AC 4353 STMARY 24 Metropolitan Borough of St. Marylebone REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1919. Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. LONDON: GEO. PULMAN AND SONS, LTD. 1 9 2 0. Telephone No.: 8008 Mayfair(5 lines) Borough of St. Marylebone Public Health Department, Town Hall, Marylebone Road, N.W.1. With the Medical Officer Of Health's Compliments. STMARY 24 Metropolitan Borough of St. Marylebone REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1919. Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. London: geo. pulman and sons. ltd. 1 9 2 0. London: Geo. Pulman & Sons, Ltd., Thayer Street, W. Public Health Department, Town Hall, Marylebone Road, N.W. 13th July, 1920. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, I have the honour, as Medical Officer of Health, to submit my Annual Report on the health of the Borough of St. Marylebone during the year 1919. The arrangement in this differs considerably from that adopted in reports for which I have been responsible in previous years, the reason for the change being the issue of instructions to Medical Officers of Health by the Ministry of Health laying down the line to be followed in each instance with a view to obtaining uniformity. Although the form has altered the report deals with the same subjects as are referred to in former reports. Speaking generally the year 1919 was marked by no particular happening as far as health was concerned. Influenza was somewhat less prevalent than in 1918, the epidemic gradually wearing itself out as the year advanced. The mortality rates were in no instance higher than had been anticipated, some indeed, the Infantile Mortality Rate for example, which fell from 110.5 to 98.5 considerably lower. I desire to thank the Public Health Committee for the help and kindness which they showed me. Under Mr. Councillor Sanger, L.C.C., and later Alderman Sir Henry New as Chairmen, they showed the greatest "interest in the work and were always ready to give consideration to any suggestion brought forward and to offer such guidance and encouragement as the occasion required. The staff of the department worked admirably throughout the year and a word of thanks is due to them also for their loyalty and devotion. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER, Medical Officer of Health. CONTENTS. page Natural and Social Conditions of the Borough. Population 9 Sanitary circumstances 10 Water Supply 11 Drainage 11 Combined Drainage 13 Closet Accommodation 13 Underground Public Conveniences 13 Scavenging 13, 14 Sanitary circumstances of the Borough 15 Staff 15, 16 Inspections 17 Nuisances Legal Proceedings 18 Smoke Nuisances. 18 Premises and Occupations controlled by By-laws and Regulations 18 Business Premises 19 Cow Sheds.. 19 Milk Premises . 20 Slaughterhouses 20 Offensive Trades 21 Ice Cream Premises 21 Butter, Margarine, etc., Premises 21 Bakehouses 21 Factories and Workshops 21 Inspections 22 Defects found 22 Home Work 23 Registered Workshops 24 Premises used for Human Habitation 25 Houses let in lodgings 25 Common Lodging Houses 25 Underground Rooms6 Premises that are not but should be Registered 26 Food Stalls 27 Schools 27 Food 28 Milk Supply 28 Milk Analysis 28 Legal proceedings for adulteration 29 Diaries, Cowsheds and Milkshops Orders 29 Milk and Cream Regulations 29, 30 Milk (Mothers and Children) Order, 1918 30-33 Food Inspections 34 Food, Unsound, Condemned . 34 Food, Unsound, Seized 35 Sale of Food and Drugs Acts 35 Proceedings under The Margarine Act, 1887 35 Reports of Public Analyst during year 36-40 Bacteriological examination of Milk 29, 40 Statistical . 41 Births 41 Births Registration 41 Births Notifications 41 Deaths and Death Rates .. 42 Sub-District Births and Deaths . 42 Deaths in relation to Age 43 Deaths among the Aged 44 page Causes of and ages at death 44 Infantile Mortality . 44 „ „ Causes 45-47 Deaths in relation to Disease 48 Diarrhoeal Diseases 48 Infectious(communicable)Diseases 48 Phthisis and other Tuberculous Diseases 49 Respiratory Diseases 49 Cancer and Malignant Disease . 50 Alcoholism 51 Accident, Suicide and Manslaughter 51 Prevalence of and Control over Infectious Diseases 51 Isolation of Cases 52 Discharge Notices 52 Diphtheria and Membranous Croup 52 Scarlet Fever 53 Enteric Fever 53 Cerebro-Spinal Fever 53 Polio-Myelitis 54 Erysipelas 54 Puerperal Fever 54 Measles and German Measles 54 Whooping Cough 54 Glanders 54 Ophthalmia Neonatorum 55 Pneumonia. 56 Tuberculosis 56 Work and Dispensaries 57-61 Notifications 62 Pulmonary Deaths 63 Non-pulmonary Notification 64 Bacteriological Diagnosis of 65 Influenza 65 Bacteriological Examinations 65 Disinfection 65, 66 Cleansing of Persons Act, 1897 67 Maternity and Child Welfare. 68 Health Visitors 69 Centres 69 Ante-Natal Work 69 Dental Clinic 69 Hospital Treatment 69 Maternity Cases 69 Babies' Nursing Home 70 Infant Consultations—Work at ... 70 Day Nurseries 71 Home Helps 71 Sanitary Administration— Staff Report of Mortuary Keeper ... 72 Proceedings under Rag Flock Act, 1911 73 Housing— General Housing Conditions 74 Overcrowding 75 Fitness of Houses 75 Unhealthy Areas 76 Statistics 77 Closing Orders 78-80 Sanitary Inspection (Summary) 81-84 Ministry of Health, Tables I—III 84-87 Vaccination Returns 88, 89 SOCIAL CONDITIONS, SANITARY CIRCUMSTANCES, AND FOOD. INTRODUCTORY. . Population.—The population of the Borough at the last Census, enumerated on the night of Sunday, the 2nd April, 1911, was found to be 118,221, distributed in the registration Sub-Districts as follows:— The Borough, All Souls, St. Mary, Christ Church, St. John. 118,221. 29,485. 32,126. 36,544. 20,066. The previous Census taken in 1901 enumerated the population at 133,301, so that during the period of ten years there was a decrease of 15,080. Since 1911 there has not, of course, been a further enumeration and the population figure for each of the years has been estimated by a special method devised by the Registrar-General. Each year, as shown in the table given below, the population has been found to be smaller than in the preceding year, until in 1919 it touched just under 98,000. Being based upon an estimate only and on enumerations made so long ago this figure would in any event probably be considerably out. Having regard to conditions in respect of housing it is almost certainly very far wrong. Judging from appearances it is not unlikely that the population actually is, if not considerably over the 1911 enumeration, probably not far under. The figures for each of the sub-districts having been worked out by proportion are only very approximate. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. 1911 118,221 29,485 32,126 36,544 20,066 1912 116,155 28,971 31,566 35,903 19,715 1913 114.532 28,567 31,124 35,402 19,439 1914 112,892 28,158 30,678 34.895 19,161 1915 100,260 25,002 27,260 30,901 17,015 1916 98,573 24,540 26,892 30,403 16,738 1917 92,796 23,098 25,334 28,621 I5,752 1918 98,526 24,528 26,880 30,391 16,727 1919 97,953 24,381 26,731 30,210 16,631 Despite what has been said with regard to the accuracy of the figures, it is, nevertheless, certain that the population has greatly diminished, the result wholly of change in the character of the Borough. Not for a very long time has St. Marylebone been, so far as its main portion at least is concerned, anything like exclusively residential. This part, which may be taken roughly to run from Tottenham Court Road on the east, to Edgware Road on the west, and from Oxford Street on the south, to Marylebone Road on the north, is too near the City and too definitely on the westward line of commercial progress to escape absorption. Year by year, for many years, premises used for human habitation have either been demolished to make way for huge shops, dress or motor warehouses, or blouse factories or hotels, or have been transformed into offices or workshops. During the ten years previous to the outbreak of war, this change went on with such rapidity that in some neighbourhoods, at the eastern end particularly, the whole appearance altered, rows of houses, many of them accommodating several families, being swept away to be replaced by large blocks of business premises. Despite the war the change continues, though on a smaller scale, and here and there a house or a block of houses falls and workshops, a shop or a bank takes its place. Most marked in the southern and eastern parts of the Borough, change has not been limited to these. Maida Vale, St. John's Wood, and Lisson Grove even, which has always been the most definitely working class, poor and thickly populated area, have not escaped. To provide sites for wholesale premises, warehouses, shops, factories and such-like large buildings, numbers of houses have been removed. The 10 main effect of these changes has been to make St. Marylebone, with a rateable value of 2i millions, one of the richest and busiest of the London Boroughs; to bring down the night population by something like 50,000 in the last 15 years or so, and to raise the day population to probably something near half a million. Curiously enough, the industries that have inevitably had to come to St. Marylebone, though they have increased her prosperity, have not done much in the way of providing employment for her residents. Apart from a few hundreds who work on the Great Central Railway, at or about the terminus or possibly on the Metropolitan Railway, or are employed by the Council, the bulk of the inhabitants are not engaged in St. Marylebone. To a considerable extent, indeed, and in all its residential quarters, rich, middleclass and poor, the Borough is a dormitory and only to a very limited extent is it suitable for dormitory purposes. From the point of view of accessibility and convenience, the view point of the worker, it is admirably situated. It is central : it is on or near the main routes to anywhere. These reasons, which, of course, inevitably have made it a business borough, tempt also to make it a residential borough: tend to keep it to an extent both. No district, however, can satisfactorily be both. The demands of commerce are too insistent, its pressure so great that crowding and overcrowding result. In the case of St. Marylebone this is what has happened and is happening, and the effects are all the more marked because, to begin with, the Borough, besides having only a comparatively small area—14,278 acres, exclusive of area covered by water—is absolutely hemmed in. It is this limitation of space and the continued encroachment of business upon the area available for housing purposes that makes the Borough, in respect of a large part, unsuitable, as already said, for dormitory purposes. Overcrowding on space, as a matter of fact, is very marked, especially in the southern portion of the Borough and in the Lisson Grove area, where, in addition to space overcrowding, there is house overcrowding as well; few of the houses being occupied by only one family. The only area where there is not overcrowding on space is in St. John's Wood, but even here, since leases are falling in, single houses with gardens are becoming fewer and large blocks of flats are arising in their place. Because of the limitation of space St. Marylebone, in relation to the housing problem of to-day, is in a worse position than perhaps any other district. It is no new problem, however, and because there was no space to solve it on, it never has been solved. Unable to find space to house properly anything like the population already within the Borough, and with claims upon them, the Council, though most anxious and willing to help in the solution of the national problem owing to lack of space, have been able up to the present to make no contribution. Any attempt to deal with the local problem or to assist with the national problem can only be by way of removing small houses and erecting "dwellings." In this way the overcrowding will be increased, even if it is given an upward direction. Despite the fact that a fairly considerable part of the Borough is overcrowded, even congested, and that a considerable percentage of the population is poor, and of the labouring rather than the working class, employed casually or engaged as costers, rather than steadily in recognized trades, the Borough, as will be seen from what follows, is by no means unhealthy and compares not unfavourably with other districts in the metropolis. SANITARY CIRCUMSTANCES. Under this heading the Ministry of Health calls for a report with regard to such matters as Water, Drainage and Sewerage, Closet Accommodation, Scavenging, Sanitary Inspection, Premises and Occupations controlled by By-Laws or 11 Regulations, Schools, &c. In respect of some of these matters, on account of the circumstances and arrangements existing in London Boroughs, there is little to be said, and much of the information is obtainable only from other departments of the Council or from other bodies. In order, however, to comply with the requirements of the Ministry, and to assist in obtaining uniformity in reports, each of the more . important matters is dealt with as fully as possible. Water. As usual, complaints as to water supply, either as regards quantity or quality, were few. All were dealt with, and a remedy found. Water Supply cut off.—In accordance with the requirements of the Public Health (London) Act, 1891, Section 49 (1), the Metropolitan Water Board reported that the water had been cut off in four premises. This is the lowest number for a considerable period. The reasons for discontinuing the supply were: empty premises, three; non-payment of rate, one. In the event of the premises being a tenement house, action was taken immediately on receipt of the Board's notice, in order to secure that the tenants should suffer no hardship as a result of being deprived of water. Cisterns.—The bulk of the houses in the Borough, in accordance with the requirement of the Water Board, are provided with a cistern, and though in a considerable percentage water for drinking purposes is drawn from the main, there are still many in which supplies for all purposes are obtained from the cistern. In many cases this leaves much to be desired, both as regards situation and accessibility, and despite the fact that a by-law of the Council requires that the apparatus shall be emptied and cleansed every six months, it cannot be doubted but that in a majority of houses no such step is taken. During the year 115 notices in regard to defects in and necessity for cleansing cisterns were served and were complied with. 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 two. In 66 instances 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, 1897. The supply was provided after receipt of the intimation notice in 54 cases. In the remaining 12 it was found necessary to report the facts specifically to the Public Health Committee, and obtain instructions for the issue of a statutory notice and the taking of all necessary proceedings for its enforcement. Following receipt of this notice the work was done, and no further action had to be taken. The number of tenement houses in the Borough without a supply of water on one or more of the upper floors, in addition to that in the lower part of the premises, is now quite small, and as opportunity arises these will be dealt with. Drainage. During the war years work in regard to drainage, as in connection with the majority of works of sanitation, fell away to a tremendous extent. Throughout 1919, however, signs of a return to activity were definite, partly as a result of increased activity on the part of the department, following the return of inspectors from the Colours, and the bringing of the staff up to more or less its prewar strength. Inspector Gorniot, who had largely dropped drainage work to take up duties on behalf of the Local Food Control Committee, once more became drainage Inspector of the portion of the Borough south of Marylebone Road; while Inspector J. C. Wilson, who had been doing Inspector Gorniot's district as well as his own, was given only the area north of Marylebone Road to supervise. Very soon after the opening of the year the fact that there was quite a number of conditions affecting drains calling for attention began to be revealed. The number of notices served in regard thereto began to increase and many more plans relating to drain reconstructions, and amendments voluntarily undertaken, were received. Even so, the number was still below the pre-war number, partly on account of shortage and high price of labour and materials. In many cases where notices were served these were given as reasons for delay in compliance or as grounds for asking that the work should be allowed to stand over. As was the practice during the war, the Public Health Committee were willing to show a certain amount of leniency and, if such a case appeared to be justified, delayed as long as possible before taking action to compel compliance with notice. One direction in which leniency was occasionally shown was in the direction of allowing of modification in relation to by-law requirements. During the war, on account of the shortage of lead, it was necessary occasionally to permit of the introduction of an iron soil-pipe indoors in place of lead, as required by the by-laws. On a few occasions a similar concession was requested during 1919, but was less frequently granted. As to why the by-laws of the London County Council should insist that whenever it is necessary to construct a soil-pipe within doors lead must be used, is not quite clear to many, and very often, where price is a consideration, permission to be allowed to depart from the requirements is asked. Conceivably the reason underlying the by-law is that the risk of leakage is less with lead than with iron, since more skilled and better workmanship is required in the construction of the pipe, and, moreover, there are fewer joints, and what there are, are very strong. Whether or not these are the reasons, there can be little doubt but that great dissatisfaction exists on account of the requirement, and that many hold amendment is necessary since iron pipes are no less sanitary and safe than those of lead. The total number of drain inspections made during the year was 7,554; a figure that may be compared with 4,725 in 1918, 8,204 in 1914 and 10,200 in 1913. The total number of plans deposited was 278 as against 117 in 1918 and 428 in 1914. The number relating to new buildings was 16. The number deposited in 1918 was 9 and in 1914, 87. In the case of old buildings, the number of plans received was 262. In 1918 the total number was 108 and in 1914, 341. In the bulk of the cases the arrangements shown were in accordance with the by-laws and the work was allowed to proceed under the preliminary approval of the Medical Officer of Health. In cases in which there was departure from the requirements a special report was made to the Public Health Committee, who rarely refused approval if satisfied that compliance was impossible and that there was no possibility of nuisance or injury to health arising. In the majority of cases the departure referred to closet accommodation and affected particularly conveniences proposed to be constructed in basements. On four occasions reports were submitted with regard to cases discovered by the inspectors in which drainage or sanitary work was being carried out without permission from the Council and without deposit of plans, or not in compliance with requirements. Proceedings in court were taken in all of these cases and fines imposed in each instance. 13 Combined Drainage.—Orders under seal as to combined drainage were issued in respect of four premises. The number in 1918 was 1 and in 1914, 6. Closet Accommodation. In the table at page 17, summarizing the work carried out by the district inspectors' figures indicating the number of defects in water closets remedied and of water closets erected are set out. In most instances the closets erected were with a view to providing additional accommodation in tenements houses, shops or workshops or in order to provide suitable separate accommodation for women in places where both sexes were or were about to be employed. Though there may be here and there a small lock-up shop in which it is necessary for the individuals engaged on the premises to make use of a convenience in some other part of the building, or more rarely in an adjoining building, there are no premises in the Borough totally without sanitary conveniences of this type. The only class of closet is, of course, the water closet. One of the great difficulties experienced from time to time is in regard to finding a suitable place for a convenience and a position in which there will be complete compliance with the requirements of the regulations in respect of water-closets. This is particularly the case as regards closets in basements and in the more overcrowded business and shopping portions of the Borough. All plans showing proposals to construct water-closets are most carefully scrutinized and only if it is impossible to find a completely suitable position, and there appears to be no possible risk of nuisance or injury to health, is permission granted to construct the convanience in a situation where there is not compliance. Public Sanitary Conveniences.—The usual supervision was exercised over the public conveniences during the year, Inspector Hill, the outdoor superintendent, visiting those provided for the males : the women inspectors, especially Miss Baker, supervising those provided for females. Reports and comparative statements as to receipts for use of the underground conveniences were regularly submitted to and considered by the Public Health Committee. The following is a statement showing the total receipts at each of the conveniences for the year ended March, 1920, and the amount of increase as compared with the previous year. 1920. 1919. Increase. £ s. d. £ s. d. £ s. d. Oxford Circus—Men's Department 1,355 9 10 860 17 3 494 12 7 ,, Women's „ 1,252 18 3 998 14 3 254 4 0 Gt. Portland Street—Men's ,, 335 9 6 184 5 10 151 3 8 „ Women's ,, 290 17 0 190 12 8 100 4 4 Marylebone Road—Men's „ 299 3 11 151 2 6 148 1 5 * ,, Women's ,, 268 6 5 166 14 9 101 11 8 Folev Street—Men only 191 13 8 104 18 6 86 15 2 St. John's Wood Road—-Men only 1S4 2 7 70 8 7 63 14 0 Barrett Street—Men only 246 6 7 130 14 6 115 12 1 * One free urinette provided. In the case of the conveniences for men, part of the increase in receipts is due to the fact that the arrangement under which no charge was made to men in uniform was discontinued in March, 1919. That the charge for the use of the lavatory was increased from 2d. to 3d. on 22nd September, 1919, accounts also for a part of the increase in the receipts. SCAVENGING. In 1917 the Council decided that the responsible duty of collecting and disposing of the house refuse should be carried out by direct labour, and a special committee 14 known as the Highways Committee (Chairman, Councillor J. T. Watson, M.B.E.) was created to deal with this and other matters. Prior to the formation of this Committee the whole of the work had been carried out by contract. The arrangements have been in the hands of the Highways Committee and under the control of the Highways Engineer, Mr. James Gair, who has had charge of this work ever since the decision to discontinue the carrying out by contract of this most important public health duty was reached. Despite tremendous difficulties, the arrangements have worked very smoothly from the beginning, and have shown marked improvement with increasing experience. Owing to labour and other difficulties it has not, unfortunately, been possible to depart from the old practice of carrying out removal once a week only, except in the case of the main business thoroughfares, large institutions, blocks of flats, etc., where a daily collection is made, or in special cases where the refuse is collected thrice or oftener as conditions warrant. As matters improve, however, it is definitely the intention of the Council to institute a system under which more frequent collection will be made, the ultimate aim being, of course, the only really sanitary one of daily removal. Another aim of the Council is to have all collection carried out by means of motor instead of horse-drawn vehicles, and considerable advance has been made in the direction of attaining this end. At the close of the year the number of motors regularly engaged was 10, the horse-drawn vehicles numbering about 12. So far as disposal is concerned, it may be noted that the practice of salvaging as much as possible of the refuse was continued, only the matters that appeared to be absolutely valueless being disposed of either by burning at the Council's Wharf, Paddington Basin, or at the Shoot at Northolt, a disused claypit close to the banks of the canal, which was taken by the Council in April, 1917. At the moment very considerable alterations are in progress at the Wharf, which when completed will not only lead to great improvement in salvage work, but will permit the carrying out of disposal on more sanitary lines. The following table, for which I am indebted to Mr. Gair, the Highways Engineer, contains much interesting information with regard to the amount of refuse collected during the year ending 31st December, 1919. The amount collected during the period ending 31st December, 1918, is also shown, from which it will be seen that the tonnage has greatly increased. Year ending 31st December, 1919. Year ending 31st December, 1918. Tons. Tons. January 3,1354 3,297 February 3,4954 2,4564 March 3,430 2,4874 April 3,220 2,521 May 2,8094 2,038 June 2,079 1,489 July 2,3234 1,612 August 1,8314 1,374 September 2,094 1,404 October 2,8934 2,130 November 3,378 2,463 December 3,794 2,644 34,484 25,916 15 The house refuse collected contained a quantity of saleable waste which was sorted at the Council's Wharf and disposed of to various contractors. The prices obtained during the whole of the year ending 31st December, 1919, were :— £ s. d. Bottles, 1,944 gross, 3 doz...1 1117 7 2 Glass, 37 tons, 4 cwt. Scrap Iron and Tin, 246 tons, 2 cwt. 621 8 0 Old Rags, 81 tons, 19 cwt. 444 12 6 Waste Paper, 237 tons, 15 cwt. 804 17 3 Bones, 18 tons, 12 cwt. 138 9 6 Total £3,126 14 5 The number of complaints and requests for remoyal of house refuse dealt with is indicated in the following table, and covers the period during which the work has been done by the Highways Department. North District. South District. Year. Complaints. Requests. Complaints. Requests. 1917 221 12 179 25 1918 82 27 84 34 1919 399 169 638 186 During the years the removal and disposal were carried out under contract, close supervision was exercised over the work of the contractors by the Public Health Committee, and to a considerable extent, the arrangements then existing were continued after the Highways Committee undertook the duty. The reports of the inspectors charged with this work and the complaints and requests received were considered by the Dust Sub-Committee of the Public Health Committee, at their meetings, reports thereon being made to the Public Health Committee. So far as the arrangements existing in houses, business premises, etc., are concerned; it may be noted that the movable, covered metal dustbin is most commonly found. Old brick receptacles are quite rare, the number demolished during the year being 1. New metal dust receptacles to the number of 559 were provided. During the year the inspectors made 3,431 visits. The majority of these were made by Inspector Hill who gives part time to this work. For neglect of the provisions with regard to the covering of dust bins, etc., 383 notices were served. Remedies in each case were carried out, legal proceedings not being necessary in any case. SANITARY INSPECTION OF THE DISTRICT. Staff.—During the year there were on the staff of the Public Health Department, in addition to the medical officer of health, a deputy medical officer of health (Dr. Prior), two drainage inspectors, one outdoor superintendent, one meat and food inspector, one house-to-house inspector, five district inspectors, six women sanitary inspectors and health visitors, one chief and four assistant clerks and an office youth. The keeper of the public mortuary, the matron and the one female and two male members of the staff of the shelter and baths, the two disinfectors, the men and women attendants at the underground conveniences, and the men employed in flushing the overground conveniences, are also attached to the department and immediately responsible to the Public Health Committee. At the outbreak of war a considerable number of the members of the outdoor staff were called up as well as several from the office itself, viz.:—One of the women inspectors, Miss N. C. Stokes (Reserve of Nurses), awarded The Royal Red Cross, 1st Class; Mr. C. H. Scowen, one of the assistant clerks, who was in the 9th Middlesex Regt. (T.F.), and after having been given commissioned rank, was killed ; and Mr. W. J. Howe, who joined the 2nd London Sanitary Company, R.A.M.C. (T.F.). 16 From time to time other members joined the forces, viz.:—Inspectors Clay, Cartledge (awarded Distinguished Service Medal), Draper (twice mentioned in despatches), Hill, Smith and Wilson; and Mr. James and Mr. Matthews of the clerical staff. Arrangements had to be made for carrying on the work of these officers and in connection with this the members of the staff remaining most loyally cooperated and the quality of the work done was in no sense inferior to that of previous years. In variety, if not also in quantity, the work increased considerably as a direct result of the war. Soon after hostilities were declared the Medical Officer of Health, in common with others in the metropolis, was asked to assist the Deputy Director of Medical Services for the London District, and to act as "Sanitary Supervisor" of camps, billets, etc., in the Borough. The Council raised no objection to this, and a great deal of work was done in the way of inspecting encampments and premises used by troops, advising commanding officers, co-operating with Army medical officers, examining food supplied to the troops, reporting sanitary defects and making periodical reports to the Deputy Director of Medical Services, etc. After arrangements to help in these ways had been made, the Local Government Board issued a letter to local authorities pointing out the necessity of close co-operation between the civil and military authorities in relation to infectious diseases, and from time to time the Board also communicated with the Medical Officer of Health on the question of food to the troops, as a great deal of material was supplied to the War Office by a large contractor in the Borough. Later, when the necessity for the control of food arose, the department was again called in. Each of the inspectors, men and women, was appointed an inspector under the Local Food Control Committee with the Medical Officer of Health as Chief and two additional men were appointed and put under his direction. The work done was difficult and onerous, but was loyally and well carried out by the inspectors. By the beginning of 1919 food control work had greatly diminished in amount, and those inspectors who had been engaged in it were able to return more fully to their normal duties. The inspectors who had been on service had all been demobilized and the staff, being practically at full strength, every effort was made to carry on the work in the same way as before the war. On account of changed conditions, the result of housing difficulties, shortage and cost of labour and materials, this has not been easy. Very much more work has to be done without obtaining any result whatever, or to obtain such a result as would have been considered most unsatisfactory in pre-war days. From the following summary some idea of the amount of work done in relation to nuisances is given. For details of other works carried out by the inspectors, reference must be made to the sections dealing with housing, food, infectious diseases, etc. In regard to nuisances, the first point to note is that the total number of complaints received was 1,588, as against 617 in 1918, and 1,747 in 1914. The majority of these complaints were made by the inspectors themselves, the number from outside being 356. These came from voluntary workers of the St. Marylebone Health Society, members of the Children's Care Committee, neighbours and others. In respect of nuisances, 380 statutory notices were issued, as against 59 in 1918 and 216 in 1914. Of these notices, 248 related to ordinary nuisances (dirt, dampness, &c.) 66 to verminous rooms, 10 to drains, and 8 to insufficient w.c. accommodation. The remaining 12 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 1918 was 6, and in 1914, 31. 17 The 66 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1904, and referred to 94 rooms. The number of notices in 1918 was 53, and in 1914, 20. In 1,269 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 6 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. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Total Inspections 3,002 2,387 4,354 2,665 3,028 5,524 20,960 Houses damp, dirty or dilapidated remedied 192 190 150 105 53 214 904 Doors, windows, floors, ceilings, sash cords, etc., repaired 159 57 46 20 15 90 387 Overcrowding abated — — 4 1 — — 5 Illegal occupation of underground rooms dealt with ... - 16 1 - 1 18 Water closet defects remedied 223 205 114 114 113 120 889 Water closets erected — 1 3 19 22 — 45 Urinal defects remedied — 9 2 2 1 1 15 Soilpipe and ventilating shaft repaired or renewed - 2 - 6 - - 8 Yard defects remedied 104 138 77 31 26 105 481 Waste pipe defects remedied 5 24 22 25 15 11 102 Water cistern defects remedied 29 53 9 17 2 5 115 Rubbish, manure, etc., accumulations removed 15 21 56 14 13 12 131 Dung or dust receptacles paired or renewed ... 177 73 87 64 21 49 471 Drains relaid or amended 30 12 29 25 7 — 103 Drains cleared 6 13 24 20 1 16 80 Rainwater pipes repaired or renewed 16 15 28 14 10 6 89 Water supply to houses reinstated 2 6 6 - - - 14 Roofs and gutters repaired 71 69 59 28 23 68 318 Area defects remedied 1 16 43 25 8 43 136 Wash-house defects remedied 125 152 66 40 11 40 434 Animal nuisances abated 5 16 15 4 4 13 57 Basement defects remedied 2 9 31 20 — — 62 Stables cleansed or repaired — 5 3 — — — 8 Water supply laid on to upper storeys of house 20 19 - 3 24 66 Miscellaneous nuisances abated Verminous rooms cleased 31 42 57 16 9 23 178 Workshops, dirty, overcrowded, 173 116 42 48 18 65 462 uninventilated or defective, remedied 3 26 22 81 67 4 203 18 Legal Proceedings in Connection with Nuisances. The number of summonses issued during the year was 6. Particulars with regard to each of the cases are given below and it should be noted that in each instance, though there were contraventions of provisions contained in other acts and by-laws, the Public Heath (London) Act, 1891, is the only enactment mentioned in the list. Premises. Offence. Proceedings taken under the Public Health (London) Act, 1891, &c. Result. 1, East Cottages Failure to comply with a statutory notice to execute certain sanitary requirements. Orders were made for the necessary works to be executed within 28 days and £l 1s. costs was allowed on each summons. 3, Do. Do. 4, Do. Do. 5, Do. Do. 6, Do. Do. 7, Do. Do. Black Smoke Nuisances.—Prior to the war a regular system of inspection of chimneys in the Borough with a view to discovering and as far as possible dealing with such as were found to be a source of nuisance was established and a special report was submitted to the Public Health Committee at each meeting setting out the number of observations made, and nuisances discovered. During the war these practices were to an extent discontinued and during 1919 on account of the coal difficulty it was found to be impracticable to re-establish the system. The number of complaints as to nuisance from smoke was trivial, i.e., three, and comparatively few regular observations were made. As matters became more normal the old plan of issuing instructions each week to the inspectors to observe and report upon a definite number of chimneys in his district will no doubt become possible. In the meantime there are other matters which appear to call more urgently for attention. PREMISES AND OCCUPATIONS CONTROLLED BY BY-LAWS AND REGULATIONS. The following list sets out the majority of the premises and occupations of the class referred to in the heading to this part of the report, and contains a certain amount of information with regard to registration, inspection, etc. Underground rooms and underground sleeping rooms, though controlled, the former under the Public Health (London) Act, 1891, and the latter under special regulations made by the Council in 1910, are not registered. 19 Number of places Number of inspection, 1919 Number of notices, 1919 Number of prosecutions, 1919 On register at end of 1918. Added in 1919. Removed in 1919. On register at end of 1919. A. Business Premises. Milk premises 183 6 6 183 402 6 — Cowsheds 5 — 1 4 56 — — Slaughterhouses 4 — 1 3 156 — — Offensive trade premises 2 — — 2 76 — — Icecream premises 118 — 24 96 102 5 — Butter and facturers and Dealers 9 2 — 11 23 2 — Bakehouses 75 — — 75 150 6 B. Habitations Houses let in lodgings 1152 — — 1152 5013 1974 6 Common lodging houses 6 — — 6 — — — Underground rooms Underground sleeping rooms} not registered - - - - - - - A.—BUSINESS PREMISES. Cow sheds.—The following list shows the number of cow sheds in the Borough, the number of cows for which they are licensed, and the actual number kept. Premises. Licensed for. Cows kept. 58, Acacia Road 44 Nil 56, Bell Street 15 4 42a, Clipstone Street 10 10 3, Malthouse Mews 22 2 Totals 105 16 For the considerable reduction in the numbers of cows kept in sheds in the Borough the war is entirely responsible, several of the cowkeepers having found it impossible, or at least impracticable, to face the increase in the cost of cows, the difficulty in obtaining fodder and labour and the increased cost of both. That in some cases it was fortunate that the conditions compelled discontinuance of the practice cannot be denied. In a Borough such as St. Marylebone there are few situations which can be regarded as anything like suitable for cowsheds. Though it may be admitted that the cow in the town shed is as a rule much cleaner, much better groomed, probably much better looked after than many of her sisters in the country, it cannot be regarded as fair or just to her that she should be shut up continuously for so long as she will give a satisfactory quantity of milk, in a place that if just sufficiently ventilated and lighted, is no more than sufficiently so and in which no more space is given her than will permit of her standing up and lying down. Even if she does provide for the people a milk that is rather fresher and probably rather cleaner than that generally provided in a town, from her point of 20 view, as well as from the point of view of the individuals in the neighbourhood of the shed who have to bear with the nuisance that must from time to time, at least, arise, the justification must appear inadequate. The system in regard to registration of cowsheds in the Borough is the same as that throughout London. The London County Council is the licensing authority and the Borough Council have the right to object to the renewal of licence before the court at which this is considered. In the absence of any objection on the part of the Borough Council the London County Council apparently grant renewal. In the case of the sheds in St. Marylebone, at least, this would appear to be the course usually adopted, no licence having been refused for many years. During the year regular and frequent visits of inspection were made and attention directed at the time to any matters that seemed to require it. The need for serving notices did not arise. Milk Premises.—The number of premises upon which milk is sold is 183. This is the same number as in 1918, 6 having been added and 6 removed, but less than in 1914 when there was 237. During the war the number of applications for registration were few and since then, partly no doubt due to the passing of the milk trade in London into the hands of a combine, there have been few or none. Most of the applications received and considered by the Committee relate merely to changes of occupier. Even in these cases a thorough examination of the premises is made and any alterations regarded as necessary insisted upon before registration is granted. Thanks to the provisions in the London County Council (General Powers) Act 1908, which empowered the Council not only to refuse registration in cases in which premises were considered unsuitable, but to withdraw registration if a place became unsuitable, e.g., on account of any other business carried on along with milk selling, conditions in most of the milk premises are not too unsatisfactory. This, despite the fact that nearly all the premises are run on the lines of what are called "general shops." The articles sold along with the milk are in the main more or less ordinary "provisions," bread, flour, butter, eggs and such like. Prior to the coming into operation of the act referred to, less objectionable articles—paraffin, fish and firewood for example—were occasionally sold over the same counter as milk, but when the new powers were granted the Public Health Committee made a determined effort to bring about improvements and succeeded. In a few cases only was appeal made to a magistrate against refusal to register or a withdrawal of registration, and in all the result was that the decision of the Committee was upheld. The last occasion on which action was taken was in 1914, when a vendor was fined for continuing to retail milk, not only after the Committee had removed his name from the register, but the court had dismissed his appeal against the Committee's decision. Slaughter Houses.—In a general way much of what was said with regard to cowsheds applies in the case of slaughter houses. Very steadily, not only has the number of licensed premises diminished, but also the number of premises actually used even though licensed. The amount of slaughtering done in the premises licensed and used for slaughtering has also been greatly reduced. The total number licensed is shown in the list below in which is indicated the situation and the conditions, if any, under which licence was granted. Premises. Conditions. 50, Henry Street, St. John's Wood Small cattle only. 134, High Street, St. John's Wood On the clear and distinct understanding that the room over the slaughter house is not used as a living room. 32a, Union Street, Middlesex Hospital Nil. 21 All these places were regularly and frequently visited during the year. In no case was objection raised to the renewal of licence after receipt of notice from the County Council that application for renewal had been made. Offensive Trades.—There are only two premises within the Borough upon which trades classed as offensive are carried on. The business in each case is that of tripe boiling. The Food Inspector made 76 visits, but no cause of complaint was found. One or two attempts have been made in recent years to establish the trade of "fur skin dressing" which, though not so classed, is, nevertheless, the source of serious nuisance. All these attempts have been defeated and the advisability of declaring the trade offensive and making by-laws with regard to it has been recommended to the County Council. Ice Cream Premises.—The number of such premises in the Borough on the Register is 96. Regular inspections were made throughout 1919 and in 5 cases notices were served in respect of uncleanly conditions. Butter, Margarine, etc., Premises.—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 8 dealers in margarine, 1 wholesale dealer in butter and milk-blended butter and 2 butter manufacturers. All the registered premises were frequently visited. Bakehouses.—At the end of 1919 the number of bakehouses on the register was 75, 65 being underground bakehouses. The provisions with regard to registration are contained in the Factory and Workshop Act, 1901, and so far as underground premises are concerned, only premises used prior to the passing of the Act were eligible for registration which was to be completed before 1904. All the underground bakehouses now in use were registered at this time. Premises underground are rarely satisfactory, but as there was no time limit fixed and the Act contains no requirement as to application for renewal, all that can be done is to exercise as close supervision as possible in order to see that the places are kept in as good condition as possible. In 1918, 123 visits were paid and no notices with regard to defects were served. In 1919, 150 visits were paid to these and 6 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. Factories and Workshops. Though factories are comparatively few in the Borough, the number of workshops, many of them domestic workshops, is considerable, and work in relation to them bulks very large amongst the duties of the district inspectors, more especially those in charge of districts on the south of Marylebone Road. The staple industry is, of course, dressmaking, millinery and tailoring in all its branches, but in a number of places other trades, some of them distinctly curious, are carried on. 22 The total number of visits to factories, workshops and workplaces during the year was 2,813, 706 by the women and 2,107 by the men inspectors, and the complaints received numbered 39. 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 Workshops Act, 1901, gives, in addition to other information, the total number of defects found and of notices served. * I.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 80 21 — Workshops (Including Workshop Laundries.) 1683 196 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1050 52 1 Total 2813 269 1 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 91 91 - - Want of ventilation 18 18 — — Overcrowding 2 2 — — Want of drainage of floors 2 2 — — Other nuisances 64 64 — — Sanitary accommodation insufficient 6 6 — - unsuitable or defective 63 63 - 1 not separate for sexes 29 29 — — 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) 6 6 - - Other offences — — — — (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 281 281 — 1 3.—HOME WORK. NATUUE OF WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. 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. List s. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) 1 (7) (8) (9) (10) (ii) (12) (IS) (14) (IS) (16) Wearing Apparel— (1) Making, etc. 126 646 1776 ... ... ... 36 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc 3 ... 16 ... ... ... ... ... ... ... ... ... ... ... ... Total 129 646 1792 ... ... ... 36 ... ... ... ... ... ... ... ... 23 24 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 2,916 Coffee Shops, &c. 214 Bakehouses 75 Total number of workshops on Register 3,235 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 23 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 39 Reports (of action taken) sent to H.M. Inspector 39 Other 2 Underground Bakehouses (s 101):— Certificates granted during the year In use at the end of the year 65 25 B.—PREMISES USED FOR HUMAN HABITATION. The only premises used for human habitation in respect of which there is a system of registration are what are called "Houses let in Lodgings" and "Common Lodging Houses." Rooms underground if used as sleeping rooms or for human habitation apart from rooms on the upper floors, though they are not definitely registered are required to comply with certain requirements contained in the Public Health Act and special regulations. They are referred to here for this reason. Houses Let in Lodgings:—Included under this head are all ordinary tenement houses in which the rooms or floors are let out at rents below a certain sum. To some extent as a result of housing shortage a very large proportion of the houses in the Borough are of course so let, but only in the case of those in which the lettings are below the sum fixed has the question of registration been raised. When the new by-laws to be made by the London County Council under "The Housing, Town Planning, etc., Act, 1919," come into operation, the number of houses on the register will be greatly increased since no provision whatever has been made for exemption. All houses suitable for the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to sanitation, cleanliness, cleansing, etc. During the year under review no additions were made to the list of registered houses. The actual number on the register at the end of 1919 was, therefore, 1,152. The object of registration being largely to ensure that the houses shall be kept under supervision, all were regularly and systematically inspected. In all 5,013 visits were paid; 1,974 notices relating to cleansing and other defects were served, all of which were complied with without the necessity for further proceedings arising. Common Lodging House.—Though the licence in the case of these houses is actually granted or renewed yearly by the London County Council, the grant or renewal is made subject to the approval of the Borough Council who are provided with a list of applications received prior to the day fixed for consideration. The following table contains all the necessary particulars with regard to the licensed premises of this class in the Borough. On account of the war and the reduction in the number of lodgers, one or two of the lodging houses were shut down and will not again be used in this way. Of those still on the list special reference may be made to "Portman "House" in which accommodation is provided for women only. Houses for woman are badly needed, but very difficult to find; houses so well arranged and conducted as " Portman House" are rare indeed. Situation, etc., of Licensed Common Lodging Houses. Address. Registered Owner. Registered number of Occupants. 54, Bell Street Eliza 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 12 & 13, Molyneux Street Frederick Charles Walters 146 men "Portman House" (late Shaftesbury Institute), Harrow and Union Street, Lisson Grove Frederick Gerard van de Linde 102 women 654 men 109 women Total 763 26 A number of visits were paid to all the houses from time to time by officers of the department and the attention of the person in charge or the London County Council directed to any matter calling for remedy. Underground Rooms.—Prior to the war and particularly after the coming into operation of the Council's regulations with regard to underground sleeping rooms very active work was carried out by the department with a view to ensuring the discontinuance of occupancy of such as appeared to be unsuitable or did not come up to requirements. As a result a very large number of underground rooms were closed and many basement rooms and areas were filled in. Part of the routine work of the District Inspectors was to visit and see that rooms that had been closed by order of the Public Health Committee for sleeping purposes were in fact not occupied as such and to see also that underground rooms were not being used in contravention of the Public Health Act. Each year showed a considerable reduction in the number of illegal occupations. In 1914 only 27 were dealt with in respect of which 17 notices were served. In 1918 the number dealt with was 14 and 14 notices were served. In 1919 owing to housing difficulties and the practical impossibility of driving any individual out of any place in which he had found accommodation it was considered necessary to be even more vigilant than in the past. Despite all efforts, however, quite a number of rooms that had been closed and disused for some years were once more found to be occupied. In these cases practically all that could be done was to warn both the person who had let and the person who had taken the rooms and to ensure that the rooms should be put into as good condition as possible. Fortunately only the best of the rooms were re-let and many that were, or on account of neglect had become, unsuitable, remain empty. C.—PREMISES THAT ARE NOT BUT SHOULD BE REGISTERED. For a variety of reasons the number of premises in the Borough in which meals are provided or food is sold ready cooked or is prepared for sale is very large. At the end of 1919 there were 634, this number including: restaurant, dining room and coffee shop kitchens, 156; tea-rooms and pastry-cooks, 50; hotel kitchens, 38; fried fish shops, 24; and fish-curers, 3. In addition, there were a number of shops in which meat, ham, sausages, &c., were cooked and sold only over the counter. None of these premises is or is required to be registered, and apart from fish-curing and fish-frying premises, which are required to be in compliance with certain requirements contained in by-laws of the London County Council, none of them is subject to any very special provisions. Any individual, in short, may take any sort of premises, and proceed to cook and prepare food for sale; no notice to the local authority is required, and unless complaint is received, or infection or suspicious illness occurs, or the premises are visited by an inspector, the fact that they are so used may never be discovered. That this is so appears to be at least unsatisfactory. On account of changed conditions the amount of home cooking done is steadily diminishing, and more and more the cook-shop, the restaurant, and the cooked-food shop are being resorted to. In the poorer quarters of the Borough the extent to which the fried-fish shop, for example, is depended upon may be judged from the number of children making 27 purchases during the school dinner hour, and the number of adult and child customers in the evenings. In the evenings, too, the busiest shops in the main thoroughfares are those where cooked foods are retailed over the counter. Legislation, which did not foresee these changes, contains no provision for dealing properly with the premises, and the Legislature has made no attempt to obtain control over them. Such places as the law, as it now stands, requires to be registered or licensed are mainly those in which uncooked food is dealt with, e.g., slaughterhouses, cow sheds, milk shops, &c. Having regard to the changes, the law should be extended in order to provide for registration of the cooked-food premises also. Before establishing a restaurant or eating rooms of any description, a cook-shop or a cooked-food shop, it should be necessary for application for registration to be made to the local authority., and registration should not be granted until the premises had been inspected and passed as suitable. For departmental and inspection purposes at present a register is kept at the Public Health Office, and particulars with regard to new premises are added as they are found. As a matter of routine, a number of restaurants, &c., are visited each week by the Food Inspector, and any matters discovered at these inspections are dealt with at once. In 1919 the total number of inspections was 1,060, the number of notices served being 11. Proceedings were necessary in only one case. If and when registration is made compulsory, the work of supervision and control will be greatly simplified, though it is just possible that at first, at least, it might entail an increase in work. The matter is, however, of sufficient importance from the public health point of view to warrant it. Just as from this point of view also, the suggestion that there should be registration of restaurants and cooked-food shops, even of all food shops, is warranted. Food Stalls.—Another class of food premises to which reference may conveniently be made at this point are the food stalls. Of these there are considerable numbers in the market streets, particularly Great Titchfield Street, Bell Street, Church Street, Blandford Street, &c. The whole question of street stalls is a thorny one, and awaits solution. In the meantime the situation must be accepted, and definite arrangements are made for the keeping of such as are used for the sale of food under close observation. Throughout 1919 visits were paid to all the market streets every day, a special feature being made of Saturday night and Sunday morning inspections. SCHOOLS. The Medical Officer of Health of a Borough in the Metropolis is not school medical officer. The work in connection with both schools and school children is entirely in the hands of the London County Council and their officers, the local medical officer of health having little or nothing to do with it. In no part of the kingdom, indeed, is the divorce between the general public health work and school medical work so complete as in the Metropolis, and since it is impossible to see any justification for it on public health grounds, certainly, and probably also on economic grounds, it is difficult to see why either the central government authorities or the local authorities have for so long acquiesced in the arrangement. For the reason that this question of re-organization of public health in London is under consideration and this as well as other anomalies are or will soon be under 28 discussion, it is not proposed to take it up here. It may be stated, however, that because of the existence of the two authorities there is frequently duplication of work, a quite unnecessary and excessive amount of interchange of correspondence and from time to time cross-purposes. All of which is contrary to the best interests of the public health locally and particularly to those of the children. In regard to the infectious diseases, as they affect the school child, that there should be two staffs—the local and the County Council—engaged, appears to be unnecessary and generally leads merely to the expenditure of a great deal of energy as a result of each endeiivouring to keep the other informed as to the state of affairs. That, so far as the general health of the school children, as determined by medical inspection, is concerned, only one authority, and that not the local authority but the County Council, possesses full information, is a serious matter. In regard to conditions found at the medical inspections, the local medical officer of health receives no direct information ; as a matter of fact, if he desires to learn where inspections are to be made, he must ask to be informed or find out from the weekly gazette of the County Council. Again, if he wishes to know what the results were, he must ask or endeavour to glean the information from the pages of reports issued by the County Council long afterwards. These are, clearly, serious objections, and it is sincerely to be hoped that when re-organization takes place, school medical work will be put in the hands of the local health authority, the Borough Council. A certain amount of information with regard to infectious diseases in the schools will be found in the section dealing with these diseases. FOOD. A. Milk Supply. Only a very small part of the milk consumed in the district is produced within the Borough and reference is made elsewhere to the cowsheds still occupied. The bulk of the supply is derived from outside, the distribution being in the hands of a few large firms, most of whom belong to the large combine. Despite the operations of this body, a considerable part of the population is served from a number of fairly large dairy shops, and in the poorer districts certain general shops continue to retail milk along with other articles of food. Speaking generally, there is little to complain of in connection with the milk supply either as regards quantity or quality. London's milk is notoriously less fresh when it reaches the consumer than is the case, probably, in any other town in the kingdom. It is almost inevitable that there should be a certain amount of delay, but that the interval between the producer and the consumer could be reduced is not unlikely. Having regard to the amount of consideration that is now being given to the milk question generally, it seem probable that there will in time be improvements in this as in other connections. Analysis of milk.—It has always been one of the chief aims of the Council to ensure that the quality of the milk supplied in the Borough shall be maintained, and during the year much of the time of the department and the food inspector was devoted to this matter. The total number of samples taken either formally and in accordance with the provisions of the Sale of Food and Drugs Act, or informally as "test" samples was 700. On examination by the Public Analyst 14 (2 per cent.) were found to be adulterated. In 1918 the percentage was 3.3, and 1917 and 1916 2.5 and 4.0 respectively. Further reference to the question of milk examinations is made in the report of the Public Analyst which will be found elsewhere. 29 As in former years, as soon as the analyst's report was obtained, vendors whose samples were found to be up to standard were informed that it would be unnecessary for them to retain the portion of milk left with them. When the samples were found to be slightly below the standard, a special report was made to the Public Health Committee, and in only one instance was it found necessary to send a letter of caution to the vendor. Proceedings.—In the case of samples definitely adulterated proceedings were instituted. In 1919 action was taken in 12 cases. In no case was the warranty defence pleaded. In respect of the 12 cases fines and costs to the amount of £74 2s. 6d. were recovered. In 1918, when there were 9 cases, the amount was £74 3s. 6d. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 74 were obtained on delivery at Marylebone Station of the Great Central Railway. Of the 74, nine proved to be adulterated, and warranted the institution of proceedings. The quarterly returns as to milk samples are tabulated below:— Quarter of the Year. No. of Samples Taken No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. and Costs. £ s. d. lst 1 89 2 1.0 2 11 3 0 2nd 158 10 6.3 9 59 18 6 3rd 140 2 1.4 1 3 1 0 4th 213 — — — - Total for year 700 14 2.0 12 74 2 6 Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, five samples were taken and submitted to Dr. Foulerton, the Council's Bacteriologist, for examination. In respect of two, the report was to the eflect that the milk was "good." The remaining three being retuined as being not quite free from foreign dirt. In no instance was any sign of tuberculosis found. Dairies, Cowsheds and Milkshops Order.—Frequent inspections of cowsheds and milk premises were made with the object of discovering whether or not the requirements of the regulations as to cleanliness, etc., under these orders, were being complied with. In no case were proceedings necessary, verbal warnings generally proving sufficient. Milk and Cream Regulations.—The following is a copy of the return required by the Ministry of Health with regard to proceedings under the Public Health (Milk and Cream) Regulations. These regulations absolutely forbid the addition of preservatives to milk, and so far as can be gathered from the reports of the Public Analyst, the prohibition is loyally obeyed. The smallness of the number of samples of cream taken is due to the fact that during the greater part of the year the inspector had difficulty in obtaining cream, the sale of which was limited under an order of the Food Controller. 30 REPORT OF ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the year ended 31st December, 1919. 1.—Milk ; and Cream not sold as Preserved Cream. (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present. Milk 314 — Cream — — Nature of preservative in each case in column (b), and action taken under the regulations in regard to it. 2.—Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correct statements made 2 (ii.) Statements incorrect — Total 2 (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent. 2 (ii.) Below 35 per cent. — Total 2 (c) Instances were (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.—Observations.—None. Milk (Mothers and Children) Order, 1918—The matter of the provision of milk and food free, or at a reduced rate to mothers and children, is referred to somewhat at length under the head of Maternity and Child Welfare. It may be noted here, however, that so long ago as April, 1917, the Public Health Committee, having been approached by the St. Marylebone Health Society, who had seen the necessity and undertaken to make provision, but found the work and the financial burden greater than they could bear, recommended the Council to relieve the Society and to continue to grant assistance. The Council endorsed the recommendation and the Local Government Board having indicated that any expenditure for this purpose would be regarded as part of the expenses incurred in connection with the Maternity and Child Welfare Scheme, the work of the Society in this direction was continued. The date of the taking over was 25th May, 1918, prior to the coming into operation of the Maternity and Child Welfare Act, 1918, which permitted Local Authorities to supply milk and food provided the Local Government Board approved. It was prior also, of course, to the various Milk (Mothers and Children) Orders of the Local Government Board, the Minister of Health and the Minister of Food. The additional powers granted by these various measures have been fully taken advantage of by the Council. The money expended for the purpose increased from £165 17s. Id. during the financial year ending 31st March, 1918, to £694 6s. at 31st March, 1919, and £2,728 15s. 6d. at 31st March, 1920. 31 The number of instances in which the supply was granted absolutely free, having regard to the total number of cases and circumstances generally, is comparatively small. The amount contributed in individual cases varies considerably, but from the very beginning what the amount should be has always been very carefully assessed, the size of the family and the family earnings and circumstances being taken into consideration. In every case formal application is required to be made by the individual whether recommended by the Medical Officer of a consultation or seeking assistance personally. The following is a copy of the form of application : METROPOLITAN BOROUGH OF ST. MARYLEBONE. [confidential] The Milk (Mothers and Children) Order, 1918. Applicants are requested to fill in this form and return it to the Medical Officer of Health. Name of Number of Under 5 family children Over 5 Address Father's work Name of Firm Address of Firm Wages each week. Mother receives each week Father 's Other members of family Rent paid Other wekly payments payments Pension Any (if any) other particulars Sign here Name of Dairyman Address Date Public Health Department, Town Hall, St. Marylebone. Following receipt of the application enquiries are made by the Health Visitors and on their report and the information provided in the application, assessment is made by the Medical Officer of Health. The accompanying table indicates the scale of the payments those granted a supply are asked to make. 32 Calculated on a Two Shillings= One Penny basis. The Milk (Mothers and Children) Order, 1918. Table to ascertain at a glance the price per quart to be paid for milk by an applicant under the above Order. Method: Read off the TOTAL FAMILY INCOME in the side column, and the TOTAL NUMBER IN FAMILY in the top column. The figure opposite the appropriate side column entry and underneath the top column entry indicates the price to be paid by the applicant per QUART. Total Number in Family (including Parents). Total Family Income. 2 3 4 5 6 7 8 9 10 11 12 13 14 £1 0 0 and over 5 3 2 2 + + + + + + + + + £1 5 0 and over 6 4 3 2 2 + + + + + + + + £10 0 and over 7 5 3 3 2 2 + + + + + + + £1 15 0 and over 8 5 4 3 2 2 2 + + + + + + £2 0 0 and over — 6 5 4 3 2 2 2 2 + + + + £2 5 0 and over — 7 5 4 3 3 2 2 2 2 + + + £2 10 0 and over — 8 6 5 4 3 3 2 2 2 2 + + £2 15 0 and over — — 6 5 4 3 3 3 2 2 2 2 + £3 0 0 and over — — 7 6 5 4 3 3 3 2 2 2 2 £3 5 0 and over — — 8 7 5 4 4 3 3 2 2 2 2 £3 10 0 and over — — 8 7 5 5 4 3 3 3 2 2 2 £3 15 0 and over — — — 7 6 5 4 4 3 3 3 2 2 £4 0 0 and over — — — 8 6 5 5 4 4 3 3 3 2 £4 5 0 and over — — — 8 7 6 5 4 4 3 3 3 3 £4 10 0 and over — — — — 7 6 5 5 4 4 3 3 3 £4 15 0 and over — — — — 7 6 5 5 4 4 3 3 3 £5 0 0 and over — — — — 8 7 6 5 5 4 4 3 3 — Denotes not eligible. + Denotes free of charge. The period for which the grant is made varies, but is usually two weeks, and at the end of this period the case is again considered and alterations made in the amount ordered, and the contribution charged if necessary. 33 The order form is shown below. Written in triplicate, one copy is given to the Mother, one is handed to the Milk Vendor, and the other is filed in the Office for reference in checking accounts, etc.:— No. METROPOLITAN BOROUGH OF ST. MARYLEBONE. The Milk (Mothers and Children) Order, 1918. To Please supply pint of milk dinner from day 1919, to day, 1919, inclusive, to Mrs of for the use of herself her child(ren) (in case of child, state age ) @ per quart, dinner, and charge the difference in cost to the Council. Inspector's Initials (Signed) Medical Officer of Health. Dated 1919. No food or milk to be supplied other than on this order, Accounts must be submitted monthly, addressed to the Medical Officer of Health, Town Hall, Marylebone Road, N.W.1. The system, it may be said, has worked with absolute smoothness and though it has thrown a tremendous amount of work upon the department, has, there can be no doubt, done a very great deal of good. Here and there an individual not quite deserving may have received assistance, but on the whole the efforts of the officers to make a first assessment have been helped rather than hindered. Letters like the following have not been rare and have proved a source of encouragement to the officers who have been concerned in the work:— "Dear Miss—Enclose note to let you know that Mr. K. started work on Monday, earning £2 10s. week, but when it is wet they cant work, but it is better than nothing as things are now days. Have been very thankful for the milk so I should like to pay something towards the milk now. With many thanks, Mrs. K." 34 FOODS OTHER THAN MILK. The main duties in relation to food protection generally were carried out by Inspector Smith, who made inspections of premises in which food is sold, stored or prepared, and acted as inspector under the Sale of Food and Drugs Acts. He also assisted the Local Food Control Committee, carrying out inspections, making enquiries and taking samples under the several Orders in which standards were laid down or prices fixed. His knowledge of the various food premises in the Borough were of the greatest value in this connection, while on the other hand the additional opportunities given in respect of the carrying out of the Orders were found to be most useful in the performance of his duties as inspector of food. Food Inspection.—There was no change in the method of carrying out the work of food inspection during the year. The special Saturday night and Sunday inspections in market streets, etc., were continued, and in carrying them out Inspector Smith received the assistance of other members of the staff having the necessary qualifications and experience. On a great many occasions the inspector was called by vendors to examine articles of food under Section 47 (8) of the Public Health (London) Act, 1891, and to accept surrender of such as were unsound or unwholesome or unfit for food. Amongst the articles dealt with in this way were— Unsound and Diseased Food Condemned During the Year 1919. Meat— Carcase of Cow, and Offal (Tuberculosis) 10 cwt. 14 lbs. Head, tongue, lungs and liver of Bull (Tuberculosis) 1/2 cwt. Carcase of Heifer, and Offal (Tuberculosis) 8 cwt. Beef 2 cwt. 57 1/2 lbs. Ox Liver (Flukes) 36 lbs. Mutton 3 cwt. 4 1/2 lbs. Pigs' Heads 3 cwt. Rabbits 5 1/2 cases Bacon 1 ton 4 1/2 cwts. 1 st. 4 lbs. 4 ozs. Fish— Wet—Miscellaneous 8 cwts. 3 qtrs. 10 lbs. Dry—Kippers 14 boxes Canned Foods— Corned Beef 14 lbs. Salmon 7,208 tins Fruit 7 tins Milk 128 tins Fruit— Fresh—Oranges 1 bushel Apples 1 bushel Cherries 1 bushel Tomatoes 7 boxes Dry—Dates 7 tons, 5 cwts. 3 qtrs, 1 st. 2 lbs. 35 Miscellaneous— Rolled Oats 145 lbs. Cheese 75 lbs. Butter 375 lbs. Eggs 13 Eggs Pickled 250 Unsound and Diseased Food Seized During the Year 1919. Eggs 102 Food Premises.—The points of importance in relation to food premises generally, i.e., slaughterhouses, bakehouses, etc., have already been defined and here it is unnecessary to say more than that during the year these places were kept under regular supervision. Numerous visits were paid and inspections both of the premises and contents carried out. C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 700. Of this number 14 were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of 2.0 per cent., which is slightly below that for 1918, when it was 2.6. The method adopted in connection with the taking of samples was similar to that followed in previous years and described in former reports. The majority were "formal" samples, and in carrying out the sampling, the inspector was almost invariably assisted by an agent. The bulk of the samples taken were of milk and dairy produce. The Public Analyst's Report, which is included in this report, contains a considerable amount of information with regard to the materials sampled, and there is little necessity for much to be said here. It may be mentioned, however, that the prosecutions in respect of adulteration of food numbered 12, and that the fines and costs recovered amounted to £74 2s. 6d. The warranty defence was raised in no prosecution for adulteration of milk. In 6 cases proceedings were instituted for an offence against the Acts other than selling adulterated articles, as follows:— THE MARGARINE ACT, 1887. Sample No. Offence. Fine. Costs. 103 Selling Margarine in a plain wrapper £0 5 0 £0 10 0 123 Ditto l 0 0 1 1 0 124 Ditto l 0 0 1 1 0 177 Exposing Margarine for Sale without being labelled 2 0 0 2 2 0 195 Ditto 5 0 0 1 1 0 313 Ditto 2 0 0 2 4 0 The following Tables and Report from the Public Analyst give full information with regard to samples submitted to and examined by him: 36 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, 1919. 97 milk Food Inspector, St. Marylebone Borough Council £500 per ann. for 700 samples. Over that number 7/6 per sample No sample contained preservative. Do. Genuine. 2 milk Do. Adulterated. Fined £6and £1/1/-costs. 37 butter Do. No. 96. 23.0 per cent. deficient in fat Fined £2 and £2/2/costs. No. 152. 13.0 do. do. Genuine. 23 were test samples 24 margarine Do. Genuine. 10 samples contained less than 10 grains of boracic acid per lb. 25 samples contained between 10-20 grains of boracic acid per lb. Two samples contained between 20-30 grains of boracic acid per lb. 12 were test samples 11 coffee Do. Do. 10 were test samples 5 mustard Do. Do. Four were test samples. 2 vinegar Do. Do. Two were test samples 2 ginger Do. Do. 5 cocoa Do. Do. Five were test samples. 1 borax Do. Do. This was a test sample. 1 dried egg Do. Do. Do. 1 pepper Do. Do. Do. 1 whisky Do. Do. Do. Total Number of Samples analysed during the Quarter 189 No preservative in any sample. Number of Samples adulterated 2 SECOND QUARTER ENDING 30TH JUNE, 1919. 97 milk Food Inspector, St. Marylebone Borough Council Genuine Three were test samples 9 milk Do. Adulterated. No. 226. 13.3 per cent. deficient in milk fat No. 226. Vendor cautioned. No. 270. 33.3 do. do. No. 270. Fined £2 and £1/6/- costs. No. 274. 6.7 do. do. No. 274. Fined £2 and £1/5/6 costs. No. 307. 13.0 do. do. No. 307. Fined £2 and £2/6/- costs. No. 310. 13.0 do. do. Mo. 310. Fined £2 and £2/6/- costs. No. 333. 6.7 do. do. (and 11.8 per cent. added water.) No. 333. Fined £2 and £2/2/- costs. No. 334. 16.7 per cent. deficient in milk fat No. 334. Fined £25 and £3/3/- costs. No. 337. 6.67 do do. No. rf37. Fined £2 and £3/3/- costs. 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. 28 butter Food Inspector, St. Marylebone Borough Council Adulterated. £500 per annum for 700 samples. Over that number 7/6 per sample. No. 338. Error was made in sample number which was wrongly given as No. 339 on summons which was withdrawn, but the magistrate granted £3 3/costs against defendant. No. 338. 26.6 per cent. deficient in milk fat Genuine Do. One was a test sample. 1 butter Do. Adulterated. Preservatives in butter— 1 had no preservative. 27 contained 10-20 grains boric acid per lb. 1 contained 20-30 grains boric acid per lb. No. 313. Fined £2 and £2/41- costs. 16 margarine Do. No. 313 contained 80 per cent. fat other than butter fat One was a test sample. No. 298. Fat 48,4. Preservative, nil. Genuine. 2 cream Do. Do. 1 coffee Do. Do. No. 302. Fat. 46.8. Preservative 14.0 grains boric acid per lb. Test sample. 1 cocoa Test sample. 1 mustard Do. Do. mixture Do. Do. 1 lard 1 evaporated milk Do. Do. Test sample. Do. Do. Total Number of Samples analysed during the Quarter 158 Number of Samples adulterated 10 THIRD QUARTER ENDING 30TH SEPTEM BER, 1919 46 milk Food Inspector, St. Marylebone Borough Council. Genuine. No sample contained added preservative. 1 milk Do. Adulterated. No. 463. Fined £1/10/and £1/11/- costs. No. 463 contained 13 per cent. added water 37 butter Do. Genuine One was a test sample. 16 margarine Do. Do. 36 samples contained between 10-20 grains of boric acid each per lb. One sample contained 21 grains of boric acid per lb. This was a test sample. 1 coffee mixture Do. Do. 6 coffee Do. Do. These were test samples. 1 coffee Do. Adulterated. This was a test sample. 1 cream preserved Do. No. 358 contained 59 per cent. chicory Fat 50. per cent., boric acid 7.0grains per lb. Genuine. 5 lard Do. Do. 15 jam Do. Do. 11 were test samples. 38 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. Genuine. £500 per ann. for 700 samples Over that number 7/6 per sample. These were test Samples. 3 marmalade 6 cocoa Do. Do. These were test samples. 1 mixed mustard Do. Do. This was a test sample. 1 dripping Do. Do. Do. Do. No. 313. Exposing margarine for sale without the same being labelled as required by the Statute No. 313. Fined £2 and £2/4/- costs. Total Number of Samples analysed during the Quarter 140 No sample contained preservatives. Number of Samples adulterated 2 FOURTH QUARTER, ENDING 31ST DECEM BER, 1919 64 milk Food Inspector, St. Marylebone Borough Council. Genuine. 24 butter Do. Do. All samples contained between 10 and 20 grains of boracic acid per lb. 21 margarine Do. Do. 3 coffee Do. Do. One was a test sample. 6 lard Do. Do. 1 compound lard Do. Do. (These were all Test Samples. 20 jam Do. Do. 5 marmalade Do. Do. 23 cocoa Do. Do. 4 mustard Do. Do. (mixtures) 1 dripping Do. Do. 5 pickles Do. Do. 1 olive oil Do. Do. 7 vinegar Do. Do. 4 honey Do. Do. 2 mincemeat Do. Do. 5 tomato catsup Do. Do. 1 lemon curd Do. Do. 1 raspberry and Do. Do. lemon curd 1 ginger syrup Do. Do. 1 blackberry jelly Do. Do. 1 cheese Do. Do. 1 golden syrup Do. Do. 2 tea Do. Do. 2 condensed milk Do. Do. 1 evaporated milk Do. Do. 2 piccalilli Do. Do. 4 pepper Do. Do. Total Number of Samples analysed during the Quarter 213 Number of Samples adulterated None 39 ANNUAL REPORT OF THE PUBLIC ANALYST, 1919. The number of samples taken under the Sale of Food and Drugs Acts and submitted for analysis, was 700: a considerable increase as compared with the samples for 1918, the number for that year being only 464, owing to war conditions. A complete list is as follows: No. Article. Genuine. Adulterated. Total. 1 Milk 304 12 316 2 Butter 126 1 127 3 Margarine 77 — 77 4 Coffee 21 1 22 5 Mustard 5 — 5 6 Mustard Mixture 6 — 6 7 Vinegar 9 — 9 8 Ginger 2 — 2 9 Cocoa 35 — 35 10 Borax 1 — 1 11 Dried Egg 1 — 1 12 Pepper 5 — 5 13 Whiskey 1 — 1 14 Cream 2 — 2 15 Lard 12 — 12 16 Compound Lard 1 — 1 17 Coffee Mixture 1 — 1 18 Cream (Preserved) 1 — 1 19 Jam 35 — 35 20 Marmalade 8 — 8 21 Honey 4 — 4 22 Lemon Curd 1 — 1 23 Raspberry and Lemon Curd 1 — 1 24 Mincemeat 2 — 2 25 Dripping 2 — 2 26 Pickles 5 — 5 27 Olive Oil 1 — 1 28 Tomato Catsup 5 — 5 29 Ginger Syrup 1 — 1 30 Blackberry Jelly 1 — 1 31 Cheese 1 — 1 32 Golden Syrup 1 — 1 33 Tea 2 — 2 34 Condensed Milk 2 — 2 35 Evaporated Milk 2 — 2 36 Piccalilli 2 — 2 686 14 700 Milk.—316 samples of milk were analysed. Of these 12 or 3.8 per cent. were adulterated. One of the 12 contained 13 per cent. of added water, the remaining 11 had been deprived of from 6.7 to 33.3 per cent. milk fat. Not one of the 316 samples contained any preservative. 40 The mean composition of the genuine samples of milk, as shown by the following table, is rather inferior in quality as compared with four previous years: Sp. Gr. Milk-fat. Solids (not fat). Total Solids. 1915 1032.0 3.72 8.82 12.54 1916 1031.0 3.63 8.57 12.20 1917 1032.0 3.70 8.80 12.50 1918 1030.2 3.75 8.75 12.50 1919 1031.5 3.66 8.74 12.40 Butter.—One hundred and twenty-seven samples of butter were examined; all contained boric acid, from 7 to 26 grains per lb. One sample was adulterated, containing 80 per cent, fat other than that of butter fat. Margarine.—The 77 samples of margarine, all genuine, contained boric acid up to 27 grains per lb. Cream.—Two samples of cream only were analysed; they were both genuine. One of these, properly labelled, contained a small quantity of boric acid. Coffee.—Twenty-one samples of coffee were analysed; one, a test coffee, contained 50 per cent, of chicory. Miscellaneous Samples.—The remainder of the samples were of a miscellaneous character and are enumerated in the table—they require no special comment. A. WYNTER BLYTH. BACTERIOLOGICAL EXAMINATION OF MILK. During the year 5 samples of milk were submitted to the Council's Bacteriologist (Dr. Foulerton) for examination. Of these 4 were found to be "good." All the reports were submitted to the Public Health Committee and a warning was only necessary in one case where a relatively small quantity of foreign dirt was reported, sufficient to suggest carelessness in handling the milk. 41 STATISTICAL. BIRTHS. Registration.—The number of births registered during 1919 was 1,492*, being 117 more than in 1918. Of the children born, 764 were boys and 728 girls. The birth rate per 1,000 of the population was 14.6 as against 12.4 in 1918. The accompanying table contains a comparison of the rates in the several registration sub-districts and the Borough as a whole for 1919, with those of each of the years since 1913:— 1913. 1914. 1915. 1916. 1917. 1918. 1919. All Souls 13.6 15.4 13.3 14.4 12.8 11.1 12.0 St. Mary 12.8 13.9 11.2 12.2 8.8 8.6 10.5 Christ Church 28.2 26.8 22.9 22.9 19.3 15.4 22.6 St. John's 18.8 17.1 18.6 17.3 17.5 15.3 12.5 The Borough 18.6 18.7 16.2 16.9 14.5 12.4 14.6 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,779. The provisions of the Act are now very generally known, and the necessity for notifying is not less well recognised than that for registration. Failures to notify within 36 hours of birth, as required, were comparatively few. In such cases as there was failure, a perfectly reasonable explanation was forthcoming, and it was not considered necessary to take proceedings against any of the parties. The main sources of the notifications are set out below. The figures, it may be noted, refer to notifications and not to births. In some cases duplicate notifications, from different sources, were received with regard to the same birth. No. Per cent. From parents 115 3.05 ,, doctors 321 8.4 ,, midwives 785 20.7 „ other persons 100 2.6 „ hospitals, etc. 2,458 65.4 3,779 Of the total births notified, 179 referred to still-hirths (96 males and 83 females): 1,974 took place at Queen Charlotte's Hospital; 262 at Middlesex Hospital 222 at * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 153 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 67 ,, Females 53 Illegitimate Males 21 ,, Females 12 42 the Workhouse; and 1,321 were born at home. Of those notified as having occurred in St. Marylebone, 2,287 belonged to other Boroughs, as follows:— Legitimate Males 1,303 „ Females 847 Illegitimate Males 65 ,, Females 72 2,287 DEATHS AND DEATH RATES. The number of deaths registered in 1919 was 1,568. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but exclusive of persons, who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. The corrected death-rate* per thousand for the year was 15.9. In the previous year, the rate was 18.5 and the number of deaths 1,835. In 1917 the rate was 17.0 per 1,000, and in 1916, 16.0. The following short table shows the death rates in the several registration sub-districts in 1919 and compares them with those of the years onward from 1913:— 1913 1914 1915 1916 1917 1918 1919 All Souls 12.0 11.2 13.6 13.7 11.9 14.8 12.9 St. Mary 11.1 12.6 15.4 14.9 16.4 15.9 15.3 Christ Church 18.4 18.0 20.6 18.8 21.4 23.2 18.5 St. John 13.6 14.0 15.2 16.5 17.4 19.8 17.0 The Borough 14.9 14.9 17.8 16.0 17.0 18.5 15.9 District births and deaths for the year ended 3rd January, 1920, are given in the following table. A further table giving the vital statistics of separate localities for 1919 and the ten preceding years, will be found amongst the Ministry of Health Tables on page 84. Sub-District. †Population estimated to middle of 1919. Males. Births. Deaths. Females. Totals. Males. Females. Total. A B All Souls 25,831 24,381 164 147 311 139 177 316 St. Mary 27,722 26,731 124 148 272 182 226 408 Christ Church 31,373 30,210 316 268 584 309 251 560 St. John 17,112 16,631 160 165 325 145 139 284 The Borough 102,038 97,953 764 728 1,492 775 793 l,568 The following table shows the number of deaths that took place amongst infants under 1 year and adults of 65 years and upwards in each of the four quarters of 1919. * A definition of the term "corrected death-rate" will be found on page 9 of the Report for 1912. † Column A gives figures used in connection with the calculation of birth-rate. B that employed, in calculating the death-rate. 43 For purposes of comparison the table for 1914 is reproduced from the report for that year. It is interesting to note that while the figures relating to infants have fallen those for the elderly are quite distinctly higher. The distribution of the deaths is the same in each of the two years, the heaviest incidence in both old and young falling in the first and last quarter. 1919 January- April- July- October- Total March June September December Infants under 1 year 46 32 29 40 147 Persons of 65 years and upwards 227 128 90 158 603 1914 January- April- July- October- March June September December Infants under 1 year 62 45 49 54 210 Persons of 65 years and upwards 185 127 96 126 534 DEATHS IN RELATION TO AGE. The age distribution of the deaths that occurred in 1919 is shown in the following table, which gives also, for the purpose of comparison, the figures for each age group since 1913. 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 1913 195 66 47 51 36 229 448 555 1,627 1914 210 38 38 42 54 228 461 534 1,605 1915 178 74 46 37 59 194 463 646 1,697 1916 188 41 31 39 53 196 427 613 1,588 1917 182 72 76 35 51 191 416 557 1,580 1918 152 63 49 59 105 344 494 569 1,835 1919 147 34 39 35 42 227 441 603 1,568 The percentage relation of each group to the total number of deaths in 1919 is shown below. Under 1 year 9.4 per cent. 1 and „ 2 years 2.1 „ 2 ,, „ 5 „ 2.4 „ 5 „ „ 15 „ 2.1 „ 15 „ „ 25 „ 2.5 „ 25 „ „ 45 ,, 14.5 „ 45 ,, „ 65 „ 28.6 „ 65 „ upwards 38.4 „ 44 Deaths amongst the Aged.—The extent to which each of the four divisions of the Borough shared in the deaths of those aged over 65 in the years 1913-1919, is shown below:— 1913 1914 1915 1916 1917 1918 1919 All Souls 112 106 129 114 100 96 103 St. Mary 140 145 181 175 144 137 172 Christ Church 187 164 202 185 177 187 191 St. Johns 116 119 134 139 136 149 137 The Borough 555 534 646 613 557 569 603 Of the total, 164 at death were aged between 65 and 70; 285 between 70 and 80; 140 between 80 and 90, and 13 between 90 and 100. Over 100—one resident died in the Infirmary at the advanced age of 103. He was a watchmaker and resided, prior to being removed to the Infirmary, in Crawford Street. The outstanding causes of death were as follows:— Causes— 1913 1914 1915 1916 1917 1918 1919 Bronchitis and other respiratory diseases 180 135 225 184 150 166 165 Nephritis and Bright's disease 22 24 17 11 15 16 12 Cancer 60 54 68 67 62 58 63 Tuberculosis 22 16 12 15 16 15 14 Influenza 6 18 7 22 12 18 23 Violent deaths 16 13 19 25 18 19 13 Causes of and ages at Death.—General information with regard to the deaths which occurred in the Borough during the year, mainly as to causes and the ages at which death took place, is given in Table III of the Ministry of Health series at page 87. This same table gives the number of deaths from various specified causes which occurred in institutions, in hospitals, nursing homes, etc. In each of the groups all deaths, whether of residents or non-residents, are included, which accounts for the fact that the total comes up to 1,568. Fuller information than is possible in the table is given in the following pages, in which also the figures relating both to causes of death and the ages at which these causes were operative are analysed. INFANTILE MORTALITY. The infantile mortality rate of any district is the number of deaths of infants under one year of age per 1,000 of the births which occurred in the same year. The number of babies under one year who died in St. Marylebone in 1919 was 147, and the number of births in that year 1,492. The infantile mortality rate is therefore 98.5. This is an improvement on 1918 when the rate was 110.5, and a great improvement on 1917 when the figure was 120.9, and the highest since 1905, at or about which time infantile mortality prevention work was seriously undertaken. The rate for 1919 marks more or less of a return to the pre-war level, and though it is always unsafe to prophesy with regard to the behaviour of death rates, it is not too much to say that it is unlikely there will be further occasion for declaring a rate anything like so high as that for 1917. 45 The course which the rate has taken is graphically shown in the chart on page 46, which indicates clearly that the only really serious interruption to the decline was in 1917. The means adopted in the Borough with a view to bringing about a reduction and generally improving the life and health chances of infants and children are described in a separate section of this report—Maternity and Child Welfare. This part being merely statistical, it is not proposed at this point to do more than give some sort of analysis of the figures relating to deaths amongst infants. Causes.—A Table (Ministry of Health, Table I) will be found on page 47, in which, in addition to the causes of death, are shown the distribution of the deaths according to age and locality. So far as age and causation are concerned, conditions vary little year by year. In 1919, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 58 were less than one month old when they died and 91 less than three months. The figures for 1918 were 60 and 90. The outstanding causes of death and the proportions traceable to them were those usually noted. Prematurity (numbers 12, 13 and 14 in the table), which as usual heads the list, caused 43 in 1918 and 55 in 1919. Diarrhoea and enteritis (7 and 8) accounted for 26 in 1918 and for 22 in 1919. Respiratory diseases, the third of the main causes, took 28 in 1918, and in 1919, 25. Amongst the other causes of death, those which call for mention are the commoner infectious diseases, which together led to 6 deaths among infants. Of the 6, 4 were due to measles and 2 to diphtheria. Neither in 1919 nor in 1918 were any deaths ascribed to injury at birth. Two deaths were stated to be due to overlaying, 1 to tuberculosis, and 3 to convulsions. In the following table information supplementary to that in the large table is given with regard to deaths in the various sub-districts. Christ Church, which always contributes most largely to the infantile as to most of the other mortality rates, being the most thickly populated area and that in which there is most poverty, most overcrowding and most neglect of ordinary precautions, is again at the head of the list with 63 deaths amongst infants. In 1918 the figure was 58. Sub District. Under 1 week. 1 and under 2 weeks. 2 and under 3 weeks. 3 and under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total. All Souls 6 1 - 2 6 5 3 4 27 St. Mary's 13 2 1 1 9 2 4 2 34 Christ Church 16 4 4 — 13 18 5 3 63 St. John's 5 2 1 — 5 5 3 2 23 Totals 40 9 6 3 33 30 15 11 147 INFANTILE MORTALITY FIGURES. Number of deaths of children under one year of age. Rate per 1,000 of registered births. 47 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year, and in Sub-Districts. No. CAUSE OF DEATH. Under 1 Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under 4 Weeks. Total under 1 month. 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Total. 1 Small-Pox - - - - - - - - - - - - - - - 2 Chicken-Pox — — — — — — - — — - — - - - - 3 Measles — — — — — — 2 — 2 4 1 - 3 - 4 4 Scarlet Fever — — — — — — - — — - — - - - - 5 Diphtheria and Croup — — — — — — 2 — — 2 — - 1 1 2 6 Whooping Cough - - - - - - - - - - - - - - - 7 Diarrhœa — — — — — 1 2 — 2 5 — 1 3 1 5 8 Enteritis — 2 — 1 3 5 4 5 — 17 5 2 9 1 17 9 Tuberculous Meningitis — — — — — — — — — — - - - - - 10 Abdominal Tuberculosis — — — — — - - — — - - - - - - 11 Other Tuberculous Diseases - - - - - - - - - - - - - - - 12 Congenital Malformation — 1 — — 1 1 1 — — 3 - 1 2 - 3 13 Premature Birth 22 — 3 1 26 3 — — — 29 3 8 14 4 29 14 Atrophy, Debility and Marasmus 1 1 - - 2 11 8 2 - 23 4 5 10 4 23 15 Atelectasis 2 — - — 2 — — — — 2 - 1 1 - 2 16 Injury at Birth - - - - - - - - - - - - - - - 17 Erysipelas - - - - - - - - - - - - - - - 18 Syphilis — 1 — — 1 1 1 — — 3 — 1 1 1 3 19 Rickets - — - — — — - - - - - - - - - 20 Meningitis (not Tuberculous) - - - - - - - - 1 1 1 - - - 1 21 Convulsions — — 1 — 1 1 1 — — 3 — 1 - 2 3 22 Gastritis — — — — — - - - 1 1 — - - 1 1 23 Laryngitis — — — — — — — — — — — — - — - 24 Bronchitis — — — — — 1 1 2 1 5 - 2 2 1 5 25 Pneumonia (all forms) 1 5 1 — 7 3 5 1 4 20 3 5 8 4 20 26 Suffocation, Overlying — — — 1 1 — - 1 — 2 2 - - - 2 27 Other Causes 14 — — — 14 6 3 4 — 27 9 7 9 2 27 Totals 40 9 6 3 58 33 30 15 11 147 27 34 63 23 147 Legitimate, 1,321 Legitimate Infants, 103 Nett Births in the Year Nett Deaths in the Year Illegitimate, 171 Illegitimate Infants, 44 Total 1,492 Total 147 48 DEATHS IN RELATION TO DISEASE. A list of the causes of deaths, with the ages at which they occurred, will be found in Table III. of the Ministry of Health series on page 87. This Table also shows the distribution of deaths according to cause in the various registration sub-districts. The following notes with regard to certain of the causes which contributed most largely to the death rate, may be of interest. DIARRHCEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 29, equal to 0'29 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants and in 1919 this was the case also, no fewer than 23 of the 29 being children under 1 year of age. In 1918 the deaths from diarrhœal diseases numbered 35, and of this number 28 were babies. In 1919, therefore, there was not only a reduction in the total, but a decrease in the number amongst babies. Deaths from diarrhceal diseases always vary most markedly with the weather conditions, being higher when the summer is warm and dry, lower when it is cold and wet. They vary also with the sanitary condition of the district and the amount of welfare work done on behalf of the babies. The year 1919 from the point of view of weather was not what might be called a "diarrhoea year," and doubtless this accounts for part of the fall. Much was also due to welfare work and even to sanitary work which, despite tremendous difficulties, was steadily gone on with, some credit must be given. Taking all things into consideration, indeed, it may be taken as reflecting credit on all parties concerned, the mothers of the babies and health workers alike, that the death figure was no higher than 29. Particularly in relation to diarrhoea amongst children, a very great deal of educational work is done at the centres of the Health Society and in the homes by health visitors and inspectors, and during the year there was the usual wide distribution of special leaflets on diarrhoea, flies in relation to disease, etc. Infectious (Communicable) Diseases. The number of deaths due to each of the diseases included in this group is referred to when dealing specifically with the disease under the heading " Prevalence of and Control over Infectious Diseases." It is interesting to note here, however, that excluding influenza, which alone caused 117 deaths, and including diarrhoea (29 deaths) the total number registered as due to them was 69. This is a comparatively low figure, lower certainly than that of any of the pre-war years. The diseases contributing most largely to the total were measles, 17; and diphtheria, 11. These two figures are exactly the same as those of 1918. 49 Phthisis and Other Tuberculous Diseases. The total deaths due to the diseases dealt with under this heading, viz., phthisis (pulmonary tuberculosis or consumption of the lungs), tuberculous meningitis, general tuberculosis, tabes mesenterica, and all conditions due to the germ of consumption, numbered 116, a figure smaller by 74 than that for 1918, and the smallest number ever registered in the Borough. The great bulk of the 116 deaths, viz., 104, was due to phthisis. The number in 1918 was 167. Of the total number of deaths registered (1,568), the percentage due to phthisis Was 6.6, as against 9.1 in 1918. The age periods at which the deaths occurred were: 2—5 years, 0 (0.0 per cent.); 5—15, 2 (1.9 per cent.); 15—25, 13 (12.5 per cent.); 25—45, 30 (28.8 per cent.); 45—65, 49 (47.1 per cent.); 65 and over, 10 (9.6per cent.). Below the age of two years, 5 deaths were certified as having occurred from this disease. The subject of phthisis is further discussed in connection with the notification and prevention of tuberculosis. The following table gives the figures for each of the years from 1909. It will be noted that though there have been occasional rises the tendency has all the time been downwards. The reasons for this will be discussed later. TABLE VIII. Deaths from Phthisis and other Tuberculous Diseases. Year. No. of Cases. Population. Rate per 1,000 of Population. 1919 116 97,953 1.18 1918 190 98,526 1.93 1917 169 92,796 1.82 1916 186 98,573 1.88 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 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 362. This is lower by 44 than the figure (406) for 1918. The death rate was 3.6 per 1,000. In 1918 the rate was 4.10. In 1914 there were 307 deaths, and the rate was 2.70. The number of deaths certified to be due to bronchitis was 170 as against 191 in 1918. Of this number 114 were amongst persons aged 65 and upwards, and 43 amongst those of the group 45—65. The deaths traceable to pneumonia numbered 165, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 29 of the deaths occurred amongst children under 2 years of age. In previous reports and particularly those of 1913 and 1914, considerable reference was made to the respiratory diseases, and to the part played by them in adding to the death-rate at the extremes of life, especially. In 1913, the practice of 50 enquiring into ail deaths from pneumonia, and of carrying out disinfection in houses in which this disease had occurred was commenced, and has been continued. In the following year the hope was expressed that eventually this most serious and treacherous disease would be made notifiable, and in 1919 the Ministry of Health by order made notification of all cases of primary pneumonia and influenzal pneumonia, compulsory as from 1st March in that year. During the period March to December, the number of notifications received was 121. Of the patients notified, 41 were aged 25-45, the other age periods contributing smaller numbers. Further particulars with regard to distribution of the cases, both in relation to age and residence will be found in the table on page 87. Visits were paid to each of the notified cases, and any assistance possible in the way of removal to hospital or nursing (under the Council's arrangement with the Paddington and Marylebone Nursing Association) offered. After recovery, or if death unfortunately occurred, as soon as convenient thereafter, disinfection was carried out. It is, of course, too early as yet to form any opinion as to what the effect of the application of notification to this disease may be. That it may lead to a reduction in the number of cases, which have shown a definite tendency to increase for some years, is sincerely to be hoped. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 165 and the death rate 1.68 per 1000 of the population. In 1918 the figures were lower, the total being 143 and the death rate 1.4 per 1,000 of the population. Information with regard to the situation of the disease and the age at which death occurred is given in the following tables:— Cancer: Ages at Death Ages Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals Male - - - - 8 29 22 16 75 Female — 1 1 6 10 21 23 28 90 Totals — 1 1 6 18 50 45 44 165 Cancer.—Situation of the Disease. Parts of the body affected. Males Females Totals Face, Tongue, Jaw 13 1 14 Throat, Neck, Gullet 14 1 15 Stomach 14 11 25 Intestines 16 20 36 Liver 4 11 15 Breast - 15 15 Uterus and Generative Organs 4 16 20 Various 10 15 25 Totals 75 90 165 51 The following table, which was included for the first time in the Report for 1912 is repeated, as it lends further support to the view then expressed that cancer was in no sense a class disease, since if those who died at home or in nursing homes are taken to represent the rich or well-to-do, and those who died in hospitals or the infirmary the less favourably circumstanced, the one group suffered equally with the other. At Home In Nursing Home In Hospitals In Infirmary In Asylums Totals Males 27 6 24 18 — 75 Females 46 3 25 12 4 90 Totals 73 9 49 30 4 165 ALCOHOLISM. Not one single death during the year was certified as due to alcoholism. Year after year the number so certified has been quite small: this is, however, the first year that no deaths amongst the inhabitants has been definitely put down to alcoholism. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 6 deaths, the same number as in 1918. In 1914 the deaths from this cause numbered 18, and from alcoholism 4. The deaths from other conditions due to the irritation produced in various organs by chronic alcoholism, e.g., nephritis (inflammation of the kidneys) and Bright's disease of the kidneys, numbered 39. The number in 1918 was 50, and in 1914, 68. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1919 numbered 69. Of these 16 were due to suicide. Deaths of babies certified as resulting from suffocation (overlaying) numbered 3. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. A table showing, with regard to the infections, the total number of notifications received, the age distribution and the number of cases notified from each of the four registration districts, will be found on page 85. The total number of notifications coming to hand, exclusive of cases of measles notified by parents, was 1,802. The bulk of the notifications related to measles and German measles, which between them contributed 920 to the total. Other diseases in respect of which fairly large numbers of notifications were received were tuberculosis (261), scarlet fever (197), diphtheria (154), and pneumonia (121). In 1918 the number of cases notified was 1,530, the rise in 1919 being partly the result of an increase in the number of cases of measles and German measles brought to notice, and the addition of other diseases, especially pneumonia and malaria, to the list of diseases notifiable. The notification rate (proportion to population of notified cases of infectious diseases) in 1919 was 18.9 per 1,000 as against 11.6 in 1913. 52 Isolation of Cases.—During the year the excessive prevalence of scarlet fever in certain parts of the Metropolis led to some difficulty in connection with isolation. Notwithstanding this, however, as the following table shows, the actual number of cases removed to hospital was fairly high:— Diphtheria 144 or 93.5 per cent, of the cases notified. Erysipelas 21 „ 35.0 „ „ „ Scarlet Fever 188 „ 95.4 „ „ „ Enteric Fever 2 „ 40.0 „ „ „ Cerebro-spinal Meningitis 1 „ 100.0 ,, „ „ Ophthalmia Neonatorum 5 „ 22.7 „ „ „ Puerperal Fever 3 „ 50.0 „ „ „ Polio Myelitis 2 „ 40.0 „ „ „ Tuberculosis 74 „ 28.4 „ „ „ Measles 99 „ 10.1 „ „ „ Malaria 2 „ 4.5 „ ,, „ Pneumonia 25 „ 2.6 ,, „ „ The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various, regulations with regard to notification was £98 11s. 0d. equal to £1 0s. 1d. per 1,000 of the population. The cost and rate per 1,000 for each of the past 10 years, are shown in the following table:— Year. Amounts paid to Medical Practitioners Cost per 1,000 of Population. 1910 74 1 0 0 11 10 1911 124 3 9 1 14 10 1912 116 11 9 1 0 1 1913 124 3 9 1 1 8 1914 137 9 9 1 4 4 1915 116 9 0 1 3 3 1916 101 8 6 1 0 6 1917 163 8 0 1 15 2 1918 86 9 6 0 17 6 1919 98 11 0 1 0 1 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 189 and referred to 255 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 rather less prevalent in 1919 than in 1918—154 cases as against 157 in the previous year. Of the cases 11 died, and the case mortality rate was 7 per cent., the same as in 1918. The number of cases per 1,000 of the population was 1.57. Throughout the whole year nothing in the way of grouping of the cases suggested that there was anything like an outbreak of the disease. The cases, indeed, were more or less evenly distributed and only in a few instances was it possible to determine 53 accurately the source of infection. In 20 it proved to be in the home of the patient, and in 10 cases was derived from a member of the family previously infected. 124 patients were believed to have obtained infection from a previous case in the neighbourhood. The number of swabs from doubtful cases submitted for bacteriological examination was 424. A positive result was returned in 73 instances. Of the registration districts, that contributing the largest number of cases, naturally, since in respect of child population it is the largest, was Christ Church, with 64. In All Souls the number was 28, in St. Mary, 21, and in St. John, 40. As usual the age groups 1-5 and 5-15 were those most affected, 45 of the cases falling into the former and 77 into the latter group. Five applications for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, were received during the period, when difficulties in connection with removal to hospital were most marked. The nuisances detected during the course of investigating the notified cases were : Dirty Premises, etc., 42. These were all remedied after service of notices. Scarlet Fever. The notifications of this disease numbered 197. Having regard to the fact that in many parts of London the disease was markedly epidemic this must be regarded as remarkable, even if it is higher by 117 than the figure for 1918 (80). That there is a tendency for scarlet fever to show epidemic tendencies at intervals of five years, more or less, is well known. It is borne out by the experience here; 1914 and 1909, like 1919, having given a number of cases higher than the normal, viz., 432 in the former, and 458 in the latter. The highest number of cases reported n any one week it may be noted was 14. The total deaths from scarlet fever numbered 3, and the number of deaths per cent, of the cases was 1.6. The districts to suffer most from this disease were Christ Church and All Souls. In the former there were 95 cases and in the later 55. In St. Mary there were 25 and in St. John 22. As usual, the majority of the patients were children of school age, the age group, 5-15, giving nearly two-thirds (129) of the total. Of the remainder 37 were aged between 1 and 5 years. The source of infection was believed to be a previous case in the same family in 13 cases. In six cases a patient had been previously notified to be suffering in the same house. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 8 instances that a definite connection could be made out. Defects in sanitation to the number of 29 were discovered. All these were want of cleanliness, etc. The nuisances were remedied after the service of notice in each case. Enteric Fever. This disease was, as usual, practically absent during the year, the notifications received numbering only 4. There were two deaths. None of the cases presented any feature calling for special mention. Cerebro-Spinal Fever. Only one case of this disease, a girl 8 years old, was notified. Isolation and treatment were carried out in a hospital, and the patient made a practically complete recovery. 54 Polio-Myelitis. This was the only one of the several diseases affecting the nervous system (viz., Polio encephalitis, Encephalitis lethargica, etc.) now notifiable, in respect of which any notifications were received during the year. The number notified was 5 and there were no deaths. Four of the patients were females and only one male, and with one exception—a woman of 28—all were less than 15. Erysipelas. The notifications of erysipelas numbered 60, and there were 5 deaths. Most of the cases were notified from the St. Marylebone Infirmary and the General Hospitals and 21 patients were treated in one or other of these institutions. Puerperal Fever. The number of cases of this disease notified, viz., 6, was just about the average, as was a'so the number of deaths registered as due to it, viz., 3. In each case a visit was paid by one of the women inspectors and the premises were disinfected. Measles and German Measles. These diseases remained on the list of those notified until the end of the year. Including notifications (58) received from parents and others, the total received was 978 as against 773 in 1918. The slight increase in the number over the previous year was due, no doubt, to the fact that the necessity for making notification was more widely recognized, particularly by mothers. There was not, in any case, any definite tendency for the infection to assume the epidemic proportions shown in 1917. It was not, as a matter of fact, expected to, measles, like scarlet fever, following a very regular course and becoming definitely epidemic only at intervals. These intervals are generally shorter than in the case of scarlet fever—three yearly instead of five yearly. The deaths numbered 17, as against 11 in 1918 and 95 in 1917. The course adopted in relation to the notified cases was the same as in the previous year. Practically every case was visited by the Health Visitors, particular attention being given to such as occurred in tenement houses. 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 nurses made 622 visits to 58 cases. The amount paid by the Council for services in connection with measles and other cases in which nursing is considered necessary is £60 per annum. Hospital accommodation was found for 89 of the patients. On no occasion during the year was it considered necessary to close any school or any department in a school on account of measles, though the bulk of the patients were children of school age. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1919 the number of deaths registered as due to whooping cough was 2. In 1918 the number was 24. The arrangements with regard to nursing and hospital isolation are similar to those in the case of measles. Glanders. No case of glanders in the human being was notified during the year, and no notices of outbreaks of the disease in stables in the Borough were received from the London County Council. The Order making the notification of glanders compulsory came into operation on 1st January, 1908, since when, viz., in November, 1908, only 1 case has been notified. 55 Ophthalmia Neonatorum. This disease—inflammation of the eyes in newl-born children—made notifiable by order of the London County Council in 1911, continued to be so during the whole of 1919. The total number of cases notified was 22, as against 28 in 1918. Visits were paid to all notified cases by the Health Visitors and in six cases arrangements were made for one of the Nuises of the Paddington and Marylebone Nursing Association to attend and apply treatment, and in this connection 150 visits were made. In bad cases removal to hospital is carried out, special arrangements having been provided at St. Margaret's Hospital for receiving and dealing with children suffering from this condition. Out of the 23 cases, as is shown in the tabular statement, with the exception of two all recovered completely. Of the two serious cases one died, the sight having been totally destroyed by the violence of the infection within a few weeks of birth. In the case of the other the blindness in one eye was complete and in the other the sight was so much damaged that there remained only sensitiveness to light. OPHTHALMIA NEONATORUM. DATE NOTIFIED NUMBER OF CASE ONE OR BOTH EYES PERMANENTLY INJURED— IF SO, TO WHAT EXTENT? 9.1.19 1 Removed to Infirmary, Kensington 17.1.19 2 Both perforated, blind. Died 18.2.19 14.3.19 3 Very slight. Cured 26.3.19 4 Only one eye. Quite cured 7.4.19 5 Very slight. Cured 12.6.19 6 Both eyes. Cured 16.6.19 7 Removed to Infirmary, Kensington 11.7.19 8 Very slight, one eye. Cured 11.7.19 9 Very slight, both eyes. Cured 20.8.19 10 Slight, both eyes. Cured 2.9.19 11 Very slight, both eyes. Cured 24.10.19 12 Very slight, only one eye. Cured 25.10.19 13 Acute, both eyes. Cured. Died Feb. 1920 31.10.19 14 Acute, both eyes. Cured 14.11.19 15 Acute, both eyes. Said to be cured, but appear weak and watery 26.11.19 16 Acute, both eyes. Cured 27.11.19 17 One eye. Cured 6.12.19 18 Both eyes, acute. Cured. Died with whooping cough and convulsions, 9.1.20 10.12.19 19 Both eyes, acute. Practically cured 15.12.19 20 One eye, slight. Cured 18.12.19 21 Slight in one eye. Cured 22.12.19 22 Acute, both eyes. Cured 15.7.19 23 Right eye totally blind, left slightly sensitive to light; (Removal slip, St. Margaret's only) latter to be operated on later The circumstances in this case were particularly sad on account of the fact that no notification having been made to the Medical Officer of Health that there was ophthalmia, a few days delay occurred before the eyes were brought fully under treatment. The child was eventually removed to hospital, but unfortunately, as already stated, it was found impossible to save the sight. 56 A very serious view of the case was taken by the Public Health Committee, and summonses were issued against both the midwife and the doctor concerned for failure to notify as required by the Public Health (Ophthalmia Neonatorum) Regulations. At the hearing both summonses were dismissed by the magistrate, that against the midwife with costs amounting to £6 6s. No costs were granted to the doctor who, apart from stating that he objected to notifying cases of ophthalmia neonatorum, since it is frequently due to venereal disease (gonorrhoea) and trouble may arise in the family, urged further that he had seen no discharge of matter from the eyes on the occasion when he saw the patient and could not be certain that the case was one to which the regulations applied. The defence of the midwife was to the effect that she also did not know the case was one of ophthalmia neonatorum. The rules under which a midwife acts require her to notify the Midwives Supervisory Authority (in London—the County Council) of any case of inflammation of the eye and this she did. She could not be expected to be able to recognize any special form of inflammation. By recommending the parents to consult a doctor she considered that she had done all she was required or could be expected to do. The case revealed the existence of a number of defects in the Public Health (Ophthalmia Neonatorum) Regulations, and to these the attention of the Ministry of Health was directed. The Ministry may in time see that the regulations are altered and that the duty is more definitely imposed upon doctors and midwives of calling the attention of the local authority to the fact that a baby is suffering from eye trouble, and so give an opportunity for everything possible to be done in order that it may not be blinded, It was unfortunate for the child in this case that there was some lack of definiteness in the regulations, and that those responsible for drafting them had a greater regard for humanity than for the niceties of the law, and a greater belief in the willingness of all the individuals named in the regulations to further the object they had in view than happenings here and, as there have been other cases, elsewhere also appear to warrant. PNEUMONIA. Figures with regard to notification and information as to methods of prevention, etc., adopted in relatiou to this disease will be found on page 49. The services of the nurses were requisitioned in 43 cases and 387 visits were paid. TUBERCULOSIS. In all 261 cases were notified, 224 being pulmonary cases, the remainder of the notifications (37) relative to cases in which structures other than the lungs were affected. The table given on page 62 contains the information required by the Ministry of Health with regard to notification. Notifications on Form B relate to school children. The number it will be noted was 8 as against 13 in 1918. Treatment of Tuberculosis.—Of the cases notified 132 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 new cases notified 124 were insured persons: of these 63 were admitted to sanatorium or hospital treatment and 17 to the Infirmary. Non-insured persons numbered 120, of whom 40 (16 being children) received sanatorium treatment and 12 were admitted to the Infirmary. Nurses were sent in to 13 cases and 292 visits were paid. 57 The following Tables, which have been prepared for the Ministry of Health and the London County Council, show the work carried out at the several Dispensaries:— Statement of work carried out in connection with the Dispensary Treatment of Tuberculosis during the period 1st January, 1919, to the 31st December, 1919, and sundry particulars in connection with the scheme of treatment. I.—PARTICULARS OF WORK CARRIED OUT IN CONNECTION WITH THE DISPENSARIES. Name of Dispensary. Names of Dispensary Medical Officers. Date of Approval of Appointment by Local Government Board. Days and Hours when the Dispensary is open. Number of Persons including Contacts who were examined for the first time during the period from 1st January, 1919, to the 31st December 1919, at or in connection with the Dispensary and where:— Number of Persons diagnosed to be suffering from Tuberculosis who were treated of supervised at or in connection with the Dispensary during the period from 1st January, 1919, to 31st December, 1919. Number of Persons who were under treatment, supervision, or o servation at or in connection with the Dispensary on the 31st December,1919. Number of Persons re erred for diagnosis or treatment to the Hospital with which the Dispensary saffiliated during the period 1st January, 1919, to 31st December, 1919. Diagnosed as suffering from Tuberculosis. Diagnosed as not suffering from Tuberculosis. Undiagnosed and remaining under observation. Total Number Examined. Insured Uninsured Insured Uninsured Insured Uninsured Insured Uninsured St. Marylebone Anti-Tuberculosis Dispensary. James Donaldson Saner. M.B., C.M., D.Ph. Monday, 9—6 Tuesday, 9—6 Wednesday, 9—12 Thursday, 9—9 Friday, 9—6 Saturday, 9—1 101 193 161 162 293 445 228 326 853 4 13 Margaret Street Hospital for Consumption. Dr. Thomas. Dr. Milligan. Dr. Barcroft. Dr. McClure. 1st April, 1916. Daily, 1.30—4.30, or as long as may be necessary. 17 12 5 13 21 20 13 29 33 — - Middlesex Hospital. Dr.Kilner. January, 1915. Daily, 1.30. Wednesday, 6 p.m. 9 3 2 6 8 12 16 14 18 — — Totals 127 208 168 181 322 477 257 369 904 4 13 58 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. 1. Name of Hospital to which Special Cases are referred from the Dispensary or Dispensaries for diagnosis or treatment 2. Is any provision for the home nursing of culous Patients made in connection with the Dispensary or Dispensaries ? If so (1) State the general nature of the arrangement (2) What qualifications are the Nurses required to possess ? (3) Do they carry out other work ? If so, what ? (4) Are their services available for Insured and Uninsured Patients ? (4) If so (a) by what procedure are their services secured for individual patients ? (b) Under whose instructions do they perform the actual duties of nursing in an individual case ? 3. If no provision of nursing is made in connection with the Dispensary or Dispensaries is any such provision contemplated? If so, give particulars 4. State number of Shelters provided by the Council or by the Dispensary Authorities up to 31st December, 1919, for lending out to Patients for use at their own homes Middlesex Hospital. District Nursing Association. The Dispensary also has a Sister of its own who carries out supervision visits. (1) Communication with Matron. (2) Certificated. (3) Yes, District Nursing. (4) Yes. (5) (a) Communication with the Matron. (b) (1) Matron. (2) Dispensary Medical Officer. Sister attached to Dispensary visits homes of definite and suspected cases of Pulmonary Tuberculosis. (1) Miss Bruce. (2) Dr. Halliday Sutherland. Prevention of Tuberculosis.—During the year the Council's scheme worked satisfactorily and, despite the fact that a number of institutions and bodies are involved, there was a complete absence of friction. Miss Baker, the tuberculosis visitor, was absent from duty for the first 6 months of the year in consequence of illness; but during the year 1154 visits were paid to the homes of patients and to 44 suspects. In addition the attendances of the inspector at the consultations numbered 110, at Middlesex Hospital 52, Margaret Street Hospital 44, and at the Anti-Tuberculosis Dispensary 14. Attendances at the latter dispensary were less frequent for the reason that the nurse attached to the dispensary does all that is required in following up cases. The Tuberculosis Care Committee continued to meet fortnightly throughout the year. The Open Air School in Regents Park, which was established in 1911, continued in operation throughout 1919. The number of children on the roll was 48—25 Boys and 23 Girls—and the attendances numbered 7,764. 59 A RETURN AS TO WORK carried out in connection with the Anti-Tuberculosis Dispensary, 15, Allsop Place, for the period from 1st January to 31st December, 1919. (Form R.) (The return should relate only to persons residing in the area served by the Dispensary in accordance with the scheme of the Metropolitan Borough Council.) Insured. Uninsured. Males. Females. Children under 16. Adults. Males Females. 1 (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 109 53 195 16 82 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 54 10 13 4 8 (c) Number included under 1 (a) who were found to be suffering from nonpulmonary tuberculosis - 2 9 - 1 (d) Number included under 1 (a) who were found to be non-tuberculous 28 27 82 9 47 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 27 14 91 3 26 Insured. Uninsured. 2 (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) 1,336 4,888 (b) Number of the above attendances at which systematic physical examinations and records were made 169 388 3. Number of visits to patients at their own homes by the Dispensary medical officers in connection with the supervision of home conditions 266 446 4. Number of visits to patients at their own homes by the Dispensary nurses in connection with the supervision of home conditions and " following up" 550 1,640 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated 4 12 6. Number of consultations with the— (a) Medical Adviser of the Insurance Committee — — (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated - - (c) Practitioners at the homes of patients 5 3 7. Number of written reports concerning individual patients made to:— (a) Public Authorities 215 92 (b) Practitioners 51 27 8. Number of specimens of sputum examined 132 77 60 A RETURN AS TO WORK carried out in connection with the Middlesex Hospital Dispensary for the period from 1st January to 31st December, 1919. (Form R.) (The return should relate only to persons residing in the area served by the Dispensary in accordance with the scheme of the Metropolitan Borough Council). Insured. Uninsured. Males. Females Children under 16. Adults. Males. Females. 1 (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 11 7 4 6 5 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 6 4 2 2 (c) Number included under 1 (a) who were found to be suffering from nonpulmonary tuberculosis 3 1 2 1 - (d) Number included under 1 (a) who were found to be non-tuberculous — 2 1 2 3 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 2 — 1 1 — Insured. Uninsured. 2 (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) 71 52 (b) Number of the above attendances at which systematic physical examinations and records were made 46 29 3. Number of visits to patients at their own homes by the Dispensary medical officers in connection with the supervision of home conditions — 1 4. Number of visits to patients at their own homes by the Dispensary nurses in connection with the supervision of home conditions and " following up " - — 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated - — 6. Number of consultations with the— (a) Medical Adviser of the Insurance Committeee - - (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated - - (c) Practitioners at the homes of patients - - 7. Number of written reports concerning individual patients made to— (a) Public Authorities 22 15 (b) Practitioners — — 8. Number of specimens of sputum examined 15 10 61 A RETURN AS TO WORK carried out in connection with the Margaret Street Hospital Dispensary for the period from 1st January to 31st December, 1919. (Form R.) (The return should relate only to persons residing in the area served by the Dispensary in accordance with the scheme of the Metropolitan Borough Council). Insured. Uninsured. Males. Females. Children under 16. Adults. Males. Females. 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 10 3 10 4 7 • (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 5 3 5 1 2 (c) Number included under 1 (a) who were found to be suffering from nonpulmonary tuberculosis 1 (d) Number included under 1 (a) who were found to be non-tuberculous 4 — 3 2 3 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 1 — 2 1 1 Insured. Uninsured. 1. (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) 156 222 (b) Number of the above attendances at which systematic physical examinination and records were made 73 109 3. Number of visits to patients at their own homes by the Dispensary medical officers in connection with the supervision of home conditions — — 4 Number of visits to patients at their own homes by the Dispensary nurses in connection with the supervision of home conditions and " following up " - - 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated - - 6. Number of consultations with the— (a) Medical Adviser of the Insurance Committee - - (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated - - (c) Practitioners at the homes of patients — - 7. Number of written reports concerning individual patients made to— (a) Public Authorities 11 13 (b) Practitioners 3 1 8. Number of specimens of sputum examined 4 4 (a) X Ray examinations 16 4 62 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 29th December, 1918, to the 3rd January, 1920. 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. Total Notifications on Form A No. of Primary Notifications. Total Notifications on Form B. Poor Law Notifications. 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 5 7 9 10 10 34 28 14 5 125 164 — 1 1 2 2 21 44 ,, Females — 7 6 6 11 23 26 13 3 4 99 118 — — — — 1 9 27 Non-pulmonary, Males — 2 5 1 2 1 3 1 1 — — 16 15 - 2 — 2 2 — 1 ,, Females — 2 8 4 2 — 2 1 1 1 — 21 22 — 1 — 1 3 2 — Totals — 7 25 18 19 22 38 62 43 18 9 261 319 — 4 1 5 8 32 72 63 Deaths from Phthisis.—Some reference has already been made to the matter of deaths from tuberculosis and at this point it is proposed only to deal with the figures relating to tuberculosis of the lungs (consumption or phthisis). During 1919, the total number certified as due to this cause was 104, the deathrate being 1.6 per 1000. That this is the lowest figure for a number of years is shown in the table given below. In the reduction all the districts shared, the fall being greatest in the case of All Souls and least in that of Christ Church, which as usual heads the list. Deaths from Phthisis. Ten years—1910-1919. Estimated Population. Year. All Ages. Sub-Districts. All Souls St. Mary. Christ Church. St. John. 97,953 1919 104 12 27 53 12 98,526 1918 167 45 39 60 23 92,796 1917 137 29 30 48 30 98,573 1916 151 32 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 25 117,844 1911 172 51 30 65 26 125,195 1910 133 28 37 56 12 The distribution of the 104 deaths was as follows:—In Poor Law Institutions, 48; general and other hospitals, 19; at home, 38. Of those who died 52 were insured (35 males and 17 females), and 52 uninsured (25 males and 27 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 104 the notified cases of pulmonary tuberculosis totalled 224. Tables similar to those printed below and showing the age distribution of the deaths and the occupation of the patients have appeared in previous reports. No comment with regard to them is necessary since no fact to which attention has not already been directed is brought out. Deaths from Phthisis—Age and Sex Distribution. Ages. Under 10. 10 and under 20. 20 and under 30. 30 and under 40. 40 and under 50. 50 and under 60. 60 and under 70. 70 and upwards. Totals. Males — 4 3 8 12 20 11 3 61 Females 1 4 8 8 10 7 2 3 43 Totals 1 8 11 16 22 27 13 6 104 64 CASES OF NON-PULMONARY TUBERCULOSIS NOTIFIED DURING THE 53 WEEKS ENDING 3RD JANUARY, 1920. Localisation of Disease. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. Cases Isolated at Home. At all Ages. At ages—years. All Souls. St. Mary. Christ Ch'ch. St. John. Totals. All Souls. St. Mary. Christ Ch'ch. St. John Totals. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Lungs 224 3 25 36 93 58 9 41 55 91 37 224 10 23 21 9 63 161 Phalanges 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Peritoneum 3 ... 2 ... 1 ... ... ... 1 1 ... 1 3 1 ... ... 1 2 1 Bladder 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Cervical Glands 10 ... 1 6 1 1 1 ... 4 2 4 ... 10 ... ... ... ... ... 10 Cystitis 1 ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Skin 3 ... ... 2 ... ... 1 ... ... 1 2 ... 3 ... 1 ... ... 1 2 Leg 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... Meninges 1 ... ... 1 ... ... ... ... 1 ... ... ... 1 1 ... ... ... 1 ... Spine 5 ... 1 1 1 2 ... ... 1 1 2 1 5 ... 1 ... ... 1 4 Hip 3 ... ... 3 ... ... ... ... ... 1 2 ... 3 ... ... 1 ... 1 2 Knee 2 ... ... ... ... 2 ... ... ... 1 1 ... 2 ... ... 1 ... ... 1 Adenitis 2 ... ... 1 ... ... 1 ... ... 1 1 ... 2 ... 1 1 ... 2 ... Rib 1 ... ... ... ... 1 ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... Femur 1 ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 Neck 2 ... ... 2 ... ... ... ... 1 ... 1 ... 2 ... ... ... ... ... 2 Non-Pulmonary Totals 37 4 18 5 7 3 ... 8 11 16 2 37 2 3 5 1 11 26 37 65 Bacteriological Diagnosis of Consumption. —The number of specimens of expectoration sent by medical men for bacteriological examination, from cases in which there was some doubt as to the diagnosis, was 459 as against 294 in 1918. Of these, 97 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—37 as against 40 in 1918—in the case of this form of tuberculosis came from institutions where the patients were undergoing treatment. Visits were paid to the homes and, where necessary, advice with regard to the obtaining of treatment was offered. Particulars as to the parts affected by the disease will be found in the table on page 64. Influenza.—The number of deaths from influenza in 1919 was 117 as against 266 in 1918. The bulk of the deaths in each of the years occurred amongst persons over 25 years of age, the lower age periods contributing a smaller proportion. During the year the efforts that had been made in 1918 to cope with the outbreak were continued. Special posters containing advice with regard to prevention, etc., were exhibited throughout the Borough, leaflets were widely distributed, special visits were paid by the Health Visitors and the assistance of the nurses of the Paddington and Marylebone Nursing Association obtained for cases which appeared to require it. BACTERIOLOGICAL EXAMINATIONS. During the year the Council continued to place facilities at the disposal of medical practitioners for having bacteriological examinations carried out in order to assist in diagnosis of infectious diseases. This work was done by Dr. Foulerton, of the University College Hospital, who, in addition, carried out a number of other examinations for the Council, e.g., of milk samples, referred to elsewhere. The following table shows the number of specimens examined for purposes of diagnosis, and indicates also the diseases in relation to which the examinations were made: 1919 Positive. Negative. Total. Typhoid fever 4 8 12 Diphtheria 73 351 424 Phthisis 97 362 459 Totals 174 721 895 DISINFECTION. The work done in this connection during 1919 is shown in the following tables. The methods employed during the greater part of the time were substantially the same as in previous years, articles suitable for treatment by steam were dealt with in the Washington Lyons Disinfector, recently installed at the Disinfecting Station, while for rooms either formalin or sulphur was generally employed. 66 The number and nature of the articles disinfected are sho\Vn in the following table:— Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other causes. Total. Beds 255 32 1 3 17 308 Mattresses 352 30 5 38 165 590 Bolsters 227 25 1 14 76 343 Pillows 756 79 4 46 342 1,227 Sheets 528 36 5 35 35 639 Blankets 898 91 3 353 194 1,539 Sundries 6,968 317 15 1,298 681 9,279 Totals 9,984 610 34 1,787 1,510 13,925 In 1918, the number of articles disinfected was 20,314. The number of journeys made by the disinfecting vans during the year ended December, 1919, was as under :— January 45 August 50 February 43 September 46 March 47 October 50 April 43 November 45 May 49 December 48 June 45 — July 43 554 The vans were used 532 times in 1913. The number of rooms disinfected and the reasons for carrying out disinfection are stated below:— Reasons for Disinfection. Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other causes. Total. January 41 7 7 1 7 63 February 52 6 8 1 4 71 March 84 27 10 4 7 132 April 54 35 9 2 1 101 May 22 75 9 4 11 121 June 35 58 6 6 5 110 July 38 5 54 5 7 109 August 16 8 66 10 9 109 September 17 19 23 12 7 78 October 26 7 5 2 4 44 November 41 8 3 — 15 67 December 96 7 3 — 14 120 Totals 522 262 203 47 91 1,125 The number of rooms disinfected in 1918 was 1,086. 67 CLEANSING OF PERSONS ACT, 1897. Table showing the number of Adults and School Children using the Baths provided under the above-mentioned Act during the year 1919:— 1919. Adults. Children. Males. Females. Total. Males. Females. Total. January 163 107 270 90 99 189 February 160 100 260 128 112 240 March 180 86 266 170 98 268 April 173 107 280 92 75 167 May 174 92 266 159 230 389 June 150 80 230 77 158 235 July 162 75 237 35 200 235 August 191 79 270 2 6 8 September 182 89 271 60 167 227 October 196 95 291 68 287 355 November 155 80 235 55 470 525 December 196 73 269 45 230 275 Totals 2,082 1,063 3,145 981 2,132 3,113 Table showing the number of persons using the Baths during the oast 22 years:— Year. ADULTS. CHILDREN. Males. Females. Total. Males. Females. Total. 1898 3,301 5 3,306 - 1899 4,340 — 4,340 — —■ — 1900 3,431 31 3,462 — — — 1901 4,140 142 4,282 — — — 1902 4,326 202 4,528 — — — 1903 5,515 655 6,170 — — — 1904 7,089 1,376 8,465 — — — 1905 7,981 1,431 9,412 107* 353 460 1906 6,891 1,974 8,865 1,873 3,311 5,184 1907 6,785 1,807 8,592 2,367 3,404 5,771 1908 8,741 2,563 11,304 2,198 3,046 5,244 1909 8,563 2,550 11,113 2,725 1,959 4,684 1910 6,433 2,051 8,484 513 859 1,372 1911 6,510 2,575 9,085 504 463 967 1912 5,818 2,384 8,202 740 1,138 1,878 1913 5,797 2,208 8,005 771 1,305 2,076 1914 5,555 2,379 7,934 623 1,243 1,866 1915 3,323 1,672 4,995 589 1,091 1,680 1916 1,919 1,158 3,077 905 1,288 2,193 1917 1,947 967 2,914 1,376 1,699 3,075 1918 2,031 1,085 3,116 1,249 1,474 2,723 1919 2,082 1,063 3,145 981 2,132 3,113 Totals 112,518 30,278 142,796 17,521 24,765 42,286 *The Children's Baths were opened in June, 1905. 68 MATERNITY AND CHILD WELFARE. Under this head the Ministry of Health asks that in the case of Metropolitan Boroughs information should be provided with regard to (a) the incidence of puerperal fever, ophthalmia neonatorum, and other infectious diseases, and (b) general arrangements for attending to the health of expectant and nursing mothers and children under five years of age. Inasmuch as the information asked for with regard to the infectious diseases has already been given under the heading relating to the prevention and control of these diseases, it is unnecessary to refer to them again here. It is proposed, therefore, at this point to deal only with the question of arrangements for attending to the health of expectant and nursing mothers and children, and to give a short description of the scheme in operation in the Borough. Although it was not then known as a "Maternity and Child Welfare Scheme," works in this connection were inaugurated in 1906, and in the discussions that arise from time to time as to which was the first district to begin infant welfare work, the name of St. Marylebone is always mentioned as at least being among the earliest. The composition of the scheme now in existence has been very frequently described in annual reports. As is well known, it contains voluntary and official elements. Of the voluntary elements, to the nature of which reference is made later, those for which the St. Marylebone Health Society is responsible bulk largest, and the Council and the inhabitants of the Borough are greatly indebted to this body and those who work for it for what they have done and what they are doing in relation to maternal and child welfare. Apart from the Health Society, however, there are other bodies that assist, and that are more or less definitely linked up to the main scheme, the connecting link being the Public Health Department of the Council. Amongst these bodies may be mentioned Queen Charlotte's Hospital and Middlesex Hospital, which in addition to providing lying-in accommodation, arrange for attention to be given to out door patients as well, and conduct ante-natal clinics and infant consultations. Less definitely part of the scheme, but still doing very valuable work and helping whenever possible, are St. Agatha's Home, The Home of the Little Company of Mary, and The Home of the St. Marylebone Female Protection Society, where unmarried mothers particularly are provided for, both before and after the birth of their child. A special feature is made at St. Agatha's of keeping the mother and child together for at least three to six months after the birth, and of endeavouring to arrange that they shall be together after leaving the home. On several occasions places on the domestic staff of one or other of the institutions—day nurseries, for example—within the scheme, have been found for mothers from the home. The following summaries give a number of details with regard to the arrangements under the scheme and of the extent of the work done during 1919. It will be noted that at the end of the year there were available seven centres where attention was given to infant and child welfare, and if those at the hospitals are included four ante-natal clinics. At some of the centres consultations are held every day, sometimes twice a day. In addition to the ordinary infant and young child ("toddlers") consultations, there is a dental clinic for mothers and young children, four days, for two of which the Health Society is responsible, and a nursing home for babies to which the Council now make a contribution of £1,000 per annum. By arrangement with the London County Council the dental clinic is used also by school children, and in conjunction with this there is now also a minor ailment treatment centre for school children. 69 The summary referred to above is based upon a return formerly called for by the Local Government Board and is given here because it is convenient as showing the elements in the scheme. Health Visitors.—There are six health visitors. One acts exclusively as tuberculosis health visitor; two give whole time to health visiting and work, one at the centre in Salisbury Street, the other at Crawford Street. Three are part time health visitors, holding appointments also as sanitary inspectors. Voluntary workers of the St. Marylebone Health Society also do visiting in co-operation with the work of the Council. The Borough for the purpose of health visiting is divided into three districts, and in 1919 the health visitors made 8,662 visits to 9,128 infants, and the voluntary visitors attached to the schools for mothers made 4,070 visits to 3,018 infants ; children are visited up to school age. Centres.—There are in all seven centres, all " voluntary," at which consultations are held. Five of these are under the Health Society, viz.:—(1) North Marylebone School of Mothercraft, Salisbury Street, has an ante- and post-natal consultation under medical supervision. The dental clinic and minor ailment treatment centre are in the same building. The Council's health visitors co-operate, one of them acting as superintendent. The nurse in charge of the dental clinic assists at the ante-natal clinics.—(2) South Marylebone School of Mothercraft, St. Marylebone General Dispensary, 77, Welbeck Street, and 30, Marylebone Lane. An ante-natal clinic is held once weekly, and an infant consultation 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 Council's health visitors co-operate.—(3) Ogle Mews, Ogle Street, W.1. Infant consultations are held weekly under medical supervision. The Council's health visitors attend. There are also classes weekly in cookery, needlework and hygiene.—(4) Barrow Hill Road. Infant consultations under medical supervision are held weekly at the day nursery here. The health visitors co-operate and one of the nurses of the day nursery gives part time to health visiting.— (5) 101, Crawford Street. Infant consultations under medical supervision are held weekly. There are also classes for nursing, etc. One of the health visitors is specially attached to this centre and acts as superintendent. In addition to these centres consultations are held weekly at Queen Charlotte's Hospital and at Middlesex Hospital. Each is presided over by a member of the Hospital Medical Staff. One of the Council's health visitors attends at each and Middlesex Hospital has also a paid health visitor in attendance. Both consultations are open to other than St. Marylebone babies, who, however, constitute the bulk of those attending. At both hospitals there is an ante-natal clinic particularly for hospital patients. Ante-Natal Work as indicated. There are two voluntary Ante-Natal Clinics. Visiting is undertaken by the Council's health visitors and in the case of the clinic in Salisbury Street by a nurse who gives part time also to the dental clinic. There is a system of co-operation with the Middlesex and Queen Charlotte's Hospitals. Dental Clinic.—This was originally established for the treatment of women and children of pre-school age. By arrangement with the London County Council, school children are also dealt with. Hospital Treatment.—Children's cases are referred from the centres to the dispensaries and hospitals in the Borough, and the Queen Charlotte's and Middlesex Hospitals are available for ante-natal and complicated maternity cases. Under a special arrangement cases calling for special examination or treatment are referred by the doctors at the centres to Middlesex Hospital. Maternity Cases.—The Council have not established a Maternity Home or Hospital, but there is accommodation within the Borough at Queen Charlotte's Hospital, Middlesex Hospital and in the Labour Wards at the Workhouse in 70 Marylebone Road. The number of births notified from these institutions during 1919 was 2,458, the total births numbering 3,779. The midwives living and practising in the Borough number 2. Both conduct maternity homes which are registered by the London County Council. Babies Nursing Home.—Through a special Committee upon which the Borough Council was strongly represented and of which the Medical Officer of Health was Chairman, a house at 20, Marlborough Place, N.W., was opened as a Nursing Home for Wasting Babies early in 1918. This home was in operation during the whole of 1919 working in co-operation with the various centres, through which alone admission to the Home is obtainable. The statement given below shows the number of admissions during the year. The Home is supported by voluntary subscriptions, but the Council in 1919 also made a grant of £500. Work done during 1919.—The following table gives some idea of the work done at the various centres during the year. Further information with regard to action taken under the Milk (Mothers and Children) Order, to which reference is made here will be found on page 30. STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE YEAR ENDED 31ST DECEMBER, 1919. CENTRE. Lord Roberts' Club, Barrow Hill Road No. 14 Salisbury Street Queen Charlottes Hospl. No 101 Crawford Street. No. 30, Marylebone Lane. No, 8 Ogle Mews. The Middlesex Hospl.* Totals. No. of consultations held 49 211 (153 children 58 maternity) 304 (255 antenatal 49 infants) 49 93 50 37 793 No. of mothers attending ante-natal clinic 987 7914 — 129 — — 9030 No. of attendances of babies 1055 3382 1561 969 856 675 859 9357 No. of attendances of children over 2 years 287 837 — 99 183 170 — 1576 No. of orders issued for milk, etc. 61 2634 93 186 15 6 8 3003 No. of home visits 777 5485 949 833 568 290 408 9310 No. of new cases 90 369 2082 72 126 122 157 3018 * Opened in April. 71 The St. Marylebone Babies' Nursing Home, 20, Marlborough Place, N.W. Admissions 16. Discharges 32. Deaths 1 Average number in the Home throughout the year 11 Day Nurseries—Attendances during the year. St. John's Wood, Barrow Hill Road 6154 Portman, Exeter Street 8320 Home Helps.—A system of providing assistance in carrying out the work of the home to expectant, nursing or ailing mothers was in operation throughout the year. The women employed were found by the health visitors, who also noted the cases in which assistance was required. Both the women and the cases were submitted for approval to the Medical Officer of Health. The system has worked exceedingly well and the assistance rendered has been greatly appreciated by those who received it. When the scheme was first adopted it was intended to engage one or more women who had received or who would be given special training and instruction at one of the centres, but at the time of starting it was practically impossible to find women considered suitable. It was decided, therefore, for a time at least to employ women experienced merely in ordinary house work, and this arrangement has proved highly successful. The chief work in connection with which assistance is required is the more or less rough work of the house and the washing, and it is essential to find women willing to undertake these. Several women both willing and capable have been found and more or less of a band of " Home Helps " has been formed. In some cases they are only required for half a day, a few days a week, in others for a whole day and every day. All of them have taken the greatest interest in the work and have willingly carried out all instructions. The system adopted is on the lines described in connection with milk orders under the Milk (Mothers and Children) Order and the scheme being a contributary one the contribution, if any, to be made by the mother towards the payment of the home help is estimated in much the same way. The number of cases in which home helps were employed in 1919 was 8; the average time for which the help was required was 4 weeks (the longest being 4 months, the reason for employing the help being rheumatism and extreme weakness). The shortest period was 2 weeks. The total amount expended during the financial year to 31st March, 1920, was £156 9s. 3d., the payments made to the helps being at the rate of 25/- per week. 72 SANITARY ADMINISTRATION. Under this, which is made a separate heading by the Ministry of Health, the Medical Officer of Health is required to make reference to a number of matters, e.g., staff, hospital accommodation and some others, most of which will be found dealt with elsewhere. (1) Staff: Work of sanitary inspectors and other officers engaged in sanitary work. This matter, so far as the inspectors are concerned, is fully discussed in an early part of the report. One officer who has not been mentioned up to the present is the Mortuary Keeper, and at this point it may be convenient to include a report showing the extent to which the mortuary was used during the year. Regular visits of inspection were made to the premises by the Outdoor Superintendent. Report of Mortuary Keeper. Number of bodies deposited from 1st January to 31st December, 1919. 1919. Males. Females. Total. For burial only. For inquests. Total. No. of. P.M.'s held No. of courts held. No. of Infectious cases. January 27 28 55 41 14 55 6 5 - February 23 30 53 33 20 53 16 9 - March 20 26 46 30 16 46 12 7 - April 15 13 28 19 9 28 7 4 - May 11 20 31 25 6 31 3 3 - June 11 14 25 16 9 25 5 4 1 (Diphtheria) July 12 10 22 15 7 22 4 4 - August 8 13 21 14 7 21 2 3 - September 3 15 18 10 8 18 8 5 - October 15 15 30 20 10 30 7 4 - November 20 26 46 3 15 46 8 6 - December 13 22 35 19 16 35 10 9 - Totals 178 232 410 273 137 410 88 63 1 (2) Hospital accommodation.—This being a matter with which the Borough Councils in London have no direct concern, it is not considered necessary to make special reference to it. (3) Local Acts, special local orders and their administration.—There are no Acts or Orders applicable in the Borough which do not apply to other parts of London. The London County Council (General Powers) Acts contain a number of provisions under which a considerable amount of work is done, e.g., those relating to food places where food is dealt with. Reference is made to these elsewhere. 73 (4) Arrangements for chemical and bacteriological work during the year and their results.—Full particulars with regard to these arrangements have been given under more appropriate headings. It may be noted at this point, however, that under the Rag Flock Act, 1911, three samples were taken and submitted to the public analyst who reported that two samples contained 0'7 and 0'8 parts chlorine per 100,000 respectively, and the third sample 60 parts of chlorine per 100,000, an excess of 30 parts above the standard laid down in the Rag Flock Regulations, 1912. Legal proceedings were instituted, when the defendant called the manufacturers of the Rag Flock who submitted an analyst's certificate showing the duplicate sample to contain only 11.2 parts chlorine per 100,000, and in view of the discrepancy between the two portions analysed the magistrate dismissed the summons but declined to give the defendant costs. 74 HOUSING. In the earlier part of this report some reference was made to the subject of housing in the Borough, and in this portion all that is attempted is to provide the particulars asked for by the Ministry of Health in the memorandum as to the contents of reports of medical officers of health. I.—General Housing Conditions. (1) Number of houses 21,000. Number of houses for the working classes : If each tenement or part of a house let as a separate dwelling be reckoned as a separate dwellinghouse, there are probably about 9,000. New houses for the working classes erected during the year or in course of erection. Nil. (2) Population (estimated) 97,953. This is almost certainly an underestimate and the actual figure is probably nearer 120,000 Important changes during the year or anticipated in the future. None. (3) (a) Extent of shortage or excess of houses, and (b) Measures taken or contemplated to meet any shortage. Since there is a very marked shortage of houses throughout London, there must be a shortage in St. Marylebone. The share of the Borough in the general shortage it is impossible to estimate. Speaking generally, and from the health point of view, for years there has always been a larger population than the area of the Borough justifies. At the moment conditions are worse than ever before. In the tenement house districts each house being divided up into the largest possible number of tenements accommodates more families than in any previous time. This squeezing of quarts into pint pots makes estimation of shortage all the more difficult. It may be mentioned, however, that in the early part of 1919, as a result of a rapid survey carried out by the sanitary inspectors, it was estimated that the population in tenement houses might be taken approximately to be 28,634, and that the number of tenements (1, 2, 3 or 4 roomed), containing at least one more person than the standard of two per room was 1,894. On this basis the number of persons in excess of accommodation was, at that time, 1,894. Since that time there is little reason to believe that matters have improved. Conditions so far as the houses themselves are concerned certainly have, but reference to this matter has been made already in dealing with the question of sanitary inspection and the difficulties and delays that have arisen in connection with the getting of work done with a view to the removal of nuisances, remedying of defects, etc. In the parts of the Borough occupied by the working classes, the bulk of the houses are of the tenement class and originally constructed to accommodate one family only. They have been sub-divided and are let out in tenements of one, two, three, and more rarely four rooms, no particular attempt having been made to fit the separate tenements for occupation by a family. As a result most of the conveniences —water-closets, etc.—have to be used in common and suffer not only as a result of over use, but from mis-use and neglect. The houses themselves are also to a large extent misused by the tenants and are neglected by the landlords or owners, who in a 75 majority of instances are holders of leases which are rapidly falling in. For the reason that land is and always has been very expensive, the houses in the tenement house areas—in Lisson Grove, in the east end behind Tottenham Court Road and Oxford Street, and in parts of St. John's Wood—have been constructed mainly with a view to economizing space. There is marked overcrowding on space and congestion, basements are common, yards are small, and small as they are, have frequently been required to accommodate outbuildings, water-closets, washhouses, etc., or additional apartments in the shape of small cottages or back additions. Apart from the conditions capable of being dealt with as nuisances, to which reference is made elsewhere (page 16), the defects found to exist arise mainly because of the limitation of space and because the space available is overbuilt. Because of lack of space, water-closets improperly placed and inadequately lighted and ventilated are not infrequently found and because of overbuilding, rooms used for living or sleeping purposes though deprived of light and air by back additions are not uncommon. In respect of measures taken or contemplated to meet the shortage, the situation, so far as the Borough itself is concerned, is very difficult. As matters now stand, within the boundaries there is no space upon which to erect houses to accommodate the working classes. Before houses can be erected, houses will have to be demolished, and there is probably no site in the Borough which, if once cleared, even if entirely used for housing purposes, could provide accommodation for all the persons dishoused. It is this largely that complicates the housing problem in St. Marylebone, and makes the task of the Council and its Housing Committee so difficult. II. Overcrowding. (1) Extent. (2) Causes. (3) Measures taken or contemplated, to deal with overcrowding. The information called for under these heads is more or less given above. (4) Principal cases of overcrowding dealt with during the year and action taken. Though the overcrowding was more marked, for various reasons, the number of cases dealt with was comparatively small. The notices served numbered 5, and for the reason that more or less of a remedy was found in each case, no proceedings were instituted. III. Fitness of Houses. (1) (a) General standard of housing in the district, and (b) General character of the dejects found to exist in unfit houses (2) Action taken as regards unfit houses under (a) the Public Health Acts, (b) the Housing Acts. The powers under the Public Health Acts have always been used to the fullest extent with a view to obtaining removal of nuisances, remedy of defects and improvements in the condition of houses. A glance at the Table on page 17, which shows the defects found by the inspectors, gives some idea as to the amount of work done by way of investigation. So far as the Housing Acts are concerned, the Table at the end of this section shows the number of houses dealt with by way of Closing, etc., Orders, under the Act of 1909. Soon after this Act came into operation the Public Health Committee gave directions that a complete house-to-house inspection should be made, and laid down a policy as to the method to be adopted in regard to closing and demolition orders under that Act. As a result of the action taken, 76 considerable improvements were made, many of them voluntarily by property owners, and others were due to be made either voluntarily or on account of action taken by the Council. The war unfortunately put a stop to the good work that was being done along these lines, and since the termination it has been found impossible and impracticable to resume it. (3) Difficulties in remedying unfitness, special measures taken and any suggestions in the matter. The nature of the difficulties in the way of remedying unfitness are common knowledge and in any case have been more or less indicated above. Special measures taken: none. Suggestions: none to offer here. (4) Conditions, so far as they affect housing, as regards water supply, closet accommodation and refuse disposal, together with measures taken during the year in these matters. These have been sufficiently referred to under the appropriate headings elsewhere. They do not, in any case, affect the housing question in the Borough to any extent. IV. Unhealthy Areas. (1) Action taken as regards areas represented before the beginning of the year under Part I or Part II of the Housing Act, 1890. None. (2) Particulars of, and action taken, as regards areas represented during the year. None. (3) Information as to complaints made during the year that areas were unhealthy and action taken. None received. V. By-laws relating to Houses, Houses Let in Lodgings, and to Tents, Vans, Sheds, etc. (1) As to working of existing By-laws. (Seep. 19.) (2) As to need for new By-laws or revision of existing By-laws. The London County Council is now the authority for making By-laws with regard to tenement houses, and new By-laws are in course of preparation. VI. General and Miscellaneous. Under this head there may be noted the fact that during the year the Council received notification that Lord Portman desired to present a site extending to about 1.6 acres to the Council for housing purposes. Unfortunately the donor died before the gift was completed, but his successor generously declared that it was his intention also to make the gift, and but for the fact that the new Lord Portman was so seriously ill as to be unable to transact the necessary business, the site no doubt would have been in the hands of the Council before the end of the year. The Housing Committee amongst other matters gave very serious consideration to the question of how to deal with the area included in the gift, and it seems certain that very soon after it is formally handed over it will be used for the purpose which the donor intended, viz., the better housing of members of the working classes. VII. Appendices. Table A contains the information asked for by the Ministry. Table B, continued from the report of 1915, having been omitted from the reports of 1916, 1917 and 1918 is introduced in order to complete the record with regard to certain of the premises. 77 Table A.—HOUSING. Statistics for the Twelve Months ended 31st December, 1919. Housing Investigations (Public Health and Housing Acts). Repair of Houses (Sec. 28, Housing Act, 1919). Closing Orders (Section 17, Housing Act, 1909). Demolition Orders (Sec. 18, Housing Act, 1909). Obstruction Buildings (Sec. 38, Housing Act, 1890). Housing Staff. Complaints by Householders. House to House Inspection. Houses Unfit for Habitation Defective Houses Repaired, Public Health Act, &c. Orders Issued. Houses Repaired by Council. Houses Closed voluntarily. Houses Represented for Closure. Closing Orders Passed. Closing Orders Withdrawn Houses Repaired. Orders Issued. Houses Demolished under Orders. Houses Demolished Voluntarily. Number of Representations. Buildings Removed. Representations under Consideration. Full Time. Part Time. — 755 10 486 Nil. Nil. Nil. 10 10 6 Adjourned sine die. 4 Cottages rear of 41, 42, 43 Hereford Street 10 Nil. Nil. Nil. Nil. Housing Inspector Hodges died. Successor to be appointed. Nil. 78 HOUSING, TOWN PLANNING, ETC., ACT, 1909. Premises reported or represented during 1919 and the six previous years. Premises. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 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 voluntarily 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 79 HOUSING, TOWN PLANNING, ETC., ACT., 1909.—continued. Premises. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 4 & 4a, Allsop Street C.O. 13th June, 1913 Question of D.O. adjourned sine die. Premises vacated and boarded up 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 19th Mar., 1915 work proceeding slowly Work complete, March, 1916 9, 10, 11, 12, 13, 14, 15 & 16 Montagu Mews South C.O. 28th, Nov., 1913 Appeal to L.G.B. 28th April, 1914. L.G.B state case for High Court Decision Case heard and decided. See note on p. 45, Annual Report, 1915, C.O. quashed 7th Sept., 1915. 424, Edgware Road, front and back basement room C.O. made 20th Mar., 1914. Vacant l5th May, 1914 5 & 6, Hardington Place C.O. made 16th July, 1915. Not served, work having been commenced Premises empty Premises empty Premises empty Premises reverted to Freeholders. Work executed and no further action necessary 4, Ogle Mews South C.O. made 3rd Aug., 1917. C.O. determined 23rd Nov., 1917 12 & 13, Union Street C.O. made 22nd Feb., 1918 D.O. made 14th Mar., 1919. Demolished 28th Nov., 1919 80 HOUSING, TOWN PLANNING, ETC., ACT, 1909. -continued. Premises. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 32, 33, 34, 35, Hereford Street C.O. made, 22nd Feb., 1918 D.O. made 14th Mar., 1919. Demolished 28th Nov., 1919 30, 31, Hereford Street Ditto, determined 3rd Oct., 1918 2, 3, 4,5, Mitcham Street C.O. made 28th June, 1918 D.O. made 20th Sept., 1918. Demolished 28th Nov., 1919 48, Hereford Street C.O. made 18th Oct., 1918 D.O. made 16th May, 1919 41, 42, 43, Hereford Street, Cottages at rear of C.O. made 17th Jan., 1919. D.O. made 11th July, 1919 1, 2, 3, 4, 4a, Hardington Place C.O. made 16th May, 1919, still occupied. Adjourned sine die 28th Nov., 1919 1, Linhope Street Ditto 15, Hereford Street, Cottage at rear of C.O made 3rd Oct., 1919 81 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 183 Cowhouses 4 Slaughterhouses 3 Offensive Trades 2 Ice Cream Premises 96 Bakehouses 75 Restaurant, Dining Room and Coffee Shop Kitchens 156 Hotel Kitchens 38 Pastrycooks and Tea Rooms 50 Fried Fish Shops 24 Fish Curers 3 Houses Let in Lodgings 1,152 Workshops and Workplaces 2,916 Total 4,702 Smoke Nuisances. Number of Observations 10 Number of Notices Nil Number of Nuisances and Complaints 3 Number of Summonses Nil Housing of the Working Classes. Number of Houses inspected 755 Number of Representations by Householders Nil Number of Representations by Medical Officer 4 Number of Houses included in such Representations 10 Number of Houses remedied Nil without Closing Orders Number of Demolition Orders 1 Number of Houses dealt with under Section 15 of the Housing, Town Planning, etc., Act, 1909 Nil Number of Closing Orders 4 Number of Houses included in such Closing Orders 10 Number of Closing Orders determined 2 adjourned sine die Number of Cottages at rear of Houses demolished— (a) In pursuance of Orders 3 (b) Voluntarily Nil 82 Obstructive Buildings. Number of Representations under Section 38 of the Housing Act, 1890 Nil Number of Representations still under consideration Nil Number of Orders for repairs issued under Section 28 of the Housing Act, 1919 Nil Total number of Houses in the Borough 21,000 Number of Houses for the Working Classes— (a) Erected during year Nil (b) In course of erection Nil Number of Buildings demolished Nil Number of Houses repaired by Local Authorities Nil Number of Houses closed on Notice by Owner that they could not be made fit Nil Number of Houses occupied by the Working Classes 7,266 Mortuary. Number of bodies received 410, Number of Infectious bodies received 1 Disinfection. Number of rooms disinfected 1,125 Number of articles disinfected 13,925 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 2,082 1,063 981 2,132 6,258 Bakehouses. Number on register at end of 1919 75 Number above ground 10 Number underground 65 Number of inspections 150 Number of Notices 6 Number of prosecutions 1 Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1919 559 Number of Inspections 506 Number of Notices 10 Number of Prosecutions 1 83 House to House Inspections. Number of Inspections Houses . 755 Number of Notices issued Intimations 486 Statutory Notices 103 Number of Prosecutions Nil House Refuse. Number of Inspections 3,431 Number of Old Brick Receptacles abolished 1 Number of New Metal Receptacles provided 559 Number of Notices served (677 Intimations, 21 Statutory Notices) 698 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 66 Number of Statutory Notices served 12 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 5 Number remedied 1 Number of Prosecutions Nil Underground Rooms. Number dealt with 18 Number of Notices served under P. H. (L.) Act, 1891 18 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 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 10 Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (1). Number of rooms cleansed 462 Number of Prosecutions 1 Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 6 Inland Revenue Act. Number of houses for which applications were received 2 Number of tenements comprised therein 8 Number of tenements for which certificates were granted 8 „ „ „ „ refused Nil ,, „ „ „ deferred Nil 84 Drainage. The total number of inspections made 7,554 The total number of drainage plans deposited 278 The number relating to new buildings 16 „ „ old buildings 262 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops, and Cowsheds 351 Number of Inspections 888 Disinfection Shelter. Persons accommodated 6 Ophthalmia Neonatorum Regulations. Number of Notifications received during the year from certified midwives Nil Sanitary Officers. Number of Sanitary Inspectors (Whole-time) Male 10 Female Nil „ „ „ (Part-time) Male Nil Female 3 „ Health Visitors Whole-time 2 Part-time 3 „ Tuberculous Visitors Whole-time 1 MINISTRY OF HEALTH AND OTHER TABLES. Table I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1919 AND PREVIOUS TEARS. 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 1918 98,526 3,340 1,375 12.4 1,852 18.7 898 879 152 110.5 1,835 18.5 1919 97,953 3,625 1,492 14.6 1,724 17.3 864 708 147 198.5 1,568 15.9 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. 85 TABLE I. (A) Vital Statistics of Separate Localities in 1919 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. 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 36,125 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 1915 100,260 1,852 1,697 178 25,002 367 341 21 27,312 337 422 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 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 1918 98,526 1,375 1,835 152 24,528 311 366 30 26,880 257 429 45 30,391 522 708 58 16,727 285 332 19 Averages of Years 1909 to 1918 110,278 2,053 1,684 208 27,893 456 353 38 30,335 388 415 40 33,745 870 635 103 18,304 337 279 27 1919 97,953 1,492 1,568 147 24,381 311 316 27 26,731 272 408 34 30,210 584 560 63 16,631 325 284 23 * The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sub-District on the 1st April, 1916, but for the purposes of District comparison over previous years the figures have been allocated to the old Sub-Districts. 86 TABLE II. Cases of Infectious Disease Notified during the 53 weeks ending 3rd January, 1920. 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 ages—years. All Souls St. Mary Christ Church St. John Totals. All Souls St. Mary Christ Church St. John Totals At all ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 154 6 45 77 18 8 ... ... 28 22 64 40 154 27 21 58 38 144 10 Erysipelas 60 3 2 8 10 10 15 12 9 18 27 6 60 3 5 7 6 21 39 Scarlet Fever 197 ... 37 129 18 12 1 ... 55 25 95 22 197 54 19 94 21 188 9 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 4 ... ... 1 1 2 ... ... 1 2 ... 1 4 1 ... 2 ... 3 1 Paratyphoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 6 ... ... ... 2 4 ... ... 1 2 2 1 6 1 1 1 ... 3 3 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 1 ... ... 1 ... ... ... ... 1 ... ... ... 1 1 ... ... ... 1 ... Tuberculosis Pulmonary 224 ... 3 25 36 93 58 9 41 55 91 37 224 10 23 21 9 63 161 Non-Pulmonary 37 ... 4 18 5 7 3 ... 8 11 16 2 37 2 3 5 1 11 26 Acute Poliomyelitis 5 ... 3 ... 1 1 ... ... ... 3 1 1 5 ... 1 ... 1 2 3 Ophthalmia Neonatorum 22 22 ... ... ... ... ... ... 2 5 10 5 22 1 1 3 ... 5 17 Measles 837 43 351 396 25 20 2 ... 168 196 296 177 837 15 25 33 5 78 759 German Measles 83 1 9 32 25 15 1 ... 20 24 16 23 83 5 4 2 ... 11 72 Measles (Notified by Parents,&c., &c.) 58 1 19 31 6 1 ... ... 13 16 19 10 58 5 ... 2 3 10 48 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Polio-Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 121 2 18 18 17 41 19 6 19 18 42 42 121 4 4 10 7 25 96 Malaria 44 ... ... ... 6 35 3 ... 2 4 31 7 44 ... ... 2 ... 2 42 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1860 78 491 736 171 254 103 27 369 402 713 376 1860 129 107 241 91 568 1292 1860 87 TABLE III.—Causes of, and Ages at Death during the year ending 3rd January, 1920. 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. 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 - - - - 1 1 - 2 2 Small Pox - - - - — — - - - — — — — — 3 Measles 17 4 5 6 2 — — - - — 5 1 9 2 17 4 Scarlet Fever 3 - 1 1 — — 1 - - - 1 — 2 — 3 5 Whooping Cough 2 — - 2 — — — - — - — 2 - — 2 6 Diphtheria and Croup 11 2 2 4 3 — — - — 1 3 — 6 2 11 7 Influenza 117 2 1 3 1 13 46 28 23 39 33 42 27 15 117 8 Erysipelas 5 — — — 1 — 1 1 2 2 — 1 4 — 5 9 Phthisis (Pulmonary Tuberculosis) 104 — — — 2 13 30 49 10 8 12 27 53 12 104 10 Tuberculous Meningitis 2 - — 1 1 — - - - 5 — — 2 — 2 11 Other Tuberculous Diseases 10 - 2 1 — — 1 2 4 2 2 2 4 2 10 12 Cancer 165 - — 1 1 19 81 63 260 32 32 58 43 165 13 Rheumatic Fever 9 - — 2 — 2 5 - 3 3 3 3 9 14 Meningitis 6 1 — 1 — 1 1 1 1 9 4 — 1 1 6 15 Organic Heart Disease 196 — — — 1 2 13 62 118 93 33 67 67 29 196 16 Bronchitis 170 3 1 — — 9 43 114 40 32 48 73 17 170 17 Pneumonia (all forms) 165 20 9 10 7 2 31 43 43 79 31 39 66 29 165 18 Other Diseases of Respiratory Organs 27 2 — — 1 — 7 9 8 13 11 5 10 1 27 19 Diarrhoea and Enteritis (under 2 years) 29 23 6 — — - — — — 22 5 3 16 5 29 20 Appendicitis and Typhlitis 10 — — — 1 1 4 3 1 14 2 5 2 1 10 21 Cirrhosis of Liver 6 - - - - - 2 2 2 5 1 3 - 2 6 21a Alcoholism - - - - - - - - - 1 - - - - — 22 Nephritis and Bright's Disease 39 — 1 — — — 6 20 12 32 11 6 11 11 39 23 Puerperal Fever 2 — — — — — — 2 — 4 — 1 1 — 2 24 Other accidents and diseases of Pregnancy and Parturition 2 - - - - - - 2 — 12 — — 1 1 2 25 Congenital Debility and Malformation, including Premature Birth 65 63 2 - - - - - - 68 10 16 30 9 65 26 Violent Deaths, excluding Suicide 53 2 — 6 6 4 12 10 13 31 9 15 19 10 53 27 Suicides 16 - — — — 1 5 9 1 3 3 3 4 6 16 28 Other defined Causes 335 25 5 3 5 4 32 73 188 243 74 86 79 86 335 29 Diseases ill defined or unknown — — — — — — — — — — — — — — — Totals 1568 147 34 39 35 42 227 441 603 989 317 408 559 284 1568 88 VACCINATION RETURNS. Supplemental Return for 1918. Return made to the Board of Guardians and Ministry of Health on the 9th February, 1920, by Mr. Edward A. Frith, Vaccination Officer of the St. Marylebone Parish, respecting the Vaccination of Children whose Births were registered in St. Marylebone, from 1st January to 31st December, 1918, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District Number of Births returned in the " Birth List Sheets " as registered from 1st January to 31st Dec, 1918. Number of these Births duly entered by 31st January, 1920, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1920, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1920, neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6, and 7 of this Return) nor temporarily accounted for in the " Report Book" (columns 8, 9, and 10 of this Return). Number of Certificates of Successful Primary Vaccination at ALL AGES received during the calendar year 1919. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1919. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, cinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown or which cannot be reached ; and Cases not having been found. Insusceptible of Vaccination. Had SmallPox. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 731 500 4 ... 41 86 19 36 27 18 2. St. Mary 1,988 1,108 2 ... 179 130 8 530 28 3 2,637 383 3. All Souls 604 471 2 ... 27 34 8 47 11 4 Total 3,323 2,079 8 ... 247 250 35 613 66 25 2,637 383 Dated 9th February, 1920. (Signed) EDWARD A. FRITH, Vaccination Officer. 89 VACCINATION RETURNS. Return for the Period January—June, 1919. RETURN made to the Board of Guardians and Ministry of Health on the 8th February, 1920, by Mr. Edward A. Frith, Vaccination Officer of the St. Marylebone Parish, respecting the Vaccination of Children whose Births were registered in St. Marylebone, from 1st January to 30th June, 1919, inclusive. Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets " as registered from 1st January to 30th June, 1919. Number of these Births duly entered by 31st January, 1920, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1920, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1920, neither duly entered in the "Vaccination Register "(columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book" (columns 8, 9, and 10 of this Return). Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, cinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown, or which cannot be reached ; and Cases not having been found. Insusceptible of Vaccination. Had SmallPox. 1 2 3 4 5 6 7 8 9 10 11 1. North Marylebone 372 243 ... ... 55 16 7 21 18 17 2. St. Mary 1,015 636 ... ... 88 74 7 193 11 6 3. All Souls 278 207 ... ... 23 9 1 30 6 2 Total 1,665 1,086 ... ... 166 99 15 244 30 25 Dated 9th February, 1920. (Signed) EDWARD A. FRITH, Vaccination Officer.