AC 4353 STMARY 22 Metropolitan Borough of St. Marylebone REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1917. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. london: geo. pulman and sons, ltd. 1918. Telephone No.: Mayfair 3008. Metropolitan Borough of St. Marylebone. Public Health Department. Town Hall. Marylebone Road, N.W. I. 28th/july/1925. Charles Porter, M.D., B.Sc. MEDICAL OFFICER OF HEALTH. With the Compliments of the Medical Officer of Health. Enclosed please find reports as requested. I am sorry that the report for the year 1918 is out of lock. STMARY 22 Public Health Department, 24, Somerset Street, Portman Square, — . London, W. 1. 28th June, 1918. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylehone. Mr. Mayor, Ladies, and Gentlemen, Again this year, as last, and for the same reasons, my annual report is a brief summary only of the work done in respect of certain of the more important matters. For the reason that I have to record a serious outbreak of measles and an increase in the infantile mortality rate as a result entirely of that outbreak, it is not by any means so satisfactory a report as most of its predecessors. Though unsatisfactory it is not a discouraging report, mainly because it shows that there was re-action to the unfavourable circumstances and that the Public Health Committee under the chairmanship of Councillor Sir Horatio Shephard and later of Councillor E. Sanger, L.C.C, helped and encouraged every effort that was made to deal with the outbreak and to maintain and improve the health of the inhabitants. The help and encouragement thus given are valued and appreciated not only by myself, but by all the members of the staff of the Public Health Department, and I take this my only real opportunity of tendering my thanks to the Committee. At the same time I desire to thank the staff and to record my appreciation of the admirable way in which they have worked during the past year. Particularly I wish to say how much I appreciate the readiness with which they agreed to undertake the additional duties imposed by the orders of the Food Controller. Willingly undertaken the work, which was often difficult and not always pleasant, was well done, and I am very grateful. I am, Mr. Mayor, Ladies, and Gentlemen, Your obedient Servant, CHARLES PORTER. 3 POPULATION. In the following pages, two figures representing population are employed, viz. : 92,796, used in connection with the calculation of all rates, except the birthrate, for which in accordance with the instructions of the Registrar-General, the figure 103,441 is used. BIRTHS. Registration.—Births registered numbered 1,506 (Boys, 784: Girls, 722). The birth rate was 14.5 per 1,000. Notifications of births received, including 3,065 belonging to other districts, numbered 4,571, the chief sources being: Parents, 123: Doctors, 259; Midwives, 627; and from Hospitals, 2,325 (Queen Charlotte's, 1,951: Middlesex, 374). In 1,143 cases, the birth occurred at home. Still births notified, numbered 179. DEATHS AND DEATH-RATES. The total deaths of Marylebone persons whether occurring within or outside the boundaries, amounted to 1,580 (males, 783: females, 797). The death-rate for the Borough was 17.0 and for the registration sub-districts: All Souls, 11.9: St. Mary, 16'4: Christ Church, 21.4: St. John, 17'4. Causes of and Ages at Death.—Table III of the Local Government Board series (p. 23) contains an analysis of the deaths in relation to cause and age. It shows that of the total 1,580, 11.5 per cent. were of infants under 1; 12'0 per cent. of persons between 25 and 45; 26'3 per cent. of persons between 45 and 65, while 35.2 per cent. were aged over 65. INFANTILE MORTALITY. The number of babies under 1 year of age who died during 1917 was 182; in the same period the number of births was 1,506; the infantile mortality rate was therefore 120.9, as against 103.6 in 1916. Apart from "Prematurity," (including "congenital malformation," ''premature birth," "atrophy," and "debility and marasmus,") which caused 59 deaths, and, as usual, heads the list, the outstanding causes were diarrhoea and enteritis (20 deaths), measles (16), pneumonia (25) and bronchitis (9). Speaking broadly, the responsibility for the increase in the rate of infantile mortality, and the failure of the number of deaths to fall in correspondence with the reduction in the number of births, is to be traced to the distinctly severe epidemic of measles which occurred in the earlier part of the year. It is true that the actual number of deaths certified to be due to this cause was only 16, but in 1916 the deaths only numbered 2. Moreover, the 16 includes only those deaths that occurred during the actual course of the disease, and does not take into account those, the result of complications, occurring later. The majority of these are found in the figures relating to pneumonia and bronchitis; the former, it will be noted, caused 25 deaths, and the latter 9. The corresponding figures for 1916 were 1 and 2. Having regard to the fact that a great deal of work was done in relation to infantile mortality prevention, and the Council was urged to make, or assist in the making of further extensions in this field of work, the figures given above when they 4 were first published proved somewhat discouraging. They need not have been. It was not because there was too little effort, or because the effort was in the wrong direction, that a higher proportion of the babies died than in any of the years since 1906. There were circumstances and conditions that even the strong organization in existence in St. Marylebone, and the great work that is done in the Borough, could not master. The organization is strong, and will be stronger and more perfect; the work done is great in amount, and will be greater. The organization contains voluntary and official elements. Of the voluntary elements, those for which the St. Marylebone Health Society is responsible, bulklargest, and the Council are greatly indebted to this body and those who work for it, for what they have done and what they are doing. Apart from the Health Society, however, there were other bodies that rendered assistance, viz.: The Women's League of Social Service, Queen Charlotte's Hospital, and Middlesex Hospital. The chief parts of the scheme are shown in the following summary, which indicates that at the end of the year there were available in the Borough no fewer than seven centres where attention was given to infant and child welfare, and if those at the hospitals are included, four ante-natal clinics. In addition, there was a dining centre for nursing and expectant mothers, a dental clinic for mothers and young children, and a day nursery ; the two latter opened during the year. The following is the summary referred to. It is based upon a return made to the Local Government Board and gives much statistical information with regard to work done in 1917. "Health Visitors.—One whole-time Health Visitor who works only in connection with the Church Street Centre of the Health Society, and three parttime Health Visitors who are also Sanitary Inspectors. The voluntary workers of the St. Marylebone Health Society and of the League of Social Service also do visiting in co-operation with the work of the Council. The borough is divided into three districts, and in 1917 the Municipal Health Visitors made 3,781 visits to 1,597 infants, and the voluntary visitors attached to the St. Marylebone School for Mothers made 5,555 visits to 712 infants. Children are visited up to school age. Centres—Voluntary.—The St. Marylebone Health Society have five centres: (1) North Marylebone School of Mothercra/t, Church Street, has an ante- and postnatal consultation under medical supervision. The Municipal Health Visitors co-operate. The ante-natal work is linked up with the Queen Charlotte's Lying-in Hospital. (2) South Marylebone School of Mothercraft, St. Marylebone General Dispensary, 77, Welbeck Street, W. An ante-natal clinic which is linked up with the Middlesex Hospital, is held once weekly, and an infant consultation is held twice weekly, both under medical supervision. There is a superintendent and a part-time assistant, both of whom are nurses. Children attend up to school age, and the Municipal Health Visitors co-operate. 226 Children attended in 1917 and there were altogether 1,415 attendances. The Municipal Health Visitor attends. No treatment is given. (3) Ogle Mews, Ogle Street, W. 163 children attended in 1917, and there were altogether 1,163 attendances at the infant consultations. Classes for cookery needlework and hygiene are held weekly : (4) Henry Street. Infant consultation held weekly, attended by the Municipal Health Visitor. 106 children attended in 1917, and there were altogether 1,511 attendances; and (5) 101, Crawford, Street.— Infant consultation held weekly, attended by Municipal Health Visitor. This Centre was only opened early in 1917, and up to the end of the year, 64 children had attended and made 517 attendances. In addition to these Centres, consultations are held weekly at Queen Charlotte s Hospital and the Branch of the Womens' League of Social Service, 35, Lisson 5 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages, and in Sub-Districts, under 1 Year of Age. No. CAUSE OF DEATH. Under 1 Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under 4 Weeks. Total under 1 month. 1 and under i Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Total. 1 Small-Pox - - - - - - - - - - - - - — — 2 Chicken-Pox — - — — — — — — — — — — — — — 3 Measles — — — — — — — 4 12 16 — 1 10 o 16 4 Scarlet Fever - - - - - - - - - - - — - — — 5 Diphtheria and Croup — — — — — — — — — — — — — — 6 Whooping Cough — — — — — — - 2 1 3 — - 1 3 7 Diarrhœa — — — — — 1 4 2 — 7 1 1 5 — 7 8 Enteritis - 1 — — 1 3 4 4 1 13 3 4 5 1 13 9 Tuberculous Meningitis — — — — - - — — — — - — — — — 10 Abdominal Tuberculosis - — — — — — — — — — - - — — — 11 Other Tuberculous Diseases - - - - - - - - 1 1 - 1 - - 1 12 Congenital Malformation 1 — - — 1 — — - — 1 — 1 — — 1 13 Premature Birth 28 6 3 — 37 2 — — — 39 12 8 19 — 39 14 Atrophy, Debility and Marasmus 1 2 1 2 6 5 6 2 - 19 - 6 8 5 19 15 Atelectasis 2 — — — 2 — — — 2 — — 2 — 2 16 Injury at Birth — — 1 — 1 — — — — 1 1 — — — 1 17 Erysipelas — — — - — 1 — — — 1 — 1 — — 1 18 Syphilis — 1 1 - 2 1 - — - 3 — — 2 1 3 19 Rickets - — — — — — — — — — — — — — — 20 Meningitis (not Tuberculous) - - - - - - l 1 1 3 - - 3 - 3 21 Convulsions . — 2 - - 2 1 2 — — 5 — 1 2 2 5 22 Gastritis — — - — - — — — — — — — — — — 23 Laryngitis — — — — — — — — — — — - — — — 24 Bronchitis — 1 — — 1 — 2 5 1 9 1 2 4 2 9 25 Pneumonia (all forms) 1 3 1 i 6 2 4 5 8 25 5 2 13 5 25 26 Suffocation, Overlying 2 — — — 2 2 — — — 4 - — 1 3 4 27 Other Causes . 15 3 1 — 19 3 3 - 5 30 5 8 12 5 30 Totals 50 19 8 3 80 21 26 25 30 182 28 41 87 26 182 Nett Births in the Year Legitimate, 1,375 Illegitimate, 131 Total 1,506 Nett Deaths in the Year Legitimate Infants, 122 Illegitimate Infants, 60 Total 182 6 Street. Each is presided over by a specially appointed Medical Officer. One of the Municipal Health Visitors attends the former. The Womens' League Centre is attended by a Heath Visitor appointed by the League, who, however, submits a weekly report to the Medical Officer of Health. The Centre at Queen Charlotte's Hospital is open to others than St. Marylebone babies, of whom only 55 attended and made 212 attendances. The number attending the Centre in Lisson Street was 79 and the total attendances 741. Ante-natal work as indicated above. There are two voluntary ante-natal clinics. Visiting is undertaken by the Municipal Health Visitors and by the workers attached to the societies, and there is a system of co-operation with the Middlesex and Queen Charlotte's Lying-in Hospitals. Hospital Treatment.—Children's cases are referred from the centres to the dispensary and hospitals, and the Queen Charlotte's Lying-in and Middlesex Hospitals are available for ante-natal and complicated maternity cases." During the year the Health Society, in addition to arranging for the provision of a Dental Clinic for mothers and young children, at the old "Champion" publichouse, and for a new Day Nursery in Exeter Street, Lisson Grove, and the reorganization of an existing Day Nursery in Barrow-hill Road, St. John's Wood, worked strenously to provide a nursing home for wasting babies. This institution was not opened until after the close of 1917 as suitable premises had not been obtained. DEATHS IN RELATION TO DISEASE. Diarrhœal Diseases.—The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels) was 27, equal to 0.29 per 1,000 of the population. The majority of the deaths, viz., 20, occurred amongst infants under 1 year of age. In 1916 the number of deaths was 28, and the rate 0'28 per 1,000. Tuberculosis.—The total deaths caused by phthisis (consumption) and other conditions due to the germ of tuberculosis was 169. Of these, 137, were due to phthisis; the age periods at which they occurred being 2-5 years, 3 (2.1 per cent.); 5-15, 1 (0.7 per cent.); 15-25, 19 (13.9 per cent.); 25-45, 53 (38.7 per cent.); 45-65, 48 (35 per cent.) ; 65 and over, 13 (9.5 per cent.) Respiratory Diseases.—The number of deaths due to bronchitis, pneumonia and other diseases of the organs of respiration was 335, and the death rate 3.61 per 1,000. Of this number, bronchitis caused 175 and pneumonia 139. Cancer or Malignant Disease caused 153 deaths, the death-rate being 1.6 per 1,000 of the population. INFECTIOUS OR COMMUNICABLE DISEASES. The table with regard to these diseases will be found on page 22. The total number of notifications received during 1917 was 2,597, the actual number of cases notified being 2,957, the bulk being measles and German measles. Diphtheria and Membranous Croup.—The number of cases notified was 168, of whom 157 were removed to hospital and 9 died. The case mortality rate was 5.3 per cent. The cases were not limited to any particular "district. The number of swabs submitted from doubtful cases for bacteriological examination was 122 and a positive result was returned in 30 instances. 7 Scarlet Fever.—The notifications numbered 94, the lowest figure for some years. The disease was of a mild type and there were no deaths. Enteric Fever.—There were 5 cases notified, none of which calls for special comment. There were no deaths. Cerebro-Sbinal (Spotted) Fever.—The notifications received numbered 7. Of the 7, 3 had died before notification was received. The first notification came to hand on 15th January, the total number for that month being 1. In each of the months of February, March, April, June, September, October and December there was also 1 case. Of the patients, 2 were males and 5 females; 1 was less than 1 year old and 1 less than 2; 1 was aged 3, one 8, the remaining 3 being adults (women) aged 40, 42 and 55. Of the cases, 5 proved fatal, viz : a boy of 3, a giri aged 4 months and the three women referred to. There was no connection between the various cases and none of them gave rise to further cases amongst persons immediately in contact with them. In each instance an attempt was made to trace the source of infection, but with comparatively little success. As far as possible all contacts were swabbed, and in 3 instances a positive result was obtained. None of the persons showed any symptoms either before or after the discovery of the presence of the germs and subsequent examinations gave negative results. Erysipelas.—Of this disease 54 cases were notified, mainly from the Workhouse Infirmary and other institutions Erysipelas was stated to be the cause of death in 5 cases. Puerperal Fever.—One notification was received. The patient recovered. Ophthalmia Neonatormn.—The total number of cases notified was 21, as against 11 in 1916. Visits were paid to all cases by the women inspectors. Measles and German Measles.—Measles which had been more or less epidemic in 1915, but had quietened down somewhat in 1916, attained markedly epidemic proportions in 1917. Under the regulations which came into force in 1916, 2171 notifications were received (measles, 1632; German measles, 539), the total for 1916, being 461. Part of the increase in the number of cases reported was, it' is probable, due to the fact that the necessity for notifying had become better known ; at the same time, however, there is no doubt that during the year there was a. sharp and widespread epidemic and few families escaped. The deaths numbered 95, as against 7 in 1916 and 53 in 1915. No fewer than 16 of the deaths occurred amongst babies under 1 year age of whom only 66 were notified as suffering. As already stated, the fact that measles directly or indirectly caused so many deaths amongst the babies accounts for the high rate of infantile mortality registered during the year. The amount of work done in connection with the outbreak was very great. Practically every case was visited by the Health Visitors. Particular attention was given to such as occurred in tenement houses, and under an agreement entered into between the Council and the Paddington and Marylebone Nursing Association the services of a nurse were obtained in cases in which the attack was severe. The number of cases dealt with in this way was 260 and the amount expended £80 Is. 4d. 8 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the. period from the 31st December, 1916, to the 29th December, 1917. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Age Periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C Number of Primary Notifications. T otal Notifications on Form A No. of Primary Notifications. Total Notifications on Form B. Poor Law Institions. 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 Primary Notifications Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary, Males — 3 17 7 19 16 60 45 42 27 8 244 287 1 1 — 2 4 54 36 ,, Females - 2 18 17 10 15 29 22 22 6 — 141 172 — — 1 1 4 23 31 Non-pulmonary, Males — 2 3 4 2 1 2 3 1 — — 18 18 — 1 1 2 4 — 3 ,, Females 1 4 4 8 2 — 3 — — 2 — 24 27 — 3 — 3 6 — — Totals 1 11 42 36 33 32 94 70 65 35 8 427 504 1 5 2 8 18 77 70 9 Hospital accommodation was found for 179 cases. In a considerable number of cases, particularly those occurring amongst occupants of the more expensive flats and such institutions as Clubs and Hostels, it was impossible to find accommodation and many complaints were received as to the difficulty of properly guarding against spread of infection. The number of notifications received from parents and guardians was 35. In one case proceedings were instituted against a woman for failing to notify that her child was suffering. The magistrate severely censured the defendant and bound her over in a sum of £5. The patient died, but might have been saved if an opportunity had been given to visit and arrange for proper nursing and treatment. Whooping Cough.—This disease was apparently less prevalent than in 1916. The deaths registered as due to it numbered 9 as against 21 in the previous year. Tuberculosis.—In all, 435 cases were notified, 392 being pulmonary cases, the remainder of the notifications (43) relating to cases in which structures other than the lungs were affected. The table given on page 8, contains the information required by the Local Government Board with regard to notifications. Notifications made on Form B. relate to school children. The number it will be noted was 18 as against 43 in 1916. Of the 43 cases in which parts other than the lungs were affected, in 8 the infection was limited to the glands of the neck: in 11 one of the joints, and in 3 the spine was the part attacked. Treatment of Tuberculosis.—Of the cases notified 92 received some form of institutional treatment, and during the year every effort was made to obtain admission to sanatoria of cases deemed suitable for such treatment. Of the total cases notified, 95 were insured persons, and of these 37 applied for sanatorium benefit, 2 dying before gaining admission to an institution. Notifications relating to insured persons numbered 182, and of the patients, 67 applied for sanatorium benefit. Of these 66 were admitted, 1 died before gaining admission, and 14 were admitted to the Infirmary, being advanced cases, or unsuitable for sanatorium treatment. Prevention of Consumption.—During the year all the official bodies concerned definitely gave their consent to the Council's scheme and the system became well established. Miss Baker gave the whole of her time to the work, and, despite the fact that a number of institutions and bodies are involved, there was a complete absence of friction. During the year Miss Baker paid 1,671 visits to the homes of patients. In addition she attended the consultations at Middlesex Hospital 101 times and those at Margaret Street Hospital 83 times. Atlendances at Allsop Place were less frequent, 58 in all, for the reason that the tuberculosis nurse attached to the dispensary does all that is required in the way of following up cases. The Tuberculosis Care Committee met frequently throughout the year, and at this 56 attendances were made. The total number of patients examined at the various institutions under the scheme was 414. Of these 160 were found to be suffering, and 119 were "suspected." Patients found to be suffering from other forms of tuberculosis than the pulmonary, numbered 23. The number of insured patients found to be suffering was 113 out of 223 examined. Of the new patients visited by Miss Baker, 188 were insured and 208 10 non-insured. Among the patients were included 44 discharged soldiers and sailors. As regards sanatorium treatment 87 children, 143 insured and 23 uninsured persons were admitted to a sanatorium or hospital and 20 insured and 15 uninsured to the Workhouse or Infirmary. All contacts from the homes of patients were referred to the various institutions included in the scheme. Deaths from Phthisis.—The table given below shows the number of deaths certified as due to consumption, and compares the figure for 1917 (137) with those of preceding years. The death rate was 1.4 per 1,000. Of those who died 73 were insured and 64 uninsured. DEATHS FROM PHTHISIS. Estimated Population. Year. All Ages. Sub-Districts. All Souls. St. Mary. ' Christ Church. St. John. 92,796 1917 137 29 30 48 30 98,573 1916 151 3',' 35 61 23 100,260 1915 135 31 37 52 15 112,892 1914 152 18 38 73 23 114,532 1913 149 32 40 57 20 116,155 1912 149 26 32 66 26 117,844 1911 172 51 30 65 26 125,195 1910 133 28 37 56 12 126,027 1909 170 43 41 66 20 126,867 1908 154 35 33 61 25 127,718 1907 179 42 46 64 27 127,960 1906 197 36 64 73 24 Disinfection.—The total number of rooms disinfected during the year was 1,546, and of articles (beds, bedding, etc.) 21,349. In the majority of instances the reason for disinfection was on accouni of infectious disease, but in 53 cases it was rendered necessary by reason of the presence of vermin. BACTERIOLOGICAL EXAMINATIONS. The number of specimens examined bacteriologically, by Dr. Foulerton, and the diseases in relation to which the examinations were made, are shown in the following table. 1917 Positive. Negative. Total. Typhoid Fever 6 9 15 Diphtheria 35 87 122 Phthisis 118 219 332 Wassermann Reaction 4 4 Totals 154 319 .473 11 Apart from the above Dr. Foulerton also examined 6 samples of Milk. In respect of these he reported favourably with regard to 4. In 1 case the examination revealed the presence of tubercle bacilli, and one was found to be " dirty." Careful enquiries were made in both these cases, but it was found impossible to trace the milk further back than to the wholesale dealer, who was cautioned. ANALYSIS AND EXAMINATION OF FOOD. The following summary contains all the necessary information with regard to the work done under the Sale of Food and Drugs Acts in repect of the protection of the food supply. Proceedings on account of food adulteration were taken in 12 cases. Warranty was pleaded in 6 cases and the summons dismissed. In the remaining 6, fines and costs to the amount of £19 10s. 6d. were imposed. The Public Analyst reports as follows:—"Notwithstanding war conditions, the provisions of the Sale of Food and Drugs Acts were enforced in the Borough, with the same systematic energy as in former years. 833 samples were submitted for analysis, the majority of them being dairy produce. Of these 34, or only about 4 % were adulterated. A complete list is as follows : LIST OF SAMPLES TAKEN DURING THE YEAR 1917. Article. Genuine. Adulterated. Total. Milk 476 21 497 Butter 233 12 245 Cream 17 — 17 Lard 7 — 7 Lard Substitute 2 — 2 Margarine 10 — 10 Dripping 2 — 2 Bread 1 — 1 Flour 5 — 5 Jam 1 — 1 Coffee 15 1 16 Cocoa 7 - 7 Sugar 4 — 4 Condensed Milk 1 — 1 Ox Tail Soup 1 — 1 Egg Powder 1 — 1 Mustard 4 — 4 Pepper 3 - 3 Cayenne . 1 - 1 Sypgar 1 — 1 Bicarbonate of Soda 3 - 3 Hydrogen Tartrate 2 — 2 Cream of Tartar. 1 - 1 Sienna Leaves 1 — 1 Totals 799 34 833 12 Milk.—497 samples of milk were analysed, of these 21 or under 5 % were adulterated, 6 of the 21 contained small quantities of added water, but mostly the offence was the direct or indirect abstraction of milk fat; the lowest amount being a little over 3 %, the highest a deficiency of 20.% milk fat, calculated on the official limit of 3 %. No Jess than 25 samples of milk contained 5 % and over of milk fat, one sample attained 11%. High and abnormal yields of milk fat are suspicious, the inference being that the Inspector has been supplied from a special can, or else the bulk has not been well mixed and therefore some customers get an excess, others a deficiency of cream. 62 of the milks were artificially coloured, but the practice of colouring milks ceased at the end of June, 1917 ; the direct effect of the Food Control regulations. One sample sent by a private purchaser was not alone deficient in fat, but filthily dirty, containing a sediment of animal cells, hair, and miscellaneous debris. The mean composition of the genuine samples of milk is shown by the following table to be quite similar to that of previous years: viz., milk well over the official standard:— Sp. Gr. Milk Fat. Solids, not Fat Total Solids. 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 1916 103 l.0 3.63 8.57 12.20 1917 1032.0 3.70 8.80 12.50 Cream.—Out of 17 samples, 5 only were free from boric acid, the remainder containing up to 10 grains of boric acid per lb Butter.—245 samples of butter were analyzed, 12 of which were either margarine or mixtures of margarine and butter. Only 4 of the samples were free from boric acid, the majority contained that preservative in about 19 grains per lb., which is well within the official limit of 35 grains per lb. Margarine.—Ten samples of margarine were submitted, mostly of a high class; in fact, succesive improvements in the manufacture have resulted in the production of a product difficult to distinguish from butter, save by the application of quantitative analysis and refined physical tests. Drugs.—A few drugs were analyzed; all these conformed to the strict and exact conditions as to purity laid down in the British Pharmacopoeia, 1914. Public Health (Milk and Cream) Regulations, 1912.—The following report is submitted in accordance with requirements of the Local Government Board 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 497— Cream— 13 2. Cream sold as Preserved Cream. (а) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correction statements made 17 (ii.) Statements incorrect — Total 17 (б) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent 17 (ii.) Below 35 per cent. — Total 17 (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—Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken—Nil. 3. Thickening substances.—Any evidence of their addition to cream or to preserved cream—None. 4. Other observations, if any—None. SANITARY WORK OF THE YEAR. The following general summary contains practically all the information necessary with regard to the Sanitary Work carried out during the year. Premises under Constant Supervision. Milk Premises 203 Cowhouses 5 Slaughterhouses 4 Offensive Trades 2 Ice Cream Premises 117 Bakehouses 65 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 1160 Workshops 3233 Total 5059 14 A statement with special reference to the list set out above, is contained in the following tables:— Number of places Number of inspections, 1917. Number of notices, 1917. Number of prosecutions, 1917. On register at end of 1916 Added in 1917. Removed in 1917. On register at end of 1917. Milk premises 201 3 1 203 203 - - Cowsheds 5 - — 5 18 - — Slaughterhouses . 4 - - 4 14 - — Offensive trade premises 2 — — 2 6 - — Ice cream premises 117 — - 117 3 - - Houses let in lodgings 1169 - 9 1160 1202 516 — MORTUARY. Removed by Inspectors. Number of bodies received 310 — Number of Infectious bodies received — Disinfection. Number of rooms disinfected 1,546 Number of articles disinfected 21,349 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 1,947 967 1,3761,699 5,989 Bakehouses. Number on register at end of 1917 65 Number above ground 10 Number underground 55 Number of inspections 140 N umber of Notices Nil Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1917 270 Number of Inspections 1186 Number of Notices Nil House to House Inspections. Number of Inspections Houses Nil Number of Notices issued Intimations Nil Statutory Notices Nil Number of Prosecutions Nil 15 House Refuse. Number of Inspections 6,328 Number of Old Brick Receptacles abolished 15 Number of New Metal Receptacles provided 173 Number of Complaints of Non-removal received 850 Number of Letters received re Removal 58 Number of Notices served 142 Number of Prosecutions Nil Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 9 Number of Statutory Notices served 9 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 5 Number remedied 5 Number of Prosecutions Nil Underground Rooms. Number dealt with 15 Number of Notices served under P. H. (L.) Act, 189115 Number of Notices served under H. T. P., &c., Act, 1909 Number of Prosecutions Nil Insanitary Houses. Number closed under Public Health (London) Act, 1891 7 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 52 Number of Prosecutions Nil Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 10 Inland Revenue Act. Number of houses for which applications were received. 5 Number of tenements comprised therein 39 Number of tenements for which certificates were granted 31 „ „ „ ,, refused Nil ,, „ ,, ,, deferred 8 The total number of inspections made was 5,734. The total number of plans deposited was 114, the number relating to new buildings being 7 (north 5, south 2). In the case of old buildings, the number was 107 (north 87, south 20). 16 WORK OF SANITARY INSPECTORS. The following summary shows the number of inspections made by each of the inspectors, and the nuisances detected by them :— Districts. No. i. No. 2. No. 3. No. 4 No. 5. Total. Total Inspections 5178 4211 4498 8910 4012 26809 Houses damp, dirty or dilapidated remedied 75 52 94 20 3 124 Doors, windows, floors, ceilings, sash cords, etc., repaired 29 15 28 2 2 76 Overcrowding abated 2 1 2 0 0 5 Illegal occupation of underground rooms dealt with 0 1 13 1 0 15 Water closet defects remedied 43 64 114 32 11 264 Water closets erected 33 1 0 0 0 34 Urinal defects remedied 6 2 3 1 0 12 Soilpipe and ventilating shaft repaired or renewed 39 2 13 9 3 66 Yard defects remedied 30 15 47 9 2 103 Waste pipe defects remedied 8 7 6 8 1 30 Water cistern defects remedied 13 4 9 10 4 40 Rubbish, manure, etc., accumulations removed 8 21 70 24 0 123 Dung or dust receptacles repaired or renewed 10 16 28 117 2 173 Drains relaid or amended 26 3 8 7 4 48 Drains cleared 9 8 26 0 0 43 Rainwater pipes repaired or renewed 10 10 13 3 2 38 Water supply to houses reinstated 5 3 15 0 2 25 Roofs and gutters repaired 47 38 43 5 0 133 Area defects remedied 25 17 45 7 0 94 Wash-house defects remedied 39 6 22 1 0 68 Animal nuisances abated ... 0 0 2 1 0 3 Basement defects remedied 3 7 39 3 0 52 Stables cleansed or repaired 4 3 0 0 0 7 Water supply laid on to upper storeys of house 1 4 3 0 1 9 Miscellaneous nuisances abated 26 30 73 7 1 137 Verminous rooms cleansed 3 23 25 1 0 52 Workshops, damp, dirty or dilapidated, remedied ... 9 2 24 1 2 38 17 FACTORIES AND WORKSHOPS. The total number of visits to factories, workshops and workplaces during the year was 1520, 1001 by the women and 519 by the men inspectors. The complaints received numbered 6. The following report is made in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901. I.—INSPECTION. Premises (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries.) 15 — — Workshops (Including Workshop Laundries.) 1486 82 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 19 14 - Total 1520 46 — 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 37 37 — - Want of ventilation 2 2 — - Overcrowding 0 0 - - Want of drainage of floors 7 7 — — Other nuisances 10 10 — — Sanitary accommodation insufficient 0 2 — — unsuitable or defective 2 - - - not separate for sexes 2 — — — 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 60 58 - — 18 • 3—HOME WORKi OUT WORKERS' 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. L st . Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)  Wearing Apparel— (1) Making, etc. 126 562 1194 2 ... 4 95 ... ... ... ... ... ... ... ... Umbrellas, etc 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Total 128 564 1194 2 ... 4 95 ... ... ... ... ... ... ... ... 19 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 2,9.30 Coffee Shops, &c. 238 Bakehouses 65 Total number of workshops on Register . 3,233 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 27 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 21 Reports (of action taken) sent to H.M. Inspector 21 Other . ... Underground Bakehouses (s 101) :— Certificates granted during the year ... In use at the end of the year 65 20 LOCAL GOVERNMENT BOARD AND OTHER TABLES. TABLE I. _ VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1917 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. 10 Rate per 1,000 Nett Births. 11 No. 12 Rate. 13 No. 4 Rate. 5 No. 6 Rate. 7 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 1916 98,573 3,936 1,814 16.8 1,681 16.9 855 720 188 103.6 1,588 16.0 1917 92,796 3,065 1,506 14.5 1,647 17.6 853 752 182 120.9 1,580 17.0 Total population at all ages at Census of 1911, 118,221. Area of district in acres (exclusive of area covered by water), 1427.8 acres. 21 TABLE I. (A) Vital Statistics of Separate Localities in 1916 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 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 118,135 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 1915 100,260 1,852 1,697 178 25,002 367 341 21 27,342 337 422 35 30,901 801 639 94 17,015 347 295 28 1916. 98,573 1,814 1,588 188 24,540 392 337 32 26,892 353 400 40 30,403 755 574 88 16,738 314 277 28 Averages of Years 1907 to 1916 116,604 2,279 1,720 228 29,892 492 373 42 32,368 460 432 44 35,395 969 639 112 18,957 358 275 28 1917 92,796 1,506 1,580 182 23,089 332 275 28 25,334 248 416 41 28,621 618 614 87 15,752 308 275 26 *The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sub-District on the 1st April, 1016, but for the purposes of District comparison oyer previous years the figures have been allocated to the old Sub-Districts. 22 TABLE II. Cases of Infectious Disease Notified during the Year ending 29th December, 1917. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home At all ages. At ages—years. All Souls St. Mary Christ Church St. John Totals. Souls St. Mary Christ Church St. John Totals Under 1 to 5 6 to 16 15 to 25 25 to 15 45 to 65 5 and upwards Diphtheria, including Membranous Croup 168 2 56 75 22 12 ... 1 39 29 77 23 168 38 26 72 21 157 11 Erysipelas 54 2 1 7 5 16 19 4 8 12 25 9 54 ... ... 1 1 2 52 Scarlet Fever 94 ... 21 34 25 14 ... ... 35 25 25 9 94 35 ... 19 8 84 10 Ophthalmia Neonatorum 21 21 ... ... ... ... ... ... 6 6 4 5 21 1 ... ... ... 1 20 Enteric Fever 5 ... ... ... 3 1 1 ... 1 2 1 1 5 ... 2 ... ... 2 3 Poliomyelitis 1 ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 Puerperal Fever 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Cerebro-Spinal Fever 7 1 2 1 ... 1 2 ... 2 ... 5 ... 7 ... ... 2 ... 2 5 Tuberculosis Pulmonary 392 ... 7 62 61 158 97 7 91 100 139 62 392 13 33 25 11 82 310 Non-Pulmonary 43 1 6 22 5 6 3 ... 14 5 18 6 43 4 ... 5 1 10 33 Measles 1597 66 651 577 161 119 21 2 266 293 727 311 1597 35 21 50 8 114 1483 German Measles 539 9 58 140 161 160 10 1 125 141 113 160 539 20 11 8 26 65 474 Measles (Notified by Parents) . 35 1 16 15 3 ... ... ... 1 6 20 8 35 1 ... ... ... 1 34 Totals . 2957 103 819 933 447 487 153 15 588 620 1154 595 2957 147 115 182 76 520 2437 2957 23 TABLE III.—Causes of, and Ages at Death during the year ending 29th December, 1917. No. CAUSES OF DEATH. Net 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. 6 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 Enteric Fever - - - - - - - - - 2 - - - - - 2 Small Pox —. — — — — — — — — — — — — — — 3 Measles 95 16 42 31 3 2 i — — 1 3 19 65 8 95 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Whooping Cough 9 3 1 5 — — — — — — — 4 5 — 9 6 Diphtheria and Croup 9 — 1 4 3 — i — — 2 1 3 4 1 9 7 Influenza 22 — — — — — 2 8 12 7 2 6 9 5 22 8 Erysipelas 5 1 — — — 1 — — 3 — 1 2 2 — 5 9 Phthisis (Pulmonary Tuberculosis) 137 - 2 1 1 19 53 48 13 15 29 30 48 30 137 10 Tuberculous Meningitis 13 - 3 6 3 — — — 1 10 1 2 9 1 13 11 Other Tuberculous Diseases 19 1 2 2 2 3 1 6 2 13 4 5 9 1 19 12 Cancer 153 - — — — — 17 74 62 307 33 45 45 30 153 13 Rheumatic Fever 10 - — — 1 1 1 3 4 7 — 6 2 2 10 14 Meningitis ... 13 3 1 3 1 — 3 2 — 10 4 1 7 1 13 15 Organic Heart Disease ... 127 1 — — 2 4 14 43 63 58 20 38 44 25 127 16 Bronchitis 175 9 2 3 1 1 4 48 107 16 31 45 79 20 175 17 Pneumonia (all forms) 139 25 10 12 6 — 17 34 36 62 21 40 55 23 139 18 Other Diseases of Respiratory Organs 21 — — — 2 — 3 8 8 8 4 6 8 3 21 19 Diarrhoe and Enteritis (under 2 years) 27 20 5 1 - 1 — - - 37 4 4 17 2 27 20 Appendicitis and Typhlitis 7 — — — - 2 2 2 1 16 1 3 — 3 7 21 Cirrhosis of Liver . 13 — — — - 5 4 4 7 1 4 6 z 13 21a Alcoholism 2 — — — - - o — — 1 1 1 10 — — 2 22 Nephritis and Bright's Disease ... 37 - - - - - 4 18 15 25 5 13 9 37 23 Puerperal Fever . — — — — - — — — — 2 — — — — — 24 Other accidents and diseases of Pregnancy and Parturition 6 — — — - 1 4 1 11 4 2 - - 6 25 Congenital Debility and Malformation, including Premature Birth 53 51 — — - — 2 — 63 13 12 21 7 53 26 Violent Deaths, excluding Suicide 49 1 — 4 2 5 11 8 18 51 4 13 15 49 27 Suicides 11 — — — — 1 5 4 1 5 3 3 5 — 11 28 Other defined Causes 428 51 3 4 8 10 39 105 208 232 85 112 144 87 428 29 Diseases ill defined or unknown ... — — — — — — — — — — — — — — — Totals 1580 182 72 76 35 51 191 416 557 968 275 416 614 275 1580