200 b ST MARY 27 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1922. 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. 1923. Telephone No: Mayfair 3003. Metropolitan Borough of St. Marylebone. Public Health Department. Town Hall Marylebone Road N.W. 1 ...............................................19................... Charles Porter. M.D., B.Sc. MEDICAL OFFICER OF HEALTH. WITH THE COMPLIMENTS OF THE MEDICAL OFFICER OF HEALTH. Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1922. 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 3. GEO. PULMAN & SONS, LTD., LONDON AND WEALDSTONE. Public Health Department, Town Hall, Marylebone Road, N.W.1. 30th June, 1923. 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 1922. It is on similar lines to that for 1921 and in accordance with the instructions of the Ministry of Health, I have made it little more than a chronicle of the principal happenings and statistical information of the year. There is no matter to which I desire to direct attention at this point, though I should like to take the opportunity of expressing my thanks to the Chairman (Mr. Alderman J. Fettes) and the members of the Public Health Committee for the kindness and consideration they showed me, and the help they gave me during the year. To the staff of the department also thanks and credit are due for excellent work done. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, CHARLES PORTER, Medical Officer of Health. CONTENTS. PAGE Foreword 7 Natural and Social Conditions of the Borough. Population. 8 Census 9-16 Sanitary circumstances 17 Water Supply 17 Drainage 17 Combined Drainage 17 Closet Accommodation 17 UndergroundPublic Conveniences 17 Removal and Disposal of House Refuse 18 Sanitary inspection of the District 18 Staff 18 Nuisances—Legal Proceedings 18, 20 Inspections 19 Rat Repression 20 Premises and Occupations controlled by By-laws and Regulations 20 Business Premises 21 Milk Premises 21 Cow Sheds 21 Slaughterhouses 21 Offensive Trades 22 Ice Cream Premises 22 Butter, Margarine, etc., Premises 22 Bakehouses 22 Fried Fish Vendors 22 Fish Curers _ 22 Factories and Workshops 22 Inspections 23 Defects found 23 Home Work 24 Registered Workshops 25 Other Matters 25 Premises used for Human Habitation 26 Houses let in lodgings 26 Common Lodging Houses 26 Underground Rooms 26 Premises that are not but should be Registered 27 Food Stalls 27 Food 27 Milk Supply 27 Milk Analysis 27 Legal proceedings for adulteration 27 Bacteriological examinations 28 Dairies, Cowsheds and Milkshops Orders 28 Milk and Cream Regulations 28 Milk for Mothers and Children 29 Food Inspections 29 Food, Unsound, Condemned 30 Sale of Food and Drugs Acts 30 Reports of Public Analyst during year 31-36 Statistical 37 Births 37 Births Registration 37 Births Notifications 37 Deaths and Death Rates 37 Sub-District Births and Deaths 38 Deaths in relation to Age 38 Causes of and ages at death. 38 PAGE Infantile Mortality 38-41 „ ,, Causes 39, 40 Deaths in relation to Disease 42 Diarrhceal Diseases 42 Infectious(Communicable) Diseases 42 Phthisis and other Tuberculous Diseases 42 Respiratory Diseases 43 Cancer or Malignant Disease 43 Alcoholism 44 Accident, Suicideand Manslaughter 44 Prevalence of and Control over Infectious Diseases 44 Isolation of Cases 45 Discharge Notices 45 Diphtheria and Membranous Croup 45 Scarlet Fever 46 Enteric and Paratyphoid Fever 47 Cerebro-Spinal Fever 47 Encephalitis Lethargica 47 Polio-Myelitis 47 Erysipelas 47 Puerperal Fever 47 Measles and German Measles 47 Whooping Cough 47 Glanders 47 Anthrax 47 Typhus Fever 48 In School 48 Ophthalmia Neonatorum 49 Influenza 50 Pneumonia 50 Tuberculosis 50 Treatment of 50 Notifications 51, 58 Prevention of 52 Bacteriological Diagnosis 53 Work at Dispensaries 54-56 Deaths 56 Disinfection 59 Cleansing of Persons Act, 1897 60 Bacteriological Examinations 61 Maternity and Child Welfare 61 Health Visitors 62 Centres 62 Ante-Natal Work 62 Dental Clinic 62 Hospital Treatment 62 Maternity Cases 62 Babies' Nursing Home 63 Infant Consultations—Work at 63 Day Nurseries 63 Home Helps 64 Sanitary Administration— Staff 64 Report of Mortuary Keeper 64 Housing— General Housing Conditions 65 Rent Act Certificates 65 Statistics 65-67 General Statistics 68 Extracts from Vital Statistics of the Year 68 General Summary 68-71 Ministry of Health. Tables I—III 72-76 Vaccination Returns 77 7 FOREWORD ON HEALTH PROPAGANDA. The practice introduced in the Annual Report for 1921 of opening with a " foreword " having met with approval it is proposed to repeat the experiment. Last year the object of the introductory remarks was to afford an opportunity of showing the advances that had taken place during the last half century. This year the foreword is written in order to give an opportunity of describing what is done to bring home to the individual the fact that hygiene is not all communal, but that each and everyone can do something for his own health and safety and has responsibilities in that connection. To have this grasped, propaganda methods of various kinds are resorted to by the Council through the Public Health Committee and the Health Department. Foremost amongst the schemes adopted may be noted the holding of "weeks" of various sorts. These have been celebrated annually for several years past, those in 1922 being: "Baby Week" (July I—7), "Health Week" (October 8—11), and "Rat Week" (November 6—11). During "Baby Week," which was inaugurated by the National Baby Week Council to arouse the public to a sense of the importance of safeguarding infant life, and to promote right ideas and ideals regarding maternity and child welfare, arrangements were made in conjunction with the St. Marylebone Health Society for throwing open to the general public the various schools of mothercraft and day nurseries. An "At Home" was held at one of the infant welfare centres, the Annual Meeting of the Health Society also took place, and a number of addresses were delivered-by members of the Public Health staff and others during the week. Special posters setting forth the arrangements were displayed throughout the Borough. "Health Week," organized by a Special Committee of the Royal Sanitary Institute, and having for its object the focussing of public attention for one week in the year on matters of health, opened with special sermons at a number of places of worship in the Borough. Throughout the week other meetings were held at which the Medical Officer of Health or one of the Health Visitors spoke, and leaflets and posters inviting the public to visit infant welfare centres, hospitals, dispensaries, municipal depots, and other local institutions, were widely distributed. During "Rat Week," held at the suggestion of the Ministry of Agriculture, the inhabitants of the Borough were notified, by means of special posters and leaflets, of the importance from the health point of view of rat and mouse destruction. Owners and occupiers of premises liable to infestation with rats were reminded of their responsibilitiy under the Rats and Mice (Destruction) Act, 1919, supplied with the latest bait recipes, and especially instructed as to methods to be adopted to rid their property of the vermin. In addition, circulars were sent to the occupiers of food premises (butchers, restaurants, grocers, dairies, provision dealers, fishmongers, etc.), property agents, large business houses and institutions, drawing their attention to, among other things, the menace to health which the presence of rats constitutes. Local chemists and proprietors of domestic stores were invited to exhibit posters and make a feature of rat poisons and traps respectively during the week. The sewers, though regularly baited, received additional attention, and a greatly increased number of barium carbonate baits were laid. Close co-operation with neighbouring boroughs was also secured in this direction. All the railway companies (above and below ground) having stations, yards, etc., in the Borough showed great activity in connection with their embankments, sidings, and warehouses, and the occupiers of the larger open areas (such as the Zoological Gardens and Lord's Cricket Ground) and the electricity works, all took suitable rat destructive measures. 8 The Medical Officer of Health attended a conference at the St. Pancras Town Hall on the subject, called by the Mayor of that Borough, and a similar meeting took place on the same day at Holborn. Since the Act of 1919 came into operation, and as result of the publicity given to the rat problem, a vast improvement has taken place and in all probability not only has the rat and mouse population of the Borough reached a point lower than any hitherto attained, but sanitary conditions in the premises dealt with have been bettered also. Every year the Medical Officer of Health is invited bv religious and other bodies to give lectures of a popular type on various aspects of health, and during the year under review a number of such addresses were given, including one to a large audience at the Presbyterian Church, Upper George Street. Under this heading may be mentioned also the several congresses and conferences held during the year, principal among which were those relating to Infant Welfare, and that of the Royal Sanitary Institute, to which the Medical Officer of Health or a member of the staff was appointed delegate. Much publicity is obtained by means of the series of leaflets and posters issued by the Public Health Department. These give advice on many matters of health, and include the precautions to be taken in regard to infectious diseases (measles, whooping cough, Epidemic (summer) diarrhoea, consumption, scarlet fever, diphtheria, enteric fever, venereal diseases, influenza, ophthalmia neonatorum). Others contain advice to expectant and nursing mothers; facts as to the dangers from flies; the need of rat destruction, and the methods of bringing this about. Posters and leaflets, inviting tenants of tenements to co-operate in the efforts to keep road- and footways clean, dealing with the nuisance caused by the fouling of footways by dogs and others, are also widely distributed. Finally, as an expression of the appreciation due to the Press for the great assistance rendered, it is gratifying to note that more and more space is given in the daily newspapers to matters of health interest, the local Press, particularly, being helpful, invariably showing a willingness to co-operate in all health propaganda schemes in the Borough by giving prominence to any matter of special interest to the inhabitants. THE YEAR 1922. POPULATION. The population of the Borough when the Census was taken on June 19th, 1921, was found to be 104,173, made up of 63,166 females and 41,007 males, the former thus exceeding the latter by 22,159. The tables, on pp. 9 to 16, which have been abstracted from the Report on the Census and are introduced into this report in accordance with previous practice, contain an analysis of the information obtained at the Census that should be found useful. 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 14,038. The population estimated to the middle of 1922 by the Registrar-General is shewn 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 set out, and for comparison the figures for 1921. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. 1921 104,173 24,956 26,680 32,428 20,109 1922 105,200 25,202 26,943 32,747 20,308 9 CENSUS OF ST. MARYLEBONE, 1921. TABLE 2.—Population and Intercensal Variations. Metropolitan Borough of St, Marylebone. Note, (a) War deaths which occurred outside the Country are included in column "m" as losses by migration. Estimates for individual districts are not available, but for the whole of England and Wales they have been assessed at about 3.1 percent, of the 1921 male population. Population Intercensal Variation 1901 1911 1921 1901 11 1911-21 District Persons Persons Males Females Persons Males Females Incr. or Dec. ( - ) Amount Inc. or Dec. (- ) E'xcess of Births over Deaths (- Deficiency) Cain or loss (-) by M ignation (see note (a)) Amount Per cent. Cols, a b c d e f k h i j k 1 m St. Marylebone 133,301 118,160 49,685 68,475 104,173 41,007 63,166 - 15,141 -13,987 -11.8 3,102 -17,089 TABI.E 3. Acreage, Population, Private Families and Dwellings. Metropolitan Borough ok St. Marylebone. Definitions. Private Family.—Any person or group of persons included in a separate return as being in separate occupation of any premises or part of premises is treated as a separate family for Census purposes, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i) Institutions or (ii), business establishments or Boarding-houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including' private domestic servants), Structurally Separate Dwellings. A structurally separate dwelling has been defined for the Census as any room or set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit; a private house which has not been structurally subdivided is similarly a single unit whether occupied by one family or by several families. But where a private house has been subdivided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. 10 Where an undivided private house is used partly for business or professional purposes, it is treated as occupied by a private family, unless the portion used for non-domestic purposes consists of at least three rooms and is more than one-quarter of the whole. The dwellings shown in this Table are those occupied by private families only. Rooms.—For the purpose of the Census the rooms enumerated are the usual living- rooms, including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office or shop rooms. Metropolitan Borough and Registration Reference Number. Area in Statute Acres (Land and Inland Water). Total Population Private Families and Dwellings (See definitions at beginning of table) 1911 1921 Private Families Population in Private Families Structurally Separate Dwellings Occupied Rooms Occupied Rooms per Person Persons Persons Males Females Persons per Acre Cols, a b c d e f g h i j k l St. Marylebone Met. B. and C.P. (7 :1-3) 1,473 118,160 104,173 41,007 63,166 71 27,214 90,495 17,137 103,145 1.14 No. 1 Hamilton Terrace (7 : 3) 274 9,688 10,129 3,413 6,716 37 2,851 9,397 2,267 15,100 1.61 No. 2 St. John's Wood Terrace (7 : 3) 132 10,369 9,980 4,152 5,828 76 2,748 9,561 1,577 10,282 1.08 No. 3 Church Street (7:3) 107 26,222 22,690 10,835 11,855 212 5,829 21,747 3,504 14,751 0.68 No. 4 Dorset Square & Regent's Park (7:3) 493 10,287 9,738 3,872 5,866 20 2,722 8,147 1,662 9,694 1.19 No. 5 Bryanston Square (7 : 2) 106 15,553 13,292 4,857 8,435 125 3,605 11,785 2,135 14,574 1.24 No. 6 Portman Square (7:2) 118 16,557 13,388 4,823 8,565 113 3,316 11,305 2,168 13,135 1.16 No. 7 Park Crescent (7 : 1) 105 13,205 12,446 4,513 7,933 119 3,335 9,906 1,723 13,800 1.39 No. 8 Langham (7 : 1) 66 10,162 8,855 3,094 5,761 134 1,997 6,569 1,578 9,035 1.38 No. 9 Cavendish (7 : 1) 72 6,117 3,655 1,448 2,207 51 811 2,078 523 2,774 1.33 TABLE 4.—Acreage, Population and Certain Age Groups.—Poor Law Unions or Parishes. Note.—The Poor Law Area is co-extensive with the Registration District except where otherwise indicated. Poor Law Union or Parish (and Registration Reference Number) Area in Statute Acres (Land and Inland Water) Population Age Groups (age last birthday) 1911 1921 Males Females Persons Persons Males Females Under 16 16-69 70 and over Under 16 16-69 70 and over Cols, a b c d e f g h i j k 1 St. Marylebone (7:1-3) 1,473 118,160 104,173 41,007 63,166 10,062 29,598 1,347 10,831 49,987 2,348 11 TABLE 5.—Population and Constitution by Metropolitan Borough.—Registration Districts and Sub-Districts. (See note to heading of Table 4.) Registration District and Civil Parish. Sub-District. Population 1921. 7. St. Marylebone 104,173 Population 1921 :— 1. All Souls (Part of St. Marylebone Met. B. and C.P.) 24,956 2. St. Mary ditto 26,630 3. North Marylebone ditto 52,537 TABLE 7.—Population and Parliamentary Electors (Autumn 1921 Register).—Parliamentary Constituencies. Note.—The Autumn 1921 Register is the half-yearly Register of Electors prepared in respect of the qualifying period of six month? ending on the 15th June, 1921. Parliamentary Constituency Area in Statute Acres. (Land and Inland Water). Population. Parliamentary Electors Autumn 1921 Register. Electors per 1,000 Population 1911 1921 Persons (all ages) Persons (all ages) Males aged 21 and over Females aged 30 and over Persons Males Females Males aged 21 and over Females aged 30 and over Cols, a b c d e f g h i j k St. Marylebone 1,473 118,166 104,173 27,643 34,518 46,339 24,125 22,214 873 644 TABLE 9.—Acreage; Population and Constitution by Metropolitan Borough. Petty Sessional Division Area in Statute Acres. (Land and Inland Water). Population 1921 Constitution St. Marylebone 1,473 104,173 St. Marylebone Metropolitan Borough 12 TABLE 10.—Buildings, Dwellings, Rooms and Families.—Metropolitan Borough of St. Marylebone. Note.—The following- table contains analyses of (1) the buildings and (2) the structurally separate dwellings of each area. In the upper part of each section the several classes (Groups 1-5) are analysed both in the left-hand columns (a-c) in respect of their characteristics as buildings, and in the right-hand columns (f-p) in respect of the dwellings which they comprise. In the lower part of each table the subjects of analysis on the left and right respectively are different; on the left the "buildings" analysis is continued in respect of an expanded classification of one of the five groups; while on the right the analysis according to dwellings is continued in respect of certain selected classes of private family occupations. Buildings.—(Left-hand columns (a-c)).—In the enumeration of buildings, a building has generally been regarded as a structure wholly detached or separated from another by a vertical party wall. A block of flats would be one building though there might be one or more separate flats on each floor. The allocation of buildings among the several classes shown in column (e) is based on the descriptions furnished by the local enumerators. The varieties of type encountered in the buildings enumerated have, however, inevitably given rise to some difference of practice on the part of enumerators in describing borderline cases; and the numbers of buildings assigned to the several classes in column (e) should, therefore, be regarded as approximate. The classification differs from that adopted in 1911 in the following respects:— (a) Structurally divided private houses are separately shown for the first time, with a view to affording an indication of the extent to which houses originally built for the occupation of single families have been structurally divided to' provide separate and independent accommodation for two or more families. There is evidence, in the returns, that it has not always been possible for enumerators to distinguish between buildings originally erected to comprise, e.g., maisonettes and those subsequently converted for the purpose. (b) Inns and Public Houses in which the business of the establishment is primarily that of retailing liquors are classed with shops (Group IV), instead of with Hotels (Group V), which are thus limited in the table to those of a residential character. Structurally Separate Dwellings (right-hand columns (f-p)).—Above the "total" line dwellings are classified according to the type of building in which they occur, while below the "total" line the same premises are classified according to> the number of families enumerated within them. Dwellings! "vacant" on Census night include those unoccupied through the temporary absence of the usual occupier as well as those without a tenant. The total rooms in dwellings occupied by private families as shown in the following table is usually slightly in excess of the total rooms occupied (Tables 3 and 11) owing to the fact that in certain dwellings inhabited by two or more families, part of the dwelling' was occupied on Census night. Definitions.—For definitions of "Private Family," "Structurally Separate Dwelling," and "Rooms," see note at the head of Table 3. 13 In course of erection Buildings Completed Population 1921 Dwellings occupied by non-private families (excluded from cols. g-P) Structurally Separate Dwellings occupied by Private Families or Vacant Vacant on Census Night Occupied by Caretaker 1—3 Rooms 4—5 Rooms 6—8 Rooms 9 or more Rooms Total Dwellings Total Rooms Not containing Dwellings Containing Dwellings {included in cols, k—p) Cols, a b c ,d e f g h k 1 m n o p 24 ... 7,151 54,505 I. Undivided Private Houses 173 247 52 319 958 2,351 3,350 6,978 64,586 ... ... 102 744 II. Structurally divided, Private Houses 1 30 2 104 82 57 13 256 1.181 6 ... 1,002 21,875 III. Blocks of Flats, Tenements, etc. 17 827 8 4,673 1,711 1,324 201 7,909 28,871 31 1,012 2,194 12,733 IV. Shops 27 96 5 318 665 872 312 2,167 12,984 6 938 1,386 14,316 V. Others 189 170 19 635 455 79 28 1,197 4,473 67 1,950 11,835 104,173 Total 407 1,370 86 6,049 3,871 4,683 3,904 18,507 112,095 Principal buildings in Group V (Others) above:— Vacant on Census night 530 399 294 147 1,370 6,854 - 554 116 436 Offices, Factories, Warehouses. Dwellings occupied by 1 private family 5,438 2,812 2,370 2,423 13,043 73,447 Workshops Dwellings occupied by 2 private families 69 453 635 241 1,338 9,232 — — 40 2,931 Hotels Dwellings occupied by 3 or more private families 12 207 1,384 1,093 2,696 22,562 2 113 5,031 Institutions — 41 7 30 Places of Worship Total Dwellings occupied by private families No. 5,519 3,472 4,389 3,757 17,137 105,241 % 32 20 26 22 100 — — 9 3 11 Places of Amusement Total private families therein 5,613 4,358 8,799 8,444 27,214 — TABLE 11.—Private Families Classified by Size of Family, Rooms Occupied and Density of Occupation.—Metropolitan Borough of St. Marylebone. Note.—The following table contains an analysis of the private families according to (a) the number of persons in the family, and (b) the number of rooms occupied by the family. 14 Where more than one family is enumerated within a structurally separate dwelling, each is classified according to the rooms it severally occupies and not to the total number of rooms in the dwelling'. If, as occasionally happens, one of the rooms is shared by two families (the allotment to each family being say 4½ and 3½ in an 8-roomed dwelling) the families are classified to the next higher integral number of rooms (5 and 4 respectively), but in arriving at the totals (column m, etc.), the actual figures (4½ and 3½) have been used. For definitions of "Private Family," "Structurally separate dwelling," and "Rooms," see note at heading of Table 3. Number of Persons in Family Number of Private Families occupying the following Number of Rooms Total Private Families Population in Private Families Rooms occupied Density of occupation Average Number of i Rooms per Person Population at following densities of occupation (rooms per person) X 2 3 4 5 6-7 8.9 io and over No. Per cent. Under 3 3 and under 5 5 and under 7 7 and under 10 Cols, a b C d e f g h i j k 1 m n o p q r 1 3,446 1,139 474 327 119 124 40 37 5,706 21.0 5,706 10,663 1.87 - _ 8 - 2 1,512 2,186 1,086 687 287 396 143 153 6,450 23.8 12,900 19,070 1.48 2 — 3,022 — 3 531 1,676 979 594 261 485 226 198 4,950 18.2 14,850 18,028 1 .21 — 1,593 5,028 — 4 187 1,091 747 519 203 383 223 250 3,603 13.2 14,412 15,195 1.05 748 4 4,360 2,988 5 69 617 505 33 7 131 249 188 280 2,376 8.7 11,880 11,670 0.98 345 3,085 2,525 1,685 6 21 354 310 245 115 182 139 264 1,630 6.0 9,780 9,183 0.94 126 2,124 3,330 690 7 4 205 217 167 59 78 75 230 1,035 3.8 7,245 6 366 0.87 1,463 1,519 1,169 686 8 2 103 102 93 42 35 39 181 597 2.2 4,776 4,288 0.90 840 816 1,080 280 9 1 45 58 81 21 31 12 134 383 1.4 3,447 2.999 0.87 414 1,251 360 180 10 1 11 36 51 7 14 10 85 215 0.8 2,150 1,944 0.90 120 870 160 150 11 2 2 18 15 5 8 7 62 119 0.4 1,309 1,308 1.00 242 220 88 110 12 — — 10 8 3 6 4 32 63 0.2 756 729 0.96 120 132 120 12 13 — 1 1 2 — 1 1 25 31 0.1 403 517 1.28 26 39 13 13 14 — — — — 1 1 — 16 18 0.1 252 312 1.24 — 28 — 28 15 and over - - - — 1 1 — 36 38 0.1 629 873 1.39 17 15 - 67 Total Private Families 5,776 7,430 4,543 3,126 1,225 1,994 1,107 1,983 27,214 l00.0 - - - - - - - Population in Private Families 9,367 22,921 16,504 12,153 4,763 7,687 4,853 12,247 — — 90,495 — — 4,463 11,696 21,264 6,889 Rooms occupied 5,772 14,859 13,629 12,504 6.275 12,823 9,255 28,028 — — — 103,145 114 — — 21.2 27.3 16.7 11.5 4.6 7.3 4.1 7.3 100.0 1921 Percentage of families living in various units of occupation 24.0 26.1 15.3 9.0 4.3 7.1 4.8 9.4 100.0 1911 „ „ „ „ „ 15 TABLE 12.—Institutions : Number, Total Population and Inmates of Certain Classes of Institutions and Other Special Premises.—Metropolitan Borough of St. Marylebone. Number of Institutions. Total Population. Inmates only (Classes 1-13). Persons. Males. Females. Persons. Males. Females. Workhouse, St. Marylebone Board of Guardians 1 1,014 507 507 973 498 475 Homes, etc., for the Blind 5 245 194 51 163 163 - Hospitals (not Naval or Military) 9 1,598 417 1,181 991 380 611 Convalescent and Nursing Homes 70 1,102 198 904 483 174 309 Military Barracks 1 90 73 17 — — — Inland Barges and Boats 1 2 2 - - - - TABLE 13.—Ages (Individual Years).—Metropolitan Borough of St. Marylebone. Age last birthday Males Females Age last birthday Males Females Age last birthday Males Females Age last birthday Males Females Age last birthday Males Females All ages 41,007 63,166 0 778 797 20 580 1,243 40 676 1,144 60 430 634 80 55 99 1 799 814 21 651 1,378 41 624 957 61 360 433 81 27 78 2 466 513 22 596 1,286 42 653 995 62 326 437 82 29 64 3 454 428 23 615 1,326 43 674 947 63 327 420 . 83 23 57 4 518 549 24 576 1,465 44 594 870 64 309 408 84 18 48 5 553 608 25 619 1,393 45 664 1,043 65 312 386 85 16 34 6 637 651 26 645 1,413 46 604 884 66 242 352 86 6 26 7 679 697 27 630 1,337 47 592 902 67 209 343 87 9 18 8 696 678 28 676 1,361 48 607 938 68 250 304 88 5 15 9 673 707 29 679 1,341 49 564 804 69 254 309 89 4 12 10 648 704 30 704 1,399 50 673 960 70 212 282 90 1 17 11 611 691 31 617 1,133 51 540 659 71 148 237 91 3 5 12 625 700 32 620 1,217 52 549 755 72 173 248 92 2 3 13 635 728 33 627 1,150 53 476 725 73 127 194 93 1 5 14 653 762 34 651 1,198 54 489 695 74 102 184 94 1 1 15 637 804 35 653 1,209 55 442 663 75 113 154 95 — 3 16 661 940 36 637 1,142 56 460 601 76 78 181 96 — 3 17 711 988 37 588 1,153 57 425 556 77 79 140 97 — 1 18 689 1,106 38 660 1,212 58 415 628 78 52 127 98 1 — 19 661 1,240 39 713 1,116 59 399 519 79 62 111 99 — 1 100 and over - - 16 TABLE 14.—Ages (Quinquennial Groups) and Marital Conditions.—Numbers and Percentages.—Metropolitan Borough of St. Marylebone. Age last Birthday Persons Males Females Percentages Total Single Married Widowed Divorced Total Single Married Widowed Divorced Males Females All ages. No. Sex Percentages 104,173 41,007 21,451 17,866 1,598 92 63,166 37,809 18,709 6,492 156 39.4 60.6 % Age Percentages ... 100.0 52.3 43.6 3.9 0.2 1000 59.9 29.6 10.3 0.2 100.0 100.0 0-4 6,116 3,015 3,015 - - - 3 101 3,101 - - - 7.4 4.9 5-9 6,579 3,238 3,238 - - - 3,341 3,341 3,341 - - 7.9 5.3 10-14 6,757 3,172 3,172 - - - 3,585 3,585 - - 7.7 5.7 15-19 ... 8,437 3,359 3,344 1 5 5,078 5,013 - - 8.1 8.0 20-24 ... 9,716 3,018 2,514 503 1 6,698 5,602 62 1,072 3 3 7.4 10.6 25-29 ... 10,094 3,249 1,672 1,546 23 8 6,845 4, 373 2,301 21 21 7.9 10.9 30-34 ... 9,316 3,219 987 2,183 34 15 6,097 3,088 2,682 150 27 7.8 9.7 35-39 ... 9,083 3,251 709 2,480 51 11 5,832 2,444 2,951 300 3 7.9 9.2 40-44 ... 8,134 3,221 626 2 482 92 21 4,913 1,894 2,534 406 28 7.9 7.8 45-49 ... 7,602 3,031 505 2,387 126 13 4,571 1,613 2,309 457 633 16 7.4 7.2 50 54 ... 6,521 2 727 494 2,059 164 10 3,794 1,232 1,816 732 14 6.7 6.0 55-59 ... 5,078 2,141 388 1,557 188 8 2,937 833 1,268 825 11 5.2 4.7 60-64 ... 4,084 1,752 327 1,205 219 1 2,332 657 846 825 4 4.3 3.7 65-69 ... 2,961 1,267 232 779 255 1 1 694 439 494 760 1 3.1 2.7 70-74 ... 1,907 762 135 407 218 2 1,145 292 254 599 - 1.9 1.8 75-79 ... 1,097 384 66 190 127 1 713 183 83 447 - 0.9 1.1 80-84 ... 498 152 20 59 72 1 346 88 26 232 - 0.4 0.5 85-89 ... 145 40 5 13 22 - 105 19 9 77 - 0.1 0.2 90 94 ... 39 8 1 1 6 - 31 10 2 19 - - - 95 & over 9 1 1 - - - 8 2 - 6 — — — 17 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 (1), the Metropolitan Water Board reported that the water had been cut off in ten premises. The reasons for discontinuing the supply were: waste of water, three; non-payment of rate, seven. In one of these cases (24 Park Road) it was necessary later (on 10th January, 1923) to apply for an order to enter the premises. This action was taken in conjunction with the police authorities, who also desired to make an inspection of the premises in connection with the search for a woman who had been associated with the owner (Cecil Maltby) and who had disappeared. Being less favourably situated in respect of powers of entry than the Council as Public Health Authority, the police took advantage of an enforced entrance to the premises made by the latter for the purpose of dealing with nuisances suspected to exist as a result of the absence of water supply, non-removal of refuse, etc. By reason of the fact that the inspection resulted in the discovery of the bodies of a murderer and his victim, the former killed by his own hand at the moment the premises were entered, and the latter in an advanced state of decomposition in a bath in the kitchen of the premises, the case attracted a considerable amount of attention. During the year 174 notices in regard to defects in and necessity for cleansing of water cisterns were served and were complied with. Water Supply in Dwelling Houses.—Nine certificates were granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. In 37 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 33 cases. In the remaining four it was found necessary to issue a statutory (" Committee ") notice. Drainage. The total number of drain inspections made during the year was 6,619 as against 7,175 in 1921. The total number of plans deposited was 493, the number in 1921 being 335. Plans relating to new buildings numbered 58, the number deposited in 1921 being 24. In the case of old buildings, the number of plans received was 435, as against 311 in 1921. On seven 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 £14 10s. and £19 13s. respectively. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 37 premises. The number in 1921 was 22. Closet Accommodation. In the table at page 19, 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. 18 The following is a statement showing the total receipts at each of the conveniences for the year ended March, 1923, and the amount of increase or decrease as compared with the previous year. 1923. 1922. Increase. Decrease. £ s. d. £ s. d. £ 8. d. £ s. d. Oxford Circus—Men's Department 1,015 7 1 1,078 4 1 — 62 17 0 * ,, Women's ,, 1,159 6 3 1,128 7 10 30 18 5 — Git. Portland Street—Men's ,, 273 8 1 305 3 2 — 31 15 1 * ,, Women's ,, 273 11 1 300 9 0 — 26 14 11 Marylebone Road—Men's ,, 236 16 11 255 18 4 — 19 1 5 * ,, Women's ,, 256 3 9 259 0 11 — 2 17 2 Foley Street—Men only 162 8 4 173 3 2 - 10 14 10 St. John's Wood Road—Men only 116 6 7 124 17 0 — 8 10 5 Barrett Street—Men only 206 18 10 215 2 0 - 8 3 2 * 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. Considerable improvements have recently been made in the plant, but as the arrangements are substantially the same as those in vogue in 1921, 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, 1923, it may be mentioned, was 39,531 tons, as compared with 37,088 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 2. New metal dust receptacles were provided to 863 premises. During the year the inspectors made 4,902 visits. The majority of these were made by Inspectors Hill and Lumley, who give part time to this work. For neglect of the provisions with regard to the covering of dustbins, etc., placed on the footway for collection from the kerb, 92 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), 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.—In 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 3,291, as against 3,217 in 1921. 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, 349 statutory notices were issued, as against 856 in 1921. 19 Of these notices, 216 related to ordinary nuisances (dirt, dampness, &c.) 48 to verminous rooms, 24 to drains, 6 to insufficient w.c. accommodation, 4 to water supply in tenement houses, and 51 to insufficient dust bins, etc. The 48 notices respecting verminous rooms were served under powers contained in the London County Council (General Powers) Act, 1922, and referred to 81 rooms. In 2,942 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 9 instances there was failure to carry out works after receipt of statutory notice and legal proceedings were instituted. Details of these cases will be found under the heading " Legal Proceedings in connection with Nuisances." The total inspections made by each inspector, and the number of nuisances of various kinds detected and remedied, are set forth in the following table:— Districts. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Total Inspections 3,492 3,000 2,959 3,817 3,516 3,564 20,348 Houses damp, dirty or dilapidated remedied 313 209 255 77 344 214 1,412 Doors, windows, floors, ceilings, sash cords, etc., repaired 409 483 101 65 305 152 1,515 Overcrowding abated 2 — 2 2 2 — 8 Illegal occupation of underground rooms dealt with - 2 10 3 2 1 18 Water closet defects remedied 243 283 176 69 269 165 1,205 Water closets erected — — 1 1 5 17 24 Urinal defects remedied — — 4 — 1 2 7 Soilpipe and ventilating shaft repaired or renewed 1 3 1 22 3 2 32 Yard defects remedied 221 166 162 28 134 70 781 Waste pipe defects remedied 30 23 9 12 19 21 114 Water cistern defects remedied 35 70 12 8 30 19 174 Rubbish, manure, etc., accumulations removed 10 7 49 23 28 20 137 Dung or dust receptacles repaired or renewed 122 95 123 72 108 42 562 Drains relaid or amended 32 19 47 10 27 17 152 Drains cleared 17 10 8 23 26 17 101 Rainwater pipes repaired or renewed 37 59 32 19 28 20 195 Water supply to houses reinstated - 3 3 1 - - 7 Roofs and gutters repaired 141 253 60 41 65 83 643 Area defects remedied 23 — 66 22 144 22 277 Wash-house defects remedied 243 162 121 32 148 108 814 Animal nuisances abated 8 — 10 — 3 9 30 Basement defects remedied 2 — 29 18 43 1 93 Stables cleansed or repaired 1 — — 1 — — 2 Water supply laid on to upper storeys of house 11 5 12 4 1 4 37 Miscellaneous nuisances abated 360 451 68 61 70 79 1,089 Verminous rooms cleansed 168 213 164 64 155 182 946 Workshops, dirty, overcrowded, unventilated or defective, remedied 7 6 5 10 20 34 82 20 Legal Proceedings in Connection with Nuisances. The number of summonses issued in respect of nuisances during the year was 9. 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. 13, King Street Failure to comply with a statutory notice to execute certain sanitary requirements. Fined £10 and £4 2s. costs. 37, Fisherton Street Do. Fined £5 and £6 6s. costs. 106, Carlisle Street Do. Fined £42 and £18 18s. costs. 110, Do. 126, Do. 19, Carlisle Place Do. 25, Richmond Street Do. 28, Aberdeen Place Do. Fined £2 and £2 2s. costs. 69, Carlisle Street Do. Fined £12 and £2 2s. costs. Rat Repression. The number of complaints received during the year, viz., 65, was lower by 30 than the 1921 figure. The investigation of these complaints necessitated the inspection of 76 premises, 19 of which were used for business purposes (16 of these for the preparation or storage of food), the remaining 41 being private or tenement houses. In 16 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 the 6th to the 11th November, 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. 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. 21 Number of places On register at end of 1921. Added in 1922. Removed in 1922. On register at end of 1922. Number of inspections, 1922. Number of notices, 1922. N umbei of prosecutions, 1922. A. Business Premises. Milk premises 159 9 24 144 350 4 - Cowsheds 3 - 1 2 50 - - Slaughterhouses 3 - - 3 140 - - Offensive trade premises 2 - - 2 70 - - Ice cream premises 120 12 4 128 160 12 Butterand facturers and Dealers 11 4 - 15 56 1 - Bakehouses 70 3 1 72 200 8 - Fried Fish Shops 22 - - 22 88 2 - Fish Curers 5 - 5 60 1 B. Habitations Houses let in lodgings 1152 - 5 1147 10331 1466 - 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 144. This is 15 less than in 1921, 9 having been added and 24 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. 56, Bell Street 15 2 42a, Clipstone Street 10 10 Totals 25 12 In 1921 the number of cows licensed to be kept in the Borough was 69, though, in fact, only 14 were kept. The difference is due to the cancellation of the licence in respect of 58, Acacia Road, not now used as a cowshed. 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. 22 Premises. 50, Henry Street, St. John's Wood 134, High Street, St. John's Wood Conditions. Small cattle only. 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. The amount of slaughtering now done is comparatively small. Offensive Trades.—There are only two premises within the Borough upon which trades classed as offensive are carried on. The business in each case is that of tripe boiling. The Food Inspector made 70 visits, but no cause of complaint was found. Ice Cream Premises.—The number of such premises in the Borough on the Register is 128. Regular inspections were made throughout 1922 and in 12 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 12 dealers in margarine, 1 wholesale dealer in butter and milk-blended butter and 2 butter manufacturers. All the registered premises were frequently visited. Bakehouses.—At the end of 1922 the number of bakehouses on the register was 72, 1 fan underground bakehouse) having been removed and 3 added during the year. Of the 72, 64 are underground bakehouses. In all, 200 visits were paid and 8 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. 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. Though factories are comparatively few in the Borough, the number of workshops, many of them domestic workshops, is considerable, and work in relation to Factories and Workshops. 23 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 3,213, 488 by the women and 2,725 by the men inspectors. The complaints received numbered 32. 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. 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries.) 75 11 — Workshops (Including Workshop Laundries.) 1772 114 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1366 6.7 - Total 3213 192 — 2.—DEFECTS FOUND. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:— Want of cleanliness 57 57 - - Want of ventilation 13 13 — - Overcrowding 12 12 — — Want of drainage of floors 3 3 — — Other nuisances 102 102 - — Sanitary accommodation insufficient 5 5 — — unsuitable or defective 40 40 - - not separate for sexes 19 19 — — Offences under the Factory and Workshop Act:- Illegal occupation of underground bakehouse (s. 101) 1 1 - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 8 8 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 260 260 — — 24 3.—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. - Instances. Orders made (S. 110). Prosecutions Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, etc. 81 197 1129 ... ... ... 59 ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrella.-, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 81 197 1129 ... ... ... 59 ... ... ... ... ... ... ... ... 25 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 3,132 Coffee Shops, &c. 331 Bakehouses 72 Total number of workshops on Register 3,535 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 30 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 32 Reports (of action taken) sent to H.M. Inspector 32 Other — Underground Bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 64 26 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 and Housing Acts and special regulations. They are referred to here for this reason. Houses Let in Lodgings:—Included under this head are all ordinary tenement houses in which the rooms or floors are let out at rents below a certain sum. To some extent as a result of housing shortage a very large proportion of the houses in the Borough are of course so let, but only in the case of those in which the lettings are below the sum fixed has the question of registration been raised. When the new by-laws to be made by the London County Council under The Housing, Town Planning, etc., Act, 1919, come into operation, the number of houses on the register will be greatly increased since no provision whatever has been made for exemption. All houses suitable for the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to sanitation, cleanliness, cleansing, etc. During the year under review no additions were made to the list of registered houses. Of houses of this class, five, all on the Council's site in Capland Street, were demolished preparatory to the commencement of the housing scheme ; the actual number on the register at the end of 1922 was therefore 1,147, most of which were registered prior to the war and before rents had attained the present high figure. In all 10,33 i visits were paid to houses let in lodgings without regard to the rentals, and 1,466 notices relating to cleansing and other defects were served under the appropriate Acts. 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 18. 27 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 1922 there were 331, this number including : restaurant, dining room and coffee shop kitchens, 191; tea-rooms and pastry-cooks, 70 ; hotel kitchens, 43; 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. On more than one occasion the Borough Council, at the suggestion of the Public Health Committee, have directed the attention of the Ministry of Health and the London County Council to the necessity for legislation requiring registration of food premises of this class. Up to the present no step in this direction has been taken by either of the authorities mentioned. 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 1922 the total number of inspections was 1,241, the number of notices served being 30. 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 1922 visits were paid to all the market streets every day, a special feature being made of Saturday night and Sunday morning inspections. 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 298. On examination by the Public Analyst 10 (3'3 per cent.) were found to be adulterated. In 1921 the percentage was 1.6. 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 the samples definitely adulterated the explanation forthcoming was accepted by the Committee and no proceedings were instituted. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 65 were obtained on delivery at Marylebone Station of the Great Central Railway. Of the 65, one proved to be adulterated, though not to an extent sufficient to warrant more than the giving of a serious warning. The quarterly returns as to milk samples are tabulated below:— Quarter of the Year. No. of Samples Taken. No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. Fines and Costs. £. s. d. 1st 84 2 2.4 — — 2nd 111 7 6.3 — — 3rd 51 1 2.0 — — 4th 52 — — — — Total for year 298 10 3.3 - - 28 Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 15 samples were taken and submitted to Dr. Foulerton, the Council's Bacteriologist, for examination. In each case in which a result not entirely satisfactory was obtained communications were sent to the Local Authority of the district in which the milk was produced in order that an investigation might be carried out locally. On all occasions the greatest willingness to co-operate was shown by the officers of these authorities, and it is safe to claim that definite improvements have followed the taking of action on fhese lines. 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 complied with. 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, 1922. 1.—Milk; and Cream not sold as Preserved Cream. (a) Number of samples (b) Number in which a examined for the pre- preservative was resence of a preservative. ported to be present. and percentage of preservative found in each sample. Milk 299 Nil. Cream 24 10 (10.0, 12.0, 11.0 13.0, 11.0, 13.0, 10.0, 11.5, 13.2 and 11.5 grains Boric Acid per lb.) Nature of preservative in each case in column (6), and action taken under the regulations in regard to it. Nil. 2.—Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correct statements made 10 (ii.) Statements incorrect Nil. Total 10 29 (iii.) Percentage of preservative found in each sample Average 11.62 grains Boric Acid. per lb. Lowest 10 grains. Highest 13.2 grains. Percentage stated on statutory label. Not exceeding 0.4%. (6) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent. 10 (ii.) Below 35 per cent. Nil. Total 10 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken Nil 3.—Thickening substances.—-Any evidence of their addition to cream or to preserved cream. Action taken where found—None. 4.—Observations, if any—Nil. Milk (Mothers and Children) Order, 1916—During 1922 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1923, was £368 7s. 1d., as against £1,637 up to March 31st, 1922. The actual number of cases dealt with was 244, and the number of orders issued 1,008. 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. In no instance was it necessary to make use of the powers in the Public Health (London) Act, 1891, as to seizure and condemnation of food. 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. The articles dealt with in this way are noted on the page following. 30 Unsound and Diseased Food Condemned and Destroyed During the Year 1922. Meat— Beef 112 lbs. 2 Pig's Heads (Tuberculosis) Pork (Tuberculosis) 2 fore quarters Mutton 57 lbs. Bacon 6 fore ends Fish— Wet—Skate 16 stone Herrings 1 box Conger eels 10 stone Roe 7 boxes Dry—Kippers 10 boxes Winkles 1 bag Fruit- Apples 6 baskets Damsons 3 baskets Strawberries 2 baskets Pears 7 baskets Red Currants 1 basket Tomatoes 50 boxes Miscellaneous— Cream 483 tins Eggs 120 C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,040. Of this number 16 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 1.5 per cent., which is lower than the figure for 1921, when the percentage was 2'3. The method adopted in connection with the taking of samples was similar to that followed in previous years and described in former reports. The majority were "formal" samples, and in carrying out the sampling, the inspector was almost invariably assisted by an agent. The bulk of the samples taken were of milk and dairy produce. The fact that no prosecutions were instituted has already been noted. The following Tables and Report from the Public Analyst, Mr. J. F. F. Rowland, give full information with regard to samples submitted to and examined by him : 31 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, 1922. 12/6 per sample. 82 milk Food Inspector, St. Marylebone Borough Council Genuine. No sample contained any preservative or colouring matter. 2 milk Do. Adulterated. Both were test samples No. 143. 13.3% deficient in milk fat and contained 4.9% added water. No. 211. 23.3% deficient in milk fat. 1 separated milk Do. Genuine. This was a test sample. 73 butter Do. Do. 53 were test samples. 6 samples contained no preservatives. 50 contained 10-20 grains boracic acid per lb. 17 contained 21-30 grains boracic acid per lb. 27 margarine Do. Do. All were test samples. All samples contained boracic acid as preservatives, the amounts being: 10 samples contained 10- 20 grains boracic per lb. 17 contained 21-30 grains boracic acid per lb. 1 cheese Do. Do. This was a test sample 1 solac Do. Do. Ditto. 39 coffee Do. Do. All were test samples. 23 cocoa Do. Do. Ditto. 14 marmalade Do. Do. Ditto. 6 mustard Do. Do. Five were test samples. 2 mustard Do. Adulterated. One was a test sample. No. 3 contained fi'5% of added starch. No action taken on advice of Solicitor. No. 85 contained 8'0% of added starch. 8 pepper Do. Genuine. All were test samples. 1 green peas Do. Do. Ditto. 14 jam Do. Do. Ditto. 1 cane syrup Do. Do. This was a test sample. 4 zinc ointment Do. Do. All were test samples. 5 boracic ointment Do. Do. Ditto. 5 compound liquorice powder Do. Do. Ditto. I sulphur ointment Do. Do. This was a test sample. 4 cream of tartar Do. Do. All were test samples. 7 cream Do. Do. One was a test sample. No. Fat. Preservatives. 277. 48.8. Nil. 279. 48.8. l0.0 grains per lb. boracic acid. 281. 46.0 Nil. 305. 52.5. 12.0 grains per lb. boracic acid. 307. 52.5. Nil. 309. 52.5. 11.0 grains per lb. boracic acid. 311. 54.0. Nil. Total Number of Samples analysed during the Qua rter 324 Number of Samples adulterated 4 32 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 SECOND QUARTER ENDING 30TH JUNE, 1922. 12/6 per sample. 104 milk Food Inspector, St. Marylebone Borough Council Genuine. No sample contained preservative or added colouring matter. 7 milk Do. Adulterated. Two were test samples. No. 356. 4 "7% of added water. No. 355.) Vendors cautioned in each case. Vide P.H. Minutes, 19th May, 1922. No. 368. 3-3% deficient in milk fat. No. 368. 1 No. 380. 4 '7% of added water. No. 380. | No. 414. 1*6% of added water. No. 414. ' No. T. 46'-!. 33'3% deficient in milk fat and contains 29.2% of added water. No. 463. This was a test sample. No. T. 468. 43-3% deficient in milk fat and contains 15-5% of added water. No. 468. This was a test sample. No. 520. 3*3% deficient in milk fat. No. 520. Vendor cautioned. Vide P.H. Minutes, 16th June, 1922. 64 butter Do. Genuine. 58 were test samples. 33 contained between 10-20 grains boracic acid per lb. 31 between 21-28 grains boracic acid per lb. 5 cream Do. Do. All were test samples. 11 jam Do. Do. Do. 2 marmalade Do. Do. Do. 8 coffee Do. Do. Do. 10 olive oil Do. Do. Do. 7 bicarbonate of soda Do. Do. Do. 3 tartaric acid Do. Do. Do. 2 self-raising flour Do. Do. Do. 2 peas Do. Do. Do 4 citric acid Do. Do. Do. 2 chicory Do. Do. Do. 3 boracic ointment Do. Do. Do. 4 zinc ointment... Do. Do. Do. 2 borax Do. Do. Do. 2 boracic acid Do. Do. Do. 1 sulphur ointment Do, Do. This was a test sample. 1 golden syrup Do. Do. This was a test sample. 2 camphorated oil Do. Do. These were test samples. 1 camphorated mineral oil Do. Do. This was a test sample and consisted of an oil of the paraffin series, containing 7 0% of camphor. It is not a preparation recognised or mentioned by the British Pharmaceutical Codex, 1911, and, therefore, has no official standard. A sample prepared in accordance with the codex should consist of olive oil containing 20% of camphor. 1 tinned strawberries Do Do. Both these samples contained small quantities of tin, which in each instance was less than 2 grains per lb. Both were test samples. 1 tinned raspberries Do. Do. 33 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. Particulars of Samples of Cream. No. Fat. Preservatives. 377. 45.0%. Absent. 411. 45.0%. 13.0 grains boric acid per lb. (preserved.) 566. 45.0%. Absent. 567. 48.0%. Do. 568. 45.0%. Do. Total Number of Samples analysed during the Quarter 249 Number of Samples adulterated 7 THIRD QUARTER ENDING 30TH SEPTEMBER, 1922 50 milk Food Inspector, St. Marylebone Borough Council Private Genuine. 12/6 per sample. No sample was found to contain either preseivative or colouring matter. 1 milk Adulterated No. 736. 6'7% deficient in milk fat. 10 cream Food Inspector Genuine. Seven were informal samples. No. Fat. Preservative. *576 52.5% 11.0 grains per lb. boric acid. 578 52.5% Nil. *587 49.0% 13.0 grains per lb. boric acid. 614 54.0% Nil. *624 52.0% 10.0 grains per lb. boric acid. *630 49.0% 11.5 do. do. 632 48.0% Nil. 641 25.5% Nil. *653 57.7% 13.2 grains per lb. boric acid. 658 27.0% Nil. *Preserved. 46 butter.. Do. Genuine. 24 were informal samples. 40 samples contained boracic acid in amounts varying from 10 to 20 grains per lb. ; ti samples contained the same preservative in amounts ranging between 21 and 26 grains per lb. 27 coffee Do. Genuine. All were informal samples. 17 cocoa Do. Do. 4 marmalade Do. Do. 13 jam Do. Do. 3 wild duck paste Do. Do. 1 bloater paste Do. Do. 1 crab paste Do. Do. 1 chicken & ham paste Do. Do. 1 lobster paste Do. Do. 1 salmon and anchovy paste Do. Do. 1 salmon and shrimp paste Do. Do. 1 shrimp paste ... Do. Do. 1 self-raising flour Do. Do. 1 tartaric acid .. Do. Do. 3 boracic o i n tment Do Do. 3 test prescriptions Do. Do. 2 zinc ointment Do. Do. Total Number of Samples analysed during the Quarter 188 Number of Samples adulterated 1 34 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. FOURTH QUARTER, ENDING 31ST DECEMBER, 1922 52 milk Food Inspector, St. Marylebone Borough Council. Genuine. 12/6 per sample. No sample was found to contain either preservative or artificial colouring matter. 75 butter Do. Do. 60 were informal samples. Every sample contained boric acid. 57 samples contained 10-20 grains per lb. 18 contained 2030 grains per lb. 4 margarine Do. Do. All were informal samples. 45 coffee Do. Do. 18 cocoa Do. Do. 3 jelly Do. Do. 12 jam Do. Do. 3 marmalade Do. Do. 8 whiskey Do. Do. 4 whiskey Do. Adulterated. No. Particulars of Adulteration. 1026. •40*74 degrees under proof. 1027. 39-47 do. do. 1033. 47*68 do. do. 1039. 38-18 do. do. C olive oil Do. Genuine. 5 boracic ointment Do. Do. 4 zinc ointment Do. Do. 6 pepper Do. Do. 1 flour Do. Do. 2 mustard Do. Do. 2 virol Do. Do. 2 cream Do. Do. No. Fat. Preservative. *841. 45.0% 11.5 grains boric acid per lb. 1038. 55.0% Nil. *Preserved. 1 liquorice powder Do. Do. 11 ground ginger Do. Do. 1 raspberry syrup Do. Do. 3 mercurial ointment Do. Do. 1 strawberry syrup Do. Do. 2 cocoa beans Do. Do. 1 magnesium carbonate Do. Do. 2 magnesium citrate Do. Do. 1 lemon syrup Do. Do. 1 ginger wine Do. Do. 1 raisin wine Do. Do. 1 orange wine Do. Do. 1 black currant wine Do. Do. Total Numbe r of Samples analysed during the Quarter 270 Number of Samples adulterated 4 35 ANNUAL REPORT OF THE PUBLIC ANALYST, 1922. The number of samples taken under the Sale of Food and Drugs Acts and submitted for analysis, was 1,040 : a decrease as compared with the samples for 1921, the number for that year being 1,130. A complete list is as follows: No. Article. Genuine. Adulterated. Total. 1 Bicarbonate of Soda 7 - 7 2 Black Currant Wine 1 — 1 3 Bloater Paste 1 — 1 4 Boracic Ointment 16 — 16 5 Boracic Acid 2 — 2 6 Borax 2 — 2 7 Butter 258 — 258 8 Camphorated Oil 2 — 2 9 Camphorated Mineral Oil 1 — 1 10 Cane Syrup 1 — 1 11 Cheese 1 — 1 12 Chicory 2 — 2 13 Chicken and Ham Paste 1 — 1 14 Citric Acid 4 — 4 15 Cocoa 58 — 58 16 Cocoa Beans 2 — 2 17 Coffee 119 — 119 18 Crab Paste 1 — 1 19 Cream 24 — 24 20 Cream and Tartar 4 — 4 21 Flour 1 — 1 22 Ginger Wine 1 — 1 23 Golden Syrup 1 — 1 24 Green Peas 4 — 4 25 Ground Ginger 11 — 11 26 Jam 50 — 50 27 Jelly 3 — 3 28 Lemon Syrup 1 — 1 29 Liquorice Powder 6 — 6 30 Lobster Paste 1 — 1 31 Magnesium Carbonate 1 — 1 32 Magnesium Citrate 2 — 2 33 Margarine 31 — 31 34 Marmalade 23 — 23 35 Mercurial Ointment 3 — 3 36 Milk 288 10 298 37 Mustard 8 2 10 38 Olive Oil 16 — 16 39 Orange Wine 1 — 1 40 Peas 2 — 2 41 Pepper 14 — 14 42 Raisin Wine 1 — 1 43 Raspberry Syrup 1 — 1 44 Salmon and Anchovy Paste I — 1 45 Salmon and Shrimp Paste 1 — 1 46 Separated Milk 1 — 1 47 Self-Raising Flour 3 — 3 36 No. Article. Genuine. Adulterated. Total. 48 Shrimp Paste 1 - 1 49 Solac (Milk Substitute) 1 — 1 50 Strawberry Syrup 1 — 1 51 Sulphur Ointment 2 — 2 52 Tartaric Acid 4 — 4 53 Test Prescriptions 3 - 3 54 Tinned Raspberries 1 - 1 55 Tinned Strawberries 1 — 1 56 Virol 2 — 2 57 Whisky 8 4 12 58 Wild Duck Paste 3 — 3 59 Zinc Ointment 14 — 14 1,024 16 1,040 Milk.—298 samples of milk were examined, of which 10 were adulterated. This gives 3.36 as the percentage of adulterated samples for this year as compared with 1.64 per cent, for the year 1921. As the number of samples taken in each period was practically the same (304 in 1921 and 298 in 1922) we must conclude that sophistication of milk is once again on the increase, the percentage of adulterated samples having slightly more than doubled during the year. The mean composition of the milks taken, omitting the adulterated samples, also shows some variation in quality from that of the previous year, the figures being:— Sp. Gr. Fat. Solids (not fat). Total Solids. 1031.00 3.6 8.60 12.20 From which it will be observed that the average amount of fat has increased (1921, Fat 3.5) while the figure for Solids not fat, has decreased, being 8.60 this year as compared with 8.70 for 1921. Butter.—258 samples were examined and all were found to conform to legal requirements. Margarine.—23 samples were analysed. All were genuine. Cream.—Of the 24 samples taken all contained, at least, the minimum amount of fat required legally. Of these 14 contained no preservative, while 10 had in them amounts of boric acid ranging from 10 to 20 grains per lb. Mustard.—10 samples were taken and 2 were found to contain added starch as a diluent or adulterant. Solac.-—A sample of solac, a milk substitute of vegetable origin, examined in the March quarter, gave figures in fair conformity with those mentioned in its specification, viz.:— Fat. Proteid. Carbohydrate. Mineral Matter. Moisture. 32.0% 28.0% 34.0 4.0 2.0 Whiskey.—12 samples were taken, and of these 4 were adulterated. This represents a percentage of 333. Drugs, etc.—Various pharmaceutical preparations were examined and all were found to conform with the prescriptions. Any impurities present were estimated and found to fall below the limits suggested, or laid down, as permissible in each instance. 37 STATISTICAL. BIRTHS. Registration.—The number of births registered during 1922 was 1,679*, being 260 less than in 1921. Of the children born, 871 were boys and 808 girls. The birth rate per 1,000 of the population was 15'9 as against 18.4 in 1921. The rates in the several registration sub-districts and the Borough were:— All Souls, 14.2 ; St. Mary, 11.3; Christ Church, 20.5; St. John, 13.9. Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,813: Live births, 3,632; Still births, 181. 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 86 2.2 ,, doctors 321 8.4 ,, midwives 696 18.3 „ other persons 206 5.4 „ hospitals, etc. 2,504 65.7 3,813 Of the total births notified, 181 referred to still-births (102 males and 79 females): 1,795 took place at Queen Charlotte's Hospital ; 579 at Middlesex Hospital; 130 at St. Marylebone Home: and 1,232 were born at home. Of those notified as having occurred in St. Marylebone, 1,941 belonged to other Boroughs. DEATHS AND DEATH RATES. The number of deaths registered in 1922 was 1,451. 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 othfer 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-ratet per thousand for the year was 13.7. In the previous year, the rate was 12.8 and the number of deaths 1,355. * This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 185 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone:— Legitimate Males 71 ,, Females 72 Illegitimate Males 20 ,, Females 22 † A definition of the term "corrected death-rate" will be found on page 9 of the Report for 1912. 38 The following short table shows the death rates in the several registration sub-districts in 1922 and compares them with those of the preceding 5 years :— 1917 1918 1919 1920 1921 1922 All Souls 11.9 14.8 12.9 9.9 10.2 11.3 St. Mary 16.4 15.9 15.3 13.2 12.0 15.4 Christ Church 21.4 23.2 18.5 14.2 14.0 14.0 St. John 17.4 19.8 17.0 13.6 16.0 14.3 The Borough 170 18.5 15.9 12.7 12.8 13.7 District births and deaths for the year ended 31st December, 1922, are given in the following table. A further table giving the vital statistics of separate localities for 1922 and the ten preceding years, will be found amongst the Ministry of Health Tables on page 73. Sub-District. Population estimated to middle of 1922. Births. Deaths. Males. Females. Total. Males. Females. Total All Souls 25,202 166 152 318 148 138 286 St. Mary 26,943 205 200 405 206 209 415 Christ Church 32,747 355 318 673 244 215 459 St. John 20,308 145 138 283 135 156 291 The Borough 105,200 871 808 1,679 733 718 1,451 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 1922. It will be seen that the heaviest incidence in both old and young falls in the first and last quarter. 1922 JanuaryMarch AprilJune July- September OctoberDecember Total Infants under 1 year 40 25 20 30 115 Persons of 65 years and upwards 205 116 90 135 546 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 76. 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 1,038. 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 1922 was 115, and the number of births in that year 1,679. The infantile mortality rate is therefore 68'0, two points over that for 1921 (66 per 1,000). 39 The course which the rate has taken is graphically shown in the chart on page 41, 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 40, in which, in addition to the causes of death, is 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 1922, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the bab es, 39 were less than one month old when they died and 63 less than three months. The figures for 1921 were 52 and 82. 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 39 deaths, a figure lower by 11 than that for the year 1921. Diarrhoea and enteritis (7 and 8) accounted for 19 in 1921 and for 15 in 1922. Respiratory diseases, the third of the main causes, took 20 in 1921, and in 1922, 19. The commoner infectious diseases together led to 2 deaths among infants, both due to diphtheria. Three deaths were stated to be due to overlaying, 2 to tuberculosis, and 4 to convulsions. In the following table information supplementary to that in the large table is given with regard to deaths in the various sub-districts. Christ Church, which always contributes most largely to the infantile as to most of the other mortality rates, being the most thickly populated area and that in which there is most poverty, most overcrowding and most neglect of ordinary precautions, is again at the head of the list with 50 deaths amongst infants. In 1921 the figure was 56. 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 8 1 1 1 3 2 1 1 18 St. Mary 3 _ 1 _ 5 7 4 1 21 Christ Church 9 4 1 3 9 8 6 10 50 St. John 5 _ 1 1 7 6 2 4 26 Totals 25 5 4 5 24 23 13 16 115 40 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 under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Total. 1 , Small-Pox — — - — ! - - - - — 2 Chicken-Pox — — — — — — — — — — — — — — — 3 Measles — — — — — — — 1 1 2 1 — 1 — 2 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Diphtheria and Croup — — — — — — — 2 — 2 — 1 1 — 2 6 Whooping Cough — — — — — — 2 — 2 4 — — 1 3 4 7 Diarrhœa — — — — — — 1 — — 1 — 1 — — 1 8 Enteritis — — — 2 2 5 5 2 — 14 4 3 4 3 14 9 Tuberculous Meningitis — — — — — — — 2 — 2 1 — — 1 2 10 Abdominal Tuberculosis — — — — — — — — — — — — — — — ll Other Tuberculous Diseases — — — — — — — — — — — — — — — 12 Congenital Malformation 2 — — — 2 1 — — — 3 — 1 1 1 3 13 Premature Birth 14 2 1 — 17 4 — — — 21 7 3 9 2 21 14 Atrophy, Debility and Marasmus — 1 — — 1 7 3 2 2 15 1 4 6 4 15 15 Atelectasis 4 — — — 4 — — — — 4 2 — 1 1 4 16 Injury at Birth — — — — — — — — — — — — — — — 17 Erysipelas — — — — — — — — — — — — — — 18 Syphilis — — — — — 1 2 — — 3 — 1 2 — 3 19 Rickets — — — — — — — — — — — — — — — 20 Meningitis (not Tuberoulous) — — — — — — — — — — — — — — — 21 Convulsions — — 1 1 2 — 2 — — 4 1 i 2 4 22 Gastritis — — — — — — — — 1 1 — — 1 — 1 23 Laryngitis — — — — — — — — — — — — — — 24 Bronchitis — — — — — 1 1 — 3 5 — 1 4 — 5 25 Pneumonia (all forms) — 2 — 2 4 4 3 6 19 — 2 11 6 19 26 Suffocation, Overlying 2 — — 2 — 1 — — 3 — 1 2 — 3 27 Other Causes 3 2 — 2 7 1 2 1 1 12 1 2 6 3 12 Totals 25 5 4 5 39 24 23 13 16 115 18 21 50 26 115 Legitimate, 1,502 Legitimate Infants, 85 Nett Births in the Year Nett Deaths in the Year Illegitimate, 177 Illegitimate Infants, 30 Total 1,679 Total 115 41 INFANTILE MORTALITY FIGURES. 42 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 76. 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. DIARRHOEAL DISEASES. The total number of deaths registered as due to diarrhoea and enteritis (inflammation of the bowels), was 17, equal to 0.16 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1922, as a matter of fact, all those who died were less than 1 year of age. In 1921 the deaths from diarrhoeal diseases numbered 22, all the victims being babies. In 1922, therefore, there was a reduction in the total. Deaths from diarrhoeal diseases are commonly found to vary with the weather conditions, being in general 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 1922, from the point of view of weather, being cold and wet, cannot be called a "diarrhoea year," and the weather may therefore have had something to do with the low mortality. It is safe and right to claim, however, that to some, even to a large, extent cases were remarkably few because during the year welfare 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 17, and that in recent years, even when the weather conditions have been against the babies, the fatalities from this most dreadful of all infant scourges have been, comparatively speaking, few. Particularly in relation to diarrhoea amongst children, a very great deal of educational work is done at the centres of the Health Society and in the homes by health visitors and inspectors, and during the year there was the usual wide distribution of special leaflets on diarrhoea, flies in relation to disease, etc. INFECTIOUS (COMMUNICABLE) DISEASES. The number of deaths due to each of the diseases included in this group is referred to when dealing specifically with the disease under the heading "Prevalence of and Control over Infectious Diseases." Excluding influenza (which caused 43 deaths), the diseases contributing to the total of 100 deaths were—diphtheria, 30; scarlet fever, 4; whooping cough, 14; and, as already noted, diarrhoea, 17. 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 127, which is greater by 10 than the figure for 1921. 43 The great bulk of the 127 deaths, viz., 98, was due to phthisis. The number in 1921 was 102. Of the total number of deaths registered (1,451), the percentage due to phthisis was 6.7, as against 7.5 in 1921. The age periods at which the deaths occurred were: 2—5 years, 2 (2.0 per cent.); 5—15, 1 (1.0 per cent.); 15—25, 17 (17.4 per cent.); 25—45, 39 (40.0 per cent.); 45—65, 34 (34.6 per cent.); 65 and over, 5 (5.0 per cent.). 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 Deaths. 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 1922 127 105,200 1.20 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 325. This is higher by 20 than the figure (305) for 1921. The death rate was 3.0 per 1,000. In 1921 the rate was 2.8. The number of deaths certified to be due to bronchitis was 151 as against 143 in 1921. Of this number 105 were amongst persons aged 65 and upwards, and 33 amongst those of the age group 45—65. The deaths traceable to pneumonia numbered 148, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 33 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified was 113. Of the patients 25 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 76. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 173 and the death rate 1.64 per 1000 of the population. In 1921 the figures were lower, the total being 154 and the death rate 1.46 per 1,000 of the population. 44 Information with regard to the age at which death occurred and situation of the disease, is given in the following tables:— Cancer: Ages at Death Ages Under 10 10 and under 20 20 and under 30 30 and under 40 40 and under 50 50 and under 60 60 and under 70 70 and upwards Totals Males - - - 1 7 21 22 28 79 Females 1 - 1 4 15 22 22 29 94 Totals 1 - 1 5 22 43 44 57 173 Cancer.—Situation of the Disease. Parts of the body affected. Males Females Totals Face, Tongue, Jaw 14 3 17 Throat, Neck, Gullet 10 2 12 Stomach 15 9 24 Intestines 15 21 36 Liver 6 9 15 Breast — 18 18 Uterus and Generative Organs — 17 17 Various 19 15 34 Totals 79 94 173 ALCOHOLISM. One death was certified during the year as due to alcoholism. Year after year the number so certified has been quite small, and in 1921 there were 3 deaths. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 7 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 same as in the year 1921. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1922 numbered 75. Of these 19 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 75. 45 The total number of notifications coming to hand was 1,008. The bulk of the notifications related to scarlet fever, which contributed 339 to the total. Other diseases in respect of which fairly large numbers of notifications were received were diphtheria (268), tuberculosis (194), and pneumonia (113). In 1921 the number of cases notified was 1,157. The notification rate (proportion to population of notified cases of infectious diseases) in 1922 was 9.5 per 1,000 as against 10'9 in 1921. Isolation of Cases.—As the following table shows, the number of cases removed was as high as usual:— Diphtheria 261 or 97.4 per cent. of the cases notified. Erysipelas 18 „ 34.6 „ „ „ Scarlet Fever 331 „ 97.6 „ „ „ Enteric and Paratyphoid Fever 9 „ 75.0 „ „ „ Ophthalmia Neonatorum 10 „ 45.4 „ „ „ Tuberculosis 69 „ 35.5 „ „ „ Pneumonia 33 „ 29.2 „ „ „ The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £89 5s. 9d. equal to 16s. 11d. 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. 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 1922 89 5 9 0 16 11 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 458 and referred to 597 cases. Visits were paid to these cases by the District Inspectors, and advice given as to date of the return of children to school and the advisability of obtaining treatment for and isolation of any suffering from any sequel of a disease. Diphtheria and Membranous Croup. Diphtheria was more prevalent in 1922 than in any year since 1896, the actual number of cases being 268. The number in 1921 was 239. Of the cases 30 died, and the case mortality rate was 11.1 per cent. 46 The number of cases per thousand of the population was 2.5. Throughout the whole year, with the exception of a small group of 32 cases in one of the hospitals in the Borough, there was nothing resembling an outbreak in any one locality. 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 31 cases the source appeared to be a member of the family previously infected ; and in 11 cases infection was counted to have been acquired in school. The number of swabs from doubtful cases submitted for bacteriological examination was 1,306. A positive result was returned in 164 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 91. In All Souls the number was 69, in St. Mary, 72, and in St. John, 36. As usual the age groups 1-5 and 5-15 were those most affected, 88 of the cases falling into the former and 119 into the latter group. One application for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, was received. The nuisances detected during the course of investigating the notified cases were: Dirty Premises, etc., 51. These were all remedied after service of notices. Scarlet Fever. In many parts of London this disease was markedly epidemic and it is not surprising, therefore, that the figure for 1922 was so high as 339. 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. It is gratifying to note, however, that even with so high a figure the disease was much less prevalent than in 1921, when the notifications numbered 478. The highest number of cases reported in any one week was 14. The total deaths from scarlet fever numbered 4, and the number of deaths per cent. of the cases was 1.1. The districts to suffer most from this disease were Christ Church and St. John. In the former there were 126 cases and in the latter 83. In All Souls there were 71 and in St. Mary 59. As usual the majority of patients were children of school age, the age group, 5-15, giving nearly two-thirds (201) of the total. Of the remainder 86 were aged between 1 and 5 years. The source of infection was believed to be a previous case in the same family in 45 cases. In one hospital there was a small outbreak of 10 cases. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 30 instances that a definite connection could be made out. Defects in sanitation to the number of 46 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. 47 Enteric and Paratyphoid Fever. The Enteric Fever notifications received numbered 8. There were 2 deaths. Of Paratyphoid Fever there were 4 cases. All the patients recovered. One case of enteric fever that deserves comment, if for no other reason than that it induced an American physician to use enthusiastic language in praise of the administrative methods in relation to infectious disease in operation in the Borough, involved a member of the party of girl students from the United States that visited Europe about the middle of the year. In the course of the trip the party paid a visit to Italy and while there the patient consumed, amongst other articles, a certain amount of salad and ices. In due time the party reached Paris where the young lady became ill. On the 14th of August she left Paris by aeroplane and later in the day was taken to a hotel in the Borough. A doctor was called, and diagnosed enteric fever, and made notification. Within two hours of its receipt and little more than that of the patient's arrival, she was under isolation in hospital, all enquiries had been made, clothing had been removed for disinfection, and the room at the hotel was sealed up and undergoing fumigation. Cerebro-Spinal Fever. There were no cases of this disease during the year. Encephalitis Lethargica. The notifications numbered 3, 2 women and 1 man. One of the patients died; the remaining 2 were discharged from hospital practically completely cured. Polio-Myelitis. One case was notified, a girl, aged 12, who was discharged from hospital practically completely cured. Erysipelas. The notifications of erysipelas numbered 52, and there were 7 deaths. Puerperal Fever. The number of cases of this disease notified, viz., 2, was rather under the average. There were no deaths. In each case special enquiries were made by one of the health visitors and the premises were disinfected. Measles and German Measles. These conditions are not now notifiable. 1,012 cases were however reported, 244 voluntarily by doctors and parents and 768 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 1922 the number of deaths registered as due to whooping cough was 14. In 1921 the number was 7. Nurses were sent in to 2 cases, and 22 visits were paid. Glanders and Anthrax. No cases were notified. 48 Typhus Fever. In the list of cases of infectious disease notified, reference is made to one of typhus fever, and as this condition is rare nowadays and commonly regarded with great seriousness, the following report with regard to it, submitted to the Public Health Committee at the time, may be of interest. "The patient, a woman named Mrs. Annie Marks (otherwise Pisetsky), aged 40 years, and residing at No. 6, Charlton Street, was first taken ill on the evening of Saturday, 19th November, 1922, with shivering and general malaise. On the Sunday she attempted to get up, but had to go back to bed again, the symptoms being more or less the same. The first time I saw her was on the night of Thursday, 23rd November, when I was asked to give an opinion as to whether or not she was suffering from smallpox. I decided that the case was not one of smallpox, and accepted the statement of the medical man in attendance that possibly the condition was pneumonia and influenza. On Friday, 24th November, I was informed that the woman was still ill, and on the Saturday, Dr. Young, one of the physicians at the Middlesex Hospital, was called in consultation, but did not suggest removal. He saw her again on Sunday morning, and apparently then began to have suspicions that the patient might have typhus fever. He arranged with the Resident Medical Officer of the Middlesex Hospital to admit her to the isolation ward at the hospital, and this was done. I was not informed that she had been admitted until Monday evening, 27th November, when I went down and had a look at her. Being unable to convince myself that the condition was, in fact, typhus fever, I asked Dr. Brincker, of the London County Council, to see her with me, and eventually, after a consultation with Dr. Goodall, of the North-Western Fever Hospital, I arranged that she should be notified as suffering from typhoid fever and admitted to the North-Western Hospital. Here she was kept under observation, and eventually, on Friday, 1st December, Dr. Goodall informed me that from the course of the illness he must conclude that the case was one of typhus fever. I visited the hospital on Sunday, 3rd December, and found the patient to be well on the way to recovery, and on the 20th December, being well enough to return home, she was discharged. Judging from the temperature chart the patient must be regarded as having suffered from some form of poisoning, and having regard to the symptons and course, though by no means typical, I cannot see that Dr. Goodall could arrive at any other conclusion than that the poisoning was due to the organism of typhus fever. Little or no assistance was obtained from tests applied to the patient's blood. The house, No. 6, Charlton Street, is an ordinary tenement house. All the rooms, and particularly those occupied by the patient, were extraordinarily clean for that type of property. The family contacts were all admitted to the Shelter in order to permit of disinfection being thoroughly carried out, and, this having been done, I induced the landlord to have the rooms stripped and re-papered. Particulars of all contacts engaged outside St. Marylebone were notified to the medical officers of health of the respective districts, and details of the case forwarded to the Medical Officer of Health of the London Counry Council, and the Ministry of Health. In conclusion, I have only to add that the case has been a rather obscure one, and, despite exhaustive investigations, I have been quite unable to discover anything as to the possible source of infection. Up to the present no other case suggestive of typhus fever, either in the patient's family or in the neighbourhood, has been noted, which may be due to the fact that as soon as it was suggested that the case might be one of typhus fever, all the preventive measures commonly applied in this disease were immediately put in operation." 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 1922. During the year in certain of the schools, one or more classrooms were closed on account of measles. 49 SCHOOLS. Scarlet Fever. Diphtheria. Typhoid Fever. Whooping Cough. Chickenpox. Measles. All other Diseases. All Souls, Foley Street 20 3 - 13 37 59 16 Barrett Street — — - — — — - Barrow Hill Road 52 15 - 15 - 44 2 Bell Street 21 29 - 49 20 63 30 Blandford Square 6 - - - - 10 6 Capland Street 13 9 - 1 12 60 9 Catholic, Richmond Street 25 - - 12 4 21 7 Christ Church, Lisson Grove 32 34 - - 24 78 26 Convent, Little Union Place - - - - - - - Council School, Grove Road 4 - - - 1 2 - Emmanuel, Aberdeen Place 4 - - 2 1 1 1 Emmanuel, North Street 4 3 - 11 44 38 - Gateforth Street 3 6 - 20 2 36 3 Hampden Gurney, Upper Berkeley Street 6 - - 13 - 82 - Homer Row, Catholic 14 - - - 6 15 5 Jewish, Hanway Street 1 7 - - - - 8 Portland, Little Titchfield Street - - - - - - - Polytechnic, Regent Street - 2 - - - - - Queen's College, Harley Street 1 - - - - 1 - St. Andrew's, Wells Street - - - - - - - St. Francis, Upper William Street - - - - - - - St. James's, Marylebone Lane - - - - - - - St. Luke's, Nutford Place 6 7 - - - 32 1 St. Mark's, Violet Hill 10 9 - 10 39 15 47 St. Mark's, Marylebone Road 1 - - - - - - St. Marylebone, High Street 52 60 - 4 9 83 66 St. Marylebone Grammar, Marylebone Road 2 3 - - - 1 - St. Mary's, Crawford Street 12 2 - 2 3 14 18 St. Paul's, East Street - - - - - - - St. Paul's, Broadley Terrace 29 4 - 3 6 27 22 St. Thomas', Orchard Street 3 12 - - 12 4 40 St. Vincent, Lower Seymour Street - — — — — — — Upper Marylebone Street 39 22 1 12 18 75 57 Schools out of Borough 4 6 — 1 1 7 4 Totals 364 233 1 168 239 768 368 Ophthalmia Neonatorum. This disease—inflammation of the eyes in newly-born children—made notifiable by order of the London County Council in 1911, continued to be so during the whole of 1922. The following table gives information with regard to the 22 cases notified. Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. At Hospital. 22 10 12 17* — — — *Five of the patients left the district, and it was impossible to obtain further information as to progress. 50 INFLUENZA. This disease showed no epidemic tendencies during the year. The deaths certified as due to Influenza numbered 43 as against 14 in 1921. PNEUMONIA. Figures with regard to notification will be found on page 75, 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 58 cases and 760 visits were paid. TUBERCULOSIS. In all 194 notifications were received, 170 relating to pulmonary tuberculosis, the remainder (24) to cases in which structures other than the lungs were affected. The table given on page 51 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 10 as against 20 in 1921. 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 1922 1. Total number of deaths from tuberculosis in the Borough 122 117 127 2. The number of cases only notified at death 46 32 49 3. The number of cases notified within a month of death 9 7 6 4. The number of cases notified within three months of death 12 9 8 5. The number of cases notified within six months of death 8 12 1 In collating these figures it has been ascertained that of the 117 deaths in 1921 32 were certified at death only and were not notified; the majority dying in Mental Hospitals. The same remark applies to 1922, when 49 cases were certified on the death returns, which had not been previously notified. Of these 27 were cases of pulmonary tuberculosis, 15 being adults, 3 children and 9 inmates of asylums. The remaining 22 related to other forms of tuberculosis, 7 of the patients being adults, 11 children and 4 inmates of asylums. Treatment of Tuberculosis.—Of the cases notified 159 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 103 were insured persons: of these 67 were admitted to sanatorium or hospital treatment and 50 to St. Marylebone Hospital. Non-insured persons numbered 91 of whom 42 (21 being children) received sanatorium treatment and 11 were admitted to the St. Marylebone Hospital. Nurses were sent in to 25 cases and 380 visits were paid. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1922, to the 30th December, 1922. 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 — — 4 1 7 9 18 18 14 8 7 86 104 — 1 - 1 4 37 59 „ Females - — 3 4 7 17 22 13 7 a 2 81 100 — 1 1 2 4 10 39 Non-pulmonary, Males — 1 3 - 3 1 — 1 — — — 11 11 — 1 2 3 3 — 10 „ Females 3 2 — 1 — — — — — — 6 7 — — 4 4 4 — 4 Totals — 4 12 7 18 27 40 32 21 14 9 184 222 — 3 7 10 15 47 112 51 52 Prevention of Tuberculosis.—In connection with preventive work in respect of tuberculosis, the Dispensary, which has now been part of the Borough tuberculosis scheme since April, 1921, continued to prove most valuable, the members of the staff rendering excellent service. Particulars with regard to patients dealt with during the year are shown in a table at page 55, while the following short table summarizes the information as to visits paid by members of the staff:— No. of visits by Tuberculosis Officer New, 84 Old, 360 No. of cases at Dispensary New, 360 Old, 2,100 No. of attendances at Dispensary 4,080 No. of visits by Miss Baker First visit, 231 Re-visits, 1,717 No. of visits by Miss Bartleet First visit, 165 Re-visits, 1,052 No. of Committee Meetings attended 26 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 continued to run during the year. The number of children on the roll was 28—13 boys and 15 girls—and the attendances numbered 8,260. Dr. Saner, who has been Medical Officer of the School since he took office at the Dispensary, continued to act in this capacity. The following short note by the Tuberculosis Officer (Dr. Saner) contains reference to a number of points that may be of interest. "The figures as to the work done at the Dispensary are embodied in the General Report, except those referring to the number of re-examinations of patients about whom information is required by the Ministry of Pensions or the London County Council, and those who at their first attendance are labelled 'Suspects.' These examinations total just over 700. In connection with the treatment of tuberculosis little more has been advanced during the year of tested value, although if one can be guided by announcements in the newspapers under imposing headlines one should have a cure at hand for all forms of tuberculosis, especially of the pulmonary type. It seems a pity that the newspapers should, particularly in regard to such a condition as consumption, advertise methods of cure which, so far, have not received confirmation of their efficiency by competent authorities. It gives the consumptive, who is only too willing to try anything that promises relief, a false impression and a forlorn hope. This refers chiefly to the more advanced cases. Amongst the patients who attend the Dispensary there are many who think, because they have found the statement in a newspaper, that it must be true, and do not understand why any special treatment vaunted in the press has not been broadcasted to every dispensary for their benefit. The process of undeceiving a patient thus misled is unpleasant, but as a rule he 53 leaves the doctor with the assurance that directly the so-called cure has been proved to be of some use and sufficient of it can be obtained he shall be treated with it. The cure for the advanced and rapidly advancing cases of consumption has yet to be found. For the early case the general opinion may be accepted that the present method of treatment at sanatoria is based on sound and correct principles. Not only is it capable of slowing down and even stopping the disease, but it trains and educates the patient as to his future, and shows him the way in which he should conduct his life in order to live healthily at his work and in his home. Unfortunately there are those who, having had the sanatorium treatment and training, lack stability and strength of character sufficient to encourage them to continue the battle against the invasion of the tubercle bacillus, and who, as a result, gradually fall back into a condition worse than before. These are most unsatisfactory cases to deal with. A case in point was a young lad of 19 who, having benefited under treatment, was able to do a certain amount of work. Seen on his return from the sanatorium, he was told that the work he was doing was sufficient exercise for the day, and that he should rest quietly at home in the evening. In an injured tone of voice he asked, 'What about my recreation? and was told that, having regard to the fact that his recreation was the picture-houses or, worse still, public-houses, he should give it up. This he refused to do, and, almost needless to say, he quickly broke down and in a comparatively short time paid the final penalty. So much depends on the patient's own efforts for his health that it is heart-breaking when he is quite indifferent to all that has been done and is being done for him: particularly as it generally happens in these cases that the patient is only too ready to blame everybody but himself." 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 498 as against 426 in 1921. Of these, 117 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—24 as against 37 in 1921—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 58. 54 Return as to work carried out in connection with the St. Marylebone Tuberculosis Dispensary for the year 1922. (The return relates only to persons residing in the area which is served by the Dispensary under the scheme of the Council.) Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary NonPulmonary. Adults (a) All persons M. 36 109 145 45 3 84 13 10 F. 43 105 148 34 — 84 30 22 (including Children "Contacts.") under 15 M 77 58 135 11 5 58 61 29 F. 73 55 128 4 8 57 59 26 Total 229 327 556 94 16 283 163 87 (b) "Contacta" Adults M. 5 5 10 - - 10 - - F. 15 13 28 4 - 22 2 1 (included in Children (a)). under 15 M. 34 30 64 1 1 36 26 11 F. 35 27 62 3 2 36 21 11 (c) Insured persons (included in (a). M. 34 89 123 41 3 70 9 6 F. 14 50 64 20 - 33 11 8 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 165 2. Total number of attendances of patients Insured 1,634 at the Dispensary during the year Uninsured 2,009 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 63 4. Number of cases in which the period of observation at the Dispensary exceeded two months 82 5. Number of insured patients under domiciliary treatment on December 31st 134 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year - 7. Number of persons referred to affiliated hospital for consultation 7 8. Number of consultations with medical prac- Insured 9 titioners at the homes of patients Uninsured 1 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 420 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 1,736 11. Number of specimens of sputum examined in connection with the work of the Dispensary 353 Insured persons under domiciliary treatment by Insurance practitioners are included under Head 5. Statement of work carried out in connection with the Dispensary Treatment of Tuberculosis during the period 1st january, 1922, to the 31st december, 1922, and sundry particulars in connection with the scheme of treatment. I.—PARTICULARS OF WORK CARRIED OUT IN CONNECTION WITH THE DISPENSARY. Name of Dispensary. Name of Dispensary Medical Officer. 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, 1922, to the 31st December 1922, at or in connection with the Dispensary and were;— Number of Persons diagnosed to be suffering from Tuberculosis who were treated or supervised at or in connection with the Dispensary during the period from 1st January, 1922, to 31st December,1922. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1922. Number of Persons referred for diagnosis or treatment to the Hospital with which the Dispensary is affiliated during the period 1st January, 1922, to 31st December, 1922. 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 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 94 170 63 158 169 194 125 242 349 9 1 The following Table, which has been prepared for the Ministry of Health and the London County Council, shows the work carried out at the Dispensary:- 55 56 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. 1. Name of Hospital to which Special Cases are Middlesex Hospital. referred from the Dispensary for diagnosis or treatment 2. Is any provision for the home nursing of Tuber- No. Application can be made to the District culous Patients made in connection with the Nursing Association Dispensary? If so (1) State the general nature of the arrangement (1) Note sent to Matron from Dispensary. (2) What qualifications are the Nurses required (2) Fully trained. to possess? (3) Do they carry out other work? If so, what? (3) Yes, District Nursing. (4) Are their services available for Insured and (4) Yes. Uninsured Patient? (5) If so (a) by what procedure are their services (5) (a) As above. secured for individual patients? (6) Under whose instructions do they perform (b) Matron of Nursing Association and the actual duties of nursing in an indiTuberculosis Officer. vidual case? 3. If no provision of nursing is made in connection with the Dispensary is any such provision contemplated? If so, give particulars? 4. State number of Shelters provided by the Council or by the Dispensary Authorities.up to 31st None. December, 1922, 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 1922 the total number certified as due to this cause was 98, the deathrate being 0.9 per 1,000. The distribution of the deaths according to registration districts is shown in the accompanying table, which gives also the figures for each of the 5 years 1918-1922. 57 Deaths from Phthisis. Five years—1918-1922. Year. Estimated Population. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 1918 98,526 167 45 39 60 23 1919 97,953 104 12 27 53 12 1920 101,856 94 14 28 38 14 1921 105,200 102 24 24 40 14 1922 105,200 98 15 27 42 14 The distribution of the 98 deaths was as follows:—In Poor Law Institutions, 46; general and other hospitals, 22; and at home, 30. Of those who died 57 were insured (41 males and 16 females), and 36 uninsured (10 males and 26 females). In addition there were 5 children. As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 98 the notified cases of pulmonary tuberculosis totalled 170. The age and sex distribution of the deaths is shown in the following table. 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. Hales — 2 6 13 10 12 6 1 50 Females 2 4 15 12 5 9 1 — 48 Totals 2 6 21 25 15 21 7 1 98 The following table, giving information as to the localization of the disease, brings out no fact to which attention has not already been directed. CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 30th DECEMBER, 1922. Localization 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 170 — — 15 40 71 35 9 37 45 61 27 170 19 12 22 8 61 109 Ulna 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 ... 1 ... ... 1 ... Glands 12 ... 1 11 ... ... ... ... ... 4 5 2 12 ... ... 1 1 2 10 Meninges 2 ... 2 ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... 2 Abdomen 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Spine 2 ... ... ... 1 1 ... ... ... ... 1 ... 2 1 ... ... ... 1 1 Hip 3 ... ... 1 2 ... ... ... ... ... 3 ... 3 ... ... 2 ... 2 1 Ankle 1 ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... 1 1 ... General 2 1 l ... ... ... ... ... ... 1 1 2 ... ... 1 ... 1 1 Totals 194 ... 4 29 45 72 35 9 39 51 73 31 194 20 13 26 10 69 125 194 58 59 The work done in this connection during 1922 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 341 15 - 2 10 368 Mattresses 489 27 5 2 123 646 Bolsters 307 19 4 — 52 382 Pillows 1,351 80 8 2 314 1,755 Sheets 841 18 7 — 30 896 Blankets 1,205 64 16 29 71 1,385 Sundries 8,683 425 280 431 113 9,932 Totals 13,217 648 320 466 713 15,364 In 1921, the number of articles disinfected was 16,166. The number of journeys made by the disinfecting vans during the year ended December. 1922. was:— January 70 February 64 March 73 April 61 May 73 June 68 July 68 August 71 September 65 October 70 November 70 December 63 816 The vans were used 819 times in 1921. 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 89 17 4 - 2 112 February 37 7 2 2 2 50 March 76 6 3 3 2 90 April 44 4 13 1 - 62 May 65 7 22 5 3 102 June 85 6 3 1 1 96 July 84 5 6 4 - 99 August 64 6 2 7 - 79 September 61 22 - - - 83 October 45 15 - - — 60 November 43 8 - - - 51 December 57 8 — 1 — 66 Totals 750 111 55 24 10 950 60 The number of rooms disinfected in 1921 was 1,136. In regard to treatment of premises with the object of destroying vermin, it may be noted that in order to assist owners and occupiers of infested premises, arrangements have now been made for placing at their disposal a spraying apparatus and a supply of a liquid believed to possess great destructive powers in this direction. This liquid is known as "Fluid D," and appears to be some form of petroleum. The results obtained up to the present have been fairly satisfactory, and a considerable number of persons have made use of the facilities provided for trying the effect of the treatment. 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 1922, and annually since 1910:— 1922. Adults. Children. Males. Females. Total. Males. Females. Total. January 284 96 380 48 153 201 February 237 93 330 42 292 334 March 273 87 360 45 322 367 April 200 90 290 30 120 150 May 261 92 353 51 261 312 June 242 102 344 30 292 322 July 228 96 324 32 292 324 August 280 97 377 4 36 40 September 200 90 290 44 324 368 October 254 92 346 40 302 342 November 258 89 347 40 330 370 December 219 39 258 23 152 175 Totals 2,936 1,063 3,999 429 2,876 3,305 Cleansing Station Attendances, 1910-1922. 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 1922 2,936 1,063 3,999 429 2,876 3,305 The total attendances since the Baths were opened in 1898 number 208,099 (adults, 155,130; children, 52,969). 61 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. 1922 Positive. Negative Total. Malaria — 1 1 Typhoid fever 4 24 28 Diphtheria 164 1,142 1,306 Phthisis 117 381 498 Totals 285 1,548 1,833 MATERNITY AND CHILD WELFARE. The composition of the Maternity and Child Welfare Scheme now in existence has been very frequently described in annual reports and more particularly in that for 1919. As is well known, it contains voluntary and official elements. Of the voluntary elements, to the nature of which reference is made later, those for which the St. Marylebone Health Society is responsible bulk largest, and the Council and the inhabitants of the Borough are greatly indebted to this body and those who work for it for what they have done and what they are doing in relation to maternity and child welfare. Apart from the Health Society, however, there are other bodies that assist, and that are more or less definitely linked up to the main scheme, the connecting link being the Public Health Department of the Council. Amongst these bodies 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 1922. It will be noted that at the end of the year there were available nine 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. 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. 62 The summary referred to above is based upon a return formerly called for by the Local Government Board and is given here because it is convenient as showing the elements in the scheme. Health Visitors.—There are six health visitors. 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 1922 the health visitors made 6,949 visits to infants, and the voluntary visitors attached to the schools for mothers made 748 visits to infants; children are visited up to school age. Centres.—There are in all nine 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 under medical supervision. The denial 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, at the Church Army Dispensary and at the Western General 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 63 Home, Marylebone Road. The number of births notified from these institutions during 1922 was 2,504, the total births numbering 3,813. 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.—This institution, which was opened early in 1918, had unfortunately, owing to lack of funds, to close down about the middle of the year. During the time it was open it did much valuable work, and it is a source of keen regret to all who were interested in it that its operations had, of necessity, to come to an end. Work done during 1922.—The following table gives some idea of the work done at the various centres during the year. The method adopted in relation to the granting of orders for milk and food under the Maternity and Child Welfare 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. STATEMENT SHOWING WORK AT INFANT CONSULTATIONS AND ANTE-NATAL CLINIC CENTRES DURING THE 52 WEEKS ENDING 31ST DECEMBER, 1922. 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 47 241 (191 children 50 maternity 304 (253 antenatal 51 infants 92 98 50 149 92 50 No. of attendances of mothers at ante-natal clinic - 681 6718 - 23 - - - 31 No. of attendances of babies 894 3655 1216 1619 1544 838 2831 545 513 No. of attendances of children over 2 years 169 564 73 215 159 138 1203 1315 34 No. of orders issued for milk, etc. 102 580 81 102 71 47 74 15 24 No.of home visits 540 2806 748 746 623 753 1010 22 258 No. of new cases 87 335 3539 86 131 57 287 327 48 Day Nurseries—Attendances during the year. St. John's Wood, Barrow Hill Road 5270 Portmar, Exeter Street 7855 64 The St. Marylebone Babies':Nursing Home, 20, Marlborough Place, N.W.8 No. in Home at beginning of year 14 Admissions 18. Discharges 30. Deaths 2 Home permanently closed on 28th August, 1922. Home Helps.—The system of providing assistance in carrying out the work of the home to expectant, nursing or ailing mothers continued 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 1922 was 10. The average time for which the help was required was 4 weeks, the longest being 12 weeks, and the shortest 1 day. The total amount expended during the financial year to 31st March, 1923, was £9 9s. 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. 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, 1922. 1922. Males. Females. Total. For burial only. For inquests. Total. No. of. P.M.'s held No. of courts held. No. of Infectious cases. January 17 13 30 14 16 30 11 5 - February 11 8 19 11 8 19 5 4 2 March 6 11 17 8 9 17 4 4 — April 12 8 20 11 9 20 5 4 — May 14 14 28 10 18 28 7 5 — June 10 5 15 8 7 15 1 4 — July 10 14 24 7 17 24 11 8 — August 12 4 16 8 8 16 3 4 — September 10 4 14 5 9 14 4 5 — October 13 8 21 11 10 21 5 4 — November 22 7 29 12 17 29 6 6 — December 12 6 18 11 7 18 5 4 — Totals 149 102 251 116 135 251 67 57 2 65 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 they 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 places where food is dealt with. Reference is made to these elsewhere. 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. At the end of the year, though a great part of the site for the Council's housing scheme had been cleared, the approval of the Ministry of Health to the scheme had not been obtained. The efforts of the Housing Committee to get the houses on the site still occupied into a reasonable state of repair were continued, and considerable improvements were made. 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. Actually, only 1 application was received, and this it was found impossible to grant, though, following pressure, certain minor defects that were detected were dealt with. Number of new houses erected during the year: (a) Total 72 Flats (b) As part of a municipal housing scheme Nil 1. Unfit dwelling-houses: Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,779 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910— Houses 793 Tenements in blocks 281 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,507 66 2. Remedy for defects without service of formal notices: Number of defective dwelling-houses rendered fit in consequence of informal action by the local authority or their officers (intimation only) 2,224 3. Action under statutory powers: (a) Proceedings under Section 28 of the Housing, Town Planning, &c. Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit— (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied (statutory notices) 283 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 283 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c. Act, 1909: (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil Table A.—HOUSING. V Statistics for the Twelve Months ended 31st December, 1922. 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. Number of Representations. Buildings Removed. Representations under Consideration. Full Time. Part Time. - 793 and 281 Tenements - 664 — — - - — - — - - - 2 - 1 - 67 68 GENERAL STATISTICS. Area (acres) 1427.8 (exclusive of water); 1473 (including water). Population (1921). 104,173. Number of inhabited houses (1921). 18,507. Number of families or separate occupiers (1921). 27,214. Rateable value.£2,449,510. Sum represented by a penny rate. £10,206. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimate 1,502 771 731 Birth Rate 18.2. Illegitimate 177 100 77 Deaths, 1,451. Death Rate 13.7. Number of women dying in, or in consequence of childbirth—from sepsis, none; other causes, 1. Deaths of Infants under 1 year of age per 1,000 births:— Legitimate 56.5 Illegitimate 169.5 Total 68.0. Deaths from Measles (all ages), 26. Deaths from Whooping Cough (all ages), 14. Deaths from Diarrhoea (under 2 years of age), 17. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 144 Cowhouses 2 Slaughterhouses 3 Offensive Trades 2 Ice Cream Premises 128 Bakehouses 72 Restaurant, Dining Room and Coffee Shop Kitchens 191 Hotel Kitchens 43 Pastrycooks and Tea Rooms 70 Fried Fish Shops 22 Fish Curers 5 Houses Let in Lodgings 1,147 Workshops and Workplaces 3,535 Total 5,364 Smoke Nuisances. Number of Observations 218 Number of Nuisances and Complaints 12 Number of Notices 4 Number of Summonses Nil 69 Housing of the Working Classes. Number of Houses inspected 793 Tenements in blocks 281 Number of Representations by Householders Nil Number of Representations by Medical Officer Nil Number of Houses included in such Representations Nil Number of Houses remedied without Closing Orders Nil Number of Damolition Orders Nil Number of Houses dealt with under Section 15 of the Housing, Town Planning, etc., Act, 1909 Nil Number of Closing Orders Nil Number of Houses included in such Closing Orders Nil Number of Closing Orders determined from year 1920 Nil Number of Houses demolished— (a) In pursuance of Orders Nil (b) Voluntarily Nil Obstructive Buildings. Number of Representations under Section 38 of the Housing Act, 1890 Nil Number of Representations still under consideration Nil Number of Orders for repairs issued under Section 28 of the Housing Act, 1919 Nil Total number of Houses in the Borough 18,507 Number of Houses for the Working Classes— (a) Erected during year Nil (b) In course of erection Nil Number of Buildings demolished 2 Number of Houses repaired by Local Authority Nil Number of Houses closed on Notice by Owner that they could not be made fit Nil Number of Houses occupied by the Working Classes 7,266 Mortuary. Number of bodies received 251 Number of Infectious bodies received 2 Disinfection. Number of rooms disinfected 950 Number of articles disinfected 15,364 70 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 2,936 1,063 429 2.876 7,304 Bakehouses. Number on register at end of 1922 72 Number above ground 8 Number underground 64 Number of inspections 200 Number of Notices 8 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1922 331 Number of Inspections 1,241 Number of Notices 30 Number of Prosecutions Nil House to House Inspections. Number of Inspections Houses 793 Tenements 281 Number of Notices issued ... Intimations 664 Statutory Notices 106 Number of Prosecutions 5 House Refuse. Number of Inspections 4,902 Number of Old Brick Receptacles abolished 2 Number of New Metal Receptacles provided 863 Number of Notices issued. Intimations 655 „ Statutory Notices 51 Number of Prosecutions 3 Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 37 Number of Statutory Notices served 4 Number of Prosecutions 1 Overcrowding. Number of Dwelling Rooms overcrowded 8 Number remedied 8 Number of Prosecutions Nil 71 Underground Rooms. Number dealt with 18 Number of Notices served under P. H. (L.) Act, 1891 Number of Notices served under H. T. P., &c., Act, 1909 18 Number of Prosecutions Nil Verminous Rooms. London County Council (General Powers) Act, 1922, Section 9 (1). Number of rooms cleansed 946 Number of Statutory Notices served 48 Number of Prosecutions 3 Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 26 Inland Revenue Act. Number of houses for which applications were received 1 Number of tenements comprised therein 56 Number of tenements for which certificates were granted 56 „ „ „ „ refused Nil „ „ „ „ deferred Nil Drainage. Number of inspections made 6,619 Number of drainage plans deposited 493 Number relating to new buildings 58 „ „ old buildings 435 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops, and Cowsheds 403 Number of Inspections 1,441 Ophthalmia Neonatorum Regulations. Number of Notifications received during the year from certified midwives 1 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 2 72 MINISTRY OF HEALTH AND OTHER TABLES. table i. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1922 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each year. 2 Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. 3 Nett. of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Under 1 Year of Age. At all Ages. No. 10 Rate per 1,000 Nett Births. 11 No. 12 Rate. 13 No. 4 Rate. 6 No. 6 Rate. 7 1911 117,844 4,130 2,375 20.2 1,578 14.2 600 840 261 109.8 1,818 16.3 1912 116,155 4,111 2,246 19.3 1,652 15.0 769 752 209 93.0 1,635 14.8 1913 114,532 3,804 2,146 18.6 1,629 14.9 755 753 195 90.0 1,627 14.9 1914 112,892 3,847 2,128 18.7 1,631 15.1 813 787 210 98.6 1,605 14.9 1915 100,260 3,647 1,852 16.2 1,741 17.2 817 773 178 96.1 1,697 17.8 1916 98,573 3,936 1,814 16.8 1,681 16.9 855 720 188 103.6 1,588 16.0 1917 92,796 3,065 1,506 14.5 1,647 17.6 853 752 182 120.9 1,580 17.0 1918 98,526 3,340 1,375 12.4 1,852 18.7 898 879 152 110.5 1,835 18.5 1919 97,953 3,625 1,492 14.6 1,724 17.3 864 708 147 98.5 1,568 15.9 1920 101,856 4,287 2,217 21.5 1,638 16.0 939 600 145 65.6 1,299 12.7 1921 105,200 3,393 1,939 18.4 1,625 15.4 877 607 128 66.0 1,355 12.8 1922 105,200 3,588 1,679 18.2 1,638 15.5 905 718 115 68.0 1,451 13.7 Total population at all ages at Census of 1921, 104,173. Area of district in acres (exclusive of area covered by water), 1427 8 acres. „ (including area covered by water), 1473 acres. TABLE I. (a) Vital Statistics of Separate Localities in 1922 and the ten Previous Years. Names of Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1912 116,135 2,246 1,635 209 28,971 452 379 45 31,566 453 411 30 35,903 971 588 108 19,715 370 257 26 1913 114,532 2,146 1,627 195 28,567 388 343 30 31,124 400 367 34 35,402 998 652 110 19,439 360 265 21 1914 112,892 2,128 1,605 210 28,158 435 317 36 30,678 418 388 33 34,895 937 630 113 19,161 338 270 28 1915 100,260 1,852 1,697 178 25,002 367 341 21 27,342 337 422 35 30,901 801 639 94 17,015 347 295 28 1916* 98,573 1,814 1,588 188 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 1,239 145 25,352 450 252 28 27,796 439 366 27 31,414 933 446 71 17,294 395 235 19 1921 105,200 1,939 1,355 128 26,184 390 268 29 28,709 445 345 27 32,445 720 455 55 17,862 384 287 23 Averages of Years 1912 to 1921 103,872 1,871 1,577 173 25,877 382 319 30 28,305 362 395 34 32,059 783 686 84 17,633 342 276 24 1922 105,200 1,679 1,451 115 25,202 318 286 18 26,943 405 415 21 32,747 673 459 50 20,308 283 291 26 * 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. 73 TABLE II. Notifiable Diseases during the Year 1922. Cases Notified. Deaths Certified. Disease. At all Ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards. To.al No. of Cases Admitted to Hospital. Total deaths Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Diphtheria 268 6 88 119 33 20 2 ... 261 30 2 6 8 14 ... ... ... ... Erysipelas 52 2 ... 3 9 11 12 15 18 7 ... ... ... ... ... 1 2 4 Scarlet Fever 339 2 86 201 31 18 1 ... 331 4 ... ... 1 2 1 ... ... ... Typhus Fever 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... Enteric Fever (including Paratyphoid) 12 ... ... 1 3 7 ... 1 9 2 ... ... ... ... ... 1 ... 1 Puerperal Fever 2 ... ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... ... Acute Poliomyelitis 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 22 22 ... ... ... ... ... ... 10 ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 3 ... ... ... ... 1 2 ... 2 1 ... ... ... ... ... ... 1 ... Pneumonia 113 7 24 20 12 25 22 3 33 148 19 14 11 5 5 16 39 39 Malaria 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis: Pulmonary—Males 87 ... ... 6 16 36 22 7 39 50 ... ... ... ... 6 18 22 4 „ Females 83 ... ... 9 24 35 13 2 22 48 ... ... 2 1 11 21 12 1 Total 170 ... ... 15 40 71 35 9 61 98 ... ... 2 1 17 39 34 5 Non-Pulmonary—Males 14 ... 1 8 4 1 ... ... 4 18 2 ... 3 3 2 2 5 1 „ Females 10 ... 3 6 1 ... ... ... 4 11 ... 2 2 4 ... 2 1 ... Total 24 ... 4 14 5 1 ... ... 8 29 2 2 5 7 2 4 6 1 74 TABLE II.(a) Cases of Infectious Disease Notified during the 52 weeks ending 30TH December, 1922. 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 5 6 to 15 15 to 25 25 to 45 15 to 65 65 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 268 6 88 119 33 20 2 ... 69 72 91 36 268 68 71 88 34 261 7 Erysipelas 52 2 ... 3 9 11 12 15 7 17 18 10 52 3 4 7 4 18 34 Scarlet Fever 339 2 86 201 31 18 1 ... 71 59 126 83 339 70 08 124 79 331 8 Typhus Fever 1 ... ... ... ... 1 ... ... 1 ... ... ... 1 1 ... ... ... 1 ... Enteric Fever 8 ... ... 1 2 4 ... 1 ... 2 5 1 8 ... 1 4 I 6 2 Paratyphoid Fever 4 ... ... ... 1 3 ... ... 2 ... 1 1 4 1 ... 1 1 3 I Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 2 ... ... ... ... 2 ... ... 1 ... 1 ... 2 ... ... 1 ... 1 1 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Farcy. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis Pulmonary 170 ... ... 15 40 71 35 9 37 45 61 27 170 19 12 22 8 61 109 Non-Pulmonary 24 ... 4 14 5 1 ... ... 2 6 12 4 24 1 1 4 2 8 16 Acute Poliomyelitis 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Polio-Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 22 22 ... ... ... ... ... ... 7 1 9 5 22 1 ... 6 3 10 12 Encephalitis Lethargica 3 ... ... ... ... 1 2 ... ... 1 2 ... 3 ... ... 2 ... 2 1 Pneumonia 113 7 24 20 12 25 22 3 10 27 56 20 113 4 2 17 10 33 80 Malaria 1 ... ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... *** ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1008 39 202 374 133 158 74 28 207 231 383 187 1008 168 149 276 142 735 273 1008 75 TABLE III.—Causes of, and Ages at Death during the year ending 30th December, 1922. No. CAUSES OF DEATH. Net deaths at the subjoined ages of “ Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church. St. John. Total. All Ages. 1* 0) c D eg 3 u rH c 3 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 05 and upwards. I Enteric Fever 2 - - - - - 1 - 1 2 - - 1 1 2 2 Small Pox - - - - - - - - - - - - - - - 3 Measles 26 2 15 9 - - - - - - 3 2 19 2 26 4 Scarlet Fever 4 - - 1 2 1 - - - - 1 1 - 2 4 5 Whooping Cough 14 4 6 4 - - - - - - 3 2 6 3 14 6 Diphtheria and Croup 30 2 6 8 14 - - - - 2 6 9 13 2 30 7 Influenza 43 1 1 - - - 9 13 19 7 9 13 13 8 43 8 Erysipelas 7 - - - - - 1 2 4 2 3 1 2 1 7 9 Tuberculosis of the Respiratory System(Lung:s, Pleura & Throat) 98 - - 2 1 17 39 34 5 21 15 27 42 14 98 9a Desseminated Tuberculosis 1 - - - - - 1 - - 2 1 - - - 1 10 Tuberculous Meningitis 11 2 2 3 3 - - 1 - 14 2 3 4 2 11 11 Other Tuberculous Diseases 17 - - . 2 4 2 3 5 1 10 5 6 4 2 17 12 Cancer 173 — — 1 — — 14 81 77 339 35 59 42 37 173 13 Rheumatic Fever 3 — — - 1 — - 2 - 1 - - 1 2 3 14 Meningitis 1 — — — — — - 1 - 2 - -. - 1 1 15 Organic Heart Disease 114 — — — 2 1 13 29 69 68 29 35 27 23 114 16 Bronchitis 151 5 3 — — 1 4 33 105 24 22 42 57 30 151 17 Pneumonia (all forms) 148 19 14 11 5 5 16 39 39 59 17 35 60 36 148 18 Other Diseases of Respiratory Organs 26 1 — — — 1 7 9 8 11 4 12 7 3 26 19 Diarrhoea and Enteritis (under 2 years) 17 17 - - - - - - - 7 4 4 6 4 17 20 Appendicitis and Typhlitis 13 — — — — 1 7 4 1 18 5 3 2 3 13 21 Cirrhosis of Liver 7 - - - - - 2 5 - 7 2 2 2 1 7 21 Alcoholism 1 - - - - - - 1 - 1 - 1 - - 1 22 Nephritis and Bright's Disease 42 — - — — 1 11 14 16 23 12 14 13 3 42 23 Puerperal Fever — — — _ — — - - - 4 - - - - - 24 Other accidents and diseases of Pregnancy and Parturition 1 — — — — — 1 — — 16 — — 1 — 1 25 Congenital Debility and Malformation, including Premature Birth 42 42 - - - - - - - 45 10 8 17 7 42 26 Violent Deaths, excluding Suicide 56 2 2 4 — 4 15 20 9 43 14 17 18 7 56 27 Suicides 19 — — — 1 9 9 11 4 6 6 4 19 28 Other defined Causes 384 18 - 4 6 4 40 120 192 299 79 113 98 94 384 29 Diseases ill defined or unknown — — — — — — — — — — — — - - - Totals 1451 115 49 49 38 39 193 422 546 1038 285 415 459 292 1451 76 VACCINATION RETURNS. Supplemental Return for 1921. return made to the Board of Guardians and Ministry of Health on the 9th February, 1923, 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, 1921, 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, 1921. Number of these Births duly entered by 31st January, 1923, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: • Number of these Births which on 31st January, 1923, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1923, 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 1922. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1922. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received. Col. V. Dead, Un vaccinated. Postpone ment by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprised. Removal to Places unknown or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had SmallPox. 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 904 592 2 ... 179 41 10 22 25 33 3,035 429 2. St. Mary 1,837 1,243 3 ... 185 124 10 254 8 10 3. All Souls 655 474 1 ... 63 23 5 74 8 7 Total 3,396 2,309 6 ... 427 188 25 350 41 50 3,035 429 Dated 9th February, 1923. {Signed) GEORGE H. BASSETT, Vaccination Officer. 77