AC 4353 STMARY 25 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1920. 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. 1921. - STMARY 25 Metropolitan Borough of St. Marylrbone. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1920. 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. 1921. London: Geo. Pulman & Sons, Ltd., Thayer Street, W. Public Health Department, Town Hall, Marylebone Road, N.W.1 13th July, 1921. 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 1920. It is the record of a healthy year, and showing as it does, a reduced death rate; a reduction in the number of deaths from tuberculosis; and an infantile mortality rate 30 per 1,000 lower than that of any previous year, it is by far the most satisfactory report I have ever submitted. I desire to congratulate the Council, and more particularly the Public Health Committee, on the excellence of the results obtained. To the latter also I wish to express my appreciation of all the kindness and consideration they showed me during the year. First under Alderman Sir Henry New and later Alderman Fettes as Chairmen, the Committee took a serious interelt in the work, and most readily considered any suggestion that appeared likely to be for the benefit of the health of the Borough and willingly gave guidance and encouragement when these appeared to be required. The Staff of the department are deserving also of thanks and credit for the great part they played in bringing about the satisfactory results referred to. 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 7 Sanitary circumstances 7 Water Supply 7 Drainage 8 Combined Drainage 8 Closet Accommodation 8 UndergroundPublic Conveniences 9 Removal and Disposal of House Refuse 911 Sanitary inspection of the District 11 Staff 11, 12 Inspections 12 Nuisances Legal Proceedings 13 Rat Repression 13, 14 Premises and Occupations controlled by By-laws and Regulations 15 Business Premises 15 Cow Sheds 15 Milk Premises 15 Slaughterhouses 16 Fish Curers 16 Offensive Trades 16 Ice Cream Premises 15 Butter, Margarine, etc., Premises 16 Bakehouses 16 Factories and Workshops 17 Inspections 17 Defects found 17 Home Work 18 Registered Workshops 19 Premises used for Human Habitation 20 Houses let in lodgings 20 Common Lodging Houses 20i Underground Rooms 21 Premises that are not but should be Registered 21 Food Stalls 21 Schools 21 Food 22 Milk Supply 22 Milk Analysis 22 Legal proceedings for adulteration 23 Bacteriological examinations 23 Diaries, Cowsheds and Milkshops CSrders 23 Milk and Cream Regulations 23, 24 Food Inspections 25 Food, Unsound, Condemned 25,26 Sale of Food and Drugs Acts 26 Proceedings under The Margarine Act, 1887 26 Reports of Public Analyst during year 27-31 Bacteriological examination of Milk and Canned Meat 22 Statistical 33 Births 33 Births Registration 33 Births Notifications 33 Deaths and Death Rates 34 Sub-District Births and Deaths 34 Deaths in relation to Age 35 page Deaths among the Aged 35 Causes of and ages at death 36 Infantile Mortality 36 ,, ,, Causes 37-39 Deaths in relation to Disease 40 Diarrhceal Diseases 40 Infectious(communicable)Diseases 40 Phthisis and other Tuberculous Diseases 40 Respiratory Diseases 41 Cancer and Malignant Disease 42 Alcoholism 43 Accident, Suicideand Manslaughter 43 Prevalence of and Control over Infectious Diseases 43 Isolation of Cases 43 Discharge Notices 44 Diphtheria and Membranous Croup 44 Scarlet Fever 44 Enteric Fever 45 Cerebro-Spinal Fever 45 Polio-Myelitis 46 Erysipelas 46 Puerperal Fever 46 Measles and German Measles 46 Whooping Cough 46 Glanders 46 Anthrax 46 Infectious Diseases in School 47 Ophthalmia Neonatorum 48 Pneumonia 49 Tuberculosis 49 Treatment of 49 Prevention of 49 Work at Dispensaries 50- 51 Deaths 53 Influenza 55 Bacteriological Examinations 55 Disinfection 55-56 Cleansing of Persons Act, 1897 57 Maternity and Child Welfare 58 Health Visitors 58 Centres 58 Ante-Natal Work 59 Dental Clinic 59 Hospital Treatment 59 Maternity Cases 59 Babies' Nursing Home 59-60 Infant Consultations—Work at 60 Day Nurseries 60 Home Helps 60 Sanitary Administration— Staff 61 Report of Mortuary Keeper 61 Proceedings under Rag Flock Act. 1911 62 Housing— General Housing Conditions 63 Overcrowding 64 Fitness of Houses 64 Unhealthy Areas 65 Statistics 65 Sanitary Inspection (Summary) 67-70 Ministry of Health, Tables I—III 70-73 Vaccination Return 74 7 SOCIAL CONDITIONS, SANITARY CIRCUMSTANCES, AND FOOD. 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. What the result of the Census due to be taken in 1921 may be, it is impossible to say; it is interesting to note, however, as shown in the table below that in 1920 the population estimated by the Registrar-General's method was found to be higher than in any year since 1914. Judging from the marked overcrowding that is known to exist it may well be that something not far short of the 1911 figure will be returned in 1921. The following table shows in addition to the estimated population for the whole borough that ot each of the registration sub-districre. These last 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 15,752 1918 98,526 24,528 26,880 30,391 16,727 1919 97,953 24,381 26,731 30,210 16,631 1920 101,856 25,352 27,796 31,414 17,294 SANITARY CIRCUMSTANCES. 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 (l), the Metropolitan Water Board reported that the water had been cut off in three premises. This is the lowest number for a considerable period. The reasons for discontinuing the supply were: waste of water, two ; 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 8 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 137 notices in regard to defects in and necessity for cleansing cisterns were served and were complied with. Water Supply in Dwelling Houses.—Only one certificate was granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. In 35 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, 1907. The supply was provided after receipt of the intimation notice in 19 cases. In the remaining 16 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. Drainage. During the year, following the death of Inspector J. C. Wilson, Inspector H. H. Clay, one of the district inspectors was appointed Drainage Inspector of the portion of the Borough north of Marylebone Road, Inspector T. Gorniot continuing in charge of the southern half. The total number of drain inspections made during the year was 6,192 as against 7,554 in 1919. The total number of plans deposited was 356, the number in 1919 being 278. Plans relating to new buildings numbered 25, the number deposited in 1919 being 16. In the case of old buildings, the number of plans received was 331. In 1919 the total number was 262 and in 1918, 108. 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 five 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 and costs imposed in each instance amounting in all to £8 and ^TlO 14s. respectively. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of five premises. The number in 1919 was 4. Closet Accommodation. In the table at page 12, 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 tenement houses, shops or workshops or in order to provide 9 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. 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, 1921, and theamountof increase or decrease as compared with the previous year. 1921. 1920. Increase. Decrease. £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus —Men's Department 1,233 19 11 1,355 9 10 — 101 9 11 * ,, Women's ,, 1,234 15 4 1,252 18 3 — 18 2 11 Gt. Portland Street—Men's ,, 336 2 4 335 9 6 0 12 10 — * ,, Women's ,, 323 14 5 290 17 0 32 17 5 — Marylebone Road —Men's ,, 286 15 3 299 3 11 — 12 8 8 * ,, Women's ,, 291 14 1 268 6 5 26 7 8 — Foley Street—-Men only 188 13 4 191 13 8 — 3 0 4 St. John's Wood Road—Men only 128 4 9 134 2 7 — 5 17 10 Barrett Street—Men only 211 16 4 246 6 7 - 4 10 3 *One free urinette provided. Removal and Disposal of House Refuse. Throughout the year the arrangements in connection with scavenging remained 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 was reached in 1917 to discontinue the carrying out by contract of this most important public health duty. The arrangements which are fully described in the following report, for which I am indebted to Mr. Gair, the Highways Engineer, have worked very smoothly from the beginning, and have shown marked improvement with increasing experience. The work was taken over from the Contractors on the 1st April, 1917, and the tonnage of refuse collected during the three years ending 31st March, 1920, has been as follows :— Year 1917-1918 26,886 tons „ 1918-1919 27,735 „ ,, "1919-1920 35,602 ,, The Highways Committee, under the Chairmanship of Mr. J. T. Watson, M.B.E., have always had in view the desirability of utilising all waste materials and disposing of the refuse in the most sanitary and economical manner. In order to obtain information as to the methods adopted by other Authorities, visits were paid by the Chairman and the Highways Engineer to Birmingham, Sheffield, Edinburgh, Glasgow and Southwark. Although the information obtained was extremely valuable and instructive, the nature of the house refuse to be dealt with combined with the local conditions, made it evident that each locality had to devise methods to suit its particular requirements, consequently a systematic series of experiments were carried out with a view to ascertaining the nature and composition of the refuse to be dealt with. 10 In November, 1918, the Highways Engineer was instructed to submit a scheme with plans and estimates for screening or otherwise dealing with the whole of the refuse collected, and in February, 1919, the plans were approved by the Council. Col lection.—The refuse is collected by means of 16 motor vans, each having a capacity of 8 cubic yards, equal to a load of from 2 to 3 tons, with three dustmen besides the motor driver. Disposal.—The dust lorries, on arriving at the Depot are first passed over a weighbridge. They then deposit their loads in a large concrete pit capable of holding 180 tons, which equals the maximum tonnage collected in one day. This pit enables the motors to discharge their loads immediately, and they are thus quite independent should any delay arise through a temporary stoppage of the screening plant. The refuse is lifted out of the pit by means of a 35 h.p. electrically driven crane, fitted with a grab capable of lifting two cubic yards at a time. This grab discharges over a steel hopper, thence on to a shaking sieve or screen constructed in four sections, each section moving in a different direction (at any given time) to the other three. The refuse passes down from one section to another, is turned over, shaken, sifted and separated into four grades according to the size and nature of the various constitutuents as follows :— (a) Fine Ash and Dust. (b) Breeze, which consists of cinders and unburnt or partially burnt coal. (c) Miscellaneous refuse, waste paper, bottles, rags bones, etc. (d) Tins and iron articles. (a) The fine ash, as it falls from the sieve, passes over a magnetic separator which extracts particles of iron such as nails, pins, hairpins, etc., after which it passes to a crusher, and is ground into a fine powder having a commercial value as a fertiliser. (b) The breeze also passes over a magnetic separator which recovers aiiy iron articles. It is then shot direct into a breeze washer which cleanses it, removing broken glass, crockery, etc. This washed breeze has a commercial value as a low grade fuel especially useful with a forced draught. (c) The miscellaneous refuse also passes over a magnetic separator which extracts further iron articles such as tins, wire, etc., and then on to a moving belt conveyor passing between a number of sorters who pick off waste paper, rags, bones, bottles and any other saleable articles. The residue passed on^ is shot into the stoke-hole and burnt by means of forced draught under a Babcock boiler, thus raising steam to drive the plant. (d) The iron articles collected from the magnetic separators are put through a de-soldering furnace, the solder extracted and the iron residue pressed into bales by means of an hydraulic press. From the house refuse received in the Depot, it will be seen that the following saleable products are extracted:— (1) Fine Ash (manure). (2) Breeze (low grade fuel). (3) Waste Paper. (4) Rags. (5) Bones. (6) Bottles, jars and glass. (7) Solder. (8) Old iron and tins. 11 Early in 1917, soon after the work was taken over by the Council, the Highways Committee decided that saleable materials should be salved, and during the. year 1920 this was continued. It is anticipated that when the plant is in full working order, the amount of refuse, chiefly in the form of clinker, to be barged away as useless will not exceed 23 per cent, of the total refuse collected. During the years the removal and disposal were carried out under contract, close supervision was exercised over the w ork 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 ihat the movable, covered metal dustbin is most commonly found. Old brick receptacles are quite rare, the number demolished during the year being 4. New metal dust receptacles were provided to 708 premises. During the year the inspectors made 3,381 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., 174 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. Jameson, who succeeded Dr. Prior after his resignation in June, 1920), two drainage inspectors, one cutdoor superintendent, one meat and food inspector, one house-to-hcuse inspector, six district inspectors, seven women sanitary inspectors and health visitors, one chief and five 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. Nuisances— 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 1,900, as against 1,588 in 1919. The majority of these complaints were made by the inspectors themselves, the number from outside being 474. 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, 475 statutory notices were issued, as against 380 in 1919. Of these notices, 326 related to ordinary nuisances (dirt, dampness, &c.) 82 to verminous rooms, 40 to drains, and 11 to insufficient w.c. accommodation. The remaining 16 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 1919 was 12. The 82 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1904, and referred to 159 rooms. The number of notices in 1919 was 66. 12 In two cases verminous bedding was destroyed and new bedding provided under the provisions of the Act at a small cost. In 1,425 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 11 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 Borough Total Inspections 3,842 4,477 3,697 3,224 3,695 18,935 Houses damp, dirty or dilapidated remedied 350 260 258 211 141 1,220 Doors, windows, floors, ceilings, sash cords, etc., repaired 348 125 96 47 91 707 Overcrowding abated — — 1 — — 1 Illegal occupation of underground rooms dealt with - - 6 - 6 Water closet defects remedied 297 172 155 201 180 1,005 Water closets erected — 2 1 16 15 34 Urinal defects remedied — — 2 1 3 6 Soilpipe and ventilating shaft repaired or renewed 7 3 3 9 2 24 Yard defects remedied 202 121 142 74 51 590 Waste pipe defects remedied 34 11 49 20 22 136 Water cistern defects remedied 56 2 31 38 10 137 Rubbish, manure, etc., accumulations removed 13 16 71 27 20 147 Dung or dust receptacles repaired or renewed 130 84 156 133 57 560 Drains relaid or amended 33 14 16 35 15 113 Drains cleared 13 8 25 28 11 85 Rainwater pipes repaired or renewed 11 26 37 6 17 97 Water supply to houses reinstated 2 2 3 1 1 9 Roofs and gutters repaired 98 122 49 27 44 340 Area defects remedied 11 20 75 86 43 235 Wash-house defects remedied — — — — — — Animal nuisances abated 231 73 89 52 51 496 Basement defects remedied 7 8 10 3 8 36 Stables cleansed or repaired 4 — 44 36 1 85 Water supply laid on to upper storeys of house 4 - - 1 - 5 Miscellaneous nuisances abated 12 7 3 3 10 35 Verminous rooms cleansed 243 72 70 88 137 610 Workshops, dirty, overcrowded, unventilated or defective, remedied 6 — 8 37 34 85 13 Legal Proceedings in Connection with Nuisances. The number of summonses issued in respect of nuisances during the year was 11. 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. 9, Richmond Street Failure to comply with a statutory notice to execute certain sanitary requirements. No fine. £4 4s. costs. 10, Ordnance Road Do. Fined £6 and £6 6s. costs. 11, Little North Street Do. Fined £l0 and £5 5s. costs. 37, Fisherton Street Do. Fined £3 and £3 3s. costs. 13, Old Quebec Street Do. Fined £5 and £2 2s. costs. 147, Carlisle Street Do. Fined £20 and £3 3s. costs. 37, Fisherton Street Do. Fined £3 and £3 3s. costs. 18, Hanover Terrace Do. Fined £3 and £2 2s. costs. 12, Bell Street Do. Fined £l and £2 2s. costs. 27, Henstridge Place Do. Fined £2 and £5 costs. 31, Manchester Street Do. Fined £2 and £1 3s. costs. Rat Repression during 1920. During the year the Rats and Mice (Destruction) Act, 1920, came into operation and in connection with its administration arrangements were made for Inspector Draper to carry out the duties of Rat Officer under it in addition to his other duties as District Inspector. He is taking the greatest interest in the work and it is largely because of this that several large premises in the Borough have been freed of the vermin and that questions of doubt and difficulty in connection with the matter are so frequently referred to the Public Health Department. The following report on the administration of the Rats and Mice (Destruction) Act, 1920, by Inspector Draper contains much useful information on the Act and the rat problem generally and also shows the results obtained during the year. That the Rajs and Mice (Destruction )Act was legislation long overdue is generally admitted, and the improvement that has ensued in premises, particularly those in which food, etc. was prepared or stored, that had been infested, has confirmed the view that organised action was necessary. The powers of the Act, though wide, leave room for extension. Particularly, advantage would be gained by making the infestation of premises notifiable, since people hesitate to appeal to the Council for assistance from the sanitary inspector feeling that though the rat trouble may be cured the remedy may be so drastic and the expense involved so considerable that even rat infestation may be preferable. Section 1 of the Act places on the occupier the whole responsibility for ridding the premises of the pest. With tenement houses containing three or more families this is a difficult proposition and provision should be introduced making owners responsible for any structural work that may be required and that is not necessitated as a result of the neglect of the tenant. 14 The rat has been said to be the most expensive animal that man maintains and unlike most vermin has no redeeming feature. As a food consumer and destructive agent he is easily first. Unfortunately, in proportion to his size, he has the largest brain of all the mammals and after centuries of oppression he is out to survive. This makes the problem more difficult and it is necessary to vary the methods employed to further his destruction. Two kinds of rats are found in this country, the black rat or mus rattus and the brown rat or mus decumanus. The former is the carrier of the plague and is said to be increasing rapidly. The brown rat, sometimes known as the sewer rat, is far more numerous than the black rat in this Borough. Rats of this type can always be found in the sewers and branch drains. This may be due to the fact that St. Marylebone is served by more large brick sewers than many other Boroughs, but although the brown rat finds brick sewers more suitable to his operations, he can more readily be dealt with in them than in the smaller pipe sewers. On the suggestion of the Public Health Committee the Borough Surveyor during the year made arrangements for the laying of 4,000 poison baits per week in the sewer entrances and at other suitable spots, the poison used being barium carbonate blended with oatmeal and fat. This had a marked effect in the direction of reducing the numbers of the vermin, dead rats being found floating in the stream and lying in the dry places, the latter as often as not being half eaten by their fellows. The small cost of this poison (under £12 per annum) and the excellent results obtained would seem, in view of the fact that no extra labour would be entailed, .to warrant an additional amount being laid in what must be considered one of the principal sources of the pest. In all cases of complaint and wherever thought necessary, inspection has been made and advice and instructions given. In many instances it was found that time and money had been spent on rat destruction without any attempt being made to locate the source of infestation, or effort to make the premises rat proof. One of the largest traders in the Borough whose premises were overrun and who had spent large sums on poisons, traps, catchers, etc., succeeded in getting rid of the vermin as a result largely of acting upon the advice given by the Council's officers. Old buildings often provide ideal accommodation for rats; hollow partitions, space between floors and ceilings and under basement flooring being used for nesting. It is sometimes difficult in view of the expense involved to treat the interior of such building, yet by dealing with the external walls, vaults, etc., the premises may be rat proofed, the ingress of additional numbers being thus prevented, the problem is reduced to the comparatively easy one of destroying the vermin left in the building. Modern buildings do not present the same difficulties as old ones, the walls and ceilings more often than not being solid, and providing the fixtures are of such a nature that nesting is not easy, it is a simple matter to clear the premises. During the year 97 complaints or requests for assistance were received', necessitating the inspection of 185 premises, 133 of which were found to be more or less infested. Of the premises 21 were used for the storage or preparation of food 66 as business premises and 46 as dwelling houses. In 55 of the cases the infestation was entirely due to defects in the drain or sewer connection, etc., and it is extremely probable that other cases originate from the same source. Pending any results that may be obtained through scientific research that will show a better method of dealing with the pest, indiscriminate slaughter of the rat both male and female is advocated' by the Board of Agriculture and this has been carried out with the use of poisons, traps, etc. wherever the vermin have been found." During 1920, two " Rat Weeks " were held with good results. 15 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. Number of places Number of inspections, 1920. Number of notices, 1920. Number of prosecutions, 1920. On register at end of 1919. Added in 1920. Removed in 1920. On register at end of 1920. A. Business Premises. Milk premises 183 5 2 186 405 7 — Cowsheds 4 — 1 3 58 — — Slaughterhouses 3 — — 3 159 — — Offensive trade premises 2 — — 2 70 — — Ice cream premises 96 — 6 90 106 4 — Butter and Margarine Manufacturers and Dealers 11 - - 11 36 - - Bakehouses 75 — 4 71 309 7 — B. Habitations Houses let in lodgings 1152 - — 1152 6621 1169 — Common lodging houses 6 - 1 5 — — — Underground rooms not registered Underground sleeping rooms - — — — — — 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 Totals 69 14 The figures for 1919 were 91 and 16 respectively, the reduction being due to the fact that in 1920 one more cowshed, v.z.: that at 3, Malthouse Mews, ceased to be used, and no application for renewal of the licence for the premises was made. During the year regular and frequent visits of inspection were made to all sheds 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 186. This is 3 more than in 1919, 5 having been added and 2 removed; in 1914 there were 237 on the register. 16 Slaughter Houses.—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. 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. Fish Curers.—The number of premises used by fish curers and registered in accordance with the By-laws of the London County Council is 5. Prior to registration steps were taken to ensure that the places were made as far as possible suitable for the purpose. Regular visits of inspection were made and action taken where necessary to have any defects noted remedied. Proceedings were instituted in one case in which premises unsuitable for the purpose were found to have been used, the defendant was called upon to pay fines and costs amounting to £10 3s. and to take steps to put the premises into a proper condition. 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 70 visits, but no cause of complaint was found. Ice Cream Premises.—The number of such premises in the Borough on the Register is 96. Regular inspections were made throughout 1920 and in 4 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 1920 the number of bakehouses on the register was 71, 4 having been removed during the year. Of these 65 were 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 circumstances permit in order to see that the places are kept in as good condition as possible. In 1919, 150 visits were paid and 6 notices with regard to defects were served. In 1920, 309 visits were paid and 7 notices were necessary. 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. 17 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. The total number of visits to factories, workshops and workplaces during the year was 2,750, 386 by the women and 2,364 by the men inspectors. 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.) 76 10 - Workshops (Including Workshop Laundries.) 1281 163 Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1393 53 - Total 2750 226 — 2.—DEFECTS FOUND. Particulars. Number of Defects. N mnber of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 66 66 - - Want of ventilation 9 9 — — Overcrowding 9 9 — — Want of drainage of floors 1 1 — — Other nuisances 70 70 — — Sanitary accommodation insufficient 8 8 — — unsuitable or defective 54 54 - - not separate for sexes 18 18 — — 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) 7 7 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 242 242 — — 18 3—HOME WORK. NATURE OF WORK OUTWOltKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PUEMISES, 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. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 148 778 1764 ... ... ... 107 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 148 778 1764 ... ... ... 107 ... ... ... ... ... ... ... ... 19 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 2,976 Coffee Shops, &c. 230 Bakehouses 75 Total number of workshops on Register 3,281 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 16 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 62 Reports (of action taken) sent to H.M. Inspector 62 Other 5 Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 61 20 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 ot 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 1920 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 6,621 visits were paid; 1,169 notices relating to cleansing and other defects were served, all of which were complied with without the necessity for further proceedings arising. Common Lodging Houses.—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. 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 "Portman House" (late Shaftesbury Institute), Harrow and Union Street, Lisson Grove Frederick Gerard van de Linde 102 women 654 men 109 women Total 763 21 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.—The difficulties referred to in the Annual Report of 1919 in regard to rooms of this type continued to be encountered in 1920. As close supervision as possible was kept over such rooms and whenever possible notices to discontinue occupation were served. The total number dealt with in this way was 6. 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 1920 there were 564, this number including: restaurant, dining room and coffee shop kitchens, 150; tea-rooms and pastry-cooks, 56; hotel kitchens, 44; fried fish shops, 25; and fish-curers, 5. In addition, there were a number of shops in which meat, ham, sausages, &c., were cooked and sold only over the counter. The routine practice of visiting a number of restaurants, &c., each week was continued by the Food Inspector, and any matters discovered dealt with at once. In 1920 the total number of inspections was 1,143, the number of notices served being 18. Food Stalls.—Of these there are considerable numbers in the market streets, particularly Great Titchfield Street, Bell Street, Church Street, Blandford Street, &c. Definite arrangements are made for the keeping of such as are used for the sale of food under close observation. Throughout 1920 visits were paid to all the market streets every day, a special feature being made of Saturday night and Sunday morning inspections. SCHOOLS. The following remarks were contained in the Report for 1919 and are reproduced here in the hope that they may attract attention to a matter of considerable importance not only from the health but the financial point of view. 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. tor 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 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. 22 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 endeavouring 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 seems 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 431. On examination by the Public Analyst 14 (3'2 percent.) were found to be adulterated. In IS 19 the percentage was 2'0, and in 1918 and 1917 3'3 and 2'5 respectively. Further reference to the question of milk examinations is made in the report of the Public Analyst which will be found elsewhere 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 1920 action was taken in 8 cases. In no case was the warranty defence pleaded. In respect of the 8 cases fines and costs to the amount of £90 0s. Od. were recovered. In 1919, when there were 12 cases, the amount was £74 2s. 6d. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 238 were obtained on delivery at Marylebone Station of the Great Central Railway. Of the 238, four proved to be adulterated, and warranted the institution of proceedings. In one case ttie defendant, a farmer, stated that he sometimes poured milk from one churn to another to fill up, and as a churn sampled at the same time had an excess of milk fat, the magistrate gave him the benefit of the doubt and inflicted no fine. In the other three cases the fines and costs amounted to £59 lis. 6d. The quarterly returns as to milk samples are tabulated below:— Quarter of the Year. No. of Samples Taken No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. Fines and Costs. £ s. d. 1st 122 4 3.3 2 68 8 0 2nd 178 7 3.9 4 16 9 0 3rd 77 1 1.3 — - 4th 54 2 3.7 2 5 3 0 Total for year 431 14 3.2 8 90 0 0 Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 8 samples were taken and submitted to Dr. Foulerton, the Council's Bacteriologist, for examination. In respect of 5, the report was to the effect that the milk was "good." The remaining 3 being returned as being 2 poor and 1 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. 24 REPORT OF ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 & 1917. Report for the year ended 31st December, 1920. 1.—Milk; and Cream not sold as Preserved Cream. (a) Number of samples (b) Number in which a examined for the pre- preservative was resence of a preservative. ported to be present, and percentage of preservative found in each sample. Milk 433 Nil. Cream 8 Nil. 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 5 (ii.) Statements incorrect Nil. Total 5 (iii.) Percentage of preservative found in each sample Average 10.7 grains per lb. Boric Acid. Lowest 10% Highest 12%. Percentage stated on statutory label. Not exceeding 0.4%. (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent. 5 (ii.) Below 35 percent. Nil. Total 5 (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. Action taken where found—None. 4.—Observations, if any.—None. Milk (Mothers and Children) Order, 1918.—Some reference to the matter of provision of milk, etc., to mothers and children is made later in dealing with the 25 work done in relation to maternity and child welfare and it is unnecessary therefore to say much with regard to this order here. Moreover in the report for 1919 the method of administration was so fully described that it need not be again set out here. During 1920 exactly the same line was followed and proved quite satisfactory. The amount expended in the year ended 31st March, 1921, was £5,040 10s. 7d., as against £2,72% 15s. 6d. up to March 31st, 1920. The actual number of cases dealt with was 850, and the number of orders issued 6,429. B.—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. 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 and Destroyed During the Year 1920. Meat— Carcase of Cow and Offal (Tuberculosis) 22 cwts. 14 lbs. Head, tongue, lungs and liver of Ox (Tuberculosis) 56 lbs. Head, tongue, lungs and liver of Cow (Tuberculosis) 60 lbs. Set of Ox lungs (Tuberculosis) Ox Liver (Flukes) 22 lbs. Sheep liver (Flukes) 3 lbs. Beef 2 cwts. 3 qtrs. 1 lb. Mutton 6 cwts. 1 qtr. 8 lbs. Rabbits 1 cwt. 12 lbs. Bacon 1 cwt. 12 lbs. Fish— Wet—Miscellaneous 4 cwts. 1 qtr. 8 lbs. Dry—Kippers 5 boxes Winkles 1 bag Canned Foods— Corned Beef 1 cwt. 1 qtr. 3 lbs. Salmon and other fish 25 tins Fruit (various) 59 tins Milk 201 tins 26 Fruit— Fresh—Tomatoes 131 boxes Plums 1 bushel Apples 2 bushels Pears 1 bushel Dry—Figs 28 lbs. Miscellaneous— Butter 93 lbs. Cheese 6 lbs. Eggs (pickled) 591 Nuts (Barcelona) 28 lbs. C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,030. Of this number 24 were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a jStercentage of adulteration of 2'3 per cent., which is slightly above that for 1919, when it was 2'0. 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 16, and that the fines and costs recovered amounted to £112 2s. Od. In no prosecution for adulteration of milk was the warranty defence raised. In 1 case proceedings were instituted for an offence against the Acts other than selling adulterated articles. Action in this case (Sample No. 75) was taken for selling margarine in a plain wrapper and exposing unlabelled margarine for sale, contrary to the provisions of the Margarine Act, 1887, and a fine of £l0 with £2 2s. Od. cost was imposed in each case. The following Tables and Report from the Public Analyst give full information with regard to samples submitted to and examined by him: 27 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, 1920. 118 milk Food Inspector, St. Marylebone Borough Council Genuine. £500 per ann. for 700 samples. Over that number 7/6 per sample No sample contained preservative. Do. 4 milk Do. Adulterated. No. 32. 10 per cent. deficient in milk fat No. 32. Fined £10 and £3/3/- costs. No. 91. 1.4 per cent. of added water No. 91. Vendor cautioned. No. 112. 3.3 per cent. deficient in milk fat No. 142. Do. No. 147. 6.7 do. do. No. 147. Fined £45 and £5/5/- costs. 33 butter Do. Genuine. Three were test samples Four contained no preservative 25 contained between 10-20 grains boric acid per 1b. Two contained over 20 but under 35 grains boric acid per lb. Two contained boric acid, amount unestimated owing to small amount of sample *18 margarine Do. Do. Three were test samples 3 pepper Do. Do. Two were test samples 2 lard Do. Do. 5 cocoa. Do. Do. Three were test samples 3 vinegar Do. Do. Two were test samples 5 coffee Do. Do. Four were test samples. 1 golden syrup Do. Do. Was a test sample 1 boracic ointment Do. Do. Do. 2 lime water Do. Do. All were test samples 5 mustard mixture Do. Do. Do. 2 condensed milk Do. Do. Do. 6 jam Do. Do. Do. 1 rice Do. Do. Was a test sample 1 cream Do. Do. Contained 10 grains borax per lb. and 53 per cent. of fat *Margarine.—Sample No. 75 was sold in an unstamped wrapper, and was exposed for sale unl abelled "Margarine." Defendants were fined ,£10 and £212/- on each of two summonses Total Number of Samples analysed during the Quarter 210 Number of Samples adulterated 4 SECOND QUA RTER ENDING 30TH JUNE, 1920. 171 milk Food Inspector, St. Marylebone Borough Council Genuine No sample contained added preservative. 7 milk Do. Adulterated. One was a test sample 28 Articles submitted for Analysis State w hether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority under Section 13 of Act, and. if so, the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. Food Inspector, St. Marylebone Borough Council No. 258. 16.67 per cent. deficient in milk fat £500 per annum for 700 samples. Over that number 7/6 per sample. No. 258. This was a test sample No. 352. 10.0 do. do. No. 352. £1/11/6 costs.† No. 356. 16.7 do. do. No. 356. This was a test sample No. 397. 30.0 do. do. No. 397. Fined £5 and 10/6 costs *No. 398. 6.7 do. do. *No. 398. Farmer cautioned (vide Public Health Minutes 25/6/20) No. 424. 16.7 do. do. No. 424. Fined £5 and 10/6 costs No. 426. 10.0 do. do. No. 426. Fined £?> and 16/6 costs 49 butter Do. Genuine 25 were test samples Two contained no preservative 44 contained between 10-20 grains boric acid per lb. 3 contained between 20-30 grains boric acid per lb. 3 margarine Do. Do. One was a test sample Two contained between 20-30 grains boric acid per lb. One contained between 10-20 grains boric acid per lb. 4 cream Do. Do. No. 306 contained 56.2 per cent. fat No. 311 contained 56.2 per cent. fat No. 314 contained 53.0 per cent. fat No. 406 contained 45.0 per cent. fat No cream contained any preservatives 1 pepper Do. Do. 3 laid Do. Do. Three were test samples 6 cocoa Do. Do. All these were test samples 3 vinegar Do. Do. Do. 1 golden syrup Do. Do. This was a test sample 6 jam Do. Do. All these were test samples 1 blackberry jelly Do. Do. This was a test sample 1 orange marmalade Do. Do. Do. †The defendant, a farmer, stated that he sometimes poured milk from one churn to another to fill up, and as one ch urn sampled at the same time had an excess of milk fat the magist rate gave him the benefit of the doubt and inflicte d no fine in this case. Total Number of Samples analysed during the Quarter 256 Number of Samples adulterated 7 THIRD QUA RTER ENDING 30TH SEPTEM HER, 1920 75 milk Food Inspector, St. Marylebone Borough Council. Genuine. No sample contained any preservative or added colouring matter 29 Articles submitted for Analysis. State whether the sample was submirted to the Analyst by an Officer acting under direction of a Local Authority under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 1 milk Private Purchaser Genuine £500 per ann. for 700 samples Over that number 7/6 per sample. 1 milk Do. Adulterated No. 570. 33.3 per cent. deficient in milk fat 30 were test samples. 6 contained no preservative 63 butter Food Inspector, St. Marylebone Borough Council. Genuine. 53 contained between 10.20 grains boric acid per lb. 4 contained over 20.0 grains boric acid per lb. 2 margarine % Do. Do. 7 cream Do. Do. One was a test sample. (For particulars of composition and preservatives see below.) 4 cocoa Do. Do. Four were test samples. 16 jam Do. Do. 16 were test samples 3 marmalade Do. Do. Three were test samples 4 vinegar Do. Do. Four were test samples 3 coflee Do. Do. Three were test samples 3 pepper Do. Do. Three were test samples 1 tomato ketchup Do. Do. One was a test sample 8 lard Do. Do. Eight were test samples 2 dried eggs Do. Do. Two were test samples 8 custard powders Do. Do. Eight were test samples 1 golden syrup Do. Do. One was a test samples CREAM. No. Fat. Preservative. 509 45.5 per cent. 10.0 grains boracic acid per lb. 513 42.0 do. 10.5 do. 515 42.0 do. Nil do. 529 43.5 do. 11.0 do. 531 47.0 do. Nil do. 535 57.0 do. 12.0 do. 590 52.5 do. Nil do. Total Number of Samples analysed during the Quarter 202 Number of Samples adulterated 1 FOURTH QUA RTER, ENDING 31ST DECEM BKR, 1920 52 milk Food Inspector, St. Marylebone Borough Council. Genuine. No sample contained any preservative or added colouring matter 2 milk Do. Adulterated. No 914. 10.6 per cent. added water Fined £1 and £1/11/6 costs No. 915. 8.0 do. do. Do. 71 butter Do. Genuine. 43 were test samples Six contained no preservative 65 contained between 10-20 grains boric acid per lb. 7 margarine Do. Do. Five were test samples 1 cream Private purchaser Do. No. 1016. 54.0 per cent. fat No preservatives 30 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 Adjlterated and if Adulterated what were the nature and extent ot the Adulteration. The sum paid in respect of the Analysis. Observations. 37 cocoa Food Inspector, St. Marylebone Borough Council Genuine £500 per ann. for 700 samples Over that number 7/6 per sample 37 were test samples 1 cocoa Do. Adulterated This was a test sample. No. 707 (T) contained added sugar 25 jam Do. Genuine. All were test samples 2 marmalade Do. Do. Do. 1 honey Do. Do. This was a test sample 38 coffee Do. Do. 38 were test samples 1 coffee Do. Adulterated No. 1006 contained 70.0 per cent. chicory Fined £ 15 and ,£1/1/- costs 20 pepper Do. Gtenuine All were test samples 5 ketchup Do. Do. Do. 11 lard Do. Do. Do. 9 dried eggs Do. Do. Do. 7 custard powder Do. Do. Do. 1 egg custard Do. Do. Do. 1 egg substitute Do. Do. Do. 3 egg powder Do. Do. Do. 1 coffee & chicory Do. Do. Do. 1 boric ointment Do. Do. Do. 4 mustard mixture Do. Do. Do. 28 mustard Do. Do. Do. 2 mustard Do. Adulterated Do. No. 830 (T) contained added starch No. 853 (T) contained very small amount of added starch 1 salmon and Do. Genuine Do. shrimp paste 3 baking powder Po. Do. Do. 2 beef dripping Do. Do. Do. 2 beef suet and rice Do. Do. Do. 4 suet and starch Do. Do. Do. 2 suet Do. Adulterated Do. No. 922 (T) contained starch Do. No. 1002 contained 11 per cent. starch Fined £5 and £1/1/- costs 1 lentils Do. Genuine 7 lime juice Do. Do. This was a test sample 1 lime juice Do. Adulterated No. 9H7 contained under 1 per cent, benzoic acid Do. 2 ginger wine Do. Adulterated No. 1008 contained 3.9 per cent. alcohol and salicylic acid Do. No. 1013 contained 9.13 per cent. alcohol but no preservative Do. 1 orange wine Do. Genuine Do. contained 0.8 per cent. alcohol but no preservative 1 raisin wine Do. Adulterated No. 1010 contained no alcohol; salicylic acid present This was a test sample 3 cheeee Do. Genuine Do. Total Number of Samples analysed dining the Quarter 362 Number of Samples adulterated 12 31 ANNUAL REPORT OF THE PUBLIC ANALYST, 1920. The number of samples taken under the Sale of Food and Drugs Acts and submitted for analysis, was 1,030: a considerable increase as compared with the samples for 1919, the number for that year being only 700. A complete list is as follows: No. Article. Genuine. Adulterated. Total. 1 Milk 417 14 431 2 Butter 216 — 216 3 Margarine 30 — 30 4 Coflee 46 1 47 5 Pepper 27 — 27 6 Lard 24 — 24 7 Cocoa 52 1 53 8 Vinegar 10 — 10 9 Golden Syrup 3 — 3 10 Boracic Ointment 2 — 2 11 Lime Water 2 — 2 12 Mustard Mixture 9 — 9 13 Condensed Milk 2 — 2 14 Jam 53 — 53 15 Rice 1 — 1 16 Cream 13 — 13 17 Blackberry Jelly 1 — 1 18 Orange Marmalade 1 — 1 19 Marmalade 5 — 5 20 Tomato Ketchup 1 — 1 21 Dried Eggs 11 — 11 22 Custard Powders 15 — 15 23 Honey 1 — 1 24 Ketchup 6 — 6 25 Egg Custard 1 — 1 26 Egg Substitute 1 — 1 27 Egg Powder 3 — 3 28 Coffee and Chicory 1 — 1 29 Mustard 28 2 30 30 Salmon and Shrimp Paste 1 — 1 31 Baking Powder 3 - 3 32 Beef Dripping 2 — 2 33 Beef Suet and Rice 2 — 2 34 Suet and Starch 4 — 4 35 Suet — 2 2 36 Lentils 1 - 1 37 Lime Juice 7 1 8 38 Ginger Wine — 2 2 39 Orange Wine 1 — 1 40 Raisin Wine — 1 1 41 Cheese 3 — 3 1,006 24 1,030 Milk.-431 samples of milk were analysed. Of these 14 or 3.2 per cent. were adulterated. Three of the 14 contained 1.4, 8.0 and 10.6 per cent. of added water, 32 respectively, the remaining 11 had been deprived of from 3.3 to 33.3 per cent. milk fat. Not one of the 417 samples contained any preservative. The mean composition of the samples of milk which did not fall below the legal minimum in either the figures for milk fat or for solids not fat, is rather below that of the four previous years. On the other hand, extreme values are rare and the tendency seems to be for the quality to become more unifortn. The mean composition was :— Sp. Gr. Milk-fat. Solids (not fat). Total Solids. 1920 1031.5 3.60 873 12.33 Butter.—21(> samples of butter were examined, or which 20 were free trom preservative. The others contained boric acid varying in amount from 10 to 30 grains per lb. No sample was adulterated. Margarine.—30 samples were examined. All contained boric acid varying from 12 to 30 grains per lb. No sample was adulterated. Cream.—13 samples of cream were examined. 5 of these were labelled as containing boric acid. The amounts were small and ranged from 10 to 12 grains of preservative per lb. Coffee.—46 samples were genuine. 1 test sample contained 77 per cent, of chicory. Mustard.—30 samples were examined. 2 test samples contained small amounts of starch. Suet.—Two test samples contained starch. Lime Juice.—One test sapiple contained, as preservative, benzoic acid in very small amount. Ginger Wine.—Two test samples were examined, one contained 3.9 per cent. of alcohol by volume, while the other had no less than 9.13 per cent, by volume. The former also had a small amount of salicylic acid present as preservative. Raisin Wine.—One test sample contained salicylic acid in small amount. Miscellaneous Samples.—These are enumerated in the table and require no special comment.* BACTERIOLOGICAL EXAMINATION OF MILK AND CANNED MEAT. During the year 8 samples of milk and 2 tins of canned meat were submitted to the Council's Bacteriologist (Dr. Foulerton) for examination. Milk.—Of these 5 were found to be "good," 2 were poor and 1 contained a small quantity of foreign dirt. All the reports were submitted to the Public Health Committee and a warning was only necessary in the case in which the presence of foreign dirt suggested carelessness in handling the milk. Canned Meat.—Tins of meat were submitted to Dr. Foulerton in connection with the investigation into an outbreak of typhoid fever—referred to later—at Bedford College. The appearance of the tins suggested that the contents might be contaminated; on examination, however, the meat was found to be sound and to contain no bacteria capable of setting up the symptoms shown by those attacked in the course of the outbreak. *I am indebted to Mr. J. F. F. Rowlands, who was chief assistant to Dr. Wynter Blyth at the time of his death, for the information contained in this report. Dr. Blyth died on 30th March, 1921, having been Public Analyst from the year 1880. During the years 1880 to 1907 he acted both as Medical Officer of Health and Public Analyst. 33 STATISTICAL. BIRTHS. Registration.—The number of births registered during 1920 was 2,217*, being 725 more than in 1919. Of the children born, l,116were boys and 1,101 girls. The birth rate per 1,000 of the population was 21.5 as against 14.6 in 1919. 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. 1920. All Souls 13.6 15.4 13.3 14.4 12.8 11.1 12.0 17.3 St. Mary 12.8 13.9 11.2 12.2 8.8 8.6 10.5 15.8 Christ Church 28.2 26.8 22.9 22.9 19.3 15.4 22.6 29.6 St. John's 18.8 17.1 18.6 17.3 17.5 15.3 12.5 22.9 The Borough 18.6 18.7 16.2 16.9 14.5 12.4 14.6 21.5 Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 4,428 : Live births, 4,234; Still births, 194. 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 146 3.3 ,, doctors 482 10.9 ,, midwives 1,022 23.8 „ other persons 116 2.6 ,, hospitals, etc. 2,662 60.0 4,428 Of the total births notified, 194 referred to still-births (107 males and 87 females): 1,849 took place at Queen Charlotte's Hospital; 532 at Middlesex Hospital; 263 at the Workhouse: and 1,766 were born at home. Of those notified as having occurred in St. Marylebone, 2,211 belonged to other Boroughs. *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 223 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone :— - Legitimate Males 88 ,, Females 81 Illegitimate Males 28 ,, Females 26 34 DEATHS AND DEATH RATES. The number of deaths registered in 1920 was 1,299. 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 12.7. In the previous year, the rate was 15.9 and the number of deaths 1,568. In 1918 the rate was 18.5 per 1,000, and in 1917, 17.0. 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 1920 All Souls 12.0 11.2 13.6 13.7 11.9 14.8 12.9 9.9 St. Mary 11.1 12.6 15.4 14.9 16.4 15.9 15.3 13.2 Christ Church 18.4 18.0 20.6 18.8 21.4 23.2 18.5 14.2 St. John 13.6 14.0 15.2 16.5 17.4 19.8 17.0 13.6 The Borough 14.9 14.9 17.8 16.0 17.0 18.5 15.9 12.7 District births and deaths for the year ended 1st January, 1921, are given in the following table. A further table giving the vital statistics of separate localities for1920 and the ten preceding years, will be found amongst the Ministry of Health Tables on page 71. Sub-District. †Population estimated to middle of 1920 Births. Deaths. Total A B Males Females. Total. Males. Females. All Souls 25,927 25,352 228 222 450 140 112 252 St. Mary 27,825 27,796 224 215 439 187 179 366 Christ Church 31,489 31,414 477 456 933 248 198 446 St. John 17,175 17,294 187 208 395 100 135 235 The Borough 102,416 101,856 1,116 1,101 2,217 675 624 1,299 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 1920. For purposes of comparison the table for 1914 is reproduced from the report for that year. It is interesting to note that the figures relating to infants and those for the elderly have fallen. 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. 1920 JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 50 34 28 33 145 Persons of 65 years and upwards 155 118 97 127 498 *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. 35 1914 JanuaryMarch AprilJune JulySeptember OctoberDecember Total 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 1920 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 1920 145 25 21 33 49 145 383 498 1,299 The percentage relation of each group to the total number of deaths in 1920 is shown below. Under 1 year 11.1 per cent. 1 and ,, 2 years 2.0 „ 2 ,, 5 ,, 1.7 „ 5 ,, ,, 15 ,, 2.6 „ 15 ,, ,, 25 ,, 3.8 „ 25 „ „ 45 „ 11.1 „ 45 ,, 65 ,, 29.5 „ 65 „ upwards 38.2 „ 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 1913-1920, is shown below:— 1913 1914 1915 1916 1917 1918 1919 1920 All Souls 112 106 129 114 100 96 103 91 St. Mary 140 145 181 175 144 137 172 165 Christ Church 187 164 202 185 177 187 191 134 St. Johns 116 119 134 139 136 149 137 108 The Borough 555 534 646 613 557 569 603 498 36 Of the total, 131 at death were aged between 65 and 70; 234 between 70 and 80; 120 between 80 and 90, and 13 between 90 and 100. Over 100—Nil. The out-standing causes of death amongst those over 65 were as follows:— Causes— 1913 1914 1915 1916 1917 1918 1919 1920 Bronchitis and other respiratory diseases 180 135 225 184 150 166 165 137 Nephritis and Bright's disease 22 24 17 11 15 16 12 13 Cancer 60 54 68 67 62 58 63 64 Tuberculosis 22 16 12 15 16 15 14 4 Influenza 6 18 7 22 12 18 23 9 Violent deaths 16 13 19 25 18 19 13 15 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 73. 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 1,110. 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 1920 was 145, and the number of births in that year 2,217. The infantile mortality rate is therefore 65'0, the lowest ever recorded in the Borough, the nearest to it being that of 1913 when the rate was 90.8. The figure for 1919 was 98.5, so that between the two years there occurred a reduction in the number of deaths amongst babies of no less than 33.5 per 1,000. Though it is the case that 1920 all over was marked by a low infantile mortality rate, there are few districts in which the drop was so marked as in Marylebone. The rate for London as a whole was 75 and in the list of the boroughs St. Marylebone stands seventh. The course which the rate has taken is graphically shown in the chart on page 38, which indicates clearly that the only really serious interruption to the decline was in 1917. That the rate will continue long at its present low level is almost too much to hope for, but it is unlikely that it will again reach the point attained in the year named. The means adopted in the Borough with a view to bringing about a reduction in infantile mortality and generally improving the life and health chances of infants and children are described in a separate section of this report—Maternity and Child 37 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 III) will be found on page 73, 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 1920, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 64 were less than one month old when they died and 92 less than three months. The figures for 1919 were 58 and 91. 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 55 in 1919 and 50 in 1920. Diarrhoea and enteritis (7 and 8) accounted for 22 in 1919 and for 20 in 1920. Respiratory diseases, the third of the main causes, took 25 in 1919, and in 1920, 26. Amongst the other causes of death, those which call for mention are the commoner infectious diseases, which together led to 4 deaths among infants. Of the 4, 2 were due to measles, 1 to diphtheria and 1 to scarlet fever. Neither in 1920 nor in 1919 were any deaths ascribed to injury at birth. Two deaths were stated to be due to overlaying, 6 to tuberculosis, and 2 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 71 deaths amongst infants. In 1919 the figure was 63. 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 and under 6 months. 6 and under 9 months. 9 and under 12 month-. Totals. All Souls 7 - 2 2 6 4 3 4 28 St. Mary 7 4 2 — 4 4 2 4 27 Christ Church 19 6 3 3 14 15 8 3 71 St. John 4 2 3 — 4 2 4 — 19 Totals 37 12 10 5 28 25 17 11 145 39 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 — — — — — 1 — — 1 2 — 1 1 — 2 4 Scarlet Fever — — — — — — — 1 — 1 1 — — 1 5 Diphtheria and Croup — — — —- — 1 — — — 1 — — — 1 1 6 Whooping Cough — — — — — 2 — 2 2 6 1 — 5 — 6 7 Diarrhœa — — — — — 1 2 1 — 4 1 — 2 1 4 8 Enteritis 2 2 2 — 6 1 4 4 1 16 5 4 6 1 16 9 Tuberculous Meningitis — — — — — — — — 1 1 — — — 1 1 10 Abdominal Tuberculosis — — — — — — — — — — — — — — — 11 Other Tuberculous Diseases 1 — — — 1 — 3 — 1 5 — 2 2 1 5 12 Congenital Malformation 1 — — — 1 1 — — — 2 — — 1 1 2 13. Premature Birth 19 2 4 2 27 — — — — 27 3 6 17 1 27 14 Atrophy, Debility and Marasmus 1 — 2 — 3 10 6 2 — 21 7 3 8 3 21 15 Atelectasis 3 — — — 3 — — — — 3 — — 2 1 3 16 Injury at Birth — — — — — — — — — — — — — — — 17 Erysipelas — — — — — — — — — — — — — — — 18 Syphilis 1 — — 2 3 — 2 — — 5 1 — 3 1 5 19 Rickets — — — — — — — — — — — — — — — 20 Meningitis (not Tuberculous) — — — — — — 1 1 — 2 1 — — 1 2 21 Convulsions — — 1 — 1 — 1 — — 2 1 — 1 — 2 22 Gastritis — — 1 — 1 2 — — 1 4 — 1 3 — 4 23 Laryngitis — — — — — — — — — — — — — — — 24 Bronchitis — 2 — — 2 5 3 2 2 14 1 4 8 1 14 25 Pneumonia (all forms) — 2 — — 2 4 2 2 2 12 2 5 4 1 12 26 Suffocation, Overlying 2 — — — 2 — — — — 2 1 — — 1 2 27 Other Causes 7 4 — 1 12 — 1 2 — 15 3 1 8 3 15 Totals 37 12 10 5 64 28 25 17 11 145 28 27 71 19 145 * Legitimate, 2,010 Legitimate Infants, 110 Nett Births in the Year Nett Deaths in the Year illegitimate, 207 Illegitimate Infants, 35 Total 2,217 Total 145 40 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 73. 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 25, equal to 0'24 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants and in 1920, as a matter of fact, all those who died were less than 1 year of age. In 1919 the deaths from diarrhoeal diseases numbered 29, and of this number 23 were babies. In 1920, therefore, though there was a reduction in the total, there was actually an increase in the number amongst babies. Deaths from diarrhoeal diseases always vary most markedly with the weather conditions, being higher when the summer is warm and dry, lower when it is cold and wet. They vary also with the sanitary condition of the district and the amount of welfare work done on behalf of the babies. The year 1920, 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 regarded as reflecting credit on all parties concerned, the mothers of the babies and health workers alike, that the death figure was no higher than 25. Particularly in relation to diarrhoea amongst children, a viery 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 caused 19 deaths), but including diarrhoea (25 deaths) the total number registered as due to them was 64. This is a comparatively low figure, lower certainly than that of any of the pre-war years. The other diseases contributing to the total were measles, 8; diphtheria, 8 scarlet fever 9 and whooping cough 12. 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 122, a figure higher by 6 than that for 1919. The great bulk of the 122 deaths, viz., 94, was due to phthisis. The number in 1919 was 104. 41 Of the total number of deaths registered (1,299), the percentage due to phthisis was 7.2j as against 6.6 in 1919. The age periods at which the deaths occurred were: 2—5 years, 0 (0.0 per cent.); 5—15, 2 (2.1 per cent.); 15—-25, 14 (14.9 per cent.); 25—45, 39 (41.4 per cent.); 45—65, 35 (37.2 per cent.); 65 and over, 3 (3.2 per cent.). Below the age of two years, 1 death was 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. 1920 122 101,856 1.19 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 276. This is lower by 86 than the figure (362) for 1919. The death rate was 2'7 per 1,000. In 1919 the rate was 3'8. The number of deaths certified to be due to bronchitis was 140 as against 170 in 1919. Of this number 86 were amongst persons aged 65 and upwards, and 32 amongst those of the age group 45—65. The deaths traceable to pneumonia numbered 116, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 19 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 enquiring into all 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 year the number of notifications received was 71. Of the patients notified, 21 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 42 and residence will be found in the table on page 73. As a result of obtaining information as to the occurrence of the disease it was possible to visit early and to arrange for nursing if this appeared to be necessary. The actual number of visits paid was 1922 and of cases nursed 46. After recovery, or if death unfortunately occurred, as soon as convenient thereafter, disinfection was carried out. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 14.6 and the death rate 1.43 per 1000 of the population. In 1919 the figures were higher, the total being 165 and the death rate 1 *68 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 Males - 1 - - 6 16 26 14 63 Females — — — — 10 24 22 27 83 Totals - 1 - - 16 40 48 41 146 Cancer.—Situation of the Disease. Parts of the body affected. Males Females Totals Face, Tongue, Jaw 11 3 14 Throat, Neck, Gullet 15 2 17 Stomach 7 12 19 Intestines 11 12 23 Liver 5 6 11 Breast — 22 22 Uterus and Generative Organs 2 14 16 Various 12 12 24 Totals 63 83 146 The following table, which was included for the first time in the Report for 1912 is repeated, as it lends further support to the view then expressed that cancer was in no sense a class disease, since if those who died at home or in nursing homes are taken to represent the rich or well-to-do, and those who died in hospitals or the infirmary the less favourably circumstanced, the one group suffered equally with the other. At Home In Nursing Homes In Hospitals In Infirmary In Asylums Totals Males 26 6 12 22 — 66 Females 37 4 18 20 1 80 Totals 63 10 30 42 1 146 43 ALCOHOLISM. There were 4 deaths certified during the year as due to alcoholism. Year after year the number so certified has been quite small, and in 1919 there were none. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 10 deaths. 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 29. The number in 1919 was 39. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1920 numbered 60. Of these 9 were due to suicide. Deaths of babies certified as resulting from suffocation (overlaying) numbered 2. 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 72. The total number of notifications coming to hand was 1,051. The bulk of the notifications related to scarlet fever, which contributed 435 to the total. Other diseases in respect of which fairly large numbers of notifications were received were tuberculosis (246), diphtheria (119), and pneumonia (71). In 1919 the number of cases notified was 1,802, the rise in that year 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 infectiou diseases) in 1920 was 10'3 per 1,000 as against 18'9 in 1919. Isolation of Cases.—During the year though scarlet fever was rather prevalent, there was little difficulty in securing isolation in hospital for persons suffering from infectious disease, and as the following table shows, the number of cases removed was as high as usual — • Diphtheria 112 or 94.1 per cent, of the cases notified. Erysipelas 37 „ 54.4 „ „ ,, Scarlet Fever 423 ,, 97.2 „ „ ,, Enteric Fever 24 ,, 82.7 „ „ ,, Cerebro-spinal Meningitis 2 ,, 100.0 ,, ,, „ Ophthalmia Neonatorum 9 „ 19.5 „ ,, ,, Puerperal Fever 3 „ 50.0 ,, ,, ,, Tuberculosis 71 „ 28.8 „ „ ,, Malaria 1 „ 5.5 „ ,, „ Pneumonia 19 „ 26.7 ,, „ ,, The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £88 2s. 6d. equal to 17s. 3d. per 1,000 of the population. 44 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. 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 1920 88 2 6 0 17 3 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of. patients sent to hospital with infectious diseases was 322 and referred to 446 cases. Visits were paid to these cases by the District Inspectors, and advice given as to date of the return of children to school and the advisability of obtaining treatment for and isolation of any suffering from any sequel of a disease. Diphtheria and Membranous Croup. Diphtheria was less prevalent in 1920 than in any year since 1909, the actual number of cases being 119. The number in 1919 was 154. Of the cases 8 died, and the case mortality rate was 6.7 per cent. The number of cases per thousand of the population was 1.16. 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 accurately the source of infection. In 6 it proved to be in the home of the patient, and in 4 cases was derived from a member of the family previously infected. The number of swabs from doubtful cases submitted for bacteriological examination was 454. A positive result was returned in 54 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 37, just over half the number in 1919. In All Souls the number was 22, in St. Mary, 36, and in St. John, 24. As usual the age groups 1-5 and 5-15 were those most affected, 23 of the cases falling into the former and 51 into the latter group. Four applications for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, were received. The nuisances detected during the course of investigating the notified cases were : Dirty Premises, etc., 20. These were all remedied after service of notices. Scarlet Fever. In many parts of London this disease was markedly epidemic and it is not surprising, therefore, that the figure for 1920 was so high as 435. In 1914, when the disease was also epidemic, the figure reached 432. It has already been explained that scarlet fever tends to become epidemic at intervals of about 5 years and the increase in this case is explained by this. No doubt the figure for 1921 will be lower and there will be more or less of a continuous decline thereafter for a few years. The highest number of cases reported in any one week it may be noted was 25. 45 The total deaths from scarlet fever numbered 9, and the number of deaths per cent, of the cases was 2.07. The districts to suffer most from this disease were Christ Church and St. Mary. In the former there were 188 cases and in the latter 109. In All Souls there were 86 and in St. John 52. As usual the majority of patients were children of school age, the age group, 5-15, giving nearly two-thirds (281) of the total. Of the remainder 81 were aged between 1 and 5 years. The source of infection was believed to be a previous case in the same family in 49 cases. In 10 cases a patient had been previously notified to be suffering in the same house, and in the neighbourhood, 13 cases. Though it seemed probable .that many of the children notified acquired their infection in school, it was only in 33 instances that a definite connection could be made out. One case which on investigaton was found to have acquired the infection in Copenhagen and to have arrived by aeroplane at Croydon aerodrome a few hours after the onset of the symptoms, suggests the possibility that with the opening up of the air as a traffic route, there has been provided also a new way of attack by infectious disease. The rate of travel through the air being so rapid, sources of infection in other countries have been brought very much nearer than formerly and unless the same or greater precautions are exercised at the air ports as at the sea ports, with a view to preventing the importation of infection, this country may quite easily come to share in a variety of diseases that at present are counted foreign. The person who having acquired an infection just before leaving a foreign country, if he travels by land or sea, has time to develop recognisable signs and symptoms and can be dealt wi.th on his arrival. The traveller by air, however, makes his passage in a few hours and sickens after his arrival. Until the signs are recognised he is a source of infection and may do a considerable amount of damage. The Air Ministry appear to have recognised this possibility and have appointed a health officer to at least one aerodrome. Defects in sanitation to the number of 81 were discovered in the premises visited. All these were want of cleanliness, etc. The nuisances were remedied after the service of notices in each case. Enteric Fever. The notifications received numbered 29. There were no deaths. Of the 29 cases, 10 related to patients amongst the staff and students at the Bedford College for Women. The outbreak of this disease occurred in February, 20 cases of the disease being notified, some in Marylebone and some in Hampstead. The only common ground on which the staff and students of all classes met was the dining-room at lunch time, and though for a time suspicion rested upon certain canned meat that had been partaken of by all those attacked, eventually it was concluded that a "carrier" in the kitchen staff was responsible. Inquiry suggested that the cook, who gave a history of diarrhoea of a few hours' duration on the night of 31st January—1st February, so slight that she did not have to cease work, was the "carrier" involved and examination of her blood confirmed this view. She was Suspended from work, and promptly resigned. No further cases occurred. Cerebrospinal Fever. Only 2 cases of this disease, 2 girls aged lli years and 8 months respectively, were notified. Isolation and treatment were carried out in a hospital. Tbe patient aged 11½ was finally diagnosed as tuberculous meningitis. The younger patient died. 46 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 2, both boys (age 7 and li) and members of the same family. Both recovered. Erysipelas. The notifications of erysipelas numbered 68, and there were 2 deaths. Most of the cases were notified from the St. Marylebone Infirmary and the General Hospitals and 37 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 averageas was also the number of deaths registered as due to it, viz., 2. In each case a visit was paid by one of the women inspectors and the premises were disinfected. Measles and German Measles. These conditions are not now notifiable. 641 cases were however reported, 159 voluntarily by doctors and parents and 482 by school-teachers. The deaths numbered 8, as against 17 in 1919 and 11 in 1918. The course adopted in relation to the 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 258 visits to 23 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 31 of the patients. Classrooms in various schools were closed for short periods on account of the occurrence of measles. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1920 the number of deaths registered as due to whooping cough was 12. In 1919 the number was 2. 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. Anthrax. No cases of this disease were notified, but on account of the occurrence from time to time in various localities of cases traceable to infection from shaving brushes, the Ministry of Health issued an order in council prohibiting the importation of Japanese shaving brushes. As it was thought possible that there might be some of these on the market, instructions were given to get into touch with hairdressers and others selling such articles. This was done by means of a circular letter, and in a few cases examinations were made. Though there were a few the origin of which was doubtful, none were found to contain the organism of the disease. 47 Infectious Diseases in Schools. The accompanying table shows the number of cases of measles, whooping cough and chicken-pox and other notifiable infectious diseases reported from Schools during 1920. SCHOOLS. Scarlet Fever. Diphtheria. Typhoid Fever. Whooping Cough. Chickenpox. Measles. All other Diseases. All Souls, Foley Street 19 4 — — — 7 5 Barrett Street — — — — — — — Barrow Hill Road 17 7 — 11 81 55 81 Bell Street 46 29 — 3 19 52 43 Blandford Square — 2 — — — 2 2 Capland Street 11 4 — 6 3 2 18 Catholic, Richmond Street 2 1 — — — 1 2 Christ Church, Lisson Grove 64 12 — 5 5 7 28 Convent, Little Union Place — — — — — — 6 Council, Grove Road — — — — — — 5 Cosway Street — — — — — — — Emmanuel, Aberdeen Place — — — 1 3 30 5 Emmanuel, North Street 7 3 — 2 5 — 2 Gateforth Street — — — 5 11 24 22 Hampden Gurney, Upper Berkeley Street 5 3 — 2 1 — 17 Homer Row, Catholic 30 5 — 19 — 8 21 Jewish, Hanway Street 1 4 — — — 4 2 Portland, Little Titchfield Street — — — — — — — Polytechnic, Regent Street — — — — — 1 — St. Andrew's, Wells Street 4 — — — 1 — — St. Francis, Upper William Street — — — — — — — St. James', Marylebone Lane 1 — — — — — — St. Luke's, Nutford Place 16 3 — 3 2 3 3 St. Mark's, Violet Hill 22 10 — 2 3 57 40 St. Mark's, Marylebone Road 1 — — — — — 2 St. Marylebone, High Street 105 8 1 13 4 31 17 St. Marylebone Grammar, Marylebone Road — 1 — — — 2 1 St. Mary's, Crawford Street 24 3 — 3 7 56 24 St. Paul's, East Street 5 2 — — — — 6 St. Paul's, Broadley Terrace 34 2 — 9 — 8 2 St. Stephen's, Charlbert Street — — — — — — — St. Thomas', Orchard Street 23 6 — 2 10 29 17 Trinity, Buckingham Street — — — — — — — St. Vincent, Lower Seymour Street 5 — — — — — — Upper Marylebone Street 47 12 — 8 2 87 27 Schools out of Borough 13 10 1 6 5 16 8 Totals 502 131 2 100 162 482 406 48 Ophthalmia Neonatorum. This disease—inflammation of the eyes in newly-born children—made notifiable by order of the London County Council in 1911, continued to be so during the whole OPHTHALMIA NEONATORUM. DATE NOTIFIED NUMBER OF CASE ONE OR BOTH EYES PERMANENTLY INJURED— IF SO, TO WHAT EXTENT? 21.1.20 1 One eye infected. Cured 28.1.20 2 Both eyes. Cured 29.1.20 3 Both eyes. Cured 12.2.20 4 Slight case. Cured 18.2.20 5 Cured. 2.3.20 6 One eye. Cured 5.3.20 7 Left Borough. Said to be cured 11.3.20 8 Both eyes. Cured. Died 23.11.20. Broncho-Pneumonia 13.3.20 9 Both eyes. Cured 15.3.20 10 Very slight, both eyes. Cured 17.3.20 11 Slight, both eyes. Cured 19.3.20 12 Acute, both eyes. Cured. 23.3.20 13 Removed to Infirmary, Kensington 12.4.20 14 Right eye. Cured 28.4.20 15 Cured 10.5.20 16 Both eyes. Cured 14.5 .20 17 Removed to Infirmary, Kensington 14.5.20 18 Cured 17.5.20 19 Case occurred in Infirmary, Kensington 18.5.20 20 Both eyes. Cured 28.5.20 21 Both eyes. Cured 1.6.20 22 Removed to Infirmarv, Kensington. 7.6.20 23 Slight case. Cured 9.6.20 24 Severe case. Said to be cured. Left Borough 12.6.20 25 Cured 18.6.20 26 Removed from Borough 22.6.20 27 Cured 21.7.20 28 One eye. Cured 26.7.20 29 Right eye. Cured 29.7.20 30 Left eye. Cured 30.7.20 31 Cured 2.9.20 32 Cured 20.9.20 33 Both eyes. Cured 21.9.20 34 Cured. 21.9.20 35 Removed to Infirmary, Kensington 22.9.20 36 Both eyes. Cured 24.9.20 37 Cured. 29.9.20 38 Cured. 29.9.20 39 Left eye. Cured 21.10.20 40 Both eyes. Left Borough 28.10.20 41 Slight case. Cured 16.11.20 42 Both eyes. Cured 26.11.20 43 Both eyes. Cured 30.11.20 44 Removed to Paddington Infirmary. Said to be cured. 7.12.20 45 Slight case. Cured 10.12.20 46 Cured 49 of 1920. The total number of cases notified was 46, as against 22 in 1919. Visits were paid to all notified cases by the Health Visitors and in 23 cases arrangements were made for one of the Nurses of the Paddington and Marylebone Nursing Association to attend and apply treatment, and in this connection 1288 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. As is shown in the tabular statement, of all the cases with which the department was able to keep touch, it is possible to report that they were cured. PNEUMONIA. Figures with regard to notification and information as to methods of prevention, etc., adopted in relation to this disease will be found on page 41. The services of the nurses were requisitioned in 46 cases and 1,922 visits were paid. TUBERCULOSIS. In all 246 notifications were received, 202 relating to pulmonary, the remainder (44) to cases in which structures other than the lungs were affected. The table given on page 52 contains the information required by the Ministry of Health with regard to notifications. Notifications on Form B relate to school children. The number it will be noted was 14 as against 8 in 1919. Treatment of Tuberculosis.—Of the cases notified 130 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 101 were insured persons: of these 65 were admitted to sanatorium or hospital treatment and 19 to the Infirmary. Non-insured persons numbered 123, of whom 38 (17 being children) received sanatorium treatment and 8 were admitted to the Infirmary. Nurses were sent in to 49 cases and 1,372 visits were paid. 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. During 1920, 1,535 visits were paid by Miss Baker to the homes of patients and to 106 suspects. In addition the attendances of the inspector at the consultations numbered 252, at Middlesex Hospital 114, Margaret Street Hospital 84, and at the Anti-Tuberculosis Dispensary 54. 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 1920. The number of children on the roll was 50—23 Boys and 27 Girls—and the attendances numbered 11,871. 50 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, 1920, to the 31st DECEMBER, 1920, 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, 1920, to the 31st December 1930, at or in connection with the Dispensary and where:— Number of Persons diagnosed to be suffering from Tuberculosis who were treated or supervised at or in connection with the Dispensary during the period from 1st January, 1920, to 31st December, 1920. Number of Persons whc were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December,1920. Number of Persons reierred for diagnosis or treatment to the Hospital with which the Dispensary is affiliated during the period 1st January, 1920, to 31st December, 1920. 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.P.H. 1st April, 1916. Monday, 9—6 Tuesday, 9—6 Wednes., 9—12.30 Thursday, 9—9 Friday. 9—6 Saturday, 9—1 107 150 161 157 261 193 439 283 633 5 12 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. 18 28 21 26 41 19 16 31 64 — — Middlesex Hospital. Dr. Williams. 1st April, 1916. Daily, 1.30. Wednesday, 6 p.m. 13 10 10 30 42 13 18 45 64 — — Totals 138 188 192 213 344 225 473 359 761 5 12 51 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. 1. Name of Hospital to which Special Cases are Middlesex Hospital. referred from the Dispensary or Dispensaries for diagnosis or treatment 2. Is any provision for the home nursing of Tuber- District Nursing Association. The Dis- culous Patients made in connection with the pensary also has a Sister of its own Dispensary or Dispensaries ? If so who carries out supervision visits. (1) State the general nature of the arrangement (1) Communication with Matron. (2) What qualifications are the Nurses required (2) Certificated. to possess ? (3) Do they carry out other work ? If so, what ? (3) Yes, District Nursing. (4) Are their services available for Insured and (4) Yes. Uninsured Patient9 ? (5) If so (a) by what procedure are their services (5) (a) The Tuberculosis Officer commu- secnred for individual patients ? nicates with the Superintendent of the above Association. (b) Under whose instructions do they perform (b) The Superintendent of the above the actual duties of nursing in an indi- Association and the Tuberculosis vidual case ? Officer. 3. If no provision of nursing is made in connection Sister attached to Dispensary visits homes with the Dispensary or Dispensaries is any of definite and suspected cases of Pul- such provision contemplated ? If so, give monary Tuberculosis. particulars 4. State number of Shelters provided by the Council (1) Miss Bruce. or by the Dispensary Authorities up to 31st December, 1920, for lending out to Patients for use at their own homes 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 1920, the total number certified as due to this cause was 94, the deathrate being 0'9 per 1000. That this is the lowest figure for a number of years is shown in the table given below. Christ Church, though, as usual, it heads the list, was the district in which the fall that brought about the general reduction took place. 52 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 4th January, 1920, to the 1st January, 1921. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Notifications on Form A. Notifications on Form B. Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A No. of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Age Periods. 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 — — 5 8 10 8 30 21 26 7 5 120 154 — 1 1 2 3 21 42 „ Females — — 4 7 8 8 22 9 13 6 — 77 96 — 1 2 3 3 7 24 Non-pulmonary, Males — 3 3 — 1 1 2 1 2 — — 13 15 — 3 1 4 4 2 5 „ Females — 4 4 4 3 1 4 2 — — — 22 23 — 4 1 5 6 — 3 Totals — 7 16 19 22 18 58 33 41 13 5 232 288 — 9 5 14 16 30 74 53 Deaths from Phthisis. Ten years—1911-1920. Estimated Population. Year. All Ages. Sub-Districts. All Souls St. Mary. Christ Church. St. John. 101,856 1920 94 14 28 38 14 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 The distribution of the 94 deaths was as follows :—In Poor Law Institutions, 23 ; general and other hospitals, 32 ; at home, 39. Of those who died 56 were insured (39 males and 17 females), and 35 uninsured (16 males and 19 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 94 the notified cases of pulmonary tuberculosis totalled 202. 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 2 3 8 11 14 10 7 — 55 Females — 3 6 13 10 5 1 1 39 Totals 2 6 14 24 24 15 8 1 94 54 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 1ST JANUARY, 1921. Localisation of Disease. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. 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. Cases Isolated at Home. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Lungs 202 ... 29 34 82 52 5 32 67 82 21 202 14 23 15 5 57 145 Glands 15 ... 1 8 3 3 ... ... 6 3 5 1 15 1 1 ... ... 2 13 Peritoneum 3 ... 1 1 1 ... ... ... 1 2 ... ... 3 1 1 ... ... 2 1 Meninges 5 ... 1 3 ... 1 ... ... 1 1 2 1 5 1 1 1 ... 3 2 Fingernail 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Spine 5 ... 3 2 ... ... ... ... 1 1 3 ... 5 1 1 2 ... 4 1 Skin 3 ... ... 3 ... ... ... ... ... 1 2 ... 3 ... ... ... ... ... 3 Larynx 4 ... ... ... 1 2 1 ... ... 1 2 1 4 ... ... ... ... ... 4 Toe 1 ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 Leg 1 ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 Brain 2 ... ... 1 1 ... ... ... 1 ... ... 1 2 ... ... ... ... ... 2 Hip 1 ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 Abdomen 1 ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 1 ... Ankles 2 ... ... 1 ... ... 1 ... ... 2 ... ... 2 ... 2 ... ... 2 ... Totals 246 7 49 40 91 54 5 43 79 96 28 246 18 29 18 6 71 175 246 55 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 440 as against 459 in 1919. Of these, 69 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—44 as against 37 in 1919—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 54. INFLUENZA. Although the Ministry of Health feared that there might be a further outbreak of influenza in 1920, and in December, 1919, issued a special warning to Medical Officers of Health and made arrangements for the distribution of special vaccine, no epidemic occurred and so far as Marylebone was concerned, the deaths certified as due to the disease numbered only 18 as against 117 in 1919 and 266 in 1918. In connection with the distribution of vaccine against the disease, though the fact that it was obtainable was made widely known, only 71 bottles were supplied. The total number of persons inoculated was 112 and of these only 2 were attacked with influenza. The attack in each instance was quite mild. During the year, special posters containing advice with regard to prevention, etc., were again exhibited throughout the borough, and leaflets were widely distributed. A supply of posters and leaflets was sent to the headmaster or headmistress of each school in the borough for posting and for distribution among the children. 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: 1920 Positive. Negative Total. Typhoid fever 3 10 13 Diphtheria 54 400 454 Phthisis 69 371 440 Totals 126 781 907 DISINFECTION. The work done in this connection during 1920 is shown in the following tables. The methods employed daring 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, while for rooms either formalin or sulphur was generally employed. 56 The number and nature of the articles disinfected are shown in the following table:— Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other causes. Total. Beds 404 26 1 8 7 446 Mattresses 473 56 28 11 127 695 Bolsters 347 25 1 7 52 432 Pillows 1,104 103 28 21 361 1,617 Sheets 856 33 — 17 22 128 Blankets 1,343 105 28 29 176 1,681 Sundries 9,083 582 111 775 1,471 12,022 Totals 13,610 930 197 868 2,216 17,821 In 1919, the number of articles disinfected was 13,925. The number of journeys made by the disinfecting vans during the year ended December, 1920, was as under:— January 71 August 68 February 64 September 70 March 79 October 68 April 69 November 70 May 66 December 70 June 70 836 July 71 The vans were used 554 times in 1919. 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 60 8 13 6 7 94 February 83 7 19 1 10 120 March 80 14 30 2 6 132 April 54 9 23 — 5 91 May 41 7 15 4 — 67 June 43 26 11 12 — 92 July 56 6 9 12 1 84 August 40 9 3 — 6 58 September 60 10 1 3 5 79 October 117 7 3 — 10 137 November 90 11 5 — 1 107 December 71 7 1 1 — 80 Totals 795 121 133 41 51 1,141 The number of rooms disinfected in 1919 was 1,125. 57 CLEANSING OF PERSONS ACT, 1897. The following table shows the number of Adults and School Children using the Baths provided under the above-mentioned Act during the year 1920:— 1920. Adults. Children. Males. Females. Total. Males. Females. Total. January 245 100 345 87 231 318 February 198 71 269 136 267 403 March 255 95 350 126 264 390 April 222 98 320 109 136 245 May 212 108 320 121 212 333 June 223 92 315 113 268 381 July 138 74 212 51 241 292 August 252 33 285 20 39 59 September 220 Closed for Painting 220 90 381 471 October 215 55 270 68 377 445 November 229 97 326 90 261 351 December 260 70 330 48 125 173 Totals 2,669 893 3,562 1,059 2,802 3,861 At the request of the Medical Officer of Health of Kensington a certain number of children suffering from Scabies (Itch) were bathed and treated at the cleansing station. Table showing the number of persons using the Baths during the past 23 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 6,89l 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 1920 2,669 893 3,562 1,059 2,892 3,861 Totals 115,187 31,171 146,358 18,580 27,567 46,147 *The Children's Baths were opened in June, 1905. 58 MATERNITY AND CHILD WELFARE. The composition of the Maternity and Child Welfare Scheme now in existence has been very frequently described in annual reports and more particularly in that for 1919. 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 maternity 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 maybe 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. More recently there has been established at the Western General Dispensary a special clinic for children under Dr. Myers which has done and is doing most useful work. 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 1920. 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, open on 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. 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 seven 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. Four 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 four districts, and in 1920 the health visitors made 10,601 visits to infants, and the voluntary visitors attached to the schools for mothers made 5,247 visits to 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.:—(l) North Marylebone School of Mothercra/t, Salisbury Street, has an ante- and post-natal consultation 59 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.—(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.I. 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, at Middlesex Hospital, and the Church Army Dispensary. One of the Council's health visitors attends at each and Middlesex Hospital has also a paid health visitor in attendance. All the consultations are open to other than St. Marylebone babies, who, however, constitute the bulk of those attending. At the 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. 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. The fact that a special centre has been established at the Western General Dispensary has already been mentioned. 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 St. Marylebone Home, Marylebone Road. The number of births notified from these institutions during 1920 was 2,644, the total births numbering 4,428. 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 1920 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 1920 also made a grant of £l,000. Work done during 1920.—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 24. 60 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE YEAR ENDING 1ST JANUARY, 1921. CENTRE. 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. The Westn. Cenl. Dispy. No. of consultations held 49 261 (205 children 56 maternity) 302 (254 antenatal 48 infants) 77 100 48 55 21 No. of mothers attending ante-natal clinic — 1041 7761 — 62 — — — No. of attendances of babies 1333 4695 1764 1598 1702 827 2529 53 No. of attendances of children over 2 years 129 958 — 137 139 88 — 101 No. of orders issued for milk, etc. 548 3461 227 585 202 92 187 2 No. of home visits 715 5811 918 1160 1070 277 1130 — No. of new cases 167 709 5110 137 168 80 339 63 The St. Marylebone Babies' Nursing Home, 20, Marlborough Place, N.W.8 Admissions 58. Discharges 53. Deaths ... 8 Average number in the Home throughout the year 12 Day Nurseries—Attendances during the year. St. John's Wood, Barrow Hill Road 5940 Portman, Exeter Street 8274 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. The number of cases in which home helps were employed in 1920 was 29; the average time for which the help was required was 5 weeks (the longest being 21 weeks). The shortest period was 1 week. The total amount expended during the financial year to 31st March, 1921, was £99 4s. 8d., the payments made to the helps being at the rate of 25/- per week. 61 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, 1920. 1920. Males. Females. Total. For burial only. For inquests. Total. No. of. RM.'s held No. of courts held. No. of Infectious cases. January 15 21 36 29 7 36 3 5 - February 14 13 27 21 6 27 4 4 - March 19 16 35 25 10 35 4 4 - April 10 12 22 13 9 22 5 5 - May 9 15 24 19 5 24 3 3 - June 17 13 30 10 20 30 10 6 - July 7 4 11 7 4 11 — 3 - August 8 4 12 5 7 12 3 5 - September 7 4 11 5 6 11 4 5 - October 10 9 19 6 13 19 5 7 - November 15 10 25 9 16 25 7 5 - December 16 12 28 16 12 28 3 5 - Totals 147 133 280 165 115 280 51 57 - (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. 62 (4) Arrangements for chemical and bacteriological work dnring 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, four samples were taken and submitted to the public analyst who reported that three samples contained 30, 30 and 13 parts chlorine per 100,000 respectively, and the fourth sample 1,000 parts of chlorine per 100,000, an amount largely above the standard laid down in the Rag Flock Regulations, 1912. Legal proceedings were instituted, when the defendant laid an information against the manufacturers of the flock, who were summarily convicted of the offence and fined £l0 and £7 7s. costs. During the year a small laboratory in the Town Hall was fitted up for the use of the Council's bacteriologist at a total cost of £106 6s. A considerable saving of time has resulted from the establishment of this laboratory, particularly in connection with the sending out of reports to medical practitioners submitting specimens for diagnostic purposes. 63 HOUSING. The particulars given here are those asked for by the Ministry of Health in the memorandum as to the contents of reports of medical officers of health. Much of what is said, is merely reproduced from the report for 1919, little or no change, except possibly for the worse, having taken place in the interval. 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), 101,856. 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. 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 then 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 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 64 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 accommodTte 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 11), 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 1, and for the reason that more or less of a remedy was found in this case, no proceedings were instituted. III. Fitness of Houses. (1) (a) General standard of housing in the district, and {b) General character of the defects 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 12, which shows the defects found by the inspectors, gives some idea as to the amount of work done by way of investigation. Soon after the Housing Act, 1909, 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, considerable improvements were made, many of them voluntarily by property owners, 65 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 o* existing By-laws. (Seep. 15.) (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 legal formalities in connection with the site presented to the Council by Lord Portman were completed, and the so-called "Fisherton Street" site is now in the Council's hands waiting to be used, as the donor desired, for housing purposes. The site extends to 1.6 acres and is covered by poor class tenement houses, the leases of which do not expire until the end of 1921. During 1920, the Housing Committee of the Council made arrangements for having a scheme prepared and also obtained possession of a certain number of empty houses, some of them in a very dilapidated condition to house some of the tenants who would be dishoused while the new houses were in course of erection. At the end of the year some progress had been made in the direction of preparing and repairing the houses and there were hopes that during 1921 something would be done in the way of solving the housing problem. VII. Appendices. Table A contains the information asked for by the Ministry. 66 Table A.—HOUSING. Statistics for the Twelve Months ended 31st December, 1920. 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. - 1094 and 102 Tenements Nil. 746 Nil. Nil. Nil. Nil. Nil. 1 Nil. Nil. Nil. Nil. Nil. Nil. 1 Nil. 67 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision :— Milk Premises 183 Cowhouses 3 Slaughterhouses 3 Offensive Trades 2 Ice Cream Premises 90 Bakehouses 71 Restaurant, Dining Room and Coffee Shop Kitchens 150 Hotel Kitchens 44 Pastrycooks and Tea Rooms 36 Fried Fish Shops 25 Fish Curers 4 Houses Let in Lodgings 1,152 Workshops and Workplaces 2,976 Total 4,739 Smoke Nuisances. Number of Observations 18 Number of Nuisances and Complaints 7 Number of Notices 2 Number of Summonses Nil Housing of the Working Classes. Number of Houses inspected 1,094 Tenements in blocks 102 Number of Representations by Householders Nil Number of Representations by Medical Officer Nil Number of Houses included in such Representations Nil Number of Houses remedied without Closing Orders Nil Number of Demolition Orders Nil Number of Houses dealt with under Section 15 of theHousing, Town Planning, etc., Act, 1909 Nil Number of Closing Orders Nil Number of Houses included in such Closing Orders Nil Number of Closing Orders determined from year 1919 3 Number of Houses demolished— (a) In pursuance of Orders Nil (b) Voluntarily Nil 68 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 21,400 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 Authority 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 280 Number of Infectious bodies received Nil Disinfection. Number of rooms disinfected 1,141 Number of articles disinfected 17,821 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 2,669 893 1,059 2,802 7,423 Bakehouses. Number on register at end of 1920 71 Number above ground 10 Number underground 61 Number of inspections 309 Number of Notices 7 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1920 559 Number of Inspections 1,061 Number of Notices 31 Number of Prosecutions 1 69 House to House Inspections. Number of Inspections Houses 1,094 Tenements 102 Number of Notices issued Intimations 746 Statutory Notices 78 Number of Prosecutions Nil House Refuse. Number of Inspections 3,381 Number of Old Brick Receptacles abolished 4 Number of New Metal Receptacles provided 708 Number of Notices served (734 Intimations, 68 Statutory Notices) 802 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 35 Number of Statutory Notices served 16 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 1 Number remedied 1 Number of Prosecutions Nil Underground Rooms. Number dealt with 6 Number of Notices served under P. H. (L.) Act, 1891 Number of Notices served under H. T. P., &c., Act, 1909 Number of Prosecutions Nil Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (1). Number of rooms cleansed 610 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 1 Number of tenements comprised therein 4 Number of tenements for which certificates were granted 4 „ „ „ „ refused Nil „ ,, ,, „ deferred Nil 70 Drainage. The total number of inspections made 6,192 The total number of drainage plans deposited 356 The number relating to new buildings 25 „ „ old buildings 331 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops, and Cowsheds 353 Number of Inspections 1,252 Ophthalmia Neonatorum Regulations. Number of Notifications received during the year from certified midwives Nil Sanitary Officers. Number of Sanitary Inspectors (Whole-time) Male 8 Female Nil „ ,, ,, (Part-time) Male 3 Female 3 ,, Health Visitors Whole-time 3 Part-time 3 „ Tuberculosis Visitors Whole-time 1 MINISTRY OF HEALTH AND OTHER TABLES. table I. VITAL STATISTICS OF THE BOROUGH OF ST. MABYLEBONE. DURING 1920 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each year. 2 Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. 3 Nett. of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Under 1 Year of Age. At all Ages. No. 4 Rate. 5 No. 6 Rate. 7 No. 10 Rate per 1,000 Nett Births. 11 No. 12 Rate. 13 1910 125,195 4,111 2,556 20.1 1,566 12.9 658 699 253 98.9 1,607 13.3 1911 117,844 4,130 2,375 20.2 1,578 14.2 600 840 261 109.8 1,818 16.3 1912 116,155 4,111 2,246 19.3 1,652 15.0 769 752 209 93.0 1,635 14.8 1913 114,532 3,804 2,146 18.6 1,629 14.9 755 753 195 90.0 1,627 14.9 1914 112,892 3,847 2,128 18.7 1,631 15.1 813 787 210 98.6 1,605 14.9 1915 100,260 3,647 1,852 16.2 1,741 17.2 817 773 178 96.1 1,697 17.8 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 9S.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 98.5 1,568 15.9 1920 101,856 4,287 2,217 21.5 1,638 16.0 939 600 145 65.6 1,299 12.7 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. 71 TABLE I. (A) Vital Statistics of Separate Localities in 1920 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. 1910 125,195 2,556 1,607 252 33,239 716 355 59 35,641 432 417 48 37,133 1,016 582 115 19,182 392 253 31 1911 117,844 2,375 1,818 261 29,392 502 400 40 32,025 485 440 49 36,425 1,041 690 137 20,002 347 288 35 1912 116,135 2,246 1,635 209 28,971 452 379 45 31,566 453 411 30 35,903 971 588 108 19,715 370 257 26 1913 114,532 2,146 1,627 195 28,567 388 343 30 31,124 400 367 34 35,402 998 652 110 19,439 360 265 21 1914 112,892 2,128 1,605 210 28,158 435 317 36 30,678 418 388 33 34,895 937 630 113 19,161 338 270 28 1915 100,260 1,852 1,697 178 25,002 367 341 21 27,342 337 422 35 30,901 801 639 94 17,015 347 295 28 1916* 98,573 1,814 1,588 188 21,540 392 337 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 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 Averages of Years 1910 to 1919 107,470 1,949 1,656 197 26,986 420 342 34 29,421 365 409 38 33,028 824 624 97 18,036 338 279 26 1920 101,856 2,217 1,299 145 25,352 450 252 28 27,796 439 366 27 31,414 933 446 71 17,294 395 235 19 *The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sob-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. 72 TABLE II. Cases of Infectious Disease Notified during the 52 weeks ending 1st January, 1921. 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 119 2 23 51 20 20 3 ... 22 36 37 24 119 21 35 36 20 112 7 Erysipelas 68 2 2 6 6 14 23 15 12 18 27 11 68 8 11 15 3 37 31 Scarlet Fever 435 6 81 281 38 26 3 ... 86 109 188 52 435 84 106 186 47 423 12 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 29 ... ... 3 17 9 ... ... 6 6 15 2 29 3 4 16 1 24 5 Paratyphoid Fever 2 ... ... 1 ... 1 ... ... 1 ... 1 ... 2 1 ... 1 ... 2 ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 6 ... ... ... 1 4 1 ... 2 ... 2 2 6 1 ... 1 1 3 3 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 2 2 ... ... ... ... ... ... ... 1 ... 1 2 ... 1 ... 1 2 ... Tuberculosis Pulmonary 202 ... ... 29 34 82 52 5 32 67 82 21 202 14 23 15 5 57 145 Non-Pulmonary 44 ... 7 20 6 9 2 ... 11 12 14 7 44 4 6 3 1 14 30 Acute Poliomyelitis 2 ... 1 1 ... ... ... ... ... ... ... 2 2 ... ... ... ... ... 2 Polio-Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 46 46 ... ... ... ... ... ... 14 9 15 8 46 1 3 3 2 9 37 Encephalitis Lethargica 5 1 ... 1 ... 2 1 ... 1 ... 3 1 5 1 ... 3 ... 4 1 Pneumonia 71 1 l2 13 8 21 9 7 7 14 30 20 71 1 4 9 5 19 52 Malaria 18 ... ... 1 4 11 2 ... 4 4 7 3 18 ... ... ... 1 1 17 Dysentery 2 ... ... ... 1 1 ... ... ... ... 1 1 2 ... ... ... ... ... 2 Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1051 59 126 407 135 202 96 27 198 276 422 155 1051 139 193 288 87 707 344 1051 73 TABLE III.—Causes of, and Ages at Death during the year ending 1st January, 1921. 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 Small Pox — — — — — — — — — — — — — — — 3 Measles 8 2 5 1 — — — — — — 2 1 5 — 8 4 Scarlet Fever 9 1 — 2 1 2 2 1 — — 3 3 2 1 9 5 Whooping Cough 12 6 4 1 1 — — — — — 2 — 8 2 12 6 Diphtheria and Croup 8 1 — 3 2 2 — — — — — 2 5 1 8 7 Influenza 19 — — — — 2 2 6 9 6 6 5 6 3 19 8 Erysipelas 2 — — — — — — — 2 — — — 1 1 2 9 Phthisis (Pulmonary Tuberculosis) 94 1 — — 2 14 39 35 3 11 14 28 38 14 94 10 Tuberculous Meningitis 15 1 2 2 7 2 1 — — 9 5 1 5 4 15 11 Other Tuberculous Diseases 13 4 — — 4 — 1 3 1 9 1 5 5 2 13 12 Cancer 146 — — — — 1 6 75 64 320 27 46 43 30 146 13 Rheumatic Fever 4 — — — 1 — 1 — 2 1 1 — 1 2 4 14 Meningitis 7 2 1 — — 1 — 3 — 10 3 2 1 1 7 15 Organic Heart Disease 174 — — — 1 5 17 61 90 102 40 54 49 31 174 16 Bronchitis 140 14 3 1 1 1 2 32 86 37 22 32 58 28 140 17 Pneumonia (all forms) 116 12 7 4 4 5 17 26 41 86 16 35 38 27 116 18 Other Diseases of Respiratory Organs 20 1 — — — — — 9 10 11 8 3 6 3 20 19 Diarrhoea and Enteritis (under 2 years) 25 25 — — — — — — — 34 6 6 12 1 25 20 Appendicitis and Typhlitis 6 — — 1 — — 3 2 — 13 3 1 — 2 6 21 Cirrhosis of Liver 10 — — — — — 2 6 2 9 1 5 3 1 10 21a Alcoholism 5 — — — — — 1 2 2 3 2 — 1 2 5 22 Nephritis and Bright's Disease 30 — — — — — 2 15 13 30 4 13 8 5 30 23 Puerperal Fever 2 — — — — — 2 — — 5 1 — — 1 2 24 Other accidents and diseases of Pregnancy and Parturition 13 4 — — — 1 7 1 — 28 4 4 4 1 13 25 Congenital Debility and Malformation, including Premature Birth 52 51 — — 1 — — — — 89 10 9 27 6 52 26 Violent Deaths, excluding Suicide 51 4 — 2 4 5 9 13 14 49 15 9 18 9 51 27 Suicides 9 — — — — 1 2 6 — 4 1 4 3 1 9 28 Other defined Causes 309 17 2 4 4 7 29 87 159 244 55 98 100 56 309 29 Diseases ill defined or unknown — — — — — — — — — — — — — — — Totals 1299 145 25 21 33 49 145 383 498 1110 252 366 446 235 1299 74 VACCINATION RETURNS. Supplemental Return for 1919. Return made to the Board of Guardians and Ministry of Health on the 9th February, i92i,byMr. 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, 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 31st Dec, 1919. Number of these Births duly entered by 31st January, 1921, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1921, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1921, 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 1920. 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 1920. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, Unvaccinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had SmallPox. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 806 532 3 ... 130 41 12 29 32 27 3,286 590 2. St. Mary 2,316 1,573 1 ... 177 176 19 343 17 10 3. All Souls 506 370 1 ... 45 21 3 50 12 4 Total 3,628 2,475 5 ... 352 238 34 422 61 41 3,286 590 Dated 9th February, 1921. (Signed) EDWARD A. FRITH, Vaccination Officer. •. K- ■ v'-"•... • - - • • • 1 ■ • * . , v ■ ■ i < , t ^