantially the same as in previous years, articles suitable for treatment by steam were dealt with in the Goddard, Massey and Warner Disinfector at the Disinfecting Station, while for rooms formalin tablets, 30 per 1000 cubic feet of space, were generally employed. The number and nature of the articles disinfected are shown in the following table:— 45  Compulsorily Notifiable Infectious Diseases. Phthisis. Measles. Vermin. Other causes. Total. Beds 549 73 2 17 23 664 Mattresses 547 75 17 17 257 913 Bolsters 601 17 12 10 60 760 Pillows 1,057 170 15 24 488 1,754 Sheets 1,137 117 23 20 53 1,350 Blankets 1,310 174 45 658 795 2,982 Sundries 7,565 719 84 772 4,000 13,140 Totals 12,766 1,403 198 1,518 5,676 21,563 In 1913, the number of articles disinfected was 13,639, and in 1912, 11,355. The number of journeys made by the disinfecting vans during the year ended December, 1914, was as under:— January 52 February 53 March 51 April 49 May 50 June 54 July 53 August 52 September 52 October 57 November 38 December 52 The vans were used 614 times in 1913. 613 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. Total. January 34 22 1 ] — 58 February 74 10 7 4 8 103 March 38 9 5 — 6 58 April 41 5 3 2 24 75 May 47 15 7 9 16 94 Tune 80 12 7 1 23 123 July 70 24 1 6 16 117 August 67 13 — 5 7 92 September 87 7 — 1 21 116 October 119 18 — 5 4 146 November 78 11 3 3 6 101 December 64 16 4 — 9 93 Totals 799 162 28 37 140 1,176 The number of rooms disinfected in 1913 was 995. 46 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, it will be noted, are more than double those for 1913, the most marked increase being in the case of diphtheria. The reasons for this have already been given. Arrangements for carrying out the examination of blood for the Wassermann reaction, the test which is of so much assistance in the diagnosis of syphilis, were made in April, 1914, with Dr. Foulerton, of the Middlesex Hospital, who was appointed by the Council at this time to carry out bacteriological work on their behalf. The majority of the specimens were sent from institutions and particularly the Workhouse Infirmary. Further information with regard to the arrangements made for the carrying out of this test will be found on page 44. 1913. 1914. Positive. Negative. Total. Positive. Negative. Total. Typhoid Fever 6 14 20 20 33 53 Diphtheria 33 105 138 93 650 743 Phthisis 120 552 672 173 686 859 Wassermann Reaction — — — 38 82 120 Malaria — — — — 1 1 Totals 159 671 830 324 1452 1776 Part II. DEPARTMENTAL. 49 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. Prior, who was appointed during the year successor to the late 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. Effect of the War.—At the outbreak of war a considerable number of the members of the outdoor staff were called up as well as several from the office itself, viz.:—one of the women inspectors, Miss N. C. Stokes. who was on the Reserve of Nurses, and is now in France ; Mr. C. H. Scowen, one of the assistant clerks, who was in the 9th Middlesex Regt. (T.F.) and is now in India ; and Mr. W. J. Howe who joined the 2nd London Sanitary Company, R.A.M.C. (T.F.) and is now in Egypt. From time to time other members joined the forces and arrangements had to be made for carrying on their work. In connection with this the members of the staff remaining most loyally cooperated and the quality of the work done is in no sense inferior to that of previous years. In quantity the work increased considerably as a direct result of the war. At the beginning a large number of premises were used in connection with mobilization, and called for a certain amount of attention. Very early Lord's Cricket Ground was placed at the disposal of the War Office, and since early in August it has been practically continuously occupied by troops. In addition, the barracks in Ordnance Road have, of course, been largely used, as have also the headquarters of the 3rd County of London Yeomanry (T.F.) in Henry Street, St. John's Wood. As time went on a number of the larger houses in the Borough, in the neighbourhood of Regent's Park particularly, were transformed into hospitals for wounded officers and soldiers, many of whom were also admitted to the numerous nursing homes and hospitals in the district. Largely owing to the efforts of the Mayor (Mr. Alderman Fettes), who took a very great interest in the matter, several premises were transformed into homes for Belgian refugees, and a number of private individuals, amongst them Lord Portman, put houses at the disposal of these unfortunate people. The presence of the military and of the refugees naturally threw a great deal of extra work upon the department, both when preparations were being made and afterwards when the necessity for supervision arose. 50 In respect of the troops, soon after the declaration of war the Medical Officer of Health, in common with others in the metropolis, was asked to assist the Deputy Director of Medical Services for the London District, and to act as " Sanitary Supervisor " of camps, billets, etc., in the Borough. The Council raised no objection to this, and a great deal of work was done in the way of inspecting encampments and premises used by troops, advising commanding officers, co-operating with Army medical officers, examining; food supplied to the troops, reporting sanitary defects and making periodical reports to the Deputy Director of Medical Services. After arrangements to help in these ways had been made, the Local Government Board issued a letter to local authorities pointing out the necessity of close co-operation between the civil and military authorities in relation to infectious diseases, and from time to time the Board also communicated with the Medical Officer of Health on the question of food to the troops, as a great deal of material was supplied to the War Office by a large contractor in the Borough. The Public Health Committee was exceedingly anxious that there should be the closest co-operation, and that every assistance should be given. The Cleansing Station was placed at the disposal of the military quartered in the Borough, and large numbers of soldiers availed themselves of the use of the baths and great quantities of blankets, clothing, etc., were submitted to treatment in the disinfecting apparatus. In addition to these baths the public baths were also thrown open to the soldiers, who were also admitted to the use free of charge of any of the underground conveniences. In carrying out the extra work entailed the Medical Officer of Healh received the greatest assistance from all the members of the staff who, in addition to this and their ordinary routine of work, had a great deal to do in connection with factories and workshops in which army clothing is made. St. Marylebone being a well-known tailoring centre, a great deal of this class of work is done, much of it in small workshops. Very close supervision has been exercised over these by the Inspectors, both male and female. In order to provide work for women several emergency workrooms were opened by the Women's Emergency Corps and others. The greater part of the work of supervising these has fallen upon the women inspectors, one of whom, Miss Baker, was appointed a member of a sub-committee of the Prince of Wales' Fund Committee, charged with attending to this matter. So far as BeJgian refugees are concerned, it may be noted that the Department is particularly fortunate in having as a temporary woman inspector Miss Meses, who has a thorough knowledge of French and Flemish and who has been of the greatest assistance in the work amongst the refugees. 51 Before leaving the discussion of the effect of the war on the work of the department, it may be mentioned that each month particular note was made, and a report submitted to the Public Health Committee and the Local Government Board, as regards distress. The investigations were made by the inspectors in connection with their ordinary work, but very little real evidence of distress was found. STAFF MEETINGS. The practice of holding Staff Meetings was continued and a number of matters were discussed. Amongst them may be noted the following: Dampness of Walls; Housing of the Poor: Weight and Composition of Lead Pipes; Smallpox Contacts; Dangerous Structures; Paper Linings to Dustbins; Pneumonia Enquiries; Schools for Mothers; Demolition Orders; Fried Fish Shops, and Deaths in Tenements. 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. He also assisted greatly in the examination of food, intended for the troops, prepared or packed in the Borough. 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. Amongst the articles dealt with in this way were— 3 Pigs' Heads (Tuberculosis) ¼crate Bananas 3 cwt. Beef 3 baskets Cherries ½ cwt. Mutton 2 baskets Strawberries ½ cwt. Bacon Quantity of Pineapples 3 Ox Livers (1 Flukes, 1 Echinococci) 3 trunks of Cod Quantity of Fowls, 1 unsound 1 trunk of Fish Roe 1 Sheep's Liver (Flukes) 1 trunk of Plaice 250 lbs. Tomatoes 1 trunk of Mackerel 1 basket of Apples Quantity of Crabs 3 baskets Pears 55i cases of Eggs The presence of so large a quantity of eggs in the list is undoubtedly one of the outcomes of the war, the delay in transit caused by the disturbance on sea and elsewhere giving the eggs an opportunity of going bad before they reached their destination. The only seizure of food made during the year as noted below was of eggs. 52 The practice of examining food and poultry obtained by Christmas clubs for distribution amongst their members, commenced in 1913, was continued in 1914 with good results. In all 9 premises were visited and 1,000 birds and joints submitted to examination and passed as sound. It is interesting to note in this connection that, doubtless as a result of the war and the absence of so many men on military duty, the total number of joints, etc., was only one-third of that examined in the previous year. The only seizure of food made during the year was of a quantity of unsound eggs. These were found deposited for sale in a house in the eastern part of the Borough, and before the department had an opportunity of dealing with the case and putting a stop to the practice considerable numbers of bad eggs must have been sold to and consumed by many of the poorer people in the neighbourhood. In most instances the eggs were taken away in mugs or cups, the vendor breaking them before handing them over, and giving the purchaser the opportunity of refusing any that appeared to be too obviously bad. All those seized were very bad, and acting on the instructions of the Public Health Committee, the vendor was proceeded against. A fine of £2 and 2/- costs was imposed. No seizures of unsound meat were made, which, as stated in the report for 1913, in which year no unsound food whatever was seized, is evidence of the value of the close supervision that has been and is now exercised over food and food premises. SLAUGHTER HOUSES. The chief point to be noted with regard to these is that during 1914 the list of licensed slaughter houses was reduced by 3, the total number now being 4. Of those no longer on the list one was pulled down and in the others no application for renewal of license was sent in. All those on the subjoined list were regularly and frequently visited. No condition calling for service of notice was found. Premises. Conditions. 75, Abbey Road Nil. 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. 32A, Union Street, Middlesex Hospital Nil. MILK SUPPLY. Cow houses.—The following list shows the number of cow houses in the Borough, the number of cows for which they are licensed, and the actual number kept. The figures are practically the same as shown for 1913. 53 Premises. Licensed for. Cows kept. 58, Acacia Road 44 26 56, Bell Street 15 10 42a, Clipstone Street 10 10 26, John Street 14 1 3, Malthouse Mews 22 16 Totals 105 63 Inspections were regularly and frequently made throughout the year. In no case were conditions regarding which it was necessary to serve notices discovered. Milkshops, etc.—The number of premises upon which milk is sold is 237, 8 more than in 1913. The number of applications received was 14. Under the powers granted by the London County Council (General Powers) Act, 1908, 3 were refused on the ground that the premises were unsuitable. Under this same Act 3 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. One appeal was made to a magistrate during the year against a decision of the Committee to remove a name from the register. The appeal was dismissed. Later, as the vendor continued to sell milk, further proceedings were instituted and a fine of £3 and 14s. 6d. costs was imposed. Examination of Milk.—Of 538 samples taken either formally or informally and examined by the public analyst 28 (5.2 per cent.) were found to be adulterated. In 1913 the percentage was 6.9, in 1912, 3.8, and in 1911, 8.9. As in former years, vendors whose samples were found to be up to standard were informed as soon as the analyst's report was obtained that it would be unnecessary for them to retain the portion of milk left with them. When the samples were found to be slightly below the standard, a special report was made to the Public Health Committee, and in 10 instances a letter of caution was sent to the vendor. In the case of samples definitely adulterated proceedings were instituted. In 1914 action was taken in 15 cases. In five of these warranty was pleaded and the case was dismissed. In respect of the remaining 10 cases fines and costs to the amount of £ 16 18s. were recovered. In 1913, when there were 22 cases, the amount was £27 16s. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 89 were obtained on delivery at Marylebone Station of the Great Central Railway. Of the 89, five proved to be adulterated, but only in one was the adulteration sufficient to warrant the institution of proceedings. The remainder were dealt with by means of letters of caution to the farmers. 54 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 1S1 9 5.9 4 9 13 0 2nd 116 10 8.6 5 2 0 0 3rd 143 4 2.7 2 2 10 0 4th 128 5 3.9 4 2 15 0 Total for year 538 28 5.2 15 16 18 0 Ice Cream Premises. The number of such premises in the Borough on the Register is 117. Regular inspections were made throughout 1914 and in 8 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 12 dealers in margarine, 1 wholesale dealer in butter and milk-blended butter, 3 butter manufacturers and 1 margarine manufacturer. All the registered premises were frequently visited. Restaurants, Food Stalls, &c. The number of premises in which food is prepared for sale is 269, made up as follows:—Restaurant, dining room and coffee shop kitchens, 155; tea rooms and pastrycooks, 45 ; hotel kitchens, 38 ; fried fish shops, 25 ; fish curers, 6. 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 803, and as a result of these, various conditions calling for attention were discovered. In all 82 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. In anticipation of the coming into operation of the by-laws of the London County Council with regard to Fish Curers and Vendors of Fried Fish, a very careful and complete inspection of all premises upon which these trades are carried on was made. In all cases in which any defect was found or the arrangements were not in compliance with those laid down for premises coming within the by-laws, the owner was communicated with and arrangements made for him to discuss the matter with 55 the Food Inspector. As a result of this procedure, a considerable number of alterations and improvements were made in each case and many possible sources of nuisance removed. 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 45 visits, but no cause of complaint was found. Bakehouses. At the end of 1914 the number of bakehouses on the register was 73, 63 being underground bakehouses. In all, 150 visits were paid to these and 1 notice with regard to defects was 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 total number of samples taken under these Acts was about the average for the last three years, viz. : 1,067. Of this number 42 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 3'8 per cent., which is slightly below that for 1913, when it was 4.2. In 1912 it was 2.9 and in 1911, 6.2. The method adopted in connection with the taking of samples was similar to that followed in previous years and described in former reports. The majority 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 17, and that the fines and costs recovered amounted to £19 17s. Od. The appeal in the 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. Od., noted as pending in the report for 1913, was dropped in June, 1914. The warranty defence was raised in 5 prosecutions for adulteration of milk, and was successful in all cases, the summonses being dismissed. In 1 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 16. Fine. Costs Obstructing an officer in course of his duties in sampling food 10s. £13s. 56 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, 1914. 142 milk Food Inspector, St. Marylebone, Borough Council. Genuine. £500 per ann.for 700 samples. Over that number 7/6 per sample. One skimmed. No sample contained any preservatives, but 34 samples had artificial colouring matter added. 9 milk Adulterated. No. 115, 6.67 per cent. deficient in milk fat No 115. Fined £1 and 12/6 costs No. 119, 20 0 do. *No. 119. See footnote No. 122, 1*42 per cent. added water No. 122. Proceedings not taken. Vendor cautioned 20/2/14. No. 130, 3.3 per cent. deficient in milk fat *No. 130. See footnote No. 132, 3.3 do. *No. 132. Do. No. 148, 6.07 do. No. 148. Fined 10/- and 12/6 costs . No. 149, 13.3 do. No. 149. Fined 10/- and 12/6 costs No. 169, 3.3 do. No. 1(59. Vendor cautioned 6/3/1914. No. 232, 6.67 do. No. 232. Fined £5 and 15/6 costs 96 butter Genuine. 81 were test samples. 50 samples contained between 10-20 grains of boracic acid per lb. 38 samples contained be tween 20-30 grains per lb. 2 contained over 30 grains per lb. The highest being 30.1 grains per lb. 13 contained no preservative 7 butter Adulterated. No. 57. Contained over 80.0 per cent. fat other than butter fat No. 57. This was a test sample. No. 88. do. No. 88. Do. No. 106. do. No. 106. Do. No. 139. do. No. 139. Do. No. 1 62. do. No. 102. Do. No. 180. do. No. 180. Do. No. 234. do. No. 234. Fined £1 and 12/6 costs on 1st summons and 2/- costs for selling margarine in a plain wrapper. 14 cream Genuine. These were test samples. Four contained 3 5-16 grains boracic acid per lb. Ten contained no preservative. 1 margarine Do. 3 coffee Do. These were test samples. *Nos. ll9, 130 and 132 Milk Samples were found to be adulturated; they were taken on delivery at the vendors' premises and the Paddington Borough Council were asked to co-operate and take samples at the Great Western Railway terminus. 21 samples were taken, 4 of which were found to be deficient in milk fat to the extent of 7, 8, 10 and 12 per cent. respective y, in respect of which proceedings were taken. 57 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. 4 coffee Food Inspector, Adulterated. £500 per ann. for 700 samples Over that number 7/6 per sample. St. Marylebone Borough Council No. 124. Contains not more than 1 per cent. chicory No. 124. This was a test sample. No. 210. Contains about 1 per cent. chicory No. 219. Do No. 240. do. No. 240. Do. No. 275 Contains about 2 per cent. chicory No. 275. Do. 3 mustard Genuine. 2 were test samples. 1 pepper Do. 1 bread & butter Do. 1 marmalade Do. This was a test sample. 4 dripping Do. These were test samples. 2 lime water Do. Do. 2 Dover's powder Do. Do. 2 lard Do. 1 saffron Do. This was a test sample. 1 boracic ointment Do. Do. Total Number of Samples analysed during the Quarter 294 Number of Samples adulterated 20 SECOND QUA RTER ENDING 30th JUNE, 1914. 106 milk Genuine No sample contained any preservative, but 23 had artificial colouring matter added. Adulterated. 10 milk . No. 305. 6.67 percent. deficient in milk fat No. 305. Fined 10/- and 12/6 costs No. 339, 13.3 do. No. 339. Warranty defence. Case dismissed No. 347, 3.3 do. *No. 347. Vendor cautioned vide P.II. Mts. 15/5/14 No. 357, 3.3 do. *No. 357. Farmers cautioned vide P. H. Mts. 15/5/14 No. 358, 6.67 do. *No. 358. No. 414, 6.67 do. No.414.Warranty defence. Case dismissed No. 420, 30.00 do. No.420. Warranty defence. Case dismissed No. 466, 10.0 do. No. 466. Fined 5/- and 12/6 costs No. 468, 13.3 do. No. 468. Fined 10/- and 12/6 costs No. 480, 6.67 do. No. 480.Vendor cautioned vide P.H. Mts. 10/7/14 8 butter Genuine Three samples contained under 10 grains per lb. boracic acid. 44 contained between 10 - 20 grains per lb. 31 contained between 20-30 grains per lb. One con. tained no preservative No. 347 taken from Vendor in District. Nos. 357 and 358, taken on delivery at G.C.R. from farmers who supplied the milk consigned to the vendor of No. 347. 58 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority under Section 13 of Act, and, if so, the name of such Authority Result of Analysis; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 1 butter Food Inspector, St. Marylebone Adulterated. No. 483. This was margarine. £500 per ann. for 700 samples. Over that number 7/6 per sample This was a test sample 8 cream Borough Council Genuine. 1 cream Preserved (Unlabelled) No. 488. Contained 4 3 grains per lb. of boracic acid 3 mustard Genuine Two were test samples. 2 pepper Do. One was a test sample 1 coffee Adulterated No. 315. Contained 2 per cent. chicory This was a test sample 1 Dover's powder Genuine Do. 1 dripping Do. Do. 3 sardines Do. These were test samples Total Number of Samples analysed during the Quarter 215 Number of Sa mples adulterated 12 and 1 cream (u nlabelled ; contained borax). THIRD QUARTER ENDING 30th SEPTEMBER, 1914. 189 milk Genuine. No sample contained any preservative, but 29 had artificial colouring matter added. 4 milk Adulterated. No. 572. 6.67 per cent. deficient in milk fat. No. 572. *See below. No. 654. 13.3 do. No. 654. Fined £1 and 12/6 costs. No. 696. 10.0 do. No. 696. Fined 5/- and 12/6 costs. No. 697. 3.3 do. This was a test sample. 104 butter Genuine. 4 samples contained no preservative, 5 contained under 10 grains per lb. of borax. 54 contained between 10-20 grains per lb., 42 contained between 20-30 grains per lb., 31 were test samples. 1 butter Adulterated. No. 721. 80 % fat other than butter fat. (Margarine). No. 721. Fined 10/- and 12/6 costs on 1st summons and 2/- costs on 2nd summons 17 cream Genuine. 4 were test samples. 3 margarine Genuine. 1 was a test sample. 4 dripping Do. These were test samples. 2 lard Do. do. 1 sweets Do. This was a test sample. '2 pickles Do. These were test samples. 5 jam Do. do. 4 Dover's powder Do. do. *No. 572 Milk, This was one of three station samples from 3 churns consigned by the same farmer. Two churns were above the standard and one below. With the three churns mixed the whole of the milk would be above the standard, hence Solicitor advised no prosecution. 59 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 1 lime water Food Inspector, Genuine. £500 per ann. for 700 samples. Over that number 7/6 per sample This was a test sample. 1 sweet spirits of nitre St. Marylebone Borough Council Do. do. 1 quinine powder Do. do. 1 boracic ointment Do. do. 2 coffee Do. One was a test sample. 1 rice Do. This was a test sample. 1 marmalade Do. do. 1 mustard Do. do. 1 self-raising flour Do. do. Total Number of Samples analysed during the Querter 296 Number of Samples adulterated 5 FOURTH QU ARTER ENDING 31ST DECEMBER, 1914. 123 milk Genuine. No sample contained any preservative, but 30 had artificial colouring matter added. 5 milk Adulterated. No. 862. 6.67 per cent. deficient in milk fat. No. 862. Fined 10/- and 12/6 costs. No. 895. 16.67 per cent. do. No. 895. Fined £1 and 12/6 costs. No. 901. 6.83 per cent. added water. No. 901. Warranty defence. Case dismissed. No. 902. 5.90 per cent. do. No. 902. Warranty defence case dismissed. No. 1030. 3.7 per cent. do. No. 1030. See note below.* 97 butter Genuine 10 samples contained no preservative, 49 contained between 10 and 20 grains of boric acid, 35 contained between 20 and 30 grains of boric acid, 3 had over 30 grains of boric acid per lb,, 61 were test samples. 17 cream Genuine. 5 were test samples. 2 jam Genuine. These were test samples. 2 salmon Do. Do. 2 boracic ointment Do. Do. 3 lime water Do. Do. 1 vinegar Do. This was a test sample. 4 coffee Do. 3 were test samples. 1 Dover's powder Do. This was a test sample 1 baking powder Do. Do. 2 chicory Do. These were test samples. 1 lard Do. This was a test sample 1 ginger brandy Do. Do. Total Number of Samples analysed during the Querter 262 Number of Samples adulterated 5 This was one of the three station samples from 3 churns consigned by the same farmer. Two churns were above the standard and one below. With the three churns mixed the whole of the milk would be above the standard, hence Solicitor advised no prosecution. SUMMARY. Number of Samples Analysed. Number Adulterated. 1st Quarter 294 20 2nd ,, 215 13* 3rd ,, 296 5 4th ,, 262 5 Totals 1,067 43 *Includes 1 sample of cream sold unlabelled. 60 REPORT OF THE PUBLIC ANALYST, 1914. During the year 1914, 1,067 samples were submitted for analysis. Of these 43 were certified to be adulterated—that is, about 4 per cent.—the same percentage as in 1913, in which year 43 out of 1,061 samples were adulterated; for the time, therefore, it would seem that the quantity of adulteration has not diminished. The samples comprise dairy produce, condiments, saccharine substances, nonalcoholic beverages, farinaceous foods, and various drugs; with the exception of a sample of ginger brandy, no ordinary alcoholic driuks, i.e., beers, wines or spirits, were analysed. Dairy produce accounts for over 91 per cent. of the total samples—the high food value of dairy produce, its influence on the health of children, and the temptation to tamper with such a plentiful and easily adulterated class of food, fully justifies this selective attention. Milk.—Out of 538 samples, 28 were certified to be adulterated. With the exception of 4 containing small quantities of added water, the adulteration consisted in the removal of fat—in six cases the fat abstracted was only 3.3%; on the other hand in one case the fat abstracted amounted to 30%, in another to 20%. Most of the samples were artificially coloured, in all cases preservatives were absent. The average composition of unadulterated samples during the four years 1911, 1912, 1913 and 1914 was as follows : Sp. gr. Milk fat. Solids, not fat. Total solids. 1911 103 l.O 370% 8.64% 12.34% 1912 1031.5 374% 8.77% 12.51% 1913 1031.7 373% 8.80% 12.53% 1914 1031.3 375% 8.77% 12.52% It is therefore evident that during the last three years, the average composition of genuine commercial milk sold in the Borough is remarkably consistent, and of good quality. It may be recorded that several samples abnormal in fat content were sampled, in one case the fat was as high as 18%, and during the third quarter 10 samples contained from 5% up to 18% milk fat. Cream.—There is no legal definition of cream, but as it is illegal to sell preserved cream containing 35 per cent. or more by weight of milk fat, save it is labelled by a label giving information to the buyer, which of the two legalized preservatives (boric acid or hydrogen peroxide) it contains, and in what quantity, it may be assumed that a liquid containing less than 35 per cent. milk fat is not cream. 61 Of the 57 samples submitted during 1914, one gave as low as 36 per cent. milk fat, which is quite poor cream; over 38 per cent. were creams containing 50 per cent. or more milk fat; these may be considered good creams. The average of the whole worked out as 48 per cent, milk fat—which is a cream of fair quality. Twenty-five of these samples contained boric acid in quantities from 3i grains per pound up to 21*7 grains per pound. In 5 of the 25 preserved creams, the sample was sold not properly labelled. Butter.— Of 384 samples sold as butter 9 were margarine—mostly informal samples. In none of these samples was the water excessive, but over 85% contained boric acid. 204 samples contained boric acid from 10 to 20 grains per lb. 118 „ „ „ 20 to 30 „ „ 5 „ „ over 30 „ „ The maximum amount was 31 grains per lb., which is just 4 grains below the permissible limit. Drugs.—Twenty-one samples of various drugs were examined and found up to standard. The publication of the new Pharmacopoeia (1914) is important from the view of administration of the Sale of Food and Drugs Acts, the more especially as this edition has been completely revised and a large number of new standards for purity settled. For example, in over 90 medicinal salts or preparations, it is laid down that they must not contain arsenic above a certain minimum, the limit varying from 1000 parts per million for antimonium sulphuratum, down to 0.2 for liquor magnesii carbonatis. How far the limits and tests for purity will hold good in the courts remains to be seen, but it is obvious that a public analyst, examining a drug enumerated and described in the British Pharmacopoeia, and finding that the official tests prove that the drug is not in conformity with the Pharmacopoeia, will be justified in certifying to adulteration. The remaining samples as set out in the annexed table were of a miscellaneous character and with the exception of 5 samples of coffee, were genuine. 62 ANALYSES UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR 1914. The following table summarizes the information submitted formally by the Public Analyst:— No. Article. Genuine. Adulterated. Total. 1 Milk 510 28 538 2 Butter 375 9 384 3 Cream 57* - 57 4 Margarine 4 - 4 5 Lard 5 - 5 6 Dripping 9 - 9 7 Flour 1 - 1 8 Rice 1 - 1 9 Bread and Butter 1 - 1 10 Sardines 3 - 3 11 Salmon 2 - 2 12 Pickles 2 - 2 13 Marmalade 2 - 2 14 Jam 7 - 7 15 Sweets 1 - 1 16 Baking Powder 1 - 1 17 Coffee 9 5 14 18 Chicory 2 - 2 19 Mustard 7 - 7 20 Pepper 3 - 3 21 Vinegar 1 - 1 22 Ginger Brandy 1 - 1 23 Limewater 6 - 6 24 Saffron 1 - 1 25 Dover's Powder 8 - 8 26 Quinine Powder 1 - 1 27 Sweet Spirits of Nitre 1 - 1 28 Boracic Ointment 4 - 4 1,025 42 1,067 *Five were sold unlabelled. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS. As will be noted, all the samples of milk and cream submitted to the public analyst were examined for preservatives. All the milks were found to be free from such substances, while of the 57 samples of cream, 25 contained boric acid in quantities from 3½ grains per lb. up to 21.7 grains per lb. None of the samples 63 63 contained less than 35% of fat, and therefore provided the requirements of the Public Health (Milk and Cream) Regulations were complied with, could be sold as preserved. In five instances the requirements were not complied with, in this respect that the vessels were not labelled, and the vendor in each case was communicated with. In four cases the explanation offered was regarded as satisfactory, and the Public Health Committee considered that a letter of caution would meet the case. In the fifth the explanation appeared to be unsatisfactory and proceedings were instituted and the vendor was fined 10/-and £1 3/- costs. The costs included 10/6 on account of the attendance of the Public Analyst, but in granting this amount the magistrate pointed out that it was unfortunate that provision had not been made in the Regulations, as in the Sale of Food and Drugs Acts, for the admission of the analyst's report as evidence. He suggested that in future cases it would be advisable to approach the defendant and find out from him whether or not he proposed to question the analysis, and desired or did not desire the presence ot the analyst. His suggestion seems an excellent one, and will in future cases be acted upon. The following is a copy of the return required by the Local Government Board with regard to proceedings under the Public Health (Milk and Cream) Regulations. REPORT OF ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the year ended 31st December, 1914. 1. Milk; and Cream not sold as Preserved Cream. (a) Number of samples (6) Number in wnich a examined for the pre- preservative was resence of a preservative. ported to be present. Milk 538 Nil. Cream 5 5 Nature of preservative in each case in column (b), and action taken under the regulations in regard to it. 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correct statements made 52 (ii.) Statements incorrect - Total 52 64 (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent. 57 (ii.) Below 35 per cent. - Total 57 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed 5 (d) Particulars of each case in which the Regulations have not been complied with, and action taken. Sample No. Contained Action taken. 25 3.5 grains boric acid per lb. The Vendor's explanation considered by Public Health Committee, who ordered him to be cautioned. 488 4.3 „ „ Do. 758 17 „ Do. 897 11.9 „ „ Do. 924 7 „ „ Prosecution ordered. Vendor fined 10/- and 12/6 costs. 3.—Thickening substances.—Any evidence of their addition to cream or to preserved cream—None. 4.—Other observations, if any—None. BACTERIOLOGICAL EXAMINATION OF FOOD. During the year 19 samples of milk, 1 of watercress, 1 of block ice, and 7 of ice cream were submitted to the Council's Bacteriologist (Dr. Foulerton) for examination. Of the milks, 16 were found to be "good," and 5 "bad." Of the ice cream samples, 3 were "bad" and 1 was " doubtful." The block ice was reported "good" and the watercress " doubtful." 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 the cases in which milk was concerned a communication was sent to the Medical Officer of Health of the district from which it was stated to have come, and he was asked to take such action as seemed necessary in order to bring about improvement. As in previous years, this procedure was found to workwell. 65 RAG FLOCK. Four 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 24. In 152 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 121 instances. In the remaining 31, it was found necessary to serve a statutory notice. Following the receipt of this, the work was done, and in 4 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 37 premises. The reasons for discontinuing the supply were : Premises empty 27 Non-payment of Rates 4 Waste of Water 5 Cut off by request of Occupier 1 37 Mr. Alderman J. Lea-Smith, the Council's representative on the Water Board, and a member of the Public Health Committee, as in the past, gave a great amount of assistance in connection with these cases. If the premises affected were a tenement house, immediately on receiving information from the department he 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 1914 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 66 were found to be defective to the Medical Officer of Health and the District Inspector to be dealt with as it 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 tor 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, Etc. Act, 1909, during 1914. 6, Hatton Street Direct external light and ventilation provided to ground floor middle room. 106, Princess Street Obstructive building at rear demolished. 78, Cochrane Street Direct external light and ventilation provided to ground floor middle room ; water supply provided to upper storeys ; defective drinking water cistern abolished; eaves gutters repaired. 80, Cochrane Street Direct external light and ventilation provided to ground floor middle room ; water supply provided to upper storeys ; defective drinking water cistern abolished; floors repaired. 66, Salisbury Street Direct external light and ventilation provided to middle room on ground floor 79, Salisbury Street External light and ventilation provided to back addition and water closet 3, St. James' Mews Living rooms disconnected from stables; rooms cleansed; defective drinking water cistern abolished. 7, St. James' Mews Living rooms disconnected from stables; external light and ventilation provided to water closet; defective drinking water cistern abolished 67 1, St. James' Mews Defective water closet abolished; new water closet constructed on external wall. 14, St. James' Mews External light and ventilation provided to water closet; rooms cleansed; roof repaired. 14a, St. James' Mews Light and ventilation of living room improved; living rooms disconnected from stables; roof repaired; defective water closet abolished; new water closet constructed with external light and ventilation. 15, St. James' Mews Defective water closet removed from room used for storage of food and vegetables; new watercloset constructed with external light and ventilation. 20, St. James' Mews 9, St. James' Mews External light and ventilation provided to water closet. 20, St. James' Mews 9, St. James' Mews Living rooms disconnected from stables ; external light and ventilation provided to water closet. 6, Henry Street Direct external light and ventilation provided to ground floor middle room 52, Townshend Road Closed voluntarily after notice. 2, Townshend Road Closed voluntarily after notice. 46, Townshend Road Direct external light and ventilation provided to ground floor back room; defective drinking water cistern abolished; drains relaid.. 48, Townshend Road Direct external light and ventilation provided to ground floor back room. 6, Milner's Mews The living rooms on first floor separated from the stables on ground floor and provided with a separate entrance direct from the mews. Additional external light and ventilation provided to the rear of the premises and to the w.c. The premises cleansed and renovated throughout. Proper supply of water provided to the tenement, and sanitary arrangements reconstructed. 68 7 & 8, Milner's Mews The living rooms on first floor separated from the stables on ground floor and provided with a separate entrance direct from mews. New w.c. provided in suitable position on first floor. The premises cleansed and renovated throughout. 4, Milner's Mews The attention of the owners was called to the unsatisfactory condition of these premises which were subsequently closed voluntarily. 5, Milner's Mews Ditto. 9, Milner's Mews The w.c. on first floor properly separated from living rooms by airtight partitions and provided with proper means ot direct external light and ventilation. 10, Milner's Mews The living rooms on first floor separated from the stables on ground floor and provided with a separate entrance direct from mews. New w.c. provided in suitable position on first floor. The premises cleansed and renovated throughout. 17, Milner's Mews The living room on first floor separated from stables and ground floor, and provided with a separate entrance direct from the mews, proper means of direct external light and ventilation provided to the w.c. Drains, etc., reconstructed. The premises renovated throughout. 3, William's Place The attention of the owner was directed to the unsatisfactory condition of these premises, which were subsequently closed voluntarily. 30, Huntsworth Mews The living rooms on first floor properly separated from the stable on ground floor and provided with separate entrance from mews. Water closet reconstructed in suitable position. Additional external light and ventilation provided to rear of the premises. The premises cleansed and renovated throughout. 69 32, Huntsworth Mews ... The living rooms on first floor separated from the stable on ground floor and provided with separate entrance from the mews. Additional means of direct external light and ventilation provided to the two bedrooms. Water closet reconstructed in suitable position. Water provided from main with proper sink under. Ventilated food cupboard provided. The premises cleansed and renovated throughout. 16, Dorset Mews North Additional means of external light and ventilation provided to the back bedroom and the water closet. The roof repaired. The premises cleansed and renovated throughout. 16, Little Church Street Additional means of direct external light and ventilation provided to the rooms at rear of the premises. 6, Clarence Mews The attention of the owner was called to the unsatisfactory condition of these premises, which were subsequently closed, with a view to their conversion into a garage. 97, Princess Street The obstructive building at the rear of these premises demolished. Open back yard provided in place of same. Direct external light and ventilation provided to the rear of ground floor, basement and to the w.c. 99, Princess Street The obstructive buildings at rear of these premises demolished. The back yard thus provided properly paved and drained. Direct external light and ventilation provided to back rooms on ground and first floors. W.C. reconstructed in suitable external position. 70 101, Princess Street Proper means of direct external light and ventilation provided to the rear of the premises. Drainage and water supply systems amended. 128 (late 74), Church Street Additional means of external light and ventilation provided to the rear of the premises on ground floor. 4 to 14 (inclusive), Sherborne Place The attention of the owners was directed to the unsatisfactory condition of these premises. The necessary works are now in progress. 3A, Queen Anne Mews Water closet separated from living rooms and external light and ventilation provided. 13, Queen Anne Mews External light and ventilation provided to bedroom; defective drinking water cistern abolished and water laid on from main. 14, Queen Anne Mews Additional ventilation provided to water closet. 16, Queen Anne Mews External light and ventilation provided to bedroom. 15, Queen Anne Mews Living rooms reconstructed; additional ventilation provided to water closet. 28, 29, 30, Harley Mews North Living rooms above stables re-arranged and provided with separate entrance from mews; water closets cut off from living rooms and provided with external light and ventilation, 4, Wimpole Mews Premises demolished. Representations and Orders.—The accompanying tabular statement gives a list of the premises dealt with each year since 1910 under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. In 1914, though proceedings commenced in previous years and carried over were concluded or taken forward one or more stages, actually only one new case was submitted to the Public Health Committee for a closing order. 71 The premises in this case consisted of a front and back room in a basement, both of which, despite notice and warning, were habitually used as sleeping rooms. Almost immediately after the closing orders were made, occupation of the rooms was discontinued. Demolition Orders. —The question of making a demolition order came before the Public Health Committee in respect of 6 premises. In 6 cases the orders were made and the premises demolished. The demolition in 3 instances was carried out by the Borough Council, and in the remainder by the owners. In respect of 8 premises, for various reasons, no orders were made. In 6 the question was adjourned sine die after the committee was satisfied that a scheme embracing the houses was in contemplation, and that the premises would be so treated in the meantime that no nuisance would occur. In 1 case at the time of the consideration of the demolition order, the owners undertook to carry out such alterations as would render the premises fit for habitation, and in another the order was held over to allow of negotiations for the sale of the site to proceed. Appeals.-During the year two appeals against closing orders were heard by the Local Government Board, the first in respect of certain flats, Nos. 1, 2, 7, 8, 13 and 14, Dorset Buildings, New Street Mews, and the other with regard to Nos. 9 and 16, Montagu Mews South. The appeal in the Dorset Buildings case was heard in January and was dismissed. Shortly afterwards the owners submitted a scheme for altering the premises, which was approved by the Public Health Committee, and when the work was completed the closing orders were withdrawn. In the case of the premises 9 and 16, Montagu Mews South, the hearing of the appeal by the Local Government Board took place in April. The premises in this instance were the subject of a closing order by the Public Health Committee under Section 43 of the Housing, Town Planning, &c., Act, 1909, which forbids the erection of back-to-back dwellings, and the Board instead of giving a decision on the appeal stated a case for the High Court asking for guidance on two points, viz., as to whether or not the premises were back-to-back, and if, having been erected for chauffeurs, they were intended for occupation by members of the working classes. The case had not been heard when the year closed. The following table contains a summary of the work done to December 31st, 1914, under sections 17 and 18 of the Act in relation to closing and demolition orders: 72 HOUSING, TOWN PLANNING, ETC., ACT, 1909. Premises reported or represented during 1914, and the four previous years, Premises. 1910. 1911. 1912. 1913. 1914. 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. D.O. made. Premises demolished 10th July, 1914. 7, do. 8, do. 9, Providence Place C.O's made 18thNov., 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. 3, 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. 23th Aug., 1911 5th July, 1912, magistrate confirmed C.O.'s 19th Sept., 1912. Not occupied. 9, Charlton Street C.O. 29th Nov., 1912 D.O. made 2nd. May. 1913. Demolished 7th June, 1913. l; 2, 7, 8, 13-14, Dorset Buildings, New Street Mews 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 heard 8th Jan., 1914. L.G.B.confirmed decision of Local Authority and dismissed appeal. Necessary work executed and C.O. determined 12th June, 1915. 73 Premises, 1910. 1911. 1912. 1913. 1914. 10, Burne Street, cottage rear of C.O. made 13th June, 1913. D.O. made 20th Feb., 1914. Demolished 20th March, 1914. 11, do. do. Ditto Ditto 12, do. do. Ditto Ditto 24, Horace Street Ditto Negotiations pending. 3, Williams Place • Ditto Question of D.O. adjourned sine die. Premises vacated and boarded up 20th March, 1914. 5, do. Ditto Ditto 15th May, 1914. 11, do. Ditto Ditto 20th Mar., 1914. 4&4a, Allsop Street Ditto Ditto 6th Mar., 1914. 5, Fairlop Place C.O. 14th Nov., 1913. Ditto 15th (May, 1914. 6, do. C.O. 14th Nov., 1913. Ditto 15th May, 1914. 10, Little Church Street C.O. 14th Nov., 1913. Negotiations pending. 9, 10. 11, 12, 13, 14, 15 & 16 Montagu Mews South C.O. 28th Nov., 1913. Appeal to L.G.B. 28th April, 1914. L.G.B. state case for High Court Decision. 424, Edgware Road, front and back basement room C.O. made 20th Mar., 1914. Vacant 15th May, 1914. Houe-to-House Inspection. The total number of streets examined by the house-to-house inspector (Inspector Hodges), was 40. 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. The houses inspected numbered 1793 (separate houses, 1023; tenements in blocks 670). 74 In respect of these, 678 notices (intimations, 572; statutory notices, 106) 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 preceding fortnight and the estimated number of first inspections which remained to be made. The following tabular statement contains the particulars regarding the work called for by the Local Government Board in the Housing (Inspection of District) Regulations, 1910. 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. 1023 1 1 1 56 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. Six Demolition orders were made. Six houses were demolished. Eight Demolition orders adjourned. Two appeals heard, one of which still pending. and 670 Tenements in Blocks of Buildings after letters to Owners 572 in respect of which Notices (Intimations and Statutory) were served. Intimation 572 Statutory 106 678 Houses Let in Lodgings. At the end of 1913 the total number of houses on the register was 1213. During the year under review no additions were made to the list; the only change being the removal of 6 houses on account of demolition. The actual number on the register at the end of 1914 was, therefore, 1207. All of these were systematically inspected, and in all 7346 visits were paid: 2010 notices relating to cleansing and other defects were served, all of which were complied with without the necessity for further proceedings arising. 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. 75 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 40, as against 89 in 1913 and 85 in 1912. In every case discovered a notice was served, and in all a remedy was found. 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 19 L4 was 27, a considerably smaller number than in any recent year. For the reduction the active work done in the past and the supervision now exercised by the staff of the department are responsible. The total number of notices served was 17. Of the rooms to which these related 4 were occupied separately in contravention of Section 96 of the Public Health (London) Act, 1891, the remaining 13 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. 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. 76 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. In the majority of cases the notices were complied with, however, and only in one instance, already referred to, was it found necessary to make a closing order. Customs and Inland Revenue Acts. The number of certificates granted during 1914 for reduction or exemption from inhabited house duty under these Acts was 3. The situation of the premises and the number of tenements affected are shown in the following statement. Premises. Number of Tenements Aubrey Mansions, Lisson Street 15 Dorset Buildings, New Street Mews 18 Grove End House, St. John's Wood 46 In all cases a thorough examination was made of the premises and the certificate withheld till any improvements called for were carried out. 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 1913, and each had charge of the same district as previously. The total number of complaints received was 1,747, as against 2,070 in 1913, and 2,372 in 1912. The majority of these complaints were made by the inspectors themselves, the number from outside being 378. 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, 216 statutory notices were issued, as against 546 in 1913, and 551 in 1912. Of these notices, 126 related to ordinary nuisances (dirt, dampness, &c.) 20 to verminous rooms, 33 to drains, and 6 to insufficient w.c. accommodation. The remaining 31 were served on owners to provide a proper and sufficient supply of water to the upper storeys of tenement houses, under the London County Council (General Powers) Act of 1907. The number of such notices in 1913 was 90, and in 1912, 101. The 20 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1904, and referred to 34 rooms. The number of notices in 1913 was 54, in 1912, 47. 77 In 1,531 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 4 instances there was failure to carry out works after receipt of statutory notice and legal proceedings were instituted. Details of these cases will be found under the heading "Legal Proceedings in connection with Nuisances." 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 3474 3626 3475 3591 3480 17646 Houses damp, dirty or dilapidated remedied 115 197 187 169 80 748 Doors, windows, floors, ceilings, sash cords, etc., repaired 60 46 26 10 16 158 Overcrowding abated 10 16 12 1 1 40 Illegal occupation of underground rooms dealt with 2 8 11 7 1 29 Water closet defects remedied 161 227 65 124 59 636 Water closets erected 2 2 10 5 19 38 Urinal defects remedied 1 9 2 5 5 22 Soilpipe and ventilating shaft repaired or renewed 5 25 10 12 2 54 Yard defects remedied 110 81 44 47 19 301 Waste pipe defects remedied 10 51 12 27 21 121 Water cistern defects remedied 223 156 15 44 41 479 Rubbish, manure, etc., accumulations removed 17 34 51 21 17 140 Dung or dust receptacles repaired or renewed 64 33 51 15 10 173 Drains relaid or amended 72 129 43 59 10 313 Drains cleared 8 3 7 19 20 57 Rainwater pipes repaired or renewed 9 33 14 7 15 78 Water supply to houses reinstated 3 6 2 — 2 13 Roofs and gutters repaired 41 66 22 13 24 166 Area defects remedied 9 19 32 23 16 99 Wash-house defects remedied 107 101 22 21 7 258 Animal nuisances abated — 14 7 4 5 30 Basement defects remedied 5 52 31 35 27 150 Stables cleansed or repaired 4 7 1 1 2 15 Water supply laid on to upper storeys of house 74 39 16 20 3 152 Miscellaneous nuisances abated 39 29 87 4 8 167 Verminous rooms cleansed 74 75 28 23 11 211 Workshops, damp, dirty or dilapidated, remedied 38 24 17 68 69 216 Legal Proceedings in Connection with Nuisances. The number of summonses issued during the year was 4. 78 Particulars with regard to each of the cases are given below, and it should be noted that in each instance, though there were contraventions of provisions contained in other acts and bye-laws, the Public Health (London) Act, 1891, is the only enactment mentioned in the list. Premises. Offence. Proceedings taken under. Result. 65, Salisbury street Failure to comply with a statutory notice requiring (1) provision of water supply to the upper storeys of the premises; (2) provision of a drinking water cistern with a close fitting cover Public Health (London) Act, 1891, etc. Work completed after 14 days adjournment. Summons withdrawn. Costs, 4/- 29, Frederick street Failure to comply with a statutory notice requiring (1) the yard and washhouse paving to be repaired; (2) provision of a drinking water cistern, with a close fitting cover, in an accessible position; (3) provision of water supply to the upper storeys of the premises Do. Work completed. Summons witndrawn. Costs, 25/- 30, Frederick street Failure to comply with a statutory notice requiring (1) the yard paving to be repaired; (2) provision of water supply to the upper storeys of the premises; (3) provision of a drinking water cistern, with a close fitting cover, in an accessible position; (4) repair of drain ventilating shaft Do. Work completed. Summons withdrawn. Costs, 25/- 42, Exeter street Failure to comply with a statutory notice requiring (1) provision of water supply to the upper storeys of the premises; (2) provision of a properly covered movable metal receptacle for storage of house refuse Do. Order to abate nuisance within 7 days. Costs, 25/-. Dustbin provided. Summons withdrawn. Costs, 23/- DRAIN PLANS AND DRAINAGE. During the whole of 1914, 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 8,204 as against 10,200 in 1913 and 9,826 in 1912. 79 The number of plans relating to new buildings was 87 (north 23, south 64). In the case of old buildings, the number of plans received was 341 (north 199, south 142). The total number of plans deposited was 428, the number for 1913 being 457. Combined Drainage.—The number of orders under Seal as to combined drainage granted by the Council was 6, the number in 1913 being 7. 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 1,267, and 3 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 many cases the excuse offered was that on account of the war it was impossible to obtain smokeless coal and, further, that Navy men, who make the best stokers, had gone back to the Service. These appeared to be reasonable, and no notices were served or summonses issued. REMOVAL OF HOUSE REFUSE. During 1914 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 financial year to 31st March, 1915, was £ 12,695. The contract expires March 31st, 1915. The following table shows the amount paid under the removal of house refuse contracts during the last 6 years:— 1909-10 £10,671 Messrs. Mead & Co., Ltd. 1910-11 £10,500 Do. 1911-12 £10,500 Do. 1912-13 £12,895 Mr. W. E. Cloke. 1913-14 £12,895 The Western Cartage Co., Ltd. 1914-15 £12,695 Do. 80 The number of complaints, letters and refusals received in respect of the removal of house refuse is shown in the table below. There were no contraventions of the terms of the contract calling for the imposition of penalties during 1914. NORTH DISTRICT. Year. Complaints. Letters. Refusals. Fines. 1905 53 66 227 W. Mead & Co., Ltd., £20 and £26 5s. 1906 49 61 51 W. Mead & Co., Ltd., £15, and E. H. Jackson & Co., Ltd., £5 1907 46 54 83 E. H. Jackson & Co., Ltd., £50 1908 26 63 114 — 1909 18 68 135 — 1910 43 84 117 W. Mead & Co., Ltd , £1 1911 105 111 466 W. Mead & Co., Ltd, £51 1912 43 98 361 G. E. Cloke, £25 1913 34 74 752 — 1914 43 112 867 — SOUTH DISTRICT. Year. Complaints. Letters. Refusals. Fines. 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 £6 269 1913 54 184 — 1914 48 204 210 — 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. The number of old brick receptacles demolished during the year was 6. New metal dust receptacles to the number of 97 were provided. During the year the dust inspectors—Lumley and Hill—made 10,797 visits; the former, 8,059 ; the latter, who only gives part time to the work, 2,738. For neglect of the provisions with regard to the covering of dust bins, etc., 268 notices were served. Remedies in each case were carried out, legal proceedings only being necessary in one case. 81 VERMINOUS PERSONS' BATHS. During 1914, the total number of adults using the Baths was 7,934 (males, 5,555; females, 2,379). The children bathed numbered 1,866, 623 being boys and 1,243 girls. The addresses given by the adults included Salvation Army Shelter 3,374 and lodging houses 494. In 1,687 instances no address was given, and in 406 (274 males, 132 females) the applicants stated they had come from the Church Army. The Portman House was given as an address by 247 females. The London County Council still continues to send the majority of the children who attend, making payment in each case for the treatments. The payments received amounted to £87 12s. 0d., and there was in addition 15s. 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 1914:— ADULTS. CHILDREN. 1914. Males. Females. Total. Males. Females. Total. January 494 161 655 64 89 153 February 449 180 629 55 110 165 March 485 191 676 79 98 177 April 430 183 613 44 69 113 May 446 176 622 32 154 186 June 450 205 655 59 107 166 July 421 185 606 36 88 124 August 486 293 779 22 52 74 September 499 264 763 60 188 248 October 519 250 769 85 108 193 November 466 144 610 60 100 160 December 410 147 557 27 80 107 Totals 5,555 2,379 7,934 623 1,243 1,866 82 Table showing the number of persons using the Baths during the past 17 years:— Year. ADULTS. CHILDREN. Males. Females. Total. Males. Females. Total. 1898 3,301 5 3,306 — — — 1899 4,340 — 4,340 — — — 1900 3,431 31 3,462 — — — 1901 4,140 142 4,282 — — — 1902 4,326 202 4,528 — — — 1903 5,515 655 6,170 — — — 1904 7,089 1,376 8,465 — — — 1905 7,981 1,431 9,412 107* 353 460 1906 6,891 1,974 8,865 1,873 3,311 5,184 1907 6,785 1,807 8,592 2,367 3,404 5,771 1908 8,741 2,563 11,304 2,198 3,046 5,244 1909 8,563 2,551 11,114 2,725 1,959 4,684 1910 6,433 2,051 8,484 513 859 1,372 1911 6,510 2,575 9,085 504 463 967 1912 5,818 2,384 8,202 740 1,138 1,878 1913 5,797 2,208 8,005 771 1,305 2,076 1914 5,555 2,379 7,934 623 1,243 1,866 Totals 101,216 24,334 125,550 12,421 17,081 29,502 The Children's Baths were opened in June, 1905. THE SHELTER. The accompanying statement shows the number of times the Shelter was used during 1914 and the reasons for such use. No. of hours occupied. Reason for occupation. No. of persons. June 8th and 9th 16 Diphtheria 2 adults, 1 child. August 28th 4 . Puerperal Fever 1 adult. December 2nd and 3rd 16 Phthisis 2 adults, 3 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. 83 Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1914. Males. Females. Total. For burial only. For inquests. Total. No. of. P.M.'s held No. of courts held. No. of Infectious cases. January 25 16 41 26 15 41 12 6 — February 10 18 28 17 11 28 4 6 1 March 16 15 31 15 16 31 8 8 — April 17 8 25 10 15 25 7 8 — May 20 12 32 14 18 32 10 7 — June 16 2 18 11 7 18 4 7 — July 13 8 21 6 15 21 7 7 1 August 12 14 26 14 12 26 5 4 — September 14 12 26 14 12 26 6 6 — October 16 11 27 11 16 27 7 7 — November 15 11 26 15 11 26 5 6 — December 12 12 24 11 13 24 7 7 — Totals 186 139 325 164 161 325 82 79 2 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 1915, and the amount of increase or decrease as compared with the previous year. 1914-15. 1913-14. Increase. Decrease. £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus—Men's Department 841 18 2 1056 14 7 — 214 16 5 „ Women's „ 693 16 9 838 12 0 — 144 15 3 Portland Road—Men's „ 235 14 5 281 0 0 — 45 5 7 „ Women's „ 166 16 1 183 9 6 — 16 13 5 Marylebone Road—Men's „ 171 13 5 214 11 10 — 42 18 5 „ Women's „ 114 11 6 130 11 7 — 16 0 1 Foley Street—Men only 117 4 7 134 13 7 — 17 9 0 St. John's Wood Road—Men only 87 10 2 101 6 2 — 13 16 0 Barrett Street—Men only 138 12 11 150 10 5 — 11 17 6 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). The fact that this provision was made accounts for the tailing off in receipts from the women's conveniences in each of these three situations; the decrease from the men's conveniences is accounted for by the fact that soon after the outbreak of war the council resolved that no charge should be made to men in uniform. 84 FACTORIES AND WORKSHOPS. The total number of visits to factories, workshops and workplaces during the year was 4,398, 684 by the women and 3,714 by the men inspectors. The complaints received numbered 42. 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. 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 196 31 — Workshops (Including Workshop Laundries.) 3,035 180 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1,167 162 — Total 4,398 373 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 102 102 — — Want of ventilation 13 13 — — Overcrowding 4 4 — — Want of drainage of floors 1 1 — — Other nuisances 137 137 — — Sanitary accommodation insufficient 29 29 — — unsuitable or defective 74 74 — — not separate for sexes 4 4 — — 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) 9 9 — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 373 373 — — 85 3.—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. NATURE OF WORK. Lists received from Employers. Notices served on 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) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 110 400 1,506 ... ... ... 66 ... ... ... ... ... ... ... ... Household Linen 2 ... 12 ... ... ... 1 ... ... ... ... ... ... ... ... Umbrellas, etc. ... ... ... 2 ... 6 1 ... ... ... ... ... ... ... ... Total 112 400 1,518 2 ... 6 68 ... ... ... ... ... ... ... ... 86 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 4,436 Coffee Shops, &c. 238 Bakehouses 73 Total number of workshops on Register 4,747 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 5 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 42 Reports (of action taken) sent to H.M. Inspector 42 Other ... Underground Bakehouses (s 101):— Certificates granted during the year ... In use at the end of the year 63 87 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 237 Cowhouses 5 Slaughterhouses 4 Offensive Trades 2 Ice Cream Premises 117 Bakehouses 73 Restaurant, Dining Room and Coffee Shop Kitchens 155 Hotel Kitchens 38 Pastrycooks and Tea Rooms 45 Fried Fish Shops 25 Fish Curers 6 Houses Let in Lodgings 1207 Workshops 4436 Total 6350 A statement with special reference to the list set out above, is contained in the folllowing tables:— Number of places Number of inspections, 1914. Number of notices, 1914. Number of prosecutions, 1914. On register at end of 1913 Added in 1914. Removed in 1914. On register at end of 1914. Milk premises 229 11 3 237 580 12 — Cowsheds 5 — — 5 33 — — Slaughterhouses 6 — 2 4 50 — — Offensive trade premises 2 — — 2 45 — — Ice cream premises 105 18 6 117 128 19 — Houses let in lodgings 1213 — 6 1207 7346 2010 — Mortuary. Removed by Inspectors. Number of bodies received 325 — Number of Infectious bodies received — 2 Disinfection. Number of rooms disinfected 1,176 Number of articles disinfected 21,563 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 5,555 2.379 623 1,243 9.800 88 Bakehouses. Number on register at end of 1914 73 Number above ground 10 Number underground 63 Number of inspections 159 Number of Notices. Intimations, 7; Statutory Notice, 1 8 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1914 269 Number of Inspections 803 Number of Notices 82 House to House Inspections. Number of Inspections Houses 1,023 Tenements in blocks 670 Number of Notices issued Intimations 572 Statutory Notices 106 Number of Prosecutions Nil House Refuse. Number of Inspections 10,797 Number of Old Brick Receptacles abolished 6 Number of New Metal Receptacles provided 97 Number of Complaints of Non-removal received 91 Number of Letters received re Removal 316 Number of Refusals of Occupiers to have House Refuse removed 1,072 Number of Notices served—Intimations, 268; Statutory Notices, 8 276 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 152 Number of Statutory Notices served 31 Number of Prosecutions 4 Overcrowding. Number of Dwelling Rooms overcrowded 40 Number remedied 40 Number of Prosecutions Nil Underground Rooms. Number dealt with 27 Number of Notices served under P. H. (L.) Act, 1891 4 Number of Notices served under H. T. P., &c., Act, 1909 13 17 Number of Prosecutions Nil 89 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 1 Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (1), Number of rooms cleansed 211 Number of Prosecutions Nil Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year:— 5 adults. 4 children. Revenue Acts. Number of houses for which applications were received 3 Number of tenements comprised therein 79 Number of tenements for which certificates were granted 79 „ „ „ „ refused Nil „ „ „ „ deferred Nil LOCAL GOVERNMENT BOARD AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1914 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 District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett No. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1914 112,892 3,847 2,128 18.7 1,631 15.1 813 787 210 98.6 1,605 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. 90 TABLE I. (A). Vital Statistics of Separate Localities in 1914 and the ten Previous Years. Names of Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John. Year., Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1904 131,000 2,791 2,172 393 34,781 598 512 79 37,293 740 560 106 38,853 1,058 753 168 20,073 395 347 40 1905 129,453 2,618 2,026 358 34,370 527 438 81 36,853 696 530 81 38,394 1,043 723 154 19,836 352 335 42 1906* 127,960 2,648 1,931 322 33,974 520 408 64 36,428 627 556 72 37,951 1,088 652 141 19,607 413 315 45 1907 127,718 2,583 1,931 264 33,908 537 415 47 36,358 629 510 51 37,881 1,029 683 131 19,571 388 323 35 1908 126,867 2,559 1,845 267 33,683 460 419 55 36,177 588 506 77 37,628 1,107 675 105 19,439 404 245 26 1909 126,027 2,534 1,849 259 33,460 674 424 59 35,878 502 461 49 37,379 1,041 681 123 19,310 317 283 28 1910 125,195 2,556 1,607 252 33,239 716 355 59 35,641 432 417 48 37,133 1,016 582 115 19,182 392 253 31 1911 117,844 2,375 1,818 261 29,392 502 400 40 32,025 485 440 49 36,425 1,041 690 137 20,002 347 288 35 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 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 Averages of Years 1904 to 1913 124,273 2,505 1,824 278 32,434 538 409 55 34,934 555 475 59 37,294 1,039 667 129 19,617 373 291 32 1914 112,892 2,128 1,605 210 28,158 435 317 36 30,678 418 388 33 34,895 937 630 113 19,161 338 270 28 *The Rectory and St. Mary's Registration Sub-Districts were amalgamated this year. 91 TABLE II. Cases of Infectious Disease Notified during the 52 Weeks ending 26th December, 1914. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. N umber of cases removed to Hospital from eitch locality. Cases isolated at home At all ages. At ages—years. All Souls St. Mary Christ Church St. John Totals. All Souls St. Mary Christ Church St. John Totals Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 anil upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 229 16 96 85 21 10 1 ... 70 31 100 28 229 70 31 99 28 228 1 Erysipelas 65 1 2 2 4 17 28 11 14 17 30 4 65 7 11 9 3 30 35 Scarlet Fever 432 2 113 244 38 34 1 ... 100 92 181 59 432 94 91 176 51 412 20 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 36 ... ... 13 13 8 2 ... 7 9 16 4 36 7 7 15 4 33 3 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 9 ... ... ... ... 9 ... ... 3 ... 2 4 9 1 ... 2 3 6 3 Ophthalmia Neonatorum 25 25 ... ... ... ... ... ... 5 10 7 3 25 5 8 3 2 18 7 Cerebro-Spinal Fever 1 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... Phthisis Pulmonary 424 2 20 62 58 152 118 12 75 91 191 67 424 15 19 35 5 74 350 Non-Pulmonary 78 2 14 33 5 16 6 2 11 9 51 7 78 4 3 8 2 17 61 Totals 1299 49 245 439 139 246 156 25 285 259 579 176 1299 203 170 348 98 819 480 1299 92 TABLE III. Causes of, and Ages at Death during the year ending 26th December, 1914. No. CAUSES OF DEATH. Nett deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 Enteric Fever 7 — — — 2 2 2 1 — 5 2 Small-pox — — — — — — — — — — 3 Measles 3 1 1 1 — — — — — 1 4 Scarlet Fever 9 — 2 4 2 — 1 — — — 5 Whooping-Cough 16 7 6 3 — — — — — 1 6 Diphtheria and Croup 17 5 4 8 — — — — — 1 7 Influenza 18 — — — 1 — 2 7 8 3 8 Erysipelas 2 1 — — — — — 1 — — 9 Phthisis (Pulmonary Tuberculosis) 152 1 1 1 4 15 58 58 14 19 10 Tuberculous Meningitis 14 3 — 4 3 — 4 — — 17 11 Other Tuberculous Diseases 17 1 1 1 5 2 1 4 2 9 12 Cancer 138 1 — — — — 14 69 54 303 13 Rheumatic Fever 6 — — — 2 — 1 2 1 3 14 Meningitis 10 2 2 2 2 — 1 — 1 10 15 Organic Heart Disease 172 — — 1 3 5 15 54 94 63 16 Bronchitis 181 10 4 3 — — 14 45 105 31 17 Pneumonia (all forms) 109 19 4 7 3 4 16 30 26 19 18 Other Diseases of Respiratory Organs 17 — — — — 1 7 5 4 6 19 Diarrhœa and Enteritis (under two years) 36 31 5 — — — — — — 4 20 Appendicitis and Typhlitis 9 — — — 1 2 1 5 — 23 21 Cirrhosis of Liver 18 — — — — — 4 10 4 9 21a Alcoholism 4 — — — — — 3 1 — 1 22 Nephritis and Bright's Disease 68 — — — 3 — 12 29 24 26 23 Puerperal Fever 3 — — — — — 3 — — 6 24 Other accidents and diseases of Pregnancy and Parturition 13 6 — — — 2 5 — — 11 25 Congenital Debility and Malformation, including Premature Birth 53 51 — 1 1 — — — — 48 2G Violent Deaths, excluding Suicide 55 — 3 1 4 5 9 20 13 38 27 Suicides 14 — — — — 3 7 4 — 7 28 Other defined Causes 444 71 5 1 6 13 48 116 184 253 29 Diseases ill defined or unknown — — — — — — — — — — Totals 1605 210 38 38 42 54 228 461 534 947 93 TABLE III. (a).—Causes of, and ages at death during the 52 weeks to 26th December, 1914, according to Sub-Districts. No. CAUSES OF DEATH. All Souls. St. Mary. Christ Church St. John. Total. 1 Entcric Fever 1 1 4 1 7 2 Small Pox — — — — — 3 Measles 1 1 1 — 3 4 Scarlet Fever 2 1 4 2 9 5 Whooping Cough 3 2 9 2 16 6 Diphtheria and Croup 2 2 11 2 17 7 Influenza 2 10 3 3 18 8 Erysipelas — 2 — — 2 9 Phthisis (Pulmonary Tuberculosis) 18 38 73 23 152 10 Tuberculous Meningitis 3 1 7 3 14 11 Other Tuberculous Diseases 3 4 9 1 17 12 Cancer 35 39 44 20 138 13 Rheumatic Fever — 4 1 1 6 14 Meningitis 2 1 6 1 10 15 Organic Heart Disease 32 46 73 21 172 16 Bronchitis 32 47 73 29 181 17 Pneumonia (all forms) 21 19 51 18 109 18 Other Diseases of Respiratory Organs 3 3 6 5 17 19 Diarrhœa and Enteritis (under 2 years) 3 5 23 5 36 20 Appendicitis and Typhlitis 3 3 3 — 9 21 Cirrhosis of Liver 4 6 4 4 18 21a Alcoholism 1 3 — — 4 22 Nephritis and Bright's Disease 19 19 19 11 68 23 Puerperal Fever — — — 3 3 24 Other accidents and diseases of Pregnancy and Parturition 3 2 6 2 13 25 Congenital Debility and Malformation, including Premature Birth 15 14 19 5 53 26 Violent Deaths, excluding Suicide 14 8 24 9 55 27 Suicides 3 3 6 2 14 28 Other defined Causes 92 104 151 97 444 29 Diseases ill defined or unknown — — — — — Totals 317 388 630 270 1605 94 VACCINATION RETURNS. Return for the Period January—June, 1914. Return made to the Board of Guardians and Local Government Board on the 8th February, 1915, 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, 1914, 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, 1914. Number of these Births duly entered by 31st January, 1915, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1915, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1915, 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 Objections actually received by the VaccinationOfficer irrespective of the dates of birth of the children to which they relate during the year 1914. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, 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 5 6 7 8 9 10 11 12 1. St. John 152 100 ... ... 36 5 1 3 6 1 414 2. Christchurch 433 276 4 ... 79 24 6 5 25 14 3. St. Mary 1,045 759 3 ... 79 60 97 29 16 2 4. All Souls 356 247 1 ... 32 22 10 31 11 2 Total 1,986 1,382 8 ... 226 111 114 68 58 19 414 Dated 8th February, 1915. (Signed) EDWARD A. FRITH, Vaccination Officer. 95 VACCINATION RETURNS. Supplemental Return for 1913. Return made to the Board of Guardians and Local Government Board on the 8th February, 1915, 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, 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 31st Dec, 1913. Number of these Births duly entered by 31st January, 1915, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1915, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1915, 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 Successful Primary Vaccination at ALL AGES received during the calendar year 1914. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, Unvaccinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had SmallPox. 1 2 3 4 6 6 7 8 9 10 11 12 1. St. John 308 224 ... ... 52 12 4 4 7 5 2,920 2. Christchurch 801 527 1 ... 113 65 12 10 62 11 3. St. Mary 2,047 1,584 3 ... 125 105 136 69 22 3 4. All Souls 662 484 ... ... 50 45 8 53 16 6 Total 3,818 2,819 4 ... 340 227 160 136 107 25 2,920 Dated 8th February, 1915. (Signed) EDWARD A. FRITH, Vaccination Officer.