AC 4353 Metropolitan JBorougb of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1915, 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. 1916. Metropolitan Borough of St. marylebonc. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1915, Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. London : Geo. Pulman & Sons, Ltd., Printers. 1916. geo. pu1.man & sons, ltd., london and wealdstonf. public Health Office, 24, Somerset Street, London, W. 29th June, 1916. 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 1915, on the public health and sanitary condition of St. Marylebone. Acting on further instructions of the Board, I have curtailed the report considerably, but I believe I have written enough to show that on the whole, the year was a fairly satisfactory one and that despite the circumstances and the great reduction in the size of the staff on account of enlistments, a great amount of really valuable work was done. I am glad to take this opportunity of thanking the members of the Public Health Committee for the kindness and consideration they have shown me throughout the year. Councillor Sir Horatio Shephard and the Committee under his chairmanship, always greatly interested in the work and impressed with the necessity of doing everything possible on behalf of the public health, showed themselves no less ready than in normal times to give sympathetic consideration to every suggestion made that was likely to lead to betterment and to support it if it were likely to do good. Fortunately during the whole year the late Mr. Alderman John Lea-Smith was with us, and though he was unable to attend the meetings as regularly as in previous years, still kept in close touch with the Department and particularly with the part of the work relating to refuse removal and disposal. Speaking as an Officer of the Council, I should like to say that Mr. Lea-Smith will be missed for a very long time. A member of the Public Health Committee for a number of years, seriously interested in the work that was done and a sound business man, his advice was always valuable, and I shall always look back with the greatest pleasure to my association with him and always regret his loss. In conclusion, I should like to thank the members of the staff—those who are now serving with the colours as well as those who are still on duty here—for their loyalty to me and for the admirable way in which they have worked. When in November the numbers were reduced by the enlistment of all men who were fit and of military age, and it became necessary to make considerable alterations and rearrangements, the remaining members without hesitation undertook to carry on all the work until their return, and willingly accepted increased duties. All have worked with an admirable devotion deserving of the mention which I am glad to make of it here. I am, Mr. Mayor, Madam and Gentlemen, Your obedient servant. CHARLES PORTER. TABLE OF CONTENTS. Part I. Statistical. Population page 9 page Records of Diseases 18 Notifications 18 Births, Registration, Notifications 9 Discharge Notices 19 Deaths and Death Rates 9 Diphtheria and Membranous Croup 19 District Births and Deaths 10 Scarlet Fever 19 Enteric Fever .. 19 Deaths in relation to age 10 Cerebro-Spinal Fever 20 Infantile Mortality 10, 11, 12, 13 Erysipelas 21 Prevention of Infantile Mortality 14, 15 Puerperal Fever 21 Measles 21 Maternity and Infant Welfare 14, 15 „ Deaths 21 „ Isolation of 21 Deaths in relation to Disease 15 Whooping Cough 22 Diarrhceal Diseases 15 Polio Encephalitis and Myelitis 21 Zymotic Diseases, Phthisis, &c., and Respiratory Diseases 16 Ophthalmia Neonatorum 21 Tuberculosis .. 22 „ Notifications 22, 23 Zymotic (Communicable) Diseases 16 „ Deaths 24 Phthisis and other Tuberculous Diseases 16, 17 „ Dispensary Scheme 25 „ Preventive Measures against 24, 25 Respiratory Diseases 17 „ Bacteriological diagnosis of 26 Syphilis 26 17 Cancer and Malignant Disease Disinfection 27 Alcoholism 18 Bacteriological Examinations 28 Part II. Departmental. page page Staff 31 House to House Inspection 47 Effect of War Conditions 32 Houses Let in Lodgings 47 Protection of Food Supply 32 Common Lodging Houses 47 Inspection 32 Overcrowding 48 Surrenders 33 Underground Rooms 48 Seizures 33 Customs and Inland Revenue Acts 48 Prosecutions 33 Nuisances 48 Slaughterhouses 33 Work of Sanitary Inspectors 49 Milk Supply 34 Legal Proceedings 50 Cowhouses 34 Drain Plans and Drainage 51 Milkshops, etc. 34 Combined Drainage 51 Examination of Milk 34, 35 Black Smoke Nuisances 50 Ice Cream Premises 35 Removal of House Refuse 51, 52 Butter, Margarine, etc. 35 Verminous Persons Baths 52 Restaurants, Food Stalls, etc. 35 Cleansing of Persons Act, 1897 52 Offensive Trades 35 The Shelter 52 Bakehouses 36 Public Mortuary 53 Sale of Food and Drugs Acts 36, 43 Public Sanitary Conveniences 53 Public Analyst's Reports 37, 43 Factories and Workshops 54 Public Health (Milk and Cream) Regulations, 1912 43 Inspection 54 Defects Found 54 Bacteriological Examination of Food 44 Home Work 55 Water Supply 44 Registered Workshops 56 Housing 45 Sanitary Inspection (Summary) 57, 59 Housing, Town Planning, etc. Act, 1909 45, 47 Local Government Board Tables I.-III. 60, 63 Part I. STATISTICAL. \ 9 POPULATION. The population of the Borough for 1915, as estimated by the Registrar-General, was 100,260, which is lower than that in 1914 by 12,632 and 17,584 below that of the census year 1911. The number given above may be taken to be distributed as follows: All Souls, 25,002 ; St. Mary, 27,342; Christ Church, 30,901; St. John, 17,015. With regard to all of these figures it should be noted that estimation of population, difficult at all times, is at present for reasons into which it is unnecessary to enter, considerably more difficult, and in order to arrive at the figure given, the Registrar-General has been driven to adopt a method quite different from that usually employed. With a few exceptions, all the rates referred to later, are calculated on the figure given, viz,: 100,260, which being so much lower than those for previous years will make death and other rates appear very much higher. BIRTHS. Registration. During 1915, 1,852 births were registered. Of these, 944 were boys and 908 girls. The total figure for 1914 was 2,128 and the boys numbered 1,095 and the girls 1,033. The birth rate for the Borough and the registration districts was as follows : The Borough, 16.2; All Souls, 13.3 ; St. Mary, 11.2: Christ Church, 22.9; St. John, 18*6. Notifications (Notification of Births' Act, 1907).—The births notified numbered 3,645. The figure for 1914 was 3,901. The chief sources of notifications were Parents : 212. Doctors : 375. Midwives : 843. Hospitals : 2,215. Of the total births notified, 136 referred to still births (83 males and 53 females); 1,825 took place at Queen Charlotte's Hospital: 369 at Middlesex Hospital; 2 at the Samaritan Hospital and 2,215 were born at home. A number of those notified (1,793), belonged to other boroughs. DEATHS AND DEATH RATES. After making allowance for deaths occurring outside the Borough boundaries and excluding those which, though registered here, belonged to other districts, the total deaths amounted to 1,697. The death rate per 1,000 for the year, calculated on this figure and the population figure provided by the Registrar-General was 17.8. Comparison with the rate for 1914 and other years is impossible since these were " corrected " figures. The rates in the registration sub-districts were : All Souls, 13.6 ; St. Mary, 15.4; Christ Church, 20.6 ; St. John, 15.2. 10 The following tables are repeated from previous reports for the reason that they contain information that has been proved to be of value: Table I. Sub-district. Population estimated to Middle of year 1915 Births. Deaths. Males. Females Total. Males. Females. Total. All Souls 25002 191 176 367 163 178 341 St. Mary 27342 172 165 337 200 222 422 Christ Church 30901 405 396 801 345 294 639 St. John . 17015 176 171 347 140 155 295 The Borough 100260 944 908 1852 848 849 1697 Table II. To show the number of deaths amongst infants under 1 year and adults of 65 and over in each of the four quarters of the year: JanuaryMarch. AprilJune. JulySeptember. OctoberDecember. Totals. Infants under 1 year 50 45 43 40 178 Persons of 65 and upwards 231 160 105 150 646 A further table giving the vital statistics of separate localities for 1915 and the 10 preceding years will be found amongst the Local Government Board tables on page 61. Deaths in Relation to Age. The following table shows the distribution of the deaths according to age and compares 1915 with the two preceding years. The deaths under 1 year it will be noted are fewer than those for 1914: 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 1913 195 66 47 51 36 229 448 555 1627 1914 210 38 38 42 54 228 461 534 1605 1915 178 74 46 37 59 194 463 646 1697 Causes of and Ages at Death.—Statistical information with regard to the causes of and ages at death will be found in Table III of the Local Government Board series on page 63. The following notes are additional to the analysis given there. INFANTILE MORTALITY, Infantile Mortality Rate.—The number of babies under 1 year who died during 1915, was 178; in the same period the number of births was 1,852; the infantile mortality rate was therefore 96.1. Infantile Mortality Figures. 12 Despite the fact that there seemed every reason for expecting an increase, the figure given is lower than that for 1914 by 2.5 per 1,000. This is exceedingly gratifying, particularly, as is shown on the accompanying chart, it brings the curve nearer to the line of fall commenced in 1912. So far as the distribution of the deaths in relation to districts, to age at death, and to causation is concerned, the following tables give very full information :— TABLE III. Sub-District. Under i week i and Under 2 weeks 2 and Under 3 weeks 3 and Under 4 weeks 4 weeks and Under 3 m'ths. 3 m'ths and Under 6 m'ths. 6 m'ths and Under 9 m'ths. 9 m'ths and Under 12 m'ths. Total All Souls 5 2 - - 5 4 1 4 21 St. Mary 10 1 3 2 3 7 3 6 35 Christ Church 8 4 1 5 18 20 16 22 94 St. John 5 1 — — 4 9 0 4 28 Totals 28 8 4 7 30 40 25 86 178 Table III. shows Christ Church to be again at the head of the list. The reasons why it should occupy this position have been so often noted that it is unnecessary to repeat them. Table IV. analyses the causes of death in relation to age and district, and, as in previous years, prematurity, diarrhoea and enteritis and respiratory diseases are again the main causes. Prematurity (numbers 12, 13 and 14 in the table) which caused 69 or 32 per cent. of the total in 1914, in 1915 took 51 or 28.6 per cent.; diarrhoea and enteritis (7 and 8) accounted for 30 or 14 per cent. in 1914 and for 31 or 17.4 per cent. in 1915, while respiratory diseases took 29 or 13'8 per cent. in 1914 and in 1915 28 or 15.4 per cent. Amongst the other causes of death, mention may be made of the commoner infectious diseases, which together led to 16 deaths amongst infants (9 per cent. of the total). Of the 16.5 were due to whooping cough and 10 to measles. Injury at birth accounted for 1 death: the smallest number for several years. Some form of tuberculosis was given as the cause in 4 instances, and in 6 convulsions. Overlying was stated to be responsible in 5 cases as against 2 in 1914. Three of the victims were aged under one month at the time of death. 13 TABLE IV. Infant Mortality. Nett Deaths from Stated Causes at various ages and in Sub-Districts, under 1 Year of Age. Under 1 and 2 and 3 and Total 1 and 3 and 6 and 9 and Total Deaths under 1 Year. No. CAUSE OF DEATH. 1 under 2 under 3 under 4 under 1 under 3 under 6 under 9 under 12 All Souls. St. Mary. Christ St. John. Total. Week. Weeks. Weeks. Weeks. month. Months Months Months Months Church. 1 Small-Pox — — - - - - - - 2 Chicken-Pox — — — — — — — — - - - - - 3 Measles — — — — — — 1 1 8 10 3 5 2 10 4 Scarlet Fever — — — — — — — — - - - - - 5 Diphtheria and Croup - - - - - - - - 1 1 - - 1 - 1 6 Whooping Cough — — — — — -- 2 2 1 5 - - 4 1 5 7 Diarrhoea — — — — — 2 4 — 6 1 - 4 1 6 8 Enteritis — 3 — — 3 3 9 4 6 25 1 4 18 2 25 9 Tuberculous Meningitis - - - - - - 1 1 2 4 1 1 I 1 4 1o- Abdominal Tuberculosis - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation 2 1 2 — 5 2 — — 1 8 1 3 2 2 8 13 Premature Birth 17 — 1 3 21 6 1 — 28 6 12 8 2 28 14 Atrophy, Debility and Marasmus 1 1 - 1 3 5 3 3 1 15 1 2 8 4 15 15 Atelectasis — — — — — — — — - - - - - - 16 Injury at Birth 1 — — — 1 — — — 1 - 1 1 17 Erysipelas — — — — — — — - - - - - 18 Syphilis 1 — — — 1 — 1 — _ 2 - - 1 1 2 19 Rickets — — — — — — — - - - - - 20 Meningitis (not Tuberculous) - - - - - - 4 1 1 6 1 1 3 1 6 21 Convulsions — 1 — — 1 2 1 1 1 6 1 1 3 1 6 22 Gastritis — - — — - - - - - - 23 Laryngitis — — — — — — — — 1 1 1 1 24 Bronchitis — — — 1 1 1 2 4 1 1 2 4 25 Pneumonia (all forms) — 1 — — 1 5 6 4 8 24 4 4 15 1 24 26 Suffocation, Overlying 2 1 — — 3 1 1 — 5 1 3 1 5 27 Other Causes 4 — 1 2 7 4 5 6 5 27 3 2 16 H 27 Totals 28 8 4 7 47 30 40 25 36 178 21 35 94 28 178 Legitimate, 1,710 Legitimate Infants, 128 Nett Births in the Year Nett Deaths in the Year Illegitimate, 142 Illegitimate Infants, 50 Total 1,852 Total 178 14 PREVENTION OF INFANTILE MORTALITY. As already noted the infantile mortality rate which had been 98'6 per 1,000 births in 1914 fell to 96T in 1915. In previous reports when, as frequently happened, it was necessary to record improvements in this connection, it was stated that, apart from the efforts put forth by the Council, those of the St. Marylebone Health Society were largely responsible. As regards 1915, the same statement may be made, but it should be added that that year saw considerable advances made by both parties. The women inspectors of the Council and the workers of the Society have combined and extended their work of visiting homes and advising mothers with regard to the feeding and care of infants and on hygiene generally. At the infant consultations everything possible has been done to induce mothers to bring their babies and to take advantage of the medical advice provided and of the classes of instruction conducted there. At the end of the year there were four infant consultations in operation, viz., at Church Street and Henry Street in the portion of the Borough north of Marylebone Road, and at Welbeck Street Dispensary and Ogle Mews in the southern portion of the Borough. At each of these there were one or more clinics every week, each presided over by a doctor, assisted by a number of voluntary workers. At these clinics assistance was rendered also by one or other of the Council's women inspectors. At the Church Street consultation, which is the largest of all, there is a paid worker who gives all her time to the work there. Up till October the salary of this officer was paid by the Health Society but later, the Local Government Board having approved, the Council made themselves responsible for the payment of the amount, and while placing her on the staff of the Public Health Department, detached her for work at Church Street. In connection with each of the consultations there operates what is known as a School of Mothercraft. At each of these, instruction with regard to cooking, sewing and other domestic matters is given. The classes, which are conducted by experienced teachers, are becoming more and more popular. One very important piece of work done during the year was the establishment, in connection with the Church Street and Welbeck Street consultations, of clinics for expectant mothers (ante-natal clinics). That at Church Street is held by Dr. Christine Murrell, who has been in charge of the infant consultation for a number of years; and that at Welbeck Street by Dr. May Thome. At both of these, exceedingly valuable work was done, and it is gratifying to be able to state that even though they have only been running a few months, they show every sign of being highly successful. 15 At Welbeck Street, between the middle of July and the end of the year, 46 visits were paid by 26 mothers. At Church Street, 20 mothers attended the clinic. Another very useful piece of work performed on behalf of the mothers, to which reference should be made, is that carried on by the Women's League of Social Service. At the restaurant, established by this body in Lisson Street, dinners for expectant and nursing mothers are provided at a small charge, and are greatly appreciated. The amount of work done at the infant consultations may be judged from the following figures:— 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 2,690, as against 2,098 in 1914. The total number of babies seen was 355. The number of mothers attending the courses at the School of Mothercraft was 158. In South Marylebone 305 babies were seen at the consultations conducted by Dr. Eric Pritchard at the Marylebone General Dispensary, Welbeck Street. The total number of attendances was 1,624. The number of women attending classes was 116. The total number of visits to homes by voluntary workers was 3,077—1,721 in the north district, and 1,356 in the south. These were supplementary to the visits paid by the Women Inspectors, which numbered 3,620. The women inspectors also visited a number of the addresses at which deaths of infants had occurred. The Health Society, it may be noted, received grants from the Board of Education and Local Government Board in respect of the work done. DEATHS IN RELATION TO DISEASE. In previous reports, it has been the practice to introduce some few notes with regard to some of the outstanding causes of death, additional to the figures contained in the tables of the Local Government Board. Diarrhceal Diseases.—The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels) was 38, equal to 0.37 per 1,000 of the population. As usual, the majority of the deaths, viz., 31, occurred amongst infants under 1 year of age. In 1914 the number of deaths was 36, and the rate per 1,000 was 0.31. Variations in the diarrhoea figure are dependant partly on climatic and partly on sanitary conditions, and a great part of the Council's work is carried out with the intention of reducing the amount of diarrhoea by improving the sanitary conditions. The improvement that has taken place in recent years in this connection may be taken as a measure of the success of the work done. 16 In addition to sanitary work, educational work exerts a considerable influence in reducing the number of cases. Probably in no year has more educational work been done than in 1915. In this the efforts of the Council's workers have been ably seconded by those of the St. Marylebone Health Society, and, as already noted, part of the credit for any improvement must be given to this body. Zymotic (communicable) Diseases ; Phthisis, &c.; and Respiratory Diseases. The following table shows the number of deaths in each of these groups 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 (communicable) Diseases 111 1.16 2. Phthisis and other Tuberculous Diseases... 170 1.78 3. Respiratory Diseases 420 4.41 All the figures, except those for phthisis are, it may be noted, higher than those for 1914. The increase in the case of respiratory diseases was from 307 to 420. Zymotic (communicable) Diseases. The figure for the diseases in this group (small-pox, measles, scarlet fever, whooping cough, diphtheria, membranous croup, typhus, enteric and continued fevers, diarrhoea and enteritis), 1T6 is considerably higher than that for 1914. The total number of deaths was 111, to which diphtheria contributed 7 and whooping cough 14. As is shown in the table at page 63, measles caused 53 deaths, and is responsible for the great increase of the figure over that for 1914. The number of deaths in that year from measles was 3, and from the zymotic diseases 72. Phthisis and other Tuberculous Deaths. The total deaths caused by phthisis (consumption) and other conditions due to the germ of tuberculosis was 170. The great bulk of these, viz., 135, was due to phthisis, which indeed caused as much as 7'9 per cent. of the total number of deaths (1697) registered. The age periods at which the deaths from phthisis occurred were 2-5 years, 1 ('7 per cent.) ; 5-15, 3 (2.2 per cent.); 15-25, 12 (8.8 per cent.); 25-45, 50 (37 per cent.) ; 45-65, 58 (47 per cent.) ; 65 and over, 11 (8.1 per cent.). Below the age of 2 years no deaths were certified as having occurred irom this disease. 17 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 V. DEATHS FROM PHTHISIS AND OTHER TUBERCULOUS DISEASES. Year. No. of Cases. Population. Rate per 1000 of Population. 1915 170 100,260 1.16 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 248 129,463 1.92 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia and other diseases of the organs of respiration was 420 and the death rate 4.41 per 1,000. Of this number, bronchitis caused 220 and pneumonia 174. In the case of bronchitis, 150 were amongst persons aged 65 and upwards and 51 amongst those between 45 and 65. Of the persons dying of pneumonia, 63 were aged over 65. As regards pneumonia, it may be noted that the practice of carrying out disinfection after the occurrence of death from this cause was continued. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 148 and the death-rate 1.4 per 1,000 of the population. The following table shows the situation of the disease, and the table on page 63, the age at which death occurred. Cancer. Situation of the Disease. Parts of the body affected. Males. Females. Total. Face, Tongue, Jaw 9 1 10 Throat, Neck, Gullet 14 - 14 Stomach 13 3 16 Intestines 11 10 24 Liver 4 8 12 Breast — 20 20 Uterus and Generative Organs — 15 15 Various 18 19 37 Totals 72 76 148 18 ALCOHOLISM. The number of deaths certified as directly due to alcoholism was 1 as against 4 in 1914. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 20 deaths as against 18 in the previous year. The combined figure for these two causes is lower by 1 than for 1914, viz., 21 against 22. The deaths from other conditions due possibly to chronic alcoholism, e.g., nephritis (inflammation of the kidneys) and Bright's disease of the kidneys, numbered 57 (.56 per 1,000). The number in 1914 was 68. RECORDS OF DISEASE. The diseases considered under this heading are (1) those made compulsorily notifiable by Section 55 of the Public Health (London) Act, 1891; (2) diseases declared to be notifiable under Orders made by the London County Counci1; (3) tuberculosis, notifiable under Regulations of the Local Government Board, and (4) 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. 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 through special returns from school teachers, and the local Registrars. A special table relating to the Infectious Diseases—Table II. of the Local Government Board series—will be found on page 62. Information additional to that given there is set out below. Notifications. The total number of notifications received during 1915 was 1,507. Especially in the case of tuberculosis, many of the notifications were duplicates, and the actual number of cases notified was 1,109. The number notified in 1914 was 1,299, so that there is a decrease of 190 from the previous year. The notification rate (proportion to population of notified cases of infectious diseases) was 11. per 1,000 as against 11.5 in 1914. *The regulations making measles a notifiable disease did not come into operation until the 1st January, 1916. 19 Isolation of Cases. As generally occurs a very large percentage of the cases notified were isolated in hospital. The cost of carrying out the requirements with regard to notification was £116 12s. 6d., equal to £1 3s. 3d. per 1,000 of the population. The figure in 1914 was £l 4s. 4d., and in 1906, 11s. 8d. Discharge Notices. The number of notices received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 332 and referred to 439 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 less prevalent in 1915 than in 1914—138 cases as against 229 in the previous year. Of the cases 7 died, and the case mortality rate was 5 as compared with 7'4 per cent., the rate for 1914. The number of cases per 1,000 of the population was 1.3. The number of swabs from doubtful cases submitted for bacteriological examination was 262. A positive result was returned in 41 instances. Of the registration districts, that contributing the largest number of cases was Christ Church, with 56 ; All Souls giving 31, St. Mary 30, and St. John, 16. As usual the age groups 1-5 and 5-15 were those most affected, 53 of the cases falling into the former and 45 into the latter group. One application was received for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910. Scarlet Fever. The notifications of this disease numbered 308, and the total deaths 10. The number of deaths per cent. of the cases was 3'2. The highest number reported in any one week was 27. As usual, the majority of the patients were children of school age; the age group, 5-15, giving more than half (158) of the total. Of the remainder 77 were aged between 1 and 5 years. Enteric Fever. The number of cases of enteric fever notified in 1915 was 11, and there were 2 deaths (18.1 per cent. of the cases). The death rate per 1,000 of the population 20 was .02. A number of cases and of deaths occurred amongst the military, the infection having been acquired abroad or elsewhere beyond the boundaries of the Borough. None of the cases amongst the civil population calls for comment. The distribution was as follows : St. John, 2; St. Mary, Christ Church and All Souls, each 3. The deaths occurred 1in All Souls and 1 in Christ Church. Paratyphoid Fever, a condition in some respects resembling enteric fever, but due to a different germ, was notified on one occasion. A certain number of certificates, indicating that soldiers who had recovered from one or other of these diseases were to be discharged to this district, were received. CEREBRO SPINAL (SPOTTED) FEVER.. There were 10 cases notified and 5 deaths. In 5 instances death had occurred before receipt of the notification. Except in one instance in which a mother and two children were taken ill at or about the same time, all the cases were single, and so far as could be made out no spread of infection took place from them. The first notification of the disease in 1915 came to hand on 1st March, and the total number for that month was 3 ; in April 2 cases were notified; in May and June 1; and in November 3. Of the patients 5 were males and 5 females : 4 were adults and the remainder children. The youngest patient was aged only 4 months, the eldest 44 years. The ages of those who died were: 4 months, 24, 6, 24 and 44 years. Careful examination of the premises did not reveal any special overcrowding or lack of cleanliness; as a matter of fact, it is noteworthy that only 2 of the cases occurred in the poorest and most overcrowded neighbourhoods. In only two instances was it possible to form anything like a definite opinion as to the source of infection. In one the child was believed to have been infected from the grandfather with whom he slept, and who was proved to be a carrier; in another that already referred to, in which a mother and two children were attacked together, the father and grandfather were found to be carriers, and suspicion fell upon the father who was a soldier and had been home on leave for a few days before the first patient, a baby 4 months old, took ill and died. Death in this case took place within 24 hours of the appearance of the first symptoms. The mother and the other child recovered, although the attack seemed fairly severe. In most of the cases in which death occurred before notification was received, the course was very short. 21 In each instance careful search was made for contacts, and with the assistance of the Bacteriologists of the London County Council all persons immediately in contact were examined. Of the considerable number examined, 3 were found to be positive, and though themselves apparently healthy, to be harbouring the organism of the disease in the throat. All of these were given instructions with regard to disinfection of the nose and throat, and were kept under observation until a negative result was obtained. In several cases definite association with soldiers was proved, and in these a note of the facts was sent to the military authorities. Polio-Encephalitis and Myelitis. Of this disease one case only was notified. Erysipelas. Of this disease 85 cases were notified, mainly from the Workhouse Infirmary and other institutions. Erysipelas was stated to be the cause of death in 2 cases. Puerperal Fever. The notifications received numbered 3, and there were no deaths. During the year the ordinary routine of visitation and disinfection was practised. Ophthalmia Neonatorum. The total number of cases notified was 14, as against 25 in 1914. Visits were paid to all cases by the women inspectors. Measles. The requirement with regard to notification in respect of this disease did not come into operation until 1st January, 1916, and the information that 1,255 cases had occurred was obtained from returns from school teachers and registrars. The deaths from measles numbered 53 as against 3 in 1914. As in previous years visits were paid to all houses in which measles was known to exist and advice given with regard to the prevention of the spread of infection and as to the necessity for taking care of the patient. For several reasons, amongst them that the accommodation was required for other purposes, the Metropolitan Asylums Board were unable to isolate cases of measles so freely as in previous years, practically all that occurred therefore were treated at home. 22 Whooping Cough. During the year the number of deaths registered as due to this disease was 14, as against 16 in 1914. Tuberculosis. The total number of cases of tuberculosis notified during the year was 385, of these 329 were pulmonary cases, the remaining 56 notifications relating to cases in which other structures than the lungs were affected. In the accompanying Table (A), the number of cases notified in each of the years since 1913, when tuberculosis first became uniformly notifiable as to all forms, is shown. 'The fact that there has been a fall, may be taken as an indication that gradually the cases that had escaped notification in previous years were being notified, and that the figure given is approaching more nearly the actual annual number of cases. The headings to show the sources of the notifications are interesting historically, and are introduced in order to permit of comparison with figures for previous years :— TUBERCULOSIS NOTIFICATIONS.—A. Year. Medical Practitioners. Hospitals and Dispensaries, etc. Poor Law. Pulmonary. NonPulmonary. Totals. 1913 Pulmonary 115 270 141 526 154 680 Non-pulmonary 53 67 34 1914 120 244 138 424 78 502 1915 138 138 109 329 56 385 Table B which follows, contains the information required by the Local Government Board with regard to notifications. Notifications made on Form Brelate to school children. The number it will be noted was 20, as against 7 in 1914. The number of notifications of cases in which parts, other than the lungs, were affected was 56, as against 78, in 1914. Of this number the majority (18) referred to cases in which the glands of the neck were attacked. In 8 the infection was limited to the spine and in 13 to the joints. Treatment of Tuberculosis. About one-third of the cases notified (113) received some form of institutional treatment, and during the year the usual amount of activity was displayed at the St. Marylebone Dispensary for the Prevention of Tuberculosis, to obtain admission to sanatoria of cases deemed suitable for such treatment. Of the total cases notified, 146 were insured persons, and of these 41 applied for sanatorium benefit. Further information with regard to insured persons is contained in the letter from the Medical Officer of the Tuberculosis Dispensary on page 25. 23 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 For an 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 - 5 6 9 16 15 39 33 31 32 8 194 224 — — - - — 74 30 „ Females _ — 9 2 8 15 35 32 16 15 4 136 161 — 1 1 2 3 21 15 Non-pulmonary, Males 1 7 2 5 2 - - - - - 2 22 24 2 6 5 13 13 — 5 „ Females 2 2 8 4 2 1 4 1 — — 1 25 25 — 3 1 4 4 — 2 3 14 25 20 28 31 78 66 47 47 15 377 434 2 10 7 19 20 95 52 24 The arrangements made by the London County Council, for providing treatment for children and others, on the whole worked very smoothly in the Borough, and little or no difficulty was experienced in obtaining the information required in connection with the removal of the patients. Deaths from Phthisis. The table given below shows the number of deaths certified as due to consumption, and compares the figure for 1915 (135) with those of preceding years. The death rate for the year was 1.3 per 1,000, the same as in 1914. TABLE X.— DEATHS FROM PHTHISIS. Estimated Population. Year. All Ages. Sub-Districts., All Souls. St. Mary. Christ Church. St. John. 100,260 1915 135 31 37 52 15 112,892 1914 152 18 38 73 23 114,532 1913 149 32 40 57 20 114,532 1912 149 26 32 66 25 117,844 1911 172 51 30 65 26 125.195 1910 133 28 37 56 12 126,027 1909 170 43 41 66 20 126,867 1908 154 35 33 61 25 127,718 1907 179 42 46 61 27 127,900 190G 197 36 64 73 21 The distribution of the deaths was as follows: in Poor Law Institutions, 79; general and other hospitals, 23; at home, 33. The age and sex distribution of the deaths is shown in the table following. Of those who died 34 were insured and 61 uninsured. Deaths from Phthisis— Age and Sex Distribution. Ages. Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals. Males - 7 6 13 19 24 12 6 87 Females 1 3 8 12 11 8 5 - 48 Totals 1 10 14 25 30 32 17 6 135 Prevention of Consumption. The works of prevention inaugurated some years ago, and described in previous reports, were continued during the year. The women inspectors paid a great number of visits to notified cases, and in addition to giving 25 instructions with regard to 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. To all of these institutions the Council owes a great deal for assistance rendered in connection with the special preventive work carried out in respect of tuberculosis. In addition to such work the Council during 1915 carried out those works of general sanitation which have for their object the improvement of the surroundings of the inhabitants. Circumstances connected with the War, including the enlistment towards the end of the year of a number of the inspectors, necessitated some re-arrangement in connection with this work, but on the whole there was little or no slackening of the effort. Tuberculosis Dispensary Scheme. In the report for 1914, in relation to schemes of prevention, it was suggested that in all probability there would be considerable delay in bringing the scheme which had been adopted by the Council formally into operation : this prophecy proved only too accurate, and at the end of 1915 matters were very little further forward than at the end of 1914. The scheme itself has so often been described that it is unnecessary to refer to it again. Fortunately, no matter how great it may be, any delay that may be caused by failure on the part of the bodies whose approval of the scheme must be obtained, affects the work very little. All the elements which will eventually make up the scheme are working together, and practically all that the delay means is that the organization is not quite formally completed. In connection with tuberculosis work the Dispensary in Allsop Place continued to render great assistance during the year. Some of the details of the work done are shown in the following note which has been kindly provided by Dr. Saner, the acting medical officer. "During the year 1915, 325 patients were examined at the Dispensary. Of these 83 were found to be definitely tuberculous, while 100 were suspected cases and were kept under observation. "Children under the age of 15 numbered 179; ot these 20 or 11.1 percent, were found to be actually consumptive, and 73 or 40.8 per cent, were suspected. Of patients aged 15 and upwards 63 or 44 per cent, were definite and 27 suspected. "The number of persons insured under the National Insurance Act coming under treatment at the Dispensary for the first time was 82. The number of insured persons actually under treatment continuing their attendance from former years was 133. The total attendances at the Dispensary of insured persons was 688 for the year and the Medical Officer paid 264 visits to their homes. "During the year 230 uninsured patients were attending from former years, so that altogether 556 patients were under treatment, i.e., 133 insured and 423 uninsured. " The Medical Officer's visits to the uninsured patient's homes numbered 919. 26 "The following statement shows the number of visits paid by the Medical Officer and Nurse, and the attendances at the dispensary of ordinary patients and of School Children at the Open Air School: Total attendances at Dispensary 3,078 Total visits of Medical Officer 1,183 Total visits by Nurse 2,298 School Children 1,175 "The number of insured patients sent from this Dispensary to the State Sanatoria was 12. Of these 5 are now working, 2 are in statu quo, 2 are worse and one has died. Two have not yet returned." Bacteriological Diagnosis of Consumption.—The total number of specimens of expectorations sent by medical men for bacteriological examination from cases in which there was some doubt as to the diagnosis was 665. Of these 140 were found to contain the bacillus of consumption, while the remainder were free. In 1914, 859 specimens, of which 173 were positive, were received. Work of the Women Inspectors.—The total number of cases seen by the Women Inspectors was 469, of which 385 were new cases. Of this number 113 were removed to hospital. The insured persons numbered 146, and of these 41 went to a sanatorium. Disinfection was carried out in 142 cases. SYPHILIS. During the year 2 deaths were certified as due to this disease. In a large number of instances, though syphilis was probably an indirect cause, no indication of the fact was given in the death certificate. Of those who died, either directly or indirectly, from syphilis, many were infants and young children, the infection having been inherited from parents who, having acquired the disease, neglected to obtain proper advice and to submit themselves to full and proper treatment. A fair proportion of the children seen at the consultations presented signs of syphilitic infection. The adults who died of sequels of syphilis would have escaped had they sought advice and treatment in the early stages. During the whole of 1915 the facilities extended in 1914 to medical men desirous of obtaining assistance in connection with the making of a diagnosis in cases of syphilis by means of the Wassermann blood test, were still available. They were, however, only, to a very small extent, taken advantage of by private practitioners, the great bulk of the specimens sent in coming from the Workhouse Infirmary with, in addition, a few from other institutions. The total number received was 171, of these 53 were positive and 4 doubtful. The specimens from males numbered 75, and from females 96. A few were from children, the majority being from adults in the age groups, 25-45, and 45-65. 27 DISINFECTION. The following tables contain all the necessary information with regard to this subject. The first, indicating the number and nature of the articles disinfected ; and the second the reasons for disinfection. A great deal of disinfection work, both of premises and articles, was done on behalf of the military quartered in the Borough in hospitals and elsewhere. Articles Disinfected. Infectious Disease. Phthisis. Measles. Vermin. Other causes. Total. Beds 337 45 18 18 27 445 Mattresses 446 49 61 40 296 892 Bolsters 416 43 41 28 59 587 Pillows 809 115 70 43 534 1,571 Sheets 852 75 86 52 70 1,135 Blankets 1,108 97 137 133 472 1,947 Sundries 5,855 450 499 21,434 4,622 32,860 Totals 9,823 874 912 21,748 6,080 39,437 In 1914, the number of articles disinfected was 12,766, and in 1913, 13,639. The number of journeys made by the disinfecting vans during the year ended December, 1915, was 620, as against 613 in 1914. The number of rooms disinfected and the reasons for carrying out disinfection were:— Infectious Disease. Phthisis. Measles. Vermin. Other causes. Total. January 61 13 11 - 11 96 February 63 12 33 4 4 116 March 79 18 66 - 9 172 April 53 20 95 8 30 206 May 58 9 62 10 20 159 June 55 7 22 6 19 169 July 37 11 15 7 14 84 August 32 8 3 7 8 58 September 32 9 1 3 9 54 October 23 7 1 9 11 51 November 36 9 2 12 20 79 December 23 19 22 2 17 83 Totals 552 142 333 68 172 1,267 The number of rooms disinfected in 1914 was 799. 28 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. As in 1914, the work was in the hands of Dr. Foulerton, who was appointed bacteriologist to the Council in April of that year. 1914 1915. Positive. Negative. Total. Positive. Negative. Total. Typhoid Fever 20 33 53 3 19 22 Diphtheria 93 650 743 41 221 262 Phthisis 173 686 859 140 525 665 Wassermann Reaction 38 82 120 57 114 171 Cerebro-Spinal Fever - - -- - 1 1 Totals 324 1451 1775 241 880 1121 Part II. DEPARTMENTAL 31 DEPARTMENTAL. At the end of the year the staff of the Public Health Department, in addition to the Medical Officer of Health, consisted of a deputy-medical officer of health (Dr. J. R. Prior, Finchley), 5 men and 4 women sanitary inspectors, and one chief and 2 assistant (women) clerks, and an office youth. The number of male inspectors in normal times is 10, and the clerical staff numbers 6, and in order to permit of the work being done considerable rearrangements were necessary. All the male members of the staff who remained being either over military age or unfit for service, with the utmost readiness, without extra reward, undertook extra duties, and most loyally and fully did all that was allotted to them. No additional men were appointed to the staff during the year, two women clerks taking over the work of certain of the male clerks who had gone on service. In the outdoor staff attached to the department the war caused a number of changes. The mortuary keeper having enlisted, his work was divided in such a way as to allow of his wife doing part, and a number of temporary attendants for the underground conveniences were taken on to replace those who had either been called up or enlisted. The Public Health Committee throughout the year were still responsible for the supervision of the disinfecting staff—2 men; the staff of the shelter and baths —a matron, and one female and 2 male attendants; the women attendants at the underground conveniences and the men employed in flushing the overground conveniences. The following list contains information with regard to the Members of the Staff on service at the end of the year :— Name. Regiment. Bassett, F. Convenience Attendant 12th Lancers Private Bright, I. Flusher Army Service Corps Private Cartledge, T. A. Sanitary Inspector 2nd London Sanitary Staff-Sergeant Co. R.A.M.C., T. Clay, H. H. Do. Do. Corporal Draper, W. H. Do. Do. Sergeant Edwards, R. Convenience Attendant Middlesex (T.F.) Sergeant England, J. Do. 29th Battalion Lance-Corporal Middlesex Regt. 32 Name Regiment. Harris, R. C. Convenience Attendant Royal Field Artillery Shoeing Smith Howe, W. J. 2nd Class Clerk 2nd London Sanitary Sergeant-Major Co. R.A.M.C., T. Hill, P. H. Sanitary Inspector Do. Corporal James, A. H. 2nd Class Clerk Royal Flying Corps 2nd Air Mech. King, W. C. Convenience Attendant Royal Garrison Private Artillery Matthews, A. 3rd Class Clerk 2nd London Sanitary Corporal Co. R.A.M.C., T. Newsham Convenience Attendant Army Service Corps Private O'Connor, D. O. Do. 4th Hussars Shoeing Smith Scowen, C. H. 3rd Class Clerk 3/9th Middlesex (T.F.) Corporal Smith, G.Food Inspector 2nd London Sanitary Sergeant Co. R.A.M.C., T. Spears, J. W.Mortuary Keeper 21st Battalion Corporal Middlesex Regt. Stokes, Miss N. C. Sanitary Inspector and Army Nursing Service Matron,Hospital Health Visitor Ship Wilson, A. S. Sanitary Inspector 2nd London Sanitary Private Co. R.A.M.C., T. Effect of the War.—What was said in the Report for 1914 with regard to the effect produced by the war on the department and its work applies fairly well to the year under review. The Medical Officer of Health continued to act as "Sanitary Surpervisor" of camps, billets, etc., in the Borough, and submitted weekly reports to the Deputy Director of Medical Services with regard to the conditions. Premises in which food intended for the troops was prepared were kept under observation, and workshops in which clothing was made were regularly visited. \ The. baths and other conveniences placed at the disposal of the men were greatly used, and large numbers of blankets and other articles were dealt with at the Council's disinfecting station. PROTECTION OF THE FOOD SUPPLY. Inspector Smith, who had acted as food inspector for some years, enlisted in November, and his duties were distributed amongst the inspectors who remained. Food Inspection.— Throughout the year, both before and after the departure of Inspector Smith, food inspection was carried out on the lines described in previous reports. 33 The practice of examining articles of food at the request of vendors was continued. Amongst the articles examined and surrendered, on the finding of the Inspector that they were unsound, or unwholesome or unfit for food, were:— A quantity of eggs. 1 cwt. ot bacon. „ „ tomatoes. Cask of meat. ,, „ pears. 1 case of herrings. „ „ oranges. 1 trunk of mackerel. „ „ strawberries. „ „ plums. During the year four seizures of unsound food were made, and proceedings were taken in each case as follows For exposing and depositing for Defendant fined £1 and £1 Is. sale a quantity of unsound oranges and costs on first summons and 2s. costs tomatoes on a stall in Church Street. on second summons. For exposing and depositing for sale Ditto. a quantity of tomatoes on a stall in Church Street. Ditto. Case dismissed. Magistrate ing that there was a doubt as to defendant's intention to sell. For exposing and depositing for Fined £1 and £1 Is. costs on sale a quantity of bacon on a stall in each of two summonses. Church Street. SLAUGHTER HOUSES AND COW HOUSES. The following lists give information with regard to such premises in the borough. Regular and frequent visits were made throughout the year. No conditions calling for the service of notice were found. SLAUGHTER HOUSES. 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. 3,2a, Union Street, Middlesex Hospital Nil. 34 COW HOUSES. Premises. Licensed for. Cows kept. 58, Acacia Road 44 26 56, Bell Street 15 10 42a, Clipstone Street 10 10 23, Crawford Place 14 1 3, Malthouse Mews 22 16 Totals 105 63 MILK SHOPS AND MILK. Milkshops, etc.—The number of premises upon which milk is sold is 194> 43 less than in 1914. The number of applications received was 6. Under the powers granted by the London County Council (General Powers) Act, 1908, 2 were refused on the ground that the premises were unsuitable. Under this same Act 47 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. Examination of Milk.—Of 502 samples taken either formally or informally and examined by the Public Analyst 36 (7.2 per cent.) were found to be adulterated. In 1914 the percentage was 5.2, and in 1913, 6.9. 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 tor 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 3 instances a letter of caution was sent to the vendor. In the case of samples definitely adulterated, if no satisfactory explanation was forthcoming from the vendor, proceedings were instituted. In 1915 action was taken in 27 cases. In 2 of these, warranty was pleaded and the case was dismissed, and in 1 case the defendant absconded. In respect of the remaining 24 cases fines and costs to the amount of £33 13s. were recovered. In 1914, when there were. 10 cases, the amount was £16 18s. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 90 were obtained on delivery at Marylebone Station of the Great Central Railway. Of the 90, 13 proved to be adulterated. In all these cases the adulteration was sufficient to warrant the institution of proceedings, and in seven cases fines and costs 35 were recovered from the defendants. In one case covering 6 samples consigned by one farmer, which upon analysis were certified to contain from 3 to 10 per cent, of added water, the defendant stated that the milk was consigned as it came from the cows, they having been turned out to grass two days previously, and all 6 summonses were dismissed. Further particulars with regard to samples of milk will be found in the report and returns of the Public Analyst. Ice Cream Premises. Ths number of such premises in the Borough on the Register is 117. Regular inspections were made throughout 1915 and in 6 cases notices were served in respect of uncleanly conditions. Butter, Margarine, Etc. 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 14 dealers in margarine, 1 wholesale dealer in butter and milk-blended butter, 4 butter manufacturers and 1 margarine manufacturer. All the registered premises were frequently visited. Restaurants, Food Stalls, Etc. The number of premises in which food is prepared for sale is 270, made up as follows:—Restaurant, dining room and coffee shop kitchens, 156; 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. The total number of inspections made was 742, and as result of these, various conditions calling for attention were discovered. In all 63 notices were served, and in every case the work called for was carried out without the necessity for taking other proceedings. The food stalls in the market streets—Great Titchfield Street, Bell Street, Church Street, Blandford Street, etc., were kept under close observation throughout the year, visits being paid every day, Saturdays and Sundays included. Offensive Trades. There are only two premises within the Borough upon which offensive trades are carried on. The business in each case is that of tripe boiling. I he food Inspector made 40 visits, but no cause of complaint was found. 36 Bakehouses. At the end of 1915 the number of bakehouses on the register was 71—61 being underground bakehouses. In all, 140 visits were paid to these and 8 notices with regard to defects were served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, etc., of the inside walls and other parts of the bakehouses were served. It was not necessary to institute proceedings to enforce compliance with any notice. SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 945. Of this number 49 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 5.2 per cent. In 1914 it was 3.8 and in 1913, 4.2. The majority of the samples 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 33, and that the fines and costs recovered amounted to £39 7s. The warranty defence was raised in 2 prosecutions for adulteration of milk, and was successful in both 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 9. Selling milk from a vehicle and cans without having the vendors address thereon. The defendant having absconded the summons was not served. The following tables and report from the Public Analyst give full particulars with regard to samples submitted to and examined by him :— 37 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, 1915. 142 milk Food Inspector, St. Marylebone, Borough Council. Genuine. £500 per ann.for 700 samples. Over that number 7/6 per sample. No sample contained any preservative, but 30 samples had artificial colouring matter added. 4 were test samples. 12 milk Adulterated. No. 27, 10.0 per cent, deficient in milk fat. No. 27. Was consigned by the wholesale dealer from whom Sample No. 33 was taken on delivery, hence proceedings were not taken on this sample. No. 33, 10.0 do. No. 33 Fined £2 and 12/6 costs. No. 125, 10.0 per cent, added water. No. 125. Fined £1 and 12/6 costs. No. 126, 20.0 per cent, deficient in milk fat. No. 126. Fined £1 and 12/6 costs. No. 169, 10.0 do. Vendor's sample. No. 190, 10.0 do. Sample taken on delivery by wholesale dealer to vendor of No. 169. Wholesale dealer requested sample to be taken at Paddington Station as consigned by farmer. 6 samples were deficient in fat, in respect of which proceedings taken by the Paddington Borough Council are pending. In these circumstances no proceedings were taken in respect of samples, Nos. 169 and 190. No. 248, 6.67 percent, deficient in milk fat, 16.9 per cent, added water. No. 218. Defendant absconded. Summons not served. No. 280, 10.0 per cent, deficient in milk fat. No. 280. Fined £2 No costs Were Station samples as consigned by Farmers. No. 282, 3.30 do. No. 282. Fined £2 No costs No. 283, 6.7 do. No. 283. Fined £2 No costs No. 274, 6.7 do. No. 274. Fined £2 No costs No. 277, 6.7 do. No. 277. Fined £2 No costs 95 butter Genuine. 22 were test samples. 49 samples contained between 10-20 grs. per lb. boracic acid, 43 contained between 20-30 grs. per lb. 3 samples had no preservatives added. 38 Articles submitted for Anaylsis State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 3 butter Food Inspector, St. Marylebone Borough Council No. 113, was margarine. £500 per ann. for 700 samples Over that number 7/6 per sample. This was a test sample. No. 212, do. Do. No. 232, do. Do. 17 cream Genuine. 1 pepper Do. Do. 1 Dover's powder Do. 1 boracic ointment Do. Do. 1 jam Do. Do. 2 jellies Do. These were test samples. 1 tea Do. This was a test sample. 3 lime water Do. These were test samples. 3 mustard Do. Do. 4 coffee Do. Two were test samples. 1 cream of tartar Do. This was a test sample. Total Number of Samples analysed during the Quarter 287 Number of Samples adulterated 15 SECOND QUA RTER ENDING 30TH JUNE, 1915. 90 milk Genuine. 3 were test samples. 30 milks contained artificial colouring matters. Only one milk contained any preservative. 20 milk Adulterated. No. 294. 3.77 per cent, added water No. 294. Vendor cautioned 30/4/15. No. 322. 10.0 per cent, deficient in fat. No. 322. No proceedings taken. See note to the 6 following numbers : No. 329. 10.30 per cent, added water. No. 329 Samples taken from farmer who supplied vendor of No. 322. He stated milk was sold as it came from the cows. Summonses dismissed. No. 330. 8.47 do. No. 330 No. 331. 3.06 do. No. : 31 No. 334. 7.00 do. No. 334 No. 335. 8.90 do. No. 335 No. 336. 10.30 do. No. 336 No. 373. 6.67 per cent, deficient in fat. No. 373 Warranty defence. Cases dismissed. No. 374. 6.67 do. No. 374 No. 381. 20.67 do. No. 381. Fined £1 and 12/6 costs. No. 396. 3.3 do. No. 396. Vendor cautioned 2.3 per cent, added water. vide P.H. Mts. 28/6/15. No. 401. 33.3 per cent, deficient in fat. No. 401. Fined £1 and 12/6 costs. No. 415. 6.67 do. No. 415. Fined £2 and 12/6 costs. No. 417. 23.3 do. No. 417. Fined £2and 12/6 costs. No. 437. 10.0 do. No. 437. Fined £2, and 12/6 costs. No. 456. 10.0 do. No. 456. Fined £1 and 14/6 costs. 39 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 Food Inspector, St. Marylebone Borough Council No. 461. 20.0 percent, deficient in fat. £500 per ann. for No 461. Fined £2 and 14/6 costs No. 470. 6.50 grains boric acid per pint. 700 samples. Over No. 470. Case not proceeded with. No. 479. 10.0 per cent, deficient in fat. that number 7/6 No. 479. Fined £1 and 10/6 costs. 80 butter Genuine per sample 32 were test samples. Out of 81 samples, 8 contained no preservatives, 37 contained from 10-20 grs. boric acid per lb., 28 contained from 20-30 grs. boric acid per lb., 4 contained from 30-35 grs. boric acid per lb. 1 butter Adulterated. No. 467 was margarine. This was a test sample. 7 cream 1 cream Genuine Adulterated. Fined 10/- and 14/6 costs. No. 472. Contained only 23.4 per cent, of fat with 10 grains boric acid per lb. 2nd summons for selling in an unlabelled receptacle withdrawn. 1 lard 3 whiskey Genuine. Adulterated. No. 418. 46.0 per cent, under proof. This was a test sample. No. 476. 27.90 do. No proceedings taken in consequence of a notice being exhibited in bar. 3 whiskey No. 504. 26.48 do. Genuine. This was a test sample. All were test samples. 5 beer Do. Do. 3 pickles Do. Do. 2 coffee Do. 2 lime water Do. Both were test samples. 1 flour Do. This was a test sample. 1 lime juice Do. Do. 1 boracic ointment Do. Do. 1 condensed milk Do. Do. Total Numbe r of Samples analysed during the Quarter 222 Number of Samples adulterated 25 THIRD QUARTER ENDING 30m SEPTEMBER, 1915. 118 milk Genuine. 29 milks contained artificial colouring matters. No milk contained preservative. 4 milk Adulterated. No. 552. 10.0 per cent, deficient in milk fat. No. 552. This was a test sample. No. 563. 13.0 do. No. 563. Fined 5/- and 10/6 costs. No. 617. 6.7 do. No. 617. Vendor cautioned vide P.H, Mts., 24/8/15. No. 720. 10.0 do. No. 720. Warranty defence. Case dismissed. 40 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. 76 butter Food Inspector, St. Marylebone Borough Council Genuine. . £500 per ann. for 700 samples. Over that number 7/6 per sample 6 were test samples, 6 contained no preservatives, 43 contained less than 20 grains boracic acid per lb., 28 contained 20-30 grains boracic acid per lb., 1 contained 31 grains boracic arid per lb. 2 butter Adulterated. No. 583. Contained 80 per. cent, of fat other than butter fat. No. 583. Fined 4/- and 10/6 costs. No. 676. Contained 80 do. No. 676. Fined £1 and 12/6 costs on 1st summons and 2/- costs 2nd summons. 12 cream Genuine. 3 margarine Do. These were test samples. 1 whiskey Do. This was a test sample. 1 gin Adulterated. No. 560. 42.9 degrees under proof Do. 2 beer Genuine. Both were test samples. 2 lime water Do. Do. 1 coffee Do. This was a test sample. 2 Dover's powder Do. Both were test samples. 1 boracic ointment Do. This was a test sample. Total Number of Samples analysed during the Quarter 225 Number of Samples adulterated 7 FOURTH QUARTER ENDING 3IST DECEMBER, 1915. 116 milk Genuine. 8 were test samples. No sample contained any preservative. 16 samples contained artificial colouring matter. 73 butter Genuine. 5 were test samples, 6 contained no preservatives, 43 contained each less than 20 grs., 25 contained between 20-30 grs. and 1 contained between 30/35 grs. of boric acid per lb. 2 butter Adulterated. No. 757. Contained over 50 per cent, of fat other than butter fat. No. 757. Fined 30/- and 10/6 costs. No. 761. Contained over 60 per cent, of fat other than butter fat; No. 761. The defendant pleaded guilty, but as it was the first complaint in 20 years trading the Magistrate dismissed the summonses. 13 cream Genuine 3 were test samples. 2 beer Do. Both were test samples. 2 whiskey Do. Both were test samples. 2 coffee Do. 1 mustard Do. Total Number of Samples analysed during the Quarter 211 Number of Samples adulterated 2 SUMMARY. dumber of Samples Analysed. Number Adulterated. 1st Quarter 287 15 2nd „ 222 25 3rd 225 7 4th „ 211 2 Totals 945 49 41 REPORT OF THE PUBLIC ANALYST, 1915 During the year 1915, 945 samples were submitted for analysis. Of these 49 or a little over 5 per cent, were certified to be adulterated. In the previous year the percentage was 4 per cent., and, as the samples were of a similar nature, it would seem that there is still need for continuous activity in the supervision of food. The number of samples taken during 1915 was 122 less than in 1914, and it appears to the writer that in a period of particular stress, with rising prices, it is an absolute necessity to enforce in every legitimate way the Sale of Food and Drugs Acts, the temptation of any dishonest retailer being greater at such a time than at any other. A complete list of the samples will be found in the annexed table. The articles analyzed comprise types of most foods and drinks, but it will only be necessary to offer a few observations on the more important. LIST OF SAMPLES TAKEN DURING THE YEAR 1915. Article. Genuine. Adulterated. Total. Milk 466 36 502 Butter 324 8 332 Cream 49 1 50 Margarine 3 - 3 Lard 1 - 1 Flour l - 1 Tea l - 1 Coffee 9 - 9 Pepper 1 - 1 Mustard 4 - 4 Pickles 3 - 3 Condensed Milk 1 - 1 Jam 1 - 1 Jelly 2 - 2 Whiskey 6 3 9 Gin - 1 1 Beer 9 - 9 Dover's Powder 3 - 3 Boracic Ointment 3 - 3 Lime Water 7 - 7 Lime Juice 1 - 1 Cream of Tartar 1 - 1 896 49 945 42 Butter.—Out of 332 samples of butter, 8 were adulterated, being practically margarine, sold as butter, at a butter price. Three of the samples were "test" samples, that is, not officially divided. 297 of the butters contained boric acid as follows:— 172 contained boric acid from 10-20 grains per lb. 119 „ „ 20-30 6 „ above 30 „ 27 samples were free from boric acid, equal to 8.4 per cent, of the total number; in 1914, about 15 per cent, of the samples were free from preservatives, so that the use of boric acid in butter is apparently not diminishing. Margarine.—Only 3 samples of margarine were analysed; in each case boric acid was present. It is rare to find a sample of margarine which does not contain from 10 to 25 grains of boric acid to the lb. Margarine manufacture has in recent years made great strides, and it is difficult to tell by the taste the difference between certain brands of margarine and butter. From a dietetic point of view good margatine is far superior to many kinds of butter. A useful guide for the consumer to know whether he has bought margarine or butter, is to melt a little by immersing a tumbler containing a sufficient portion of the article in water hot enough to melt the fat. Butter fat forms a clear layer on the surface of the curd and water and filters rapidly through dry filter paper in a warm oven. Margarine fat, on the contrary, forms a turbid, fatty layer, and filters slowly through a similar filter. The test, like most simple processes, is not infallible, but sufficiently useful in practice, and can be carried out by any one without special apparatus or expert knowledge. Milk— 502 samples of milk were analysed; of these, 36 or about 7 percent, were adulterated. The main adulteration was abstraction of cream, in one case the milk fat being deficient to the extent of 33.3 per cent. A few milks showed added water, the worst sample containing nearly 19 per cent, added water. Most of the milk is artificially coloured, but no preservatives were detected. There were two abnormal samples, one containing 8 per cent, fat, the other 14.5 per cent. fat. After eliminating adulterated and abnormal milk the mean composition of the remainder was strikingly similar as shown by the following table, to the mean composition of the previous four years. Sp.Gr. Milk fat. Solids not fat. Total solids. 1911 1031.0 3.70% 8.64% 12.34% 1912 1031.5 3.74% 8.77% 12.51% 1913 1031.7 3.73% 8.80% 12.53% 1914 1031.3 3.75% 8.77% 12.52% 1915 1032.0 3.72% 8.82% 12.54% 43 It is remarkable that over 2,400 samples of commercial milk, supplied to the inhabitants during five years, should give an average ot 3.7 per cent, milk fat and 12.5 total solids; this is well in excess of the legal standards. Cream.— Of 49 samples of cream examined, one only was adulterated in a technical sense, that is, it contained some 11 grains of boric acid to the pound and it was sold with no notice of the fact; 19 of the 49 contained boric acid in quantities from 6 up to 13 grains per pound. One sample had a content of milk fat of only 23 per cent. ; on the other hand many yielded over 50 and eyen 60 per cent, milk fat—, the mean of the whole being 49 per cent, milk fat. As compared with the previous year, the creams were richer in fat, and there was a distinct increase in the number of creams sold without any antiseptic or preservative addition. Spirits.— 10 samples of spirits, 9 of whiskey and 1 of gin, were taken during the year, the samples were "test" samples, for the majority of licensed victuallers evade the Sale of Food and Drugs Act quite successfully by a general notice in or near the bar to the effect that the spirits sold are diluted below standard. Of the 10 samples, three of whiskey were found to be reduced by the addition of water below the legal standard of 25 degrees under proof. Miscellaneous Samples.— The remaining samples were of great variety, all genuine, but the number is too small to justify any special comment. May 25th, 1916. A. WYNTER BLYTH. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. The following report submitted in accordance with requirements of the Local Government Board, with regard to the administration of these regulations contains some interesting information :— 1. Milk; and Cream not sold as Preserved Cream. (a) Number of samples (b) Number in which a examined for the pre- preservative was resence of a preservative. ported to be present. Milk 502 1* Cream 30 1 Nature of preservative in each case in column (b), and action taken under the regulations in regard to it *Boracic acid 6½ grains per pint. Committee decided not to prosecute. 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 20 (ii.) Statements incorrect — Total 20 44 (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent 20 (ii.) Below 35 per cent Total 20 (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 1 (d) Particulars of each case in which the Regulations have not been complied with, and action taken. Sample No. Contained Action taken. 472 10 grains boric acid per lb. Prosecution ordered. Vendor fined 10/- and 14/6 costs. The second summons for selling in an unlabelled receptacle was withdrawn. 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 12 samples of milk, 4 of water, and 6 of ice cream were submitted to the Council's Bacteriologist (Dr. Foulerton) for examination. Of the milks, 9 were found to be "good," 2 "fair," and 1 "bad." Of the ice cream samples, all were reported "good." The water samples were reported "excellent." 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 work well. 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. 45 In 97 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 76 instances. In the remaining 21, it was found necessary to serve a statutory notice. Following the receipt of this, the work was done, and in no case was it necessary to apply for a summons against the owner. Water Supply Cut Off.— The Metropolitan Water Board reported, in accordance with the requirements of the Public Health (London) Act, 1891, Section 49 (1), that the water supply had been cut off in 22 premises. The reasons for discontinuing the supply were :— Premises empty 8 Non-payment of Rates 7 Waste of Water 7 Cut off by request of Occupier — 22 No complaints with regard to the water supplied were received during the year. HOUSING. Representations and Orders.— The accompanying tabular statement contains information with regard to closing and demolition orders made since 1910. During 1915 the proceedings in respect of the premises 9— 16 Montague Mews South were completed. In the early part of the year the appeal of the Local Government Board to the Courts for guidance as to whether or not the premises were as alleged by the Council, back-to-back houses and being occupied by chauffeurs were inhabited by members of the working classes was heard. The decision in effect was that the Board would be justified in regarding the premises as back-to-back and the tenants as members of the working classes. Having obtained this decision, and having deliberated upon it for some months, the Local Government Board decided that the appeal of the owner of the houses must be upheld, and by an Order in Council, dated the 7th September, 1915, the closing orders were quashed. Three representations were made in 1915 and closing orders were made in respect of the premises, Nos. 5 and 6, Hardington Place, but were not served in consequence of the owner having put the necessary work in hand to render them fit for habitation. With regard to 18, Crawford Place, no closing order was made, the owner taking advantage of an opportunity offered by the committee to carry out certain works. There were no appeals under The Housing, Town Planning, &c., Act, 1909, during 1915. 46 HOUSING, TOWN PLANNING, ETC., ACT, 1909. Premises reported or represented during 1915, and the two previous years. Premises. 1913. 1914. 1915. 1, 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. C.O. determined 12th June, 1915. 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 Premises demolished 31st May, 1915. 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&16Montagu Mews South C.O. 28th Nov., 1913. Appeal to L.G.B. 28th April, 1914. L.G.B. state case for High Court Decision. Case heard & decided. See note on page 45. C.O. quashed 7th Sept. 1915. 424, Edgware Road, front and back basement room C.O. made 20th Mar., 1914 Vacant 15th May, 1914. 5 & 6 Hardington Place C.O. made 16th July, 1915. Not served, work having been commenced. 47 House-to-House Inspection. For a number of reasons, amongst them the re-arrangement of work necessitated by enlistment of members of the staff, fewer house-to-house inspections were made than in previous years. The following table contains information with regard to the inspections carried out. HOUSING, TOWN PLANNING, Etc., ACT, 1909. (Section 17.) No. of houses inspected. No. unfit lor 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. 373 3 3 2 1 after letter to Owner 223 in respect of which Notices were served. Intimation 223 Statutory Nil. 224 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. Appeal in case of 9-16, Montagu Mews South, decided in favour of appellant, and C. O's. subsequently quashed. Houses Let in Lodgings. At the end of 1915 the total number of houses on the register was 1,169. All of these were systematically inspected, and in all 3,033 visits were paid; 1,169 notices relating to cleansing and other defects were served, the majority were complied with, but in 59 cases statutory notices were issued and the necessary works executed without the necessity for further proceedings arising. Common Lodging Houses. The following table contains all the essential information with regard to these. A number of visits were paid from time to time to the premises by the District Inspectors. Address. Registered Owner. Registered number of Occupants. 54, Bell Street Alfred Crew 55 men 2, Burne Street and Lisson Street W. Bramwell Booth 499 men 6, Charlotte Place Emma Lawson 7 women 29, Circus Street William H.G. Richardson 100 men 47, Hereford Street Alfred Wilson 19 men 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 Total 993 men 109 women 1,102 48 Overcrowding.— The number of dwelling rooms found to be overcrowded during the year was 29, as against 40 in 1914. In every case discovered a notice was served, and in all a remedy was found. Underground Rooms.— The total number of underground rooms dealt with in 1915 was 6. The 6 notices served were in respect of rooms 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. Customs and Inland Revenue Acts. Possibly because of the increase in the various rates, a larger number of applications for a certificate qualifying for exemption from or reduction in inhabited house duty was received. The situation of the premises and the number of tenements affected were : Premises. Number of Tenements. 372, Edgware Road 3 31-60, Hanover Gate Mansions 3 17 & 18, Nassau Street 1 6 & 8, Blandford Street, Buckland House 6 13 NUISANCES. During the greater part of the year, five district inspectors were at work, and it was not till November that it became necessary to rearrange the work and districts to allow of the four inspectors who remained taking over the duties of those who had. enlisted. The total number of complaints received was 1021, as against 1,747 in 1914. The majority of these were made by the inspectors; the number from outside being 345. These came from voluntary workers of the St.Marylebone Health Society, members of Care Committees, neighbours and others. In respect of nuisances, 249 statutory notices were issued, as against 216 in 1914. Of these notices, 150 related to ordinary nuisances (dirt, dampness, &c.) 21 to verminous rooms, 53 to drains, and 1 to insufficient w.c. accommodation. The remaining 21 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 1914 was 31. The 21 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1904, and referred to 20 rooms. The number of notices in 1914 was 20. 49 In 771 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 2 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 No. 6. Total Inspections 2635 3022 3207 2560 2488 2155 16067 Houses damp, dirty or dilapidated remedied 97 207 63 50 28 3 448 Doors, windows, floors, ceilings, sash cords, etc., repaired 42 54 20 3 3 2 124 Overcrowding abated 8 8 6 1 0 6 29 Illegal occupation of underground rooms dealt with - 2 2 - 2 - 6 Water closet defects remedied 110 187 59 43 57 2 458 Water closets erected - 1 3 1 3 — 8 Urinal defects remedied — 3 6 — 3 — 12 Soilpipe and ventilating shaft repaired or renewed 19 9 12 5 1 - 46 Yard defects remedied 40 95 32 14 10 2 193 Waste pipe defects remedied 15 9 7 7 6 — 44 Water cistern defects remedied 167 111 13 18 12 1 322 Rubbish, manure, etc., accumulations removed 8 35 52 11 13 4 123 Dung or dust receptacles repaired or renewed 37 20 32 9 4 - 102 Drains relaid or amended 48 74 61 19 10 1 213 Drains cleared 2 15 16 3 — 1 37 Rainwater pipes repaired or renewed 5 20 11 5 15 2 58 Water supply to houses reinstated 3 3 5 1 — 12 Roofs and gutters repaired 57 69 33 7 9 4 179 Area defects remedied 2 37 20 13 7 1 80 Wash-house defects remedied 45 101 9 9 2 5 171 Animal nuisances abated - 13 6 4 4 - 27 Basement defects remedied 4 4 20 12 - - 40 Stables cleansed or repaired - 3 5 1 11 — 20 Water supply laid on to upper storeys of house 47 41 3 1 5 4 101 Miscellaneous nuisances abated 16 28 15 8 11 1 79 Verminous rooms cleansed 37 3i 12 4 5 2 91 Workshops, damp, dirty or dilapidated, remedied 2 1 8 5 6 12 34 50 Legal Proceedings in Connection with Nuisances. The number of summonses issued during the year was 2. The particulars are as follows:— Premises. Offence. Proceedings taken under, Result. 35, New St., St. John's Wood, N.W. Failure to comply with a statutory notice to abolish the W.C. in the basement and provide a W.C. in accordance with the By-laws of the L.C.C., to lengthen the shaft of the fresh air inlet to the drains so as to cause the same to open into the external air and failing to provide a supply of water to the upper storeys of the premises P.H. (L.) Act, 1891, Sec. 2, Sub. Sec. B. Adjourned for 28 days for defendant to do the work. 11th June, 1915. Costs, £1 6s. L.C.C.(G.P.) Act, 1907, Sec. 78. P.H. (L.) Act, 1891, Sec. 48. 64, Seymour Place, W. Failure to comply with statutory notices to re-drain the premises and provide proper light and ventilation to the ground floor closet at 64, Seymour Place M.M.Act,1855 P.H. (L.) Act, 1891. Summons adjourned for 14 days for work to proceed. Further adjourned for 14 days to 3rd December, 1915. Further adjourned till 31st December, 1915. Premises vacated and handed over to Port man Estate, the lease having been surrendered. Costs £8 5s. In one case, the Owner of 45, Church Street, lodged an appeal to the London County Council againt a Statutory Notice served upon him to redrain the premises. The Appeal was heard at the County Hall, Spring Gardens, on the 29th April, 1915, and was dismissed. The premises were subsequently redrained. Black Smoke Nuisances.—The total number of observations of chimneys made by the inspectors was 1,072, and 8 nuisances were 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. 51 In many cases the reason given 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 explanations appeared to be reasonable, and no notices were served or summonses issued. DRAIN PLANS AND DRAINAGE. During the whole of 1915 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 10,823 as against 8,204 in 1914. The number of plans relating to new buildings was 52 (north 14, south 38). In the case of old buildings, the number of plans received was 209 (north 136, south 73). The total number of plans deposited was 261, the number for 1914 being 428. Legal proceedings were taken in one instance as follows:- Premises. Offence. Proceedings taken under. Result. 84, Maida Vale. Executing works in connection with sanitary arrangements without having first given notice and depositing plans. L.C.C. By-Laws made under M.M. Act, 1865, Sec. 20 Fine £2 Costs £1 1s. Combined Drainage.—The number of orders under seal as to combined drainage granted by the Council was 6, the number in 1914 being 6. 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. REMOVAL OF HOUSE REFUSE. During 1915 the removal and destruction of house refuse was, as in former years, in the hands of the Council's contractors, the Western Cartage Co., The Wharves, Paddington. The total cost for the whole Borough during the financial year to March, 1916, was £12,495. The figure for the year ending March, 1915, was £12,695. Despite very great difficulties with traction, labour, etc., the work was very well done. The number of complaints, 43 in the North and 58 in the South District, compares not unfavourably with the figure for 1914, viz., 43 in the North District and 48 in the South. The number of letters was 332 and of refusals 391. 52 The usual close supervision was exercised over the work by the Public Health Committee during the year, and the Dust Sub-Committee under the late Alderman J. Lea-Smith considered all complaints, and letters and every case in which a refusal was reported. There were no contraventions of the terms of contract calling for the imposition of penalties during the year. The number of old brick receptacles demolished during the year was 25. New metal dust receptacles to the number of 158 were provided. During the year the dust inspectors—Lumley and Hill—made 6,926 visits. In November Inspector Hill having enlisted, Inspector Lumley took over the whole of the work. For neglect of the provisions with regard to the covering of dust bins, etc., 113 notices were served. Remedies in each case were carried out, without the necessity for further proceedings. VERMINOUS PERSONS' BATHS. During 1915, the total number of adults using the Baths was 4,995 (males, 3,323; females, 1,672). The children bathed numbered 1,680, 589 being boys and 1,091 girls. The majority of the children were sent by the London County Council; the payments made in respect of them amounting to £80 12s. Od. In addition 1/- was paid on account of cleansing of a person sent by the County Council inspector from a common lodging house. The practice of visiting the homes of all children sent for cleansing, and arranging, wherever possible, for the bathing of other members of the family and the disinfection of bedding, etc., was continued. THE SHELTER. The accompanying statement shows the number of times the Shelter was used during 1915 and the reasons for such use. No. of hours occupied. Reason for occupation. No. of persons. January 7th and 8th 16 Scarlet Fever 2 adults, 2 children. 53 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 were made by the Outdoor Superintendent, or Inspector Gorniot. Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1915. Males. Females. Total. For burial only. For inquests. Total. No. of. P.M.'s held No. of courts held. No. of Infectious cases recd. January 18 19 37 20 17 37 11 7 - February 14 12 26 15 11 26 6 5 - March 12 14 26 15 11 26 5 5 - April 22 20 42 21 21 42 14 11 - May 11 12 23 11 12 23 6 7 - June 12 8 20 6 14 20 9 6 - July 8 13 21 9 12 21 9 5 - August 12 9 21 11 10 21 5 7 - September 11 14 25 11 14 25 12 6 - October 13 17 30 14 16 30 8 8 - November 19 11 30 13 17 30 10 9 - December 11 16 27 13 14 27 11 5 - Totals 163 165 328 159 169 328 106 81 5 PUBLIC SANITARY CONVENIENCES. There was no addition to the number of conveniences, which were supervised as in former years. That there was, as shown below, a considerable falling off in the receipts, is to some extent due to the fact that in the case of men in uniform no charge was made tor the use of the conveniences. 1915-16. 1914-15. Increase. Decrease. £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus—Men's Department 729 3 1 841 18 2 — 112 15 1 ,, Women's ,, 652 11 7 693 16 9 — 40 15 2 Portland Road—Men's ,, 191 16 6 235 14 5 — 43 18 11 ,, Women's ,, 140 6 9 166 16 1 — 26 9 4 Marylebone Road—Men's ,, 122 18 11 171 13 5 — 48 14 6 ,, Women's ,, 91 6 4 114 11 6 — 23 5 2 Foley Street—Men only 99 16 8 117 4 7 — 17 7 11 St. John's Wood Road—Men only 67 10 8 87 10 2 — 19 19 6 Barrett Street—Men only 115 8 2 138 12 11 — 23 4 9 During the year, the roof of the convenience at Marylebone Road, which for some time had been in a defective and leaky condition, was re-constructed at a cost of £ 196 10s. 3d. 54 FACTORIES AND WORKSHOPS. The total number of visits to factories, workshops and workplaces during the year was 803, 207 by the women and 596 by the men inspectors. The complaints received numbered 15. 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 otter information, the total number of defects found and of notices served. I.—INSPECTION. Premises. (I) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries.) 42 — - Workshops (Including Workshop Laundries.) 743 — - Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 18 - - Total 803 - - 2.—DEFECTS FOUND. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:— Want of cleanliness 46 46 - - Want of ventilation 6 6 — — Overcrowding 3 3 — — Want of drainage of floors - - - - Other nuisances 16 16 - - Sanitary accommodation insufficient 1 1 — — unsuitable or defective 10 10 - - not separate for sexes 5 5 — — 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) - - - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 87 87 - — 55 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. 82 504 624 41 252 314 46 ... ... ... ... ... ... ... ... Umbrellas, etc. 2 ... 7 1 ... 3 ... ... ... ... ... ... ... ... ... Total 84 504 631 42 252 317 46 ... ... ... ... ... ... ... ... 56 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 4,512 Coffee Shops, &c 238 Bakehouses 71 Total number of workshops on Register 4,821 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 183) 1 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 15 Reports (of action taken) sent to H.M. Inspector 15 Other Underground Bakehouses (s 101):— Certificates granted during the year ... In use at the end of the year 71 57 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 194 Cowhouses 5 Slaughterhouses 4 Offensive Trades 2 Ice Cream Premises 117 Bakehouses 71 Restaurant, Dining Room and Coffee Shop Kitchens 156 Hotel Kitchens 38 Pastrycooks and Tea Rooms 45 Fried Fish Shops 25 Fish Curers 6 Houses Let in Lodgings 1169 Workshops 4512 Total 6344 A statement with special reference to the list set out above, is contained in the following tables:— Numbers of places Number of inspections, 1915. Number of notices, 1915. Number of prosecutions, 1915. On register at end of 1914. Added in 1915. Removed in 1915. On register at end of 1915. Milk premises 237 4 47 194 530 10 - Cowsheds 5 - - 5 32 — — Slaughterhouses 4 — — 4 41 - — Offensive trade premises 2 — — 2 40 — — Ice cream premises 117 — - 117 185 - - Houses let in lodgings 1207 — 38 1169 3033 - — Mortuary. Removed by Inspectors. Number of bodies received 328 — Number of Infectious bodies received '— 5 58 Disinfection. Number of rooms disinfected 1,267 Number of articles disinfected 39,437 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 3,323 1.672 589 1,091 6.675 Bakehouses. Number on register at end of 1915 71 Number above ground 10 Number underground 61 Number of inspections 140 Number of Notices. Intimations, 8 8 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1915 270 Number of Inspections 742 Number of Notices 63 House to House Inspections. Number of Inspections Houses 373 Number of Notices issued Intimations 223 Statutory Notices Nil Number of Prosecutions Nil House Refuse. Number of Inspections 6,926 Number of Old Brick Receptacles abolished 25 Number of New Metal Receptacles provided 158 Number of Complaints of Non-removal received 101 Number of Letters received re Removal 332 Number of Refusals of Occupiers to have House Refuse removed 391 Number of Notices served—Intimations, 113; Statutory Notices, 11 124 Number of Prosecutions Nil 59 Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 97 Number of Statutory Notices served 21 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 29 Number remedied 29 Number of Prosecutions Nil Underground Rooms. Number dealt with 6 Number of Notices served under P. H. (L.) Act, 1891 Nil Number of Notices served under H. T. P., &c., Act, 1909 6 Number of Prosecutions Nil Insanitary Houses. Number closed under Public Health (London) Act, 1891 Nil Number closed under Part II of the Housing of the Working Classes Act Nil Number closed under Section 17 Housing, Town Planning, &c., Act, 1909 Nil Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (1), Number of rooms cleansed 91 Number of Prosecutions Nil Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. N umber of persons accommodated during the year :— 2 adults. 2 children. Revenue Acts. Number of houses for which applications were received 4 Number of tenements comprised therein 13 Number of tenements for which certificates were granted 13 „ „ „ ,, refused Nil „ „ „ „ deferred Nil 60 LOCAL GOVERNMENT BOARD AND OTHER TABLES. table i. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1915 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each year. 2 Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. 3 Nett. of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Under 1 Year of Age. At all Ages. No. i Rate. 5 No. 6 Rate. 7 No. 10 Rate per 1,000 Nett Births. 11 No. 12 Rate. 13 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 1915 100,260 3,647 1,852 16.2 1,741 17.2 817 773 178 96.1 1,697 17.8 Total population at all ages, 118,221, at Census of 1911. Area of district in acres (exclusive of area covered by water), 1427 8 acres. 61 TABLE I. (A). Vital Statistics of Separate Localities in 1915 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.[/##] 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 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 Averages of Years 1905 to 1914 122,462 2,439 1,787 259 31,772 521 388 51 34,272 523 458 52 36,899 1,027 655 123 19,526 368 283 31 1915 100,260 1,862 1,697 178 25,002 367 341 21 27,342 337 422 35 30,901 801 639 94 17,015 347 295 28 *The Rectory and St. Mary's Registration Sub-Districts were amalgamated this year. 62 TABLE II. Cases of Infectious Disease Notified during the 52 Weeks ending 25TH December, 1915. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospit al from each locality. Cases isolated at home At all ages. At ages—years. All Souls St. Mary Christ Church St. John Totals. All Souls St. Mary Christ Church St. John Totals Under 1 1 to 5 5 to 15 15 to 25 25 to 46 46 to 65 65 and upwards Anthrax 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... Polio Myelitis 1 ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 Diphtheria, including Membranous Croup 138 7 63 45 14 16 3 ... 32 32 56 18 138 31 30 56 16 133 5 Erysipelas 85 1 4 5 9 27 25 14 11 20 47 7 85 3 8 7 2 20 65 Scarlet Fever 308 1 77 158 32 38 2 ... 81 53 97 77 308 81 50 96 71 298 10 Chicken Pox 152 13 75 60 3 1 ... ... 19 33 79 21 152 10 13 13 2 38 114 Enteric Fever 11 ... ... ... 2 8 1 ... 3 3 3 2 11 2 2 2 i 7 4 Ophthalmia 14 14 ... ... ... ... ... ... 3 9 2 ... 14 ... 4 ... ... 4 10 Puerperal Fever 3 ... ... ... ... 3 ... ... ... 1 2 ... 3 ... 1 2 ... 3 ... Continued (Paratyphoid) Fever 1 ... ... ... ... 1 ... ... 1 ... ... ... 1 1 ... ... ... 1 ... Cerebro-Spinal Fever 10 2 2 2 1 3 ... ... 1 5 3 1 10 1 4 2 1 8 2 Tuberculosis Pulmonary 329 ... 5 26 54 139 91 14 60 92 140 37 329 20 41 33 6 100 229 Non-Pulmonary 56 3 11 29 5 5 ... 3 14 7 26 9 56 4 1 7 1 13 43 Totals 1109 41 227 326 121 241 122 31 225 255 456 173 1109 153 154 219 100 626 483 1109 63 TABLE III.—Causes of, and Ages at Death during the year ending 25th December, 1915. 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 Souls. St. Mary. Christ Church St. John. Total. 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 Entcric Fever 2 - - - - - 1 - 1 2 1 - 1 - 2 2 Small Pox - — — — — — — — - — — — — — — 3 Measles 53 10 29 8 3 — - - 2 1 2 6 40 6 53 4 Scarlet Fever 10 - 2 4 1 1 2 1 - - 4 3 1 2 10 5 Whooping Cough 14 5 5 3 1 — — — - 1 4 1 7 2 14 6 Diphtheria and Croup 7 1 3 1 2 — — — — 1 1 1 3 2 7 7 Influenza 23 - — - 1 1 1 13 7 6 5 6 7 5 23 8 Erysipelas 2 — — — — — — 2 - 1 1 — 1 — 2 9 Phthisis (Pulmonary Tuberculosis) 135 — — 1 3 12 50 58 11 22 31 37 52 15 135 10 Tuberculous Meningitis 18 4 3 6 4 1 — - - 5 3 4 9 2 18 11 Other Tuberculous Diseases 17 - 1 3 2 3 2 5 1 9 1 4 11 1 17 12 Cancer 148 - - — - 1 17 62 68 324 30 43 48 27 148 13 Rheumatic Fever 5 - — 1 2 1 1 - - 3 1 — 2 2 5 14 Meningitis 20 6 1 3 2 — 3 3 2 18 5 4 7 4 20 15 Organic Heart Disease 160 - — 1 3 7 11 49 89 65 41 33 55 31 160 16 Bronchitis 220 3 4 1 1 1 9 51 150 22 36 73 81 30 220 17 Pneumonia (all forms) 174 25 15 6 2 8 19 36 63 47 33 32 85 24 174 18 Other Diseases of Respiratory Organs 26 1 — 1 — — 2 10 12 7 4 10 6 6 26 19 Diarrhœa and Enteritis (under 2 years) 38 31 7 - - - - - - 3 3 4 29 2 38 20 Appendicitis and Typhlitis 10 1 — — 1 3 1 3 1 19 2 1 3 4 10 21 Cirrhosis of Liver 20 — — - — — 3 12 5 15 8 3 7 2 20 21a Alcoholism. 1 - - - - - - 1 - 2 — - 1 — 1 22 Nephritis and Bright's Disease 57 1 1 1 — 3 8 26 17 30 14 17 20 6 57 23 Puerperal Fever — - - - - — - - - 3 — — — — — 24 Other accidents and diseases of Pregnancy and Parturition 4 1 — — — — 3 — — 15 — — 2 2 4 25 Congenital Debility and Malformation, including Premature Birth 43 41 1 — 1 — — — — 68 9 15 13 6 43 26 Violent Deaths, excluding Suicide 77 1 2 - 2 8 17 28 19 54 17 15 30 15 77 27 Suicides 13 - — - — 2 3 8 - 5 3 4 3 3 13 28 Other defined Causes 400 47 — 6 6 7 41 95 198 229 82 106 115 97 400 29 Diseases ill defined or unknown — - — — — — — — — — — — — — Totals 1697 178 74 46 37 59 194 463 646 977 341 422 639 295 1697