AC 4353 STMARY 28 Metropolitan Borough of St Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1923. 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 4. Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH ♦ FOR THE YEAR 1923. 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 4. GEO. PULMAN & SONS, LTD., LONDON AND WEALDSTONE. Public Health Department, Town Hall, Marylebone Road, N.W.I. 16th May, 1924. 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. In accordance with the instructions of the Ministry of Health I have contented myself with making it little more than a chronicle of the principal happenings and statistical information of the year. In the body of the report any matters that appeared to be of importance have been commented upon and there is nothing that I desire to draw particular attention to here. This year, perhaps, more than in previous years, I have reason to do more than merely formally thank the Public Health Committee and the two members (Mr. Alderman J. Fettes and Mr. Alderman Rickatson) who have presided over it. It was largely owing to the view taken of my request for leave of absence by the Committee and the two gentleman I have named that the Council was pleased to allow me to accept the invitation of the Health Section of the League of Nations to visit the United States and study the system of public health administration in vogue there. That during my absence I had not one moment of anxiety so far as the work of the department was concerned, as indeed, the reports I received assured me I need not, and was proved to me when on my return after nearly five months' absence I found all matters in perfect order, was no less due to the Committee, their interest in the work and their willingness to assist the workers. To the staff also it is something more than formal words of thanks I have to offer and I would ask them to believe that I do most highly appreciate the excellent work they did and the loyalty with which they carried on. Dr. Jameson, the Deputy Medical Officer of Health, who took my place throughout the period of my absence, despite other calls upon him, devoted himself unsparingly to the work and increased the esteem and regard in which he is held by the Committee and the department alike. 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 Census 19 Sanitary circumstances 19 Water Supply 19 Drainage 20 Combined Drainage 20 Closet Accommodation 20 Underground Public Conveniences 20 Removal and Disposal of House Refuse 21 Sanitary inspection of the District 21 Staff 21 Nuisances—Legal Proceedings 21-23 Inspections 22 Rat Repression 23 Premises and Occupations controlled by By-laws and Regulations 23 Business Premises 24 Milk Premises 24 Cow Sheds 24 Slaughterhouses 24 Offensive Trades 25 Ice Cream Premises 25 Butter. Margarine, etc., Premises 25 Bakehouses 25 Fried Fish Vendors 25 Fish Curers 25 Factories and Workshops 25 Inspections 26 Defects found 26 Home Work 27 Registered Workshops 28 Other Matters 28 Premises used for Human Habitation 29 Houses let in lodgings 29 Common Lodging Houses 29 Underground Rooms 30 Premises that are not but should be Registered 30 Food Stalls 31 Food 31 Milk Supply 31 Milk Analysis 31 Legal proceedings for adulteration 31 Bacteriological examinations 31 Dairies, Cowsheds and Milk shops Orders 32 Milk and Cream Regulations 32 The Milk (Special Designations) Order, 1922 33 Milk for Mothers and Children 33 Food Inspections 33 Food, Unsound, Condemned 34 Sale of Food and Drugs Acts 34 Reports of Public Analyst during year 35-42 Statistical 42 Births 42 Births Registration 42 Births Notifications 42 Deaths and Death Rates 43 Sub-District Births and Deaths 43 Deaths in relation to Age 43 Causes of and ages at death 43 Infantile Mortality 44-46 ,, ,, Causes 44, 45 Deaths in relation to Disease 47 Diarrhœal Diseases 47 Infectious(Communicable)Diseases 47 Phthisis and other Tuberculous Diseases 47, 48 Respiratory Diseases 48 Cancer or Malignant Disease 48 Alcoholism 49 Accident, Suicide and Manslaughter 49 Prevalence of and Control over Infectious Diseases 49 Isolation of Cases 49 Discharge Notices 50 Diphtheria and Membranous Croup 50 Scarlet Fever 50 Enteric and Paratyphoid Fever 51 Cerebro-Spinal Fever 51 Encephalitis Lethargica 51 Polio-Myelitis 51 Erysipelas 51 Puerperal Fever 51 Measles and German Measles 51 Whooping Cough 51 Glanders 51 Anthrax 51 Smallpox 52 In Schools 52 Ophthalmia Neonatorum 53 Influenza 53 Pneumonia 53 Tuberculosis 53 Treatment of 53 Notifications 54, 61 Prevention of 55 Bacteriological Diagnosis 56 Work at Dispensaries 57-59 Deaths 59, 60 Disinfection 62 Cleansing of Persons Act, 1897 63 Bacteriological Examinations 64 Maternity and Child Welfare 64 Health Visitors 65 Centres 65 Ante-Natal Work 65 Dental Clinic 65 Hospital Treatment 65 Maternity Cases 66 Infant Consultations—Work at 66 Day Nurseries 66 Home Helps 67 Sanitary Administration— Staff 67 Report of Mortuary Keeper 67 Housing— General Housing Conditions 68-70 Statistics 70 General Statistics 71 Extracts from Vital Statistics of the Year 71 General Summary 71-74 Ministry of Health. Tables I—III 75-79 Vaccination Returns 80 7 FOREWORD Under this heading in the reports of the last two or three years I have given a note with regard to some matter of importance or interest from the health point of view. This year it appears to me that it might not be out of place if instead of following the usual practice I give instead some of my impressions of the health work I saw during the visit I had the opportunity of paying to the United States in the autumn of 1923. These impressions were originally given in letters sent to the Chairman of the Public Health Committee of the Council, and the notes that follow are abstracts from these letters. WASHINGTON : THE UNITED STATES PUBLIC HEALTH SERVICE. What we have been doing here has been making a study of the activities of the Federal Public Health Service, a body which is quite different from any organization at home, and so far as I know, is unique in the world. Its aims, objects and constitution have been explained to us by various of its members, and by others we have had the work either described or demonstrated. Primarily it exists for the purpose of preventing the entrance of disease into the States as a whole, and in addition for preventing the spread of disease from one State to another. As regards disease within the various States, the States themselves are responsible, the majority having a State Board of Health that deals with this and a variety of other matters that affect the State as a whole. In the matter of disease, the Federal Public Health Service is given a very wide field, and is particularly concerned with investigating into causes and modes of prevention. For the purpose there is a special Research Division with one of the finest equipped laboratories I have ever seen. At this laboratory splendid work is done, the staff, like the staff of all the departments I have seen, being highly qualified, and most enthusiastic. One most valuable piece of work is that done in connection with such things as vaccines against smallpox, etc., antitoxin, as used in diphtheria, and so on. All manufacturers of these materials must be licensed, and this is only done after a full inspection is made and the department is satisfied as to the purity and value of the material. At home there is no such arrangement, though it is obviously one that ensures a great measure of protection for the people. In addition to this Research Division, within the department and under the Surgeon-General there are six others, each concerned with one special branch of work, e.g. Quarantine and Immigration. On our arrival in American waters the first man to board the vessel was an officer of this latter division. As he was charged to welcome us in the name of the Public Health Service and to show us his work we had an opportunity of judging of its value. We had only about 250 immigrants on board. These were all roughly examined for vermin and gtoss defects, fairly thoroughly I thought, by people of experience. Afterwards they would be more completely examined. As we visit Ellis Island at the end of the course I shall be able to form an opinion with regard to the work done there. The relations of the Federal Health Department with the . States are rather peculiar. Apparently they have little or no powers of supervision or criticism, interfering only if requested to do so. Their services in this direction are widely taken advantage of, many of the States that have health departments having set them up after consultation with the Public Health Service. 8 The medical members of this service are all commissioned by the President and are entirely unaffected by political upsets. They rank as officers in both the Army and the Navy. The chief is the Surgeon-General, and under him are assistant surgeon-generals in charge of divisions; senior surgeons; surgeons; passed assistant surgeons ; and assistant surgeons. The department has nothing to do with the administration of the food laws, this being in the hands of the Bureau of Animal Industry and the Bureau of Chemistry; the second is not fully staffed, and the supervision of manufacturers is far from complete. The officers admit this. On this point I should like to say, that I have been greatly impressed at the manner in which every door has been thrown open to us. There has been, so far as I can see, no attempt either to conceal anything or to exaggerate the value and importance of what is done. This is, of course, because the men we have met are highly scientific and probably the pick of the American medical profession. As a fact, they are in many respects like the health people one meets at the Ministry of Health and in the bigger districts at home, their aims and motives and attitude towards their work being exactly the same. We have had a great deal of kindness shown to us. The Assistant Secretary of the Treasury (the Health Department is under the Treasury for some reason) invited us to lunch one day, and we have been given the freedom of all the chief clubs. Prohibition is greatly favoured by all the people I have spoken to—a selected class, of course—and all hope that the old arrangements will never come back again. THE STATE OF VIRGINIA. The last time I wrote to you was after my stay in Washington. To-day we finish up the time allotted to the study of conditions in Virginia and sail for Baltimore, where we are to spend two days in examining the course of study in Public Health provided at the Johns Hopkins University. Altogether we have been just over three weeks in this State, and in that time have covered a tremendous amount of ground and seen specimens of the work done in a large number of representative areas. Virginia is largely rural and what we have seen has been mainly rural work. The great problems have been the filth diseases, typhoid fever, and "hook-worm disease," and malaria. To get rid of the first two the chief necessity has been to abolish insanitary methods of disposing of filth and to improve the water supply. Before anything could be done it was essential to educate the people, who were extraordinarily ignorant and bigoted. Even to-day, so far as education is concerned, the people who live in the more remote parts are very far behind, and even when they can be got at—the roads generally being very bad—resent any attempt to teach them, quite commonly showing a tendency to use a gun to make clear their point of view. The life of a health officer, since the introduction of prohibition, in outof-the-way places particularly, has been far from pleasant, more especially if he should find himself in the neighbourhood of a "moonshine" factory. In the State there are in all 100 counties, varying in size from 250 to GOO or 700 square miles. Up to the present only in 34 has any health organization been set up, and in many places this is represented by a man only more or less qualified as a sanitary inspector. The number of county health officers who are medically qualified is not great, partly because the "Board of Supervisors" will not make the necessary appropriations, despite the fact that the State Board of Health and the International Health Commission (operating with Rockefeller funds) are prepared to share the cost of the work done. Though the counties are quite large it should be noted that the populations are in general small, going down as low as 12,000, e.g., in Nansemonde county in the neighbourhood of which the first English colony was set up by Captain John 9 Smith. This being so it can readily be understood why the population, which is exceedingly widely scattered, hesitates to incur the expense. What: is very commonly done is to arrange lor an officer with a staff of one or two inspectors and possibly a nurse to combine the duties of health officer of some small town with those of the county. This is an arrangement that works very well, and it is here that the best results are obtained. Typhoid in counties so dealt with has been verv greatly reduced, and hookworm disease has been practically wiped out, almost entirely as a result of substituting a sanitary form of convenience for a bad form or none at all. Hookworm disease is practically non-existent in Great Britain but here, in the South, it has been and is responsible for a vast amount of ill-health, the sufferers though able to go about being so weak and languid as to be incapable of physical exertion. As a result their homes and farms get into a dreadful condition and they and their families starve. In some places 1 have seen so much of it that now I can almost invariably tell the individuals who are victims of the disease merely by noting their bearing. The effect of treatment on the patients and of minor health works at their homes is the bringing about of a miracle. The individual is given a new lease of life, and in a short time he is able to pull his place round. It was to fight this disease particularly that Rockefeller gave such large sums of money some few years ago. In very many counties malaria (chills and fever) has been a curse for ages. Jamestown, one of the earliest settlements, was abandoned because of it and to-day is left as a memorial of lost endeavour. It is chiefly, of course, in the low-lying coastal areas, the counties round about Norfolk, Newport, etc., in which we have been for the past week, where marshes are numerous and extensive (the "Dismal Swamp" lies between Norfolk and Suffolk) and mosquitoes abound, that the problem is most acute. Drainage, which is the chief and best method of dealing with the marshes, is so costly that it cannot be done on a large scale, but by spraying with oil, by screening the windows and doors of the houses and inducing the inhabitants to take quinine, much can be done and has in fact been done. Thousands of people indeed, because of these things, have been completely relieved, and 1 saw quite a number who told me that whereas formerly there was never a year but they had numerous attacks, now they do not know what a "chill" is. On the whole I am very greatly impressed by what I have seen. The work is, of course, very elementary and only the fringe of it has been touched. It will go forward, however, mainly because the people themselves are beginning to realise its value. The coloured problem is a very interesting one and may become a prominent one. The relations of the whites and the coloured in Virginia, and throughout the South as a whole, 1 suppose, are most peculiar. The whites behave as though the blacks do not exist. They speak to them, of course, and are waited upon and served (very badly) by them, but otherwise do not recognize them. Theoretically they have equal rights, but by an amendment of the constitution and the introduction of an "educational qualification" the coloured have been in effect disfranchised. The coloured folks apparently quite quietly accept all this but have their revenge, since much of what they get in the way of advantages of civilization they do not pay for; they are a continual threat from the health point of view on account of their careless habits, and more important still, they are keeping the white children back so far as education is concerned. This last happens because though education is compulsory it is in fact not enforced, the main reason being that if enforced at all it must be enforced in respect of both races. To enforcing it in respect of the coloured there are many objections, social mainly, one being that the assistance of the coloured children is required for a great part of the year by the farmers. 10 Generally speaking the conditions under which the negro is housed are exceptionally bad : in fact nobody seems to bother very much about housing here. There are, I believe, provisions with regard to nuisances in the health regulations, but they cannot possibly be enforced. Housing provisions, if there are any—which I doubt—are not used. In most towns there are numerous houses that should be under a closing order, and many areas that should be made the subject of a scheme. Nothing however, is done about them. The proportion of negroes in various counties and towns varies very much, being in some places as high as 62 per cent. As I said at the beginning, the visit to Virginia has been largely in order to look into the rural hygiene, and though we have stayed in a number of towns, it has been merely because they have been suitable centres from which the surrounding country might be inspected. In most we did not visit the health department, if there was one, though usually we were shown some of the interesting hygienic or historical features. Richmond, to which we went first of all, was our headquarters for about ten days, and we went there in order to have explained to us the organization of the Central Health Department, i.e., the State Board of Health, and to have described the methods employed by this body with a view to inducing the county and town authorities to undertake health work. The chief of the State Board is the Commissioner, a medical man who is appointed by the Governor. As the Governor only serves for four years the term of office of the Commissioner may also be limited to this period. The present Commissioner has, however, held the post since 1908, and is one of the best loved and most popular men in the State, in addition to being a quite admirable health officer. It is largely as a result of his efforts that so much has been done in Virginia to bring it up to its present position in relation to public health, and that so many as 34 counties have some sort of health organization, elementary though it may be. In his department there are a number of sub-departments, e.g., of maternity and child welfare, which has not done much yet; a venereal disease section, which has done a certain amount; a tuberculosis section, which is quite active though not tremendously effective; and a statistical department which is helping the other departments greatly, though hindered by the absence of laws making births, etc., compulsorily registrable. In addition, there is a good State laboratory where a great amount of bacteriology is done. The inner workings of all these departments were explained to us and exposed for our inspection. Of the men who are in charge of them I formed the highest opinion. All of them are enthusiastic and all of them have but one aim— to see that health conditions are improved. Though we had not much opportunity, officially, of studying the workings of the City of Richmond Health Department, I took the liberty of paying several visits on my own account and noted what was being done. All the work in relation to infectious disease is done by medical men, two assistants having been appointed for the purpose. As in most other American towns, there is no fever hospital and all patients are therefore isolated at home. Each house in which there is a case is quarantined and placarded wih a ticket naming the disease and warning off visitors. Another matter I investigated was the milk supply, and without hesitation may say that so far as regards clean milk production Richmond is years ahead of any city in Great Britain. Largely this is due to the fact that no one may produce milk for sale unless he has a permit from the health officer, and is liable to have his permit withdrawn if conditions at the farm and in connection with production fail to give satisfaction and to come up to a certain standard. The type of approved cowshed is admirable. All milk is sold in bottles and is graded. Grade "A" is milk from tuberculin tested cows and only such milk may be sold raw. All other milk is Grade "B," and is pasteurized before sale. Anyone who holds a permit 11 to sell foods may sell milk and you can buy it in a grocery store or a drug store, etc. Being in bottle this is, of course, quite unobjectionable. The number of persons who drink milk in restaurants is amazing, but that the poorest classes and more particularly the negroes use much of it I very much doubt. In the poorer quarters much tinned and condensed milk appears to be sold. In Richmond I should like to say that I had the honour of lecturing to the students at the medical school. The chief of the other towns visited included Charlottesville, the chief city in Albemarle county, and famous as the seat of the University of Virginia, designed and built by Jefferson. It is fairly progressive, the population being about 6,000 and certain to increase. We received much attention from the medical staff here and saw an (American) football game—one of the least interesting pastimes I have ever witnessed. Roanoke, a thriving city of about 60,000, is only about 40 years old. The bulk of the water supply of Roanoke is obtained from a spring that escapes from under a high hill within the boundaries of the city itself. The water is as clear as crystal and as it emerges contains only about 2 germs per cubic centimetre. It is carried a short distance in an open channel into a reservoir whence it is distributed to the city. For safety's sake a little chlorine is added. The yield of the spring is about two-million gallons per day. Another remarkable town from the water point of view is Suffolk. It is remarkable because it has more water than it can use and more plant than it knows what to do with. The plant was greatly increased during the war to meet the needs of the military and was handed over to the town after the armistice. The other towns—Pulaski, Norfolk, Suffolk, etc.—need no mention, except the last perhaps which is the centre of the pea-nut (monkey nut) industry, which is a source of fortune to many farmers and manufacturers alike. I have written such a lot that I hesitate to add more. I must say, however, that most of the places I have visited I have found very dirty; the streets are neglected and though things are nice when they are new they are not looked after properly. It is easier, of course, to get new things than to find people able or willing to help you to maintain what you have. In the towns also there are always fires to solve the housing problem and to take the place of legal provisions as to unhealthy areas. School building is going ahead rapidly and many of the places I have seen I have liked very much. Most are of brick and are admirably designed. BALTIMORE. Since I last wrote from Norfolk, Virginia, at the close of our tour of that State, all my time with the exception of a few days in Baltimore, has been spent in the State of Massachusetts. Our object in going to Baltimore was to visit the Johns Hopkins University there, and more particularly the School of Hygiene and Public Health which is becoming, if it has not already become, one of the most famous institutions of this kind in the world. A great deal of the money with which the school is run comes from the Rockefeller Foundation, which, as I have already explained, is being devoted mainly to the solution of public health problems. Apart from this money there is a great deal more, so much indeed that research into any subject, no matter how complicated or how long it is likely to last, or how much it is to cost, is readily undertaken. Indeed, this matter of investigation in laboratories or outside them is one that appears to me to receive every possible encouragement everywhere in the 12 United States, and practically no one with any ideas as to lines along which an investigation into disease causation or prevention, might be carried out, need fail to find a place in which he can carry out his work and the money necessary for carrying it out and supporting himself while he is engaged upon it. As a result, in this School of Hygiene at Baltimore there are laboratories almost innumerable and workers engaged in studies that may or may not prove to be epoch-making. Here, for example, there is working Dr. McCollum, who discovered so much about the vitamines that everybody has heard of, and out of which so many food and drug producers hope to make a fortune. Also there is a Professor Raymond Pearl, a famous biologist and statistician, who is working out various problems in connection with the duration of life in man and the conditions that affect it, using for the purpose a kind of fly which has an average duration of life in days similar to that of man in years. One fact that he had made out that particularly interested me was that while great overcrowding amongst the flies in his colonies definitely shortened life a certain amount appeared to be beneficial and certainly not harmful. Practically the same has been proved to be the case with man. I have rarely enjoyed anything so much as the talk we had from Professor Pearl, but on the whole I would rather spend my time trying to look after the health of the people in Ward 3 and the Borough generally than acting as physician to or High Commissioner of a large number of fly colonies. Apart from these two investigators and teachers there is a very large staff in the school, amongst them a young Canadian who received his first instruction in Public Health at Middlesex Hospital from myself. Largely because he was anxious that I should do so I gave a lecture to the students in the school on some differences between the English health methods and those in vogue in the United States. I noted amongst the students several Japanese and Chinese, as well as a number from South America, Canada, etc., foreigners, indeed, forming the bulk of the students in the school. While in Baltimore we had the opportunity of meeting the Mayor of the City and of going over some of the public health work with the health officer or rather Commissioner of Health, who I was interested to find, received his medical education at Edinburgh University. The city is a large one with a population of about 800,000, and the work seems to be fairly well covered though there is very much more specialization than would be the case in a town of this size at home. One of the gravest troubles here as in other towns is with diphtheria of which they have a large number of cases every year. This they are endeavouring to fight, in some areas at any rate, by methods similar to that adopted in the case of smallpox, by immunizing children against it. The great difference in the procedure, however, is that instead of seeking, as we do in smallpox, to immunize everybody they first try to find out such as are liable to take the disease and immunize only these. The results, they believe, have been fairly satisfactory, but there is still a considerable amount of disease which may, I imagine, be due to the fact that isolation of patients is carried out at home and not in hospital as with us. Speaking generally the States, or such as I have visited, are very poorly provided with isolation hospital accommodation and to me, accustomed as I am to the excellent arrangements made by the Metropolitan Asylums Board, this appears deplorable and to make the proper dealing with infectious diseases almost impossible. That it is cheaper from the point of view of the authorities is doubtful and that it is more inconvenient for the ratepayers is certain. The water supply of Baltimore is very good, but like much of the water in the States I have visited it is doctored with chlorine for safety's sake and tastes of the chemical. 13 The milk supply of Baltimore is in the main good and clean. The bulk comes from farms within a radius of 50 to 60 miles round the city though some travels long distances. About 98 per cent. is pasteurized and except hulk supplies to bakeries, hotels, etc., all is sold in bottle. A very large number of samples are taken daily and examined bacteriologically in the laboratory of the health department. While in Baltimore I gave one morning to an inspection of the hospital. This contains nearly 700 beds and is very largely a teaching institution. It is richly endowed and has, in most departments, all the most up-to-date of appliances and arrangements. Many of the doctors and surgeons at Johns Hopkins are, of course, men of world wide reputation. At Baltimore the whole personnel of the interchange had met, but on leaving we once more re-formed into our own groups. The group of which I had charge left for Boston to investigate conditions in the State of Massachusetts, and in two cities in that State—one small, viz., New Bedford, and the other large, Boston itself. THE STATE OF MASSACHUSETTS. Our arrival in Boston was not well timed. Dr. Kelly, the Commissioner of Health for the State, was at the moment exceedingly busy, partly in preparation for his annual leave, which was to begin two days later, and could only spare us a few hours on the morning of our arrival from Baltimore. Moreover, on account of the fact that various of the State Departments were in the throes of an economy campaign, the staff, or certain members of it at any rate, appeared to be upset and the wheels of the organization appeared to be running less smoothly than might otherwise have been the case. In conncction with the economy campaign one of the efforts that appealed to me, on account of its originality and because I suffered personally on account of it, I noted in the lavatory provided for male members of the staff. This involved the discontinuance of towels of all kinds for hand-drying purposes with the substitution therefor of rolls of ordinary toilet paper. The programme of our visit to Boston to study the organization, work and methods of the Health Department of the State of Massachusetts was timed to begin at 10 o'clock on the morning of our arrival in the city and before we had had an opportunity of finding accommodation and removing the stains of a very uncomfortable night journey. In spite of all these difficulties Dr. Kelly, the Commissioner, endeavoured to give us information with regard to the activities of his department. From him we learned that the State Board of Health of Massachusetts is one of the oldest in the United States; that the body charged with the responsibility of looking after health matters is the Health Council, consisting of six members all appointed by the Governor. The Commissioner is also appointed bv the Governor. The chief functions of the State Board in Massachusetts are advisory and investigatory. Unlike other Boards, e.g., in Virginia, it has no power to make orders or regulations, the various towns in the State, of which there are 3(5"), being completely independent even though their total population may number no more than 50. For one reason or another the authorities of many of the towns are unwilling to undertake health works, and it is one of the chief duties of the members of the staff of the department to induce them to give attention to various matters and to assist them by advice and encouragement. Assistance particularly in connection with outbreaks of disease, is also rendered, the State being divided into seven districts with a medical member of the staff in charge of each. In addition to these officers there is one charged with the duty of encouraging authorities to give attention to maternity and child welfare; another—Dr. Pfeiffer, 14 an old Middlesex Hospital man and at one time in practice in Queen Anne Street— who deals with venereal disease, and a third who devotes his whole time to tuberculosis, visiting the various State sanatoria. The State in connection with infectious disease provides a laboratory at which specimens are examined free of charge for diphtheria, malaria, etc. At another laboratory, diphtheria antitoxin, vaccine against smallpox, and other materials of this class are manufactured and supplied to the various authorities throughout the State. In regard to the work done in the department the only thing that really calls for mention is that in connection with tuberculosis. This, as a matter of fact, appeared to me to be the only one in which any particular activity was being shown, the officer in charge being exceedingly energetic and enthusiastic, and the legislature apparently less unwilling to spend money on this than on any other work. For the reason that on at least three out of the ten days devoted to the State Board we were sent to inspect State sanatoria we were able to form some sort of idea of what was being done in this direction. One of these institutions (Essex County Sanatorium) is by far the most magnificent I have seen, no expense whatever having been spared in connection with its construction and equipment. Intended for 200 patients but at the time of our visit accommodating only 120, it cost 1,600,000 dollars, which works out at something like £1,800 per bed. Another most useful sanatorium is that provided exclusively for children, where most excellent work is being done. As a matter of fact, the question of tuberculosis in childhood is one to which the Board, at the instigation of the tuberculosis officer, Dr. Remick, is devoting much attention, and he is receiving every encouragement to seek out all school children who are under weight, to have them examined for signs of tuberculosis, and to have all such as appear to be the subject of or seriously threatened with the disease put under treatment. In the experience of Dr. Remick some 10 per cent. of children examined have been under weight and of this number 2 per cent. are in need of treatment. For the benefit of the remainder there is attached to the staff an "expert on nutrition" or "dietician" (in the States specialization is carried to great lengths) who tries to get into touch with the parents and to give advice as to food and feeding by means of talks, leaflets, and so on. Amongst other things visited were the metropolitan waterworks, which are under the State, and the experimental station at Lawrence, some few miles out of Boston. Much of the great reputation enjoyed by Massachusetts, so far as health matters are concerned, has been built up on the work of the engineering department of the Board, and all the members of the staff I met struck me as men of a very high grade. Some of the works I saw, e.g., the Wachusett Dam, though I do not pretend to be a judge, were stupendous and may safely be described as remarkable engineering feats. The experimental station at Lawrence, known to water and sewerage engineers all over the world on account of the researches and discoveries made there in connection with sewage disposal, has been rather adversely affected by the economy wave and presents rather the appearance of a place whose glory has departed. NEW BEDFORD (MASSACHUSETTS). Having finished the programme of the State Board of Health, which, as explained, consisted almost exclusively of tuberculosis and engineering, we left for New Bedford, which had been chosen as the place in which the public health administrative methods in a small town might be studied. This city, with a population of 130,000, was formerly a great whaling centre, but is now almost entirely industrial, its cotton mills providing employment for thousands. The mixture of races in New Bedford is extraordinary, there being in addition to many English—from Lancashire mainly—a great number of Portuguese and French Canadians. 15 We were kept very fully occupied, hearing about the work done and visiting places of public health interest in the city and surrounding country—waterworks, sewage disposal plant, hospitals, schools, etc. The local health authority is a body known as a "Board of Health," appointed by the Mayor. It consists of three members who receive each 700 dollars per annum and meet generally once a week. The chief executive or "Health Officer" or "Agent" is also appointed by the Mayor. The present holder of the office is not a medical man. He was at one time a member of the Council and Board of Health, and has done and is doing excellent work. The staff of the department is adequate and capable and very good results are being obtained. Every kindness was shown to us in New Bedford, and as had been the case in other places visited, the fullest possible use was made of our presence for propaganda purposes and to bring public health and the work of the Board of Health and the health department prominently before the public. I had several interesting experiences in New Bedford, amongst other things delivering an Armistice Day address from the pulpit of one of the churches, and meeting two people who had pleasant recollections of the Borough, one as a student at the Polytechnic and the other as a patient in the Hospital of St. John and St. Elizabeth. BOSTON (MASSACHUSETTS). Having completed our tour of investigation in New Bedford we returned to Boston for attachment to the City Health Department and a study of the activities there. Boston, with its population of 800,000, is surrounded on all sides by about 20 or 30 other cities, which are continuous with it. The population in the area occupied by these cities is about 1,200,000 or nearly one-third of the total population —4,000,000—of the State. The health officer of Boston is known as the Commissioner of Health, and is appointed by the Mayor. The present Commissioner is a Dr. Mahoney, and remarkable on account of his size. We saw him only twice during our stay, on the first day when he presented us to the Mayor of Boston, who received us most kindly and arranged that we should accompany him to a ceremony at the City Hospital; and on the day of our departure. Of health work and organization we heard nothing from him, such information as we obtained coming from the Deputy Health Commissioners in charge of the various branches of the work, who enjoy more fixity of tenure of office than the Commissioner. The programme arranged for us in Boston was originally intended to last about a fortnight, but on account of a change of plans in connection with our visit to New York it had to be altered. Partly for this reason, partly because of a certain lack of precision in the directions as to meeting-places and times, and because further, or so I thought, we were interfering with the work of very busy people, I could not feel that I was getting at the heart of the organization and obtaining a really proper insight into the health activities of the city. Many interesting things I did see, and learn, in connection, for example, with the methods adopted in regard to the prevention of diphtheria, which here as in Baltimore is a source of trouble. Diphtheria cases, like cases of other infectious diseases, are in the main isolated at home, houses and rooms occupied by the patients being placarded and quarantined. That this procedure is likely to be very effective I doubt. The officers, however, appear to believe in it, a number of part-time doctors, as well as nurses, being employed to see it applied and to visit from time to time. In diphtheria an attempt is being made to render the school children, or as many as possible, immune to the disease by means of special injections and by giving protective doses of antitoxin to family contacts with cases. The antitoxin for this and treatment purposes is provided free. I had an opportunity of seeing a large number of children in one of the schools tested for diphtheria immunity, and the first injection given to those shown by the test to require it. The number of children already dealt with in Boston is 48,000, so that very soon a reduction in the amount of diphtheria should be noticeable.* 16 While on the subject of school children I may say that the school medical work is carried out by a staff entirely separate from the health department staff, the work of medical inspection being in the hands of a staff of 52 part-time medical officers under a Director of Hygiene, who is an officer of the School Committee of the Council. Each school doctor is required to visit the schools in his district each morning and also to examine each child in the schools once a year. In addition to the doctors there are 62 school nurses each with a district and responsible for the oversight of some 2,000 children. In regard to maternity and child welfare work I found that much reliance was placed on voluntary effort, though by means of what are called "Health Centres" an attempt is made to bring all the voluntary agencies together and into co-operation with the Health Department. At the moment only one such centre has been established, and under the direction of one of the medical inspectors of the department, a Dr. Wilinsky, is doing excellent work. Under one roof I found an infant clinic and a dental clinic in operation, and also accommodation for tuberculosis and district nurses, used bv them as a sort of headquarters, as it is also by the inspector of the district. Maternity work in Boston, as in the States, or such of them as I have visited, I have found very interesting. In the South a very great part of the work is done by coloured midwives, who in the main are intensely ignorant and illiterate, there being no provision for the training of midwives, and a great unwillingness to provide for training. In New Bedford there are again many midwives, mostly Portuguese and largely employed and kept under close supervision. In Boston no one but a medical practitioner may repcrt a birth, which is taken to mean that no one but a medically qualified person may attend a woman in labour. Despite all this it is believed that many women do practise midw ifery and that many women have none but a woman to attend to them, though the reports of births, in accordance with the law, are made by medical practitioners. In Boston I visited a most beautiful and modern maternity hospital. In this as in another maternity hospital I visited in New Bedford, I saw none of the herding together of mothers and babies in one ward with a nurse sitting by the fire making the baby comfortable. Instead, I found separate wards for mothers and babies, and adjoining the babies' ward a room in which all washing, etc., of the babies was done. The question of whether or not they ever had diarrhoea amongst mothers, babies, and members of the staff, though it trembled on my lips, I did not dare to ask. In any case, I know quite well that they never have it. Indeed, diarrhoea amongst infants is becoming less and less in cities in the United States and this they ascribe, as they ascribe also the reduction in the amount of tuberculosis of glands and bowels, to the fact that nearly 98 per cent. of all milk sold is pasteurized. This last piece of information which I had received from others I had confirmed at the Children's Hospital in Boston, which again is a most beautiful building. Like the Maternity Hospital it is in the neighbourhood of the Harvard University Medical School, which I had the opportunity of visiting on more than one occasion. The public health school in the University I also visited and found amazingly well equipped. Here, as in Baltimore, there appears to be no lack of money for research, and in practically every room in the building I found people engaged in trying to solve some problem or other in connection with the causation or prevention of disease. The number of students, American students particularly, in the school is small, the public health service not being attractive and so much less remunerative than private practice. While on the subject of institutions I should like to refer to a visit paid to the Forsyth Dental Infirmary. This is, I imagine, the largest establishment in the world entirely given over to dental and nose and throat work, and is intended exclusively for the use of children. In the main room there are something like 160 dental chairs with an equal number of dentists or "dental hygienists," the 17 latter being young women specially trained to carry out all forms of tooth work, except actual extractions and stoppings. At the infirmary a special course of instruction is arranged for dental hygienists of whom there are now a certain number qualified and at work. In other parts of the building there are departments in which extraction of teeth or removal of tonsils and adenoids is carried out. The children in need of treatment are selected in the schools and a small fee is charged to those who can pay it. In regard to dental work amongst school children I may say that in most places I have visited more or less is done, and a great deal of the inspiration undoubtedly comes from the Forsyth Dental Infirmary. Though quite a good deal of work appears to be done in connection with tuberculosis in Boston, I am bound to say that what I saw did not greatly impress me. So far as I could gather there is only one dispensary in the city, at which clinics are held on five days in each week, one being an evening clinic. The staff engaged at the clinic consists of five doctors—all part-time— and ten nurses. The number of patients varies, and may be as many as 100, a great many, however, are asthmatic and attend to receive injections. These are given by the nurses who also take blood from every patient attending the dispensary for examination for venereal disease. Wholesale examination of patients for this infection seems to be quite a feature in American hospitals and dispensaries. The nurses attending the dispensary are only part of the staff of tuberculosis nurses of whom there are in all 32 engaged mainly in following up cases. The doctors do not visit the cases in their homes. Apart from doctors and nurses there are several clerks, laboratory workers, etc., at the dispensary. The laboratory is partly for the examination of expectorations, but largely for research into problems connected with tuberculosis. The cost of running the dispensary appeared to me to be very high, working out at about 5s. per visit of each patient. The hospital accommodation provided for the treatment of tuberculosis is in the main intended for advanced cases. In all there are 422 beds, but in general there are about 120 vacant. The patients are kept as long as they will remain though they are allowed out one day per month to spend the money they can earn in the workshop of the institution making rugs, baskets, etc. I was told that since prohibition came into effect the patients appeared to be more contented to remain though it was not at all unusual for those who are allowed out to return to the hospital under the influence of drink. A statement of the nurses to the effect that they had noticed great improvements in the homes they visited since prohibition interested me very much as I had not been impressed by the sobriety of the population of Boston. The same may be said of New York. In this connection, however, it must be noted that both of these places are sea-ports and alcohol is more readily obtainable. Moreover, they are large cities and the foreign populations are very big. Back from the sea coast, and more particularly in the South, the effect of the Act is much more pronounced. On inquiry at the City Hospital in Boston I learned that the number of cases of alcoholism treated had definitely increased, and in New York the number of deaths from this cause has also increased and is considerable. The number of persons in prison has, however, I am told, very markedly decreased. All the same, it would appear that the people who have been accustomed to drink are still from time to time able to obtain alcohol, and it is alleged that people who never would have taken alcohol do in fact take it now when it is available and take it to excess. Most of the drinking which I have seen openly or secretly on the street or in hotels or restaurants has not been convivial, but almost entirely with the object of getting drunk. Since coming to the Northern States I have seen more people completely and hopelessly inebriated, at all hours of the day, than I have seen for years at home. I had not intended to say anything with regard to prohibition and alcohol, and you will note that I have expressed no opinion upon it. As a matter of fact, officially, 18 we have heard nothing of it, mainly no doubt because we have been most of our time with health workers, who have nothing to do with the work carried out under the Act. Much more interesting has been the work I have seen and heard of in connection with milk supply, and very definitely I have come to the conclusion that in general, and in towns of a medium size, say from 50,000 up to 250,000, where health work is done, the milk is better and cleaner and safer than in England. Even in the largest cities that I have visited, Washington, Boston, Baltimore, New York, etc., it is in general, despite the difficulties there must always be in big places, of better quality than at home. In Boston the milk supply is fairly well looked after, even though much of it comes from very long distances, and in some cases from quite small farms. Practically all is pasteurized, and is sold in bottles. 'I he powers of the Commissioner of Health in regard to milk are very great, and the practice of sampling both for chemical and bacteriological examinations much more thorough than with us. The fat standard is higher than that in England, and from the records I studied at the laboratories in Boston it appears to be certain that the average milk on the market is richer in fat than ours. Also it contains infinitely fewer bacteria. One creamery near Boston that I visited greatly impressed me. The machinery for washing bottles and for bottling and sterilizing the milk was of the type formerly used in breweries here and worked perfectly. This, of course, was only to be expected since here as at home beer has always been more carefully dealt with than milk. To some extent this is not surprising since the profits on beer are so very much larger and leave quite a margin that can be used for improving the product. The price of milk in Boston, as elsewhere in the States, is higher than at home, but even then does not leave very much in the way of profit to the dealer, particularly if his business is small. NEW YORK. There are many other things in connection with our visit of which I should like to speak, but I am afraid I have already said much more than sufficient to weary you. Before I close I should like to say a little with regard to what I have seen in New York. The first three days were spent in company with the quarantine officers, who are all members of the Federal Health Service, in visiting Ellis Island, Staten and Hoffman Islands, and in inspecting passengers on board ship. Ellis Island I was, not unnaturally, particularly interested in. At this season of the year and at the end of a month things were very quiet, but we did make some sort of inspection of the island and did see the kind of examination to which immigrants must submit. All that we saw was, of course, on the medical side and seemed to be excellently arranged and so as to cause no unnecessary inconvenience. The work was rapidly done and the person who passed the examination was free to go in about three hours at the outside, provided the immigration authorities, of whose work we saw nothing, were satisfied. The object of the medical examination is to discover whether or not the persons are suffering from diseases that might spread if they were allowed to enter, or that will incapacitate the individual from earning his own living. It appears to me to be not at all unreasonable. The hospitals on Ellis Island are well kept, though some of the wards appeared somewhat crowded. The examination on board ship is a rough and rapid one for the detection of verminous conditions chiefly, and if the number of steerage passengers is large it is usual only to examine about 10 per cent. and if these are reasonably clean to pass all except those who are infested. Hoffman Island is provided for the isolation of infected persons found on board ship, and to it also persons who require disinfection on account of vermin are taken. The hospital accommodation is good, and the apparatus and baths, and the methods of treating those found to be 19 verminous satisfactory. At the time of our visit there were on the island some 150 or so Italian immigrants who were being held, I believe, on account of some passport irregularity. They all appeared exceedingly unhappy, and on inquiry I learned that they had been on the island, which is less than half a mile in length, for over two months. They are well fed, but I did not find the sleeping accommodation or the sanitary arrangements particularly adequate or satisfactory. It must be admitted, however, that the problem of what to do with persons detained is a very difficult one, and it must not be forgotten that they as guests are unwilling and the United States as hosts are equally unwilling. One very interesting morning was spent in studying the American method of freeing ships from rats, using a form of prussic acid gas for the purpose. As this is not a matter likely to be of great interest to you I will not describe it. In New York itself I have not had an opportunity to do more than visit one of the Isolation Hospitals and see some of the work done in the Laboratory Division of the city. All the various vaccines, including that against smallpox, are made by this department, and I was interested to see something of the methods employed and to hear of the work being done in an attempt to immunize children against diphtheria. Some experiments in this connection which are now being carried out may, if successful, be exceedingly useful in modifying the methods now in vogue. Another place I have visited is the National Health Council offices at which the various voluntary agencies concerned in public health work are housed. Since in London an attempt is being made to concentrate all agencies concerned with child welfare in one building also, I was interested to see exactly what was being done on these lines here. Before we sail on the 12th December I hope to visit other places of public health interest here and possibly at Philadelphia, and if I find anything that appears worthy of note, I will write to you again. It had been my intention to visit Chicago, but, unfortunately, certain appointments have been made for us that will necessitate our remaining in or near New York, and I have had to abandon the idea. THE YEAR 1923. 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 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 1923 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 1922. Year. The Borough. All Souls. St. Mary. Christ Church. St. John. 1922 105,200 25,202 26,943 32,747 20,308 1923 105,400 25,258 26,992 32,806 20,344 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. 20 During the year 154 notices in regard to defects in and necessity for cleansing and repairing of water cisterns were served and were complied with. Water Supply in Dwelling, Houses.—Five certificates were granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. In 25 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 21 cases. In two cases the supply was provided after the issue of a statutory notice and in the remaining two cases proceedings were instituted. Drainage. The total number of drain inspections made during the year was 6,369 as against 6,619 in 1922. The total number of plans deposited was 553, the number in 1922 being 493. Plans relating to new buildings numbered 49, the number deposited in 1922 being 58. In the case of old buildings, the number of plans received was 504, as against 435 in 1922. On six 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 two cases and fines and costs imposed in each instance, amounting in all to and £\ 4s. respectively. Combined Drainage.—Orders under seal as to combined drainage were issued in respect of 19 premises. The number in 1922 was 37. Closet Accommodation. In the table at page 22, 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. The following is a statement showing the total receipts at each of the conveniences for the year ended March, 1924, and the amount of increase or decrease as compared with the previous year. 1924. 1923. Increase. Decrease. £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus—Men's Department 978 16 1 1,015 7 1 — 36 11 0 * ,, Women's ,, 1,191 19 1 1,159 6 3 32 12 10 — Gt. Portland Street—Men's ,, 281 13 0 273 8 1 .8 4 11 — * ,, Women's ,, 280 3 4 273 1 1 1 6 9 3 — Marylebone Road—Men's ,, 243 10 9 236 16 11 6 13 10 — * ,, Women's ,, 263 0 2 256 3 9 6 16 5 — Foley Street—Men only 165 9 2 162 8 4 3 0 10 — St. John's Wood Road—Men only 116 17 10 116 6 7 0 11 3 — Barrett Street—Men only 219 3 3 206 18 10 12 4 5 * One free urinette provided. 21 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, 1924, it may be mentioned, was 40,174 tons, as compared with 39,531 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. New metal dust receptacles were provided to 514 premises. During the year the inspectors made 4,792 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, 130 notices were served. Remedies in each case were carried out, legal proceedings not being necessary in any instance. Removal of Offensive Refuse.—Owing to the number of hotels, boarding houses, restaurants, and large private establishments in the borough, considerable quantities of food refuse (hog wash) are collected by pig-feeders daily, and close watch is necessary in order to ensure that the requirements of the by-laws relating to removal of offensive refuse, as to hours of removal, provision of proper receptacles, &c., are complied with. During the year though a number of warnings with regard to these matters were issued, it was only necessary to institute proceedings in one case in which there was serious neglect. In this instance a fine of £6 was imposed and the defendant was ordered to pay £2 2s. costs. 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 3,600, as against 3,291 in 1922. 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, 261 statutory notices were issued, as against 349 in 1922. Of these notices, 160 related to ordinary nuisances (dirt, dampness, &c.) 46 to verminous rooms, 12 to drains, 4 to insufficient w.c. accommodation, 4 to water supply in tenement houses, 34 to insufficient dust bins, etc., and 1 to underground rooms. 22 The 46 notices respecting verminous rooms were served under powers contained in the London County Council (General Powers) Act, 1922, and referred to 24 rooms. In 3,339 cases the nuisances were abated by the persons responsible for their removal after receipt of a preliminary (intimation) notice advising them of the existence of the defect. In 6 instances there was failure to carry out works after receipt of statutory notice and legal proceedings were instituted. Details of these cases will be found under the heading "Legal Proceedings in connection with Nuisances." The total inspections made by each inspector, and the number of nuisances of various kinds detected and remedied, are set forth in the following table:— Districts. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Borough Total Inspections 3,475 3,000 3,222 2,004 2,951 , 3,163 17,815 Houses damp, dirty or dilapidated remedied 334 242 279 48 139 166 1,208 Doors, windows, floors, ceilings, sash cords, etc., repaired 458 516 97 23 90 138 1,322 Overcrowding abated — — 5 — — — 5 Illegal occupation of underground rooms dealt with — 1 7 — — 2 10 Water closet defects remedied 266 253 159 40 115 114 947 Water closets erected — — 2 1 3 20 26 Urinal defects remedied 2 — 1 — 1 — 4 Soilpipe and ventilating shaft repaired or renewed 2 — 8 9 5 3 27 Yard defects remedied 221 169 128 29 114 74 735 Waste pipe defects remedied 30 16 16 2 8 18 90 Water cistern defects remedied 30 72 23 4 19 6 154 Rubbish, manure, etc., accumulations removed 27 11 46 10 32 19 145 Dung or dust receptacles repaired or renewed 101 55 90 46 86 21 399 Drains relaid or amended 45 20 47 2 44 21 179 Drains cleared 14 34 5 7 33 5 98 Rainwater pipes repaired or renewed 46 26 28 9 19 10 138 Water supply to houses reinstated 1 1 2 — 1 1 6 Roofs and gutters repaired 204 173 78 25 17 46 543 Area defects remedied 14 11 52 11 26 26 140 Wash-house defects remedied 264 130 127 36 15 97 669 Animal nuisances abated 2 4 5 1 — 1 13 Basement defects remedied 3 2 23 7 18 2 55 Stables cleansed or repaired 16 — — 1 1 — 18 Water supply laid on to upper storeys of house 10 4 5 3 2 1 25 Miscellaneous nuisances abated 547 186 86 27 47 42 935 Verminous rooms cleansed 156 202 191 15 30 95 689 Workshops, dirty, overcrowded, unventilated or defective, remedied 4 4 12 11 22 31 84 23 Legal Proceedings in Connection with Nuisances. The number of summonses issued in respect of nuisances during the year was 6. Particulars with regard to each of the cases are given below and it should be noted that in each instance, though there were contraventions of provisions contained in other acts and by-laws, the Public Heath (London) Act, 1891, is the only enactment mentioned in the list. Premises. Offence. Proceedings taken under the Public Health (London) Act, 1891, &c. Result. 19, William Street, Lisson Grove Failure to comply with a statutory notice to execute certain sanitary requirements. Abatement order for work to be executed within 14 days 21, Carlisle Place Do. Abatement order for work to be executed within 14 days and £ 12 12s. costs 29, Aberdeen Place Do. 41, Blenheim Terrace Do. Abatement order for work to be executed within 21 days and £1 1s. costs 34, James Street Do. Costs £10 10s.; order made to comply with notice Rat Repression. The number of complaints received during the year, viz., 60, was lower by 5 than the 1922 figure. The investigation of these complaints necessitated the inspection of 70 premises, 22 of which were used for business purposes (12 of these for the preparation or storage of food), the remaining 48 being private or tenement houses. In 11 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 5th to the 10th November, 1923, 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. 24 Number of places On register at end of 1922. Added in 1923. Removed in 1923. Numberj o inspections, 1923. Number of notices, 1923. Number of prosecutions, 1923. A. Business Premises. Milk premises 144 10 15 139 361 6 — Cowsheds 2 — — 2 30 — — Slaughterhouses 3 — — 3 142 — — Offensive trade premises 2 — — 2 60 — — Ice cream premises 128 21 20 129 200 18 — Butter and facturersand Dealers 15 — — 15 40 — — Bakehouses 72 — 4 68 180 6 — Fried Fish Shops 22 3 1 24 90 6 — Fish Curers 5 — — 5 62 — — B. Habitations Houses let in lodgings 1147 — 32 1115 9832 1239 3 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 139. This is 5 less than in 1922, 10 having been added and 15 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 Nil 42A, Clipstone Street 10 10 Totals 25 10 In 1922 the number of cows licensed to be kept in the Borough was 25, though, in fact, only 12 were kept. 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. 25 Premises. Conditions. 50, Henry Street, St. John's Wood ... Small cattle only. 134, High Street, St. John's Wood On the clear and distinct understanding that the room over the slaughter house is not used as a living room. 32a, Union Street, Middlesex Hospital Nil. All these places were regularly and frequently visited during the year. In no case was objection raised to the renewal of licence after receipt of notice from the County Council that application for renewal had been made. 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 64 visits, but no cause of complaint was found. Ice Cream Premises.—The number of such premises in the Borough on the Register is 129. Regular inspections were made throughout 1923 and in 18 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 1923 the number of bakehouses on the register was 68, 2 underground bakehouses and 2 above ground having been removed. Of the 68, 62 are underground bakehouses. In all, 180 visits were paid and 6 notices served. In accordance with the requirements of the Factory and Workshop Act, 1901, notices calling for the limewashing, etc., of the inside walls and other parts of the bakehouses were issued. It was not necessary to institute proceedings to enforce compliance with any notice. Fried Fish Vendors and Fish Curers.—The number of premises in the Borough used by vendors of fried fish is 24 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. Factories and Workshops. Though factories are comparatively few in the Borough, the number of workshops, many of them domestic workshops, is considerable, and work in relation to 26 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 3,095; 337 by the women and 2,758 by the men inspectors. The complaints received numbered 45. The following report which the Medical Officer of Health is required to make to the Secretary of State for the Home Department in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901, gives, in addition to other information, the total number of defects found and of notices served. I.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (i) (2) (3) (4) Factories (Including Factory Laundries.) 91 5 — Workshops (Including Workshop Laundries.) 1284 111 1 Workplaces (Other than Outworkers' premises included in Part 3 of this lteport.) 1720 116 Total 3095 232 1 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (i) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 60 60 — — Want of ventilation 16 16 — — Overcrowding 11 11 — — Want of drainage of floors — — — — Other nuisances 139 139 — — Sanitary accommodation• 'insufficient 8 8 — — unsuitable or defective 44 44 — — not separate for sexes 14 14 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 6 6 — — Other offences — — — — (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 292 292 — 1 27 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. 83 199 1237 ... ... ... 51 ... ... ... ... ... ... ... ... Total 83 199 1237 ... ... ... 51 ... ... ... ... ... ... ... ... 28 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 3,276 Coffee Shops, &c 232 Bakehouses 68 Total number of workshops on Register 3,576 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 10 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 45 Reports (of action taken) sent to H.M. Inspector 45 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 62 29 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 1923 was therefore 1,115, most of which were registered prior to the war and before rents had attained the present high figure. In all 9,832 visits were paid to houses let in lodgings without regard to the rentals, and 1,239 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 30 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 9. 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 1923 there were 232, this number including: restaurant, dining room and coffee shop kitchens, 172; tea-rooms and pastry-cooks, 40; hotel kitchens, 20; fried fish shops, 24; 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 1923 the total number of inspections was 1,362, the number of notices served being 46. During the year a special investigation was made with the object of discovering exactly the arrangements provided in restaurants, etc., for the sanitary convenience of the employees and particularly the provision made for and the instructions given as to the washing of hands after using the conveniences and at other times. The information obtained is summarized below. In connection with the investigation it was interesting to find that conditions were no worse than the figures indicate and pleasant to note the readiness with which the persons responsible for finding a remedy recognised the need for improvement and took steps to provide it. FOOD PREMISES ENQUIRY. Summary. Total number of premises inspected 296 Number of premises where a water closet failed to comply with the By-laws of the London County Council 22 (7.4%) Number of premises with no separate water closet accommodation for women *37 (12.5%) Number of premises with no facilities for hand washing 4 (1.4%) Number of premises without soap and towels for hand washing 8 (2.7%) Number of premises where no instructions had been given as to hand washing 9 (3.0%) *In the large majority of these cases one woman only (commonly the wife of proprietor) was employed. 31 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 1923 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 321. On examination by the Public Analyst 7 (2.1 per cent.) were found to be adulterated. In 1922 the percentage was 3.3. Further reference to the question of milk examinations is made in the report of the Public Analyst, which will be found elsewhere. Proceedings.—During the year proceedings were instituted in two cases and fines and costs amounting to £1 10s. and £2 1s. respectively imposed A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 98 were obtained on delivery at Marylebone Station of the London North Eastern Railway. Of the 98, 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. 1st 70 3 4-3 2 £ s. d. 3 11 0 2nd 81 1 1-2 — — 3rd 84 1 1-2 — — 4th 86 2 2.3 — — Total for year 321 7 2-1 — — Bacteriological Examination of Milk.—With a view to testing the purity of milk from the bacteriological point of view, 10 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 these lines. 32 In addition to these samples, 19 of certified milk were taken and submitted to Dr. Foulerton for examination. The reports, which were all satisfactory, were, in accordance with the usual arrangement forwarded to the Ministry of Health. 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. In one case in which the conditions were found to be unsatisfactory, proceedings were instituted with the result that the defendant was fined £5 with costs amounting to £5 5s. 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. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 & 1917. Report for the year ended 31st December, 1923. 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 321 Nil. Cream 23 11 (14.0, 11.0, 12.2 10.0, 10.5, 7.9, 9.8, 9.7, 5.6, 6.5 and 9.6 grains Boric Acid per lb.) Nature of preservative in each case in column (b), 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 11 (ii.) Statements incorrect Nil. Total 11 (iii.) Percentage of preservative found in each sample Average 9.7 grains Boric Acid. per lb. Lowest 5.6 grains. Highest 14.0 grains. Percentage stated on statutory label. Not exceeding 0.4%. 33 (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent. 11 (ii.) Below 35 per cent. Nil. Total 11 (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. The Milk Special Designations Order, 1922.—Under this Order 19 applications were received from 8 dealers in the Borough for licences to sell milk as Certified Milk, or Grade "A" Tuberculin Tested Milk. As the milk in each case was obtained from a producer licensed under the Order and the premises of the applicants were found to be satisfactory, licences were granted in each case, the numbers being 16 in respect of Certified Milk and 3 for Grade "A" Tuberculin Tested Milk. In accordance with the instructions of the Ministry 20 samples were taken during the year and submitted to the Council's Bacteriologist, Dr. A. J. R. Foulerton, and in each case the milk was found to be up to the standard of purity laid down, the samples showing a bacteriological count of less than 30.000 bacteria per c.c. Copies of the reports were duly forwarded to the Ministry. Milk (Mothers and Children) Orders.—During 1923 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1924, was £305 12s. 4d., as against £368 7s. 1d. up to 31st March, 1923. The actual number of cases dealt with was 222, and the number of orders issued 914. 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. 34 Unsound and Diseased Food Condemned and Destroyed During the Year 1923. Meat— Beef 84 lbs. Mutton 60 lbs. Rabbits 1 crate Bacon 8 fore ends Poultry 5 fowls Fish— Wet—Lemon Soles 1 box Plaice 1 box Witch 1 box Dry—Kippers 10 boxes Fruit— Tomatoes 40 boxes Pears 37 baskets Apples 2 barrels Apricots 9 baskets Miscellaneous— Cream 313 tins Bacteriological Examination of Foods.—In addition to the milks examined bacteriologically and already referred to, certain other articles were also sent to Dr. Foulerton for investigation. Amongst these were two of sausages, three of ice cream and two of cocoa, the last at the request of the Board of Guardians. Of the sausages one was reported as unsatisfactory and the attention of the vendor was directed to it, a similar course being adopted in regard to one of the ice-creams found to contain a distinct amount of foreign dirt. The reports as to the samples of cocoa were on the whole satisfactory. C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,060. Of this number 22 were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of 2.0 per cent., which is higher than the figure for 1922, when the percentage was 1.5. 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. Reference has already been made to the cases (2) in which prosecutions were instituted. In addition to these there were 6 prosecutions in respect of selling whisky under proof. Fines amounting to £10, and costs £14 15s. 6d., were imposed. 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: 35 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, 1923. 12/6 per sample 67 milk Food Inspector, St. Marylebone Borough Council Genuine. No sample was found to contain either artificial colouring matter or preservative. 3 milk Do. Adulterated. No. 34. 13.3% deficient in fat. Fined 10/- and £1 1s. 0d. costs. No. 108. 23.3% do. Fined £1 and £1 costs. No. 200. 6.7% do. Vendor cautioned. 87 butter Do. Genuine. 58 were test samples. One sample contained no preservative. 70 contained less than 20 grains boric acid per lb. 16 contained between 20 and 30 grains boric acid per lb. 18 margarine Do. Do. 17 were test samples. 3 cream Do. Do. No. Fat. Preservatives. 16 45.0% Nil 22 50.5% Nil 131 63.0% Nil 13 jam Do. Genuine. All were test samples. 43 coffee Do. Do. Do. 8 mustard Do. Do. Do. 2 currant jelly Do. Do. Do. 5 marmalade Do. Do. Do. 4 zinc ointment. Do. Do. Do. 6 boric ointment Do. Do. Do. 3 tartaric acid Do. Do. Do. 1 ground ginger Do. Do. This was a test sample. 2 bicarbonate of soda Do. Do. Both were test samples. 19 scones Do. Do. All were test samples and were examined for phosphates and the amounts estimated. Added phosphate was present in each instance. The amounts present on being calculated into terms of "Clover Cream" ranged from 0.06% to 2.4%, the average being 0.94% Clover Cream in each scone. 1 clover cream. Do. Do. This was a test sample and had the following composition—Moisture 11.0%, mono sodium phosphate 63%, starch 26%. 1 cooked meat Do. Do. This was a test sample. 2 bovril Do. Do. One was a test sample. Tin was present in the two samples of bovril taken,the average amount being 1 grain per 1b. 36 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority under Section 13 of Act, and. if so, the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 12/6 per sample. 2 sponge cakes Food Inspector, St. Marylebone Borough Council Genuine. Both were test samples. Contained small patches of green colouring matter. This was shown to consist of neither arsenic nor copper compounds but was possibly produced by organic change of the colouring matter present. It was not a mould as there were no traces of mycelium filaments present. 1 blanc mange powder Do. Do. This was a test sample 3 basilicon ointment Do. Do. All were test samples. 1 strawberry syrup Do. Do. This was a test sample. 3 liquorice powder Do. Do. All were test samples. 10 whisky Do. Genuine. 9 were test samples. 15 whisky Do. Adulterated. 6 were test samples. No. Adulteration. 24 38.18° under proof. Costs £3. 25 39.47° do. Case dismissed. Notice exposed in bar effectually protected the defendant. 26 49.44° do. Fined £3 and £1 costs. 27 36.12° do. These were test samples. 70 49.60° do. 72 46.44° do. 73 39.47° do. 76 46.14° do. Fined £4 and £2 costs. 78 40.74° do. Fined £3 and £3 costs. 79 41.91° do. These were test samples. 80 38.18° do. 101 40.74° do. 102 36.83° do. Notice in Bar. 240 37.77° do. 211 42.20° do. Costs £5 15s. 6d. Total Number of Samples analysed during the Quarter 323 Number of Samples adulterated 18 SECOND QUARTER ENDING 30th JUNE, 1923. 80 milk Do. Genuine. No sample was found to contain either artificial colouring matter or preservative. Two were test samples. 1 milk Do. Adulterated. No. 445. 8.2% of added water. Vendor cautioned, and has ceased to sell milk. 33 butter Do. Genuine. 28 were test samples. All the samples contained boric acid as preservative, 3 having 20-30 and 30 having 10-30 grains boric acid per lb. 15 margarine Do. Do. All were test samples. 6 cheese Do. Do. Do. 11 jam Do. Do. Do. 29 coffee Do. Do. Do. 37 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority under Section 13 of Act, and, if so, the name of such Authority Result of Analysis; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 7 marmalade Food Inspector, St. Marylebone Borough Council Genuine. 12/6 per sample. All were test samples. 1 tinned peaches Do. Do. Do. 7 self-raising flour Do. Do. Do. 3 olive oil Do. Do. Do. 4 lard Do. Do. Do. 9 cream Do. Do. Particulars of preservatives:— No. Fat. Preserv tives. 325 46.5 Nil 354 52.0 14 0 grains per lb boric acid 427 46.5 11.0 do. 434 51.0 12.2 do. 437 48.0 10.0 do. 525 49.0 Nil 540 47.0 10.5 grains per lb. boric acid 545 39.8 7.9 do. 550 45.7 Nil 4 were test samples. 4 ice cream Do. Do. 1 sample contained 10 grains boric acid per lb. All test samples. 10 sausages Do. Do. Of the 10 samples of sausages and 2 of brawn, none contained any sulphurous acid compound as preservative, but 5 samples contained boric acid; the amounts varied from 4.2 to 26.0 grains per lb. All were test samples. 2 brawn Do. Do. 3 meat pie Do. Do. No sample was found to contain sulphurous acid, but one of the samples contained 8.4 grains of boric acid. All were test samples. 1 tinned peas Do Do. Test sample. 3 tea Do. Do. Do. 1 suet with flour Do. Do. Do. 2 pepsodent (tooth paste) Do. Do. Roth samples contained small but negligible amounts of lead compounds. 2 boric ointment Do. Do. Test samples. 5 zinc ointment Do. Do. All were test samples. Total Number of Sample analyed during the Quarter 239 Nuber o Samples adulterated 1 THIRD QUARTER ENDING 30TH SEPTEMBER, 1923 83 milk Do. Genuine. 4 were test samples. Of the 84 samples of milk taken, none contained either preservative or added colouring matter. 1 milk Do. Adulterated No. 663 contained 6.58% of added water. This was a station sample and the Farmer was cautioned. Vide Public Health Committee Minutes 14 th September, 1923, page 181. 38 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations 30 butter.. Food Inspector, St. Marylebone Borough Council Genuine. 12/6 per sample. 26 were test samples. 2 samples contained no preservative. 28 samples contained boric acid in amounts which varied from 9 to 21 grains per lb. 7 margarine Do. Do. All were test samples. 9 cream Do. Do. For details see below: 3 were test samples. 8 cheese Do. Do. All were test samples. 21 lard Do. Do. 8 jam Do. Do. 6 mustard Do. Do. 8 pepper Do. Do. 12 coffee Do. Do. 8 cocoa Do. Do. 3 tea Do. Do. 3 marmalade Do. Do. 7 olive oil Do. Do. 3 camphorated oil Do. Do. 6 sweets Do. Do. Particulars of Creams:— No. Fat. D. 589. 37.6%. (preserved.) Preservative. 9.8 grains boric acid per lb. D. 591. 15.0%. Nil. T. 593. 47.0%. (preserved.) 97 do. D. 597. 39.0%. Nil. T. 602. 48.5%. Nil. T. 614. 49.0%. Nil. D. 617. 48.7%. (preserved.) 5.6 do. D. 624. 50.0%. (preserved.) 6.5 do. D. 626. 56.5%. Nil. D = Divided. T = Test. Total Number of Samples analysed during the Quarter 223 Number of Samples adulterated 1 FOURTH QUARTER, ENDING 31st DECEMBER, 1923 - 84 milk Do. Genuine. 3 were test samples. Of the 86 samples examined none contained either preservative or colouring matter. Adulterated. 2 milk Do. No. 853. 3.3% deficient in milk fat. No. 941. 6.7% do. No. 853 vendor cautioned vide Public Health Committee Minutes 16th November, 1923. No. 941 vendor cautioned vide Public Health Committee Minutes 7th December, 1923. 39 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. 42 butter Food Inspector, St. Marylebone Borough Council Genuine. 12/6 per sample. 33 were test samples. Of the 42 samples examined only two were found to be free from preservatives. The 40 other samples all contained boric acid. In no case did the amount exceed 0.4%. 12 cheese Do. Do. All were test samples. 7 tea Do. Do, Do. 2 cream Do. Do. One was a test samples. No. Fat. Preservative. 805. (preserved. 48.0%. 9.68 grains boric acid per lb. 1033 (T) 50.0%. Nil. 3 mustard Do. Genuine. All were test samples. 1 compound mustard Do. Do. 5 self-raising flour Do. Do. 9 cocoa Do. Do. 4 lard Do. Do. 14 coffee. Do. Do. 6 jam Do. Do. 12 margarine Do. Do. 2 jelly Do. Do. 4 marmalade Do. Do. 2 pepper Do. Do. 20 condensed milk Do. Do. 10 sponge cake Do. Do. 3 dried milk Do. Do. 2 pears Do. Do. 2 tomato ketchup Do. Do. 1 camp coffee Do. Do. 1 O.K. sauce Do. Do. 1 lemonade powder Do. Do. 1 haricot verts Do. Do. 1 cocoa essence Do. Do. 1 peas Do. Do. 1 barley Do. Do. 2 tapioca Do. Do. 1 blanc mange powder Do. Do. 1 orange wine Do. Do. 1 raisin wine Do. Do. 1 jelly crystals Do. Do. 1 pickles Do. Do. 1 cream doughnut Do. Do. 1 turkey and ham Do. Do. paste 3 cod liver oil Do. Do. 2 zinc ointment Do. Do. 3 boric ointment Do. Do. 1 cascara tablets Do. Do. 2 olive oil Do. Do. Total Number of Samples analysed during the Quarter 275 Number of Samples adulterated 2 40 ANNUAL REPORT OF THE PUBLIC ANALYST, 1923. The number of samples taken under the Sale of Food and Drugs Acts and ubmitted for analysis, was 1,060 : an increase as compared with the samples for 922, the number for that year being 1,040. A complete list is as follows: No. Article. Genuine. Adulterated. Total. 1 Barley 1 — 1 2 Basilicon Ointment 3 — 3 3 Bicarbonate of Soda 2 — 2 4 Blanc Mange Powder 2 — 2 5 Boracic Ointment 11 — 11 6 Bovril 2 — 2 7 Brawn 2 — 2 8 Butter 192 — 192 9 Camp Coffee 1 — 1 10 Camphorated Oil 3 — 3 11 Cascara Tablets 1 — 1 12 Cheese 26 — 26 13 Clover Cream 1 — 1 14 Cocoa 17 — 17 15 Cocoa Essence 1 — 1 16 Cod Liver Oil 3 — 3 17 Coffee 98 — 98 18 Compound Mustard 1 — 1 19 Condensed Milk 20 — 20 20 Cooked Meat 1 — 1 21 Cream 23 — 23 22 Cream Dough-nut 1 — 1 23 Currant Jelly 2 — 2 24 Dried Milk 3 — 3 25 Ground Ginger 1 — 1 26 Haricot Verts 1 — 1 27 Ice Cream 4 — 4 28 Jam 38 — 38 29 Jelly 2 — 2 30 Jelly Crystals 1 — 1 31 Liquorice Powder 3 — 3 32 Lard 29 — 29 33 Lemonade Powder 1 — 1 34 Margarine 52 — 52 35 Marmalade 19 — 19 36 Meat Pie 3 — 3 37 Milk 314 7 321 38 Mustard 17 — 17 39 O.K. Sauce 1 — 1 40 Olive Oil 12 — 12 41 Orange Wine 1 — 1 42 Peas 1 — 1 43 Pepper 10 — 10 44 Pepsodent (Tooth Paste) 2 — 2 45 Pickles 1 — 1 46 Raisin Wine 1 — 1 47 Sausages 10 — 10 41 No. Article. Genuine. Adulterated. Total. 48 Scones 19 — 19 49 Self Raising Flour 12 — 12 50 Sponge Cakes 12 — 12 51 Strawberry Syrup 1 — 1 52 Suet with Flour 1 — 1 53 Sweets 6 — 6 54 Tapioca 2 — 2 55 Tartaric Acid 3 — 3 56 Tea 13 — 13 57 Tinned Peaches 1 — 1 58 Tinned Peas 1 — 1 59 Tinned Pears 2 — 2 60 Tomato Ketchup 2 — 2 61 Turkey and Ham Paste 1 — 1 62 Whisky 10 15 25 63 Zinc Ointment 11 — 11 1,038 22 1,060 Milk.—Of the 321 samples examined during the year, 7 were found to be adulterated. This represents a percentage of 2.18 as compared with 3'36 per cent. for 1922, and 1.64 per cent. for 1921. Omitting the adulterated samples, the mean composition of the remaining samples taken showed a slight improvement on the figures obtained for 1922. Sp. Gr. Total Solids. Fat. Solids (not fat). 1923 1031 12.36 371 8.65 1922 1031 12.20 3.60 8.60 Butter.—All the samples taken were found to conform with the accepted standards of purity. Margarine.—Of the 52 samples taken none contained butter fat in amount exceeding the quantity (10 per cent.) allowed by statute. Neither was any sample found to contain more than the permitted amounts of preservative or water. Cream.—The samples examined were all genuine and in no instance contained a deficiency of fat when preservative was present. All the creams which contained preservative had it in amounts less than that mentioned on the labels. Cascara Tablets.—A sample of these tablets was examined and were found to consist of the usual constituents and contained no deleterious substances. Clover Cream.—One specimen of this article (used in connection with the baking of scones) was analysed and found to consist of 50 per cent. of sodium dihydrogen phosphate mixed with corn starch. Scones.—19 samples were examined and all contained phosphate in amounts ranging from 0.2 to l.l per cent. Ice Cream.—Of the 4 samples taken one was found to contain 10 grains of boric acid per lb.* *The source of the boric acid in this case was the preserved cream used in the manufacture of the ice cream. 42 Tinned Foods.—The contents of 4 tins were examined, viz: — 1 Tinned Peaches. 1 Tinned Peas. 2 Tinned Pears. Small amounts of metallic contamination were found in each instance. Although the amount of metal present was individually small in amount and in each instance no doubt to that extent innocuous, yet, it may be well to draw attention to the fact that many metals tend to accumulate in the system. Therefore in the case of families living largely on tinned foods, the individuals concerned may store up gradually in their system metallic compounds in amounts which may tend eventually to affect the health of the young or those naturally delicate. Whisky.—25 samples were examined and 15 were found to be adulterated. This represents 60 per cent. of the samples taken. STATISTICAL. BIRTHS. Registration.—The number of births registered during 1923 was 1,668*, being 11 less than in 1922. Of the children born, 865 were boys and 803 girls. The birth rate per 1,000 of the population was 15.8 as against 15.9 in 1922. The rates in the several registration sub-districts and the Borough were:— All Souls, 12.8; St. Mary, 12.7; Christ Church, 19.6; St. John, 17.8. Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3,829: Live births, 3,647; Still births, 182. 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. From parents 59 1.5 ,, doctors 314 8.2 ,, midwives 720 18.8 „ other persons 125 3.3 „ hospitals, etc. 2,611 68.2 3,829 No. Per cent. Of the total births notified, 182 referred to still-births (102 males and 80 females) : 1,896 took place at Queen Charlotte's Hospital; 524 at Middlesex Hospital; 105 at St. Marylebone Home; and 1,218 were born at home. Of those notified as having occurred in St. Marylebone, 1,991 belonged to other Boroughs. *This figure is exclusive of births occurring in the Borough to persons usually non-resident the rein, but includes 193 births which occurred outside the district, and which have been transferred as belonging to St. Marvlebone:— Legitimate Males 71 „ Females 82 Illegitimate Males 27 „ Females 13 43 DEATHS AND DEATH RATES. The number of deaths registered in 1923 was 1,235. This figure is inclusive of persons who, though normally resident in the Borough, died in institutions outside, but exclusive of persons, who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures, if they occur in the Borough. The corrected death-rate† per thousand for the year was 11.7. In the previous year, the rate was 13.7 and the number of deaths 1,451. The following short table shows the death rates in the several registration sub-districts in 1923 and compares them with those of the preceding 5 years:— 1918 1919 1920 1921 1922 1923 All Souls 14.8 12.9 9'9 10.2 11.3 8.9 St. Mary 15.9 15.3 13.2 12.0 15.4 12.3 Christ Church 23.2 18.5 14.2 14.0 14.0 12.5 St. John 19.8 17.0 13.6 16.0 14.3 13.0 The Borough 18.5 15.9 12.7 12.8 13.7 11.7 District births and deaths for the year ended 31st December, 1923, are given in the following table. A further table giving the vital statistics of separate localities for 1923 and the ten preceding years, will be found amongst the Ministry of Health Tables on page 76. Sub-District. Population estimated to middle of 1923. Births. Deaths. Males. Females. Total. Males. Females. Total All Souls 25,258 169 154 323 116 110 226 St. Mary 26,992 179 161 340 157 176 333 Christ Church 32,806 336 307 643 213 197 410 St. John 20,344 181 181 362 109 157 266 The Borough 105,400 865 803 1,668 595 640 1,235 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 1923. It will be seen that the heaviest incidence in both old and young falls in the first and last quarter. 1923 JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 39 16 24 32 111 Persons of 65 years and upwards 138 138 91 134 501 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 79. 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 967. 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. † A definition of the term "corrected death-rate" will be found on page 9 of the Report for 1912. 44 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 1923 was 111, and the number of births in that year 1,668. The infantile mortality rate is therefore 66'0, two points under that for 1922 (68 per 1,000). The course which the rate has taken is graphically shown in the chart on page 46, which indicates clearly that the only really serious interruption to the decline was in 1917. The means adopted in the Borough with a view to bringing about a reduction 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 45, 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 1923, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 50 were less than one month old when they died and 72 less than three months. The figures for 1922 were 39 and 63. The outstanding causes of death and the proportions traceable to them were those usually noted. Prematurity (numbers 12, 13 and 14 in the table), which as usual heads the list, caused 43 deaths, a figure higher by 4 than that for the year 1922. Diarrhoea and enteritis (7 and 8) accounted for 15 in 1922 and for 13 in 1923. Respiratory diseases, the third of the main causes, took 19 in 1922, and in 1923, also 19. ' • The commoner infectious diseases together led to only 1 death among infants, the child in this case dying of diphtheria. Three deaths were stated to be due to overlaying, 3 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 52 deaths amongst infants. In 1922 the figure was 50. 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 2 2 1 1 — 1 5 2 14 St. Mary 14 3 3 — 2 4 2 — 18 Christ Church 17 3 3 — 10 6 7 6 52 St. John 8 — 2 1 10 4 1 1 27 Totals 31 8 9 2 22 15 15 9 111 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year, and in Sub-Districts. No. CAUSE OF DEATH. Under 1 Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under 4 Weeks. Total under 1 month. 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Total. 1 Small-Pox — — — — — — — — — — — — — — — 2 Chicken-Pox — — — — — — — — — — — — — — 3 Measles — — — — — — — — — — — — — — — 4 Scarlet Fever — — — — — — — — — — — — — — — 5 Diphtheria and Croup — 1 — — 1 — — — — 1 — — 1 — 1 6 Whooping Cough — — — — — 1 1 2 2 6 2 — 3 1 6 7 Diarrhoea — — — — — — — 1 1 2 1 — 1 — 2 8 Enteritis — — — — — 3 5 3 11 1 3 6 1 11 9 Tuberculous Meningitis — — — — — — — 1 — 1 1 — — — 1 10 Abdominal Tuberculosis — — — — — — — — — — — — — — — 11 Other Tuberculous Diseases — — — — — — 1 — 1 2 — — 2 — 2 12 Congenital Malformation 7 — — — 7 1 — — — 8 1 — 6 1 8 13 Premature Birth 13 3 5 1 22 1 1 — — 24 1 8 8 7 24 14 Atrophy, Debility and — — Marasmus 1 — 2 — 3 8 — — — 11 — 2 6 3 11 15 Atelectasis 3 — — — 3 — — — — 3 — — 3 — 3 16 Injury at Birth — — — — — — — — — — — — — — — 17 Erysipelas — — — — — — — — — — — — — — — 18 Syphilis — — — — — — — — — — — — — 19 Rickets — — — — — — — — — — — — — — — 20 Meningitis {not Tuberculous) — — 1 — 1 — — — — 1 — — — 1 1 4 21 Convulsions — 1 — — 1 1 — I 1 4 1 — 2 1 22 Gastritis — — — — — — — 1 — 1 — 1 — 1 23 Laryngitis — — — — — — - - - - — — — 24 Bronchitis — — — — — — — — 1 1 — — 1 1 19 25 Pneumonia (all forms) — 2 1 — 3 4 4 5 3 19 4 3 7 5 26 Suffocation, Overlying 2 — — — 2 — 1 — — 3 — — — 3 3 27 Other Causes 5 1 — 1 7 3 2 1 — 13 2 2 5 4 13 Totals 31 8 9 2 50 22 15 15 9 111 14 18 52 27 111 Legitimate, 1,516 Nett Births in the Year Illegitimate, 152 Total 1,668 Legitimate Infants, 91 Nett Deaths in the Year ( Illegitimate Infants, 20 Total 111 45 46 INFANTILE MORTALITY FIGURES. 47 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 79. 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 15, equal to 0.14 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur amongst infants, and in 1923, as a matter of fact, all those who died, with the exception of 2, were less than 1 year of age. In 1922 the deaths from diarrhoeal diseases numbered 17, all the victims being babies. In 1923, therefore, there was a reduction in the total. The steady and remarkable reduction that is taking place year by year in the number of deaths from this condition is one of the outstanding features of public health statistics. Having regard to the fact that this reduction has been continuous for some years it seems safe to regard it as something more than accidental. Equally it is safe to claim it, as so many do, as one of the rewards of the work that has been done in regard to sanitation and hygiene, more particulary the hygiene of infancy and childhood. 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 15 deaths), the diseases contributing to the total of 37 deaths were—diphtheria, 2; scarlet fever, 3; whooping cough, 16; and, as already noted, diarrhoea, 15. 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 115, which is lower by 12 than the figure 127 for 1922. The great bulk of the 115 deaths, viz., 94, was due to phthisis. Of the total number of deaths registered (1,235), the percentage due to phthisis was 7.7, as against 6.7 in 1922. The age periods at which the deaths occurred were: under 1 year, 1 (l.l per cent..); 2—5, 1 (l.l per cent.); 5—15, 3 (3.2 per cent.); 15—25, 12 (12.8 per cent.); 25—45, 45 (47.8 per cent.); 45—65, 26 (27.6 per cent.); 65 and over, 6 (6.4 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. 48 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 1.9 1921 117 105,200 1.ll 1922 127 105,200 1.20 1923 115 105,400 1.09 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 283. This is lower by 42 than the figure (325) for 1922. The death rate was 2'6 per 1,000. In 1922 the rate was 3.0. The number of deaths certified to be due to bronchitis was 144 as against 151 in 1922. Of this number 103 were amongst persons aged 65 and upwards, and 33 amongst those of the age group 45—65. The deaths traceable to pneumonia numbered 117, and as in the case of bronchitis the later age groups contributed the greatest numbers, though 20 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified was 51. Of the patients 10 were aged 5—15, 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 79. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 159 and the death rate 1.50 per 1000 of the population. In 1922 the figures were higher, the total being 173 and the death rate 1.51 per 1,000 of the population. 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 3 3 18 21 18 64 Females - — 2 6 17 17 23 30 95 Totals — — 3 9 20 35 44 48 159 49 Cancer.—Situation of the Disease. Parts of the body affected. Males Females Totals Face, Tongue, Jaw 10 5 15 Throat, Neck, Gullet 13 1 14 Stomach 7 14 21 Intestines 15 22 37 Liver 2 7 9 Breast — 17 17 Uterus and Generative Organs — 17 17 Various 17 12 29 Totals 64 95 159 ALCOHOLISM. No death was certified during the year as due to alcoholism. Year after year the number so certified has been quite small, and in 1922 there was 1 death. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 5 deaths. The deaths from conditions sometimes due to the irritation produced in various organs by chronic alcoholism, e.g., nephritis (inflammation of the kidneys) and Bright's disease of the kidneys, numbered 39, as against 42 for the year 1922. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1923 numbered 67. Of these 17 were due to suicide. Deaths of babies certified as resulting from suffocation (overlaying) numbered 3. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. A table showing, with regard to the infections, the total number of notifications received, the age distribution and the number of cases notified from each of the four registration districts, will be found on page 78. The total number of notifications coming to hand was 614, which is lower by 394 than the figure (1,008) for 1922. The bulk of the notifications related to tuberculosis, which contributed 224 to the total. Other diseases in respect of which fairly large numbers of notifications were received were diphtheria (127), scarlet fever (126), and pneumonia (51). The notification rate (proportion to population of notified cases of infectious diseases) in 1923 was 5.8 per 1,000 as against 9.5 in 1922. Isolation of Cases.—As the following table shows, the number of cases removed was as high as usual:— Diphtheria 127 or 100.0 per cent. of the cases notified. Erysipelas 20 „ 42.5 „ „ „ Scarlet Fever 120 „ 95.2 ,, „ ,, Enteric and Paratyphoid Fever 11 „ 69.0 „ „ „ Ophthalmia Neonatorum 8 „ 50.0 „ „ „ Tuberculosis 53 „ 23.6 „ „ „ Pneumonia 17 „ 33.3 „ „ „ 50 The cost of carrying out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £40 7s. 6d. equal to 7s. 8d. 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. 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 1923 40 7 6 0 7 8 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 486 and referred to 613 cases. Visits were paid to these cases by the District Inspectors, and advice given as to date of the return of children to school and the advisability of obtaining treatment for and isolation of any suffering from any sequel of a disease. Diphtheria and Membranous Croup. Diphtheria was less prevalent in 1923 than in any year since 1909, with the exception of the year 1920 when 119 cases were notified. The actual number of cases was 127, the number in 1922 being 268. Of the cases 2 died, and the case mortality rate was 1.5 per cent., a marked reduction on the rate for 1922, viz., 11.1. The number of cases per thousand of the population was 1.2. The cases were more or less evenly distributed, as usual, throughout the Borough, and only in a few instances was it possible to determine accurately the source of infection. In 6 cases the source appeared to be a member of the family previously infected; and in 8 cases infection was counted to have been acquired in school. The number of swabs from doubtful cases submitted for bacteriological examination was 1,013. A positive result was returned in 94 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 47. In St. Mary the number was 34, in All Souls, 32, and in St. John, 14. As usual the age groups 1-5 and 5-15 were those most affected, 39 of the cases falling into the former and 49 into the latter group. Two applications for a free supply of antitoxin under the Diphtheria Antitoxin (London) Order, 1910, were received. The nuisances detected during the course of investigating the notified cases were : Dirty Premises, etc., 20. These were all remedied after service of notices. Scarlet Fever. There was no epidemic prevalence of this disease during the year; the number of cases being 126 as against 339 in 1922, when there was more or less of an epidemic throughout the metropolis. 51 The highest number of cases reported in any one week was 19. The total deaths from scarlet fever numbered 3, and the number of deaths per cent. of the cases was 2.4. The districts to suffer most from this disease were Christ Church and St. John. In the former there were 39 cases and in the latter 33. In All Souls there were 26 and in St. Mary 28. As usual the majority of patients were children of school age, the age group, 5-15, giving nearly two-thirds (60) of the total. Of the remainder 26 were aged between 1 and 5 years. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 4 instances that a definite connection could be made out. Defects in sanitation to the number of 27 were discovered in the premises visited. All these were want of cleanliness, etc. The nuisances were remedied after the service of notices in each case. Enteric and Paratyphoid Fever. The Enteric Fever notifications received numbered 11. There were no deaths. Of Paratyphoid Fever there were 5 cases. All the patients recovered. Cerebro-Spinal Fever. There were no cases of this disease during the year. Encephalitis Lethargica. There were no cases of this disease during the year. Polio-Myelitis. Three cases were notified, one girl, aged 10 months, and 2 boys, aged 4 and 5 respectively. The girl and the boy aged 5 years are still under medical treatment, both being unable to walk. The boy aged 4 is progressing favourably. Erysipelas. The notifications of erysipelas numbered 47, and there was 1 death. Puerperal Fever. The number of cases of this disease notified, viz., 1, was rather under the average; the patient, however, died. Measles and German Measles. These conditions are not now notifiable. 215 cases were however reported, 41 voluntarily by doctors and parents and 174 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 1923 the number of deaths registered as due to whooping cough was 16. In 1922 the number was 14. Nurses were sent in to 3 cases, and 36 visits were paid. Glanders and Anthrax. No cases were notified. 52 Small Pox. Although there was a small outbreak of small pox in the autumn, and notification was received as to contact between residents in the borough and recognized cases, no actual cases occurred in St. Marylebone. Contacts were kept under observation, and every encouragement was given to any persons desirous of being vaccinated or revaccinated. A number of cases in which there was doubt as to diagnosis were seen during the year. All of these proved to be chicken-pox or some other condition difficult at times to distinguish from small pox. 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 1923. During the year in certain of the schools, one or more classrooms were closed on account of measles. Schools. Scarlet Fever. Diphtheria. Typhoid Fever. Whooping Cough. Chickenpox. Measles. All other Diseases. All Souls, Foley Street 13 - - - 4 - 16 Barrett Street — — - - — — — Barrow Hill Road 15 — - 7 18 56 52 Bell Sfreet 14 7 - 20 52 23 23 Blandford Square — — - — — — — Capland Street 3 5 - 2 19 4 19 Catholic, Richmond Street — 1 - — — — — Christ Church, Lisson Grove 25 16 - 18 38 18 16 Convent, Little Union Place — — — — — — — Council School, Grove Road — — - — — — — Emmanuel, Aberdeen Place 1 - - - - - 3 Emmanuel, North Street 2 4 - 2 — 2 1 Gateforth Street 1 5 — 4 5 6 2 Hampden Gurney, Upper Berkeley Street 9 6 - 1 12 — 1 Homer Row, Catholic 3 6 - 3 15 13 — Jewish, Hanway Street 1 - - - - - - Portland, Little Titchfield Street - - - - - - - Polytechnic, Regent Street 1 - - - - - - Queen's College, Harley Street — — - — — — — St. Andrew's, Wells Street - - - - - - - St. Francis, Upper William Street - - - - - — - St. James's, Marylebone Lane - - - - - - - St. Luke's, Nutford Place 4 1 - 9 — 1 3 St. Mark's, Violet Hill 27 8 - 3 26 21 14 St. Mark's, Marylebone Road — — - — — 1 — St. Marylebone, High Street 13 15 - 22 13 20 15 St. Marylebone Grammar, Marylebone Road — — - — - - — St. Mary's, Crawford Street 6 16 - 32 47 2 8 St. Paul's, East Street — — - — — — — St. Paul's, Broadley Terrace 10 2 - — 18 1 4 St. Thomas', Orchard Street 2 5 - 1 3 1 5 St. Vincent, Lower Seymour Street — — - — — — — Upper Marylebone Street 12 8 - 4 20 3 81 Schools out of Borough 1 2 - - - 2 — Totals 163 107 - 128 290 174 263 53 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 1923. The following table gives information with regard to the 16 cases notified. Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. At Hospital. 16 8 8 14 2 - - Nurses were sent in to 5 cases and 100 visits were paid. Three of the patients notified as suffering from ophthalmia died of some other condition. INFLUENZA. This disease showed no epidemic tendencies during the year. The deaths certified as due to Influenza numbered 15 as against 43 in 1922. PNEUMONIA. Figures with regard to notification will be found on page 78, 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 35 cases and 370 visits were paid. TUBERCULOSIS. In all 224 notifications were received, 190 relating to pulmonary tuberculosis, the remainder (34) to cases in which structures other than the lungs were affected. The table given on page 54 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 9 as against 10 in 1922. 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:— 1. Total number of deaths from tuberculosis in the Borough 115 2. The number of cases only notified at death 10 3. The number of cases notified within a month of death 6 4. The number of cases notified within three months of death 4 5. The number of cases notified within six months of death 10 Treatment of Tuberculosis.—Of the cases notified 168 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 114 were insured persons: of these 39 were admitted to sanatorium or hospital treatment and 12 to St. Marylebone Hospital. Non-insured persons numbered 110 of whom 20 (9 being children) received sanatorium treatment and 8 were admitted to the St. Marylebone Hospital. Nurses were sent in to 11 cases and 125 visits were paid. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1923, to the 30th December, 1923. 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 l 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 — 1 3 1 4 12 21 25 19 17 8 111 132 — 3 1 4 7 40 59 „ Females — 1 — 5 4 13 22 12 6 7 3 73 92 — 2 — 2 3 15 38 Non-pulmonary, Males 1 4 3 2 3 1 1 — 1 — — 16 17 1 1 — 2 2 — 6 „ Females 1 5 1 2 2 — — 2 2 — — 15 15 — 1 — 1 1 1 4 Totals 2 11 7 10 13 26 44 39 28 24 11 215 256 1 7 1 9 13 56 107 54 55 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 57, while the following short table summarizes the information as to visits paid by members of the staff:— No. of visits by Tuberculosis Officer New, 95 Old, 236 No. of cases at Dispensary New, 396 Old, 1,629 No. of attendances at Dispensary 3,155 No. of visits by Miss Baker First visit, 206 Re-visits, 1,259 No. of visits by Miss Bartleet First visit, 225 Re-visits, 768 No. of Committee Meetings attended 24 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, continued its useful work during the year. The number of children on the roll was 25—12 boys and 13 girls—and the attendances numbered 9,503. 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 difficulty of finding employment for the consumptive person still remains acute. Employers are loath to take a man on, first, on account of infection, and secondly, because he is not a 100 per cent. unit. As regards infection, there is no necessity for any consumptive to be infectious to his fellow workers if he takes an ordinary amount of care. If he has been to a sanatorium he has received full instructions as to how to avoid being a danger to others, and if, thereafter, he carries out what he has learnt, chance of infection is reduced to a minimum. This refers to the patient who has a cough with expectoration. The man who returns from sanatorium with his complaint practically arrested or in a quiescent state experiences the same difficulty of obtaining work, when it is known he has been under treatment for consumption, although for the time being he is capable of doing a full day's work. The man-who coughs and expectorates is provided with a sputum flask in which to spit; this, unfortunately, is enough to damn him in the eyes of his neighbour, and people in the street give him a wide berth. These same people, however, have no such terror of the man who spits on the pavement, in tram, bus or train, and is the real source of danger to the community—they tolerate him, but 56 the poor chap who is doing his best not to infect others with his complaint is ostracised. There is no reason why a man should not return to his original employment if the conditions under which he works are suitable. The idea that it is an absolute necessity for him to work out of doors has too much stress laid upon it; he is far more likely to be able to earn a wage at the job he has been brought up to since leaving school, than he is at something new and with which he is unfamiliar. The question of a man who has been under treatment becoming a 100 per cent. unit, depends greatly on the stage of the disease he was in at the commencement of his treatment; therefore his degree of utility varies on leaving sanatorium. Mr. Ford, of motor car fame, can find employment for all disabled men in his works even if they can only do a few hours work per diem. It seems a pity that the big firms in our country cannot do likewise and so prevent these men from becoming more or less demoralised from want of some employment to take their minds off themselves and their complaint when after treatment they feel they would still go on improving in general health if only they had something to occupy their minds and their hands." 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 413 as against 498 in 1922. Of these, 122 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—34 as against 24 in 1922—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 61. Return as to work carried out in connection with the St. Marylebone Tuberculosis Dispensary for the year 1923. (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 ...1 (a) All persons (including Children "Contacts") under 15 M. 3 128 131 53 1 61 2 14 F. 8 122 130 31 2 74 2 21 M. 32 89 121 8 12 51 19 31 F. 33 59 92 5 10 43 17 17 total - 76 398 474 97 25 229 40 83 Adults (b) Contacts (included in Children (a)).under 15 M. 10 10 1 9 - - F. 1 32 33 2 26 — 5 m. 15 40 55 1 3 26 7 18 F. 10 38 48 1 2 30 6 9 (c) Insured persons (included in (a) ). m. 3 95 98 40 1 44 2 11 F. 3 55 58 17 1 25 1 14 57 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 166 2. Total number of attendances of patients Insured 1,329 at the Dispensary during the year Uninsured 1,826 3. Number of persons placed daring the year under observation at the Dispensary for the purpose of diagnosis 81 4. Number of cases in which the period of observation at the Dispensary exceeded two months 14 5. Number of insured patients under domiciliary treatment on December 31st 170 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 1 8. Number of consultations with medical prac- Insured 8 titioners at the homes of patients Uninsured 6 9. Number of other visits paid by Tuberculosis Officer to the homes of patients 333 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 1,263 11. Number of specimens of sputum examined in connection with the work of the Dispensary 367 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, 1923, to the 31st december, 1923, 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, 1923, to the 31st December 1923, at or in connection with the Dispensary and were:— Number of Per sons diagnosed to be suffering from Tuberculosis who were treated or supervised at or in connection with the Dispensary during the period from 1st January, 1923, to 31st December,1923. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1923. Number of Persons referred for diagnosis or treatment to the Hospital with which the Dispensaryis affiliated during the period 1st January, 1923, to 31st December, 1923. 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—1 116 201 81 150 248 187 173 226 404 — 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:— 58 59 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. l Name of Hospital to which Special Cases are referred from the Dispensary for diagnosis or treatment Middlesex Hospital. 2. Is any provision for the home nursing of Tuberculous Patients made in connection with the Dispensary? If so Yes. Application can be made to the District Nursing Association (1) State the general nature of the arrangement (1) Note sent to Matron from Dispensary. (2) What qualifications are the Nurses required to possess ? (2) Fully trained. (3) Do they carry out other work ? If so, what? (3) Yes, District Nursing. (4) Are their services available for Insured and Uninsured Patients? (4) Yes. (5) If so (a) by what procedure are their services secured for individual patients? (5) (a) As above. (b) Under whose instructions do they perform the actual duties of nursing in an individual case? (b) Matron of Nursing Association and Tuberculosis Officer. 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 December, 1923, for lending out to Patients for use at their own homes None. 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 1923 the total number certified as due to this cause was 94, the deathrate being 0.8 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 1919-1923. 60 Deaths from Phthisis. Five years—1919-1923. Year. Estimated Population. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. St. John. 1919 97,953 104 12 27 53 12 1920 1921 101,856 105,200 94 102 14 24 28 24 38 40 14 14 1922 105,200 98 15 27 42 14 1923 105,400 94 19 25 33 17 The distribution of the 94 deaths was as follows:—In Poor Law Institutions, 29; general and other hospitals, 24; and at home, 41. Of those who died 55 were insured (35 males and 20 females), and 36 uninsured (16 males and 20 females). In addition there were 3 children. As it may be useful for statistical purposes it may be mentioned that while the deaths numbered 94 the notified cases of pulmonary tuberculosis totalled 190. The following table prepared at the request of the Ministry of Health contains information with regard to age and sex distribution that may be found interesting. Age Periods. NEW CASES. DEATHS. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 - - 1 1 1 - - 2 1—5 1 1 5 5 — 1 3 3 5—10 6 2 4 2 — — 2 2 10—15 2 5 2 2 — 3 — 2 15—20 4 4 3 2 — 3 2 1 20—25 12 13 1 3 6 — — 25—35 21 22 1 — 12 9 — — 35—45 25 12 — 2 14 10 — — 45—55 19 6 1 2 13 6 — 1 55—65 17 7 — - 4 3 — 1 65 and upwards. 8 3 - - 5 1 1 1 Totals 115 75 18 16 52 42 8 13 The following table, giving information as to the localization of the disease, brings out no fact to which attention has not already been directed. 61 CASES OF TUBERCULOSIS NOTIFIED DURING THE 52 WEEKS ENDING 29th DECEMBER, 1923. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. Localization of Disease. At all Ages. At ages—years. All Souls. St. Mary. Christ Ch'ch. St. John. Totals. All Souls. St. Mary. Christ Ch'ch. s,. 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 190 ... 2 15 33 80 49 11 40 58 73 19 190 11 9 12 5 37 153 Peritoneum 3 ... 1 ... 2 ... ... ... ... 2 1 ... 3 ... 2 ... ... 2 1 Glands 15 1 5 7 2 ... ... ... 2 5 8 15 ... 1 1 5 7 8 Hip 3 ... 2 ... 1 ... ... ... 1 ... 2 ... 3 ... ... ... ... ... 3 General 1 ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... Meninges 2 ... 1 1 ... ... ... ... ... ... 2 ... 2 ... ... 2 ... 2 ... Abdomen 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 Knee 4 ... ... 1 2 ... 1 ... ... ... 3 1 4 ... ... 2 1 3 1 Spine 1 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... 1 Breast 1 ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 Miliary 2 1 ... 1 ... ... ... ... ... 2 ... 2 ... ... 1 ... 1 1 Shoulder 1 ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... 1 Totals 224 2 12 25 39 83 52 11 43 62 90 29 224 12 12 18 11 53 171 224 62 DISINFECTION. The work done in this connection during 1923 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 133 8 1 1 17 160 Mattresses 285 33 3 26 102 449 Bolsters 137 23 1 7 34 202 Pillows 598 77 6 26 343 1,050 Sheets 418 14 2 11 7 452 Blankets 702 33 11 22 184 952 Sundries 5,095 444 8 378 1130 7,055 Totals 7,368 632 32 471 1817 10,320 In 1922, the number of articles disinfected was 15,364. The number of journeys made by the disinfecting vans during the year ended December, 1923, was :— January 48 August 49 February 44 September 45 March 50 October 48 April 43 November 48 May 50 December 44 June 47 — July 47 563 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 53 5 1 – 5 64 February 31 6 4 — — 41 March 83 12 2 6 — 103 April 39 11 7 1 — 58 May 40 5 2 2 — 49 June 50 10 — 1 — 61 July 40 16 1 3 — 60 August 34 16 4 1 — 55 September 32 3 — 1 — 36 October 25 4 — 2 — 31 November 20 5 — — — 25 December 40 17 o 1 — 60 Totals 487 110 23 18 5 643 63 The number of rooms disinfected in 1922 was 950. In regard to treatment of premises with the object of destroying vermin, it may be noted that the arrangements referred to in the report for last year for placing a spraying apparatus and a supply of " Fluid D " at the disposal of owners and occupiers of infected premises have proved highly successful* The sprayers are in great demand and satisfactory results have been obtained. 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 :— 1923. Adults. Children. Males. Females. Total. Males. Females. Total. January 281 78 360 35 182 217 February 237 80 317 54 250 304 March 229 71 300 20 270 290 April 230 94 324 26 134 160 May 241 89 330 26 246 272 June 230 86 316 32 326 358 July 254 95 349 20 206 226 August 258 93 351 — 55 55 September 223 47 270 5 292 297 October 237 79 316 18 290 308 November 247 100 347 53 174 227 December 240 80 320 16 103 119 Totals 2,907 993 3,900 305 2,528 2,833 Cleansing Station Attendances, 1910-1923. 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 1923 2,907 993 3,900 305 2,528 2 833 The total attendances since the Baths were opened in 1898 number 214,832 (adults, 159,030 ; children, 55,802). 64 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. 1923 Positive. Negative Total. Typhoid fever 14 37 51 Diphtheria 94 1,019 1,013 Phthisis 122 291 413 Totals 230 1,247 1,477 MATERNITY AND CHILD WELFARE. The composition of the Maternity and Child Welfare Scheme now in existence has been very frequently described in annual reports and more particularly in that for 1919. As is well known, it contains voluntary and official elements. Of the voluntary elements, to the nature of which reference is made later, those for which the St. Marylebone Health Society is responsible bulk largest, and the Council and the inhabitants of the Borough are greatly indebted to this body and those who work for it for what they have done and what they are doing in relation to maternity and child welfare. Apart from the Health Society, however, there are other bodies that assist, and that are more or less definitely linked up to the main scheme, the connecting link being the Public Health Department of the Council. Amongst these bodies maybe mentioned Queen Charlotte's Hospital and Middlesex Hospital, which in addition to providing lying-in accommodation, arrange for attention to be given to out door patients as well, and conduct ante-natal clinics and infant consultations. 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 1923. 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 65 London County Council the dental clinic is used also by school children, and in conjunction with this there is also a minor ailment treatment centre for school children. The summary referred to above is based upon a return formerly called for by the Local Government Board and is given here because it is convenient as showing the elements in the scheme. Health Visitors.—There are 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 1923 the health visitors made 8,480 visits, and the voluntary visitors attached to the schools for mothers made 1,076 visits ; 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 dental clinic and minor ailment treatment centre are in the same building. The Council's health visitors co-operate, one of them acting as superintendent.—(2) South Marylebone School of Mothercraft, St. Marylebone General Dispensary, 77, Welbeck Street, and 30, Marylebone Lane. An ante-natal clinic is held once weekly, and an infant consultation twice weekly, both under medical supervision. There is a superintendent and a part-time assistant, both of whom are nurses. Children attend up to school age, and the Council's health visitors co-operate.—(3) Ogle Mews, Ogle Street, W.1. Infant consultations are held weekly under medical supervision. The Council's health visitors attend. There are also classes weekly in cookery, needlework and hygiene.—(4) Barrow Hill Road. Infant consultations under medical supervision are held weekly at the day nursery here. The health visitors co-operate and one of the nurses of the day nursery gives part time to health visiting.—(5) 101, Crawford Street (temporarily held at Western General Dispensary). 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, 66 Maternity Cases.—The Council have not established a Maternity Home or Hospital, but there is accommodation within the Borough at Queen Charlotte's Hospital, Middlesex Hospital and in the Labour Wards at the St. Marylebone Home, Marylebone Road. The number of births notified from these institutions during 1923 was 2,525, the total births numbering 3,829. The midwives living and practising in the Borough number 2. Both conduct maternity homes which are registered by the London County Council. Work done during 1923.—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, 1923. CENTRE. Barrow Hill Road. No. 14 Salisbury Street. Queen Charlotte's Hospl. *No 101 Crawfous streer. No. 30 Marylebone Lane. No. 8 Ogle Mews. The Middlesex Hospl. The Westn. Genl. Dispy. The Church Army Dispy. No. of consultations held 55 249 (201 children 48 nity) 303 (252 antenatal 51 fants) 93 96 51 151 93 50 No. of attendances of mothers at ante - natal clinic – 745 7888 – 39 – 104 No. of attendances of babies 1000 3382 1345 1479 1044 896 2816 583 579 No. of attendances of children over 2 years 76 658 71 314 148 227 1365 1806 50 No. of orders issued for milk, etc. 93 440 65 30 75 61 80 1 No.of home visits 695 2736 694 435 632 830 1024 10 192 No. of new cases 81 317 3632 58 88 78 282 328 68 Day Nurseries—Attendances during the year. St. John's Wood, Barrow Hill Road 6302 Portman., Exeter Street 7891 *Temporarily held at Western General Dispensary. 67 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 1923 was 6. The average time for which the help was required was 3 weeks, the longest being 4 weeks, and the shortest 1 week The total amount expended during the financial year to 31st March, 1924, was £l 10s. 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, 1923. 1923. Males. Females. Total. For burial only. For inquests. Total. No. of. P.M's held No. of courts held. No. of Infectious cases. January 6 7 13 5 8 13 2 4 – February 14 10 24 11 13 24 6 4 – March 12 14 26 15 11 26 6 6 – April 22 9 31 21 10 31 8 5 – May 4 8 12 10 2 12 2 3 – June 15 14 29 9 20 29 10 7 – July 6 10 16 8 8 16 4 3 – August 9 6 15 5 10 15 8 5 – September 15 9 24 9 15 24 12 7 – October 14 16 30 12 18 30 14 8 – November 5 5 10 6 4 10 3 5 – December 10 9 19 8 11 19 8 4 – Totals. 132 117 249 119 130 249 83 61 — 68 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. Apart from the information asked for by the Ministry and given in tabular form there is little to say, accept that during the year considerable progress was made in connection with the Council's scheme. The approval of the Ministry of Health having been received to the erection of two blocks, the work was early put in hand, and by the end of the year was well forward. Table A contains 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 a certificate in this case was granted. Number of new houses erected during the year: (1) Total 1 Hose 129 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) 2,331 (2) Number of dwelling-houses which were inspected and recoided under the Housing (Inspection of District) Regulations, 1910— Houses 758 Tenements in blocks 205 (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 69 (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 2,061 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) 1,716 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) ... 167 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 167 (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 70 TABLE A.—HOUSING. Statistics for the Twelve Months ended 31st December, 1923. 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. — 758 and 205 Tenements — 656 — — — — — — — — — — — — 1 6 71 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.£2,483,780. Sum represented by a penny rate. £lO,349. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimate . 1,516 780 736 Birth Rate 15 8. Illegitimate 152 85 67 Deaths, 1,235. Death Rate 11.7. Number of women dying in, or in consequence of childbirth—from sepsis, 1 ; other causes, 6. Deaths of Infants under 1 year of age per 1,000 births :— Legitimate 60.0 Illegitimate 131.7 Total 66.0. Deaths from Measles (all ages), Nil. Deaths from Whooping Cough (all ages), 16. Deaths from Diarrhoea (under 2 years of age), 15. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 139 Cowhouses 2 Slaughterhouses 3 Offensive Trades 2 Ice Cream Premises 129 Bakehouses 68 Restaurant, Dining Room and Coffee Shop Kitchens 172 Hotel Kitchens 20 Pastrycooks and Tea Rooms 40 Fried Fish Shops 24 Fish Curers 5 Houses Let in Lodgings 1,115 Workshops and Workplaces 3,576 Total 5,295 Smoke Nuisances. Number of Observations 817 Number of Nuisances and Complaints 8 Number of Notices 8 Number of Summonses Nil 72 Housing of the Working Classes. Number of Houses inspected ... 758 Number of Houses dealt with under Section 15 of theHousing, Town Planning, etc., Act, 1909 Nil Tenements in blocks 205 Number of Representations by Number of Closing Orders Nil Householders Nil Number of Representations by Number of Houses included in Medical Officer Nil such Closing Orders Nil Number of Houses included in Number of Closing Orders such Representations Nil determined from year 1920 Nil Number of Houses remedied without Closing Orders Nil Number of Demolition Orders Nil Number of Houses demolished— (a) In pursuance of Orders Nil (b) Voluntarily Nil Obstructive Buildings. Number of Representations under Number of Buildings demolished Nil Section 38 of the Housing Act, 1890 Nil Number of Representations still under consideration Nil Number of Orders for repairs Number of Houses repaired by issued under Section 28 of the Local Authority Nil Housing Act, 1919 Nil Number of Houses closed on Notice by Owner that they could not be made fit Nil Total number of Houses in the Number of Houses occupied by Borough 19,039 the Working Classes 8,080 Number of Houses for the Working Classes— (a) Erected during year 5 (b) In course of erection (Flats) 32 Mortuary. Number of bodies received 249 Number of Infectious bodies received Nil Disinfection. Number of rooms disinfected 643 Number of articles disinfected 10,320 73 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 2,907 993 305 2,528 6,733 Bakehouses. Number on register at end of 1923 68 Number above ground 6 Number underground 62 Number of inspections 180 Number of Notices 6 Number of prosecutions Nil Places where Food is prepared for Sale (excluding Bakehouses). Number on Register at end of 1923 232 Number of Inspections 1,362 Number of Notices 46 Number of Prosecutions Nil House to House- Inspections. Number of Inspections Houses 758 Tenements 205 Number of Notices issued Intimations 656 Statutory Notices 84 Number of Prosecutions Nil House Refuse. Number of Inspections 4,792 Number of Old Brick Receptacles abolished Nil Number of New Metal Receptacles provided 514 Number of Notices issued. Intimations 514 Number of Statutory Notices 34 Number of Prosecutions Nil Water Supply. London County Council (General Powers) Act, 1907. Section 78. Number of Premises where water supply has been provided to Upper Storeys 25 Number of Statutory Notices served 4 Number of Prosecutions 2 Overcrowding. Number of Dwelling Rooms overcrowded 5 Number remedied 5 Number of Prosecutions Nil 74 Underground Rooms. Number dealt with 9 Number of Notices served under P. H. (L.) Act, 1891 Number of Notices served under H. T. P., &c., Act, 1909 9 Number of Prosecutions Nil Verminous Rooms. London County Council (General Powers) Act, 1922, Section 9 (1). Number of rooms cleansed 689 Number of Statutory Notices served 46 Number of Prosecutions Nil Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 5 Inland Revenue Act. Number of houses for which applications were received Nil Number of tenements comprised therein Nil Number of tenements for which certificates were granted Nil „ „ „ „ refused Nil ,, „ ,, „ deferred Nil Drainage. Number of inspections made 6,369 Number of drainage plans deposited 553 Number relating to new buildings 49 „ „ old buildings 504 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops, and Cowsheds 300 Number of Inspections 1,542 Ophthalmia Neonatorum Regulations. Number of Notifications received during the year from certified midwives Nil Sanitary Officers. Number of Sanitary Inspectors (Whole-time) Male 8 Female Nil „ ,, ,, (Part-time) Male 3Female 3 ,, Health Visitors Whole-time 3 Part-time 3 „ Tuberculosis Visitors Whole-time 2 75 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1923 AND PREVIOUS YEARS. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1911 117,844 4,130 2,375 20.2 1,578 14.2 600 840 261 1098 1,818 163 1912 116,155 4,111 2,246 193 1,652 150 769 752 209 93.0 1,635 148 1913 114,532 3,804 2,146 18'6 1,629 14'9 755 753 195 90 0 1,627 149 1914 112,892 3,847 2,128 187 1,631 151 813 787 210 986 1,605 149 1915 100,260 3,647 1,852 162 1,741 172 817 773 178 96 1 1,697 178 1916 98,573 3,936 1,814 168 1,681 16'9 855 720 188 1036 1,588 160 1917 92,796 3,065 1,506 14.5 1,647 176 853 752 182 120.9 1,580 17'0 1918 98,526 3,340 1,375 12.4 1,852 18'7 898 879 152 110.5 1,835 185 1919 97,953 3,625 1,492 146 1,724 173 864 708 147 985 1,568 159 1920 101,856 4,287 2,217 215 1,638 160 939 600 145 656 1,299 12-7 1921 105,200 3,393 1,939 18.4 1,625 15'4 877 607 128 660 1,355 128 1922 105,200 3,588 1,679 159 1,638 155 905 718 115 68-0 1,451 137 1923 105,400 3,601 1,668 158 1,468 139 827 594 111 660 1,235 117 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. 76 TABLE I. (A) Vital Statistics of Separate Localities in 1923 and the ten Previous Years. Names of Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages Deaths under 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. 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 1,299 145 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 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 Averages of Years 1913 to 1922 102,778 1,814 1,560 164 25,501 369 310 28 27,842 357 396 33 31,743 754 573 78 17,692 334 281 25 1923 105,400 1,668 1,235 111 25,258 323 226 14 26,992 340 333 18 32,806 643 410 52 20,344 362 266 27 *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. 77 TABLE II. Notifiable Diseases during the Year 1923. 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. Total No. of Cases Admitted to Hospital. Total deaths Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards. Diphtheria 127 6 39 49 19 14 ... ... 127 2 ... ... 1 1 ... ... ... Erysipelas 47 1 1 4 5 10 19 7 20 1 ... ... ... ... ... ... ... 1 Scarlet Fever 126 1 26 60 23 15 1 ... 120 3 ... 1 1 ... 1 ... ... ... Enteric Fever (including Paratyphoid) 16 ... 4 5 4 3 ... 11 ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... ... 1 1 ... ... ... ... ... 1 ... ... Acute Poliomyelitis 3 1 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 16 16 ... ... ... ... ... ... 8 ... ... ... ... ... ... ... ... ... Pneumonia 51 3 7 6 6 13 10 6 17 5 ... ... 1 ... ... ... 1 Dysentery 2 ... ... ... . 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... Malaria 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis, Pulmonary 190 2 15 33 80 49 11 37 28 ... ... 1 ... 2 15 8 2 ,, Non-Pulmonary 34 2 10 10 6 3 3 ... 16 5 1 ... 1 2 1 ... ... ... Total 614 30 87 148 98 142 85 24 360 45 2 1 5 2 5 16 10 4 78 Cases of Infectious Disease Notified during the 52 weeks ending 29TH December, 1923. 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 ageR—years. All Souls St. Mary Christ Church St. Jolin Totals. All Souls St. Mary Christ Church St. John Totals Under 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 127 6 39 49 19 14 ... ... 32 34 47 14 127 32 34 47 14 127 ... Erysipelas 47 1 1 4 5 10 19 7 5 18 14 10 47 1 12 3 4 20 27 Scarlet Fever 126 1 26 60 23 15 1 ... 26 28 39 33 126 25 27 38 30 120 6 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 8 ... Enteric Fever 11 ... ... 4 1 4 2 ... 6 1 ... 4 11 5 1 ... ... 8 3 Paratyphoid Fever. 5 ... ... ... 4 ... 1 ... ... 1 2 2 5 ... 1 2 ... 3 2 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Puerperal Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 1 ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis Pulmonary 190 2 15 33 80 49 11 40 58 73 19 190 11 9 12 5 37 153 Non-Pulmonary 34 2 10 10 6 3 3 ... 3 4 17 10 34 1 3 6 6 16 18 Acute Poliomyelitis. 3 1 2 ... ... ... ... ... 1 ... 2 ... 3 ... 2 ... 2 1 Polio-Encephalitis. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 16 16 ... ... ... ... ... ... 3 4 4 5 16 ... 2 2 4 8 8 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia . 51 3 7 6 6 13 10 6 4 12 25 10 51 1 5 8 3 17 34 Malaria 1 ... ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 1 Dysentery 2 ... ... ... 1 1 ... ... ... ... ... 2 2 ... ... ... 1 1 1 Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals. 614 30 87 148 98 142 85 24 120 160 224 110 6 14 76 94 120 70 360 254 614 79 TABLE III.—Causes of, and Ages at Death during the year ending 29th December, 1923. No. CAUSES OF DEATH. Net deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of Residents or Non-Residents in Institutions in the District. All Souls. St. Mary. Christ Church. » St. John. Total. All Ages, Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 Entcric Fever — _ — — — — 2 Small Pox. — — — — — — — — — — — — — — — 3 Measles — — — — — — — — — — — — — — — 4 Scarlet Fever 3 — 1 1 — 1 — — — 1 1 — 1 3 5 Whooping Cough 16 7 6 3 — — — — — — 2 4 9 1 16 6 Diphtheria and Croup 2 — — 1 — 1 — — — 1 1 — — 1 2 7 Influenza 15 — — — — — 1 2 12 1 2 4 2 3 15 8 Erysipelas 1 — — — — — — — 1 1 — 1 — — 1 94 9 Tuberculosis of the Respiratory System (Lungs, Pleura & Throat) 94 1 — 1 3 12 45 26 6 11 19 33 17 9a Disseminated Tuberculosis 5 1 1 — 2 1 — — — 6 3 — 2 — 5 10 Tuberculous Meningitis. 8 1 2 2 2 1 — — — 8 2 1 1 4 1 8 11 Other Tuberculous Diseases 8 — — 1 2 1 — 2 2 8 1 2 4 8 12 Cancer 159 — — — — 2 15 75 67 301 39 40 42 38 159 13 Rheumatic Fever 7 — — — 3 2 — 1 1 — 1 1 5 — 7 14 Meningitis 3 1 — — — — 2 — — 2 — — 2 1 3 15 Organic Heart Disease. Bronchitis 124 — — — — 4 11 36 73 68 20 38 37 29 124 16 144 1 1 — — — 6 33 103 36 22 45 50 27 144 17 Pneumonia (all forms) 117 20 8 3 — 4 8 39 35 73 20 29 46 22 117 18 Other Diseases of Respiratory Organs 22 1 2 — — – 3 11 5 6 3 1 11 7 1 22 15 19 Diarrhoea and Enteritis (under 2 years) 15 13 2 — — 3 7 2 3 9 20 Appendicitis and Typhlitis 8 — — — — — 1 4 14 — 4 2 2 8 21 Cirrhosis of Liver 5 — — — — — — 3 — 8 — 1 — 2 5 21a Alcoholism. — — — — — — — — — — — — — — — 22 Nephritis and Bright's Disease ... 39 — — — — 2 4 22 11 19 8 12 11 8 39 23 Puerperal Fever 1 — — — — — 1 — — 1 15 — — — 1. 1 24 Other accidents and diseases of 6 1 — — — o 2 1 — — — 4 1 6 Pregnancy and Parturition 10 19 12 44 25 Congenital Debility and 44 44 — — — — — — — 45 3 tion, including Premature Birth 14 14 50 26 Violent Deaths, excluding Suicide 50 4 2 2 2 3 9 12 16 32 13 9 27 Suicides 17 — — — — 2 6 7 2 6 4 7 4 2 17 28 Other defined Causes 322 16 1 2 12 12 28 89 162 297 60 95 96 71 322 Totals 1235 111 26 16 26 50 142 363 501 967 226 333 410 266 1235 80 VACCINATION RETURNS. Supplemental Return for 1922. Return made to the Board of Guardians and Ministry of Health on the 9th February, 1924, 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, 1922, 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, 1922. Number of these Births duly entered by 31st January, 1924, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1924, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1924, 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 1923. 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 1923. 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 832 516 6 ... 184 35 14 21 17 39 2. St. Mary 2,083 1,534 1 ... 161 79 11 268 22 7 2,731 310 3. All Souls 675 461 3 . ... 64 14 5 119 4 5 Total 3,590 2,511 10 409 128 30 408 43 51 2,731 310 Dated 9th February, 1924. (Signed) GEORGE H. BASSETT, Vaccinatio Officer. ■ • V C - - ' ( ■