Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1914. T. SHADICK HIGGINS, M.D., B.Sc. (Lond.), D.P.H. (Camb.). 3 CONTENTS. page. Map of St. Pancras, showing the Registration Sub-Districts 6 Public Health Committee 7 Staff of Public Health Department 8 Introduction 10 Part I.—General Statistics— Population 13 Marriages 13 Births 14 Illegitimacy 15 Notification of Births Act, 1907 15 Deaths 17 Infantile Mortality 21 Infectious Diseases 26 Part II. —Special Subjects— Prevention of Infant Mortality 31 Circular of Memorandum of Local Government Board of July, 1914, on Maternity and Child Welfare 31 Maternity and Child Welfare Work 33 Work Done 42 Infantile Diarrhoea 43 Ophthalmia Neonatorum 44 Puerperal Fever 47 Tuberculosis 48 Work Done 56 Treatment 57 Scarlet Fever 61 Return Cases 62 Outbreaks in Institutions 63 Diphtheria 66 Typhoid Fever 67 Anterior Polio-Myelitis 69 Epidemic Cerebro-Spinal Meningitis 70 Other Notifiable Infectious Diseases 71 Measles 72 Whooping Cough 73 4 CONTENTS—continued. page Diarrhoea and Enteritis 74 Syphilis 75 Alcoholism 77 Cancer 77 Vaccination 78 Dwelling Houses 80 Inspection of Dwelling Houses 80 Analysis of results of Inspections 86 Water Supply 88 Underground Rooms 88 Representations Closing Orders 89 Inland Revenue Act, 1903 91 Housing Schemes 91 Canal Boats Acts 91 Factories and Workshops: Bakehouses, Restaurant—kitchens, Laundries, Home-Work 92 Inspection of Food and Food Places 96 Sale of Food and Drugs Acts 96 Summonses 98 Public Health (Milk and Cream) Regulations, 1912 99 Inspection of Food 100 Dairies, Cowsheds and Milkshops 102 Requirements for registered Milkshops 105 Ice Cream Premises 106 Fried Fish and Fish Curing Premises 106 Other Food Premises 107 Slaughterhouses 107 Rag Flock Act, 1911 107 General Sanitary Work 107 Total Inspections 107 Intimation Notices 108 Summonses 108 Smoke Prevention 109 Regulated Trades 109 Constructional Drain Work 109 Drainage Register 110 Water Service 110 5 CONTENTS—continued. page Disinfecting and Cleansing Station 111 Disinfection 111 Cleansing Station 111 Public Mortuary and Coroner's Court 113 Bacteriological Examinations 114 Clerical Work 114 Staff 114 Appendix— Table No. 1.—Vital Statistics of the whole District for 1914 and previous years required by the Local Government Board 118 Table No. 2.—Showing registered Deaths classified for Causes Age and Sex 119 Table No. 3.—Summary of above 123 Table No. 4.—Showing the number of Deaths from certain groups of diseases, and the number per 1000 Population and per 1000 Deaths from all Causes 124 Table No. 5.—Showing Birth-rates, Death-rates and Infantile Mortality-rates of England and Wales and of certain large Towns, and of the County of London, and the Metropolitan Cities and Boroughs 125 Table No. 6.—Showing Inmates of, and the number of Births and Deaths occurring in Public Institutions 126 Table No. 7.—Meteorology 127 Table No. 8.— Showing Inspections made by the District Inspectors and Women Inspectors 128 Table No. 9. —Showing Re-Inspections do. do. 130 Table No. 10—Showing Inspections and other work of the Special Inspectors 132 Table No. 11.—Showing Inspections and Re-Inspections made by individual Inspectors 134 Tables Nos. 12, 13, 14 and 15.—Showing details of Intimation Notices served 135 New Legislation 138 Acts of Parliament 138 Orders 138 By-Laws 142 Legal Decisions 142 6 7 St. Pancras Borough Council. PUBLIC HEALTH COMMITTEE, 1914. CHAIRMAN. Councillor Dr. Kenneth Harrison Alloa Kkllie (Ward 5). DEPUTY-CHAIRMAN. Councillor Henry Groom (Ward 8). EX-OFFICIO. The Right Worshipful the Mayor. (Councillor Thomas Andrew Collins, J.P.) ALDERMEN. Bryan, James Thomas Davies, David, J.P., L.C.C. Hickling, George, J.P. Williams, Charles. COUNCILLORS. Ward 5 Blount, George. 3 Bolsom, Sidney. 2 Brown, Henry Joseph, J.P. 1 Carrington, Thomas. 1 Coggan, Cornish Arthur. 3 Cooke, Joseph John. 2 Cosburn, George Frederick, J.P. 8 Davis, Abraham. 3 Edwards, Alfred Harold. 4 Escott, Arthur. 1 Jennens, Henry Harbridge. 6 Knight, William Stanley Macbean. 4 Lloyd-Taylor, William, J.P. 8 Stoney, Rev. Ralph Sadlelr, M.A. 7 Swift, Mansell James. 5 Washington, Alfred Charles. 6 Woffendale, Rev. Zephaniah Banks (Died 14th July, 1914), 7 Wood, William Charles. 8 STAFF OF PUBLIC HEALTH DEPARTMENT, 1914. MEDICAL OFFICER OF HEALTH. T. Shadick Higgins, M.D., B.Sc., D.P.H. PUBLIC ANALYST. J. Kear Colwell, F.I.C. SANITARY INSPECTORS. District Inspectors. District. Ward. Inspector. N. 1 (Highgate) l G. Rackham. N. 2 (St. John's Park) and N. 3 (Gospel Oak) l W. L. Brown. N. 4 (Grafton) and N. 5 (Maitand Park) 2 B. H. Thompson.* E. 1 (Bartholomew), E. 2 (Camden Square), and E. 3 (College) 3 E. J. Dilion. E. 4 (Oakley Square) 6 W. G. Auger. E. 5 (Ossulston) 6 R. E. James. W. 1 (Castle) and W. 2 (Chalk Farm) 4 H. G. West.† W. 3 (Mornington) and W. 4 (Regent's Park) 5 J. I. Lonnon. W. 5 (Euston) 5 G. W. Adkins. S. 1 (Argyle) and S. 2 (Mecklenburgh) 8 E. G. Holmes. S. 3 (Burton) 8 A. H. Walker. S. 4 (Endsleigh) 7 R. C. Akers.‡ S. 5 (Whitfield) ˜ J. Landen. Inspectors of Food and Food Places. South and West Divisions J. Osborne. E. 3 (College) and E. 4 (Oakley Square) W. G. Auger. North and rest of East Divisions H. R. Child. Women Sanitary Inspectors. For women's workplaces and for consumption . Miss M. E. Bibby, B.A. For infant mortality and cleansing of children Miss Celia Smith.§ Temporary Health Visitor Miss Mary Giles. * Mr. Thompson was called up with the Territorial Force at the beginning of the war, and his place was taken by Mr. Pottier, Junior Clerk, who was appointed Temporary Sanitary Inspector, † Mr. West became Male Inspector of Factories and Workshops on 5th October, his district being taken over by Mr. Akers. ‡ This district was divided between Mr. Walker and Mr. Landen from 5th October. § Miss Smith is appointed as a Sanitary Inspector and Health Visitor. 9 CLERICAL STAFF. Chief Clerk A. Powel Coke, Barrister-at-Law. First Clerk Harry Riches. Second Clerk Alfred George Capel. Clerk Howard Claud Spokes. Clerk Henry Frank Mullis. Clerk George Netherton Cove. Junior Clerk Percy William Pottier.* Junior Clerk Joseph Bernard Molloy.† DISINFECTING STAFF. Foreman of Disinfecting Station Henry Catch. Stoker and General Assistant T. Bartholomew. Assistant Disinfector John Stanley. Assistant Disinfector Arthur D. Dibben. Matron of Personal Cleansing Station Mrs. Alice Oakey. Assistant „ „ Mrs. M. Millan. RESIDENT CARETAKERS, ETC. Mortuaries and Coroner's Court Joseph Roots. Goldington Buildings Walter Brown. Flaxman Terrace John Evans. Prospect Terrace A. H. Reid. Prospect Terracc Baths— Male Attendant A. Smith. Female ,, Mrs. Reid. *Mr. Pottier was appointed as Temporary Sanitary Inspector at the beginning of the war, his place bring filled by a temporary clerk. Mr. C. Batter. ‡ Mr. Molloy enlisted in October, and his place was filled by a temporary clerk, Mr. W. C. Harvey. 10 Public Health Department, Town Hall, Pancras Road, N.W. June, 1914. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Gentlemen, I have the honour to present to you the Fifty-ninth Annual Report on the vital statistics and sanitary condition of the Sanitary District of St. Pancras. This is the second annual report which it has been my duty to submit, though it is the first complete year of office on which I have had to report. The year 1914 has been made memorable by the war, but although this was in progress during the last five months of the year it has not had much influence upon the vital statistics. One sanitary inspector was called up with the Territorial Force, and one clerk enlisted. Their places were temporarily filled. Otherwise the staff of the department has not been affected by the war. The department sustained a loss during the year by the death of Mr. J. Osborne, sanitary inspector. Mr. Osborne had been engaged as sanitary inspector for 41 years, the last 30 of which had been spent in the service of St. Pancras. The staff is still one inspector short by reason of this loss. The routine inspection of houses in the Borough prescribed by the Housing, Town Planning, etc., Act, 1909, has been continued during the year. A number of underground rooms have been closed as sleeping placcs, and many notices have been served for the provision of additional water supply to the upper floors of tenement houses. Two appeals were heard by the Local Government Board during the year against your Council's action in regard to Closing Orders, and in both cases the decision of the Council was upheld. Perhaps the most serious problem in the Borough is the very unsatisfactory conditions under which so many families have to live in tenement houses. The evils arise from the letting out in floors of houses which were built, and have conveniences, only for one family each. Besides the insufficient number of rooms, many families having to do with one or two rooms for all purposes, proper domestic management and cleanliness are rendered almost impossible by the absence of separate kitchen, scullery, food-storage, washing, water-closet and yard accommodation for each tenement. It is the exception in such houses for a family to have any room which is not used as a sleeping-place at night. Throughout the year the department has been in negotiation with the authorities of the St. Pancras Dispensary and University College Hospital, and with the Local Government Board, the London County Council, and the London Insurance Committee, in regard to the dispensary treatment of tuberculous persons, but no final arrangements were come to by the end of the year. No grants were made by the Council for this purpose during the year. 11 The subject of Maternity and Child Welfare was brought into prominence by the publication in July, 1914, of a circular and memorandum on this subject by the Local Government Board offering grants towards expenditure for this purpose. This matter was having attention at the end of the year in conjunction with my previous recommendation that additional health visitors should be appointed. Besides maternity and infant welfare much useful work might be done in connection with the non-notifiable infectious diseases and verminousness. Particularly in regard to measles and whooping cough, both of which produce a serious mortality amongst children, much saving of life might be effected by the provision of nursing and other facilities both in hospitals and in the homes of the patients. The registered milkshops in the Borough have been given much attention in 1914, and a considerable number of milksellers whose premises were unsuitable for the sale of milk have been removed from the register. During the year the duty of inspecting factories, workshops, and workplaces, including bakehouses and restaurant kitchens, was transferred from the district inspectors to one sanitary inspector, who was released from his duties as District Inspector by a re-arrangement of the districts, and appointed Inspector of Factories and Workshops. The number of districts was thus reduced to 12. The duties of the Woman Sanitary Inspector in regard to factories and workshops remain unchanged. The new arrangement came into force on 5th October, 1914, when the compilation of new registers of factories and workshops on the card-index system was begun. There was a considerable outbreak of scarlet fever during 1914, in which St. Pancras shared in common with the rest of London. The number of fatal cases was, however, not sufficient to produce any marked increase in the general death-rate. In conclusion, I desire to express my thanks to the Staff of the Public Health Department who have carried out their important duties loyally and amicably; to your Public Health Committee who have given me most encouraging support; and to the Members of your Council for the personal consideration they have shown me during the year. I am, Gentlemen, Your obedient Servant, Medical Officer of Health. Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1914. Part I.—GENERAL STATISTICS. For the purposes of this Report the year 1914 is the 52 weeks ended 2nd January, 1915. POPULATION. The estimated population of the Borough at the middle of 1914, upon which the rates in this report are based, is 218,387. The Registrar-General's estimate is 214,133. The returns of the Rating Department give the number of houses used as dwellings (less " empties") to be 22,542 for the census year 1911, and 22,574 for 1914, a slight increase instead of a decrease. It has therefore been considered advisable to take the 1911 census population for the 1914 estimate rather than that of the Registrar-General. The census figures for the population of the different Wards and Registration Sub-Districts have also been retained in calculating the rates in this Report. The Registrar-General's estimates for 1912 and 1913 were based on the assumption that the decrease in population which took place between the censuses of 1901 and 1911 had since continued at the same rate. On this basis the 1914 estimate would be 212,497. His 1914 estimate (214,133), however, has been made by another method (Waters'). MARRIAGES. The number of marriages celebrated in St. Pancras during 1914 was 2,310, equal to a rate of 10.6 per 1,000 population. 14 BIRTHS. The number of births registered in the Borough during 1914 was 4,945. From information received from the Registrar-General the excess of births to parishioners occurring outside the Borough over births to non-parishioners occurring inside the Borough was 280. This correction gives the net number of births for St. Pancras registered during the year as 5,225, making an annual birth-rate of 23.9 per 1,000 population. The following table shows the number of births thus corrected, and the birth-rate for each of the four Registration Sub-Districts and eight Wards into which the Borough is divided, and also the corresponding rates in former years. In this table from 1911 onwards the transferred births referred to above are allocated to the Sub-Districts and Wards, in proportion to their respective populations, but some of the births which took place in St. Pancras Institutions are not re-distributed, but are allocated to the Districts in which the Institutions are situated. districts. estimated population. west. south. east. north. whole borough. Bates for whole Borough calculated on the 1911 census population (218,387). county of london birth rate. Ward Total. Ward Total, Ward Total. Ward Total. 4 5 7 8 3 6 1 2 Number of Births Registered for the year 1914 .. 667 747 1414 286 711 997 831 691 1522 706 586 1292 5225 Birth Rate per 1000 population 218387 25.2 23.4 24.2 15.7 26.2 22.0 23.9 30.4 26.5 19.8 26.8 22.5 23. 9 Birth Rate for the Year 1904 237088 26.9 21.7 29.3 26.8 25.8 27.9 ,, ,, 1905 237149 25.3 20.9 26.2 25.2 24.5 27.1 ,, ,, 1906 237149 23.3 20.6 27.4 25.4 24.2 26.7 ,, ,, 1907 237173 23.9 17.3 25.7 25.2 23.1 25.8 ,, ,, 1908 237247 24.2 18.2 27.6 23.2 23.4 25.2 ,, ,, 1909 237247 22.4 17.9 24.7 23.0 22.1 24.0 24.2 ,, ,, 1910 237247 22.7 18.5 25.5 23.9 22.7 24.7 23.6 ,, ,,1911 237129 23.3 19.9 25.5 24.7 23.4 25.4 24.8 ,, ,,1912 220353 22.1 23.4 27.7 24.0 *24.4 24.6 24.5 ,, ,, 1913 218387 23..3 22.5 28.2 24.5 *24.7 24.7 25.0 ,, ,,1914 218387 24.2 22.0 26.5 22.5 *23.9 23.9 24.3 * For 1911 onwards the number of births and the rates are corrected for inward and outward transfers. 13 327 births occurred in Public Institutions in the Borough, and are tabulated in table 6 on page 126. These are equal to 6.6 per cent, of the total births which took place in the Borough. Table 5 on page 125 shows the birth-rate for 1914 of England and Wales, the County of London, the several Metropolitan Boroughs, and the 30 large towns with a population exceeding 125,000. It should be noted that the St. Pancras figures are shown in the table on the basis of the RegistrarGeneral's estimate of the population, which, as explained before, differs from the estimate made in this report. Illegitimacy. Of the 4,945 births which were registered in the Borough 187, or 3-78 per cent., were returned as illegitimate. These are classified (in Wards) according to the place of birth :— W. S. E. N. Whole Borough 4 5 7 8 3 6 1 2 Registered births returned as illegitimate 16 16 18 59 25 374 6 9 187 * Includes the Homes of Hope, Regent Square. + Includes the Workhouse. Of the 5,225 births to parishioners within and without the Borough 230, or 4.40 per cent., were registered as illegitimate. This is the figure which is to be taken as representing the proportion of illegitimate births in the St. Pancras population. The Notification of Births Act, 1907. Notifications were received during the year of 4,674 births, or 94.5 per cent, of the total births occurring in the Borough. In the following table the total births notified and registered in the Borough are classified according to the Registration Sub-Districts and Wards in which the births took place. W. S. E. N. Whole Borough 4 5 7 8 3 6 1 2 Total Births (excluding stillbirths) registered 633 706 263 676 787 632 660 558 4945 Births (includingstill-births) notified 569 609 371* 554 747 689 * 594 541 4674 Still-births notified 20 17 36 14 15 17 21 14 154 * The excess of notified over registered births in Wards 6 and 7 is due to the nonredistribution of births in institutions in the notification figures. 16 In the tables below the notified births are also classified (in Registration SubDistricts and Wards) according to the person notifying the birth, and according to the person in attendance upon the mother in her confinement. Births. W. S. E. N. Total 4 5 7 8 3 6 1 2 Notified by—Fathers 198 172 11 58 305 159 337 231 1471 Mothers 7 — — 1 7 4 7 5 31 Others persons 71 183 117 196 93 107 68 60 895 Medical Students 84 156 5 72 126 256 1 8 708 Midwives 169 50 25 112 129 25 150 186 846 Doctors 40 45 13 81 82 43 25 46 375 from Workhouse — — — — — 90 — — 90 Homes of Hope — — — 31 — — — — 31 University College Hospital — — 200 — — — — — 200 Not stated — 3 — 3 5 5 6 5 27 569 609 371 554 747 689 594 541 4674 4 5 7 8 3 6 1 2 Total Attended in their own homes by— Private Doctors 213 150 35 140 324 71 327 195 1455 Private Midwives 201 31 8 60 130 10 259 312 1011 Doctors from New Hospital for Women 18 10 1 21 35 32 4 14 135 Medical Students from— University College Hospital 132 294 4 2 227 467 3 14 1143 „ Middlesex Hospital — 67 89 3 1 3 — — 163 Royal Free Hospital — — — 56 1 — — — 57 „ St. Bartholomew's Hospital — — — 10 — — — — 10 Midwives from— University College Hospital 1 34 32 191 — 4 — — 262 „ Maternity Nursing Association, Myddleton Square 1 37 38 ,, Maternity Nursing Association, Oakley Square Branch 4 22 3 — 27 10 1 6 73 569 608 173 520 745 597 594 541 4347 Attended in Institutions— University College Hospital — — 198 — — — — — 198 Homes of Hope, Regent's Square — — — 31 — — — — 31 Lying-inWard of Workhouse — — — — — 90 — — 90 Other Institutions — 1 — 3 2 2 — — 8 569 609 371 554 747 689 594 541 4674 Certain of the notified births set out in the above table as having taken place in St. Pancras Institutions were of infants of mothers not resident in St. Pancras. On the other hand a number of St. Pancras mothers were confined in Institutions outside the Borough. In the following table is given the number of births of infants (including still-births) of mothers resident in St. 17 Pancras which took place in London Institutions during 1914. The information as to St. Pancras births in outlying Institutions has been obtained mainly from weekly returns supplied by the London County Council. Institution where birth took place. Notified births. Queen Charlotte's Lying-in Hospital 189 University College Hospital 141 Middlesex Hospital 137 City of London Lying-in Hospital 80 St. Pancras Workhouse 77 St. Bartholomew's Hospital 11 Other Institutions 8 643 DEATHS. The number of deaths that were registered during the year as having taken place in the Borough was 3,386. Of these 721 were of persons whose residence was not in St. Pancras (nonparishioners), 652 dying in St. Pancras Institutions, and 69 in other places in the Borough. There were also reported by the Registrar-General 625 deaths of St. Pancras parishioners who died in institutions in other parts of the County of London, and 52 who died in other parts of England and Wales. This correction gives the net number of deaths for St. Pancras registered during the year as 3342 making an annual death-rate of 15.3 per 1000 population. As compared with England and Wales for sex and age distribution, the factor of correction for St. Pancras is 0 0971, which makes the death-rate so corrected 15.2 per 1000 of population per annum. The following table shows the number of deaths and death-rate for each of the four Registration Sub-Districts and eight Wards into which the Borough is divided, and also the corresponding rates in former years. In this table deaths in Public Institutions, whether within or without the Borough, are classified in the respective Sub-Districts and Wards of their previous residence :— 18 DISTRICTS. Estimated Population. West. South. East. North. No Addres*. Whole Borough. Rates for whole Borough calculated on the 1911 Census population (218387). County of London Death Rate. Ward Total. Ward Tolal. W ard Total. Ward Total. 4 5 7 8 3 6 1 2 Number of Deaths Registered lor the Year 1914 372 527 899 2S8 423 681 473 416 889 480 3291 802 71 3342 Death-rate per 1000 population 218387 14.1 16.5 14.2 15.6 15.0 13.6 18.3 15.4 13.5 14.7 13.9 — 15.3 Death.rate for the Year 1924 137088 17.8 18.1 18.3 1.5 — 17.4 16.5 ,, ,,1905 237149 l6.3 16.2 16.6 14.1 — 15.7 15.6 ,, ,, 1906 237149 15.8 16.1 16.9 14.5 — 15.8 15.8 ,, ,, 1907 237173 15.4 11.9 16.3 13.4 — 15. 0 15 .3 ,, „ 1908 237247 14.7 14.9 16.5 13.8 — 15.0 14.6 ,, ,, 1909 237247 15.6 14.4 16.0 13.3 — 14.8 16.1 15.0 ,, ,,1910 237247 11.3 12. 0 15.5 13.1 — 13.8 15.0 13.7 ,, ,,1911 237429 14.8 15.4 15.1 14.0 — 14.1 15.4 15.0 ,, ,, 1912 220353 14.5 14.7 15.2 12.9 — 14.3 14.4 13.6 ,, ,,1913 218387 14.9 15.0 15.3 14.8 — 15.0 15.0 14.2 ,, ,, 1914 218387 15.4 15.0 15.4 13.9 — 15.3 15.3 14.4 It will be seen that the death.rate for 1914 (15.3) was rather higher than that for 1913 (15.0) which was higher than that for 1912 (14.4). It is interesting to note that during these three years a closely parallel increase has taken place in the death.rate for London as a whole. The Wards are set out in the table below in order according to their death. rates. Ward Death.rate per 1000 population. Ward. Death.rate per 1000 population. 1 13.5 2 14.7 3 13.6 8 15.6 4 14.1 5 16.5 7 14.2 6 18.3 1,777 deaths occurred in Public Institutions in the Borough. These are tabulated in table 6 on page 126. Taking from these the number which were of non.parishioners (652), and adding the number of deaths of St. Pancras parishioners in Public Institutions outside the Borough (625 —both from the Registrar.General's figures), the number of St. Pancras deaths which took place in Public Institutions is shown to be 1,750 or 52.3 per cent, of the total deaths. 19 Thus, of the St. Pancras parishioners whose death took place during the year, more than one-half died in Public Institutions, Table 5 on page 125 shows the death-rates for 1914 of England and Wales, the County of London, the several Metropolitan Boroughs and the 30 largo towns with populations exceeding 125,000, It should be noted that the St, Pancras figures are shown in this table on the basis of the Registrar-General's estimate of the population which, as explained before, differs from the estimate made in this report. Causes of Death. The deaths are fully classified for causes and age periods in table 2 (pp. 119-122). The following table shows the deaths from infectious diseases aud certain other causes classified according to Wards and Registration Sub-Districts. DISEASES. West . South. East. North. No Address Whole Borough. W ard | Total. Ward Total. Ward Total. Ward Total. 4 5 7 8 3 6 [ 2 Enteric Fever 1 3 4 — — — — — — — — — — 4 Small-Pox — — — — — — — — — — — — — — Chicken-Pox — — — — — — — — — — — — — — Measles 7 3 10 1 9 10 8 13 21 4 8 12 — 53 Scarlet Fever 2 4 6 1 6 7 3 — 3 1 2 3 — 19 Whooping Cough 3 8 11 — 1 1 3 13 16 10 11 21 — 49 Diphtheria and Croup 4 5 9 — 5 5 7 3 10 2 4 6 — 30 Puerperal Fever — 2 2 1 — 1 — — 4 — — — — 7 Influenza 3 2 5 1 3 4 2 — 2 3 1 4 — 15 Erysipelas 2 2 4 — — — 2 1 3 2 — 2 — 9 Tuberculosis, Pulmonary 41 78 119 32 60 92 38 41 79 41 24 65 10 365 ,, Other Forms 11 10 21 3 9 12 13 10 23 2 8 10 1 67 Cancer, Malignant Disease 34 34 68 27 30 57 47 27 74 40 22 62 6 267 Rheumatic Fever 1 1 2 — 1 1 3 1 4 2 1 3 — 10 Heart Disease 34 52 86 28 38 66 49 35 84 43 33 76 7 310 Bronchitis, Pneumonia & Pleurisy 40 93 142 36 76 112 87 84 171 80 50 130 11 566 Diarrhoea an Enteritis 18 16 34 6 13 19 15 28 43 23 23 46 — 142 Injuries 18 20 38 17 21 38 19 20 39 20 12 32 3 150 20 ages at death, The next table shows the deaths for the year classified acoording to ages and to Wards and Registration Sub-Districts, AGES AND RATES. West. South. East. North. No address. Whole Borough. Ward Total. Ward Total. Ward Total. Ward Total. 4 5 7 8 3 6 1 2 Under 1 year (infants) 61 82 143 24 48 72 63 81 144 60 58 118 4 481 1 and under 5 22 39 61 11 31 12 43 57 100 32 31 63 — 266 5 and under 10 8 8 16 2 8 10 8 13 21 9 12 21 — 68 10 and under 15 6 7 3 5 6 11 8 5 13 8 4 12 — 49 15 and under 25 22 23 45 11 13 24 19 17 36 13 11 24 1 130 25 and under 35 24 34 58 18 21 39 20 24 44 26 20 46 6 193 35 and under 45 37 51 88 22 61 83 46 39 85 41 23 64 7 327 45 and under 55 41 65 106 36 47 83 54 44 98 56 33 89 9 385 55 and under 65 50 83 133 45 51 96 65 53 118 75 39 114 9 470 65 and under 75 45 68 113 43 74 117 64 50 114 85 47 132 22 498 75 and upwards 56 67 123 41 63 104 83 33 116 75 44 119 13 475 Total Deaths at all Ages 372 527 899 258 423 681 473 416 889 480 322 802 71 3342 The table below is constructed to show what percentage of total deaths is furnished by these age groups :— Ages. Percentage of deaths at all Ages. West. South. East. North. No Address. . Whole Borough. Ward. Total. Ward. Total. Ward. Total. Ward. Total- 4 5 7 8 3 6 1 2 Under 1 year 16.4 15.6 15.9 9.3 11.3 10. 6 13. 3 19.5 16.2 12.5 18.0 14.7 5.6 14.4 1 and under 5 5.9 7.4 6.8 4.3 7.3 6.1 9 1 13.7 11.2 6.7 9.6 7.9 — 7.9 5 „ 10 2.2 1.5 18 0.8 1.9 1.5 1.7 31 7.4 1.9 3.7 2.6 — 2.0 10 „ 16 1.6 1.8 1.4 1.9 1 4 1.6 17 12 1.5 1.7 1.2 1.5 — 1.5 15 „ 35 5 9 4.4 5.0 4.3 3.1 3.5 40 41 4.1 2.7 3.4 3.0 1.4 3.9 35 ,, 35 6.5 6.5 6 4 7.0 5.0 5.7 4.2 5.8 4.9 5.4 6'2 5.7 8.5 5.8 35 „ 45 9.9 9.7 9 8 8.5 14.4 12 2 9.7 9.4 9.6 8.5 7.2 8.0 9.8 9.8 45 „ 55 11.0 12.2 11.8 13.9 11.1 12.2 11.4 10.6 11.0 11.7 10.3 11.1 12.7 11.5 55 ,, 65 13.4 15.8 14.8 17.4 12.1 14.1 13.8 12.7 13.3 15.6 12.1 14.2 12.7 14.1 65 „ 75 12.1 12.9 12.6 16.7 17.5 17.2 13.5 12.0 12.8 17.7 14.6 16.5 31.0 14.9 75 and upwards 15.1 12. 7 13.7 15.9 14.9 15.3 17.6 7.9 13.0 15.6 13.7 14.8 18.3 14.2 21 In the following table is shown the death-rate for the whole Borough for each of the age periods per 1000 population living at each period:— (Based on the figures of the 1911 Census.) Ages. Population. Death-rate. Under 1 year 4755 101.1 1 and under 5 16,995 15.6 5 „ 10 19,475 3.5 10 „ 15 18,073 2.7 15 „ 25 40,000 3.2 25 „ 35 40,584 4.7 35 „ 45 30,853 10.6 45,, 55 22,493 17.1 55 ,, 65 14,448 32.5 65 ,, 77 7,830 63.6 75 and upwards 2,881 164.8 218,387 15.3 Mortality ok Soldiers and Sailors. After the outbreak of war in August only four deaths of men in the naval and military forces were reported as having occurred in St. Pancras during 1914, and none of these were resident in the borough. Seven such deaths of St. Pancras residents took place during the year in parts of the country outside the borough, and have been counted in St. Pancras. Of the 11 deaths, 6 were from bullet-wounds, 3 accidental, and 2 from natural causes. Infantile Mortality. 481 deaths of St. Pancras infants under one year of age took place during the year. This is equal to a rate of infantile mortality of 92 per 1,000 births. 22 The table required by the Local Government Board, showing the causes of deaths amongst these infants is set out below : — 1914. Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSE OF DEATH. Under 1 week. 1 —2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months thunder 6 months. 6 months under 9 months. 9 months & under 12 months. Total Deaths under 1 year. All causes Certified 89 22 26 17 154 101 102 60 64 481 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — 1 3 4 8 Scarlet Fever — — — — — — — — — — Whooping-Cough — — — — — 3 5 5 10 23 Diphtheria and Croup — — — — — — — 2 2 4 Erysipelas — — — — — — 1 1 — 2 Tuberculous Meningitis — — — — — — 2 1 — 3 Abdominal Tuberculosis — — — — — 1 — — 1 2 Other Tuberculous Diseases — — — — — — 1 2 — 3 Meningitis (not Tuberculous) — — — — — — 2 1 1 4 Convulsions 3 2 2 1 8 1 2 — — 11 Laryngitis — — — — — — — — — — Bronchitis — 5 4 1 10 19 16 14 17 76 Pneumonia (all forms) — 1 — — 1 2 5 4 4 16 Diarrhoea — — — — — 10 6 5 3 21 Enteritis — 1 1 1 3 24 29 15 11 82 Gastritis — — — — — — — — — — Syphilis — 1 2 5 8 4 1 1 1 15 Rickets — — — — — — 1 — — 1 Suffocation, overlying 3 1 3 — 7 7 4 — — 18 Injury at birth 2 — 1 — 3 — — — — 3 Atelectasis 4 — — — 4 1 — — — 5 Congenital Malformations 7 2 1 2 12 6 5 — — 23 Premature birth 61 6 4 2 73 7 4 — — 84 Atrophy, Debility and Marasmus 5 2 3 3 13 12 8 1 4 38 Other cases 4 1 5 2 12 4 9 5 6 36 Totals 89 22 26 17 154 101 102 60 64 481 Nett Births in the year legitimate illegitimate 1995 N 230 Nett Deaths in the year of legitimate infants illegitimate infants 421 57 23 The next table shows the number of deaths of infants and the rates of infantile mortality for the several Wards and Registration Sub-Districts for the past 9 years :— NFANT1LE Mortaltiy West. south. East north. No Address Whole Borough. County of London. War d Total. Ward Total. Ward Total. W ard Total. 4 5 7 8 3 6 I 2 Deaths of Infants under 1 year of age 61 82 143 24 48 72 64 80 144 60 58 118 4 481 — nfantile Mortality rate per 1000 births 91 110 101 84 67 72 77 116 94 85 99 91 — 92 — Lnfantile Mortality rate for year 1905 130 165 139 116 136 130 ,, ,, 1906 131 148 130 119 — 131 131 ,, ,,1907 107 144 130 84 — 114 116 „ ,, 1908 126 128 115 94 — 115 113 ,, ,, 1909 125 127 99 90 — 109 108 ,, „ 1910 108 108 128 85 — 103 103 ,, ,, 1911 132 94 113 107 — 112 129 ,, ,, 1912 96 83 95 76 — 88 91 ,, ,, 1913 101 102 93 80 — 93 105 ,, ,, 1914 101 72 94 91 — 92 104 An examination of this table shows some interesting results. It will be seen in the first place that there has been a considerable reduction in the St. Pancras infantile death-rate during recent years. The average rate for the five years 1905-1909 was 121, while that for the five years 1910-1914 was 99, a reduction of 18 per cent. For the same periods the corresponding rates for the County of London were 120 and 106, a reduction of 12 per cent. The reduction has therefore been greater in St. Pancras than in London as a whole, and this is also illustrated by the fact that for the quinquennium 1905-1909 the St. Pancras rate (121) was slightly higher than that of London (119), while in the quinquennium 1910-1914 the St. Pancras rate (99) was distinctly lower than that of London (106). No similar improvement in the position of St. Pancras as compared with that of the County of London has taken place in regard to the general deathrate (see table on page 18). Indeed, while for the quinquennium 1905-1909 the average death-rates were the same for the borough and for London, for the years 1910-1914 the St. Pancras death-rate was in excess of that of London. 24 There is no doubt that during the past 10 years the subject of infant welfare has received more attention in St. Pancras (both from this department and from voluntary agencies) than any other phase of public health; and it is encouraging to find that the special campaign has been accompanied by this marked change in the infantile mortality rate. There remains still much work to be done, as the present infant mortality rate is not less than double that which would prevail under ideal conditions. The actual work that is being done in regard to this subject is described elsewhere in this report (pages 34-43). The infantile mortality occurring during the whole year per 1,000 births is classified in the following table according to the quarter of the year in which the deaths took place, and the corresponding figures are given for each of the past 9 years :— infantile mortality. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. Whole Year. Infantile Mortality rate per 1000 births for year 1905 130 96 175 139 135.7 ,, ,, 1906 128 103 172 121 131 .7 ,, ,, 1907 109 122 102 123 113.8 ,, ,, 1908 129 91 116 130 115.0 ,, ,, 1909 118 87 106 125 108.8 ,, „ 1910 94 103 95 143 107.8 ,, ,,1911 100 82 178 126 121.3(112.1)* ,, ,, 1912 105 82 87 102 94. 3 ( 88.0)* ,, ,, 1913 97 72 105 121 99.1 ( 92*8) * ,, ,,1914 105 66 102 111 95.9 ( 92.1)* * The figures in backets are corrected for outward and inward transfers. This additional information was supplied by the Registrar-General for the first time for the year 1911. 25 The table below shows the total infantile mortality and that from congenital, intestinal, pulmonary and certain zymotic causes, during a series of 9 years contrasted with certain meteorological records taken at Camden Square, N.W., indicating the severity of the summers as regards heat and dryness and the severity of the winters as regards coldness : — Year. Maximum monthly earth temperature taken at Camden Sq. at 4 ft. 0 in. depth. Rainfall (luring the third quarter. Inches. Lowest mean weekly temperature recorded duriug the year. Rate of Infantile Mortality. Deaths under one year of age. Injury at Birth, Atelectasis, Congenital Malformations, Premature Birth, Atrophy, Debility and Marasmus. Diarrhoea and Enteritis. Bronchitis 1 nil Pneumonia. Measles. Whooping Cough. 1905 60.8 5.65 27.8 135.7 251 159 144 15 29 1906 607 2.98 25.9 131.1 199 189 136 24 J8 1907 57.8 3.77 26.6 113.8 198 75 150 20 33 1908 59.8 8.15 26.5 115.0 221 94 129 11 31 1909 58.8 7.43 23.4 108.8 211 74 101 28 8 1910 58.2 6.08 28.4 107.8 213 52 106 42 40 1911 62.8 2.94 286 121.3 (112.1)* 204 168 105 17 16 1912 58.4 5.64 23.7 94.3 ( 83.o)* 175 32 70 13 21 1913 58.0 5.43 31.2 99 1 ( 92.'8)* 177 †95 114 10 12 1914 59.3 4.50 32.4 95.9 ( 92.1)* 153 100 92 8 23 * The figures in brackets are corrected figures (see Note above), † The figures prior to 1913 are for " Diarrhoea and Dysentery." It will be seen that the rate of infantile mortality has tended to vary in direct proportion to the 4 foot earth temperature, and (to a less extent) to the the amount of rainfall. The mortality in the latter years in the table is distinctly lower than in the earlier years with corresponding earth temperatures, and this is particularly noticeable in the case of 1914. It seems reasonable to ascribe this to a betterment in the conditions under which the infant population lives. No connection between infant mortality from bronchitis and pneumonia and cold weather can be deduced from the table. Table 5 on page 125 shows the infantile mortality rates for 1914 of England and Wales, the County of London, the several Metropolitan Boroughs, and the 30 large towns with a population exceeding 125,000. 26 INFECTIOUS DISEASES. The number of cases of the compulsorily notifiable infectious diseases that have been notified during 1914 is shown in the table below, where they are also classified according to ages. The figures have not been corrected for subsequent revisions of diagnosis. DISEASES. At all Ages. At Ages—Years. Under 1. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. I. Variola or Small-pox — — — — – — — — 2. Scarlatina or Scarlet Fever 1207 17 258 499 275 107 51 — 3. Diphtheria and Membianous Croup 458 10 115 188 61 51 33 — 4. Typhus Fever — — — — — — — — 5. Enteric or Typhoid Fever 44 — — 3 8 5 28 — 6. Fever, Simple or Continued 1 — — — — — 1 — Relapsing Fever — — — — — – — — 8. Puerperal Fever 18 — — — — 6 12 — 9. Erysipelas.. 223 8 6 7 11 21 150 20 10. Cholera — — — — _ – — — 11. Plague — — — — — — — — 12. Anthrax — — — — — – — — 13. Glanders — — — — — – — — 14. Hydrophobia — — — — — — — — 15. Ccrebro-Spinal Meningitis 2 — 2 — — — — — 16. Polio-Myelitis 3 1 — — — — — — 17, Ophthalmia Neonatorum 34 34 — — — — — — Total under Public Health (London) Act, 1891, Sec. 15 1990 70 382 698 355 190 275 20 Tuberculosis—Public Health (Tuberculosis) Regulations, 1912, Primary Notifications on Forms "A," "B," "C& D": Pulmonary 893 7 14 31 28 142 638 33 Do. other Forms 121 4 24 28 17 18 37 3 SAINT PANCRAS, LONDON. WEEKLY NUMBER OF CERTIFIED DEATHS FROM THE DANGEROUS INFECTIOUS DISEASES DURING THE YEAR 1914. Quarters First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Totals. Quarters. Months January February. March. April. May. June. July. August. September. October. November. December. Months. Week ending 10 17 24 31 7 14 21 28 7 14 21 28 April 4 11 18 25 May. 2 9 16 23 30 6 13 20 27 July 4 11 18 25 Aug. 1 8 15 22 29 5 12 19 26 Oct. 3 10 17 24 31 7 14 21 28 5 12 19 26 Jan. 2 .. Week ending. Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Number of Week. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small-pox. Scarlet Fever .. .. .. .. .. .. .. .. 1 .. 2 2 .. .. .. 1 .. 1 .. .. .. .. 1 1 .. .. .. .. .. 1 1 .. 1 1 1 1 .. .. .. .. .. .. .. .. 1 .. 1 .. .. 1 1 .. 19 Scarlet Fever. Diphtheria and Membranous Croup 2 .. 1 .. 1 1 1 .. 1 .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. 2 .. .. .. 2 1 .. .. .. .. .. 1 .. .. 3 1 1 1 1 1 2 .. 1 .. 1 .. 1 .. 2 30 Diphtheria and Membranous Croup. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Fever. Enteric Fever .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 Enteric Fever. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever. Puerperal Fever .. 1 .. .. .. 1 .. .. .. .. .. 2 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 7 Puerperal Fever. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera. Erysipelas .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 2 .. .. .. .. .. 1 .. .. .. 1 1 .. .. .. .. 1 .. .. 9 Erysipelas. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague. Cerebro-Spinal Meningitis .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Cerebro-Spinal Meningitis Polio- Myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Polio-Myelitis. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum. Totals 2 1 1 .. 1 4 2 1 2 .. 2 4 .. .. 1 1 .. 2 1 1 1 .. 1 3 .. .. .. 3 1 1 1 .. 1 3 2 2 1 3 1 2 1 1 1 3 2 1 1 1 .. 4 1 2 70 Totals. Tuberculosis (Pulmonary) 6 10 6 8 13 6 6 5 6 8 12 3 9 4 6 7 6 10 6 6 12 6 8 5 4 2 8 5 7 11 4 8 10 1 10 8 6 10 6 8 6 7 7 2 4 5 10 9 4 11 8 10 365 Tuberculosis (Pulmonary) „ other forms .. 1 2 1 1 2 2 1 2 1 2 1 .. 1 2 2 1 1 1 .. 2 1 1 2 2 .. 1 1 1 .. 2 .. 1 1 2 1 1 .. 2 .. 3 2 2 2 1 2 1 2 2 3 2 67 „ other forms Measles .. .. .. .. .. .. .. .. .. .. 1 1 1 1 1 .. .. .. 3 .. 1 2 .. 1 2 1 1 .. .. .. .. 1 1 .. 1 .. 2 2 1 2 4 .. 1 3 1 3 2 5 2 3 1 1 52 Measles. Whooping Cough .. .. 1 2 1 2 1 2 2 3 4 4 4 2 1 2 2 2 1 1 1 1 1 2 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 1 .. .. .. .. .. 1 .. 2 .. .. .. 49 Whooping Cough Diarrhœa and Enteritis .. .. 1 2 1 1 .. 1 .. 1 1 3 .. .. 2 2 1 1 1 .. 2 1 1 1 2 4 2 2 3 4 5 5 5 7 9 10 12 1.1 7 9 2 5 1 5 1 1 2 1 1 3 .. 1 143 Diarrhœa and Enteritis. SAINT PANCRAS, LONDON. WEEKLY NUMBER OF INFECTIOUS CASES CERTIFIED TO THE MEDICAL OFFICER OF HEALTH DURING THE YEAR 1914. Quarters First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Totals. Quarters. Months January February. March. April. May. June. July. August. September. October. November. December. Months. Week ending 10 17 24 31 7 14 21 28 7 14 21 28 April 4 11 18 25 May. 2 9 16 23 30 6 13 20 27 July 4 11 18 25 Aug. 1 8 15 22 29 5 12 19 26 Oct. 3 10 17 24 31 7 14 21 28 5 12 19 26 Jan. 2 .. Week ending. Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Number of Week. Small-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small-pox. Scarlet Fever 24 19 15 10 11 17 16 19 9 19 21 13 23 22 12 10 19 23 23 29 24 18 28 27 23 17 15 30 20 21 21 11 14 39 35 30 27 15 24 59 48 47 42 33 34 30 29 21 19 20 13 19 1207 Scarlet Fever. Diphtheria and Membranous Croup 4 6 7 14 8 8 10 12 8 11 4 7 4 5 7 5 1 4 7 4 2 4 10 14 14 11 7 11 6 9 9 6 6 8 5 10 6 13 16 17 17 12 16 9 12 17 11 9 10 6 11 8 458 Diphtheria and Membranous Croup. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Fever. Enteric Fever 1 2 1 2 1 .. 1 1 1 1 .. .. 1 2 1 1 1 1 1 1 2 .. 1 .. 1 1 2 .. 1 .. .. 3 .. .. .. 1 .. 1 .. 1 2 .. .. 1 .. 2 1 1 2 .. .. 1 44 Enteric Fever. Continued Fever 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Continued Fever. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever. Puerperal Fever .. .. .. .. 1 1 .. .. .. .. .. 1 1 .. .. 1 .. .. .. 1 .. 2 .. .. 3 .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. 1 1 .. .. .. 1 .. 1 .. .. 18 Puerperal Fever. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera. Erysipelas 8 5 4 8 7 1 3 3 5 2 4 6 5 2 3 3 5 .. 4 1 4 5 4 3 4 3 3 5 5 3 4 5 9 5 6 6 3 4 4 3 6 6 10 4 4 2 7 7 1 3 4 2 223 Erysipelas. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague Cerebro-Spinal Meningitis .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Cerebro-Spinal Meningitis Polio-Myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Polio-Myelitis. Ophthalmia Neonatorum 1 .. .. .. .. .. 3 1 .. .. 1 .. 2 .. .. 2 1 .. 1 .. .. .. 1 2 .. 1 .. 1 1 .. 1 1 1 .. .. .. .. .. 1 1 1 .. 1 .. 3 .. 1 .. 1 2 .. 2 34 Ophthalmia Neonatorum. Totals 39 32 27 34 28 27 34 36 23 33 31 27 36 31 23 22 27 28 36 36 32 29 44 47 45 33 27 47 33 33 35 26 30 53 46 48 37 33 47 81 74 65 70 48 53 51 49 39 33 32 28 32 1990 Totals. 407 433 495 655 27 In the accompanying tables (inset) are shown the number of notifications of the notifiable infectious diseases received in each week of the year, and also the corresponding weekly numbers of deaths from these and certain other diseases. In the next table the number of notifications are set out for the past ten years. Diseases. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 Small-pox 3 – – – – – – – – – – Scarlet Fever 840 987 791 851 957 774 681 445 598 568 1207 Diphtheria 332 278 271 337 292 3'2 259 416 550 440 458 Membranous Croup 7 4 4 8 4 3 3 3 — — — Typhus Fever – – – – – – – – – – – Enteric Fever 135 72 96 54 60 50 61 66 29 4??? 44 Fever, Simple and Continued — 1 — 1 — — — — — 1 1 Relapsing Fever – – – – – – – – – – – Puerperal Fever 9 10 10 4 8 15 14 16 20 11 18 Erysipelas 251 228 231 188 156 160 186 201 190 210 223 Cholera — — — — — — 1 — — — — Plague – – – – – – – – – – – Chicken-pox (part of year) 407 .. .. .. .. .. .. 198 .. .. .. Cerebro-Spinal Meningitis .. .. .. 5 5 6 10 7 3 5 2 Polio-Myelitis .. .. .. .. .. .. .. 2 3 9 3 Ophthalmia Neonatorum .. .. .. .. .. .. .. 26 18 23 34 Totals 1984 1580 1403 1448 1482 1320 1215 1380 1411 1308 1990 28 The notifications of and deaths from the notifiable infectious diseases are classified in the following table according to Registration Sub-Districts:— INFECTIOUS DISEASES. Notifications. Deaths. West. Ward South. Ward East. Ward North. Ward No Address. Whole Borough. West. Ward South. Ward East. Ward North. Ward No Address. Whole Borough. 4 5 7 8 3 6 1 2 4 5 7 8 3 6 1 2 1. Variola or Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2. Scarlatina or Scarlet Fever 161 146 65 155 202 147 147 184 .. 1207 2 3 2 6 3 .. 1 2 .. 19 3. Diphtheria and Membranous Croup 54 81 34 39 57 46 87 60 .. 458 3 5 .. 5 7 3 3 4 .. 30 4. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5. Entericor Typhoid Fever 5 16 2 1 5 2 9 4 .. 44 1 3 .. .. .. .. .. .. .. 4 6. Fever, Simple and Continued .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 7. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8. Puerperal Fever 1 2 1 1 .. 4 7 2 .. 18 1 2 1 .. .. 3 .. .. .. 7 9. Erysipelas 17 28 16 31 39 31 30 30 1 223 2 2 .. .. 2 1 2 .. .. 9 10. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 12. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 13. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15. Cerebro-Spinal Meningitis .. .. .. .. .. 1 .. 1 .. 2 .. .. .. .. .. 1 .. .. .. 1 16. Polio-Myelitis .. .. 1 1 .. .. .. 1 .. 3 .. .. .. .. .. .. .. .. .. .. 17. Ophthalmia Neonatorum 5 2 1 9 8 2 2 5 .. 34 .. .. .. .. .. .. .. .. .. .. Total under Public Health (London) Act, 1891, Section 55 243 276 120 237 311 230 282 287 1 1990 9 15 3 11 12 8 6 6 .. 70 Tuberculosis primary notifications— Public Health (Tuberculosis) Regulations 1912, Articles 5 and 6, Forms "A" "B " "C " and " D"; ,, Pulmonary 110 138 86 112 118 95 97 83 54 893 41 78 32 60 38 41 41 24 10 365 „ other forms 17 19 10 9 16 16 21 10 3 121 11 10 3 9 13 10 2 8 1 67 29 In the following table is shown the number of cases of infectious diseases notified during 1914 in the several Metropolitan Cities and Boroughs, and in the County of London:— Boroughs. Estimated Population in the middle of 1914. (Revised Estimates). Total Cases. Enteric Fever. Typhus. Continued Fever. Small-pox. Scarlet Fever. Diphtheria (including Membranous Croup). Cholera. Erysipelas. Cerebro-Spinal Fever. Puerperal Fever. Anthrax. Glanders. Ophthalmia Neonatorum. Poliomyelitis. WEST. Paddington 142,103 1255 10 ... 2 ... 743 295 ... 140 1 10 ... ... 51 3 Kensington 171,234 1379 11 ... 2 ... 962 200 ... 165 2 6 ... ... 31 ... Hammersmith 123,853 1313 14 ... ... ... 977 179 ... 102 2 7 ... ... 31 1 Fulham 157,303 1580 40 ... 1 ... 1043 271 ... 152 1 33 ... ... 39 ... Chelsea 64,511 417 23 1 1 ... 272 74 ... 34 1 8 ... ... 3 ... City of Westminster 154,514 1223 49 ... 2 1 844 186 ... 111 1 10 ... ... 18 1 North. St. Marylebone 114,355 808 37 ... ... ... 434 235 ... 67 1 9 ... ... 25 ... Hampstead 86,388 596 17 ... ... ... 281 231 ... 45 ... 7 ... ... 12 3 St. Pancras 214,133 1990 44 ... 1 ... 1207 458 ... 223 2 18 ... ... 34 3 Islington 325, 496 3016 75 ... ... ... 1851 661 ... 335 7 25 ... ... 54 8 Stoke Newington 50,511 429 4 ... ... ... 264 98 ... 49 ... 3 ... ... 11 ... Hackney 223,393 1699 28 ... 3 ... 8U6 495 ... 296 3 17 2 ... 44 5 Central. Holborn 46,832 282 15 ... ... ... 171 64 ... 22 ... 4 ... ... 6 ... Finsbury 84,521 801 19 ... ... ... 449 145 ... 157 3 11 ... ... 16 1 City of London 17,831 137 5 ... ... 1 85 31 ... 10 ... ... ... ... 5 ... East. Shoreditch 109,569 899 19 ... 1 ... 424 221 ... 198 3 13 1 ... 18 1 Bethnal Green 127,807 1402 18 ... ... ... 654 376 ... 305 2 9 ... ... 31 7 Stepney ... 275,081 3537 47 ... ... ... 2089 885 ... 403 4 33 ... ... 19 27 Poplar 160,839 1384 34 ... ... ... 663 353 ... 222 9 23 2 ... 71 8 South. Southwark 188,321 2248 24 ... ... ... 1447 340 ... 325 6 29 4 ... 69 4 Bermondsey 124,683 960 8 ... ... ... 581 216 ... 123 5 5 1 ... 20 1 Lambeth 297,094 2706 50 ... 3 ... 1754 560 ... 237 5 23 ... ... 63 10 Battersea 167,451 1502 21 ... ... ... 996 267 ... 156 1 13 ... ... 47 1 Wandsworth 331,321 2319 47 ... ... ... 1410 637 ... 238 3 31 1 ... 50 2 Camberwell 261.828 2371 29 ... 1 ... 1541 458 ... 270 4 24 ... ... 39 5 Deptford ... 109,269 1370 9 ... ... ... 863 259 ... 229 ... 5 ... ... 11 1 Greenwich 96,018 915 10 ... ... ... 552 243 ... 123 4 3 ... ... 9 ... Lewisham 169,211 1563 51 ... ... ... 955 406 ... 129 ... 7 ... ... 14 1 Woolwich 122,431 1218 15 ... ... ... 693 387 ... 101 1 7 ... ... 14 ... Port of London ? 15 6 ... ... 1 4 1 ... 2 1 ... ... ... ... ... Administrative County of London 4,518,021 41,364 779 l 18 3 25,015 9,125 ... 4969 72 393 11 ... 885 93 30 Below is given the number of advices received from the London Count Council Schools respecting the exclusion from school of children (patients, contacts, and suspects) on account of infectious conditions:— School Notification of Exclusion. Patients, contacts and suspects. Actual cases. Notifiable Infectious Diseases 2239 Tuberculosis 2 Measles 1812 922 Whooping Cough 635 544 Chicken-pox 759 465 Mumps 885 831 Other Definite Diseases 155 132 Suspicious Symptoms 195 195 Ringworm 247 231 Impetigo, &c. 113 106 Scabies 41 35 Pediculosis 4 4 7087 3465 31 PART II.—SPECIAL SUBJECTS. PREVENTION OF INFANT MORTALITY. The annual statistics in regard to deaths of infants under one year of age are given on pages 21 to 25 of this Report. The subject was brought into prominence during the year by a Circular and Memorandum on Maternity and Child Welfare, which the Local Government Board sent out in July. These are of great importance and are therefore set out in full below:— Circular County Councils and Sanitary Authorities. Local Government Board, Whitehall, S.W. 30th July, 1914. MATERNITY AND CHILD WELFARE. Sir, I am directed by the Local Government Board to state that an estimate has been laid before Parliament for a grant to be distributed by the Board in aid of the expenditure of local authorities and voluntary agencies in respect of institutions or other provision for maternity and child welfare. This grant, if voted by Parliament, will be made in aid of expenditure in respect of clinics, dispensaries or other institutions primarily concerned with the provision of medical and surgical advice and treatment, as well as in respect of the salaries of health visitors and other officers engaged for this work. The Local Government Board have in recent years devoted considerable attention to questions connected with infant welfare and they have observed with much satisfaction that efforts have been made by many local authorities and voluntary agencies, to deal with the matter. These efforts have undoubtedly helped to secure improved conditions for children and hare played an important part in the campaign for the reduction of infantile mortality. It is evident from the Reports issued by the Medical Department of the Board and those of many Medical Officers of Health that more extended and systematic measures than have hitherto been generally adopted are necessary, and it is hoped that the grant of assistance from the Exchequer will stimulate those local authorities who have not yet taken action to give the matter their earnest consideration and will encourage those already engaged in work to develop it still further. Up to the present local authorities, in their infant welfare work, have concerned themselves more especially with the child in its first year of life; the matter is, however, one which needs to be dealt with on a more comprehensive basis and it is clearly desirable that there should be continuity in dealing with the whole period from before birth until the time when the child is entered upon a school register, i.e., the register of a public elementary school, nursery school, creche, day nursery, school for mothers, or other school. Extension of the existing work is accordingly needed in two directions: on the one hand it is necessary that measures should be taken for securing improved ante-natal and natal conditions, and on the other, provision should be made for continuing the work in relation to children beyond the first year of life. 32 The accompanying memorandum, which has been prepared by the Board's Medical Officer with a view to assisting the formulation of schemes or extending the work already undertaken, sets forth in outline the matters needing consideration in the preparation of a comprehensive scheme. It will be seen that the memorandum contemplates that medical advice and, where necessary, treatment should be continuously and systematically available for expectant mothers and for children till they are entered on a school register, and that arrangements should be made for home visitation throughout this period. The work of home visitation is one to which the Board attach very great importance and in promoting schemes on the lines laid down in the accompanying statement the first step should be the appointment of an adequate staff of Health Visitors. It will be desirable, at all events in the case of the larger urban authorities, to provide consultation centres which may fitly be termed Maternity Centres, to which expectant mothers and mothers with infants and little children may be referred for advice and treatment; the operation of these Maternity Centres will be rendered most effective if co-operation is secured with the midwives of the district and with any local hospital having a maternity department. It will be necessary to arrange for a medical officer to be in charge of such a Centre and for the attendance at the Centre of members of the staff engaged in home visiting. Careful records, for which the medical officer should be responsible, will need to be kept, and in regard to children the records should be in such a form that they may subsequently be available for the information of the School Medical Officer when the child is entered at a school. For the rural and smaller urban areas the Board think it will generally be found desirable to develop a county organisation, but in all cases the county work should be intimately related with that of the local sanitary authority, and on the other hand any work separately undertaken by a sanitary authority should be co-ordinated with the county scheme. It is not expected that all local authorities will be able at once to initiate complete schemes but it is important that any partial arrangements that may be made shall be such as can ultimately form part of a more extended organisation. Subject to the estimate now before Parliament being accepted by Parliament, the Board will be willing to consider applications for grants in respect of any work falling within the scope of the scheme outlined in the memorandum accompanying this letter; the grants will normally amount to one-half the approved expenditure on any of these purposes, but may be less if the Board so decide. Grants to institutions of the nature of Schools for Mothers, the object of which is primarily educational, which provide training and instruction for mothers in the care and management of infants and little children, and which may include systematic classes, or home visiting, or infant consultations (the provision of specific medical and surgical advice and treatment, if any, being only incidental), will be administered by the Board of Education. Any case of doubt or difficulty will be investigated by a Joint Committee of Officers of the two Boards, which will include women Medical Officers. In sending a copy of this circular to voluntary agencies engaged in infant welfare work, the Board will state that applications for grants in respect of voluntary work may be made by a voluntary agency either directly or through a local authority. The grant now presented to Parliament will be appropriated in aid of the expenditure of the half-year ended 30th September, 1914, and applications for grants should be accompanied by an account of the work undertaken by the authority and by a detailed statement of the expenditure incurred, certified by the officer of the local authority in charge of the accounts. I am to add that the Board will be happy to afford advice and assistance to local authorities in the initiation of schemes or the extension of existing schemes. I am, Sir, Your obedient servant, The Clerk to the Council. H. C. Monro, Secretary. 33 MEMORANDUM. MATERNITY AND CHILD WELFARE. A complete scheme would comprise the following elements, each of which will in this connection, be organised in its direct bearing on infantile health. 1. Arrangements for the local supervision of Midwives. 2. Arrangements for— (1) An Ante-natal Clinic for expectant mothers. (2) The home visiting of expectant mothers. Ante-Natal (3) A Maternity Hospital or beds at a hospital, in which complicated cases of pregnancy can receive treatment. 3. Arrangements for— (1) Such assistance as may be needed to ensure the mother having skilled and prompt attendance during confinement at home. (2) The confinement of sick women, including women having contracted pelvis or suffering from any other condition involving danger to the mother or infant, at a hospital. Natal. 4. Arrangements for— (1) The treatment in a hospital of complications arising after parturition, whether in the mother or in the infant. (2) The provision of systematic advice and treatment for infants at a Baby Clinic or Infant Dispensary. (3) The continuance of these Clinics and Dispensaries, so as to be available for children up to the age when they are entered on a school register, i.e., the register of a Public Elementary School, Nursery School, Creche, Day Nurgery, School for Mothers or other School. (4) The systematic home visitation of infants and of children not on a school register as above defined. Local Government Board, Whitehall, S.W. July, 1914. In consequence of this Circular and Memorandum, a report on the subject from the Medical Officer of Health was asked for. This was presented to the Public Health Committee in April, 1915, and the following statement of the position in St. Pancras in regard to the matter is largely a reproduction of the report. Apart from the supervision of Midwives, which in London is in the hands not of the Borough Councils but of the County Council (thus splitting the local responsibility for maternity welfare), the model scheme of the Local Government Board includes :— (1) The home visiting of mothers and young children. Post-Natal. 34 (2) The provision where necessary of help for mothers at and about the time of their accouchement, either in their own homes or in institutions. (3) The provision of institutions where mothers and young children can obtain advice and treatment. These institutions are to be preventive as well as curative, and would fall under two headings:— (a) Resident hospitals (e.g., hospitals for sick children, and for diseases of pregnancy and the puerperium). (b) Consultations, etc., of the out-patient type (e.g., infant sultations, maternity centres, and clinics for sick children). The present position in St. l'ancras is detailed in the following section, which is divided into three parts on the lines of this classification. 1.—Home Visiting. Health Visitors.—At the present time only one health visitor is available for maternity and child welfare, and this lady has also other duties to perform. This only enables a small proportion of the five thousand births which are notified annually to be visited, and additional stuff is urgently required for this purpose.* In addition to the visits made by the Council's health visitor, a good deal of visiting is being done from the various infant welfare centres, both by trained workers paid by the institutions and by voluntary visitors. These visits are confined to mothers who are in attendance at the centres, and are therefore supplemental to the visits paid by the Council's health visitor. They do not abolish the need of at least one call by her at each case. Advice Cards.—A printed card of information and advice is sent by post from the Town Hall to every mother upon the receipt of notification of birth. Expectant Mothers. —Until recently no information as to expectant mothers was available, but now arrangements have been made whereby the Medical Officer of Health will be furnished periodically with lists of those women who have made arrangements for their accouchement with University College Hospital, Middlesex Hospital, the New Hospital for Women, and the Maternity Nursing Association. This will ensure ante-natal information in regard to more than one quarter of the births in the borough. Similar information from midwives and medical practitioners will be welcomed, but, at any rate, for a time is not likely to be available to any great extent. Now that we shall receive lists of expectant mothers an appropriate Advice Card will be prepared and arrangements made for a copy to be given to each expectant mother when she arranges with the hospitals or other institutions for attendance at her confinement. Good results are to be expected from this extension of our visiting and other work to the ante-natal period, and also from the work amongst expectant mothers which the various local centres are beginning, and which is mentioned in a later paragraph. Already the health visitor is calling upon as many expectant mothers as she can manage, and has been welcomed by them in a manner which augurs well for this kind of work. This, however, still further reduces the number of post-natal visits she is able to make. * The Council on 21st July, 1915, resolved to appoint additional staff 35 II.—The Assistance of Mothers at and about the time of their Accouchement. "Extern" Midwifery.—This problem is much modified in St. Pancras by the fact that a very large number of confinements are attended gratuitously in their own homes by charitable bodies. The number of births attended gratuitously during 1913 and 1914 in the homes of the patients was asfollows:— 1913. 1914. * New Hospital for Women (doctors) 113 135 University College Hospital (medical students) 999 1143 Do. do. (midwives) 235 262 Middlesex Hospital (medical students) 124 163 Royal Free Hospital (medical students) 54 57 St. Bartholomew's Hospital (medical students) 7 10 * Maternity Nursing Association, Myddleton Square and Oakley Square (midwives) 88 111 1620 1881 (or one-third of the total number of births). * (In some of these cases the women were charged reduced fees.) " Intern " Midwifery.—There are no hospitals in the borough used solely for lying-in, but a ward is available for this purpose at University College Hospital. This is not much used for ordinary cases, but more particularly for cases where difficult confinements are expected. More St. Pancras births take place in lying-in and general hospitals outside of the borough. The number of St. Pancras births notified as occurring in institutions during 1913 and 1914 (exclusively of the St. Pancras House—formerly the Workhouse,— where there were 87 births in 1913, and 77 in 1914), were as follows: — 1913. 1914. University College Hospital 117 141 Middlesex Hospital 127 137 Queen Charlotte's Lying-in Hospital 184 189 City of London Do. 51 80 British Do. (Endell Street) (Closed in May, 1913) 38 Other hospitals 17 19 534 566 (or over one-tenth of the total number of births). There is no doubt that in St. Pancras many births take place in rooms and houses and under conditions which are quite unsuitable; and that a greater use of hospitals for the purpose is desirable. There is not at present,, however, any great demand for further provision in this direction, and no immediate action in regard to it was suggested in the report of the Medical Officer of Health referred to above. It is probable, however, partly as a result of the establishment of maternity centres, that such a demand will' arise. It may be mentioned that the Royal Free Hospital are at present arranging for beds to be provided for this purpose. 36 In view of the fact that over 40 per cent. of all St. Pancras births are attended gratuitously either in their own homes or in institutions, no immediate action appears to be necessary in the direction of the further provision of free attendance by doctors or midwives. In the extreme north of the borough, free attendance by medical students is not available, but it is probable that in the near future one or other of the teaching hospitals will extend their work to this part of the borough. Attendance by a doctor or midwife at the confinement is not all that is required at such times by the poorer part of the St. Pancras population. A good deal of unnecessary suffering is caused by the lack of suitably trained women to look after the mother and her sick room on the one hand, and the rest of the household on the other, during the time of lying-in. The women who assist the medical or other attendant at the actual birth are in many cases totally unsuited for the duty. It would be a great advance if a sufficient number of women could be trained to act as " monthly nurses " to second the work of doctors, students and midwives amongst these classes who are unable to afford the services of the modern " trained nurse." The St. Pancras Local Representative Committee (for the relief of distress arising from the war) has undertaken work in this direction by the training and paying of certain women as "home helps." These women, of whom there are now 24, are paid 10s. a week and are trained and sent (gratuitously) to give help in time of sickness in the homes of the poor, relief thus being provided for the " home helps " themselves and for the people to whom they are sent. Miss Bibby, the lady sanitary inspector, has been largely concerned with the institution of this scheme. It is very much to be hoped that The sub-committee doing this emergency work will later become the nucleus -of a local body undertaking such work on a larger scale, and under a scheme whereby the patients will pay according to their means for the services rendered. A scheme on such lines is at present at work in Whitechapel. III.—Institutions for advice and Treatment. (a) In-patient Hospitals.—Beds are available at University College Hospital and the New Hospital for Women for diseases of pregnancy and the puerperium, and the Royal Free Hospital are shortly opening beds for this purpose. There is similar accommodation in other hospitals lying near to but outside St. Pancras. In many cases " hospital letters " have to be obtained from subscribers before patients can obtain admission to these institutions, and it is to be hoped that if grants are made to them by the Local Government. Board under the Board's Maternity and Child Welfare scheme, it will be made a condition that the need for " hospital letters" in these cases be abolished. There are also beds available for sick children under school age in the hospitals in the Borough (University College and Royal Free), and in the neighbourhood of the Borough (Hospital for Sick Children, Great Ormond Street, and others). " Hospital letters " are likewise required at most of these hospitals, and should be abolished in the event of grants being made to the Institutions. 37 (b) Maternity and Child Welfare Centres.—There are now several such centresin St. Pancras supported by voluntary funds and worked in co-operation with the Public Health Department. Most of them maintain Infant Consultations to which the mothers are encouraged to bring their infants periodically for examination until they reach school age. At these consultations the infants are weighed and seen by the doctor in attendance, and the mother receives advice from the doctor and the superintendent (who is generally a trained nurse) as to the nurture of the child. If necessary, minor ailments of the children are also treated. The consultations are followed up by visits paid to the homes by the Superintendent or by voluntary workers. This important work is supplemented in certain cases by classes for the mothers in such subjects as domestic hygiene,, cookery, needlework, etc., and by the provision of cheap dinners for those nursing mothers who are in need of them. A more recent development is the Maternity Centre, which in its simplest form is a place where expectant mothers are welcomed to receive practical advice as to the hygiene of pregnancy and infancy, and the preparations to be made for confinement. The mothers are also interviewed by a doctor and advised as to treatment. Some of the St. Pancras centres now undertake this work. The existing Maternity and Child Welfare Centres in St. Pancras at the end of 1914 were seven in number. Since then three more centres have been opened, so that at time of writing they number ten. They are set out be'ow with brief details of their work: — The St. Pancras School for Mothers, 1, Ampthill Square, Hampstead Road, N. W. Three consultations a week, two for infants and one for expectant mothers. Classes in domestic subjects. Day nursery for infants. Cheap dinners for mothers and young children. Home visiting by paid and voluntary visitors. Premises are a detached house rented exclusively by the Institution. The North St. Pancras School for Mothers, 4, Rhyl Street, Kentish Town, N.W. The. North St. Pancras School for Mothers (branch), Winscombe Street, Highgate New Town, N.W. Infant consultations twice a week at the former, and once a week at the latter. Consultation for expectant mothers once a week recently started at Rhyl Street. Home visiting by paid and voluntary workers. Premises lent by the London Domestic Mission and the People's Gospel Mission respectively. Mothers in need are referred to the Kentish Town Dining Room for Mothers, Lyndhurst Hall, Warden Road, N.W., and to the Invalid Kitchen, 23, Maiden Crescent, where cheap dinners are provided. The Passmore Edwards' Settlement School for Mothers, Tavistock Place, W.C. Infant consultations once a week. Consultations for expectant mothers to be started shortly. Premises lent by the Passmore Edwards' Settlement. The work here is amongst the Holborn population as well as that of St. Pancras. 38 The Camden Town Mothers and Infants Wtlfare Centre, Greenland Street, N.W. This centre was started on 20th April, 1915, in rooms in the St. Michael's Mission Buildings. Consultations for infants and expectant mothers once a week. The Highgate Road Maternity Centre, 5, Grove Terrace, Highgate Road, N.W. Started in November, 1914, in rooms lent by the St. Michael's Nursery College (Mrs. Bernard Mole). Open once a week, when expectant mothers are interviewed by the doctor, and, if necessary, examined and advised. Mothers in need are referred to the Invalid Kitchen, Maiden Crescent, and the Kentish Town Dining Rooms for Mothers. The Mothers' and Infants' Welcome, 40, Argyle Square, King's Cross, W.C. This centre was started in a house of its own on 13th May, 1915. It is open every day in the week and has a weekly consultation for nursing and expectant mothers. The Maternity Nursing Association, 73, Oakley Square, W.C. This as-ociation added to its maternity work on 21st March, 1915, a consultation for nursing and expectant mothers which is to be held weekly. University College Hospital, Gotcer Street, W.C. Medical students and midwives from this hospital attend gratuitously about one-quarter of the births in the borough. An obstetric physician sits once a week for the purpose of interviewing, and, if necessary, examining, advising, and treating the expectant mothers, and an infant consultation is held weekly at the hospital. There is a Samaritan Fund from which needy mothers are assisted. This hospital attending as it does such large numbers of births has a magnificent opportunity for maternity and infant welfare work. The Royal Free Hospital, Gray's Inn Road, W.C. Has a scheme in preparation for maternity and infant welfare work on a large scale, including maternity consultations, beds for lying-in, and for illness of pregnancy, &c., operation rooms, infant consultations and home visiting. The scheme is already in partial operation. These ten centres are so arranged that with a few exceptions there is no part of the borough more than half a mile from a centre. All the Infant Consultations above-mentioned give treatment for minor illnesses of young children, but not for more severe cases. For the latter, in 39 addition to the outpatients' departments at University College Hospital, the Royal Free Hospital, and the Hospital for Sick Children, Great Ormond Street, and other hospitals near the borough, a special Children's Clinic is held once a week at the St. Pancras Dispensary, 39, Oakley Square. This is for sick infants sent from Infant Consultations, and other institutions (such as nursery schools and creches) which make a small subscription to the dispensary on account of this. In the event of contributions being made by the Government towards these out-patient departments for sick infants, it is desirable that the " hospital letter" system should be abolished in respect of them. Grants of Public Money. The Local Government Board in their circular (see pages 31 and 32) state that " the Board will be willing to consider applications for grants in " respect of any work falling within the scope of the scheme outlined in the " memorandum accompanying this letter : the grants will normally amount to " one-half the approved expenditure on any of these purposes, but may be less " if the Board so decide." The Board of Education in their Regulations (1914) for the Payment of Grants to Schools for Mothers state that they will make grants to these institutions, and it doss not yet appear to be definitely settled what is the exact relationship of the two Boards in regard to this matter. Considerable delay in the making of grants to the " Centres " in the borough has arisen from this. Grants have been made by the Government, as follows:— To the St. Pancras School for Mothers, 1, Ampthill Square. A grant of £310 has been made by the Board of Education for the year ended March 1914, being one-half of the expenditure in respect of which grants are available. Application has been made for future grants to the Local Government Board and the Board of Education. The expenditure of this institution for the six months ended 30th September, 1914, was £363, including £70 for rent, rates, taxes, and insurance, and £189 for salaries and wages (certain expenses in connection with dinners for mothers and for children in the day nursery are omitted from this total). To the North St. Pancras School for Mothers, 4, Rhyl Street. A grant of £64 has been made by the Local Government Board for the half-year ended 30th September, 1914, being one-half of the expenditure in respect of which grants are available. One of the conditions of the grant is " that the work of the Institu" tion shall be co-ordinated as far as practicable with any " scheme instituted by the Local Authority on the lines " indicated in the Board's circular and Memorandum of the " 30th July, 1914." The expenditure of this institution for the six months ended 30th September, 1914, was £111, including 40 £80 for salaries and making no allowance for the hire of roomsand cleansing, lighting, etc., which are allowed free. No grants have been made by the Borough Council. Applications have also been made to the Local Government Board for grants by the following institutions — The Paismore Edwards' Settlement School for Mothers. The expenditure of this institution for the year ended 30th September, 1914, was £63, including £48 for salaries and making no allowance for the hire of rooms and cleansing,, lighting, etc., which are allowed by the Settlement free. University College Hospital (for their large maternity practice as well as for their maternity and infant welfare consultations, etc.) The Royal Free Hospital (for their scheme as above described). The St Pancras Dispensary, 39, Oakley Square (for their infant clinic). The Maternity Nursing Association, 73, Oakley Square (for their maternity practice as well as for the maternity and infant welfare centre which they have established). All these applications are under discussion and appear to have been favourably received. Kentish Town Dining Room for Mothers, Lyndhurst Hall, Warden Read, N.W. (in respect of the provision of cheap dinners for needy expectant and nursing mothers). The Board have replied that grants are not available for the provision of food. Applications have been made to the Borough Council for assistance by the following institutions: — The St. Pancras School for Mothers, 1, Ampthill Square, N.W. The North St Pancras School for Mothers, 4, Rhyl Street, N.W., and Winscombe Street, N.W. These two bodies wrote to the Town Clerk on 5th September, 1914, and 18th September, 1914, respectively, asking for help either in the form of a money grant, or by means of the assistance of Borough health visitors. The Highgate Road Maternity Centre, 5, Grove Terrace, Highgate Road, N.W. The Women's Co-operative Guild wrote to the Town Clerk on 10th November, 1914, asking that the Council should take over this maternity centre. They estimated the yearly expense at £166, of which the Local Government Board would presumably pay half. A deputation of members of the Guild and others was received on 2nd December, 1914, by a Sub-Committee of the Health Committee, when they urged the same view. 41 In the past the work of reducing the amount of preventable illness and mortality amongst the infant population has been a definite function of the Council, and it is desirable from every point of view that the large extension of this work that is now going on should be intimately linked up with the Council's work which at present centres round the Notification of Births Act. For this reason it should be urged that grants made by government departments should be paid to the voluntary organizations through the Borough Council. This would enable the Council to secure a certain amount of control and thus act as the co-ordinating authority in the borough for maternity and infant welfare. In this connection it may here be stated (as reported in the Council's Minutes for 24th June, 1914) that at a Conference held at the St. Pancras Town Hall on 11th June, 1914, under the Chairmanship of the Mayor of St. Pancras (Councillor T. A. Collins, j.p.) when representatives of 16 Metropolitan City and Borough Councils were in attendance, a resolution was unanimously passed in the following terms:— " That in view of the fact that the work of Schools for Mothers and " Infant Consultations is intimately associated with that of local " sanitary authorities for the reduction of infantile mortality and " sickness under the Notification of Births Act, and otherwise, this " Conference of representatives of Metropolitan Borough Councils " is of the opinion that the proposed grants to these institutions " should be made by the Local Government Board, through the " local sanitary authorities." It would also be advantageous for the Council themselves to make grants in aid of the more needy of these voluntary centres which are carrying out public health functions which in many districts are performed entirely at the cost of the Local Authority. Such grants will still further enable the Council to exercise the control necessary for the perfection of a well co-ordinated scheme. Assistance, however, is already given by the Council in the form of help rendered by its paid officers, and this can be extended if additional health visitors are appointed. The question of the Council's making of money grants to those Maternity and Infant Welfare Centres which are in need of support for the efficient performance of their work has been held over for the present until the Council is in possession of fuller information as to the amount and effect of the Government grants. An important question arises out of the Local Government Board's reply to the application for a grant on the part of the Kentish Town Dining Room for Mothers, and in this connection a letter dated 6th November, 1914, was received by the Town Clerk from the Poplar Borough Council asking the Council to support their action as set out in the following resolution which they have passed:— " That strong representations be made to the Local Government Board " urging the pressing necessity for authorising in ante-natal and post" natal cases intended to be assisted under the Maternity and Child " Welfare Scheme, the provision (outside the Poor Law) of susten" ance for the mother in suitable necessitous cases ; and that the cost " of such contribution should rank for contribution from the Govern" ment Grant." 42 There is no doubt that in cases where an expectant or nursing mother is not having the ample nourishment that her condition requires it is more important both for herself and her infant that the necessary food should be supplied to her than that she should be given either advice and instruction, or medical treatment. In spite of possible economic objections that may be raised against the giving of food, it is clearly illogical to supply at the public expense medical advice, &c., to insufficiently fed women, while withholding the more important nourishment. It would seem, moreover, in view of the national importance that healthy babies should be born, and that adequate natural feeding should be available for them after birth, that money spent on food for needy mothers would be an advantageous and economical investment for the State. Work doxe. The work done in the Department during 1914 has consisted in the following up of births which have been notified under the Notification of Births Act. A printed card of advice on the subject of infant nurture has been sent to the mother in each case. Where the returns of registered births have shown births which have not been notified, a warning letter has been sent to the parent, pointing out the provisions of the Act in this respect. Only a small proportion of mothers have received personal visits. These have been made chiefly by Miss Smith, but in addition work of this kind was done from 1st February to 20th June, 1914, by a qualified voluntary visitor (Miss E. Al. Davies) working in this department. The work done during the year is indicated by the following figures (including the work of the voluntary visitor):— Total births (excluding still-births) registered 4945 Births (including still-births) notified. 4674 Still-births notified 154 Advice cards sent to cases notified (on day of receipt of notification) 4520 Advice cards sent to cases registered but not notified (on receipt of Registrars' returns) 492 Cautionary letters sent to cases registered but not notified 492 Visits—No. of births visited 744 Additional visits 878 Total visits to mothers 1622 (Of these, number where case was not traced 19) Extra visits (to Infant-Consultations, Hospitals, Midwives, etc.) 442 Particulars as to the mode of feeding of the infants visited will be found on page 44. 43 The work that has been done at some of the voluntary Maternity and Infant Welfare Centres during 1914 is shown in the following table:— No. of '' new " mothers who have attended. No. of attendances. No. of visits paid. , St. Pancras School for Mothers 277 2559 968 North St. Pancras School for Mothers:— Rhyl Street " Centre " 268 3569 1363 Winscombe Street " Centre " 62 615 83 Passmore Edwards Settlement School for Mothers 69 1063 300 Highgate Road Maternity Centre* 17 89 .. University College Hospital† 24 82 .. • From 29th November, 1914 to March, 1915 (expectant mothers). † Opened October, 1914. Infantile Diarrhœa. 106 deaths of infants under one year of age from diarrhoea and enteritis were registered during 1914. Compared with recent years this is a high figure, and the increased mortality is probably to be attributed to the warm summer. In this connection reference should be made to the table on page 25. The number of such deaths in each quarter of the year, was as follows:— First quarter 9 Second ,, 13 Third ,, 62 Fourth „ 22 The number of deaths of children under 5 years of age from diarrhoea and enteritis was 127. Visits were paid by Miss Smith to the homes of most of the infants under one who died from these diseases during the third quarter of the year. In the subjoined table is set out the mode of feeding of the infants at the time of the onset of the illness:— Weeks. Months. Total. under 1 —2 —3 —4 1—2 —3 —4 —5 —6 —7 —8 —9 —10 —11 —12 Breast fed .. .. 1 .. 1 .. 1 1 .. .. .. .. .. .. .. 4 Mixed ,, .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. 2 Bottle „ .. .. 1 1 11 2 4 7 6 5 2 2 3 1 1 46 Total .. .. 2 1 13 3 5 8 6 5 2 2 3 1 1 52 * Eight of these were illegitimate. 44 Contrasting with this result, is set out below the result of inquiries as to the feeding of the infants made by Miss Smith at the time of her first visits to notified births selected promiscuously. Weeks. Months. Total. under 1 —2 —3 —4 1—2 —3 —4 —5 —6 — 7 —8 —9 —10 —11 –12 Breast fed 39 48 115 106 136 35 4 2 4 .. .. 1 .. .. .. 490 Mixed ,, .. 1 4 8 9 2 .. .. 1 .. .. .. .. .. .. 25 Bottle „ 2 7 5 11 11 8 .. 3 .. 2 2 2 .. .. .. 53 Total 41 56 121 125 156 45 4 5 5 2 2 3 .. .. .. 568 A more striking illustration of the fact that hand-fed children are more likely to develop fatal diarrhoea than breast-fed children could scarcely be desired than that furnished by the contrast between these tables. In four of the cases, the mothers confessed to using the old-fashioned tube feeding-bottles. Far more deaths from diarrhoea and enteritis took place amongst infants, than from all the notifiable infectious diseases (except tuberculosis) in the whole population, and this mortality must be regarded as strictly preventible. Apart from the vital influence of breast-feeding as opposed to hand-feeding the prevention of such deaths must be looked for (a) in better housing conditions, and (b) ill a better social standard amongst the poor, particularly in regard to cleanliness. Hand-feed infants who died of diarrhoea in the 3rd quarter, were fed as ollows:— Plain cows' milk only 22 Pasteurised cows' milk 1 Cows' milk + general food 2 Cows' milk + condensed milk 3 Cows' milk + patent food 3 Condensed milk only 9 Condensed milk + patent food 1 Not known 7 48 OPHTHALMIA NEONATORUM. The importance of this disease lies in the fact that it is responsible for more cases of blindness than any other single cause, and that it is largely preventible by suitable treatment of the eyes immediately after birth. When it has developed, also, early and efficient treatment will generally avoid permanent damage to the eyes. It has been compulsorily notifiable by medical practitioners in London since March, 1911, under Sec. 56 of the Public Health (London) Act, 1891. 45 On 1st April, 1914, new regulations came into force in regard to this disease. These regidations were made by the Local Government Board under Sec. 130 of the Public Health Act, 1875, as amended by the Public Health Act, 1896, and are known as the Public Health (Opthalmia Neonatorum) Regidations, 1914. They are set out on pages 138-140 of this Report. They define "Ophthalmia Neonatorum" as meaning " a purulent discharge from the eves of an infant commencing: within twenty-one days from the date of its birth." Notification of the disease by medical practitioners remains as before, except that information must also be supplied as to the date of the birth of the child, the name and address of the parent or other person having charge of the child, and the date of onset of the disease. The duty of notifying cases of the disease to the Medical Officer of Health of the Metropolitan Borough is also imposed by the Regulations upon every Certified Midwife. 1 here is a scheduled form for such notification, and a fee of one shilling is payable to the midwife for each notification. 34 cases of ophthalmia neonatorum were notified during 1914, 29 by medical practitioners, 2 by midwives, and 3 by both. Of these one proved not to be a case of ophthalmia neonatorum, and one was a child who was born and developed the disease in Leicester, where the the case was also notified. The corrected number of notified cases was therefore 32. In addition to these information was received from the Medical Officer of Health of the London County Council in respect of two other cases of inflammation of the eyes in the newly born. These had been reported by registered midwives to the County Council as the Local Supervising Authority under the Midwives Act. Both of these cases were slight. The total number (corrected) of cases which came to the knowledge of the Department during 1914 was therefore 34, equal to an incidence rate of 6'5 per 1,000 births. Other numerical details will be found on pages 26-29. All the cases were visited by Miss Smith, who made full enquiries, and where necessary took steps, in some cases in consultation with the doctors in attendance, to ensure that the baby's eyes received proper attention. In this matter the services of the Queen's Jubilee Nurses have been of great assistance. In regard to severity 7 of the cases were regarded by the visitor as grave, 13 as moderate, and 14 as slight. The cases are classified on the following page according as the mothers were attended in their confinement by doctors, midwives from University College Hospital, other midwives or medical students (in their own homes), or were delivered in hospital. 46 Attended at birth by Cases of Ophthalmia Neonatorum. Total number of births notified. No. of cases per 1000 births notified. Doctors 13 1590 8 Midwives from U.C.H 0 262 0 Other Midwives 13 1011 13 Medical Students 2 1373 1.5 Delivered in Lying-in Hospitals 6 .. .. „ Workhouse 0 .. .. 34 These figures, like those of last year, show that, judging from the cases notified, much more ophthalmia neonatorum occurred in the practice of doctors and midwives than in that of the extern midwifery work of the hospitals (University College, Middlesex, and Royal Free). There is, moreover, no reason for believing that cases occur in the latter without, being notified. This is probably connected with the use of silver nitrate solution as a preventive application to the eyes of the infants soon after birth, which is the method adopted by the medical students and midwives sent out by the hospitals. The total figures since the disease became notifiable (1911-1914) are as follows:— Attended at birth by Cases of Ophthalmia Neonatorum. Total number of births notified. No. of cases per 1000 births notified. Doctors 39 7274 5 Midwives 40 5564 7 Medical Students 4 4828 0.8 Delivered in Hospitals 17 .. .. The 34 cases were treated as follows:— By private Doctor, nursing being done by members of family 7 „ ' Visiting Nurse 11 By Hospitals (out-patient departments):—Central London Ophthalmic Hospital, Royal London Ophthalmic Hospital 8 University College Hospital 1 ,, Middlesex Hospital 2 „ North-West London Hospital 1 — 12 (Of these 8 were nursed by Visiting Nurse and 4 by members of family). Admitted to Royal London Ophthalmic Hospital 1 „ St. Pancras Infirmary 2 Treated in Queen Charlotte's Lying-in Hopital 1 34 The results of treatment were as follows:— Complete recovery 27 Sight damaged, but improving 2 Blindness 0 Cases lost sight of 4 Died 3 days after notification 1 34 47 PUERPERAL FEVER. 18 patients were notified as suffering from puerperal fever during the year. Of these 3 were afterwards found not to be suffering from this disease. The corrected number of notified cases was therefore 15, equal to an incidence rate of 2.9 per 1,000 births. Seven deaths from this disease were registered during the year, giving a case mortality of 46.7 per cent. 12 cases followed the birth of live-born infants. 2 cases followed the birth of dead viable infants. 1 case followed an abortion. 7 of the patients were pri miparse (i.e., women who had not previously borne children). 8 of the patients were multipara). In 4 cases " instruments" were used at the confinement. Inquiries were made in each case as to the existence in the home of scarlet fever, erysipelas, or other infectious disease, or of septic conditions, with negative results, except that in one case a member of the family (the husband) was stated to be suffering from " blood poisoning in the leg." Symptoms developed on 1st day after delivery in 2 cases. ,, ,, ,, 2nd ,, ,, ,, ,, 2 ,, ,, ,, „ 3rd ,, ,, ,, ,, 2 ,, „ „ 4th ,, ,, ,, ,, 4 ,, ,, ,, ,, 5th ,, ,, ,, ,, 2 ,, ,, ,, ,, 7 th ,, ,, ,, ,, 1 ,, „ „ „ 8th ,, ,, ,, ,, 1 „ „ „ „ 13th ,, „ „ „ 1 „ In the following table the cases are classified according to the manner in which the patients were attended in their confinements:— Confinement attended by No. of cases of Puerperal Fever. Total number of births notified. No. of cases per 1000 births. Doctors 7 1590 4 Midwives from U.C.H. 0 262 0 Other Midwives 4 1011 4 Medical Students 2 1373 1.5 In Hospital 1 – – No Attendance 1 – – The cases were treated as follows:— At home 2 In M.A.B. hospitals 4 In other hospitals 9 48 TUBERCULOSIS. Notification.—All forms of tuberculosis are notifiable by medical practitioners under the Public Health (Tuberculosis) Regulations, 1912, and 1914 was the first complete year during which the regulations were in force. Notification is required of every case, unless the practitioner has reasonable grounds for believing that the case has already been previously notified. Such notifications are made on " Form A," except in the case of the notification of school children by school medical inspectors, which is made on "Form B." "Form C" is used for the notification of admission to Poor Law Institutions and Sanatoria of previously notified cases, and these notifications should be sent to this authority whenever a St. Pancras case is admitted to any such institution. "Form D" is used for the notification of discharge from Poor Law Institutions and Sanatoria of previously notified cases, and these notifications should be sent to this authority whenever a case is discharged toa St. Pancras address. The total number of notifications of cases of tuberculosis received during 1914 (Forms A, B, C and D), including duplicate notification was 2,057 (1897 pulmonary: 160 non-pulmonary). The total gross number of notifications received each year since the diseasebecame notifiable is set out below:— Notifications (including Duplicates). 1906 System of voluntary notification instituted 1st January, 1906 Pulmonary. Other Forms. 207 – 1907 235 – 1908 249 – 1909 Public Health (Tuberculosis) Regulations, 1908, came into operation 1st Januarv, 1909 936 – 1910 907 – 1911 Public Health (Tuberculosis in Hospitals) Regulations, 1911, came into operation 1st May, 1911 1464 – 1912 Public Health (Tuberculosis) Regulations, 1911, came into operation 1st January, 1912 1735 – 1913 Public Health (Tuberculosis) Regulations, 1912, came into operation 1st February, 1913 1877 273 1914 1897 160 1,023 notifications (900 pulmonary, 123 non-pulmonary) were received during the year on forms A and B. Of these 161 (145 pulmonary, 16 nonpulmonary) had been notified to this authority before; so that the number of primary notifications received on forms A and B was 862 (755 pulmonary, 107 non-pulmonary). 1034 notifications (997 pulmonary, 37 non-pulmonary) were received on forms C and D. Of these 152 (138 pulmonary, 14 non-pulmonary) were in respect of cases which had not been notified previously to this authority. The total number of primary notifications received during the year was,, therefore, 1,014 (893 pulmonary, 121 non-pulmonary). In the previous year (1913) the number of primary notifications received was 1158 (928 pulmonary, 230 non-pulmonary). In the following table the notifications received are set out in the forms suggested by the Local Government Board. 49 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from 4th January, 1914, to the 2nd January, 1915 (inclusive). Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors). Primary Notifications. Total Notifications including cases previously notified by other Doctors). Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. 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. Under 5 5 to 10 10 to 15 Total. Pulmonary—Males 3 3 12 10 15 42 116 132 80 39 13 465 561 – 2 3 5 5 436 107 125 121 ,, Females 3 9 12 13 25 34 68 55 37 13 14 283 332 – 2 – 2 2 86 46 24 52 Non-pulmonary—Males 3 11 12 5 4 7 8 1 1 1 1 54 63 – 2 3 5 6 8 2 – 8 „ Females 1 10 7 4 4 2 6 3 – 3 2 42 48 – 4 2 6 6 5 4 4 6 Totals 10 33 43 32 48 85 198 191 118 56 30 844 1004 – 10 8 18 19 535 159 153 187 Age Periods. Number of Primary Notifications on Form C. included in above. Number of Primary Notifications on Form D. included in above. 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. 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. Pulmonary—Males 1 2 – 2 2 10 14 27 20 8 6 93 – – 1 – – 1 4 3 3 – – 12 „ Females – – – – 2 10 7 5 3 2 – 29 – – 1 – – 1 2 – – – – 4 Non-pulmonary—Males – 1 1 1 – 1 – 1 – 1 – 6 – – 1 – – – 1 – – – – 2 „ Females – – 1 2 – – 1 – – – – 4 – 2 – – – – – – – – – 2 Totals 1 3 3 5 4 21 22 33 23 11 6 132 – 2 3 – – 2 7 3 3 – – 20 50 The 1,014 primary notifications are analysed for age and sex in the next table:— Primary Notifications during 1914. Ages. Pulmonary Tuberculosis. Other Tuberculosis. Total all forms. Males. Females. Total. Males. Females. Total. 0–1 4 3 7 3 l 4 11 1–5 5 9 14 12 12 24 38 5–10 16 15 31 16 12 28 59 10–15 15 13 28 9 8 17 45 15–25 70 72 142 12 6 18 160 25–35 134 77 211 9 7 16 227 35–45 162 60 222 2 3 5 227 45–55 103 40 143 1 – 1 144 55–65 47 15 62 2 3 5 67 65 upwards 19 14 33 1 2 3 36 Totals 575 318 893 67 54 121 1014 The rates for 1914 of (primary) notification of tuberculosis based on the 1911 census population of the Borough (Males 106,728, Females 111,659) were therefore:— Of males per 1000 male population. Of females per 1000 female population. Total persons per 1000 population. Pulmonary tuberculosis 5.39 2.85 4.09 Other forms of tuberculosis .62 .48 .55 All forms of tuberculosis 6.01 3.33 4.64 The deaths from tuberculosis during the year numbered 432, of which 365 were from phthisis, and 67 from other forms of tuberculosis. 51 These are analysed for age and sex in the following table:— Deaths from Tuberculosis during the Year 1914. Ages. Phthisis. Other Tuberculosis. Total. Males. Females. Total. Males. Females. Total. 0–1 l 2 3 5 – 5 8 1–2 3 – 3 5 3 8 11 2–5 – 1 1 3 11 14 15 5–10 1 3 4 9 3 12 16 10–15 2 5 7 3 4 7 14 15–25 26 35 61 3 2 5 66 25–35 44 22 66 1 1 2 68 35–45 70 26 96 1 2 3 99 45–55 45 24 69 3 – 3 72 55–65 26 10 36 4 2 6 42 65–75 10 5 15 – 1 1 16 75–85 1 2 3 1 – 1 4 85 & upwards – 1 1 – – – 1 Totals at all Ages. 229 136 365 38 29 67 432 The death rates for 1914 from tuberculosis based on the 1911 census population of the borough were therefore:— Of males per 1000 male population. Of females per 1000 female population. Total persons per 1000 population. Phthisis 2.14 1.21 1.67 Other forms of tuberculosis .36 .26 .30 All forms of tuberculosis 2.50 1.47 1.97 52 The standardising factors for 1911 for St. Pancras (supplied by the Local Government Board) are as follows:— Males. Females. Persons. Phthisis .9043 .9479 .9206 Other forms of tuberculosis 1.1021 1.0969 1.0986 All forms of tuberculosis .9537 .9918 .9685 These factors enable standardised death rates to be made for tuberculosis in St. Pancras, which are strictly comparable with standardised rates for other districts, irrespective of differences of the age and sex distribution of the population. The standardised tuberculosis death-rates for St. Pancras for 1914 were as set out below:— Males Females. Persons. Phthisis 1.93 1.14 1.53 Other forms of tuberculosis .39 .28 .32 All forms of tuberculosis 2.38 1.45 1.91 In regard to the incidence of tuberculosis the figures for 1914 again show that:— (a) Pulmonary tuberculosis has its greatest incidence in the age periods 15-55 years; that is to say, it is a disease particularly affecting people in the working years of life. 80 per cent. of the deaths and 80 per cent. of the new cases notified were of persons aged from 15 to 55 years. On the other hand the other forms of tuberculosis have their greatest incidence in the age periods 0-15 years; that is to say they affect particularly children of school age and under. 69 per cent. of the deaths and 60 per cent. of the new cases notified were of children aged 15 years or under. (b) Males suffer to a greater extent than females from tuberculosis, this being shown both by the notification rate and the death rate, and applying both to pulmonary and non-pulmonary tuberculosis, but especially the former. This is not the case amongst children under 15. 53 As was pointed out in last year's report, this excess of the disease in males is found in all urban communities, but hardly at all in purely rural districts, and as it is absent in children is probably due to the difference between the industrial life of men and the domestic life of women. The deaths from tuberculosis in 1914 are classified in the following table according to the part of the body affected and according to age and sex. 0–1 1-5 5—15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85 up. Total Males. 0–1 1-5 5-15 15—25 25—35 35—45 45—55 55-65 65-75 75—85 85 up. Total Females Total Persona. Pulmonary Tuberculosis l 3 3 23 40 66 41 22 9 1 — 209 2 1 8 29 19 20 20 8 5 2 114 223 Phthisis (not defined as Tuberculosis 3 4 4 4 4 1 20 6 3 6 4 2 1 22 42 Acute Phthisis Total Pulmonary Tuberculosis l 3 3 26 44 70 45 26 10 1 229 2 1 8 35 22 26 24 10 5 2 1 136 365 Acute Miliary Tuberculosis 1 1 1 1 4 1 1 5 Tuberculosis Meningitis 3 5 9 1 18 7 5 12 30 Tabes Mesenterica 1 1 1 Other Peritoneal and Intestinal Tubercle 1 2 1 1 1 6 2 1 1 1 2 1 8 14 Tuberculosis of Spinal Column 2 2 2 Tuberculosis of Joints 1 1 1 3 1 1 2 5 Lupus Scrofula Tuberculosis of other other Organs 1 1 2 1 2 3 5 Disseminated Tuberculosis 1 l 2 2 1 3 5 Total Non-Pulmonary Tuberculosis 5 8 12 3 1 1 3 4 1 38 14 7 2 1 2 2 1 29 67 Total all forms of Tuberculosis 6 11 15 29 45 71 48 30 10 2 267 2 15 15 37 23 28 24 12 6 2 1 165 432 54 In the next table the new cases notified during 1914 are classified according to the part of the body affected and according to age and sex. Location of Disease. Ages. Total. 0—5 5-15 15 and upwards. Males. Females. Males. Females. Males. Females. Pulmonary Tuberculosis 9 12 31 28 535 278 893 Phthisis – – – – – – – Acute Phthisis – – – – – – – Total Pulmonary Tuberculosis .. .. 9 12 31 28 535 278 893 Glands 2 6 9 10 9 5 41 Meninges 6 1 4 2 – – 13 Bones and Joints 3 2 10 5 9 11 40 Lupus – – – – 1 – 1 Other Organs 4 4 2 3 9 4 26 Total Now-pulmonary Tuberculosis 15 13 25 20 28 20 121 Total all forms of Tuberculosis 24 25 56 48 563 298 1014 55 In the following table the deaths from and primary notifications of tuberculosis, together with the corresponding rates, are classified in Wards. Registration Sub-District. Wards. Primary Notifications. Notification Rates. Deaths. Death-rates. Pulmonary. Other Form8. All Forms. Pulmonary. Other Forma. All Forma. Phthisis. Other Forms. All Forms. Phthisis. Other Forms. All Forms. West 4 110 17 127 4.17 .64 4.81 41 11 52 1.55 .42 1.97 5 138 19 157 4.33 .59 4.92 78 10 88 2.45 .31 2.76 South 7 86 10 96 4.74 .55 5.29 32 3 35 1.76 .17 1.93 8 112 9 121 4.13 .33 4.46 60 9 69 2.21 .33 2.54 East 3 118 16 134 3.40 .46 3.86 38 13 51 1.09 .37 1.46 6 96 15 111 4.22 .66 4.88 41 10 51 1.80 .44 2.22 North 1 97 21 118 2.73 .59 3.32 41 2 43 1.15 .05 1.20 2 83 10 93 3.80 .45 4.25 24 8 32 1.10 .36 1.46 No Address – 54 3 57 – – – 10 1 11 – – – Whole Borough – 894 120 1014 4.09 .55 4.64 365 67 432 1.67 .30 1.97 The Wards are set out below in order according to their death-rates for tuberculosis:— Ward Deaths from tuberculosis per 1000 population. Ward Deaths from tuberculosis per 1000 population. 1 1.20 4 1.97 2 1.46 6 2.22 3 1.46 8 2.54 7 1.93 5 2.76 When this table is compared with that for the general death-rate (page 18), it will be seen that the difference between the best and worst wards is much more marked in the case of the tuberculosis death-rate than in the case of the general death-rate. Moreover the order of the wards is not the same. Ward 1 suffered least in both cases, but whereas Ward 6 (Somers Town) had much the highest general death-rate it is distinctly better than either Ward 5 or Ward 8 in regard to deaths from consumption. 56 In the following table are shown the death.rates from tuberculosis for the past 10 years:— Year. Estimated Population. Tuberculosis Death.Rate. Corresjiondiwj rates for " all Forms based on 1911 census Population County of London Phthisis Death Rate. Phthisis. Other Forms. All Forms. 1905 237149 1 .49 .40 1.89 1.45 1906 237149 1.69 .2 2.21 1.50 1907 237173 1.59 .43 2.02 1.46 1908 237247 1.53 .41 1.94 1.39 1909 237247 1.58 .33 1.91 2.07 1.46 1910 237247 1.25 .32 1.57 1.71 1.25 1911 237129 1.39 .35 1.74 1.89 1.35 1912 220353 1.48 .32 1.82 1.84 1.35 1913 218387 1.46 .30 1.79 1.79 1.30 1914 218387 1.67 .30 1.97 1.97 1.39 The table shows that the St. Pancras rate for 1914 was higher than for any year since 1909, the increase being due to the pulmonary form. The tendency of the disease to decrease which has been such a feature of recent decades seems to have disappeared during the past few years, and this is noticeable also in the figures for London. The position of St. Pancras amongst the metropolitan boroughs in regard to tuberculosis mortality is very bad. The death-rate for 1914 is 13 per cent. greater than that for the County as a whole, and is only exceeded by three other boroughs, viz., Shoreditch, f insbury and Holborn. It is between two and three times as great as in the case of the borough with the lowest rate, viz., Hampstead, where phthisis death.rate for 1914 is 0.64. Our po.ition in regard to infantile mortality (see page 23) offers a striking contrast to this, St. Pancras ranking in that respect among the better boroughs. Our position as to general death.rate is intermediate between these extremes. The weekly distribution of deaths from tuberculosis will be found in the table inset at page 27. Work Done. As in former years the work in connection with tuberculosis has been done by the female staff under the direction of the Medical Officer of Health. Miss Bibby has devoted part of her time to it, paying special attention to supplementary and after.care, and Miss Giles, the temporary visitor, practically the whole of her time. The work which has been done has consisted mainly in the visiting of notified cases. At these visits a case paper is filled up for each case, and advice is given as to the means that can be adopted by the patients to assist their recovery, and by the families of the patients to avoid contracting the disease. Where there are contacts whose health is not all that can be desired, 57 or where the patient appears not to be under adequate medical attention the contacts or patients are advised to seek medical advice. In many such cases use has been made of the two approved dispensaries who have willingly examined any persons sent to them by the Department. Care has been taken not to trespass upon the preserves of private practitioners, and no complaints have been received on this score. Practically all cases notified during the year have been visited, and a good deal of systematic re-visiting has been done. Disinfection of bedding and bedrooms has been carried out on the advice of the tuberculosis visitors, and on application after the death or removal of patients, and in other cases. Where insanitary conditions have been found they have been reported by the tuberculosis visitors to the District Sanitary Inspectors, and dealt with in due course. Much good work has been done by the tuberculosis visitors in putting necessitous patients and families into touch with various charitable and other agencies. They have also been in frequent attendance at the approved dispensaries to see cases who have been treated there. The actual work done by the Lady Inspector and Visitor is shown below:— No. of visits to homes of notified cases— (а) First visits 1188* (b) Subsequent visits 882 No. of cases in which disinfection was carried out 113 Attendances of inspector or visitor at the dispensaries 140 Other visits made for various purposes 745 No. of contacts and suspects examined at the St. Pancras Dispensary at the instance of the inspector or visitor 127† Treatment of Tuberculosis. Most of the medical work in the borough in regard to tuberculosis remainsundistinguished from that in connection with other diseases; that is to say, it is done by private practitioners (including panel doctors) and the outpatients departments of hospitals. In addition to this a growing amount of work is being done by the two "approved" tuberculosis dispensaries and by sanatoria. Tuberculosis Dispensaries.—On 8th April, 1914, the Borough Council approved of a scheme whereby the St. Pancras Dispensary, 39, Oakley Square, N.W., together with a branch dispensary to be opened in the northern part of the borough, would serve that part of the Borough lying north of Euston Road (viz., Wards 1—6, comprising a population of 173,132); while the tuberculosis dispensary at University College Hospital, Gower Street, W.C., would serve the remaining part (viz., Wards 7 and 8, comprising a population of 45,255). The scheme also provided for payment through the Borough * This figure is greater than the total number of persons visited, because in many instances more than one visit was paid to a patient's house in the course of the original inquiry. † This figure does not include those cases who were given cards to be examined at the St. Pancras Dispensary but did not arrive there; nor the numerous cases who were examined at other Institutions or by their private doctors at the instance of the inspector or visitor. 58 Council to be made to each, dispensary both for insured and non-insured patients, of which £141 in the case of the St. Pancras Dispensary and £50 in the case of the University College Hospital Dispensary, being 25 per cent. of the total grants in respect of non-insured persons, would come from the borough funds, the remaining part of the grants coming from the Local Government Board, the London County Council, and the London Insurance Committee. Protracted negotiations took place and at the end of the year, in spit-) of every wish on the part of the Borough Council and of the two institutions to complete and carry out some such scheme, and of the fact that the dispensaries were dealing with cases without payment, no arrangement was come to, and no public money had been paid to the dispensaries. The St. Pancras Dispensary, however, received interim grants from the London Insurance Committee in respect of insured persons. The work of the dispensaries consists mainly in the treatment of tuberculous patients living at home, the examination of "contacts" and "suspects" with a view to diagnosis, and the examination of patients to determine the form of treatment ("sanatorium, hospital or home) to be allotted them. The actual work done at the dispensaries during 1914 is set out below, from figures Kindly supplied by the dispensaries St. Pancras Dispensary. University College Hospital. Insured. Noninsured. Total. Insured. Noninsured. Total. No. of new cases 60 173 233 29 32 61 ,, ,, new contacts – 127 127 17 91 108 Total number of attendances:– Cases 987 1084 2071 154 176 330 Contacts – 158 158 20 99 119 No. of examinations for determining form of treatment 20 – 20 Residential Institutions.—While the dispensary arrangements are in the hands of the Borough Council, the provision of institutional treatment (sanatorium and hospital) for non-insured persons has been undertaken bv the London Count}7 Council. This was only begun at the end of 1914, and only some 5 non-insured persons (3 children and 2 women) were dealt with by the County Council during the year. In this connection it is to be remembered that many tuberculous poor are dealt with by the Guardians in the Infirmaries and that charitable societies, such as the Invalid Childrens' Aid Association, send away a number of cases. The London Insurance Committee have continued to provide sanatorium and hospital treatment for insured tuburculous persons, and information was received from them of 138 persons sent away during 1914 (compared with 165 during 1913). Nearly all of these were suffering from pulmonary tuberculosis. 59 The table below indicates what institutions have been utilised for the treatment of St. Pancras insured persons. Men. Women. Brompton Hospital for Consumption, etc. 7 – City of London Hospital, Victoria Park 6 – University College Hospital 2 – Metropolitan Hospital 4 – Eversfield Chest Hospital, St. Leonard's-on-Sea 1 – Mount Vernon Hospital for Consumption 1 – The Downs Sanatorium (M.A.B.) 63 – Northern Hospital, Winchmore Hill (M.A.B.) 1 31 Brompton Hospital Sanatorium, Frimley 5 – Fairliglit Sanatorium, Hastings 3 – Southern Sanatorium, Hastings 2 – Royal National Sanatorium, Bournemouth 3 – Home Sanatorium, West Southbourne, Bournemouth 1 – Mailing's Farm Sanatorium, Nayland 2 – Southern Sanatorium, Pinewood, Wokingham 1 – The Hermitage 1 – Kelling Sanatorium, Holt 1 – Benenden Sanatorium, Kent 1 – Hawthorn Dene Home for Phthisis, Bonchurch – 1 Heywood Home, Heywood Park, Bighgate – 1 105 33 In addition to these 138, nine patients who had institutional treatment in 1913 were re-admitted for farther treatment during 1914. Results of treatment.—Most of the after-care of the patients who have had sanatorium treatment lias been done through the panel doctors. The approved dispensaries have not been much used for this purpose. The cases have all been visited by the borough tuberculous visitors, who have made careful inquiries into the progress of the patients and given such assistance as thev were able. The condition in June, 1915 (as judged by the tuberculosis visitor) of the 138 insured persons (adults) who were reported to the department as having been sent to sanatorium or hospital during 1914, was as follows:– Men. Women. Persons. Dead 17 4 21 Worse 11 2 13 No change 18 11 29 Relapse after improvement 1 – 1 Improved 33 8 41 Lost sight of 25 8 33 105 33 138 All the 3 children sent away by the London County Council in 1914 were improved in June, 1915, and of the two adults (women) one was dead and one had relapsed after improvement. 60 For the estimate of the value of the institutional treatment from the point of view of the community, more than a year must have elapsed from the sojourn in the institution. For this reason the investigation into the condition of the 165 Persons who were sent to sanatoria and hospitals by the Insurance Committee during 191:3 has been continued down to June, 1915,. and the results are set out in the next table. After-HIsTORY of 165 uninsured persons who received sanatorium or hospital treatment IN 1913. Condition in April, 1914. (See Annual Report for 1913). Condition in June, 1915. Dead. Worse. No change. Relapsed after improvement Improved. Lost sight of. Men. Women. Men. Women. Men. Women. Men. Women. Men. Women. Men. Women. Men. Women. Dead 22 6 22 6 – – – – – – – – – – Worse 16 3 10 2 1 – 2 – – – 1 – 2 1 No change 25 4 5 – 1 1 5 – 5 2 3 1 6 – Relapsed after improvement – – – – – – – – – – – – – – Improved 30 17 6 2 – – 2 – 3 1 10 11 9 3 Lost sight of 28 14 – – – – – – – – – – 28 11 121 44 43 10 2 1 9 – 8 3 14 12 45 18 These results are summarised in the next table:– After-history ok 165 insured persons who received sanatorium or hospital treatment in 1913. Condition in April, 1914. Condition in June, 1915. Men. Women. Persons. Men. Women. Persons. Dead 22 6 28 43 10 53 Worse 16 3 19 2 1 3 No change 25 4 29 9 – 9 Relapsed after improvement – – – 8 3 11 Improved 30 17 47 14 12 26 Lost sight of 23 14 42 45 18 63 121 44 165 121 44 165 The completeness of the results is marred by the large number (more than one-third of the total) of persons lost sight of. Of the 102 cases which remained under observation in June, 1915 (an average of two years after admission) 53, or more than half, were dead and only 26, or one quarter, were reported as improved. 61 This high mortality amongst tuberculous patients who have received sanatorium benefit in the form of sanatorium or hospital treatment is very striking, though it is to be noted that the 165 patients included advanced as well as early cases when the treatment began in 1913. It would be interesting to compare these results with the facts in regard to those cases notified in 1913 who were not sent away for institutional treatment. In fact, however, such a large number of these have been lost sight of that the figures would have no value. Bacteriological Examinations.—245 specimens of sputum from St. Pancras patients have been examined for medical practitioners by the Lister Institute of Proventive Medicine at the expense of the Borough. 83 of these were reported as containing tubercle bacilli and 162 as negative. SCARLET FEVER, 1,207 St. Pancras patients were notified during 1914 as suffering from scarlet fever. This figure includes St. Pancras cases wrongly notified to medical officers of health of other authorities and transmitted to St. Pancras, and excludes 61 cases notified to this authority but belonging to other districts. Of the 1,207 cases notified, 27 were afterwards found not to be suffering from scarlet fever, all by the Medical Superintendents of the Metropolitan Asylums Board Hospitals. This gives the net number of cases of scarlet fever notified during the year as 1,180, equal to an incidence rate of 5.40 per 1,000 population. The number of deaths from scarlet fever certified during the year was 19, equal to a death-rate of 0.09 per 1,000 population, and a case mortality of 1.61 per cent. of cases notified. Other statistical facts in regard to the disease will be found at pp. 26-29. In the following table are set out the number of cases of scarlet fever notified, the number of deaths, and the corresponding rates during the past 10 years:— Year. Number of Notifications. Notification rate per 1000 Population. Number of Deaths. Death-Rate per 1000 Population. Percentage of Cases Removed. Case-Mortality per Cent. 1904 840 3.54 27 0.11 94 3.22 1905 987 4.16 27 0.11 95 2.74 1906 791 3.34 32 0.13 94 4.05 1907 851 3.59 26 0.11 91 3.06 1908 957 4.04 20 0.08 93 2.09 1909 774 3.26 17 0.07 97 2.20 1910 681 2.87 17 0.07 96 2.49 1911 445 1.88 10 0.04 95 2.24 1912 598 2.71 5 0.02 97 0.08 1913 568 (536) 2.55 (2.41) 6 0.03 94 1.06 (1.12) 1914 1207 (1180) 5.53 (5.40) 19 0.09 91 1.57 (1.61) The figures in brackets are corrected for errors of diagnosis. The other figures are not corrected. 62 It will be seen from the table that there was a large increase in the scarlet fever in the borough in 1914. More cases of scarlet fever were notified in St. Pancras than in any previous year since 1893, though in 1902 the numbers were only slightly less (1,200). The epidemic affected the whole of London. Reference to the table inset at page 27 will show the weekly distribution of the cases throughout the year. As usual, the disease was most prevalent during the autumn, the numbers rising during the latter part of August, remaining high during September, October and November, and falling again in December. The amount of scarlet fever during the rest of the year also was greater than usual. There was a corresponding increase in the number of deaths from scarlet fever during 1914, the mortality being greater than in any year since 1908. The percentage case-mortality, however, remained very low (1.61 per cent.) though it was higher than in the two preceding years. The notification rate of scarlet fever per 1,000 population for the County of London was 5.54, practically the same as that for St. Pancras. Eleven Metropolitan boroughs had notification rates greater than St. Pancras and 15 (exclusive of the City) less. The death-rate from scarlet fever per 1,100 population for the County of London was 0.07. Of the notified cases of scarlet fever 1,102 (or 91 per cent.) were removed to hospital, as follows:— To Metropolitan Asylums Board hospitals1072 To other hospitals 30 1102 During the autumn months, when the disease reached its highest incidence,, the Metropolitan Asylums Board were unable to admit all notified cases without delay. The Board sent a letter to the Metropolitan Medical Officers of Health, asking that removal should be asked tor only in those cases where proper accommodation could not be provided at home. Owing to the tenement house system of housing in this borough the vast majority of cases belonged to the latter class, but a certain number of cases which otherwise would have been removed to hospital were treated at home, thus accounting for the somewhat diminished percentage of removals during the year. Delay also arose in the removal of some of the cases for whom hosp tal accommodation was ultimately found. Return Casks of Scarlet Fkver. The definition of "return-case" of scarlet fever adopted is as follows:—A return-case of scarlet fever is one beginning within 28 days of the return from hospital to the same house of a previous case of scarlet fever. Upon this definition there were 46 return-cases of scarlet fever during 1911. These were made up as follows:— Houses with one return-case only 24 ,, ,, a series of 2 return cases 8 „ „ „ „ 3„ „ 2 63 There were, therefore, 34 return outbreaks of scarlet fever, which means that 34 houses were affected. In 30 of these the return-case or cases were in the same family as the infecting (?) case, and in 4 in a different family in the same house. The cases are classified below according to the number of days that elapsed between the return of the infecting (?) case and the onset of illness of the return-case:— 1 day 1 2 day 1 3 ,; 3 4 „ 4 5 „ 3 6 „ 2 7 days 3 8 „ 3 9 „ 2 10 „ 3 11 1 12 „ 1 15 days 2 17 1 19 „ 1 21 „ 1 22 „ 1 27 „ 1 Twelve of the infecting (?) cases had rhinitis subsequently to their return from hospital (of which 1 also had otorrhœa and 2 also had desquamation), and 3 others had otorrhœa subsequently to their return. (All the infecting (?) cases were not examined, and therefore there may have been others with discharges or other obviously infectious conditions.) In addition to the above cases there were 5 cases of scarlet fever occurring rather more than 28 days after the return of a former case to the same house. One of these w as in the same house as one of the 46 return cases considered above, and the other 4 were in separate houses. Three of the latter occurred 30 days after the return of the intecting case, and one 33 days after. One case of scarlet fever occurred 14 days after the return home from hospital of a case of diphtheria in the same family. The latter was found to have sore nostrils and a sore on the chin upon examination. There was no evidence of any spread of scarlet fever through infected milk supplies during the year. Outbreaks of Scarlet Fever in Institutions. The Orphan Working School, Maitland Park. A considerable outbreak of scarlet fever occurred during 1914 at this school. The school is a resident institution for orphan children who numbered 452 at midsummer 1914, and there is a resident staff as well as certain officers who live out of the school. It is divided into three separate departments, viz., the Boys' Department (numbering 268 boys, aged from 7 to 13), the Girls' Department (numbering 142 girls of similar ages), and the Junior Department (numbering 42 children of both sexes aged from 3 to 7). The departments are quite separate except that the boys and girls meet for meals, and all three departments meet for chapel. During the epidemic the mixing of departments was stopped. In all there were 90 cases of scarlet fever in the school during the year, made up of 79 from the Boys' Department, 7 from the Girls' Department, 1 from the Junior Department and 3 members of the staff. The cases were, with a few exceptions, exceedingly mild, and there were no deaths. 64 The first developed about 24th January, and the last case in the year on 11th December. The latter was practically the end of the epidemic. There were two outbursts, one lasting from February to May (inclusive), and the other in October and November, with a period of quiescence in the summer. The cases were confined to the Hoys' Department until November when they spread to the Girls' Department. All the patients were removed to the fever hospital as soon as they were recognised, and suspected cases were kept under observation in the school infirmary. The cases are set out in the following table, which shows the monthly distribution and also the dormitories and school classes to which they belonged:— Boys' Department. Girls' Department. Other cases. Total cases. Queen's dormitory (172 beds). Prince dormitory (68 beds). Chartier dormitory (58 beds). Total. Tomkins dormitory (82 beds). Princess dormitory (66 beds). Total. January l l .. 2 .. .. .. .. 2 February 14 2 3 19 .. .. .. .. 19 March 9 5 4 18 .. .. .. .. 18 April 5 1 .. 6 .. .. .. 1* 7 May 4 .. .. 4 .. .. .. .. 4 June 1 .. .. 1 .. .. .. .. 1 July .. .. .. .. .. .. .. .. .. August .. .. .. .. .. .. .. .. .. September .. 1 .. 1 .. .. .. .. 1 October 19 1 6 26 .. .. .. .. 26 November 2 .. .. 2 l 5 6 3† 11 December .. .. .. .. l .. 1 .. 1 55 11 13 79 2 5 7 4 90 The cases were fairly evenly distributed amongst the school classes. A careful inspection of the school buildings was made, but nothing was found which in any way accounted for the epidemic. The drains also were tested and found sound. Nothing in the food supply was peculiar to the Boys' Department. Apparently, therefore, the disease was to be attributed to spread from case to case, and probably also to the existence of unrecognised "carriers." Careful inspection, however, of all the children and staff by the Medical Officer, and particularly of those earlier cases who had returned to school after recovery, failed to discover any such; nor was any reason apparent for the subsidence of the epidemic in June and December. No light was thrown on the matter by the dormitory or school class distribution. The Medical Officer of Health had several consultations with the Medical Officer of the Institution. Closure of the school was recommended, but this was Found to be impracticable. * A maid in the Girls' Department. † A laundry maid, a teacher in the Junior Department, and a boy in the Junior Department. 65 In view of the large number of children involved in the epidemic it is important to record that the institution had previously been comparatively free from scarlet fever. The last cases were three in October, 1911. The most noteworthy points in reference to the epidemic were:— (1) Its confinement to the boys' department until towards the end, and the almost complete escape of the infants' department.* (2) The large percentage of children affected. (3) Its extremely mild character. (4) The obscurity of its causation. One of the cases in the scarlatina outbreak (in September) suffered from diphtheria as well as scarlet fever, and one case of diphtheria—a resident teacher —was removed during November. The St. Pancras Femah Orphanage, 108, Hampstead Road. A small outbreak of scarlet fever also occurred during 1909 at this institution, which is a resident orphanage for girls. At the time there were 45 girls in the orphanage. In all there were 7 cases, the dates of onset of illness being 27, 28, 31 and 31 May, and 4, 5, and 8 June respectively. Five of the cases were from the second-floor dormitory (where the first case occurred), and two from the first-floor dormitory. The cause of the outbreak was not discovered. University College Hospital. Some trouble was experienced here from scarlet fever during 1914. In January, February and March, 6 cases were notified from Ward 13, four being nurses and two patients. In May and June, 3 cases were notified from Ward 15, one nurse and two patients. In November, 3 other nurses were notified as suffering from the disease, two of them having worked in Ward 8. Moreover 6 nurses were notified as suffering from diphtheria during the year from different wards. Hc/al Free Hospital. Four cases of scarlet fever (three nurses and one patient) occurred in the Grosvenor Ward during December, 1914 and January, 1915. Princess Road Council School From March to June (inclusive) 1914, 34 cases of scarlet fever occurred amongst children attending this school. 4 of the cases were notified in March, 7 in April, 19 in May, and 4 in June, when the outbreak ended. 28 of the cases were reported as belonging to the Infants' Department. As in other years, small outbreaks of the disease, each consisting of several cases obviously causally connected also occurred in certain other schools. There are no other institution outbreaks of scarlet fever to record. * Two more cases occurred here in March, 1915. 66 DIPHTHERIA. 458 St. Pancras patients were notified during 1914 as suffering from diphtheria or membranous croup. These figures include St. Pancras cases wrongly notified to mcdical officers of health of other authorities and transmitted to St. Pancras, and excludes 35 cases notified to this authority, but belonging to other districts. Of the 458 cases notified 32 were afterwards found not to be suffering from diphtheria, 24 by the Medical Superintendents of the Metropolitan Asylums Board hospitals, and 8 by other medical practitioners. This gives the net number of cases of diphtheria notified during the year as 426, equal to an incidence rate of 1.95 per 1.000 population. The number of deaths from diphtheria certified during the year was 30, equal to a death.rate of 0.14 per 1,000 population, and case mortality of 7.04 per cent. of cases notified. In the following table are set out the number of cases of diphtheria notified, the number of deaths, and the corresponding rates during the past ten years:— Year. Number of Notifications. Notification Rate per 1000 Population. Number of Deaths. Death Rate per 1000 population. Percentage of Cases Removed. Case.Mortality per cent. 1904 338 1.43 40 0.17 92 11.80 1905 282 1.19 26 0.11 91 9.22 1906 275 1.16 22 0.09 88 8.00 1907 345 1.45 28 0.12 92 8.12 1908 296 1.25 23 0.09 91 7.77 1909 315 1.33 28 0.12 93 8.89 1910 262 1.10 20 0.08 97 7.63 1911 419 1.77 37 0.15 94 8.83 1912 550 2.50 26 0.11 98 4.73 1913 440 (391) 1.98 (1.76) 19 0.08 97 4.31 (4.86) 1914 458 (426) 2.10 (1.95) 30. 0.14 87 6.55 (7.04) The figures in brackets are corrected lor errors of diagnosis. The other figures are not corrected. It will be seen that as in the case of scarlet fever there was a rise in the incidence, death-rate and case mortality in 1914; the rise, however, was much less marked. The notification rate of diphtheria per 1,000 population for the County of London was 2.02, nearly the same as that for St. Pancras. Nine Metropolitan Boroughs had notification rates greater than St. Pancras, and 18 (exclusive of the City) less. The death.rate from diphtheria per 1,000 population for the County of London was 0.16. Other statistical facts in regard to diphtheria will be found on pages 26.29. 67 Of the notified cases of diphtheria 399 (or 87 per cent.) were removed tohospital, as follows:— To Metropolitan Asylums Board hospitals 376 To other hospitals 23 399 Return Cases.—In 4 houses cases of diphtheria occurred within 28 days of the return from hospital to the same house of a former case of diphtheria. In 4 houses also, cases of diphtheria occurred within 28 days of the return from hospital to the same house of a case of scarlet fever. No important outbreaks of diphtheria in institutions occurred during the year, and no evidence of the spread of the disease by means of milk was found. Bacteriological Examinations.— 297 swabs from St. Pancras patients were examined during the year by the Lister Institute of Preventitive Medicine for the presence of diphtheria bacillus at the expense of the Borough. Of these 85 gave positive results and 212 negative results. TYPHOID FEVER. 44 St. Pancras cases were notified as suffering from typhoid fever during 1914. This figure does not include 5 cases notified to this authority, but belonging to other districts. Of the 44 cases notified, 17 were afterwards reported not to be suffering from the disease, 13 by Medical Superintendents of the Metropolitan Asylums Board hospitals, and 4 by doctors of other hospitals. One patient was also notified as suffering from continued fever, and was found not to be suffering from typoid fever or other notifiable disease. The number of true cases of typhoid fever reported during the year was therefore 27, equal to an incidence rate of 0.012 per 1,000 population. Four deaths was certified in 1914 as due to typhoid fever. This represents a death rate of .02 per 1,000 population, a case mortality (reckoned on the actual cases notified during the year) of 14.8 per cent. In the following table are set, out the number of cases of typhoid fever notified, the number of deaths certified, and the corresponding rates during the past 10 years. 68 Year. Number of Notifications. Notification Rate per 1,000 Population. No. of Deaths. Death Rate per 1,000 Population. Case-mortality per cent. 1904 135 0.57 17 0.07 12.60 1905 72 0.30 8 0.03 11.11 1906 96 0.40 13 0.05 13.54 1907 54 0.22 4 0.02 7.40 1908 60 0.25 10 0.04 16.67 1909 50 0.21 6 0.03 12.00 1910 61 0.26 4 0.02 6.56 1911 66 0.27 7 0.04 10.60 1912 29 0.13 2 0 .01 6.89 1913 41 (26) 0.18 (0.12) 6 0.03 14.6 (23.0) 1914 44 (27) 0.20 (0.12) 4 0.02 9.0 (14.8) The figures in brackets are corrected for errors of diagnosis. The other figures are not corrected. Other statistical facts in regard to the disease will be found on pp. 26-29. The 1914 (uncorrected) notification rate of typhoid fever in the County of London was 0.17 per 1,000 population, and the death rate from the disease 0.03 per 1,000 population. The 44 persons notified were treated as follows:— Cases notified. Not Typhoid. Diagnosis not contradicted. In hospitals of the M.A.B. 25 13 12 In other public hospitals 15 4 11 In their own homes 4 0 4 44 17 27 Thus more than half of the cases admitted to the Metropolitan Asylums' Boards' Hospitals were returned as not true cases of the disease. Probably some of the cases treated elsewhere and finally included as true cases were not so, the information under these circumstances being less complete. Inquiries were made as to possible sources of infection in all cases notified, with the following results:— (a) In 2 of the 27 cases the infection was definitely contracted out of St. Pancras. 1. Arrived from Toronto already ill. 2. Developed typhoid fever three days after 23 days' "hopping" near Faversham, Kent. (b) Three cases (in 3 houses) followed upon cases in the same families at intervals which suggested that they were secondary to the earlier cases. (c) One was a hospital nurse who had been nursing a case of typhoid fever, and another was a nurse in a hospital where such cases were under treatment, although not by her. 69 (d) Not much evidence was obtained in reference to shellfish infection. One case developed the disease 9 days after eating mussels, and another 10 days after eating winkles. Two other cases gave indefinite histories of having eaten shellfish. (e) No source of infection was traced in the other 16 cases. It is to be remembered that many of these cases work outside St. Pancras, and that in most cases it is very difficult to obtain a record of the patients' previous movements, food, etc. No "carrier" cases or spread of infection through milk or other foodstuffs have been unmasked, although a careful watch has been kept. Bacteriological Examinations.—39 specimens of blood of St. Pancras patients were examined by the Lister Institute of Preventive Medicine for the Widal reaction of typhoid fever at the expense of the Borough. Of these 14 gave positive results, and 25 negative results. ANTERIOR POLIO-MYELITIS. 3 cases of anterior Polio-Myelitis were notified during 1914. In one of these cases the diagnosis was doubtful, and the patient died three months afterwards of "intestinal toxaemia." The other two cases recovered. One of the cases fell ill on 11th June, and the other two in August. The dates of the cases therefore accord with the experience of the past three years when the disease was most prevalent from June to the end of the year, This is shown in the following statement of cases notified:— ST. PANCRAS. COUNTY OF LONDON. 1st quarter. 2nd quarter. 3rd quarter. 4th quarter. Total. 1st quarter. 2nd quarter. 3rd quarter. 4th quarter. Total. 1911 .. .. .. 2 .. .. .. .. 41 .. 1912 0 0 3 0 3 19 22 69 24 137 1913 0 2 (June) 3 4 9 9 22 60 55 146 1914 0 1 (June) 1 1 3 6 7 56 24 93 Careful inquiries were made in each case and no source of infection or relation between the cases was discovered. 70 Particulars about the individual cases are given in the following table:— Date of Notification. 1914. Name. Age and Sex. Date of Onset. 1914. Subdivision of Boro'. Removal to Hospital. 1914. Muscles affected. Result. Remarks. 16th June W—H M. 3/12 11th June S.1 in (Ward 8) No. Left leg. Died 9th Sept. Death took place in Infants Hospital, and was certified as due to intestinal toxaemia." Original diag nosis doubtful. Notified by private practitioner. 25th Aug. O-P— F. 2 13th Aug S.4 in (Ward 7) Children's Hospital, Great Orhiond Street. 21st Aug. Both legs. Partly recovered : Degree of recovery unknown. Partly lost sight of. Notified by doctor at Great Ormond Street Hospital. lst. Oct. A-H- M. 5 Early in Aug. N.4 in (Ward Children's Hospital, Great Ormond Street. 28th Sept. Intercostal muscles and legs. Permanent curative of vpine. Notified by doctor at Great Ormond Street Hospital. EPIDEMIC CEREBROSPINAL MENINGITIS. 3 cases of this disease (including one of Posterior Basic Meningitis) were notified during 1914. Of these two cases were fatal, and the other case was left deaf and dumb by the illness. Careful inquiries were made in each case, and no source of infection or relation between the cases was discovered. Since epidemic cerebro-spinal meningitis was made notifiable the number of cases notified year by year in St. Pancras and in London as a whole, have been as follows:— St. Pancras. County of London. 1907 (from 12th March) 5 136 1908 5 85 1909 6 111 1910 10 115 1911 7 101 1912 3 105 1913 5 92 1914 3 73 71 The details of the cases are given below, from particulars kindly supplied by the hospitals concerned:— E. A. Male, aged ,'a (Posterior Basic Meningitis). Notified 4th February, District South 5, in Ward 7:— Onset with convulsions on 29th January. Admitted to Middlesex Hospital same evening. Head retracted; legs drawn up; arms and legs stiff; occasional cries; extensor reflex; tache cerebrate; no fluid on lumbar puncture; fluid obtained from anterior fontanelle, in which were found gram-negative intracellular and extracellular diplocci, typical of meningoccus, which did not grow iu cultures. Anti-meningitis serum injected through anterior fontanelle. Died 12th February. R. S. Male, aged 13 ½. Notified 16th February. District East 4 in Ward 6:— Onset sudden on evening 12th February with vomiting and convulsions. Taken to London Temperance Hospital early next morning, and died on evening of that day. Coma; no reflexes; Kernig's sign; marked head retraction; blurring of discs and engorgement of retinal vessels; small petechial haemorrhages over abdomen and back, especially on skin over spine. Meningococci isolated from cerebro-spinal fluid, which was slightly turbid and under pressure, and showed intracellular gram-negative diplococci. Post-mortem:—-Engorgement of cerebral veins. One or two small patches at base of brain, resembling lymphatic deposits or purulence. Congestion of both lungs and slight effusion into right pleural cavity. L. C. Female, aged 2. Notified 19th March. District North 4, in Ward 2:— Onset on 9th March with headache, followed by vomiting; drowsiness; some spasticity of limbs; internal strabismus of left eye; slight head retraction; reflexes increased. Cerebro-spinal fluid turbid and under pressure, great excess of polymorphonuclear cells; gram-negative cocci; meningococcus obtained in culture. Admitted to Hampstead General Hospital 10th March. Recovery, but patient left deaf and dumb. There were also 14 deaths during the year certified as due to meningitis without any qualification showing the nature of the meningitis. OTHER NOTIFIABLE INFECTIOUS DISEASES. No case of Small-pox was notified in St. Pancras during 1914. Two cases were reported in the County of London (exclusive of the Port), one in the City of London and one in the City of Westminster. Both cases caught the infection on ship-board. No case of Typhus was notified in the Borough, though one case (Chelsea) was reported in the County. No case of human Anthrax was notified in St. Pancras, though 11 were reported in different parts of the County of London. Cholera, Plague, human Glanders, and human Hydrophobia were completely absent both in the Borough and the County. Two St. Pancras persons were reported during the year as having been in contact with a case of small-pox and were kept under observation. Three groups of persons were also kept under observation who had proceeded to St. Pancras from ships or ports infected with small-pox, one group from a port 72 infected with plague, and one group from an infected port with no disease specified. Two outbreaks of glanders in horses were reported during 1914 in stables in the Borough by the Veterinary Inspector of the London County Council. In each case the stables were visited but no human cases occurred. MEASLES. In the following table are set out the deaths and death.rate from measles for the past ten years for the whole Borough and for the four registration sub.districts:— Year. Deaths. Bate per 1,000 population. West. South. East. North. Whole Borough. West. South. East. North. Whole Borough. 1904 33 30 31 31 125 0.54 0.54 0.52 0.52 0.53 1905 14 15 23 25 77 0.22 0.26 0.38 0.41 0.32 1906 28 26 30 12 96 0.45 0.46 0.50 0.20 0.40 1907 37 5 33 16 91 0.60 0.08 0.55 0.27 0.40 1908 9 13 5 19 46 0.14 0.23 0.08 0.31 0.19 1909 30 9 30 33 102 0.48 016 0.50 0.55 0.43 1910 39 21 60 23 143 0.65 0.37 1.00 0.38 0.60 1911 26 28 19 40 113 0.42 0.50 0.32 0.68 0.47 1912 25 11 33 25 94 0.41 0.24 0.58 0.43 0.42 1913 8 5 6 17 36 0.13 0.10 0.10 0.29 0.16 1914 10 10 21 12 53 0.17 0.22 0.36 0.19 0.24 It will be seen that both 1913 and 1914 were favourable years in regard to measles. In spite of this and of the marked prevalence of scarlet fever and diphtheria in 1914, the deaths from measles in the year were greater in number than those from these two diseases together. Of the 53 deaths, 8 were in children under one year of age, and 50 in children under five years of age. The distribution of the deaths in wards is shown in the next table. Deaths from Measles, 1914. West. sodth. East. North Ward. Ward. Ward. Ward. No Address. Whole Borough. 4 5 Total. 7 8 Total. 3 6 Total. 1 2 Total. 7 3 10 1 9 10 8 13 21 4 8 12 •• 53 73 Reference to the table inset at page 27 shows that 29 of the 53 deaths from measles were certified during the last quarter of the year. The higher mortality was continued into 1915. Measles not being a notifiable disease no exact information as to the number of rases is available. The head teachers of the Council Schools are instructed to inform the Borough medical officer of health, of children absent from school on account of measles and other infectious diseases (see page 30), distinguishing between cases and suspects and contacts. During 1914, 922 children were reported in this manner as actually suffering from measles. These cases were not verified and the numbers do not include cases under school age. In spite of the large mortality from measles, cases of this disease are not visited, the staff being insufficient for the purpose. Under certain circumstances severe cases are treated either in the Poor Law Infirmaries or the Metropolitan Asylums Board hospitals, but in June, 1914, the admission of cases of measles (and of whooping cough) to the latter hospitals was suspended, owing to the increased number of scarlet fever patients to be dealt with. The small mortality from measles in well-to-do families shows that deaths from it are largely preventible, and there is every reason for the spending of public money for this purpose. To provide hospital accommodation for any large proportion of total cases would be a large undertaking, and this would be rendered still more difficult by the tendency of the disease to occur in epidemic waves. But supervision of cases in their own homes bv \isiting nurses (and, where necessary, doctors) together with the provision in necessitous cases of the means to keep the patients, especially in the early stages of the disease, properly supplied with food, warmth and accommodation would probably prevent manydanyerous complications and lead to a reduction of mortality. A fraction of the money spent upon other infectious diseases, such as scarlet fever and diphtheria, would go far if spent in this direction. Hospital treatment of certain cases would no doubt be necessary, but with a disease so highly infectious and so hard to diagnose in the early stage before the appearance of the rash, no isolation method of prevention can be expected to go far in the direction of the prevention of canes. In this connection it is to be borne in mind also that there is very little evidence that scarlet fever or diphtheria have been in any way reduced in incidence by very complete hospital isolation of recognised cases. WHOOPING COUGH. Tn the following table will be found the deaths and death-rate from whooping cough for the past ten years for the whole Borough and for the four registration sub-districts:— 74 Year. Deaths. Rate per 1,000 population. West. South. East. North. Whole Borough. West. South. North. East. Whole Borough. 1904 20 20 15 24 79 0.32 0.36 0.25 0.40 0.33 1905 15 17 31 17 80 0.24 0.39 0.51 0.28 0.33 1906 18 15 22 13 68 0.29 0.27 0.37 0'21 0.28 1907 17 19 22 18 76 0.27 0.34 0.37 0.30 0.32 1908 22 12 16 17 67 0.35 0.21 0.26 0.28 0.28 1909 2 6 9 10 27 0.03 0.10 0.15 0.16 0.14 1910 13 5 41 15 92 0.50 0.08 0.68 0.25 0.38 1911 31 7 12 16 48 0.22 0.12 0.20 0.26 0.20 1912 6 14 22 5 47 0.10 0.30 0.38 0.09 0.21 1913 8 3 8 17 36 0.13 0.06 0.13 0.29 0.16 1914 11 1 16 21 49 0.19 0.02 0.27 0.36 0.22 Of the 49 deaths, 23 were of children under one year of age and 49 of children under five years of age. 42 of the deaths took place during the first six months of the year, the disease being less prevalent in the latter half (see table inset at page 27). The ward distribution of the deaths is shown in the next table: — Deaths from Whooping Cough, 1914. West. Sooth.. East. North. No Address. Whole Borough. Ward. Total. Ward. Total. Ward. Total. Ward. Total. 4 5 7 8 3 6 1 2 3 8 11 .. 1 1 3 13 16 10 11 21 .. 49 Much of what is stated in the preceding section in reference to measles applies also to whooping cough. DIARRIICEA AND ENTERITIS. 142 deaths from diarrhoea and enteritis were registered during 1914, equal to a death.rate of 0.60 per 1,000 population. Of these 127 were in children under five years of age and 106 in babies under one. Reference is made on page 43 to infantile diarrhoea. 75 SYPHILIS. In recent years much attention has been paid to this disease as a cause of Preventible mortality. It is well realised that far more deaths are due to it than appear under its name, partly owing to a reluctance to place the name upon a death-certificate which is handed to the friends of the deceased, and partly owing to the fact that many diseases with other names are due to antecedent syphilis. In the following table are given the age and sex distribution of deaths certified during 1914 as due to (a) declared syphilis, (b) locomotor ataxy and general paralysis of the insane, which are believed by most experts to be late manifestations of the disease, and {c) aortic aneurysm, which many authorities now consider to be at any rate frequently caused by it: — 0-1 1-5 5—15 15—25 25—35 35—4.1 45—55 55-65 65—75 75 96 85 up.| Total Males. 0-1 1 1-5 1 5-15 !5—25 25-35 35- 45 45—55 65—65 65—75 75-85 85 up. Total Females. Persons. Syphilis 8 3 1 — 1 1 - - - - - 14 7 2 - - - - - - - - - 9 23 Gummatous disease - - - - - - - 1 - - - 1 - - - - - - - - - - - - 1 Total declared Syphilis 8 3 1 - 1 1 - - - - - 15 7 2 - - - - - - - - - 9 24 Locomotor ataxy - - — — — — 4 - 1 - - 5 - - - - - - - - - - - - 5 General paralysis of the insane - - - - 3 7 4 7 — — - 21 — — - 2 — 3 1 — — — — 6 27 Aortic aneurysm — — — — 1 2 4 < 2 - - 13 - - - - - - 2 1 - 1 - 4 17 The above figures are too small to allow of any conclusions being drawn, but it will be noticed that the deaths of adult males are in considerable excess over those of females. There is reason to believe that many abortions and miscarriages are caused by this disease and also that it is responsible for a certain mortality (occulted) amongst infants and young children. With a view of determining what number of average live-born infants are infected with the disease a research has been carried out during the year by F. W. Mott, Esq., M.D., F.R.C.P., F.B.S., upon material which has been supplied to him from St. Pancras by the Medical Officer of Health. For this purpose the authorities of certain maternity charities in the Borough have kindly obtained for us samples of foetal blood from infants at the time of birth. This has been d ine by collecting a few cubic centimeter s of blood from the placental end of the cut umblical cord, and these samples have been sent to Dr. Mott who has tested them for the Wassermann reaction of syphilis. Three institutions have co-operated with us in supplying the samples, viz.: — a general hospital with a maternity practice (intern and extern) carried out bv medical students and midwives (described as A) a second hospital with a maternity practice (extern) carried out by medical practitioners (described as B), and a maternity charity (extern) worked by midwives (described as C). The work began in May, 1914, and the results given below extend over the period to the end of April, 1915. 76 Excluding cases in which the blood collected became decomposed or w as for other reasons unsuitable for testing, 151 samples were dealt with. A certain number of these were from births which took place outside of St. Pancras. The results were as follows* :— Institution. No. of Cases. No. negative. No. definitely positive. No. probably positive. A 50 (12 intern) 38 extern) 48 2 (+40 & +13) B 42 (extern) 40 2 (+40 & +20) — c 59 (extern) 54 2 (all +40) 3 (+40 & +) 151 142 6 3 The details of the positive cases were as follows: Institution. Date of Birth. ^identification. Reaction. Remarks. A. 7th May, 1914 A. 1094† +40 Specimen of serum good—Reaction reliable. A. 21st ,, L. 50 + 13 Specimen of serum good—Reaction reliable. C. 26th „ J. 8† +40+ Specimen of serum good—Reaction reliable. C. 27th P. 7 † + Specimen of serum small—Reaction ? c. 8th June, 1914 D. 15 +40 Specimen of serum hsomolysed—Reaction ? B. 10th „ Bk. 7. P. 161 No. 107 +20+ Specimen of serum good—Reaction reliable. B. 2nd July, 1914 Bk.7.P. 161 No. 106 +40+ Specimen of serum good—Reaction reliable. C. 28 th T. 16† +40 Specimen of serum good—Heaction reliable. C. 27th Nov., 1914 D. 49 +40 Specimt n of serum small—Reaction ? * See note on next page. † Not St. Pancras cases. 77 Accepting the Wassermann reaction as diagnostic of syphilis, and counting only the "definitely positive" cases 4 per cent. of the new-born infants tested were affected with the disease; while if the " probably positive" cases are also included the proportion goes up to 6 per cent. These results are in respect of an unselected series of cases of the lower working class. With one exception the births were all legitimate. Particulars were taken in each case as to the number of former live-births and former miscarriages and abortions. In none of the 9 cases giving' “ positive " results was there any history of miscarriages, and an examination of the number of former live-births in each case reveals no points of interest. It was not found possible to obtain details of the parents' history as regards this disease, though in one case giving a positive result (+ 13) the mother was known to be suffering from secondary syphilis. Nor has it been possible to trace out the after-history of the children ; in two of the positive cases still under observation (J. 50 and D. 49) the child is said to be in good health. The technique of the method employed is described in a paper " The Wassermann Reaction in the Diagnosis of Mental Disorders," by Dr. Candler and Mr. Mann (Archives of Neurology and Psychiatry, Vol. VI., 1914, pp. 59-72). The following extract from their paper indicates the numerical manner of expressing results:— " We have taken as a unit of complement the minimum complementary dose of our " technique (which is generally represented by O'Ol c.c. of pure guinea-pig " serum) and express our results as units of complement absorbed per 1 c.c. of " cerebro-spinal fluid or serum. In each tube we have four minimum comple" mentary doses of complement, and when any quantity of fluid gives total " prevention of haemolysis we say that four units of complement have been " absorbed. For example, if a tube containing 0.l c.c. of cerebro-spinal fluid " or serum shows complete prevention of haemolysis the reaction is recorded " +40, and similarly for tubes containing other fractions of a cubic centimeter " of cerebro-spinal fluid or serum." ALCOHOLISM. As in the case of the last disease, the number of deaths due to excessive use of alcohol is in no way represented by the number certitied as such. During 1914 seventeen deaths were returned as due to alcoholism, and three others to alcoholic cirrhosis of the liver. There were 34 deaths from cirrhosis of the liver not returned as alcoholic. CANCER. 267 deaths were registered during 1914 as due to cancer, under the various names of cancer, carcinoma, epithelioma, scirrhus, malignant disease, rodent ulcer, and sarcoma. This is equal to a death-rate of 1.22 per 1,000 population. 78 The sex distribution of the deaths and death-rate is shown in the following table :— No. of Deaths. Death-rates per 1,000 males or females living (based on 1911 Census). Sex. Cancer, Carcinoma, &c. Rodent Ulcer. Sarcoma. Total malignant disease. Sex. Cancer, Carcinoma, Ac. Rodent Ulcer. Sarcoma. Total malignant disease. Males . 119 1 7 127 Males . 1.11 0.01 0.07 1.19 Females 134 — 6 140 Females 1.20 0.00 0.05 1.25 Both Sexes. 253 1 13 267 Both Sexes . 1.16 0.00 0.06 1.22 In the accompanying table the deaths from malignant disease are classified according to age and sex and the part of the body affected, as stated on the death certificates; and also according to the terms used on the death certificates to express the cause of death (cancer, carcinoma, etc.). All "cancer" deaths are grouped with carcinoma, but rodent ulcer and sarcoma are each grouped separately. The tables show that females suffered from malignant disease more than males, though the excess of deaths of females over that of males was only 13. Of the female deaths, 68 were due to cancer of the breast and of organs peculiar to women, against only 5 deaths amongst men from cancer of the breast and of organs peculiar to males. If these cases are subtracted, the remaining deaths from cancer amongst males (122) were in considerable excess of those amongst females (72). This difference is partly accounted for by the great excess in males of cancer about the mouth and throat (30 in males compared with 4 in females). VACCINATION. The following table is drawn up from returns kindly supplied by the Clerk to the Guardians in respect of children whose births were registered in the Parish of St. Pancras from 1st January to 31st December, 1913, inclusive:— DEATHS FROM CANCER, CARCINOMA, EPITHELIOMA, MALIGNANT DISEASE, SCIRRHUS, &c., 1914. Locality. Cancer, Carcinoma. Epithelioma. Malignant disease. Scirrhus. Papilloma. Males. Females. 0 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 up. Total. 0 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 up. Total. Total all Ages. Mouth M - 1 - - - - F - - - - - - - - - - - - 1 - - - 1 - - - - - - - 1 - - 1 2 Tongue M - 5 3 - - - - 1 2 F - - - - - - - - - - - 3 3 2 - - 8 - - - - - - - - - - - 8 Lip M 1 - - - - - - - F - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - 1 Jaw M - 1 1 - - - F 1 - - - - - - - - - - 1 1 - - 2 - - - - - - 1 - - - 1 3 Tonsil M — - 1 1 — - F - - - - - - - - - - - 1 1 - - - 2 - - - - - - - - - - - 2 larynx M 1 7 - - - - - - F - - - - - - - - - - 1 4 2 1 - - 8 - - - - - - - - - - - 8 Pharynx M - 4 1 - - - F - - - - - - - - - - - 1 2 - - - - - - - - - - - - - - 5 Thyroid M - 1 - - - - F - 2 - - - - - - - - - - 1 - - - 1 - - - - - 1 - 1 - - 2 3 Glands of Neck M — 1 - - - - F - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - 1 Parotid Gland M - 1 - - - - - F - - - - - - - - - - - 1 - - - - 1 - - - - - - - - - - - 1 Neck M 2 1 - - - - F - 2 - - - - - - - 1 - - - 2 - - 3 - - - - 1 - - - 1 - 2 5 Oesophagus M 2 2 1 - - - F - 3 - - - - - - - - 1 1 1 2 - - 5 - - - - - - - 3 - - 3 8 Stomach M 1 18 - 2 - - F - 10 - 1 - - - - - - 1 4 9 8 5 1 21 - - - - 3 - 4 2 1 1 11 32 Bowel (unless stated as Rectum) M 4 13 — - - - F 4 11 - 3 - - - - - - 2 4 4 - 3 - 17 - - - - 1 2 4 6 4 1 18 35 Rectum M 1 7 - 1 - - F 2 3 1 1 - - - - - - - - 5 3 1 - 9 - - - - - - 3 3 1 - 7 16 Liver M 2 9 - 1 - - F 1 8 - 1 - - - - - - 2 3 2 4 1 - 12 - - - - 1 2 2 2 3 - 10 22 Gall Bladder M - 2 - - - - F - 1 - - - - - - - - - 1 1 - - - 2 - - - - - 1 - - - - 1 3 Pancreas M - - - - - - F - 1 - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 Peritoneum M - 1 - - - - F - - - 1 - - - - - - - - - 1 - - 1 - - - - - - 1 - - - 1 2 Abdominal M 1 - - - - - F - 4 - - - - - - - - - - 1 - - - 1 - - - 1 1 1 - 1 - - 4 5 Spleen M - 1 - - - - F - - - - - - - - - - 1 - - - - - 1 - - - - - - - - - - - 1 Bronchus M - 1 - - - - F - - - - - - - - - - 1 - - - - - 1 - - - - - - - - - - - 1 Lungs M - - - - - - F 1 - - - - - - - - - - - - - - - - - - - - - 1 - - - - 1 1 Bladder M 1 - - 2 - - F - - - - - - - - - - - - 1 1 1 - 3 - - - - - - - - - - - 3 Kidney M - 2 - - - - F - - - - - - - - - - 1 - - 1 - - 2 - - - - - - - - - - - 2 Inguinal Glands M - - - - - - F - 1 - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 Skin (Scalp) M - - - - - - F - - - 1 - - - - - - - - - - - - - - - - - - - - - 1 - 1 1 Locality not Stated M 4 - - 1 - - F 1 - - - - - - - 1 - - 1 3 - - - 5 - - - - - 1 - - - - 1 6 Abdominal Neoplasm —- - - - - - - - - 1 - - - - - 1 - - - - - - - - - - - 1 Female Breast and Generative Ongans— - - Breast F 4 25 - - - - - - - - - - - - - - - - - - 1 4 9 7 5 3 1 30 30 Ovaries F - 2 - - - 1 - - - — — — — — — - - - - - - 2 1 — — — — 3 3 Uterus F 4 29 — 1 — — - - - - - - - - - - - - - 1 1 3 10 10 7 2 — 34 34 Vulva F — 1 — — — — - - — — — — — — — — - - - - - — — — — 1 — 1 1 Male Breast and Generative Oraans— - - Breast M — 1 - - - - - - - - - - - - - 1 1 - - - - - - - - - - - 1 Prostate M 1 2 — - - - - - - - - - - 1 2 - 3 - - - - - - - - - - - 3 Penis — 1 — — — — - - — — — — — 1 — — 1 — — — — — — — — — — — 1 Total 38 187 8 17 1 1 - - 1 1 11 25 30 36 13 2 119 — — 1 3 16 29 34 31 17 3 134 253 Rodent Ulcer— - - Ear — — — — — — — - — — — — — — 1 — 1 — - — — — — — — — — 1 Sarcoma. Maxilla - - - - - - - - 1 - - - - - - - - - - - - - - - - - 1 1 2 Scapula - - - - - - - - - - - - - - - - - - - - - - 1 - - — — 1 1 Femur - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - - - 1 Pelvis. - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - 1 Ear - - - - - - - - - - - - - - - - - - - - 1 - - - - - - 1 1 Uterus - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 Retro-peritoneal - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 1 Bowel - - - - - - - - — - - - - - 1 - 1 - - - - - - - - - - - 1 Post-rectal - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 1 Back - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - 1 Brain, - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - 1 Chest — — — — — — — - — — — 1 — — - 1 — - - - - - - - - - - 1 Total — — — — — - - - 1 — — 2 1 1 2 - 7 2 - — 1 — 1 1 — 1 1 6 13 TOTAL MALIGNANT DISEASE - - - - - - - - 2 1 11 27 31 37 16 2 127 2 — 1 4 16 30 35 31 17 4 140 267 79  Number. Percentage of Births registered. North. East. West. South. Whole Borough. North. East. West. South. Whole Borough. Births registered 1333 1535 1264 942 5074 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 87 115 60 61 323 6.5 7.5 4.8 65 6.4 Successfully vaccinated 516 589 556 389 2050 38.7 38.4 44.0 41.3 40.4 Had small pox 0 0 0 0 0 - - - - - Insusceptible of vaccination .. 4 1 2 1 8 0.3 0.1 0.2 0.1 0.2 Received certificates of conscientious objection 482 380 281 139 1282 36.2 24.8 22.2 14.7 25.3 Postponed by medical certificate 20 46 52 47 165 1.5 3.0 4.1 5.0 3.2 Moved to known address in other districts 5 16 11 30 62 0.4 1.0 0.9 3.2 1.2 Lost sight of by removal 197 360 223 192 972 14.8 32.4 17.6 20.4 19.1 Unvaccinated and not accounted for in previous columns 22 28 79 83 212 1.6 1.8 6.2 8.8 4.2 It will be seen that 1,282, or 25.3 per cent. of the children born, were the subjects of certificates of conscientious objection to vaccination, the percentage being as high as 36.2 per cent. in the North division. The children with such certificates, together with those unvaccinated and not otherwise accounted for (bottom row in table), numbered 1,494 or 29.4 per cent. of the total births. The corresponding figures for the past ten years arc as follows: — Year. Births, Successfully vaccinated. Per cent. Conscientious Objections, and Children otherwise escaping Vaccination. Per cent. 1903 6384 3923 61.5 120 1.9 1904 6157 3891 63.2 138 2.2 1905 5816 3798 65.3 93 1.6 1906 5816 3952 68.0 80 1.4 1907 5508 3351 60.8 226 4.1 1908 5437 3357 61.7 618 11.3 1909 5285 3097 58.6 622 11.8 1910 5394 2787 51.7 953 17.6 1911 5139 2353 45.8 1235 24.4 1912 5079 2318 45.6 1149 22.6 1913 5074 2050 40.4 1494 29.4 80 It will be seen from this table that since 1906 there has been a very great increase in the number of children who escape vaccination, the figures having risen from under a hundred to near fifteen hundred, and the percentage twenty-fold. The effect of this is seen in the reduction of the percentage of children successfully vaccinated from 68.0 to 40.4 since the same year. This change is, no doubt, a consequence of the Vaccination Act, 1907, which provided for the substitution of a statutory declaration as to conscientious objection for the certificate of the Justices. As a result, the "immunity" to small pox of the population of the Borough, and particularly of the younger members, must be much less than seven years ago, and still diminishing. DWELLING HOUSES. The most important feature of the housing problems in St. Pancras as in many other parts of London is the almost universal practice of sub-letting to several families each houses which were built for single families. A typical case is a house consisting of a basement and ground floor with two or more floors above, each floor, consisting of two rooms, being let out to one family. Such sub-letting renders the provision of even reasonably good accommodation for each family impossible, quite apart from the fact that two rooms are not sufficient for the needs of a family with several children. Notices have been served during the year under section 78 of the London County Council (General Powers) Act, 1907, for additional water taps upstairs in many houses, and much work has also been done in prohibiting the use for sleeping-places of underground rooms in contravention of section 7 of the Housing, Town Planning, &c., Act, 1909. and the regulations made thereunder. This, however, only affects for the better the tenement-house problem in a minor degree. It leaves untouched the difficulty of the lack of separate kitchen, scullery, food-storage, water-closet and yard accommodation for the separate tenements. In many houses these difficulties can only be dealt with by complete or partial rebuilding, but in large blocks of our tenement houses much could be done by the erection at the rear of each house of a sanitary annexe which would enable each floor to have a balcony giving access to a w.c. and washhouse, and perhaps other accommodation. Inspection of Dwelling-Houses. At the present time inspection of dwelling-houses is carried out under the following circumstances : — 1.—Whenever a case of notifiable infectious disease (except Consumption) is reported, the house where the case occurred is subjected to a sanitary inspection and the drains tested. During the year 1,733 such inspections were made, followed by 1,484 re-inspections. 2. — Whenever a complaint is received as to the condition of any house a sanitary inspection of the house is carried out. The drains of many houses are tested by this procedure. During the year 2,291 inspections were made in consequence of complaints, and 5,440 consequent re-inspections. 81 3.—All registered tenement houses, and certain other dwellings which require frequent inspection (known as " inscribed dwellings") are visited periodically (six monthly, where possible), and inspected. There were at the end of 1914, 2,364 houses on the tenement house register (i.e., the register of " houses let in lodgings, or occupi ed by members of more than one family "). These are sub-let houses which are of such a nature as to make frequent inspection desirable. They are nearly all let unfurnished. Four such houses were added to the register during 1914. The number of ' inscribed dwellings" at the end of the year was 207. 338 routine inspections and 280 consequent re-inspections of these houses were made during 1914, in addition to those made under the Housing, Town Planning, etc., Act, 1909 (see below). Weekly inspections were also made of the yards of mews and stables. 4429 inspections of these and 207 consequent re-inspections were made in the year. 4.—During 1914 the routine inspection of houses prescribed by Sec. 17 (1) of the Housing, Town Planning, etc., Act, 1909, has been continued. This sub-section provides that “ it shall be the duty of every local authority to cause to be made from time to time inspection of their district with a view to ascertaining whether any dwelling-house therein is in a state so dangerous or injurious to health as to be unfit for human habitation." It also enacts that in this connection regulations made by the Local Government Board must be complied with. In accordance with the regulations a list of streets was prepared by the late Medical Officer of Health, the houses in which, in his opinion, ought to be inspected at once. This consisted of those streets, the majority of the houses in which were already subject to periodical inspection as registered tenement houses or "inscribed dwellings." The number of houses included in these streets was 3824. The inspections under the regulations were begun on 1st January, 1913, and in every instance a case paper has been filled up and filed. A number of streets which are not included in the above-mentioned list have also been inspected. During 1913, 1545 houses were inspected for the first time under the Act, and 26 of the houses received a second routine inspection later in the year. In 1914 there have been made 1582 further first inspections, and 789 houses have had a subsequent routine inspection. Since 1st January, 1913, therefore, 3127 of the 25,000 houses in the Borough have been inspected under the Act, and 815 of these have received subsequent routine inspections. It is not to be forgotten that most of these inspections involved re-inspections after the service of intimation notices. The details of this work are set out in the following table :— 82 First Routine Inspections under Sec. 17 (1) of thk Housing, Town Planning, etc., Act, 1909, made during 1914. Division and SubDivision. Street or Place. No. of Houses inspected under Sec. 17 No. of intimations served. North Highgate Bertram Street (24) 24 21 „ „ Doynton Street (35) 35 28 „ „ Raydon Street (53) 9 5 „ „ Winscombe Street (18) 18 17 „ St. John's College Park Falkland Place (23) 8 6 ,, Gospel Oak Gospel Oak Grove (33) 15 13 „ „ Oakfleld Crescent (21) 13 12 „ „ Wellesley Place (9) 2 2 „ „ Wellesley Road 60) 1 1 „ Grafton Dickenson Street (45) 45 29 „ „ Tovey Place (25) 21 10 „ „ Weedington Road (84) 1 1 Maitland Park Chaston Street (9) 9 6 „ „ Newberry Mews (18) 7 8 „ „ Weedington Road (69) 16 8 East Bartholomew Nil ... ... Camden Square Little Randolph Street (26) 5 4 ,, College Nil ... ... Oakley Square Aldenham Street (82) 38 31 „ „ Clarendon Square (8) 7 7 „ „ Gee Street (10) 10 6 „ „ Hampden Street (19) 7 7 „ „ Medburn Street (19) 1 1 „ „ Seymour Street (37) 14 11 „ „ Stibbington Street (100) 53 49 „ „ Werrington Street (53) 30 22 „ Ossulston Chapel Grove (30) 19 15 „ „ Charles Street (19) 9 9 „ „ Christopher Place (9) 5 ... „ „ Clarendon Place (26) 26 16 „ „ Drummond Crescent (56) 24 23 „ „ Drummond Street (41) 40 29 „ „ Eastnor Place (25) 6 3 „ „ Gee Street (10) 8 7 „ „ Grafton Place (11) 10 9 „ „ Hampden Street (11) 10 10 „ „ Phoenix Street (24) 14 5 „ „ Weirs Passage (9) 9 9 „ „ Wilstead Cottages (23) 22 16 West Castle Belmont Street (95) 1 ... „ „ Ferdinand Place (56) 46 32 „ „ Ferdinand Street (56) 16 14 „ „ Hartland Road (71) 2 2 „ „ Haverstock Place (9) 9 5 „ „ Hawley Street (16) 1 1 „ „ Hethersett Street (15) 3 3 „ „ Carried forward (1492) 669 513 83 Division and SubDivision. Street or Place. No. of Houses inspected under Sec. 17 No. of intimations served. Brought forward (1492) 669 513 West Castle Powlett Place (24) 24 17 „ „ Victoria Road (90) 4 3 „ Chalk Farm Arlington Road (48) 1 1 „ „ Erskine Mews (10) 10 10 „ „ James Street (58) 2 2 „ „ Manley Street (38) 2 1 „ „ Oval Road (27) 1 2 „ „ Princess Road (52) 1 1 „ „ St. George's Mews (14) 1 1 „ „ St. George's Road (64) 2 1 „ „ Stucley Place (12) 11 10 „ „ Wellington Street (40) 1 1 Mornington Seymour Street (7) 1 1 Regent's Park Clarence Gardens (58) 2 2 „ „ Edward Street (7) 1 1 „ „ Glen Street (10) 1 1 „ „ Osnaburgh Street (93) 8 2 „ „ Redhill Street (62) 28 25 „ „ Robert Street(72) 4 4 „ „ Seaton Street (7) 7 9 „ „ Stanhope Street (......75) 9 7 „ „ William Street (64) 3 2 Euston Cobourg Street (73) 38 35 „ „ Drummond Street (101) 29 27 „ „ Euston Road (46) 4 4 „ „ Exmouth Street (30) 21 21 „ „ George Street (76) 6 4 „ „ Melton Street (28) 1 2 „ „ Netley Street (27) 10 9 „ „ Robert Street (38) 1 1 „ „ Robert Mews (16) 9 4 „ „ Seaton Street (31) 11 13 „ „ Seymour Row (18) 9 11 „ „ Stanhope Buildings (19) 14 18 „ „ Stanhope Street (53) 45 39 „ „ Tolmers Square (29) 2 2 „ „ William Mews (19) 13 6 „ „ William Street (32) 15 13 South Argyle Cromer Street (53) 43 33 „ „ St. Chad's Place (4) 1 ... „ „ Stanley House Buildings (15) 17 ... „ „ Swinton Street (72) 14 8 Mecklenburgh Cubitt Street (11) 10 5 „ „ Elm Street (8) 1 1 „ „ Kenton Street (12) 5 1 „ „ Pakenham Street (19) 8 2 „ „ Sidmouth Street (27) 4 1 „ „ Wells Street (20) 1 1 „ „ Wilson Street (20) 11 7 Carried forward (3321) 1131 885 84 Division and SubDivision. Street or Place. No. of Houses inspected tinder Sec. 17 No. of intimations served. Brought forward (3321) 1131 885 South.—Burton Wakefield Street (26) 26 19 „ „ Lucas Place (12) 12 9 ,, Endsleigh Cleveland Street (42) 30 12 „ „ Conway Mews(1) 1 ... „ „ Fitzroy Mews (8) 8 4 „ „ Grafton Mews (4) 4 ... „ „ Grafton Street (21) 21 9 „ „ Huntley Street (39) 35 22 „ „ Maple Street (26) 22 19 „ „ Mortimer Street (18) 8 3 „ „ Pancras Street (19) 12 10 „ „ Richardson Mews (—) 1 1 „ „ Warren Street (61) 54 40 „ „ Whitfield Place (8) 7 5 „ „ Whitfield Street (28) 27 13 Whitfield Charlotte Place (6) 6 2 „ „ Chitty Street (14) 13 8 „ „ Cleveland Mews (12) 10 4 „ „ Cleveland Street (32) 24 5 „ „ Hanway Place (5) 5 ... „ „ Hanway Street (16) 7 ... „ „ Howland Mews West (5) 2 1 „ „ Maple Street (81) 30 16 „ „ Percy Street (37) 29 6 „ „ Stephens Mews (2) 3 2 „ „ Tottenham Street (44) 6 1 „ „ Tudor Place (12) 1 ... „ „ Whitfield Street (92) 6 5 „ „ Windmill Street (40) 36 7 „ „ Rathbone Place (6) 5 ... Totals (3991) 1582 1108 85 Subsequent Routine Inspections under Sec. 17 (1) or the Housing, Town Planning, etc., Act, 1909, made during 1914. Division and SubDivision. Street or Place. No. of Houses reinspected under Sec. 17 No. of intimations served. North.—Higligate Balmore Street (45) 40 34 „ „ Doynton Street (34) 34 10 „ „ Lulot Street (45) 42 25 „ „ Raydon Street (53) 49 11 „ „ Retcar Street (43) 41 20 West.—Castle Little Charles Place (8) 5 3 „ Euston Euston Street (103) 1 1 „ „ Seymour Row (18) ] 1 South.—Argyle Britannia Street (26) 8 4 „ „ Stanley House, St. Chad's Place (15) 17 9 „ „ Wicklow Street (32) 28 9 Mecklenburgh Gough Street (54) 11 ... „ „ Sidmouth Street (27) 3 ... „ „ Wilson Street (20) 6 ... Burton Bidborough Street (32) 22 6 „ „ Cromer Street (37) 54 48 „ „ Harrison Street (78) 115 62 „ „ Leigh Street (22) 10 3 „ „ Hastings Street (25) 12 5 „ „ Sandwich Street (34) 3 ... „ „ Seaford Street (5) 5 5 „ „ Sidmouth Mews (16) 16 ... „ „ Sidmouth Street (16) 4 ... „ „ Thanet Street (25) 17 8 „ „ Wakefield Mews (18) 22 ... Endsleigh Whitfield Place (8) 4 ... „ „ Whitfield Street (28) 26 2 Whitfield Bennett Street (3) 4 2 „ „ Gresse Street (12) 6 3 „ „ Little Goodge Street (26) 20 4 „ „ Maple Street (31) 26 4 „ „ Percy Buildings (12) 10 1 „ „ Pitt Street 15) 14 1 „ „ Stephen Street (27) 13 4 „ „ Tottenham Street (44) 38 12 „ „ Whitfield Street (92) 62 30 Totals (1129) 789 327 86 The number of houses inspected under Sec. 17 by individual Inspectors is shown in the next table :— Inspector. Number of Houses Inspected. Total. 1st routine inspection. Subsequent routine inspection. Mr. Rackham 86 206 292 ,, Brown 39 — 39 ,, Thompson — — — ,, Dillon 5 — 5 „ Auger 160 — 160 „ James 202 — 202 ,, West 52 — 52 ,, Lonnon 59 — 59 ,, Adkins 228 2 230 ,, Holmes 115 73 188 ,, Walker 38 280 318 ,, Landen 197 193 390 Akers 302 35 337 ,, Pottier 99 — 99 Total 1582 789 2371 As was previously stated most of the above recorded inspections involved subsequent visits for supervising work in progress and other purposes. The following is an analysis of the results of inspection of 1547 of the 1582 houses inspected for the first time under the Act during 1914: — No. of houses with 2 rooms* 49† „ „ „ „ 3 „ 68 „ „ „ „4 „ 140 „ „ „ „ 5 „ 81 „ „ „ „ 6 „ 189 „ „ „ „ 7 „ 171 „ „ „ „ 8 „ 365 „ „ „ „ 9 „ 98 „ „ „ „ 10 „ 145 „ „ „ „ 11 „ 99 „ „ „ „ 12 „ 44 „ „ „ „ 13 „ 32 „ „ „ „ 14 „ 18 „ „ „ „ 15 „ 17 „ „ „ „ 16 „ 12 ,, ,, ,, ,, more than 16 rooms* 8 Total number of rooms* 11737 Average ,, ,, „ per house 7.6 * Not counting wash-houses. † Not including 11, 2-roomed flats. 87 No. of houses with 1 floor or storey 68† „ „ „ „ 2 floors „ storeys 220 „ „ „ „ 3 „ 370 „ „ „ „ 4 „ 525 „ „ „ „ 5 „ 345 „ ,, ,, „ more than 5 floors or storeys 8 Average number of floors or storeys per house 3.5 No. of houses occupied by 1 family 349 „ „ „ „ 2 „ 288 „ „ „ „ 3 „ 349 „ „ „ „ 4 „ 270 „ „ „ „ 5 „ 149 „ „ „ „ 6 „ 65 „ „ „ „ 7 „ 37 „ ,, „ ,, „ more than 7 families 40 Total number of families 4806 Average ,, ,, ,, per house 3.1 No. of persons over 10 years of age 11921 „ „ „ under 10 „ „ „ 5000 Total number of persons 16921 Average number of persons over 10 per house 7.7 „ „ „ under 10 „ „ 3.2 „ „ „ all persons per house. . 10.9 Average number of persons over 10 per room 1.0 „ „ „ under 10 „ „ 0.4 „ „ „ all persons per room 1.4 No. of houses with 1 person or less per room 409 „ „ „ ,, more than land not more than 2 persons per room 849 „ „ „ „ „ „ 2 „ „ „ „ 3 „ „ „ 274 „ „ „ „ „ „ 3 persons per room 15 No. of houses with underground rooms 946 (or 62 per cent.) Total number of underground rooms 1717 No. of houses with empty rooms (not underground) 239* „ „ „ „ „ underground rooms 113* „ „ „ „ „ rooms (underground or otherwise) 306* No. of empty rooms (not underground) 441* „ „ „ underground rooms 173* No. of familes with one room at least used solely as a living room (i.e, not as a sleeping room) 1623 (or 34 per cent. of all families) No. of houses with drinking water from a cistern only 158 „ „ „ „ „ the main „ 1197 „ „ „ „ „ both main and cistern 192 No. of houses with no water-supply above ground floor 1096 „ „ „ „ a water-supply „ ,, ,, 440 No. of houses with Yards 1324 „ „ „ „ without yards 212 f Not including 11, 2-roomed flats. * Not including houses totally empty. 88 All the ash-places consisted of metal bins except for the following:— Wood or brick bins 79 Refuse thrown on manure heap 52 All the ash-bins were kept in the yards or otherwise in the open air (forecourts, areas, open vaults or roofs) except the following:— In the house 30 „ ,, wash-house 7 ,, ,, stable 3 Water Supply. Section 78 of the London County Council (General Powers) Act, 1907, provides that ever}' house let to the working classes and occupied by members of more than one family must have a water supply on every floor let to a separate family or families. In this borough the section has only been used to secure that every family shall have a water-tap on its own or the next floor. In the house comprising basement, ground, first and second floors with water on the ground floor level only we have been satisfied with an additional tap on the landing between the first and second floors. During 1914 notices were served for additional water supply in regard to 871 houses. Underground Rooms. The procedure provided by the Housing and Town Planning Act for underground rooms is somewhat cumbrous, and before any pressure can be brought to bear a closing order has to be made. The method which has been adopted in St. Pancras since September, 1913, when the section was first put into operation is as follows :— The Sanitary Inspector reports to the Medical Officer of Health any underground room which appears to be illegally occupied, full details and measurements being supplied to the latter on a special form. If the room is not in conformity with Section 17 (7), a printed letter is sent to the owner and occupier respectively informing him of the fact, and asking him to see that the use of the room for sleeping purposes is discontinued. If after a delay of two months the room is found to be still used for sleeping purposes the case is reported to the Public Health Committee for the purpose of making a closing order. After the closing order has been made the provisions of the Act are allowed to take their cour3e. This method has been very successful, and in no case have we found it necessary to take legal proceedings to secure the compliance with closing orders in respect of underground rooms. During the year letters were sent in respect of 268 underground rooms (in 236 houses) which did not comply with the requirements of the Act and regulations. 95 closing orders in respect of underground rooms (in 85 houses) were made. In addition, 30 intimation notices were served during the year under the Public Health (London) Act, 1891, in regard to underground rooms illegally occupied as dwellings. Of these 4 (in 4 houses) were underground rooms in respect of which no action had been taken previously. 89 Houses unfit for Human Habitation. During 1914, in addition to underground rooms (which arc dealt with on page 88) '67 houses were represented by the Medical Officer of Health as unfit for human habitation. No closing orders were made. Closing orders were determined in respect of 15 houses which had been rendered fit for human habitation, and demolition orders were made in respect of 17 houses. In the following table are given the particulars in reference to all the houses which have been represented as unfit by the Medical Officer of Health during the past 2 years:— Address. Date of M.U.H.'s representation. Date of Closing Orders. Date of determination of Closing Orders, houses having been made tit for human habitation. Date of Demolition Orders. Condition at end of 1914. Little Clarendon Street Nos. 29-43 (inclusive) 16th July, 1913 17th Sept., 1 913 - 28th Oct., 1914 empty. No. 44 „ „ 8th April, 1914 — re-occupied. Nos. 45-54 (inclusive) „ „ 6th May, 1914 — re-occupied. Equity BuildingsNo. 1 22nd Oct., 1913 26th Nov., 1913 28th Oct., 1914 — re-occupied. Nos. 2-4 (inclusive) „ „ 25th Nov., 1914 — re-occupied. Nos. 5-37 (inclusive) „ „ - - empty. Nos. 2a and 3a „ „ — 25th Nov., 1914 empty. Warren Street, No. 37 „ „ — — empty. Little Clarendon Street, No. 16 „ „ - - empty. Johnson Street, No. 23 „ „ — — empty (repaired). Aldenham Street— Nos. 94 and 98 „ „ - - empty. No 104 „ „ — — empty. Ashdown Street, No, 45 21st Oct., 1914 - — — negotiations continuing. Cromer Street, No. 61 „ - — — „ Stibbington Street, No. 79 „ - - - „ Crawley Mews— Nos. 3 and 5 „ - - - „ Nos. 6 and 7 „ - - - „ Wakefield Mews — Nos. 1, 2, 3, 4, 5, 6. 7, 7a, 8a, 9, 10, 11, 12, 14, 15, 16, 17 and 18 „ - - - „ St. George's Mews— Nos. 1, 2, 3, 4, 5, 6, 10, 11, 13, 14, 15 and 16 „ - - - „ 90 After the making of closing orders, Nos. 45-54, Little Clarendon Street were acquired by a purchaser, together with the adjoining houses in Johnson Street (32.35), and the block of 14 houses were gutted and thoroughly repaired. Further work in Little Clarendon Street which it was understood the purchaser had in view was prevented by his untimely death. In connection with the efforts to improve the character of the street its name has since been altered to Wolcot Street. Following upon the making of a closing order in respect of No. 104, Aldenham Street on 26th November, 1913, an appeal was made to the Local Government Board by the owners against this action of the Council. I he Board held a local inquiry on 21st April, 1914, and on 23rd June, 1914, made on Order dismissing the appeal. On 8th April, 1914, the Council considered an application from the owner of Nos. 1-4 (inclusive), Equity Buildings for the closing orders on those houses to be determined, the owner claiming to have rendered them fit for habitation. The Council not being satisfied with the manner in which the repairs were carried out refused to determine the closing orders, and the owner appealed to the Local Government Board against the action of the Council. The Board held a local inquiry on 30th June, 1914, and on 22nd August, 1914, made an Order dismissing the appeal. The houses were subsequently repaired to the satisfaction of the Council, who determined the closing orders on 28th October, 1914, and 25th November, 1914, and the owner has since continued to repair the other houses in the Buildings to the satisfaction of the Council. On 28th October, 1914, the Council made demolition orders in respect of Nos. 38-43 (inclusive), Little Clarendon Street, and an appeal was made to the Local Government Board by the owners. No local inquiry was held as the appeal was abandoned by the owners, the houses having in the meantime been demolished by a purchaser. In accordance with the Housing (Inspection of District) Regulations, 1910, the following table is submitted for the year 1914 :— The number of dwelling-houses inspected under and for the purposes of Section 17— Totals. First routine inspections 1582 Subsequent ,, 789 2371 The number of dwelling-houses which, on inspection, were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation— As regards the whole house 37 „ underground rooms (268 rooms) 236 273 The number of representations made with a view to the making of closing orders— As regards the whole house 37 „ underground rooms (95 rooms) 85 122 91 The number of closing orders made— As regards the whole house Nil. ,, underground rooms (95 rooms) 85 85 The number of dwelling-houses, the defects in which were remedied without the making of closing orders 2334 The number of dwelling-houses which, after the making of closing orders, were put into a fit state for human habitation 15* Inhabited House Duty. Inland Revenue Act, 1903. Applications for certificates under Section 11 of the above Act (dealing with the abatement of Inhabited House Duty in the case of certain tenement dwellings) were received by the Medical Officer of Health during 1913 in respect of 11 blocks of dwellings. The certificates required are to the effect " that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their sanitary requirements." Certificates were granted and refused as follows :— Granted: Application made before 1914 1 Applications made during 1914 8 Total granted 9 Refused 1 Held over to 1915 2 Homing and Town. Planning,&c., Act, 1909. Section 35 of the Act provides that lodging-houses taking in working-class persons at a charge not exceeding sixpence a night shall be exempt from Inhabited House Duty on the production of a certificate from the Medical Officer of Health in similar terms to that mentioned above. Two applications for such certificates were received during the year, both of which were refused. Housing Schemes. Goldington Buildings.--The gross income for the year ended 31st March, 1915, from rents amounted to £1378 0s. 9d. The loss from empties, &c., amounted to £55 18s. 3d (equal to 3.85 per cent.). Flaxman Terrace.—These flats continue to let well. During the year The loss from empties amounted to £3 6s. (id. (equal to 0.16 per cent.), out of a gross rental of £2028. The sum of £14 8s. 11d. was also received for the use of the perambulator and bicycle sheds. Prospect Terrace.— These flats also continue to let well. The loss from empties amounted to £5 16s. 6d. (equal to 0.33 per cent.), out of a gross rental of £1725 2s. Od. A sum of £9 14s. 8d. was also received for the use of the sheds and £236 8s. 9d. from the baths. Canal Boats Acts. The late Inspector Osborne continued to act as Canal Boat Inspector until his death on 14th December, 1914. During the year he made 51 inspections, and did not find it necessary to serve any notices. No case of infectious or other illness on canal boats came to the knowledge of the department. * The closing orders in respect of these houses were made in 1913. 92 FACTORY AND WORKSHOP ACTS. The following five tables arc those asked for by the Home Secretary :— 1.—Inspections made by Male and Female Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including factory laundries) . . 63 9 - Workshops (including workshop laundries) 743 143 — Workplaces Other than Outworkers' premises included in Part 3 of this Report) 163 11 — Total 969 163 — 2.—Defects Found. Particulars. (1) Number of Defects. N umber of Prosecutions. (5) Found. (2) Remedied. (3) Referred to h.m. Inspectors. (4) Nuisances under the Public Health Acts' : — Want of cleanliness 115 115 Nil. Want of ventilation 2 2 Overcrowding 1 1 Want of drainage of floors 1 1 Other nuisances 28 28 Sanitary accommodation Insufficient. . 2 2 Unsuitablecr defective 3 3 Not separate for sexes 4 4 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 6 6 Other offences ( Excluding offences relating to outwork which are included in Part 3 of this Report) 1 1 Total 163 163 — — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 93 NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in unwholesome premises, Sec. 108. Outwork in infected premises, Sections 109, 110. 3,—Home 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. Contractors. Workmen. Contractors. Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing Apparel— (1.) making, etc — — — 21 43 79 21 - - - - - - - - (2) cleaning and washing - - - - - - - - - - - - - - - Household linen - - - - - - - - - - - - - - - Lace, lace curtains and nets - - - - - - - - - - - - - - — Curtains and furniture hangings - - - - - - - - - - - - - - - Furniture and upholstery - - - - - - - - - - - - - - - Electro-plate - - - - - - - - - - - - - - - File making - - - - - - - - - - - - - - - Brass and brass articles - - - - - - - - - - - - - - - Fur pulling - - - - - - - - - - - - - - - Cables and chains - - - - - - - - - - - - - - - Anchors and grapnels — - - - - - - - - - - - - - - Cart gear - - - - - - - - - - - - - - Locks, latches and keys - - - - - - - - - - - - - - - Umbrellas, etc. — — — — — — — - — — — — - - - Artificial flowers - - - - - - - - - - - - - - - Nets, other than wire nets — - - - - - - - - - - - - - - Tents — — — — — — — — — — — — — — — Sacks — — — — — - - — — - — — - - - Racquet and tennis balls — — — — — - - - - - - - - - - Paper bags and boxes — — — 1 — 3 - - - - - - - - - Brush making — — — 1 — 1 - - - - - - - - - Pea picking — — — — - - - - - - - - - - Feather sorting — — — — — — - - - - - - - - - Carding, etc., of buttons, etc. — — — — — - - - - - - - - - - Stuffed toys — — — - - - - - - - - - - - - Basket making — — — — — — — - - - - - - - - Total - - - 23 43 83 21 - - - - - - - - 94 4.—Registered Workshops. Workshops on the Register (Set. 131) at the end of the year. (1) Numbers. (2) Bakehouses 115 Restaurant kitchens 338 Laundries 76 Domestic workshops 71 Other workshops where women are employed 424 Other workshops .. ... 1314 Total number of workshops on Register 2338 5.—Other Matteks. Class (1) Number (2) Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) - Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 32 Reports (of action taken) sent to H.M. Inspector 32 Other — Underground bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 89 In the earlier part of the year the inspection of workshops, workplaces and factories (except in regard to certain matters arising out of the employment of women) was carried out by the District Inspectors. This arrangement had been in force since the end of 1904, but it was found that very inadequate and (except in regard to bakehouses) hardly any systematic industrial inspection was being done, and that the register of workshops and of factories was out of date. It was felt that this work would be done most efficiently if it were in the hands of one inspector who would be responsible also for keeping the register. This view was taken by the Public Health Committee who thereupon instructed the Medical Officer of Health to make such an arrangement for a period of six months. The action was approved by the Council on 24th June, 1914. Mr. H. G. West, who until that date was district sanitary inspector for Ward 4, accordingly took over the factory and workshop work for the whole borough from 5th October, 1914. Miss Bibby 95 still remained responsible for outworkers and domestic workshops and for matters concerned with the employment of women. A card index system of registration was adopted and the workshop inspector at once commenced a routine inspection of all factories, workshops and workplaces in the borough. This will take two years or more on the first occasion as complete details and measurements are being recorded, and the details of the old register checked. A six-monthly inspection of all bakehouses is also being maintained during this time, and all complaints in regard to workshops, &c., and all notices of new occupation of workshops dealt with. The number of inspections that were made during 1914 were as follows:— District Inspectors before 5th October. Workshop Inspector 5th October and after. Woman Sanitary Inspector. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-in- e spectios. Inspections. Re-inspections. Bakehouses 126 129 189 100 — — 315 229 Restaurant kitchens 118 38 5 — — — 123 38 Laundries — — — — 6 2 6 2 Domestic workshops — — — — 21 2 21 2 Other workshops 33 17 87 29 23 2 143 48 Other workplaces — 2 — — — — — 2 Other factories 9 9 27 16 2 — 38 25 Total 286 195 308 145 52 6 646 346 Bakehouses.—At the end of the year there were 132 bakehouses on the register in use), including 17 factory bakehouses. 89 of these were underground bakehouses. Restaurant Kitchens.—At the end of 1914 338 restaurant kitchens were on the register. 96 INSPECTION OF FOOD AND FOOD-PLACES, Sale of Food and Drugs Acts. Too samples have been taken under these Acts, and 698 of these proved to be genuine and 57 adulterated. The details are given in the following table : — Articles of food of which samples have been taken. Total number samples. Genuine. Adulterated. Milk 391 357 34 Cream 20 11 9 Butter 175 162 13 Lard 14 14 — Pepper 20 20 — Mustard 30 30 — Rice 2 2 — Coffee 26 26 — Jam 9 8 1 Flower of Sulphur 3 3 — Arrowroot 6 6 — Cheese 11 11 — Camphorated Oil 5 5 — Honey 1 1 — Demerara Sugar 15 15 — Vinegar 4 4 — Cod Liver Oil 5 5 — Oatmeal 7 7 — Seidlitz Powders 2 2 — Cocoa 6 6 — Ginger (ground) 3 3 — Total 755 698 57 In addition 24 informal samples have been purchased and submitted for analysis, viz., 14 of butter and 10 of sugar. One of these (butter) was found to be adulterated. Many informal samples have been taken and not submitted for analysis. 97 The milk samples are further classified in the following table:— Stage of Sale. Place. Reason. Number of Milk samples examined. Result of Analysis. tions. Genuine. Adulterated. On sale to public In street Periodical—Week-day 89 35 4 3 ,, Early morning — — — — ,, ,, Sunday 80 73 7 4 By request — — — — In shop Periodical—Week-day 167 151 15 7 „ Sunday 28 25 3 2 Consecutive 1 1 — — By request — — — — On delivery At shop Periodical — — — — 99 Consecutive — — — — By request — — — — At Railway Depot or Station Periodical 51 47 4 3 Consecutive 3 3 — — By request Totals 22 21 1 1 39l 356 34 20 The record of the samples taken and the results of analysis are shown in the following table for the past ten years: — Year. Number of samples analysed. Number of samples adulterated. Percentage of adulteration. 1905 750 96 12.8 1906 750 145 19.3 1907 750 126 16.8 1908 750 117 15.6 1909 750 95 12.7 1910 750 67 8.9 1911 750 86 11.4 1912 750 76 10.1 1913 750 76 10.1 1914 755 57 7.5 Prosecutions were undertaken in respect of 20 of the 57 samples which were reported during the year as being adulterated. Four prosecutions were also undertaken for other contraventions of the Food and Drugs Acts. These are set out in the following table:— 98 Summonses—Under the Sale of Food and Drugs Acts—Adulteration. No. of Sample, Article. Result of Analysis Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. 1914. £ s. d. £ s. d. O. 10 Milk Added water, 10.4 per cent. 26th February 2 0 0 0 12 6 O. 16 „ „ 16.7 „ 6th March 2 0 0 0 12 6 C. 10 Butter Foreign fat, other than the fat of butter, 69 per cent. 6th „ 2 0 0 0 12 6 C. 21 Milk Deficient in milk fat, 12-0 per cent. 20th „ 1 0 0 0 12 6 C. 34 „ Added water, 16.8 per cent. 3rd April 4 0 0 0 12 6 C. 50 „ „ 36 „ 17th „ 10 0 0 (Or in default of Payment two months' imprisonment ment) C. 48 ,, Deficient in milk fat, 7.6 per cent. 21st ,, 5 0 0 0 12 6 c. 94 Butter Foreign fat, other than the fat of butter, 81 per cent. 22nd May 5 0 0 0 12 6 C. 96 Milk Added water, 8.4 per cent. 29th „ Summons dis missed without costs (Milk poor from natural causes) 0. 90 Butter Foreign fat, other than the fat of butter, 38 per cent. 24th June 1 0 0 0 12 6 C. 126 Milk Deficient in milk fat, 9.6 per cent. 24th „ Summons dis missed without costs (Milk poor from natural causes) A. 30 „ „ 86 „ 10th July — 0 12 6 0. 135 „ „ 12.3 „ 31st „ 1 0 0 0 12 6 C. 155 „ „ 7.0 „ 21st August 0 5 0 0 12 6 A. 57 „ Added water, 121 per cent. 10th Sept. 1 0 0 0 12 6 O. 183 „ Deficient in milk fat, 6.6 per cent. 15th „ Warranty defence successfully pleaded. C. 183 „ Added water. 17.1 per cent. 9th October 5 0 0 0 19 6 C. 180 „ Deficient in milk fat, 8.0 per cent. 9th „ — 0 12 6 C. 187 „ Added water, 8.1 per cent. 16th ,, Warranty defence successfully pleaded. C. 186 Butter Foreign fat, other than the fat of butter, 82 per cent. 16th „ 2 0 0 0 12 6 O. 196 „ „ 86 „ 16th „ 2 0 0 0 12 6 O. 224 „ „ 84 „ 6th Nov. 1 0 0 0 12 6 A. 60 Milk 1 Added water, 71 per cent. 27th „ W arranty defence successfully pleaded. C. 233 Butter Foreign fat. other than the fat of butter, 83 per cent. 4th Dec. 2 10 0 0 12 6 C. 238 „ „ „ „ 84 „ 4th ,, 1915. 1 0 0 0 12 6 O. 276 Milk Selling milk from vehicle on which the name and address of seller was not visible 1st January Summons wit hdrawn owing to decease of complainant O. 276 Refusing to sell milk to duly authorised officer of the Borough Council 1st ,, ditto C. 271 Margerine Containing more than 10 per cent. of butter fat 1st „ Summons dismissed insufficient evidence C. 271 „ „ „ „ 1st ditto C. 272 „ Exposing for sale margarine without a label attached clearly visible marked " Margarine " 1st ditto C. 272 „ ,, M ,, 1st ditto C. 285 Milk Deficient in milk fat, 6.6 per cent. 26th Feb. 2 0 0 0 2 0 C. 320 Butter Foreign fat, other than the fat of butter, 82 per cent. 12th „ 5 0 0 0 12 6 99 Registration of Premises wherein the business of a wholesale dealer in Margarine is carried on. On 22nd July, 1914, the following premises, all belonging to the same Company, were registered for this purpose under the Sale of Food and Drugs Acts:— 139 and 241, High Street, Camden Town; 96, Queen's Crescent; 21, Hampstead Road; 72, Marchmont Street; 18, Chapel Street, Somers Town; 253, Kentish Town Road; 145, Fortess Road; and 167, York Road. The Public Health (Milk and Cream) Regulations, 1912. The following is the Report of the Administration in connection with the above regulations asked for by the Local Government Board. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for Year ended 31st December, 1914. 1. Mills, and Cream not sold as Preserved Cream. (a) (b) Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 391 — Cream 11 9 Nature of preservative in each case in column (b) and action taken under Regulations in regard to it:— Cream. 0.053 per cent. boron trioxide, equal to 0.094 per cent. of crystallised boric acid. „ 0.124 per cent. boron trioxide, equal to 0.219 per cent. of crystallised boric acid. „ 0.049 per cent. boron trioxide, equal to 0.086 per cent. of crystallised boric acid. „ 0.14 per cent. boron trioxide, equal to 0.248 per cent. of crystallised boric acid. „ 0.175 per cent. boron trioxide, equal to 0.31 per cent. of crystallised boric acid. „ 0.203 per cent. boron trioxide, equal to 0.36 per cent. of crystallised boric acid. „ 0.13 per cent. boron trioxide, equal to 0.23 par cent. ef crystallised boric acid. 100 Cream. 0.09 per cent. boron trioxide, equal to 0.16 per cent. of crystallised boric acid. „ 0.08 per cent. boron trioxide, equal to 0.14 per cent. of crystallised boric acid. In all of these cases an explanation was asked of and furnished (by letter) by the vendors and a warning letter addressed to the vendors by order of the Public Health Committee. No legal proceedings were instituted. 2. Cream, sold as Preserved Cream. (а) Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservatives were correct:— (i) Correct statements made 9 (ii) Statements incorrect 0 9 (b) Determinations made of milk fat in cream sold as preserved cream (i) Above 35 per cent. 9 (ii) Below 35 per cent. 0 9 (c) (i) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) (as to declaration of preserved cream in advertisements, price lists, or trade lists) have not been observed. Nil. (ii) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream under the proviso in Article V. (2) (as to the placing of notices in a conspicuous position or making statements on bills of fare, or giving similar information by some other adequate means in public refreshment rooms, restaurants, shops, or other public premises where preserved cream is sold for consumption on the premises) have not been observed. 2*. As to action taken see paragraph 1 above. * Included in the 9 cases mentioned above. (d) Particulars of each case in which the Regulations have not been complied with, and action taken. Nil. (Apart from those cases mentioned above.) 3. Thickening substances. There was no evidence of the addition to cream or preserved cream of any thickening substances. Inspection of Food [Public Health (London) Act, 1891, Sec. 47]. The Food-Inspectors, J. Osborne, H. R. Child, and W. G. Auger (parttime) have kept under regular inspection food exposed or deposited for sale in slaughterhouses, shops (especially butchers', cooked meat and fishmongers' shops), stalls, and market places. In addition, the district inspectors assist during the summer (from June to September, inclusive) with the inspection of marked streets. During these months four district inspectors and one food inspector are on duty for this purpose on every Saturday night, and two district inspectors and one food inspector every Sunday morning. They are selected for this duty by rotation. No seizures of unsound food have been made during 1914. 101 The following unsound food has been surrendered by the owners to the food nspectora and destroyed as trade refuse:— Date. Division and Sub Division. Description of Article. Removal requested. Prosecutions and Result. 1914. Jan, 5 East—Camden 2 pairs sheep's lungs Yes Nil. ,, 14 North—Highgate 1 pig's head, pluck, liver, lungs, heart and tongue ,, ,, Feb. 3 East—College 2 doz. escalopes ,, ,, Mar. 11 ,, Oakley Square 58 cauliflowers ,, ,, ,, 27 ,, ,, ,, 12 boxes of tomatoes ,, ,, ,, 16 ,, Camden 1 sheep's liver ,, ,, ,, 16 ,, ,, 1 lamb's liver ,, ,, 16 ,, Bartholomew 1 sheep's liver ,, ,, 30 Camden Square 1 ,, lung ,, ,, April 7 ,, ,, ,, 1 ,, carcase and offal ,, ,, ,, 7 ,, ,, ,, 1 pair sheep's lungs ,, ,, ,, 15 ,, College ??? trunk uncured herrings ,, ,, ,, 21 ,, Ossulston 11 cases of oranges ,, ,, May 8 ,, ,, 2 kits of fish ,, ,, ,, 26 ,, College 1 trunk of codfish ,, ,, ,, 29 ,, Ossulston 105 lbs. of yeast ,, ,, June 5 ,, ,, 336 ,, ,, ,, ,, 10 ,, Bartholomew 1 bullock's liver ,, ,, ,, 17 1 „ ,, ,, ,, 23 North—Maitland Park 4 stones of skate ,, ,, ,, 24 East—Ossulston 1 box of mackerel ,, ,, ,, 24 ,, ,, 4 boxes of haddocks ,, ,, ,, 25 ,, ,, 105 lbs. of yeast ,, ,, July 1 ,, ,, 21 ,, ,, ,, ,, 3 ,, College 3 large fish ,, ,, ,, 1 West—Castle 12 cwt, of winkles .. ,, ,, ,, 6 East—Ossulston 112 lbs of yeast ,, ,, ,, 9 North—Gospel Oak 5 boxes strawberries ,, ,, ,, 10 St. John's Park 1 trunk codfish ,, ,, ,, 15 East—Ossulston 112 lbs. yeast ,, ,, ,, 15 ,, Camden Square 10 tubs strawberries ,, ,, ,, 20 South—"Whitfield 8 stones fish ,, ,, ,, 20 East—Ossulston 20 lbs. cherries ,, ,, ,, 21 30 „ ,, ,, ,, 22 ,, Oakley 1 trunk of codling ,, ,, ,, 22 ,, Ossulston 120 mackerel ,, ,, ,, 23 ,, Camden Square 40 lbs. raspberries ,, ,, ,, 24 South—Burton 8 lbs. loganberries ,, ,, „ 23 West—Chalk Farm 14 lbs. gooseberries ,, ,, ,, 24 East—Oakley 2 bags mussels ,, ,, ,, 25 ,, ,, 50 lbs. yeast ,, ,, August 5 North—Gospel Oak 2 trunks fish ,, ,, ,, 10 East—Camden Square 3 flats watercress ,, ,, ,, 19 ,, Oakley 5 tons yeast ,, ,, ,, 20 ,, Ossulston 3½ flats of watercress ,, ,, ,, 22 North—Maitland Park 1 box dogfish ,, ,, ,, 26 East—College 1 trunk catfish ,, ,, Sept. 2 ,, Ossulston 37 pig's heads ,, ,, ,, 2 5½ ,, ,, ,, ,, 5 ,, Camden Square 1 ton 1 qr. apples ,, ,, ,, 8 ,, Bartholomew 1 carcase of heifer ,, ,, ,, 11 ,, Camden Square 1 ton 1 cwt. apples ,, ,, ,, 12 ,, ,, 8 cwt apples ,, ,, ,, 15 ,, ,, 11½ ,, ,, ,, ,, 17 North—Maitland Park 4 stone skatefish ,, ,, Oct. 15 East—Ossulston 189 lbs. yeast ,, ,, ,, 27 ,, ,, 1 barrel of herrings ,, ,, Dec. 4 ,, ,, 75 paunches ,, ,, ,, 16 West—Chalk Farm 70 lbs. skate and 3½ stone flat fish ,, ,, ,, 22 East—Ossulston 2 tons 13 cwt. brussels sprouts ,, ,, ,, 21 North—St. John's Park 3000 eggs ,, ,, ,, 24 ,, ,, 3000 „ ,, ,, ,, 30 South—Whitfield 14 boxes tangerine oranges ,, ,, 102 DAIRIES, COWSHEDS, AND MILKSHOPS Cowsheds.—There were at the end of 1914 five licensed cowsheds in the borough, being one less than in the previous year. These arc registered for 110 cows. They have been kept under inspection by the food inspectors, 61 inspections having been made during the year. Milkshops and Dairies.—Reference was made in the last Annual Report to the unsatisfactory conditions under which milk was being sold by retail in the borough, and to the fact that the powers conferred upon the Council in regard to the registration of milksellers by Sec. 5 of the London County Council General Powers) Act, 1908, had not been put into operation. A report on the subject was presented to the Public Health Committee on 7th January, 1914, and although much of this was set out in last year's report it appears well, for the sake of completeness, to reproduce it here in full. The report was as follows:— METROPOLITAN BOROUGH OF ST. PANCRAS. Public Health Department, Town Hall, Pancras Road, N.W. 7th January, 1914. To the Public Health Committee. Mr. Chairman and Gentlemen, In accordance with your resolution of the 6th December, 1913, I present for your consideration, this report upon the conditions under which milk is sold by retail from shops in the Borough, and certain recommendations in regard to the matter. A special investigation has been made during the past few months into this question, in the course of which every milkshop has been visited by food inspectors, and the particulars for each shop entered up separately on a special schedule drawn up for the purpose. The results of this enquiry are given below. The items relating to the quantity of milk sold are expressed iu imperial gallons, and are based on estimates as to the amount of the daily sale which have been made by the shopkeepers themselves (except in a few instances where the estimate has had to be made by the inspectors). No account has been taken of the amount of milk delivered on "milk-rounds," the figures given relating exclusively to milk sold " over the counter." It may be explained that the term "dairy" is used to indicate a shop where the principal goods sold are milk and dairy-produce such as butter and eggs, but where also in many cases various articles of grocery, etc., are also sold. The total number of registered milkshops actually selling milk by retail in the Borough has proved to be 389. In addition to these there are a few registered premises from which no milk is sold by retail over the counter. The amount of milk sold daily by retail in these shops, otherwise than by milk-rounds, appears to be about 1,460 gallons. The numerical result of this enquiry include the following items:— No. of shops where milk is sold by retail by registered persons 389 Total quantity of milk sold per diem 1460 gallons. Average do. do. per milksliop 3.8 „ No. of shops in which one gallon or less of milk is sold per diem 93 or 24 per cent. Do. between one or two gallons do. 109 „ 28 „ Do. over two gallons do. 187 „ 48 „ 103 Mo. of shops iu which the registered milkseller has also a "milk-round" 105 or 27 per cent. Do. do. not do. 284 „ 73 „ No. of "dairies" 107 „ 27 „ Do. "general shops" 246 „ 63 „ Do. grocery and provision shops 22 „ 6 „ Do. other shops 14 „ 4 „ No. of milkshops where paraffin oil is sold 123 „ 32 „ Do. do. firewood is sold 264 „ 68 „ Do. do. pickles are sold (otherwise than in closed jars) 240 „ 62 „ Do. do. coal blocks, coal or coke are sold 91 „ 23 „ Do. do. greengrocery is sold 31 „ 8 „ Do. do. other dirty goods are sold (hearthstone, &c.) 182 47 ,, No. of milkshops with floor so lumbered with articles or goods that it cannot be kept properly clean 192 ,, 49 „ Do. do. sleeping room in direct communication 25 „ 6 „ Do. do. without fixed permanent ventilation 266 „ 68 „ Do. do. with floor not structurally sound 44 „ 11 „ Do. do. without a properly covered milk-vessel 298 „ 76 „ An outstanding feature of these results is the fact that a very large proportion of shopkeepers who sell milk do so on a very small scale. Nearly a quarter (93) of the whole sell no more than one gallon a day, and more than a half (202) sell no more than two gallons a day. The principal type of shop in which milk is sold in this way is the general shop, commonly known as the chandler's or huckster's shop. It will be noticed that this kind of shop makes up 63 per cent. of registered milkshops, and the same fact is indicated by the small proportion of the total 389 which have a milk-round attached to the business (27 per cent.). The ordinary general shop is well-known to be one which sells almost everything that is required in a household, and is found principally in the poorer parts of the Borough. They are crowded with a great variety of goods usually sold in grocers' shops, oil shops, chemists', hardware, and even drapers' shops, and many of them sell firewood, coal or coal-blocks, hearthstone, soap, soda, greengrocery (potatoes, onions, &c.), vinegar, pickles (open as well as in closed jars), paraffin oil, and other dirty, dusty, or strong-smelling commodities, which are likely to load to contamination of the milk. In the foregoing table I have shown how that amongst the St. Pancras milkshops a large proportion sell these various goods (firewood 68 per cent., open pickles 62 per cent., paraffiu oil 32 per cent., coal or coal-blocks 23 per cent. &c.). Many of the general shops are kept in a dirty condition, and even when the shopkeeper is a clean and careful person the crowded condition of the shop and the fact of the floor being permanently lumbered up with such objects as boxes, barrels, firewood, &c., often effectually prevents proper cleanliness. One half of the milkshops in the borough have their floors lumbered up in this way. It is now generally recognised that milk, probably more than any other food, requires special care iu its handling. This is due to the circumstance that on the one hand it readily takes up any kind of contamination to which it is exposed, and on the other hand it is an eminently suitable medium for the multiplication of all kinds of microbic and other injurious growths. This is all the mora important for the reason that cow's milk is almost the sole food of many of the infants in our population. The use of contaminated milk for this parpose is one of the factors maintaining the high rate of infantile mortality which prevails in the poorer parts of the Borough, where the worst type of milkshop is commonest. Disturbance ot the digestive system is, in years with hot summers, the largest cause of death in infants under one year of age, and some of this form of illness must be attributed to the use of contaminated milk. It is very significant iu this connection that breast-fed children are far less liable to this malady than are those fed on cow's milk. There is no doubt that, so long as milk is stored and sold as at present in open vessels, the milkshop ought to be so ordered as to minimise the risk of the milk becoming contaminated. At present many of the milkshops in the Borough are far from such a standard, and it is the duty of the Sanitary Authority to use such power as they possess to limit, as far as possible, the sale of this food to suitable premises. 104 It should be remembered also that this is only justice to those purveyors of milk who have premises which are really suitable. Besides the shops which strike one at once as being quite unsuitable for the sale of milk, many of the others require certain improvements. For instance, many need more ventilation. Nearly 70 per" cent. of the whole are without any fixed permanent ventilators. Again, a few (25) are in direct communication with sleeping rooms. Another important matter is the vessel in which the milk is stored. Many of the dealers keep their milk on the counter in open pans, or in other vessels which do not protect the milk from flies and particles floating in the air. Only one quarter of all milkshops are furnished with milk-pans provided with proper metal covers. The 107 milkshops which I have classed as "dairies," and a proportion of the other milkshops can readily, where necessary, be made suitable for the sale of milk. In the case of the remainder this will depend upon how far the vendor is prepared to go in order to bring his milkshop into line with any standard that may be set up. In over a hundred shops the conditions are very bad, and so long as the class of trade that is carried on in them remains as it is they can hardly be made suitable. I may add that conversation with the shopkeepers makes it clear that the majority of those who only sell small quantities of milk do not do so for the doubtful profit which they make, but in order to attract customers for their other goods, and they would even be pleased to give up the trade if their competitors did the same. Legal Powers. The sale of milk in the Borough is regulated principally by the Dairies, Cowsheds, and Milkshops Orders of 1885, 1886, and 1899, and the local regulations made thereunder in 1885. These lay down certain conditions with the object of preserving milk in milkshops from infection and contamination, and provide that all purveyors of milk shall be registered; but although they prescribe a penalty for breaches of their provisions, they do not give the Sanitary Authority power to refuse to place on the register any person who applies to be registered, or to remove the name of any person from the register, however unsuitable his premises may be for the sale of milk. This state of affairs was altered by the London County Council (General Powers) Act of 1908, section 5 of which enables the Sanitary Authority to remove from the register, or to refuse to register any person carrying on the trade of a dairyman or purveyor of milk upon premises which are in their opinion for any reason unsuitable for the sale of milk therein. There is a proviso that the grounds upon which the premises are deemed to be unsuitable must not be inconsistent with the provisions of any order or regulation in force applicable to the premises; and the right of appeal from the decision of the Sanitary Authority to a Court of Summary Jurisdiction is given to any aggrieved person. Article II. of the Order of 1885 reads as follows:— "It shall not be lawful for any person following the trade of purveyor of milk, or being the occupier of a milk-store or milk-shop, to use a milkstore or milk-shop in his occupation, or permit the same to bo used, for any purpose incompatible with the proper preservation of the cleanliness of the milk-store or milk-shop, and of the milk-vessels and milk therein, or in any manner likely to cause contamination of the milk therein." This (and section 32 of the local Regulations, which has a similar effect), together with section 5 above-mentioned of the 1908 Act. appears to give the Council full power to deal with any milkshop in which the other trades carried on are of such a nature as to be incompatible with the preservation of the cleanliness of the milk. Many of the Metropolitan Boroughs have put into execution the new powers conferred by the 1908 Act, and have brought pressure to bear npon certain milk-sellers and removed others from the register. In certain Boroughs (St. Marylebone, Paddington, Battersea, Lambeth, and others) this has been done very extensively, and hundreds of unsuitable milkshops have been struck off the register. 105 Recommendations. I would suggest that a circular letter be sent to all those milk-vendors whose premises or trade are such as to need considerable alteration if they are to continue to sell milk, pointing out this fact and containing a printed list of conditions constituting a standard to which they must conform. They should be informed that unless they conform to the standard their name will be removed from the register, which removal will make it illegal for them to sell milk. This course of action has been taken in certain boroughs, including Lambeth and Kensington. I suggest the following list of requirements:— (1) The premises to be kept in good condition, and to be adequately and permanently ventilated and adequately lighted. (2) The floor to be kept clear of articles which lumber it up in such a way as to prevent easy cleansing of the floor; and the premises and contents to be so constructed and arranged as to be capable of being maintained in a satisfactory state of cleanliness. (3) The premises to be kept at all times clean, and the floor scrubbed and swept at proper intervals. (4) The milk-vessel or vessels to be provided with a suitably constructed metal cover, and all milk to be kept properly covered. (5) No paraffin or firewood, and no strong-smelling or dirty goods to be sold in the milkshop. (In this category are included coal, coke, coal-blocks, hearthstone, potatoes, onions, pickles, fish, &c.) (6) The provisions of all orders and regulations in force respecting the sale of milk, and of Sec. 8 of the London County Council (General Powers) Act, 1908 (relating to the conditions under which food may be sold or exposed or deposited for the purposes of sale) to be observed. In regard to future applications for the registration of new purveyors of milk I suggest that no ordinary general shops be regarded as suitable except under special circumstances. I am, &c., Your obedient Servant, T. SHADICK HIGGINS, Medical Officer of Health. The suggestions in the report were adopted by the Council on 14th January, 1914, and the matter again came np for discussion by the Council on 6th May, 1914, when requirement No. 5 was amended to the following form:— "(5). No paraffin to be sold in the milkshop, and no firewood or strongsmelling or dirty goods to be stored in the milkshop. (In this category are included coal, coke, coal-blocks, hearthstone, potatoes, onions, loose pickles, fish, etc.)." On 26th January a circular letter was sent to the shopkeepers of those of the 389 milkshops which were not considered to be kept in a suitable condition for the sale of milk. The letter stated that the Council were considering the removal from the register of the names of those milksellers whose premises were regarded as unsuitable for the sale of milk, and set out the list of conditions which the Council had adopted as a standard in this respect. The letter was sent in regard to 240 milkshops, In consequence of this action a number of the shops were brought into compliance with Council's requirements, and in certain other cases the sale of milk was abandoned. There were 106 left 85 milkshops which were unsuitable for the sale of milk, and were not im accordance with the requirements laid down, and those were removed from the register by resolutions of the Council of 27th May, 24th .Tune, and 22nd Jul}r. There were no appeals against this action of the Council. 57 applications for registration under the Dairies, Cowsheds, and Milkshops Orders were considered during 1914, and of these the Council decided to register in 40 cases, and to refuse to register on account of unsuitability in 17 cases. The figures in regard to registration of milkshops are set out below:— No. of purveyors of milk at retail milkshops on register at end of 1913 389 Deduct No. of purveyors removed from register by resolution of Council during 1914 85 Do. do owing to removals, &c., during 1914 103 188 Add No. of purveyors added to register by resolution of Council during 1914 40 No. of purveyors of milk at retail milkshops on register at end of 1914 241 At the end of 1914 there were on the register in addition to these 241 retail milkshops and 5 cowsheds (of which 4 are attached to retail milkshops included in the 241), 2 persons in respect of premises where only a wholesale milk trade is done, and 5 itinerant vendors without milkshops. Legal Proceedings.—No legal proceedings were taken during the year in respect of the sale of milk. Ice-Cream Premises. 325 of these premises arc known to the department and 220 visits were paid to them by the food inspectors during 1914. No legal proceedings were taken in respect of the manufacture or sale of ice cream. Fried Fish and Fish Curing Premises. The position in regard to the control of these premises was altered during the year by the coming into force of By-laws in respect of them made by the London County Council under Sec. 9 of the London County Council (General Powers) Act, 1908, and finally approved on 24th March, 1914. These by-laws provide for the proper condition and cleanliness of the premises and utensils, including limewashing four times a year ; for the avoidance of nuisance from the improper storage of offensive or putrescible garbage; and for the avoidance of nuisance from the process of frying, smoking or drying fish. The effect of the by-laws is much modified by the proviso contained in the Act that they shall not impose any obligation to alter existing fried fish or fish curing premises or to provide new fittings or apparatus in existing premises. Except for such structural alterations, however, the by-laws apply to old premises as well as new. 107 During the early part of the year the inspection of premises of fried fish vendors and fish curers was carried out as before by the district inspectors; but from 5th October this work was transferred to th 3 inspectors of food and foodplaces, who already had to visit the premises for the purpose of food inspection. A careful initial inspection of these places was made by the food inspectors with a view of finding to what extent they complied with the new by-laws. On May 12th, 1914, a circular letter was sent to all fish curers and vendors of fried fish in the borough enclosing a copy of the appropriate set of by-laws. At the end of the year there were 81 fried fish vendors' premises in the borough, at four of which fish curing was also carried on. There were 16 fish curers premises, including these four. A large number of these premises are not in compliance with the by-laws as regards the structure of their premises and apparatus, but as practically all of them have been in use for some years they are exempt from the operations of the by-laws in this respect. Other Food Premises The number of inspections made of butchers' and fishmongers' shops, premises where prepared meats (such as sausages, pies, tripe, cooked meat, &c.) are made, marketing places, premises where fish is fried or cured, &c., will be found in table 10 on page 132. Bakehouses and restaurant kitchens are referred to under the heading of Workshops (see pages 92-95.) Slaughter-Houses. There were 13 licensed slaughter-houses in the borough at the end of 1914. 440 visits to slaughter-houses were made by the food inspectors during the year. The Rag Flock Act, 1911. No samples were taken under this Act during 1914. GENERAL SANITARY WORK. In this section reference is made to sanitary work carried out during the year by the staff. Some of this is mentioned in the foregoing parts of the report. Total Inspections. Altogether 59,106 inspections were made during 1914 bv the staff of Inspectors. These consisted of 27,690 inspections and 31,416 re-inspections (generally after the s rvice of intimation notices). Of these inspections, 46,233 were made by the District Inspectors (including the male Workshop Inspector for the last three months of the year), 7,590 by the Inspectors of Food and Food-places, and 5,283 by the Women Inspectors. The inspections actually made by each individual Inspector are shown in table 11 on page 134. The work of the District Inspectors and Women Inspectors is set out in detail in tables 8 and 9 on pages 128-131, and that of the Food Inspectors in table 10 on pages 132 and 133. 108 Intimation Notices. 6,727 intimation notices have been served by the Sanitary Inspectors during 1914. These were made up as follows — In respect of Nuisances 3,415 In respect of Breaches of the Tenement House By-laws 911 on respect of Breaches of Statutes in Factories, Workshops and Work-p aces 163 In respect of other Breaches of Statutes and By-laws 2,238 6,727 These intimation notices are classified in tables 12, 13, 14 & 15 on pages 135-137. Summonses. The following prosecutions were undertaken in respect of general Sanitary work:— Under the Public Health (London) Act, 1891 (except in respect of food). Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 66, Warren Street Dust recep???acle kept in an improper position 13th Feb. Abatement order. 66, ,, Failing to cleanse part of ,, Fined 5s. and 2s. costs. 67, Do. do. ,, ,, 5s. ,, 2s. ,, 8, Kenton Street Failing to provide a proper and sufficient supply of water 13th Mar. ,, £2 ,, 2s. „ 10. Do. ,, „ £2 „ 2s. „ 136, Cleveland Street Do. ,, ,, £2 „ 2s. ,, 15, Pitt Street Do. ,, ,, 5s. ,, 2s. ,, 25, Do. ,, ,, 5s. ,, 2s. ,, 269, Gray's Inn Road Failing to provide water supply 12th June Closing Order made. 43, Redhill Street Failing to provide sufficient water supply 2nd Oct. Fined £1 and 2s. costs. 44, ,, Do. ,, ,, £1 „ 2s. „ 45, ,, Do. ,, ,, £1 ,, 2s. „ 46, ,, Do. ,, „ £1 „ 2s. „ 47, ,, Do. ,, „ £1 „ 2s. „ 17, Clarence Gardens Do. 20th Nov. ,, £1 ,, 2s. 40, Stibbington Street Do. ,, ,, £5 ,, 2s. ,, 37, Drummond Crescent Defective drain and insufficient water supply 4th Dec. Abatement order. Fined £5 and 4s. costs. 38, ,, Failing to remedy dampness and provide a sufficient^ ater supply ,, Abatement order. Fined £3 and 4s. coats. 40, ,, Do. ,, Abatement order. ,, Fined £2 and 4s. costs. 41, ,, Failing to remedy defective paving, dampness, and provide a sufficient water supply ,, Abatement order. Fined £2 and 4s. costs. 54, William Street Failing to provide a sufficient water supply 18th Dec. Abatement order. Fined 5s. and 2s. costs. 37, Mornington Crescent Do. ,, Fined 5s. and 2s. costs. 16, Drummond Street Failing to remedy dampness and 4th Dec. and Nuisance abated, provide sufficient water supply 15th Jan., mons withdrawn on 1915 payment of costs, £2 4s. 0d. 109 Under the Metropolis Management Act, 1855, Sec. 202. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 45, Twisden Road. . Failing to give notice of fixing of new w.c. 27th April Fined 10s. and 2s. costs. 227, Kentish Town Road Failing to give notice of fixing new pedestal basin and trap 1st Aug. Fined 5s. and £ 13s. 0d. costs. 10, Robert Street Failing to provide a new sink waste 18th Dec. Fined 5s. and 2s. costs. Smoke-Prevention. A register of smoke shafts is kept in the department. At the end of 1914 there were 343 shafts on the register. During the year 332 observations were made and 7 re-inspections after the service of notices. There were no prosecutions. Regulated Trades. Offensive Trades.—There are two licensed premises for such trades in St. Pancras, viz., a tripe-dresser's in Kentish Town Road, and a tallow-melter's in Tudor Place. Other Businesses giving rise to Effluvia.—Fried fish shops and fish-smoking places have been dealt with elsewhere (pages 106 and 107). A list is also kept of rag and bone stores, and at the end of 1914 there were 38 premises in this list. 17 visits were paid to rag and bone stores during the vear. Constructural Drain Work. The construction of, and repairs to, house drains are supervised by the sanitary inspectors. During the year the following work has been done under this heading:— First inspections. Consequent re-inspections. Drainage work done under notice 606 5481 Voluntary drainage work 843 3835 Drains of new buildings 68 976 1517 10292 110 The tests which have been applied to drains daring 1914 are shown in the following table:— After Infectious Disease. Upon Complaint. Upon systematic Inspection Old Buildings. New Buildings at completion of work. Total. At commence ment of work. At completion of work. By Grenade. 1. Defects found 134 51 — — 17 — 202 2. No result 938 119 — — 51 — 1111 3. Total 1072 170 – – 71 — 1313 By Smoke. 1. Defects localised — — 6 — — — 6 2. No result — — 11 — 2 — 13 3. Total — — 17 – 2 — 19 By Watar. 1. Not found water-tight — — — 1 72 20 93 2. Found water-tight — — — — 974 193 1167 3. Total — — — 1 1046 213 1200 Total 134 51 6 1 89 20 301 938 119 11 — 1030 193 2291 1072 170 17 1 1119 213 2592 Drainage Register.—The following is an analysis of the Drainage Register during 1914:— Total number of Applications and Plans. . . . 698 Number of Applications without Plans 263 ,,, Number of Plans 435 Plans—Old Buildings under Notice 163 J 435 Plans—Old Buildings, Voluntary 226 Plans—New Buildings and Additions 46 Water Service. The following notices have been received from the Metropolitan Water Board as to houses from which water has been cut off:— 1.—Demolition 1 2. — Empty 17 3.—Leakage 3 4.—Non-payment of Rates 7 5.—No statement — 6.—By request 5 33 111 DISINFECTING AND CLEANSING STATION. Disinfection. The work done during the year by the disinfecting staff is shown in the following table: — Disease. No. of Cases. No. of Houses. No. of Rooms Contents Disinfected or Destroyed. No. of Rooms Sprayed and Fumigated. Scarlet Fever 1127 1083 1158 1142 Diphtheria 412 403 431 434 Enteric Fever 42 42 42 1 Erysipelas 116 116 116 3 Puerperal Fever 16 16 16 0 Continued Fever 2 2 2 0 Cerebro-Spinal Meningitis 1 1 1 1 Consumption 107 107 98 70 Measles 26 26 27 14 Cancer 31 34 32 17 Other Diseases 46 46 44 15 Totals 1929 1876 1967 1697 Below is shown the number of articles destroyed or disinfected during the year on account of infectious disease (see also p. 118): — Destroyed. Disinfected. Beds, mattresses and palliasses 76 2071 Bolsters and pillows 84 4313 Sheets, blankets and counterpanes 16 7177 Rugs, mats, cushions, carpets, covers, and curtains 24 1460 Wearing apparel 27 4213 Books 12 352 Sundries 69 906 Total 258 20492 The following table shows the number of persons cleansed and disinfected sifter having been in contact with infectious disease:— Males. Female. Children under 10. Scarlet Fever 2 6 — Diphtheria 4 — — Puerperal Fever — 11 — Erysipelas — 1 — There was one family sheltered in the contact shelter during the year. Cleansing Station. The amount of work done here during the year is indicated in the table below. The fiomras represent the number of attendances. At each attendance the person receives a bath, and his or her clothes are stoved. 112 Slept previous night at Reason for Cleansing, Adults. Children. Sum Total Males. Females. Total. St. Pancras. Ex St. Pancras. 10 to 15. 5-10 0-5 Total. 10 to 15. 5-10 0-5 Total. M. F. M. F. Private Pediculosis—Head — 18 18 8 272 158 3 441 — 26 18 — 44 503 Addresses —Body 6 12 18 118 13 59 — 190 18 2 5 — 25 233 —Both 5 3 8 459 684 771 1 1915 162 210 201 — 678 2496 Rowton —Head — — — — — — — — — — — — — — Houses — Body 109 — 109 — — — — — — — — — — 109 —Both 45 — 45 — — — — — — — — — — 45 Common —Head — — — — — — — — — — — — — — Lodgiug —Body 276 11 287 — — — — — — — — — — 287 Houses —Both 180 2 132 — — — — — — — — — — 182 Salvation —Head — — — — — — — — — — — — — — Army —Body — — — — — — — — — — — — — — Shelter —Both 1 — 1 — — — — — — — — — — 1 In the open —Head — — — — — — — — — — — — — — —Body 214 15 229 — — — — — — — — — — 229 —Both 64 1 65 — — — — — — — — — — 65 Total Pediculosis ,, —Head — 18 18 8 272 158 3 441 — 26 18 — 44 503 „ —Body 605 38 643 118 18 59 — 190 18 2 5 — 25 858 ,, —Both 245 6 251 459 684 771 1 1915 162 210 201 — 573 2789 Doubtful — — — 6 2 8 — 16 1 — 1 — 2 18 Scabies 5 3 8 78 61 52 6 197 17 12 14 8 46 251 Totals 855 65 920 669 1032 1048 10 2759 198 250 239 3 690 4,369 In addition to the foregoing work, the following cleansings were carried out in respect of bedfellows of these:— Vermin. St. Pancras Children. Ex-St. Pancras Children. Sum Total. 15 and over. 10—15. 5-10. Under 5. Total. 15 and oyer. 10—15. 5—10. Under 5. Total. Pediculosis—Head — 12 42 1 55 — 2 3 — 5 60 —Body — 7 18 — 25 — 2 6 — 8 33 „ —Both — 71 319 6 396 — 21 68 1 90 486 Doubtful — 1 — — 1 — — — — — 1 Scabies—Acari — 11 77 7 95 — 2 21 6 29 124 Totals — 102 456 14 572 — 27 98 7 132 704 113 The school children included in the first of the foregoing two tables have been brought to the cleansing station by officials of the London County Council as the Education Authority under the powers conferred upon them by their General Powers Act, 1904, Sec. 36, and the Children's Act, 1908, Sec. 122. The children are those found to be verminous upon examination in the Public Elementary Schools, and a sum of two shillings for one month's course of cleansings for every child is paid by the County Council to the Borough Council, according to an agreement between the two Authorities. During the year the children for whom a month's treatment was paid for by the London County Council numbered 1,820. The health-visitor, Miss Smith, has devoted part of her time to visiting the homes of these verminous children, and helping the families to rid themselves of these verminous conditions. For this purpose the bedding and bedfellows in the household have been cleansed in many instances. The visits paid by Miss Smith for this purpose have numbered 281, but the female staff is quite inadequate to deal with this problem effectively. The work done in cleansing verminous clothing, etc., is shown in the following table:— Destroyed. Disinfected. Beds, mattresses and palliasses 11 59 Bolsters and pillows 1 68 Sheets, blankets, and counterpanes — 1864 Rugs, mats, cushions, carpets, covers, and curtains 12 17 Wearing apparel 10 93 Elastic goods — 55 Skin rugs — 21 Sundries 12 20 Total 46 2197 These figures include 1803 blankets, 21 skin rugs, 12 bolsters, and 63 articles of wearing apparel which were disinfected for the military authorities. PUBLIC MORTUARIES AND CORONERS' COURT. Number of bodies deposited in the General Mortuary during 1914 433 „ „ Infectious „ „ 6 Total 439 Inquests hkld during 1914— In the Coroner's Court — General Cases 351 „ „ Poor Law ,, 58 Elsewhere in St. Pancras — Total 409 114 BACTERIOLOGICAL EXAMINATIONS. The following work has been done by the Lister Institute of Preventitive Medicine, Chelsea Gardens, S.W.. at the expense of the Borough in respect of St. Pancras persons :— Total. Positive. Negative. Examinations of swabs for B. diphtheria 297 85 212 ,, sputum for B. tuberculosis 245 83 162 ,, blood for Widal reaction (typhoid) 39 14 25 CLERICAL WORK. The following figures give an indication of the clerical work done during 1914. Much other clerical work (such as the vital statistics, and the keeping of notification and other accounts) is also done by the clerical staff. No. of complaints received (communications) 1685 ,, notifications of dangerous infectious disease received 1990 „ ,, reported in daily returns to Metropolitan Asylums Board 1990 ,, ,, „ „ School Teachers 2931 „ „ „ ,, St. Pancras Library 1990 ,, advisory notices sent to householders in respect of above notifications 1990 ,, statutory notices served requiring disinfection 1990 ,, certificates of disinfection forwarded 1734 ,, cases of tuberculosis notified (received: Forms A, B, C, & D) 2057 „ ,, ,, reported in weekly returns to London County Council '2057 ,, advice-cards sent to notified cases of tuberculosis 1014 ,, notices of voluntary drainage work received 226 „ drainage plans received 435 ,, birth notifications received 4674 „ ,, reported in weekly returns to London County Council 4674 „ advice-cards re infants' nurture sent to moth 4674 „ general letters received (other than complaints and notices of drainage work) 2470 ,, letters, etc., despatched 5048 ,, intimation notices served 3579 „ statutory 1961 ,, summonses applied for 52 „ hearings and adjournments 46 ,, meetings of Council 15 ,, „ Public Health Committee and Sub-Committees 50 STAFF. Mr. B. H. Thompson, Sanitary Inspector, was called up with the Territorial Force at the beginning of the war. Mr. P. W. Pottier, Junior Clerk in the 115 department was appointed on 28th September, 1914, to act temporarily as Sanitary Inspector in Ward 2 in Mr. Thompson's absence. The vacancy in the Clerical Staff caused by Mr. Pottier's appointment was filled by the engagement of a temporary Clerk (Mr. C. Hatter). Mr. J. B. Mulloy, Junior Clerk in the department, enlisted on 26th October, 1914, and his place was filled bv the engagement of a temporary Clerk (Mr. W. C. Harvey). Mr. P. C. Taylor, Clerk in the department, was transferred to the Works Department on 7th October, 1914, and Mr. H. C. Spokes was appointed to fill ' the vacancy thus caused. Mr. H. G. West, Sanitary Inspector for Ward 4, was appointed Male Inspector of factories and workshops for the whole Borough, and Mr. R. C. Akers, Sanitary Inspector for the Endsleigh Division of Ward 7 tranferred to Ward 4. The part of the Endsleigh Division lying to the West of Tottenham Court Road was added to Inspector Landen's district (the Whitfield Division of Ward 7), and the part lying to the East of Tottenham Court Road to Inspector Walker's district (the Burton Division of Ward 8). These changes took place on 5th October. Miss Mary Giles has continued to act during the year as temporary Woman Inspector. Reference has already been made to the death of Mr. J. Osborne, Sanitary Inspector, on 14th December, 1914. This post was not filled until after the end of the year. APPENDIX. 118 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1914 AND PREVIOUS YEARS Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000Nett Births. Number. Rate. Number. Rate. Number. Rate. 1909 237247 5238 — 22.1 3668 15.4 738 591 570 108 3521 14.8 1910 237178 5385 — 22.7 3415 14.4 710 562 580 107 3267 13.8 1911 23???129 5135 5555 23.4 3418 14.4 673 611 623 112 3356 14.1 1912 220353 5008 5367 24.4 3147 14.3 595 605 472 88 3157 14.3 1913 218387 5167 5517 24.7 3409 15.6 728 662 512 93 3343 15.0 1914 218387 4945 5225 23.9 3386 15.5 721 677 481 92 3342 15.3 Area of district in acres (land and inland water), 2694.4; total population at all ages, '218,387; number of inhabited houses, 22,246; average number of persons per house, 9.82; at Census, 1911 (cf. Census, Vol.V .). 119 Table No. 2. Deaths Registered from all Causes for the Year 1914. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the Borough are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the Borough are included. Cause of Death. AGES. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards. Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. persons 1.—General Diseases. I 1. Enteric Fever – – – – – – – – – – – – – – – 1 2 1 – – – – – – – – – – 2 2 4 2. Typhus ,, – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 3. Relapsing Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 4. Malaria – – – – – – – – – – – – – – 1 – – – – – – – – – – – – – 1 – 1 5. Small Pox— (a) Vaccinated – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) Not Vaccinated – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (c) Doubtful – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 6. Measles 4 4 12 10 12 8 28 22 – – – – – – – – – – – – – – – – – – – – 3l 22 53 7. Scarlet Fever – – 2 1 4 5 6 6 1 3 – 1 – 1 – 1 – – – – – – – – – – – – 7 12 19 8. Whooping Cough 12 11 8 10 6 2 26 23 – – – – – – – – – – – – – – – – – – – 26 23 49 9. (a) Diphtheria 3 1 2 1 4 6 9 8 4 6 2 – 1 – – – – – – – – – – – – – – – 16 14 30 (b) Croup – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 10. Influenza – 1 – – – – – 1 – – – – – – 2 1 2 – 1 1 1 – 1 1 1 1 2 – 10 5 15 11. Miliary Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 12. Asiatic Cholera – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 13. Cholera Nostras – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 14. Dysentery – – – – – – – – – – – – – 1 3 – – 1 – 1 2 – 1 – – – – 3 6 9 15. Plague – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 16. Yellow Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 17. Leprosy – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 18. Erysipelas – 2 – – – – – 2 – – – – – – 1 2 – – – 1 – 1 1 – – 1 – – 3 6 9 19. (a) Mumps – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) Geiman Measles – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (c) "Varicella – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (d) Other Epidemic Diseases – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 20. (a) Pyæmia – 2 – – – – – – 2 – – – – – – – – – – – – – – – – – – – 1 2 3 (b) Septicæmia – – – – – – – – 1 – – – – 1 2 – – – – – – – 1 – – – – _ 4 2 6 (c) Vaccinia – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 21. Glanders – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 22. Anthrax (Splenic Fever) – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 23. Rabies – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 24. Tetanus – – – – – – – – – – 1 – – – – – – – – – – – – – – – – – 4 – 4 25. Mycoses – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 26 Pellagra – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 27. Beri-Beri – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 28. (a) Pulmonary Tuberculosis 1 2 3 – – 1 4 3 1 3 2 5 23 29 40 19 66 20 41 20 22 8 9 5 1 2 – – 209 114 323 (b) Phthisis (not defined as Tuberculosis) – – – – – – – – – – – – 3 6 4 3 4 6 4 4 4 2 1 – – – – 1 20 22 42 29. (a) Acute Phthisis – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) Acute Miliary Tuberculosis – – 1 – – 1 1 1 – – – – – – – – 1 – 1 – 1 – – – – – – – 4 1 5 30. Tuberculous Meningitis 3 – 2 2 3 5 5 8 7 8 2 1 3 – – – 1 – – – – – – – – – – – 18 12 30 31. (a) Tabes Mesenterica 1 – – – – – 1 – – – – – – – – – – – – – – – – – – – – – 1 – 1 (6) Other peritoneal & intestinal tubercle 1 – 2 – – 2 3 2 – 1 – – 1 – – – – – – – 1 – – – – – – – 6 8 14 32. Tuberculosis of Spinal Column – – – – – – – – – 1 – 1 – – – – – – – – – – – – – – – – 2 – 2 33. Tuberculosis of Joints – – – – – – 1 – 1 – – 1 1 1 – – – – – 1 – – – – – – – – 3 2 5 34. (a) Lupus – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) Scrofula – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (c) Tuberculosis of other Organs – – – – – – 1 – 1 – – – – – – – – – 2 – 1 – – – 1 – – – 2 3 5 35 Disseminated Tuberculosis – – – – 1 – 1 – 2 – – – – 1 1 – – – – – 1 – – – – – – – 2 3 5 36. Itickets, Softening of Bones – 1 1 1 1 – – 1 2 – – – – – – – – – – – – – – – – – – – 1 2 3 37. Syphilis 8 7 3 2 – – 11 1 9 l – – – – – 1 – 1 – – 1 – – – – – – – 15 9 24 38. Other Venereal Diseases – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 39. Cancer of the Buccal Cavity – – – – – – – – – – – – – 1 – – – – 4 – 5 1 4 1 – – – – 14 2 16 40. , Stomach, Liver &c. – – – – – – – – – – – – – – – – 6 4 11 3 9 7 17 8 7 5 1 1 51 28 79 41. m Peritoneum, Intestines, and Rectum – – – – – – 1 – 1 – – – – – – – 2 1 4 1 6 9 8 6 4 3 – 1 24 22 46 42. ,, Female Genital Organs – – – – – – – – – – – – – 1 – 1 – 5 – 11 – 11 – 7 – 3 – – – 39 39 43. ,, Breast – – – – – – – – – – – – – – – 1 – 4 – 9 – 7 – 5 – 3 1 1 1 30 31 41. „ Skin – – – – – – – – – – – – – – – – – – – – – – – – – 1 – – – 1 1 45. Cancer of other or unspecified Organs – – – – – 1 – 1 – – – – 1 – 1 2 3 2 8 6 11 – 8 4 5 2 – 1 37 18 55 4(7. Other Tumours (situation undefined) – – – – – – – – – – – – – – 1 – – – – – 1 1 – – 1 – – – 3 1 4 47. Rheumatic Fever – – – – 1 – 1 – – – 3 1 1 1 1 – 1 – 1 – – – – – – – – – 8 2 10 48. (a) Chronic Rheumatism – – – – – – – – – – – – – – – – – – 1 – 1 – – 1 – – – – – 2 2 (b) Osteo-Arthritis – – – – – – – – – – – – – – – – – 1 – 1 1 – 3 1 – – – – 5 2 7 (c) Gout – – – – – – – – – – – – – – – – – – – 3 – – – – – – – – 3 3 49. – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 120 Deaths Registered from all Causes for the Year, 1914-continued. Cause of Death. ages. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. M. F. M. F. M F. M F. M. F. M F M F M F. SONS 1. General Diseases-con. 50. Diabetes - - - - - - - - - 1 1 - - - - - 3 2 3 1 5 4 2 5 - 1 - - 14 1 28 51. Exopthalmic Goitre - - - - - - - - - - - - - - - - - - 1 - 1 - - - - - - - 2 2 52. Addison's Disease - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 1 53. Leucocythaemia Lymphadenoma - - - - - - - - - - - - - - - 1 - - - - - 2 - - - - - 3 3 54. Anaemia, Chlorosis - - - - - - - - - - - - - - 1 1 - 1 1 - - l - - - - - - 5 3 8 55. (a) Diabetes insipidus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Purpura - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Haemophilia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (d) Other General Diseases - 1 - - - - - 1 - - - - - - - 1 1 - - - - - 1 1 - - - - 3 4 7 56. Alcoholism (acute or chronic) - - - - - - - - - - - 1 - - 2 4 1 3 2 - 3 1 - - - - - 9 8 17 57. (a) Occupational Lead Poisoning - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Non-occupational Lead Poisoning - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 58. Other Chronic Occupational Poisonings - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 59. Other Chronic Poisonings - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2. Diseases of the Nervous System and of the Organs of Special Sense. 60. Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 61. (a) Cerebro-Spinal Fever - - - - - 1 - 1 - - - - - - - - - - - - - - - - - - - - - 1 1 (b) Posterior Basil Meningitis 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - 1 - 1 (c) Meningitis, other forms 2 1 4 2 2 1 8 4 - 2 1 - 1 2 - - 1 - - - - - 1 - - - - - 12 8 20 62. Locomotor Ataxy - - - - - - - - - - - - - - - - - - 4 - - - 1 - - - - - 5 - 5 63. Other Diseases of the Spinal Cord - - - - - - - - - - - - - - 1 - 1 2 - 1 1 - 2 1 1 - - - 6 6 12 64. Cerebral Haemorrhage, Apoplexy - - - - - - - - - - - - - - - 2 2 3 8 9 14 16 14 22 7 18 3 3 48 73 121 65. Softening of Brain - - - - - - - - - - - - - - - - - - - 1 - - 2 2 - - 1 - 3 3 6 66. Paralysis without specified cause - - - - - - - - - - - - - - - - - - - - 3 5 4 3 2 1 - - 9 9 18 67. General Paralysis of the Insane - - - - - - - - - - - - - 2 3 - 7 3 4 1 7 - - - - - - - 21 6 27 68. Other forms of Mental Alienation - - - - - - - - - - - - - - - - - 1 - - 2 2 1 - - - - - 3 3 6 69. Epilepsy - - - - - - - - - - - - - 1 1 1 2 - 4 - - 1 - 1 1 - - - 8 4 12 70. Convulsions (Non-puerperal; 5 years and over) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 71. Infantile Convulsions (under 5 years) 8 3 - 1 - - 8 4 - - - - - - - - - - - - - - - - - - - - 8 4 12 72. Chorea - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 73. Hysteria, Neuralgia, Neuritis - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 1 74. Other Diseases of the Nervous System - - - - - - - - - - - - - - 2 1 l 1 - 2 - - - - - - - - 3 4 7 75. Diseases of the Eyes and Annexa - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 76. (a) Mastoid Disease - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - 1 1 (b) Other Diseases of the Ears 1 1 - - - - 1 1 - 1 1 1 - - - - - 1 - 1 - - - - - 1 - - 2 6 8 3. Diseases of the Circulatory System. 77. Pericarditis - - 1 - - - 1 - - - - - 1 - - - - - - 1 - - 1 - - - - - 3 1 4 78. Acute Myocarditis and Endocarditis - - - - - - - - 1 - 2 2 2 1 2 3 4 2 3 2 4 5 1 2 - 2 - 1 19 26 39 79. (a) Valvular Disease - - - - - - - - 2 - 1 2 2 3 5 6 10 8 8 10 7 19 11 9 7 4 1 - 54 61 115 (b) Fatty Degeneration of the Heart - - - - - - - - - - - - - - - 1 1 1 6 5 7 7 10 21 10 13 2 1 36 49 85 (c) Other Organic Disease of the Heart - 1 - - - - - 1 - - - 1 - 6 1 4 5 7 8 8 17 8 16 16 9 9 - 3 56 63 119 80, Angina Pectoris - - - - - - - - - - - - - - - - - - - 1 4 - 2 1 - - - - 6 2 8 81. (a) Aneurysm - - - - - - - - - - - - - 1 - 2 - 4 - 4 1 2 - - 1 - - 13 4 17 (b) Arterial Sclerosis - - - - - - - - - - - - - - - - - - 3 1 1 1 1 2 3 2 1 1 9 7 16 (c) Other Diseases of Arteries - - - - - - - - - - - - - - - - 1 - 1 - 1 - - - - - - - 3 - 3 82. (a) Cerebral Embolism and Thrombosis - - - - - - - - - - - - - - - - - 3 2 1 1 4 2 1 1 3 - 2 6 14 20 (b) Other Embolism and Thrombosis - - - - - - - - - - - - - - - - - 1 - 1 1 - 2 5 - 1 - 1 3 9 12 83. Diseases of the Veins (Varices, Haemorrhoids, Phlebitis, etc.) - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 1 84. (a) Status Lymphaticus - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - 1 1 (b) Other Diseases of the Lymphatic System - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 1 85. Hæmorrhage; other Diseases of the Circulatory System - - - 1 - - - 1 - - - - - - 1 - - - 1 - - 1 - - - - - - 2 2 4 4. Diseases of the Respiratory System. 86. Diseases of the Nasal Fossae - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 87. Diseases of the Larynx - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - 1 1 88. Diseases of the Thyroid Body - - - - - - - - - - - - - - - - - - - - - 2 - - - - - - - 2 2 89. & 90. Bronchitis 8 9 4 7 2 1 14 7 - - - - - - 2 3 3 4 9 3 2 8 23 32 27 27 29 51 41 30 120 230 91. Broncho-Pneumonia 33 26 16 8 14 6 63 40 1 1 - - - - 1 1 3 3 1 2 3 8 5 8 3 3 - 1 80 67 147 92. (a) Lobar Pneumonia 3 3 2 1 2 3 7 7 - 1 - 1 1 1 - 3 12 1 17 2 9 8 5 4 2 2 - 1 53 31 84 (b) Pneumonia (type not stated) 6 4 1 1 4 2 11 7 - 1 - 2 l - 2 1 8 2 6 61 10 4 6 3 2 6 - 2 46 34 80 93. Pleurisy - - - - - - - - - - - - - - - - - - - - - 1 1 2 - - - 1 1 4 5 121 Deaths Registered from all Causes for the Year, 1914-continued. Cause of Death. AGES. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. M. F. M. F. M. F. M. F. M. F. M F. M F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. SONS 4. Diseases of the Re'piratory System- con. 94. Pulmonary Congestion Pulmonary Apoplexy - - - - - 1 - 1 - - - - - - - - 1 1 1 - - - - - - - - - 2 2 1 95. Gangrene of the Lung - - - - - - - - - - - - 1 - - 2 - - - - - - - - - - - - 1 2 3 96. Asthma - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 2 2 97 Pulmonary Emphysema - - - - - - - - - - - - - - 1 - - - - - 2 - - - - - - - 3 1 4 98. (a) Fibroid Disease of the Lung - 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - 1 1 (b) Other Diseases of the Respiratory System - - - - - - - - 1 - - - - - - - - - - 1 - - 2 - - - - - 3 1 4 5. Diseases of the Digestive System 99. (a) Diseases of the Teeth and Gums - 1 - 1 - - - 2 - - - - - - - - - - - - - - - - - - - - - 2 2 (b) Other Diseases of the Mouth and Annexa - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 100. Diseases of Pharynx, Tonsillitis - 1 1 - - 1 1 2 - - - 1 - - 1 - - - - - - - - - - - - - 3 3 6 101. Diseases of (Esophagus - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 1 2 102. Perforating Ulcer of Stomach 1 - - - - - 1 - - - - - 1 5 - 4 1 3 1 1 - 4 - - - - - 18 3 21 103. (a) Inflammation of Stomach 1 - - - - - 1 - - - - - - - - - - - - - - - 2 1 - - - - 3 1 4 (b) Other Diseases of Stomach 1 - - - - - 1 - - - - - - - - - 1 - - 1 1 - 2 1 - - - - 5 2 7 104 & 105. (a) Infective Enteritis 16 6 - 2 1 2 17 10 1 - - - - - - - 1 - - - - - - - - - - - 19 11 29 (b) Diarrhoea (not returned as infective) 16 8 2 1 - 1 18 10 - - - - - - - - 1 - - - - 1 1 - - 1 - - 20 12 32 (c) Enteritis (not returned as infective) 17 22 1 2 2 1 20 25 - - - - - - - - - - - 1 - - 2 1 - - - - 22 27 49 (d) Gastro-Enteritis (not returned as infective) 9 12 1 4 1 - 11 16 1 1 - - - - - - - - 1 1 - - 1 - - - - - 14 18 32 (e) Dyspepsia (under 2 years of age 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - 1 - 1 (f) Colic - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (g) Ulceration of Intestines - - - - - - - - - - - - - - 1 1 - - 1 - - - - - - - - - 2 1 3 (h) Duodenal Ulcer - - - - - - - - - - - - - - - - 2 - - - - - - - - - - - 2 - 2 106. Ankylostomiasis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 107. Other Intestinal Parasites - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 108. Appendicitis - - - - 1 - 1 - 1 - - 1 2 2 1 - - 1 1 1 - - - 1 - - - - 8 5 13 109. (a) Hernia - - - - - - - - - - - - - - - - - - 1 1 1 2 1 2 - 1 - - 3 6 9 (b) Intestinal Obstruction 1 - - - - - 1 - - - - - 1 - - 1 - - 1 - 3 2 - 2 - - . 6 5 11 110. Other Diseases of the Intestines - - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 2 - 2 111. Acute Yellow Atrophy of Liver - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 2 - 2 112. Hydatid of Liver - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 113. (a) Cirrhosis of the Liver (not returnee as alcoholic) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Cirrhosis of the Liver (returned as alcoholic) - - - - - - - - - - - - - - - - 2 2 6 5 5 7 4 1 1 1 - - 18 16 34 (c) Diseases formerly classed to "Other Diseases of Liver and Gall Bladder" - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - 2 1 3 114. Biliary Calculi - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 1 115. Other Diseases of the Liver - - - - - - - - - - - - - 1 - - - - - 1 - 1 2 1 - 1 - - - 3 3 116. Diseases of the Spleen - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 3 5 117. Peritonitis (cause unstated) 1 - - - - - 1 - - 1 1 - - - - 1 - - - 1 1 3 - - --- - - - - - - 118. Other Diseases of the Digestive System - - - - - - - - - - -1- - - - - - - - - - 1 - 1 - - - - - 3 6 9 6. Non- Venereal Diseases of the Genito-Urinary System and Annexa. 119. Acute Nephritis - - - - - 1 - 1 1 - - - 1 - - - 1 - 4 2 7 1 3 1 - 3 - - 17 8 25 120. Bright's Disease - - - - - 1 - 1 - - - - 1 - 1 4 4 5 11 10 8 13 7 8 1 13 - - 33 34 87 121. Chyluria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 122. Other Diseases of the Kidney and Annexa - 1 - - - 1 - 2 - 1 - - - - - - - 1 - - - - - 1 - - - - - 5 5 123. Calculi of the Urinary Passage - - - - - - - - - - - - - - 1 1 - - - - - - - 1 - - - - 1 2 3 124. Diseases of the Bladder - - - - - - - - - - - - - - - - - - 2 - 1 - 5 - 1 - - - 11 - 11 125. Diseases of the Urethra, Urinary Abscess - - - - - - - - - - - - - - - - - 2 - 1 - - - - - 1 - - - 4 4 126. Diseases of the Prostate - - - - - - - - - - - - - - - - - - - 1 - - - 3 - 3 - - - 7 7 127. Non-Venereal Diseases of Male Genital Organs - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 128. Uterine Hæmorrhage (Non-puerperal) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 129. Uterine Tumour (Non-cancerous) - - - - - - - - - - - - - - - - - 2 - 1 - - 1 - - - - 4 4 130. Other Diseases of the Uterus - - - - - - - - - - - - - 1 - 1 - - - - - - - - - - - - - 3 3 131. Ovarian cyst, Tumour (Non-Cancerous) - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - 1 1 132. Other Diseases of the Female Genita Organs - - - - - - - - - - - - - 2 - - - - - - - - - - - - - - - 2 2 133. Non-puerperal Diseases of the "Breast (Non-cancerous) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 122 Deaths Registered from all Causes for the Year, 1914-continued. Cause of Death. AGES. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. m. f. M. f. M. f. M. f. M. f. M. f. M. f. M f. m. f. M. f. M. f. M. f. m f. m. f. m. F. SONS 7. The Puerperal State. 134. Accidents of Pregnancy - - - - - - - - - - - - - - - 3 - 4 - - - - - - - - - - - - 7 135. Puerperal Hæmorrhage - - - - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 1 1 136. Other Accidents of Childbirth - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 137. Puerperal Fever - - - - - - - - - - - - - 3 - 2 - 2 - - - - -_- - - - - - - 7 7 138. ,, Albuminuria and Convulsions - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 1 1 139. ,, Phlegmasia Alba Dolens, Embolism and sudden death - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - 140. ,, Insanity - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 141. ,, Diseases of the Breast - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8. Diseases of the Skin and of the Cellular Tissue 142. (a) Senile Gangrene - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 - - 1 3 4 (b) Gangrene (other types) - - - 1 - - - 1 - - - - - - - - - - - - - - - 1 - - - - - - - 2 2 143. Carbuncle, Boil - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 144. Phlegmon, Acute Abscess - 2 1 - 1 - 2 2 - - - - - - 1 - 1 - 1 1 1 - 1 - - - - - 7 3 10 145. Diseases of the integumentary System - 4 1 - - 5 - - - - - - - - - - - 1 1 - 1 - - - 2 6 8 9. Diseases of the Bones and of the Organs of Locomotion. 146. Diseases of the Bones 1 - - - - - 1 - - - 1 - - - - - 1 1 - 1 - - - - - - - - 3 2 5 147. Diseases of the Joints - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 148. Amputations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 149. Other Diseases of Locomotor System - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - 1 10. Malformations. 150. Congenital Malformations 13 10 - - 1 - 14 10 - 1 1 - - - - - - - - - - - - - - - - 15 11 26 11. Diseases of Early Infancy. 151. (a) Premature Birth 50 34 - - - - 50 34 - - - - - - - - - - - - - - - - - - - - - 50 34 84 (b) Infantile Debility, Icterus, and Sclerema 24 14 1 1 - - 2 5 15 - - - - - - - - - - - - - - - - - - - - 25 15 40 152. Other Diseases peculiar to early Infancy 7 6 - - - - 7 6 - - - - - - - - - - - - - - - - - - - - 7 6 13 153. Lack of Care 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - 1 - 1 12. Old Age. 154. (a) Senile Dementia - - - - - - - - - - - - - - - - - - - - - 2 3 1 2 2 1 - 6 5 11 (b) Senile Decay - - - - - - - - - - - - - - - - - - - - 3 5 22 29 48 65 14 28 87 127 214 13. Affections Produced by External Causes. 155 to 163. Suicides - - - - - - - - - - - - 2 - 3 - 4 2 3 1 4 1 3 1 1 - - - 20 5 25 164. Poisoning by Food - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 165. Other Acute Poisonings - - - - - - - - - - - - 1 - - - - - - - 1 - - 1 - - - - 3 1 4 166. Conflagration - - - - - - - - - _ - - - - - - - - - - - - - - - - - - 167. Burns (Conflagration excepted) 2 - 2 - 2 3 6 3 - 2 1 - - 1 1 - - - - - - - - - - - - - 8 6 14 168. Absorption of Deleterious Gases (Confla gration excepted) 11 7 1 - - - 12 7 - - - - 1 - - - - - 2 - 1 - - 1 - - - - 16 8 24 169. Accidental Drowning 1 - - - - - 1 - 1 - - - 1 - 1 1 - - 3 - 1 - - - - - - - 8 1 9 170 to 176. Injuries 1 2 - - 3 - 4 2 7 1 1 - 4 1 13 - - 2 4 2 5 1 4 2 3 1 1 3 55 15 70 177. Starvation - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 1 178. Excessive Cold - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 179. Effects of Heat - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 180. Lightning - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 181. Electricity (Lightning excepted) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 182 to 184. Homicide - - - - - - - - 1 - - - - - - 2 - - - - - - - - - - - - 1 2 3 185. Fractures (cause not specified) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 186. Other Violence - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4. Ill'defined Causes. 187. Dropsy - - - - - 1 - ] - - - - - - - - - - - - - - - - - - - - - 1 1 188. (a) Syncope (aged 1 year and under 70) - - - - - - - - - - 1 - - - - - - - - 1 - 1 - 2 - - - - 1 4 5 (b) Sudden death (not otherwise defined) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 189. (a) Heart Failure (aged 1 year and under 70) - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 - 1 (b) Atrophy, Debility, Marasmus (aged 1 year and under 70) - - 1 1 - - 1 1 - 1 - - 1 - - - - - - - - - - - - - - - 2 1 3 (c) Teething - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (d) Pyrexia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (e) Other ill-defined Deaths - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - 1 (f) Cause not specified - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 123 Table No. 3. Summary of Ages. 0 to 1 1 to 2 2 to 5 Total under 5 years. 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals General Diseases 65 64 65 194 36 24 76 96 147 149 137 110 42 9 1020 Diseases of the Nervous System and of the Organs of Special Sense 17 7 4 28 3 4 6 11 25 35 52 54 33 7 258 Diseases of the Circulatory System 1 2 - 3 3 9 15 24 45 68 91 106 65 13 445 Diseases of the Respiratory System 93 40 35 168 6 3 4 16 49 48 99 95 75 24 587 Diseases of the Digestive System 111 15 10 139 5 4 8 11 17 31 28 31 7 2 283 Non-Venereal Diseases of the Genito-Urinary System and Annexa 1 - 3 4 2 - 5 8 16 33 30 30 24 - 152 The Puerperal State - - - - - - 4 5 7 - - - - - 16 Diseases of the Skin and of the Cellular Tissue 6 3 1 10 - - - 1 1 2 4 2 3 1 24 Diseases of the Bones and of the Organs of Locomotion 1 - - 1 - 1 - - 2 1 1 - 1 - 7 Malformations 23 - 1 24 1 1 - - - - - - - - 26 Diseases of Early Infancy 136 2 - 138 - - - - - - - - - - 138 Old Age - - - - - - - - - - 10 55 117 43 225 Affections produced by External Causes 21 3 8 35 12 2 11 21 18 16 14 12 5 4 150 Ill-defined Causes - 2 1 3 - 1 1 - - 2 1 3 - - 11 Totals 481 138 128 747 68 49 130 193 327 385 470 498 372 103 3342 124 Table No. 4. ST. PANCRAS SANITARY DISTRICT. Showing the number of Deaths at all ages in 1914: from certain groups of Diseases, and the number per 1,000 Population and per 1,000 Deaths from all causes. Divisions. Deaths. Deaths per 1000 of Population at all ages. Deaths per 1000 of Total Deaths at all ages. 1. Principal Zymotic Diseases 307 1.40 91.6 2. Respiratory Diseases 587 269 175'6 3. Tubercular Diseases 432 1.98 129.3 Notes. 1. Includes Small.pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid) and Simple and Continued Fevers, and Diarrhoea, Enteritis and Dysentery. 2. Includes Laryngitis, Asthma, Emphysema, Bronchitis, Pneumonia, Pleurisy, and other diseases of the Respiratory System. 3. Includes Phthisis, Scrofula, Tuberculosis, Tabes, and other Tubercular Diseases' 125 Table No. 5.—Showing the Birth rates, Death rates, and Infantile Mortality rates of England and Wales and certain of the large Towns, and of London and the Metropolitan Boroughs for 1914. Population as Estimated by the Registrar. General in the middle of 1914. Birth Rate. Death Rate. [nfantile Mortality. Population as Estimated by the Registrar. General in the middle of 1914. Birth Rate. Death Rate. (Crude). [nfantile Mortality. England and Wales 36,960,684 23.8 14.0 105 County of London 4,518,021 24.3 14.4 104 Birmingham 860,591 27.0 15.0 122 west. Liverpool 763,926 80.3 19.4 139 Paddington Kensington 142,19 3 171,34 209 18.8 13.0 13.1 95 94 Manchester 731,830 25.8 16.7 127 Hammersmith 123,853 23.8 13.9 94 Sheffield 472,234 27.4 16.3 132 Fulham 157,303 23.5 13.4 113 Leeds 457,507 23.5 14.8 123 Chelsea 64,511 20.2 13.5 67 Bristol 361,573 21.5 13.3 100 City of Westminster 154,544 14.0 12.6 80 West Ham 294,476 30.3 14.8 106 north. Bradford 290,612 19.6 15.6 123 St, Marylebone 114,355 18.7 13.8 98 Hull 237,472 27.6 15.3 121 Hampstead 86,388 14.8 24.4. 10.4 80 Newcastle-on-Tyne 271,523 27.9 17.0 136 St. Pancras 214,133 24.4 15.6 92 Islington 325,496 25.2 15.2 105 Nottingham 264,970 23.4 15.3 145 Islington Stoke Newington 50,511 20.7 13.1 78 rortsmoutn 241,748 23.6 12.6 85 Hackney 223,393 24.5 13.9 92 Stoke.on.Trent 239,515 31.9 17.6 144 central. Salford 233,970 26.7 16.5 125 Holborn 46,832 16 .4 16.1 90 Leicester 231,152 22.0 13.9 120 Finsbury 84,521 30.1 19.6 123 Cardiff 185,763 25.7 13.9 120 City of London 17,831 10.2 134 94 Bolton 184,026 21.9 14.4 119 east. Shoreditch 109,569 32.1 19.0 141 Croydon 178,511 22.4 11.0 80 Bethnal Green 127,807 29.7 16.0 137 Willesden 164,115 24.0 10.5 86 Stepney 275,081 29.4 16.5 124 Rhondda 162,592 34.0 14.5 136 Poplar 160,839 81.6 17.1 116 Sunderland 152,436 32.4 16.9 134 south. Oldham 150,055 23.2 17.7 138 Southwark 188,321 29.8 17.8 124 Tottenham 146,141 26.0 11.5 92 Bermondsey 124,633 310 17.4 125 East Ham 142,905 23.9 10.3 77 Lambeth 297,094 23.7 14.6 104 Birkenhead 135,789 27 .8 15.2 120 Battersea 167,451 25.8 13.3 93 Blackburn 134,015 20,8 14,6 115 Wandsworth 331,321 20.2 10.9 89 Camberwell 261,828 25.2 13.7 99 Brighton 133,186 17.6 133 82 Deptford 109,269 28.6 14.4 99 Walthamstow 131,890 23.3 10.5 80 Greenwich 96,018 25.1 14.7 98 Leyton 131,224 20.9 10.2 79 Lewisham 169,211 19.8 10.9 74 Derby 125,562 24.0 12.8 92 Woolwich 122,431 23.3 13.8 85 126 Table No. 6. Registration SubDistricts. Number of Inmates. St. Pancras Institutions. No. of Beds. Daily Average No. of Inmates Deaths. Births. Parishioners. NonParish ioners. Total. St. Pancras: West 110 St. Saviour's Hospital for Ladies of Limited Means 25 15 - 4 4 - London Temperance Hospital 100 84 79 44 123 1 753 Homes of Hope 18 11 - - - 31 South Infirmary, Cleveland Street 267 247 3 139 142 - University College Hospital 305 281 90 204 294 198 Home Hospitals 30 22 - 21 21 - Medical Surgical and Nursing Homes 15 10 2 5 7 - Metropolitan Throat and Ear Hospital 20 9 - 1 1 - London Skin Hospital 0 0 - - - - Oxygen Home 0 0 - - - - Central London Ophthalmic Hospital 26 17 - - - - Central London Throat and Ear Hospital 30 24 - 14 14 - Royal Free Hospital 165 143 32 155 187 5 Mount Vernon Hospital (O.P.D.) 0 0 - - - - Western Skin Hospital 0 0 - - - - East 1663 New Hospital for Women 64 58 7 28 85 2 St Pancras House 1543 1262 96 8 99 90 Infirmary (South) 400 343 448 27 475 - North West London Hospital 0 0 4 - 4 - O.P.D. of Hampstead Gen. Hos North 599 St. Margaret's Home 60 46 - - - - Infirmary (North) 542 554 364 7 371 - Totals in Institutions within the Borough 3610 3125 1125 652 1777 327 ,, „ without the Borough - 2403 625 - 625 - Totals 3610 5528 1750 652 2402 827 127 Table No. 7. METEOROLOGICAL TABLE FOR SAINT PANCRAS, 1914. (Extracted from the Monthly Returns of the Meterological Office.) Deduced from Observations at Camden Square, n.w., under the Superintendence of H. Robert Mill, d.sc., L L.d. January. February. March. April. May. June. July. August. September. October. November, December. Barometer. Mean Pressure at 32º F. at Station Level* (Bar 123 ft. above M.S.L.) 300.39 29.647 29.515 29.973 29.970 29.923 29.764 29.929 29.964 29.893 23.770 29.524 Air Temperature. Mean of Maximum A. 42.1 51.1 51.2 62.5 65.4 73.9 74.6 75.5 69.6 59.6 51.1 47.0 Minimum B. 33.7 38.5 37.9 41.5 45.5 50.9 55.6 54.8 48.7 45.7 40.0 37.6 Mean of A. and B 38.1 44.8 44.6 52.0 55.5 62.4 65.1 65.2 59.2 52 .7 45.6 42.3 Difference from Average † -0'5 +4.8 +1.6 +3.5 + 1.2 + 1.5 +0.7 +19 +0.7 +2.6 +1.7 +2.3 Humidity—Morning 90 89 84 68 65 67 69 76 76 85 87 90 Earth Temperature at 4 ft. depth 43.6 43.5 43.8 45.9 50.1 54.3 58.8 59.3 58.9 54.5 50.8 46.7 Bright Sunshine. Total Observed (Daily mean) Hours 0.51 2.04 2.55 7.07 6 .03 7.90 4.81 5.42 5.90 1.84 1.63 0.87 Per cent. of total possible 6 21 22 51 39 48 30 38 47 18 19 11 Difference from Average Hours — — - — - — — — — — - — Rain and other forms of Precipitation. Number of Days 12 14 25 9 8 12 15 9 9 13 18 24 Total Fall Inches 0.55 2.37 4.51 0.81 1.74 1.15 1.26 1.24 1.00 1.25 3.52 6-.34 Difference from Average † ,, -1.32 +0.74 +2.85 + 0.57 -0.01 -1.14 -1.31 -115 -1.17 -1.49 + 1.16 + 4.29 * The hours of observation are 9 a.m. and 9 p.m., local time. † The averages used are obtained from observations extending over 35 years for Rainfall and Temperature and 25 years for Sunshine. 128 129 Table No. 8. Inspections made by District Inspectors and Women Inspectors during the Year 1914. DUTIES AND PREMISES. n. 1. Highgate. N. 2. 1 St. Tohn's Park.. N. 3. GosDel Oak. 1 N. 4. Gralton. N. . Maitland Park. E. 1. Bartholomew. E. 2. Camden Square. E. 3. College. E. 4. Oakley Square. E. 5. Ossulston. W. 1. Castle. w.2. Chalk Farm. w. 3. Mornington. w. 4. Regent's Hark. w, 5. Euston. S. r. Argyle. s. 2. Mecklenburgh. s. 3. Burton. s. 4. Endsleigh. s. 5. Whitfield. factories and Workshops. Whole Borough. Whole Prough Women. Totals. M.E.B. u.s. and Visitors Miss Giles. Infectious Diseases-Inquiry, removal, disinfection, etc. 69 92 13 132 210 101 9??? 168 127 11 134 132 99 148 127 135 83 82 71 74 - - - - 2320 Subsequent sanitary inspection, etc. 60 81 112 110 89 53 37 77 95 89 136 91 55 63 87 82 38 47 29 53 - - - - 1484 Complaints 74 53 133 123 120 47 70 133 97 135 130 123 126 185 113 159 115 116 82 157 - - - - 2291 Drainage-Under notice. Plans, supervision, etc. 7 19 55 65 43 73 55 51 3 4 21 11 18 23 14 6 1 2 115 19 1 - - - 606 Voluntary 27 23 41 37 34 15 20 14 15 48 38 27 27 63 36 42 9i 29 165 49 2 - - - 843 New Buildings 7 3 - 1 - 1 - 1 1 1 2 - - - 3 8 6 1 33 - - - - - 68 Yards of Mews and Stables 297 214 237 128 272 9 16 - 26 341 145 232 185 389 305 98 310 338 389 498 - - - - 4429 House-to-House Inspections - Housing, Town Planning, etc., Act, 1909: 17(1). First Inspections 86 8 31 67 32 - 5 - 160 202 106 32 1 58 228 75 40 38 230 183 - - - - 1582 Subsequent routine Inspections 206 - - - - - - - - - 5 - - - 2 53 20 2 80 30 193 - - - - 789 Inspections of registered tenement houses other than above 6 - - - - - - - - - 5 - - - 2 - 12 10 10 - - - - 45 Other house-to-house Inspections - - - - - - - - - - - 1 - 7 - - - - - - - - - - 8 Visits to closed underground rooms - - - - - - - - - '4 2 1 - 1 - - - 17 41 109 - - - - 285 Smoke Shafts observed - 3 5 1 - - 1 1 - 33 2 3 - - 170 - - 64 49 - - - - - 332 Factories - - - - - - - - - - - - - - - - - - 9 - 27 - - - 36 Workshops - - - - - - - - - - - - - 4 6 - - 17 4 2 87 - - - 120 Workplaces - - - - - - - - - - - - - - - - - - - - - - - - - Bakehouses 5 8 13 8 5 - - 1 - 8 10 8 5 9 5 4 4 6 9 18 193 - - - 319 Restaurant Kitchens - - - - 1 - - - - - - - - - 1 - - 2 18 96 5 - - - 123 Regulated Trades. Offensive Trades - - - - - - - - - - - - - - - - - - - 2 - - - - 2 Rag and Bone dealers - - - 3 1 - - - - - - - - - 1 - - 3 8 - - - - - 16 Fried fish vendors - - 1 4 7 - - - - - - - - - - - - 1 13 8 - - - - 34 Fish Curers - - - - 2 - - - - - - - - - - - - - - - - - - - 2 Other effluvia businesses - - - - - - 6 - - - - 2 - - - - - - - - - - - - 8 Inspections of Market Streets 10 6 8 5 2 20 19 36 - - 3 4 10 1 6 8 24 8 9 27 - - - - 206 Other Duties 3 - - 9 6 4 2 4 38 102 - 6 3 7 14 14 31 67 5 4 - 649 1825 1346 4139 Totals 857 10 69 693 814 323 327 486 562 1094 739 673 529 958 1120 684 763 1230 1319 1502 *315 649 1825 1346 20087 * These figures are in respect of the fourth quarter of 1914 only. 130 131 TABLE No, 9. Re-Inspections after Intimations made by the District Inspectors and Women Inspectors during the Year 1914. DUTIES AND PREMISES. N. 1. Highgate. N. 2. St. John's Park. N. 3. Gospel Oak. N. 4. Grafton. N. s. Maitland Park. E. 1. Bartholomew. E.2. Cam Jen Square. E.3. College. E.. 4. Oakley Square. E.5. Ossulston. W . 1. Castle. w. 2. Chalk Farm. W. 3. Mornington. w . 4. Regent's Park- w. 5. Euston. S. 1. Argyle. S. 2. Mecklenburgh. S. 3. Burton. s. 4. Fndsleigh. S. 5. WhitHeld. Factories and Workshops, Whole Borough Borough Women. Totals. M.E.B. C.S and Visitors. MISS Giles. Infectious Diseases-Inquiry, removal, disinfection, etc. 4 10 19 is 29 38 25 71 28 8 17 5 3 1 66 5 1 5 13 62 - - - - 428 Subsequent sanitary inspection, etc. - 102 182 255 210 9 5 23 120 53 147 80 88 163 97 5 2 73 41 40 38 - - 1733 Complaints 510 229 260 258 334 55 100 140 78 281 429 218 183 272 426 281 329 418 193 101 35 - - 5440 Drainage-Under notice. Plans, Supervision, etc. 255 200 635 239 115 506 694 700 60 59 376 426 136 179 221 168 87 40 112 227 46 - - - 5481 Voluntary 251 163 199 186 91 76 148 17 113 123 178 244 147 294 472 324 380 201 36 186 6 - - 3835 New Buildings 414 27 27 68 - 13 7 2 - - - 2 - - - 121 99 141 37 18 - - - - 976 Yards of Mews and Stables 3 1 5 1 6 - - 3 1 - - - - - - - - - - - - - - - 20 House-to-House Inspections- Housing, Town-Planning, etc., Act, 1909 17 (1). First Inspections 692 2 323 245 125 - - - 1482 1643 205 230 82 171 1502 457 271 464 797 597 29 - - - 9317 Subsequent routine Inspections 256 - - - - - 7 - - 167 - - - 83 1 143 - 1180 12 228 - - - - 2085 Inspections of registered tenement houses other than above 29 - - - - - - - - 27 9 11 - 15 17 - - - 8 - - - - - 116 Other house-to-house inspections - - - - - - - - - - - - - - - - - - - - - - - - - Visits to closed underground rooms - - - - - - - - 6 3 - 1 - - 3 - 4 1 146 - - - - 164 Smoke Shafts observed - - - - - - - - - - 1 - - - - - - 3 3 - - - - - 7 Factories - - - - - - - 3 - - - 2 - 1 - - - - - 3 16 - - - 25 Workshops - - - - - - - - - - - - - 4 1 - - - 3 9 29 - - - 46 Workplaces - - - - - - - - - - - - - - - - 1 - 1 - - - - - 2 Bakehouses - 5 3 5 2 - - - - 23 4 3 1 - 17 - 2 2 - 62 96 - - - 225 Restaurant Kitchens - - - - - - - - - - - - - - - - - - 7 31 - - - - 38 Regulated Trades. Offensive Trades - - - - - - - - - - - - - - - - - - - - - - - - - Rag and Bone dealers - - - - - - - - - - - - - - - - - 1 - - - - - 1 Fried fish vendors - - - 11 - - - - - - - - - - - - - - - - - - - - 11 Fish curers - - - - - - - - - - - - - - - - - - - - - - - - - Other effluvia businesses - - - - - - - - - - - - - - - - - - - - - - - - - Inspections of Market Streeta - - - - - - - - - - - - - - - - - - - - - - - - - Other Duties - - - 3 - - - - - - - - - - - - - - - - - 233 588 642 1466 Totals 2424 739 1653 1289 912 697 986 958 1882 238 1366 122 640 118 3282. 1504 117 2540 1264 2010 *295 233 588 642 31416 * These figures are in respect of the fourth quarter of 1914 only. 132 TABLE NO. 10. Inspections and Re-Inspcctions and other work of the Spccial Inspectors during 1914. DUTIES AND PREMISES. Visits and Inspections. Re-Inspections after Intimation Notices. E. 3 & 4. Inspector Auger. N. & E. 1, 2, 5. Inspector Child. w. & s. Inspector Osborne Totals. E. 3 & 4. Inspector Auger. N. & E. 1, 2, 5. Inspector Child, w. & s. Inspector Osborne Totals. Milkshops 98 538 314 950 - - - - Dairies 3 17 14 34 - - - - Cowsheds 8 37 16 61 - - - - Other Premises of Milk Purveyors - 3 - 3 - - - - Margarine Factories - - - - - - - - Butter Factories - - - - - - - - Ice Cream Pi emises 42 99 79 220 - - - - Slaughter Houses 7 168 135 440 - - - - Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 1 219 220 440 - - - Butchers'Shops 9 384 74 467 - - - - Fishmongers' Shops 87 231 106 424 - - - - Marketing Places 948 1132 1531 361 - - - - Other Premises where Food or Drugs are sold 4 15 19 - - - - Other Visits 9 108 60 177 - - - - Total 1212 2940 2564 6716 - - - - SAMPLES, &c., TAKEN. Formal Samples Informal Samples No, of Milk samples 49 '83 '59 391 - - - ,, Cream samples 8 12 - 20 - - - - ,, Butter and Margarine samples 14 78 83 175 - 11 - 11 ,, Other samples (specified below)- Lard 5 9 - 14 - - - - Cheese 2 9 - 11 - - - - Coffee 2 10 4 26 - - - - Rice 2 - - 2 - - - - Demerara Sugar - 10 5 '5 - - - - Camphorated Oil - S - 5 - - - - Vinegar - 2 2 4 - - - - Arrowroot 6 - - 6 - - - - Mustard 12 9 9 30 - - - - Oatmeal 2 5 - 7 - - - - Flower of Sulphur - 3 - 3 - - - - Seidletz Powders 2 - - 2 - - - - Papper 5 8 7 20 - - - - Jam - - 9 9 - - - - Cocoa 6 - - 6 - - - - Cod Liver Oil - 5 - 5 - - - - Ginger (Ground) 3 - 3 - - - - Honey 1 1 - - - - Total 118 349 288 755 - 11 - 11 Samples taken under the Rag Flock Act - - - - - - - - 133 Table No. 10.-con. DUTIES AND PREMISES. Visits and Inspections. Re-Inspections after Intimation Notices. E. 3 & 4. Inspector Auger. N. & E. 1, 2, 5. Inspector Child. W & S. Ins-pector Osborne Tot als. E. 3 & 4. Inspector Auger. N. & E. 1, 2, 5. Inspector Child. w. & s. Inspector Osborne Totals. UNSOUND FOOD. SURRENDERED SEIZED No. of surrenders and seizures :- Meat - 10 - 10 - - - - Fish 8 5 2 15 - - - - Shellfish 2 - 1 3 - - - - Other Foods (specified below):- Oranges - 2 - 2 - - - - Apples 1 2 - 3 - - - - Strawberries - 2 - 2 - - - - Cherries - - 2 2 - - - - Gooseberries - - 1 1 - - - - Loganberries - - 1 1 - - - - Watercress - 1 1 2 - - - - Tomatoes 1 - - 1 - - - - Cauliflower 1 - - 1 - - - - Brussel Sprouts 1 - - 1 - - - - Yeast - 8 - 8 - - - - Pig's Head - 2 - 2 - - - - Liver Sausage - - 1 1 - - - - Eggs - 2 - 2 - - - - Total 14 34 9 57 - - - - Inspections of Registered Canal Boats 2 - 49 51 - - - - 134 Table No. 11. Total Number of Inspections and Re-inpections made by individual Inspectors during the year 1914. Inspector. Area. Inspections. Re-inspections. Total. 1. Mr. Raekliam N. 1 943 2582 3525 2. „ Brown N. 2, 3 1381 2580 3961 ,, *Thompson N. 4, 5 761 1355 2116 „ *Pottier (Temporary Inspector from 28tli September) „ 578 542 1120 4. „ Dillon E. 1, 2, 3 1046 2534 3580 5. ,, Auger E. 4 661 2125 2786 6. „ James E. 5 1064 2287 3301 7. West (to 3rd October) W. 1, 2 987 2285 3272 „ Akers (from 5tli October) „ 436 305 741 8. „ Lonnon W. 3, 4 1475 1802 3277 9. ,, Adkins W. 5 1118 2838 3956 10. ,, Holmes S. 1, 2 1374 2659 4033 11. „ Walker S. 3, and part of S. 4 S. 4 1416 2698 4114 ,, Akers (to 3rd October) 1150 979 2129 12. „ Landen S. 5, and part of S. 4 1575 2137 3712 13. „ West (Factories & Workshops from 5th October) Whole Borough 315 295 610 14. „ * Auger Food and Food premises E. 3, 4 1336 - 1336 15. ,, Child N. 1, 2, 3, 4, 5, & E. 1, 2, 5 3562 3562 16. ,, "Osborne W. & S. 2692 2692 17. Miss Bibby Whole Borough 649 233 882 18. „ Smith „ 1525 358 1883 19. „ Giles (Temporary Inspector) „ 1346 642 1988 20. „ Davies (Voluntary „ to 20th June) „ 300 230 530 Totals Whole Borough 27690 31416 59106 Inspector 1 hompson away on active service. * Inspector Osborne died on the 14th December, 1914. 135 Table . No. Intimations as to Nuisances served by the Sanitary Inspectors during 1914. a Schedule of Nuisances. Districts and Inspectors. N. 1. G. R. N. 2 & 3. W. L. B. N. 4 A 5. b.h.t.&p.w.p. E. 1, 2 & 3. E. J. D. E. 6. EE."J. W. 1 & 2. H.G.W.&R.C.A. VV. 3 & 4. J. I. L. W. 5. G. W. A. S. 1 & 2. E. G. H. S. 3 & part S, 4 A. H. W. S 1. R. C. A. S. 5 & part S. 4 j. l, Factories & Work shops. H.G.W. Food Inspectors. Whole Borough Women. Totals. hi. 4 & part of Wd.3. W.G.A. N. & E. H. R. C. W. & S. J. 0. M. E. B c. s. 1 Part of the house in a dirty condition 7 56 61 66 69 110 84 81 57 38 16 44 2 8 - - - - 698 2 ,, damp ,, 16 12 13 7 66 34 1 3 11 11 10 10 - 6 - - - - 200 3 Roof defective 24 28 36 13 24 76 8 12 10 28 17 25 2 11 - - 1 - 315 4 Guttering defective 6 3 2 3 3 11 2 1 4 3 - 3 - 4 - - 45 5 Water fittings defective 5 14 29 5 1 28 , 5 4 2 8 2 6 4 8 - - 121 6 Water-closet apartment with absence of external ventilation 3 1 3 3 1 6 7 - 2 2 1 3 2 - - - - - 34 7 „ ,, so foul as to be a nuisance or dangerous to health - 1 - 5 1 - 1 6 2 2 - 12 - 1 - - - 31 8 Water-closet basin foul 3 - 13 5 3 12 8 8 8 9 3 19 8 4 - - 103 9 ,, „ defective 2 8 8 3 8 17 4 2 2 14 9 5 5 - - - 87 10 ,, ,, choked 11 5 13 2 5 7 8 16 8 8 10 7 1 16 - - - 117 11 Urinal in a foul condition - - - - - 1 - - - - - 2 - - - - - - 3 12 Privy in a foul condition - - - - - - - - - - - - - - - - - 13 Soil pipe defective 13 - 1 7 1 8 1 - 5 3 2 10 - 1 - - 52 ]4 ,, unventilated 6 - - 1 - 4 2 - 1 2 - - - - - - - 19 15 ,, improperly ventilated 3 8 - 4 - 3 2 1 - - - - - - - - - - 21 16 Absence of waste pipe to sink, lavatory or bath - - - - - 1 - - - - - - - - - - - - 1 17 Waste pipe of sink, lavatory, or bath connected with drain 3 1 1 1 - 5 1 1 1 - 1 4 - 2 - - 21 18 ,, ,, ,, ,, defective 12 5 6 2 8 15 - 12 2 - 2 1 - 3 - - 63 19 ,, ,, ,, ,, foul 3 2 1 1 - 3 1 1 1 4 - 3 - 1 - - - 21 20 Inlet of drain improperly trapped 1 3 1 1 - 5 2 - - 1 - - 2 1 - - - 17 21 Drain defective 22 32 27 20 11 64 7 13 17 5 4 16 1 8 - - 247 22 ,, stopped 7 7 14 4 4 23 7 5 9 6 - 2 - 18 - - - 106 23 ,, ventilating pipe defective 6 1 4 2 1 20 3 3 7 - 1 - 1 2 - - - 51 24 Rain-water pipe in direct communication with drain 5 6 - 1 2 7 2 - 1 2 - 1 - 2 - - 29 25 ,, ,, defective 3 6 4 4 2 13 3 15 - - 3 5 3 15 - - - 76 26 Unpaved condition of roadway - - - - - - - - - - - - - - - - - - 2 27 Undrained ,, ,, - - - - - - - - - - - - - - - - - - - 28 Area or part unpaved - - - - - - - - - - - - - 1 - - - - 12 29 ,, undrained - - - - - - - - - - - - - - - - - 2 30 Yard or space unpaved - - 1 - - 1 - 3 1 1 - - - - - - - 7 31 ,, ,, undrained - - - - - - - - - - - - - - - - 2 32 Defective condition of washhouse paving 7 4 5 - 5 25 9 16 6 4 2 - 1 10 - 1 - 95 33 Dust-bin defective 5 16 24 27 34 58 18 31 13 8 12 10 3 14 - - - 289 34 ,, in an improper position - - - - - - - - - - 1 3 - ~ - - - - 1 35 Accumulation of stagnant water which is a nuisance dangerous to health - 1 - 1 1 2 1 2 - 5 1 - 1 - - - - 17 36 Accumulation or deposit which is a nuisance dangerous to health 4 7 7 7 7 9 19 34 4 16 14 19 - 21 - - 168 37 Animals kept in such a manner as to be a nuisance dangeious to health 2 2 2 1 - 1 2 3 1 - 1 2 - 2 - - - - 21 38 Part of the house so overcrowded as to be dangerous to health - 5 8 1 3 9 - 25 4 - 1 2 - - - - - - 58 39 Space below floor in basement or ground floor insufficiently ventilated 2 2 4 2 11 1 2 i 1 - - - - 1 - - - - 27 40 Issuing of black smoke in such a quantity is to be a nuisance - - - - - - - - - - - - - 1 - - - - - 41 Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health 1 - - - - - - - - - - - - - - - - - 3 42 Tent, van, shed, or similar structure used as a human habitation which is in such a state as to be injurious or dangerous to the health of the inmates - - - - - - - - - - - - - - - - - - - 43 Other nuisances 35 18 16 25 8 44 10 27 16 6 6 2 4 9 - - - - 226 Totals 217 257 316 223 275 626 221 335 196 191 119 227 39 171 - - 2 - 3415 136 Table No. 13. Intimations as to Breaches of Statutes and Statutory By-laws served by the Sanitary Inspectors during 1914. B Breaches of Statutes and Statutory By-laws. Districts and Inspectors. N. 1. G.R. N . 2 & 3. W. L. B. N. 4 & 5. B. H. T & P. W. P. E. 1, 2 & 3. E. J. n. E. 5. R E. J. W. 1 & 2. H G.W.&R.C.A. W. 3 & 4. j. i. i.. W. 5. G. W. A. S. 1 & 2. E. G. H. S. 3 & part S. 4. A. H. W. S. 4. R.C. A. S 5 & part S. 4. J. I.. Factories & Work. shops. H.G.W. Food Inspector. Whole Borough Women Totals. E. 4 part of Wd.3.W.G. A n. k. H. R. C. W. & s. J. O. M. E. B. C. S. 1a An occupied house without a proper and sufficient supply of water (1907 Act. See. 78) 57 36 58 3 110 52 63 144 41 46 56 53 - 152 - - - - 871 1b ,, ,, ,, (other than above) - - 2 4 3 2 2 1 3 1 1 - - - - - - - 19 2 Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet - - - - - - 1 - - 1 1 - 1 - - - - - 4 3 Water-closet not supplied with a sufficient quantity of water for securing its effective action 16 27 10 8 5 22 24 15 16 16 9 12 1 5 - - - - 186 4 Tank, cistern, or other receptacle for storing of water used or likely to be used by m in for drinking purposes-dirty condition of 1 1 1 - 2 14 2 24 2 2 - 8 - 2 - - - - 59 5 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes of a proper cover to 1 - 3 - - - 3 22 2 - 2 10 - 4 - - - - 62 6 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes placed in an improper position - - - - - - - - - - - - - - - - - - - 7 Animals so kept as to be likely to pollute the water supply - - - - - - - - - - - - 1 - - - - 1 8 Offensive matters not deposited in manure receptacle 3 - - - - 1 - - - - - - - - - - - 4 9 Manure not removed at proper intervals 3 - - - - 1 1 3 1 - - - - - - - - - 9 10 Manure-absence of proper receptacle for 1 - 1 - - 1 - 1 - 3 3 - - - - - - 10 11 Manure receptacle not property constructed - - - - - - - - 1 - - - - - - 1 12 Sufficient drain to stables or cowshed-absence of a - - 1 - - - - - - - - - - - - - - - 1 13 Receptacle for house refuse-absence of a proper 43 32 14 - 4 27 13 21 24 15 18 14 1 22 - - - - 248 14 Receptacle for house refuse-absence of a proper cover for 1 - - - - 3 5 - - - 7 8 - - - - - - 24 15 Yard or open space unpaved 57 - - - - - - - - i - - - 1 - - - - 59 16 ,, paving defective 13 26 22 3 18 32 31 31 11 9 5 3 11 - - - - 217 17 Insufficient water-closet accommodation to "lodging house " 2 11 4 3 14 12 1 1 18 9 lb 2 - 2 - - - - 95 18 A furnace improperly constructed or negligently used - - - - - - - - 1 - - - - - - - - - 1 19 Effluvia arising from premises used for trade, business, or manufacture which is a nuisance dangerous to the inhabitants of the district - - - - - - - - - - - - - - - - - - - 20 Offensive matters suffered to run out of trade premises into an uncovered place - - - - - - - - - - - - - - - - - - - 21 Dairies and cowsheds-breach of By-laws as to 1 - - - - - - - - - - - - 1 - - - - 2 22 Slaughterhouses-breach of By-laws as to - - - - - - - - - - - - - - 1 - - - 1 23 Steam whistle-use of a, without authority - 1 - - - - - - - - - - - - - - - - 3 24 Parts of houses infested with vermin requiring stripping, purifying, and cleansins 20 7 14 10 44 38 6 18 6 2b 3 12 - 53 - - - - 257 25 Articles in an unwholesome condition requiring to be purified or destroyed - - - - - - - - 1 - - - - - - - - - 1 26 Underground room illegally occupied as a dwelling - 2 - 2 - 3 - - - - 2 - 1 - - - - 30 27 Other breaches 10 5 5 6 1 11 10 4 5 10 1 3 1 - - 1 - - 73 Totals 231 148 134 38 203 229 167 289 139 139 127 131 6 255 - 1 - - 2238 137 Table No. 14. Intimations as to Breaches of By-laws and Breaches of Statutes served by the Sanitary Inspectors during 1914. c Registered Tenement Houses-Breaches of By-Laws. Districts and Inspectors. N. 1. G. K. n. 2 & 3. w. l. b. N- 4 & 5. B.H.T. A-P.W.P. e. 1. 2 & 3. e. j. d. e. 5. r. e. j. w. 1 & 2. h.g.w.&r.c.a. W. 3 & 4. j. i. l. w. 5. g. w. a. s. 1 & 2. e. g. h. S. 3 & part S. 4. A. H. W. S 4. R. 0. A. S. 5 & part 8. 4. J. L. Factories & Workshops. H. G.W. Food Inspectors. Whole Borough. Women. Totals. E. 4 & part of Wd.3.W.G.A. n. & e. H. R. C. w. & s. J. o. m. e b. C. S. 1 Overcrowding - - 2 - 9 - - 20 6 - 1 - - - - - - - 38 2 Inadequate water supply - - - - - - - - - - - - - - - - - - 3 Contaminated water supply - - - - - - - - - - - - 4 Foul closet, basin or trap 1 - 1 3 1 4 - 5 - - 15 5 Want of means of ventilation - - - - 1 - 1 - - - - - - - - - - - 2 6 Want of annual cleansing - - - 2 - - 19 15 - - 36 7 Want of cleansing of the part or parts of premises used in common 41 10 7 10 5 49 27 88 26 11 - 17 - 394 8 „ ,, ,, in sole use 87 15 8 47 5 24 24 91 43 19 - 34 - - - 388 9 Want of cleansing of the room or part of the dwelling - - - - - - 1 - 12 15 - - - - - - 2828 10 Animals improperly kept 1 1 - - - - - - - - 1 - - - - - - - 3 11 Other breaches 2 - - - - - - - 1 - 4 - - - - - - - 7 Totals 131 26 17 - 118 12 1 93 60 182 107 58 - 106 - - - 911 TABLE NO. 15. D Factories, Workshops and Work Places-Breaches of Statutes. Districts and Inspectors. n. 1. G. R. N. 2 & 3. W. L. B. JN . 4 a 5. B. H. T. & P. W.P. e. l, 2 & 3. E. J. D. E. 5. R. E. J. w . 1 & 2. H.G.W.&F.C.A. W. 3 & 4. J. I. L. W. 5. G. W. A. b. 1 & 2. E. G. H. S. 3 & part S. 4. A. H. w. s. 4. ft. C. A. 3. 5 & part S. 4. J. L. Factories .W orksbops. H. G. W. Food Inspectors, Whole Borough. Totals. E. 4 & part, of Wd. 3.W.G.A N. & K. H. B. C. w. & s. J. 0. M. E. B. c. s. 1 Want of cleanliness - 1 - 1 1 - 1 5 1 3 6 31 61 - - - 4 - 115 2 Want of ventilation - - - - - - - - - - 1 1 - - - - - 2 3 Want of air space, overcrowding - - - - - - - - - - - 1 - - - - - - 1 4 Sanitary accommodation, absent or insufficient - - - - - - - - - - 1 - - - - - - - 2 5 ,, ,, unsuitable or detective - - - - - - - - - - - 1 - - 2 - 3 6 „ „ not seprate for sexes - - - - - - - - - - - - 3 - - - 1 4 7 Want of drainage of floors - - - - - - - - - - - - 1 - - - - - 1 8 Other nusisances - - - 1 - 1 - - - - - 25 - - - 1 - 28 9 Illegal occupation of underground bakehouse - - - - - - - - - - - - - - - - - - - 10 Breach of special sanitary requirements for bakehouses - - - - 1 - - - - - - 1 1 - - 6 11 Failure as regards list of outworkers - - - - - - - - - - - - - - - - - - - 12 Giving out work to be done in premises which are unwholesome - - - - - - - - - - - - - - - - - - - 13 ,, ,, infected -- - - - - - - - - - - - - - - - - - 14 Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox - - - - - - - - - - - - - - - - - - - 15 Other contraventions - - - - - - 1 - - - - - - - - - - - 1 Totals - 1 3 3 2 1 2 5 1 3 7 33 13 1 - - 8 - 163 138 NEW LEGISLATION. Acts of Parliament. The Milk and Dairies Act, 1914, has been postponed until after the war, and there was no other general or local public health legislation during the year. Orders. The Public Health (Ophthalmia Neonatorum) Regulations, 1914, Notification of Ophthalmia Neonatorum. (5th February, 1914.) General Order. To the Mayor, Aldermen, and Commons of the'City of London, in Common Council assembled;— To the Councils of tlie several Metropolitan Boroughs, Municipal Boroughs, and other Urban Districts in England and Wales;— To the Councils of the several Rural Districts in England and Wales;— To all Medical Practitioners;— To all Certified Midwives;— And to all Others whom it may concern. Whereas We, the Local Goverment Board, are empowered by Section 130 of of the Public Health Act, 1875, as amended by the Public Health Act, 1898, from time to time, to make, alter, and revoke Regulations with a view to the treatment of persons affected with any endemic or infectious disease and for preventing the spread of the disease; and to provide for the enforcement and execution of the Regulations; And whereas Ophthalmia Neonatorum as herein-after-defined is an endemic and an infectious disease: Now Therefore, We, by this Our Order aud in the exercise of tlie powers conferred upon Us by the Public Health Act, 18'i5, the Public Health (London) Act, 1891, and the Public Health Act, 1896, and of every other power enabling Us in that behalf, do hereby make the following Regulations, that is to say :— Definitions. Article I.—In these Regulations, unless the contrary intention appears:— (а) Words importing the masculine gender include females; (б) Words in the singular include the plural, and words in the plural include the singular; (c) Expressions referring to writing include references to printing, and to other modes of representing or reproducing words in a visible form, and references to printing include references to other mechanical modes of so representing or reproducing words; (d) The expression " Local Authority " means, as the case may be. the Mayor, Aldermen, and Commons of the City of London in Common Council assembled, the Council of a Metropolitan Borough, the Council of a Municipal Borough or other Urban District, or the Council of a Rural District; (e) The expression " District" means the District subject to the jurisdiction of the Local Authority for the purposes of the Public Health (London) Act, 1891, or of the Public Health Act, 1875, as the case may be; 139 (f) The expression "Medical Officer of Health" means Medical Officer of Health of a Local Authority; (g) The expression "Medical Practitioner" means any person for the time being registered under the Medical Acts; (h) The expression "Certified Midwife " means a woman certified under the Midwives Act, 1902 ; (i) The expression ''Ophthalmia Neonatorum " means a purulent discharge from the eyes of an infant commencing within twenty-one days from the date of its birth. Commencement of Regulations. Article II.—These Regulations shall come into operation on the First day of April, One thousand nine hundred and fourteen, and shall then and thereafter apply and have effect throughout England and Wales, and shall be enforced and executed by every Local Authority. Supply of Forms of Notification. Article III.—For the purpose of these Regulations every Local Authority shall provide and maintain a sufficient supply of printed copies of the Form set out in the Schedule to these Regulations, and shall as soon as practicable after these Regulations come into operation, and afterwards from time to time when application is made to them, furnish printed copies of the said Form to every certified midwife resident or practising within the District of the Local Authority. Notice of Provisions of Regulations. Article IV.—The Local Authority shall forthwith cause notice to be given to all Medical Practitioners and to all Certified Midwives resident or practising within the District of the Local Authority of the duties imposed upon them by these Regulations. Notification by Medical Prartitioners. Article V.—(1) Subject to the provisions of these Regulations every Medical Practitioner, on first becoming aware that a child upon whom he is in professional attendance is suffering from Ophthalmia Neonatorum, shall forthwith make and sign a notification of the case in the Form prescribed for the purpose of certificates under Section 3 of the Infectious Disease (Notification) Act, 1889, at the same time stating in writing, either on the form or on a separate sheet attached to the form, the date of the birth of the child, the name and address of the parent or other person, if any, having charge of the child, and the date of the onset of the disease, and shall transmit the notification and statsment aforesaid to the Medical Officer of Health for the Distric t within which the place of residence of the parent or other person, if any, having charge of the child is situate at the date of notification : Provided that a Medical Practitioner shall not be required to notify a case of Ophthalmia Neonatorum under these Regulations in any of the following cases; that is to say,— (а) If the case is notifiable or has been notified under the Infectious Disease (Notification) Act, 1889, Section 55 of the Public Health (London) Act, 1891, or under the provisions of any Local Act or Order made thereunder; or (b) If the case has been notified by a Certified Midwife as herein-after provided. (2) Every Medical Practitioner who transmits to a Medical Officer of Health a notification of a case of Ophthalmia Neonatorum under the Infectious Disease (Notification) Act, 1889, Section 55 of the Public Health (London) Act, 1891, or 140 under the provisions of any Local Act or Order made thereunder, shall at the same time state in writing, either on the form or on a separate sheet attached to the form, the date of birth of the child, the name and address of the parent or other person, if any, having charge of the child, and the date of the onset of the disease. Notification by Certified Midwives. Article VI.—Subject to the provisions of Article X. of these Regulations every Certified Midwife who has reasonable grounds for supposing that a child upon whom she is in attendance or whom she is called in to visit in the course of her practice is suffering from Ophthalmia Neonatorum, shall, unless the case has been already notified by a Medical Practitioner, forthwith make and sign a notification of the case in the Form set out in the Schedule to these Regulations, and shall transmit the notification to the Medical Officer of Health for the District within which the place of residence of the parent or other person, if any, having charge of the child is situate at the date of notification. Transmission of Notifications. Article VII.—A notification to be transmitted to a Medical Officer of Health in pursuance of these Regulations shall be enclosed in a sealed envelope addressed to that Officer and may be transmitted by being delivered to him or by being delivered at his office or residence, or may be sent by prepaid letter post addressed to him at his office or at his residence. Fees for Notification. Article VIII.—(1) The Local Authority shall pay to every Medical Practitioner a fee of two shillings and sixpence for each notification duly made, signed and transmitted by him under these Regulations if the case occurs in his private practice, and of one shilling if the case occurs in his practice as medical officer of any public body or institution. (2) The Local Authority shall pay to every Certified Midwife a fee of one shilling for each notification duly made, signed and transmitted by her under these Regulations. (3) Every fee shall be paid as soon as practicable after the end of the quarter during which the notification was sent, and the Local Authority shall not require before payment an account of fees claimed under these Regulations. (4) The said fees shall in each case be deemed to cover all expenses, including the cost of transmission. Duties of Medical Officers of Health. Article IX.—The duties assigned to the Medical Officer of Health by the Sanitary Officers (London) Order, 1891, or the Sanitary Officers (Outside London) Order, 1910, as the case may be, shall be deemed to extend to and to include all action by the Medical Officer of Health in the execution of these Regulations. Notification not required in certain eases. Article X.—Nothing in these Regulations shall be deemed to require a notification to be transmitted to a Medical Officer of Health in respect of the child of an inmate of any building, ship, vessel, boat, tent, van, shed or similar structure belonging to His Majesty the King. Short Title. Article XI.—These Regulatious may be cited as " The Public Health ''(Ophthalmia Neonatorum) Regulations, 1914." 141 SCHEDULE. Public Health (Ophthalmia Neonatorum) Regulations, 1914. Form of Notification by Certified Midwife. To the Medical Officer of Health for the of (Address) t, the undersigned, being a Midwife holding the Certificate No the Central Midwives Board, hereby notify that the infant child of—* who was born on (state date of birth). , 19 , is in my opinion suffering from Ophthalmia Neonatorum, and that I first noticed that the child was suffering from this disease {state the time and date) Name of Midwife Address of Midwife Date , 19 . * State name and address of parent or other person, if any, having charge of the child. Note.— The address, lie. of the Medical Officer of Health should be filled in by the Local Authority before the forms are furnished to the Midwife. Given under the Seal of Office of the Local Government Board, this Fifth day of February, in the year One thousand nine hundred and fourteen. ©John Burns, President. H. C. Monro, Secretary. Date of publication in the London Gazette, 6th February, 1914. The Tuberculosis Order, 1914, of the Board of Agriculture and Fisheries was issued in place of that of 1913, its purpose being mainly to remove difficulties in making valuations for the purpose of compensation for the slaughter of diseased animals and to bring within its scope all bovines obviously tuberculous. The order is administered in London by the London County Council. 142 By-Laws. By-Laws were made during 1914 by the London County Council under Sec. 9 of the London County Council (General Powers) Act, 1908, for regulating the conduct of the businesses of a Vendor of Fried Fish and of a Fish Curer, respectively. These are somewhat lengthy and it does not seem necessary to set them out here. LEGAL DECISIONS. Anderson v. Buitcher. 12 L.G.R. 10. (Before Darling, Avory and Atkin, J.J.) Food—Trade description—Sugar —" Demerara "—Place of Origin-Generic term—Article of the nature, substance and quality demanded—Sale of Food add Drugs Act, 1875 (38 & 39 Vict., c. 63) s. 6. The respondent was charged under section 6 of the Sale of Food and Drugs Act, 1875, with selling a crystallised cane sugar grown in Mauritius as "Demerara sugar." There was evidence that this sugar was equal in quality to the best West Indian cane sugar that the public expect to buy under the designation "Demerara sugar" without reference to its origin, and had undergone the same application of an organic dye. The magistrate on his dismissal of the summons, found as a fact that "Demerara sugar" had become a term applicable to any sugar of the same substance, kind and colour wherever produced. Held, that since the magistrate had found upon the evidence before him that "Demerara sugar" had become a generic term referring rather to the process of colouring sugar with an organic dye than to the place where it was grown, and that the sugar in question was Demerara sugar in every respect except that it was not grown there, his decision must be affirmed. Batchklour v. Gee. 12 L-G.R. 931. (Before Avory, Rosvlatt and Shearman, J.J.) Food—Adulteration—Cream mixed with boric acid—Sale to prejudice of purchaser—Label on pot—Notice to purchaser — Sale of Food and Drugs Act, 1875 (38 & 39 Vict., c. 63), ss. 6, 8. By section 8 of the Sale of Food and Drugs Act, 1875, "No person shall "be guilty of any offence in respect of the sale of any "article of food mixed with any matter not injurious to health "if at the time of delivering of such articles he shall supply to the "person receiving the same a notice by label written or printed on "the said article to the effect that the same is mixed." Held, that the words "shall supply to the person receiving the same a "notice" means that the person selling must bring to the mind of the purchaser the fact there is a label on the article sold; and that where a notice by label is so affixed to a package or vessel that it cannot be seen or is not 143 observed by a purchaser it is 110 notice at all, and even in the absence of evidence of intentional concealment, the seller is not protected by the section. Dicta of Lord Alverstone, C.J., in Pearks, Gunston & Tee, Ltd., e Houghton, 1902, 1 K.B. 889; and Hayes v. Rule (1902), 87 L.T. 133 followed. Jones r. Jones (1894), 58 J.P. 653 dissented from. Gjumble & Co., Limited v. Preston. 12 L.G.R. 382. (Before Darling, Rowlatt and Atkin, J.J.) Food—False warranty to Purchaser—Place where given—Jurisdiction of Justices in place where received —Analyst's certificate —Omission to serve copy with summons—Waiver—Meaning of " Malt Vinegar "—Sale of Food and' Drugs Act, 1899 (62 & 63 Vict., c. 51, ss. 19 (2), 20 (5) (6). A charge of false warranty of food may be entertained under section 20 of the Sale of Food and Drugs Act, l!-99, before the Court of Summary Jurisdiction at the place where the warranty has been received by the purchaser, notwithstanding that the label warranting them may have been attached to the goods, and the invoice embodying the warranty may have been written and posted, at a place outside the jurisdiction of such Court. The requirement of section 19 of the Act that, in any prosecution under the Sale of Food and Drugs Acts, a copy of the analyst's certificate obtained by the prosecutor must be served with the Summons, does not deprive the Justicps, forming such a Court, of jurisdiction to hear the information. Such a failure to serve the copy certificate with the summons is an informality only, which may be waived by the defendant. \Vhere a warranty has been given that vinegar was " pure malt vinegar," and the analysis of the vinegar obtained by the prosecutor showed that 30 per cent, of it was not derived from malted barley or cereals and contained only •024 of phosphoric acid, and the Somerset House analysis showed that a third of the vinegar consisted of vinegar not derived from malt, evidence that vinegar, containing less than *05 per cent, of phosphoric acid, was not malt vinegar but vinegar which must have been made from something other than malt or cereals was held sufficient to support the finding of the Justices that the warranty was false. Marcus v. Crook. 12 L.G.R. 923. (Before Avory, Rowlatt and Shearman, J.J.) Food—Adulteration—Warranty—Notice to warrantor of intention to rely on warranty — Time within which notice must be sent—Sale of Food and Drugs Act, 1875 (38 & 39 Vict., c. 63), ss. 6, 25—Sale of Food and Drugs Act, 1899 (62 & 63 Vict., c. 51), 8. 20. Where a defendant to proceedings under section 6 of the Sale of Food and Drugs Act, 1875, gives notice that he intends to rely on a warranty as a defence, such notice, upon the true construction of section 20, sub-section (1), of the Sale of Food and Drugs Act, 1899, need only be given " within seven 144 days after the service of the summons" as regards the purchaser, but as regards the warrantor the notice is sufficient if it he sent to him at any time before the Court of Summary Jurisdiction comes to determine whether the warranty be a good defence. Accordingly where a summons was served on the appellant (a milk vendor) on September 27th, returnable October 17th, 1913, and then adjourned sine die to enable him to get a sample analysed at Somerset House, a notice given by the appellant to his warrantors (a dairy company) on October 26th, and before the final hearing, that he should rely on his warranty from them was held to be sufficient. Booth v. Het.liwell. 12 L.G.R. 940. (Before Avory, Rowlatt and Shearman, J.J.) Food—Provision shop—One man Company—Sale of adulterated butter by assistant — Sale of Food and Drugs Act, 1875 (38 & 39 Vict., c. 63), s. 6. The appellant was a director, general manager, and Secretary of a limited company whose business was carried on under his sole control at a shop and premises where he resided. Iu the appellant's absence the shop assistant sold to the prejudice of a purchaser butter adulterated with 90 per cent, of margarine. Upon a prosecution against the appellant under section 6 of the Sale of Food and Drugs Act, 1875, the Justices found that the sale was to the prejudice of the purchaser, that the assistaut was employed by the appellant as shopman, that he effected the sale in the scope of his employment, and convicted the appellant of the offence charged. Held, that the company must be regarded as a separate entity notwithstanding nearly all the shares were in the hands of the appellant ; that the shop assistant was the servant of the limited company and not of the appellant and that the conviction could not stand. » Locai. Government Board v. Arlidge. 12 L.G.R. 1109. (Before Viscount Haldane, L.C., Lord Shaw, Lord Moulton and Lord Parmoor.) Housing Acts—Insanitary dwelling—Closing Order—Public local inquiry— Report of Inspector—Right of Appellant to see report and to be heaid in support of Appeal—Housing, Town Planning, &c., Act, 1909 (9 Edw. VII., c. 44), ss. 17, 39—Housing of Working Classes, England, Rules, January 11th, 1910, rr. 1, 4, 5, 8, 9. The owner of a dwelling house in the Metropolitan area applied to the local authority to determine a closing order which had been made in respect thereof under the Housing, Town Planning, &c , Act, 1909, and on their refusal to do so appealed to the Local Government Board. The Board directed a public inquiry to be held by an inspector as provided for by section 39, sub-section 1 (b), who, after holding the inquiry and personally inspecting the premises, made certain reports to the Board. The Board dismissed the appeal without having disclosed to the owner the contents of the inspector's 145 reports, and without having given him an opportunity of being heard by the members of the Board who were going to determine the appeal. Upon an application by the owner for a certiorari to quash the order, Held, that it was competent for the Board to determine the question before them as to whether or not the closing order should be confirmed or discharged solely upon the report of the inspector and upon the perusal of written statements by the parties without hearing the applicant and without previously giving him an opportunity of seeing the inspector's report. The Act of 1909 had introduced a change in the procedure by transferring the jurisdiction, both as regarded original applications and as regarded appeals, from the Courts of Justice to the local authority and to the Local Government Board respectively, both of which were administrative bodies and therefore, although the Board was bound to act judicially, so long as it followed it usual procedure it was not bound either to disclose the report of its inspector or to hear the owner ora.lv. Decision of Court of Appeal (Hamilton, L.J. dissenting) (1914), 1 K.B. 160 ; 11 L.G.R. 1186 ; 83 L.J.K.B. 86, reversed and that of Divisional Court (1913), 1 K.B. 463 ; 11 L.G.R. 242 ; Si L.J.K.Li. 313, restored. Board of Education r. Rice, 1911, A.C., 179; 9 L.G.R. 652; 80 L.J.K.B. 796, considered and approved. Lancaster v. Burnley Corporation. 12 L.G.R. 1319. (Before Lord Coleridge, Horridge, and Shearman, J.J.) Buildings—Dwelling-house unfit for human habitation—Closing Order— Demolition Order—Duty of Local Authority—Appeal—Powers of Local Government Board—Housing, Town Planning, etc., Act, 1909 (9 Edw. VII., c. 44) ss. 17, 18, 3 \ Where a closing order of a local authority under Section 17 of the Housing, Town Planning, etc., Act, 1909, in respect of any dwelling-house has remained operative for a period of three months, and the owner of the house has taken no steps to render it fit for human habitation, Section 18 casts an imperative duty on the local authority to order the demolition of the house, even though there be no intention on the part of the owner to use it in future as a dwelling-house. Nevertheless Section 39 empowers the Local Government Board in determining an appeal against such a demolition order to make such order as they think equitable and to confirm, vary or quash the order of the local authority (although the local authority were bound to make it) according as the Board having regard to all the circumstances of the case think just. Hall v. Manchester Corporation. 12 L.G.R. 688. (Before Cozens-IIardy, M.R., Buckle}7, L.J., and Channell, J.) Building—Closing Order—" LTnfit for human habitation "—Building not in O O 146 itself unfit—Power to make Order—Construction—Manchester Corporation Waterworks and Improvement Act, 1867 (30 Vict., c. 36) s. 41. The Manchester Corporation Waterworks and Improvement Act, 1867, Section 41 provides that " in any case where it is certified to the corporation " by an inspector of nuisances . .. .that any building or part of a building " is unfit for human habitation, the corporation may by their order affixed conspi" cuously on such building or part of the building declare the same is not fit " for human habitation, and shall not, after a date therein to be specified, be " inhabited" ; and the Section goes on to impose a penalty on anyone occupying the house after that date. Held, on the construction of the Section that it was applicable to the case of a building that was from any cause whatever unfit for human habitation and not merely in the case of a building which was so unfit through some defect in itself. Where therefore three houses were situated in such a congested area that they were rendered unfit for human habitation through the lack of a sufficient access of air, the Court held that the power conferred by the Section could be properly employed by the corporation. Kershaw r. Patne. 12 L.G.R, 297. (Before Channell, Avorv, and Atkin, J.J.) Sewers —" Drain " or " Sewer Metropolis—Pipe carrying internal drainage of one house and rainwater from roofs of adjoining houses—Metropolis Management Act, 1855 (18 & 19 Vict., c. 120) ss. 74, 76, 250. A pipe (not being a drain for the drainage of a block of houses by combined operation) which carries off the internal drainage of one house only, but which also receives and carries off the rainwater from the roofs of the adjoining houses on either side, is a sewer and not a drain within Section 250 of the Metropolis Management Act, 1855. Silles r. Fulham Borough Council (1903), 1 K.B. 829; 1 L.G.R 643; 72 L.J.K.B. 397, followed ; but discussed by Channell, J., in view of the possible distinction capable of being drawn between the facts in that case and those in Holland v. Lazarus (1897), 66 L.J.Q.B. 285. Dicta of the same learned Judge in Heaver v. Fulham Borough Council (1901), 2 K.B. 383; 2 L.G.R. 672 ; 72 L.J.K.B. 715, referred to. London County Council v. Hank ins. 12 L.G.R. 313. (Before Channel], Rowlatt and Atkin, J.J.) Common Lodging )louse — Keeping without licence - Common room either for sleeping or eating essential to conviction—Common Lodging Houses Act, 1851 (14 & 15 Vict., c. 28) - Public Health (London) Act, 1894 (54 & 55 Vict., c. 76) s. 94. 147 To support a prosecution under Part IX, of the L melon County Council (General Powers) Act, 1902 (2 Edw. VII., c. 173) for keeping a common lodging house and receiving lodgers therein without a license, proof that the house contains some kind of common rojm either for sleeping or eating is essential. Unless such a room or rooms exists on the premises the house is not a common lodging house. The necessity of community of some kind, whether of eating or sleeping accommodation, has not been displaced by Parker v. Talbot (1905) 2 Ch. 643 ; 4 L.G.R. 27 ; 75 L.J.Ch. 8, nor by the definition in section 3 of the Common Lodging Houses Act, Ireland, 1860 (23 Vict., c. 26). Logsdon v. Booth (1900), 1 Q.B. 401 ; 69 L.J.Q.B. 131, and Logsdon v. Trotter (1900), 1 Q.B. 617; 69 L.J.Q.B. 312 explained.