AC 4353 STMARY 29 Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1924. 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-atLaw. LONDON : VAIL & CO., 170, FARRINGDON ROAD. 1925. ' Metropolitan Borough of St. Marylebone. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1924. 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: VAIL & CO., 170, FARRINGDON ROAD. 1925. VAIL & COMPANY 170, FARRINGDON ROAD • - LONDON, E.C.I. - - t • . : I Public Health Department, Town Hall, Marylebone Road, N.W.1. 5th June, 1925. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, I have the honour, as Medical Officer of Health, to submit my Annual Report on the Health of the Borough of St. Marylebone during the year 1924. It is one of the series of short reports, and, in accordance with the instructions of the Ministry of Health, contains simply a chronicle of the principal happenings of the year and statistical information as to population, births, deaths, etc. Any matter which appeared to call for particular comment I have noted in the way of the report, and the "foreword" I have devoted to a short discussion on "Food." Heie I wish to repeat the assurances I have so often given of my great appreciation of the help and consideration and many kindnesses shown me in connection with my work by the Chairman (Mr. Councillor Hugh Jones) and all the Members of the Public Health Committee. Also I would thank the members of the staff of the Department for their loyalty and co-operation. Throughout the year the work done by all was up to the normal high standard. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CHARLES POKTER, Medical Oflicer of Health i CONTENTS. page Foreword 7 Natural and Social Conditions of the Borough. Population 8 Water Supply 9 Drainage 9 Combined Drainage 9 Closet Accommodation 9 Underground Public Conveniences 9 Removal and Disposal of House Refuse 10 Sanitary inspection of the District 10 Staff 10 Nuisances—Legal Proceedings 13 Inspections 12 Rat Repression 13 Premises and Occupations controlled by By-laws and Regulations 13 Business Premises 14 Milk Premises 14 Cow Sheds 14 Slaughterhouses 14 Offensive Trades 15 Ice Cream Premises 15 Butter, Margarine, etc., Premises 15 Bakehouses 15 Fried Fish Vendors 15 Fish Curers 15 Factories and Workshops 15 Inspections 16 Defects found 16 HomeWork 17 Registered Workshops 18 Other Matters 18 Premises used for Human Habitation 19 Houses let in lodgings 19 Common Lodging Houses 19 Underground Rooms 19 Premises that are not but should be Registered 20 Food Stalls 20 Food 20 Milk Supply 20 Milk Analysis 20 Legal proceedings for adulteration 20 Bacteriological examinations 21 Dairies, Cowsheds and Milkshops Orders 21 Milk and Cream Regulations 21 The Milk (Special Designations) Order, 1922 22 Milk for Mothers and Children 22 Food Inspections 22 Food, Unsound, Condemned 22 Sale of Food and Drugs Acts 23 Reports of Public Analyst during year 24-30 Statistical 31 Births 31 Births Registration 31 Births Notifications 31 Deaths and Death Rates 31 Sub-IJistrict Births and Deaths 32 Deaths in relation to Age 32 Causes of and ages at death 32 Infantile Mortality 33-35 ,, „ Causes 33-35 page Deaths in relation to Disease 36 Diarrhoeal Diseases 36 Infectious (Communicable) Diseases 36 Phthisis and other Tuberculous Diseases 36, 37 Respiratory Diseases 37 Cancer or Malignant Disease 37-38 Alcoholism 38 Accident, Suicide and Manslaughter 38 Prevalence of and Control over Infectious Diseases 38, 39 Isolation of Cases 38 Discharge Notices 39 Diphtheria and Membranous Croup 39 Scarlet Fever 39, 40 Enteric and Paratyphoid Fever 40 Cerebro-Spinal Fever 40 Encephalitis Lethargica 40 Polio-Myelitis. 41 Erysipelas 41 Puerperal Fever 41 Measles and German Measles 41 Whooping Cough 41 Glanders 41 Anthrax 41 Smallpox 41 In Schools 42 Ophthalmia Neonatorum 42 Influenza 43 Pneumonia 43 Tuberculosis 43 Treatment of 43 Notifications 44,45,52 Prevsntion of 46 Bacteriological Diagnosis 47 Work at Dispensaries 48-50 Deaths 50, 51 Disinfection 53 Cleansing of Persons Act, 1897 54 Bacteriological Examinations 55 Maternity and Child Welfare 55 Health Visitors 56 Centres 56 Ante-Natal Work 56 Dental Clinic 56 Hospital Clinic 56 Maternity Cases 57 Infant Consultation—Work at 57 Day Nurseries 57 Home Helps 58 Sanitary Administration— Staff 58 Report of Mortuary Keeper 58,59 Housing— General Housing Conditions 59,61 General Statistics 62 Extracts from Vital Statistics of the Year 62 General Summary 62-65 Ministry of Health. Tables I—III 66-70 Vaccination Returns 71 7 FOREWORD. ON FOOD. Amongst the several matters to which consideration is given in this report one dealt with at some length is Food. In one section space is devoted to a description of the work done in relation to slaughter-houses, cowsheds and dairies, and to indicating the nature and amount of foodstuffs condemned as unfit for food, and in another the number of samples of milk, etc., submitted for analysis and of visits paid to restaurants, etc., is set out. The amount of work involved in carrying out the inspections, sampling, etc., is very considerable. It is amongst the most important of the duties performed in the Public Health Department, and one to which too much attention cannot be given, having regard to the real risks to health in the form not only of definite disease but of less obvious interferences with bodily welfare resulting from what may be called a reduction in the nutritive quality of the food. Of the definite diseases the most outstanding are those that belong to the same group as typhoid (enteric fever). All of these are due to germs derived from filth, and the chances of contamination of food from such germs through blown dust, flies and in other ways are tremendous. Amongst the conditions due to lack of nutritive quality are rickets and the many dis'orders that for want of better names are grouped as "malnutrition" and "general debility," which are now so common, particularly amongst children. The main causes of the interference with the nutritive quality of the food are lack of freshness and the application of methods of preservation adopted by one or more of the parties concerned in the production and marketing of foods. Considerable as is the amount of work done by the Department in the way of supervision, inspection, sampling, and so on, very little of it can really be counted as effective in ensuring complete freedom from contamination at all or any of the stages or hands through which the bulk of articles pass before they reach the consumer. As regards the use of preservatives and methods of preservation, which are, of course, vast in extent, the amount of control obtained along the lines of procedure adopted is infinitesimal. In the sampling of food—milk and dairy produce generally and other articles —all that is aimed at and that can be assured is that so far as composition is concerned it is satisfactory; that, in fact, the consumer is not paying for an inferior article. The analysis is a chemical analysis, and no opinion is given or can be given as to whether or not the food is good from a nutritive or any other health point of view. It is true that the presence of chemical preservatives can be detected, and it may be suggested that they are only there because the food is less fresh than it should be, or have been added in order that the article may be kept longer than in the interests of the consumer is justifiable. Even so, however, very little can be done at present by the Council to prevent the use of these objectionable substances. 8 So also with supervision of food premises, the inspection of slaughter-houses, cowsheds, milk-stores, food stores and shops and restaurants and of foods exposed for sale; the utmost that can be ensured is that a reasonable amount of care is exercised and that the consumers' health is not exposed to too violent risks. The chances of carrying out a really close observation are limited, and the Council and its officers cannot guarantee at any time that all the foods have been under their eye, and that as regards their freshness and nutritive quality and freedom from contamination they are all that could be desired. Thing's clearly unsound or diseased or obviously stale and visibly unclean and contaminated they can deal with, but they can g-o no further. They cannot interfere with the excessive and careless handling- of food; they cannot insist upon absolute cleanliness even of the hands of the food salesman; they cannot limit the time beyond which vegetables or eggs or butter shall not be sold because though not rotten they are dead ; they cannot forbid the sale as food of articles that are without food value; they cannot even interfere with the vendor who resorts to tricks and preservatives to keep in a saleable condition an article of food that has long since ceased to be of real value as such. In many directions it is probable that the Council, the ratepayers chosen guardians of health, never will be able to help. In some it appears certain they will, and in others, they can help, but only if the people see that they are given the power to do so. More than once the St. Marylebone Borough Council have urged the Minister of Health and the London County Council to increase their powers of supervision over food premises of all kinds, but without success. If the people on whose behalf these powers were sought ranged themselves behind the Council in their demands there is little doubt but that the extra powers would be granted. Some years ago, writing on this same subject, I suggested that in the education of the authorities as to the need for these powers the people were the best teachers, and added that "a dozen housewives with market baskets complete could more easily move a Minister of Health to action than a dozen Medical Officers of Health with sacks full of hygienic and scientific reasons." When I wrote those words I believed them to be true. I am still convinced of their truth, and it is because of this I have used this foreword for discussing the question of food, drawing attention to the need for safeguarding it from contamination and ensuring its freshness and the necessity for co-operation between the public and the authorities if these results are to be obtained. THE YEAR 1924. 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 1924 by the Registrar-General is shown 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 1923. Year. The Borough. All Souls. St.. Mary. Christ Church. St. John. 1923 105,400 25,258 26,992 32,806 20,344 1924 105,300 25,233 26,967 32,775 20,325 9 SANITARY CIRCUMSTANCES. Water. Complaints as to water supply, either as regards quantity or quality, were few. In accordance with the requirements of the Public Health (London) Act, 1891, Section 49 (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. 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.—Thirteen certificates were granted under Section 48 of the Public Health (London) Act, 1891, in respect of new and rebuilt premises. The number in 1923 was five, the increase indicating a definite increase in building activity within the Borough. In 27 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 six cases the supply was provided after the issue of a statutory notice. Drainage. The total number of drain inspections made during the year was 6,350, as against 6,369 in 1923. The total number of plans deposited was 536, the number in 1923 being 553. Plans relating to new buildings numbered 86, the number deposited in 1923 being 49. In the case of old buildings, the number of plans received was 450, as against 504 in 1923. On three 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 one case, the fine and costs imposed amounting to £3 Is. Combined Drainage.—Orders as to combined drainage were issued by the Council in respect of 37 premises. The number in 1923 was 19. Closet Accommodation. In the table on page 12, summarising 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 public conveniences were regularly submitted to and considered by the Public Health Committee. 10 The following is a statement showing the total receipts at each of the conveniences for the year ended March, 1925, and the amount of increase or decrease as compared with the previous year. 1925 1924 Increase Decrease £ s. d. £ s. d. £ s. d. £ s. d. Oxford Circus—Men's Department 1,004 10 3 978 16 1 25 14 2 - „ Women's „ 1,257 11 6 1,191 19 1 65 12 5 - Gt Portland Street—Men's „ 292 9 10 281 13 0 10 16 10 - ., Women's „ 283 16 10 280 3 4 3 13 8 - Marylebone Road—Men's „ 334 0 0 243 10 9 90 9 3 - „ Women's „ 333 0 11 263 0 2 70 0 9 - Foley Street—Men only „ 161 14 11 165 9 2 — 3 14 3 St. John's Wood Road—Men only 120 6 2 116 17 10 3 8 4 - Barrett Street—Men only „ 237 18 9 219 3 3 18 15 6 - †Salisbury Street— Men's Department 2 12 3 — — — †‡| „ Women's „ 3 10 3 - - - *One free urinette provided. †Opened 10th March, 1925. ‡Two free urinettes provided. Removal and Disposal of House Refuse. Throughout the year the arrangements in connection with scavenging remained in the hands of the Highways Committee and under the control of the Highways Engineer, Mr. James Gair. Considerable improvements have recently been made in the plant, but as the arrangements are substantially the same as those in vogue in 1921, and fully described in my report for that period, it is unnecessary to repeat the information there given. The total amount of refuse collected for the year ended 31st March, 1925, it may be mentioned, was 41,908 tons, as compared with 40,174 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 506 premises. During the year the inspectors made 4,588 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, 82 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 bye-laws relating to removal of offensive refuse, as to hours of removal, provision of proper receptacles, etc., 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. 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. 11 In the staff of health visitors and sanitary inspectors two changes were rendered necessary by reason of the resignation of two of the members : Miss A. M. Baker, who was appointed in July, 1921, and resigned on her marriage; and Inspector D. J. Andrews, who, though he had not quite attained the age of 65, the retiring age under the Superannuation Act, felt compelled for health reasons to tender his resignation. Mr. Andrews was first appointed to the staff of inspectors, under the Vestry, in 1886, and had thus been engaged in this work for a period of 38 years. During all that time he had given most faithful and useful service, and his resignation was received with sincere regret. In his place the Council appointed Mr. T. W. Forbes, formerly a sanitary inspector at West Ham and Kensington. To fill the vacancy created by the resignation of Miss A. M. Baker, the staff of health visitors was completed by the appointment of Miss E. D. Mann, who has had wide experience of the work in Hackney, Paddington and elsewhere. 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. The only alteration in this part of the Committee's staff was one unfortunately rendered necessary by the death of the mortuary keeper (Mr. J. W. Spears), who had been attached to the department since July, 1913. Mr. Spears, who volunteered for active service in the early days of the War, unfortunately contracted tuberculosis during that service, eventually succumbing to the infection in July, 1924. During his absence on service, and as a result of his illness, the duties of his post had been carried on most satisfactorily by his wife, and when the question of filling the vacancy arose the Committee had no hesitation in recommending the Council to give the appointment to Mrs. Spears. The appointment was made in November, and she continues to carry out the work in as satisfactory a manner as heretofore. 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 3,804, as against 3,600 in 1923. 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, 199 statutory notices were issued, as against 261 in 1923. Of these notices, 134 related to ordinary nuisances (dirt, dampness, etc.), 28 to verminous rooms, 7 to drains, 2 to insufficient w.c. accommodation, 6 to water supply in tenement houses, and 22 to insufficient dust bins. The 28 notices respecting verminous rooms were served under powers contained in the London County Council (General Powers) Act, 1922, and referred to 59 rooms. In 3,605 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," 12 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 3,832 2,938 3,767 1,582 3,555 3,498 19,172 Houses damp, dirty or dilapidated remedied 305 394 377 196 230 109 1,601 Doors, windows, floors, ceilings sash cords, etc., repaired 393 465 111 294 140 73 1,476 Overcrowding abated — 1 2 — — — 3 Illegal occupation of underground rooms dealt with - - - 1 3 - 4 Water closet defects remedied 260 214 282 150 212 109 1,227 Water closets erected — - 1 — 7 20 28 Urinal defects remedied 1 1 1 — 2 1 6 Soilpipe and ventilating shaft repaired or renewed 1 2 6 - 4 1 14 Yard defects remedied 199 256 196 119 122 42 934 Waste pipe defects remedied 31 14 38 4 20 18 125 Water cistern defects remedied 45 42 15 9 33 10 154 Rubbish, manure, etc., accumulations removed 17 8 58 5 34 17 139 Dung or dust receptacles repaired or renewed 130 39 122 39 36 11 377 Drains relaid or amended 35 27 62 23 43 16 206 Drains cleared 23 34 22 1 25 1 106 Rainwater pipes repaired or renewed 44 31 23 15 18 8 139 Water supply to houses reinstated 5 - 1 - - 1 7 Roofs and gutters repaired 227 181 114 64 52 30 668 Area defects remedied 15 3 103 16 77 27 241 Wash-house defects remedied 248 129 158 188 91 45 859 Animal nuisances abated 8 1 11 3 2 — 25 Basement defects remedied 3 1 16 3 50 - 73 Stables cleansed or repaired - — — — 1 - 1 Water supply laid on to upper storeys of house 7 - 9 5 5 1 27 Miscellaneous nuisance abated 548 310 149 122 87 85 1,251 Verminous rooms cleaned 79 214 252 83 65 57 750 Workshops dirty, overcrowded, unventilated or defective, remedied 5 7 15 — 41 35 103 13 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 Health (London) Act, 1891, is the only enactment mentioned in the list. Premises. Offence. Proceedings taken under the Public Health (London) Act, 1891, &c. Result. 22, Abercorn Place Failure to comply with a statutory notice to execute certain sanitary requirements. Abatement order for work to be executed within 14 days. Fine £8 0s. 0d. and £33s. 0d. costs Flat 11, 29-30, Saville Street Do. Order made to abate nuisance. £2 0s. 0d. Fine and £4 4s. 0d. costs 81, Carlisle Street Do. £5 penalty and a continuing penalty of 5/- per day for 206 days—£55 15s. 0d. penalty and £10 10s. 0d. costs 13, Blenheim Terrace Do. Order made to abate nuisance within 14 days. £3 3s. 0d. costs 1, Barrow Hill Road Do. Order made to abate nuisance within 14 days. £1 1s. 0d. costs 8, 9, 10, 11 and 12, Manning Place Do. Case dismissed with £10 10s. costs against the Council Rat Repression. The number of complaints received during the year, viz., 85, was higher by 25 than the 1923 figure. The investigation of these complaints necessitated the inspection of 91 premises, 22 of which were used for business purposes (11 of these for the preparation or storage of food), the remaining 52 being private or tenement houses. In 9 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 3rd to the 8th November, 1924, 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 arid 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. 14 Number of places On register at end of 1923 Added in 1924 Removed in 1924 On register at end of 1924 Number of inspections 1924 Numbei of notice: 1924 Number of prosecutions. 1924 A. Business Premises Milk premises 139 15 11 143 356 7 — Cowsheds 2 — — 2 26 — — Slaughterhouses 3 — — 3 151 — — Offensive trade premises 2 — — 2 53 — — Ice cream premises 129 4 12 120 215 16 — Butter and Margarine Manufacturers and Dealers 15 1 — 16 35 — — Bakehouses 68 — 1 67 156 10 — Fried Fish Shops 24 1 1 24 86 5 — Fish Curers 5 — — 5 76 — — B. Habitations Houses let in lodgings 1,115 — — 1,115 11,798 2,000 — Common lodging houses 5 — — 5 — — — Underground rooms Underground sleeping rooms not re-gistered - - - - - - A.—BUSINESS PREMISES. Milk Premises.—The number of premises upon which milk is sold is 143. This is 4 more than in 1923, 15 having- been added and 11 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 1923 the number of cows licensed to be kept in the borough was 25, though, in fact, only 10 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. 15 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. Humane killers, in accordance with the requirements of the L.C.C. by-laws, are being used in every case, and apparently with complete success. 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 53 visits, but no cause for complaint was found. Ice Cream Premises.—The number of such premises in the borough on the Register is 120. Regular inspections were made throughout 1924, and in 16 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 13 dealers in margarine, 1 wholesale dealer in butter and milk-blended butter, and butter manufacturers. All the registered premises were frequently visited. Bakehouses.—At the end of 1924 the number of bakehouses on the register was 67, 1 underground bakehouse having been removed. Of the 67, 61 are underground bakehouses. In all, 156 visits were paid and 10 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 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. 16 The total number of visits to factories, workshops and workplaces during the year was 3,253; 528 by the women and 2,725 by the men inspectors. The complaints received numbered 33. The following report which the Medical Officer of Health is required to make to the Secretary of State for the Home Department in accordance with the provisions of Section 132 of the Factory and Workshop Act, 1901, gives, in addition to other information, the total number of defects found and of notices served. 1 — INSPECTION. Premises Number of Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories (Including Factory Laundries) 182 26 - Workshops (Including Workshop Laundries) 1620 124 - Workplaces (Other than Outworkers' Premises included in Part 3 of this Report) 1451 105 - Total 3253 255 - 2.—DEFECTS FOUND. Particulars Number of Defects Number of Prosecutions Found Remedied Referrec to H.M Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts— Want of cleanliness 89 89 — - Want of ventilation 17 17 — — Overcrowding 7 7 — — Want of drainage of floors — — — — Other nuisances 86 86 — — Sanitary accom moda tion insufficient 3 3 — — unsuitable or defective 52 52 - - not separate for sexes 27 27 — — 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) 10 10 - - Other offences (Excluding offences relating to outwork which are included in Part 8 of this Report) - - - - Total 291 291 — — 17 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. 64 180 1179 ... ... ... 40 ... ... ... ... ... ... ... ... Total 64 180 1179 ... ... ... 40 ... ... ... ... ... ... ... ... 18 4—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year (1) Number (2) Dressmaking, Millinery, Laundry, Cabinet Making, &c. 3,310 Coffee Shops, &c. 240 Bakehouses 67 Total number of workshops on Register 3,617 5.—OTHER MATTERS. Class (1) Number (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 55 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s 5.) Notified by H.M. Inspector 32 Reports (of action taken) sent to H.M.Inspecto 32 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 61 19 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 number of houses listed for registration. All houses on the Council's site in Capland Street were demolished preparatory to the commencement of the housing scheme; the actual number remaining on the list at the end of 1923 was 1,115, most being houses which were registered prior to the War and before rents had attained the present high figure. • In all, 11,798 visits were paid to houses let in lodgings without regard to the rentals, and 2,000 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 "Portinan House" (late Shaftesbury Institute), Harrow and Union Street, Lisson Grove Ellen Homewood 102 women 654 men 109 women Total 763 A number of visits were paid to all the houses from time to time by officers of the department and the attention of the person in charge or the London County Council directed to any matter calling for remedy. Underground Rooms.—As close supervision as possible was kept over rooms of this class, and whenever possible notices to discontinue occupation were served. The total number dealt with in this way was 4. 20 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 1924 there were 240, this number including : Restaurant, dining room and coffee shop kitchens, 176; tea-rooms and pastry-cooks, 44; hotel kitchens, 20; fried fish shops, 24; and fish-curers, 5. In addition, there were a number of shops in which meat, ham, sausages, etc., 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, etc., each week was continued by the Food Inspector, and any matters discovered dealt with at once. In 1924 the total number of inspections was 1,256, the number of notices served being 31. Food Stalls.—Of these there are considerable numbers in the market streets, particularly Great Titchfield Street, Bell Street, Church Street, Blandford Street, etc. Definite arrangements are made for the keeping of such as are used for the sale of food under close observation. Throughout 1924 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 313. On examination by the Public Analyst 8 (2.2 per cent.) were found to be adulterated. In 1923 the percentage was 2.1. 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 four cases and fines and costs amounting to £41 and £9 9s. respectively imposed. A considerable number of samples were taken on Saturday nights and Sunday mornings, and in all 85 were obtained on delivery at Marylebone Station of the London & North Eastern Railway. Of the 85, five proved to be adulterated, and proceedings were instituted in three cases and fines and costs amounting to £41 and £7 7s. respectively imposed. 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 68 1 1.4 1 £ s. d. Warranty defence. 2nd 60 2 3.3 1 45 5 0 3rd 78 2 2.5 1 2 2 0 4th 107 3 2.8 1 3 2 0 Total for year 313 8 2.5 4 50 9 0 21 Bacteriological Examination oj Milk.—With a view to testing the purity of milk from the bacteriological point of view, 16 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. In addition to these samples, 35 of certified milk were taken and submitted to Dr. Foulerton for examination. The reports were, in accordance with the usual arrangement, forwarded to the Ministry of Health. Dairies, Cowsheds anct 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 no case was it necessary to take action. 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, 1924. 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 preset ative found in each sample. Milk 313 Nil. Cream 28 13 (17.4, 9.68, 6.5, 9.65,5.28,6.0, 9.5,5.48,6.75, 9.5,6.4,6.7, and 4.6 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 13 (ii.) Statements incorrect Nil Total 13 (iii.) Percentage of preservative found in each sample Average 7.95 grains Boric Acid per lb. Lowest 4.6 grains. Highest 17.4 grains. Percentage stated on statutory label. Not exceeding 0.4%. 22 (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent. 13 (ii.) Below 35 per cent. Nil Total 13 (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, 1923.—Under this Order 23 applications were received from 9 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 17 in respect of Certified Milk and 6 for Grade " A " Tuberculin Tested Milk. In accordance with the instructions of the Ministry 35 samples were taken during the year and submitted to the Council's Bacteriologist, Dr. A. J. R. Foulerton. Copies of the reports were duly forwarded to the Ministry. Milk (Mothers and Children) Orders.—During 1924 exactly the same line was followed as in former years. The amount expended in the year ended 31st March, 1925, was £304 19s. 9d., as against £305 12s. 4d. up to 31st March, 1924. The actual number of cases dealt with was 199, and the number of orders issued 920. 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 one instance only was it necessary to make use of the powers in the Public Health (London) Act, 1891, as to seizure and condemnation of food. The article in this case was fish, and the seizure was made at a stall in Church Street, Edgware Road. The proceedings that followed resulted in the imposition of a fine of £9, the defendant being further ordered to pay costs amounting to £10 10s. 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 set out below. Unsound and Diseased Food Condemned and Destroyed During the Year 1924. Meat— Beef 64 lbs. Mutton 62 lbs. Rabbits 11 Pork (Tuberculous) 1 carcase and 4 heads Poultry 150 turkeys 23 Fish— Wet—Coal Fish 2 boxes Plaice 2 boxes Skate 3 boxes Roe 4 boxes Sprats 2 barrels Crabs 1 barrel Herrings 6 stone Dry—Kippers 5 boxes Fruit— Tomatoes 10 boxes Apples 2 barrels Strawberries 10 baskets Pears 4 baskets Grapes 3 boxes Vegetables— Carrots 50 tons Miscellaneous— Cream 150 tins C.—SALE OF FOOD AND DRUGS ACTS. The total number of samples taken under these Acts was 1,106. Of this number 16 were reported by the analyst as being below standard or not of the nature, substance and quality demanded by the purchaser. This gives a percentage of adulteration of 1.4 per cent., which is lower than the figure for 1923, when the percentage was 2.0. The method adopted in connection with the taking of samples was similar to that followed in previous years and described in former reports. The majority were " formal " samples, and in carrying out the sampling the inspector was almost invariably assisted by an agent. The bulk of the samples taken were of milk and dairy produce. Reference has already been made to the cases (4) in which prosecutions were instituted. In addition to these there were 3 prosecutions in respect of selling margarine as butter. Fines amounting to £19, and costs £9 10s., 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: 24 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. FIRST QUARTER ENDING 31st MARCH, 1924. 67 milk Food Inspector, St. Marylebone Borough Council Genuine. 12/6 per sample. 2 were test samples. No sample was found to contain either preservative or colouring matter. 1 milk Do. Adulterated. Warranty defence. Case dismissed. No. 254 10.0% deficient in milk fat. 62 butter Do. Genuine. 32 were test samples. Of the 62 samples examined, two only were found to be free from preservative. Boric acid was the preservative used in every instance and this ranged in amount from 10.2 to 26.8 grains per lb. 19 condensed milk Do. Do. All were test samples. 1 evaporated milk Do. Do. This was a test sample 1 milk powder Do. Do. Do. 3 cream Do. Do. All were test samples. No. Fat. Preservative. 212 38.7% 17.4 grains of boric acid per lb. 215 31.9% No preservative found. 217 30.6% Do. 5 cbeese Do. Genuine. Do. 9 roll and butter Do. Do. Do. 11 sugar Do. Do. 9 were test samples. 1 sugar Do. Adulterated. This was a test sample. No. Nature of adulteration. 27 1.1 grains of tin per lb. 2 preserving sugar Do. Genuine. All were test samples. 14 margarine Do. Do. 21 coffee Do. Do. 9 jam Do. Do. 21 cocoa Do. Do. 9 mustard Do. Do. 7 tinned peas Do. Do. 6 were test samples. 5 arrowroot Do. Do. All were test samples. 1 coffee essence Do. Do. 3 chicory & coffee essence Do. Do. 5 sausages Do. Do. 3 rice Do. Do. 2 marmalade Do Do. 1 fruit drops Do. Do. 2 lard Do. Do. 1 oxo Do. Do. 2 lemonade powders Do. Do. 1 red currant jelly Do. Do. 25 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by au Ofticer acting under direction ot a Local Authority, under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 1 cod liver oil Food Inspector, St. Marylebone Borough Council Genuine. All were test samples. 4 lime water Do. Do. 1 glycerine and borax Do. Do. olive oil Do. Do. 2 boric ointment Do. Do. 1 zinc ointment Do. Do. Total number ot Samples analysed during the Quarter 300 Number of Samples adulterated 2 SECOND QUARTER ENDING 30TH JUNE, 1924. 58 milk Food Inspector, St. Marylebone Borough Conucil Genuine. 12/6 per sample. Of the 60 samples examined none was found to contain preservative or colouring matter. 2 milk Do. Adulterated. Fine £40 0s. 0d. and £5 5s. 0d. costs. Both these were station samples from one farmer. No. 421 contains 10.59% added water. No. 422 contains 14.59% added water, and is deficient in milk fat to the extent of 6.7%. 13 cream Do. Genuine. 4 were test samples. No. Fat. Preservatives. 360 Presd. 57.2 9.68 grains per lb. boric acid. 394 Do. 49.0 6.5 do. 410 Do. 49.7 9.65 do. 415 Do. 51.9 5.28 do. 460 Do. 52.84 6.0 do. 483 Do. 45.0 9.6 do. 498 finned 23.1 Nil. Metals Nil. 502 Do. 26.18 Nil. Metals Nil. 514 Do. 27.9 Nil. Metals Nil. 536 49.75 No Preservative found. 538 37.0 do. 540 45.6 do. 542 Presd. 50.0 5.48 grains per lb. boric acid 57 butter Do. Genuine. 41 were test samples. One sample contained no preservative, 56 samples contained boric acid ranging in amount from 10.2 to 26.5 grains per lb. 1 butter Do. Adulterated. Fine £6 0s. 0d. and £2 2s. 0d. costs. No. 438. The sample is not butter but margarine. 1 roll and butter Do. Genuine. All were test samples. 10 margarine Do. Do. 3 dried milk Do. Do. 3 lard Do. Do. 26 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and, if so. the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 19 condensed milk Food Inspector, St. Marylebone Borough Council Genuine. All were test samples. 6 cheese Do. Do. 2 sausages Do. Do. 3 tea Do. Do. 5 preserving sugar Do. Do. 21 coffee Do. . Do. 3 cocoa Do. Do. 3 olive oil Do. Do. 10 jam Do. Do. 2 soda water Do. Do. 1 pickles Do. Do. 6 mustard Do. Do 2 liquorice powd'r Do. Do. 2 flowers of sulphur Do. Do. 3 lemonade powd'r Do. Do. 3 sulphur ointment Do. Do. 2 boracic ointment Do. Do. 2 zinc ointment Do. Do. 1 beer Private Sample Adulterated. This sample is contaminated either with phenol alone or with something containing phenol, e.g., a disinfectant. The amount, however, is extremely minute and the source of contamination probably the stopper. No trace of arsenic was present. Total Number of Samples analysed during the Quarter 244 Number of Samples adulterated 4 THIRD QUARTER ENDING 30th SEPTEMBER, 76 milk Food Inspector, St. Marylebone Borough Council Genuine. 12/6 per sample. 11 were test samples. No sample was fouud to contain either preservative or added colouring matter. 2 milk Do. Adulterated. No. 701 contains 10.6% added water. Proceedings not instituted on advice of Solicitor— 3rd sample broken in transit. 44 butter Do. No. 803 10% deficient in milk fat. Genuine. Costs £2 2s 0d. All were test samples. 2 contained no preservative, 43 contained boric acid in amounts which ranged from 9.6—27.0 grains boric acid per lb. 27 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated, and if Adultereted, what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 1 butter Food Inspector, St. Marylebone Borough Council Adulterated. This was a test sample. No. 799 consisted of Margarine. All were test samples. 16 condensed milk Do. Genuine. 2 were test samples. 5 cream Do. Genuine. No. Fat. Preservatives. Remarks. 552 29.7%. Nil. Tinned Cream. 559 52.36% Nil. — 561 50.82% Nil. — 563 50.82% Nil. — 740 27.1%. Nil. Tinned Cream. 6 margarine Do. Genuine. A11 were test samples. 10 jam Do. Do. 3 preserving sugar Do. Do. 15 coffee Do. Do. 7 cocoa Do. 1)0. 5 Demarara sugar Do. Do. 11 lard Do. Do. 4 marmalade Do. Do. 2 lemonade powd'r Do. Do. 19 cheese Do. Do. 8 pepper Do. Do. 7 mustard Do. Do. 1 mustard mixture Do. Do. 3 granulat'd sugar Do. Do. 3 tea Do. Do. 2 olive oil Do. Do. 6 zinc oitment Do. Do. 3 boracic ointment Do. Do Total number of Samples analysed during the Quarter 259 Number of Samples adulterated 3 FOURTH QUARTER ENDING 31ST DECEMBER, 1924. 104 milk Food Inspector, St. Marylebone Borough Council Genuine. 12/6 per sample 13 were test samples. All the samples were free from artificial colouring materials and contained no preservatives. 3 milk Do. Adulterated. No. 971. 40% deficient in milk fat. This was a test sample. No. 982. 9.4% added water. Fined £1 1s. 0d. Costs £2 2s. 0d. No. 999. 8.3% deficient in milk fat. Vendor cautioned vide Public Health Committee Minutes 5/12/24. 10 condensed milk Do. Genuine. 7 cream Do. Do. All were teBt samples. No. Fat. Preservatives. Remarks. 4 were test samples. 916 50.7% 67.5 grains boric acid per lb. Preserved. 963 57.0% Nil. 965 54.0% Nil. 1012 46.62% 9.5 grains boric acid per lb. Do. 1019 48.2% 6.4 Do. Do. 1058 50.75% 6.7 Do. Do. 1060 48.6% 4.6 Do. Do. 28 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 ot the Adulteration. The sum paid in respect of the Analysis. Observations. 47 butter Food Inspector, St. Marylebone Borough Council Genuine. 43 were test samples. Of the 50 samples of butter examined only one was entirely free from preservative; all the others contained boric acid in amounts which range from 7.2 to 26.4 grains per lb. 3 butter Do. Adulterated. No. 840 not butter but margarine. Fined £8 0s. 0d. Costs £3 5s. 0d. No. 870 Do. This was a test sample. No. 1008 Do. Fined £5 0s. 0d. Costs £4 3s. 0d. 4 icing sugar Do. Genuine. 3 were test samples, 12 margarine Do. Do. All were test samples 24 cheese Do. Do. 5 lard Do. Do. 1 Atora suet Do. Do. 1 tea Do. Do. 20 coffee Do. Do. 3 cocoa Do. Do. 1 granulated sugar Do. Do. 1 honey Do. Do. 2 golden syrup Do. Do. 2 jam Do. Do. 1 bramble jelly Do. Do. 1 marmalade Do. Do. 5 mustaad Do. Do. 5 pepper Do. Do. 2 arrowroot Do. Do. 6 sponge cake Do. Do. 1 ginger wine Do. Do. 1 raisin wine Do. Do. 1 orange wine Do. Do. 2 milk of sulphur Do. Do. 6 sulphur ointment Do, Do. 5 boric acid powd'r Do. Do. 3 borax Do. Do. 2 compound liquorice powder Do. Do. 5 whisky Do. Do. 1 whisky Do. Adulterated. No. Nature of Adulteration. 909 36.59% under proof instead of 35% 2 boric ointment Do. Genuine. Total number of Samples analysed during the Quarter 303 Number of Samples adulterated 7 29 ANNUAL REPORT OF THE PUBLIC ANALYST, 1923. The number of samples taken under the Sale of Food and Drugs Acts and submitted for analysis, was 1,106; an increase as compared with the samples for 1923, the number for that year being 1,060. A complete list is as follows: No. Article Genuine Adulterated Total 1 Arrowroot 7 - 7 2 Atora Suet 1 - 1 3 Beer — 1 1 4 Borax 3 - 3 5 Boric Acid Powder 5 - 5 6 Boric Ointment 10 - 10 7 Bramble Jelly 1 - 1 8 Butter 210 5 215 9 Cheese 54 — 54 10 Chicory and Coffee Essence 3 — 3 11 Cocoa 37 — 37 12 Cod Liver Oil 1 — 1 18 Coffee 77 - 77 14 Coffee Essence 1 - 1 15 Condensed Milk 64 — 64 16 Cream 28 — 28 17 Demerara Sugar 5 — 5 18 Dried Milk 3 — 3 19 Evaporated Milk 1 — 1 20 Fruit Drops 1 — 1 21 Flowers of Sulphur 2 — 2 22 Ginger Wine 1 — 1 28 Glycerine and Borax 1 — 1 24 Golden Syrup 2 — 2 25 Granulated Sugar 4 — 4 26 Honey 1 — 1 27 Icing Sugar 4 — 4 28 Jam 31 — 31 29 Lard 21 — 21 30 Lemonade Powders 7 — 7 31 Lime Water 4 — 4 32 Liquorice Powder 4 — 4 33 Margarine 42 — 42 34 Marmalade 7 — 7 35 Milk 305 8 313 36 Milk Powder 1 — 1 37 Milk of Sulphur 2 — 2 38 Mustard 27 — 27 39 Mustard Mixture 1 — 1 40 Olive Oil 7 — 7 41 Orange Wine 1 — 1 42 Oxo 1 — 1 43 Pepper 13 — 13 44 Pickles 1 — 1 45 Preserving Sugar 10 — 10 46 Raisin Wine 1 — 1 47 Red Currant Jelly 1 — 1 48 Rice 3 — 3 49 Roll and Butter 10 — 10 50 Sausages 7 — 7 51 Soda Water 2 — 2 52 Sponge Cake 6 - 6 53 Sugar 11 1 12 54 Sulphur Ointment 9 — 9 55 Tea 7 — 7 56 Tinned Peas 7 — 7 57 Whiskey 5 1 6 58 Zinc Ointment 9 — 9 1,090 16 1,106 30 Milk.—313 samples of milk were examined during the year, and of these 8 were found to be adulterated. This represents a percentage of 2.56%, as compared with 2.18% for 1923, and with 3.36% for 1922. The worst example of adulteration during 1924 was one having a deficiency of 40% of milk fat. During 1923 the worst was 13.3% deficient in fat, but 1922 provided one instance of a 43.3% deficiency in fat combined with 15.5% of added water. Taking all these points into consideration, it is seen that the figure for the number of samples adulterated has increased slightly as compared with 1923, and that for 1923 the average deficiency of fat in the adulterated samples was 8.66%, as compared with 14% for 1924. Again, omitting the adulterated samples, the mean composition of the remaining samples taken during 1924 shows that practically no change in average quality has taken place, the figures for the respective years being : Sp. Gr Total Solids. Fat. Solids (not fat). 1924 1031 33 12.42 3.70 8.72 1923 1031 12.36 3.71 8.65 Butter.—5 samples of butter were found to consist of margarine. This number, out of a total of 215 examined, represents a percentage of 2.33 adulterated. Margarine.—42 samples were examined, and none were found to be adulterated. Cream.—28 samples were taken. These were all genuine, and only contained preservative when such fact was mentioned on the label. In every instance the preservative found was of the nature stated on the label and of less amount than that allowed legally. Sugar.—Of the 12 samples of ordinary sugar examined one contained 1.1 grains of tin per lb. The Ministry of Health investigated the case and confirmed the presence of tin, their particular sample yielding 1.0 grain of tin per lb. Tin salts were used previously in the manufacture of sugar, but the practice was believed to be obsolete, as the manufacturers had undertaken to cease using such an undesirable substance. This instance of the presence of tin is disquieting, indicating as it does that the metal is still finding its way into a substance of universal consumption, used largely by old and young alike. Beer.—One sample was examined and found to be contaminated by a small quantity of phenol (carbolic acid). Preserving Sugar.—Many of the 10 samples taken were somewhat dirty, and contained fibres and particles of wood. Whisky.—Of the six samples examined one was 36.59% underproof. This represents a sample containing 97.7 parts of whisky of 35 degrees underproof and 2.3 parts of water, a state so near the border line of the legal standard that evaporation of spirit may possibly account for the deficiency. Tinned Peas.—Several of the seven samples taken contained small quantities of copper, but in each instance the amount was less than the quantity notified on the label. Tin was not found in any one of the samples examined, but one sample contained well marked traces of lead, the amount being 0.002%. Orange Wine.—The one sample of orange wine taken was found to contain 1.7% of alcohol. 31 STATISTICAL. BIRTHS. Registration.—The number of births registered during 1924 was 1,531,* being 137 less than in 1923. Of the children born, 799 were boys and 732 girls. The birth rate per 1,000 of the population was 14.5, as against 15.8 in 1923. The rates in the several registration sub-districts and the borough were All Souls, 11.1; St. Mary, 12.4; Christ Church, 19.1; St. John, 14.0. Notifications.—The total number of notifications received during the year under the Notification of Births Act, 1907, was 3.590; Live births, 3,422; Still births, 168. Failures to notify within 36 hours of birth, as required, were comparatively few. In such cases as there was failure, a perfectly reasonable explanation was forthcoming, and it was not considered necessary to take proceedings against any of the parties. The main sources of the notifications are set out below. The figures, it may be noted, refer to notifications and not to births. In some cases duplicate notifications, from different sources, were received with regard to the same birth. No. Per cent. From parents 58 1.6 ,, doctors 257 7.1 ,, midwives 655 18.2 ,, other persons 168 4.7 ,, hospitals, etc. 2452 68.4 3,590 Of the total births notified, 168 referred to still-births (85 males and 83 females) : 1,871 took place at Queen Charlotte's Hospital, 400 at Middlesex Hospital; 79 at St. Marylebone Home; and 1,138 were born at home. Of those notified as having occurred in St. Marylebone, 1,888 belonged to other Boroughs. DEATHS AND DEATH RATES. The number of deaths registered in 1924 was 1,436. 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-ratef per thousand for the year was 13.6. In the previous year, the rate was 11.7, and the number of deaths 1,235. *This figure is exclusive of births occurring in the Borough to persons usually non-resident therein, but includes 218 births which occurred outside the district, and which have been transferred as belonging to St. Marylebone :— Legitimate Males 82 „ Females 84 Illegitimate Males 27 ,, Females 25 †A definition of the term "corrected death-rate " will be found on page 9 of the Report for 1912. 32 The following short table shows the death rates in the several registration sub-districts in 1924, and compares them with those of the preceding 5 years:— 1919. 1920. 1921. 1922. 1923. 1924. All Souls 12.9 9.9 10.2 11.3 8.9 9.7 St. Mary 15.3 13.2 12.0 15.4 12.3 15.6 Christ Church 18.5 14.2 14.0 14.0 12.5 14.4 St. John 17.0 13.6 16.0 14.3 13.0 14.6 The Borough 15.9 12.7 12.8 13.7 11.7 13.6 District births and deaths for the year ended 31st December, 1924, are given in the following table. A further table giving the vital statistics of separate localities for 1924 and the ten preceding years will be found amongst the Ministry of Health Tables on page 67. Sub-District Population estimated to middle of 1924 Males Births. Females Total Males Deaths. Females Total All Souls 25,233 139 141 280 119 126 245 St. Mary 26,967 174 162 336 193 229 422 Christ Church 32,775 329 300 629 255 219 474 St. John 20,325 157 129 286 132 165 297 The Borough 105,300 799 732 1,531 699 739 1,438 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 1924. It will be seen that the heaviest incidence in both old and young falls in the first and last quarter. 1924. JanuaryMarch AprilJune JulySeptember OctoberDecember Total Infants under 1 year 36 26 25 36 123 Persons of 65 years and upwards 198 112 95 154 549 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 70. This same table gives the number of deaths from various specified causes which occurred in institutions, in hospitals, nursing homes, etc. In each of the groups all deaths, whether of residents or non-residents, are included, which accounts for the fact that the total comes up to 1,071. 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. 33 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 1924 was 123, and the number of births in that year 1,531. The infantile mortality rate is therefore 78, which is somewhat above that for 1923 (66 per 1,000). The course which the rate has taken is graphically shown in the chart on page 35, which indicates clearly that in spite of occasional variations 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 1) will be found on page 34^ 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 1924, as in other years, the greatest number of deaths occurred in the early weeks of life. Of the babies, 47 were less than one month old when they died, and 69 less than three months. The figures for 1923 were 50 and 72. 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, the same as the figure for the year 1923. Diarrhoea and enteritis (7 and 8) accounted for 13 in 1923, and for 18 in 1924. Respiratory diseases, the third of the main causes, took 19 in 1923, and in 1924 31. The commoner infectious diseases together led to 7 deaths among infants, the particular disease being in each case measles. Two deaths were stated to be due to overlaying, 4 to tuberculosis, 2 to convulsions, and 2 to meningitis. 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 55 deaths amongst infants. In 1923 the figure was 52. 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 3 1 2 1 3 7 2 3 22 St. Mary 10 1 — — 7 5 2 5 30 Christ Church 15 2 2 2 6 11 11 6 55 St. John 5 — 2 1 4 1 3 — 16 Totals 33 4 6 4 20 24 18 14 123 The births are the net numbers registered in the calendar year. The rate per 1,000 births is based on deaths in the 53 weeks, and has therefore been adjusted for that period. 34 TABLE I. Infant Mortality. Nett Deaths from Stated Causes at various ages under 1 Year of age, 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 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-Fox - - - - - - - - - - - - - - - 2 Chicken-Pox - — - - — - — - — — — — - - - 3. Measles - — - - — - 2 3 2 7 1 1 4 1 7 4 Scarlet Fever - — - - — - — — — — - — - - - 5 Diphtheria and Croup - - - - - - - - - - - - - - - 6 Whooping Cough - — - - — - — — 1 1 1 — — - 1 7 Diarrhœa - - - - - - - 1 — 1 — — 1 - 1 8 Enteritis - - 1 1 2 6 4 3 2 17 2 7 6 2 17 9 Tuberculous Meningitis - - - - - - 1 — 2 3 2 — 1 - 3 10 Abdominal Tuberculosis - - - - - - - - - - - - - - - 11 Other Tuberculous Diseases - - - - - - - 1 - 1 - - 1 - 1 12 Congenital Malformation 4 1 - - 5 2 - - - 7 1 2 4 - 7 13 Premature Birth 20 1 - - 21 1 1 — — 23 2 8 9 4 23 14 Atrophy, Debility and Marasmus 2 - 2 - 4 1 6 2 - 13 1 3 7 2 13 15 Atelectasis 1 — - - 1 — — — — 1 — — 1 - 1 16 Injury at Birth - — - - — — — — — — — — - - - 17 Erysipelas — — — - — — — — — — - — — - - 18 Syphilis — — - - — — — — — — — — — — - 19 Rickets — — - - — — — — — — — — - - - 20 Meningitis (not Tuberculous) - - - - - 1 1 - - 2 - 1 1 - 2 21 Convulsions — — — - — 1 — 1 — 2 2 - - - 2 22 Gastritis — — — - - — — — — — — - - - - 23 Laryngitis — — — - — — — — — — — — — - - 24 Bronchitis — — 1 1 2 2 4 — — 8 2 1 4 1 8 25 Pneumonia (all forms) 1 1 1 - 3 6 2 7 5 23 4 2 14 3 23 26 Suffocation, Overlying 1 — — - 1 — — - 1 2 — 2 1 - 2 27 Other Causes 4 1 1 2 8 — 8 — 1 12 4 3 1 3 12 Totals 33 4 6 4 47 20 24 18 14 123 22 30 55 16 123 Legitimate, 1,309 Nett Births in tho Year Illegitimate, 162 Total 1,531 Legitimate Infants, 102 Nett Deaths in the Year Illegitimate Infants, 21 Total 123 35 36 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 70. This Table also shows the distribution of deaths according to cause in the various registration sub-districts. I he following notes with regard to certain of the causes which contributed most largely to the death rate may be of interest. DIARRHŒAL DISEASES. The total number of deaths registered as due to diarrhcea and enteritis (inflammation of the bowels), was 21, equal to 0.19 per 1,000 of the population. As a general rule, the majority of deaths from this cause occur among infants, and in 1924, as a matter of fact, all those who died, with the exception of 3, were less than 1 year of age. In 1923 the deaths from diarrhceal diseases numbered 15, all the victims being under one year of age with the exception of 2. In 1924, therefore, there was an increase in the total, 18 being under 1 year of age. In the report for the previous year reference was made to the remarkable decline that has taken place in the number of deaths from this condition, and though there is a slight rise in the figures for the present year, there is no reason for regarding it as anything more than accidental. Whether the improvement is due to improved sanitation or to a combination of this with other causes, improvement in the milk supply for example, it need not be doubted but that these will continue to operate, and that the present rise will not prove to be anything more than merely temporary. 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 diseases under the heading " Prevalence of and Control over Infectious Diseases." Excluding influenza (which caused 40 deaths), the diseases contributing to the total of 80 deaths were— diphtheria, 3; scarlet fever, 2; whooping cough, 3; enteric fever, 2; measles, 46; erysipelas, 3; and, as already noted, diarrhcea, 21. 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 121, which is higher by 6 than the figure 115 for 1923. The great bulk of the 121 deaths, viz., 98, was due to phthisis. Of the total number of deaths registered (1,436), the percentage due to phthisis was 6.1, as against 7.7 in 1923. The age periods at which the deaths occurred were: 5—15, 2 (2.0 per cent.); 15—25, 21 (21.4 per cent.); 25—45, 29 (29.6 per cent.); 45—65, 38 (38.8 per cent.); 65 and over, 8 (8.2 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. 37 TABLE VIII. Deaths from Phthisis and other Tuberculous Diseases. Year No. of Deaths Population Rate per 1,000 of Population 1916 186 98,573 1.88 1917 169 92,796 1.82 1918 190 98,526 1.93 1919 116 97,953 1.18 1920 122 101,856 1.19 1921 117 105,200 1.11 1922 127 105,200 1.20 1923 115 105,400 1.09 1924 121 105,300 1.14 RESPIRATORY DISEASES. The number of deaths due to bronchitis, pneumonia, and other diseases of the organs of respiration was 366. This is higher by 83 than the figure (283) for 1923. The increase no doubt was associated directly or indirectly with the increase in the amount of influenza, which, as already noted, caused 40 deaths, as against 15 in the previous year. The death rate was 3.4 per 1,000. In 1923 the rate was 2.6. The number of deaths certified to be due to bronchitis was 184, as against 144 in 1923. Of this number 111 were amongst persons aged 65 and upwards, and 55 amongst those of the age group 45—65. The deaths traceable to pneumonia numbered 156, and as in the case of bronchitis the later-age groups contributed the greatest numbers, though 41 of the deaths occurred amongst children under 2 years of age. The number of cases of pneumonia notified was 68. Of the patients 20 were aged 1—5, 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 70. CANCER OR MALIGNANT DISEASE. The number of deaths due to cancer was 186, and the death rate 1.76 per 1,000 of the population. In 1923 the figures were lower, the total being 159 and the death rate 1.50 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 2 - 2 7 18 32 21 83 Females — 1 2 1 15 28 29 27 103 Totals 1 3 2 3 22 46 61 48 186 38 Cancer : Situation of the Disease. Parts of the body affected Males Females Totals Face, Tongue, Jaw 7 1 8 Throat, Neck, Gullet 19 1 20 Stomach 19 13 82 Intestines 18 22 40 Liver 4 8 12 Breast — 22 22 Uterus and Generative Organs — 23 23 Various 16 13 29 Totals 83 103 186 The fact that the number of deaths certified as due to cancer is showing a definite tendency to increase is common knowledge, and has been referred to more than once in these reports. No reason, generally acceptable, to account for this has as yet been put forward, nor has any theory to account for the occurrence of the disease, to which the medical profession as a whole can subscribe, been submitted. ALCOHOLISM. Two deaths were certified during the year as due to alcoholism. Year after year the number so certified has been quite small, and in 1923 there were no deaths. Cirrhosis of the liver, a condition in most cases probably resulting from abuse of alcohol, was held to be accountable for 10 deaths, double the number in the previous year. The deaths from conditions sometimes due to the irritation produced in various organs by chronic alcoholism, e.g., nephritis (inflammation of the kidneys) and Rright's disease of the kidneys, numbered 31, as against 39 for the year 1923. ACCIDENT, SUICIDE AND MANSLAUGHTER. Accidental or violent deaths during 1924 numbered 61. Of these 17 were due to suicide. Deaths of babies, certified as resulting from suffocation (overlaying) numbered 2. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. A table showing, with regard to the infections, the total number of notifications received, the age distribution and the number of cases notified from each of the four registration districts, will be found on page 69. The total number of notifications coming to hand was 703, which is higher by 89 than the figure (614) for 1923. 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 scarlet fever (185), diphtheria (122), and pneumonia (68). The notification rate (proportion to population of notified cases of infectious diseases) in 1924 was 6.6 per 1,000 as against 5.8 in 1923. Isolation of Cases.—As the following table shows, the number of cases removed was as high as usual :— Diphtheria 119 or 97.5 per cent, of the cases notified. Erysipelas 24 ,, 48.0 ,, „ ,, Scarlet Fever 171 ,, 92.4 ,, ,, ,, Enteric and Paratyphoid Fever 12 ,, 70.6 „ ,, Encephalitis Lethargica 11 ,, 61.1 ,, ,, ,, Tuberculosis 73 ,, 32.5 ,, ,, „ Pneumonia 20 ,, 29.1 „ ,, ,, 39 The cost of carrying- out the requirements of the Public Health (London) Act, 1891, and the various regulations with regard to notification was £49 14s. Od., equal to 9s. 5d. 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 £ s. d. £ s. d. 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 1924 49 14 0 0 9 5 Discharge Notices.—The number of certificates received from the Metropolitan Asylums Board regarding the return of patients sent to hospital with infectious diseases was 327, and referred to 418 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. The number of cases notified was 122, the number in 1923 being 127. Of the cases 3 died, and the case mortality rate was 2.4 per cent. The number of cases per thousand of the population was 1.1. 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 7 cases the source appeared to be a member of the family previously infected ; in 2 cases infection was counted to have been acquired in school, and in 8 cases in an institution. The number of swabs from doubtful cases submitted for bacteriological examination was 1,607. A positive result was returned in 68 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 56. In All Souls the number was 23, in St. Mary 22, and in St. John 21. As usual, the age groups 1-5 and 5-15 were those most affected, 49 of the cases falling into the former and 42 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., 24. 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 185, as against 126 in 1923. The highest number of cases reported in any one week was 9. The total deaths from scarlet fever numbered 2, and the number of deaths per cent, of the cases was 1.0, 40 The districts to suffer most from this disease were Christ Church and All Souls. In the former there were 90 cases and in the latter 37. In St. Mary there were 32 and in St. John 26. As usual, the majority of patients were children of school age, the age group, 5-15, giving 84 of the total. Of the remainder 63 were aged between 1 and 5 years, and 38 over 15 years of age. Though it seemed probable that many of the children notified acquired their infection in school, it was only in 5 instances that a definite connection could be made out. Defects in sanitation to the number of 46 were discovered in the premises visited. All these were want of cleanliness, etc. The nuisances were remedied after the service of notices in each case. Enteric and Paratyphoid Fever. The Enteric Fever notifications received numbered 7. There were 2 deaths. Of Paratyphoid Fever there were 10 cases. All the patients recovered. Cerebro-Spinal Fever. There was one case of this disease notified during the year. Encephalitis Lethargica. There were 18 cases of this disease notified, 13 prior to the middle of the year. For the reason that the disease frequently runs a slow and long course and the sequels are often of a serious and distressing nature, arrangements were made for following up and keeping the patients under observation. The following table contains information as to result in each case:— Name Age Sex Date Notified Subsequent progress, i.e., whether recovery complete or partial 1 H. T. 8 M 7th April Partial recovery. 2 J. G. 12 M 10th April Recovered. Slow progress of knee. Neuritis. 3 M. W. 21 F 9th April Recovered. 4 J. F. 43 M 14th April Partial recovery. 5 A. G. 13 M 22nd April Still suffering at home. 6 D. W. 24 F 26th April Complete recovery. 7 G. W. 7 F 30th April Periodical spells of sleepi- ness. 8 R. M. 23 M 6th May Cured 20/5/24. 9 F. M. 32 M 28th May Unable to obtain particulars. 10 S. W. 10 M 6th June In West Park Mental Hospital, Epsom. 11 J. B. 50 M 4th June Recovered. 12 D. A. 24 F 18th June Unable to obtain particulars. Non-resident. 13 E. G. 38 F 20th June Cured after 4 weeks treatment. 14 F. F. 38 F 15th July Removed from District. 15 E. W. 17 F 30th July Still in hospital. 16 K. H. 17 F 10th Sept. Recovered. 17 M. S. 41 F 30th Sept. Recovered. Slight recurrence. 18 E. B. 24 F 11th Dec. Still in hospital. 41 Polio-Myelitis. There were no cases of this disease during the year. Erysipelas. The notifications of erysipelas numbered 50, and there were 3 deaths. Puerperal Fever. The number of cases of this disease notified, viz., 10, was much above the average. Two of the patients died. A nurse was sent in to one case, and paid 30 visits. Measles and German Measles. These conditions are not now notifiable. 1,770 cases were, however, reported, 328 voluntarily by doctors and parents and 1,452 by school teachers. There were 46 deaths. The course adopted in relation to the cases was the same as in previous years. Nurses were sent in to 26 cases, and 385 visits were paid. Whooping Cough. Most of the information obtained with regard to this disease is derived from the death returns, and during 1924 the number of deaths registered as due to whooping cough was 3. In 1923 the number was 16. Glanders and Anthrax. No cases were notified. Small Pox. No cases were notified. 42 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 1924. During the year in certain of the schools, one or more classrooms were closed on account of measles. SCHOOLS Scarlet Fever Diphtheria Whooping Cough Chickenpox Measles All other Diseases All Souls, Foley Street 16 1 - - 51 1 Barrett Street — — — — — — Barrow Hill Road 4 17 11 79 183 11 Bell Street 24 15 10 19 147 25 Blandford Square — 1 — — 19 - Capland Street 20 5 — 44 39 11 Catholic, Richmond Street 1 3 — 1 13 2 Christ Church, Lisson Grove 32 6 7 8 154 27 Convent, Little Union Place — — — — — — Council School, Grove Boad - - — 1 2 — Emmanuel, Aberdeen Place - 5 — 31 — 3 Emmanuel, North Street 9 1 1 14 72 — Gateforth Street 9 9 — 1 67 10 Hnmpden Gurney, Upper Berkeley Street 11 1 4 29 15 11 Homer Row, Catholic 4 1 — 15 48 — Jewish, Hanway Street - - - - - - Portland, Little Titchfield Street - - - - - - Polytechnic, Regent Street — — — — — — 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 3 8 — 10 24 2 St. Mark's, Violet Hill 5 11 2 13 149 28 St. Mark's, Marylebone Road — — — 10 — — St. Marylebone, High Street 12 8 1 18 71 58 St. Marylebone Grammar, Marylebone Road — — — — 4 — St. Mary's, Crawford Street 16 — 3 5 153 4 St. Paul's, East Street — — — 1 — — St. Paul's, Broadley Terrace 6 9 2 19 27 4 St. Thomas', Orchard Street 1 — 1 2 20 26 St. Vincent, Wigmore Street 1 — — — — — Upper Marylebone Street 31 12 83 6 101 22 Schools out of Borough 33 20 4 29 93 11 Totals 240 133 79 355 1452 256 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 1924. The following table gives information with regard to the 7 cases notified. Notified Cases Treated Vision Unimpaired Vision Impaired Total Blindness Deaths At Home At Hospital *7 5 2 3 — — — Nurses were sent in to 3 cases and 95 visits were paid. *Four of the cases left the district and could not be traced. 43 INFLUENZA. This disease showed no epidemic tendencies during the year. The deaths certified as due to Influenza numbered 40, as against 15 in 1923. Nurses were sent in to 10 cases, and 112 visits were paid. PNEUMONIA. Figures with regard to notification will be found on page 69, 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 62 cases, and 1,123 visits were paid. TUBERCULOSIS. In all 224 notifications were received, 178 relating to pulmonary tuberculosis, the remainder (46) to cases in which structures other than the lungs were affected. The table given on page 44 contains the information required by the Ministry of Health with regard to notifications. Notifications on Form B relate to school children. The number, it will be noted, was 17, as against 9 in 1923. 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 121 2. The number of cases unnotified or notified at death 39 3. The number of cases notified within a month of death 17 4. The number of cases notified within three months of death 13 5. The number of cases notified within six months of death 4 Treatment of Tuberculosis.—Of the cases notified 182 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 94 were insured persons; of these 31 were admitted to sanatorium or hospital treatment, and 10 to St. Marylebone Hospital. Non-insured persons numbered 130, of whom 30 (20 being children) received sanatorium treatment and 4 were admitted to the St. Marylebone Hospital. Nurses were sent in to 19 cases and 306 visits were paid. 44 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1924, to the 30th December, 1924, METROPOLITAN BOROUGH OF ST. MARYLEBONE. Notifications on Form A. Notifications on Form B. Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. No, of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Primary Notifications. Under 5 5 to 10 10 to 15 Total Primary Notifi. cations. Pulmonary Males — — 2 2 6 8 14 13 18 14 7 84 100 — 5 2 7 9 39 70 „ Females — 1 1 14 8 10 22 10 10 3 3 82 96 — — 1 1 3 17 31 Non-Pulmonary Males — 5 4 3 3 1 1 1 1 1 1 21 22 2 4 6 6 - 7 „ Females ~ 1 1 4 - - 2 2 1 1 - 12 12 1 1 1 3 3 - 5 Totals — 7 8 28 17 19 39 26 30 19 11 199 230 1 8 8 17 21 56 113 45 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. supplemental return of new cases coming to the knowledge of the medical Officer of Health otherwise than by Notification on Form A and B during the period 30th December, 1923, to the 3rd January, 1925. METROPOLITAN BOROUGH OF ST. MARYLEBONE. Age Periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45,45 to 55 55 to 65 65 and upwards Total Cases Pulmonary, Males — — — — — — 1 2 5 5 2 15 „ Females — — — — — 1 3 3 1 1 1 10 Non-Pulmonary Males 2 2 1 — 1 — — — 2 — 1 9 „ Females 2 4 — — 1 — 1 — — — — 8 4 6 1 — 2 1 5 5 8 6 4 42 46 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 48, while the following short table summarises the information as to visits paid by members of the staff:— No. of visits by Tuberculosis Officer New, 72 Old, 154 No. of cases at Dispensary New, 337 Old, 2,014 No. of attendances at Dispensary 4,010 No. of visits by Miss Baker First visit, 212 Re-visits, 1,225 No. of visits by Miss Bartleet First visit, 179 Re-visits, 854 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 29—14 boys and 15 girls—and the attendance numbered 9,278. Dr. Saner, who has been Medical Officer of the School sinpe he took office at the Dispensary, continued to act in this capacity. The following extracts from a report by the Tuberculosis Officer (Dr. Saner) contain reference to a number of points that may be of interest. " St. Marylebone Hospital.-—As this year represents the first complete year that I have been associated with the work in the tuberculosis wards at the St. Marylebone Hospital, it occurs to me that it might be of interest to submit a short note with regard to this institution, and to indicate some of the advantages which I believe have resulted or are likely to result from the co-operation that has been established between the tuberculosis department of the Borough Council and the officers of the Board of Guardians dealing with this disease at the hospital. In the first place I should like to say how much personally I have appreciated the opportunity of keeping in touch with cases that I have seen at the Dispensary, and that afterwards have been admitted to treatment at the hospital. In general terms also I should like to express my belief that, so far as the patients are concerned, nothing but benefit can result from the association that has been established. The opportunities given to the tuberculosis officer are that, apart from being able to maintain contact with his patients, he has a chance of studying the disease in more of its phases and of applying and watching different forms of treatment." " Amongst the objections to entering the hospital that, prior to taking duties there, one frequently heard was that it was at a considerable distance from the borough, and that it was under the Poor Law. The latter excuse is not so frequently heard now as formerly since so many of those who have been out of work have had to apply for relief. The hesitation to enter its precincts is chiefly confined to those people who have never had to apply to the Guardians and suddenly finding themselves in need of treatment, learn that all the general hospitals are full. Having thus been more or less forced to enter, it is seldom they have anything except praise for the institution and the treatment received. "The distance is a real grievance with many, since a visit necessitates either an omnibus or rail and omnibus journey, which takes so much out of a slender income. The disadvantages of the distance to the relatives of patients is fully 47 counteracted by the benefit to the patient himself, inasmuch as he is being treateu in better surroundings, especially as regards atmosphere. The hospital stands in an open space, and is not hemmed in by other buildings nearly to the same extent as other infirmaries and general hospitals. In no part of St. Marylebone except Regent's Park, and perhaps St. John's Wood, could the hospital enjoy such open environment as it does in its present position. Visitors must be struck, especially on a fine day, with the rows of cots in the spaces between the pavilions full of infants basking in the sun, and the beds on the balconies containing adults suffering from consumption. " Few, if any, of the other hospitals can provide this for the inmates. The large and airy wards with which the building is supplied tend to disperse the gloominess of illness so obvious in the hospitals in the more crowded parts of the metropolis. " Since my appointment to the hospital I have been able to observe the kind of case of tuberculosis which seeks refuge in its wards, and regret to find it is the more advanced case which is beyond sanatorium treatment, and for which little can be done except to relieve the more distressing symptoms as they arise, and thus mitigate the sufferings of the patient approaching the end. " If possible, it would be an advantage if one could persuade patients waiting admission to a sanatorium to commence treatment at the hospital, but as a rule they will not, in the earlier stages of the disease, generally not feeling sufficiently ill to believe hospital treatment necessary. Further, of course, it is a disadvantage for an early case to be in the same ward with the advanced cases, since the association is apt to produce a gloomy outlook on the personal condition instead of an optimistic view and a feeling that the patient himself is going to get better. This being so, one feels that it would be a great advantage if arrangements for keeping the cases separate could be made, the ward for the advanced cases being distinct and apart from that for the early or less advanced cases. " Recently there has been installed an X-ray apparatus, which is now in full working order, and which adds to the equipment, especially for the diagnosis of tuberculosis. "It is pleasing to know also that one can give patients, as they are continually under the supervision of the resident physician and the sister of the ward, the advantage of new forms of treatment, a thing it is impossible to do in the dispensary, where continual observation cannot, of course, be maintained. One has hopes of testing the efficacy of more modern treatment under very much better conditions than hitherto. "In my opinion, the people of the borough of St. Marylebone should be thankful that they have such an excellent institution to which they can be admitted so easily, and where they can be treated so well. Most of all, I think, the unfortunate sufferers from tuberculosis are to be congratulated, and feel sure that as time goes on the hospital will be more used by these to their own and the general advantage." 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 655, as against 413 in 1923. Of these, 105 were found to contain the bacillus of consumption, while the remainder were free. Non-Pulmonary Tuberculosis.—The great bulk of the total notifications—46, as against 34 in 1923—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 w ill be found in the table on page 52. 48 Return as to work carried out in connection with the St. Marylebone Tuberculosis Dispensary for the year 1924. (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. Non. Pulmonary. (a) All persons Adults M. 2 103 105 38 6 49 4 8 F. 2 120 122 38 4 64 6 10 (including " Contacts ") Children under 15 M. 19 57 76 7 16 30 15 8 F. 17 57 74 6 4 38 13 13 Total _ 40 339 377 89 30 181 38 39 (6) " Contacts " Adults M. - 13 13 5 - 8 - - F. - 29 29 - — 26 3 - (included in (a)). Children under 15 M. 7 26 33 2 7 15 7 2 F. 6 30 36 2 3 20 3 8 (c) Insured persons in (a) ). (included M. 2 73 75 33 3 31 2 6 F. 1 57 58 25 1 26 2 4 1. Number o£ patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 250 2. Total number of attendances of patients Insured 1,219 at the Dispensary during the year 1 Uninsured 2,791 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 79 4. Number of cases in which the period of observation at the Dispensary exceeded two months 25 5. Number of insured patients under domiciliary treatment on December 31st 119 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 17 7. Number of persons referred to affiliated hospital for consultation 4 8. Number of consultations with medical prac- Insured 7 titioners at the homes of patients Uninsured 3 9. Number of other visits paid by Tuberculosis Officer to the homes of patients 216 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2,470 11. Number of specimens of sputum examined in connection with the work of the Dispensary 316 * Insured persons under domiciliary treatment by Insurance practitioners are included under Head 5. 49 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:— Statement of Work carried out in connection with the Dispensary Treatment of Tuberculosis during the period 1st January, 1924, to the 31st December, 1924, 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 the 1st January, 1924, to the 31st December, 1924, at or in connection with the Dispensary and were:— Number of Persons diagnosed to be suffering from Tuberculosis who were treated or supervised at or in connection with the Dispensary during the period from 1st January, 1924, to 31st December, 1924. Number of Persons who were under treatment, supervision, or observation at or in connection with the Dispensary on the 31st December, 1924. Number of Persons referred for diagnosis or treatment to the Hospital with which the Dispensary is affiliated during the period 1st January, 1924, to 31st December, 1924. 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—5 112 146 79 130 207 184 136 167 222 3 1 Tuesday, 9.30—5 Wednes., 9.30—5 Thursday ,9.30—9 Friday, 9.80—5 Saturday, 9.30—1 50 II.—SUNDRY PARTICULARS IN CONNECTION WITH THE SCHEME OF TREATMENT. 1. Name of Hospital to which Special Cases are referred from the Dispensary for diagnosis or treatment 2. Is any provision for the home nursing of Tuberculous Patients made in connection with the Dispensary ? If so (1) State the general nature of the arrangement (2) What qualifications are the Nurses required to possess ? (3) Do they carry out other work ? If so, what ? (4) Are their services available for sured and Uninsured Patients ? (5) If so (a) by what procedure are their services secured for individual patients ? (6) Under whose instructions do they perform the actual duties of nursing in an individual case ? 3. If no provision of nursing is made in connection with the Dispensary 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, 1924, for lending out to Patients for use at their own homes Middlesex Hospital. Yes. Application can be made to the District Nursing Association. (1) Note sent to Matron from Dispensary. (2) Fully trained. (3) Yes, District Nursing. (4) Yes. (5) (a) As above. (i>) Matron of Nursing Association and Tuberculosis Officer. 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 1924 the total number certified as due to this cause was 98, the deathrate being 0.9 per 1,000. The distribution of the deaths according to registration districts is shown in the accompanying table, which gives also the figures for each of the 5 years 1920-1924. 51 Deaths from Phthisis. Five years—1920-1924. Year Estimated Population All Ages Sub-Districts All Souls St. Mary Christ Church St. John 1320 101,856 94 14 28 38 14 1921 105,200 102 24 24 40 14 1922 105,200 98 15 27 42 14 1923 105,400 94 19 25 33 17 1924 105,300 98 18 32 35 13 52 CASES OF TUBERCULOSIS NOTIFIED DURING THE 58 WEEKS ENDING 3rd JANUARY, 1925. Localization of Disease. Cases notified in whole District. Total cases notified in each Locality. Number of cases removed to Hospital from each Locality. At all Ages. At ages—years. All Souls St. Mary Christ Church St. John Totals All Souls St. Mary Christ Church St. John Totals Cases Isolated at Home Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Lungs 178 — 1 26 32 60 48 11 29 49 80 20 178 9 12 19 7 47 131 Rib 1 - - 1 - - - - - - 1 - 1 - - 1 - 1 - Meninges 4 - 4 — — — — - 1 - 2 1 4 1 - 2 1 4 - Genito-urinary 1 - — — 1 — - — — — 1 - 1 - - - - - 1 Ischio-rectal abscess 1 - - - - 1 - - - 1 - - 1 - 1 - - - - Knee 8 - 2 1 — - - - - - 3 - 3 - - 3 - 3 - Eye 1 - — — — — 1 — — — — 1 1 - — - - - 1 Hip 3 - - 1 1 1 — - 1 - 1 1 3 1 - 1 1 3 - Skin 1 - - — — 1 - - 1 - - - 1 - - - - - 1 Intestine 1 1 - — - — — - - - 1 - 1 - - 1 - 1 - Glands 16 - 2 12 2 -___ - - 2 3 7 4 16 - 1 1 2 4 12 Spine 6 - 1 5 - - - - - 1 4 - 6 - - 3 1 4 2 Caecum 1 - - — — 1 — - - 1 - - 1 - - - -_ - 1 Larynx 2 - - - - 1 1 - - 1 1 - 2 - - - - - 2 Peritoneum 3 - - 1 - 1 1 - 1 1 1 - 3 1 1 1 - 3 - Foot 1 - - — — — — 1 - 1 - - 1 - 1 - - 1 - General 1 - - - - - 1 — — — — 1 1 - — — 1 1 — Totals 224 1 10 47 36 66 52 12 35 58 102 29 224 12 16 82 13 73 151 224 53 DISINFECTION. The work clone in this connection during 1924 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 143 12 1 2 158 Mattresses 414 31 8 10 87 550 Bolsters 198 17 2 8 38 263 Pillows 690 83 12 18 260 1,072 Sheets 446 14 5 8 15 488 Blankets 753 24 13 12 53 855 Sundries 10,764 337 58 245 95 11,490 Totals 13,408 518 99 801 559 14,885 In 1923 the number of articles disinfected was 10,320. The number of journeys made by the disinfecting vans during the year ended December, 1924, was:— January 50 August 46 February 46 September 48 March 47 October 50 April 46 November 45 May 49 December 47 June 45 — July 59 578 The number of journeys made during 1923 was 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 44 2 10 1 6 63 February 49 9 11 1 3 73 March 34 16 33 — 8 91 April 44 8 66 — 9 127 May 57 10 45 1 1 114 June 62 7 5 6 — 80 July 48 6 1 — — 55 August 25 13 3 — — 41 September 34 7 — 8 — 49 October 38 9 — 3 — 50 November 50 22 — — — 72 December 50 10 - - - 60 Totals 535 119 174 20 27 875 54 The number of rooms disinfected in 1923 was 643. At the request of the Public Libraries Committee, whose rules require that on the occurrence of a case of infectious disease in any house in which there is a library book, information must be given to the librarian, arrangements were made to receive and disinfect the volumes. The number dealt with during the year was 245. The arrangements referred to in previous reports for placing a spraying apparatus and a supply of " Fluid D " at the disposal of owners and occupiers of premises infested with vermin continued in operation. The sprayers were in great demand and satisfactory results were 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 1924 and annually since 1910:— 1924 ADULTS CHILDREN Males Females Total Males Females Total January 277 83 360 42 139 181 February 252 81 333 60 229 289 March 245 85 330 23 230 253 April 242 92 334 7 167 174 May 255 94 349 15 220 235 June 235 80 315 21 275 296 July 312 101 413 44 343 387 August 263 105 368 13 26 39 September 252 108 360 53 254 307 October 283 72 355 37 270 307 November 294 96 390 35 270 305 December 396 84 480 23 120 143 Totals 3,306 1,081 4,387 373 2,543 2,916 Cleansing Station Attendances, 1910-1924. 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 1924 3,306 1,081 4,387 373 2,543 2,916 The total attendances since the Baths were opened in 1898 number 222,135 (adults, 163,417 ; children, 58,718). 55 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. 1924. Positive. Negative. Total. Typhoid fever 9 35 44 Diphtheria 68 1,539 1,607 Phthisis 105 550 655 Totals 182 2,124 2,306 MATERNITY AND CHILD WELFARE. As is well known, the Maternity and Child Welfare Scheme now in existence contains voluntary and official elements. Of the voluntary elements, to the nature of which reference is made later, those for which the St. Marylebone Health Society is responsible bulk largest, and the Council and the inhabitants of the Borough are greatly indebted to this body and those who work for it for what they have done and what they are doing in relation to maternity and child welfare. Apart from the Health Society, however, there are other bodies that assist, and that are more or less definitely linked up to the main scheme, the connecting link being the Public Health Department of the Council. Amongst these bodies may be mentioned Queen Charlotte's Hospital and Middlesex Hospital, which in addition to providing lying-in accommodation, arrange for attention to be given to out-door patients as well, and conduct ante-natal clinics and infant consultations. At the Western General Dispensary the special clinic for children under Dr. Bernard Myers does most useful work. Less definitely part of the scheme, but still doing very valuable work and helping whenever possible, are St. Agatha's Home, The Home of the Little Company of Mary, and The Home of the St. Marylebone Female Protection Society, where unmarried mothers particularly are provided for, both before and after the birth of their child. 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 1924. It will be noted that at the end of the year there were available nine centres where attention was given to infant and child welfare, and if those at the hospitals are included four ante-natal clinics. At some of the centres consultations are held every day, sometimes twice a day. In addition to the ordinary infant and young child (" toddlers ") consultations, there is a dental clinic for mothers and young children, open on four days, for two of which the Health Society is responsible. By arrangement with the London County Council the dental clinic is used also by school children, and in conjunction with this there is also a minor ailment treat, ment 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. 56 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 Cosway 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 1924 the health visitors made 8,476 visits, and the voluntary visitors attached to the schools for mothers made 578 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. :—(1) North Marylebone School of Mothercraft, Salisbury Street, has an ante- and post-natal consultation under medical supervision. The dental clinic and minor ailment treatment centre are in the same building. The Council's health visitors cooperate, 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) Ogl° Mews, Ogle Street, W.l. Infantile 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 were held weekly at the day nursery here until April, when the centre removed to new premises at 24, Hill Road. The health visitors co-operate, and one of the nurses of the day nursery gives part-time to health visiting.—(5) Temporarily held at Western General Dispensary, Cosway Street. Infant consultations under medical supervision are held weekly. There are also classes for nursing, etc. One of the health visitors is specially attached to this centre and acts as superintendent. In addition to these centres, consultations are held weekly) at Queen Charlotte's Hospital, at Middlesex Hospital, at the Church Army Dispensary, and at the Western General Dispensary. One of the Council's health visitors attends at each, and Middlesex Hospital has also a paid health visitor in attendance. All the consultations are open to other than St. Marylebone babies, who, however, constitute the bulk of those attending. At the hospitals there is an ante-natal clinic particularly for hospital patients. Ante-Natal Work as indicated. There are two voluntary Ante-Natal Clinics. Visiting is undertaken by the Council's health visitors. There is a system of co-operation with the Middlesex and Queen Charlotte's Hospitals. Dental Clinic.—This was originally established for the treatment of women, and children of pre-school age. By arrangement with the London County Council, school children are also dealt with. Massage Clinics are held weekly at Salisbury Street and Ogle Mews. 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. 57 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 1924 was 2,350, the total births numbering 3,590. The midwives living and practising in the borough number 4. Two 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. Full details of the method adopted in relation to the granting of orders for milk and food under the Maternity and Child Welfare Act, 1918, will be found in previous reports, 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, 1924. CENTRE. Barrow Hill Road. No. 14 Salisbury Street. Queen Charlotte's Hospl. Cosway Street. No. 30 M arylebone Lane. No. 8 Ogle Mews. The Middlesex Hospl. The Westn. Genl. Dispy. hurch Army Dispy. No.of consultations held 49 247 (196 children 51 maternity) 310 (256 antenatal 54 infants) 93 98 49 150 91 52 No. of attendances of mothers at ante-natal clinic . - - 42 - - - 164 538 8,553 No. of attendances of babies . 1,204 3,747 1,451 1,547 1,288 1,162 3,015 495 523 No. of attendances of children over 2 years 118 978 195 474 112 245 1,053 1,523 204 No. of orders issued for milk, etc. 102 296 66 43 81 100 61 9 2 No. of home visits . 823 2,884 776 646 389 853 1,277 22 380 No. of new cases 94 323 3,681 71 83 62 276 312 64 Day Nurseries—Attendances during the year. St. John's Wood, Barrow Hill Road 4,966 Portman, Exeter Street 8,597 58 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 1924 was 4. The average time for which the help was required was 3 weeks, the longest being 7 weeks, and the shortest 2 weeks. The total amount expended during the financial year to 31st March, 1925, was £6 10s., 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. Reference has already been made to the appointment of Mrs. Spears as Mortuary Keeper in succession to her husband, who died in July, and the following report gives some indication of the amount of work done at the mortuary and the extent to which it 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, 1924. 1924. Males. Females. Total. For burial only. For inquests. Total. No. of P.M 's held. No. of courts held. No. of Infectious cases. January . 9 9 18 10 8 18 2 6 February 13 13 26 18 8 26 5 5 - March 18 15 33 14 19 33 15 7 - April 9 6 15 9 6 15 5 2 - May 8 6 14 8 6 14 3 6 - June 6 6 12 6 6 12 2 4 - July 14 11 25 12 13 25 6 3 - August 5 2 7 — 7 7 6 4 - September 9 9 18 5 13 18 12 7 - October 10 8 18 8 10 18 9 7 - November 9 14 23 15 8 23 4 4 - December 13 14 27 7 20 27 12 6 - Totals 123 113 236 112 124 236 81 61 — 59 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. From the formal return given below, which is that required to be made by the Ministry, it will be noted that amongst the new houses erected there are, " as part of a municipal housing scheme, 32 flats." This indicates the completion of two of the seven blocks of flats planned to be erected upon the site presented by the late Lord Portman to the Council for the purpose of housing the working classes, and known as The Fisherton Street Site. The first block, the completion of which was considerably delayed by strikes and other labour difficulties, was formerly opened by the Mayor (Mr. Councillor Brooks) on 7th November, and very shortly afterwards the second also was completed and occupied. The accommodation provided in each of the flats consists of a living room, scullery, bathroom, and W.C., and three bedrooms. There is a plentiful supply of hot water to each, and there is in addition a laundry with washing and drying rooms for the use of the tenants in common. The blocks are well situated as regards light and air, and both gas and electricity are available for cooking, lighting, etc. As this scheme is rather in the nature of a slum clearance the provision made in the various blocks will help hardly at all towards a reduction of the housing shortage, most of the families taking up occupation of the flats being such as have been dishoused in order to permit the scheme to proceed. Even when the scheme is completed, it is doubtful if any but previous residents on the site will be accommodated. At the end of the year progress was being made in connection with arrangements for the erection of two of the remaining five blocks. The information asked for by the Ministry with regard to housing is contained in the following statement, and in the Table A. 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: (a) Total (b) As part of a municipal housing scheme 7 houses and 147 flats. 32 flats. 1. Unfit dwelling-houses: Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,593 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910— Houses 973 Tenements in blocks 504 60 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,111 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) 1,997 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) 114 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 114 (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 tion Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 61 Table A.—HOUSING. Statistics for the Twelve Months ended 31st December, 1924. Housing Investigations (Public Health and Housing Acts) Repair of Houses (Section 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 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 — 973 and 504 Tenements — 2,111 - - - - - - - - - - - - — 7 62 GENERAL STATISTICS. Area (acres) 1,427.8 (exclusive of water); 1,473 (including water). Population (1921). 104,173. (1924). 105,300 (estimated). Number of inhabited houses (1921). 18,507. Number of families or separate occupiers (1921). 27,214. Rateable value. £2,568,117. Sum represented by a penny rate. £10,302. Extracts from Vital Statistics of the Year. Births— Total M. F. Legitimate 1,369 717 652 Illegitimate 162 82 80 Deaths, 1,438. Death Rate, 13.6. Birth Rate, 14.5. Number of women dying in, or in consequence of, childbirth—from sepsis, 2; other causes, 6. Deaths of Infants under 1 year of age per 1,000 births:— Legitimate 74. Illegitimate 129. Total 78. Deaths from Measles (all ages), 46. Deaths from Whooping Cough (all ages), 3. Deaths from Diarrhoea (under 2 years of age), 21. GENERAL SUMMARY. The following is a list of the special premises in the Borough requiring constant supervision:— Milk Premises 143 Cowhouses 2 Slaughterhouses 3 Offensive Trades 2 Ice Cream Premises 120 Bakehouses 67 Restaurant, Dining Room and Coffee Shop Kitchens 176 Hotel Kitchens 20 Pastrycooks and Tea Rooms 44 Fried Fish Shops 24 Fish Curers 5 Houses Let in Lodgings 1,115 Workshops and Workplaces 3,617 Total 5,338 63 Smoke Nuisances. Number of Observations 689 Number of Notices 9 Number of Nuisances and Complaints 9 Number of Summonses Nil Housing of the Working Classes. Number of Houses inspected 973 Tenements in Blocks 504 Number of Representations by Householders Nil Number of Representations by Medical Officer Nil Number of Houses included in such Representations Nil Number of Houses remedied without Closing Orders Nil Number of Demolition Orders Nil Number of Houses dealt with under Section 15 of the Housing, Town Planning, etc., Act, 1909 Nil Number of Closing Orders Nil Number of Houses included in such Closing Orders Nil Number of Closing Orders determined Nil Number of Houses demolished— (a) In pursuance of Orders Nil (b) Voluntarily Nil Obstructive Buildings. Number of Representations under Section 38 of the Housing Act, 1890 Nil Number of Representations still under consideration Nil Number of Orders for repairs issued under Section 28 of the Housing Act, 1919 Nil Total Number of Houses in the Borough 19,270 Number of Houses for the Working Classes— (a) Erected during year 32 flats (b) In course of erection 32 flats Number of Buildings demolished Nil Number of Houses repaired by Local Authority Nil Number of Houses closed on Notice by Owner that they could not be made fit Nil Number of Houses occupied by the Working Classes 8,112 Mortuary. Number of bodies received 236 Number of Infectious bodies received Nil Disinfection. Number of rooms disinfected 875 Number of articles disinfected 14,885 64 Cleansing of Persons Act, 1897. Adults. Children. Males. Females. Males. Females. Total. Number of persons cleansed 3,306 1,081 373 2,543 7,303 Bakehouses. Number on Register at end of 1924 67 Number above ground 6 Number underground 61 Number of Inspections 156 Number of Notices 10 Number of Prosecutions Nil Places where Food is Prepared for Sale (excluding Bakehouses). Number on Register at end of 1924 240 Number of Inspections 960 Number of Notices 30 Number of Prosecutions Nil House to House Inspections. Number of Inspections Houses 973 Tenements 504 Number of Notices issued Intimations 1,079 Statutory Notices 21 Number of Prosecutions Nil House Refuse. Number of Inspections 4,588 Number of Old Brick Receptacles abolished 2 Number of New Metal Receptacles provided 578 Number of Notices issued. Intimations 506 Number of Statutory Notices 22 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 27 Number of Statutory Notices served 6 Number of Prosecutions Nil Overcrowding. Number of Dwelling Rooms overcrowded 3 Number Remedied 3 Number of Prosecutions Nil 65 Underground Rooms. Number dealt with 4 Number of Notices served under P. H. (L.) Act, 1891 4 Number of Notices served under H. T. P., &c., Act, 1909 Number of Prosecutions Nil Verminous Rooms. London County Council (General Powers) Act, 1922, Section 9 (1). Number of rooms cleansed 750 Number of Statutory Notices served 28 Number of Prosecutions 1 Shelter Provided under Section 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year Nil 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 6,350 Number of drainage plans deposited 536 Number relating to new buildings 86 ,, ,, old buildings 450 Sale of Food. Number of Premises used other than Ice Cream Premises, Milk Shops, and Cowsheds 347 Number of Inspections 1,155 Ophthalmia Neonatorum Regulations. Number of Notifications received during the year from certified midwives Nil Sanitary Officers. Number of Sanitary Inspectors (Whole-time) Male 8 Female Nil „ „ „ (Part-time) Male 3 Female 3 „ Health Visitors Whole-time 3 Part-time 3 ,, Tuberculosis Visitors Whole-time 2 66 MINISTRY OF HEALTH AND OTHER TABLES. TABLE I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE. DURING 1924 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each Year. 2 Births. Total Dbaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected No. 3 Nett. of Non. residents registered in the District. 8 of Resi.dents not registered in the District. 9 Under 1 year of Age. At all Ages. No. 4 Rate. 5 No. 6 Rate. 7 No. 10 Rate per 1,000 Nett Births. 11 No. 12 Rate 13 1911 117,844 4,130 2,375 20'2 1,578 14.2 600 840 261 109'8 1,818 16.3 1912 116,155 4,111 2,246 19.3 1,652 15.0 769 752 209 93.0 1,635 14.8 1913 114,532 3,804 2,146 18.6 1,629 14.9 755 753 195 90.0 1,627 14.9 1914 112,892 3,847 2,128 18.7 1,631 15.1 813 787 210 98.6 1,605 14.9 1915 100,260 3,647 1,852 162 1,741 17.2 817 773 178 96.1 1,697 17.8 1916 98,573 3,936 1,814 16.8 1,681 16.9 855 720 188 103.6 1,588 16.0 1917 92,796 3,065 1,506 14.5 1,647 17.6 853 752 182 120.9 1,580 17.0 1918 98,526 3,340 1,375 12.4 1,852 18.7 898 879 152 110.5 1,835 18.5 1919 97,953 3,625 1,492 14.6 1,724 17.3 864 708 147 98.5 1,568 15.9 1920 101,856 4,287 2,217 21.5 1,638 16.0 939 600 145 65.6 1,299 12.7 1921 105,200 3,393 1,939 18.4 1,625 15.4 877 607 128 66.0 1,355 12.8 1922 105,200 3,588 1,679 15.9 1,638 15.5 905 718 115 68.0 1,451 13.7 1923 105,400 3,601 1,668 15.8 1,468 13.9 827 594 111 66.0 1,235 11.7 1924 105,300 3,432 1,531 14.5 1,686 15.9 936 688 123 78.0 1,436 13.6 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. 67 TABLE I (A). Vital Statistics of Separate Localities in 1924 and the Ten Previous Years. Names of Localities The Whole Borough All Souls St. Mary Christ Church St. John Year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year . Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year a. b. C. d. a. b. c. d. a. b. C. d. a. b. c. d. a. b. c. d. 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 1,862 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 26,834 248 416 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 31,414 938 446 71 17,2!/4 395 235 19 1921 105,200 1,939 1,355 128 26,184 390 268 29 28,709 445 345 27 82,446 720 455 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 1923 105,400 1,668 1,235 111 25,258 328 226 14 26,992 340 333 18 32,806 643 410 52 20,344 362 266 27 Averages ' of Years 1914 to 1923 113,318 1,981 1,684 175 28,026 401 333 29 30,542 391 428 35 35,024 818 615 84 19,726 371 308 27 1924 105,300 1,531 1,436 123 25,233 280 245 22 26,967 336 422 30 32,775 629 472 55 20,325 286 297 16 *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. 68 TABLE II. Notifiable Diseases During the Year 1924. 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 122 3 49 42 16 10 1 1 119 3 — 1 1 — 1 ' — — Erysipelas 50 1 4 6 5 8 14 12 24 3 - - - - - - 1 2 Scarlet Fever . 185 2 63 84 21 14 1 — 171 2 — — 2 — — — — — Enteric Fever (including Paratyphoid) . 17 - 2 - 4 7 4 - 12 2 - - - - 1 - 1 - Puerperal Fever 10 — — — 2 8 — — 8 2 — — — — — 2 — Encephalitis Lethargica 18 — — 6 6 5 1 — 11 — - - - - - - - - Ophthalmia Neonatorum 7 7 - - - - - - 2 - - - - - - - - - Pneumonia 68 3 20 9 4 16 11 5 20 12 — 4 1 — — 2 3 2 Dysentery 1 — 1 - - - - - 1 - - - - - - - - - Cerebro Spinal Fever 1 — 1 - - - - - 1 - - - - - - - - - Tuberculosis, Pulmonary . 178 — 1 26 32 60 48 11 47 36 — — — 2 7 7 17 3 Tuberculosis, Non-Pulmonary . 46 1 9 21 4 6 4 1 26 8 1 1 3 — 1 — 2 - Total . 703 17 150 194 94 134 84 30 442 68 1 6 7 2 10 11 24 7 69 TABLE II. (a). Cases of Infectious Disease Notified during the 53 weeks ending 3rd January, 1925. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home. At all ages. At Ages—years. All Souls. St. Mary. Christ Church St. John. Totals. All Souls. St. Mary. Christ Church St. John. Totals. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Smallpox - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - Diphtheria, including Membranous Croup . 122 3 49 42 16 10 1 1 23 22 56 21 122 23 21 55 20 119 3 Erysipelas 50 1 4 6 5 8 14 12 3 15 24 8 50 1 11 8 4 24 26 Scarlet Fever. 185 2 63 84 21 14 1 — 37 32 90 26 185 34 31 87 19 171 14 Typhus Fever - - - - - - - - - - - - - - - - - - - Enteric Fever 7 — — — — 5 2 — 2 4 — 1 7 1 4 — — 5 2 Paratyphoid Fever 10 - - — 4 2 2 — 1 4 5 — 10 1 2 4 — 7 3 Relapsing Fever - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - Puerperal Fever 13 — — — 2 8 -— — 4 3 3 — 10 2 3 2 1 8 2 Plague . - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - Farcy - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever . 1 - 1 - - - 1 1 - 1 - 1 Tuberculosis— Pulmonary 178 — 1 26 32 60 48 11 29 49 80 20 178 9 12 19 7 47 131 Non-Pulmonary 46 1 9 21 4 6 4 1 6 9 22 9 46 3 4 13 5 26 20 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — Polio-Encephalitis Ophthalmia - - - - - - - - - - - - - - - - - - - Neonatorum Encephalitis 7 7 — — — — — — — 2 5 — 7 — — 2 — 2 5 Lethargica 18 — — 6 6 5 1 — 3 6 6 3 18 2 4 3 2 11 7 Pneumonia 68 3 20 9 4 16 11 5 8 5 38 17 68 4 2 10 4 20 48 Malaria . — — — — — — — — — — — — — — — — — — — Dysentery 1 — 1 — — — — — — — 1 — 1 — — 1 — 1 — Trench Fever - - - - - - - - - - - - - - - - - - - Totals 703 17 150 194 94 134 84 30 116 151 331 105 703 80 94 205 62 442 261 703 70 TABLE III.—Causes of, and Ages at Death during the year ending 3rd January, 1925. 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 under65 65 and upwards. 1 Enteric Fever 2 - - - - 1 - 1 - 1 - 1 1 - 2 2 Small Pox - — — — - — - - -- - - — — — — 3 Measles 46 7 21 15 - 1 2 — - — 5 6 30 5 46 4 Scarlet Fever 2 — - 2 - - — - - — 1 — — 1 2 5 Whooping Cough 3 1 1 1 - — — — — — 2 — 1 - 3 6 Diphtheria and Croup 3 — 1 1 - 1 — — — 1 — 2 1 - 3 7 Influenza 40 — - 2 - — 4 12 22 9 6 18 9 7 40 8 Erysipelas 3 — - — - — — 1 2 1 1 1 - 1 3 9 Phthisis (Pulmonary Tuberculosis) 98 - - - 2 21 29 38 8 15 18 32 35 13 98 9a Tuberculosis of the Respiratory System (Lungs, Pleura and Throat) 4 - - 2 - 1 - - 1 2 1 - 2 1 4 10 Tuberculous Meningitis 10 3 1 4 1 1 — — ,— 4 2 - 6 2 10 11 Other Tuberculous diseases 9 1 - 1 — 4 — 3 — 10 1 2 3 3 9 12 Cancer 186 — - — 2 2 15 91 76 325 35 64 44 43 186 13 Rheumatic Fever 2 — - 1 — — 1 - - 1 - 1 — 1 2 14 Meningitis 8 2 1 — 2 1 1 — 1 5 — 4 3 1 8 15 Organic Heart Disease 129 — - — — 8 11 38 72 81 21 29 48 31 129 16 Bronchitis 184 8 2 2 — 1 5 55 111 28 32 44 67 41 184 17 Pneumonia (all forms) 156 33 18 9 4 3 20 40 39 78 18 36 73 29 156 18 Other diseases of Respiratory Organs 26 - - - - - 3 16 7 8 5 10 8 3 26 19 Diarrhœa and Enteritis (under 2 years) 21 18 3 - - - - - - 9 3 8 7 3 21 20 Appendicitis and Typhlitis 6 — — — 2 — 3 1 - 20 — 2 1 3 6 21 Cirrhosis of Liver 10 — — - — - 1 7 2 8 - 6 2 2 10 21a Alcoholism 2 — — - — — 2 - - 3 - - 1 1 2 22 Nephritis and Bright's Disease 31 — — — 1 — 5 16 9 23 7 12 6 6 31 23 Puerperal Fever 2 — — -— — — 2 — - 4 — 1 1 — 2 24 Other accidents and diseases of Pregnancy and Parturition 6 - - - - 1 5 - - 14 1 2 1 2 6 25 Congenital Debility and Malformation, including Premature Birth 48 47 1 - - - - - - 60 5 15 20 8 48 26 Violent Deaths, excluding Suicide 42 3 - 2 4 1 5 15 12 37 9 13 9 11 42 27 Suicides 17 — — — — 2 6 7 2 4 3 8 4 2 17 28 Other defined Causes 340 10 2 2 7 5 32 97 185 320 69 105 89 77 340 Totals 1436 123 51 44 25 54 152 438 549 1071 245 422 472 297 1436 71 VACCINATION RETURNS. Supplemental Return for 1923, Return made to the Board 01 Guardians and Ministry of Health on the 9th February, 1925, 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, 1923, 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,, 1923 Number of these Births duly entered by 31st January, 1925, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1925, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1925, 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 1924 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 1924 Col. I. Success fully 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 Insuscep tible of Vaccination Had SmallPox 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Marylebone 824 516 7 — 129 48 22 24 44 34 2,561 2. St. Mary 2,173 1,644 2 — 124 82 20 276 18 7 292 3. All Souls 636 454 - — 42 19 18 85 11 7 Total 3,633 2,614 9 — 295 149 60 385 73 48 2,561 292 Dated 9th February, 1925. (Signed) GEORGE H. BASSETT, Vaccination Officer. £