AC 4353 STMFRY 26 Metropolitan Borougb of St. Marylebone. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1921. Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law.. london: geo. pulman and sons. ltd. 1 9 2 2. Telephone No.: Mayfair 3008. Metropolitan Borough of St. Marylebone. Public Health Department. Town Hall. Marylebone Road, N.W.!. 19___ Charles Porter. M.D., B.Sc. MEDICAL officer of health. 3ilitl] tht Compliments of the jltefrical ©fficer of +lealtl]. STMARY 26 Metropolitan Borough of St. Marylebone. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1921. Including the Report of the Public Analyst and the Report on Factories and Workshops. CHARLES PORTER, M.D., B.Sc., M.R.C.P. (Ed.) Of the Middle Temple, Barrister-at-Law. london: geo. pulman and sons. ltd. 1 9 2 2. London. Geo. Pulman & Sons, Ltd., Thayer Street, W. Public Health Department, Town Hall, Marylebone Road, N.W.I 14th July, 7922. 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 1921. In accordance with the wishes of the Minister of Health who considers full or"Survey Reports"necessary only at five-yearly intervals I have endeavoured to make this one as simple as possible. Again, as last year, I have to congratulate the Council on the lowness of the Infantile Mortality Rate which, despite the adverse conditions, works out at 66 per 1,000, only one point higher than that for 1920, when the lowest rate on record was reached. I most gladly avail myself of this opportunity of expressing my thanks to the Chairman (Mr. Alderman J. Fettes) and members of the Public Health Committee for the kindness and consideration they showed me and the help they gave me during the year. The Staff of the department are deserving also of thanks and credit for the splendid work they have done. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES PORTER, Medical Officer of Health, . CONTEN T S. page Foreword 7 Natural and Social Conditions of the Borough. Population 8 Census 8 Sanitary circumstances 9 Water Supply 9 Drainage 9 Combined Drainage 9 Closet Accommodation 9 Undergroundl'ublic Conveniences 9 Removal and Disposal of House Refuse 10 Sanitary inspection of the District 10 Staff 10 Nuisances—Legal Proceedings 10, 12 Inspections 11 Rat Repression 12 Premises and Occupations controlled by By-laws and Regulations 13 Business Premises 13 Cow Sheds 13 Milk Premises 13 Slaughterhouses 14 Fried Fish Vendors 14 Fish Curers 14 Offensive Trades 14 Ice Cream Premises 14 Butter. Margarine, etc., Premises 14 Bakehouses 14 Factories and Workshops 15 Inspections 15 Defects found 15 Home Work 16 Registered Workshops 17 Premises used for Human Habitation 18 Houses let in lodgings 18 Common Lodging Houses 18 Underground Rooms 18 Premises that are not but should be Registered 19 Food Stalls 19 Schools 19 Food 20 Milk Supply 20 Milk Analysis 20 Legal proceedings for adulteration 20 Bacteriological examinations 20 Dairies, Cowsheds and Milkshops Orders 20 Milk and Cream Regulations 21, 22 Milk for Mothers and Children 22 Food Inspections 22 Food, Unsound, Condemned 22,23 Sale of Food and Drugs Acts 23 Reports of Public Analyst during year 24-29 Statisticai 29 Births 29 Births Registration 29 Births Notifications 30 Deaths and Death Rates 30 Sub-District Births and Deaths 31 Deaths in relation to Age 31 page Causes of and ages at death 31 Infantile Mortality 31, 34 ,, „ Causes 32, 33 Deaths in relation to Disease 35 Diarrhoeal Diseases 35 Infectious(Communicable) Diseases 35 Phthisis and other Tuberculous Diseases 35 Respiratory Diseases 36 Cancer or Malignant Disease 37 Alcoholism 37 Accident, Suicideand Manslaughter 37 Prevalence of and Control over Infectious Diseases 37 Isolation of Cases 38 Discharge Notices 38 Diphtheria and Membianous Croup 39 Scarlet Fever 39 Enteric and Paratyphoid Fever 40 Cerebro-Spinal Fever 40 Encephalitis Lethargica 40 Polio-Myelitis 40 Erysipelas 40 Puerperal Fever 40 Measles and German Measles 40 Whooping Cough 40 Glanders 40 Anthrax 40 Infectious Diseases in School 41 Ophthalmia Neonatorum 42 Influenza 42 Pneumonia 43 Tuberculosis 43 Treatment of 43 Notifications 44 Prevention of 45 Bacteriological Diagnosis 46 Work at Dispensaries 47, 48 Deaths 48, 49 Disinfection 51 Cleansing of Persons Act, 1897 52 Bacteriological Examinations 52 Maternity and Child Welfare 53 Health Visitors 53 Centres 53 Ante-Natal Work 54 Dental Clinic 54 Hospital Treatment 54 Maternity Cases 54 Babies' Nursing Home 54 Infant Consultations—Work at 54, 55 Day Nurseries 55 Home Helps 55 Sanitary Administration— Staff 56 Report of Mortuary Keeper 56 Proceedings under Rag Flock Act, 1911 57 Housing— General Housing Conditions 57 Rent Act Certificates 57 Statistics 5S General Summary 59-62 Ministry of Health. TablesI—III 62-65 Vaccination Returns 66 FIFTY YEARS AGO. FOREWORD. 7 The object of the Ministry of Health being to obtain full reports from Medical Officers of Health at intervals of five years, with skeleton reports merely for each of the intervening years, it is conceivable that they may not regard this note with favour. There is in it, however, so much that is likely to be interesting to the members of the Council and, possibly, some of the ratepayers, that I venture to introduce it. It contains a brief survey of health conditions as they existed in the Borough in the year 1871, the information being derived from certain old annual reports that came to light in the course of turning over papers prior to moving into the new Town Hall. For the purposes of comparison, wherever statistics are quoted, corresponding figures for 1921, if available, are shown in italics and within brackets. In (he year 1871 Dr. John Whitmorewas"Medical Officer of Health and Chemical Examiner of Gas,"and impressed, like myself, with the necessity of sometimes looking back, in making his annual report for the year, he glanced at the figures for 1801 to see how matters then stood, particularly as regards population. In that year, he found, there lived in the parish 63,982 persons, which was some 100,000 less than in 1861, when Robert Dundas Thomson, M.D., F.R.S., was Medical Officer of Health, the population having risen by an average annual increase of about 1,600 to 161,680. In the decade that followed there was a falling off in ihe number of inhabitants of about 240 annually, till in 1871 the population was 159,254 (105,200). Special attention is drawn to the great preponderance of females over males, the census of 1871 showing an excess of over 20,000 (22,108). Half a century ago the inhabited houses in the district numbered 16,340 (17,345), uninhabited premises 837 (5J6),andthe gross valuation of rateable property amounted \.o£ 1,393,701 (£3,008,246), as compared with ^"5 09,244 in 1815; 5,183 (1,939) births took place in the year under review, giving a rate of 32'50 per 1,000 (18'42). Deaths numbered 3,848 (1,355), equal to 24T6 per 1,000 (12'87). The annual death rate of Christ Church District, for many years as high as 32 per 1,000, had fallen to 26 per 1,000 (14'0). Commenting on the infantile mortality rate of 173 per 1,000 births (66'0), the Medical Officer of Health points to the"melancholy fact that out of every 100 children born in St. Marylebone about 37 (9) die in the first five years of their existence, no inconsiderable number of them being victims to the great and glaring defects that still continue to characterize our social and sanitary enactments."It is also significant to note that over one-fifth (one twenty-fourth) of the total deaths were caused by zymotic diseases, which were particularly rife during 1871. Measles, 40 deaths (0), whooping cough, 136 (7), typhus fever (including typhoid or enteric fever) 72 (3 typhoid), scarlatina 90 (5), and diarrhoea '96 (22), were extensively prevalent, and in addition the most formidable smallpox epidemic for half a century was raging during the year. No fewer than 1,200 inhabitants (0) of the parish fell victims to this loathsome malady, and of that number 238 cases (0) proved fatal. In this connection Dr. Whitmore states that his experience"clearly demonstrates not only the necessity of efficient vaccination in early infancy, but of re-vaccination also at an early period of adult life."The sanitary staff in 1871 consisted of the medical officer of health and three inspectors of nuisances. there was also a sanitary committee"for the inspection of courts, alleys and dwellings."The years since 1871 have seen many changes in both these regards. The duties and the responsibilities of the Public Health Committee (a name substituted for"Sanitary Committee"in 1901), as may be gathered from the report now submitted, are definitely more varied and extensive and the staff as a consequence considerably larger. In one of the reports, under the heading of"Sanitary Work,"is reprinted an interesting statement made by the vestry to the Metropolitan Board of Works on sanitary and street improvements effected in the parish since the passing of the Metropolis Local Management Act, 1855. It records, among other matters, the closing of several of the parish pumps, the water from which was found to be impregnated with sewage and other organic impurity. the filling in of over 4,000 cesspools; the acquisition of certain highways owin^ to the abolition of 8 turnpike tolls. the improvement in the lighting and ventilation of the district churches by the adoption of " the sun light". and concludes .with the gruesome intimation that vaults under various churches and other places had been bricked up and coffins to the number of 1,791 embedded in dry earth mixed with charcoal. A great improvement is stated to have taken place in the quality and quantity of the water supplied by the West Middlesex and Grand Junction Water Companies, but owing to a report laid before the Lambeth vestry, in which it was stated that the Thames water supplied by certain companies was "extensively diluted sewage," Dr. Whitmore considered it desirable to take steps to allay any feeling of uneasiness so far as St. Marylebone was concerned. To this end he visited the various pumping stations and storage reservoirs, and made a weekly analysis of the water. In a lengthy report on the subject he expresses the opinion that the water is " perfectly " wholesome and may be drunk, even during the prevalence of an epidemic of cholera, " with the most perfect safety." In another report are details of the daily testings of the gas supplied to consumers in the parish by the Imperial and Chartered Gas Companies. Owing to the absence of sulphuretted hydrogen and to a reduction in the quantity of ammonia, a greater degree of purity was recorded in connection with the gas, the illuminating power of which had improved from 13 to 17 sperm candles of six to the pound. This should interest the Electricity Committee of the Council. Of points of interest to others there are many in the reports from which the information given has been quoted, but enough has been said to show that except perhaps in the matter of population the movement in the Borough during the last 50 years has been very definitely forward. THE YEAR 1921. POPULATION. The population of the Borough when the Census was taken on June 19th, 1921, was found to be 104,222, made up of 63,165 females and 41,057 males, the former thus exceeding the latter by 22,108. The populatton of each of the Wards is shown in the following table: Census—1921. Ward Populations. Males. Females. Totals Ward 1. 3,416 6,718 10,134 „ 2 4,154 5,830 9,984 „ 3 10,856 11,853 22,'709 „ 4 3,870 5,858 9,728 „ 5 4,868 8,435 13,303 „ 6 4,826 8,559 13,385 „ 7 4,520 7,932 12,452 „ 8 3,100 5,772 8,872 „ 9 1,447 2,208 3,655 41,057 63,165 104,222 The previous Census taken in 1911 enumerated the population at 118,211, so that during the period of ten years there was a decrease of 13,989. The population estimated to the middle of 1921 by the Registrar-General is given below, and is that used in calculating the various rates, etc., given in this report. For information the estimated population of each of the wards is also shown, and for comparison the figures for 1911. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. 1911 118,221 29,485 32,126 36,544 20,066 1921 105,200 26,184 28,709 32,445 17,862 9 SANITARY CIRCUMSTANCES. Water. Complaints as to water supply, either as regards quantity or quality, were few. 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 seven premises. The reasons for discontinuing the supply were: waste of water, one; non-payment of rate, four. and empty premises, two. During the year 146 notices in regard to defects in and necessity for cleansing of water cisterns were served and were complied with. Water Supply in Dwelling Houses.—Six certificates were granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. In 32 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 13 it was found necessary to issue a statutory ("Committee") notice. Drainage. The total number of drain inspections made during the year was 7,175 as against 6,192 in 1920. The total number of plans deposited was 335, the number in 1920 being 356. Plans relating to new buildings numbered 24, the number deposited in 1920 being 25. In the case of old buildings, the number of plans received was 311, as against 331 in 1920. On 10 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 six cases and fines and costs imposed in each instance, amounting in all to ^24 and £\b 15s. respectively. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 22 premises. The number in 1920 was 5. Closet Accommodation. In the table at page 11, 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. 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. 10 The following is a statement showing the total receipts at each of the conveniences for the year ended March, 1922, and the amount of increase or decrease as compared with the previous year. 1922. 1921. Increase. Decrease. £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus—Men's Department 1,078 4 1 1,253 19 11 - 175 15 10 * ,, Women's ,, 1,128 7 10 1,234 15 4 - 106 7 6- Gt. Portland Street—Men's ,, 305 3 2 336 2 4 - 30 19 2 * ,, Women's ,, 300 9 0 323 14 5 - 23 6 5 Marylebone Road—Men's ,, 255 18 4 286 15 3 - 30 16 11 * ,, Women's ,, 259 0 11 294 14 1 - 35 13 2 Foley Street—Men only 173 S 2 188 13 4 - 15 10 2 St. John's Wood Road—Men only 124 17 0 128 4 9 - 3 7 9 Barrett Street—Men only 215 2 0 241 16 4 - 26 14 4 * 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. As these arrangements are similar to those in vogue in 1920, and fully described in my report for that period, it is unnecessary to repeat the information there given. The total amount of refuse collected for the year ended 31st March, 1922, it may be mentioned, was 37,088 tons, as compared with 35,744 tons in the previous year. So far as the arrangements existing in houses, business premises, etc., are concerned, it may be noted that the movable, covered metal dustbin is most commonly found. Old brick receptacles are quite rare, the number demolished during the year being 17. New metal dust receptacles were provided to 1281 premises. During the year the inspectors made 3,259 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 dustbins, etc., 30 notices were served. Remedies in each case were carried out, legal proceedings not being necessary in any instance. 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. W. W. Jameson), a tuberculosis officer and assistant medical officer of health for tuberculosis purposes (Dr. J. Donaldson Saner, who joined the staff in April, 1921, when the Tuberculosis Dispensary was taken -over by the Council), two drainage inspectors, one outdoor superintendent, one meat and food inspector, one house-to-house inspector, six district inspectors, seven women sanitary inspectors and health visitors, one chief and five assistant clerks and an office youth, with, in addition, at the Tuberculosis Dispensary, a sister and a clerk dispenser. 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 caretakers at the dispensary, 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 3,217, as against 1,900 in 1920. The majority of these complaints were made by the inspectors themselves, though a certain number came from other members of the Council's staff, from voluntary health workers, etc. In respect of nuisances, 856 statutory notices were issued, as against 475 in 1920. 11 Of these notices, 641 related to ordinary nuisances (dirt, dampness, &c.) 159 to verminous rooms, 35 to drains, 8 to insufficient w.c. accommodation, and 13 to water supply in tenement houses. The 159 notices respecting verminous rooms were served under powers granted by the London County Council (General Powers) Act, 1904, and referred to 329 rooms. In 2,361 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 15 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 o various kinds detected and remedied, are set forth in the following table:— Districts. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Total Inspections 3,637 3,457 3,895 3,612 3,382 3,233 21,216 Houses damp, dirty or dilapidated remedied 312 271 184 162 192 112 1,233 Doors, windows, floors, cei 1 ings, sash cords, etc., repaired 398 377 82 77 55 26 1,015 Overcrowding abated 1 — — — — 1 2 Illegal occupation of underground rooms dealt with - 2 8 1 11 Water closet defects remedied 256 261 107 97 163 123 1,007 Water closets erected 6 — — 2 9 10 27 Urinal defects remedied 1 1 2 — — 1 5 Soilpipe and ventilating shaft repaired or renewed 11 - 31 8 8 58 Yard defects remedied 199 270 75 93 77 28 742 Waste pipe defects remedied 32 33 38 18 28 17 166 Water cistern defects remedied 58 10 15 31 16 16 146 Rubbish, manure, etc., accumulations removed 10 13 42 20 36 50 171 Dung or dust receptacles repaired or renewed 190 253 196 201 169 118 1,127 Drains relaid or amended 28 25 31 10 35 7 136 Drains cleared 27 25 9 17 24 9 111 Rainwater pipes repaired or renewed 24 53 33 31 14 13 168 Water supply to houses reinstated 1 3 2 2 1 9 Roofs and gutters repaired 118 180 80 48 18 28 472 Area defects remedied 15 2 45 72 76 32 242 Wash-house defects remedied 222 223 69 86 68 20 688 Animal nuisances abated 6 4 8 6 4 6 34 Basement defects remedied 2 — 8 36 51 1 98 Stables cleansed or repaired 3 — — 5 — 8 Water supply laid on to upper storeys of house 12 8 6 6 32 Miscellaneous nuisances abated 197 211 109 90 89 49 745 Verminous rooms cleansed 166 455 60 51 99 44 872 Workshops, dirty,overcrowded, unventilated or defective, remedied 2 5 12 20 31 49 119 12 Legal Proceedings in Connection with Nuisances. The number of summonses issued in respect of nuisances during the year was 15. 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. 147, Carlisle Street Failure to comply with a statutory notice to execute certain sanitary requirements. Fined £25 and £5 5s. costs. 37, Fisherton Street Do. No fine. £2 2s. costs. 135, Carlisle Street Do. Fined £16 and £6 6s. costs. 14, New Street, St. John's Wood Do. Fined £10 and £2 2s. costs. 15, Aberdeen Place Do. No fine. £2 2s. costs. 27, Henry Street Do. Orders made for abatement of nuisance in 14 days in each case. 31, „ Do. 35, „ Do. 36, Richmond Street Do. No fine. £l Is. costs. 84, „ Do. Adjourned sine die as certain works had been completed. 72, „ Do. Adjourned sine die in view of the fact that dilapidation notices had been served on the defendant by the Freeholders, and these notices covered the statutory notices served by the Council. 76, „ Do. 80, „ Do. 82, „ Do. 88, „ Do. Rat Repression. The number of complaints received during the year, viz., 95, was practically the same as in 1920, and may be taken to indicate continued desire on the part of the public to deal with the nuisance rather than a want of improvement in the general condition of the Borough. The investigation of these complaints necessitated the inspection of 101 premises, 37 of which were used for business purposes (17 of these for the preparation or storage of food), the remaining 64 being private or tenement houses. In 34 of the cases investigated the infestation was directly attributable to defects in the drainage system and disappeared immediately these were remedied. In every instance all advice and assistance was given to the owner or occupier by Inspector Draper, who continued to act as Rat Officer, and to obtain excellent results from the methods advocated. A Rat Week was held during the year from October 31st to November 5th, 1922, and attracted a considerable amount of attention to the subject. Great assistance was obtained from the Borough Surveyor and his staff, and also from a number of large firms in the Borough. The result, it is safe to state, was a considerable reduction in the rat population of the sewers and other places affected by these vermin. 13 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, 1921. Number of notices, 1921. Number of prosecutions, 1921. On register at end of 1920. Added in 1921. Removed in 1921. On register at end of 1921. A. Business Premises. Milk premises 186 9 36 159 362 — — Cowsheds 3 — — 3 66 — — Slaughterhouses 3 — - — 3 154 — — Offensive trade premises 2 — — 2 68 1 — Ice cream premises 90 36 6 120 156 10 — Butterand MargarineManufacturers and Dealers 11 - - 11 47 - Bakehouses 71 — 1 70 201 6 — Fried Fish Shops — — — 22 - - — Fish Curers B. Habitations — — — 5 - - — Houses let in lodgings 115 2 — — 1152 10014 2087 — Common lodging houses 5 — — 5 — — — Underground rooms not registered - - - - - - Underground sleeping rooms A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 159. This is 27 less than in 1920, 9 having been added and 36 removed; in 1914 there were 237 on the register. 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 3 42a, Clipstone Street 10 10 Totals 69 13 14 The figures for 1920 were 69 and 14 respectively. 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. 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. Fried Fish Vendors and Fish Curers.—The number of premises in the Borough used by vendors of fried fish is 22 and by fish curers 5. Notices calling for periodical lime-washing, etc., of such premises as required by the By-laws of the London County Council, made under Section 9 of the London County Council (General Powers) Act, 1908, were issued, and regular visits of inspection made and action taken where necessary to have any defects noted remedied. 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 68 visits, but no cause of complaint was found. Ice Cream Premises.—The number of such premises in the Borough on the Register is 120. Regular inspections were made throughout 1921 and in 10 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. AH the registered premises were frequently visited. Bakehouses.—At the end of 1921 the number of bakehouses on the register was 70, 1 having been removed during the year. Of these 65 were underground bakehouses. In all, 201 visits were paid and 6 notices served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, etc., of the inside walls and other parts of the bakehouses were issued. It was not necessary to institute proceedings to enforce compliance with any notice. 15 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 dressmaking, millinery and tailoring in all its branches. The total number of visits to factories, workshops and workplaces during the year was 3,735, 169 by the women and 3,566 by the men inspectors. The complaints received numbered 42. The following report which the Medical Officer of Health is required to make to the Secretary of State for the Home Department in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901, gives, in addition to other information, the total number of defects found and of notices served. I.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 95 14 — Workshops (Including Workshop Laundries.) 1794 201 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1846 92 - Total 3735 307 — 2.—DEFECTS FOUND. Particulars. Number of Defects. N umber of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances wider the Public Health Acts:— Want of cleanliness 102 102 Want of ventilation 4 4 — — Overcrowding 13 13 — — Want of drainage of floors — — — — Other nuisances 167 167 - — Sanitary accommodation insufficient 4 4 — — unsuitable or defective 74 74 - - not separate for sexes 8 8 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 6 6 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 378 378 — — 3—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. NATURE OF WORK Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (8. 110). Prosecutions (Sections 100, 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) (ii) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 80 200 1020 ... ... ... 53 ... ... ... ... ... ... ... ... Umbrellas, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 80 200 1020 ... ... ... 53 ... ... ... ... ... ... ... ... 17 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. N umber. (1) (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 2,994 Coffee Shops, &c. 274 Bakehouses. 70 Total number of workshops on Register 3,338 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 9 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 65 Reports (of action taken) sent to H.M. Inspector 65 Other ,.v — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 65 18 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 1921 was therefore 1,152, most of which were registered prior to the war and before rents had attained the present high figure. The object of registration being largely to ensure that the houses shall be kept under supervision, all were regularly and systematically inspected. In all 2,087 visits were paid; and notices relating to cleansing and other defects served when necessary under the appropriate Acts. All notices were complied with without the necessity for further proceedings arising. Common Lodging Houses.—The following table contains all the necessary particulars with regard to the licensed premises of this class in the Borough. 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 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.—As close supervision as possible was kept over rooms of this class and whenever possible notices to discontinue occupation were served. The total number dealt with in this way was 11. 19 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 1921 there were 301, this number including: restaurant, dining room and coffee shop kitchens, 170. tea-rooms and pastry-cooks, 58. hotel kitchens, 46; fried fish shops, 22. 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 1921 the total number of inspections was 1,259, the number of notices served being 26. 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 1921 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 1920 and are reproduced here in the hope chat 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 understand why either the central government authorities or the local authorities have for so long acquiesced in the arrangement. For the reason that the 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. 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 20 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. Analysis of milk.—The total number of samples taken either formally and in accordance with the provisions of the Sale of Food and Drugs Acts, or informally as"test"samples was 304. On examination by the Public Analyst 5 (1'6 per cent.) were found to be adulterated. In 1920 the percentage was 3'2. Further reference to the question of milk examinations is made in the report of the Public Analyst which will be found elsewhere. Proceedings.—In the case of samples definitely adulterated proceedings were instituted. In 1921 action was taken in 5 cases. In no case was the warranty defence pleaded. In respect of the 5 cases fines and costs to the amount of £54 10s. Od. were recovered. In 1920, when there were 8 cases, the amount was £90 0s. Od. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 121 were obtained on delivery at Marylebone Station of the Great Central Railway. Of the 121, one proved to be adulterated, and warranted the institution of proceedings. The quarterly returns as to milk samples are tabulated below:— Quarter of the Year. No. of Samples Taken. No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. Fines and Costs. 1st 104 - 0.0 £ s. d. 5 3 0 2nd 67 2 3.0 — 6 2 0 3rd 51 — 0.0 — — - 4th 82 3 3.6 — 43 5 0 Total for year 304 5 1.6 — 54 10 0 Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 23 samples were taken and submitted to Dr. Foulerton, the Council's Bacteriologist, for examination. In respect of 6, the report was to the effect that foreign dirt was present, the remainder being returned as clean or fairly clean. In each case in which foreign dirt was reported present, a warning was sent by the Public Health Committee to the producer and vendor. In no instance was any sign of tuberculosis found. Dairies, Cowsheds and Milkshops Orders.—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 21 complied with. In one case proceedings were instituted for selling milk without being registered under the Order. The Magistrate held that the defendant was not a purveyor of milk inasmuch as he only supplied milk to neighbours frcm consignments sent up and obtained from one of his own cows kept in the country and that he did not, therefore, come under the definition of a purveyor of milk in accordance with the Dairies, Cowsheds and Milkshops Orders, and dismissed ihe summons with £\ Is. costs against the Council. 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. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 & 1917. Report for the year ended 31st December, 1921. 1.—Milk; and Cream not sold as Preserved Cream. (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present, and percentage of preservative found in each sample. Milk 309 Nil. Cream 18 3 (11.9, 14.7, and 14.0 grains Boric Acid per lb.) Nature of preservative in each case in column (b), and action taken under the regulations in regard to it. See note on Report of Public Analyst for September Quarter, 1921. 2.—Cream sold as Preserved Cream. (а) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correct statements made 6 (ii.) Statements incorrect Nil. Total 6 (iii.) Percentage of preservative found in each sample Average 11.1 grains Boric Acid. per lb. Lowest 10 grains. Highest 13 grains. 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. 6 (ii.) Below 35 per cent. Nil. Total 6 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed 3 22 (d) Particulars of each case in which the Regulations have not been complied with, and action taken See note * 3.—Thickening substances.—Any evidence of their addition to cream or to preserved cream. Action taken where found—None. 4.—Observations, if any.—See note on Report of Public Analyst for September Quarter, 1921. "During the year proceedings were instituted in one case under this order, a conviction being obtained against Messrs. Edwards Creameries, Ltd., for delivering and depositing for sale preserved cream in a receptacle not labelled in accordance with the regulations. While admitting the facts, the defendants asked for a dismissal on the ground that Article VI. of the regulations, which requires that an opportunity of offering an explanation should be given, had not properly been complied with. This view the magistrate refused to accept, agreeing with the prosecution that, as the inspector had enquired verbally of the vendor's employe why labelling had not been done and had received in explanation a reply from him that he had forgotten it, due notice in this respect had been given. An appeal by Messrs. Edwards Creameries Ltd. against the magistrate's decision was heard in the King's Bench Division before the Lord Chief Justice and Justices Avory and Greer, on the 17th May, 1922, and was dismissed, the Council being allowed costs,-the Court holding that the local authority acting by their agent, the sanitary inspector, did afford an opportunity to the appellants of furnishing an explanation in the matter. Milk (Mothers and Children) Order, 1916—During 1921 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1922, was ^"1,637, as against ^5,040 10s. 7d. up to March 31st, 1921. The actual number of cases dealt with was 819, and the number of orders issued 3,051. B.—FOODS OTHER THAN MILK. 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. Unsound Food—Seizures. (1) Exposing for sale half a pig's head. (2) Exposing for sale a hand and spring of pork On a stall in Church Street market. Fined £25 on each summons {£50) and £5 5s. costs. (1) Depositing for sale unsound fish on a stall outside 33 Salisbury Street Fined £2A and £6 6s. cost. (2) Selling the same Fined £8 and £2 2s. costs. 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 1921. Meat— 1 Ox Liver (Tuberculosis) 12 lbs. Beef 6 stone 4 lbs. 4 ozs. 1 Pig's Head (Tuberculosis) Bacon 7 cwt. 3 qtr. 3 lbs. 23 Fish- Wet—Miscellaneous 8 cwts. 1 qtr. Dry—Kippers 7 boxes Winkles 1 bag Crabs 2 barrels Prawns 22 Canned Foods— Corned Beef 12 lbs. Salmon 9 tins Crabs 34 tins Fruit 30 tins Milk 6,858 tins Fruit— Apples 10 barrels Grapes 9 boxes Pears 10 baskets Miscellaneous— Eggs 1440 Mustard Ketchup 14 cases Pickles 39 cases Chestnut 2 bags Ducks 1 box C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,130. Of this number 27 were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of 2'3 per cent., the same as for the year 1920. 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. Prosecutions in respect of adulteration of food numbered 20, the fines and costs recovered amounting to £\12 8s. 6d. In no prosecution for adulteration of milk was the warranty defence raised. In no case were proceedings instituted for an oftence against the Acts other than selling adulterated articles. The following Tables and Report from the Public Analyst, Mr. J. F. F. Rowland, who was appointed successor to the late Dr. Wynter Blyth in April, 1921, give full information with regard to samples submitted to and examined by him: 24 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, 1921. 103 milk Food Inspector, St. Marylebone Borough Council Genuine. £500 per ann. for 700 samples. Over that number 7/6 per sample Three were test samples. No sample contained preservative or added colouring matter. 1 milk Private sample Do. 132 butter 4 Food Inspector Do. 99 were test samples. 21 samples contained no preservative. 97 samples contained from 10-20 grains boric acid per lb. 14 samples contained from 21-30 grains boric acid per lb. 7 margarine Do. Do. Seven were test samples. 1 suet Do. Do. Test sample. 2 stout Do. Do. One was a test sample. 36 cocoa Do. Do. 36 were test samples. 1 jelly Do. Do. This was a test sample. 7 jam Do. Do. Seven were test samples. 29 coffee Do. Do. 29 were test samples. 1 coffee & chicory Do. Do. This was a test sample 3 marmalade Do. Do. Three were test samples. 9 pepper Do. Do. Nine were test samples. 7 mustard Do. Do. Seven were test samples. 2 tea Do. Do. Two were test samples. 1 chocolate Do. Do. This was a test sample. Scream Do. Do. Eight were test samples. No. 219. 51.0% fat. Preservatives No. 281. 45.0% „ „ [Nil. No. 283. 40.5% ,, 10.0 grains (Presd.) boric acid per lb. No. 341. 46.5% ,, Preservatives No. 343. 46.5% „ „ [Nil. No. 345. 45.5% „ No. 347. 44.5% „ No. 349. 39.0% „ Total Number of Samples analysed during the Qua rter 350 Number of Samples adulterated Nil SECOND QUA RTER ENDING 30TH JUNE, 1921. 65 milk Food Inspector, St. Marylebone Borough Council Genuine. From 31st March to 25th April, 1921, arrangements were made for samples to be analysed by Mr. M. WynterBlyth at 10/6 per sample. From 26th Apl., 1921, Mr. J. F. F. Rowland was appointed Public Analyst at a fee of 12/6 per sample.* Two were test samples. No sample contained any preservative or colouring matter. 2 milk Do. Adulterated. No. 482. 6.7 per cent, deficient in milk fat No. 482. Fined £4 and £2 2s. costs. 5 separated milk Do. No. 4S4. 3.3 Genuine. No. 484. Proceedings not instituted. †See footnote. 84 butter Do. Do. 78 were test samples. 60 contained 10-20 grains per lb. boric acid, 24 contained 21-30 grains per lb. boric acid. *Appointment confirmed under Seal by Ministry of Health, 29th June, 1921. † This was a station sample and the Farmer stated that the milk was sent exactly as milked from the cows by himself. 25 Articles submitted for Analysis State whether the sample was submitted to the Analyst by an Officer acting unde 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. 14 margarine Food Inspector, St. Marylebone Borough Council Genuine. 13 were test samples. 14 contained 15 30 grains per lb. boric acid. 17 cocoa Do. Do. All were test samples. 2 jam Do. Do. Both were test samples. 21 coffee Do. Do. 20 were test samples. 1 coffee & chicory Do. Do. This was a test sample. 10 pepper Do. Do. All were test samples. 10 mustard Do. Do. Nine were test samples. 3 malt vinegar Do. Do. 1 whiskey Do. Do. This was a test sample. 18 roll and butter Do. Do. Seven were test samples. 18 roll and butter Do. Adulterated. Four were test samples as follows :— No. 577 consisted of bread and margarine. No. 577. These four were test samples. No. 580 do. No. 580. No. 581 do. No. 581. No. 583 do. No. 583., No. 590 consisted of roll and margarine. No. 590. Fined £2 and £2/2/- costs. No. 591 do. No. 591. Fined £2 and £2/2/- costs. No. 592 do. No. 592. Fined £2 and £2/2/- costs. No. 593 do. No. 593. Fined £2 and £2/2/- costs. No. 594 do. No. 594. Fined £2 and £2/2/- costs. No. 595 consisted of a roll spread with a mixture which consisted of butter and margarine. Of the mixed fats, 74 per cent, was margarine. No. 595. Fined £5 and £2/2/- costs. No. 598 consisted of roll and margarine No. 598. Fined £2 and £2/2/- costs. No. 599 do. No. 599. Fined £2 and £2/2/- costs. No. 602 do. No. 602. Defendant absconded. Summons not served. No. 603 do. No. 603. Fined £2 and £2/2/- costs. No. 604 do. No. 604. Fined £2 and £2/2/- costs. No. 605 do. No. t:05. Fined £2 and £2/2/- costs. No. 617 do. No. 617. Fined £2 and £2/2/- costs No. 619 do. No. 619. Fined £3 and 12/6 costs. Total Number of Samplts analysed during the Qua rter 271 Number of Samples adulterated 20 26 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. THIRD QUA RTER ENDING 30TH SEPTEM BER, 1921 51 milk Food Inspector, St. Marylebone Borough Council. Genuine. 12/6 per sample. No sample contained colouring matter or preservative. 16 butter Do. Do. Seven were test samples. One sample contained no preservative. 15 contained between 10 - 20 grains per lb. each. 1 butter Do. Adulterated No. 701 was margarine This was a test sample. 2 roll and butter Do. Genuine. Two were test samples. 9 margarine Do. Do. Nine were test samples. 15 coffee Do. Do. 15 were test samples. 7 cocoa Do. Do. Seven were test samples. 1 ground rice Do. Do. This was a test sample. 1 pepper Do. Do. Do. 7 cream Do. Do. Two was test samples. No. Fat. Preservative. 625 45.0 per cent. 13*0 grains boric acid per lb. Preserved. 660 45.0 do. 11.0 do. Do. 662 45.0 do. 11.0 do. Do. 664 45.0 do. 11.9 do. Not labelled. 692 45.0 do. 14.7 do. Do. 693 45.0 do. 14.0 do. Do. 694 42.0 do. Preservatives absent. No. 664. Was purchased by Vendor from Wholesaler as Unpreserved and was sold by him unlabelled. The M.O.H. wrote to the Vendor and it was arranged that a test sample should be taken after delivery to ascertain whether the Wholesaler was delivering Preserved Cream unlabelled. No. 692. Was therefore taken as a test sample and was reported by the Analyst to be preserved. It was delivered by the Wholesaler unlabelled; in consequence thereof a further sample was taken (No. 693) from the Wholesaler on delivery at the Vendor's premises from which Nos. 664 and 692 had been previously purchased, and was found to be preserved cream and was delivered unlabelled. Proceedings were taken in respect ot this sample, when the Wholesaler was fined £1 and 2s. costs. Total Number of Samples analysed during the Quarter 109 Number of Samples adulterated 1 FOURTH QUA RTER, ENDING 31ST DECEM BER, 1921 79 milk Food Inspector, St. Marylebone Borough Council. Genuine. 12/6 per sample. One was a test sample. None of the 82 samples contained preservative or artificial colouring matter 3 milk Do. Adulterated. No. 781. 50% deficient in milk fat. No. 731. Fined £18 and £2/2/- costs. No. 732. 66.7% do. No. 732. Fined £20 and £3/3/- costs. No. 865. 10% do. No. 865. Letter of caution sent. 27 Articles submitted for Analysis. State whether the sample was sub mitted 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 ill rcspect of the Analysis. Observations. 48 butter Food Inspector, St. Marylebone Borough Council. Genuine. 12/6 per sample. 47 were test samples. Of the 48 samples examined one was free from preservative, the others contained between 10 to 25 grains boric acid per lb. 1 butter Do. Adulterated. No. 1114 (T) consisted of margarine. This was a test sample. 31 margarine Do. Genuine. All were test samples. Contained between 14 to 28 grains boric acid per lb. 9 condensed milk Do. Do. All were test samples. 1 evaporated milk Do. Do. This was a test sample. 2 egg yolk Do. Do. All were test samples. 1 solac Do. Do. This was a test sample. 1 egg albumen . Do. Do. Do. 45 coffee Do. Do. All were test samples. 1 coffee mixture Do. Do. This was a test sample. 43 jam Do. Do. All were test samples. 5 jelly (fruit) Do. . Do. Do. 13 pepper Do. Do. Do. 11 mustard Do. Do. Do. 2 mustard Do. Adulterated. Do. No. 846 (T) contained 10% of added starch This was a test sample. No. 1093 (T) contained 10% of added starch Do. 4 mustard mixture Do. Genuine. All were test samples. 4 marmalade Do. Do. Do. 21 cocoa Do. Do. Do. 9 green peas Do. Do. Do. 1 sponge cake Do. Do. This was a test sample. 3 vinegar Do. Do. All were test samples. 1 pickles Do. Do. This was a test sample. 14 ground ginger Do. Do. All were test samples. 3 lime water Do. Do. Do. 6 compound liquorice powder Do. Do. Do. 6 ammoniated tinct. of quinine Do. Do. Do. 8 zinc ointment Do. Do. Do. 3 camphorated oil Do. Do. Do. 8 boracic ointment Do. Do. Do. 2 Gregory's powder Do. Do. Do. 2 gall and opium ointment Do. Do. Do. 9 cream Do. Do. Do. No. 970 (T) 51% fat. 11.0 grains boric acid per lb. No. 971 (T) 48% fat. 10.6 do. No. 1004 (T) 45% fat. Preservatives absent. No. 1017 (T) 45% fat. do. No. 1072 (T) 45% fat. do. No. 1082 (T) 45% fat. do. No. 1102 (T) 46% fat. do. No. 1104 (T) 48% fat. do. No. 1110 (T) 46% fat. do. Total Numbe r of Samples analysed during the Qu arter 400 Number of Samples adulterated 6 28 ANNUAL REPORT OF THE PUBLIC ANALYST, 1921. The number of samples taken under the Sale of Food and Drugs Acts anc submitted for analysis, was 1,130: a considerable increase as compared with the samples for 1920, the number for that year being 1,030. A complete list is as follows: No. Article. Genuine. Adulterated. Total. 1 Ammoniated Tincture of Quinine 6 - 6 2 Boracic Ointment 8 - 8 3 Butter 279 2 281 4 Camphorated Oil 3 - 3 5 Chocolate 2 — 2 6 Coftee 110 — 110 7 Coffee and Chicory 2 — 2 8 Coffee Mixture 1 — 1 9 Cocoa 80 — 80 10 Compound Liquorice Powder 6 — 6 11 Cream 24 — 24 12 Egg Yolk 2 — 2 13 Egg Albumen 1 — 1 14 Gall and Opium Ointment 2 — 2 15 Green Peas 9 — 9 16 Gregory's Powder 2 — 2 17 Ground Rice 1 — 1 18 Ground Ginger 14 — 14 19 Jam 52 — 52 20 Jelly 1 — 1 21 Jelly (Fruit) 5 — 5 22 Lime Water 3 — 3 23 Margarine 61 — 61 24 Marmalade 7 — 7 25 Milk 299 5 304 26 Milk, Separated 5 — 5 27 „ Evaporated 1 — 1 28 „ Condensed 9- — 9 29 Mustard 28 2 30 30 Mustard Mixture 4 — 4 31 Pepper 33 — 33 32 Pickles 1 — 1 33 Roll and Butter 20 18 38 34 Sponge Cake 1 — 1 35 Solac 1 — 1 36 Stout 2 — 2 37 Suet 1 — 1 38 Tea 2 — 2 39 Vinegar 3 — 3 40 Vinegar (Malt) 3 — 3 41 Whisky 1 — 1 42 Zinc Ointment 8 — 8 1,103 27 1,130 Milk.—304 samples of milk were examined, of which 5 were adulterated, the adulteration in each instance being deficiency in fat ranging from a 3.3 per cent, deficiency to 66.7 per cent. 29 The mean composition of the milks which did not fall below the legal minimum for milk fat or for solids not fat again shows a reduction on the figures for the 5 previous years. Extreme values are even more rare than they were the year before and the tendency noted then of the quality of the samples becoming more uniform is even more evident in the year just completed. May, June and July provided the milks of the lowest average quality, as they generally do, but this year this tendency was no doubt accentuated by the drought which prevailed. Mean composition. Sp. Gr. Milk-fat. Solids (not fat). Total Solids. 1921 1031.25 3.50 8.70 12.20 Butter.—281 samples were examined, of which 2 informal samples were found to consist of margarine. Roll and Butter.—38 samples were examined; of these no less than 18 were adulterated. 17 consisted of roll and margarine. Margarine.—61 samples were examined. All were genuine, and all contained boric acid as preservative, in quantities ranging from 15 to 30 grains per lb. Cream.—24 samples were taken, all of which on examination proved genuine. 15 were free from preservative, while 9 contained boric acid in quantities ranging from 10 to 14.7 grains per lb. Coffee.—110 samples were examined. All were genuine. Mustard.—Of the 30 samples examined, 2 contained 10 per cent, of starch each. Solac.—One sample of this preparation of vegetable milk was examined and gave the following results. Sp. Gr. Fat. Total Solids. Solids (not fat). 1015 3.1 7.74 4.64 It is a vegetable product made from the soya bean. The "solids (not fat)" of this preparation compare unfavourably with those of a normal milk, the legal minimum for which is 8.5 per cent, for the solids not fat. On the other hand, when made from the powder the quality could be improved by reducing the amount of water used. Green Peas.—Nine samples were examined and all contained small amounts of tin, the highest amount being 1.6 grains per lb. It is usually accepted that anything under 2 grains per lb. is not harmful to the individual, but it may be permissible to doubt if some may not react more readily to this substance than others, and, if so, this may account for some of the gastric and other troubles which so frequently occur, and which are so difficult to account for. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1921 was 1,939*, being 278 less than in 1920. Of the children born, 996 were boys and 943 girls. The birth rate per 1,000 of the population was 18*4 as against 21*5 in 1920. * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 217 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 83 ,, Females 89 Illegitimate Males 26 ,, Females 19 30 The rates in the several registration sub-districts and the Borough were:— All Souls, 14.8; St. Mary, 15.5; Christ Church, 22.1; St. John, 22.0. Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,606: Live births, 3,445; Still births, 161. 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 105 2.9 „ doctors 398 ll.O „ midwives 702 19.5 „ other persons 265 7.4 „ hospitals, etc. 2,136 59.2 3,606 Of the total births notified, 161 referred to still-births (99 males and 62 females): 1,466 took place at Queen Charlotte's Hospital; 520 at Middlesex Hospital; 150 at the Workhouse: and 1,406 were born at home. Of those notified as having occurred in St. Marylebone, 1,667 belonged to other Boroughs. DEATHS AND DEATH RATES. The number of deaths registered in 1921 was 1,355. 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 12'8. In the previous year, the rate was 12'7 and the number of deaths 1,299. The following short table shows the death rates in the several registration sub-districts in 1921 and compares them with those of the preceding 5 years:— 1916 1917 1918 1919 1920 1921 All Souls 13.7 11.9 14.8 12.9 9.9 10.2 St. Mary 14.9 16.4 15.9 15.3 13.2 12.0 Christ Church 18.8 21.4 23.2 18.5 14.2 14.0 St. John 16.5 17.4 19.8 17.0 13.6 16.0 The Borough 16.0 17.0 18.5 15.9 12.7 12.8 District births and deaths for the year ended 31st December, 1921, are given in the following table. A further table giving the vital statistics of separate localities for 1921 and the ten preceding years, will be found amongst the Ministry of Health Tables on page 63. * A definition of the term " corrected death-rate " will be found on page 9 of the Report for 1912, 31 Sub-District. Population estimated to middle of 1921. Males. Births. Males. Deaths. Females. Total. Females. Total. All Souls 26,184 209 181 390 133 135 268 St. Mary 28,709 231 214 445 162 183 345 Christ Church 32,445 358 362 720 253 202 455 St. John 17,862 198 186 384 116 171 287 The Borough 105,200 996 943 1,939 664 691 1,355 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 1921. It will be seen that the heaviest incidence in both old and young falls in the first and last quarter. 1921 JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 39 26 31 32 128 Persons of 65 years and upwards 123 133 76 158 490 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 65. 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 1,020. 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 1921 was 128, and the number of births.in that year 1,939. The infantile mortality rate is therefore 66'0. Though this is not the lowest rate recorded for the Borough, being one point over that for 1920 (65 per 1,000), it must nevertheless be regarded as the most remarkable of all the rates. A year of phenomenal drought, it was generally anticipated that it would be marked by an excessive mortality amongst infants, particularly from diarrhoea and diarrhceal infections. This view was based upon experience, especially upon the happenings of 1911, when the summer was characterised by conditions resembling those that occurred in 1921. In the former year, in spite of the efforts made, the rate reached to nearly 110; in 1921 with conditions almost as bad as regards weather and worse, because of strikes and unemployment, in other respects, the rate reached was practically that of the most favourable year on record. If, as is commonly stated, the rate of infantile mortality is the finest index of the sanitary condition of and the health work done in a district, it may be taken that St. Marylebone occupies a distinctly high position in these respects. Amongst London Boroughs, as a matter of fact, she 32 stands sixth, having above her, only such favoured districts as Stoke Newington and Lewisham and being well ahead of others, such as Hampstead (88), Paddington (92), Kensington (110) and Westminster (80). The rate for London as a whole was 80. The course which the rate has taken is graphically shown in the chart on page 34, which indicates clearly that the only really serious interruption to the decline was in 1917. The means adopted in the Borough with a view to bringing about a reduction 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 Welfare. This part being merely statistical, it is not proposed at this point to do more than give some sort of analysis of the figures relating to deaths amongst infants. Causes.—A Table (Ministry of Health Table I) will be found on page 33, 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 1921, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 52 were less than one month old when they died and 82 less than three months. The figures for 1920 were 64 and 92. 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 50 deaths, the same as in 1920. Diarrhcea and enteritis (7 and 8) accounted for 20 in 1920 and for 19 in 1921. Respiratory diseases, the third of the main causes, took 26 in 1920, and in 1921, 20. Amongst the other causes of death, those which call for mention are the commoner infectious diseases, which together led to 3 deaths among infants, all due to diphtheria. Three deaths were stated to be due to overlaying, 3 to tuberculosis, 1 to convulsions, and 1 to injury at birth. 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 56 deaths amongst infants. In 1920 the figure was 71. 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 months. Totals. All Souls 7 1 3 2 8 1 I 6 29 St. Mary 3 1 4 3 8 1 — 1 21 Christ Church 13 1 1 1 10 10 8 11 55 St. John 8 2 1 1 4 4 1 2 23 Totals 31 5 9 7 30 16 10 20 128 33 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 under4 Weeks. Total under 1 month. 1 and u nder 3 Months 3 and under6 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. Small-Pox 2 Chicken-Pox 3 Measles — — — — -7- — — — — — — — — ' — — 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Diphtheria and Croup 2 — 1 — 3 1 — 2 — 3 6 Whooping Cough — — — 1 1 1 — — 3 5 1 1 3 — 5 7 Diarrhcea 2 2 2 8 1 1 5 1 8 8' Enteritis 1 1 — — 2 3 3 2 1 11 3 o 4 2 11 9 r Tuberculous Meningitis — — — — — — — — 2 2 1 1 — — 2 10J Abdominal Tuberculosis — — — — — — — — — — — — — — — 11 Other Tuberculous Diseases 1 1 1 1 12 ( Congenital Malformation 2 1 — — 3 — — — — 3 — 1 2 — 3 13- Premature Birth 16 1 1 2 20 5 — — — 25 6 5 10 4 25 14 1 Atrophy, Debility and Marasmus 2 1 5 1 9 9 4 22 7 3 8 4 22 15 Atelectasis 2 — — 2 — — — — 2 — — — 2 2 16 Injury at Birth 1 — — — 1 — '— — — 1 — — — 1 1 17 Erysipelas 1 — 1 2 1 1 — — 2 18 Syphilis — — — — — o — — — — 1 — 1 19 Rickets -- — 20 Meningitis (not Tuberculous) _ 1 1 — 1 — i 21 Convulsions — i — — 1 — — — — 1 — — — 1 i 22 Gastritis — — 1 — 1 — — — — 1 — — — 1 i 23 Laryngitis 24 Bronchitis — — — — — — 1 1 — 2 — — 1 1 25 Pneumonia (all forms) 1 — 1 2 4 4 3 — 9 20 4 2 11 3 20 26 Suffocation, Overlying 2 — — — 2 1 — — — 3 1 1 — 1 3 27 Other Causes 4 — 1 1 6 1 2 3 1 13 3 2 7 1 13 Totals 31 5 9 7 52 30 16 10 20 128 29 21 55 23 128 Nett Births in the Year C Legitimate 1,862 Nett Deaths in the ( Legitimate Infants, 103 Year ] (.Illegitimate 77 ( Illegitimate Infants, 25 Total 1,939 Total 128 34 INFANTILE MORTALITY FIGURES. 35 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 65. 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 diarrhcea and enteritis (inflammation of the bowels), was 22, equal to 0'20 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants and in 1921, as a matter of fact, all those who died were less than 1 year of age, with the exception of two. In 1920 the deaths from diarrhceal diseases numbered 25, all the victims being babies. In 1921, therefore, there was a reduction in the total. Deaths from diarrhceal diseases always vary most markedly with the weather conditions, being higher when the summer is warm and dry, lower when it is cold and wet. They vary also with the sanitary condition of the district and the amount of welfare work done on behalf of infants. The year 1921, from the point of view of weather, was what might be called a " diarrhcea year," and definitely, though there may have been and probably were other factors at work, it is safe and right to claim that to some, even to a large, extent cases were remarkably few because during the year weltare and sanitary work, despite tremendous difficulties, was steadily gone on with. 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 22 from this most dreadful of all infant scourges. Particularly in relation to diarrhcea amongst children, a very great deal of educational work is done at the centres of the Health Society and in the homes by health visitors and inspectors, and during the year there was the usual wide distribution of special leaflets on diarrhoea, flies in relation to disease, etc. INFECTIOUS (COMMUNICABLE) DISEASES. The number of deaths due to each of the diseases included in this group is referred to when dealing specifically with the disease under the heading " Prevalence of and Control over Infectious Diseases." It is interesting to note here, however, that excluding influenza (which caused 1+ deaths), but including diarrhcea (22 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 diphtheria, 24 ; scarlet fever, 5 and whooping cough, 7. 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 117, which is less by 5 than the figure for 1920. 36 The great bulk of the 117 deaths, viz., 102, was due to phthisis. The number in 1920 was 94. Of the total number of deaths registered (1,355), the percentage due to phthisis was 7.5, as against 7.2 in 1920. The age periods at which the deaths occurred were : 2—5 years, 0 (0.0 per cent.); 5—15, 1 (1.2 per cent.); 15—25, 11 (11.0 per cent.) ; 25—45, 50 (49.1 per cent.); 45—65,33 (32.6 per cent.); 65 and over, 6 (6.1 per cent.). Below the age of two years, 1 death was certified as having occurred from this digease. 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 1916. 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. 1916 186 98,573 1.88 1917 169 92,796 1.82 1918 190 98,526 1.93 1919 116 97,953 1.18 1920 122 101,856 1.19 1921 117 105,200 1.11 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 305. This is higher by 29 than the figure (276) for 1920> The death rate was 2'8 per 1,000. In 1920 the rate was 2'7. The number of deaths certified to be due to bronchitis was 143 as against 140 in 1920. Of this number 95 were amongst persons aged 65 and upwards, and 36 amongst those of the age group 45—65. The deaths traceable to pneumonia numbered 141, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 29 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified was 55. Of the patients 15 were aged 25-45, the other age periods contributing smaller numbers. Further particulars with regard to distribution of the cases, both in relation to age and residence will be found in the table on page 65. 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 1025 and of cases nursed 49. After recovery, or if death unfortunately occurred, as soon as convenient thereafter, disinfection was carried out, 37 CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 154 and the death rate 1.46 per 1000 of the population. In 1920 the figures were lower, the total being 146 and the death rate 1.43 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 50 and under 50 under 60 60 and under 70 70 and upwards Totals Males 2 4 12 31 21 70 Females — 1 2 2 16 23 23 17 84 Totals — 1 2 4 20 35 54 38 154 Cancer.—Situation of the Disease. Parts of the body affected. Males Females Totals Face, Tongue, Jaw 7 7 Throat, Neck, Gullet 13 — 13 Stomach 16 10 26 Intestines 17 18 35 Liver 8 8 16 Breast — 18 18 Uterus and Generative Organs — 19 19 Various 9 11 20 . Totals 70 _ 84 154 ALCOHOLISM. There were 3 deaths certified during the year as due to alcoholism. Year after year the number so certified has been quite small, and in 1920 there were 4 deaths. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 6 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 42. The number in 1920 was 29. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1921 numbered 65. Of these 16 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 64. 38 The total number of notifications coming to hand was 1,157. The bulk of the notifications related to scarlet fever, which contributed 478 to the total. Other diseases in respect of which fairly large numbers of notifications were received were tuberculosis (271), diphtheria (239), and pneumonia (55). In 1920 the number of cases notified was 1,051. The notification rate (proportion to population of notified cases of infectious diseases) in 1921 was 10'9 per 1,000 as against 10'3 in 1920. Isolation of Cases.—As the following table shows, the number of cases removed was as high as usual:— Diphtheria 222 or 92.8 per cent, of the cases notified. Erysipelas 15 „ 32'6 „ „ „ Scarlet Fever 466 „ 97'4 „ „ „ Enteric and Paratyphoid Fever 9 „ 69'2 „ „ „ Cerebro-spinal Meningitis 4 ,, 80'0 ,, „ ,, Ophthalmia Neonatorum 4 „ 11'7. „ „ ,, Puerperal Fever 3 „ 75'0 „ „ ,, Tuberculosis 77 „ 28'4 „ „ „ Malaria 2 „ 66'6 „ ,, „ Pneumonia 20 „ 36'3 ,, „ „ The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £82 Is. Cd. equal to 15s. 7d. per 1,000 of the population. The cost and rate per 1,000 for each of the past 10 years, are shown in the following table:— Year. Amounts paid to Medical Practitioners Cost per 1,000 of Population. 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 1921 82 1 0 0 15 7 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 388 and referred to 537 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. 39 Diphtheria and Membranous Croup. Diphtheria was more prevalent in 1921 than in any year since 1901, the actual number of cases being 239. The number in 1920 was 119. Of the cases 24 died, and the case mortality rate was lO'O per cent. The number of cases per thousand of the population was 2'1. 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 12 it proved to be in the home of the patient; in 18 cases the source was a member of the family previously infected ; and in 10 cases in school. The number of swabs from doubtful cases submitted for bacteriological examination was 685. A positive result was returned in 78 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 79, just over double the number in 1920. In All Souls the number was 51, in St. Mary, 42, and in St. John, 67, As usual the age groups 1-5 and 5-15 were those most affected, 49 of the cases falling into the former and 109 into the latter group. Two 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., 49. These were all remedied after service of notices. Scarlet Fever. In many parts of London this disease was markedly epidemic and it is not suiprising, therefore, that the figure for 1921 was so high as 478. In 1920, when the disease was also epidemic, the figure reached 435. It has already been explained that scarlet fever tends to become epidemic at intervals of about 5 years, but to find a year showing anything like so large a number of cases it is necessary to go so far back as 1896. In having such a prevalence St. Marylebone did not differ from other Boroughs in the Metropolis, many of which were more seriously involved in the epidemic. The highest number of cases reported in any one week it may be noted was 28. The total deaths from scarlet fever numbered 5, and the number of deaths per cent, of the cases was 1.04. The districts to suffer most from this disease were Christ Church and St. Mary. In the former there were 199 cases and in the latter 118. In All Souls there were 81 and in St. John 80. As usual the majority of patients were children of school age, the age group, 5-15, giving nearly two-thirds (311) of the total. Of the remainder 80 were aged between 1 and 5 years. The source of infection was believed to be a previous case in the same family in 34 cases. In 11 cases a patient had been previously notified to be suffering in the same house, and in the neighbourhood, 12 cases. 40 Though it seemed probable that many of the children notified acquired their infection in school, it was only in 55 instances that a definite connection could be made out. Defects in sanitation to the number of 88 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 and Paratyphoid Fever. The Enteric Fever notifications received numbered 13. There were 3 deaths. Of Paratyphoid Fever there were 7 cases. All the patients recovered. Cerebro-Spinal Fever. There were 5 cases of this disease. Two were girls—one 8 and the other 5j months. The 3 male patients were 50 years, 28 years, and 6 months respectively. All died. Encephalitis Lethargica. Five cases of this disease were notified, 3 women and 2 men. Two of the patients died; of the remaining 3, two were found to be suffering from some condiition other than Encephalitis, while the third was discharged from hospital practically completely cured. Polio-Myelitis. The notifications numbered 2, one a boy, aged 8, and the other a girl of 10. The boy was discharged from hospital " improved" while the girl is still in hospital, suffering from Chorea (St. Vitus' Dance). Erysipelas. The notifications of erysipelas numbered 46, and there were 3 deaths. Puerperal Fever. The number of cases of this disease notified, viz., 4, was just about the average, as 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. 189 cases were however reported, 22 voluntarily by doctors and parents and 167 by school-teachers. There were no deaths. The course adopted in relation to the cases was the same as in previous years. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1921 the number of deaths registered as due to whooping cough was 7. In 1920 the number was 12. The arrangements with regard to nursing and hospital isolation are similar to those in the case of measles. Glanders and Anthrax. No cases were notified. 41 Infectious Diseases in Schools. The accompanying table shows the number of cases of measles, whooping cough, chicken-pox and the notifiable infectious diseases reported from Schools during 1921. schools. OJ u & .5 u £ 2 d. 5 •a . I I a- <u >-[£. h so I ° • a <d • k O o 2 o- o CO a) s s s 1 3 o u , T. All Souls, Foley Street 23 15 2 5 Barrett Street 1 — — — — — — Barrow Hill Road 62 43 — 5 18 21 Bell Street 59 19 — 7 5 10 18 Blandford Square 8 — — — 2 — — Capland Street 37 21 — 6 12 16 Catholic, Richmond Street 17 11 1 — 13 21 Christ Church, Lisson Grove 30 5 — 8 3 — 23 Convent, Little Union Place 6 — — — — 4 Special School, Grove Road 9 1 — — — — 7 Emmanuel, Aberdeen Place 11 1 — 1 — 10 7 Emmanuel, North Street 18 1 — — — — 7 Gateforth Street 27 13 — 8 1 10 9 Hampden Gurney, Upper Berkeley Street 11 1 — — 3 — 15 Homer Row, Catholic 9 — — 3 — 6 Polytechnic, Regent Street — 1 St. Andrew's, Wells Street 1 1 St. James', Marylebone Lane 3 3 — — — 2 — St. Luke's, Nutford Place 30 — — 1 1 — 20 St. Mark's, Violet Hill 14 7 — 3 — 15 22 St. Mark's, Marylebone Road 1 4 — — — — — St. Marylebone, High Street 40 11 — 3 16 9 23 St. Marylebone Grammar, Marylebone Road 1 — — — 1 — 3 St. Mary's, Crawford Street 34 — — — 4 17 25 St. Paul's, East Street 4 — — — — — 1 St. Paul's, Broadley Terrace 25 — — 2 2 20 19 St. Thomas', Orchard Street 35 — — — 4 3 6 St. Vincent, Lower Seymour Street — — — — 1 3 — Upper Marylebone Street 50 14 — 4 12 14 13 Schools out of Borough 37 1 5 9 17 Totals 603 184 — 43 69 167 308 42 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 wljple of 1921. The following table gives information with regard to the 34 cases notified. NUMBER OF CASE DATE NOTIFIED ONE OR BOTH EYES PERMANENTLY INJURED— IF SO, TO WHAT EXTENT? 1 10.1.21 Both eyes affected. Cured 2 17.1.21 Slight case. Cured 3 3.2.21 Slight case. Cured 4 16.2.21 Cured 5 5.3.21 Cured 6 7.3.21 Cured 7 8.3.21 Cured 8 11.3.21 Very slight. Died 13.3.21. Suffocation—Bronchial Catarrh 9 12.3.21 Cured 10 16.3.21 Cured 11 22.3.21 Cured 12 23.3.21 Cured 13 30.3.21 Very slight. Cured 14 11.4.21 Very slight. Cured 15 16.4.21 Very slight Cured 16 22.4.21 Right eye, slight. Cured 17 3.5.21 Slight case. Left Borough 18 10.5.21 Cured 19 18.5.21 Still under treatment 20 20.5.21 Very slight. Cured 21 21.5.21 Cured. Died 23.9.21. Syncope. Epileptiform fits, consequent upon thrush. Scabies and Marasmus. Natural. Inquest 22 2.6.21 Cured 23 17.6.21 Cured 24 30.6.21 Acute case. Died 3.8.21. (1) Premature Birth. (2) Ophthalmia Neonatorum 25 4.7.21 Slight case. Cured 26 8.7.21 Slight case. Cured 27 16.7.21 Cured 28 25.7.21 Cured 29 25.7.21 Cured 30 3.8.21 Cured 31 23.8.21 Cured 32 29.8.21 Slight case. Cured 33 5.9.21 Still under treatment 34 13.10.21 Cured INFLUENZA. This disease showed no epidemic tendencies during the year. The deaths certified as due to Influenza numbered 14 as against 18 in 1920. 43 PNEUMONIA. Figures with regard to notification will be found on page 64, and information as to methods of prevention, etc., adopted in relation to this disease will be found in previous reports. The services of the nurses were requisitioned in 49 cases and 1,025 visits were paid. TUBERCULOSIS. In all 271 notifications were received, 234 relating to pulmonary tuberculosis, the remainder (37) to cases in which structures other than the lungs were affected. The table given on page 44 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 20 as against 14 in 1920. From time to time reference is made to the difficulty associated with the obtaining of notifications sufficiently early, and the following figures are introduced because they are interesting in this connection. They relate, as will be seen, to cases in which death had taken place before the fact that the individual was suffering from the disease had been brought to the notice of the Medical Officer of Health, as required by the regulations :— 1920 1921 1. Total number of deaths from tuberculosis in the Borough 122 117 2. The number of cases only notified at death 7 1 3. The number of cases notified within a month of death 9 7 4. The number of cases notified within three months of death 12 9 5. The number of cases notified within six months of death 8 12 In collating these figures it has been ascertained that of the 122 deaths in 1920 46 were certified at death only and were not notified; the majority dying in Mental Hospitals. The same remark applies to 1921, when 32 cases were certified on the death returns, which had not been previously notified. Treatment of Tuberculosis.—Of the cases notified 185 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 148 were insured persons: of these 81 were admitted to sanatorium or hospital treatment and 47 to the Infirmary. Non-insured persons numbered 117, of whom 51 (27 being children) received sanatorium treatment and 6 were admitted to the Infirmary. Nurses were sent in to 18 cases and 850 visits were paid. 44 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 2nd January, 1921, to the 31st December, 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 — I 2 5 9 10 30 29 27 11 3 127 159 1 6 4 U 11 20 69 „ Females — — 7 5 , 5 18 24 12 17 2 1 91 118 — 3 2 5 8 18 42 Non-pulmonary, Males — 3 4 2 3 1 — 2 — — — 15 16 1 2 — 3 4 — 4 ,, Females 1 3 5 3 2 3 1 — — — 18 19 — 1 — 1 2 — 6 Totals — 5 16 17 20 31 57 44 44 13 4 251 312 2 12 6 20 25 38 121 45 Prevention of Tuberculosis. — Early in the year the Committee of the Tuberculosis Dispensary, 111, Marylebone Road, which for a number of years had formed a large part of the Council's scheme for combating tuberculosis, finding it impossible to obtain the funds necessary for continuing operations on a voluntary basis, approached the Council and offered to hand over the dispensary as a going concern. Of financial consideration there was practically none, the only request made being that the Council should endeavour to take over the officers attached to the institution. As these officers were highly trained and experienced and had in fact been part of the Council's scheme for a number of years and in everything but name officers of the Council, no hesitation was shown in accepting the suggestion of the Dispensary Committee when the Dispensary was formally taken over on 1st April, 1921. The opportunity presented by the transfer was taken to reorganize the whole of the Dispensary part of the scheme and to bring it into accordance with the requirements of the Ministry of Health and London County Council, both of which bodies had been for some time pressing for reorganization. In the case of St. Marylebone, this necessitated the termination of agreements with the Middlesex Hospital and Margaret Street Hospital. This was done with regret, having regard to the fact that both had gone to considerable trouble in order to make their arrangements fit into the Council's scheme. The co-operation had been carried on in the most friendly manner, with great smoothness and success. Both bodies offered every assistance in connection with the reorganization and in a very short time the Council was able to submit a scheme to the Ministry and London County Council which was purely municipal and entirely self-contained. In order to ensure proper attention to the preventive aspect of the work at the Dispensary, Dr. J. Donaldson Saner, who had been for some years tuberculosis officer under the Voluntary Committee of the Dispensary, was appointed Assistant Medical Officer of Health for Tuberculosis Purposes as well as Tuberculosis Officer and made an officer of the Council. Sister Bartleet, who also had been at the Dispensary, was placed upon the Council's staff in the Public Health Department, as was also Miss M. T. Challis, who had been Clerk - Dispenser for some time. Miss Baker, who had been on the Council's staff for a number of years, acting as Tuberculosis Visitor, remained in that position at the reorganization and with the others already named completed the staff whose duties were exclusively dealing with this disease. So far as the working of the Dispensary was concerned, comparatively little change was necessary in order tQ make it serve the needs of the whole borough instead of part only as in the past. Quite readily the new scheme was made to cover the work to be done and during the period between 1st April and the end of the year worked remarkably smoothly. Particulars with regard to patients dealt with during the year are shown in a table at page 47. It may be mentioned, however, that in addition to work done at the Dispensaries, 1,263 visits were paid by Miss Baker to the homes of patients and to 72 suspects. In addition the attendances of the inspector at the consultations numbered 182, at Middlesex Hospital 92, Margaret Street Hospital 58, and at the Anti-Tuberculosis Dispensary 32. The Tuberculosis Care Committee continued to meet fortnightly throughout the year, Dr. Saner, Miss Baker and Sister Bartleet attending and assisting in every way possible. The Open Air School in Regent's Park, which was established in 1911, the Dispensary Committee agreed to continue to run after the taking over of the remainder of their work by the Borough Council. The fact that they were willing to do so was greatly appreciated by the Council, who consider the work most valuable. The number of children on the roll was 27—14 boys and 13 girls—and the attendances numbered 7,922. Dr. Saner, who has been Medical Officer of the School since he took office at the Dispensary, continues to act in this capacity. 46 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 426 as against 440 in 1920. Of these, 83 were found to contain the bacillus of consumption, while the remainder were free. Non-Pultnonarv Tuberculosis.—The great bulk of the total notifications—37 as against 44 in 1920—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 50. The following short note by the Tuberculosis Officer (Dr. Saner) contains reference to a number of points that' may be of interest. It relates to the period following the taking over of the Dispensary and its incorporation with the Public Health Department. " So far the Dispensary Premises have been adequate to cope with the number of patients attending. Under the voluntary system many more patients were kept under observation, but now these suspect cases are examined and according to their condition requested to attend in 1, 2, or 3 months as the case may be for further consultation. This arrangement works satisfactorily and accounts for the drop in the number of attendances recorded in past years. The main figures for the year are embodied in the Report of the Medical Officer of Health ; it may be noted, however, that during the year about 128 patients have received Institutional treatment through the London County Council, the Invalid Children's Aid Association or the Guardians. A certain number of advanced cases remain in their homes chiefly because they refuse to take advantage of the St. Marylebone Hospital, the only Institution to which patients in this stage of the disease are readily admitted. The nursing of those who remain at home is undertaken by the District Nursing Association under the supervision of Miss Marsters. Perhaps the most difficult part of the problem of prevention of tuberculosis lies in relation to the advanced case. As a rule it is impossible to isolate the patient from the rest of the family, especially during sleeping hours, owing to the lack of room and beds and all that can be done in addition to providing nursing is to give advice and instructions, and to visit periodically to see that the instructions are being carried out as fully as possible. The Care Committee meets fortnightly to consider the cases for treatment at Institutions and to assess the amount of payment required, which as a rule is according to income. Necessitous cases are also dealt with and referred to the Charity Organization Society, or the Guardians for assistance. The Charity Organization Society also assist patients returning from Sanatorium to obtain suitable employment. So far as regards the occupation of patients attending the Dispensary it may be noted that whereas most of the ordinary trades are represented, except in the cases of porters (8), clerks (7), and labourers (5) on the male side, housewives (11) and domestic servants (10) on the female, there appears to be no particular involvement of any class of employment. Among children definitely affected there were 3 boys and 5 girls. It is difficult to explain why housewives and servants should predominate, though it is notorious that during the War there was a very definite increase in the number of cases amongst women. The importance of the fact in relation to spread of infection is obvious." 47 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, 1921, to the 31st December, 1921, 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, 1921, to the 31st December 1921, at or in connection with the Dispensary and where:— Number of Per sons diagnosed to be suffering from Tuberculosis who were treated or supervised at or in connection with the Dispensary during the period from 1st January, 1921, to 31st December, 1921. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1921. Number of Persons ret erred for diagnosis or treatment to the Hospital with which the Dispensary is affiliated during the period 1st January, 1921. to 31st December, 1921. 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, 9.30—5 Tuesday, 9.30—5 Wednes., 9.30—5 Thursday, 9.30—9 Friday, 9.30—5 Saturday, 9.30—1 146 179 131 199 257 295 511 266 491 2 — * Margaret Street Hospital for Consumption. Dr. G. C. Thomas Dr. W. A.Milligan Dr. D.M.Barcroft Dr. J. C. McClure Dr. Nathan Raw Dr. R. M. Chance Dr. H. A. Ellis Dr. F. E. Gunta 1st April, 1916. Daily 1.30 p.m. until such time as is necessary. 7 18 11 13 23 9 6 31 51 — — * Middlesex Hospital. Dr. T. P. Williams 1st April, 1916. Daily, 1.30. Wednesday, 6 p.m. 2 2 2 5 1 11 4 18 20 — — Totals 155 199 144 217 281 315 521 315 562 2 — * Ceased to be part of Councils Scheme on 31st March, 1921. All figures from these institutions relate to work done between 1st January and 31st March, 1921. 48 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT 1. Name of Hospital to which Special Cases are referred from the Dispensary or Dispensaries for diagnosis or treatment Middlesex Hospital. 2. Is any provision for the home nursing of Tuber- culous Patients made in connection with the Dispensary or Dispensaries ? If so District Nursing Association. (1) State the general nature of the arrangement (1) The Superintendent is notified. (2) What qualifications are the Nurses required to possess ? (2) Fully trained. (3) Do they carry out other work ? If so, what ? (3) Yes, District Nursing. (4) Are their services available for Insured and Uninsured Patients ? (4) Yes. (5) If so (a) by what procedure are their services secured for individual patients ? (5) (a) As above. (6) Under whose instructions do they perform (b) Superintendent and Medical Officer, the actual duties of nursing in an individual case ? 3. If no provision of nursing is made in connection with the Dispensary or Dispensaries is any such provision contemplated ? If so, give particulars 4. State number of Shelters provided by the Council None or by the Dispensary Authorities up to 31st December, 1921, 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 1921, the total number certified as due to this cause was 102, the deathrate being 0.9 per 1,000. Christ Church, though, as usual, it heads the list, was the district in which the fall that brought about the general reduction took place. 49 Deaths from Phthisis. Five years—1917-1921. Estimated Population. Year. All Ages. Sub-Districts. All Souls St. Mary. Christ Church. St. John. 92,796 1917 137 29 30 48 30 98,526 1918 167 45 39 60 23 97,953 1919 104 12 27 53 12 101,856 1920 94 14 28 38 14 105,200 1921 102 24 24 40 14 The distribution of the 102 deaths was as follows:—In Poor Law Institutions, 33; general and other hospitals, 36; at home, 32; and in the street, 1. Of those who died 61 were insured (49 males and 12 females), and 41 uninsured (12 males and 29 females). As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 102 the notified cases of pulmonary tuberculosis totalled 234. 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 — 3 8 10 17 11 5 1 55 Females 1 3 13 11 14 3 1 1 47 Totals 1 6 21 21 31 14 6 2 102 50 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 31ST DECEMBER, 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 234 — 2 33 43 95 57 4 43 60 92 39 234 17 20 20 5 62 172 Glands 17 ... 2 8 4 3 ... ... 6 3 3 5 17 2 ... 1 3 6 11 Peritoneum 6 ... ... 5 1 ... ... ... 1 3 1 1 6 1 2 1 1 5 1 Skin 1 ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 Kidney 1 ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... ... ... 1 Intestine 1 ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Ulna 1 ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 Thigh 1 ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... Abdomen 2 ... ... 2 ... ... ... ... 1 ... 1 ... 2 ... ... ... ... ... 2 Meninges 3 ... 2 ... 1 ... ... ... 1 ... 1 1 3 ... ... ... ... ... 3 Spine 3 ... 1 ... 2 ... ... ... ... 2 ... 1 3 ... 2 ... ... 3 ... Hip 1 ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 Totals 271 ... 7 50 52 101 57 4 53 69 100 49 271 20 24 23 10 77 194 271 51 DISINFECTION. The work done in this connection during 1921 is shown in the following tables. The methods employed during the greater part of the time were substantially the same as in previous years, articles suitable for treatment by steam were dealt with in the Washington Lyons Disinfector, while for rooms either formalin or sulphur was generally employed. The number and nature of the articles disinfected are shown hereunder:— Compulsorily Notifiable Diseases. Phthisis. Measles. Vermin. Other causes. Total. Beds 408 18 - 3 4 433 Mattresses 720 19 - 37 111 887 Bolsters 353 24 - 19 43 439 Pillows 1,625 51 - 59 305 2,040 Sheets 926 40 - 18 20 1,004 Blankets 1,470 47 - 34 101 1,652 Sundries 8,468 658 2 456 127 9 711 Totals 13,970 857 2 626 711 16,166 In 1920, the number of articles disinfected was 17,821. The number of journeys made by the disinfecting vans during the year ended December, 1921, was as under:— January 68 August 71 February 64 September 70 March 68 October 68 April 66 November 70 May 68 December 67 June 70 — July 69 819 The vans were used 836 times in 1920. 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 63 9 6 3 4 85 February 70 9 1 2 — 82 March 58 12 1 — — 73 April 38 12 1 — 4 57 May 74 11 1 — 5 91 June 69 10 — 1 2 82 July 82 11 1 3 97 August 57 22 1 9 4 93 September 98 7 — 4 3 112 October 137 6 — 3 — 146 November 112 9 1 8 130 December 73 7 1 — 7 88 Totals 931 125 13 25 42 1,136 The number of rooms disinfected in 1920 was 1,141. 52 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 each month during the year 1921, and annually since 1910:— 1921. Adults. Children. Males. Females. Total. Males. Females. Total. January 310 90 400 72 156 228 February 278 92 370 115 252 367 March 303 95 398 88 240 328 April 297 121 418 48 278 326 May 283 103 386 83 305 388 June 286 132 418 77 259 336 July 343 107 450 71 262 333 August 239 94 333 16 45 61 September 308 112 420 18 386 404 October 323 146 469 75 277 352 November 265 95 360 36 209 245 December 251 100 351 16 133 149 Totals 3,486 1,287 4,773 715 2,802 3,517 Cleansing Station Attendances, 1910-1921. Year. adults. children. Males. Females. Total. Males. Females. Total. 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 2,802 3,861 1921 3,486 1,287 4,773 715 2,802 3,517 The total attendances since the Baths were opened in 1898 number 200,795 (adults, 151,131; children, 49,664). BACTERIOLOGICAL EXAMINATIONS. 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. The work, as formerly, was carried out by Dr. Foulerton, at University College Hospital. 1921 Positive. Negative Total. Typhoid fever 5 9 14 Diphtheria 78 607 685 Phthisis 83 343 426 Totals 166 959 1,125 53 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. During the year the Council made a special grant of £500 in aid of the work of the Society. Apart from the Health Society, however, there are other bodies that assist, and that are more or less definitely linked up to the main scheme, the connecting link being the Public Health Department of the Council. Amongst these bodies may be mentioned Queen Charlotte's Hospital and Middlesex Hospital, which in addition to providing lying-in accommodation, arrange for attention to be given to out-door patients as well, and conduct ante-natal clinics and infant consultations. At the Western General Dispensary the special clinic for children under Dr. Bernard Myers does 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 1921. 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 1921 the health visitors made 9,448 visits to infants, and the voluntary visitors attached to the schools for mothers made 1,111 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 Mothercraft, Salisbury Street, has an ante- and post-natal consultation 54 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.1. Infant consultations are held weekly under medical supervision. The Council's health visitors attend. There are also classes weekly in cookery, needlework and hygiene.—(4) Barrow Hill Road. Infant consultations under medical supervision are held weekly at the day nursery here. The health visitors co-operate and one of the nurses of the day nursery gives part time to health visiting.-—(5) 101, Crawford Street. Infant consultations under medical supervision are held weekly. There are also classes for nursing, etc. One of the health visitors is specially attached to this centre and acts as superintendent. In addition to these centres consultations are held weekly at Queen Charlotte's Hospital, 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 1921 was 2,136, the total births numbering 3,606. 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 1921 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 1921 also made a grant of £l,000. Work done during 1921.—The following table gives some idea of the workdone at the various centres during the year. The method adopted in relation to the granting of orders for milk and food under the Milk (Mothers and Children) Act, 1918, is fully detailed in the reports for 1919 and 1920, and need not again be discussed. The total number of orders issued is shown in the table. 55 STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE YEAR ENDING 31ST DECEMBER, 1921. CENTRE. Barrow Hill Road. No. 14 Salisbury Street. Queen Charlotte's Hospl. No 101 Crawford Street. No. 30 Marylebone Lane. No. 8 Ogle Mews. The Middlesex Hospl. The Westn. Genl. Dispy. * The Church Army Dispy. No. of consultations held 50 280 (232 children 48 maternity) 308 (256 antenatal 52 infants) 100 98 50 134 86 27 No. of attendances of mothers at ante - natal clinic 616 7255 46 17 No. of attendances of babies 1178 4560 1283 1865 1784 1115 2784 422 300 No. of attendances of children over 2 years 79 868 33 201 151 132 996 1412 32 No. of orders issued for milk, etc. 308 2245 254 433 110 63 176 25 4 No. of home visits 440 4652 852 861 794 545 1427 24 148 No. of new cases 125 510 4068 154 156 78 302 309 23 * Consultation at this Dispensary was first held in May, 1921. The St. Marylebone Babies' Nursing Home, 20, Marlborough Place, N.W.8 Admissions 44. Discharges 38. Deaths 1 Average number in the Home throughout the year 11 (Home closed during February and re-opened 22nd March.) Day Nurseries—Attendances during the year. St. John's Wood, Barrow Hill Road 6738 Portman, Exeter Street 7015 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 and were well known to the health visitors, who also noted the cases in which assistance was required. The number of cases in which home helps were employed in 1921 was 22. The average time for which the help was required was 6 weeks (the longest being 16 weeks) and the shortest 10 days. The total amount expended during the financial year to 31st March, 1922, was £35 11s. 0d., the payments made to the helps being at the rate of 25/- per week, part of which in most cases was paid by the person receiving the assistance of the Home Help. 56 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, 1921. 1921. Males. Females. Total. For burial only. For inquests. Total. No. of. P.M.'s held No. of courts held. No. of Infectious cases. January 11 11 22 15 7 22 4 4 — February 18 14 32 12 20 32 13 6 — March 16 8 24 12 12 24 8 5 — April 15 9 24 7 17 24 11 7 1 May 12 8 20 6 14 20 8 6 1 June 7 5 12 7 5 12 1 3 — July 11 9 20 14 6 20 4 4 1 August 11 9 20 10 10 20 7 4 — September 11 12 23 18 5 23 3 4 — October 9 5 14 8 6 14 6 5 1 November 17 15 32 15 17 32 11 7 1 December 23 18 41 21 20 41 10 7 1 Totals 161 123 284 145 139 284 86 62 6 The fact that there are caretakers (a man and his wife) at the Tuberculosis Dispensary has already been noted. In addition to looking after the premises these officers also render great assistance in connection with conduct of the clinics, taking notes, helping in the weighing of the patients, etc. (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. 57 (4) Arrangements for chemical and bacteriological work during the year and their results.—Full particulars with regard to these arrangements have been given under more appropriate headings. It may be noted at this point, however, that under the Rag Flock Act, 1911, 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. HOUSING. Under this heading it will probably be sufficient to say that there is little or nothing to be added to the information given in the reports for 1919 and 1920. So far as the Council's scheme in respect of the "Fisherton Street" site, the gift of Lord Portmati, is concerned, a certain amount of advance was made in the direction of obtaining approval from the Ministry. A considerable number of the tenants were moved out into houses in Exeter Street and Ashmill Street, etc., that had been put into a habitable condition for them, and the premises vacated were prepared for demolition. A house-to-house inspection of the occupied houses on the site was carried out and, with the permission of the Council, the Housing Committee are making an effort to put them into a proper state of repair. Table A contains the information asked for by the Ministry. The Increase of Rent and Mortgage Interest (Restrictions; Act, 1920, so far as regards the provisions of Section 2 (2), relating to certificates as to suitability for occupation of houses, was comparatively little taken advantage of during the year, despite the fact that numbers of posters notifying the existence of these provisions were displayed at the Town Hall and elsewhere. The actual number of applications received was 7 and only in one case was it found possible to grant the certificate asked for. 58 Table A.—HOUSING. Statistics for the Twelve Months ended 31st December, 1921. 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). Obstructive 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. N umber of Representations. Buildings Removed. Representations under Consideration. Full Time. Part Time. — 1009 and 100 Tenements — 723 — — — — — — — 1 I 1 — — 1 — 59 GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 159 Cowhouses 3 Slaughterhouses 3 Offensive Trades 2 Ice Cream Premises 120 Bakehouses 70 Restaurant, Dining Room and Coffee Shop Kitchens 170 Hotel Kitchens 46 Pastrycooks and Tea Rooms 58 Fried Fish Shops 22 Fish Curers 5 Houses Let in Lodgings 1,152 Workshops and Workplaces 3,338 Total 5,148 Smoke Nuisances. Number of Observations 40 Number of Nuisances and Complaints 14 Number of Notices 4 Number of Summonses Nil / Housing of the Working Classes. Number of Houses inspected 1,009 Number of Houses dealt with under Section 15 of the Housing, Town Planning, etc., Act, 1909 Nil Tenements in blocks 100 Number of Representations by Number of Closing Orders Nil Householders Nil Number of Representations by Number of Houses included in Medical Officer Nil such Closing Orders Nil Number of Houses included in Number of Closing Orders such Representations Nil determined from year 1919 Nil Number of Houses remedied without Closing Orders Nil Number of Demolition Orders Nil Number of Houses demolished— (a) In pursuance of Orders 1 (b) Voluntarily 1 60 Obstructive Buildings. Number of Representations under Number of Buildings demolished 2 Section 38 of the Housing Act, 1890 Nil Number of Representations still under consideration Nil Number of Orders for repairs Number of Houses repaired by issued under Section 28 of the Local Authority Nil Housing Act, 1919 Nil Number of Houses closed on Notice by Owner that they could not be made fit Nil Total number of Houses in the Number of Houses occupied by Borough 21,400 the Working Classes 7,266 Number of Houses for the Working Classes— (a) Erected during year Nil (b) In course of erection Nil Mortuary. Number of bodies received 84 Number of Infectious bodies received 6 Disinfection. Number of rooms disinfected 1,136 Number of articles disinfected 16,166 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 3,486 1,287 715 2,802 8,290 Bakehouses. Number on register at end of 1921 70 Number above ground 5 Number underground 65 Number of inspections 201 Number of Notices 6 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1921 333 Number of Inspections 1,259 Number of Notices 26 Number of Prosecutions Nil 61 House to House Inspections. Number of Inspections Houses 1,009 Tenements 100 Number of Notices issued Intimations 723 Statutory Notices 237 Number of Prosecutions Nil House Refuse. Number of Inspections 3,259 Number of Old Brick Receptacles abolished 17 Number of New Metal Receptacles provided 1,281 Number of Notices served (1,295 Intimations, 171 Statutory Notices) 1,466 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 32 Number of Statutory Notices served 13 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 1 Number remedied 1 Number of Prosecutions Nil Underground Rooms. Number dealt with 11 Number of Notices served under P. H. (L.) Act, 1891 Number of Notices served under H. T. P., &c., Act, 1909 11 Number of Prosecutions Nil Verminous Rooms. London County Council (General Powers) Act, 1904, Section 20 (1). Number of rooms cleansed 599 Number of Prosecutions 3 Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 9 Inland Revenue Act. Number of houses for which applications were received 1 Number of tenements comprised therein 6 Number of tenements for which certificates were granted 6 „ „ „ „ refused Nil „ „ „ „ deferred Nil 62 Drainage. The total number of inspections made 7,175 The total number of drainage plans deposited 335 The number relating to new buildings 24 „ „ old buildings 311 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops, and Cowsheds 376 Number of Inspections 1,259 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. MARYLEBONE. DURING 1921 AND PREVIOUS TEARS. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate. 1 2 3 4 5 6 7 8 8 10 11 12 13 1911 117,844 4,130 2,375 202 1,578 14.2 600 840 261 109.8 1,818 16.3 1912 116,155 4,111 2,246 193 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 2,128 187 1,631 15.1 813 787 210 98.6 1,605 14.9 1915 100,260 3,647 1,852 162 1,741 17.2 817 773 178 96.1 1,697 17.8 1916 98,573 3,936 1,814 168 1,681 16.9 855 720 188 103.6 1,588 16.0 1917 92,796 3,065 1,506 145 1,647 17.6 853 752 182 120.9 1,580 17.0 1918 98,526 3,340 1,375 124 1,852 18.7 898 879 152 110.5 1,835 18.5 1919 97,953 3,625 1,492 146 1,724 17.3 864 708 147 98.5 1,568 15.9 1920 101,856 4,287 2,217 215 1,638 16.0 939 600 145 65.6 1,299 12.7 1921 105,200 3,393 1,939 184 1,625 15.3 877 607 128 66.0 1,355 12.8 Total population at all ages at Census of 1921, 104,222. Area of district in acres (exclusive of area covered by water), 1427 8 acres. 63 TABLE I. (A) Vital Statistics of Separate Localities in 1921 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 i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. 1 Deaths under i year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1911 117,844 2,375 1,818 261 29,392 502 400 40 32,025 485 440 49 36,425 1,041 690 137 20,002 347 288 35 1912 118,135 2,246 1,635 209 28,971 452 379 45 31,566 453 411 30 35,903 971 588 108 19,715 370 257 26 1913 114,532 2,146 1,627 195 28,567 388 343 30 31,124 400 367 34 35,402 998 652 110 19,439 360 265 21 1914 112,892 2,128 1,605 210 28,158 435 317 36 30,678 418 388 33 34,895 937 630 113 19,161 338 270 28 1915 100,200 1,852 1,697 178 25,002 367 341 21 27,312 337 422 35 30,901 801 639 94 17,015 347 295 28 1916* 98,573 1,814 1,588 188 24,540 392 337 32 26,892 353 400 40 30,403 755 574 88 16,738 314 277 28 1917 92,796 1,506 1,580 182 23,089 332 275 28 25,334 248 416 41 28,621 618 614 87 15,752 308 275 26 1918 98,526 1,375 1,835 152 24,528 311 366 30 26,880 257 429 45 30,391 522 708 58 16,727 285 332 19 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 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 Averages of Years 1911 to 1920 105,136 1,915 1,625 186 26,197 394 332 31 28,636 366 404 36 32,455 816 610 92 17,847 338 277 25 1921 105,200 1,939 1,355 128 26,184 390 268 29 28,709 445 345 21 32,415 720 455 55 17,862 384 287 23 * The Christ Church and St. John Registration Sub-Districts were amalgamated and re-named Northern Sub-District on the 1st April, 1916, but for the purposes of District comparison over previous years the figures have been allocated to the old Sub-Districts. 64 table ii. Cases of Infectious Disease notified during the 52 weeks ending 31st December, 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 all ages. At ages—years. All Souls St. Mary Christ Church St. John Totals. All Souls St. Mary Christ Church St. John Totals Under 1 1 to 6 5 to 15 15 to 25 25 to 46 45 to 65 65 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 239 11 49 109 35 31 4 ... 51 42 79 67 239 45 41 77 59 222 17 Erysipelas 46 1 2 7 3 11 13 9 9 15 17 5 46 4 7 2 2 15 31 Scarlet Fever 478 4 80 311 50 33 ... ... 81 118 199 80 478 80 115 194 77 466 12 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 6 ... ... 1 1 3 1 ... 3 1 1 1 6 2 1 1 ... 4 2 Paratyphoid Fever 7 ... ... 1 1 3 2 ... 2 2 2 1 7 2 ... 2 1 5 2 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... ... 1 3 ... ... 1 1 1 1 4 1 ... 1 1 3 1 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 5 2 1 ... ... 1 1 ... 1 l 2 1 5 ... 1 2 1 4 1 Tuberculosis Pulmonary 234 ... 2 34 42 95 57 4 43 60 92 39 234 17 20 20 5 62 172 Non-Pulmonary 37 ... 5 17 9 6 ... ... 10 9 8 10 37 3 4 3 5 15 22 Acute Poliomyelitis 2 ... ... 2 ... ... ... ... 1 ... ... 1 2 ... ... ... 1 1 1 Polio-Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 34 34 ... ... ... ... ... ... 14 9 8 3 34 2 1 1 ... 4 30 Encephalitis Lethargica 5 ... ... ... ... 4 1 ... ... 3 1 1 5 1 2 2 1 4 1 Pneumonia 55 4 10 10 3 15 8 5 13 6 21 15 53 1 1 g 10 20 35 Malaria 3 ... ... ... ... ... 3 ... 2 ... 1 ... 3 1 ... 1 ... 2 1 Dysentery 2 ... ... ... ... 2 ... ... ... 1 1 ... 2 ... ... ... ... ... 2 Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1157 56 149 492 145 207 90 18 231 268 433 225 1157 158 193 313 163 827 330 1157 65 TABLE III.—Causes of, and Ages at Death during the year ending 31st December, 1921. No. CAUSES OF DEATH. Netdeaths 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 2b. 25 and ; under 45. 45 and under 65. (55 and upwards. 1 Enteric Fever 3 — — — — — 2 1 — 1 2 — — 1 3 2 Small Pox — — — — — — — — — — — — — — — 3 Measles — — — — — — — — — — — — — — — 4 Scarlet Fever 5 — 1 2 1 — 1 — — — — 2 3 — 5 5 Whooping Cough 7 5 1 — 1 — — — — 1 2 2 3 — 7 6 Diphtheria and Croup 24 '6 3 9 8 i — — — 2 3 3 10 8 24 7 Influenza 14 — — — — 1 1 9 3 7 3 4 4 3 14 8 Erysipelas 3 2 — — — — — 1 — 1 1 1 — 1 3 9 Phthisis (Pulmonary Tuberculosis) 102 1 — — 1 11 50 33 6 13 24 24 40 14 102 10 Tuberculous Meningitis 6 1 1 1 — — — 1 10 1 1 2 2 6 11 Other Tuberculous Diseases 9 — 1 1 1 i 3 2 6 2 2 4 1 9 12 Cancer 154 — — — — 1 11 76 66 314 31 46 49 28 154 13 Rheumatic Fever 1 — — — — — — — 1 2 — — 1 — 1 14 Meningitis 7 1 1 1 2 — — — 2 5 1 1 3 2 7 15 Organic Heart Disease 136 1 — 1 2 5 6 58 68 60 18 40 42 36 136 16 Bronchitis 143 2 — — — 2 8 36 95 29 27 35 50 31 143 17 Pneumonia (all forms) 141 21 8 2 3 3 1C 49 89 58 26 31 64 20 141 18 Other Diseases of Respiratory Organs 21 — 1 — — — o 12 6 10 2 7 7 5 21 19 Diarrhoea and Enteritis (under 2 years) 22 20 2 — — — — — — 42 5 3 10 4 oj 20 Appendicitis and Typhlitis 13 — — 2 1 1 2 5 2 22 5 2 3 3 13 21 Cirrhosis of Liver 6 — — — — — 1 3 2 3 1 — 2 3 6 21a Alcoholism 3 — — — — — 1 2 — 2 — 1 1 1 3 22 Nephritis and Bright's Disease 42 — — 1 1 2 3 20 15 30 12 6 13 11 42 23 Puerperal Fever 2 — — — — 1 1 — — — — 1 1 — 2 24 Other accidents and diseases of Pregnancy and Parturition 6 — — — — 2 4 — — 25 — 3 2 1 6 25 Congenital Debility and Malformation, including Premature Birth 52 51 1 — — — — — — 61 13 9 21 9 52 26 Violent Deaths, excluding Suicide 49 3 2 3 1 6 16 14 32 10 12 17 10 49 27 Suicides 16 — — — — 1 6 7 2 11 4 7 3 2 16 28 Other defined Causes 368 17 — 2 4 9 46 119 171 273 75 102 100 91 368 29 Diseases ill defined or unknown — — — — — — — — — — — — — — Totals 1355 128 22 26 28 44 167 450 490 1020 268 345 455 287 1355 66 VACCINATION RETURNS. Supplemental Return for 1920. return made to the Board of Guardians and Ministry of Health on the 9th February, 1922, by Mr. George H. Bassett, 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, 1920, 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, 1920. Number of these Births duly entered by 31st January, 1922, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1922, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1922, 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 1921. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of tne children to which they relate during the calendar year 1921. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, Unvaccinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had SmallPox. 1 2 3 4 6 6 7 8 9 10 11 12 13 1. North Marylebone 1,180 795 5 ... 213 42 21 27 39 38 2,306 2. St. Mary 2,358 1,648 2 ... 226 184 13 266 14 5 440 3. All Souls 752 538 2 ... 76 23 10 82 15 6 Total 4,290 2,981 9 ... 515 249 44 375 68 49 2,306 440 Dated 9th February, 1922. (Signed) GEORGE H. BASSETT, Vaccination Officer. .7 ■ i '